Relativity, Dog Years, and Aging

I was watching TV tonight. 

It was a show about the universe. 

Sometimes I think they created the Discovery Channel just for me. 

Anyway.


The scientists were describing how close the next sun or star is to our sun and solar system. 

It's actually three suns, two that orbit each other and one red dwarf... sounds like some medieval romance or dark comedy. Two star crossed lovers, metaphorically speaking, menaced by the red dwarf who constantly is circling them...

But, I digress, again.

These three suns are approximately 4 light years away from us, thus making for one long trek in the current space machine to get to any planet that might be in the vicinity. One light year is about 6 trillion miles. So, it's pretty far.

But with any show or book on space, time is always a key element of the discussion because it is really impossible to comprehend just how big the universe is, and how the use of time and the measurement of time and distance doesn't really adequately pin down the scope of the universe. I mean, there is really only so much we can understand at any given time. And some shit, well we just want to forget that all together. 

Although in the show some of the graphics give a fairly good intuitive sense of the interrelationship of things up there. It's like looking at the brain from a molecular level.

So, I am sitting there with my dog, Annie, and I am wondering, if it is 4 light years away for me from the three suns, how far away is it for Annie, my Bouvier. Never a mind for math, I am immediately thrown into a catatonic state and only her sniffing my hand brings me back around.

With a more measured attempt to calculate the distance to the three stars for Annie, I wonder how many dog years away are they? Or, more precisely, how many dog light years away are they?

My first thought is that Einstein must have been dropping an early form of acid, because after figuring out the relativity thing, E=MC (squared), he probably thought that to dumb the whole thing down a little he came up with the concept of dog years. We had to have something to figure out ourselves.

Why dog years? Other animals don't have their own concept of time, so why do dogs?

When Einstein was figuring how Quarks, Black Holes, and bending space and time by the measure of gravitation fields, he was using what was common and normal to him, human years and our experience of time, speed, and distance. Thus making it somewhat relatable to the rest of us, we all just had to put a whole lot of zeros on anything we were trying to measure. Worked for me and looked about right at the time. I passed the course, although I don't think it was my understanding of the theory of relativity that got me through.

But the concept of Dog years he threw in there to confuse us, I am sure, because once we knew how big the universe was, and our relative (there's that word again) relationship to it, we would be daunted and might begin to create religions and ideologies that explained the entire thing for us so we wouldn't have to think about it. Then we would have built temple as places to worship for these religions into which we would go to bow our heads and close our eyes so we wouldn't see just how big everything is. Oh yeah, we did do all that...never-mind.

Einstein was a clever guy and had one wild sense of humor, thus "dog years." He must have been sipping a good German lager after he finished thinking about space, the universe, and all that other space time continuum stuff, and thought, here's a riddle for you..."dog years."

And if you look into this, as I have been doing, there has been a lot of thought and energy spent trying to figure this out. 

Two examples to further confuse the issue.

"One common nomenclature uses "human years" to represent a strict calendar basis (365 days) and a "dog year" to be the equivalent portion of a dog's lifetime, as a calendar year would be for a human being. Under this system, a 6-year-old dog would be described as having an age of 6 human years or 40–50 (depending on the breed) dog years."

"The other common system defines "dog years" to be the actual calendar years (365 days each) of a dog's life, and "human years" to be the equivalent age of a human being. By this terminology, the age of a 6-year-old dog is described as 6 dog years or 40–50 human years, a reversal from the previous definition." (no kidding Einstein)

To further confuse the matter, no specific measure is agreed upon to judge how long a dog year is, although a 1 to 10-15 year ratio is accepted. So that would mean that 1 light year for us would be 10-15 light years for Annie, probably more in the 10-12 range because she is a large bred. That would mean that the three suns are approximately 40 to 60 dog light years away, but that doesn't measure how long it would take a dog to get there, with all the napping and having to go out to pee and stuff.

And if we are traveling with the dogs, like some hyperspace dog sledge, would we get there sooner or later than the dogs, because dog years are also measured by their size. So we'd have to get dogs that are all the same size or we'd arrive with some and the others would still be trekking along so many dog light years behind us. 

Very problematic.

And, as one researcher put it about dogs;

"Aging begins at birth, but its manifestations are not noticeable for several years. The first sign of aging is a general decrease in activity level, including a tendency to sleep longer and more soundly, and a waning of enthusiasm for long walks and games of catch."

I still like a good game of catch, and I am definitely up for long walks. The soundness of understanding that aging begins at birth, is well, illuminating, eh. I mean really, hadn't we already figured out that at birth, and probably before for a living organism on this planet anyway, don't know about those other planets, that the degradation process begins. And as the essay continued...

"In general, dogs age in a manner similar to humans. Their bodies begin to develop problems which are less common at younger ages, they are more prone to serious or fatal conditions such as cancer, stroke, etc., they become less mobile and may develop joint problems such as arthritis, and in old age often become less physically active. Additionally, they become less able to handle change, including wide climatic or temperature variation, and may develop dietary or skin problems or go deaf. In some cases incontinence may develop and breathing difficulties may appear."

Sounds remarkably like people, doesn't it. Visit any retirement village, for people, not dogs, and this would be a common list of aliments. And, if they are motoring to the next solar system, how many dog light years before they begin to show their age, and start peeing all over the spacecraft?

Again, problematic.

So why do they get their own life measure independent of all other creatures on this planet?

I don't know. 

I am going to continue to look into it. But focusing on dogs and dog years allows us to see our relative life in relationship to our dog's life rather than our own. Works for me.

Chow, like in dog chow....

Annie, the Bouvier

BLACK PEBBLES: Luck, Planning, and WTF Anyway

Sunday is a big day.

Changed my profile picture on Facebook and checked to see how many people liked it.

I am recovered from my East Coast tour last week, with an exciting afternoon spent in the big apple last Monday, mostly at the airport working feverishly as a NONREV trying to find standby seats to Maine or Boston. But Southwest Airlines had other ideas, and after skidding their 737-700 down the runway without suitable nose gear we made our escape from New York, or Queens actually.

I have found in situations like that, that an alternative plan you have already accepted in your mind should be in place so that moments of indecision do not eat away at time better spent putting PLAN XYZ into action. The key is recognizing the moment to go to that plan. So, to the car rental company we went and we got there before the other people who had suffered those moments of indecision and got on the road ahead of them.

I can't shake this race mentality.

Although the other tens of thousands already on the road didn't make a different because it seemed they were all stuck in traffic going southbound...caused by some knucklehead who couldn't read the sign that said no trucks (especially tractor-trailer trucks) on the parkway because the bridges are too low. But I guess he thought somehow his 11 foot high trailer was going slip beneath a 9 foot 7 inch overpass on one of the old, and very quaint, stone bridges that cross the parkway. Well, he didn't, causing unknown cosmic unrest in the automobiles of tens of thousands of New Yorkers heading southbound on the Hutchinson Parkway, and an accordion like new look to the trailer he was towing. But, we were going north, and aside from an occasional nut driving too fast on the rain soaked roadway, it was a pretty smooth escape into CT and northeast on the Merritt Parkway, one of my favorite roads.

A friend mentioned that I should make a list of all the unlucky shit that has happened to me, and thus residually to my family, this year. But, believe it or not, I don't see any of it as unlucky, or as I mentioned in another post, that I am the victim of something. And believe it or not, I have had worse years. For me, a victim is someone who suffers from the malignant intent of someone else or group of someone else's. Spousal abuse, child abuse, that type of thing, or racial abuse, anyway, something that has taken some inner energy by another critter of this species to do something bad to another critter of this species. Just because things happen that interrupt an otherwise bland life doesn't mean that that event deems you, or me, unlucky, or as my brother says, "You drew the black pebble, grasshopper."

Personally, I don't remember drawing any fucking pebble and if I had I'd be happy to put some return postage on it. The DNA of which I have grown up with, and suited me quite well until now, is the culprit, and the metaphoric black MF pebble that has decided to test me and see how I respond to another part of my, and the emphasis is, on my body and how it is hosting a branch of mutant fuckers that belong to me, and that they are otherwise breaking down my health with the suicidal intensity which would result in the ending my life, and thus their life too. Curious thing, that.

Although my feelings about alien probes is being tested as a very viable option, but I digress.

This is all me and luck or no luck had nothing to do about it. It just is, and like being stuck at LGA wishing for open seats on a plane going in my direction, if they are not there, well time to have another plan in place to put into action that uses time effectively.

I have never really believed in luck. I mean really, the idea that some cosmic force has somehow deemed it lucky for me not to be sent to Viet Nam in 1972, would make me relatively important in the larger forces of nature. And, if I sat around thinking about how lucky I was then, how about all those poor guys (and gals) who got their number punched somewhere in Southeast Asia. Were they unlucky, or was it just the way it was and their intersection with the larger forces of the world around them got them killed. Victims? maybe, but some wanted to go, like me at one point before I realized just how "lucky" I was to get orders to do something else. Now, my body is trying to cause my end, and unknowing, causing an end to the forces that are trying to cause the end. Say that three times fast. But, that is the way it is. Arteries clot, cancer grows, shit happens, but usually better after taking a stool softener.

So here I am, with some of you listening in, and looking at my body I know that it is doing what it has to, like it has for countless millions before me, attempt to destroy itself, while I try to, with the help of the current state of medicine, save myself for more adventures in the time I have left, before it is ultimately successful. Which it always is.

SO, luck or no luck, you have to have a PLAN XYZ that can be adapted to your life. And during that adaption you have to persevere, until you overcome the current malady that is interrupting an otherwise smooth and uneventful life.

The best plan I know is to think mostly about recovery, no matter what you have wrong with you, and judging by the black pebbles distributed out there in the world, my black pebbles are reasonably manageable. Recovery, because that means that you are not laying in a corner of the proverbial terminal because your flight has been canceled, but that you are taking positive steps to do something about it, no matter what. And, don't count on luck, because at that point you might as well be stringing garlic around your neck to keep the vampires away.

Be positive, assert your self against the illness, and do not let it win while you can still open your eyes.

WTF anyway...I have been almost surprised by the grim reaper a couple of times now, not because of things I was actively doing, like getting down range of some contemporary war, driving too fast with the headlights off (did that, and WTF was I thinking at the time) or any other life activity that might cause serious bodily harm to me...no, these experiences are not even exciting or interesting, except that they are happening to me. But I feel this time around that I have learned, from my earlier cancer and near death experience, that I don't have to recoil from the illness just because my flight is being delayed or canceled, but get that fucking rental car and head for the parkway!

The Neanderthalic Krell, the Yellow Brick Road, and the Tinman Returns

Well, the Tinman has returned after a splendid week in a small corner of semi-tropical paradise known as Tybee Island.



While I was gone, I have studied more about the KRELL and determined with great certainty that we are a sub-species still evolving. As I mentioned before, the 1956 science fiction film (really a documentary of our relatives the KRELL), the "Forbidden Planet" described that extinct race of advanced beings on the planet Altair IV.

The Krell had reached a stage of technological and scientific development they were able to construct, a machine that turned their thoughts into reality, or unreality.

(We call this the U.S. Congress).

Another Krell device was their educator, a device that operated directly on the brain to measure intelligence and impart knowledge.

(We, the simple sub-species of Neanderthalic Krell have not reached the intellectual synthesis of the Altair IV KRELL, but we have perfected something we call the re-educator, and it is a device that works directly on our brain to sap our intelligence and destroy what limited Knowledge we possess, we call this the political process.)

The characteristic arch, the doorway they used to move between rooms by the KRELL was much wider at the middle than at the top and bottom, suggests a being of enormous girth.

(In that manner the development of the Neanderthalic Krell (us) we are definitely catching up and demonstrating that we too can become obese beings. Phat kids and parents strive to be the KRELL, but like the KRELL, eating those fucking chips and dip will cause unknown problems down the road. If only we could see the future, but then, even the KRELL couldn't do that. Because if they could, well, they wouldn't have destroyed themselves on the blade of their own hubris described in the 'documentary' as an 8,000-cubic-mile (33,000 km³) machine that was supposed to create a heaven on Altair IV, so to speak, but instead eradicated the entire population of KRELL.

Now, as Neanderthalic Krell, we haven't managed the perfection and the simplicity of causing our own extinction in one night, although I remember when I was in the 3rd grade and practicing hiding under my desk from the possibility of an atomic strike by the Red Menace, we were pretty fucking close. And, what kind of desks did they make in those days that they could withstand an atomic blast? No wonder we won the Cold War...but, I digress.

As Neanderthalic Krell, we do possess the bright lights of creating amazing good solutions to solve problems, but when we endeavor to do too much, we unwittingly destroy the very things we try to create by not having the ability to understand what we were trying to do in the first place.

Again, see the Congress here, or take a close look at Detroit, and how, in the short period of my lifetime they have gone from the most affluent city, probably in the world, to the most corrupt and bankrupt community in the country.

As Mark Steyn commented:

Forty-seven percent of adults are functionally illiterate, which is about the same rate as the Central African Republic, which at least has the excuse that it was ruled throughout the Seventies by a cannibal emperor. The illiterates include a recent president of the school board, Otis Mathis.

[and] 

Detroit was in 1960 the city with the highest per capita income in the land. Half a century on, Detroit’s population has fallen by two-thirds, and in terms of “per capita income,” many of the shrunken pool of capita have no income at all beyond EBT cards. The recent HBO series Hung recorded the adventures of a financially struggling Detroit school basketball coach forced to moonlight as a gigolo.

Passing through several airports on our return journey from Tybee Island, and communicating with the Neanderthals that seem to be running amuck in all directions and all manner of attire, it is clear that their (because obviously I am not one of this species, but must have been sent here from some other planet to observe this society) ...penchant for self-destruction is the more dominant aspect of their existence.

And like the KRELL, who were originally frog-like with two long legs and a big tail, think of our early fetal form, they never used steps but depended upon ramps between the steps to accommodate their dragging tail. And, here on earth, the Neanderthalic Krell, seem to be evolving in that same direction, because the pants don't seem to fit and many of the younger Neanderthals must be dragging something down their pant legs to walk so uncomfortably. Maybe, like the Detroit gigolo mentioned by Mr. Steyn, that tail the KRELL had to drag up the ramp was because they too had turned to a tortured form of gratification before their KRELLETRON could do the job for them, because, at least in the minds of many Neanderthalic Krell, the size of their tail is an important consideration.

So, back from a week away, and returning back up the Yellow Brick Road with dark clouds sent by the evil witch the Widowmaker, that caused a night in ATL, a trip to JFK the next morning, a cab ride to LGA in the afternoon, and waiting for a flight that was never going to happen, because as my wife and I were trying to catch a flight to BOS where we could catch a bus to PWM, a funny thing happened, an airplane landed without any front nose gear, or nose gear that could withstand the landing...so airport closed...turn to ace in the Tinman's back pocket, we rented a car and drove five hours from NYC to PWM arriving home about 1245 in the morning...not bad for a quad by-pass patient, but personally I would have preferred to have bypassed the waiting all day in NYC for a flight that was not destined to takeoff... but then again, it's the Krell in me...

Victim? Is being sick an injustice?

I was thinking the other day, while watching the TV, that there seem to be so many people who crowd together and demand they be recognized as victims. And, in my job as a public contact person, people use the victim angle usually as the first thing out of their quiver when they want something...

On an individual basis, being sick with anything brings out the I want to lay down attitude and please wait on me.

Cup of tea, please. And, a cookie.

And, being really sick can be overwhelming for the person that is ill as well as all those who are close to that person. My own experience has been on both sides of this fence, having family that have been terribly and deathly ill, and also I have been deathly ill. This year's experience, cardiac problems, were something I had no idea about, thinking I was just going to confront that pesky little cancer in my chest.

But, the heart was out to get me, but it didn't. So time to move on. Fuck you Widowmaker.

Now, back to the victim thing. Everyone is different and brings an alternate emotional and psychological package to whatever it is they have to confront. But, many time I see for some that it seems so easy to lay down and cry victim when that is not the case. What does that get anyone?

What does victim mean?

1      a living being sacrificed to a deity or in the performance of a religious rite ... not many of these around anymore.

 

2      one that is acted on and usually adversely affected by a force or agent : What? This seems like a stretch. Misuse of term here, and this type of language becomes all too easy for those parents of victimhood that are trying to stroke whatever social agenda they may have. Schools aren't victims of anything, they are simply a reflection of the social and civic world that funds and supports them. So #2 is out.

 

And try these for ideas of being a victim:

 a (1) : one that is injured, destroyed, or sacrificed under any of various conditions (now I have cancer but I am not being sacrificed under any various condition, but I do understand that cancer is a condition that I have but I do not feel helpless or hopeless in confronting it, it is something that has to be managed even if it is end of life...)  

 

 

 

(2) : one that is subjected to oppression, hardship, or mistreatment b : one that is tricked or duped  

 

Now the last sequence reflects a lot of what we see on TV. A group wants to be consistently and constantly seen as a victim and recall real events of when their group was a victim, as though living in the after glow of victimhood garners them some prestige and position in any argument over which no else can deny them. But, their victimhood is a false reality, and now that victimhood has more to do with political positioning and money than anything close to the real crimes that caused other sto be the real victims of injustice. There are real victims in the world and diminishing and misusing the term undermines its meaning.

I had stage three renal cancer seven years ago which almost got me. It didn't. I remember mourning my own life while I was still alive, and I had a feeling of loss which comes with mourning...falling into the victim state of mind. Natural from what I can tell, and I didn't have that much time to do it before my surgical procedure that removed the offending organ and sending it off to some shelf in the bowels of the Maine Medical Center. But, I didn't  dwell on being the victim of cancer, didn't have time, and not really a strong part of my nature. My view, which isn't particularly special, was to get up and live whatever life I had left.

As I have told my doctors, even though I have had seven years of clear Scans, I expected that the cancer would come back. You know that once you have been shot once, the gun is loaded and there's no immunity against being shot again, or multiple time for that matter. And, in the end, something is going to end this life, whether we are victims of something or this amazing life support system we have stops on its own.

So, once I got my head around that, I did not deceive myself with false expectations, but lived my life as fully as I could within the means of my world and that of my families needs. Thus the FIVE PLUS experience, which is inherently a non-victim idea or personal philosophy.

Even when something really bad happens, I think after the initial shock, one has to stand up to the new rules and adjust to them. It would be easier to lay down and bemoan ones illness or that of the family member, but accept the illness, educate oneself to its ramifications, and have a clear idea what the outcome will be. Just because you are sick doesn't mean that whatever kernel of strength you have need turn into a bowl of jelly.

...adapt, persevere, and overcome...
 

The Widowmaker, the Tinman, and Aisle Two...

Just returned from Oz, where the white wizards of the Emerald City have approved my progress.

The Docs were happy with their handy work re-plumbing my heart to thwart the evil witch, the Widowmaker, who was about ready to step into the plotline and cast her dark spell on my life and  explode my heart like a Taliban goat herder's pressure cooker, to say nothing of her flying monkeys that still need to be crushed by my friends, the Cowardly Lion and the Scarecrow, as well as the army of munchkins waiting in the wing. Dorothy, I haven't seen her in a while, last time I heard she was a slut working a corner in the Combat Zone in Boston, busting tricks for twenty bucks... crack Ho.

Now, for those of you who do not know, the Widowmaker is a medical term for the type of heart disease that I was suffering. A hidden, non-presenting illness for the most part, it suddenly makes itself known by trying to kill your ass, thus, the name Widowmaker, because, well, it makes a widow out of your spouse. Women, by the way, are slightly more susceptible to this heart disease than men...be warned.

It's a secret and insidious disease that lurks in the shadows like some fucking terrorist ready to strike with no warning and seemingly no purpose, other than to perform it's basic function and to prove a point, no system and no thing is perfect...everything and everybody is flawed, and no depth of hubris can deny the fact that everything breaks with whatever consequences that are the result. I just got lucky again, and the fates stepped in and pulled me out of the express checkout lane with one item to price and threw me down a couple of lanes in the 15 item checkout lane. So, I think I will continue shopping and go down Aisle Two (IL-2) to see how many more things I can stuff in my shopping cart.

So the Tinman has a new heart, and like the Tinman of Dorothy fame, slut and crack Ho that she is now, I just need to keep oiled so that I don't stiffen up and go belly up. As mentioned, I also talked to the wizards of Aisle Two Fame (IL-2), white wizards deserving of the white wizard status and ready to help this Tinman stay well oiled and they have nodded and smiled in my direction approving my entry into their magic world that fights the friends of the Widowmaker and her ilk.

One down...heart disease, and one to go, cancer. WTF, anyways...maybe I should get leprosy also and call it a fucking hat trick and be done with the whole thing.

But, like Odysseus, Frodo, the Tinman or Ishmael, the journey has many ordeals of temptation and struggle. So, for those of you in Boston, that red streak you may have seen on the news was me heading north as they have approved me to drive, and with some new tires on my red mini, the road was mine, as it always has been and always will be.

NOTE: computer was messed up this week, so two posts never made it to the web...oh well.........
 

Drones, Cruise Missiles and that Rascally Rabbit

After surgery, many times one's emotional world is not as controlled as it might be on a day to day basis. That means, like Jack in picture here, spontaneous crying can occur for what appears to be no apparent reason.

When I had my kidney removed 7 years ago, I was dumbfounded by the tears that suddenly shot out of my eyes like Obama drones attacking a village in Yemen...but then, there were no Obama drones and Yemen was and still is that mud and waddle nation appended to the bottom of the Arabian peninsula.

So, the other day, I am having a good day, and suddenly something happens and again here come the Bush era cruise missiles from my eyes, ready to shock and awe anyone in the vicinity. Understanding now why I was having this spontaneous and uncontrolled outburst of emotion didn't make it any easy.

I was watching Bugs Bunny, and when Elmer Fudd raised his bluster buster to shoot that rascally rabbit, and well, it was more than I could take. I mean really, it's Bugs Bunny.

Walmart & the Krell

I had an outing the other day, Doc's office to check something. But, as it is when out of the house there's other things to do, So, within a very short span of time I found myself sitting in the Wal-Mart parking lot. Because I am infirm, I have a temporary sticker that allows us to park in the slots designated for people with different maladies.

My wife went into Wal-Mart, something I refuse to do, even when I am feeling OK. She disappeared into the crowds of people that comprise the life cycle of the cultural Serengeti, I hunkered down so that any predators in the bunch wouldn't see me, like that baby gazelle we have all seen on the Discovery Channel trying to wait out the hyenas...which after scoping out the herds of this species and that, I am convinced that my survival on this planet has been a rather significant cosmic error, because the foundation upon which the modern medical world is based is like some kind of mutant viral life form. At some point, the swell of humanity will destroy it's own achievements.

Survival in a Wal-Mart parking lot is no small consideration. Just taking into account the other folks parking near me, as I peered over the edge of my window, I thought, "Geez, I'm part of this?" And, well, yes I am. No matter that some have reshapened their bodies by sitting down most of their lives and the obesity that is as much a result of poor choices seems to be a pandemic, their asses turned into flat shelves or their bodies unable to move in a coordinated fashion, or others dressed in stretchy jersey material that they probably picked out of their daughters dirty clothes bin and exposing more flesh than even a medical student would be comfortable with.

But, for me, somewhat of a keen observer of my fellow man and woman, I have long held the contention that we are a distant relative of the Krell.

Krell, you ask? And who are the Krell?

The Krell have lived in my imagination since I was a small boy. They were the race that populated the planet Altair IV. See, there are more populated planets in the universe. Yes, we are not alone. Well, back to the Krell of Altair IV. A film, which I consider a documentary, was made in 1956 and called the Forbidden Planet, not unlike our own planetary world here on earth, that is becoming more foreboding all the time, our own tower of Babel that keeps getting built upon the failures of the past.


The story goes that the Krell invented a machine that would allow them to realize anything within their imagination. Heady stuff, even for an earthling, because I don't know about you, but I have a pretty vivid imagination. And one look at Anne Francis...

However, the Krell forgot one thing in their ambitions to satisfy their hubris, and that is living within them was a dark primitive past. And once they turned on their machine that would produce a host of wealth, pleasures, and entertainment, it also produced monsters that destroyed them all. We are all just Greeks in the end.

I sat in the Wal-Mart parking lot wondering if the Great Mart with all the parking wasn't our latest version of the Krell imagination machine or a version of the Tower of Babel, giving us all so much stuffs of the wealth we have, the pleasures we want, like a bag of Doritos - which I sorely miss by the way, and the things of entertainment that help us tread water until our final destruction.

Well, in the end, I survived the pull of the Great Mart and the sundry devices of distraction that it possesses. Spotting my wife return through the herds still streaming toward the door, and looking totally unaffected by her experience, I moved slowly to put my seat belt on and unlocked the door as she got closer. Once on the road moving away, I wondered how long it would be before we fulfill the destiny of the Krell, unable to fully comprehend our own dark side and living in the carefree world of the distractions offered to us by the Great Martworlds across the globe. 

INFO - Coronary Artery Bypass Surgery

Coronary Artery Bypass Surgery

1. Charles J. Mullany, MB, MS

 

1. From the Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.

1. Reprint requests to Charles J. Mullany, MB, MS, Mayo Clinic, 200 First St S.W., Rochester, MN 55905. E-mail cmullany@mayo.edu

 

Introduction

Coronary artery disease (also known as CAD) is the most common cardiovascular disorder in adults. It is caused by the build-up of cholesterol deposits in the wall of the coronary arteries that convey the blood to the heart muscle (myocardium). These deposits limit the flow of blood through the coronary arteries. Coronary artery disease often results in heart attack (myocardial infarction) or chest pain (angina pectoris), even in the absence of prior symptoms. Warning signs of a heart attack have been well outlined in a previous publication.¹ Treatment for coronary artery disease can include changes in lifestyle, diet modification, weight reduction, and cholesterol reduction,² as well as control of diabetes and high blood pressure (if either or both are present). Smoking cessation is essential.³ Many patients can be adequately treated with medications. Some individuals, however, will require invasive treatments such as stretching (dilatation) of the coronary arteries with a balloon (percutaneous transluminal coronary angiography or PTCA) or coronary artery bypass surgery.

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What Is Coronary Artery Bypass Surgery?

Coronary artery bypass surgery (CABG) involves creating new arteries to provide blood to the heart by use of other blood vessels as conduits to bypass the obstructions in the patient’s coronary arteries (Figure). In most cases, the surgeon constructs at least one of the bypasses by using an artery called the internal mammary artery that is located behind the breastbone or sternum. Other bypasses may be constructed by using a vein from the leg (saphenous vein) or an artery from the forearm (radial artery). In almost all cases, the operation requires an incision in the midline of the chest (sternotomy). During most bypass operations, the heart is stopped and is connected to a heart-lung machine that does the work of both the heart and the lungs (cardiopulmonary bypass). If the surgeon’s assessment is that the operation could be done without the heart-lung machine, the surgery may be performed while the heart continues to beat (off-pump CABG). Not all patients are suitable for off-pump surgery, however, and off-pump surgery still requires a sternotomy.

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Coronary artery bypass grafts allow blood to flow directly from the aorta to the heart muscle by going around the obstruction in the vessels.

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Which Patients Need Coronary Artery Bypass Surgery?

Many patients with coronary artery disease will require more aggressive therapy other than medications and lifestyle modification. For patients who have severe chest pain (angina) or severe obstruction of the coronary arteries, further treatment may involve either enlargement of the coronary arteries by balloon dilatation (PTCA) or bypass surgery. Your cardiologist and cardiac surgeon will decide what is the most appropriate treatment for you. The location, the extent, and the number of obstructions in the arteries often dictate what is the most appropriate treatment for any particular individual. Patients who have undergone PTCA in the past may need bypass surgery in the future if their coronary disease progresses. Patients who have no symptoms but who have evidence of impaired blood supply to the heart muscle (ischemia) or poor function of the pumping chamber of the heart (left ventricle) may require surgery to improve heart function and prolong survival. This applies particularly to diabetic patients. CABG is also often performed at the same time as a heart valve operation or before other major surgery, such as abdominal aneurysm surgery.

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What Should I Expect in the Hospital?

In non-urgent cases, patients are usually admitted to hospital on the same morning as the surgery. General anesthesia is always used, and surgery may take 3 to 5 hours, depending on the complexity of the case. Under anesthesia in the operating room, a breathing tube (endotracheal tube) is inserted through the mouth. This tube helps patients breathe both during and after the surgery and allows the medical staff to clear secretions from the lungs. After surgery, patients are usually admitted to an intensive care unit for 1 or 2 days. While in the intensive care unit, breathing is assisted for several hours with a ventilator. The breathing tube is usually removed within 2 to 4 hours after surgery. Medications are given to relieve pain, and intravenous fluids are used to maintain hydration. One or more temporary drainage tubes exit from the chest cavity to drain any excess blood or fluid that may build up after the surgery. Many patients will require blood transfusions during or after the operation.

Within 24 hours of surgery, most patients are out of bed, and they are able to walk within 1 or 2 days. Over the next few days, patients usually regain sufficient strength so that they can be discharged within 5 to 7 days after surgery. The most common complication after bypass surgery is an irregular rapid heart rate (atrial fibrillation). In most cases this can be adequately treated with medications. More serious but less common complications are stroke (in 1% to 2% of patients) and infection of the sternum (in 1% to 2% of patients).

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What Should I Expect After Leaving the Hospital?

In most instances recovery is rapid. Most patients are able to drive in about 3 weeks. Sexual activity can be resumed in 3 to 4 weeks. The main limitation to activity is healing of the sternum. Like any bone that is divided, the sternum may take up to 12 weeks to fully heal. Therefore, strenuous upper limb activities that would put extra stress on the sternum should be avoided during this time.

Legs Shaved?

For those of you who do not about cardiac surgery, the legs are an important part of the process, because that is where they harvest veins to use as the new plumbing on the heart. But, before they can begin that harvest, they need to shave the legs.

As you can see the hair grows back pretty quickly.

 Just for fun, Tim