Diabetes Support Forum

Living with diabetes => General discussion => Topic started by: Dr DeEath on 06 September 2017, 01:33:59 PM

Title: My Heart Operation
Post by: Dr DeEath on 06 September 2017, 01:33:59 PM
I thought it was worth a new thread as the original one is getting rather long and at times off-topic at times. After I posted yesterday I got a somewhat puzzling phone call (very bad line). When I got a chance a bit later in the afternoon I rang the hospital as I had caught the words "heart" and "procedure".  It appears that I have now been referred to the Royal Brompton for triple bypass (is that a motorway). It was a bit of a shock as everyone has  been talking stents for over three months. Apparently I have been sent a letter which I imagine is in the post as the letters for some reason are posted around 100 miles away with a 2nd class stamp.

I am now wondering if I will have to go through the various angio/cardio grams again?

Wonder if I will spot Avocado there?
Title: Re: My Heart Operation
Post by: Avocado on 06 September 2017, 04:04:40 PM
The Royal Brompton is the best heart hospital so you will be in good hands there. I would hope they send copies of your recent scans to the hospital so you don't have to have them all over again.


When I next have surgery the Brompton is the place where I think I wil get the best level of aftercare and nursing which is most important after heart surgery, as the hospital is dedicated just to heart and lung.


The food is very good too - at least it was when I was a day patient there in June. Of course they do all the low fat stuff but I managed to get a very good omelette with cheese and fresh green vegetables - and I asked for butter to put on them, apparently they try to source the veggies locally and try to get organic ! That's what I read any way. Mind you, you might not feel like much food after your op, at least not for a few days. They will obviously be aware of your diabetes when it comes to the surgery and how that will affect your diabetes.

Do keep us posted !
Title: Re: My Heart Operation
Post by: Pattidevans on 06 September 2017, 06:23:07 PM
Oh goodness, what a shock for you!  Any idea when?
Title: Re: My Heart Operation
Post by: Liam on 06 September 2017, 07:06:17 PM
Glad Anne (Avocado) was on to see your post. I know we can offer support but some first hand knowledge is much more helpful I'm sure!
Title: Re: My Heart Operation
Post by: Paulines7 on 06 September 2017, 08:51:00 PM
Wishing you all the best and hoping that you do not have to wait too long for your op.

I go in to Cardiology at Salisbury District Hospital on 27th September as my pacemaker battery is now reaching its limit.  I have had a scan but they haven't told me yet whether they will just be changing the battery or fitting in a completely new pacemaker. 

We live in the age now when heart operations, triple bypasses and stent insertions is all routine.  It's just as well we aren't all living in the 19th Century!  Good luck Dr DeEath.
Title: Re: My Heart Operation
Post by: Venomous on 06 September 2017, 10:31:38 PM
Good luck for your operation, I'll be thinking of you!
Title: Re: My Heart Operation
Post by: Dr DeEath on 07 September 2017, 02:01:41 PM
Thank you fr the good wishes. I will let you know when I get an appointment through.

Personally I would have thought that I would have been given a appointment t discuss the test results and treatment options. The good side is that I was referred quickly - I just hope things move forward as I tire more easily than\n just a few months ago!
Title: Re: My Heart Operation
Post by: Venomous on 07 September 2017, 08:52:45 PM
I hope the operation is sooner rather than later.
Title: Re: My Heart Operation
Post by: Alan on 07 September 2017, 11:44:44 PM
Sorry about the shock. Best wishes, it appears you will be at a good hospital.
Title: Re: My Heart Operation
Post by: Dr DeEath on 03 October 2017, 01:20:08 PM
Had hoped I would find an appointment for my initial consultation when I got back but still nothing. I have heard stories of people waiting 3 - 4 months for an appointment after referral to the major heart hospitals. It's hard not to let it get you down!
Title: Re: My Heart Operation
Post by: Quantum Learning on 03 October 2017, 02:07:02 PM
We have to wait 3-4 months for any referral to see anybody. Then you get there and they send you for a blood test & say see you in another 3 months, so much time wasting.  :(
Title: Re: My Heart Operation
Post by: sedge on 03 October 2017, 02:13:29 PM
I'd be ringing up to find out what's going on, after this length of time Dr D.
Title: Re: My Heart Operation
Post by: Venomous on 04 October 2017, 08:57:33 AM
One of my daughter's coworkers had a triple heart bypass at Barts a couple of weeks ago. He is 51, a little extra weight, but not diabetic. He was in ICU for 2 days..then they sent him home! He doesn't have anyone living with him so we were very worried and I cooked and sent round meals. He soon didn't need them and went into work 7 days following his operation just to say hi to everyone and show them his chest scar and a long scar on his leg where I think they took veins or something?

I hope your operation goes as smoothly!
Title: Re: My Heart Operation
Post by: Pattidevans on 04 October 2017, 03:56:49 PM
It's strange, another post code lottery I suppose.  J's elder brother who lives on the south coast (Worthing) went for a treadmill test, next day he was in London having a triple by-pass op.  Think it was University College Hospital.
Title: Re: My Heart Operation
Post by: Dr DeEath on 05 October 2017, 01:28:12 PM
It's strange, another post code lottery I suppose.  J's elder brother who lives on the south coast (Worthing) went for a treadmill test, next day he was in London having a triple by-pass op.  Think it was University College Hospital.

Yes it seems so especially as one consultation said I was to have no stress tests (exercise or drug induced) as it would provide no useful information and could be dangerous!
Title: Re: My Heart Operation
Post by: Avocado on 05 October 2017, 03:21:48 PM
I read on the BHF website a story by patient who had surgery at the Brompton. She lived in Cornwall, had all her cardiac tests at Truro Hospital and was referred to the Royal Brompton for valve surgery. She didn't go to the Brompton for any more tests as they'd all been done in Truro. When her appointment for surgery came through from the Royal Brompton they sent a van/ambulance car to pick her up ! She met the surgeon the next day and then had surgery. So fingers crossed Dr DeEath that it's as simple as that for you - no more tests, just the surgery when the date comes through. But do chase it - perhaps your GP has a copy of the referral letter ?
Title: Re: My Heart Operation
Post by: Blueduck on 06 October 2017, 08:20:29 AM
Good luck DrD, my mums had a triple heart by pass and she is now 83, it was about 5 years ago, she was like a new woman after the op. And for a lady of her age got over it it very well and quickly. They do normally take a veins from somewhere, in my mum it was her leg, like some one said previously, my aunt also had THB and they took her vein for the repair from her arm. She was quite a bit younger, but in both cases they did really well.  :D
Title: Re: My Heart Operation
Post by: Dr DeEath on 06 October 2017, 05:04:45 PM
Have been told they will use arm or chest blood vessels because of the PAD!
Title: Re: My Heart Operation
Post by: EdmundK on 20 October 2017, 08:47:35 AM
I hope everything goes well and you have a speedy recovery Dr DeEath!
Title: Re: My Heart Operation
Post by: Dr DeEath on 01 November 2017, 01:17:01 PM
The upset stomach I had a few weeks ago has come back a couple of times accompanied by dizziness. For the moment I have dropped the Vitamin C but am looking into the buffered variety. My pharmacist said it might be getting the GP to review my meds as I am on three different tablets that reduce BP, including the nitrate. The only appointment available this week was tomorrow when I am at ophthalmology. As the latter is four weeks overdue I will just have to go with next Monday!
Title: Re: My Heart Operation
Post by: Pattidevans on 02 November 2017, 08:50:54 AM
It sounds like a good idea to me Dr D.  Let us know what happens on Monday.  Oh, and at the ophthalmologists.
Title: Re: My Heart Operation
Post by: Dr DeEath on 09 November 2017, 01:49:22 PM
Monday was one of my more constructive appointments. I waited a few days before posting and so far so good. After checking my BP (105/62) he took me off the slow release diltiazem hydrochloride which can cause dizziness and nausea. My last attack was on Sunday morning and it got to the point my partner was on the verge of calling the paramedics. I need to contact him if the angina returns but hope the mono-nitrate I was prescribed at the same time will do the trick. I also asked for an Lp(a) blood test - that will not happen so I will ask a cardiologist next time I see one.

I am also off the Vitamin C for the time being as it can also be a cause of acidity. If there is no return of the acidity/reflux he suggested restarting with the buffered variety although he is skeptical about the inflamed arteries theory but says it can do no harm as ling as I stick to the RDA. After leaving I went into a well known health food/supplements shop.Nobody including the manager had a clue of what I was talking about. I will ask my pharmacist when I collect my repeat on Saturday.
Title: Re: My Heart Operation
Post by: Avocado on 09 November 2017, 02:50:05 PM
I am also off the Vitamin C for the time being as it can also be a cause of acidity. If there is no return of the acidity/reflux he suggested restarting with the buffered variety although he is skeptical about the inflamed arteries theory but says it can do no harm as ling as I stick to the RDA. After leaving I went into a well known health food/supplements shop.Nobody including the manager had a clue of what I was talking about. I will ask my pharmacist when I collect my repeat on Saturday.
Here is the buffered vitamin C I take, it's made by BioCare and I get it at my local health food shop or online, here: https://www.amazon.co.uk/Biocare-Vitamin-C-Powder-60g/dp/B0013G340I/ref=sr_1_1_a_it?ie=UTF8&qid=1510238820&sr=8-1&keywords=biocare+vitamin+c+powder&dpID=41WpSw5iHXL&preST=_SY300_QL70_&dpSrc=srch (https://www.amazon.co.uk/Biocare-Vitamin-C-Powder-60g/dp/B0013G340I/ref=sr_1_1_a_it?ie=UTF8&qid=1510238820&sr=8-1&keywords=biocare+vitamin+c+powder&dpID=41WpSw5iHXL&preST=_SY300_QL70_&dpSrc=srch)  It says: "Biocare vitamin C powder contains magnesium ascorbate which is a low acid form of vitamin C, produced by our unique solvent free freeze dried method. It is free from additives and excipients. This form of vitamin C is more gentle on the stomach. It provides a readily absorbable form of vitamin C and magnesium. It is buffered, low acid form of vitamin C to reduce stomach irritation."
Title: Re: My Heart Operation
Post by: Dr DeEath on 11 January 2018, 01:21:06 PM
Spent some time on the phone on Tuesday and now have my first consultation with the cardiology surgeon in a couple of weeks. It has been a long time coming!

Doing fine with the buffered Vitamin C BTW.
Title: Re: My Heart Operation
Post by: Liam on 11 January 2018, 01:40:01 PM
Glad to hear you are making some progress. Hope the appointment goes well.

Title: Re: My Heart Operation
Post by: sedge on 11 January 2018, 02:03:09 PM
That's better news then - isn't it a PITA that so much of sorting out appointments is down to us chasing, rather than HCPs having a reminder system in place?

Wouldn't last 5 minutes in a normal commercial office, would they?
Title: Re: My Heart Operation
Post by: Venomous on 11 January 2018, 07:14:00 PM
glad to hear you have an appointment
Title: Re: My Heart Operation
Post by: Dr DeEath on 31 January 2018, 01:39:18 PM
Well I had my first appointment at RB a couple of days ago.I did not post yesterday as I was still getting my head around things after endless months in limbo. My operation will be in about five months but prior to that I need to pass the pre-op and have further tests. The further tests are slightly annoying as they could have been done by my local hospital or RB during the limbo period.

The consultant also examined my legs because of the PAD and concluded I really needed a bypass.Now is not the time as any procedure might dislodge something which is undesirable.Post-op I am crossing my fingers crossed that I might get some support for sorting out the blood flow in my leg as this will restrict me exercising and hence my recovery!
Title: Re: My Heart Operation
Post by: Dr DeEath on 13 February 2018, 01:39:17 PM
Things seem to be moving now - not fast but moving. Got my pre-op in a month's time.
Title: Re: My Heart Operation
Post by: Avocado on 13 February 2018, 06:58:03 PM
Normally the pre-op is done a week or two before surgery so it's a good sign you have been given your pre-op appointment date !
Title: Re: My Heart Operation
Post by: sedge on 13 February 2018, 10:14:17 PM
Ordinary pre-ops stay in date for up to 6 months Ann - Pete had to have his re-done cos his prostatectomy was overdue - my pre-op for my cataract op was done on 4th December last year so they wouldn't need another unless it was after 4th June I had it done.

If they need other specialist tests to be done within a different timescale then these aren't part of the pre-op process cos they require specialised staff to do them.
Title: Re: My Heart Operation
Post by: Avocado on 14 February 2018, 07:29:25 AM
It might be different for cardiac surgery Jenny as six months would be too long between some of the tests and surgery, at least everyone I've know of whose had cardiac surgery has had their surgery done within a few weeks of the the pre-admission test. Since Dr DeEath is having surgery at the Brompton I've got a link to their pre-admission test page: http://www.rbht.nhs.uk/patients/condition/heart-surgery/heart-surgery-pre-admission/ (http://www.rbht.nhs.uk/patients/condition/heart-surgery/heart-surgery-pre-admission/)  Of course they might find something else wrong and that would delay things....
Title: Re: My Heart Operation
Post by: Venomous on 14 February 2018, 08:12:32 AM
Maybe it's hospital based. My surgery was meant to be done within 2 weeks after the pre-op too.
Title: Re: My Heart Operation
Post by: Dr DeEath on 20 February 2018, 01:27:13 PM
Normally the pre-op is done a week or two before surgery so it's a good sign you have been given your pre-op appointment date !

Yes, its Monday 12th. No idea how long it is valid for if everything is OK. Once I needed a second minor op four months after the first and they said there was no need for another pre-op. Another hospital delayed an op for a couple of months (again not major) and I had to do the whole pro-op again! So who knows - I suspect it can be down to individual hospitals/departments and staff. Sometimes I think it is redone to buy time!
Title: Re: My Heart Operation
Post by: Pattidevans on 20 February 2018, 02:28:42 PM
Good luck
Title: Re: My Heart Operation
Post by: Venomous on 22 February 2018, 01:39:30 PM
Hopefully all goes well!
Title: Re: My Heart Operation
Post by: Dr DeEath on 14 March 2018, 01:37:57 PM
Had my pre-op on Monday and awaiting results. The ECG was repeated as it had expired. Fingers crossed that all is OK!  :)
Title: Re: My Heart Operation
Post by: Pattidevans on 14 March 2018, 02:29:14 PM
Thinking of you DrD.
Title: Re: My Heart Operation
Post by: Venomous on 14 March 2018, 05:08:47 PM
fingers crossed!
Title: Re: My Heart Operation
Post by: Paulines7 on 14 March 2018, 05:59:33 PM
Good luck Dr D.
Title: Re: My Heart Operation
Post by: Avocado on 14 March 2018, 09:52:29 PM
Keep us posted !
Title: Re: My Heart Operation
Post by: Dr DeEath on 22 March 2018, 01:39:20 PM
Got an appointment to see my surgeon next week.There were a couple of issues with my blood tests the most relevant one being that my HbA1c was 7.9 and the guidelines are 7.5 or below. Last time I had surgery (not so major)it was 9.0 or below). looking on the web it seems not all NHS Trusts have the same guidelines!  :(
Title: Re: My Heart Operation
Post by: nytquill17 on 22 March 2018, 03:24:04 PM
Oh dear. That seems quite ill-advised. I understand wanting lower BGs pre-and post-surgery for better healing but it's frankly unrealistic to expect a T1 to be able to maintain a 7.5 when there are also concomitant issues affecting your pain and stress levels and your ability to exercise!! Hopefully they will see reason at the appointment.
Title: Re: My Heart Operation
Post by: Avocado on 22 March 2018, 03:39:11 PM
Hi Dr DeEath - As a result of heart surgery, and in the days following it, everyone’s blood glucose levels rise significantly so that they have to put everyone, even non-diabetics, on insulin for a while until blood glucose levels reduce - I think it’s called insulin sliding scale, it’s done intravenously along with all your other meds at the beginning. It’s probably because of that there is some concern, but they will have a lot of experience with diabetics, I’m sure.
Title: Re: My Heart Operation
Post by: Pattidevans on 22 March 2018, 06:58:13 PM
Trouble is Anne, there are many T1s who dread being put on a sliding scale as the hospital parameters are so divergent from our own and it's very hard to relinquish control.  Pity Dr D is not on a pump, cos those who are can usually revert to it and being in control themselves as soon as they are conscious.
Title: Re: My Heart Operation
Post by: nytquill17 on 22 March 2018, 07:08:57 PM
Completely understand the aversion to letting anybody else have the reins. Especially when you have seen firsthand how incompetent or just inattentive / inconsiderate hospital staff can be! Have definitely been in hospital having a hypo before, and never got anything to eat despite my repeatedly speaking to passing nurses to tell them I was hypo! Thankfully it wasn't one of those terrifying panic-stricken ones, just "gee I would really like to eat now" kind of a thing, but it was VERY worrying to me that you can tell a nurse in a hospital that you are having a recognized medical emergency and absolutely nothing happens.

However, with that said I have also been in for minor outpatient-type surgery but under general anesthesia and had to be put on a sliding scale while I was under and waking up. And my thinking on that is that while I'm normally the best person in the room to manage MY diabetes, at the moment, I am unconscious or trying to lay very still and not vomit, so I'm actually NOT the best person right now, someone else is! And if they don't do a perfect job of it, so what, it's only temporary, and if they REALLY botch it, well I'm in the best place I could be to get things put right again quickly. So I try not to worry too much!

(Post-op though, trying to explain to the home health nurse how carb ratios work...watching her eyes glaze over until she said "okay, I'll just put down in my notes that you can handle yourself on that front...")
Title: Re: My Heart Operation
Post by: Avocado on 22 March 2018, 07:15:00 PM
Trouble is Anne, there are many T1s who dread being put on a sliding scale as the hospital parameters are so divergent from our own and it's very hard to relinquish control.
With heart surgery you are unconcious for minimum 24 hours, and even then not able to be in control for at least a further 24 hours - that's assuming no complications, so you're talking about not being in control for 48 hours with extremely high blood glucose due to the effects of the actual surgery. Once Dr D is back to eating and checking own blood glucose then it's different, and generally they like diabetics to be in control themselves.
Title: Re: My Heart Operation
Post by: sedge on 22 March 2018, 09:55:43 PM
I agree Ann - my own experience of being on a sliding scale and then coming back off it PDQ and back on my pump - were not the most brilliant at all cos the anaesthetist had me at a constant 5.5 on the scale whereas I wasn't whatsoever prepared to need 3x as much insulin and have ketones for days on end.  I haven't died and my A1c at the end of November was in fact lower than it was at the last check in June when I hadn't got anything wrong with me!

And the hospital Diabetes nurses were on call, and I did call! - I daresay a Consultant would have been too had I needed one.  Different hospital and different Trust to my 'usual'.  I've always had brill care.
Title: Re: My Heart Operation
Post by: Avocado on 23 March 2018, 02:26:51 PM
Open heart surgery leads to much higher blood glucose levels than other types of surgery and can affect recovery. Just found on the heart valve replacement forum a thread about high blood glucose after open heart surgery which might interest Dr DeEath: http://www.valvereplacement.org/forums/forum/post-surgery/42167-high-blood-sugar-diabetes-post-heart-surgery 
Title: Re: My Heart Operation
Post by: sedge on 23 March 2018, 11:42:46 PM
There's only one person who defined 'high' and he was at between 100 and 200.  100 = 5.5 and 200 = 11 - and the first is non-diabetic whilst the second is elevated but not that high to a T1.  Wouldn't cause ketones, just need a smidge more insulin and nowt else.

I see no evidence there that heart ops cause far higher BG than other ops, cos it says in non-d's when it happens it's only temporary and normally well resolved before the person leaves hospital.

Have to say all the obs I saw being done on heart op patients on the cardio thoracic ward Pete was on with his collapsed lung - none included BG.  However of course they'd all been in the cardiac ITU for however long (only 24 hrs for most of the bypass chaps) so no idea what obs were done on them in there.  They were still drugged up to the eyeballs and non communicative for the first 24-ish hours but by the time I got there in the evening on Day 2 of them being out of ITU they were talking to anyone who said Hello!  LOL
Title: Re: My Heart Operation
Post by: Avocado on 24 March 2018, 07:23:21 AM
I see no evidence there that heart ops cause far higher BG than other ops,
Sedge - I've had open heart surgery and it was explained to me quite clearly that blood glucose levels during the actual heart surgery and for some time after cause very high blood glucose and this can affect mortality and complications from the surgery. I posted that from the valve replacement forum just to give an idea to Dr DeEath why they are concerned about high BG's. But here's a study  https://www.hindawi.com/journals/isrn/2012/292490/ (https://www.hindawi.com/journals/isrn/2012/292490/)
Title: Re: My Heart Operation
Post by: Pattidevans on 24 March 2018, 09:08:20 AM
Hi


How I read the study, having read it carefully, was that heart surgery is more prevalent in diabetics (I.e 30 - 40% of heart patients have diabetes) and that high postoperative blood sugars need to be intensively managed as they directly affect the healing process and outcomes.  Also that the Hyperglycemia may last longer due to the severity of the operation, which I should think rather obvious given the difference in the trauma caused by say a hernia op and open heart surgery, even though the hernia op will still raise BGs, it won’t be so bad due to the lesser trauma on the body.  The reason truly non-diabetic people will have high blood glucose is that any bodily trauma will raiseBGs because the body will be producing hormones including Cortisol, that are natural steroids and all steroids raise BGs.  It also did allude to the fact that people may find themselves to actually be diabetic afterwards, but given that there are so many undiagnosed T2s that’s not surprising.  I know people will have had HbA1c tests prior to surgery but that’s not always indicative, given the many ways T2 can creep on ie broken first phase which may be mopped up quickly etc.   The point is that undoubtedly a heart operation is very high on the severity range.


On the other hand, Sedge was commenting on the thread you linked and reading that, as Sedge says, 100 to 200 isn’t what a T1 wouold call “high”.  I can’t comment on how long a truly non-diabetic person would have high BGs, I expect it depends on their ability to cope with the trauma.
Title: Re: My Heart Operation
Post by: Avocado on 24 March 2018, 10:01:40 AM
Those people on the valve replacement forum who were writing about their blood glucose levels would all have been on insulin during, and for a while after, heart surgery. The blood glucose levels they talk about are despite that.
Title: Re: My Heart Operation
Post by: sedge on 24 March 2018, 02:04:15 PM
All in a day's work to heart teams then according to that article.

Main thing is, that it seemed to me on an ortho ward where all the other 9 ladies were older than me and 5 of them were T2, one was also T1 and me - being non-D was more of a novelty to ALL the nurses and HCAs!  Couple were coeliac too - and the catering staff were all on-song too when helping people choose meals from the day's menu, suggesting they mixed and matched their meals to get the right combinations for their wants and needs.

Everyone is scared before anything unfamiliar is undergone.
Title: Re: My Heart Operation
Post by: nytquill17 on 24 March 2018, 11:11:32 PM
Let's not lose sight of the fact that the original issue here is not what kinds of BGs can be expected post-op - certainly high BGs are the norm for any diabetic, for any op, and while it makes sense that this would be even more true for heart operations which are quite intensive in terms of healing processes, for a T1 already on insulin the difference between "high" and "higher" is not that drastic, in that the answer is the same in both cases - more insulin.

The real issue at hand is that Dr D's op is potentially being held up over an A1c of 7.9 as being higher than the "requirement" of 7.5 pre-op. The problem is that 7.5 is quite a good A1c for most T1s not on a pump in the best of circumstances, and Dr D is currently having a lot of stress and pain (so, cortisol production probably elevated) and is restricted from most physical activity. In those circumstances I daresay a 7.9 is excellent. I really don't understand how they can justify postponing needed care on the basis of other health conditions being out of whack, when one of the reasons they are out of whack is the postponing of needed care up to this point! So infuriating. Hopefully the actual person Dr D meets with will see reason and it's just a box ticking exercise!
Title: Re: My Heart Operation
Post by: Dr DeEath on 26 March 2018, 02:22:04 PM
I am now getting quite nervous about my appointment as I am concerned there will be further delays. After all this time I feel my health is deteriorating, albeit slowly,and my life is on hold!  :(
Title: Re: My Heart Operation
Post by: nytquill17 on 26 March 2018, 03:14:52 PM
I don't blame you for being nervous.

If it were me, I would want to go in with some questions/arguments prepped to make my case. Things like:
 - Do you have any suggestions for how I might lower my A1c further while I am 1. experiencing recurring and chronic pain due to circulatory issues, 2. unable to take physical exercise due to physical exercise, 3. already on an intensive insulin regime (MDI with carb counting and dose adjustment) and a restricted diet?
 - Do you have any justification other than a slightly out of range A1c - something very normal for a T1D patient - for denying or postponing critically needed care?
 - (if you need to play the slightly manipulative card) Do you really think that the better risk for me as a patient is to allow me to go home and have my health continue to deteriorate than to refer me for an operation that is known to be necessary for someone with the health condition I have been diagnosed with while I have a slightly higher BG that may slow healing somewhat? (remind them if necessary that you ARE already diabetic - so higher BG is going to be par for the course with you anyway - and by the same fact you have many years of experience self-managing your BGs to keep them as close to normal as is humanly possible for a T1)

I would also go in prepared to ask them to please bring in a QUALIFIED T1D-specialized consultant of some kind. As in, I will not leave this office until you have contacted a CDE, DSN or other person attached to a proper diabetes clinic with experience in treating TYPE 1 diabetes. In my personal experience, people who actually see a significant number of T1 patients are very quick to say "oh yes well the treatment goals and expectations are different for T1!" whereas people who don't and just read "diabetes" off a screen are usually completely oblivious to what a difference diabetes type can play in terms of clinical measurement ranges.

Also don't hesitate to remind them of how long you have been diabetic, how long you have been waiting and preparing to have this operation, and all the other hoops you have jumped through up to this point. Let them see that you are complying with everything they ask thus far and it is they who are the obstacles here, not you.

You could also ask if there is some sort of waiver you could sign saying you understand that there are additional risks to the healing process when BGs are not in the recommended range. This might be less of an issue in the UK than over here where there is more potential for the doctors themselves to come under fire if a procedure doesn't go as expected. I suspect in the UK they are more concerned about the burden of aftercare which falls to the NHS and would be more expensive if you take longer to heal, but it's something to ask about and if nothing else will show them you are serious about getting this operation DONE.

I think if you can, you should take along someone else who you have briefed on your concerns and the "talking points" above. That way if they do try to bully you or you are feeling intimidated or nervous on the day - because it is a major thing affecting your life, after all, who wouldn't be emotional! - you can have someone there who can step in and be firm in your place where you might be tempted to acquiesce or be at a loss for words. I do think that if they are reluctant to put you forward for the op at this point, if you really put the screws to them and force them to admit (1) this surgery is of critical necessity for you and your overall health WILL deteriorate, not improve, if you don't have it done soonest (2) their expectations are quite unreasonable for a T1 diabetic who is already doing everything he can to manage the totality of his conditions and (3) they appear to be putting box-ticking above actually caring for you as a patient and for your health...then they should see sense!

Not to mention, having some prep work to do like this can help you feel a bit less nervous about the whole thing, since you are *doing something* instead of just waiting. You said the appointment is this week - I hope the time passes quickly and everything is as smooth as can be, maybe your case just got flagged automatically and the person you meet with will see sense and you won't need any of this!
Title: Re: My Heart Operation
Post by: sedge on 26 March 2018, 04:27:47 PM
I'm with Nyt Dr D - let's hope it's an 'automatic' response letter rather than an individually prepared one specific to you.

Good luck!
Title: Re: My Heart Operation
Post by: Pattidevans on 26 March 2018, 06:04:07 PM
I find when I get very prepared to have an argument it's not necessary, but it doesn't stop me worrying!  So I am just keeping my fingers crossed for you.
Title: Re: My Heart Operation
Post by: nytquill17 on 26 March 2018, 07:06:46 PM
Bit like bringing an umbrella, isn't it? By the very fact of having one you almost guarantee that it won't actually rain! But try forgetting it just one time...
Title: Re: My Heart Operation
Post by: Dr DeEath on 28 March 2018, 01:52:06 PM
Fortunately, I do not often get intimidated. Being over 6' and in proportion some people say I am intimidating!

However, it never came to that. The consultant was really good and went over all the aspects with me. He said that the HbA1c could be slightly  better and that I should try my hardest over the next few weeks to reduce it but realised that the figure is more easily achievable with Type II. The potential concern is the PAD as in a 4 - 5 hour operation there is a risk of DVT but with PAD there is the risk of a blockage in a diseased leg artery. All things being equal I should have surgery in early May.

One annoying thing is I woke up with toothache after getting the dental form signed by my dentist a fortnight ago. It seems to be where I had a big filling in a molar in before getting the signature. I just rang up when I got back from the Brompton but was asked to ring back in the  morning. With Easter coming I am getting a bit worried about it!
Title: Re: My Heart Operation
Post by: nytquill17 on 28 March 2018, 01:53:35 PM
Apart from the toothache that sounds very positive! So relieved for you. And early May is not too far away - fingers crossed everything holds up until then!
Title: Re: My Heart Operation
Post by: Venomous on 30 March 2018, 08:05:06 PM
Hope the tooth is fixed soon... Surgery in early May sounds good! Get some crosswords and puzzle books ready for the time spent in hospital!
Title: Re: My Heart Operation
Post by: Liam on 01 April 2018, 01:34:34 AM
Hope either the toothache goes away or you manage to find a dentist open over Easter.

The meeting with the consultant sounds fairly positive. Good at have a rough idea of a date for the surgery.
Title: Re: My Heart Operation
Post by: Pattidevans on 01 April 2018, 10:08:32 AM
Just wondering if the toothache has settled.  I remember going away for a break on the day I had a large filling some years ago.  I thought I may have to go home again, but after taking some painkillers it settled.
Title: Re: My Heart Operation
Post by: Blueduck on 03 April 2018, 07:30:23 AM
Good news about the opp. Sorry to hear about tooth, hope it’s not so bad now
Title: Re: My Heart Operation
Post by: Dr DeEath on 03 April 2018, 01:18:33 PM
Some painkillers over the weekend and put on a 7 day course of antibiotics. I have a follow up appointment next Monday. The problem is that my dental pre-op is no longer really valid!  :(
Title: Re: My Heart Operation
Post by: sedge on 03 April 2018, 04:23:58 PM
Sorry, do you have to have a dental op done as well? 

Or do you mean when they ask at any pre-op if we have any dental prob?  Cos it's really any loose, natural teeth, or the sort that could crumble away if they happen to clunk an instrument against whist shoving the anaesthetic/revival plumbing in, that they're bothered about.  Not how many fillings we have!  Oh as my dear OH has kindly pointed out - they need to know if we normally wear dentures, to make sure they're out before they start!
Title: Re: My Heart Operation
Post by: Dr DeEath on 05 April 2018, 01:14:23 PM
Sorry, do you have to have a dental op done as well? 

Or do you mean when they ask at any pre-op if we have any dental prob?  Cos it's really any loose, natural teeth, or the sort that could crumble away if they happen to clunk an instrument against whist shoving the anaesthetic/revival plumbing in, that they're bothered about.  Not how many fillings we have!  Oh as my dear OH has kindly pointed out - they need to know if we normally wear dentures, to make sure they're out before they start!

Currently I do not need a dental op but if the tooth does not settle it may need extraction!  :( Whatever happens further work is needed - we will see on Monday.

Basically with any general anaesthetic loose teeth are a no-no as if one fell out it could be swallowed. With heart operations they also want teeth free of decay and gum diseasr as the heart can be susceptible to infection, particularly originating from the teeth. I just hope I get the new dental sign-off before too long!
Title: Re: My Heart Operation
Post by: Pattidevans on 05 April 2018, 03:39:09 PM
Oh dear... if it's not one thing it's another.  Here's hoping it will all be settled soonest!
Title: Re: My Heart Operation
Post by: Alan on 07 April 2018, 12:49:13 AM

Currently I do not need a dental op but if the tooth does not settle it may need extraction!  :( Whatever happens further work is needed - we will see on Monday.

Basically with any general anaesthetic loose teeth are a no-no as if one fell out it could be swallowed. With heart operations they also want teeth free of decay and gum diseasr as the heart can be susceptible to infection, particularly originating from the teeth. I just hope I get the new dental sign-off before too long!

I know they would not do it, but a pity you can't get it all done under one general anaesthetic. Just thinking efficiently :) . I had an upper rearmost molar/wisdom removed under general about six months ago. So pleased I was fully under and never felt a thing.
Title: Re: My Heart Operation
Post by: Dr DeEath on 11 April 2018, 02:03:42 PM
Well I am now on a course of different antibiotics. I was all for just having the tooth out as I really need the all clear for surgery! So another review on Friday - if it is no better I will be arguing that I want it out! Is there a Hayne's manual?
Title: Re: My Heart Operation
Post by: sedge on 11 April 2018, 04:49:22 PM
Is there a Hayne's manual?

Not seen one, but they did do one for understanding where all the bits of a Woman can be located, one year!
Title: Re: My Heart Operation
Post by: Dr DeEath on 17 April 2018, 01:46:28 PM
So the antibiotics did not work  and the conclusion was that the tooth has to come out. I was expecting this but not for the dentist to say "I need to refer you for this". She said it could be up to four weeks so yesterday I rang the people and enquired. There was a possibility of just over two weeks but no certainty. Not keen on further delays and probably ongoing antibiotics I asked a bout going privately. Things started moving! I had a panoramic X-ray yesterday (£85) and am having the tooth out at 4:00 today. It will cost £250 plus the taxi fares as they advised me not to drive afterwards as I did yesterday. Fingers crossed things can get moving afterwards. The delays have got ever more frustrating.
Title: Re: My Heart Operation
Post by: nytquill17 on 17 April 2018, 02:05:07 PM
Oh I'm so sorry to hear this. Would have been nice if they'd listened to you in the first place and gone straight to taking the tooth out instead of wasting time trying to be conservative! You have other priorities right now! I'm glad you're able to get it done quickly but sorry you've had to go out of pocket to do so. Fingers crossed the procedure and recovery will all go smoothly!
Title: Re: My Heart Operation
Post by: Pattidevans on 17 April 2018, 02:13:13 PM
Sorry to hear this news, but sometimes you just have to bite the bullet and get things moving even if it costs!

Good luck with it.
Title: Re: My Heart Operation
Post by: nytquill17 on 17 April 2018, 02:15:41 PM
Maybe don't bite any bullets until that tooth is out  ;D
Title: Re: My Heart Operation
Post by: sedge on 17 April 2018, 07:18:52 PM
LOL -hope it all goes well and you get lasting relief Dr D.
Title: Re: My Heart Operation
Post by: Alan on 17 April 2018, 10:06:20 PM
Best wishes for a swift and painless op mate. Sorry it became expensive. Does private mean different surgeons, nurses etc or just the same ones paid more?
Title: Re: My Heart Operation
Post by: Venomous on 18 April 2018, 08:52:04 AM
So the antibiotics did not work  and the conclusion was that the tooth has to come out. I was expecting this but not for the dentist to say "I need to refer you for this". She said it could be up to four weeks so yesterday I rang the people and enquired. There was a possibility of just over two weeks but no certainty. Not keen on further delays and probably ongoing antibiotics I asked a bout going privately. Things started moving! I had a panoramic X-ray yesterday (£85) and am having the tooth out at 4:00 today. It will cost £250 plus the taxi fares as they advised me not to drive afterwards as I did yesterday. Fingers crossed things can get moving afterwards. The delays have got ever more frustrating.

Glad you are getting it done and over with. Totally understand how all the delays are frustrating and so negative to your health. Good luck for today.
Title: Re: My Heart Operation
Post by: sedge on 18 April 2018, 12:17:51 PM
It's a bit weird round here Alan - Pete needed an extraction a while ago and our dentist said he'd have to refer him to the hospital.  A letter came from a Dental surgery, one that's been there years and years but not partic near us so we don't 'know' them.  Pete went and they said they were doing work for the hospital.  Had a look, had the jabs, he was out again in 10 minutes.

No idea why ordinary dentists can't just do it like they always used to.

Ah - Pete's just wondered if normal dentists are not Dental Surgeons any more, only Doctors?
Title: Re: My Heart Operation
Post by: Dr DeEath on 18 April 2018, 01:14:54 PM
Best wishes for a swift and painless op mate. Sorry it became expensive. Does private mean different surgeons, nurses etc or just the same ones paid more?

Thanks for all the good wishes!

To my knowledge the people I was referred to are the same if you are private or NHS just that things happen far quicker privately!

I was in about 30 minutes. Because of the sensitivity I had anaesthetic to either side and a bit of a wait for the bad tooth to become totally numb. I am glad I did not drive as I did not feel 100% after - probably from extra doses of anaesthetic and maybe from some of it and (a little) blood going down! Feel quite exhausted today so changed my p/t hours around. It didn't help that my BG was 8.7 at 7:30 last night and despite eating very little (on the other side) it was 21.4 at 10:30 calling for some extra neutral insulin. Quite stable today. I was also given some different antibiotics to start today Privately they were little more than the standard prescription charge (£8.80?).
Title: Re: My Heart Operation
Post by: Liam on 18 April 2018, 06:35:32 PM
I had a tooth pulled a couple weeks back. The "dentist" had to ask a different dentist to do the work. I'm not really sure why.

In my case it was a wisdom tooth that broke into little bits as they removed it. The had to cut my gum to get at the root.

It wasn't really painful but my cheek got bigger and harder. On the fourth day my partner took me to A&E as the advice from the dentist said to do out of hours.

The desk staff didn't know what to do, so she went to ask the charge nurse. She said the charge nurse said I should wait to see my dentist.

A couple hours later when my dentist opened, I went and asked about an emergency appointment. They asked me to just wait to be seen. The dentist seemed shocked I'd be turned away at A&E without antibiotics. He the prescribed be two different ones.

They took awhile to work but the did. I was fairly shocked that all this seemed to have little affect on my BGs. Control was fairly good. Not sure if the antibiotics were keeping it down or not.

Hopefully you'll not have that problem Dr as you have antibiotics to stop it getting infected.
Title: Re: My Heart Operation
Post by: Alan on 18 April 2018, 10:44:01 PM
I had a tooth pulled a couple weeks back. The "dentist" had to ask a different dentist to do the work. I'm not really sure why.

In my case it was a wisdom tooth that broke into little bits as they removed it. The had to cut my gum to get at the root.

It wasn't really painful but my cheek got bigger and harder. On the fourth day my partner took me to A&E as the advice from the dentist said to do out of hours.

The desk staff didn't know what to do, so she went to ask the charge nurse. She said the charge nurse said I should wait to see my dentist.

A couple hours later when my dentist opened, I went and asked about an emergency appointment. They asked me to just wait to be seen. The dentist seemed shocked I'd be turned away at A&E without antibiotics. He the prescribed be two different ones.

They took awhile to work but the did. I was fairly shocked that all this seemed to have little affect on my BGs. Control was fairly good. Not sure if the antibiotics were keeping it down or not.

Hopefully you'll not have that problem Dr as you have antibiotics to stop it getting infected.

I had tenderness in the gum region for too long after my wisdom tooth removal and mentioned it at my next dentist's appointment some time after the operation.

She found a chip (bone or tooth?) was coming through the gum. Apparently it had been unnoticed at the time of the op and had slowly moved to the surface over time.
Title: Re: My Heart Operation
Post by: sedge on 18 April 2018, 11:23:28 PM
We've both had that - had perfectly uneventful extractions with no ABs or anything and forgot about them - then months and even years later - had the bit of 'ivory' work itself out.  Pete's was fascinating - a complete ring!
Title: Re: My Heart Operation
Post by: Dr DeEath on 19 April 2018, 01:22:12 PM
I have had it all over the years. One resulted in a late night visit to A&E where a badly bleeding socket was treated after an argument amongst the staff - it needed the same stuff as they use on boxers cuts around the eye, etc. but I have forgotten the name. A few years ago I had an abscess and went around the same loop with endless antibiotics - part of the reason I eventually left the practice. When I was a child my mother had a piece of tooth left in but was told for months it was in her mind!

I think many dentists don't pull teeth as they focus on prevention decay and cosmetic treatments. When I had my check-up for my pre-op I was given a survey that asked if I wanted whiter teeth/straighter teeth/etc. I put other "I want bypass surgery!". The receptionist did a double take when she went checked the form!
Title: Re: My Heart Operation
Post by: Quantum Learning on 19 April 2018, 02:56:20 PM
You have to see a specialist dentist for what they call a 'surgical extraction' if there's not enough tooth above the gumline to pull it out normally.
Title: Re: My Heart Operation
Post by: sedge on 19 April 2018, 03:38:50 PM
They just have a gadget that fits round the bit of tooth inside the gum though - blimey all my wisdom teeth snapped off after causing agony for months on end coming through - one by one - so one by one my dentist removed em.  No prob, walked to the bus stop, jumped on a bus and went back to work.  Last one the dental hospital in Brum did whilst I was there having something else treated.  That was good - although yes it takes them time cos all the students have to have a peer and prod and tell the prof what they reckon - but it costs nowt LOL
Title: Re: My Heart Operation
Post by: Dr DeEath on 16 May 2018, 01:11:31 PM
They are now looking at mid - late June. Whilst everything was OK once the tooth was sorted I had to go back to repeat the electrocardiogram. Just hope the CT scan doesn't expire - that made me feel quite queasy with the extra drugs they give you! It is a strange sensation as I feel quite excited bout it  but also quite nervous.
Title: Re: My Heart Operation
Post by: Avocado on 16 May 2018, 02:05:46 PM
They are now looking at mid - late June.
If they are happy to wait till mid-late June then that is okay. Be good if they could keep to their timetable !