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Andrew Tsamis, 62, of suburban Chicago appeared to be the perfect picture of health. A weight lifter who could at one time bench-press over 400 pounds, he had lifted much of his life, as well as served in the Green Berets — an elite special force of the military that requires soldiers to pass grueling physical tests to be accepted into their ranks.
On Feb. 19, 2003, Andrew, who owns HI-Tech Automotive in Mokena, Ill., went to an auto show at the McCormick Place Convention Center in Chicago with his children, daughter-in-law, son-in-law and grandson. That night was very cold, so they jogged into the building from a nearby parking lot.
"When I came inside the entrance, I was having a very hard time breathing, but figured it was due to the cold," says Andrew. He and his family enjoyed the show, and when it was over, once again jogged out to the parking lot.
"This time, I was so short of breath, I wondered if I would I make it to the car," he says. "We drove in two cars, and my daughter's was closer, so I went with her."
Andrew chose not to tell his wife or children what had happened, but instead went to the gym the next day and ran the stairs to see if the shortness of breath returned. It did, so the following day, a Monday, he called a local cardiologist who performed tests that lasted from 5 p.m. until 4 a.m. On Tuesday, he was referred to yet another care center for testing, then went home and waited for the results.
"On Friday I got a call and they said I was fine," says Andrew. "'No way,' I thought. I knew something was wrong."
Earlier in the year, Andrew had scheduled an unrelated appointment at Mayo Clinic, so he decided to wait for that appointment, which was nearly a month away, to inquire about the problem.
"At Mayo, they put me on a treadmill," says Andrew. "I wasn't on it very long at all and one of my doctors, Dr. Rodriguez, said, 'I want you to stop right now' and he gave me water. I had shortness of breath, but otherwise felt okay."
Andrew knew something was wrong, but was stunned to learn how serious his condition really was.
"The doctor asked, 'Where is your wife?' He went out and got her, and when she came in the room, he said, 'Your husband has to go to the hospital now,'" says Andrew. "I was going to drive, but it was serious enough that he had an ambulance take me and my wife across town."
When Andrew got to the hospital, tests confirmed he had coronary blockage and had to be operated on soon. Andrew and his wife tried to grasp the news.
Next, Andrew was introduced to Thoralf M. Sundt III, M.D., the Mayo Clinic physician who would be his surgeon.
"I will never forget — it was a Friday and I was scheduled for surgery that following Friday," says Andrew. "My wife asked Dr. Sundt, 'Please, can you do it sooner?' He put his arm around her and said, 'I will do it on Monday.'"
Dr. Sundt describes Andrew's condition as a silent disease, and stresses that it is important to look into any unusual symptoms one may be having.
"Mr. Tsamis had no known risk factors," says Dr. Sundt. "He took care of himself, was a nonsmoker and didn't have hypertension or high cholesterol. For men and women in his same age group who otherwise appear healthy, it is very easy to pass these things off."
Andrew agrees that the problem could have been easy to ignore. "If I didn't have that appointment already set up at Mayo, I could have easily said, 'Oh well, I guess I'm fine.' But I knew something was wrong. If I hadn't gone to that appointment, I doubt I'd be here today."
Dr. Sundt chose off-pump bypass surgery, also known as "beating heart" surgery for Andrew, in part because his blood vessels were large and generally healthy except for the specific areas of critical narrowing. He also chose to use all arterial grafts, taken from Andrew's chest.
"The blood vessels on the heart have branches like the branches on a tree. His blockages were up high, close to the main trunk" says Dr. Sundt. "Because of the location of the stenosis and the size of the vessels beyond, off-pump bypass was selected as the best option."
An off-pump bypass is done without a heart-lung machine. Special devices stabilize the heart during surgery. It is considered to be less invasive than traditional bypass surgery, and some studies suggest this procedure has less chance for kidney complications and postoperative bleeding, and may result in a quicker recovery.
However, Dr. Sundt emphasizes that while off-pump bypass is a valuable option, it is not for everyone. Numerous factors must be considered, particularly the condition of the coronary vessels and location of the blockages. Mayo Clinic first perfected the use of the pump, but has now embraced surgery without the pump when appropriate.
During surgery, Andrew's family gathered in the waiting room, and they told him later they felt fully supported by Mayo staff during this difficult time.
"I was in surgery for seven hours, and every hour, someone would tell my family what was going on," says Andrew. "If they didn't know, they would find out what was happening. Everyone was kind and helpful."
The surgery went well, and Andrew was moved back into his hospital room to begin the recovery process.
"All the doctors and nurses told me not to get discouraged," says Andrew. "It was a big operation and it would have been easy to get depressed. There were some difficult times during recovery, but it helped to remember what everyone had said."
There was another piece of valuable advice that Andrew remembers and has, literally, taken it to heart.
"I remember Dr. Sundt saying, 'You look like you work out,' and I said that I did. Then he asked me how often I did cardio [cardiovascular exercise]. Well, the answer was not at all. Then he put his hand on my heart and said, 'Always concentrate on cardio before anything else.' So now, that's what I do."
Andrew's rehab program started in May 2003, which included work on a treadmill, stationary bicycle and curls with 10 pound weights. Today, he continues his exercise routine faithfully, focusing on cardiovascular exercise, such as working out on a treadmill or Stairmaster. He does some weight lifting, but does not lift heavy weights as he did before.
Andrew also feels strongly about his positive experience at Mayo Clinic and the support he and his family received at the time of the surgery and today.
"After the disappointing results I had down here with the other clinic, I now send my whole family to Mayo for checkups," he says. "Also, I almost couldn't believe this, but Dr. Sundt gave me his cell phone number and said to call him any time — and he's called me to see how I am doing. My experience with other doctors at other clinics is that you can't even get them to call you back."
Today, Andrew enjoys spending time with his family, and travels frequently with his wife to Florida, where they have a vacation home. Andrew says he values his time more now, and no longer takes things for granted.
"There's nothing more important than your health," says Andrew. "I've had to make a few changes, like I don't eat red meat any more. But I've learned a lot through this experience — especially that you have to appreciate and enjoy your life."
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