Ken’s Cardiac Catheterization Procedure – Insurance, Fear, Pain, Going Home
By Adam Pick on August 18, 2008
Considering that a cardiac catheterization is on Time Magazine’s “Top 10 Scary Medical Procedures”, I am always looking for good patient information to dispel the fear associated with this procedure. (FYI, many heart valve surgery patients have a cardiac catheterization prior to valve repair and valve replacement operations.)
On that note, Ken just sent me a very detailed account of his recent cardiac catheterization. So you know, Ken has severe mitral regurgitation and is scheduled for surgery later this month. As you can read below, he has some interesting points specific to insurance, fear, the procedure and going home afterwards.
Without further ado, here are Ken’s thoughts specific to his recent cardiac cathetherization:
Insurance Considerations For The Cardiac Catheterization
I am enrolled in an HMO and therefore needed referrals from my primary care physician for the cardiologist and the hospital. Since my cardiologist was performing the procedure at Massachusetts General Hospital, I also needed a referral for the admitting cardiologist there as well.
Massachusetts General will discharge day surgery patients as late as 10pm at night. If I had to stay overnight, I would have been liable for a $500 co-pay under my plan. Since my procedure was originally scheduled for mid- afternoon, I asked for an earlier time on another day. My cardiologist and the hospital were very understanding and accommodated my request. This required me to change the referral to a different admitting cardiologist.
Be prepared to coordinate everything among multiple, participating physicians. With the medical community’s ability to raise prices at will, it seems they have very little incentive to become more efficient.
My Fears & Concerns About The Catheter
I have small veins and people have trouble drawing my blood. During a blood test, two weeks earlier, it took two people, three tries to reach my vein. That left me with a bruise larger than a silver dollar.
Because doctors have not always told me the truth in the past, I did not know what to expect in terms of discomfort and pain from the catherization. Unable to find good information about catherizations on the web, I needlessly worked myself into a frenzy over the two punctures that would be made in my abdomen.
Given my experience with the “blood letters,” I was particularly worried about moving on the operating table and causing internal injury to my artery.
Being a “Type A” personality, I was even more so the day of the procedure. A double sedative failed to put me asleep. I’m sure the nursing staff was glad to see me finally go under. The medication caught up with me later that evening at home. After the procedure was over, I realized my fears were completely unjustified.
Procedure & Diagnosis
My cardiologist is exceptionally skilled and gentle. Everything went as planned. He had previously performed a TEE on me in September of 2007 with equal skill and will be performing another in 2 weeks.
This is how my procedure went:
I fasted after midnight but was allowed clear liquids up until 8am that morning. I had a small amount of water at 4am and again at 7am, and then nothing until after the procedure.
After check-in and completion of paperwork, I began getting ready around 11am.
I told the nurse who inserted the I.V. that it would be hard to find a good vein. She quickly terminated the first attempt and succeeded on the second try. Before being sedated, Dr. LaMattina came by and explained the risks of the procedure. He had me sign a consent form.
The procedure began around noon time. It took 35 minutes. Both an artery and a vein were explored right back to the heart. No blockages or calcification were found. No stents and no bypass surgery will be needed. I have a very strong and regular heartbeat. There is severe mitral regurgitation (over 60%) due to a prolapsed mitral valve which we knew about.
I was awake, apprehensive and talking (too much) throughout the procedure. I did not feel a thing, except when the warm dye was injected. I actually found that to be a rather pleasant feeling.
In the recovery area, a technician removed two plastic tubes (about 5-6 inches long) from my abdomen. It was painless. He applied pressure for about 10 – 15 minutes to each wound, then applied a clear bandage. Plugs were not used to seal the wounds because plugs could have delayed cardiac surgery.
My Transfer To A Regular Floor After The Cardiac Cath
The staff in recovery called ahead and warned the nurses what to expect. (Yak, Yak)
I had to keep my right leg still for at least 4 hours and could not bend it. My head could not more elevated more than 30 degrees. I forgot about this twice and moved the right leg slightly with no adverse effects.
I was given a delicious turkey sandwich lunch with lettuce, tomatoes, sweet pickles, grapes and apple juice. My wife had to help me because I could not elevate my head to feed myself properly. Drinking from the straw was the most awkward part of the meal.
Before my release, a nurse took me for a walk around the floor. I initially had the very slightest amount of dizziness. The walk was pain free. I would say that the maximum amount of pain I felt that day was less than 1 on a pain scale of 1 to 10 with 10 being unbearable.
I was in a regular hospital room from about 1pm until discharge time at 6 PM.
I recommend that patients bring a book or watch TV to pass the time. My wife had a book. Being the type of person who must keep busy, I was still hyperactive. If I could have had my laptop with me, I would have been fine, but my recovery position made that impossible.
Despite the volume of people they service, the entire staff at Mass General is very professional and attentive. I would be remiss, however, if I did not single out Ms. Kim Powers, a physician’s assistant who extremely proficient and caring. Despite a caseload that changes daily, she does an excellent job of keeping up with everyone’s progress by personally visiting each patient under her care before and after their procedure. If you are fortunate enough to be assigned to her care, appreciate the fact that you are receiving a level of care that does not exist everywhere.
Finally… Going Home!
We carefully monitored the groin area for puffing and internal bleeding in the lower abdomen. To avoid climbing stairs, I slept on a couch the first two nights. My sleep has been choppy for some time because of the heart valve issue.
I went to bed at 8pm that first evening and fell asleep without any need for Tylenol or other pain medication. I woke up around 2am, as I usually do, but did not feel any discomfort at all throughout the night.
During the first 24 hours, a very small amount of blood leaked where the upper leg and abdomen meet. The clear bandage that was applied after surgery was lifted slightly at the crease. My jockey shorts acted like a wick and absorbed the blood.
The day after the procedure some linear bruising began to appear in this area.
The afternoon of day 2, my wife helped remove the bandage, as directed, and I was able to shower. To get upstairs to the shower, I took it one step at a time. Pushing down on a railing, I put my weight on the good leg and lifted it first. Then I brought the affected leg up to the same step. This was precautionary.
For the first two days after, I tried not to bend my right leg. I had trouble putting on my trousers and could not put on my socks either day. The morning of the second day, my pain level went from negligible to 1 out of 10. More bruising was evident but not anything significant. Over the next few days, it became larger and spread toward the hip area.
No swelling or internal bleeding was observed. By the afternoon of day 3, all pain was gone. I was also moving up and down stairs very fluidly. I took it easy, as advised in the discharge papers, for a full week. Some bruising remains after a week, but I now healing.
I am now looking forward to the heavy duty mitral valve surgery in three weeks and hope to be a better patient. I will be completely under anesthesia and am prepared to deal with the associated issues when I awake.
So far I have not experienced any form of depression after my cardiac catherterization.
I hope this helps future patients and caregivers!
Adam… Thanks again for your heart valve surgery book!