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. 

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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...