A bypass in life II – the second and third opinion

The adventures of Unspun’s heart problems…continued from A bypass in life – the discovery. Speaking with a friend in Singapore I also learned of another blogger with a heart problem. He’s none other than Singapore’s Khaw Boon Wan who apparently also, like Unspun, showed almost no symptoms of heart disease yet had to undergo a bypass. He’s blogged about it here so maybe he and Unspun could form a Bypassed Bloggers Club sometime (or maybe he could come to Pesta Blogger and we can share experiences and knowledge to heart patients)

…I had more blood drawn out of me.

This time they were for testing with cancer markers to determine if the “white” spot on my lung was actually a tumor. My mind thought that cancer must be one of the worst things to happen to someone as it brings a lot of suffering.

Years ago I remember visiting my Godmother for the last time in Ipoh. When I was still a kid she took a liking to me and insisted on being my godmother. She had always been full of life and had a way with people. She was also very pretty and had a winning smile that would make all the expletives and double entandres she was so fond of like a good-natured joke. She embraced life to the fullest.

But she had been stricken by cancer for many years and was now nearing the end of her life. I returned from Indonesia and paid her a visit. She had been reduced to skin and bones and lay in a coma. We all weren’t sure if she was still conscious.  I went and sat by her and tried talking to her. She remained motionless and expressionless but a tear formed in her eye and rolled down her cheek. It was the most heartrending moment of my life. When I took my leave her husband, who had faithfully took care of her all these years and is my role model for a loving husband, gave me one of her rings. He said she had wanted me to have it. I was devastated.

I digress though…

I was fortunate in that I had brought an X-Ray film of my lungs that I had taken recently in Jakarta because of another ailment a few weeks back. The doctor looked at that X-Ray and told me to relax. The Jakarta X-Ray was clear of any white spots, meaning that I did not have a tumor as none could have developed to the size of the white spot in a few weeks. It had to be an infection. I breathed a sigh of relief.

The other upside of the infection was that they could not operate on me until the infection cleared. So they discharged me for the meantime. When I got back to my mother’s house, where I was staying in KL, I started thinking that I needed a second opinion. What if the cardiologist was wrong? I could be cut up for nothing.

I called around and found an old friend who was a doctor in a reputable hospital. He knew a cardiologist, one of the best in Malaysia, but he was on Christmas vacation overseas. Di he know any other good doctors. He recommended Cardiologist #2, who scruninized the results of my tredmill test, a CD of my angiogram and said that he could not make a decisive conclusion since the crucial part of my left main artery was not captured properly in the angiogram.

He said because I was relatively healthy and the heartbeat lines of my treadmill test began to separate only when I had a big strain, and the angiogram not being conclusive, I should just take some medication to lower my cholesterol, a cardiac aspirin a day and come back in six months for another test. But he would like to confer with his colleagues before making a final diagnosis. His colleagues, including the original one I was supposed to see, was, however, on holidays. So Unspun waited out the Christmas in no mood to celebrate  for the doctor to come back to from his vacation.

Nothing to do but to try to divert the mind and Unspun was lucky to have a wife who planned a diversion to Malacca, Malaysia’s historic town for a couple of days. While there, however, Cardiologist #2 called and said he had conferred with is colleague and they had come to the conclusion that I did not merit a bypass there and then. I should come back in six months. The fact that Cardiologist #2 had the bedside manner and communication skills of a bear in hibernation did not help. He told me to take some medication and come back in six months. Full stop. I did not need to know more.

So there I was stuck with what seemed two extreme medical opinions: Cardiologist #1 who seems to think that I could die of a heart attack at any moment and therefore needed to have a bypass soonest and Cardiologist #2 and friends who seem to think that I should pop a few aspirins, a Lipitor or two and stroll back six months later for an examination.

Since I suffered from no cardiac disease symptoms whatsoever, I opted to go for Cardiologist #2’s. I came back to Jakarta and tried to get on for six months before the next examination. Then the Missus found me a doctor who had been trained in Western Medicine but was now practicing Traditional Chinese Medicine.

I went to see him about the heart but since I was there, and I was kiasu, I also asked him to treat my snoring problem. My snoring had got so bad over the years that once I was kicked out by my roomate during a liveaboard dive trip. He told me that he couldn’t sleep because of my snoring and when I turned over to my side and still kept snoring he knew that there was no hope of me shutting up. It was embarrassing but I had gotten used to that. I would usually start to snore loudly at massage spas, disrupting the relaxation of everyone else but me. The snore was also so bad that I suffered from sleep apnea – the condition where you choke yourself because of snoring. This prevents you from going into full sleep and rest mode and causes sufferers to be irritable and tired (so now you know why I was grumpy and sleepy).

The doctor was a skeptic of Western medicine and he had interesting views about statins, the class of drugs like Lipitor and Crestor, that Western-trained doctors prescribe to lower your blood cholesterol level. His view is that statins did more harm than good and you should avoid them as much as possible.

He prescribed instead lichitin injections and consumption of huge doses of fish oil and lichitin. Lichitin is an interesting substance, naturally found in the fatty tissues of animals. It is extracted from soy beans and it acts as a solvent of sorts. Sometimes it is used for cosmetic surgery where lichitin is injected to “dissolve” the fat in certain areas. A bit like liposuction without the pain.

He pumped me full of lichitin and gave me acupuncture about once a week for four months. One thing that happened very early, from the second visit actually, was that my snoring problem was cured. Where Unspun was once a lion in full roar when asleep, he was now a silent as a babe. The doctor explained that according to Chinese medical belief snoring is caused by the disruption of flow of forces in the area near the mouth/nose. If you smoothen the flow then the snoring would stop. His needles at somewhere on the top half of my shin was designed to do that and it apparently stopped my snoring.

He wasn’t so successful with my heart though and after four to five months of acupuncture and lechitin (during which Unspun regularly worked out in the gym with no heart aches whatsoever) Unspun went back to KL to find Cardiologist #3, the cardiologist my friend had wanted me to see in the first place. He had qualifications from various reputable hospitals up the wazoo and was (I Googled him) considered one of the best in Malaysia. He put me through a state-of-the-art MRI scanner as he too could not tell from my angiogram whether the narrowing of my left main artery was naturally occuring (at which case we need not do nothing) or whether it was caused by plaque buildup.

10 seconds was all it took for them to gather enough information that would render my heart in 3D on the terminal screen of the MRI scanner. There they showed Unspun his heart, in color, and the technology was so fantastic that when they moved the sursor along an artery there was a side window showing the cross section of the artery as we went along.

The MRI scan was pretty conclusive: Unspun apparently has four blockages, with the most severe being in he left main artery.There was also some calcification of the artery. That settled it. I had to go for a bypass. But which procedure?

The cardiologist told me that there has been a lot of hullabaloo recently about keyhole surgery. many medical organizations, even in KL, were claiming that they could perform key hole surgeries for conditions like mine. What they do is make a couple of holes in your chest, one above your rib cage, another below, and perform a bypass operation from there. The claim is that since it is less intrusive than a bypass surgery, you’d be abl to heal faster and suffer much less pain.

My cardiologist was, however, very vehement that I do not choose this option. “The technology is still not here for anyone, no matter how skilled, to perform a keyhole surgery well,” he said, adding that he’s seen many patients running into problems as early as six months after the keyhole surgery.

The only safe and lasting alternative for now, he said, was still open heart surgery because the surgeon could graft the replacement artery properly. “If you have it done by a good surgeon you’re virtually guaranteed that you don’t need to do another operation in the same area for the next 20 years.”

So he sent Unspun to the heart surgeon, who apparently is the best in Malaysia who had operated on Mahathir before. Unspun thought that what is good enough for Mahathir was good enough for him so agreed to be cut up, but could he wait for a couple of months so that Unspun could get on and finish some projects for clients? He said no, my blockage was actually quite severe. I may look and feel fine but if there should be a blood clot it could be the unspinning of Unspun. So he scheduled the operation for June 14.

Next: What one learns and goes through the mind when one has a heart condition