‘It was urgent’ | Health Beat

Last spring, when a routine referral led Jim Boismier to undergo a cardiac catheterization procedure to take a closer look at his heart, he didn’t see much cause for alarm.

He has had problems with chest pains in the past, but nothing to cause major concern.

On March 9, Boismier underwent a cardiac catheterization procedure with Spectrum Health cardiologist Gregory Bernath, MD.

dr. Bernath inserted a catheter deep into his heart chambers and blood vessels, evaluating him for coronary artery disease, valvular heart disease, and congestive heart failure.

While Boismier may not have been worried going into the procedure, the results of that test changed everything.

“The (catheterization) test revealed that one artery — the one associated with a type of cardiac event called widowhood — was 95% occluded,” Boismier, 78, said.

Widow refers to a significant blockage in the left anterior descending artery of the heart.

That same day, Boismier received a referral to meet with Spectrum Health’s cardiothoracic surgeons to discuss coronary artery bypass grafting.

To keep Boismier’s care close to home, John Heiser, MD, chief of cardiothoracic surgery, arranged an office visit at the new Specialty Care Clinic in Muskegon, Michigan.

There, on March 17, Boismier underwent an echocardiogram and surgical evaluation by Dr. Heiser, who determined that open heart surgery would be the best treatment option.

“It was urgent,” Dr. Heiser said. “With a lesion like this and no symptoms, he probably would have no warning if the blockage caused a heart attack. And he would probably die at home before he could get treatment.”

The team scheduled Boismier’s surgery for March 24.

They also set up a virtual appointment for March 18, giving Boismier a chance to meet with cardiothoracic surgeon Justin Fanning, MD, ahead of time. The team also ordered pre-operative labs and chest X-rays, which were completed at the Integrated Care Campus just downstairs.

Boismier also had a virtual preoperative education appointment with Cardiothoracic Surgery Nurse Educator Heather Bolhuis, RN, who provided him with important information about what to do the night before surgery and what to expect during and after surgery.

Everything was done with extraordinary speed, said Dr. Heiser.

Boismier went from test results to surgery in 13 days, with appointments happening virtually or at nursing campuses near his home.

Surgery and rehabilitation

dr. Fanning performed Boismier’s surgery at Spectrum Health Hospitals Fred and Lena Meijer Heart Center in Grand Rapids.

Boismier underwent coronary artery bypass grafting, in which Dr. Fanning used the left internal mammary artery to bypass a blockage in the left anterior descending artery. The team also fitted Boismier with a pacemaker to help regulate his heart rate.

Boismier was impressed by the speed with which he went from testing to operation. But after that, he was also surprised by the pace of recovery and the rehabilitation process.

“Even on that first day, I was sure on my feet and could walk a little,” he said. “I could use the toilet by myself and take a few steps in the hall.”

Patients usually stay in the hospital for five to seven days after open heart surgery, gradually increasing their daily activity.

“After the hospital stay, we send them home with a walking map that we want them to progress through,” said Bolhuis, who helped care for Boismier.

After heart surgery patients return home, “we like them to have someone to stay with them for the first week, 24/7, in case there are complications,” Bolhuis said.

Each patient’s progress must be carefully monitored.

“The nurses will visit the patient’s home three days in the first week to make sure they are healing properly, two days in the second week and one day in the third week,” she said. “He will see his surgeon in the fourth week.”

At that point, Boismier moved on to the next phase of the weaning process. This key component of recovery is also offered in Muskegon, which spared Boismier the drive to Grand Rapids.

There, he works out several times a week with rehabilitation experts, using an exercise bike and treadmill under the watchful eye of team members.

This local care probably leads to better outcomes for patients undergoing surgery, Dr. Heiser said.

“The more practical we can make rehabilitation, the more likely it is that the patient will be able to follow through and achieve optimal recovery,” he said.

Finding support

Team members are always aware that patients who undergo major heart surgery may face a higher risk of depression.

Boismier, who has a doctorate in psychology and retired as an engineer from General Dynamics in 2007, knew that.

And he had a plan.

First of all, he used the support of his wife, children and grandchildren. He has also long believed that an active life and multiple interests are the key to emotional resilience. He is a passionate photographer.

After the operation, he faced some difficult moments.

“There were two or three occasions where I thought I might go into something like depression,” he said.

He was engaged in photography, painting butterflies and dragonflies, his favorite subjects. He enjoys editing digital images on his computer, but is also eager to get out into nature.

“I’m out in the field a lot, in natural areas that are beautiful, with flowers and ponds,” he said.

Bolhuis helps families understand that there is a component to psychological recovery after surgery that many do not expect.

“It’s best to let patients go through all these emotions,” she said. “After all, they faced their own mortality. But if it persists, it’s important to talk to their primary care physician. They may need medication or some other treatment to feel better.”

The more likely effect is that they are much happier.

“People often didn’t realize the effect the lockdown had on them,” she said. “After surgery, they have better blood flow and feel much better—especially when they walk or exercise.”

‘Good health’

The most important thing a person can do is seek care as soon as any symptoms appear, including chest pain and pain in the jaw, neck, back or arms, Dr. Heiser said.

Although Boismier’s symptoms were not severe, people are usually aware that they have a problem, Dr. Heiser said.

“They should get tests and exams until they know what’s causing the symptoms,” he said.

It would be difficult to overemphasize the importance of heart health awareness.

Heart disease remains the leading killer in the US, claiming an estimated 659,000 lives annually.

If surgery is necessary, there are many reasons for optimism. Recovery is scary, but the success rate is impressive.

About 95% of these bypasses remain effective 15 years later, Dr. Heiser said.

“People do very well in the long run,” he said.

He is glad that Boismier received much of this vital care in a place close to home.

“We want to make it easier for patients to stay in good health,” said Dr. Heiser