Under Pressure Overcoming Obstacles–Again

Martin Santos is no stranger to the medical malady. At 19, a strep-throat infection led to a disease that caused his kidneys to begin shutting down. At 36, he needed a new kidney, a gift of life that came from his wife, Esther. At 55, despite unrelenting adherence to a strict diet and plenty of exercise, he suffered a massive heart attack.

But with every setback he’s encountered, Martin emerged, more determined than ever to be healthy, positive and strong. “It’s not the end of the world. It’s a second chance,” says the Vacaville resident. “It’s a blessing. You’ve got to move on.”

His wife, Esther, agrees. “You’ve got to have hope. You can’t sit around feeling sorry for yourself.”

Sept. 29, 2012, was a busy Saturday for the Santos family. First a soccer game for 6-year-old grandson Isaiah and then a family barbecue to celebrate their daughter-in-law’s birthday. Martin planned to veer off his diet that day, looking forward to a rare splurge. But once at his son Issac’s house, he started feeling light-headed and woozy; he told Esther he needed to go home and lie down. “Fine,” she said.

When he ran into Rosie, his daughter-in-law, on the way to his car, she noticed something was amiss. “He looked awful,” she told Esther a few minutes later. “You should call him to make sure he made it home.”

He never did. In the car on the way, Martin started to sweat profusely and he got the chills.

Martin is enjoying life, and reveling in his cardiac rehab classes in NorthBay Medical Center.

When he felt his chest clench, he knew something was really wrong. “I felt like my heart was a water balloon and someone was trying to squeeze all the water out of it.”

Instead, he drove to NorthBay VacaValley Hospital and walked right into the Emergency Department. “They took one look at me and got me in a wheelchair.”

Within minutes, an EKG confirmed Martin was having a major heart attack. He was whisked to NorthBay Medical Center, the only receiving center for chest pain in Solano County, where Martin could receive immediate attention at a time when every minute matters.

His first stop after the Emergency Department was the cardiac catheterization lab where cardiologist Benjamin Romick, M.D., valiantly tried to open the blockage using endovascular procedures. It wasn’t enough. Surgeons Rob Klingman and Seph Naficy were called into action.

Dr. Klingman decided to perform “beating heart surgery.” Instead of using the traditional method of stopping Martin’s heart in order to perform surgery, the muscle continued to beat while Dr. Klingman and Dr. Naficy worked in tandem to perform a double bypass.

“In all cases, beating heart surgery is a good option, but in high-risk cases, it’s the very best choice,” explains Dr. Klingman.

“You don’t have to use blood thinners as much, and you don’t have to put big tubes into the blood vessels, which can be problematic,” he says. “With beating heart surgery, you decrease the risk of stroke, kidney failure and other issues after surgery.”

In addition to end-stage renal disease, Martin also had hypertension, and high cholesterol levels, says Dr. Naficy.

The team had to leap into motion quickly.

While nurses/first assistants Dan Hartley and Suzann Gourieux worked to extract a vein from Martin’s leg, Drs. Naficy and Klingman concentrated on removing an artery from the chest wall. Both would be instrumental in bypassing the blocked arteries.

“It takes a lot of teamwork just to take a vein. There’s a lot of precision involved with the whole team,” says Dr. Klingman.

A perfusionist used a Cell Saver machine to recirculate Martin’s own blood, so little or no transfusion would be needed.

Anesthesiologist Filip Roos, M.D., monitored multiple points of data and vitals, which were measured and displayed by catheters placed in Martin’s heart and arteries.

He also kept his eye on images from the Transesophageal Echocardiogram, or TEE. By slipping a scope down Martin’s throat, he was able to let everyone in the room see the very best images of the heart from the advantageous location inside the esophagus.

Very fine needles are used for sutures—so small they can’t be seen by the naked eye, says Dr. Klingman. A loop is used to magnify them 3.5 times their size.

Each person in the room—as many as seven or eight at a time—knew their job and the risks.

“I’ve practiced this kind of medicine in very large hospitals, where they do 1,600 open heart surgeries a year, but I prefer doing this type of surgery at a smaller institution because I get to know the team very well. We know how to communicate when things are urgent,” says Dr. Klingman. “We also have more ability to follow up with the patient.”

Martin doesn’t remember much after arriving at the Fairfield hospital, or much about his recovery in the ICU where he spent three days. He does remember his last two days in the hospital, especially the people he met before his discharge.

“I know we’ve been blessed with great doctors,” he says. “There were so many caring staff members. They made sure at every step that I knew what was going on.”

While Martin and Esther encountered dozens of nurses, techs and other staff members, a few stand out, such as Amy Ziegler, a nurse practitioner, whose job is to look out for cardiac care patients, from the moment their surgery is complete until they leave for home.

“Being a kidney transplant recipient, Mr. Santos had special medication needs, so I worked with a nephrologist, Dr. Oleg Rubin, to coordinate his post-operative medications to help in his recovery,” she remembers.

Of course, nothing compares to the value of having a solid family member at the bedside, being the patient’s eyes and ears, says Amy. “Having his wife Esther there was pivotal—she was a rock, very calm and grounded and reassuring during what was certainly a difficult time for him.”

After 37 years of marriage, Esther rolls with the punches. “I learned a long time ago not to panic,” she says with a smile. “I just try to stay calm and learn as much as I can. I think the doctors appreciate that and share more with me because they trust I can handle it.”

In the first weeks of recovery, Esther made sure Martin got plenty of rest. She even posted a sign outside their Vacaville home for potential visitors: “Thank you for all your prayers… Martin is doing well, but at this time no visitors. Thank you for your understanding.” Courteous friends left notes of encouragement.

Today, Martin is enjoying life, and reveling in his cardiac rehab classes in NorthBay Medical Center. “I love being active and moving around,” says the retired postal worker who used to walk about seven miles every day. “It just gives me a boost of energy.”

Esther continues to prepare heart-healthy—and kidney-healthy—meals for him, a special diet that is devoid of sodium and sugar. Martin’s diet is no different than the diet he’s been on since his kidneys first failed.

“I learned a long time ago how to cook for him, so he could be as healthy as possible,” says Esther. “You have to be creative sometimes, or it gets boring, but I’ve learned.”

“Well, yes, my food is bland,” Martin admits, “but she finds ways to spice it up. Lots of garlic, pepper, rosemary and our friend, Mrs. Dash.”

In fact, the couple’s cheerful kitchen is decorated with red chili peppers. “It did take about a year to get used to it,” Esther remembers, “but even our children ate that way. And now if they have fast food, it tastes too salty to them.”

She knows how difficult it can be at first, to make the adjustment toward cooking for someone who cannot consume salt or sugar, so she offers some of her favorite tips and recipes.

Martin Santos and his wife Esther proudly show off the recovery pillow he used after his open heart surgery. It was signed by NorthBay staff who worked with the Santos family during his recovery.

Grilled Bass Filet

In a zip-lock bag, place: 1lb of bass filets, 1 tbsp olive oil,
a dash of fresh rosemary, ¼ tsp lemon pepper, ¼ tsp garlic and 2 tbsps of lemon juice.

Marinate for 2 hours.

Grill on barbecue, 4 minutes on each side.

Top with fresh diced tomatoes and avocado.

Spicy Chicken

On the bottom of a pan: line six boneless, skinless thighs.

Cover them with the following: half an onion, cut in fourths; ½ tsp garlic; ½ tsp pepper; two bay leaves; three fresh jalapeño peppers, cut in half long-ways (leave seeds in if you want it spicy); an 8 oz. can black olives, drained; 1 c uncooked baby carrots; 1 c raisins; 8 oz. low-salt tomato sauce, 8 oz. water.

Cover pan and cook over medium heat for 30 minutes. Enjoy over steamed rice.

Albóndigas (Meatball Soup)

Bring 6 quarts of water to a boil.

In a separate bowl, mix together 1 pound of lean ground beef or turkey, an egg, ¼ tsp fresh oregano, ¼ tsp fresh mint, half of a diced tomato; half of a diced onion; ¼ tsp pepper, ¼ tsp garlic and ¼ c of rice and form into small or medium-sized meatballs.

Add meatballs to boiling water, then add in another ¼ tsp pepper, ¼ tsp oregano, ½ tsp mint, ¼ tsp of garlic, the other half of the diced tomato, the other half of the onion, and another ¼ c of rice.

In addition, add two potatoes, cut into fourths, 1 c of baby carrots, 1 fresh squash, yellow or green, cut into slices, and 1 c of fresh spinach.

Cook for another 30 minutes, or until potatoes are done.

Spicy option: Add hot sauce to taste.

Esther’s Tips

Always buy fresh fruits and vegetables.

Don’t buy vegetables in cans; there’s so much salt and preservatives.

Limit the amount of meat, but if you want protein, use more chicken and fish.

Shop for groceries at least every other day because it’s the only way to make sure the vegetables and fruit are as fresh as can be.

When eating fruits and vegetables, leave the skin on because it’s rich in nutrients.

Mrs. Dash is a great way to add some spice without the salt.

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