MINUTES OF THE NATAL BYPASS CLUB HELD IN THE CONFERENCE ROOM OF THE ENTABENI HOSPITAL, DURBAN ON WEDNESDAY 1 MARCH 2006
- WELCOME:
In spite of the public holiday due to elections, there was a splendid attendance of 65 as per register. Special welcome to the Nesbitts from Maritzburg and the Parry’s from Port Shepstone. Thanks to Chris o’Flaherty for his donation of red wine.
- APOLOGIES:
Maggie and Roy Saunders, Carol and Stuart Mackay, Eddie Rowe, Vernon Wilson, Harold and Yvonne Milan, Cissy and Neville Farr, Ken Howell, Colin Burness and Sam Wallace.
- TESTIMONIES FROM FIRST-TIMERS:
SHANE NEWMAN (47): Suffered a mild heart attack last year.
Ten years ago his cholesterol was 10.3 and medication brought this under control and is now 6.75 (was the damage done a long time ago?) On the 29 November last year he awoke at 4 am with pain in his central chest. As we so often hear, he thought it was heartburn and took Rennies antacid tablets. As this did not help he visited his G.P. who assured Shane that his heart was OK. But the next day the pain resulted in a referral to Kevin O’ Connell the cardiologist who diagnosed a heart attack requiring surgery. After 5 days in hospital and 2 weeks at home to prepare Shane physically and mentally, a quadruple bypass was performed and 7 days later, Shaun returned home on Christmas Day.
His rehabilitation has not been as rapid as he had hoped and he still suffers from breathlessness. However with a change in his lifestyle (no smoking, drinking and lots of exercise) we are sure that he will make a full recovery and prove to us all that “There’s lots of life after Bypass surgery!”
JACQUI MILLER: A first timer who was a little reluctant to give a testimony but we did get it out of her that she had a heart event whilst holidaying in the Drakensberg which was diagnosed and resulted in a double bypass.
Jacqui suffers from breathlessness and was given advice by our guest speaker after the meeting.
DOUG JONES: A staunch member and one of our counselors at St Augustus had bypass surgery years ago and suffered no after effects.
Last month however he decided to take Vicks Acti-Plus for a cold. This reacted adversely to his heart medication resulting in an abnormal e.c..g. and an accumulation of fluid in his lungs. His condition was serious but not critical but felt that we should be aware of his experience. This was followed by a member from the hall who reported exactly the same experience. So we have been warned BEWARE VICKS ACTI-PLUS (Jack will conduct a separate investigation) someone else mentioned that Lipitor should not be taken with grapefruit! We do have the most extraordinary testimonies and reports at our meetings!)
- VISITATION REPORTS:
St Augustine’s: Ken Monckton (welcome back) and Doug Jones are still being warmly welcomed and appreciated.
Entabeni: Chris O’ Flaherty reported that in his view, counseling patients BEFORE the operation was of greater benefit than post-op visitations.
Jack agreed and said on this topic, he had shown the Cardiac High Care the videos such as “Heart Bypass”, “What’s going to happen” and “Better than before”. Their reaction was that they would equip the lounge on their floor with the necessary equipment for patients to view before and after surgery.
Jack also mentioned the most pathetic case of a patient in high care who had been waiting for a donor heart for 2 years.
With 54 murders, 30 road fatalities per day and many more dying from unnatural causes, it’s a shame that so many people are succumbing to organ failure because of the apathy of potential donors. (For interest, Jack has mentioned this to his Rotary Club which is now very enthusiastic to adopt Organ Donation as a Community Service project.)
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- RAFFLE: In the absence of Colin Burness, Les Veckrange kindly volunteered to organize the raffle. Thanks Les! The whisky was won by Moira Newman who generously donated it to our guest speaker Mr. Winter. The raffle realized R160.00 and was gratefully received.
- MEMBERSHIP AND FINANCE Due to the resignations of Les Bolt (Finance) and Geoff Stuart (printing and postage), Jack has undertaken these functions. The club presented each of the previous members with Honorariums for their excellent voluntary service and these were acknowledged in writing. With Les Bolt returning his requesting that he would rather be rewarded with “Life Member No 1 “.
Jack then explained that the club was of such an informal nature that we did not even have a constitution nor a committee and still called the “Natal Bypass Club”(He had been taken to task about this from a non-member who told Jack that it was now KZN! Point taken, and ignored!)
Dr Herman Davidson stood and thanked Jack for his efforts in running the club. (Thanks Herman for your kind words but my reward is in arranging these meetings which always enjoys an enthusiastic good attendance, good speakers, fellowship and interaction, etc. You folks deserve the thanks, not I. My reward is also bringing encouragement and advice to the patients that I visit.) Jack has cancelled the membership of individuals who are 2 years and more behind in their subscriptions. Many members have paid for 2005 and not as yet for this year. Please phone me if uncertain, we cannot afford accounts or receipts to be posted but careful records are kept. The fees of R25.00 should be posted to my home address. Cheques are preferred and made payable to “The Natal Bypass Club” Cash in envelopes is hampered by the R5 coin. Many are sending R30.00 making the R5 a donation. Thank you for this. Sorry about the system but please consider January 1 to be “subs due” date. Thank you.
- GUEST SPEAKER: Mr. Delarey Winter has partnered Mr. Robbie Kleinloog in cardio-thoracic surgery for the past 2 years. He was schooled in Pretoria and qualified at Stellenbosch University and after 2 years as a post graduate registrar, he specialized in cardio thoracic surgery under Robbie Kleinloog for 5 years at Wentworth hospital.
Unfortunately his presentation met a disastrous start: Being his first visit to us he had carefully prepared a power point presentation to be viewed by the new state of the art projector system at our venue. Alas everyone had gone home and so had the key to unlock the projection system! We really felt for Mr. Winter who had to give us his talk by holding up his laptop with of course a very limited view to most of the audience. For those who could see however, it was evident that this was to be an illustrated (visual) presentation par excellence, but more of that later. Suffice to say at this stage we were taken through every stage of the bypass operation from the scrubbing up, the preparation in the operating theatre, the duties of the perfusionist and the anaesthetist, the angiograms showing the blocked arteries to be bypassed, the main arteries including the “Widow Makers” i.e. The main coronary arteries which cause sudden death when blocked. The saw used for the parting of the breast bone and the clamps to keep the chest cavity open to the paddles occasionally used to shock the heart back into rhythm (not often necessary).
During these outstanding visuals, Dr Winter had this to say: The anticoagulant Heparin was discovered in 1915 and made heart surgery possible. In 1962 the angiogram was developed as a diagnostic procedure. In 1960 the first successful bypass was performed. In 1988 the first bypass on a beating heart i.e. without the patient being connected to a heart/lung machine was performed. The Cardiac Perfusionist is not a doctor but has to study for 4 years to qualify. A most important function is to connect the patient to the heart/lung machine to keep the heart oxygenated (normally performed by the lungs) a small error of judgment such as allowing air into the system can lead to stroke and possibly death. There are 5 cardiac anaesthetists in Durban who are reserved by the surgeons for their experience and expertise. Apart from the traditional bypass operation, there are 2 other techniques: The Op-cab which is an “off-pump” procedure and the Bi-cab where an intra-aortic balloon pump is inserted per catheter to supply extra blood after bypass surgery.
ANATOMY OF SURGERY It all depends upon which arteries are blocked. The aorta supplies blood to the coronary arteries of which the main ones are the left and the right anterior descending and the circumflex also referred to as the widow makers. The branches of these arteries are bypassed due to artheroscleroses (blockages).
SURGERY
The surgeon studies the presentation which is submitted by the cardiologist after an angiogram.
If an operation is necessary, the surgeon will visit the patient to put his/her mind at ease. This is a very necessary obligation to prevent pre-op nervousness and post-op depression.
After surgery the patient is cared for in an ICU exclusive for heart surgery patients where highly trained specialized nursing staff is on a 24 hour duty basis. The usual routine is ICU for 3-4 days, high care for 5-7 days and 6 weeks later a visit to the surgeon to see if the Sternum has fully healed and that the patient can resume a normal lifestyle.
The theatre staff comprises 2 surgeons, 1 perfusionist, 1 anaesthetist and 2 highly trained sisters. Perfusion usually lasts for approximately 40 minutes.
OTHER OBSERVATIONS, COMMENT AND QUESTIONS WITH ANSWERS.
If you refuse to alter your lifestyle and return to the old habits of smoking, drinking, poor diet and lack of exercise, you are a candidate for further heart disease.
Patients are tailored to the type of operation such as whether to use the one or two mammary arteries, saphenous veins from below the knees or from the fore-arm etc.
The heart has its own electric-conduction system comprising the S.A. Node and normally starts beating on its own after it has been stopped for surgery. The same applies to a transplanted heart. There are usually 2 tubes and 2 wires protruding from the patient’s torso after surgery.
The tubes are to drain the chest cavity of possibly accumulated blood and the wires can be used in the unlikely case of electrical impulses required by the heart. The operation usually lasts 2½ - 3 hours as compared to 8 hours some years ago.
The heart has 4 valves. Two on each side. The replacement is usually of the aortic valve between the aorta and the left ventricle which often becomes calcified with old age. This causes a stenosis of the valve. There are 2 types of valves: A tissue valve which will not require warfarin treatment afterwards and a metal valve followed by warfarin post-op.
Off pump surgery can only be used where the blockages are in arteries which are accessible in the front.
Heart surgery is the most investigated surgery in the world. New advances are constant. E.g. Robotics as used in Germany but this usually takes up to 12 hours and the machines costs twelve million US dollars!
Suturing is not done by laser but always manually. Sutures are non absorbent and very strong although very thin.
Coughing is sometimes experienced and in extreme cases can fracture the breast bone. Often after a discharge, certain medications can cause coughing. Speak to your cardiologist. A member said that she had heard that saphenous(leg) veins do not last as long as mammary arteries but hers has lasted for 19 years. Encouraging news but several of us who had the operation in the early eighties i.e. before the internal mammary arteries were “discovered” had to have the operation repeated years later. It is common practice now to use one internal mammary artery, and one or two leg veins.
Potassium is used every 15 minutes during the operation to paralyze the heart to keep it still for surgery.
The heart is surrounded by a thick membrane which is filled with “water” and known as the pericardium.
Obviously this must be cut to give the surgeon access to the heart. It is interesting to note that it is not closed up again as it has been found not necessary. The inflammation of this sac is known as peri-carditis and could be painful but not dangerous.
The restoration of blood circulation in the leg is almost immediate after the saphenous vein has been harvested and used as a conduit for bypass grafting.
As this informative presentation was so well received it was unanimously decided to invite Mr. Winter to give us the power-point back up presentation again when were assured that we could view it on the big screen.
For those members who were unable to attend this evening’s talk please make every effort to attend a re-run on Wednesday 5 July. Please diarize and avoid disappointment.
I am sure that those of us who were present this time will be back again.
Thank you,
Jack Piek
(Chairman, Secretary & Treasurer!)
Tel: 031-5633200
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