The patient room

After my time in the ICU, they wheeled me into my room. I think the hospital rule has it so you can't be in the OR/ICU for more than 24 hours, but I think I was just over that amount of time. By the time I got to my room, I was fully awake and feeling okay. Trying to get my bearings and remember things I couldn't remember seemed to be more of an issue than the pain.

Dream a little dream.

For the first few days, I was having bad dreams. Weird, gross dreams that involved gross things (I'll spare you the details) that I normally don't dream about. And they were very vivid. I didn't ask the docs about it (maybe I should have), but it seemed to be related to my heavy pain meds. (I think I was on Vicodin). The dreams went away when I stopped taking the heavy stuff. Thankfully.

And then things got complicated.

I would have been home sooner from the hospital, but 1) my surgery was delayed two days and 2) I had some complications.

First, I had post-operative/subcutaneous emphysema. This is where air gets trapped around the lungs as a result of the surgery. More info can be found here. Either I didn't remember or they didn't tell me this could happen. I'm sure it was in the paperwork they handed to me in the two-inch binder, but I wasn't clear as to the complications that might occur. The next time I have any surgery, I will definitely ask the complications that may occur. Obviously, death is the worst of complications. But I wish I would have known what to expect versus learning after the fact. Actually, in order to get the air out, they had to put the tube back in my chest. In the patient room!! Without anesthetic!!! It was the absolute worst pain of my entire life. Either the pain was horrible (which it was) and/or I've never had to experience pain that often in my life. Come to think of it, I haven't had that many "stereotypically" painful experiences in my life: kidney stone, appendicitis, broken bone, gunshot wound. Just your run-of-the-mill sprains and lacerations/stitches. When they put the tube in, and I was yelling out in pain, I could feel the air go from my mouth through my chest/lungs and through the tube out my side. Very weird (and did I mention painful?) sensation.

Next complication: Crepitus. I think this complication sounds like a heavy metal band, don't you? It is defined as "a crackling sound resulting from subcutaneous emphysema, or air trapped in the subcutaneous tissues." When the doctor or I or some other person would press on the skin around my chest, it would feel like "rice krispies". Their words. Another very weird sensation. Mine wasn't a very bad case. You couldn't even see it with your eyes. Some severe cases you can see with your eyes and the patient even has trouble breathing.

Pulmonary edema. According to Wiki, is fluid in the lungs. When they went in on my right side with the surgical instruments, they had to deflate my lung to get to my heart. Crazy. When the surgery was over, they reinflate the lung. However, sometimes the lung doesn't inflate completely. I pictured a pool toy being blown up and part of it is stuck together so that part doesn't inflate. That's basically the idea. I needed to do breathing exercises to help reinflate the lung and, therefore, get the fluid out. Technically speaking, it's called a collapsed lung or pneumothorax.

"Why is daddy glowing??"

I asked at one point, but I don't remember now, but I think I had a total of 13 chest Xrays after surgery. They wanted to check the pulmonary edema and the pneumothorax. This is what kept me from being released. It's also why I wasn't allowed to take a plane ride home. We basically ate our tickets and rented a car. Otherwise, we would have been stuck in Cleveland until I was allowed to get on a plane again...in 6 to 8 weeks.

Stir crazy...and I don't mean the movie.

By the time it was time for me to go, I was really ready to go. Actually, this is one of the few knocks against the Cleveland Clinic. I had to wait on the doc to release me, and I thought I was going to be released in the morning. It was after 1 when we left. I know this is common for most hospitals, but they either need to fix the problem or manage expectations better than they did. After having some rental car problems (some rental places don't take debit cards), we hit the road. I was supposed to get out of the car and walk around every hours, but we still made pretty good time. We really wanted to get home. And we did, finally, on Sunday night. It was awesome/wonderful/emotional to see the kids. My mom (or sister, I don't remember now) made some homemade chicken n' dumplins. It was the best comfort food I have ever had in my life. Thank God we're home.

Random Thoughts, Part 1

Random thoughts and addendums: 

• We never made it to the Rock Hall. Delays. Changes in plans. We had planned to go on Sunday before my surgery, but changed our plans when we learned the Browns game would be letting out and Bruce Springsteen was performing a free concert in downtown Cleveland. Things were hopping in Cleveland this day, and we didn't want to have to deal with the throngs of people. 

• I arrived at the CC on November 4 for my surgery. Standard questions. Vitals. Gowned up. They even shaved my chest. Ready to go. Not yet. A doc and a nurse came in and told me that Dr. M had an emergency come up and that I was going to be bumped till Wed. They said there was a chance that I could get bumped, but I didn't think I'd get bumped TWO days. 

• Since I wasn't having surgery, we had a nice lunch at Claddagh (factoid: they do serve beer on election day in Ohio...not sure if they still prohibit it in Indiana or not).  

• The patient rooms at the CC has 42-inch flat screen TVs. But a lot of the effect was lost because the sound still came out of the crummy, bed-side, drive-in-movie-theater-like speaker. Man, I'm a whiner, don't you think?

• Lots of ways to improve efficiency, even at one of the best hospitals in the world. 

• We had to drive back from Cleveland because I had complications with my lungs. Note: make sure the rental company takes debit cards BEFORE you reserve a car. 

Addendum I

A couple things I forgot to mention from our meeting with Dr. M:

1) He said there's only a small chance (I think he said 10 to 15%) that I'll have to have my valve fixed again during my lifetime. 

2) He said there's a less than 1% chance that they'll get in there and have to replace my valve instead of repairing it. Therefore, he said I needed to choose what type of valve I would like: mechanical or biological. Mechanical would require that I take coumadin (blood thinner) the rest of my life, and be careful not to get too bruised (due to the blood thinner). He also said there would be a 2% chance, each year, of having some sort of issue that would require hospitalization of some sort. The biological (pig valve) is the preferred method these days because there is no need for blood thinner and the overall risk is less than the cumulative risk of the mechanical. Not that I'm going to need it, but I chose the biological. 

Delay of game

Well, I got a call from Dr. M's office last night and learned that my surgery will be bumped until Tuesday. Drat. He didn't get through all his patients/procedures on Friday, which pushes everything back a day. 

There's a chance it could even get moved back up, but we won't know until the last minute (the day before). Stay tuned. 

Meeting the surgeon...

It's been a pretty stressful week, as you can imagine, so we took advantage of our quiet, kid-free accommodations and slept in till late morning. The only thing on our schedule for the day was to meet Dr. Mihaljevic, my surgeon at 1:00. 

As I said in my earlier post, the hotel is very close to the hospital. We left our room around 12:50 and were on the fourth floor of the hospital at 12:55. We, of course, wanted to be on time because the surgeon's time is very limited and we didn't want to miss our chance. As it turns out, he got stuck in surgery and didn't end up seeing Dr. M until 3:00. You would think that the ladies at the desk would have told us that he was running late, but they didn't. Only when we asked did they mention it. Once we found that out, we were able to get a beeper and go down to the cafeteria to get something to eat. 

One of the things Juli and I have been noticing is the variety of types/colors of scrubs at the CC. As in most hospitals, the colors represent the occupation. We're making it a game (trying to pass the time) to guess what color went with what job. One of the reasons this is on Juli's mind is that she will soon be in nursing school and is "upset" that the scrubs the nursing students wear are "clown red". At the CC, we notice a lot of people wearing all white, which, to me, look like they were employed at some sort of mental asylum. Not that I've been to that many mental asylums, but it always seems to be the standard "funny farm" outfit in movies and cartoons alike. 

Bear with me, this IS going somewhere. 

While we we sitting in the cafeteria eating our lunch, I noticed a guy at the table across from me in an all-white outfit. For some reason, I noticed that we was wearing white dress shoes (not tennis shoes). I guess the fact that he was wearing white shoes (and black socks) kind of caught my attention, and I wondered to myself (not aloud) if this guy was an orderly, a nurse, or a janitor. Again, killing time does allows your brain to wander in goofy directions, but I noticed that even the people in the cafeteria had their own colored uniforms. I joked to Juli that they could really make themselves sound important by saying..."Yes, I work at the Cleveland Clinic...(under his breath) in the food court." 

After lunch, we head back upstairs and find out that it won't be too long until we see the surgeon. We get called back, wait in the room for a few minutes, and in walks the surgeon...the same white-shoe, black-sock-wearing man I saw in the cafeteria. I find out later that Juli had seen him walking in, in his all-white garb, and thought he might be a janitor or something. 

Sorry for all the preamble, but here's the important part relating to our meeting with the surgeon:

• Even though we had preconceived notions of this man as anything but a world-class surgeon who probably makes a million dollars per year, he blows us away with his knowledge, his demeanor, and his unassuming personality. He's from Croatia, has a slight accent, but has has an air (but not an arrogance) about him that is very soothing. 

• He said that, after the tests, that they confirmed that the leakage is severe, that I've had this condition for a long time and, as a result, my heart is enlarged. The fact that I'd stopped running for a few months would not have made my heart reduce in size because it's taken years for this to occur. 

• He says that the robotically assisted surgery is even better (with even smaller scars) than the traditional minimally invasive surgery. He also says that one of the great things about mitral valve repair surgery is that it's the only surgery that brings the patient back to his/her normal life expectancy. Other surgeries improve life expectancy, of course, but this one brings it back to normal. After all, the valve is fixed, therefore the heart is fixed. Cured. 

• Once my recovery is over, I can do ANYTHING a normal person can do. I wasn't sure if I was going to run again after the surgery (just to be safe), but there's no reason for me to worry. I think I'm going to register today or tomorrow for the Mini Marathon, which happens in May, but usually sells out in November. 

• Juli and I were talking about this before, so I asked Dr. M to describe how the heart/lung machine works. This may not be 100% medically accurate, but I'll do my best. They run a line in and out of my femoral artery and vein (in my thigh, near the femur). They then inflate a balloon in my aorta, which stops the blood from entering the heart (and the heart from pumping the blood). The heart/lung machine then circulates my own blood in and out, oxygenating in along the way. Then they stop the beating of the heart (kinda tough to operate on a moving object) by  injecting some potassium in/on the heart. Juli asked Dr. M how they keep the heart tissue from dying, and he says they "bathe" the heart in the nutrient-rich blood every ten minutes or so. It just blows my mind that this is even possible. In total, my heart with be shut off (asleep, according the the doc) for 60 to 80 minutes. Once the blood starts flowing, and the potassium wears off, the heart starts beating on its own. Sometimes, they have to give it a little jump start. Simply amazing. 

Testing, testing

Due to some sort of medical protocol or federal guidelines or some obscure and long-lost section of the Hippocratic Oath, the Cleveland Clinic needed to do all their own tests even though they already had all my records from Indy. 

The hospital is only two blocks from our hotel so at about 6:40am, we walked down Euclid Avenue in the dark (okay, there were street lights along the way) to the hospital. We get there, give them my name, and wait to get checked in. 

The hospital is an incredible building and, according to one conversation I overheard during the day, cost $1 billion dollars to build. That's along the lines of the new Lucas Oil Stadium and Convention Center or a new Casino in Vegas, but given all the high-tech equipment, I wouldn't be surprised one bit. Well, just did a quick search and found that it was more around $600 to $650 mill. Ish. But still. The place is impressive. While the renovated Community North in Indy is very nice, it's more like a great, big Starbucks. This place is more streamlined, high-tech and minimalist, which I'm sure is due in part to the fact that they get so many international patients. Just a guess. One of the coolest features is the "fountain" in the front of the hospital that is clear glass on the sides and has a blue hue due to, I think, colored glass. Looks like a big, blue Jell-o mold jiggling anytime the wind blows across it...watch it wiggle, see it jiggle. I can't seem to find a photo on the web, but here is the building itself with the reflecting pools in front.  

We were at the hospital from before 7am and didn't leave till around 5pm. Actually, the testing didn't take very long at all, but the waiting is what made our day so very long. A quick recap: 

Meeting Dr. Grimm (great name, huh?). Actually, Dr. Grimm was very positive. And nice. He walked us through through the procedure and answered a few questions. He's one of the cardiologists who sees patients before and after surgery. One of his partners will probably see me after surgery, but this Grimm fellow seemed pretty sharp. I told Juli that, mostly because of his hair, that he looked like he could play a TV doctor (I am a doctor, but I don't play one on TV). The best news was that he said that I might be able to avoid the Trans Esophageal Echo cardiogram. But he'd have to wait till he saw the results of my lab work and the regular echo. He also said that they'd be doing a TEE during my surgery (I'll be asleep) so that's another reason I might not need to have it beforehand. Fingers crossed. Toes, too. 

EKG/Chest X-Ray/Blood Test. It seemed like the completed all of these in less than 10 minutes, and it couldn't have been much longer than that. They have lots of techs working and they got me in and out and from room to room fairly quickly. 

Echo cardiogram. I've had several of these in Indy, and this one was similar for the most part...other than the fact that the tech was very friendly and chatty and we talked football (he's a Denver fan living in Browns town). The one thing they didn't differently here was, after the standard digging around with the goo-covered sensor on the left side of my ribcage, they placed the sensor at the bottom of my ribcage and just above my sternum below my neck. He said it gives them images of the aorta, and that it is standard protocol at the CC. He said a lot of places don't do it (including the several places I had been to), but it's good information to have. Dr. Grimm came in and looked at the results, and said he'd meet with me and Juli later. He did. And he said I didn't have to have the TEE. 

Cafeteria. You wouldn't think that going to the cafeteria would be a meaningful experience, but it actually was. After having lunch at the deli across the street from the hospital, we brought back a piece of carrot cake so we could eat it with Starbucks coffee instead of the often-questionable coffee-shop coffee. When we were sitting at the table, and older couple sat down next to us and starting chatting. Turns out, he was 91 and she was 92. He was cracking jokes left and right (funny jokes, not your typical old-guy, heard-them-a-thousand-times before jokes). One of the funniest things was that he kept joking how the lady next to him had food that looked so much better. He was eating, Talapia. Or, as he said, "an urbane way of saying catfish." He closed the top to his styrofoam box that contained the fish and said..."I'm going to go trade this in for a donut." I'm sure that line will come up again in my future conversations (at least with Juli) and I'll think of this very nice couple. They were there for a surgery their daughter was having. They had been married 70 years. In-credible. We offered to push the woman, who was in a wheelchair, back to the surgery floor. And they kept saying how nice we were to do that. I think (or I would hope) that anyone would have done the same for them. I never got their names, but said a prayer for them and their daugher. God bless them. 

Pre-operative clearance. Watched a horribly produced video that walked us through the day of the surgery. I knew most of it, but it was good to hear it all again, in chronological order, with visuals. Met a very upbeat nurse who, Juli observed, had hair the same color and length as our dog, Coco. She took a nasal swap to check for strep and, if I had it, would prescribe some nose gel to help fight it. But it wouldn't delay the surgery. Also gave me the pre-surgery rinse (to shower with) and some listerine to swish around the final two times I brush my teeth. They must have something against germs in their OR or something. 

Registration. Strangely enough, this was the last thing we did all day. And we waited. And waited for someone to call us back. After they finally did, we found out that I was already registered in their system (a guy had called me a couple of weeks back to get all the info). That's really the only gripe I have so far is the lack of connectivity between departments and between people. You'd think that a high-tech place like this would have their EMR (electronic medical records) so dialed in that their left hand would know what their right hand is doing. Apparently not. 

Dinner. Room service of a burger and some crab cakes. Very good. 

Kids. Juli and I both talked to all of them. Wesley needed some help with his science homework and I was able to assist telephonically. Gramma Holland was doing well. I got a phone call a little later from Sophia, in bed, who was crying because she missed us. I told her we missed her too and tried to make her feel better by looking ahead to the next few days...her fall party at school on Friday, Halloween, staying at Papa's house over the weekend, etc. I miss the kids a LOT, but of course need to keep things positive. It'll okay, honey, it'll only be a few days. We'll be home before you know it. (I can't believe I'm not going to see my kids for ten days!)  

We're here.

Arrived in Cleveland after a short, bumpy flight. Crazy trying to get everything tied up before we left town for 10 days, but we're here. Whew. 

The walk from the gate to the baggage claim had to be more than a half mile. We got our bags, and the prearranged shuttle/car driver was supposed to call us. He didn't. I called the hotel and they didn't seem to have any record of my car reservation. They sent another driver and he was there in about 30 minutes. 

The good news. When I talked to the lady at the hotel (the guesthouse), she said they were overbooked due to extended stays and that we would be upgraded to the "nicer" suites hotel. Owned by the same company. Also on the CC campus. The price was twice as much, and since we're going to be here for 10 days, it seemed prudent to stay at the guesthouse. I asked if they would be able to keep us in the nicer joint at our original price due to the inconvenience. The lady said I'd have to ask the front desk at the other hotel. Great. On the ride to the hotel, I was planning my argument and rationale to convince them to let us stay in the nicer hotel for the same rate. But when we got to the front desk, amazingly, they agreed without blinking an eye. Of course they'd let us stay. Outstanding. 

Let's hope the service at the hospital is this good. 

It's been eight days since my last confession...

Okay. Now that the surgery is scheduled for November 3rd, it's going to feel like a loooong four-week wait. I guess we'll work on getting work and bills and sundry other tasks taken care of before my hiatus from normal life kicks in. 

A few adds/updates since my last post (which many of you may have seen in an e-mail from Juli):

Dr. Who? Surgeon's name is Dr. Mihaljevic (click the link to check out his bio). This link here has some additional background info, plus some online Q&A between the doc and some patients. Note that the questions are from 2007. Very interesting stuff. Dr. M is one of the docs who brought this procedure to the CC. He is 44 years old. He hired and trained another surgeon and they now perform between 250 and 350 non-invasive procedures per year. 

Timing. We will be flying into Cleveland on Wed, October 29 and flying back to Indy on Saturday, November 8. 

Some good news. The CC said my leakage and enlarged heart are not as severe as the docs indicated here in Indy. But they still need to fix it. 

Pre-op. The pre-op appointment on October 30 will include blood tests, chest x-ray, echocardiogram, and a transesophageal echocardiogram (TEE) —you can probably guess by the name the route that's taken to capture the image. It gives the surgeon a much clearer (and posterior) look at the heart because the image isn't as obstructed by skin and muscles and organs and such. The TEE doesn't sound like much fun , but Juli said her Nana just had one during her recent stay at the hospital and they'll sedate me beforehand. Hey, it still beats the heck out of having my chest cracked open like a Thanksgiving turkey. 

Smile. I'm supposed to see my dentist (Dr. Jack!) before we go to Cleveland to make sure I don't have any oral infections. Appointment is October 20th. 

Operation notes. Just rec'd the package from the CC yesterday and it said that there will be three small incisions (I thought it was just one). Also, the surgery may be performed on or off pump (they may or may not stop and bypass my lungs and heart during surgery). I need to call and find out which one they'll be doing. 

Important events while we are in Cleveland: 

• Halloween. I'm sad that we'll miss seeing the kids on Halloween. It will be strange, but it makes more sense for us to stay in Cleveland. They'll have fun and get all sugared up with or without us. I'll just make sure grandma (or whoever's watching them that night) takes lots of pictures. 

• Election day. I've already printed out the absentee ballot form online. Juli and I will each fill one out. They will send us a ballot and we will vote by mail. Not as inspiring or fulfilling as walking into the polls on election day and casting your vote, but it will have to do. Hmmm, who will it be??? The "maverick" or the "messiah"????

• Colts versus Patriots, which kicks off at 8:15 the night before my surgery. I will definitely stay up to watch the entire game. It doesn't really matter if I'm tired the day of surgery, right? As long as I don't oversleep (which I won't). 

That's it for now. Maybe not many posts for a couple of weeks because we're just waiting at this point. Thanks to all those reading (and praying).

Cleveland Rocks!

I'm going to Cleveland, baby! The NON-INVASIVE, robotically assisted surgery will take place on Monday, November 3 (I guess I'll be voting absentee). We need to arrive the Wednesday or Thursday beforehand (29th or 30th) for pretesting. We'll have to stay the weekend in a hotel and then have the surgery on Monday. We'll probably get to go home on Saturday, November 8th. 

One last thing: whooooooooohooooooooooo!!!!!

I'll make another post with regard to some specifics of the surgery and surgeon as soon as I can. 

Tick. Tock.

Juli talked to the charge nurse at the Cleveland Clinic on Monday (Sept 29) and, supposedly, she had already reviewed my chart and was supposed to present it to the surgeon on Tuesday (Sept 30) afternoon. 

It's now Wednesday night and we haven't heard back. Juli's going to call the office in the morning to try and expedite the answer. 

If I were to put odds on it, I would say that the chances are 60/40 that they'll be able to do the minimally invasive procedure at the CC. But that's just a guess. Let's hope the odds and the answer are better than that. 

Kids, questions, and cab rides

The thought of having open heart surgery has prompted, as you can imagine, a lot of soul searching on my part. 

Why is this happening to me? What will happen to the kids if I don't make it? Should I write them each a letter to let them know everything I want them to know? What would I say? There's so much to say! Am I going to feel like a "new man" with lots of energy because my heart will now be pumping at 100%? Is there any way I can avoid crying my eyes out as they wheel me back into the OR? Or when I actually wake up from surgery to see my first blurry light of day??? I know the surgeons are top notch and that the procedure is successfully performed most of the time, but it still doesn't keep my mind from wondering...and wandering. 

Another thing my situation has made me think about is the way I live my life. How can I be a better person? A better husband and father? How can I be a better Christian? The stress has been pretty overwhelming, but I'm hoping that once the surgery and the recovery are over, and my heart is fixed, I can start focusing on fixing/improving other aspects of my life. 

Sure, it's the totally cliché, new-lease-on-life type of attitude, but it's my new lease on life and I'm going to try and make the most of it. 

That being said, I came across an article that really hits on the idea of perspective and helping others. It's called The Cab Ride I'll Never Forget. If you're jaded by all the corny e-mail chains that float around the worldwide web, you may not find this very moving. But I think it's a well-written, well-pointed commentary on life. I hope you enjoy it. 

The best medicine

I enjoy laughter as much as the next guy, but Cookie Cottage cookies are on the top of my list.  

Thanks Cathy (Coops) and Greg Clark for the care package from Lansing by way of Fort Wayne!

News to me...

Just got a package in the mail from Clarian Cardiovascular. We went ahead and scheduled the procedure to get it in the books. As of now, it's going to be Tuesday, October 14 at 7:30am. We're supposed to arrive at 5:30am. Yikes! I don't think this is like the airports where they say to get there two hours ahead of time and you can get by with arriving 45 minutes beforehand. We should probably arrive when they tell us to. 

I'm supposed to have a pre-op appointment on Friday, October 10. 

However, we still haven't heard back from the Cleveland Clinic and won't until this week or next (they said it'd take 2-3 weeks for them to review my records, and they received them on September 15). 

We want to make sure we have all the information and make the best decision, but the timing may make things a bit complicated. We may need to push back the date with Clarian so we can hear what Cleveland has to say. Not sure the rules with regard to un-booking an OR, but I'm sure they'd rather know sooner than later. Let's hope we hear from Cleveland this week. Fingers crossed. 

The packet contained the how-tos, what-fors, and what-to-expects for pre, during and post-op. Most of it I already knew, but several things were new information:

• The kit contained two bottles of antiseptic wash. I'm supposed to shower with the stuff the two days before the procedure. Supposed to help prevent infection. It also smells like a hospital, so maybe they're just trying to get the patient accustomed to the smell. After all, I'm going to be hanging out there for 5 to 7 days after surgery. Sleeping on clean sheets and not sleeping with your pet is also recommended. 

• Another preventive measure to prevent infection is using some nose medicine (Bactroban nasal ointment, if you really want to know) two days before the surgery. 

• After surgery, my wrists "will be secured with soft cloth restraints" to remind me not to pull out my breathing tube. 

• I should wake up 3-6 hours after surgery. They will remove the breathing tube 3-6 hours after surgery. It could take longer. I just hope it comes out as soon as possible. The only surgery I've ever had was when I was six (hernia) and I'm not looking forward to this aspect of it. 

• They said I'll be doing lots of breathing treatments with a spirometer. I had forgotten this about my dad's recovery from his heart conditions. The treatments and coughing are supposed to help prevent pneumonia. 

The also included a DVD regarding what to expect. I expect we'll watch that sometime soon. 

I'm sure I'll learn a lot more as my jouney continues, but it's always better to know what to expect than to be taken off guard by something totally surpising. If you hear anything (or know anything) else, please let me know. 

b

The Heart Cath

We arrived at the Heart Hospital at 6:45 am, Tuesday, September 24. We checked in at the registration desk and Juli waited in the lobby while they ushered me back to prep me for the procedure.

Questions. Vitals. Gowning. Shaving of certain areas. I answered the same questions from the very friendly nurses: who's your surgeon? where are you having your surgery? how many kids do you have? 

Juli came back and we waited for awhile before they carted me back to the cath lab. 

I guess I really hadn't thought about it, but the cath lab was not what I expected. They wheeled me into a room that looked like something out of a science fiction film. A large, square room with two or three large pieces of medical equipment, with a control room behind glass in one corner, and several masked medical personnel scurrying about. The same list of questions followed, and one of the nurses asked about the minimally invasive procedure. She was very friendly and fired up about the latest medical techniques. Clearly, she is in the right profession. 

They hooked the bag up to IV and it started to hurt like crazy. The nurse said something about the needle hitting the wall or something and moved the IV to the right side. I didn't mind being re-stuck just as long as that shooting pain was removed from my forearm. 

It's certainly a strange perspective looking up at the top halves of faces and muffled mouths. I'd been in similar rooms when our kids were born, but it's a different thing when you're the center of medical attention. Not a very earth shattering observation, but something I hadn't considered before. 

They started the IV drip. Someone said I could stay awake for the procedure and the anesthetic was only a local, but I was knocked out almost immediately. I do remember seeing and talking to Dr. Fisch, but I can't remember whether it was before or after the cath. 

The next thing I remember, I am back in the recovery room and Juli and her sister Betsy (with little Cameron in tow) had e-mailed and text-messaged everyone they could think of...the results of the cath were negative. There were NO blockages in my arteries. I wouldn't have to have a bypass when they fix my mitral valve. Whew!

The surgery was over by 8:30 am, but I had to wait four hours recovering, waiting for my artery to clot. I'm not exactly sure how they insert the probe into the artery (near the groin on the top inside of my right leg), but it didn't require a stitch afterwards. Just bedrest. After four LONG hours, they sat me up to walk me around. Unfortunately, the "puncture wound" started bleeding again. As they had done before, they had to apply HARD direct pressure to the spot to stop the bleeding. Well, either the nurse applying pressure or the blood loss or the scare of the situation or the change in blood pressure did a number on me. Both the nurse and Juli asked if I was nauseous. I didn't feel it till they mentioned it. Then I felt it. Turns out my face was literally green, so they gave me some meds before I got sick. 

Since my incision (or whatever they call it) started bleeding, I had to start over. Four more hours of waiting (torture). I know lots of people go through much worse things than this, but I was uncomfortable and feeling a bit claustrophobic. The nurse ordered me a movie On Demand (not a comedy, because laughing could slow the clotting). Michael Crichton. Looked like a pretty good movie, but between the poor sound and the complex plot and my general discomfort, I ended up not watching the movie. 

Finally, after another four hours, they allowed me to walk around. So far, so good. But right before we were ready to go (after I had put on my clothes and they had removed the IV), the incision looked a bit puffy. They told me to wait another 15 minutes. If it got worse, I'd probably have to stay the night, which I didn't want to do. 

Fortunately, it didn't get worse and they released me. 

Juli and I went to pick up Ben and Sophia (who were being watched by Grandma Phyllis) and waited for Wesley to come home from his game (which Papa took him to). Of course, Wesley had made the game-winning tackle on the opponent's quarterback and we weren't there to see it. But the joy and excitement on Wesley's and Papa's faces were almost as good as being there. 

Good news

Good news: the heart cath showed I have zero blockages in my arteries, which is the best news we could have received.

I'll write another post about the details of the day, but wanted to share the most important info first.

One Fisch, Two Fisch

Had an appointment with Dr. Fisch this morning. Just a pre-meeting before my heart cath tomorrow, which he will be performing over at the Heart Hospital. I spent many, many hours at that place in 2005 and late 2008 when my dad was sick. He always liked the food there (so much so that my mom and he would go over there for lunch sometimes), so maybe I'll grab a green Jello in his memory. The cath is an outpatient procedure, but I'll be there for several hours. The agenda, according to Dr. Fisch:

6:30 Arrive

8:00 The cath

8:30 Finished with cath

8:30-12:30ish Rest, recovery, applying pressure to the incision

12:30-2:30 More rest, walk around, check to see if the bleeding has stopped

2:30-3ish Go home

I had an EKG at my appointment. Had a blood test afterwards (at the lab down the stairs) to ensure my blood count is good and my kidneys are functioning properly. 

For the cath, for those who don't know, they will fish a thin line through my femoral arteral (near the groin) up to my heart. Dr. Fisch said I won't be able to feel it feeding through my arteries, which is a good thing. They'll inject dye through the scope to see how the blood is flowing and to see if there are any blockages. He said that they'll have to do the bypass or put in a stent if there is any blockage 70%+. They would do this procedure at the same time they fix my mitral valve...two surgeries for the price (or the pain) of one. 

The risks are minimal. I have more chance of being killed in an auto accident, according to Dr. F. After a measured pause, he asked jokingly..."So...how good of a driver are you?" I'm sure he's used that line before on dozens of patients, but his timing and delivery were spot on. And he got a good belly laugh from this patient. 

Chronology

The chain of events (as I remember them)...

December 2007. Dr. Charles Cornett, my regular doctor, hears a murmur during my annual checkup. He recommends that I have an echocardiogram to get it checked out. 

December 2007. I have an echo done at Community North. Results show that I have Mitral Valve Prolapse, leakage (regurgitation) as a result of the prolapse, and an "enlarged" heart (due to increased blood volume and compensation of my heart muscles). 

December 2007. Second opinion time. Went to see Dr. Gary Fisch, father of Adam Fisch, who is married to Kate Emswiller, who is the daughter of Phyllis Garrison, who is married to my father in law. (Did you follow that?) He did a stress echo (treadmill) and either at that appointment or my next (don't recall) put me on 10mg of Lisinopril (an ACE inhibitor that offers many benefits to your heart, including reduction in blood pressure). I don't have high blood pressure to start, but this was prescribed to lower it even more in hopes that it might reduce the leakage of my valve and reduce the stress on my ticker. The stress test found that leakage was moderate/severe and that I had an enlarged heart. 

March/April 2008. Went to see Dr. Fisch again as a follow up. He referred me to his mentor and professor at IU med school, Dr. Paul McHenry. 

May 2008. I meet with Dr. McHenry and had a stress echo the same day (recumbent bike this time). His results were the same. But the leakage was a little more on the severe side. Plus the enlarged heart. Dr. M decides to up my Lisinopril to 20mg per day. And asks that I limit my cardio activity. I had already stopped running on my own as a precaution. He wants to follow up in three months to see if the meds and the reduction in activity makes an impact. 

May 2008. Dr. M sits down with me and Juli to answer our long list of questions. He is awesome. And reminds me a lot of Dr. James (Grandpa) Garrison (Juli's grandpa). He talks with us for FORTY minutes...and doesn't charge us for the visit. Amazing. 

May 2008. I don't run the Mini Marathon or the Geist Marathon (even though I'm registered for both). I feel pretty bummed about it. I had just run my best half time in the Lawrence half in the fall. The mini is so big (35,000 runners), you lose a little time in the beginning weaving through the crowd. But the inaugural Geist marathon went around the lake, my normal long-course training route...literally my stomping grounds. I felt like I could do really well in this race.  

August 27, 2008. After a loooooooooong wait, I go back to see Dr. McHenry for a regular echo (no stress involved). The results are not so good. Dr. McHenry recommends surgery and indicates that I'm a good candiate for a repair versus a replacement. He refers me to Dr. Mark Turrentine, an impressive surgeon with great credentials. I can't get in to see Dr. T until September 24 (busy man). 

September 2008. After doing some research, I'm interested in having a minimally invasive procedure if possible and Dr. Turrentine doesn't perform that type of procedure. I have my records sent to the Cleveland Clinic. They perform the MI procedure there as the best cardiac hospital in the country. Find one doc who does the surgery in Indy (Dr. Coffey), and Juli calls his office. They are able to get us in for an appointment in just two days. 

September 19, 2008, 10:15 am. Finally, we get to meet Dr. Coffey. Very anxious and looking forward to "solving the problem." He is the answer. He is the guy who will be able to peform the small incision in my side instead of having my ribs cracked and spread open...ER or Grey's Anatomy-style. He is the miracle worker who is going to uncomplicate the situation, reduce my time in the hospital, and reduce my recovery time. The difference between the two procedures is three weeks (best case scenario for the Min Invasive surgery) to up to 8 weeks recovery if they open up my ribs. How in the WORLD will I be able to take off 4 to 6 weeks if I have to go the traditional route?? I have to support my family!? A long, incessant drumroll echoed inside in my 7 5/8-sized head since I first learned about the minimally invasive procedure, accompanying my impatience, waiting for my appointment, anticipating the answer. And the loud high hat that dramatically ends the drumroll was supposed to accentuate the answer I wanted to hear. But it was just the opposite....Dr. Coffey says I'm not a candidate for the minimally invasive procedure. 

It was the best of times, it was the worst of times

Okay, so I could have also started with "In the beginning..." or "Once upon a time." 

Hello. Is this thing on? This is my first official jump into the blogosphere. My sister, Dorothy, churns out cool content for several blogs (I'll add those links later, somehow, whenever I figure out how to do it). And I read several blogs from time to time (dooce, onlikepopcorn, adrants, american copywriter). But this is me dipping my big toe into the big, ginormous web-content pool. A place for me to post updates on my forthcoming heart surgery, which could take place as early as October. 

ASIDE: Mom, if you're reading this, "blog" is short for weblog. Basically an online diary that's accessible by the entire world wide web. A "secret public journal," as comedian Mike Birbiglia might say. 

Anyways, since I'm going to be having surgery to fix my Mitral Valve Prolapse, I thought this would be a good place for friends and family, near and far, to find information. We (Dorothy, I think) came up with an old-fashioned way of doing this when my dad was in the hospital back in 2005. We would leave health updates on our answering machine so people calling would know the status. It seemed like a good idea and people seemed to appreciate it. HIPAA not withstanding. 

This is the intro post. I will post separate entries that detail the discovery of my murmur in December of 2007, my first visit with the cardiac surgeon (just three hours ago), and other new information/updates as I receive them. 

Update: Coffey Talk

Well, we met today with Dr. Arthur (Art) Coffey of Clarian Health. I found his name the old-fashioned way: Google search. After learning about the Cleveland Clinic and the many benefits of minimally invasive surgery (less time in the hospital, less recovery time, reduced chance of infection, etc), I tried to find a local surgeon who could do it. Let's just say that the Cleveland Clinic does a MUCH better job with their marketing and search engine optimization than the hospitals in Indianapolis. It took me a while to figure out who's doing what here in town. 

Dr. C was the first in Indiana to perform the minimally invasive mitral valve repair surgery (2005). My cardiologist  (Dr. McHenry) had referred me to Dr. Mark Turrentine, who couldn't get me in for a few weeks. Juli called Dr. C's office out of the blue and was able to get me an appointment in two days. 

After looking at my records, Dr. C indicated that I was NOT a candidate for the minimally invasive procedure. His blunt words kicked me in my gut pretty hard, but I did manage to keep from bursting into tears on the spot. I'm going to be fine, I thought to myself, it's just going to be more complicated than I had hoped. 

I have an enlarged ventricle due to the strain the muscle has been under as a result of the prolapse. I also have an enlarged atrium (both left). The enlargement is the body's way of trying to compensate for the problem. The left ventricle, believe it or not, will probably shrink after surgery. The body is an amazing machine. The atrium, however, will not shrink. But that's normal. 

Dr. C describe the mitral valve like a parachute cut in half. The pressure of blood in the ventricle causes the "parachutes" to close, preventing leakage of blood back into the atrium. These parachutes are called leaflets. During the previous moment of the cardiac cycle, the parachute halves are open and the oxygenated blood in the atrium flows into the ventricle. A beautiful design. However, my valve doesn't  close back up and blood leaks (regurgitates) back into the left atrium. Pretty severely. The parachute analogy works pretty well because there are also several cords (chordae tendineae) that anchor the mitral valve to the left ventricle. The surgeon will attach my repaired valve with cords made of Gortex. Pretty cool. He says they will outlast me. I think that's a comment about how long the cords last, not how long I'm going to last. :) 

One of the other factors that makes this procedure more complicated is that I have some excess tissue on the valve that needs to be removed. 

Given all that has to be done, it rules me out for the minimally invasive procedure. He said that if he did hundreds of these a year he might do it, but he doesn't. The CC, which does do hundreds of these every year, may or may not recommend minimally invasive. Don't know yet. 

I asked about pain after the procedure and he said, believe it or not, the people who have the worst time with pain are young men (lucky 37-year-old me). He also said, as counter-intuitive as it may seem, that "little old ladies" have the least pain. 

Another thing that Dr. C recommended is that I have a heart cath. According to WebMD, "Cardiac catheterization is a test to check your heart and coronary arteries. It is used to check blood flow in the coronary arteries, blood flow and blood pressure in the chambers of the heart, find out how well the heart valves work, and check for defects in the way the wall of the heart moves...the purpose is to find out if you have disease in your coronary arteries (atherosclerosis). If you have atherosclerosis, this test can pinpoint the size and location of fat and calcium deposits that are narrowing your coronary arteries."

If they find I have blockages, they will address that during my mitral valve surgery. Hey, they may as well fix everything while they have me cracked open. They are doing this test as a preventive measure. My dad had his first heart attack when he was around 60, so my chances of having a problem are increased because of my family history. Let's hope that history doesn't repeat itself in this case. But better safe than sorry. 

One of the last questions I asked was whether or not I'll be able to return to normal physical activities after the surgery. Dr. C said that after three months I will be able to do everything I could do before (e.g. skiing). The muscle and bone mend and heal. Incredible. But I'm sure I'll still want to take it easy. Note to self: become a better skier so I don't fall down so much. 

Symptoms I don't have

Amazingly, I've been walking around with this condition without any symptoms. I had also run six half-marathons in the previous two years without any symptoms. Turns out that it's not uncommon to be asymptomatic. 

Thank God my GP heard the murmur and recommended that I see a cardiologist. 

Above clip is from the Cleveland Clinic website...