Today (Friday, Aug. 11) I am home after a successful TAVR procedure at Scripps Hospital in La Jolla. My procedure was on Tuesday morning, and doctors not only installed a new aortic valve, but put in a stent where I had a partial blockage in an artery near my heart.
All I remember from that morning was being wheeled into the cath lab, and moving from the bed to the operating table. Then the anesthesiologist said he had given me some medicine to relax and the next thing I knew, I was waking up in the recovery room. I do remember Van Halen playing on the speakers in the cath lab as I was wheeled in, which I liked.
Later that afternoon, I was wheeled up to my private room in the Prebys Cardiovascular Institute. A bunch of family and friends came by to visit and support me. The sixth-floor room had a great view, but I couldn't see it because I had to lay flat on my back due to the temporary pacemaker that had been placed in my leg.
The hardest part of the whole procedure was having to lay flat without raising my head or bending my legs for more than 24 hours. I didn't really sleep much due to that, and the normal hospital goings on, vital signs, blood draws, etc., so I was exhausted by Wednesday, when the pacemaker was removed and I could sit up and move around.
But the important thing is that all the tests and indications showed the procedure was a success, and my new Medtronic aortic valve is working the way it is supposed to.
I was released from the hospital Wednesday afternoon. Apart from being a little tired and sore where the catheters were inserted in my groin area, I am feeling fine. I am walking several times a day around my neighborhood, and trying to build on that each day without overdoing things.
After a week, the restrictions on activity, driving, etc. will be lifted and I hope to feel a lot better when I exert myself. But so far, the heart seems to be doing just fine.
It is simply amazing to me that I can sit here in my kitchen typing these words, having gone for a walk this morning and then made French toast for breakfast, just 72 hours after a major heart procedure. I am also very glad to have this behind me, and want to thank my wife, Ava, my daughter, Salome, and all of my friends and family for their love and support.
Talk to you soon!
Friday, August 11, 2017
Sunday, August 6, 2017
Almost time
It's Sunday, Aug. 6, and I am two days out from my TAVR procedure. I feel a mix of excitement that the day is almost here, and of course, a good dollop of nervousness and anxious energy. I think I am less anxious than I would be if I were having open heart surgery, but still I know this is a complicated procedure, and there are risks.
I am happy because I have been waiting for this day for a long time, and I have high hopes that I will feel a lot better afterward, that I will be able to exercise and exert myself without feeling like I might pass out or my heart is pounding out of my chest. I just want to feel like my old self again, and be able to do things like ride a bike or paddle my kayak around Oceanside Harbor.
At the same time, I am stressed out because I want everything to go very smoothly. I'm optimistic but still worried. I'm sure these feelings are "normal" for what I am going through, but none of this really seems normal to me. These last few months have been a blur of doctor's appointments, tests, ups and downs and lots of stress. I'm more than ready to move on.
I keep thinking there are things I should do to prepare for my surgery and hospital stay. But really there isn't much to do. I have paid the bills, gone over the finances with my wife (normally I take care of the household finances so I wanted to get her up to speed), arranged for a friend to take care of our dog and talked to the editor of the newspaper I write for. I changed the oil on all three of our family cars, even though it wasn't quite time to do it!
I don't think I will be bringing much to the hospital other than my phone, charger and headphones. If all goes well I will only be in the hospital for a night or two anyway.
Tomorrow I will go to the doctor's office for my pre-op bloodwork, and meet with the nurse who will go over details with me about the procedure and what to expect post-op.
Then I will show up bright and early (5:45 a.m.) on Tuesday for my procedure. By Tuesday afternoon, I should be in my hospital room, beginning my recovery.
Very soon, I hope to be writing about my recovery and my life post-TAVR, and reporting about how much better I feel! Until then, I hope anyone reading this has good health and happiness.
I am happy because I have been waiting for this day for a long time, and I have high hopes that I will feel a lot better afterward, that I will be able to exercise and exert myself without feeling like I might pass out or my heart is pounding out of my chest. I just want to feel like my old self again, and be able to do things like ride a bike or paddle my kayak around Oceanside Harbor.
At the same time, I am stressed out because I want everything to go very smoothly. I'm optimistic but still worried. I'm sure these feelings are "normal" for what I am going through, but none of this really seems normal to me. These last few months have been a blur of doctor's appointments, tests, ups and downs and lots of stress. I'm more than ready to move on.
I keep thinking there are things I should do to prepare for my surgery and hospital stay. But really there isn't much to do. I have paid the bills, gone over the finances with my wife (normally I take care of the household finances so I wanted to get her up to speed), arranged for a friend to take care of our dog and talked to the editor of the newspaper I write for. I changed the oil on all three of our family cars, even though it wasn't quite time to do it!
I don't think I will be bringing much to the hospital other than my phone, charger and headphones. If all goes well I will only be in the hospital for a night or two anyway.
Tomorrow I will go to the doctor's office for my pre-op bloodwork, and meet with the nurse who will go over details with me about the procedure and what to expect post-op.
Then I will show up bright and early (5:45 a.m.) on Tuesday for my procedure. By Tuesday afternoon, I should be in my hospital room, beginning my recovery.
Very soon, I hope to be writing about my recovery and my life post-TAVR, and reporting about how much better I feel! Until then, I hope anyone reading this has good health and happiness.
Friday, July 21, 2017
Sitting in limbo
Hi all, as usual, it's been a while since my last post. I know I say that every time, for some reason I have been lax about updating the blog. Maybe because we are now in the hot, muggy days of summer and it's hard to get motivated? Or maybe I'm just lazy. Or too stressed. Or all of the above.
I named this post after one of my favorite Jimmy Cliff songs, and it captures exactly how I feel at this moment. I am waiting for some major stuff to happen, and it all has to take its own sweet time. There is nothing I can do to move things along any faster.
At the top of the list, of course, is my heart valve operation. Since I last wrote an update, I met with Jennifer Lutes, the nurse practitioner for Dr. Stinis, the cardiologist who will perform my TAVR procedure. She said my procedure had been approved by the medical committee, and is scheduled for Tuesday, Aug. 8.
That was welcome news, and I would have been totally elated, except for the little tagline at the end. "When we did the CT scan of your body, there was an incidental finding, some enlarged lymph nodes. It's probably nothing, or related to your history of Hodgkin's disease and radiation..."
That felt like a gut punch just when I was ready to hear some good news about the TAVR procedure, setting a date and talking about my recovery.
I know I am kind of a glass-half-empty kind of guy, but that information cast a shadow over things, and I found it hard to focus on the excitement of finally moving forward with my needed heart procedure.
My family doctor then ordered some blood work, which came back mostly normal, so that is reassuring, but she wanted me to see a cancer specialist to be sure. So that appointment is set for next week.
In the meantime, the date for my TAVR is just over two weeks away, and I am waiting to hear from Dr. Stinis's office on my pre-op tests and other preparations. I am both excited and nervous about that, but much less worried than if I was facing open heart surgery.
On top of all that, I am eagerly awaiting my daughter's return, in just under two weeks, from her study abroad year in Germany. Both my wife and I can't wait for her to come home, it is so exciting to think about our daughter being here for the rest of the summer, until fall classes begin at UC Santa Barbara.
As a self-employed free-lance writer, my work is dependent on assignments from my editors and clients, and right now we are in a typical period of summer doldrums, which means I have even more time to sit and brood and imagine worst-case scenarios.
So in between sparse work assignments, I am doing little home projects, taking lots of walks, playing my guitar for the first time in a long while, watching soccer and baseball and trying not to be too impatient about the things outside of my control.
As Jimmy sings:
"Sitting here in limbo, waiting for the dice to roll,
sitting here in limbo, have some time to search my soul
well, they're putting up resistance
but I know that my faith will lead me on..."
I named this post after one of my favorite Jimmy Cliff songs, and it captures exactly how I feel at this moment. I am waiting for some major stuff to happen, and it all has to take its own sweet time. There is nothing I can do to move things along any faster.
At the top of the list, of course, is my heart valve operation. Since I last wrote an update, I met with Jennifer Lutes, the nurse practitioner for Dr. Stinis, the cardiologist who will perform my TAVR procedure. She said my procedure had been approved by the medical committee, and is scheduled for Tuesday, Aug. 8.
That was welcome news, and I would have been totally elated, except for the little tagline at the end. "When we did the CT scan of your body, there was an incidental finding, some enlarged lymph nodes. It's probably nothing, or related to your history of Hodgkin's disease and radiation..."
That felt like a gut punch just when I was ready to hear some good news about the TAVR procedure, setting a date and talking about my recovery.
I know I am kind of a glass-half-empty kind of guy, but that information cast a shadow over things, and I found it hard to focus on the excitement of finally moving forward with my needed heart procedure.
My family doctor then ordered some blood work, which came back mostly normal, so that is reassuring, but she wanted me to see a cancer specialist to be sure. So that appointment is set for next week.
In the meantime, the date for my TAVR is just over two weeks away, and I am waiting to hear from Dr. Stinis's office on my pre-op tests and other preparations. I am both excited and nervous about that, but much less worried than if I was facing open heart surgery.
On top of all that, I am eagerly awaiting my daughter's return, in just under two weeks, from her study abroad year in Germany. Both my wife and I can't wait for her to come home, it is so exciting to think about our daughter being here for the rest of the summer, until fall classes begin at UC Santa Barbara.
As a self-employed free-lance writer, my work is dependent on assignments from my editors and clients, and right now we are in a typical period of summer doldrums, which means I have even more time to sit and brood and imagine worst-case scenarios.
So in between sparse work assignments, I am doing little home projects, taking lots of walks, playing my guitar for the first time in a long while, watching soccer and baseball and trying not to be too impatient about the things outside of my control.
As Jimmy sings:
"Sitting here in limbo, waiting for the dice to roll,
sitting here in limbo, have some time to search my soul
well, they're putting up resistance
but I know that my faith will lead me on..."
Friday, July 7, 2017
Decision time
Well, here I am a few days after the July 4th holiday, and I am awaiting a big decision point in the treatment of my aortic stenosis.
As I have written about in previous posts, I have been pursuing the possibility of a TAVR procedure rather than open heart surgery to replace my aortic valve. Most importantly, my history of chest radiation in the late 1980s puts me at potentially greater risk during open heart surgery, because the radiation may have caused damage that would be unknown until the operation begins.
On June 27th, I met with a surgeon, Dr. Tyner, for a second surgical opinion on whether I would be a candidate for TAVR. His opinion was that TAVR should be my first option.
So a couple of days ago, I spent most of the day at Scripps Clinic in La Jolla, undergoing a battery of tests known as the "TAVR workup." As I understand it, the tests are both a planning tool for the TAVR procedure, and a way of making sure there would be no impediments if I were to have the procedure.
The tests included a breathing or pulmonary test, in which I inhaled and exhaled into a mouthpiece to check my lung capacity; a "frailty" test which included a number of questions about my physical condition, a grip test and a walking test; a very extensive echocardiogram; and a CT scan of my heart.
Because the last two tests required contrast dye, I was turned into a human pincushion, getting three needle sticks for IVs.
But all of the tests went smoothly, and I was on my way home in the afternoon.
The next step is a meeting with Dr. Stinis, the interventional cardiologist, who would be the doctor performing the TAVR. On Tuesday morning, a committee of doctors will review my case and determine if TAVR is the best course for me. Later in the morning, I will meet with Dr. Stinis and his medical assistant, and learn which way the doctors want to go. I am hopeful we will get the green light for the TAVR procedure, and maybe even set a date!
I have to say that I am a bit nervous right now, while trying to maintain an optimistic outlook that things will work out the way I hope and expect.
Either way, whether I end up having the TAVR or surgery, I am looking forward to having the valve replaced (and my coronary artery blockage treated) so I can feel better and return to my previous, more active, lifestyle.
As I have written about in previous posts, I have been pursuing the possibility of a TAVR procedure rather than open heart surgery to replace my aortic valve. Most importantly, my history of chest radiation in the late 1980s puts me at potentially greater risk during open heart surgery, because the radiation may have caused damage that would be unknown until the operation begins.
On June 27th, I met with a surgeon, Dr. Tyner, for a second surgical opinion on whether I would be a candidate for TAVR. His opinion was that TAVR should be my first option.
So a couple of days ago, I spent most of the day at Scripps Clinic in La Jolla, undergoing a battery of tests known as the "TAVR workup." As I understand it, the tests are both a planning tool for the TAVR procedure, and a way of making sure there would be no impediments if I were to have the procedure.
The tests included a breathing or pulmonary test, in which I inhaled and exhaled into a mouthpiece to check my lung capacity; a "frailty" test which included a number of questions about my physical condition, a grip test and a walking test; a very extensive echocardiogram; and a CT scan of my heart.
Because the last two tests required contrast dye, I was turned into a human pincushion, getting three needle sticks for IVs.
But all of the tests went smoothly, and I was on my way home in the afternoon.
The next step is a meeting with Dr. Stinis, the interventional cardiologist, who would be the doctor performing the TAVR. On Tuesday morning, a committee of doctors will review my case and determine if TAVR is the best course for me. Later in the morning, I will meet with Dr. Stinis and his medical assistant, and learn which way the doctors want to go. I am hopeful we will get the green light for the TAVR procedure, and maybe even set a date!
I have to say that I am a bit nervous right now, while trying to maintain an optimistic outlook that things will work out the way I hope and expect.
Either way, whether I end up having the TAVR or surgery, I am looking forward to having the valve replaced (and my coronary artery blockage treated) so I can feel better and return to my previous, more active, lifestyle.
Thursday, June 29, 2017
One day at a time...
It's been a while since I've had a chance to update my blog. Over the past couple of weeks, I've felt like I was a bit in limbo, as I worked through the system to continue pursuing the TAVR option for replacing my aortic valve, as opposed to open heart surgery.
My concern with open heart, which has an excellent track record for decades as a way of treating heart valve problems, is my history of chest radiation for Hodgkin's Disease. Doctors have told me this is a "wild card," because the radiation may have caused damage that could complicate surgery and make it more risky.
In order to be considered for a TAVR procedure, which would allow me to avoid some of the potential risks of surgery in my situation, I needed a second surgical opinion that put me in an "intermediate" risk category. (The first surgeon I saw considered me a "low risk" patient for surgery, meaning I would not qualify for TAVR, a procedure in which the new heart valve is installed via a catheter inserted in my femoral artery.)
This week, after a few starts and stops, I met with a second surgeon who in fact agreed that due to my history, TAVR would be a good option for me.
Now things are moving full speed ahead. Next week, I am scheduled for the full TAVR workup, a series of tests to prepare for the TAVR procedure. The following week, a panel of doctors will review my case and, hopefully, give me a green light to move forward. I have an appointment with the TAVR specialist, a doctor who has done more than 1,000 TAVR procedures, and if all goes well we will set a date for my procedure.
I am definitely less stressed out now that we have a definite plan of action. Until this week, I was anxious because things were so unsettled. I will feel even better once I have a date in hand and can prepare myself both mentally and physically for the upcoming procedure and the recovery beyond.
I am seeing a therapist to help me maintain a positive attitude as I work through this, and also continuing to practice my Buddhist chants and listen to guided imagery tapes to visualize a future in which I have a new, fully functioning heart valve and can resume the level of physical activity that I am accustomed to.
It's still a challenge for me to get a full night's sleep, as I was never a great sleeper in the best of times. I've tried Melatonin, and also Ativan, which my doctor prescribed, with mixed results. Any suggestions from those who have dealt with similar issues would be greatly appreciated.
Best wishes to everyone approaching their surgical date, or now in the recovery phase. Keep heart!
My concern with open heart, which has an excellent track record for decades as a way of treating heart valve problems, is my history of chest radiation for Hodgkin's Disease. Doctors have told me this is a "wild card," because the radiation may have caused damage that could complicate surgery and make it more risky.
In order to be considered for a TAVR procedure, which would allow me to avoid some of the potential risks of surgery in my situation, I needed a second surgical opinion that put me in an "intermediate" risk category. (The first surgeon I saw considered me a "low risk" patient for surgery, meaning I would not qualify for TAVR, a procedure in which the new heart valve is installed via a catheter inserted in my femoral artery.)
This week, after a few starts and stops, I met with a second surgeon who in fact agreed that due to my history, TAVR would be a good option for me.
Now things are moving full speed ahead. Next week, I am scheduled for the full TAVR workup, a series of tests to prepare for the TAVR procedure. The following week, a panel of doctors will review my case and, hopefully, give me a green light to move forward. I have an appointment with the TAVR specialist, a doctor who has done more than 1,000 TAVR procedures, and if all goes well we will set a date for my procedure.
I am definitely less stressed out now that we have a definite plan of action. Until this week, I was anxious because things were so unsettled. I will feel even better once I have a date in hand and can prepare myself both mentally and physically for the upcoming procedure and the recovery beyond.
I am seeing a therapist to help me maintain a positive attitude as I work through this, and also continuing to practice my Buddhist chants and listen to guided imagery tapes to visualize a future in which I have a new, fully functioning heart valve and can resume the level of physical activity that I am accustomed to.
It's still a challenge for me to get a full night's sleep, as I was never a great sleeper in the best of times. I've tried Melatonin, and also Ativan, which my doctor prescribed, with mixed results. Any suggestions from those who have dealt with similar issues would be greatly appreciated.
Best wishes to everyone approaching their surgical date, or now in the recovery phase. Keep heart!
Friday, June 16, 2017
A rotten week
Okay, I know I wrote earlier about the importance of maintaining a positive attitude. And I really have been trying to do that. But this past week has been a real test. And my attitude has taken a beating.
A quick recap... last Saturday night, after a very nice day in which I went for a walk at Miramar Lake and felt great, I started having a rapid heartbeat later at night and ended up going to the emergency room. When a blood test showed that my my cardiac markers, called "triponins," were slightly elevated, they decided to admit me for observation. They pumped me full of meds and by the time I was discharged on Monday, everything was looking pretty good, in terms of my vital signs, etc. But still a scary and not fun experience.
Later in the week, I developed a toothache and a trip to my dentist revealed that I have a damaged molar that will probably have to be pulled. I'm worried, of course, that it could delay things in terms of fixing my aortic valve and blockage. One more thing to fret about.
The capper came on Thursday afternoon, when I got a call from the surgeon's office. I had an appointment on Friday morning to get a second opinion that is required if I am to have the TAVR procedure instead of open heart surgery.
I was hopeful this consultation would help clear the way for me to move forward with the TAVR (transcatheter aortic valve replacement, in which the new aortic valve is threaded through my femoral article and put in place.)
Instead, I was told I had things out of order, and that I need to get a battery of tests BEFORE I see the surgeon, which is the final checkoff. Never mind that I had been told by my doctors that I had to see the surgeon first.
So now, at a glacial pace, (to me) I have to wait for next week till I can be scheduled for the tests I need, etc.
It was a blow that left me reeling, very depressed and having a hard time dealing with the entire situation. I know in my head that this only puts me about a week behind where I was, but it doesn't feel that way. It feels frustrating, and scary and just overall dispiriting. I cried for a while this morning.
One side note. A friend had offered us tickets to see the Dalai Lama speak Friday morning at UC San Diego. When I scheduled the appointment with the surgeon, we had to pass on the tickets. As it turned out, we missed both the Dalai Lama and the appointment with the surgeon. And I can tell you, I could have used the inspiration.
In the big picture, I just need to get things back on track and I will be fine. If the TAVR route doesn't happen, I will go back to the tried and true method of open heart surgery. A little riskier for me than TAVR, I believe, because of the radiation treatment I got in the 1980s, but still very doable.
So either way, my valve will be replaced and I will go on to a brighter, healthier future. Right now, though, I'm having a hard time embracing the positive. Hey, no one ever told me this would be easy.
A quick recap... last Saturday night, after a very nice day in which I went for a walk at Miramar Lake and felt great, I started having a rapid heartbeat later at night and ended up going to the emergency room. When a blood test showed that my my cardiac markers, called "triponins," were slightly elevated, they decided to admit me for observation. They pumped me full of meds and by the time I was discharged on Monday, everything was looking pretty good, in terms of my vital signs, etc. But still a scary and not fun experience.
Later in the week, I developed a toothache and a trip to my dentist revealed that I have a damaged molar that will probably have to be pulled. I'm worried, of course, that it could delay things in terms of fixing my aortic valve and blockage. One more thing to fret about.
The capper came on Thursday afternoon, when I got a call from the surgeon's office. I had an appointment on Friday morning to get a second opinion that is required if I am to have the TAVR procedure instead of open heart surgery.
I was hopeful this consultation would help clear the way for me to move forward with the TAVR (transcatheter aortic valve replacement, in which the new aortic valve is threaded through my femoral article and put in place.)
Instead, I was told I had things out of order, and that I need to get a battery of tests BEFORE I see the surgeon, which is the final checkoff. Never mind that I had been told by my doctors that I had to see the surgeon first.
So now, at a glacial pace, (to me) I have to wait for next week till I can be scheduled for the tests I need, etc.
It was a blow that left me reeling, very depressed and having a hard time dealing with the entire situation. I know in my head that this only puts me about a week behind where I was, but it doesn't feel that way. It feels frustrating, and scary and just overall dispiriting. I cried for a while this morning.
One side note. A friend had offered us tickets to see the Dalai Lama speak Friday morning at UC San Diego. When I scheduled the appointment with the surgeon, we had to pass on the tickets. As it turned out, we missed both the Dalai Lama and the appointment with the surgeon. And I can tell you, I could have used the inspiration.
In the big picture, I just need to get things back on track and I will be fine. If the TAVR route doesn't happen, I will go back to the tried and true method of open heart surgery. A little riskier for me than TAVR, I believe, because of the radiation treatment I got in the 1980s, but still very doable.
So either way, my valve will be replaced and I will go on to a brighter, healthier future. Right now, though, I'm having a hard time embracing the positive. Hey, no one ever told me this would be easy.
Friday, June 9, 2017
Change of course
Big news! Yesterday, I saw my cardiologist, Dr. Charlat, who was very supportive of my interest in pursuing a TAVR procedure to replace my aortic valve, rather than open heart surgery. He agreed that, because the potential tissue damage I may have incurred due to radiation many years ago, it makes sense to look into having the TAVR procedure. He was also on board with having the procedure done by Dr. Stinis and his team, who have done more than 1,000 TAVR heart valve procedures since 2008.
After meeting with Dr. Charlat, I came home and called the office of my surgeon, Dr. Stahl, to put off the surgery for now and cancel my June 27 surgical date. I need more time to complete the workup for a TAVR procedure, which consists of a series of tests to make sure I am a suitable candidate, help the doctors determine what size valve I need, etc.
In order to go this route, I need a second surgical opinion, and I set this up with Dr. Tyner, who is head of the division of thoracic and cardiac surgery for Scripps. Dr. Tyner comes highly recommended from a number of sources, including my wife, Ava, who worked with him at Scripps Green Hospital in La Jolla.
So, I am feeling cautiously optimistic that the TAVR procedure is a possibility for me, which would of course mean a less invasive way of replacing my aortic valve, quicker recovery, shorter hospital stay, etc.
If I do have the TAVR, Dr. Stinis and Dr. Stahl, the surgeon, would team up to carry out the procedure, and I am very comfortable with that.
Through all of this, I am trying to maintain an even keel in spite of the stress from the barrage of information I am dealing with, and the factors that are out of my control. To that end, I am taking advantage of a program offered through Ava's work, which allows for a limited number of sessions with a therapist. I'm hoping this will help me manage my stress and keep a positive attitude through all of this. I met for the first time with a new therapist yesterday, and it went well, so I will probably continue meeting with her periodically.
After meeting with Dr. Charlat, I came home and called the office of my surgeon, Dr. Stahl, to put off the surgery for now and cancel my June 27 surgical date. I need more time to complete the workup for a TAVR procedure, which consists of a series of tests to make sure I am a suitable candidate, help the doctors determine what size valve I need, etc.
In order to go this route, I need a second surgical opinion, and I set this up with Dr. Tyner, who is head of the division of thoracic and cardiac surgery for Scripps. Dr. Tyner comes highly recommended from a number of sources, including my wife, Ava, who worked with him at Scripps Green Hospital in La Jolla.
So, I am feeling cautiously optimistic that the TAVR procedure is a possibility for me, which would of course mean a less invasive way of replacing my aortic valve, quicker recovery, shorter hospital stay, etc.
If I do have the TAVR, Dr. Stinis and Dr. Stahl, the surgeon, would team up to carry out the procedure, and I am very comfortable with that.
Through all of this, I am trying to maintain an even keel in spite of the stress from the barrage of information I am dealing with, and the factors that are out of my control. To that end, I am taking advantage of a program offered through Ava's work, which allows for a limited number of sessions with a therapist. I'm hoping this will help me manage my stress and keep a positive attitude through all of this. I met for the first time with a new therapist yesterday, and it went well, so I will probably continue meeting with her periodically.
Wednesday, June 7, 2017
Plot complication
Yesterday, I met with an "interventional cardiologist" who has performed more than 1,000 of the TAVR procedures, replacing diseased heart valves through a catheter placed in the groin.
Based on that conversation, I want to know more about the procedure,to see if I would be a candidate.
The bottom line is that because I had radiation many years ago for Hodgkin's Disease, I could have scar tissue or other damage that would make surgery more complicated, and potentially more risky.
My surgeon, Dr. Stahl, discussed this possibility with me, and told me that it is impossible to know if the scarring is there until I am opened up during surgery.
The potential risk is scary, and after talking with the other doctor yesterday, I am having more concerns about whether surgery is the best option for me.
While that still may be the route I take, I want to explore more fully the TAVR option, to see if I might be a candidate for that.
The problem is, that in spite of the history of radiation, I am still classified as a low-risk for open heart surgery, and currently, the TAVR is only approved for intermediate- and high-risk patients.
The doctor I met with yesterday said that because of the radiation, I would not qualify for a randomized clinical trial in which low-risk patients have either a TAVR or open-heart surgery on a 50-50 basis. If that's the case, I would think that I would qualify for a TAVR as an intermediate-risk patient.
So, I will continue to gather more information and pursue the option of having a TAVR, and see where that leads me....
Based on that conversation, I want to know more about the procedure,to see if I would be a candidate.
The bottom line is that because I had radiation many years ago for Hodgkin's Disease, I could have scar tissue or other damage that would make surgery more complicated, and potentially more risky.
My surgeon, Dr. Stahl, discussed this possibility with me, and told me that it is impossible to know if the scarring is there until I am opened up during surgery.
The potential risk is scary, and after talking with the other doctor yesterday, I am having more concerns about whether surgery is the best option for me.
While that still may be the route I take, I want to explore more fully the TAVR option, to see if I might be a candidate for that.
The problem is, that in spite of the history of radiation, I am still classified as a low-risk for open heart surgery, and currently, the TAVR is only approved for intermediate- and high-risk patients.
The doctor I met with yesterday said that because of the radiation, I would not qualify for a randomized clinical trial in which low-risk patients have either a TAVR or open-heart surgery on a 50-50 basis. If that's the case, I would think that I would qualify for a TAVR as an intermediate-risk patient.
So, I will continue to gather more information and pursue the option of having a TAVR, and see where that leads me....
Monday, June 5, 2017
OHS or TAVR?
Now that my open heart surgery is scheduled for June 27, I am trying to mentally prepare myself for both the surgery itself and the recovery that will follow. I am comfortable with the procedure that I will have, which is an aortic valve replacement and bypass of a partially blocked artery. Also, I am comfortable with the surgeon, Dr. Richard Stahl, who will perform the operation.
But I still wonder if it would be better to have a TAVR procedure, in which the diseased valve is replaced through a catheter inserted into my groin, rather than having the full open heart procedure.
The advantage is a shorter recovery period and a shorter stay in the hospital; the disadvantage is that the TAVR procedure has less of a track record than OHS, and higher risk of some complications, such as valve leakage. Also, for a patient considered "low risk," such as myself, the TAVR procedure (which stands for transcatheter aortic valve replacement) is not approved by the FDA.
That means my only option, as I understand it, would be to enroll in a clinical trial, which is designed to determine the effectiveness and safety of the TAVR method for low-risk patients. Because the clinical trial is randomized, that means I would have a 50-50 chance of having either the TAVR or OHS.
With all this going through my head, I am scheduled to meet with an interventional cardiologist who is part of the clinical trial tomorrow. Right now, I feel it is likely I will go forward with the open heart operation, but I wanted to at least explore this other option before making a final decision.
When I talked about this with my primary care doctor a couple of weeks ago, she agreed it would make sense to learn more about the TAVR procedure. To that end, she found a doctor for me to talk to, and put in a referral.
While this is a big decision, I'm also still wrestling with the question of whether to get a tissue or mechanical valve.
As I have written about before, the tissue valve (from a cow or pig), does not require the patient to be on blood-thinners for life. However, for someone of my age (56), it would last 10-15 years, and I'm not crazy about the thought of a potential second operation when the tissue valve wears out.
A mechanical valve lasts much longer, 20-30 years, but patients must take blood thinners, which could impact my diet and activity level and would require regular blood tests to make sure the dosage is correct.
A lot to think about...
But I still wonder if it would be better to have a TAVR procedure, in which the diseased valve is replaced through a catheter inserted into my groin, rather than having the full open heart procedure.
The advantage is a shorter recovery period and a shorter stay in the hospital; the disadvantage is that the TAVR procedure has less of a track record than OHS, and higher risk of some complications, such as valve leakage. Also, for a patient considered "low risk," such as myself, the TAVR procedure (which stands for transcatheter aortic valve replacement) is not approved by the FDA.
That means my only option, as I understand it, would be to enroll in a clinical trial, which is designed to determine the effectiveness and safety of the TAVR method for low-risk patients. Because the clinical trial is randomized, that means I would have a 50-50 chance of having either the TAVR or OHS.
With all this going through my head, I am scheduled to meet with an interventional cardiologist who is part of the clinical trial tomorrow. Right now, I feel it is likely I will go forward with the open heart operation, but I wanted to at least explore this other option before making a final decision.
When I talked about this with my primary care doctor a couple of weeks ago, she agreed it would make sense to learn more about the TAVR procedure. To that end, she found a doctor for me to talk to, and put in a referral.
While this is a big decision, I'm also still wrestling with the question of whether to get a tissue or mechanical valve.
As I have written about before, the tissue valve (from a cow or pig), does not require the patient to be on blood-thinners for life. However, for someone of my age (56), it would last 10-15 years, and I'm not crazy about the thought of a potential second operation when the tissue valve wears out.
A mechanical valve lasts much longer, 20-30 years, but patients must take blood thinners, which could impact my diet and activity level and would require regular blood tests to make sure the dosage is correct.
A lot to think about...
Friday, June 2, 2017
Now this s**t is getting real
I now have a date for my open heart surgery. June 27 is when I will show up at the hospital at 5 a.m., be prepped for surgery, and wheeled into the operating room. It is a date that I both dread and look forward to with a sense of anticipation.
Dread, because in spite of the high odds this operation will be successful, this is a big, scary deal. And anticipation, because once I get through this, I will have a brand-new heart valve, and with it, improved physical vitality and energy and the possibilities they provide.
As I waited to see my surgeon yesterday, I felt anxious. Two days earlier, an angiogram revealed a partial blockage in one of my coronary arteries. I was sure this discovery meant that my surgery would even riskier and my odds for success lower.
But Dr. Richard Stahl, who will operate on my heart later this month, exuded calm confidence, reassuring me that the bypass - in which a vein from another part of my body is installed as a detour around the offending blockage - is something he and the surgical team can easily handle along with the replacement of my aortic valve.
He told my wife and I that he has completed more than 1,000 heart valve replacement surgeries during his 31 years in practice, which also made me feel like I will be in good hands.
Between now and my surgery, I will continue to work to maintain a positive attitude. I know this will get harder and harder as the date approaches. I will visualize a successful outcome to my surgery and the recovery period that will follow. I will also focus on the future beyond my surgery, to keep in mind the "prize" that is the reason for going through all of this in the first place.
A shout out to my good friend, Wendi, who practices Buddhism, and is channeling energy during her daily chants toward my successful surgery. She has also taught me how to do my own chants, which I will definitely incorporate into my other meditation exercises.
One other silver lining - as soon as I got the date for my surgery, I bought a ticket for my daughter, Salome, to fly home from Berlin, where she is studying abroad during her junior year of college. She will be with my wife and I during and immediately after the surgery, which will be a great comfort.
My thoughts go out to everyone who is either facing a similar surgery in the near future, or who has recently undergone a heart operation and is now on the mend. Good health to all of you! We will get through this!
Dread, because in spite of the high odds this operation will be successful, this is a big, scary deal. And anticipation, because once I get through this, I will have a brand-new heart valve, and with it, improved physical vitality and energy and the possibilities they provide.
As I waited to see my surgeon yesterday, I felt anxious. Two days earlier, an angiogram revealed a partial blockage in one of my coronary arteries. I was sure this discovery meant that my surgery would even riskier and my odds for success lower.
But Dr. Richard Stahl, who will operate on my heart later this month, exuded calm confidence, reassuring me that the bypass - in which a vein from another part of my body is installed as a detour around the offending blockage - is something he and the surgical team can easily handle along with the replacement of my aortic valve.
He told my wife and I that he has completed more than 1,000 heart valve replacement surgeries during his 31 years in practice, which also made me feel like I will be in good hands.
Between now and my surgery, I will continue to work to maintain a positive attitude. I know this will get harder and harder as the date approaches. I will visualize a successful outcome to my surgery and the recovery period that will follow. I will also focus on the future beyond my surgery, to keep in mind the "prize" that is the reason for going through all of this in the first place.
A shout out to my good friend, Wendi, who practices Buddhism, and is channeling energy during her daily chants toward my successful surgery. She has also taught me how to do my own chants, which I will definitely incorporate into my other meditation exercises.
One other silver lining - as soon as I got the date for my surgery, I bought a ticket for my daughter, Salome, to fly home from Berlin, where she is studying abroad during her junior year of college. She will be with my wife and I during and immediately after the surgery, which will be a great comfort.
My thoughts go out to everyone who is either facing a similar surgery in the near future, or who has recently undergone a heart operation and is now on the mend. Good health to all of you! We will get through this!
Wednesday, May 31, 2017
Stabbed in the wrist
A small bandage covers the spot on my wrist where, yesterday, my cardiologist inserted a catheter into my artery and threaded it up to my heart. The procedure was called an angiogram, and it was intended to let my doctors know if there are any blockages in my coronary arteries before I have my aortic valve replacement surgery.
It felt like a preview of my upcoming operation, because it was in the same hospital where I will have my surgery. I had to put on a hospital gown, an IV was inserted in my arm, and I was wheeled into an operating room with lots of high tech equipment, bustling medical staff and very bright lights in the ceiling. I was given a cocktail of drugs that put me in la la land, but not completely out. I felt some discomfort in my wrist and right arm, then it was over and they were ready to take me back to the recovery area. I was pretty groggy, but I remember my doctor telling me that they did find one partial blockage, of about 70-80 percent, in one of my coronary arteries.
I was happy they did the angiogram through my wrist, a method that is becoming much more prevalent, than through the femoral artery in my groin, because the risk of bleeding is reduced, and I didn't have to lay flat for hours after my procedure (although they kept me in recovery for the afternoon, to receive IV fluids to help flush out the contrast dye that was put into my system to aid in the examination of my coronary arteries.)
Two things stand out in my mind from yesterday's experience - one, although I was very nervous going into the procedure, it actually wasn't that scary once things got going. I was a passive participant; the medical staff did all the work, and I just went along for the ride. Of course, the sedatives I was given before and during the procedure helped.
Second, the staff, especially the nurses, was amazing. I had my procedure at the new Prebys Cardiovascular Center in La Jolla, which is part of the Scripps system and dedicated solely to cardiac care and treatment. Beautiful facility, top notch staff. They were caring, attentive and very sharp and knowledgeable. The nurses had read up on my history before I arrived, which impressed me. I felt well cared for and in excellent hands.
Of course, I had hoped that no blockages would be found, to simplify my surgery. But, I think of it like taking your car in for repair of a blown head gasket. The mechanic usually suggests replacing the timing belt and water pump as long as the engine is torn apart. So it will be good to take care of this problem now, before it gets worse, as long as I am already having open heart surgery.
I am supposed to take it easy for the next day or two, especially on my wrist, since I don't want to reopen the wound and make it bleed. No driving or dog walking for a couple of days. Otherwise, I feel fine.
Now for the next step, a meeting with my heart surgeon tomorrow. Perhaps I will get a date for my surgery...
It felt like a preview of my upcoming operation, because it was in the same hospital where I will have my surgery. I had to put on a hospital gown, an IV was inserted in my arm, and I was wheeled into an operating room with lots of high tech equipment, bustling medical staff and very bright lights in the ceiling. I was given a cocktail of drugs that put me in la la land, but not completely out. I felt some discomfort in my wrist and right arm, then it was over and they were ready to take me back to the recovery area. I was pretty groggy, but I remember my doctor telling me that they did find one partial blockage, of about 70-80 percent, in one of my coronary arteries.
I was happy they did the angiogram through my wrist, a method that is becoming much more prevalent, than through the femoral artery in my groin, because the risk of bleeding is reduced, and I didn't have to lay flat for hours after my procedure (although they kept me in recovery for the afternoon, to receive IV fluids to help flush out the contrast dye that was put into my system to aid in the examination of my coronary arteries.)
Two things stand out in my mind from yesterday's experience - one, although I was very nervous going into the procedure, it actually wasn't that scary once things got going. I was a passive participant; the medical staff did all the work, and I just went along for the ride. Of course, the sedatives I was given before and during the procedure helped.
Second, the staff, especially the nurses, was amazing. I had my procedure at the new Prebys Cardiovascular Center in La Jolla, which is part of the Scripps system and dedicated solely to cardiac care and treatment. Beautiful facility, top notch staff. They were caring, attentive and very sharp and knowledgeable. The nurses had read up on my history before I arrived, which impressed me. I felt well cared for and in excellent hands.
Of course, I had hoped that no blockages would be found, to simplify my surgery. But, I think of it like taking your car in for repair of a blown head gasket. The mechanic usually suggests replacing the timing belt and water pump as long as the engine is torn apart. So it will be good to take care of this problem now, before it gets worse, as long as I am already having open heart surgery.
I am supposed to take it easy for the next day or two, especially on my wrist, since I don't want to reopen the wound and make it bleed. No driving or dog walking for a couple of days. Otherwise, I feel fine.
Now for the next step, a meeting with my heart surgeon tomorrow. Perhaps I will get a date for my surgery...
Sunday, May 28, 2017
Attitude adjustment
Second, I believe, and medical research has shown, that having a positive attitude can help speed up that recovery and make it more comfortable. People in a more positive state of mind feel less pain, and have fewer detours and speed bumps on the road to recovery, at least from my past experience and what I have read. (As a cancer survivor, I have already endured radiation and chemo therapy, as well as two major abdominal surgeries.)
But how to do this when I am facing one of the scariest things I am likely to encounter in my life? Simply put, the idea of open-heart surgery scares the shit out of me. I know that the statistics are on my side, that the vast majority of people who undergo the procedure I need (aortic valve replacement) do very well and make a full recovery, and enjoy both improved health and a better quality of life.
I am one of those people, however, who can't help dwelling on the negative sometimes. My mind gravitates toward the worst-case scenario, the things that can go wrong, and the thought that I won't make it through my surgery.
I'm not always morose - I love to laugh and enjoy good conversation, and the finer things in life like spending time with my wife and daughter (a college student now studying abroad in Germany), as well as art, music, books and movies. And good food, and, of course, beer, how could I forget that?
So how do I keep focused on the positive? Well, for one, I love to write, so this blog is therapeutic for me, allowing me to confront my fears and deal with them. For those who haven't done so, try keeping a journal of your thoughts, it might be a big help.
Also, as I found during my cancer treatment and recovery (25 years cancer-free this July!), human contact is critical to getting through such a life-changing experience. You will find that some of your friends and family are too worried or upset themselves to be hugely supportive, but then other people will surprise you with their willingness to lend a shoulder to lean or cry on. Take advantage of those opportunities.
Support groups are another great way to get through the worst of your emotional lows. I remember thinking when I was going through cancer treatment that a support group would be too depressing, just a bunch of people sitting around feeling terrible. The exact opposite was true. Sure there were tears sometimes, but they were far outweighed by laughter and inspiration. There is nothing like being in a room with people who know exactly what you are going through.
Some people find meditation is very helpful to calm their nerves and focus on the positive. To that end, you can use relaxation CDs or audio downloads, which guide you to a place of peace, tranquility and positivity.
In two days, I will take my first step toward surgery, when I have an angiogram. This is a procedure that will let my doctors know if I have any blockages in my coronary arteries that need to be addressed along with my troublesome aortic valve.
One thing that is helping me now is a determination to look ahead,
beyond the surgery. I intend to be around next summer to watch my daughter graduate from college, and travel to Russia for the World Cup (our family has attended the last two World Cups, in South Africa and Brazil. The photo above is from our Brazil trip in 2014.) And I have other plans, like spoiling my grandchildren, and possibly moving to South Korea or Japan to teach English for a year. I am setting aside time to visualize these future activities.
In order to have these desired experiences, first I have to get through the upcoming surgery and the post-op recovery. That is an essential first step toward embarking on the next chapter of my life. My full story isn't close to being written.
Friday, May 26, 2017
Heartbroken in Oceanside
Hello to anyone who is reading the first post of my new blog, "Straight From the Heart." I am a 56-year-old Southern California resident, who works as a freelance writer/journalist. I have blogged in the past about travel, which is my passion and what I spend my "extra" money on, but this blog is different. It's personal, very personal. It's all about my "broken heart."
And no, this isn't a country song, I didn't get fired from my job, my dog didn't die and my girl didn't leave me.
I'm talking about a different kind of heartbreak - the kind where a doctor in a white coat tells you that, essentially, your heart is broken. In my case, the specific diagnosis was "severe aortic stenosis," which simply means that the aortic valve in my heart needs to go because it's kaput. In its place will be a new valve, which could be made of metal and plastic, or tissue from a pig or cow. I will get to some of those details in later posts.
For now, I'll just give you a little bit of the "how I got here."
About 8 or 9 years ago, I began to have what I call palpitations, and what a medical type would call heart arrhythmia. I went to see a cardiologist, who noticed a heart murmur, which is a funny, kind of squishy sound that my heart makes on each beat.
The next thing I know, I'm having a test in which some lubricating jelly is squeezed onto my chest, and a handheld device with a bulb on the end is being moved around through the lubricant. It's like a sonogram that a woman has to check her pregnancy, only this procedure is aimed at the heart.
I was told that I had aortic stenosis and one day, several years in the future, I would need a new heart valve.
Well,that day is today, about seven years after my initial diagnosis.
I'm not happy about it, but I don't have a whole lot of choice. You see, there is no treatment for aortic stenosis other than replacement of the valve. There's no pill or shot that can remove the calcium that has built up on the "leaves" of my heart valve, which is slowly closing up the opening to the aorta, the artery that carries life-giving, oxygenated blood to my entire body.
So, now I am looking at the prospect of, gulp, open heart surgery, and it's not fun anymore.
In subsequent posts, I will write about some of the decisions that I must make with the help of my doctors. And what I know about the procedure I am facing, and what lies in store for me after the operation.
So fasten your seat belt, we're about to hit some turbulence, and things may get bumpy!
And no, this isn't a country song, I didn't get fired from my job, my dog didn't die and my girl didn't leave me.
I'm talking about a different kind of heartbreak - the kind where a doctor in a white coat tells you that, essentially, your heart is broken. In my case, the specific diagnosis was "severe aortic stenosis," which simply means that the aortic valve in my heart needs to go because it's kaput. In its place will be a new valve, which could be made of metal and plastic, or tissue from a pig or cow. I will get to some of those details in later posts.
For now, I'll just give you a little bit of the "how I got here."
About 8 or 9 years ago, I began to have what I call palpitations, and what a medical type would call heart arrhythmia. I went to see a cardiologist, who noticed a heart murmur, which is a funny, kind of squishy sound that my heart makes on each beat.
The next thing I know, I'm having a test in which some lubricating jelly is squeezed onto my chest, and a handheld device with a bulb on the end is being moved around through the lubricant. It's like a sonogram that a woman has to check her pregnancy, only this procedure is aimed at the heart.
I was told that I had aortic stenosis and one day, several years in the future, I would need a new heart valve.
Well,that day is today, about seven years after my initial diagnosis.
I'm not happy about it, but I don't have a whole lot of choice. You see, there is no treatment for aortic stenosis other than replacement of the valve. There's no pill or shot that can remove the calcium that has built up on the "leaves" of my heart valve, which is slowly closing up the opening to the aorta, the artery that carries life-giving, oxygenated blood to my entire body.
So, now I am looking at the prospect of, gulp, open heart surgery, and it's not fun anymore.
In subsequent posts, I will write about some of the decisions that I must make with the help of my doctors. And what I know about the procedure I am facing, and what lies in store for me after the operation.
So fasten your seat belt, we're about to hit some turbulence, and things may get bumpy!
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