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Coronary bypass

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RosieE

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Type 1
Hi, has anyone had a coronary bypass operation? It has been offered to me but after 57 years of type 1 diabetes I am a bit concerned about healing and potentially infection.
 
Hi @RosieE
I cant offer any advice/experince about the procedure Im afraid. I can understand you’re concerns about post operative recovery. You should be very closely monitored following the procedure and your cardiologist and diabetes consultant in close contact both prior to and post surgery.
Having bgl as close to target as possible before the operation should help the recovery too and surgeons are not keen to operate if levels too high unless it’s an urgent procedure as they are as concerned about your recovery as you.
Have either doctors offered you any reassurance?
 
Well - you know when you have the odd minor injury, like small scratches from gardening or anything like that - do you heal OK?
 
LucyDUK said:
Hi @RosieE
I cant offer any advice/experince about the procedure Im afraid. I can understand you’re concerns about post operative recovery. You should be very closely monitored following the procedure and your cardiologist and diabetes consultant in close contact both prior to and post surgery.
Having bgl as close to target as possible before the operation should help the recovery too and surgeons are not keen to operate if levels too high unless it’s an urgent procedure as they are as concerned about your recovery as you.
Have either doctors offered you any reassurance?
Click to expand...
Thank you Lucy. Yes both have. The surgeon has said the risk is only 2% risk during op but the healing part is a bit unknown. And I am not sure if that 2% risk is out of everyone or out of people with diabetes. I suspect everyone. I think I need to find out if I can the statistics for people in the same position as me.
My BMI is 40 but a lot of that is fluid probably due to my heart. My HBA1C is 8 in old money.

I had 4 stents put in last year , 1 became stenosed in 3 months but the others seem okay. I am not having symptoms now so hopefully the stents are working okay. The surgeon said that I should think carefully about my quality of life afterwards! That didn’t really help! My diabetic consultant says from his point of view I should go for it.
It would be great if there was someone who had a bypass in the same situation that could dm me
 
trophywench said:
Well - you know when you have the odd minor injury, like small scratches from gardening or anything like that - do you heal OK?
Click to expand...
Hi

yes I guess small scratches heal ok but when they harvest veins it can be a very long deep wound. I have got neuropathy in my feet so have to be really careful. Very difficult to get a chiropodist during lockdown (I live in Leicester!)
 
Blimey - doesn't the NHS in Leicester refer you to their Podiatry clinic? - they do in Coventry but I stopped going since my toenails won't wait 6 weeks between cutting - it's unbearable and sets my teeth on edge having them scrape along the quilt cover above them every time I move jn bed!
 
I am waiting for the gp to come back to me about the chiropodist. I did have a very good registered chiropodist visit me at home but she has retired. I get the feeling it is like the dentist at the moment - emergencies only.
 
Hi Rosie.

This is really an existential question. The risk of infection is small. The effect on healing is marginal. Your're right - the 2% risk is the absolute risk of the surgery itself. They would not operate if the risk from your diabetes put you in any peril. So trust your surgeons and doctors to manage your operation and diabetes to the best of their ability.

I say it's existential, because to be brutally honest, if you decline the surgery it makes it more likely that you will die of heart problems before any more diabetes complications appear. If you wait for another one, or two stents to block you may not be fit enough for surgery later. I agree with your diabetes consultant - go for it now. There isn't any other realistic option.

(i'm a retired doctor, and if I saw you in my surgery I would say the same thing, but with more emphatic industrial language. 🙂)

I wish you the very best in your adventure, tell us all about it when they release you. And tell us all about how the scars look in ten year's time.
 
mikeyB said:
Hi Rosie.

This is really an existential question. The risk of infection is small. The effect on healing is marginal. Your're right - the 2% risk is the absolute risk of the surgery itself. They would not operate if the risk from your diabetes put you in any peril. So trust your surgeons and doctors to manage your operation and diabetes to the best of their ability.

I say it's existential, because to be brutally honest, if you decline the surgery it makes it more likely that you will die of heart problems before any more diabetes complications appear. If you wait for another one, or two stents to block you may not be fit enough for surgery later. I agree with your diabetes consultant - go for it now. There isn't any other realistic option.

(i'm a retired doctor, and if I saw you in my surgery I would say the same thing, but with more emphatic industrial language. 🙂)

I wish you the very best in your adventure, tell us all about it when they release you. And tell us all about how the scars look in ten year's time.
Click to expand...
Hi Mike

thank you. I appreciate your advice. I really do.However the surgeon did say the healing and my subsequent quality of life could be a problem. I have arthritis in my shoulders which I broke in 2009 and have never mended so if the legwound didn’t heal and the worst scenario did happen I would end up bedbound. The smallest of wounds could end up with infection and amputation and this one would be deep and long.
I don’t think the 2% risk applies to the healing. It applies to the operation and I am not concerned about the operation. The hospital is one of the best chest hospitals in Europe, the Glenfield in Leicester and presumably the surgeons follow suit.
He did ask me how my kidneys were and so far scans are good, blood tests are good and UTI’s are rare although if I do get them they take up to a year to go.

So to the philosophy. I have been diabetic for nearly 60 years and for the first 20 years life expectancy was not reallly beyond middle age. Now with pumps, flash monitoring etc and a return to carb counting life expectancy is a lot better. But I do feel anything now is a bonus be it one year, five years. I am happy with what I have achieved in my life.

But it would make me very unhappy to have a wound that doesn’t heal and worse. I forgot to mention pulses are very weak in my legs, and they have been full of fluid for many years. I cannot wear constriction stockings because my skin would break up and risk of infection. The cardiologist does think I have probably had coronary artery disease for 20 years.
I still would like to speak to someone in a similar situation to me and has had a bypass. At the moment I don’t think they are comparing like with like in the 2% risk factor.
 
Ps. I have heard this ‘they wouldn’t offer it to you if there was any danger’ many times but in reality I have found the surgeons and cardiologists have different opinions. Some would do it some wouldn’t. This chap said the decision is mine. 2% risk in the op but my quality of life COULD be compromised afterwards. I still think it is an impossible decision and he is phoning me in a couple of months for my decision. He is not saying leave it to the medics!
 
I would advise you not to keep looking on the Internet for worst case scenarios. That research only applies to those who developed infections. It tells you nothing about the likelihood of infection. I would assume that any NHS cardiac surgery department does not have a significant infections rate currently - it would be all over the news if it did. If you want to research anything, find out the post op infection rate in the cardiac unit you will be attending. You are no more likely to get a post op infection than anyone else.

Obviously, I know nothing about your current family or social situation, or work situation. I don't know the quality of life you have now, or expect in the future. To me, it's not an impossible question. If you don't have the surgery, you are almost guaranteed a cardiac death, with no indication when that might happen. Could be tomorrow, a years time, or possibly longer. You have had warning of that already. If you have the surgery, that is largely taken away, for a good few years, anyway. Those are the certainties in this discussion.

The uncertainties are all speculation with no assessable odds, but diabetic or not, if you are not obese you are far less likely to develop complications of this kind of surgery. Obesity and emergency surgery are the far and away the biggest risk factors.

But I'm not here to persuade you. You've got to make your own mind up, but I hope you get to decision time before you become an emergency..

That's all I'm going to say on the subject, but as I said before I wish you all the best.
 
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