A bypass in life III – the postponment

Over the past month in the leadup to my bypass operation, I had been very careful about not falling sick or contracting any infection.

But as luck would have it, I ran a fever yesterday, the eve of the operation. The surgeon, on discovering my fever, said he could not operate as it would be an unnecessary risk for such a major operation.

I was lucky though in that another patient who was scheduled for a bypass Thursday could not go through with it until he had his kidney stones cleared.

So now Thursday is the day.

We still have a problem though: getting enough blood donors.

My surgeon is very insistent that we should have only fresh blood and blood of the same blood group. This creates difficulties, especially when you blood group type is AB+ which is relatively rare. The fact that the hospital requires donors to be screened prior to donation also adds to the difficulties as they would have to make two trips during office hours – once for the screening and one more time for the actual donation on the morning of the bypass itself.

The fact that I have not been living in KL for the past two decades also doesn’t help as I know much fewer people than in Jakarta.

Nevertheless, my sister has been doing a super job harnessing her network of friends and Facebook contacts to get us some sponsors. I am humbled by the kindness and generosity of the donors wo don’t know me from Adam yet have taken the trouble to give their blood. Thank you. Thank you. Thank you.

We are still a few donors short though so if any of you know anyone with AB+ blood living in KL or near Subang Jaya who’s willing to donate on Thursday morning please let me know.

In the meantime, with my fever abated I feel fine and look forward to the bypass.

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

A bypass in life: The discovery

Note: Unspun found out that he had a sever heart problem in December last year. After a series of incidents and confusion he found out that he would definitely have to have a bypass surgery, which is slotted for next week. Throughout this time he wrestled on whether he should blog about it. Initially he and the Missues thought no, as it might only trigger a sense of pity among some readers and friends. But with the bypass around the corner, Unspun has had a change of heart (OK, bad pun). Part of blogging is to share our experiences and boy, have I had a spadeful of experiences since last December. Its Unspun‘s hope is that his experiences may prove instructive or valuable to others who may find themselves in the same position and confronting all the confusion of medical advice and what to do.

Unspun‘s glad that through the experience so far friends and family, especially my sister and wife, has been so understanding and helpful. Is’s actually humbling experience – not a usual one for the likes of Unspun – and he hopes that you’d read this series of postings (yes, the adventures are too long to be squeezed into one post) with the right spirit – that shit happens in life, but what’s important is not to dwell on it but to accept it and move on- often with large doses of humor that is even more efficacious than Crestor.

The first time they told me I had to have open heart surgery it sounded like a death sentence.

It was two days before last Christmas and my family was in Kuala Lumpur visiting relatives. In between we managed to do something that we could not find time to do over the past two to three years – my wife and I went for a regular health screening.

We did the bloodwork, the urine bit and the XRays. Then we did the treadmill test. That was the first time I had an inkling that I could drop dead any moment.

During the treadmill test the attendant kept asking me if felt any heart pains. I was nonchalant and a little irritated: “Absolutely not,” I said. After all, I work out at the gym about four to five times a week, doing cardio and weights. And hadn’t I just breezed through all four stages of the treadmill test?

When the results were in the resident cardiologist shook his head and said: “This is bad. I won’t be surprised if you have multiple blockages.”

I was taken aback. This can’t be happening to me, I thought. Not especially since the results of the other tests showed that my cholesterol level, while a little high was still in the normal range; ditto my triglycerides, blood pressure and other usual cardiac tell tale signs. On top of that there was no known heart disease or diabetic history in my family. I don’t smoke apart from the rare occasional puff and I drink moderately. What went wrong?

My questions were cut short by the cardiologist who said that I needed to do an angiogram as soon as possible to verify the treadmill test results. I was warded the same day and he did the angiogram. It’s a pretty weird experience. The stick this wire like tube through a cut in your wrist and push it all the way to your heart. You can feel the wire traveling through your arms.

You can also see on the TV screen, when they train the “cameras” on the heart, a black and white image of the wire, your pumping heart and your arteries, especially when they inject a dye into your blood stream.

When he had finished, they wheeled me to the next room to show me the results. I could see images of my arteries and the blood flowing through them when the dye was injected. I could also see that plainly some parts were constricted. The cardiologist said that I had three blockages, the most severed being an 80 percent blockage on my left main artery, next to where it branches out into two arteries that supply blood to the heart.

The severity, coupled by the position of the blockage meant that I could not just have an angioplasty – the process of inserting stents into blocked areas. A process that some people refer to as ballooning or catheter-ing. I would have to have a bypass or I could collapse any time.

In such moments Unspun always finds himself dissociating and, like someone looking on myself, wondering how I should be reacting to all this shocking news. I remembered playing out some scenarios in my mind, high-speed movies that my mind constructs to cope with such news. I now do not remember what the rest are. The only enduring one was this weird feeling in my chest as I contemplated how they would have to cut me up, crack open my rib cage, to get to my heart. Then they’d have to sew me up and it must hurt like hell recovering after that.

That was the image/feeling that kept looping through my mind. On another level I was contemplating that, if what the doctor says is true, I might suffer a heart attack at any time and drop dead on the spot. Death, it seemed, was close by, biding its time but ready to pounce. I remember feeling that I should be worried but instead found myself dissociating again and wondering, with some amusement, how I should react to the prospect of Death at any time soon. The bottom line, however, is that it seems one of inexplicable things in life. If I go, I go but there doesn’t seem to be much point worrying about it, or being afraid of it.

The cardiologist warded me immediately and scheduled a bypass surgery in two days time.

Then, when I was in hospital, my X-Ray results came in and they found something “white-ish” on my lungs. I asked him what that meant. He said it could be anything. I asked him to spell out the range of anything. He said the best case was that its an infection; the worst case was that it was a tumor (and the worst case if its a tumor was that it was malignant – we’re talking cancer here).

“Oh shit!” I thought. “Please don’t let be a tumor. I can’t handle so much good news in one day.”

Next: Was it tumor or infection and how it saved Unspun from the operating table for the next six months.