Wednesday, 23 July 2014

Angioplasty: A guest post from JC Callister

I am chuffed to bits to have JC Callister as my first guest blogger. He's talking about the angioplasty operation he recently went through, and I warn you, it's not for the squeamish, but it is well worth reading.

For more on angioplasty check out the NHS site on it here.

Thanks JC!


Without much ado, I was wheeled through the winding corridors of Broadgreen, or Liverpool Heart And Chest Hospital, as it's called proper, like.

I arrived in surgery in the traditional costume of the surgical warrior, a loosely tied gown and stern grimace.

I was able to sit myself on the operating table, a spongy slab not quite as wide as my shoulders and just a bit longer than I am tall and having undone the robe it was shuffled out from under me and my vanity (and the incredulity of those present), spared by a strategically placed radiation shield blanket.

As this was happening, the surgeon introduced himself and took my right arm and began scrubbing vigorously at my wrist and palm with a swab on a stick, then prodding and pinching the flesh just on the arm side of the wrist itself. He was explaining what he was about to do in a sort of distracted way, like airline cabin staff reciting safety announcements.

I was told to sit on my left hand, which I did and the scanner was maneuvered into position.

The Angiogram-mer is like something out of Star Trek, big, streamlined and totally unfathomable, it looked like it could have taken off, solved all the puzzles of physics... and made toast, too. Great circular arms with pods swinging from the ends, screens dangling from it like sky pictures. It whirred and hummed menacingly, ticking whilst at rest like it was straining to get going again... Two of the pods were brought close to my chest, one above and one along side at right angles to each other, and it sat there, waiting...

Meanwhile, the surgeon informed me that I would feel a 'slight nip' in my wrist...

I don't know which Sado-Masochist club he uses but his description of a slight nip is a lot more like 'having your arm bitten off by an old shark with broken teeth'.

He managed to get the probe into my artery and I asked why he used my arm and was there much danger of damaging the artery and my suffering any long term damage to my hand. His reply that there are two arteries in the wrist so he could trash one and my hand would still work was not comforting, not at all...

So he starts to thread this probe up the artery, and I can feel it pushing its' way through my forearm, through my elbow and upper arm. He paused before threading it through my armpit, which felt like an inverted tickle and then across my chest...

As soon as the probe arrived in my heart, I felt it, not unpleasant, but my heart seemed to not like it there as it began to pump heavily which I could feel as a thumping in my chest. He maneuvered the probe to inject a radio-dark dye into each of the three arteries in my heart. I felt this dye travel through my heart and out through an artery high in my chest, my lips and gums throbbed, tingled and made me grimace like a constipated donkey and I felt instantly as if I was boiling from within. The Angiogram-mer began to whirl around me, clacking and ticking and buzzing and whirring like it was in a demented three dimensional barn-dance. Do-se-do-ing and to-and-fro-ing like a mad thing. I was told to take a big breath which was not an option as I was by this time trying to breath as shallow as poss to alleviate the crushing pain in the centre of my chest, my heart seemed to be climbing out of my ribcage, flapping about like a dolphin's tail at the same time as someone was holding it down with the sharp end of a pencil.

This went on for a good twenty minutes as the surgeon injected the dye into each of the arteries by turn and followed the darkness as it swept through the blood vessels.

Eventually he told me that he had isolated the area of damage to my right cardiac artery and showed me a photo of it, with a section so narrowed as to be almost closed. It was difficult to estimate the size as I think the artery is maybe 3" long and this pic was a foot across, but I would say about a 1/2" long and a millimeter wide was the damage in what should have been about a 10mm wide vessel.

So the surgeon says he will repair this, and as he hadn't seen anything else, he was quite positive that this would cure my angina, for the time being, at least...

The next stage involved changing the dye injecting probe for a ballooning probe which he inflated in the artery to squeeze it open...

I say this in a calm manner as if it was just done. In reality, this was the most painful thing I have ever endured. I could feel the balloon wriggling into position as it restricted the blood flow causing a lot of back pressure, not unlike angina itself, but more widespread and a 'harder' pain than that. And knowing that this was the repair meant that there was no point in asking for any relief at all, as there is none available. I could feel the balloon inflating and stretching the fabric of my heart muscles to ease open the artery, the force felt tremendous, it seemed my heart would burst under this strain, it was struggling to maintain a rhythm and I could hear every corpuscle which rumbled and tumbled past my ears. I had flashes of bright light in my eyes and parts of my vision were shutting down. I couldn't breathe, in or out.

One of the nurses asked me if I was ok, which served to remind me that I was still on earth and hadn't actually entered Hades yet... 

He held the inflated balloon in place for about five minutes to allow the shock of the stretching to subside a bit and also allow the muscles to adjust to having what was now a lump in them, rather than in the artery wall. All that time a third of my heart was starved of it's blood supply and was struggling to keep up with the other two thirds, the two sections seemed to be involved in a 'tear each other to pieces' fight in the middle of my chest until the surgeon was happy with the result and deflated the balloon.

Now came the really clever part. If the opening of the artery had been simply left like that, it would soon close again of its' own accord, so... Another balloon was introduced with a 'stent' mounted on it. This consists of a stainless-steel tube, made of fine threads in the style of a Chinese Finger Puzzle, you know the one, where the harder you pull apart, the tighter it gets, as you push the ends together the tube opens up... so the Stent does exactly that as the balloon inflates, and once the balloon is removed, the stent holds the artery open and prevents the subsequent collapse. This particular stent is also coated in an anti-platelet surface so it doesn't cause any clotting problems itself.

So, another foray with a balloon stopping the blood flow and as my heart was already a bit bruised by all the action, I think it felt even worse than before, the thumping and flapping, the acute stabbing and gripping pain in my chest literally took my breath away and watered my eyes, I didn't breathe until he deflated the second balloon, by which time I was drenched in sweat and trembling from head to foot with the stress and strain of trying to lie still throughout. 

My left arm kept coming adrift and flopping to the floor so I had to weave it back into the folds of the gown so I could sit on my hand again but the sweat meant that it slithered and squeezed out again and again. My right arm had been trapped in a vice like arrangement on the side of the operating table and had by now become totally numb and was starting to cramp.

The demented dancers continued to weave about around my head and chest, coming in close and retreating by turns as they swirled around me to afford the surgeon a view of what he was doing inside my heart. Several times I thought one of the pods would crush my skull against the operating table, but it always stopped a few mil short of contact.

Eventually, after almost an hour of sharp pain and numbness, sweating and gasping, the surgeon announced that he was about to withdraw the probe... I felt it all the way back as well, not so painful but very noticeable... He left a guide canula in my wrist for a few moments and then, with the help of a nurse, withdrew that, pressing very hard over the wound, the nurse was able to clean up the blood which had escaped from the wound during the operation and fitted a smart balloon wrist band which stemmed the flow from the opened artery. this she had to deflate in stages over the next few hours until it was ok to take it right off.

I was still sweating and hadn't caught my breath when the surgeon asked if I would like to see the photographs of his work, a before and after, if you like. I was stunned that any blood could have made it through the narrowed artery at all, let alone function fairly normally 98% of the time, apart from the actual episodes of angina that I had been suffering. the 'after' photo looked indistinguishable from the rest of the artery and indeed, if I hadn't seen what had gone on, I would not have believed that there was anything wrong with that artery at all.

As I was now done, and also the last customer that day, the staff began cleaning the whole place from top to bottom, all the pods and arms were whirred to a resting position and scrubbed before I was got out of the theatre and back to the ward.

My chest was painful for most of the evening and I had a bit of trouble with a tickly cough due to the deep breathing I had been doing, but it went away soon enough. The pain persisted and I was given a couple of paracetamol to help me sleep, which I needed.

I haven't had a single twinge of angina since, and truly don't expect any, either. But if I do get a pain, I will recognise it sooner and get it sorted sooner next time...


The wonders of modern science, eh...

I felt like I was having a limb amputated on an old sailing warship... 

Things haven't changed that, much, have they...