The last few chapters of this story has yet to be written, but perhaps the events thus far can be of some help to the readers of this board. Background: I'm 70 years old, east European descent, about 20 pounds overweight and pretty much out of shape. Had a by-pass operation in 1991. Was a heavy smoker until 1981. Considered a type A personality. Married for 40 years - 2 adult children.
Three and a half years ago I had a sonogram at a local hospital in Orange County in California on an emergency basis to discover what was causing severe flank pain. (Turned out to be a kidney stone which was eventually removed.) The next morning I got a phone call from an emergency room doctor whom I never met. He said he was looking at my sonogram and did I know that I had an aortic aneurysm. He further suggested I see a doctor pretty soon. Not only didn't I know, I didn't even know what an AA was.
Over the years, I had many more sonograms - every 6 months. We tracked the A from 3.6 cm to its present size of 5 cm. I also started researching the net - this site and links the very best! - and my wife, very much a book person, did yeoman work at the library. Little by little I got used to living with that thing growing inside me. As a result of the research, and the further assistance of Eugene Sterling - with whom I corresponded on this board - I decided that I wanted to try the endovascular approach. It was minimally invasive and had a very short recovery time. General Sterling (I Went The Endovascular Route) put me in touch with Endovascular Technologies, Inc in Menlo Park, CA and they, in turn, put me in touch with UCLA and Dr. Wesley Moore, chief surgeon at Gonda Vascular Center.
Dr. Moore's assistant told me that in order to evaluate me for the procedure that would need a CT scan (3mm cuts), and an angiogram with marker catheter and that the angiogram must be done at UCLA. This first conversation was about a year ago. Also, since I was a member of Kaiser Permanente (a large HMO) I would need for them to refer me to UCLA. Kaiser refused the referral and instead referred me to a Cardiac surgeon within their own system. He was a pretty straightforward young man and tried as best he could to talk me out of the endovascular procedure. He said that if I were his father (grandfather?) he would lay me on the table, cut me open, sew in a permanent graft, and that would be the end of it. He almost talked me into it. He did, however, authorize a CT scan be done and sent to UCLA.
Based on that CT scan, Dr. Moore's office told me that I would probably be approved for the endovascular approach. The next month (December, 1998) I resigned from Kaiser (boy, do I feel naked), and went to UCLA for another CT scan and angiogram. I also met Dr. Moore who examined me and chatted a bit about the upcoming (so I thought) procedure.
However, it seems it is not to be. Dr. Moore's note to the file, with copy to me received last week, states in part, "This confirms the presence of of a large infrarenal abdominal aortic aneurysm. There also appears to be a distal neck before bifurcation. His iliac arteries appear somewhat small and tortuous. THIS MAY BE A MAJOR LIMITATION FOR USE OF THE ENDOVASCULAR APPROACH. (Cap mine). Nonetheless, we will forward his angiogram and CT scan to Endovascular Technologies, Inc for careful measurement and review by their consultants."
Earlier today, I received a telephonic report from Dr. Moore's office that Endovascular Technologies, Inc concurs with Dr. Moore's initial reaction and that, furthermore, they find that the condition of the iliac arteries and of the the aorta, itself, may not support any sort of graft - much less a bifurcated graft - because of the calcification, atheroma and general atherosclerotic condition of the site. Wow! What now?
Stay tuned. I'm to hear from Dr Moore next week when he returns from vacation.
Update 8 Mar 99
Dr. Moore has determined that I would be a good candidate for a different operational approach to repairing my aneurysm (which now measures 5.5cm). It's called retroperitoneal. They go in from the left side with about an 8 inch angled incision, go between the large muscles, move the stomach aside and expose the aorta from that angle. They clamp off the bulge, remove it and sew in the Dacron tubing. Supposedly, it's quicker to heal than the traditional "top down" approach with a few days less in the hospital.
We proceeded with pre-operational testing to determine if my heart and other arteries could take the strain and then set the operation for March 10. However, this was not to be.
My operation has been postponed. Seems I have another problem that must be resolved first. A quick summary: about 3 weeks ago on a Sunday, I went to the Emergency Room with a really bad pain in the right rib cage. (It had been bothering me on a much lesser level for several months). They gave me every test they could think of and came up empty. After 12 hours, they released me and told me to get a bone scan which I did the following week. (Meanwhile the pain subsided). 2 days after the bone scan, the Doctor called me and said to come to his office right away. When I arrived he told Jan and me that my bone scan lit up like a Christmas tree ("Hot spots" all over)and that he had made an appointment for me with an Oncologist for that same afternoon.
The Oncologist opined that I had a metastasized cancer and that he needed a chest x-ray and a bone marrow biopsy right away. The following Wednesday they did both of those. (Of course by this time I had convinced myself that I had lung cancer and was about to die!). The following day, he reported to me that he didn't see anything on my x-ray or my blood tests. The biopsy report wasn't due until March 10. On March 3, he called me to report that the preliminary report on the bone marrow aspiration had shown negative but he still is looking for a cancer (to a hammer everything looks like a nail!) and that he wants another biopsy in the neck/shoulder area this coming Monday. That's where things stand...except for the fact that one of his hot spots which is the area in the right hip from where he took the bone marrow is still causing so much pain that I can't walk.
Ain't we got fun? As Frank Sinatra said, "The golden years can go kiss my ass!"
I feel pretty confident that I don't have cancer and the "hot spots" are being caused by something else much more benign. I'll probably be rescheduling the aneurysm operation shortly and will keep this board advised as to its progress.
Update 7 May 1999
Unfortunately, the preliminary diagnosis of cancer has been confirmed. It's lung cancer (adenocarcinoma) that has metastisized to the bone - stage 4. I'm going through chemotherapy at the City of Hope in Duarte, California. My pain has subsided and, generally, I feel pretty good.
Of course, the aneurysm repair has been put on hold. It now seems the least of my problems.
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