Chapter 26. There were many people asking about heart disease to me

Before “writing the book” or to be exact “write the series of posts on my blog” I’d been wondering, why did the God choose me to experience a heart disease and underwent an open-heart surgery to replace the aortic blood vessel and aortic valve – which is called the Bentall procedure? Why me? I said in my heart. A moment later, I could get the answer, as quickly as grabbing oxygen from the air. That the answer was because I love to write on blog… so if I had to suffer from a heart disease and undergo a cardiac surgery, I would write it all in a series of posts on my blog that may be useful to the readers of my blog… and with that I’ve done a humanitarian duty –that is sharing with the fellows…

Even during the writing of “the book” or the “series” posts I’ve received many questions about heart disease. Of course, from my friends, faculty friends, students or ex-students, relatives, acquaintances, or even new friends who came from nowhere that I had never known. I’m pleased to try to answer their questions, either orally, through comments on my blog, through Facebook messages, SMS, or via e-mail. Even in my heart I thought, the more you ask the better, because it means that my blog is read by many people and so many people need the information about heart disease from the standpoint of a laity cardiac patient like me…

Of course, in a long-term… it’s just kidding,… who knows this series of posts I wrote can be written back in a good and proper Indonesian language, or translated into English and will be published by American publisher there and one day it gets into the “Best seller list of The New York Times”? Who knows? It can be, can’t it? You think so, don’t you?

If there is any question about heart disease, I tried to answer it well through reading articles on the internet, discussing with the fellow patients, asking the nurse or the nun who was taking care of me, and for some cases I asked the cardiologist directly. To be simple, some questions about heart disease that I have to answer as best as I can are written again below in the form of FAQ (Frequently Asked Questions) as follows:

Q1: How many types of heart disease?

A1: There are three, namely congenital heart disease (congenital), heart disease because of habit, and heart disease because of age. The first type, congenital heart disease such as heart valve leaks or heart cavity perforated which is brought innately causes the heart function cannot work perfectly. The second type, heart disease caused by bad habits such as smoking, eat fries which the cooking oil origin is unknown (used cooking oil), eat foods that contain lots of fat (coconut milk, animal fat), or eat foods that contain high cholesterol (egg yolk), which resulted in blockage of the blood vessels of the heart (cardiovascular). The third type, heart disease because of age that is increasingly aging and causes our heart’s spare parts lose its elasticity (aortic blood vessel inflation which is called “aneurysm” or “dilation”, which can cause damage to the aortic valve, for example).

Q2: What are the early symptoms of heart disease?

A2: Of the various parties who have talked to me, especially the patients themselves, the early symptoms of congenital heart disease ever since as a baby is if crying or agitated the tip of the nails, lips, and lower eyelids will be bluish. While the initial symptoms for cardiovascular heart disease are pain in the left chest, numbness of the left shoulders, arms and hands, the back felt stiff, and the chest felt like squeezed by a big rock. The last symptom of swollen aortic heart disease (aortic dilation, aneurysm) and or valve (one or more of the four heart valves that exist) is often struggling breathing even doing light work such as teaching in the classroom or climbing the office stairs though only 1 level.

Q3: What to do if exposed by heart disease?

A3: According to the book by a cardiologist that I read (I forget the name of the author) entitled “Cardiovascular Heart Disease: The No. 1 Killer”,  if a person is exposed by a heart disease –especially heart attack– what to do is to see a doctor as soon as possible, preferably a cardiologist. Usually the doctor will give you blood thinning pill (I’ll check the name) that is usually placed under the tongue. With this blood thinning pill, the blood becomes thin and is temporarily enough for the first aid for people who have heart attacks. But they must be rushed to the hospital ER –better it is Harapan Kita Heart Hospital ER if possible. For me as a sufferer of leaked valve, if the breathe is out or struggling you should immediately cough or insert your finger into your mouth until you feel like throwing up. Then after going to throw up, moreover coughing, usually the heart will work normally again for a while, so this can also be done for the first aid.

Q4: How do I choose a cardiologist and heart hospital?

A4: If you live in inland, such as NTB or Papua or the Bangka Belitung province that I ever found out from the cardiac patients who shared the same room with me, in the three provinces (probably most other provinces in Indonesia) the number of cardiologist is very minimal. Probably one province only has one heart doctor, for that you sure had to see the only cardiologist. But if you live in big cities like Jakarta, Bandung, Surabaya, Medan, and Makassar… perhaps there are many cardiologists, so you could choose to be examined or treated by which cardiologist you choose. In the big cities you will also have more than one option of the available heart hospitals. For example, in Jakarta there are Abdi Waluya Hospital across Cililitan bus station, or directly to the National Cardiovascular Center Harapan Kita Heart Hospital (RSJHK). Especially for RSJHK, the heart disease patients will be linked with one of the doctors who work in RSJHK…

Q5: how much does a heart surgery cost?

A5: Maybe it could be asked directly to the telephone operator of each hospital. But as far as I know in RSJHK case, the cost of installing one stent (ring) is Rp. 36 millions (if to install 2 stents means it costs 2 x Rp. 36 millions and so on.), a by-pass surgery costs Rp. 75 millions, and the valve and its shell replacement surgery which is called “Bentall procedure” costs Rp. 105 millions. These prices may vary from the payment method you take: whether cash, whether using Askes, or using Jamkesmas. For details, please inquire to the information section of each hospital… For me as a bureaucrat of category IV/b, most of the heart surgery costs will be borne/covered by Askes and we as the patients only pay a small amount of money called “cost sharing”… not to mention, this cost is only the cost of the surgery, and doesn’t include: the cost of medicines, equipments or materials (e.g. infusion tubes), foods for the patients’ watchmen, and for the patients outside the city have a lodging cost of the patients’ watchmen (there are a guesthouse which costs Rp. 300 thousands for one night, and a boarding house which costs Rp. 800 thousands, and so on)

Q6: What should be prepared before the cardiac surgery?

A6: actually I have already written a separate post with almost has the same title, which is what should be prepared before the cardiac surgery. Non-technical preparation: mental preparation that will soon be at a big surgery in the heart area, the mental preparation for the accompanying family, preparation of the money for the surgery and medicines costs, and meals+lodging expenses for the patient watchmen. Technical preparation: cleaning the teeth tartar, checking the ears, nose and throat –if there are problems in ENT then ask the otolaryngologist to heal the ENT diseases before undergoing the cardiac surgery.

Q7: What should be done to recover the health after the open-heart surgery?

A7: an ex-cardiac surgical patient has to undergo a rehabilitation program Phase I (cardiac exercise, walking, riding static bike), Phase II (cardiac exercise, walking, riding a static bike that at some point replaced with a treadmill to strengthen the legs), and Phase III (cardiac exercise, treadmill, load exercise by using a “dumble” which its purpose is to strengthen the hands). One month after the cardiac surgery the patient is allowed to consume any food, but the emphasis is in the foods that contain protein to restore the heart surgery wound. Usually within the first 2-3 months, the patient isn’t allowed to lift things weighing more than 5 kg….

Q8: What are the foods that are appropriate for the cardiac patients?

A8: Foods that contain sufficient nutrients for cardiac surgery healing are in the form of enough carbohydrates (rice, boiled yam, boiled potatoes, and noodles), adequate proteins (anything, except for egg yolk, it should be limited), sugar (white sugar, syrup, sugar liquid). Then if to eat fries, it should be fried at home with cooking oil such as peanut, sunflower, coconut, or corn oil. Milk is actually not necessary, and please be careful to drink milk as the cardiac patients have many types of medicines. The medicines’ efficacy would be reduced much or ineffective if at the same time you take the medicines you also drink milk.

Q9: What sports are allowed for the heart patients?

A9: The “official” sports that are allowed for the cardiac patients are only 3: aerobics, swimming, and bicycling because the three sports although are pretty heavy, the “burden” of the heart function is relatively stable because from time to time the burden is the same or if there is a difference, the difference will be very few alias insignificant. Even to the level that is competitive, the cardiac patients (who have undergone cardiac surgery) could perform all the three sports. Sports that aren’t recommended to be done by the cardiac patients are they who have stomping reason and the heart function burden can load up and down such as: badminton, ping pong, field tennis, and of course martial arts…!

Q10: Why do I as a cardiac patient must believe in what Mr. Tri says?

A10: Because Mr. Tri has experienced himself how the heart surgery is like, so what Mr. Tri says comes from “first-hand experience” that is worth to be listened to. Moreover, what is said by Mr. Tri is from the patient’s perspective, using simple language, and the medical notions are presented in a layman’s language…

So that’s all the questions that I receive most frequently from my friends, relatives, acquaintances and blog readers about heart disease. Hopefully though this FAQ list is brief, it can be useful to enlighten the would-be cardiac patients or medical students who are seeking the heart surgery understanding information from the perspective of the patient… (To be continued)

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