The next step after finding out you need surgery is to meet with your surgeon. The purpose of this meeting is to talk about what will be done and of course when the surgery will take place. As it stood I was going to need bypass surgery, the valve may or may not be taken care of and there didn't seem to be a great urgency as long as it happened within the next 2 months.
I'm very fortunate to live in a city that has a heart specialization institute like the OHI. That means that the place is jammed packed with heart specialists, researchers, high-end nurses an rehabilitation specialists. Little did I know that the surgeon recommended by my cardiologist was "da Man" when it comes to valves, and heart surgery in general. Our meeting with the doctor was scheduled for late January.
I didn't know much about the surgeon except that he was a valve specialist. As it turns out the guy was the chief of surgery at the OHI and very reputable in valves. As I mentioned earlier the bypass part of the surgery was a given, but the way we were going to deal with valve hadn't been decided yet. For valve treatment there are 3 options: (1) a prosthetic valve, which is completely mechanical and has a life span of 10 to 25 years; (2) a tissue valve, which is made for pig tissue and has a life span of 5 to 15 years; and (3) a transplant valve, which comes from cadaver. The 3rd option is pretty rare given the requirement of a good match and timing of a donor. The doctor explained that the ecocardiogram, the CT and the angiogram indicated that there was significant valve calcification and malformation. He recommended that we deal with the valve at the same time as the bypass.
As each option was explained to me, the big difference comes down to quality of life after the operation. A mechanical valve has a long lifespan and is typically the default choice for people my age however there is a requirement to use blood thinners for the rest of your life. In short, if you're on blood thinners there is a requirement to visit a blood clinic bi-weekly for testing and adjustment of the medication formula as well any time you get hurt (cut or bruise) you may have to go to the hospital to get the bleeding to stop. The tissue valve has a shorter lifespan, but life goes on normally. For me the choice was simple; I lead a pretty active life that includes travel and lots of wilderness activity. The idea of being super careful about cuts and bruises as well as going to a clinic for tests every two weeks was not so popular. I talked it over with M. and tissue valve was the decision. The only drawback with the tissue valve is that with current technology I would be going in for more surgery in 5 to 15 years to change the valve again. I felt that was acceptable especially with some of the improvements being made in heart surgery where they no longer open the chest and some advancements contemplating working on beating hearts. To me, at 37 years old, I wanted to continue living a regular life.
The last big item was the date of the operation. Personally, I was ready for any time, but as it turned out the surgeon was a pretty busy guy and we scheduled the surgery date for March 5. This ended up being ideal for me because it would give me the time to inform people, transition the management of the business over to the team, get my life together and rest a bit before operation.
An interesting sub note is the doctor mentioned, almost in passing, "we'll really only know for sure what we're going to do when we get in there". I figured it was just one of those CYA things doctors say in case its worse than expected.
Friday, January 25, 2008
Sunday, January 20, 2008
Finding Out
It was early June 2007 when I was working in Quebec city on a software implementation proof-of-concept that I started to feel chest pains. At first it only occurred when I was walking up hill at a good clip, but then it started to occur any time I was under stress. This particular proof-of-concept had a contract contingent on its success and every day was stressful. Internally I began to get frightened--I just knew that something wasn't right.
Upon returning to Ottawa one weekend I discussed it with my girlfriend and we were able to set up an appointment with a GP in short order. My meeting with the GP along with blood tests from a lab indicated a possible heart murmur, slightly higher than average cholesterol and slightly lower than average red blood cell count. My GP recommended me to the Ottawa Heart Institute and an Echocardiogram (sonography of the heart) and Stress Test. In the mean time I was traveling to Quebec city every week to start delivering on the project (we completed the PoC and won the business).
The purpose of the echocardiogram was to get a better look at the valves and the stress test was to determine if there might be other issues, like blockage in the arteries. After both tests I met with my Cardiologist. She confirmed that the murmur identified by the GP was a valve malformation that was most likely congenital. What she found puzzling was my angina like symptoms because my stress test had no indications of heart problems. In consultation the cardiologist and I decided to move ahead with a second test called a CT scan. A radioactive dye is fed intravenously and technicians use a CT scan device to capture pictures of the heart, it s arteries and its valves.
When I was 17 I was diagnosed with Hodgkins disease. During that period I was subject to a early version of the CT scan where a significant amount of iodine (the dye used at the time) was fed into my body. Only once all the dye was in my blood stream did I start to have breathing problems and the discovery that I was allergic to radioactive dyes. The reason I bring this to light is that CT scan I was about to undergo uses the same dyes and there's all kinds of precautions to take. I was terrified because I remember the sensation of not being able to breath, I remember the adrenalin shot and I remember the 5 days on a benadryl drip. The CT scan for heart patients is a pretty cool innovation. Typically, hospitals go to an Angiogram right away to look for arterial plaque. An Angiogram is a day surgery procedure that uses a catheter inserted into your femoral artery that moves up close to the heart and injects dye directly into the hearts arteries while an x-ray camera captures it all on video. With the CT scan, there's no surgery. The result aren't as conclusive, but if you're looking for indicators it is a much less invasive way of taking a look. Probably a lot cheaper as well. My CT was almost invalid because they couldn't get my heart rate down. I was so nervous about the dye allergy. It ended being nothing. As I found out later the dyes used now a much improved from the one used 20 years ago and all the preparations were simply a precaution.
My CT scan results were a bit of a shocker. The scan indicated that I had 1 artery with 80-100% blockage and 2 other arteries with 20-50% blockage. As I mentioned the CT scan is not meant to be a conclusive test, simply an indicator. With that information we again decided to take a closer look and I was scheduled for the full angiogram.
The results from the angiogram were a little hard to take. The angiogram confirmed that 1 artery was 100% blocked and another was 70% blocked. There was a possible 3rd blockage but it seemed to be less of an issue. I was sitting up in bed in recovery when the Cardiologist told me the news. I remember first thinking "ok, now we know so what do we do to fix it". My second thought was "holy shit, what did she say". After those first two internal thoughts, I simply said out loud "Ok?". The Cardiologist then went on to say that I was going to need bypass surgery and she was recommending me to a surgeon at the institute. She also mentioned that surgeon was a valve specialist because the thinking was valve repair may be an option at the same time as the bypass.
My next step was to start telling people. Who do you tell first, how do you tell them and what do you tell them? One decision I made early on was to not keep my examinations, tests and their results a secret. The only place I did keep it a secret was with my folks. As I mentioned when I was 17 I had Hodgkins disease (cancer of the lymphatic system). Since that time I have always been careful share any health information with my folks because they get worried pretty quickly. I informed my girlfriend, then I informed my boss and friend, then I started informing others, including my mother and father. I'm a 37 year old, fit, healthy living and hard working person. Pretty much everybody was shocked. I now had 6 weeks to transition the company I manage and get my personal information together. Surprisingly I was upbeat. I think the big reason is that I had full support from my family, my friends, my boss and we had a plan. Bypass and valve replacement is not something new and the OHI was the place in Canada to get it done. My meeting with the surgeon was scheduled for the end of January.
Upon returning to Ottawa one weekend I discussed it with my girlfriend and we were able to set up an appointment with a GP in short order. My meeting with the GP along with blood tests from a lab indicated a possible heart murmur, slightly higher than average cholesterol and slightly lower than average red blood cell count. My GP recommended me to the Ottawa Heart Institute and an Echocardiogram (sonography of the heart) and Stress Test. In the mean time I was traveling to Quebec city every week to start delivering on the project (we completed the PoC and won the business).
The purpose of the echocardiogram was to get a better look at the valves and the stress test was to determine if there might be other issues, like blockage in the arteries. After both tests I met with my Cardiologist. She confirmed that the murmur identified by the GP was a valve malformation that was most likely congenital. What she found puzzling was my angina like symptoms because my stress test had no indications of heart problems. In consultation the cardiologist and I decided to move ahead with a second test called a CT scan. A radioactive dye is fed intravenously and technicians use a CT scan device to capture pictures of the heart, it s arteries and its valves.
When I was 17 I was diagnosed with Hodgkins disease. During that period I was subject to a early version of the CT scan where a significant amount of iodine (the dye used at the time) was fed into my body. Only once all the dye was in my blood stream did I start to have breathing problems and the discovery that I was allergic to radioactive dyes. The reason I bring this to light is that CT scan I was about to undergo uses the same dyes and there's all kinds of precautions to take. I was terrified because I remember the sensation of not being able to breath, I remember the adrenalin shot and I remember the 5 days on a benadryl drip. The CT scan for heart patients is a pretty cool innovation. Typically, hospitals go to an Angiogram right away to look for arterial plaque. An Angiogram is a day surgery procedure that uses a catheter inserted into your femoral artery that moves up close to the heart and injects dye directly into the hearts arteries while an x-ray camera captures it all on video. With the CT scan, there's no surgery. The result aren't as conclusive, but if you're looking for indicators it is a much less invasive way of taking a look. Probably a lot cheaper as well. My CT was almost invalid because they couldn't get my heart rate down. I was so nervous about the dye allergy. It ended being nothing. As I found out later the dyes used now a much improved from the one used 20 years ago and all the preparations were simply a precaution.
My CT scan results were a bit of a shocker. The scan indicated that I had 1 artery with 80-100% blockage and 2 other arteries with 20-50% blockage. As I mentioned the CT scan is not meant to be a conclusive test, simply an indicator. With that information we again decided to take a closer look and I was scheduled for the full angiogram.
The results from the angiogram were a little hard to take. The angiogram confirmed that 1 artery was 100% blocked and another was 70% blocked. There was a possible 3rd blockage but it seemed to be less of an issue. I was sitting up in bed in recovery when the Cardiologist told me the news. I remember first thinking "ok, now we know so what do we do to fix it". My second thought was "holy shit, what did she say". After those first two internal thoughts, I simply said out loud "Ok?". The Cardiologist then went on to say that I was going to need bypass surgery and she was recommending me to a surgeon at the institute. She also mentioned that surgeon was a valve specialist because the thinking was valve repair may be an option at the same time as the bypass.
My next step was to start telling people. Who do you tell first, how do you tell them and what do you tell them? One decision I made early on was to not keep my examinations, tests and their results a secret. The only place I did keep it a secret was with my folks. As I mentioned when I was 17 I had Hodgkins disease (cancer of the lymphatic system). Since that time I have always been careful share any health information with my folks because they get worried pretty quickly. I informed my girlfriend, then I informed my boss and friend, then I started informing others, including my mother and father. I'm a 37 year old, fit, healthy living and hard working person. Pretty much everybody was shocked. I now had 6 weeks to transition the company I manage and get my personal information together. Surprisingly I was upbeat. I think the big reason is that I had full support from my family, my friends, my boss and we had a plan. Bypass and valve replacement is not something new and the OHI was the place in Canada to get it done. My meeting with the surgeon was scheduled for the end of January.
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