By Laura Goetzinger, The Decorah Newspapers
Two heart attacks, three options and one choice.
That's what Bruce Christopher and his wife, Mary, of Decorah, faced during the summer of 2010.
But rather than taking one of the three options first discussed - stents, open-heart surgery or nothing - the Bruce had an alternative procedure to correct his heart.
Minimally invasive coronary surgery has been offered at Gundersen in La Crosse, Wis. for a little more than two years. That hospital is one of three main facilities to offer the surgery - the others are in Staten Island, N.Y., and Ottawa, Canada.
"Most people don't have the decision," Bruce said. "Probably that's what most people would have like to have. But we debated all summer."
"It (deciding) was something a lot of people don't experience," Mary said. "It was kind of surreal because it is not a typical heart attack story."
The Christophers first read about the surgery from a La Crosse Tribune newspaper article; a billboard near the roller rink south of Decorah advertising the procedure kept it in their minds, the Christophers said.
In November 2010, Bruce was the 64th person to have the surgery performed by Dr. Prem Rabindranauth in La Crosse.
The first time Bruce had a heart attack - it was Thursday, May 13, 2010, he remembers - he woke up in the middle of the night with chest pains.
"I mean, they hurt," he stressed. He took baby aspirins.
The next day it happened again.
Bruce kept the issue to himself, even flying to Massachusetts for a hall of fame event at his old high school with his daughter that weekend.
"I guess I had been planning on going on that trip, so I did," he said.
On Tuesday, after returning from Massachusetts, Bruce went to see Dr. Ignatius Greene, a Gundersen Family Medicine doctor in Ossian, for a check-up related to his borderline diabetes. He said he planned to ask his long-time doctor what a heart attack felt like. He didn't have time.
"The office got a little excited," Bruce said, when they realized the state of his health. He was sent by ambulance to Gundersen's La Crosse hospital.
Mary said Bruce casually told her about the heart attacks then.
"Not knowing anything... Most people can't hardly survive one, not two," she said. "It was scary."
Doctors found a blood clot in his heart and three blocked arteries.
After four days in the hospital, Bruce was sent home for cardiac rehabilitation at Winneshiek Medical Center in Decorah to correct the blood clot. He lost about 20 pounds and passed a stress test.
"I was doing real well," he said.
But during those months, the Christophers debated what the next step should be while on their daily three-mile walks. Bruce said he didn't want stents and didn't want to leave it alone. That meant surgery.
"Of course, no one wants to be opened up," he said. "It (open heart surgery) is pretty routine for doctors. For the average person, that's not routine. It's very traumatic. You think of the worst consequences."
"It's a decision you have to make. The doctors can tell you the options, but you have to make that decision," Bruce said.
After considering the article they saw, the billboard they passed and input from Dr. Greene in Ossian, the Christophers scheduled an appointment to talk with Rabindranauth about the minimally invasive procedure. The surgery was scheduled for Nov. 30, 2010.
The main difference between minimally invasive coronary surgery is the way the doctor accesses the heart, Rabindranauth said.
In minimally invasive heart bypass surgery, the doctor works through a 3- to 4-inch incision between ribs. Traditionally, the chest is split open.
"You think about it, that's very traumatic to a patient because they have to heal that," he said, of the traditional method.
Beyond the incision to enter the chest, the bypass procedure is the same, he said.
"The reason we do it is, of course, the results have been shown to be very good," the doctor said.
Patients who have the minimally invasive surgery heal faster. They average 3.8 days in Gundersen hospital after the procedure; traditional open-heart operations average 5.5 days. They are able to resume their normal activities, like driving, sooner, Rabindranauth said.
When Rabindranauth learned the procedure from a doctor in Staten Island, he said he planned to operate on those needing single bypasses.
"I was a little surprised that we were able to adapt this thing and do multiple bypasses," he said. Bruce had a triple bypass. "That's probably the pleasant surprise for me in all this."
Patients who don't qualify for traditional open-heart procedures can sometimes have the minimally invasive work done.
Rabindranauth estimated he's seen 150 cases at Gundersen in a little more than two years. There have been no major complications or operative mortality, he said. He now teaches the procedure to other cardiac surgeons.
The first night after surgery was painful, Bruce admitted.
"My heart was taking off like a gang buster," he said.
"You could hear it just whosh-a whosh-a whosh-a in there," Mary said. "It was like a washing machine."
The symptom was typical, the Christophers were told.
"It was probably the heart just saying 'I can pump things again,'" Bruce said.
Friday morning, only three days after surgery, Bruce was discharged. He was able to drive the following week.
He again did cardiac rehab at Winneshiek Medical Center.
"The therapists here were just terrific," he said. "I think we're very fortunate in Decorah that we have the medical access we do have, with both Mayo (Clinic Health System) and Gundersen."
They also praised Rabindranauth.
"He's probably on one of the highest pedestals I could put him," Bruce said.
Bruce said he would advise others experiencing health concerns to talk to their doctor immediately, not wait as he did.
"If you have something that's questionable, go in to see the doctor," Bruce said. "Which I didn't do."
"We just feel it changes your way of living, your thoughts on life," Mary said. "A wake-up call of how you have to take care of yourself."