Life not easy after heart surgery

By Tri Hafiningsih

JAKARTA (JP): Six-year-old Aji Bangun seems no more physically different from any other boy his age. He is just as active as most of his friends.

But a closer look shows a boy who is actually too small for his age. Weighing a mere 16 kg, Aji's tiny frame is able to squeeze under a low table or hide under a chair. His mother, Rumsinah, and father, Agus, can carry him around with ease.

Aji had heart surgery three years ago. Doctors "sealed" a hole in his heart so that he could survive to live a relatively normal life.

Aji, four-year-old Lusi, nine-year-old Martha and six-year-old Nurul were among the children and adults attending a meeting for post-surgery coronary heart disease (CHD) patients in Jakarta last week.

The meeting, sponsored by Mitra Keluarga Hospital in East Jakarta and Health Care of Australia Group, a foundation managing all Mitra hospitals, was the third of its kind for patients who had heart surgery between 1992 and 1998. The gathering reunited the patients and their relatives with the hospital's administrative staff, doctors and paramedics.

Life was not easy for Aji's parents when they found out that the younger of their two children had a coronary heart ailment three years ago.

"That explained why he got tired easily and turned blue after just a few jumps or running around the house," Rumsinah recalled, adding that the doctors' diagnosis also explained why Aji had never put on weight. He weighed only nine kilograms from when he was 10 months old until his third birthday.

Rumsinah and Agus said they did not know exactly what happened to Aji. "All I knew is that something was wrong with his heart, and that it would cost him his life if he did not have it operated on," Rumsinah said.

Surgeon Triatmo Budiyuwono told the meeting that in most cases, children's heart problems cleared up once they passed the critical post-operation stage. All heart surgery patients, however, bear a common badge: a surgical scar across the chest.

He said parents should not be concerned about whether their children could handle strenuous physical activity.

"They are not sick anymore. They deserve to grow up normally and can be very healthy and strong," he said.

But another doctor, Anna Ulfah Rahayoe, who treated most of the hospital's children patients said that children born with heart ailments should be treated as early as possible to compensate for the impediment of their physical and mental growth development while sick.

Anna reminded parents that their children should continue to undergo regular medical checkups to make sure that they are living a normal life.

The meeting's organizers, who plan to hold similar gatherings in the future, included a discussion to help the participants understand how to lead a healthy and normal life after heart surgery. Other problems related to health care of children with a history of CHD were also touched upon.

Triatmo said that children were able to forget the fact that doctors had cut into their chest to fix their heart but that adults usually could not. Either way, former patients should change their habits after surgery.

"You may have to kick all the bad habits that brought you to the operating room." He said that leading a healthy life was a lifetime commitment: "That is, if you don't want to go back to the operating room for another 'fix up'."

He warned that repeated operations may yield undesirable results.

Triatmo said post-surgery CHD patients and people with no history of heart problems should both pay attention to a number of risk factors.

"If you are a male over 45, a female over 55, have gone through menopause, are a current smoker, have ancestors with a history of heart problems, have a high level of blood cholesterol, a diabetic, suffer from hypertension or on anti- hypertension therapy, then you are at high risk of getting a heart attack in the near future."

Doctor Suharyuni, in charge of the hospital's cardiac rehabilitation program, said his staff had developed an integrated recovery program for post-surgery CHD patients, which usually took at least six months to complete.

"The three-phased program is developed to ensure a thorough recovery for patients, so they can lead a normal life after such trauma," she said.

The first is a recovery phase which takes one to two weeks, starting the moment a patient is moved from the intensive care unit.

The next phase is a treatment period for at least one month. During this phase, a patient undergoes an individual physio- therapy program.

"A patient starts with 'passive' movements, exercised on his hospital bed. When the program is completed, the patient should be able to walk at least 1.5 kilometers with ease," Suharyuni said.

The last phase is a post-treatment period, in which a patient and his family must regularly visit the hospital for "active" exercise programs and consultations with doctors.

For Eri Sumardi, 50, life had just "begun" two years ago after he had coronary by-pass surgery. "I watch my diet, exercise regularly and avoid stress," he said.

Eri has shunned junk food and meat. For exercise, he strolls around the neighborhood every morning. He fasts every two days for his stress management.

"I lost eight kilograms through regular fasting, and more importantly, I always feel cool," he said, adding that he was glad to be a "new" person -- much healthier than he was before his heart attack.