Week three

Last Friday was the three week anniversary of my surgery.  I was and am very thankful for the good result from surgery, but didn't want to write a nostalgic reflection.  As a French friend emphasized, I am lucky to have both good healthcare and insurance.

Technically, week three has ushered in significant improvement.  I have begun exercising, walking at least thirty minutes a day.  Yesterday, I climbed back onto a stationary bike for an easy fifty minute ride that felt great.  The pain has decreased sufficiently that I am now sleeping five to seven hours a night.

The interesting physiological effect was a noticeable lack of confidence for the the first two and a half weeks.  A deep sense of mortality and simple pain were the catalyst of this effect.  Week three seems to be significantly different.  Possibly the depletion of drugs from my body, plus the decrease of pain, plus a sense of overcoming has lead a feeling of tepid confidence.  You know folks, death is near; either you face it or fear it.  Fearing it inappropriately will not extend your life.  I write this because of hearing too many stories about people who put off seeing a cardiologist, resulting in a fatal heart attack.  A heart attack isn't the recommended metric for measuring your heart health.

Now

Its now two weeks and two days since my sternum was cut and three heart arteries were bypassed utilizing a vein from my right leg and a mammary artery.  I walked with my good friend, Hugh Jones, for over 30 minutes today in the beauty of a cool autumn evening.  Though I feel tinges of pain in my rib area and my right leg, I am recovering rapidly and, at moments today, felt better than before the surgery.  Would you give two weeks of pain in exchange for twenty years or more of a healthy heart?

I have had several friends ask for a description of the symptoms that lead me to talking with Dr. Swords (my general physician) about having a stress test.  On review, the key symptomatic correlation was that I felt the symptoms while exercising actively: at first, tingling in my right thumb, later some tingling in my right arm, and also the feeling or need to burp.  But, these symptoms were not "strong".

Don't become paranoid, but if you clearly have symptoms that cause you some concern, talk to a physician, now.  Don't wait.  Talk with someone who has heart damage, and he or she will tell you, don't wait for a heart attack to learn that you need medicine, a stint, or a bypass.

In my pre-operation meeting with Dr. Gerhardt (surgeon), he indicated that if all goes reasonable well, I should be snow skiing, maybe even racing by early February.  Right now, at my current pace of recovery, I am feeling more confident, each day, that this may become a reality.  So, don't wait to face your reality, whatever it is, act now.

Feel free to write me if you have questions.  My private email is belboro@mac.com

Sonogram this morning

I'm off to have heart sonogram.  This is normal follow up to verify that no fluid is collecting around the heart.  Surgery was two weeks ago today.  I am feeling good.  Will walk for 30 minutes to an hour today.  Sleep is still a problem, but feeling less pain at night so as I exercise more, I am hoping my body will call for more sleep.

Letter to Sarah Palin

Dear Sarah,
I've heard that you've been read'n my blog.  Wow, Alaska looks like a wonderful place.  With my improved arteries, I should be able to get there someday.  Anne and I hope to see you when we visit.  As you probably know, Anne and I lived in the Washington DC area after we were graduated from university.  You'd be happy to know that I worked for the Republican Congressional Committee.

I really don't recommend the place for a gal like you from Alaska.  For one, you can't shoot in the backyard.  This is really frustrating since there is an over population of raccoons and other rodents.  Washington is full of democrats and you can't shoot them either.  They are everywhere and vote for all kinds of silly things: roads, bridges, national parks, and so on.  You wouldn't believe it.  Oh, and Congress, they are constantly disagreeing with the president, but you would like the veto thing.  Overall, I don't recommend it.

On a more personal note, lately it's been rumored that you might run'n for president in two years.  Though me and a bunch of the boys down here in the south think you'd win, we really don't think its the right job for a refined woman like you.  Heck, you know how to dress out a bear.  That would be a darn waste of talent inside the beltway where there ain't no bears.  No, you can see Russia from your area, so we really hope you'll keep our border protected way up there where the sun don't shine (or does it shine all the time?).  I am also concerned for your appearance.  We just love watching you on TV, but did you see what happened to Bill Clinton?  Look at his pictures in 1992 and then in 2000, he looks, like, fifty years older.  That would be a sad shame if you became president.  Anyhow, I don't want to bust your balloon, but you and me, we've always been straight shooters, and frankly, I think the President of the United States should know a bit more.  Don't get me wrong, you know a lot about a lot of important stuff, like hunt'n, fish'n, sex'n, all that, but what 'bout the EU (whatever that is) and places like Serbia, and Kazakhstan, and Tajikistan and a bunch of other places we can't spell.  I'm sure you can balance your checking account, but do you have any idea how to balance a government budget with all those earmarks and social securities?  And, CDSs; everybody says they caused the credit crisis, but do you know how to stop them in the future, whatever they are?  Is QE2 a boat or what?  I ain't say'n you ain't smart or anything, I'm just hoping that the Republicans can find a President who knows a lot about small business job stimulation, Chinese-Indian business and political affair developments, a deeper sense of the financial markets and long term fiscal policy implications, and so on.

I ain't prejudice or sexist but maybe a mother of five who resigned from her job as governor should keep on do'n what you're do'n in Alaska.
Yours truly,
Byron


CC: Harriette Knox, Democrat

A few lessons I've learned

The most important lesson I have learned is be proactive with health.  Don't wait for a heart attack to warn you.  If I had waited, I might have had a fatal heart attack.  Listen / feel the signals your body is sending.

Several doctors, nurses, and friends have commented that too few of us are proactive about heart conditions and health.  Over 1.2m people in the U.S. experience a heart attack each year.  Of the 1.2m, approximately 425k die as a result.  Also, approximately 625k bypass surgeries are performed annually.

Should you get checked?  YES, particularly if: 1) if you experience chest pain, strange arm pain or numbness; 2) heart issues are in your family; 3) you possess other risk factors: overweight, smoke, high cholesterol.

What are the various forms of a heart check up?
From simplest (and least invasive) to most complex
1. EKG - Electrocardiography - electrical activity of heart over time captured non-invasively.
2. EKG plus a stress test (walking on a treadmill).
3. Nuclear stress test - one is injected with a lightly radioactive substance plus an xray is taken before and after stress (walking on treadmill).
4. Cardiac Catheterization (CC) - a catheter is inserted into an artery in groin (old) or wrist (new).  Mine was performed through wrist.

I imagine that a new technology will soon emerge utilizing something like a sonogram or MRI, plus software that digitally reproduces the hearts activity, i.e. a virtual heart and surrounding vessels on screen.

Should I skip straight to the CC?  CC has its own risks.  Seek the advise of good doctors, and trust their advice.  But, we are in an era of significant technical advancement in healthcare.  I strongly encourage a diverse and well rounded health education, particularly respective to one's genetic ancestry.   My family has no prostate cancer history, but does have heart (artery) issues.

Scar II as of 11-15-10

More than 25% of the visits (total visits in last 14 days have been 1,886) to this blog have been visitors viewing the scar.  Humans like the Macabre, so here's Scar II

Sleep

During recovery, a nights sleep has been the most difficult conflict.  I write conflict because as the night approaches, I am almost apprehensive about facing insomnia resulting from the inability to achieve a comfortable sleeping position.  Like many of the simple, routine activities of daily life, sleep is desired, yet night is dreaded.  Sleep was often one of those activities I take for granted.  Others, like shaving (painful to lift arms and I can't lean on the sink edge), walking (I must pay closer attention so as to not slip or become too winded), phone conversation (enjoyable, but many times, I am tired and it contributes to a stiff neck), work (I love to work, particularly right now, with great people who are driven by vision and purpose), I appreciate much more.

I guess my point is that sleep contributes overall to health and its something many of us take for granted.  I returned to see my cardiologist, Dr. Nishan today.  My recovery is going well.  Next, I will have a sonogram of my heart this Friday to verify no fluid collection around my heart.

This sleep difficulty reminds me that I want to acknowledge the small blessings of life as well as the specific blessings that have saved my life: Dr. Nishan moving aggressively and working with his partner Dr. Cooper to identify my condition and get me scheduled for surgery; my friend and neighbor Dr. Gerhardt who really seems to have surgically fixed me in, at least to me, an amazing way; Nurse Portia Payne, who I will forever envision as an angel carrying me from the hell of pain, fear, and misery while in ICU.

So, I am writing this both for that person who is or has or will encountered this and for myself.  After two weeks of near insomnia, this too will pass. Someday soon, I will, once again, be back in a comfy bed for a full 7 or 8 hours of sleep.

Because I love U2's Unforgettable Fire disk, I'll leave you with a great lyric:

MLK

Sleep, sleep tonight
And may your dreams be realised
If the thundercloud passes rain
So let it rain - rain down on him
So let it be - so let it be

Sleep, sleep tonight
And may your dreams be realised
If the thundercloud passes rain
So let it rain
Let it rain - rain on him

--Bono and U2

Mornings

Mornings are difficult.  The pain is worsens after being stationary during the night for 4-5 hours.  Typically, awakening at 4:45am, I shuffle around the house to get my body moving in search of pain reduction, usually light a cup of tea.  Its a terrifyingly fantastic moment of the day.  Its nice to add music to my tea.  This morning, I listened to this several times:
http://www.youtube.com/watch?v=Eo-UKCxCglg
Vedder at his best

Passing Time

Bright Star Bright star, would I were steadfast as thou art - Not in lone splendour hung aloft the night And watching, with eternal lids apart, Like Nature's patient, sleepless Eremite, The moving waters at their priestlike task Of pure ablution round earth's human shores, Or gazing on the new soft-fallen mask Of snow upon the mountains and the moors - No - yet still stedfast, still unchangeable, Pillow'd upon my fair love's ripening breast, To feel for ever its soft fall and swell, Awake for ever in a sweet unrest, Still, still to hear her tender-taken breath, And so live ever - or else swoon to death. -- John Keats 1819

Still too tired to write a lengthy description, but here are a few important points

1.  Get checked early!  Don't wait.
2. Verify that your doctors are working together well.  Generalist with Cardiologist with Surgeon (if necessary).
3. Stay ahead of the pain.
4. People who care make the difference in life.  My heros are two nurses I haven't even met yet because I was so drugged, Samantha, and Portia Payne, my ICU nurses.  The first two nurses gently brought me out of anesthesia, held my hand, brought me back to life.  I'll find them and tell their story later.  Samantha (Sam) worked the 7PM to 7AM shift.  That shift in ICU is a little hades on earth.  Heart and lung alarms going off all night long.  Its a little like trying to sleep in Times Square after a beating.  Unfortunately, Sam was so busy, I didn't really get to know her.

My hero is Portia Payne.  She was incredible.  At each stage, she nursed me with health care, knowledge, and confidence.  For example, gently walking me through the extraction of two 1/2 tubes out of my abdomen (used to drain any blood that might collect around heart and lungs).  Saturday was, physically, the most miserable day I can imagine.  But, please, if you know a critical cancer patient, that is worse and they need our care and support much more than me.  Portia kept me positive and forward thinking spiritually, emotionally, and physically.  A few more Portia Payne's in the world and we would solve most of humanity's ridiculous problems.

Also, here are my two sweet at home nurses:

Sister Lynn and Anne

Tuesday morning!!  Only four days after open heart surgery.  At home in front yard for my 100yard exhausting walk. Wonderful walk!  Only 27 days of recuperation to go.

The scar

Behind this scar is an improved heart.  This probably isn't my only scar, but it's one that has taught me a profound and hopeful lesson.  A lesson of hope and of commitment;  a better friend; a better leader; a person committed to truth.  Veritas!  Thank you for the support.  I will write a more lengthy detail of the surgery and aftermath as I regain energy.

In Search of Rhythm

In Search of Rhythm 

Loose rhythm and you loose life.

Tomorrow’s coming

Forty years or so search’n for rhythm

Tomorrow’s coming

One of those days that change us

Like the death of a newborn

In a far away place

Tomorrow’s coming

There was a day, I didn’t know

Now, don’t forget

Tomorrow’s coming

My heart’s a’beaten

I need your love

Like a rhythm unbroken

They need your love

Dear Friends,

Thank you from the bottom of my heart.  In these brief ten days, I have experienced fear, confusion, compassion, grace, exhilaration, love and much more.  More than once, my eyes have swelled tears - not only for fear - for the thought of those who don’t have this support.  I can’t imagine the fear and loneliness of facing any serious physical condition alone.  Anne, Michael, Megan, Katherine, and Tucker have felt so very close.  You, friends have have boosted my resolve, confidence and sense of humanity, a humanity that can effect magnificent change.  

I don’t understand the equations Green’s “String” nor the sequences of genetic code, but this process, deciding the fate of my heart, receiving encouragement from you, confirms more than ever to me that we are all, all of humanity connected by a force far far beyond my - our nascent understanding.  I marvel at the surgeons skill, but so much “risk” remains, so much we don’t understand.  There is so much we don’t know.  I can only hope and pray and ask for prayer that the surgeon’s skill is adequate.

A few years ago, a few friends, David Gentile, Anthony and Cathy Cordle visited us from Africa.  David described that in the bush, far away from the skill of an experienced physician, one isn’t endowed with the option to believe in the “almighty pill”, that person only possesses mere option to believe in God.  Does God use pills, apparently so, but I’m no expert; is love apart of the healing process, yes, and part of the death process also.  Folks, the world seems to be torn asunder by religion today, but this isn’t a new battle.  I have experienced a personal battle, and I have been armed by love to face the enemy.  My heart is strong, my will is strong, the rest is in God’s hands.... and His nurses and doctors.

With great love and fondness,

Byron

Albania

I've had a large number of hits on this blog from Albania.

Michael (my son) with Medi and Donika in Tirana

Albania is a small but proud country that holds a special place in my heart.  If you like to travel, put Albania on your bucket list.

Parker and I in Berat with Dorian

Pre-operation preparation - two days before heart surgery

More info for those interested in the technical process of preparing for heart bypass.

Today, two days before surgery, the doctors ordered a series of tests.  These tests provide the surgical team with current patient information.

First, blood was drawn from an artery (not vein) in my left wrist.  This was a fascinating experience mostly because of the high technical proficiency and personality of the flobotomist.  I admit, he just didn't look like a flobotomist.   He was a wily young man with 12 years experience drawing blood.  When I asked him of his prior experience.  He exclaimed that he had hung and finished sheetrock,  adding that he often helps some the nurses in little remodeling projects.  So, I had to ask if he found that the sheetrock experience benefited flobotomy.  "Come to think of it", he reflected in a pleasant rural North Carolina accent, "you know when your trying to screw an inside sheetrock corner?"  Yes, I said.  "Well" he went on, "if you don't drive that screw in straight, it'll twist and damage the sheetrock."  What a great explanation.  Ryan did a great job.

Next, I was ushered to a cardiac sonogram room.  The purpose of cardiac sonograms is two fold.  One help identify the possibility of stroke; and, identify blood flow in arm and leg arteries.  These procedures are conducted with my cloths on, buy the way.  The technician, who unfortunately I didn't get a name, squirted a gel on my neck, then used a sonogram device to record the flow of blood in my right and left carotid artery.  Basically, she was searching for plaque on the walls of these arteries.  Fortunately, she found clear arteries in my neck.

Two, she used a sound recorder and sonogram device to record and film the flow of blood through the arteries in my ankles, feet, wrists, and hands, my extremities.  Of particular interest was the two arteries in the wrist and hand, named palmar arch.  This site provides a good diagram: http://home.comcast.net/~wnor/lesson5artofhand.htm

These tests help the surgeon's knowledge of the patient and provide them with risk indicators.  They both indicated that I was in good shape according to their experience.  These processes required about two hours.

This Friday - details of surgery and recovery prognosis

This evening's blog is about the science of my heart surgery.  I hope that this helps others who either have personal concerns about their health or know of others who are experiencing heart health concerns.

We (Anne, Megan, Michael, and I) met with Dr. Ed Gerhardt, my cardiovascular surgeon,  today.  He explained that my Left Anterior Descending (LAD) artery is 100% blocked (very bad).  This probably occurred several years ago.  My Right Coronary Artery (RCA) is 60% blocked (bad).  This is most likely a more recent occurrence.  Interestingly, collateral arteries have grown from the RCA over to the lower section of the LAD supplying blood to that area of my heart.  This is probably why I have not experienced a heart attack.  If I don't go ahead with surgery, and if the RCA blockage increases, I could die of a heart attack.  Conversely, a successful surgery will give me a very high likelihood of many healthy years, and more ski racing!!

Surgery is scheduled for first thing Friday.  I will enter the hospital around 6am.  Ed explained that surgery will begin around 8am and last 4-5 hours.  By 2pm I should be in a Cardiac ICU room and awake by 3pm.  They would like me to walk with support by early evening Friday.  I will remain in ICU mildly sedated for one or two days.  Next I will step down to a intermediate ICU for two or so days.  During this time, I should be walking steadily.  He explained that the more I move, generally, the faster I will heal and recover, with the help of pain medicine.

If all goes very well, I will be home in three to five days.  The fact that I have not experienced a heart attack and am in pretty good physical shape, offers me a very high probability of relatively speedy recovery.  At home, he wants me to exercise (walk) as much as possible.  I should be back to bench pressing 150 lbs. by next Thursday - just joking - testing whether anyone is reading at this point.  Seriously, Ed said There will be walls that you didn't know existed in your home;  "suddenly you will be walking and hit that wall and you will need to rest".

The at home initial recovery is one to two weeks, then progress will be dictated by my resolve and ability to fight against laziness and my fight to recover.  The mean probability of success for this surgery and recovery is 98.5%.  This mean number includes all heart bypass patients in all age categories, so my probability number is closer to 99.9%, being that I am 50 years old and in good health.   During the next several weeks, if you read this and have questions, particularly questions about your emotional, physical or spiritual health, email me at belboro@mac.com.  I'll try to answer as best I can.

Schedule Upadate

Doctor called this morning.  He reviewed my charts and prognosis looks fine.  Anne, Megan, Michael, and I meet with him tomorrow at 4pm for preparation consultation.  Right now, surgery is scheduled for this Friday morning.

Poverty money and love from TED

Jessica is a very bright beautiful Stanford MBA grad with a big heart.  She and I pulled weeds at an inner city Washington DC half way house two years ago.  She told me this story.  I fell in love with Jessica's vision.  She now runs the world's most unusual $150m investment bank.  Take a few minutes to watch this.  If you're a HBS fellow, this is a good case.  Hope you enjoy this talk from Jessica at TED last year in Oxford, UK:

http://www.ted.com/talks/lang/eng/jessica_jackley_poverty_money_and_love.html

www.kiva.org