‘It was urgent’ | Health Beat

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

He had issues with chest pain on and off in the past, but nothing that led to major concerns.

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

Dr. Bernath threaded a catheter deep into his heart’s chambers and blood vessels, evaluating him for coronary artery disease, valvular heart disease and congestive heart failure.

While Boismier may not have been concerned 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 a widowmaker—was 95% obstructed,” Boismier, 78, said.

The widowmaker refers to a significant blockage in the heart’s left anterior descending artery.

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

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

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

“It was urgent,” Dr. Heiser said. “With this kind of lesion and no symptoms, it’s likely that he would have no warning when the blockage caused a heart attack. And he probably would die at home before he could get treatment.”

The team scheduled Boismier’s surgery for March 24.

They also arranged for a March 18 virtual appointment, giving Boismier the opportunity to meet in advance with cardiothoracic surgeon Justin Fanning, MD. The team ordered pre-op labs and chest X-rays, too, which were completed at the Integrated Care Campus right down the road.

Boismier also had a preoperative education appointment virtually with cardiothoracic surgery nurse educator Heather Bolhuis, RN, who provided important information about what he should do the night before surgery and what to expect during and after surgery.

It was all done in remarkable speed, Dr. Heiser said.

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

Surgery and rehab

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

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

Boismier was impressed with how quickly he’d moved from testing to surgery. But afterward, he also felt surprised at the pace of the recovery and the rehab process.

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

Patients typically 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 chart we want them to progress through,” said Bolhuis, who helped care for Boismier.

Once heart surgery patients return home, “we like them to have someone to stay with them for the first week, 24/7, in case there’s a complication,” Bolhuis said.

Each patient’s progress must be carefully monitored.

“Visiting nurses will come to the patient’s home three days the first week to make sure they are healing as they should, two days the second week, and one day the third week,” she said. “On the fourth week, they’ll follow up with their surgeon.”

At that point, Boismier switched to the next phase of the rehab process. This crucial component of recovery is also offered in Muskegon, which spared Boismier the drive to Grand Rapids.

There, he is working out several times a week with rehab specialists, using a stationary bicycle and treadmill under the watchful eyes of the team members.

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

“The more convenient we can make rehab, the more likely it is the patient will be able to follow through, making an optimal recovery,” he said.

Finding support

Team members are ever mindful that patients who undergo major heart surgery may face higher risk of depression.

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

And he had a plan.

First, he tapped into the support of his wife, children and grandchildren. He has also long believed that an active life and plenty of interests are the key to emotional resiliency. He’s an avid photographer.

After surgery, he faced a few difficult moments.

“There were two or three occasions where I thought I could be slipping into something like depression,” he said.

He leaned into his photography, taking pictures of butterflies and dragonflies, his favorite subjects. He enjoys editing the digital images on his computer, but he’s also eager to get 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 there’s a component of psychological recovery after surgery that many aren’t expecting.

“The best thing is to let patients go through all those emotions,” she said. “After all, they’ve had a brush with their mortality. But if it lingers, it’s important to talk to their primary care doctor. They may need medication or other treatment to feel better.”

A more likely effect is that they are much happier.

“Often, people didn’t realize the impact the blockage had on them,” she said. “After surgery, they’ve got better blood flow and feel so much better—especially when they walk or exercise.”

‘In good health’

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

While Boismier’s symptoms weren’t pronounced, people are usually cognizant that they’re having some troubles, Dr. Heiser said.

“They should get tests and a workup until they know what is causing any symptoms,” he said.

It would be hard to overstate the importance of awareness about heart health.

Heart disease remains the leading killer in the U.S., taking an estimated 659,000 lives annually.

If surgery is required, there are plenty of reasons to be upbeat. The recovery is daunting, but the success rate is impressive.

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

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

He’s pleased that Boismier received much of this vital care at a location close to home.

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