INTERVIEW: Asthma, and Bypass Surgery

ON ASTHMA, AND ON BYPASS SURGERY

An Interview

Len – “I grew up, was born and raised in Kenora, Ontario. I was born on October 10, in 1928. When I was growing up I never had enough to eat, never had nothing. I had poor clothes, poor stuff.

In November of 1929 they had a flu epidemic, just around that area. I had a double-hernia operation just a month before that, in October. Then – one year old – I came down with pneumonia.”

Len

Len and his wife Nellie live in Ontario but spend their winters in B.C., as so many easterners do.

POOR LIFE, EARLY ILLNESS… AND HARSH ‘CURES’
“The doctor there said, ‘You can’t do nothing with him, you’ve just got to leave him. If he doesn’t make it through the night’ – across the road was the undertaker – ‘Call Tackaberry up, tell him to come over and pick him up in the morning.’

My Grandmother was a midwife, she brought me into the world. Well, my Grandmother got goose grease, bear grease, coal oil (kerosene) – you tried to swallow the coal oil every time you needed to spit up the phlegm. But it wouldn’t come up for me, they couldn’t get the phlegm up with all those (‘medicines’), so my Grandmother said to my Dad, ‘Pick up a piece of rock sulfur’.”

WHAT CURES AN ILLNESS MAY NOT ITSELF BE A HEALTHY THING…
“So they put up a tent, and they burned that – burned pure sulfur in there. It did cure, clear my lungs, but it did damage. That’s what damaged my lungs, and that’s why I have asthma. When I was born I weighed ten and a half pounds. Fourteen months later, after the pneumonia, I weighed nine pounds.

So if you look backwards you’d maybe say, ‘No,’ (that the sulfur fumes were too dangerous, too harsh of a treatment) but if you look forward you say, ‘Yes. If they hadn’t have done it I wouldn’t be here’.”

Even with today’s evolution of medicine, there are still constantly choices where you must weigh doing what might save your life against the possibility that it may also cause other serious damage.

“My parents didn’t tell me about this until I was older, could understand. Then when I would annoy my Grandmother later, she’d say (teasingly), ‘I shouldn’t have put you in that tent, I should have just called Tackaberry the undertaker to come pick you up!’” (Ha)

GETTING OLDER
“Then later on when I got to working, I was always fortunate, always had a good job, a paying job. And then I got married, had a couple of kids… I had money coming out of my ears, in them days. I was a paper-maker, good money, oh yeah.

I started in the (paper) mill in 1944, and got .46 ½ cents an hour. I went up (was promoted) to the paper-making machines in 1948, and I was getting something like $1.75 an hour. That was big money. That was more than my Dad was getting as a millwright. So – prosperity – I didn’t know what to do with money. I never learned it (money handling) at home, Mother and Dad spent money as it came in.

So I got to (spending the money on) abusing myself. Drinking too much. I never smoked, from that day (when he was one year old) when I had the problem with my chest, pneumonia. When I was a kid, nine, ten years old, stealing my Mother’s cigarettes… I tried it, but it would bother me. I couldn’t breathe. So I gave that up.

But I drank beer. I was twenty-six before I started drinking, then I drank beer excessive. I drank a lot, and I over-ate. I weighed 273 pounds at one time (he’s of average height). Now I weigh about 190-195. But that’s what I did, I just abused myself.

Your lungs and your stomach share the same space (in your torso). If your (too-large) stomach pushes up against your lungs, they lose capacity for air. If you can keep your stomach smaller, it’s out of the way of breathing.”

EARLY PROBLEMS CAN BLOOM LATER CONSEQUENCES
“Time went on. In 1973 (at age forty-five), this asthma came on. They started giving me ‘puffers’.”

Puffers, or inhalers, are little cans of aerosol-pressurized medicine, sprayed or ‘puffed’ through your mouth directly into your lungs. They work immediately.

The names of some of the drugs used in them are mentioned in the following paragraphs. Each puffer medicine is a little different. For example: Ventolin is an albuterol sulphate, used for bronchodilation, while Flovent is a corticosteroid, used as an anti-inflammatory. Their different uses are mentioned later.

“When you get a puffer… that’s when you really put on the weight. I can’t tell you why – it’s a medical thing. (A side-effect of the medicine in the puffer) And it wasn’t doing me hardly any good; the Ventolin was just for emergency, you weren’t supposed to take any more than ten puffs a day – and I was taking twenty and it wasn’t doing any good.

So I’d sit there and puff and puff. I’d have to go to the hospital, where they’d give you Benadryl in liquid form, heat it and you’d inhale the steam. When you take that kind of medicine (and that amount)… it bothers your heart. Not for everyone, but for some people.

So I started having high blood pressure – as a side effect of the Benadryl (even though Benadryl was used sparingly), other pills and puffers I was taking, drinking too much, eating too much – everything combined. But I didn’t know (how much his whole lifestyle was endangering his health, his weight). You go to the doctor (back then), he just says to go on a diet. They didn’t know too much about asthma and the side-effects of medications in them days.”

By the SS Sicamous

Beside the sternwheeler S.S. Sicamous.

MORE MEDICINES AND SPECIALISTS
“I was about forty, forty-five years old by then. I knew that my breathing problems were from way back then (the sulfur), along with being self-inflicted from later vices.

And I’d been using the Ventolin, but it gave no help, no control over my breathing. So my doctor sent me to this specialist in Winnipeg. I asked to see him after I saw him on the TV telling the farmers what he could do for asthma, from all that dust blowing around in Manitoba.

So I went and seen him. I told him what kind of job I had… and he jumped out of his seat and says, ‘I’m not signing no paper for Compensation (government benefits)!’ I says, ‘I’m on salary. It pays a lot more than Compensation.’ I says, ‘I read you got something in Sweden.’ He had gone there, came back with something (some process/medication to help people with asthma). Swedish paper mills had a lot of allergies, asthma in their mills.

I don’t know what he said, he told me stuff that didn’t make any sense. And he was a specialist.”

A HANDFUL OF NEW MEDICINES
“So that went on for awhile, then I went to see a doctor who was another specialist, he was the administrator for the respiratory section of the Health Science Centre in Winnipeg. He gave me Serevent, that’s a puffer. When I started that, I’d been taking the first puffer for about ten years. So I tried Serevent for years, then the doctor said, ‘You’re getting worse, your lungs are terrible.’ He said, ‘So I’m going to give you Serevent and I’m going to give you Becloforte… another puffer. And that’s the worst puffer, of all of them, for your heart – they’ve quit making Becloforte these days. (Note: in some countries it’s discontinued, others still carry it)

Then they came out with Flovent, another puffer. It replaced Beclofort. So I took Serevent and Flovent, two puffs of each in the morning and two of each at night. Four years ago they came out with the new puffer, the Advair puffer is Flovent and Serevent combined into one puffer. Two puffs in the morning, two at night. If I miss one time, it’s okay, doesn’t bother me.

All of these drugs are not that good for your heart. This one’s not as bad because you don’t take as much. That Ventolin that I originally started with… in four years I haven’t taken one puff. I don’t even carry any emergency medicine on me any more, for asthma.”

To clarify: puffers for asthma are generally classed into two groups: ‘preventers’ (like Advair, Flovent and Serevent) are taken each day for long-term upkeep, and ‘relievers’ (like Ventolin) are taken during emergency breathing difficulties only.

INSIDE HIS BODY, THINGS ARE QUIETLY GETTING WORSE
“I still was drinking, and abusing myself with so much eating. I had quit drinking around 1984… I was about fifty-five years old. But the eating got worse. I got in bad with eating cholesterol-rich food; I could eat half a pound of bacon, you know? Half a pie. Big plate of potatoes. It was nothing for me to eat T-bone steak for dinner, T-bone steak for supper. Big ones.

After about five years – around 1989 – I started going on a diet, cutting down on my food. It wasn’t as hard to quit drinking as it was to diet. I could drink a case of beer a day – twenty-four bottles of beer – and I quit that (without much difficulty), but I have a hard time with the diet. I was going to the casinos in the ’States, they’ll give you everything you want to eat there.”

AN IGNORED VOICE…
“We spent our winters in Florida, starting around ’92, ’93. I can’t go now since this bypass surgery – can’t get medical insurance (to go to another country). I had a heart specialist there in Sun City Center, and when I was checked in 1996 he told me nothing was wrong. Even though they monitored me all that night, they didn’t see anything.

The nurse tapped me on the shoulder, said, ‘Come outside.’ She told me, ‘You have a heart problem.’ She was between fifty and sixty, so – she had experience. I later said to (his heart specialist in Kenora), ‘A nurse in that Florida hospital told me ‘There’s something wrong with your heart.’ The Kenora specialist said, ‘I wish the nurses would just do their job, and leave the doctors to do their job’.”

ANGIOPLASTY
Angioplasty is the process of inserting a catheter with a balloon at its tip into your blood vessel. When it reaches the clogged or narrow area, the balloon is inflated – sometimes repeatedly – wider and wider to enlarge the vessel. This makes room for the blood to flow past the blockage, and helps push some blockage free. It’s a procedure that’s tried before the more extreme bypass surgery.

“Later that same year (1996) I had an angiogram, and they found something. After you have the angiogram and find out where the blockage is, angioplasty is when they push a long balloon in your clogged vein, then blow the balloon up. That widens the vein. If that doesn’t work, they’ll try inserting a ‘stent’ – like a coil, or a spring – in there.”

A stent is a wire mesh tube, inserted into the vessel to hold it open. Damaged vessels, especially those with plaque build-ups, lose their elasticity, their ability to expand and stay open.

“For my blockage, they put the balloon in starting below the groin, all the way up to my heart… a thirty-nine inch balloon, for me. It didn’t work. Too far, the balloon couldn’t get through to where they wanted it.”

Len by SicamousFINALLY, THE HEART ACTED UP AND MADE ITSELF KNOWN
“In June of 2000 (he was seventy-one years old, then), I was okay. I had high blood pressure, but it had never bothered me. I still weighed 240, still pretty heavy. In August… my heart started to beat like hell. All of a sudden, one night… like this (he thumps his chest hard and fast).

That went on… I let it go on for about three weeks. It was getting so I couldn’t walk even two or three steps without being tired, couldn’t breathe. Pressure, horrible, terrible pressure. It hurts everything. Hurts your breathing. Couldn’t walk, no energy. Was constipated, I couldn’t even grunt (push to go to the bathroom) because it hurt too much. I had to take a laxative just to go to the bathroom, ’cause if I didn’t I’d have that pressure, too.”

BEGINNING TO REALLY INVESTIGATE WHAT’S WRONG
“I had gone to the hospital in Winnipeg to have some tests on my prostate, then have some work done on it. The nurse (after the tests) said, ‘We must have scared you, your heart beat’s up, and your blood pressure’s up.’ I told her my heart’s been beating like that for two, three weeks now. My heart beat was 153 to 170 beats per minute. And it should be around 70 or 80.

We drove back to Kenora later that day, I told my wife I couldn’t drive, I asked her to take me to the hospital there. I went to see the doctor. When I told the emergency doctor how long my rapid heartbeat had gone on for, he asked why I’d let it go on so long before coming in. I said that I’d just come from a doctor (his prostate specialist) who had said everything was okay. And my family doctor had told me my heart was okay.

The emergency doctor sent me to a heart specialist in Kenora… he said everything was okay, said he couldn’t find anything wrong with me. He took an ECG, nothing showed up.”

An ECG – Electrocardiogram – is a ‘picture’ of the electric current, and other movements, generated within the heart muscle during a heartbeat.

“He said to go home, take Nitro if it keeps bothering me. That’s Nitrous Oxide (also known as ‘laughing gas’) – opens your breathing up. He said to take one puff every twenty seconds, and if you need a third puff, go to the hospital. So we tried that. This was a Friday, he said to come in on Tuesday, that they’d give me a stress test (for his heart).

Well, that Tuesday morning I got out of bed, fell on the floor. I couldn’t walk. That was the end of that. Doctor said, ‘No more stress test.’ My heart was still beating fast all this time. I think it was him – or my family doctor – who said that it (rapid heartbeat) could ‘just happen’, sometimes you can’t do anything about it.

We had to go to Winnipeg for a second angiogram. After a week of waiting (in line to have the test) I told the doctor that I just can’t stand the pressure in my chest. He said, ‘You have to wait, have to wait. Or you could go to the ’States to have it done.’ I said, ‘But then I’d have to pay for it.’ (Rather than have it paid for by medical insurance) He said, ‘Well, don’t complain about it, then.’

I asked him to send me to (the heart specialist); he said he didn’t think he would. I walked out the door of his clinic, got into the car, said to my wife, ‘Take me to the hospital’.”

GOING TO EMERGENCY; IT’S (FINALLY) TREATED AS SERIOUS
“They put me in a wheelchair right away, took me in. That was, again, on a Friday. On Saturday, they rushed me to the hospital in Winnipeg by ambulance. My daughters met me there, they live in Winnipeg. The doctor there said to them right away, ‘Your Dad won’t be going home.’

They took me to the bed and said, ‘Don’t move.’ My heart’s pounding and pounding. I told my kids, ‘I’m gonna die, I don’t want to live like this.’ Heart was beating…. when your heart beats that fast – you’ve held a water hose and seen water and air splatter out (when under high pressure) like that? That’s what happens in your heart, when you get a blood clot. (The heart beats faster and faster, trying to force blood past the blockage)

We went to the Catholic hospital in Winnipeg. I’m not Catholic, but that’s where they would do the operation. It was a cancer hospital, and was also for hearts. There was a nun’s residence close by, people could stay there, really nice. A room cost $25 a day, and $5 for each meal. Really good prices.

My wife stayed there, it was a short walk to the hospital. They had alarms there, very safe, she was safe there. In the daytime she would be at the hospital with me.”

ANGIOGRAM: NOT AS AMIABLE AS IT SOUNDS
An angiogram is, simplified, an x-ray picture of all your blood vessels – arteries and veins. A water-soluble substance containing iodine is injected into your blood – sometimes injected under great pressure if your vessels are shrunken or blocked.

The iodine makes the blood show up in the picture as a dark shadow, so all your vessels look like a black ‘road map’ set against a grey background. It shows where the flow is blocked, pinched, expanded, or leaking.

An angiogram is needed before the operation, in order to find out where vessels are plugged and in need of a by-pass. Of the accounts I read, it’s very rare for them to be as painful as the one Len talks about here. Remember that his first angiogram wasn’t like this.

“I’d had an angiogram years ago and it was okay. This time when they did it, they had the intravenous in me in case something happens, they have oxygen there for you because you can die having an angiogram, the same as you can while having a bypass or a heart attack.

They put coloring in the blood, and then put pressure on the blood flow… to find out where it’s blocked, where it’s leaking through. They pushed that in there (the iodine solution through the catheter tube)… I broke out in a sweat. (The iodine makes you feel warm)

I remember I was swearing, hollering, ‘For Christ’s sakes, stop it, stop it, you’re killing me!’ I just screamed and screamed. They said, ‘A couple more minutes, couple more minutes…’ I’ve never had pain like that, ever. It seemed like… I don’t know how long it seemed like.

They found where the plug was, showed me where the veins were plugged. That’s when the doctor told me, ‘You’re not going home, we have to operate’.”

PREPARING…
“On Thursday night I told my wife… ‘Well, this is it. I’ll either see you tomorrow, or I won’t.’ But I had to have it done. Couldn’t walk, pain, I couldn’t live like that.

The girls (his daughters from his previous marriage – he and his present wife of thirty-two years have no children together) didn’t know the exact day it was going to be done… I didn’t want to tell them. I told them maybe Monday, Tuesday of next week. I knew it was this Friday, but I didn’t tell them. Told Nellie not to tell them.”

ZOOOM: YOU’RE IN FOR BYPASS SURGERY
“Friday morning again, on a Friday they took me in to operate. Never told me nothing, didn’t say what time it was coming, zooom, took me at seven in the morning.

At six o’clock at night I came through, ten and a half hours on the operating table. Ten and a half hours. The doctor came in to see me the next day and said, ‘There’s a guy still waiting for me to operate on him, I do two a day.’ They have teams of five or six doctors and nurses for each operation. That team could only do one that day… I took the whole day.

The doctors had told my wife it would be from four and a half to five hours. My wife was waiting, on pins and needles, for an extra five hours. Couldn’t contact the doctor, he had told her beforehand, ‘We’ll contact you.’ Nellie phoned the girls up, said, ‘I haven’t heard from your Dad yet.’ So they thought… for the worst… when you’re there that long, ’cause I should’ve been in and out by then.

The girls came from work.”

Len on benchTHE SURGERY
“They cut a hole in your neck to (insert tubes from a machine that will) re-circulate your blood. The blood goes through a purifying process. I don’t know if they stop your heart or not, but they don’t use it. During that operation, the machine has to pump your blood.”

A heart-lung machine provides blood-pumping while the heart is repaired. The heart is stopped – though doesn’t need to be in every patient – with a drug.

(He showed me a long scar up his leg, starting at the ankle and going up to his groin) “They cut all the way up here, to get veins for the bypass. And down this side to my knee. (More scars on the other leg) They had nothing to work with.”

That is, they need to ‘steal’ substantial, strong vessels – the Saphenous veins in the leg are usually used – from other parts of the body to use as vessels that bypass the plugged or damaged coronary arteries (or other vessels)… and the vessels elsewhere in his body weren’t that adequate either.

Double, triple, and quadruple refer to how many damaged vessels need to have substitutes grafted to replace them.

“I was supposed to have triple bypass, and all they could give me was double – my (leg and other substitute) veins were too small.

They do take veins from out of your arms, they claim they’re better – because most people’s forearms (and therefore the vessels) are stronger, from working all the time at manual labor. The reason they usually don’t is because it leaves a more visible scar, people don’t like that forearm scar.

They jack your rib cage open (spread your ribs apart at the sternum to access your chest cavity). Nowadays, I hear they can just split a small part of your ribs, get to the blockage from there. You can see it’s bent in here, a little crooked (he showed me his sternum). Later (long after the surgery), they said they could fix that. I said, ‘You’re not touching nothing.’ They’ve got it wired together in two places. The wire stays there forever.

See those three holes (scars) in my stomach? – those are where the draining tubes were, for about four days afterwards, to drain any poisons, bleeding, from inside. Then on each side of those, there are two more little holes – they had wires in them (wires sticking out of his abdomen); if something went wrong during the operation, they could hook a pacemaker to them. The wires were screwed through there right into my heart – just like wood screws. After the operation they twist them right out.

It’s amazing what they can do.”

ALL THAT… AND IT DIDN’T FIX THE HEARTBEAT?
“After about three days in the recovery ward I said to the nurse, ‘Look at that thing up there (a machine that monitors his heart and vital signs was showing that his heart was still beating very fast)… I want this thing (his heart) fixed!’

I called the nurses all the time, but they couldn’t do anything – I had to finally talk to the doctors through a Public Relations person. She gave the order. That afternoon the doctor came in with a great big machine with two huge pads, and said, ‘We’re gonna do this to you in the morning.’ I said, ‘What are you going to do?’ He said, ‘We’re gonna put that (the pads) on there (his heart) and stop your heart.’

He said it would start back up again. Right away, by itself. I asked if it’s ever happened where it doesn’t start up again? He said no… but I thought to myself, ‘… I could be the first….’

The next morning they put me to sleep. Nellie had to step out of the room while they did it. My daughters were there, too. They put the jumpers (the electric pads) on my chest… and it’s been okay ever since.”

RECOVERY… AND THOSE WACKY NURSES
“I was in my own recovery room for about seven days total. Then the nurse came to me and said, ‘You’re going down there, and the honeymoon is over! You want anything done, you do it yourself.’ Then they moved me down to a semi-private ward shared with a few other patients. I had a hard time even to wash. That first day there (this was about three days after the ‘heart stopping’ procedure) I could only walk about here to there, about 25 yards.

The nurse says, ‘Come with me.’ She says, ‘I want you to climb those stairs.’ I climb them to the top, puffing. She said, ‘You know why I got you to do this? – When you go home, I don’t want you to do this – you’re not supposed to climb stairs.’

In Manitoba, after you have a bypass, you have to by law turn in your driver’s license. (For safety of both the driver and others – effects of the surgery and medications can make driving dangerous if side effects suddenly arise) Three months later you can get tested, get it back.

When I went back to Kenora my doctor said I didn’t have to (give up his license legally), it’s discretionary, between the doctor and the patient. He said, ‘I’m just telling you not to drive for thirty days.’ I said, ‘I’m gonna tell my wife it’s three months – it’ll give me a rest’.” (Ha)

UPKEEP
“I take Aspirin, those two puffers, another drug that keeps your heart, your pulse steady. I take a cholesterol pill, high blood pressure pill, and also a thyroid pill.

I get up every morning at six for that pill that regulates my pulse. I don’t have any electronics in me, no pacemaker. If that pill doesn’t do it for me, they’ll put in a pacemaker. My chest doesn’t feel tight at all, now. It’s completely normal.

Exercising, walking around doesn’t bother me. If I exercise to extremes it cuts my breath down. If I rest, it goes away; that’s sometimes an indication that it’s your heart. If the breathing difficulty doesn’t go away, it could be the asthma. That’s what my body tells me.”

A CHAMPION GIVEN HER DUE
“In December of 2000, three months after this operation, I had to see that specialist in Kenora again. He checked, asked if everything was okay. I said yes. I asked if I had to come back and see him again for anything, he said no.

I said, ‘I want to say one thing to you, if you don’t mind; hope you don’t get mad. Remember two years ago, I said a nurse told me there’s something wrong with my heart? – I think she was smarter than some doctors.’

He was writing in his pad… he never lifted his head.”

LIFE NOW
“From there to there (looking at his leg scars), it’s still sore. From the scar tissue.

So… that’s better than nothing.”

You’re alive.

“Yup. So far. Going on four years in September, since the operation.

When I passed seventy-five, I remember thinking back – when my Dad hit seventy-five I thought (as a younger man), ‘I don’t want to live that long’. Emphysema killed both my Mother and Dad. From smoking.

Now… I walk at least twice a day. One hour and forty minutes for the longer one. No use in getting mad, getting excited anymore… ’cause maybe I shouldn’t even have been alive.”

Len Smiling

Len

THE SIMPLEST, CLEAREST WISDOM…
“I think, when I look back on my life – if we could only teach some of these teenagers: if you don’t look after yourself… there’s a payback down the road. I abused myself … then I got what I deserved.”

Or perhaps: it’s not a ‘blame’ or ‘deserve’ thing… just cause and effect in all its simplicity, inevitability, and power.

…SAID WITH CLEAREST ELOQUENCE:
“You don’t eat the right foods, overindulge in something, drink too much… it’s going to….”

Len
75

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