Tada! First of all, thank you guys for praying for me, and thank you for keeping me in your thoughts. I know, because you’ve been telling me, messaging me, asking me if I’ve had the operation or if I have the schedule already. I felt all the love and care. *gives out hugs*
It’s been 67 days since I posted about the “state of my heart” and now, guys, it’s t minus 10 days to Z-day. Again, I say I’m glad I opened up about my condition. It has helped me to still work full-time, with some adjustments, and stay as normal as I can (apart from missing the traveling, tennis, swimming, dancing, and some other stuff – waaaahhhh!!!). And now I’m scheduled to undergo my CABG (coronary artery bypass graft) procedure on Jan 16 at the Philippine Heart Center (PHC).
It did take a while to get through all the hurdles to get to this stage (whew! *wipes forehead*). I’ll tell you more about it later at a separate section of this blog.
Hospital Days Ahead
The CABG surgery typically takes between 3 to 6 hours under general anesthesia. I will get an incision on my chest along the breastbone and my rib cage will be opened to expose my heart (makita kaya nila yung TOTGA ko dun? Secret na lang Doc, ha). One of the doctors said I qualify for a beating heart procedure because of my general health condition. But otherwise, I need to be connected to a heart-lung machine to take over the pumping and breathing functions during surgery. I really don’t know yet which of these will actually happen. Basically, CABG means that they will harvest blood vessels from inside the chest wall (internal mammary artery) and/or the lower leg (sa mga fans ng legs ko, sorry, babye na. O, meron talagang fans yan, wag kayong ano!), and “stitch” these into my heart’s vessels to make like “flyovers” to “bypass” the offensive blockages (in my case 3). (Kasi naman, hanggang sa puso ko, may traffic e. *hugot*)
I will spend some time in the ICU, then the post-surgical recovery unit, before being moved to a private room where I’ll spend the next few days, maybe a week, plus minus a few days, recovering, and trying to get back to my normal self after the procedure. There will be some vitals monitoring, medication, pain management, rehab exercises and probably a cranky version of me (si Abet v1.5 – pagbigyan po natin sya, minsan-minsan lang yan lumalabas) during those hospital days.
Eto po, pakiusap. Please do not feel obligated to come visit me in the hospital at those times. Promise talaga, I will not think any less of you if I don’t get a visit. Please understand that it is my choice to allow only my immediate family and my closest friends physical access to me at those times. Plus of course, my health care providers.
Should you need to relay a message to me at those times, well, you already know that there are now various means, including digital methods (Please just don’t be too electronically annoying. Peace!). But I just can’t promise to read and respond to the messages especially while I’m unconscious or something (ngi, matakot kayo pag nag-respond ako, ganun!). The other way to reach me will be through my secretary Sherlaine Alvior (6288827, firstname.lastname@example.org, for business matters) or through my best friend Nona. Request ko lang, please spare my family from too much bother. They are great folks but are really not Manila people so I don’t want them stressed out any further by these (I’m serious about this po. Taray!).
Now, as promised earlier, let me tell you about the Philhealth Z Benefit. It’s the matter that took a while to accomplish before I got scheduled for CABG. Most of the information here is from the patient literature and advice I received from the Philippine Heart Center on the subject. I’m not officially speaking in behalf of anyone, I am just sharing it with you out of my experience, in case you, or someone you know, might need it too (we never know, di ba nga, parang ako?). Note though, that applications for the benefit are evaluated on a case-to-case basis, so these may or may not all apply to each specific case. Patients need to undergo a stringent clinical screening and approval process. To qualify, the patient must not have had severe angina, no previous cardiac surgery or cardiac intervention such as angioplasty or stenting. Patients with a lower mortality risk score will have a higher chance of approval. The evaluation is handled by a panel, and it would be best to provide as detailed information as possible during the application process. (In my case, it helped that I kept copies of my previous medical and health check up results handy for discussion with the health professionals.)
The Z Benefit Package is officially titled “Clinical Pathway for Standard Risk Elective CABG Surgery”. It is a Philhealth supported process for the treatment of qualified member patients with CAD (coronary artery disease) who need to undergo elective non-emergency CABG surgery.
I don’t know when this Philhealth benefit started, but they said it’s relatively new, and as of now, available only at the Philippine Heart Center and several other accredited hospitals (Not in St Luke’s, not in Makati Med. I’m not sure where else it is available. I think there are provincial hospitals as well. Ayan, how informative naman, Abet. Sorry.). It is called the Z benefit because if we were to rank illnesses from A to Z, based on gravity, those that will require prolonged hospitalization and most expensive treatments will be classified as “Z”, i.e., catastrophic, like CAD. And these are the types that Philhealth wants to address with the Z benefit. If a patient is qualified, Philhealth shoulders Php 500K of the cost and the patient “co-shares” the rest of the expenses.
The package covers hospital services such as professional fees, room and board, medicines, lab exams, operating room fees, and other mandatory medical requirements per illness.
The process involves inpatient and outpatient aspects. Outpatient phases include the pre-operative evaluation supervised by a primary cardiologist. In my case, I had to undergo and submit the following:
- A coronary angiogram within 1 year (with the results CD) – this was actually how I found out I needed CABG
- 2D echo results within 6 months (with CD too)
- ECG with the tracings and results (within 3 months)
- Chest x-ray (PA) official results (within 6 months) – no need to submit the plate
- Complete blood count (CBC), creatinine, fasting blood sugar (FBS) test results – within 3 months
- Blood typing
- Clinical abstract – in my case, this was issued by Philippine Heart Center
And because I am a type 2 diabetic, I also had the following:
- Carotid duplex scan (within 6 months)
- HBA1C (within 3 months)
For the Philhealth requirements, the following are needed:
- Member Data Record
- Certificate of Contributions (most recent 12 months, from employer) – if self-paying, submit the Official Receipts
- Original Copy of Philhealth Claims Form 1 (CF1) – c/o member and employer
- Original Copy of Philhealth Claims Form 2 (CF2) – c/o the hospital
- Pre-authorization Checklist – application form for the Z benefit
- Preoperative Evaluation Checklist – to be accomplished by you, your cardiologist and surgeon
- Member Empowerment Form – to acknowledge the information received and provide consent on access by Philhealth and your healthcare providers to your health records
- Commitment Form – it’s like a waiver that you sign after the interview
The inpatient phase is the operative and immediate post-operative stage of the process, where the patient’s case will be managed by a multi-disciplinary team. In the case of private patients, the attending cardiologist and surgeon will be the patient’s choice.
The outpatient aspect also includes the recovery process after being discharged from the hospital, where the patient continues physical exercises and home-based therapy, while keeping watch on possible infections indicated by high fever, fast heart beats, bleeding, pains on the operative wounds, and other unusual symptoms.
In general, they say it takes from 6 to 12 weeks for a CABG patient to fully recover and receive clearance from the doctors to return to work. It all depends on how each patient responds to specific treatments and rehabilitation routines.
Evaluation for Z Benefit included an interview by a member of the cardiac unit in the hospital.
The application needs several layers of approval – the patient’s consent, next of kin, primary cardiologist, surgeon, the social service desk, the Director of the PHC, Philhealth officials, etc.
There is an office at the Philippine Heart Center, the Clinical Cardiology Division, that handles the Z benefit applications. It’s at the 2nd floor of the Medical Arts Building, open Monday to Friday, 7am to 4pm. The lady that assisted me there is very nice, remembering names, faces and cases even if she has only met them once. She recognized me even if she sees me somewhere in PHC other than the Z benefit office.
Once the Philhealth approves, the patient will receive notification via SMS and a case manager will be assigned.
Since Z is a co-pay sharing arrangement with Philhealth, the patient has to fully pay his share upon admission to the hospital. PHC only accepts cash or manager’s check.
LeZZ Do It!
This is it for now, folks. As you can see I’m trying to make light of this. We each have our own perspectives on the matter. Some see it as serious and life-threatening, while some might just brush it off as something routine, even trivial. But I will be dishonest if I claim that I am not scared a bit. Yes, I am scared, but I’m really trying to be brave about it. What did somebody say? “Courage is not the absence of fear, but something something…” Who said that ba? Well, let me say,
“Courage is not the absence of fear, but the determination to go on despite its presence.”
I know that I’ll be in good hands and God will take care of me and people around me.
Hinga lang, laban lang. Take care, guys, stay healthy, no worries, and Z you soon! Abet v2.0 coming.