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As I may have mentioned on here in the past, I have a rare condition known as Coarctation of the Aorta. Since I was diagnosed I've been going for routine checkups including echo cardiograms and MRIs. Years ago a surgeon assessed my condition and told me that he did not recommend surgery at the time and I have just continued to monitor it while using beta blockers to keep my blood pressure under control. But my internist who I see every 6 months now tells me he's having me re-evaluated with some of the newer surgeons and they seem to be more pro-surgery then the first Dr. So I'm starting to prepare myself psychologically for the day where they'll tell me I'll be going under the knife. So when my mom told me she was going in for an aortic valve replacement, I took an extra keen interest in the entire procedure as I also have a valve condition which only increases my chances for surgery.
The funny thing about my mom's valve is that it was discovered in her 50s by non other then my sister while she was going through med school. Somehow all other doctors missed her murmur, but my sister picked it up and told her to get it checked. My mom thought my sis was just hearing things, but she eventually got it looked at and it turns my sis nailed it. But it was minor and didn't really need any immediate attention, just routine check ups like they're doing with me. But sometime last year she got some bad news that her valve had deteriorated quickly. More intense examinations confirmed this. This was of course not at all what we wanted to hear as we knew there's really only one way to fix a bad valve, and that's to have your chest cut wide open, have your heart stopped, be placed on a heart/lung by-pass and hope the surgeons do a perfect job. It's scary stuff and there was a lot of anxiety associated with it.
Not having the surgery wasn't much of an option. When your valve starts to go, your heart is basically pumping blood in two directions. As a result, the heart can get stretched out which weakens it. This will eventually lead to sudden heart attack or instant death. So on the waiting list she went and it didn't take long. You know your surgery date is close when they tell you to go for an angiogram. It is a very invasive type of imaging system that uses fluoroscopy to snake wires and catheters up your veins all the way into your heart, releasing a die that can be picked up by the x-ray. The procedure itself poses some risk but nothing as to what comes next.
They never gave us an exact date until 2 days before the surgery. My understanding is that emergencies happen all the time so it's pointless setting a date far in advance. But overall my mom didn't wait very long at all before she got the date (she was expecting months, but it took about a week). Of course, that's when it really hits you and all the plans you made get put on hold. No one slept the night before, it happened so fast and we needed time to process. The surgery itself has a mortality rate and you try to rationalize that. You tell yourself that those who don't make it are probably really old, have other conditions or are fat smokers or something. My mom was otherwise healthy, ate very healthy, never smoked and exercised often. So you focus on the good and convince yourself that you're ahead of the curve. Of course it helped that my sis was a Dr and she assured us the surgeon we had was the surgeon to have, one of the best in the nation. Most importantly, the cardiac surgery team in Winnipeg is overall a "well oiled machine" with a very strong track record. Sure that was good to know, but it wasn't enough to get you pasted the thought of your chest being opened up with a vice.
There's another dimension of anxiety associated with valve replacement, and that is, what will you replace the valve with? Well, luckily, you have two choices. Unluckily, they both kinda suck. Your first choice is to go with a tissue valve, which means a valve from a pig, cow or horse. It turns out pig valves are the most human like and tend to be the most common. However, there is a bit of a downside to the tissue valve: it lasts on average 15 years. There's also a risk that your body will reject it. In either case you'd need to go back for the same surgery. Not at all appealing, is it?
Your other choice is the mechanical valve. It last forever (good for 50,000 years, give or take) but has it's own drawbacks: it damages your blood cells which in turn causes your blood to clot. It also makes an audible ticking noise, but that's small potatoes to the clots. To get around the blood clot problem you'll need to take anticoagulants called coumadin, also known as Warfarin (some people call it a blood thinner, but it's not and directly affects only the liver). So what would you choose? My mom chose the mechanical valve due to her age. She hopes to live for more then 15 years and doesn't want to repeat the surgery when she's much older.
Of course Warfarin has it's own set of issues. It's a drug that needs to be monitored closely. And I mean very closely: routine blood tests every couple of weeks. In a way, living with Warfarin is like being a diabetic, you need to watch what you eat and watch your blood levels. You can eat anything you like, but you need to be consistent as some foods neutralize the drug effect. Vitamin K counters the drug, so foods high in it should be eaten in consistent amounts every day. For many people this may be a real challenge, but I think my mom is the type of person who could effectively manage this well. Like I said before, she eats healthy which means she's already aware of what she eats and she already eats consistently. Also, if this turns out to be a major issue, there is a new drug coming out soon that is not sensitive to your diet and is equally effective, but it may be a few years before she'll be eligible for it. Of course, worst case scenario is you undergo surgery again and have a tissue valve inserted, but that never happens really.
So the day of the surgery we meet the surgeon in the pre-op area. That's when we tell him what valve we've decided on. He tells us it's a good choice as mechanical valves also allow for more blood flow, making it easier for the heart to work. While waiting I noticed that the one most nervous between myself, my dad and my sis, was my sister. Her motto is that if you can avoid surgery, you should avoid surgery. Simply being intubated involves risk, and you should always avoid such risk if you can. Her opinion of people who go for elective cosmetic surgery isn't all that great. And she's also intimately aware of the risks in this type of surgery and the steps involved, so when the OR nurse came to tell us that my mom was safely on the bypass machine, she was greatly relieved as that means she made it past a great number of milestones. Plus, once on the bypass it's hard to die as they can keep you on the machine for many hours if they have to. Still, there was still risk and things were tense until a few hours later when the surgeon himself came in. Thank god he didn't decide for any dramatic pauses or anything, he promptly told us that the surgery went smoothly and that she's doing well. A freight trains worth of anxiety suddenly just lifted of our shoulders and finally we had an appetite again.
About an hour later we saw her wide awake in the intensive care unit. I couldn't even count the number of wires and tubes that were coming out of her. A central line in her neck, others in her arms, a drainage tube sticking out her chest and of course pacing wires which were still attached to directly to the heart in case of emergency. You spend about a day in the ICU, or until you stabilize. My mom did really well in the ICU, her heart rate was normal and it looked like she was bound for a speedy recovery, even if she was kinda grumpy. She even got up and took a few steps within 24 hours of her surgery. Pretty amazing.
After the ICU you spend around a week in the wards. She was lucky to be one of the first patients in the new Asper cardiac care building, which is brand new and all state of the art. Every day they take away some tube or wire as you get better. In fact just yesterday they pulled out the pacing wires, which is kinda freaky. They just yank them out, they somehow detach from the heart and slide out. Apparently you don't feel a thing. What I thought was interesting is the device used to monitor vitals like heart rate. It's a little wireless device you keep in your pocket, with wires taped to your chest. You can walk anywhere in the ward and your vitals are displayed on monitors scattered around the halls. Kinda neat and sure beats hauling equipment around with you when walking.
Of course recovering isn't easy. There were good days and bad. Bad days often involved irregular heart beats along with nausea and constipation and a complete loss of appetite. That, plus chest pain - but that's simply from your chest plate as it's trying to heal (it can take up to 3 months for it to heal, and you may hear the bones clicking at times as you move around so you gotta be careful). These are fairly normal by the looks of it. They train you to lay in bed, how to sit up and how to walk (they also give you your very own heart shaped pillow to comfort yourself). The surgeon examined my mom every day and was very good at explaining things. We all have a very good opinion of him, and I already know that when it's my turn, he's the one for me. The nursing staff was also very helpful and understanding. No complaints there either, we received top notch care from start to finish, I was very impressed. Not so impressed I'd volunteer to have it done tomorrow, but if I was told it needed to be done, I think I'll be a lot more comfortable about it. They even have former surgery patients come in and talk to them and answer questions. This was a great way to instill some confidence as they know some people have a natural mistrust of doctors but are willing to listen to regular folks.
So ya, my mom should be home sometime today. Which is great as I'm sure we're all sick of the hospital by now. Quite the experience but we're all glad it's behind us and along with it, an amazing amount of anxiety. We still need to figure out the Warfarin equation, but it's something I'm sure we can manage. Aside from that, my mom can now live a normal life without worry. She'll get used to the valve ticking and from what I've read, hearing it tick can be assuring after a while. And as for me, well, I have a renewed motivation for living healthy, eating well and continued exercise. And in fact, that's exactly what I'm gonna do right now. It's a beautiful day and I'm gonna go out for a jog.
The funny thing about my mom's valve is that it was discovered in her 50s by non other then my sister while she was going through med school. Somehow all other doctors missed her murmur, but my sister picked it up and told her to get it checked. My mom thought my sis was just hearing things, but she eventually got it looked at and it turns my sis nailed it. But it was minor and didn't really need any immediate attention, just routine check ups like they're doing with me. But sometime last year she got some bad news that her valve had deteriorated quickly. More intense examinations confirmed this. This was of course not at all what we wanted to hear as we knew there's really only one way to fix a bad valve, and that's to have your chest cut wide open, have your heart stopped, be placed on a heart/lung by-pass and hope the surgeons do a perfect job. It's scary stuff and there was a lot of anxiety associated with it.
Not having the surgery wasn't much of an option. When your valve starts to go, your heart is basically pumping blood in two directions. As a result, the heart can get stretched out which weakens it. This will eventually lead to sudden heart attack or instant death. So on the waiting list she went and it didn't take long. You know your surgery date is close when they tell you to go for an angiogram. It is a very invasive type of imaging system that uses fluoroscopy to snake wires and catheters up your veins all the way into your heart, releasing a die that can be picked up by the x-ray. The procedure itself poses some risk but nothing as to what comes next.
They never gave us an exact date until 2 days before the surgery. My understanding is that emergencies happen all the time so it's pointless setting a date far in advance. But overall my mom didn't wait very long at all before she got the date (she was expecting months, but it took about a week). Of course, that's when it really hits you and all the plans you made get put on hold. No one slept the night before, it happened so fast and we needed time to process. The surgery itself has a mortality rate and you try to rationalize that. You tell yourself that those who don't make it are probably really old, have other conditions or are fat smokers or something. My mom was otherwise healthy, ate very healthy, never smoked and exercised often. So you focus on the good and convince yourself that you're ahead of the curve. Of course it helped that my sis was a Dr and she assured us the surgeon we had was the surgeon to have, one of the best in the nation. Most importantly, the cardiac surgery team in Winnipeg is overall a "well oiled machine" with a very strong track record. Sure that was good to know, but it wasn't enough to get you pasted the thought of your chest being opened up with a vice.
There's another dimension of anxiety associated with valve replacement, and that is, what will you replace the valve with? Well, luckily, you have two choices. Unluckily, they both kinda suck. Your first choice is to go with a tissue valve, which means a valve from a pig, cow or horse. It turns out pig valves are the most human like and tend to be the most common. However, there is a bit of a downside to the tissue valve: it lasts on average 15 years. There's also a risk that your body will reject it. In either case you'd need to go back for the same surgery. Not at all appealing, is it?
Your other choice is the mechanical valve. It last forever (good for 50,000 years, give or take) but has it's own drawbacks: it damages your blood cells which in turn causes your blood to clot. It also makes an audible ticking noise, but that's small potatoes to the clots. To get around the blood clot problem you'll need to take anticoagulants called coumadin, also known as Warfarin (some people call it a blood thinner, but it's not and directly affects only the liver). So what would you choose? My mom chose the mechanical valve due to her age. She hopes to live for more then 15 years and doesn't want to repeat the surgery when she's much older.
Of course Warfarin has it's own set of issues. It's a drug that needs to be monitored closely. And I mean very closely: routine blood tests every couple of weeks. In a way, living with Warfarin is like being a diabetic, you need to watch what you eat and watch your blood levels. You can eat anything you like, but you need to be consistent as some foods neutralize the drug effect. Vitamin K counters the drug, so foods high in it should be eaten in consistent amounts every day. For many people this may be a real challenge, but I think my mom is the type of person who could effectively manage this well. Like I said before, she eats healthy which means she's already aware of what she eats and she already eats consistently. Also, if this turns out to be a major issue, there is a new drug coming out soon that is not sensitive to your diet and is equally effective, but it may be a few years before she'll be eligible for it. Of course, worst case scenario is you undergo surgery again and have a tissue valve inserted, but that never happens really.
So the day of the surgery we meet the surgeon in the pre-op area. That's when we tell him what valve we've decided on. He tells us it's a good choice as mechanical valves also allow for more blood flow, making it easier for the heart to work. While waiting I noticed that the one most nervous between myself, my dad and my sis, was my sister. Her motto is that if you can avoid surgery, you should avoid surgery. Simply being intubated involves risk, and you should always avoid such risk if you can. Her opinion of people who go for elective cosmetic surgery isn't all that great. And she's also intimately aware of the risks in this type of surgery and the steps involved, so when the OR nurse came to tell us that my mom was safely on the bypass machine, she was greatly relieved as that means she made it past a great number of milestones. Plus, once on the bypass it's hard to die as they can keep you on the machine for many hours if they have to. Still, there was still risk and things were tense until a few hours later when the surgeon himself came in. Thank god he didn't decide for any dramatic pauses or anything, he promptly told us that the surgery went smoothly and that she's doing well. A freight trains worth of anxiety suddenly just lifted of our shoulders and finally we had an appetite again.
About an hour later we saw her wide awake in the intensive care unit. I couldn't even count the number of wires and tubes that were coming out of her. A central line in her neck, others in her arms, a drainage tube sticking out her chest and of course pacing wires which were still attached to directly to the heart in case of emergency. You spend about a day in the ICU, or until you stabilize. My mom did really well in the ICU, her heart rate was normal and it looked like she was bound for a speedy recovery, even if she was kinda grumpy. She even got up and took a few steps within 24 hours of her surgery. Pretty amazing.
After the ICU you spend around a week in the wards. She was lucky to be one of the first patients in the new Asper cardiac care building, which is brand new and all state of the art. Every day they take away some tube or wire as you get better. In fact just yesterday they pulled out the pacing wires, which is kinda freaky. They just yank them out, they somehow detach from the heart and slide out. Apparently you don't feel a thing. What I thought was interesting is the device used to monitor vitals like heart rate. It's a little wireless device you keep in your pocket, with wires taped to your chest. You can walk anywhere in the ward and your vitals are displayed on monitors scattered around the halls. Kinda neat and sure beats hauling equipment around with you when walking.
Of course recovering isn't easy. There were good days and bad. Bad days often involved irregular heart beats along with nausea and constipation and a complete loss of appetite. That, plus chest pain - but that's simply from your chest plate as it's trying to heal (it can take up to 3 months for it to heal, and you may hear the bones clicking at times as you move around so you gotta be careful). These are fairly normal by the looks of it. They train you to lay in bed, how to sit up and how to walk (they also give you your very own heart shaped pillow to comfort yourself). The surgeon examined my mom every day and was very good at explaining things. We all have a very good opinion of him, and I already know that when it's my turn, he's the one for me. The nursing staff was also very helpful and understanding. No complaints there either, we received top notch care from start to finish, I was very impressed. Not so impressed I'd volunteer to have it done tomorrow, but if I was told it needed to be done, I think I'll be a lot more comfortable about it. They even have former surgery patients come in and talk to them and answer questions. This was a great way to instill some confidence as they know some people have a natural mistrust of doctors but are willing to listen to regular folks.
So ya, my mom should be home sometime today. Which is great as I'm sure we're all sick of the hospital by now. Quite the experience but we're all glad it's behind us and along with it, an amazing amount of anxiety. We still need to figure out the Warfarin equation, but it's something I'm sure we can manage. Aside from that, my mom can now live a normal life without worry. She'll get used to the valve ticking and from what I've read, hearing it tick can be assuring after a while. And as for me, well, I have a renewed motivation for living healthy, eating well and continued exercise. And in fact, that's exactly what I'm gonna do right now. It's a beautiful day and I'm gonna go out for a jog.
And ya, she's doing good, just got home apparently.
