Today is Tuesday, July 29th, exactly 29 days before the surgery date. Or at least I thought. Just received a message from my surgery's secretary, requesting a change in my surgery date from Wednesday, August 27th to Tuesday, August 26th. The surgeon's son is heading to college on the 28th, and the surgeon likes to see his patients the day after surgery to see how they are progressing.
Obviously, this makes sense, and one day is not really a big deal in the grand scheme of things.
So why is this freaking me out so much???
Tuesday, July 29, 2008
Saturday, July 26, 2008
My surgery, medically speaking
Today is Saturday, July 26th, and it's an absolutely perfect day in SE Wisconsin - 80 degrees, lots of sun, not working today!, etc. My brother set up this blog last night as a way to inform my friends and family of my status before, during and after my August 27th surgery (currently 32 days from now).
Before my surgery, I will be giving some updates regarding medical appointments, state of mind (which varies right now from very optimistic to occasionally concerned), etc. During my surgery, someone (probably my wife or brother) will be providing up-to-the-minute reports on the surgery as they are given to the friends and family that will be at the hospital. After my surgery, I will be giving updates on my recovery and state of mind, and generally attempting to communicate with the outside world given that I will be largely confined to my home for several weeks after surgery.
To provide some background, in medical terms, I was diagnosed with a bicuspid aortic valve almost four years ago (meaning that it has only two leaflets instead of the usual three), as well as an enlarged aortic root. At the time, my cardiologist thought that I probably had 5-10 years before I would need surgery. However, even though the size of the aortic root has been stable and I don't have any symptoms such as shortness of breath, based on a recent and relatively dramatic enlargement of the left ventricle (one of the heart's four chambers), I have been directed to move forward with my surgery. As such, I am scheduled for surgery (valve replacement and perhaps some or all of the aortic root) on August 27 at the Wisconsin Heart Hospital. Since I have a low vonWillebrand factor (meaning that my blood doesn't clot well) and blood thinners are not a good option (ruling out a mechanical valve that could last for the rest of my life), my surgeon has suggested a tissue valve (made from a cow's pericardial) that will hopefully last 15-20 years before it needs to be replaced again.
The surgery will go as follows: The chestbone is sawed in half using an electrically powered sternal saw (a term that, quite honestly, freaks me out a little bit). Once the pericardium (the thin membrane that surrounds the heart) has been opened, the heart and lungs are stopped and the patient is placed on a cardiopulmonary bypass machine, also referred to as the heart-lung machine. This machine takes over the task of breathing for the patient and pumping his blood around while the surgeon replaces the heart valve.
Once the patient is on bypass, an incision is made in the aorta. The surgeon then removes the patient's diseased aortic valve and a mechanical or tissue valve is put in its place. In addition, a composite aortic valve graft is used to replace the enlarged ascending aorta, and the coronary arteries are attached to that graft (which is made of Dacron, a man-made fiber that is also used as a thermal insulation layer on the outside of the International Space Station). Once the valve and graft are in place and the aorta has been closed, the patient is taken off the heart-lung machine. Pacing wires are usually put in place, so that the heart can be manually paced should any complications arise after surgery. Drainage tubes are also inserted to drain fluids from the chest and pericardium following surgery. These are usually removed within 36 hours while the pacing wires are generally left in place until right before the patient is discharged from the hospital (usually 5-7 days after surgery).
There are numerous factors that determine the success/failure rates of aortic valve surgery in the 21st century (patient's age and health, complexity of surgery, skill of surgeon, etc.), but in general, the surgery has a 2-4% mortality rate (or in other words, a 96-98% non-mortality rate!). I'm guessing that my odds are similar since my relatively young age and good health are offset by the added complexity of the ascending aorta replacement as well as my bleeding disorder), but I truthfully have no basis for this guess. However, since I'm a numbers guy and 96-98% seems like good odds to me, I'm going with it. And to quote renowned philosopher Forrest Gump, "That's all I've got to say about that". For now, at least.
Before my surgery, I will be giving some updates regarding medical appointments, state of mind (which varies right now from very optimistic to occasionally concerned), etc. During my surgery, someone (probably my wife or brother) will be providing up-to-the-minute reports on the surgery as they are given to the friends and family that will be at the hospital. After my surgery, I will be giving updates on my recovery and state of mind, and generally attempting to communicate with the outside world given that I will be largely confined to my home for several weeks after surgery.
To provide some background, in medical terms, I was diagnosed with a bicuspid aortic valve almost four years ago (meaning that it has only two leaflets instead of the usual three), as well as an enlarged aortic root. At the time, my cardiologist thought that I probably had 5-10 years before I would need surgery. However, even though the size of the aortic root has been stable and I don't have any symptoms such as shortness of breath, based on a recent and relatively dramatic enlargement of the left ventricle (one of the heart's four chambers), I have been directed to move forward with my surgery. As such, I am scheduled for surgery (valve replacement and perhaps some or all of the aortic root) on August 27 at the Wisconsin Heart Hospital. Since I have a low vonWillebrand factor (meaning that my blood doesn't clot well) and blood thinners are not a good option (ruling out a mechanical valve that could last for the rest of my life), my surgeon has suggested a tissue valve (made from a cow's pericardial) that will hopefully last 15-20 years before it needs to be replaced again.
The surgery will go as follows: The chestbone is sawed in half using an electrically powered sternal saw (a term that, quite honestly, freaks me out a little bit). Once the pericardium (the thin membrane that surrounds the heart) has been opened, the heart and lungs are stopped and the patient is placed on a cardiopulmonary bypass machine, also referred to as the heart-lung machine. This machine takes over the task of breathing for the patient and pumping his blood around while the surgeon replaces the heart valve.
Once the patient is on bypass, an incision is made in the aorta. The surgeon then removes the patient's diseased aortic valve and a mechanical or tissue valve is put in its place. In addition, a composite aortic valve graft is used to replace the enlarged ascending aorta, and the coronary arteries are attached to that graft (which is made of Dacron, a man-made fiber that is also used as a thermal insulation layer on the outside of the International Space Station). Once the valve and graft are in place and the aorta has been closed, the patient is taken off the heart-lung machine. Pacing wires are usually put in place, so that the heart can be manually paced should any complications arise after surgery. Drainage tubes are also inserted to drain fluids from the chest and pericardium following surgery. These are usually removed within 36 hours while the pacing wires are generally left in place until right before the patient is discharged from the hospital (usually 5-7 days after surgery).
There are numerous factors that determine the success/failure rates of aortic valve surgery in the 21st century (patient's age and health, complexity of surgery, skill of surgeon, etc.), but in general, the surgery has a 2-4% mortality rate (or in other words, a 96-98% non-mortality rate!). I'm guessing that my odds are similar since my relatively young age and good health are offset by the added complexity of the ascending aorta replacement as well as my bleeding disorder), but I truthfully have no basis for this guess. However, since I'm a numbers guy and 96-98% seems like good odds to me, I'm going with it. And to quote renowned philosopher Forrest Gump, "That's all I've got to say about that". For now, at least.
Friday, July 25, 2008
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