Cardiac surgery and CPAP

[tvmangum]

I am going to have cardiac surgery as early as April or as late as 2-3 years--depending on the progression of my valve.

I'm trying to get my "ducks in a row" and was wondering what I need to do about my SA when they put me under. All my docs at Duke know about my SA and I will have a special gas passer and other docs since it is a congenital defect they are going to fix.

What special concerns should I have regarding my SA and CPAP while in surgery and afterwards in the hospital? I know this is probably jumping the gun but we say April now but something could happen between now and April that would change the schedule.

TIA for you help.

[PST]

Duke has one of the best cardiac surgery departments anywhere, so you will be in great hands. Anesthesiologists have the responsibility during and immediately after surgery for keeping all the body systems working while the surgeons look after the repairs. Anesthesiologists have done a terrific job in the last 15 years of improving their patient safety record. Part of it is technology. The days are long gone when the anesthesiologist would keep an eye on blood oxygenation by asking the surgeon whether the the blood looked nice and red. Everything is electronically monitored now. In addition anesthesiologists have been leaders in formulating standards that reduce surgical risk. A generation ago, when explaining the risk of surgery, surgeons would talk about anesthesia risk as if there were some irreducible small percentage of deaths that could not be avoided. That's attitude is likewise long gone. One indication of the change is the way that medical malpractice premiums for anesthesiologists have fallen in comparison to those of other specialists. Anesthesiologists at a place like Duke are going to recognize and know how to deal with OSA in ways that go well beyond making sure you have access to CPAP. For example, the same factors that cause OSA can make someone difficult to intubate, so knowing of OSA doctors can follow a difficult intubation protocol, delay extubation in order to reduce the chance of having to re-intubate quickly, and monitor longer during post-anesthesia care. At a place like Duke, I would feel completely comfortable doing what the doctors tell me, as long as I had made sure they knew about my OSA. The big issues today are how to recognize undiagnosed cases of OSA, which are thought to greatly outnumber diagnosed cases, and making sure that same-day procedures done outside the hospital setting are getting the same attention as major surgical cases.

[sthnreb]

I believe your surgery to be more complex than mine was and more lengthy, but I took my Bipap machine with me. I had and ICD Teligen implant 9-15-09. That's a Implantable Cardioverter Defibrillator. I'm on the Latitude system now that monitors the implant. I was hospitalized prior to that and used my Bipap in Saint Joseph's Hospital in Dunwoody Georgia. During surgery, I didn't have the machine. You can take yours just in case. Normally they would be giving you oxygen and monitoring you continuously anyway with/without it. They probably don't mind if you snore some. Let your doctor decide.

[midnightdweary]

Amazing! It is a wonderful testimony to the marvels of modern medicine that they have the high tech ability to implant cardioverter defibrillators. Thank you for sharing with us the details of such a wonderful piece of news of how you are being treated.

I am waiting for the good news, soon to be delivered I hope, that the same kind of high tech will produce the same success for OSA. Frankly, it seems to me that, speaking relatively, the complexities of the cardio system is more of a challenge than that of the hypoglassal nerve. Yet, companies such as Imtherma and Inspire II say that it will be some time before those of us with OSA will have access to an implantable device. Just curious why it is taking so long.

Best wishes, and keep us informed, TvMagnum, on how things are going.
Yes, Duke is a wonderful place. I had to take my then 2-year old daughter there once for special treatment.
I will be forever grateful to them.
Jay

[sthnreb]

I believe I read they do have an implant similar to what I have for OSA....I think I would prefer the bipap though. I will see if I can find the info.

[sthnreb]

http://stanford.wellsphere.com/healthca ... ems/617493

There you go.

[PST]

That implant looks awesome! I don't think I want to be in the initial test group, but it might be time to sell ResMed stock.

[cpapmask]

I had a 3 level cervical fusion 7 weeks ago. I had a spinal cord stimulator implant Aug. 2008. I had no issues with my OSA during the 2008 surgrey. The surgrey 7 weeks ago I had some issues, they moved me from the surgrey room into the recovery room, They had all kinds of issues trying to wake me up from the surgrey. They had it in my files that I had sleep apnea, my daughter walked into the recovery room and while there informed them that I had OSA, they wanted my cpap machine when she mentioned it. My wife went to the car and brought it in for the nurses at that time. They put my mask on me while still intubed and i woke up 15 minutes later. They had been trying to get me awake for 6 hours in recovery, so anesthesia does effect me now, so make sure somone knows and has access to your cpap machine. My wife never gave my OSA any thought when I did not wake up, but my daughter did as she is a RN. So make them all aware of your OSA.

[Goofproof]

Amazing! It is a wonderful testimony to the marvels of modern medicine that they have the high tech ability to implant cardioverter defibrillators. Thank you for sharing with us the details of such a wonderful piece of news of how you are being treated.

I am waiting for the good news, soon to be delivered I hope, that the same kind of high tech will produce the same success for OSA. Frankly, it seems to me that, speaking relatively, the complexities of the cardio system is more of a challenge than that of the hypoglassal nerve. Yet, companies such as Imtherma and Inspire II say that it will be some time before those of us with OSA will have access to an implantable device. Just curious why it is taking so long.

Best wishes, and keep us informed, TvMagnum, on how things are going.
Yes, Duke is a wonderful place. I had to take my then 2-year old daughter there once for special treatment.
I will be forever grateful to them.
Jay

AMAZING, Not quite, I had a defibrillators put in in 2006, If they work they only have a 30% chance of restarting a heart, Very poor odd's if you ask me. They added to my grief by installing mine with know defective leads. Leads that they can't replace safely due to scar tissue binding to them. Mine has never fired, that's the good thing, it appears to be unable to fire, and that would be the best option. Meanwhile, I carry this time bomb in my chest hoping it will never work, and the Doctors collect their fees every three month until I die. AMAZING, I think not!!!! Failure for the leads avgs 18 months, I almost to 24 months, many were killed by their units by 18 months.
Happy Camper, Not! Jim

[sthnreb]

Dang, what kind do you have? Mine is Boston Scientific Teligen with Guidiant leads. I think BS bought out Guidiant. Hope I don't have bad leads or ICD. The media I read says there is a 95% survival rate with them. A friend has one, for 2 years now and it did save his life. He had a heart attack and it knocked him down with the shock. It did break his ankle but saved his life. His is Biotronic. My doctor said with congestive heart failure and a low ejection fraction, the average survival rate is about 5 years. He said having a bad electrical system if you do have a heart attack you would die within a few minutes unless shocked back into rhythm. So, do you get one to increase the odds or not? Seems yours didn't help. If the leads are bad and the ICD doesn't work, why not have them remove it? I would, I don't care for the alien anyway. I don't understand a doctor putting in leads knowing they were bad. I assume you don't see that doctor anymore. You say yours is unable to fire, don't they check it at the doctors office? Mine is checked for battery life every Monday and at the doctors office they go through a series of tests speeding up my heart rate to be sure it is functioning properly. It does a cardiogram too, all wirelessly. Sorry to hear you have such problems with yours Jim. It's something for me to think about.

[PST]

Dang, what kind do you have? Mine is Boston Scientific Teligen with Guidiant leads.

I feel sure that Goofproof is talking about Medtronics Sprint Fidelis leads. Their use was discontinued in October 2007, so there is no need to worry that they were used in any any recent procedure. There is controversy over how great the danger is.

[sthnreb]

I'm glad I don't have those then. It sure seems unlawful for a medical professional to put in "known" defective leads. The defibrillator itself can be remove leaving the wires if he feels it is a hazard rather than help. What is the danger? That they just don't conduct the electrical transmission or do they deteiorate and fail? My doctor said when the ICD is replaced for battery wear out, it is seldom the wires have to be replaced, meaning adding new ones. So, he could have new wires added and another ICD but probably to gun shy now for that. Seems the manufacturers should be responsible for replacement. I hope mine is not recalled!

[Goofproof]

I'm glad I don't have those then. It sure seems unlawful for a medical professional to put in "known" defective leads. The defibrillator itself can be remove leaving the wires if he feels it is a hazard rather than help. What is the danger? That they just don't conduct the electrical transmission or do they deteiorate and fail? My doctor said when the ICD is replaced for battery wear out, it is seldom the wires have to be replaced, meaning adding new ones. So, he could have new wires added and another ICD but probably to gun shy now for that. Seems the manufacturers should be responsible for replacement. I hope mine is not recalled!

Mine was implanted on 09-21-2006

It is a Medtronics EnTrust Defibrillator, Model# D154VRCID
The leads are Medtronics Sprint Fidelis leads, Model# 6948651D

If they failed to turn on that would be a small problem, when they fail and tell the unit you have died and turn on to try to restart your heart, and nothing is wrong, big problem. It can jump start you with up to 750 volts, ten times what they use with the paddles. This can go on for up to 20 minutes or until the battery fails. If your heart is operating normal, it kills you in a very painful way. As for as recall, when it kills you, you don't need the recall, the wire can't be safely removed and is just one more thing to clog up the blood flow.

The Doctor who put mine in, (a painless local novicane install, HA! HA!), my Doctor didn't use enough Novicane or wait for it to deaden the area. I can take pain, but when he burnt the bleeders, with something like a soldering gun, without the Novicane working, he exceeded my high limits, The nurse had me hold her hand so she could tell how I was doing, after the first attack with the soldering iron, she let go. I was tied down, he had eventally done this job before. If I hadn't been tied he would have never got to the second burn. When they wheeled me to the room the nurse said she was sorry and had never seen anything like that.

The reason I don't think the unit works, before hospital discharge, they send in a Medtronics employ with a computer to check the function. He tells me this will hurt, so I figure he's going to cycle the defib. He does, I feel nothing, he gets a deer in the headlights look on his face, the Doctor comes into the room, they talk in the corner, and he puts the machine thru its paces again they stare at the screen and then at each other (Look out for Deer), then the doctor says that's good, and leaves the room. I go home.

I have this nice Medtronics Carelink Transmitter, so I can phone in from the implant data every 6 months, in between I see the doctor for the same with the Medtronic tech and their computer. Do I trust anything they say or do, NO, they are probably lying through their teeth.

I go to the same Doctor because no doctor in their right mind would take over my treatment this Quack put in me. When It comes time something has to be done, they will have to find another Quack to do it, because I'm Quacked out.

You may think I'm nuts, but these are the facts on the treatment I got. Bill over $140,000 for the defib install and still climbing 4 office visits a year, for the defib. Jim

[sthnreb]

That is really a gruesome tale Jim. Sorry you had so much trouble and actually still having trouble. Did the Doctor recommend it for congestive heart failure? I believe under your circumstances I would have the thing removed and take my chances without it. My ejection fraction was at 25%

Mine is Boston Scientific Teligen E110 implanted 9-15-09 with Guidiant leads

I went to Saint Joseph's Hospital in Atlanta which is a known heart facility. And yes, they did strap my hands down as they did yours. I assume that is to keep you from moving them up during the surgery. I felt the doctor injecting the shots to deaden the area. They actually cover you with a tent and just raise one edge so you can see out. I felt a slight sting and asked if he were cutting the area and he said yes and asked if I felt it. He asked a couple of more times and I did fell it again once. I felt dabbing and asked if it were bleeding and he said yes. At that time, I kind of went out as they were giving me anesthesia. He said they had to stop the heart to insert the leads and I assume that was what they were doing. When I woke up I could feel him pressing hard on my chest along with scrapping noise. I guess when it was installed it was tested because I felt a few buzzes. I was kind of in and out then until it was time to leave the OR. He said all went well and I was released that evening. It was an outpatient surgery. I went to his office the following week and a Boston Scientific Tech was there and checked it again, it is wireless, no loop required. I set and watched my cardiogram on her portable computer and she increased my heart beat three different levels and said all was fine. I assume they did other tests also. As the heart rate was increased she said I may feel a flushing on the last one and I did slightly. Controlling the heart beat she did say I better be nice to her jokingly. I have the Latitude system which calls in every week after reading the data and interogating me, asking questions I have to respond to. I'm still new at this as mine has only been in about 2 months. That's why what you stated was disturbing. You are definately not nuts, you just got bad treatment and have a bad doctor. I'll go back in December to my doctor and I guess I will find out then if it has delivered any therapy shocks. It can deliver minor shocks to regulate an irregular heartbeat too which are probably not felt.
My battery is good for 8 years if not used and has to be replaced. The usage determines the battery life. I guess you plan to wait out the battery life and have it removed or have new wires? If it is a walking death trap, I might do something sooner. At least have it removed. I don't know how much my surgery was as my private insurance covered it. It will expire in December when Medicare will kick in. I think the Doctors bill was about $12,000. Keep us informed.

[Goofproof]

That is really a gruesome tale Jim. Sorry you had so much trouble and actually still having trouble. Did the Doctor recommend it for congestive heart failure? I believe under your circumstances I would have the thing removed and take my chances without it. My ejection fraction was at 25%

Mine is Boston Scientific Teligen E110 implanted 9-15-09 with Guidiant leads

I went to Saint Joseph's Hospital in Atlanta which is a known heart facility. And yes, they did strap my hands down as they did yours. I assume that is to keep you from moving them up during the surgery. I felt the doctor injecting the shots to deaden the area. They actually cover you with a tent and just raise one edge so you can see out. I felt a slight sting and asked if he were cutting the area and he said yes and asked if I felt it. He asked a couple of more times and I did fell it again once. I felt dabbing and asked if it were bleeding and he said yes. At that time, I kind of went out as they were giving me anesthesia. He said they had to stop the heart to insert the leads and I assume that was what they were doing. When I woke up I could feel him pressing hard on my chest along with scrapping noise. I guess when it was installed it was tested because I felt a few buzzes. I was kind of in and out then until it was time to leave the OR. He said all went well and I was released that evening. It was an outpatient surgery. I went to his office the following week and a Boston Scientific Tech was there and checked it again, it is wireless, no loop required. I set and watched my cardiogram on her portable computer and she increased my heart beat three different levels and said all was fine. I assume they did other tests also. As the heart rate was increased she said I may feel a flushing on the last one and I did slightly. Controlling the heart beat she did say I better be nice to her jokingly. I have the Latitude system which calls in every week after reading the data and interogating me, asking questions I have to respond to. I'm still new at this as mine has only been in about 2 months. That's why what you stated was disturbing. You are definately not nuts, you just got bad treatment and have a bad doctor. I'll go back in December to my doctor and I guess I will find out then if it has delivered any therapy shocks. It can deliver minor shocks to regulate an irregular heartbeat too which are probably not felt.
My battery is good for 8 years if not used and has to be replaced. The usage determines the battery life. I guess you plan to wait out the battery life and have it removed or have new wires? If it is a walking death trap, I might do something sooner. At least have it removed. I don't know how much my surgery was as my private insurance covered it. It will expire in December when Medicare will kick in. I think the Doctors bill was about $12,000. Keep us informed.

One year before I had the Defib, I had two Stents put in, they sent me home for a month to see if I would get strong enough for surgery. Then I went in for a Quad-By Pass, I don't know about ejection fraction was at 25%, but they said I had 1/4 normal heart function. (I guess it doesn't pay to wait three days after you have a heart attack to go to the E.R.) They did say if I had waited 4 more hours, it wouldn't have been necessary. I felt no pain from the attack, probably from the type II diabetes. It may have been the second attack, At work 15 years earlier I had a pain that knocked me down at 0 degrees F, working outside alone in the snow, I laid down in the snow for 15 minutes, then made my way to the shop building, and finished all my hot drinks. I was lucky I wasn't climbing or on top of the trucks I was working on, anyway I went back to working as usual. I was a lot tougher in those days. My unit doesn't pace unless it has to after a shock. My install was a lot like yours but you got the novicane, I got the distilled water. My head was totally covered and I had my cpap on, with O2. They said mine started to react but my heart rate corrected on it's on before the unit fired, when it sees a problem it starts at low power and keeps increasing until it sees the rate return to normal. Jim

If you need a pacemaker, you have no choice, but a defib, what I know now it's a no brainer.