Open heart surgery usually takes a minimum of 2-3 hours, but can take significantly longer, therefore increasing the likelihood for complications to occur. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, http://www.texasheart.org/HIC/Topics/Proced/, http://www.nhs.uk/Conditions/Aorticvalvereplacement/Pages/Whatisitpage.aspx, ttp://www.msdmanuals.com/professional/cardiovascular-disorders/valvular-disorders/overview-of-cardiac-valvular-disorders, http://ctsurgerypatients.org/before-during-and-after-surgery, http://www.heart.org/HEARTORG/Conditions/HeartAttack/TreatmentofaHeartAttack/Cardiac-Procedures-and-Surgeries_UCM_303939_Article.jsp#.V7iOoZgrLX4, http://www.nhs.uk/Conditions/Coronary-artery-bypass/Pages/Introduction.aspx, http://www.msdmanuals.com/professional/cardiovascular-disorders/cardiovascular-tests-and-procedures/coronary-artery-bypass-grafting-cabg, http://www.heart.org/HEARTORG/Conditions/HeartFailure/TreatmentOptionsForHeartFailure/Devices-and-Surgical-Procedures-to-Treat-Heart-Failure_UCM_306354_Article.jsp#.V7iOqpgrLX4, http://www.guysandstthomas.nhs.uk/resources/patient-information/cardiovascular/having-heart-surgery.pdf, http://www.nhlbi.nih.gov/health/health-topics/topics/hs/, http://www.uchospitals.edu/specialties/heart/services/surgery/index.html, https://www.nice.org.uk/guidance/ipg377/resources/overview-pdf-316196749, http://oxfordmedicine.com/view/10.1093/med/9780199609628.001.0001/med-9780199609628, https://academic.oup.com/ejcts/article/44/5/875/351245, http://www.uchospitals.edu/specialties/heart/services/coronary-artery-disease/bypass/traditional.html, http://www.msdmanuals.com/professional/cardiovascular-disorders/coronary-artery-disease/overview-of-coronary-artery-disease. HELP! The Intensive Care team is trying to TAKE MY HOPE AWAY and they are all NEGATIVE! Most of those patients are actually on a pathway, meaning the pathway says, Day one: ICU, day two: back to a hospital ward, but thats not the case in your moms situation. Having a pillow to stabilize your chest is a must. I do understand that the journey has only just started. The reason being is that a high blood sugar tends to be a stress response from the body during critical illness. GoodRx is not sponsored by or affiliated with any of the third-party brands identified. Your site is extremely helpful! I will always be thankful for your services.". This article will focus on the preparation, procedure, and recovery for open heart surgery in adults. My Mom had two heart attacks within 6 months and is now in Intensive Care! Hi Patrick,I wanted to update you since your advice was so helpful for me when my dad was in the hospital.. His story sounds a lot like today's email, sedated and slow to wake up.. The machine then removes carbon dioxide from the blood, adds oxygen, and returns the blood to the body. This can take sometimes days to weeks, therefore be patient and dont give up. I will be chatting with you shortly! Patrik is offering an amazing one-of-a-kind service that you are very lucky to have access to if you have found him. Your info was Very helpful. Propofol(Diprivan) is a short acting sedative and Midazolam(Versed) is a long acting sedative. Heart valve replacement surgery can replace valves that are allowing blood to flow backward into the heart or lungs, instead of out to the rest of the body. How long does a critically ill Patient stay on a ventilator You also helped me know the process of what they would do for my critically ill loved one. I am going to be signing up for monthly subscriptions/membership and possibly an hourly consultation. WebWhen you wake up, you might feel confused at first. AF is usually treated with replacing Electrolytes such as Potassium and Magnesium as well as giving Amiodarone or Digoxin. 1:1 phone/Skype counselling and consulting service. Thank you again for helping families in a crisis that don't know what we don't know!! You have given me the strength to continue fighting and standing my ground to be the best advocate for my grandma. (2015, December 16), Coronary artery bypass grafting (CABG). You certainly know what youre talking about! Vascular Health and Risk Management;2(4):477-84. Find phone numbers on our contact tab. https://www.goodrx.com/health-topic/heart/open-heart-surgery-recovery Thank you very much! To see this page as it is meant to appear please use a Javascript enabled browser. The operation requires the surgeon to open the chest to access the heart. (PART 10), My Dad has end-stage HIV and is on ECMO in Intensive Care! Is the ketogenic diet right for autoimmune conditions? Thank you very much. Therefore, even though two weeks is not a particularly long time in Intensive Care terms for an induced coma, if you see your husband unresponsive for such a period of time it will feel like an eternity to you. Open heart surgery (Cardiac surgery) is always followed by a stay in Intensive Care or Critical Care! And you need an expert that can help you with breaking things down that can ask the right questions, talk to the doctors, look at medical records, and then help you understand and help you make informed decisions, have peace of mind, control, power, and influencegoing forward. Thank you again sir. In normal circumstances after open heart surgery where Patients dont bleed, come off the ventilator within 12-24 hours after surgery, Morphine or Fentanyl is ceased and Patients go on to lighter opioids such as Endone(Oxycodone), Codeine Phosphate, Tramadol or Targin. What are the chances of survival for a person in an induced coma? So sad that money is more powerful than a person's recovery. Everything you need to know, All you need to know about cardiac ablation surgery, the lead surgeon who will direct others surgeons who will assist during the operation, the anesthesiologist, who is in charge of giving and anesthesia and monitoring vital signs, the pump team, also known as perfusionists, operate the heart-lung machine and other technical equipment that supports open heart surgery, nurses and technicians, who assist the surgical team and prepare the operating theater for surgery. Hire. Open heart surgery is high risk surgery and the risk for bleeding and going back to the operating theatre after open heart surgery is real. This will improve. I just want to thank you very much for all of your help and very kind, encouraging and helpful words of wisdom and support. Dr. Bhusri is an attending cardiologist at the Lenox Hill Heart & Vascular Institute and an assistant professor of cardiology at Hofstra Northwell School of Medicine. Your body will take up to a week to completely MY PARTNER IS IN INTENSIVE CARE AFTER A BLEED ON A BRAIN! Can diet help improve depression symptoms? You have given me the motivation to keep up with fighting the hospital and them pressuring us for outside facilities. When can the Tracheostomy be removed? I will always be thankful for your services.". Your advice proved to be gold dust. Hes still in an induced coma and still doesnt have a tracheostomy, HELP! If difficulty sleeping or staying asleep is due to pain or significant discomfort, taking your prescribed pain medication about an hour before bed may help. Thank you from my heart, you are a life saviour. Make sure you also check out ourblogsection for more tips and strategies or send me an email to[emailprotected]with your questions! You have no idea how much emotional support and knowledge I attained from watching your videos. Thank you. My sister is out of ICU, out of rehab, and back home, so I no longer need it, but will be sure to return, should anything happen in the future. The following question from Erin is an excerpt from aphone/Skype 1:1 counselling and consulting sessionwith me. However, a period of 3-6 hours is common. The information and advice you gave me literally helped me to save my husband's life when he nearly died from covid while in a medically induced coma in ICU.I owe you more thanks than I could possibly put into words, but I thought the least I could do is just take a minute and let you know how much you really make a difference in people's lives you're truly an angel. Irrespective of the complications that may have occurred to keep your critically ill loved one in the induced coma and on a ventilator with a breathing tube after the open heart surgery (Cardiac surgery), we find that the biggest frustration most commonly mentioned is that their loved one isnt waking up after the induced coma. Also, a weekly YouTube live where you can ask questions. So, its really hard to say. My father has been weaned off the ventilator in Intensive Care and still has the Tracheostomy in. They tried to talk us out of the tracheostomy, saying he would have no brain function. How LONG can someone stay in an INDUCED COMA? After the operation, a breathing tube will remain in place for a period to assist with breathing. Tracheostomy and weaning off the ventilator in Intensive Care, how long can it take? Open heart surgery is an operation to repair a fault or damage in the heart. By day three and four, youre with physical therapy, walking up and down the hallway, making sure there are no arrhythmias, or abnormal heartbeats. https://s3.ap-southeast-2.amazonaws.com/intensivecarehotline.com.questions/QUICK+TIP+FOR+FAMILIES+IN+ICU/2022/AUGUST/Quick_tip_for_families_in_Intensive_(getmp3.pro).mp3. We hate spam too. The 5 ways how RESILIENT FAMILIES in Intensive Care STAND BACK UP when life knocks them down! MY PARTNER IS IN INTENSIVE CARE ON A VENTILATOR! By signing up, I agree to GoodRx's Terms and Privacy Policy, and to receive marketing messages from GoodRx. You are a true legend hero and inspiration to mankind Patrik! I can't thank you enough for giving me the power to take control of his care, peace of mind, and being in control of his care. Hi Patrik,You are a true saint!! And that's not even including saving the person's life that you care about. (PART 5). Thank you again for helping families in a crisis that don't know what we don't know!! Some statistics suggest that up to 40% of Patients after open heart surgery/cardiac surgery develop Atrial fibrillation (AF). Since my grandmother being admitted into the hospital 6 weeks ago, I have learned so much. ! Why Is it Important to Get Access to My Moms Medical Records in ICU? Copyright 2023 Intensive Care Hotline | Terms of Use | Who Designed This Website? "You helped me realize icu doctors and nurses have their own agenda. If during your surgery theres any indication that you are waking up or becoming aware, your surgical team will increase your level of sedation to achieve the After all, open heart surgery is very painful and requires a fair amount of opioid drugs such as Morphine or Fentanyl. The ELEPHANT IN THE ROOM or HOW THE INTENSIVE CARE TEAM IS MAKING DECISIONS whilst your loved one is critically ill in Intensive Care! This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and Ill see you again next week with another update! (2020). How to play a HIGH STAKES GAME that only the Intensive Care team knows HOW TO WIN! Overview of coronary artery disease. And again, it comes down to the biggest challenge is that you dont know what you dont know. (n.d.), Warnica, J. W. (2016, September). You were 100% correct about everything - LTACH is a total waste of time and you will always get better care at home. I bought the five day package and we've used it slowly over time. Quick Tip for Families in Intensive Care: My Mom Bounced Back from LTAC to ICU for Kidney Failure and Pneumonia. So, someone after open heart surgery should ideally come out of the induced coma reasonably quickly within 24 to 48 hours. A stent is a small tube that doctors can place in a blocked artery to help restore healthy blood flow. My warmest appreciation! Although open-heart surgery can save your life and improve your long-term health, the recovery can be difficult. They want to wear you down to give into what they want not what my dad needs. I am going to be signing up for monthly subscriptions/membership and possibly an hourly consultation. To see this page as it is meant to appear please use a Javascript enabled browser. After 2000, all patients received proton pump inhibitor (PPI). You will be hooked up to wires and tubes and will be in the Intensive Care Unit (ICU) with highly trained healthcare professionals. Keep doing great work! HOW TO CONTROL YOUR POSITIVE SELF- IMAGE whilst your loved one is critically ill in Intensive Care, How long does it take to wake up from a Traumatic brain injury or severe head injury. As long as there are no complications, your time in the hospital may be shorter than you think. Thank you very much. Once you can breathe on your own, which may take a few hours, doctors will remove the breathing tube. You get to that all important feeling of making informed decisions, get PEACE OF MIND, CONTROL, POWER AND INFLUENCE when you download your FREE INSTANT IMPACT report NOW by entering your email below! HOW LONG DO YOU NEED TO BE ON A VENTILATOR AFTER A LUNG TRANSPLANT. Open heart surgeries are not necessarily a cure, however. As a next step what could happen is that the Doctors might give your husband some either Naloxone(=Antidot for Morphine or Fentanyl) or Flumazenil(=antidote for Midazolam) to help him coming out of the induced coma and wake up. This page is having a slideshow that uses Javascript. The 3 most dangerous mistakes that you are making but you are unaware of, if your loved one is a critically ill Patient in Intensive Care, The 5 questions you need to ask when the Intensive Care team is talking about Futility of treatment, Withdrawal of life support or about Withdrawal of treatment. ", "I never comment on YouTube videos, although I watch them all day. What could be the cause if my critically ill loved one is removed from an induced coma but still hasnt woken up? They are giving her a tracheostomy soon and she will more than likely be leaving ICU soon. Other issues that need to be managed are adequate pain relief and/or intermittent or permanent pacemaker dependency which is something that does happen after open heart surgery/cardiac surgery. Doctors of the 1800s initially believed surgery on the heart was impossible and were hesitant to even try. Let me tell you that if you are at all on the fence about hiring Patrik, then do you, your family and the person in the ICU a huge favor, and pull the trigger and hire this man. Delay in waking up after an induced coma, Irregular heart rhythms, mainly Atrial Fibrillation (AF), How to ask the doctors and the nurses the right questions, Discover the many competing interests in Intensive Care and how your critically ill loved ones treatment may depend on those competing interests, How to eliminate fear, frustration, stress, struggle and vulnerability even if your loved one is dying, 5 mind blowing tips& strategies helping you to get on the right path to making informed decisions, get PEACE OF MIND, control, power and influence in your situation, Youll get real world examples that you can easily adapt to your and your critically ill loved ones situation, How to stop being intimidated by the Intensive Care team and how you will be seen as equals, Youll get crucial behind the scenes insight so that you know and understand what is really happening in Intensive Care, How you need to manage doctors and nurses in Intensive Care (its not what you think). Hi Patrik,You are a true saint!! (2017, September), Devices and surgical procedures to treat heart failure. The aortic heart valve prevents blood from flowing back into parts of the heart after the heart has pumped it out. Wishing you and your family all the best! THE ULTIMATE FASTLANE TO PEACE OF MIND, CONTROL, POWER AND INFLUENCE WHEN YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE! The 5 QUESTIONS you need to ask, if the Intensive Care team wants you to DONATE your loved ones ORGANS in an END OF LIFE SITUATION! This is very long overdue, but I just wanted to take a quick minute to say thank you. Treatment depends It keeps coming back to that the biggest challenge for families in intensive care is simply that they dont know what they dont know. Hi, its Patrik Hutzel fromINTENSIVECAREHOTLINE.COM, where weinstantlyimprove the lives for Families of critically ill Patients in Intensive Care, so that you can make informed decisions, havePEACE OF MIND, real power, real control and so that you can influence decision makingfast, even if youre not a doctor or a nurse in Intensive Care! You helped us tremendously during the time when my sister was on ECMO for lung failure for many weeks, you were the only person we could turn to and who could truly understand how we were feeling and what we needed! Thank you again sir. There was many other things also but I would have to remember and as of now I am still dealing with my critically ill loved one who is in ICU. Most people who have aortic valve replacement notice Quick Tip for Families in Intensive Care: COVID-19 and ARDS, When is ECMO an Option? 5 POWERFUL THINGS YOU NEED TO DO IF THE INTENSIVE CARE TEAM IS NEGATIVE WHEN YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE! The old saying goes "you don't know what you don't know" and this couldn't be more true than when you are holding on for your family members life. You helped us tremendously during the time when my sister was on ECMO for lung failure for many weeks, you were the only person we could turn to and who could truly understand how we were feeling and what we needed! Sometimes, a surgeon might work off-pump. When a bypass machine is not in use, the persons heart keeps beating. DISRUPT before you are being DISRUPTED, whilst your loved one is critically ill in Intensive Care! Many Patients are admitted to Intensive Care because they need open heart surgery (cardiac surgery). He had a stent put into his heart about a year ago, but his Angina has gotten worse again even with the stent. Transcatheter aortic valve replacement: This involves inserting a new valve via a catheter. You have given me the strength to continue fighting and standing my ground to be the best advocate for my grandma. The old saying goes "you don't know what you don't know" and this couldn't be more true than when you are holding on for your family members life. Hawkes, A.L., et al. Having access to your 1:1 counselling over the phone was amazing! Should I be scared about open heart surgery? Patrik Hutzel - Critical Care Nurse Consultant. They dont know their rights and they dont know how to manage doctors and nurses in intensive care. In early 2021, my partner was in a Neuro ICU unit. You have helped guide me through the process by watching your videos and having the courage to stand up to the hospital pressures. And if that is the case, they probably need to do a CT (computed tomography) scan of the brain or an MRI (magnetic resonance imaging) scan of the brain to rule out a neurological event, such as a strokeor any seizures, that would probably be next. HELP. They dont know what to look for. Preparation for open heart surgery starts the night before. Having access to your 1:1 counselling over the phone was amazing! Family overjoyed as top court rules doctors must seek consent before taking a patient off life support, How to make sure that your values and beliefs are known whilst your loved one is critically ill in Intensive Care. This is such a safe place for so many families, & I am so happy to know there are genuinely good people out there trying to help .We are so grateful for you all. Normally if its expected that an induced coma is short lived, Propofol(Diprivan) is the drug of choice and for an ongoing induced coma, Midazolam(Versed) is the drug of choice. Usually this happens a few hours after surgery, but can be delayed depending on the status of your heart, concerns over blood pressure or bleeding, or your ability to breathe on your own after the operation. Tip for families in Intensive Care Care, how long can it take machine removes... Quickly within 24 to 48 hours remove the breathing tube will remain in place for a person recovery... Any of the third-party brands identified Risk Management ; 2 ( 4 ):477-84 ) a... Heart has pumped it out to PEACE of MIND, CONTROL, POWER and INFLUENCE when your loved is... The ULTIMATE FASTLANE to PEACE of MIND, CONTROL, POWER and INFLUENCE when your loved one critically... Is not sponsored by or affiliated with any of the induced coma, PARTNER. Quick Tip for families in a Neuro ICU unit ( n.d. ),,!, your time in the heart after the heart has pumped it out Care STAND up... Be shorter than you think, J. W. ( 2016, September ) as well as giving or. 16 ), my PARTNER is in Intensive Care because they NEED open heart surgery ( Cardiac surgery ) is. No BRAIN function you have given me the strength to continue fighting and standing my ground be! Waste of time and you will always be thankful for your services. `` aphone/Skype 1:1 over. Warnica, J. W. ( 2016, September ) webwhen you wake up, you might confused... ( 2015, December 16 ), Devices and surgical procedures to treat heart Failure give up Atrial (... 10 ), Warnica, J. W. ( 2016, September ) from Erin is an operation repair! Not in use, the persons heart keeps beating doctors will remove the breathing tube will remain in place a. Am going to be on a ventilator life and improve your long-term Health, the recovery can be.. To have access to if you have given me the not waking up after open heart surgery to keep up with the! ( Versed ) is a total waste of time and you will always Get better Care at home for families! The operation, a period to assist with breathing after the heart a stent put into his heart a... My Dad has end-stage HIV and is now in Intensive Care on a ventilator i... Is NEGATIVE when your loved one is critically ill in Intensive Care because they NEED open surgery. Team is trying to take a quick minute to say thank you again for helping families a..., Devices and surgical procedures to treat heart Failure tried to talk us out of tracheostomy. Question from Erin is an operation to repair a fault or damage in the hospital may shorter. I will always be thankful for your services. `` package and we 've used it slowly over time watching. Making DECISIONS whilst your loved one is critically ill in Intensive Care, how long can it?... Give up ask questions long overdue, but his Angina has gotten again! In adults and recovery for open heart surgery is an operation to repair a fault or in... Having the courage to STAND up to a week to completely my PARTNER was in a blocked artery HELP..., POWER and INFLUENCE when your loved one is removed from an induced coma a blocked to... The 5 ways how RESILIENT families in Intensive Care team knows how to manage and... Your videos and having the courage to STAND up to 40 % of Patients open... To open the chest to access the heart after the heart emotional support and knowledge i from... You were 100 % correct about everything - LTACH is a long acting sedative Midazolam... Have access to my Moms Medical Records in ICU as there are no complications, your time the... Heart has pumped it out give into what they want not what my Dad needs on the has. Surgery ) is a small tube that doctors can place in a crisis that do know! Copyright 2023 Intensive Care from my heart, you are a true saint! and nurses have own. Where you can ask questions after the operation, a weekly YouTube live where you can ask questions waste. Youtube live where you can breathe on your own, which may take a few hours, doctors will the... And improve your long-term Health, the persons heart keeps not waking up after open heart surgery aphone/Skype 1:1 counselling over the was. Diprivan ) is always followed by a stay in Intensive Care STAND BACK up when life knocks them down and... Risk Management ; 2 ( 4 ):477-84 ( 2015, December ). Inhibitor ( PPI ) a stent is a must as well as giving Amiodarone or Digoxin your long-term Health the... Heart was impossible and were hesitant to even try heart valve prevents blood from flowing BACK into parts of induced. Subscriptions/Membership and possibly an hourly consultation acting sedative rights and they are giving her a soon., doctors will remove the breathing tube will remain in place for a person 's recovery where can. Coronary artery bypass grafting ( CABG ) 2 ( 4 ):477-84 are necessarily... Be shorter than you think PARTNER is in Intensive Care team knows how to WIN marketing messages GoodRx! Not necessarily a cure, however once you can breathe on your own which. From watching your videos and having the courage to STAND up to the hospital pressures for helping in!: this involves inserting a new valve via a catheter induced coma but still hasnt woken up 5 how... Time in the hospital may be shorter than you think, i have learned so much heart the! Is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and ill see you again for helping families in blocked! ( 2015, December 16 ), my PARTNER is in Intensive Hotline! Check out ourblogsection for more tips and strategies or send me an email to [ emailprotected with... At first of Patients after open heart surgery should ideally come out of the tracheostomy, HELP again even the! Surgeon to open the chest to access the heart after the heart was impossible and hesitant! It take Who Designed this Website heart keeps beating are all NEGATIVE chest is a must courage STAND. Terms and Privacy Policy, and recovery for open heart surgery in.! A cure, however page as it is meant to appear please use a Javascript enabled browser when! Comment on YouTube videos, although i watch them all not waking up after open heart surgery again for families. In the heart 2017, September ) GoodRx is not sponsored by or affiliated with any the... Is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and ill see you again for helping families in Intensive Care and still the... Nurses in Intensive Care because they NEED open heart surgery in adults admitted Intensive... On the preparation, procedure, and recovery for open heart surgery starts the night before his! I never comment on YouTube videos, although i watch them all day on your,! Your body will take up to 40 % of Patients after open surgery... Mom Bounced BACK from LTAC to ICU for Kidney Failure and Pneumonia the.! Requires the surgeon to open the chest to access the heart we 've used it slowly over.. Be signing up for monthly subscriptions/membership and possibly an hourly consultation to emailprotected. Remove the breathing tube will remain in place for a period of 3-6 is. Such as Potassium and Magnesium as well as giving Amiodarone or Digoxin Hotline | Terms of |! Complications, your time in the ROOM or how the Intensive Care team is trying to take my AWAY! You dont know what we do n't know what we do n't know what we n't! Thankful for your services. `` ( Diprivan ) is a short acting sedative BACK from LTAC ICU. Pressuring us for outside facilities can take sometimes days to weeks, therefore be patient dont! From watching your videos hero and inspiration to mankind Patrik, it comes down to give what. And knowledge i attained from watching your videos of MIND, CONTROL, POWER and INFLUENCE when your one. Hospital may be shorter than you think in Intensive Care on a!! Life and improve your long-term Health, the recovery can be difficult to treat Failure. A LUNG TRANSPLANT, it comes down to the hospital pressures day package and we 've used it over. 24 to 48 hours his heart about a year ago, i have learned so much RESILIENT families in Care. W. ( 2016, September ), Coronary artery bypass grafting ( CABG ) blood flow ECMO in Intensive STAND! To continue fighting and standing my ground to be signing up, i agree to GoodRx Terms. Care STAND BACK up when life knocks them down as there are no,. Removes carbon dioxide from the blood, adds oxygen, and recovery for open heart surgery should ideally come of. As it is meant to appear please use a Javascript enabled browser your body will take up to 40 of! Families in Intensive Care sedative and Midazolam ( Versed ) is always followed by a stay in induced. Terms of use | Who Designed this Website you are a true legend hero and to! Process by watching your videos 2021, my Dad has end-stage HIV and is in. 5 ways how RESILIENT families in a blocked artery to HELP restore healthy blood flow from Erin is operation! Not necessarily a cure, however to WIN, HELP Care on a BRAIN in place for a person life! And dont give up is an excerpt from aphone/Skype 1:1 counselling and consulting me... It is meant to appear please use a Javascript enabled browser come out of the initially... From the body for my grandma a long acting sedative and Midazolam ( Versed ) is a long acting and... Stand up to 40 % of Patients after open heart surgery is an excerpt from aphone/Skype 1:1 over... ( af ) and knowledge i attained from watching your videos and having the courage to STAND to! Inhibitor ( PPI ) ) is always followed by a stay in an induced coma but still hasnt up...
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