Asheviller: Ron and Valerie Move to Asheville…

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Wed
30
Sep '09

Achy, Breaky Heart

Hole Count2 (as of 7:15am): 1 small pain killer injection for 1 HUGE IV needle.
ID Bracelet Count: 3 wrist, 1 ankle

10:55 -  Ron wants to sleep; the nurse turned down the lights. I returned to the hotel.
10:50 – Ron uses the spirometer again; the double dose of morphene makes it easier.
9:00 – Ron’s big outing:  sits up, moves to a chair next to the bed and then back into bed (with assistance).
8:30 – Ron’s entourage leaves the building.
7:00 – Ron is talking to everyone now.; he’s looking much better. Luis give Ron the highlights of his procedur; the 4 hours on heart-lung by-pass shocks him.
6:30 – Ron feels awake now. He is surprised that it is 6:30 pm, expecting it to be about 2 pm. 
6:15 – Luis convinces me to take pictures of Ron. Mine are blurry, so he takes them. I won’t post them unless Ron agrees.
6:00 – Checked Ron again. He is off the ventilator and breathing on his own through the breathing tube.
5:20 – Held Ron’s hand; actually just his fingertips (too many tubes). Told him thumbs-up twice (our signal for valve was repaired). The nurse will take him off the respirator soon to see if he can breathe on his own. After 20 minutes of breathing on his own, she will check his blood O2 to make sure he does need to be hooked back up.
5:00 – Checking on Ron, no change. I can’t stay in the room with him.
4:15 – Ron is covered head-to-toe in yellow betadine. He is still sleeping and has tubes everywhere. He’s been assimilated; he’s a Borg.
3:50 – Ron’s family is visiting Ron.
3:25 – Checked with the CICU info to see if we could see Ron. We were told to come back at 4:00; since there was no room in the waiting room Jolie, Luis and I went downstairs to wait until 4:00.
3:00 – The surgeon discussed Ron’s surgery with us. Ron had more extensive repairs that he anticipated. Ron’s heart was stopped and restarted twice to do the two valve repairs. He was on the heart -lung by-pass for a total of 4 hours (he likes to keep it under 2 hours). He also repaired Ron’s mitral valve strands with reinforcing fibers (usually only the valve or the valve strands are fixed, not both). To further support the valve the surgeon replaced the valve ring with a smaller one. Ron will be moved to CICU (Cardiac ICU). He will be on meds to try to reduce his heart and wo’nt be bouncing back as quickly.
1:41 – Update: Ron is off the heart-lung by-pass; his heart is beating. I should be able to see him and the surgeon in about an hour. This was tense a 2 hours of waiting, knowing that they were doing additional valve repairs. (6 1/2 hours so far)
11:51 – Update: the surgeon tested the valve repair, but was not happy with it. He is now doing  more valve repair; adding another hour to Ron’s surgery. Jolie said Ron is not going to like being off schedule.
10:46 – Update: the surgeon is repairing the heart valve; it looks good.
10:46 – Update: Ron’s mitral valve repair has started.
9:36 - A surgery nurse called with an update: Dr. Siwek is in and will enter the heart soon. Ron’s heart is stopped and on heart-lung by-pass.
8:10 – Ron’s entourage goes to the waiting room.
7:25 – My sister Pat and niece Abby pray for Ron and light a candle at the Basilica in Washington DC; they are on Abby’s class trip to DC and conveniently arrive as Ron surgery is about to start.
7:15 – Ron goes to surgery.  Ron’s entourage (Luis, Jolie, Walter, Eleanore, Walter, Saundra, Cassidy, and Valerie) gathers in the cafeteria.

A gown and plastic ID.TMI:
7:00 – Kathryn informs us it’s time for good-byes.  She walks us to the Skybridge waiting room and lets us know we have until 8:00 am to visit the cafeteria. Ron declines a epidural (much higher that the epidural for labor).
6:56 – The anesthesiologist arrives.
6:55 – The surgeon leaves; Ron’s bp is 109.
6:54 – The surgeon arrives. Ron’s BP is 121. Ron asks about the appendage repair; the surgeon explains that it is closed with internal stitches.
6:45 – Heart rate 102, O2 96.
6:35 – Ron’s parents arrive.
6:30 – The shave is complete – 45 minutes. We had to ask: Lisa’s longest shave took 1 hour and 45 minutes.
6:05 – OR nurse, Kyle, arrives to meet Ron. Lisa is still shaving; he gets Mohawked – not on his head.
5:49 – Kathryn starts Ron’s IV (a huge needle, that is replaced with a plastic tube). Lisa is still shaving.
5:45 – Lisa, the body barber, starts shaving the ‘robotic’ (Ron); a full body shave, neck to toes.
5:30 – The prep nurse, Kathryn, checks Ron’s bloodsugar (101 – perfect), blood pressure (136/85) and takes his history.
5:21 – Ron is clothed only in a gown and 1 plastic ankle ID. The nurse explains the surgery prep process.
5:15 – Ron and I go to Surgery Prep while Ron’s parents wait.
5:11 – Next we go to Surgery Admitting.
5:00am – Surgery Procedure Check-in.
4:45am – Ron, his parents and I walked to the hospital (Ron’s last outdoor walk for a while).

Today’s blog by Valerie.

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Tue
29
Sep '09

Here We Go…

I had a wonderful day today. It wasn’t anything grand. Pretty simple actually, but that’s what was special about it. It was sunny and cool. I had a Belgian waffle with fresh local peaches for breakfast. All eight of us sat at the counter at Frank’s. I held Valerie’s hand. Smiled when I thought of Serena. Hugged my parents and my sister. Laughed out loud with Cassidy. She and Luis are having a grand time – with Jolie keeping him in check. Checked in the hospital and had my blood draws, peeded in a cup, had an EKG and a chest x-ray. I now have two wristband IDs that the nurse defied me to remove. We all had cheeseburgers of various makes and models at the Sawtooth Grill for dinner. I skipped having beer but substituted a huckleberry shake. It seemed like the right thing to do being less than 14 hours from surgery. Afterwards we all sat around the hotel lobby, talking and laughing. That’s what I’ll remember when the lights go out tomorrow morning at 7:15. Here’s to the lights coming back on around noon.

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Mon
28
Sep '09

It’s Like Trying to Herd Cats

Herding CatsAs I write this, my parents, sister and niece, and Luis and Jolie are on their way to Spokane — but we aren’t…yet. My parents are on their way to Las Vegas for a long layover and then should arrive in Spokane at approximately 10pm. Luis and Jolie are driving and will pick up my parents at the airport and take them to the hotel. Saundra and Cassidy are flying non-rev on American (Saundra used to work for them) which means they can only fly if there are empty seats. They left San Antonio very early this morning around 5am (3am our time). They got to Dallas no problem but were bumped off every flight to Seattle. They finally made it on a 4:30pm flight that’s scheduled to arrive in Seattle at 6:30pm. If they had gotten bumped off that flight we were going to leave without them and they would have gotten a hotel room in SeaTac (when they eventually arrived) and driven a rental car over tomorrow. As it stands, we’ll pick them up around 7pm and head east, racing the rain that’s due any time. With a little luck we’ll make it by midnight. I’m curious to see what a mom and 3-year-old are like after travelling for 23 hours…or maybe I’m not.

Tomorrow will be a late breakfast, maybe at Frank’s Diner, pre-op tests at 2:00pm, then a friends and family dinner at the Sawtooth Grill. I can eat until midnight but won’t have anything heavy or spicy since it’ll be hanging around in me for a couple days. TMI.

Fri
25
Sep '09

T-Minus

Cue up the music…[fergcorp_cdt].

Thu
24
Sep '09

The Friends and Family Plan

I am going to have quite the entourage here to support me through this “little procedure.” My parents are flying from Pittsburgh to Spokane on Monday evening. My sister and 3-year-old niece are flying from San Antonio to Seattle on Monday and then riding with us to Spokane. Good friends, Luis and Jolie, are driving to Spokane on Monday as well. I’m glad they’re coming and am truly grateful for their support. I’m also getting good vibes from all my friends and family around the country. Thank you for your calls, emails, and prayers. Knowing that you care will really help me, and Valerie, get through this.

P.S. Please don’t send flowers (a card is okay). For what flowers cost, I’d rather the money went as a donation to the Sacred Heart Medical Center and Children’s Foundation or the American Heart Association.

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Tue
22
Sep '09

Coulda Shoulda Woulda

I had my meeting with Dr. Siwek today. I don’t have much experience with surgeons so I can’t compare him with others, but he comes across as a very confident, serious, quiet guy. I got the impression that while other top-notch surgeons might be out there promoting themselves for fame and notoriety, he’s happy letting his statistics talk for themselves. More on that later.

The first ten minutes of our conversation were a bit disconcerting. He wanted to know my history and why I waited until now to have my valve repaired. He felt that my heart was enlarged enough last year that he would have recommended surgery then. He also felt that with my marginal high blood pressure over the years that some doctor should have correlated the bad valve with the high blood pressure and recommended that something be done. Ultimately, I think the problem was that I was “externally” symptomless. If I was short of breath or had dizzy spells that would have been a sign that something was seriously wrong. But, since I was walking, talking, example of good health and my blood pressure was only borderline 140/90 my doctors took a wait-and-see approach. It wasn’t until this August’s exam that my heart changed enough in size to warrant surgery – in the opinion of my cardiologist.

It’s easy to Monday-morning-quarterback but if I would have had surgery 20 years ago they would have replaced, not repaired, my valve using dark-ages surgery techniques/technology and I would have been on blood thinners for the rest of my life. Even 10 or 5 years ago I doubt they would have been able to fix my valve. Should I have had it done last year? In retrospect, maybe, but my heart didn’t change from 2007 to 2008 so my cardiologist thought it was stable. I did, too. And, I felt fine. The big change from last year to now means that it’s time. Better late than never, right?

Here’s the scoop from our discussion:

Dr. Siwek currently has a 99%+ fix rate (that compares to a 60% fix rate for surgeons who open your chest and don’t do it robotically). The valves that he can’t fix are ones that were damaged from rheumatic fever and he usually knows that going in. He doesn’t see anything in my echo or angio that makes him think he can’t repair it – but nothing’s guaranteed. If he can’t fix it he will install (is that the right word?) a St. Jude mechanical valve. That means taking Coumadin (a blood thinner) for the rest of my life but he reiterated that he believes, and his stats back up, that he can fix my valve and I don’t need to worry about that.

While he’s “under the hood” I have two additional problems that need fixed. My enlarged heart has stretched out the electrical connections and that is causing my occasional bouts of atrial fibrillation (A-Fib). Even with my valve repaired it’s unlikely that my heart will shrink back to normal size, though it will hopefully shrink back some. It’s likely that my A-Fib will become more frequent and it may stop self correcting. Having A-Fib is dangerous because it can cause blood clots and strokes. In an attempt to prevent these problems he’s going to perform a Maze procedure on the left side of my heart. It’s basically a series of carefully placed scar lines that look like a maze (hence the name) that disrupts the errant electrical signals and keeps them from getting stuck in an infinite loop. He’ll do this by freezing the heart tissue, called an ablation, which will then form scar lines when it heals. He feels there’s little to no risk in doing this and if it helps prevent future bouts of A-Fib it should be done.

And finally, because of the regurgitation and pressure buildup into my left atrium caused by my bad mitral valve, my left atrial appendage is “extremely large and dilated” (to quote my angiogram report). I had never heard of a left atrial appendage, but sure enough, there is such a thing protruding from everyone’s left atrium. Your heart uses it as a reservoir for your left atrium but it’s apparently unnecessary, sort of like your appendix. When it’s enlarged it can collect blood clots so Dr. Siwek is going to “address it, too.” I didn’t ask what that involves but I read some studies that suggest closing it off completely is beneficial. I need to add that to my follow-up question list.

So, what does all this translate to for next Wednesday?

- Four to five hours of surgery starting at 7:15am
- A puncture in my neck into my carotid artery for the anesthesiologist
- A 2” cut (the largest of all of them) in my groin for access to my femoral vein and artery for the cardiopulmonary bypass
- Two dime-sized holes in my right side between my ribs for the robot
- A 1” cut in my right side for the camera and for passing in contraband devices, stitches, etc

If all goes perfectly well Dr. Siwek would expect me to be discharged on Friday (WOW!) and then stay in the next-door hospital hotel until Monday or Tuesday. However, he feels that with my history of A-Fib he wouldn’t be surprised if I go into A-Fib while I’m in the hospital (even after the Maze procedure) because of the irritation/healing of my heart. They, obviously, won’t release me with an unstable heart rhythm so he said not to be surprised if I need to stay in the hospital an extra day or two until my heart is beating properly.

Happy Happy Joy Joy

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Fri
18
Sep '09

Me and My Robot

robot

Dr. Siwek’s (pronounced “SEEweck”) office called this morning to say that he has more thoroughly reviewed my echocardiogram and angiogram films and decided that I am a good candidate for robotic mitral valve repair. Yah!

The questions ”Can it be repaired (vs. replaced)?” and “Can it be done with the da Vinci robot?” will continue to be there until the surgery is actually over. But, I’ve passed the first decision point! Dr. Siwek wrote on my chart, “Should be done sooner than later” and was then happy to hear that we were already scheduled for the 30th. They confirmed my Tuesday appointment to discuss the surgery and my Wednesday, September 30th, date with the robot.

UPDATE:  Just got confirmation that surgery is scheduled for 7:15am on Wednesday, September 30. Check-in is at 5:00am. Surgical pre-screening is at 2:00pm on Tuesday, September 29.

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Thu
17
Sep '09

Jane Robelot’s (CBS Early Show) Mitral Valve Surgery

Here’s a great video about Jane Robelot from the CBS Early Show and her March 2006 mitral valve surgery that was done using the da Vinci robot in Atlanta. It chokes me up to watch because it’s eerily similar to my story.

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Wed
16
Sep '09

Two Weeks From Today…Surgery September 30

I just got off the phone with Aubrey in Dr. Siwek’s office. My surgery is scheduled for Wednesday, September 30. I have an appointment with him next Tuesday to meet, discuss the surgery, and ask questions. For the surgery, we’ll probably drive to Spokane on Monday, Sept 28th, since Tuesday will likely be busy with tests and pre-surgery prep. FYI, the hospital is Providence Sacred Heart Medical Center.

I don’t know if I feel better or worse now that I have a date.

Tue
15
Sep '09

Being of Sound Mind and Body…

Still no word yet from the surgeon. I did call my cardiologist today and left a message of essentially, “What’s up?”  They haven’t called me back yet. Frustrating.

In the interim, I decided to work on updating my will. Valerie and I had our wills done in 1998 and there have been a few “personnel” changes since then so now seemed like a good time to update them—or at least, mine.

And, probably more important, is updating our Power of Attorney and Living Wills. Although we had those done in 1998, too, there’s now a new (better) form called “Five Wishes” that incorporates both of those documents into one, is good in 40 states, and doesn’t require a lawyer to be valid. It covers the following Wishes:

  • The Person I Want To Make Health Care Decisions For Me When I Can’t Make Them For Myself
  • My Wish For The Kind Of Medical Treatment I Want Or Don’t Want
  • My Wish For How Comfortable I Want To Be
  • My Wish For How I Want People To Treat Me
  • My Wish For What I Want My Loved Ones To Know

You can read the document (but not print it) here: www.agingwithdignity.org/forms/5wishes.pdf

Blank forms are $5 and are available from: www.agingwithdignity.org/five-wishes.php

If you want to make it easier on your loved ones (should you become incapacitated) I’d highly recommend getting and completing “Five Wishes”.

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Mon
7
Sep '09

Robin Williams

I had forgotten that Robin Williams had heart surgery last March at the Cleveland Clinic to replace his aortic valve and repair his mitral valve.  See here for more details…

He was recently on David Letterman discussing his surgery.

Sun
6
Sep '09

Angiogram Day

I’ve been delayed making this entry because of a bout with (likely) swine flu. Friday was an ugly ugly day but I’m much better today.

Anyway, as I said, earlier, I survived my angiogram. Its purposes was two-fold: 1) Validate the results of the echocardiogram that showed I need my mitral valve fixed and 2) Check my heart’s arteries to make sure they are healthy enough for surgery and determine if I might also need by-pass surgery. The test did confirm that I need my valve fixed and it also showed that my heart is, otherwise, in fine shape. There’s no blockage or even the beginning of blockage so bring on those BBQ ribs!

Here’s a picture of me high on Versed and Fentanyl.

angiogram-2

You can read all about the technical details of angiogram here…

I checked in at Overlake Hospital admitting at 7:00am, was in the room by 7:20, signed all the papers and was hooked up to IV’s and a heart monitor by 7:45. I was rarin’ to go but then learned that my procedure was not scheduled until 10:30. Argh. Luckily they took me up early at 9:15 and the procedure was over by 10:15. Although they had me on Versed to calm me down and Fentanyl for pain I can tell you that the two punctures in my leg, one in the artery and one in the vein, were pretty painful — but only for about 10 seconds. Couple things I remember: Dr. Maidan telling me, “I’m up into your heart now. You won’t feel it but you may feel your heart skip a few beats. That’s okay.” “I’m going to release some dye now. It’s going to feel like you’re urinating but you’re not.” It did, and I didn’t.  And, I remember looking down (I wasn’t allowed to lift my head) and seeing Dr. Maidan pulling out the catheter with what looked like several long arm movements — like a magician pulling out an unending roll of ribbon from his fist. I know it’s less than three feet from my groin to my heart so there couldn’t have been that much catheter in me, and it was probably the drugs talking, but for a moment it was a bit unnerving. Afterwards he shook my hand, said that I did need my valve fixed but otherwise my heart was fine. That’s good, I think.

I was back in my room by 10:15. Kat (nursing tech) and Sarah (RN) took the ports out of the artery and vein in my leg. This can be a bit tricky because they have to keep them from bleeding, inside and outside. Kat clamped down on my groin with two fingers for 15 minutes! You go girl. After that they bandaged me up and told me not to move my leg or lift my head for three hours – 2:00pm. They brought me snacks, lunch, a newspaper and checked on me several times an hour. Kudos! Valerie fed me J. At 2:00 Sarah checked my bandages and gave me the okay to discharge. She gave the discharge instructions to Valerie (foiled again) and there was some blather about me not being allowed to lift more than 10 pounds for a week.

unfair-2

I was out of there and at home a little after 3:00. My results are being forwarded to Dr. Siwek in Spokane and we’ll wait for him to call us next week with, hopefully, the news that he thinks my valve can be fixed (not simply replaced which I don’t want) and that he can do it robotically. Fingers crossed.

I’ll close this entry with another picture. We were at Starbucks a few days ago and I watched this ”elderly” guy leave the store and head for an outside table. He could barely walk. He mostly shuffled. He held on to the chair and the table when he sat down. After taking a few sips of his coffee he pulled out a pack of cigarettes and started smoking. Coincidentally, there was an empty beer can on the table, probably from the night before, and he pulled it closer to use as an ashtray. Caffeine, nicotine, and alcohol! Nice picture. Valerie got in the car. I pointed the guy out and said, “And, I’m the one with heart problems.” She looked at me and said, “Yah, but he’s the same age as you.”

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Thu
3
Sep '09

I Survived My Angiogram

I’ll blog in more detail, tomorrow. Right now I have a headache and am pretty tired. My heart is fine except for the bad valve and the resulting increase in size. There’s no blockage at all, not even the start of blockage. Time for another nap.