Take It from Me: Heart Surgery Is Best Avoided

A few weeks back, I told you the horrifying story of a kidney stone that needed to be surgically removed in the hopes of scaring you into drinking more water. Reader response indicated that it worked.

Unfortunately, “kidney stone” had a sequel for me, one even more terrifying, horrifying, and shocking.

Medical tests during the kidney-stone crisis explained some other symptoms that have been gradually worsening for me over the last several years. The diagnosis was aortic valve stenosis, a stiffening of the valve that feeds oxygenated blood to the rest of the body. This is primarily a birth defect associated with aortic valves that do not have the normal three leaves. This was causing not only breathlessness, but permanent heart damage, and led to something far worse than kidney stone removal: heart surgery.

Please learn from my following medical adventure, to avoid my suffering. (While primarily a birth defect, better diet and exercise programs the last thirty years might have delayed this agony.)

I suspect that most people, unless they know someone who has gone through heart surgery, underestimate how much pain, time, and cost it involves. Search for “double bypass surgery” news stories, and you might almost get the impression that it is not really all that bad -- a very common procedure that is just a bit worse than a tonsillectomy. This may be one of the few cases where the news media fail to adequately convey the seriousness in pain, time, costs, and risks of what is a surprisingly common procedure (230,000 procedures a year in the U.S. costing about $144,000 each).

Let me start out by explaining that I was actually pretty lucky on this -- I was able to have a “keyhole” aortic valve replacement instead of an open chest procedure.

What did they do to me?

1. Heart-lung machine at the right groin artery and vein. (You don’t think they are going to replace a valve while the heart is running, do you?)

2. Cut a keyhole through the muscles of the chest.

3. Spread a couple of ribs apart.

4. Cut open the aorta through the keyhole.

5. Remove the malfunctioning valve.

6. Sew in a new bioprosthetic valve made of Dacron and (in my case) a horse aortic valve. (Yes, I can now boast of at least being valved like a horse.)

7. Sew up the aorta and close up the keyhole between my ribs.

8. Leave two sharp plastic drainage tubes in the chest that you feel every time you cough, breathe, or move for the next few days. They come out two days post-op, and they hurt when they come out, but at least they stop intensely hurting then.

9. Leave two electrical leads in place for a couple of days in case the doctors decide that you need a pacemaker. To quote the nurse: “Most patients say that removing them feels ‘funny.’” No, there was nothing confusing or ambiguous when the nurses removed them two days post-op; they hurt enormously.

The surgery took five hours on a Friday. I have a few thankfully vague memories of the recovery room, of which the worst was that I still had a breathing tube down my throat and I was gagging. (Yes, my anesthesiologist warned me that this would likely happen.) I don’t remember if I was strapped down to prevent me from pulling it out, but I suspect so.

Saturday was one enormous fog of pain, confusion, and despair. I was aware of my surroundings, but the details made no sense to me. My family was with me for most of this time; the nursing staff at St. Alphonsus’ did a spectacular job of trying to alleviate my suffering, but there are holes in your chest, and every time you move, cough, or inhale, it stings incredibly. Even if you stop breathing it hurts, pain the narcotics only dull but do not eliminate. You are coughing up occasional globs of clotted blood, perhaps from being on oxygen, which dries out your airways. You can’t really sleep, except in a narcotic stupor.

Every couple hours around the clock someone comes by to poke the end of your finger for a blood sugar test. Why? I did not know this: major surgery causes your body to release a flood of sugar, even if you do not have diabetes. This requires IV drips and separate injections of two different kinds of insulin to try to balance it out, because all that blood sugar screws up healing of blood vessels.

Sunday was perhaps the worst day. I was coming out from under the anesthetic fog enough to fully appreciate my pain and helplessness. At the same time, the hurt of breathing, moving, and extreme constipation caused me to wonder if I might have been better off dying on the operating table.

On Monday the hospital discharged me, although I was still in considerable pain, when I wasn’t doped up on oxycodone. At least there was progress, and by Thursday I was able to switch to 500 mg of acetaminophen to dull the pain. Still, the reduction in pain was not a step back to normal. Seven days after the surgery, I found myself wondering if I was ever going to be able to write, code, or even read again. The depth of anesthetic required to perform such a dramatic operation causes mental confusion that can last for days or even weeks. I will not try to drive a car for at least two weeks -- yet another piece of dependency. I am only now reaching the point where I can write an article like this, and prepare to teach history classes in the fall. It is still some weeks before I can return full-time to my day job as a software engineer.

And let me emphasize: I got off lucky. Many of those in the cardiac ICU were having procedures that require cracking open the rib cage.

Readers in their 50s who have been through this tell me that two years later they are still in pain when they move. If you need a cardiac bypass surgery (where they graft a blood vessel from elsewhere to go around a blocked cardiac artery), you are almost certainly going to get your chest cracked. My employer’s human resources department tells that instead of four weeks unable to draw a paycheck, I would have been looking at three to four months of being unable to work. This is not a paid vacation: disability pay is far less generous than you might think, at least in states like mine where adults are in charge.

As I write this, it is now ten days since the operation. When I got up yesterday morning, I briefly felt energetic enough to shower and dress myself. For the next three hours, I had enough energy to watch television, and that was it. Even getting up from the couch for a snack was a major planning and motivational exercise. It is going to be weeks before I am fully recovered. I shudder to think of what a ribcage opening would have been like.

Are you now afraid of heart disease? You should be. This is serious business.

The economic costs to our society are huge: U.S. heart disease costs for 2010 were $444 billion. Your out-of-pocket costs for any substantial heart surgery are breathtaking: hospital admitting estimated that the total bill to my insurer would be about $60,000. I am fortunate that my health insurance plan caps my out-of-pocket expense for the year at $3250.

Economists talk about the insurance problem of “moral hazard,” where people take risks because they aren’t going to be paying the costs of their stupidity -- the rest of the insurance pool will. There are certainly parts of the health care public policy problem that fall into this category: people engage in risky behaviors because the immediate pleasure is large and the long-term costs are diffuse and distant. Every 925 calorie burger contributes only a tiny portion to the risk that you will need one of these $144,000 operations … someday. It is no surprise that many people just don’t take the risks seriously enough.

But that’s just looking at the economic costs. I suspect that if most Americans realized that enormous physical suffering that heart disease is going to bring them in twenty to thirty years, this might be sufficient to get them to start paying attention. Trust me: this hurts.

It is not the government’s job to tell you to stop smoking, or to increase your exercise level, or to control your eating. It is the job of an adult to do so for himself -- to demonstrate that he has the self-discipline to think about a future twenty years in the future, instead of today’s 1500 calorie lunch. Please: find the time and the money to hit the gym a few hours a week; reject the glorification of gluttony that ad campaigns like “Go Big or Go Hungry” promote; stop smoking. You don’t want to go through an experience like I just had, and certainly not the much worse chest-cracking procedures.