Sunday, February 17, 2013

How to Fix a broken heart - Part 4

Now out of hospital after successful surgery. Home tomorrow - More later.

Friday, February 08, 2013

How to fix a broken Heart - Part 3

This is the third in a series describing my journey through the process of discovering that I (literally)  have "a broken heart" and beginning the process of getting it fixed.

In this series I've been putting in a plug for the (Canadian)  Heart and Stroke Foundation   which provides  funds for research and  supports  people who are dealing with heart disease and strokes.

Since, in Canada, February is Heart Month  and I am about to benefit from their work, I'd encourage you to consider contributing to this work. 

In the first part  titled "How to fix a broken heart"  I told the story of how I came to find out that I had  severe aortic valve stenosis.  (Step 1 - Diagnosis)

The second part described Step 2:Talk to a cardiac surgeon

I've been playing a catch -up game describing  "what happened in the past" -this post brings us up to date.
Step 3 - Preparing for surgery

Last time,  when I left off we were home waiting for a call from the hospital.

Enjoying life: On  Friday (February 1), the day after our trip to see the surgeon, our daughter arrived home for the weekend. She had made the plan to come  shortly after we knew that the "echo"  was scheduled for the 19th and she thought it would be good to be here to help us pass the time while we were waiting to get the results on  February 5. 

Little did we know that God had other plans and  not only did we have a firm diagnosis but we also already had completed  the surgical consult. However, her idea of helping us with waiting was still a good one -- just that we were waiting for a different thing. 

It was  a great time - see "Snow time to post". 

Facing reality: I was sorry (even though it was out of my control) to see the distress in her eyes trying to deal with the fact that her "invincible father"  was in fact very "vincible" (Yes Virginia that's a word - I looked it up!!).

(And her brother's have shown the same thing as we have talked and Skyped with them)

(As an aside  - I am so proud of the adults my children have become -- I am acutely aware of my many failings as a parent - I was too often too occupied with other things and not "there in the moment" with them when I should have been but as the saying goes "I must have done something right".

I continue to pray that I can, by the power of His Spirit,  become a better husband, father and grand-father as I continue my walk with God through this world.)

It was a time for lots of conversation, some serious,  some painful, but mostly about daily routine  and "the business of life".  A few tears  and lots of laughter. 

15-2, 15-4 and there ain't no more: We played a few games of  cribbage -  something I enjoyed doing with my Dad -- and Melissa  had the idea that  there must be an online version. Sure enough there is. 

Monday morning we gave her mother a good laugh - Melissa was sitting at the desk using the laptop and I was sitting on the bed using my kindle and we were playing cribbage on-line while talking back and forth -- your play, 15-2, etc., etc. So we are all geared up to play a few games while I'm recuperating.

The waiting game: After we put her on the plane Monday afternoon we began waiting in earnest.

 Linda began packing and organizing for an extended stay away from home. We had been planning for her to stay at her niece's place - She is in the nursing program at Laurentian University and lives a couple of kilometers (mile or so) from the hospital.

Much of Tuesday was occupied with being "out and about"  doing a few errands.

Linda's uncle called to tell us about  the Travelway Inn  which is "next door" to the hospital.

 For 2-3 days following the surgery I'll be in the ICU (cardiac intensive care)  which has restricted visiting hours (30 minutes every 2 hours) so it would be difficult to  stay at the Hospital all day and equally difficult and time consuming to be running back & forth to Hilary's place.  Since it's a few minutes to walk from/to the Travelway it seems like a good idea for her to stay there at least until I'm out of ICU.

Once I've moved to a "regular" surgical recovery unit the visiting hours are more generous (11:00 a.m. to 7:00 p.m.)  and Linda  can move to Hilary's and mke 1 trip to hospital and stay for the  entire period.

I began working seriously on "preparing for the worst" - although I'll confess there was a lot of procrastination - after all it wouldn't do to get it all done and then have to sit around "twiddling my thumbs". 

The reality is that I was (self diagnosis) mildly depressed -finding it hard to focus on anything and spent (wasted) a lot of time playing free cell on my kindle and trying to clean up a large backlog of "C"-file email. 

 I also  was spending lots of time on Facebook, on some discussion groups and using email  to communicate with family and friends. And thee was of course my desire to keep writing in this blog.

On top of that (or maybe as part of it) I found I was tiring easily. That had been happening all fall but I wrote it off to the workload of teaching 3 courses - equivalent to a full time job and something I hadn't done for a long time. 

I guess it wasn't the workload after all!!! (which I should have known because it was unusual for me to get that tired that easily).

So the days went by without much being accomplished or so it seemed -- although looking back perhaps I was using the wrong measure -- that I was doing more "living in the moment" and doing "last day" things in relationships - perhaps -- or perhaps I'm just rationalizing  -- it is what it was. 
I was just reminded in this recalling of the last few days of this excerpt from the   Rubaiyat of Omar Khayyam

“The Moving Finger writes; and, having writ,
Moves on: nor all thy Piety nor Wit
Shall lure it back to cancel half a Line,
Nor all thy Tears wash out a Word of it.”

So  we move on 

What's really important?  
Throughout this waiting we continued to "pray without" ceasing.

I was also doing the most important thing.  I wanted to  spend as much time as I could being close to and talking with my beautiful "Irish eyes". She was having a difficult time - hovering a bit -- and being anxious about  every little thing I did because of the severity of the stenosis and the increased risk of sudden death.   

It is  a test of our faith - repeating many times "Lord I trust you and help me in my lack of trust"  and "not my will but yours but I really want it to be my will" --  I want to live - I choose life"  -- not because of the fear of death but because my job here isn't finished and I don't want Linda to be left here without me.  (Interesting conversation with our son the psychologist on the question he asks "Is there any part of you that wants to die?") 

I am mindful of what Paul wrote in Phillipians 1: 18b-26  "For to me to live is Christ, and to die is gain." but I'll admit that unlike him   "My desire is to NOT  depart and be with Christ"    although I share his commitment to life because . 24  to remain in the flesh is more necessary on your (their) account.

We talk again about our constant prayer that when it's time "please God take us together" but we'll never do anything to help Him with that request -- and whatever comes we know that - if one of us is left here without the other -- we will find the good (cf. Rom 8:28) somewhere sometime after the "valley"  has been walked.

Another ending: I am, along with my older sister, an executor for my Dad's estate. 

Wednesday I managed to complete a job that had been hanging around since September when I committed to doing the most of the financial "wrapup".

I completed my Dad's "final" income tax and a "balance sheet" for his estate so it could be wrapped up. 

And the wait is (almost) over: This brings us to yesterday (Thursday) when the phone rang at 8:30 a.m. It was the hospital calling to say my surgery was scheduled for  the upcoming Wednesday (13th). They said I needed pre-op and asked did I want to do it "tomorrow" (Friday) or Monday. Given the  7 hour round trip it seemed "prudent" to say "Monday" and just plan to stay there for the extra day so Monday pre-op and Wednesday surgery. 

I was ecstatic - the wait was over - well almost anyway. Wednesday will  be less than 2 weeks from when the surgeon said 3 to 6 weeks  and only a week later than when I was originally supposed to be learning the results of the echocardiogram.   

Thank you my Father. I could almost hear the Hallelujah chorus. Of course, at the same time, my anxiety about the procedure increased - I'm not looking forward to the pain and tubes and all that major surgery entails and at the same time there is a wonderful anticipation of being able to DO things again!

Just as I had finished notifying family  the phone rang again - your surgery has been moved up to Tuesday -  That's even better  Double Hallelujah!

Well - now we are up to date.  Final preparations - do all those things I've been procrastinating on and get on the road on Sunday.

More to come  - hope to describe the final days of getting  "Ready for Surgery"
in a post on Monday night.

God Bless

Thursday, February 07, 2013

How to fix a broken Heart - Part 2

I have a broken heart  - literally – or to be more medically correct I have severe aortic valve stenosis. 

This series of posts is a record of the steps that I am taking to fix my broken heart.  

Heart And Stroke Foundation
Before proceeding, a reminder that, in Canada   February is Heart Month. 

The Heart and Stroke Foundation  focuses on canvassing to raise funds for research and  support of people who are dealing with heart disease and strokes

The first post in the series covered Step 1: Find out it's broken (diagnosis).

This post describes   Step 2:Talk to a cardiac surgeon

It's a serious problem: I  finished the "Step 1" post with the confirmed diagnosis via an echocardiogram on January 22nd.   I  had been told that I would have to wait until a doctor's visit  scheduled for February 5 before I got the results of the "echo". 

When the technician  was finished the test I said "So I guess I have to wait for the doctor's appointment to get the results?"  He said "Yes" and then asked "When is that?".  I replied two weeks.  He said "Finish  putting your shirt on and then come out" and he left the room. 

In less than a minute he was back with the doctor who said "The results show the valve needs to be replaced - I will refer you to a cardiac surgeon  in Sudbury" --   he said the narrowing (stenosis) was severe.  

Waiting again but not as long as we thought:   I  "guessed" that the technician was able to tell that it was serious  and had decided to inform the doctor  so  more time would be lost in waiting and  -- what ever the reason -- I was thanking God that it was moving ahead -- because it's really tough waiting for answers once the test has been completed. 

I was told that I would hear from the surgeon in 2 to 3 weeks so I was (again) pleasantly surprised when I got a call from the surgeon's office on Friday for the "consult" on Thursday January 31. 

"Snow" way to travel: Three and a half hours on snow covered roads isn't  my idea of fun but  it wasn't as bad as had been forecast - so we made the trip pretty much  as "normal" speeds (i.e  speed limit or slightly below -- not my summertime speeds which I'll confess are often 10- 15% above the posted limit (90 km/hour or 55 mph outside the towns -- never go over in the reduced limits unless you want the OPP flagging you down!!) (We didn't take a picture - The forecast was for "snow packed" roads with snow flurries  - there wasn't any snow falling  flurries or otherwise.  Anyone from Northern Ontario will understand what I mean when I say we had mostly "track bare with a few snow-packed sections" but for those from more friendly climates this picture (taken from theWeathernetwork photo galleryshows what we were dealing with. (It's NOT Northern Ontario and I forgot to note location before I saved it. When I went back I couldn't find it again.Sigh ...) 

What the surgeon said:  He started with "The stenosis is  severe and the surgery needs to be done as soon as possible". He proceeded with his "due diligence" to explain the surgery and the associated risks and ended with "However you are healthy otherwise so it should go well -- but it is major surgery and I need  you to be aware of risks and give informed consent"  blah, blah, blah, the usual "doctor speak before surgery -- I've have 4 other  relatively minor surgeries so I knew that drill.

Agreeing to proceed and signing the consent form was, for us,  a "no brainer" -- however I did want (perhaps my analystical, engineering brain kicked in here) to know what they meant by "severe" .

Wow -now that's severe alright! He proceeded to explain that with the echocardiogram they are able to calculate the pressure gradient across the valve and the size of the valve opening. Now he was talking my language. After all,  I had just finished teaching a first year course in physics that had touched on fluid dynamics. 

In a normal aortic valve it opens fully and there is almost no pressure drop through the valve.  If there is a 40% drop the valve should be replaced. Mine averaged 59% with bursts much higher.  

The fully open normal valve has a cross sectional area of around 2.5 cm squared. They replace when it gets below 1 -- mine is 0.39 ! 

Now I understood what they meant by severe.  There were some other results of the echo showing thickening (hyertrophy) of the ventricle (muscle) wall,  and  distortion  (distension) of the ventricle (chamber). These caused by the increased pressures inside the ventricle.

Also some  "ballooning" (distension) of the aorta just above the valve  (caused by the high velocity "jet" exiting the narrowed valve  - think putting your finger over the opening at the end of a water hose!!)

None of  these were cause for serious concern  and the Doctor thought they would "self-correct" after the valve replacement.

What's a healthy guy like you doing in a place like this:   The surgeon affirmed what the cardiologists had said: There's nothing you could have done to prevent this. It  just happens to a certain percentage of the population usually between 65 and 70 (so I'm right in the window of age!!).  The good news is that I'm otherwise very healthy - no clogged arteries, no high blood pressure, do diabetes, etc., etc. -- none of the "risk factors" that would increase the likelihood of complications or future problems. Fix this and you're "good to go".

To be (organic) or not to be: The big decision was the choice of valve type. There are two (major) options

  •  a mechanical valve which lasts a lifetime but requires  a lifetime regime of taking a blood thinner to prevent clots  (and has a higher risk of bleeding and/or stroke )
  • a tissue valve (in this case a  valve constructed from bovine pericardial tissue, (the tough tissue sac that surrounds the heart of a cow) which lasts for 10 to 15 years  without any requirement for blood thinners (and has a higher risk of future  heart disease -- and possible need for another surgery --- when the valve begins to fail).

The Doctor says less if you are younger than 55 or need to take blood thinners anyhow for other reasons  you should  chooses a mechanical valve for sure and if you are older than 70  then you should choose a tissue valve for sure.  I'm in between and (as my lovely wife is kind enough to say) a young 68. 

However, I more inclined to go with immediate benefit of no ongoing medication and increased risk of stroke rather than the POSSIBILITY of future problems  so out choice is to use the tissue valve.

(I did have some second thoughts after we got home and did a fair amount of research which at the end confirmed my comfort with the choice. I was particularly influenced by 2 factors 

  • I found some recent studies that suggest that for people over 65 over 95% of tissue valves are fine after 20 years           
  • There are emerging "minimally invasive" techniques for valve replacement and even one that uses same process as is used  for inserting artery stents that is done via inserting a catheter through the groin. So who's to say if the valve starts failing in 10 years that these methods won'y  be more "routinely" available. 
Go home and wait some more: Having agreed to the surgery, discussed the severity of the stentosis and its side effects  AND picked the valve - we asked "When?".

It seemed to us  the sooner the better. The doctor sais he would inform the cardiac surgery coordinator at the hospital  and they would get back to us. He said it was difficult to say how long because  there could be emergency or other higher priority surgergies that came up but he expected the surgery would occur in 3 to 6 weeks.

That was a bit  challenging for us -- especially Linda since , with her medical knowledge, she was concerned of the risk of sudden cardiac arrest in the meantime and one of the less-than-comforting  facts the surgeon had explained to us was that if I had cardiac arrest for any reason it  would be highly unlikely that the heart could be re-started (for the mechanical minded think about trying to re-start a water pump if the outlet  valve is clogged!)  

The trip home was uneventful (other than the challenges of the last 2 hours being after dark and some issues with getting the windshield properly cleaned and cleaning the grit of the headlights so she could see the road -- that was  a kind of Gen. 1:3 moment for her :)  

Certainly we were both anxious to get the surgery scheduled 

Continued to-morrow 
God Bless

Tuesday, February 05, 2013

How to fix a broken heart!

I have a broken heart -- you might think I’m using this as a metaphor for the emotional state of feeling very sad or deeply hurt --  as in “I’m heart-broken because ….”

And you might be wondering if I’m going to give advice for the love lorn – but no - I’m not going into competition with Dear Abby.

It is literally true – I have a broken heart – or to be more medically correct I have severe aortic valve stenosis. 

Because of that I want to put in a plug for the Heart & Stroke Foundation. February is Heart Month.

For  several years I have canvassed door to door in my neighborhood in February. It is ironic that this year I said I couldn't because I planned to be away all month.

Instead I’m at home waiting for surgery – and if I had said I would canvas I would have had to back out

This series of blog posts will be a record of the steps that I followed to fix my broken heart starting with …

Step 1: Find out it's broken (diagnosis).

Maybe something’s wrong?  In my case it was almost accidental – I was in emergency (just before Christmas)  because of a cough. I mentioned that I had some minor indigestion-like “burning” pain in the right side of my chest. (I actually thought it was likely a pulled muscle from coughing). Tests showed I was NOT having a heart attack and everything looked OK.

Doctor scheduled stress test to follow-up.

Nah – it’s just indigestion!  I was fairly confident that it wasn't my heart – although I had been noticing for a month or so that I would get this “burning” (right side of upper chest and that’s not your heart – right!!) and be mildly out-of-breath when walking briskly for a relatively short period but I had “compensated” by just backing off and walking a little slower.

OK- something’s wrong but what? Morning of stress test (January 4)  I drove myself to hospital for the test and I “failed”  ( mild pain, minor shortness of breath but “wacky ECG”  resulted in terminating the stress test.

Time for a conference with God!! I have a deep and abiding faith in God – my “Abba” Father and I often find myself in conversation with him, Sometimes thanking, sometimes asking and always listening in my heart (metaphorical sense) for his guidance and answers.  Sometimes more frequently than others – and especially when things are going well I may not be as grateful as I should be.  When I  heard the Doctor say “There’s a problem – we need more tests – prayer was  immediate and  while hopefully not  “demanding” I was pretty clear that I was trusting Him to make this “go away” – Well I learned  that for now his answer is “my grace is sufficient..” (2 Cor. 12:9)

Maybe it’s clogged arteries?  -- Doctor was able to schedule me into his angiogram clinic that morning – which caused a bit of frantic activity for Linda to get a ride so she could be there for the procedure.  

Doctor was pretty sure there’d be serious blockages and he was preparing me for needing to have that treated.

Nope – plumbing is clear – Now what? The angiogram showed arteries were clear but doc couldn't get the catheter to “thread” into left ventricle which suggested problem with aortic valve (stenosis)

As part of the angiogram the catheter is “threaded” into the artery (from my wrist – sometimes from groin) and up through the aorta and into the left ventricle through the aortic valve where the dye is released to allow the cardiologist to see the shape and size of the left ventricle.  

When the cardiologist was unable to do this despite trying several larger (stiffer) catheters  he strongly suspected a serious  “narrowing” of the valve

Waiting isn’t my strong suit:  The doctor says he needs echocardiogram to confirm and they’ll call in 3 to 4 weeks to set it up. So we come home from the hospital to wait. 

First thing is to let our family and church family know. It is good to know that many will be praying for a speedy test (and maybe a less serious diagnosis).

Next thing is ResearchWhat is it and what are the treatment options?

Aortic valve stenosis? — or aortic stenosis — occurs when the heart's aortic valve narrows. This narrowing prevents the valve from opening fully, which obstructs blood flow from your heart into your aorta and onward to the rest of your body.

There are many sources that can be found describing this disease and its’ treatment by searching  for   Aortic valve stenosisThis one  by Mayo Clinic  seems to be one of the better ones.

Treatment is surgery!!  Most frequently  Open Heart Surgery  where the chest is opened by cutting through the breast bone (sternotomy). 

There are other less invasive surgeries  but  they seem to be less well established and I begin to prepare myself for the sternotomy. 

Now I know lots of people who have had this surgery for “bypasses” and I tell myself this is  not as complex because they don’t remove the  vein from the leg to graft into the heart – they “simply” replace the valve. 

I also  learn there are two options for the "new" valve - “mechanical” and tissue both with advantages and disadvantages – more on that later.

I start telling people what I've found out – and soon Linda is saying “ You've read so much – next thing you’ll be picking up a scalpel and doing the surgery yourself. 

Yeah right – NOT!! I would likely faint at the first sign of blood!!

A new diet In addition, Linda wants to be sure that my diet is the best possible to be prepared for surgery if it comes. 

So we consult with a nutritionist - Tammy at the Country Way who suggests a high alkaline diet.  Now I’m a little skeptical of the underlying science – and  we aren't going the route of checking pH balance. However adhering to a healthy diet plan that keeps us away from processed foods, sugar and meat seems like a reasonable thing to try for at least a month or so prior to surgery (if it comes to that). 

I’ll warn you that doing this is not for the faint of “wallet” – the supplements and vitamins recommended are way beyond anything that our budget could sustain in the long run – however we have been blessed with the resources (money!!) that will allow us to do this for 6 to 8 weeks.

I’ll post a separate item on the diet plan – for now suffice it to say it’s almost a full-time job that fills our day trying to keep on top of it J

Throughout this waiting time I am operating on the “hope for the best- prepare for the worst” philosophy and I’m working on getting our finances in order – updating our records and preparing a “DRAFT” 2013 budget. 

Praying: Linda & I talk about the “what if’s” and we continue in prayer. 

1 Thessalonians 5:17 (ESV) says pray without ceasing” and I’m probably closer to this being a literal fact  than ever before in my life.

We were geared up for  waiting and were  pleasantly surprised when the Doctor’s office called within a week and scheduled the echocardiogram  for January 19 and a  visit with the Doctor on February 5  to get the results

Yep –it’s  a bad valve: January 19  the echocardiogram confirmed that I have severe stenosis and that the valve needs to be replaced.

I’ll pick up here next time.
God Bless

Saturday, February 02, 2013

Snow time to post

Didn't post yesterday - was vegging out after our day long  (600 km - 350 mile)  round trip  for a 30 minute consultation with cardiac surgeon. He seems quite good in terms of explaining things and answering our questions.  We left home 8:30 a.m. and arrived back 8:15 p.m.   

I drove most of way there and Linda drove most of the way back -- neither of us likes driving after dark and Linda was  pretty stressed for a while until I realized that the headlight  lens were covered with grit -- when I cleaned them it was like Genesis 1:3  -- and it was almost tangible the  wave of relaxation that Linda felt.  Rest of trip was very smooth.

I'll  talk more about the health issues next post -- this is an interlude

Our daughter flew in yesterday for the weekend and we've been enjoying a visit with her. Had a great game of cribbage with a close finish -- but she  beat her  Dad -- Sigh!!

This morning  we SKYPed with our oldest son and his family.  Got caught up on all the things our garandson and granddaughter  are doing.

Then we had a long phone conversation with our other son in BC and covered all the goings on in our lives and got caught up on his efforts to wrap up his dissertation and get licenced as a neuropsychologist .

Later we enjoyed watching a pair of pileated woodpeckers, a red headed woodpecker and a downy woodpecker and lots of chick-a-dee's eating at our suet balls.

This afternoon  we went for a  walk through  the Bon Soo Winter Carnival -- and that's why there was "Snow" time to post anything more than this.

God Bless