A Celtic Cardiac Journey

Teamwork makes long trek from cath lab to bypass surgery to recovery successful.

Retired life insurance attorney John States has always taken a great deal of pride in his Scottish and Irish ancestry. John is so proud of his heritage, in fact, that he has spent years mastering one of the true staples of the Celtic culture – the bagpipes.

Thanks to everyone at Manatee Memorial Hospital, bagpipe player John States had a successful journey from the cath lab to bypass surgery and beyond.

John (right) fulfilled his promise to pipe Amazing Grace for Dr. Nguyen.

“I first picked them up back in the 1980s,” John relates. “A friend of mine started taking bagpipe lessons, and when I saw how much fun he was having with it, I decided I would give it a try, too. I can’t say I’ve been playing them ever since, though.

“I played for about nine years and got pretty good at it, but then there was another nine-year period there where I got away from it. Family responsibilities and things like that got in the way. But about nine years ago, I picked them back up again.”

In the nine years since, playing the bagpipes has become John’s favorite hobby. It has also become a bit of a vocation for the now 81-year-old, who regularly throws on his kilt, Jacobite shirt and sporran and performs at fairs, festivals and local pubs.

“That’s what old people do,” John says with a laugh. “But seriously, we have a lot of fun with it, my wife and I. She plays the bass drum and I play the pipes, and we stay pretty busy with it. Over St. Patrick’s Day weekend this year, we had three performances.”

Were it not for the care he received at Manatee Memorial Hospital a few months earlier, John might not have been able to play those holiday gigs. After all, it was the hospital’s cardiac team that helped put the wind back in his pipes.

“I felt for a while as if I’d lost some of my energy,” John relates. “I just wasn’t feeling quite as spry as I usually do. Then, after I turned eighty in January of 2017, I felt it a lot more. I also noticed that if I bent over, when I stood back up, I was a bit out of breath.”

John’s steady decrease in energy and sudden shortness of breath prompted a trip to his general practitioner, who promptly referred John to James Nguyen, MD, a board-certified cardiologist at Bradenton Cardiology.

Test Pattern

“When John first came to me, he didn’t think much was going on,” remembers Dr. Nguyen, who is part of the Structural Heart Team at Manatee Memorial Hospital. “But then he told me about playing the bagpipes and how it had become a bit difficult for him.

“He said, When I start playing, I get really short of breath, and I start getting these chest pains. The moment he said that, I started thinking to myself, There might be something wrong with his heart, so I ordered a stress test for him.”

A stress test is a cardiological exam designed to measure the heart’s response to external stress during periods of exercise. There are several different types of stress tests, with the most common being the treadmill test.

During a treadmill test, the patient walks on an inclined treadmill at a brisk pace while he or she is hooked up to an electrocardiogram that tracks the patient’s heart rate.

For patients who are unable to exercise, doctors can perform an adenosine stress test in which the flow of blood to the heart is monitored before and after the patient is given a drug that makes the heart work and react as if the patient were exercising.

Finally, there is the nuclear scan. In this test, the patient is injected with a radioactive dye that is recognized by a sensor that creates an image that can be seen by a camera. The camera’s images show which areas of the heart are not receiving proper blood flow.

To determine the cause of John’s symptoms, Dr. Nguyen first had John walk on a treadmill. Then, after John’s heart rate rose to a specified target rate, Dr. Nguyen performed a nuclear scan, which produced images showing two defects.

To determine the extent of the defects, Dr. Nguyen ordered John to return for treatment in the cardiac catheterization laboratory, or cath lab, where cardiologists perform minimally invasive cardiac procedures.

Procedures performed in the cath lab include the use of special equipment so the doctor is able to see the arteries and monitor the flow of blood through them in real time. This allows the doctor to determine the true nature of any potential problem.

“When a doctor performs a cardiac catheterization, he is advancing a catheter straight into the arteries, where he can then take pictures of both the left and right coronary arteries to see what, if any, problems might exist,” Dr. Nguyen explains.

“There are two ways to access the heart in this way – through either the groin or the wrist. For all my patients, I go through the wrist instead of the groin because it allows for a quicker recovery time from the procedure.

“By going through the wrist, the patient can get up and walk as soon as the procedure is done. If you go through the groin and then through the leg to reach the heart, the patient must lie in bed for up to six hours without moving to recover.

“There can also be some bleeding complications when you run the catheter through the groin, so I run the catheter through the radial artery in the forearm, and when I brought that into John’s heart and took a look, I said, I think I found your problem.”

What Dr. Nguyen discovered was “significant blockages” in two of the three arteries leading to John’s heart. Such blockages can sometimes be repaired during the same procedure by putting stents into the arteries, but Dr. Nguyen determined that would not work for John.

“If we find either triple-vessel disease or a significant blockage, that’s a surgical indication that the patient needs bypass surgery,” Dr. Nguyen states. “In John’s case, he had significant left and right main disease, so I admitted him to the hospital right then and there.”

Tag Team

It was at this stage in the process that Dr. Nguyen handed John’s case off to Alessandro Golino, MD, a University of Naples, Italy-trained cardiothoracic surgery specialist who was named chief of staff at Manatee Memorial Hospital in 2013.

Dr. Golino, who has been practicing for more than 30 years, begins his work with a review of the images produced during the cardiac catheterization and a consultation with the patient. He then determines whether the patient is fit enough for bypass surgery.

If a patient is deemed to be unfit for surgery, a cardiothoracic surgeon such as Dr. Golino can defer to an internist such as Dr. Nguyen, and stents can be put in. John, however, was deemed fit for surgery. His surgery did not go off as initially planned, however.

“I first met with Dr. Golino on a Friday, and my surgery was scheduled for the following Tuesday,” John recounts. “But that was the weekend that Hurricane Irma came along, and so on Friday, the hospital decided to evacuate all its patients and shut the whole thing down.

“I was actually sent home because they felt I was stabilized. My wife and I packed up the following morning and headed north to escape the hurricane. We came back a couple days later and the house was fine, but the yard was completely covered with litter from our trees.

“It was after we returned that I got a chance to go back and see Dr. Golino in his office. He went over the entire procedure with me and my wife, showing us on an electronic chart exactly where the blockages were and what he needed to do to bypass those blockages.”

A Calming Influence

John wound up having his bypass surgery ten days after Hurricane Irma tore through Florida, on September 20. Prior to entering the operating room, however, Dr. Golino and his entire surgical team introduced themselves to John’s wife, Mary, and explained the surgery they were about to perform in detail.

“They all came up to me and introduced themselves, and each one explained what their role would be in the procedure,” Mary remembers. “That was impressive and informative, and for me to know exactly who was doing what and what was going on, it helped put me at ease a little bit. I appreciated that a lot.”

That brief discussion helped to put John at ease as well.

“Dr. Golino’s team told my wife everything that was going on, and they were very nice,” John relates. “And they helped to calm me, too. I can’t say I was scared going into the surgery, but I was certainly concerned, and by explaining everything to me the way they did, they helped me remain as calm as I could be.”

Though he has performed hundreds of invasive heart surgeries, Dr. Golino says he still considers it imperative that he and his team put the patient and his or her family at ease prior to the operation because these procedures are anything but routine for the patient and the patient’s family.

“Typically, the patient is very concerned about having to undergo open heart surgery,” Dr. Golino explains. “It’s a major event for them, and it can be very traumatic on the body. We make it our job to make sure the patient and his or her family understand the surgery is very doable and that it’s done a lot and with good outcomes.”

Three in One

During what proved to be a three-hour operation on John, Dr. Golino performed two slightly different procedures to bypass the blockages. During the first, he removed a piece of the saphenous vein from John’s right leg and grafted it to the right coronary artery to create a bypass around the blockage there.

Thanks to everyone at Manatee Memorial Hospital, bagpipe player John States had a successful journey from the cath lab to bypass surgery and beyond.

John States

He then performed what is known clinically as a LIMA to LAD bypass to open up the left coronary artery. During a LIMA to LAD procedure, the left internal mammary artery, or LIMA, is grafted to the left anterior descending artery, or LAD. This procedure is considered the gold standard in surgical revascularization.

Dr. Golino did not stop there, however. While performing the two bypass procedures, he also detected an irregularity in John’s heartbeat. To prevent the irregularity from recurring, Dr. Golino performed a third procedure – an atrial fibrillation ablation – which neutralizes the tissue in the heart that sparks the faulty electrical impulses that cause the arrhythmia.

“An atrial fibrillation can be the start of a vicious cycle,” Dr. Golino explains. “If it’s not corrected, it can lead to further complications such as the patient feeling weaker, and in some cases, they can become dizzy. That can lead to a stroke. So, we took care of that problem as well, and John came out of the surgery just fine.”

John spent the first five days of his recovery period at Manatee Memorial Hospital. During that time, he began his rehabilitation regimen, which consisted of some light exercise. He was prohibited, however, from lifting anything more than ten pounds or doing anything that required him to raise his arms over his head.

John continued the exercise regimen for another week after he returned home. Just before he was scheduled to see Dr. Nguyen for his first follow-up visit, he suffered a gallbladder attack. That resulted in yet another operation, this one to remove the gallbladder, and another stay at Manatee Memorial Hospital, this one lasting nine days.

The gallbladder issue further robbed John of some of his strength, so his recovery from the bypass surgeries was slowed somewhat, but John is now back to his normal lifestyle with no notable restrictions. He is also back playing his bagpipes, which recently included honoring a special request from Dr. Nguyen.

“When John first came to see me and told me about playing the bagpipes, I was very intrigued,” Dr. Nguyen explains. “I told him at the time that we were going to fix this problem of his and make it better, and when I told him that, I also asked him if he would come back when we were all done and playAmazing Grace’ for me on his bagpipes.

“He looked at me and he said, Doc, if you fix me, I’ll play whatever song you want me to play on the bagpipes. And he honored that request. He came in here for a follow-up visit on February 23, and he brought his bagpipes. He had on the whole outfit and everything, and he played ‘Amazing Grace’ for us. That was a great moment.”

As great as it was for Dr. Nguyen and his staff, it was even better for John.

“It was a pleasure and an honor to play for Dr. Nguyen,” John states. “I truly could not have been more pleased with him and Dr. Golino and everyone at Manatee Memorial Hospital. Everyone was just exceptional, even during my stay for the gallbladder surgery.

“The doctors answered every question we had and always made us feel very comfortable with everything that was happening, and the hospital personnel were all so nice and helpful. Whether it was the day-shift nurse or the night-shift nurse, they were all so kind and empathetic. They were always there whenever I needed them.

“I had a pretty rough couple of months there, but the doctors and staff at Manatee Memorial Hospital made it a lot easier for me. Everyone was just great. I could not have asked for better care.”

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