2009-07-05 11:29

On July 2, 2009 I got stent #2 implanted in my heart at the Mass General hospital in Boston (the first was in October 2006, at the Lahey Clinic). This incident developed way faster than last time. At the first sign of pain in my left arm I was pretty sure what was going on; saw my doctor for an EKG that same afternoon (Wednesday). Last time it had taken me two weeks to twig to it. He strongly suggested I see my cardiologist real soon. I went the next day, Thursday, and after a stress EKG (treadmill) he brought me a little card of four Plavix tablets and a cup of water, and I knew beyond a doubt what was coming.

My cardiologist’s office in Concord is attached to Emerson Hospital so we walked over there and I “became a patient” (as the lead nurse would have it — i.e. got in a hospital johnnie and got tubes inserted in my left hand) for all of an hour, while they got a drip of the anti-coagulant heparin started. The ambulance arrived in short order for a lights-n-sirens ride to the Mass General in Boston. We did not pass go, we did not collect 200 of anything. Breezed by Admissions and wheeled straight into the Cath Lab. I was getting dreamy drugs by IV no more than 2-1/2 hours after stepping off the treadmill.

One reason for the haste was that The General’s Cath Lab was going to be closed Friday, Saturday, and Sunday for the 4th of July holiday. They preferred to get me done rather than letting me ripen over the weekend.

Talking with the surgeon beforehand — same guy as last time — I requested a bare-metal stent, if at all possible, not a drug-eluting one like they used in 2006. The main reason is that bare metal requires you to be on Plavix for only a month, while the drug-eluting ones call for 3 months to a year. I had significant problems with nose bleeds last time. In the end the surgeon did use bare metal, and would have anyway it turns out, due to the diameter of the artery being treated.

My procedure in 2006 happened the same week that lots of attention was getting focused on drug-eluting stents by the FDA and others. I assume they are safer now than 2-1/2 years ago (and anyway mine has worked out fine), but I just wanted to avoid that damned Plavix to the extent possible.

This time I couldn’t see the monitors (showing a real-time x-ray visualization) as they worked, but did get to see a before-and-after of my Right Coronary Artery — 90% blockage, then fixed. For this procedure, percutaneous coronary intervention (“balloon angioplasty” to its friends), they make a puncture in the femoral artery — conventionally, and in my case, on the right side of the groin, where leg meets trunk. Read the details of the rest of the procedure at the Wikipedia link above. I was startled to learn that “The cardiologist controls the movement and direction of the guide wire by gently manipulating the end that sits outside the patient through twisting of the guidewire.” Somehow I assumed that such precise manipulations would have to be machine-controlled — but perhaps that’s a bias influenced by my profession.

In 2006 I had heard from the nurses that some balloon angioplasties were being done through an artery in the arm, not the groin. This procedure is so much less invasive that it can be done on an out-patient basis. I asked my surgeon about this approach pre-op; he said that they were finding significant complications, with as many as 6% of patients experiencing subsequent problems with the involved artery. Not my kind of odds (nor my surgeon’s, either).

My wife had driven in, having found someone to cover the bookstore Thursday afternoon and Friday, and they got her a cot. She couldn’t stay in the same room, however, as it wasn’t private. The other guy, arriving before me, had the view over the Charles River. From what I overheard, he needed another procedure that was scheduled for Monday so he was going to stay over; he must have had a killer view of the fireworks on Saturday evening, the 4th.

The post-op was a good deal less comfortable this time. I believe they used a lighter dosage of sedation; in 2006 I remember just kind of drifting for a few hours, and my wife commented how relatively more alert I was this time. Also, they removed the “introducer needle” from my femoral artery post-op, instead of in the OR. Last time they used a bio-degradable plug in the artery, and this time nothing but the passage of time (about 3 hours) as an IV drip flushed the heparin from my system. After a nurse pulled the invasive device and applied pressure for about 20 minutes, I needed to keep that leg unmoving for another four hours, till 2:30 am. Between that and the Holter monitor, not much sleeping took place.

We knew doctors were likely to be scarce on the ground the Friday before the holiday, so we made sure to let the nurses know we were anxious to get sprung. They found a doctor to glance at me as we hung out in the sun room, watching a construction crew frame iron next door, and declare me fit to discharge; we were on the road by 11 am and home by noon.

Like last time, the recovery time really is only about healing the artery puncture. No lifting for a week, no driving for three days, take it easy. I can do that.

My friend Art Medlar emailed after the fact: “People complain that we got to the 21st century without jetpacks and flying cars. But outpatient cardiac surgery on the timescale of dry cleaning: that’s really something.”