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....
Wednesday, June 7, 2017
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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