Surgery On My Second Heart!

We all know that no human is born with two hearts! So, where is the question of a second heart? We also know that our heart pumps blood to take it to all parts of our body, right? The point is that our body has a second blood pump, which is our calf muscles! The calf muscle is often considered the second heart because it plays a significant role within the circulatory system that is similar to the heart. 

Calf blood circulation diagram (veinatlanta.com)

The heart pumps oxygen-rich blood through arteries to reach every part of the body, providing oxygen and nourishment. The calf muscle pumps the oxygen-depleted blood back through the veins to reach the heart.

Once we learn how the calf muscle assists the heart in circulating blood throughout our body, we’ll understand why keeping our calves strong is just as important as protecting our heart through good nutrition, exercise, and other healthy lifestyle choices.

What happened to my legs and why an urgent surgery is required is explained in an earlier post: The Sky Gets Dark, SLOWLY!  This post is a record of the daily proceedings of what I went through in the hospital, Mazumdar Shaw Medical Center (MSMC), NH City, Bangalore. 

Admission Day (16-05-2023)

The open surgery on my calf muscle to remove the blood clot was fixed for tomorrow the 17th. In preparation for that, I got admitted in the hospital at 9:30 am after paying 100% fees in advance, as I don't have any health insurance, being an NRI for a long time. I am in a semi-private room, 318B. 

Dr Robbie George, the reputed vascular surgeon, came with a team of doctors and explained what was going to be done. They will open up behind the right leg just below the knee. What exactly they will do after that will be decided on seeing the ground reality! It may include just removing the blockage created by the disintegrated clot coming from the heart chamber, applying a bypass if required, and investigating the condition of the previous two stents using the catheter that will be inserted. 

Later a few doctors came to check on the various things in preparation for the surgery. Clearances came from a cardio doctor (Sherril) and then an anesthesia doctor (Sukra...). All set for the surgery tomorrow. 

Surgery Day (17-05-2023)

This morning at 5:30, I had four slices of bread with some milk. No food, including water, till the surgery at 12 pm. I took a bath, and applied antiseptic foam all over my body. 

Then another young doctor came. She explained all the risk factors involved, the worst possible situations that can happen during the surgical procedure, and the remedial measures they will take! And if I agree to all this, I should sign a form where she has written down all the things, she explained to me. I asked her with a smile, "do I have a choice?" and she sympathetically admitted No, and I duly signed on the dotted line! 

At 9:15 am, the nurse kept a board with the letters NPO on the table adjacent to my bed. It is a term whose expansion no one knows (as it is a Latin term nil per os) but whose meaning is very clear to everyone concerned! NPO means “nothing by mouth”, a medical instruction to the care givers to withhold all food and fluids.

Then the sister inserted a cannula in my right arm. It is an IV cannula placed into a vein for blood transfusions, administration of medication, blood draws, and providing fluids. It was used to provide the Saline solution (sodium chloride) to me using the drip stand.

I am ready to be taken into the operating theatre by 11:30 or so. The doctor had informed me that during the surgical procedure my breathing will be taken over by a ventilator with the help of a tube inserted through the mouth down into the windpipe. A ventilator is a machine that acts as bellows to move air in and out of our lungs. The doctor had also told me that I'll be put under general anesthesia first and therefore I would be unaware of the procedures. Once the team of doctors have had their time on my limbs, I'll be shifted to the ICU for the night. 

So Vasantha will be alone in the room tonight. Fortunately, my old friends Narayan and Geetha dropped in sometime in the afternoon and provided company to Vasantha.

At 12'o clock I was taken out of my room and wheeled into the OT. This was my first surgery under full anesthesia since my previous angioplasty in 2011 was under local anesthesia when I was fully aware of my surroundings. I don't know when I was put to sleep but vaguely remember a nurse firmly pressing down a mask on my mouth and nose. 

At about 5pm, my wife was called into the ICU, where Dr Robbie George briefed her that the surgery went well, that the blood clot was fresh and therefore could be removed easily, and that there was no need for a bypass. 

I don't remember exactly when I slowly came back to consciousness but I remember struggling with the uncomfortable tube in my mouth that was soon removed. 

Anniversary Day (18-05-2023)

At 4 am I woke up in the ICU. Sister Janani, a fresher after completing her 4-year Nursing Course from NH itself, a slender figure, was assigned to my bed. She gave the required medicines and pain killing injections at periodic intervals. 

She also gave me a bath in the lying down position with wet wipes. Then she changed the bed sheet, with me lying on the bed. My daily Yoga routines came in handy to give her maximum cooperation by contorting my body whichever way it helped her complete the task. In this vulnerable position, I was reminded of Zhou Daxin's words in his novel "The Sky Gets Dark, SLOWLY!", where he warns about the old age when one day, you are back to lying in bed like the baby you were born as!

I asked the sister to call Vasantha and request her to come to the ICU since visitors were permitted in the morning. She arrived and promptly wished: "Happy Anniversary!". That is when I realized that this day is the most precious for me, as today, 48 years back, is when Vasantha entered my life as a blessing and I decided to hold her hand and build my future with her! Since then, she was my true friend, my constant companion, my daily source of respite throughout my life, who took utmost care of me and my children and later in life, my grandchildren too.

Around 11:30 am I was shifted back to my room. And a nurse continued administering antibiotic and paracetamol injections through the cannula at periodic intervals. I tried walking in the room as per the doctor's advice. I used to be served patient's meal in the room. But Vasantha had to fetch for herself from the nearby canteen. That is when she learned the art of using Google Pay for the first time. 

Fortunately, we were very lucky that Dr Veena's mother Saroja Ramachandran took upon herself to send packed lunch for Vasantha too. Today, I tasted the Kannur style Kaya Erissery (plantain curry made with grated coconut) that felt heavenly! 

There was some confusion in the afternoon. At 3pm a nurse informed us that I should go for a coronary angiography scheduled at 4pm in the Cardiac building. We were shocked to hear this since I was still recovering from yesterday's open surgery. So, Vasantha went to check with our doctor, Dr Robbie George on the first floor. He said it can be done tomorrow and he will speak with the Cardiac surgeon Dr Ramakrishnankumar.

Angiogram Day (19-05-2023)

In the morning, I made it a point to walk slowly through the hospital corridors. On one side is the semi-private room and on the other side, the more expensive private rooms. The nurses were busy with their duties including filling the check lists of individual patients with the minute details of medicines, food, etc. administered. 

There was another patient who was walking up and down like me in the corridor. He said he too had surgery to remove a block in one leg, and that he had come the previous year too for a similar procedure on his other leg. He happened to be a Chinese settled in West Bengal and he was very happy with the staff, treatment, and facilities at the NH hospital.

Around 2.30 pm, I was taken to the Cardiac building in an ambulance to get a coronary angiogram done. Vasantha accompanied me but at some point, she was told that the attendant could not accompany the patient, and she returned to the room. 

So, I am back to the operating theatre for the second time in three days, lying on the angiography table on my back. In Jan 2011, following a heart attack in Abu Dhabi, Dr C G Venkitachalam had done an angiogram and an angioplasty placing two stents in my artery. At that time, a catheter (a long, thin, flexible tube) was inserted into the artery with a small incision at the groin, and it was threaded through the artery towards the heart. 

In the OT, there were quite a few nurses and doctors around. One of them strapped my right hand with the palm upwards firmly to the table. This time, the incision was made at the wrist and the catheter was carefully guided to the area being examined. Though I was conscious of the surroundings, I didn't feel any pain caused by the pushing and pulling of the tube, as I was under local anesthesia. But I could feel the injected contrast dye passing through my blood vessels. The angiography machine with the imaging screen on one side and the x-ray panel close to my body looked the same.   

After the procedure, Dr Ramakrishnakumar said my previous two stents of 2011 are intact but there is a new block just ahead of it. Since it has not given me any trouble so far, he said there is no need for any emergency stenting, and it will clear off by the medication I am going to have.

I was brought back to my room in an ambulance by 5:30pm. By that time, two of my young friends Devidas and Manoj from SSO came to visit us. They sat with us for more than an hour. Manoj said he and Vineetha would come to help us complete the discharge formalities tomorrow and pick us up and take us back home. 

Discharge Day (20-05-2023)

In the morning the nurse took a blood sample to decide on the dosage of various medicines to be given while discharging from the hospital. We were happy that we would be discharged from the hospital by 12:30 pm. But the whole discharge process turned out to be a nightmare, not because of any bill settlement issue, as I had paid in advance more than what was required. 

All the running around between the IT department in the basement, the bill payment center on the first floor, and getting the discharge summary from the Nurses Station would have been a big challenge for Vasantha alone to handle. But Vineetha and Manoj went to the different sections, and deftly handled all the paperwork and procedures required on time. Still there was no discharge summary sheet and no one knew what the delay was. 

Vineetha went to the Nurses Station and insisted on knowing the cause of the delay and they informed her that in the final bill, an amount due to Cardiac Unit was wrongly attributed to Vascular Unit. Even after an hour the clearance from the doctor had still not come. So Vasantha went to Dr George who said that he would first get the clearance from the Cardio doctor and affix his signature immediately.  We waited for another hour and still the discharge summary was not available. So, Manoj approached the Nurses Station again and upon some heated exchange of words learned that the clearance from the Cardiac Center had still not come. There were other patients like us quite exasperated at the lengthy discharge process. Finally, we managed to leave the hospital at 5:30 pm. In our case, the problem seems to be the lack of proper coordination between the two Units involved. 

But for this administrative hassle, the treatment at MSMC was very effective, the stay was very comfortable, the staff was very efficient and helpful, and overall, it was a great experience. Some of the pleasant and likeable nurses I remember include Janani, Rajeswari, Chris Maria, Merlin, Soumya, Aashifa, Malini, Saranya, ... They provided care, comfort, and humor even while enduring late shifts, long hours, and standing on their feet most of the day. I owe them my thanks.

Post Discharge Medication

The medicines prescribed were:

• Rozavel A Capsule (Rosuvastatin 10MG + Aspirin 75MG) - once daily at night
• Acitrom 4MG tablet (Acenocoumarol) - once daily at night
• Pantakan 40MG tablet (Pantoprazole) - 1/2 hr before breakfast for 1 week
• Paracetamol 1000MG Tablet - 3 times after food 
• Renerve Plus Capsule - once daily at night

Acitrom tablet is a blood thinning medication that works by preventing the formation of blood clots within the blood vessels. A PT-INR blood test was required at intervals to determine the correct dosage of Acitrom. As shown below I have taken 5 tests so far and have stabilized on a dosage of 3MG of Acitrom.

Today, on 09-06-2023, I would have a video consultation with Dr Robbie George at 5:30 pm. There is still slight pain in the surgical wound. I am hoping for the best and eager to get back to my daily exercise routines.