More than 6000 New Zealanders die of coronary disease each year. Herald on Sunday publisher and APN executive Rick Neville reports on a close encounter with heart disease, undergoing coronary bypass surgery, and how you can avoid it.
KEY POINTS:
I really didn't have a clue anything was wrong. It was only when I walked up the hill to work one morning late this year that I noticed a tightness in my chest and shortness of breath. After a few days I saw my GP, thinking she'd diagnose a muscular ache or some other minor ailment.
Wishful thinking. As soon as I'd described the symptoms, she was on the phone getting me an appointment with cardiologist Andrew Maslowski at Ascot Hospital, Auckland. A couple of hours later, I was pounding on his treadmill. Initially, I felt fine. But then I could feel the familiar tightening in my chest, a dull ache and, after only seven minutes, I'd had enough.
Looking at the ECG results, Andrew explained my arteries were constricted, starving the heart of blood and oxygen, causing angina symptoms. His next move was to do an angiogram, where photo-sensitive dye was pumped into my arteries via a vein in my wrist, and x-rays taken to reveal the extent and location of the narrowed arteries. Andrew said, if possible, he would carry on and insert stents to open up any defective arteries. This is a common method of treatment, done in hospitals every day and effective in treating angina. The stents are small, wire-netting-like tubes, which are inserted using a micro-surgical probe. You're sedated, and, apparently, don't feel a thing.
Andrew warned stents were not the answer for high-risk areas, such as the left main coronary artery and others which are blocked or severely restricted. Such problems need coronary bypass surgery. Gulp.
Coming to after the angiogram, I realised I hadn't been "stented", and tried to get used to the idea of what lay ahead. Sure enough, the pictures showed a major narrowing of the "left main", the vital trunk from which two out of a person's three coronary arteries arise. On a Saturday morning two days later, my wife Pam and I were sitting in the consulting rooms of cardiac surgeon F Paget Milsom, learning about coronary bypass surgery.
In our naivety, Pam and I had thought keyhole surgical techniques would have overtaken the invasive, open-chest surgery her father had experienced in having a heart valve replaced in 1970. Alas, no. Bypass surgery still requires the sternum (breastbone) to be sawn down the middle, for the surgeons to gain access to heart and lungs. That was reality check number one.
Reality check number two came when I was shown a form I'd need to sign agreeing to the operation, and which also listed the potential risks, such as dying under anaesthetic, or getting an infection.
I dopily asked: "What if I decide not to go ahead with the surgery?"
"There's a 50 to 60 per cent chance you'll be dead within five years."
"I see, where do I sign?"
Paget, a cheerful former farmer who switched to medicine, explained how they take "pipes" from other parts of the body and graft them in place to take over the job the diseased arteries have been struggling to do. His preference is to take the mammary arteries from inside the patient's chest, as these are strong and last a long time. The other arteries often used are from arms and legs.
The disease is caused by plaque build-up caused by too much cholesterol in blood. My cholesterol level had been 6.6 at last count, far too high, and I've been kicking myself for not doing more to reduce it.
Paget says I've got to get it down into the 3s, and this will be assisted by taking cholesterol-reducing drugs and daily aspirin for the rest of my days, sticking to a healthy, fat-free diet, and getting as lean and fit as possible.
He reckons genetics also play a big part, which is not something you can do much about. I was to learn more about that in Mercy Hospital in the coming days when a patient in a neighbouring room, journalist Ian Stuart, astonished me by saying he was one of three brothers all to have had coronary bypass operations during 2007 (as reported in Herald on Sunday, December 9).
I cheered up a bit when Paget said I was in good nick for the operation being in reasonable health, had never smoked, and importantly, hadn't had a heart attack.
He also said bypass surgery is more effective than other treatments in increasing a patient's life expectancy and reducing the likelihood of a return of angina or the need to re-operate.
He predicted I'd make a good recovery, and get back to doing all the things I used to do and probably more. But he did add: "Before then, you'll go through purgatory."
Admission day came. Specialists visited including the surgeon, anaesthetist and perfusionist. The latter operates the heart-lung machine, which keeps your blood flowing to the brain and other vital organs while your heart is disconnected and joined up to the new arteries. I'm sure they found it tiresome, but I did ask all three not to have an off-day tomorrow.
The anaesthetist responded: "I don't have off-days." Gooood.
I was given something to help me sleep and woke around 6am to have a final scrub before being wheeled into the operating theatre. It was 7am on Thursday, November 15, and I was first up. I can't remember much about that day, other than hearing the surgical team exchanging small talk around me, then waking up sometime in the afternoon. Pam and my daughter Alice were with me, and apparently I said something like, "A bloody truck has run over me."
The nurses and physiotherapists had me up walking the day after. Not much fun, but pain under control thanks to a magic blue button I could press every time I wanted a blast of morphine. After maybe three days, tubes into my neck and body were removed, and it was a lot easier to breathe and move.
Appetite disappeared early. Like a (large) jockey, I weighed in before the event at 92kg and emerged a week later at 84kg, so I can recommend this if you want to lose weight quickly. But perhaps there are easier ways.
Patients are advised not to return to work for eight weeks, maybe a bit less for pen pushers.
I've got instructions on exercises and increasingly long walks to do twice-daily.
Getting right isn't something that happens quickly. There are good days and not so good. I get exhausted if I overdo it. But the good days are increasing, I'm sleeping better and tackling longer walks.
Purgatory it may be - but the end's in sight.
Coronary disease fact file
Coronary disease causes 6000 deaths per year, 22 per cent of all deaths in New Zealand.
By comparison, 2 per cent are caused by motor vehicle accidents.
The mortality is higher among men than women.
Smokers have two to three times the risk of contracting heart disease.
1800 coronary bypass operations a year are done in New Zealand, half of them in Auckland.
Auckland City Hospital (public) does 550, while 300 are done at Mercy (private), with the remainder at Starship (public children's).
Bypass operations are also carried out at Hamilton, Wellington, Christchurch and Dunedin public hospitals.
The average time a patient spends on the waiting list at Auckland City is less than six months, although some wait for more than two years.
