I have often been in the position of discussing the needs of the patient, and
how sometimes doctors are unaware of the fears, questions, and general uneasiness
engendered by the complex and intimidating nature of medical treatment. However,
no amount of reading, discussions with patients, dealing with their psychology,
or awareness of sensitivities can prepare a doctor as much as actually being
a patient. In fact, even being a patient is not sufficient preparation for
I have had a defective aortic heart valve since I was a child, and I have known
for 40 years that someday I would have to have it replaced. My parents were
told by the surgeon when I was 18 that he wanted to replace the valve then,
otherwise, he predicted, I would have symptoms of heart failure after 10 to
20 years. They also said that I should give up exercise. I did not take their
Years later, after I had run several marathons, I visited George Sheehan, a
cardiologist who had written books on running. After lunch he listened to my
heart. He told me that I did have the leaky valve, but he said there was no
science behind the recommendation that I not exercise. (Of course, I always
had in the back of my mind that I might be taking a risk by exercising.)
It has now been 40 years, rather than the predicted 20, and I have done well,
but because of the increasing strain on the heart, on March 11th, I had valve
replacement surgery to protect my heart muscle from damage. I feel great, but
through all the weeks of anticipation I went through the entire range of thoughts,
feelings, and fears that any patients would (am I going to wake up?; should
I say goodbye before the operation?; will I feel better?; will I be changed
mentally?; how will I tolerate the pain and discomfort?). The experience is
what all patients go through, and all doctors should try to understand, although
they can't be in those shoes until they are.
However, I was also excited during those few preceding weeks about being able
to be physical again without limitation, to run, swim, and bicycle with no
fear of harming my heart and no symptoms. I love physical activity, and soon
I'll be able to go back to all of those activities. Right now I am beginning
my walking program, increasing every day, and I can tell I have not been using
those muscles–amazing how quickly they lose tone and mass!
Naturally, I took all of the supplements to protect my heart and brain during
and after surgery, to promote the healing process, and to maintain my immunity.
In addition, I took liver support (silymarin and calcium D-glucarate) to help
detoxify the anesthetic. I also did not eat hospital food, but had healthy
whole foods brought in for me, and I was fortunate enough to have the nutritionists
at the Brigham closely accommodating my own dietary needs. (All hospital food
should be so nutritious.) I look forward to my full schedule of activities,
aesthetic, professional, and recreational, and I'll have a new understanding
I was in the hospital just over a week. The care in the cardiac surgical ICU
was superb. I had constant attention to my medical and personal needs and my
monitors, and careful adjustments to medications by highly-skilled cardiac
surgical nurses and surgical fellows. I did have to leave that unit for two
days before discharge, and those days left something to be desired.
Hospital staff does not realize how difficult it is to sleep (and how important
it is to healing), and they pay little attention to the noise level, night
and day, at the nurses' station. I finally asked them to shut the door
to eliminate the chatter, and that simple step made a dramatic difference in
my comfort levels. Hospitals would be well advised to provide ear plugs and
eye masks to enhance the possibility of getting adequate rest. (If they are
not provided, bring your own.)
It is not easy to have an operation on the heart, even though the technology
is far superior to what it was 40 years ago when they first wanted to do mine.
In coming out of anesthesia, they have to make sure your breathing is strong
enough to take out the breathing tube. By the time you are that awake, you
have recovered your gag reflex, and it is common to gag on the tubes before
they are removed (I did, several times). This is quite painful on the evening
of the operation, in spite of ample medication.
After the tubes are removed, it is an incredible relief (for the patient and
for loved ones watching the process). At that time, you realize how dry your
mouth and mucous membranes are, in spite of ample fluids being given intravenously.
It is a great relief to be allowed to suck on ice chips, enough fluid to wet
your mouth without being likely to choke. The problem, however, is that ice
chips are more likely than water to provoke vomiting. Having survived the discomfort
of the gagging, I was unpleasantly surprised by the pain and wrenching of two
episodes of vomiting.
Because I recommend chelation therapy for arterial disease, I have seen many
patients who have had coronary artery bypass grafts (CABG). A number of them
have had it more than once, which is now a much greater shock to me than it
was before I had my own open heart surgery. I am shocked because repeat CABG
is almost totally preventable through lifestyle change.
A patient in the next room to me had just had a bypass at 45 years old, and
he was a smoker, with some emphysema. I overheard the nurse giving him discharge
instructions, including information on a stop-smoking program. I would have
thought that the surgery itself would be all the “stop-smoking” program
he would need.
The same holds true for diet and exercise. It is quite clear in the medical
literature that whole, natural foods, rich in vegetables, fruits, whole grains,
beans, seeds, nuts, and fish can prevent and reverse hardening of the arteries.
With even the possibility that you could avert the need for another operation,
why not give yourself the best shot at a healthy future, free of surgery and
other medical interventions. My preliminary angiogram showed that my arteries
were large and free of plaque, surely related to my exercise, healthy diet,
Michael Janson, MD
180 Massachusetts Ave.
Arlington, Massachusetts 02474 USA