Minutes May 2005

MINUTES OF THE NATAL BYPASS CLUB HELD IN THE CONFERENCE ROOM OF THE ENTABENI HOSPITAL, DURBAN ON WEDNESDAY 4 MAY 2005.

1. WELCOME

95 As per attendance register. Apologies to members who were inconvenienced due to a lack of chairs.

2. APOLOGIES

Jennifer McInnes, Ken Howell, Ron Masters, Chris O‘Flaherty, Stewart & Carol McKay Jill Thomas Herman Davidson Brian Kidd Geoff Stuart

3. TESTIMONIES FROM FIRST TIMERS

a. MERRILL PIKE (75) Led a very active outdoor life including many sports in particular cycling (Cape Argus several times, Tour D’Urban, etc) and has cycled from Durban to Johannesburg in 2½ weeks. He suffered no symptoms to indicate heart disease, but on the 18 March last year, he blacked out during a cycle race near 'Toti causing him to fall heavily and crack his helmet plus fracture two ribs. The diagnosis was a mild heart attack which was confirmed at St Augustine’s where he had a triple bypass, plus a valve replacement. Merrill was back on his bike after three months and started walking briskly. Determined to cycle the Argus once more, he flew to Cape Town but during a practise run, he blacked out again which put paid to his Argus. Undaunted, Merrill is exercising regularly again and is determined to enter next year’s Argus.

b. SAM WALLACE (63) Like Merrill, Sam has been a keen sportsman and has run six Comrades. Recently he suffered pains in his arms, shoulders and back and became fatigued which led to a visit to a cardiologist who tested him on the treadmill but due to his fitness, it was only with severe effort that an e.c.g. revealed heart disease. At first it was felt that a stent would suffice, but this was followed by a double bypass. Unfortunately, Sam suffered serious complications with his pulse racing at 200 and serious internal cardiac bleeding and a B.P. of 70/50 which necessitated an open-heart operation being performed again.

Happily, the news now is good with his pulse and blood pressure back to normal. He has lost 10 kg and is trying to run next years Comrades.

c. RONALD NAIDOO (52) Apologised for not being as fit as the previous two new members. He plays tennis and golf. He suffered a pain in his neck and his doctor prescribed an anti-inflammatory (Voltaren). As the pain persisted, Ronald was consulted by a Cardiologist who did an angiogram (after the treadmill) and found two partially blocked coronary arteries. Mr Kleinloog bypassed these. Ronald is currently studying for a degree in theology and told us that he believes that God has asked him to “slow down”.

d. MANSUET BIYASE (72) Is the Catholic Bishop of Eshowe. He was a clergyman at Ixopo from 1960-1975 and a keen soccer player, but his transfer to his present position resulted in a deterioration of his health. Whilst on a visit to Germany, the bishop started having trouble with his breathing and he as diagnosed as suffering from high blood pressure and diabetes. His first heart attack followed and on returning to Natal he saw David Gillmer followed by a triple bypass. Later he started feeling very tired and Dr Gillmer fitted a pacemaker.

e. BERYL DRAPER Showed symptoms of heart disease seven years ago, but it was not considered necessary to have surgery until recently when it was discovered that she had excessively high blood pressure and a faulty heart valve. At the end of last year Beryl’s G.P. referred her to David Gillmer who found that bypass surgery plus valve replacement were necessary. Fine now after the operation.

4. SPECIAL GUEST NARGI BARMANIA introduced herself as an Echo Cardiographer and explained the technology based on a similar basis as MRI scanning but conducted on the heart to determine damage or the success of bypass surgery. It detects blockages and areas of the heart which are starved of blood. It determines the difference between a normal and a diseased heart. Her brief introduction resulted in an enthusiastic request from members to address us with a fuller explanation with illustrations.

We have invited her to comply by talking to us at our next meeting on 6 July. Should be interesting.

5. INVITATION BY PFIZER FOR LIPITOR USERS

Jack displayed the handsome folders and informative bulletins which Pfizer are offering on an ongoing routine basis to all Lipitor users. Many members took application forms with them for enrolment. The programme is entitled “An Exciting free programme that aims to help you lower your risk of heart Disease”.

6. RAFFLE

Once again very well supported and the whisky was won by W.Merle a member for 15 years. Congratulations!

7. MEMBERSHIP & FINANCE

We have 225 members of which only 106 have paid their annual subscriptions. These were due on 1 January 2005 and we will have to review the continuation of the membership of the defaulters.

A further reminder that R25 subs should not be posted to Jack but to :

· Les Bolt

Natal Bypass Club

P O Box 1805

New Germany 3610

Or to be deposited into bank account :

· Standard Bank Savings Account

Pinetown Branch

Account No 257360549

But please follow this up with a fax or phone call to Les on 7013435 giving details of your name and deposit. Thank you.

Thank you also to the two members who very generously sent cheques for R250 as donations.

This brings us to Item

8. BYPASS BULLETIN

At the last meeting the suggestion of a booklet for patients and families was discussed. A sub-committee comprising Les Bolt, Chris O’Flaherty and Jack Piek has met and resulted in the following decisions.

a. Chris who is in London will approach the British Heart Foundation for a complete list of all their publications and establish whether a copyright obtains re duplication.

b. Jack will peruse the envisaged publication currently being printed for the benefit of patients at St Augustine’s.

c. Les will co-ordinate all information presently and pending available and investigate the feasibility of condensing this into our publication. The costs, number of copies, etc.

9. VISITATION REPORTS

a. St Augustines – We are grateful to Doug Tomes who has volunteered to assist Ken Monckton. Doug reported that the ward has been fairly quiet.

b. Westville - Les Bolt and Tony Ries are making sure that two visits per week are arranged as nowadays patients are often discharged within 5 or 6 days after ICU.

c. Entabeni – With Chris O’Flaherty in London, Jack has increased the frequency of his visits.

10. GUEST SPEAKER

Dr Alan Hold’s association with the Bypass Club goes back to its inception some 21 years ago when Jack and his team were counselling adult patients at Wentworth (the only hospital where bypass surgery was performed). Alan was looking after the babies and children by visiting, providing toys and giving them hope and encouragement. These unfortunate little ones often came to the hospital for open-heart surgery by ambulance from a clinic closest to the homes of their parents. Very often they only saw their parents again after their operation and convalescence. Alan did a wonderful job of playing a parental role during this period.

Alan has been the anaesthetist at many of the bypass and transplant operations and this included the only heart and lung transplant performed in South Africa by Robbie Kleinloog.

His presentation was supported by a power point presentation which was highly entertaining, amusing and risqué.

These cartoons were used to provide the analogy to the work of an anaesthetist.

Alan has assisted in 17 -1800 bypass operations and can therefore talk with many years of experience and knowledge.

Up to 1850 in the absence of anaesthetics, patients had to “bite the bullet”. Pain from operations, amputations and dentistry was excruciating and often was followed by bacterial infection. Mortality was very high.

Nitrous Oxide (laughing gas) and ether were introduced in 1850 and chloroform in 1890.

Interesting that Queen Victoria was given chloroform when she gave birth to one of her many sons – Leopold.

The second world war resulted in many new developments such as Pentothal used during the Pearl Harbour attack

Included in anaesthetics is the drug used for epidurals which is used in back or leg operations etc, and during labour.

40% of the anaesthetics are administered outside the operating theatre.

The patient’s lifestyle before and after an operation is of utmost importance. This would include drug users, asthmatics, alcoholics, smokers.

Even obesity is taken into account to determine the anaesthetic. “Fat babies make fat adults make fat corpses.”

Patients are graded between low and high risks. Often patients are reluctant to divulge their true personal details. This has partially been taken care of by completing a detailed questionnaire which is to ensure defence against litigation.

Interesting that certain herbs also react adversely with specific anaesthetics.

There have been massive improvements and developments which have reduced the risks and recovery rates of surgery such as cataracts, dentistry and above all, cardiac operations. Now it is even possible to do bypass surgery on a beating heart. (A technology which was presented to us in an illustrated talk by Robbie Kleinloog. He called it the mid-cab operation.)

During an open-heart operation, copious doses of oxygen are administered to reduce the workload of the heart. Also lots of Warfarin to reduce the risk of clotting.

The perfusionist operates the heart /lung machine once the patient is anaesthetized so that the surgeon can perform bypass surgery on a still heart.

The body is cooled down to further facilitate the operation. This must be carefully controlled to about 30° C because below this, the heart goes into ventricular fibrillation. This danger is however reduced due to the patient’s connection to the heart /lung machine.

After the operation, the patient is gradually warmed up and drugs are administered to counteract those used to put the patient to sleep. This recovery is a critical stage of the operation.

Adrenalin is also used.

Interesting to note that the heart is the only muscle that beats spontaneously after it has been stopped. This even applies to a heart transported over thousands of kilometre for a transplant. Only seldom is it necessary to shock the heart back into beating.

There are hundreds of drugs which are used to balance the important triad of sleep, pain and relaxation.

It is important to get the patient up and about as soon as possible and not to practise the old Wentworth regime which was 1½ to 3 days.

A monitor is used to test the patient for pain or paralysis, known as the BIS monitor, it has only been in use for five years and has removed the previous “talking to the patient” method.

There has been a tremendous advance in the development of gadgets to assist the operating team. A small example is to use scented masks for children.

Anaesthetics are administered by either or a combination of intravenous injection, inhalation or epidural (into the spinal chord).

Drugs are used to prepare patients before going to the theatre, and these too have undergone vast improvements.

Apart from operating the heart /lung machine, the perfusionist must carefully monitor the cardiac output and waste disposal. These are even more important than blood pressure.

HIV/AIDS are always a major danger for the use and disposal of needles, masks and other materials must be disposed of with due care.

Finally, the technology of anaesthetics has come a long way in recent years and rapid advances are still pending.

In the treatment of ischaemic heart disease (IHD) research into mechanical hearts, the injection of foetus cells into the heart and drugs which will dissolve cholesterol and atheroma blockages are but a few.

Alan was bombarded with questions all of which have been incorporated in this report on his outstanding presentation. He certainly deserved the full house here this evening. Even the fridge ran out of refreshments!

Thank you

Jack Piek

Tel 031 563 3200