"Heart Surgeon & Mechanic" & Discussions

The Blogger's Note: I found the following joke from the XciteFun.net the other day and forwarded to some cyberspace friends. Little did I expect a strong reaction from the formidably learned medical scientist Dr JB Lim who rubbished the joke would ensue followed by interesting discussions on whether "the heart needs to be stopped before cardiac surgery" and also a misunderstanding between an uncle and his niece which I sincerely hope will be cleared up soon (remembering "blood is thicker than water"). Upon googling, I further discovered that this joke was circulated as early as 2001 in the internet (see http://www.mail-archive.com/jensen-cars@british-steel.org/msg06796.html) or maybe even earlier BUT the name of that particular heart surgeon was never mentioned. It must be the mischievous act of the "joker" who posted this modified version to the XciiteFun.net.

"The Heart Surgeon & The Mechanic"

Real story happened with famous Heart Surgeon Lt. Dr. Nitu Mandke. He had done many heart operations.

A mechanic was removing the cylinder heads from the motor of a car when he spotted the famous heart surgeon in his shop, who was standing off to the side, waiting for the service manager to come to take a look at his car.

The mechanic shouted across the garage, "Hello Doctor! Please come over here for a minute."

The famous surgeon, a bit surprised, walked over to the mechanic.

The mechanic straightened up, wiped his hands on a rag and asked argumentatively, "So doctor, look at this. I also open hearts, take valves out, grind 'em, put in new parts, and when I finish this will work as a new one. So how come you get the big money, when you and me is doing basically the same work?"

The doctor leaned over and whispered to the mechanic...
.
.

"TRY TO DO IT WHEN THE ENGINE IS RUNNING".

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The following emails were received by the blogger and chronologically reproduced word by word without any editing of spelling and/or grammatical errors so as to maintain their originality:

17 June, 2010 2:53 AM

I think that surgeon is talking absolute rubbish. This is the problem with chain-e-mails and Internet stuff coming from unqualified person claiming all sorts of rubbish things to misinform others. I have been getting a lot such ‘medical’, ‘nutrition’ and ‘health’ junk stuff coming from all kinds of people claiming this and that in my e-mail for a long time.

But I just kept quite and do not wish to comment. But I know they write rubbish. Even though the attached article seems just a ‘joke’, still it carries misguided information to others through chain e-mails.

Internet stuff:

The Internet is full of junk stuff. A lot of information is correct and useful, but a lot are all unsubstantiated rubbish. Just claims, and claims, that’s all.

Medical research scientists with credentials and high professional integrity, don’t entertain such stuff without seeing the proper study and literature. They must be peer reviewed papers published in proper international refereed scientific journals. Sorry, we need all that. We don’t rely on claims from the Internet.

As far as I am concerned, I am not the least impressed whether he or she is a professor, a doctor, a scientist, or an engineer who claims this or that? I want to see only his original research publications. So this ‘famous’ Heart Surgeon called Lt. Dr. Nitu Mandke in the article does not impress me the least. So what even if he is a Tan Sri.

The heart must be stopped first:

It is not true that a heart surgeon who performs an open heart surgery can execute a cardiac procedure without first stopping the heart, even though in recent years there seems to be some advances in surgical techniques called keyhole procedures using minimally invasive techniques for some minor repairs to the heart, in which case probably the heart need not be stopped completely, but slowed down considerably. Medically this is called bradycardia. This surgeon who asked the mechanic to ‘try to do it with the engine running’ is talking through his ass-hole.

In almost all cases, the heart surgeon must stop the heart first. He has no choice. He cannot operate when the heart is still beating. They do this by infusing the heart with a solution called a cardioplegia to arrest the heart into asystole in the systole (contraction) stage. There are many types of cardioplegia in use. The composition varies from country to country, and even from centre-to-centre.

Composition:

The main salt that stops the heart is Potassium chloride (KCl). Even during our undergraduate class we already knew about this when we learn about cardiac perfusion in our physiology lectures.

However a cardioplegic solution normally also contains many other salts and cardio-protective substances in them, not just Potassium chloride alone. A typical cardioplegia would contain for instance – Potassium chloride, Mannitol, Magnesium chloride, Procaine, Calcium chloride. This is just one example. There are many others combinations also.

Unsure, even though:

I do not know the exact chemical composition of cardioplegia used by heart surgeons in Malaysia. I am not an expert in perfusion physiology even though I am currently a Special Medical Adviser, and Chief Scientist with an International Pharmaceutical and Nutraceutical Group, and have knowledge in Pharmacology, and Nutraceutical.

But if you are interested, you may contact my youngest brother (Professor Dr) Lim Yew Cheng who is a Mayo Clinic trained Senior Consultant Cardiothoracic and Vascular Surgeon, formerly with the Singapore General Hospital, then at the University of Malaya Medical Centre, and now at Gleneagle Intan Medical Centre in Jalan Ampang, Kuala Lumpur.

He will be able to tell you a lot about various types of cardioplegia in use in various countries since he has performed countless heart operations around the world. He will be able to tell you how the heart is stopped first, and restarted again after the procedure.

His CV is attached. He is a real heart-lung and vascular surgeon with proper qualifications.

Unfortunately this ‘joke’ was sent to me by my niece. She should have consulted her uncle Professor YC Lim, the real heart surgeon first before misleading others.

Lim ju boo
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17 June, 2010 6:30 AM

Dear Dr JB Lim,

Thanks for the lenghtly explanation of an open heart operation.

Can you please explain, or rather, get yr youngest brother, Professor Dr. Lim Yew Cheng, to explain what is an "Off-pump" CABG @ OPCAB?

All this while, I was given the impression that with the latest surgical techniques, an Off-pump coronary artery bypass or "beating heart" surgery can be performed without stopping the heart and without undergoing cardiopulmonary bypass (heart-lung machine) as a treatment for coronary heart disease.

The heart beat of the patient can be reduced medically to as low as 15 beat per minute in order for the cardiac surgeon to be able carried out the delicate operation procedures.

Therefore, if it is true, then I wouldn't write off the Joke as "This surgeon who asked the mechanic to ‘try to do it with the engine running’ is talking through his ass-hole"

http://www.heartsurgeons.com/pr2.html

written by

A grateful OPCAB patient, 2005
The Royal Melbourne Hospital

wise nite owl (Perry Tan)
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17 June, 2010 1:19 PM

Ju Boo,

Thanks for the wonderful write up. I agree fully with you on your views. Sometimes, we need to stop the heart pumping entirely using the heart-lung bypass machine. Sometimes we merely need the keyhole or the catheter procedure. Sometimes we need to slow the heart down using cardioplegia.

Am I right in saying that the surgeon only operates but the other works are done by others?

Is the administration of cardioplegia performed by the anaesthetician or the surgeon?

Who is responsible to handle the heart-lung machine procedure?

I hope you can help me with these questions.

Thanks a lot.

If I am the doctor faced with this mechanics, I will ask him.

May I know how many years you study your mechanics and how many years a surgeon studies for his practice?

I can learn to do your work in 1 month. But can you learn to do my work in 5 years? How about 20 years?

Rgds,

Khoon (Tan Seng Khoon)
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SIDE TRACK:

From: Magdalene Lim
To: T.O. Lau
Date: Thursday, 17 June, 2010, 9:52 PM

Thanks for the rescue. It is too sensitive for me to voice my say.

Therefore, I rather keep my mouth "Zipped", Pardon me to say, my uncle has lost his sense of humour and he is taking seriously those e-mails of which I have forwarded. A silly joke turns out to be a disaster for certain people.

Once again, many thanks. I do appreciate that.

God Bless and have a wonderful night.

Cheers Mag

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From: Tai-Onn Lau
Sent: Thu, June 17, 2010 10:05:40 PM

Dear Mag,

I feel so sorry for causing you chided by your uncle. In fact, that piece of joke about "the surgeon and mechanic" was originated from me forwarding from XciteFun to you all, and I don't understand why he mistook it as from you.

Cheer up, I'm on your side.

Lau
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From: Magdalene Lim
Date: Thursday, 17 June, 2010 11:17 PM

Hi Tai,

Don't feel sorry cos' I am a happy go lucky person. My uncle is too tense and he should learn to relax and take things easy and not too seriously. I am so used to his bombardment and sarcastic remarks without reconsidering other's feelings.

FYI , we called him JUDGE. If, he says the sky is purple, we have to agree. Just kidding!!!!

Anyway, we respect and love him as one of the "BEST", multi-talented, highly knowledgeable, very details and in depth.

Magdalene Lim
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From: David Chen
Date: Thu, 17 Jun 2010 23:26:20 +0800

Prof. perry,

YOU ARE RIGHT IN ONE ASPECT - WITH ONE FORMAT.

DID YOU INCLUDE THE OTHER TWO FORMAT AS WELL IN YOU LETTER OF CONTENT TO JB.

CAN I STILL PROCEED WITH A SUPPORT FOR YOU AND SAY YOU ARE RIGHT?

As a independent observer, and a interested party to the Subject as discussed, the scenario i have is such:

1. Perry says, heart operation can be performed even without the procedure of first stopping the heart. The Heart beat of a patient can be reduced to as 15 beat per minute in order for the Heart Surgeon to proceed with the operation. (one format - with no mention of other methods under other circumstances)

2. Dr JB LIM says, Heart beat for most cases (except for minor repairs to the Heart, slowed down only) must be stop first before an operation proceeds. (two format) Most cases need to be stopped, with the other excetion on Minor which need not be stopped)

3, ts khoon says, sometimes we need to stop the heart pumping-- Sometimes we merely need the key Hole or the catheter procedure--Sometimes we need to slow the heart beat down using cardioplegia. (three format) two cases of heart beat to be stopped inclusive of the other one on minor case which need not be stop.
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Friday, 18 June, 2010 11:46 AM
From: david chen

Dear Lau

This letter is a post mortem between us (on the issue) as discussed. side talk.

Perry was not completely wrong, but partially right.

Can i pass this judgment, as an independent observer.

To me, what ever method is used, as long as it saves life matters,

wishes

david
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Abundance of food ready for party



Balance of food dumped on the soil after the party
One part of the world wasting the food

The other part of the world doesn't have enough food to run their lives

From: JB Lim
Sent: Thursday, 17 Jun, 2010 8: 21 PM

Dear friends,

Someone sent me these pictures recently.

If that ‘famous’ key-hole, sorry I mean ass-hole heart surgeon claims he can fix all those health problems of these rich, obese and partying Arab gluttons after getting a heart attack with his ass-hole surgery, then the world need to kick both these partying Arabs and that surgeon out from decent human society. It shall be directly through their beating ass-holes. There is no room for such people in society. See pictures above.

But if that surgeon can tell the world how to feed all these millions of hungry, starving and malnourished children and adults so as to relieve them of unthinkable misery, abject poverty, inhuman squalor and ill-health so that their hearts can go on beating from day-to-day without having to stop forever, then we will turn his key-hole into The Golden Key to Peace, Health and Happiness for all of us on this Planet. This world does not need ass-hole techniques.

We will all celebrate his true success, his true discovery to Health and Well-Being with 10 Nobel Prizes in Medicine or Physiology instantly. Scroll back upwards to see their miseries.

Fondest Thoughts and Regards

Lim juboo
A Very Depressed and Compassionate Nutritionist and Health Care Provider
My heart truly beats for these children. But My Heart Will Go On - Forever (Theme Song from Titanic). Truly, ‘A song of love is a sad song’. I am crying for them.

(Inserted by the blogger: Click on the underlined to listen to the wonderful song by Celine Dion and watch the video clip of the best-selling movie "Titanic".)
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From: T.O. Lau
Sent: Friday, 18 Jun, 2010 12: 55 AM

Dear Dr JB Lim,

Your humanitarian stand as expressed in this mail is much applauded.

By the way, I believe the joke about "the heart surgeon and the mechanic" was originally circulated by me among your circle of friends. This joke was posted in XciteFun.net by somebody and finding it funny, I took the liberty to forward to you guys although I think some of you have also subscribed to XciteFun.net.

Please don't be hard on your niece Mag. She is innocent. Please don't let your sense of humour diminish and be so serious on everything or anything. Life is short. Be happy.

Thanks for your indulgence.

Best regards,

T O Lau

18/06/2010

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NOTE: THE ‘SAGA’ WILL CONTINUE WITH DR JB LIM’S REPLY ON HEART SURGERIES (OFF-PUMP HEART BYPASS) TO BE POSTED LATER.