Open Heart Surgery: Preparing Mentally and Physically

Part 1 of 3   (See all 3 parts of this article here)

By Mike DuBose with Dr. Surb Guram, MD and Blake DuBose

 

“It’s an ascending thoracic aortic aneurysm. You’ll need open heart surgery.” When I heard the words coming from my doctor’s mouth, I was stunned! My cholesterol and blood pressure were healthy and I had absolutely no symptoms, family history of heart disease, or chest pain. I felt great! But a simple EKG had turned up something odd, so my internist ordered an ultrasound, nuclear stress test, and, eventually, a CT scan. These tests confirmed that I had an ascending thoracic aortic aneurysm, which, at that time, was just a lot of big words I had never heard before. Without treatment, my doctor explained, the aneurysm would eventually grow large enough to rupture, and I would die.

For three years, my excellent physicians (internist Dr. Surb Guram, surgeon Dr. Reid Tribble, and cardiologist Dr. Barry Feldman) monitored the aneurysm as it expanded. Once it reached 5.5 cm, it was time to operate. On January 27, 2012, I had open heart surgery at the Cleveland Clinic in Ohio. Since that time, I have continued to learn about my condition and have helped others prepare for and recover from open heart surgery.

The purpose of this article is to share, as both a patient and a researcher, my experience of having open heart surgery, along with tips for you to consider as you travel down this road. I am not a medical doctor, and my advice is no substitute for the attention of a medical professional. I highly recommend that you work closely with your physicians to decide your course of treatment.

Discovering the Need for Open Heart Surgery

Hearing that you need to have open heart surgery can be quite a shock—it certainly was for me! When faced with this information, many people become angry, scared, sad, or in denial at their circumstances. They fail to realize that they are fortunate to still be alive! During my research before my own open heart surgery, I learned that aneurysms (like the one I had) are the 15th most common cause of death in the US. Of those people with ruptured aortas who make it to a hospital, only 25% survive!

Discovering your need for open heart surgery before an actual cardiac event occurs is a blessing. For the best possible chances of preventing medical emergencies (including heart problems), my initial advice is to establish a relationship with a competent internist before you need him or her. By connecting with great physicians before anything is wrong, you can stay on top of any health issues that may be arising. Seeing these doctors regularly and undergoing yearly wellness can cue you into major health problems in their early stages—one key to extending your life.

Between visits with your doctors, keep records of any unusual symptoms or changes to your mind or body during that time. Then, bring your notes to your next appointment. The more you can tell your doctor about what you are experiencing, the higher the chances of accurate diagnosis and treatment. Encourage your doctor to run as many tests as he or she feels necessary to generate a good conclusion. Some of my friends (a few died prematurely) have left excellent physicians because they felt they ran too many time-consuming and costly tests, but it was one such test that revealed my aneurysm!

Learning About Your Condition

I have learned over time that, to make effective decisions, you should research your problem with an open mind, understand its causes, seek input from those with different perspectives, develop several options, and then make a timely decision based on the facts before you. When you are diagnosed with a heart condition, it can be overwhelming, but you need to remain calm and logical. In addition to doing your own research, listen to your doctors’ counsel so that you can intelligently discuss your prognosis with them and take an active role in your treatment.

The Internet is an excellent source of information for better understanding your health issues. If you are not comfortable with Internet search engines like Google, ask a friend or family member to research the condition for you and print relevant articles. Another resource that may be helpful to you is an article I recently published with Dr. Surb Guram about how to work effectively with your doctors. You can read “How to Get Excellent Care from Your Doctor: Tips That Could Save Your Life” at my non-profit website www.mikedubose.com under the Health section of the Published Articles page.

Selecting a Cardiologist

Once you have been diagnosed with a heart condition, you need to locate a competent cardiologist. Survey doctors, nurses, neighbors, coworkers, church members, relatives, heart patients, and friends to find professionals that they have either received good care from or heard great things about. I chose Dr. Barry Feldman in my town of Columbia, SC because he has a great reputation and he and Dr. Guram talk closely (effective communication between all of your doctors is very important). Dr. Feldman patiently explains his patients’ problems to them, is humble and smart, and does not rush you out of the door. His cardiac nurse practitioner, Phyllis Williamson, is also brilliant.

If you keep hearing the same names or practices being recommended, you are on the right trail. Ideally, you want to select an experienced cardiologist who is part of a practice that also includes heart surgeons. Once you pick a cardiologist, ask your internist for a referral, which will secure an appointment faster than calling yourself. Have your internist’s office send a copy of your medical records to the cardiologist to expedite treatment, and call the cardiologist’s office before the appointment to make sure that the records were received. Regardless, be sure to take a copy of your records just in case.

Before any doctor visit, create a detailed list of your problems, questions, and concerns so that the meeting will be productive. Medical care is a partnership between you and your doctor. It’s like visiting an auto shop when your car is having problems: the more information you can give the mechanic, the greater the chances that they can accurately diagnose and fix your car’s issues.

Determining the Venue for Your Surgery

Open heart surgery has become increasingly common, with about 500,000 individuals in the US undergoing it each year. There are many different conditions that may require surgeons opening up your chest, such as artery bypasses, valve replacements, aneurysm repair, rhythm adjustments, and transplants. New technologies are constantly being developed to save even more lives. For example, doctors are now employing robotics to conduct less invasive heart surgery, and for some conditions, repairs may now be made through the groin rather than the sternum. There are many places across the US where you can receive great care.

If a thorough assessment indicates that you will need open heart surgery, think carefully about the hospital where you want to have the procedure done and the surgeon who will perform it. You should always seek a second opinion before committing to any major surgery (including open heart surgery), as there is a small possibility that you could die during the procedure. If your condition does not require immediate action, take your medical records to another cardiologist or surgeon outside of your doctor’s practice for a second opinion.

Because of the complexity of my condition, Dr. Guram felt that I needed to have my surgery performed at a well-known hospital with very experienced staff and one of the best surgeons in the nation. We both independently researched the possibilities and came up with the same surgeon (Dr. Lars Svensson) and hospital (Cleveland Clinic) as our top picks. In fact, US News and World Report ranks the Cleveland Clinic in Ohio as the best cardiology and heart surgery facility in the nation (see http://health.usnews.com/best-hospitals/rankings/cardiology-and-heart-surgery for the report).

There are several great heart hospitals other than Cleveland Clinic that may also suit your needs (listed in order of their rank in the report):

• Mayo Clinic
• New York—Presbyterian Hospital of Columbia and Cornell
• Massachusetts General Hospital
• Duke University Hospital
• Northwestern Memorial Hospital

Consumer Reports also offers rankings of hospitals that perform heart surgery, conveniently divided by US region (see www.cr.org/hearthospitals0517 for their report). These guides are an excellent starting point for choosing the location of your surgery, although you should also consider other factors as well. The official US government Medicare website offers a helpful tool at www.medicare.gov/hospitalcompare where you can search for hospitals in your area and see how many “stars” (ranging from 1-5) each has been awarded. The stars are based on patient experience surveys; “timely and effective care” (how long it takes patients to receive medical attention for different ailments); surgical complication and infection rates; hospital readmission and death rates (within 30 days of a hospital stay); usage of medical tests (particularly, whether they perform too many unneeded tests); and value of care patients receive for their money. While all of these factors are important, you should pay special attention to the surgical complication, infection, hospital readmission, and death rates when selecting your hospital.

Traveling away from your home area to go to a highly-ranked hospital has pros and cons. Research on open heart surgery places the death rate at 3 percent, depending on the experience of the surgeon, the hospital, and their staff, but going out of town to a more prestigious hospital requires expensive hotel stays and separates you from your local support system. If you choose to travel for your surgery, some hospitals (including Cleveland Clinic) will send you an information packet with special hotel rates. Also, explore the hospital’s website and ask about discounted rates for local services. Cleveland Clinic contracted with a limo service to provide me and my family with one free pickup and return to the airport.

All the pre-surgery tests and appointments can be time-consuming, so if you are having your surgery a significant distance from your home, I suggest making the trip alone or with one person during that period and having your family members come up a few days before the surgery. If possible, try to see some sights and have fun before your hospitalization so you go in relaxed and happy. The night before my surgery, we went out to dinner and had a good time!

If you select a local hospital, pick the one with the most experience in heart surgery. Consumer Reports ranks hospitals by state, which can help guide your selection. Usually, the best surgeons and medical staff can be found in larger metropolitan areas.

Obtaining Pre-Hospitalization Tests and Records

Having been through many medical tests, I have seen firsthand how widely results can vary between different machines and technicians. An ultrasound, MRI, and CT scans at one hospital can produce images and measurements of a heart that are different from those taken at another. Doctors like to run tests through facilities with modern equipment and operators they trust, and they will usually want you to have future images taken at the same place so that they can compare them to your baseline over time.

When choosing a surgeon, cardiologist, test location, and hospital for a future heart surgery, ensure that they are all located near each other. Because I live in South Carolina, I followed my doctors’ advice and had most of my tests run in Cleveland the week before the surgery to avoid making multiple trips.

CT scans offer the best views of the heart from different angles, and chances are you will need at least one. However, CT scans shower patients with far more radiation than other diagnostic tests. For example, a routine head CT generates the same amount of radiation as 400 dental x-rays, and the dose from a chest CT equals more than 100 chest x-rays. That radiation can wreak havoc at the cellular level, breaking or altering DNA strands and causing mutations that can lead to cancer. Studies from Columbia University and the National Cancer Institute have predicted that radiation from CT scans will kill 15,000 people a year, and NBC and the Wall Street Journal both reported on the dangers of CT scans, especially in young children. Doctors and manufacturers are beginning to address these dangers by encouraging other tests and developing new machines for diagnosing conditions with less radiation, according to the Wall Street Journal.

I had two CT scans before to going to the hospital for surgery, four at the hospital before and after surgery, and a seventh at a local hospital when I experienced complications upon my return home, so I have been exposed to the radiation equivalent of approximately 700 chest x-rays. I believe that some of these scans were needed and others were just done because they generate fast and detailed results. However, sometimes, especially in emergencies, CT scans are truly necessary.

Don’t sit and wait to be told what tests to have—understand and give input into your treatment options. Explain your concerns about radiation to your surgeon and ask if you can opt for high-contrast MRIs instead. MRIs work with magnetic imaging and take longer than CT scans, but they don’t expose you to large amounts of radiation. Some hospitals now use modern CT scan equipment that emits lower levels of radiation, but I still caution against them. You don’t want to fix your heart condition only to raise your risk of cancer later!

Prior to surgery, your surgeon will most likely order other tests like an ultrasound, echocardiogram, blood analysis, and most importantly, a heart catheterization (often referred to as a heart cath). In this procedure, cardiologists insert a thin line with a camera on it through your groin or other body entry point to look inside your heart and assess the condition of the valves and arteries. Then, surgeons use the findings to decide the extent of the surgery that you will need (e.g., if your arteries are blocked, and if so, how many need repairing). I was glad to hear that, apart from the aneurysm, surgeons scored my heart a 10 out of 10!

Your cardiologist and surgeon will need all of your medical records prior to surgery. I suggest picking up both the hard copies and imaging test CDs personally from the relevant doctors and test centers. Then, deliver them to the surgeon’s office or send via Federal Express (with a tracking number) to the medical facility. Hospitals are big places, and it is easy for things to get lost in the mail there. If mailing your records, get the exact physical address, the name of person who needs to receive them, and their telephone number; then check to make sure they have been delivered prior to meeting with the surgeon. Although my records were verified as delivered to the hospital, they never arrived to my surgeon’s staff. I also suggest carrying additional copies with you!

Verifying Your Insurance and Completing Pre-Admission

My 2012 surgery and tests at Cleveland Clinic cost $175,000, but were almost completely covered by my insurance. Before you schedule your surgery, ensure that the facility you select is considered “in-network” by your insurance company or, if you are on Medicare or Medicaid, that the hospital accepts it. Otherwise, it will be very costly out-of-pocket expense. I always ask the registration folks to conduct a pre-certification to confirm that I am covered, and to give me an estimate of my co-pays or deductibles. If you have reason to believe that you may need heart surgery in the near future, you may want to choose a more expensive monthly insurance payment with lower co-pays and deductibles during your work’s open enrollment period.

The hospital will contact you prior to surgery to obtain your basic information. It is important that all of this paperwork is completed and received prior to testing and surgery. I had to go through two pre-certifications, one for testing and another for surgery.

You won’t be able to take your own medicines in the hospital, but you will be given the ones you need. For this reason and to check for potential interactions, your doctors will want to know what types of medications you are on and in what doses. Instead of bringing them all in a bag, simply make a list (separated into prescribed, supplement, herbal, and over-the-counter categories), their dosages, and your pharmacy’s contact information. Make several copies of your list for the doctors you will visit as you prepare for surgery so they can easily see all of your medications at one glance. You will probably be asked to discontinue any blood thinning medications (like aspirin and fish oil) several days before surgery. Carefully read all of the information the hospital sends you! While a lot of it is repetitive or unnecessary, there will be some helpful morsels of information in the packet.

Mentally Preparing for Surgery

Open heart surgery is no picnic. Expect some pain after your surgery, but keep telling yourself and your family, “Things may be hard for a while, but I will get better and live longer.” Patience and a positive attitude are keys to preparing for and recovering from open heart surgery.

Quite frankly, I was excited about having my open heart surgery because I wanted to get it behind me after waiting three years from the time it was discovered. However, I have seen others who were very depressed, scared, and worried prior to their surgeries. A negative mood can add weeks or months to your recovery, whereas a positive outlook expedites it! Delaying your surgery will only make the mental stress worse.

At the same time, no surgery is risk-free. Although it sounds morbid, get everything in order before your surgery as if you will not live through it. You simply have to “hope for the best and plan for the worst.” Every day I plan to die, while hoping that my future will be bright and long, and I recognize that every day is a gift from God.

If you are spiritual, ask others to pray for you. Our family doesn’t often pull the big “prayer trigger” with others, but more than 1,000 Christians across the world were praying for me when I had my open heart surgery. I could feel those prayers after the surgery, when I did not even need painkillers! Trust me—you will need some divine assistance on this one.

Meeting with Your Surgical Team

The day before the surgery, your surgeon and his or her team will meet with to inform you about the process, gather information, complete forms, and prepare for the procedure. This is your time to ask questions and make requests, so write down any concerns ahead of time. Bring your list of medications and supplements, and be prepared to answer the same questions repeatedly because some facilities’ computer systems do not share information. During your tests, on the day of your surgery, and after the surgery, expect staff to constantly ask you for your name, date of birth, and the procedure you are having to ensure you are the correct patient. I’m glad they did—once, they almost gave me someone else’s medicine!

Ask for copies of all your records for your local doctors so they may treat you properly when you return home and include their names, addresses, and fax numbers on your admission papers. I also suggest that you ask for anti-nausea medications to be administered to you prior to and during surgery. I was severely nauseated for days after my surgery, and it was worse than the surgery itself! This is also a good time to request alternatives to CT scans.

The bottom line: The best preparations for open heart surgery start before you even know you need it! By building a solid foundation of trust and respect with competent physicians, you have a better chance of finding out about heart and other health problems before they reach emergency status. The more time you have to make a decision, the more options you have, and the greater the likelihood that you’ll make wise choices. So, get started today, and as my grandmother always said, “Hope for the best, but prepare for the worst!”

Look for our next article on what to expect while hospitalized for your surgery.

 (See all 3 parts of this article here)

About the Authors: Our corporate and personal purpose is to “create opportunities to improve lives” by sharing our knowledge, research, experiences, successes, and mistakes. You can e-mail us at [email protected].

Mike DuBose received his graduate degree from the University of South Carolina and is the author of The Art of Building a Great Business. He has been in business since 1981 and is the owner of Research Associates, The Evaluation Group, Columbia Conference Center, and DuBose Fitness Center. Visit his nonprofit website www.mikedubose.com for a free copy of his book and additional business, travel, and personal articles, as well as health articles written with Dr. Surb Guram, MD.

Blake DuBose graduated from Newberry College’s Schools of Business and Psychology and is president of DuBose Web Group (www.duboseweb.com).

Katie Beck serves as Director of Communications for the DuBose Family of Companies. She graduated from the USC School of Journalism and Honors College.

Dr. Surb Guram, MD is a board-certified internist and a graduate of the University of South Carolina School of Medicine. He is a partner with the SC Internal Medicine Associates in Irmo, SC and has practiced internal medicine in the Midlands for the past 30 years. See www.scinternalmedicine.com for more information on Dr. Guram and his practice.

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