(Narrative written by Kirk Holmes for Mitchel Holmes)
10 October 1999
Mitchel is 72 years old with a fairly weak heart (using standard measurements). This narrative describes his survival through traditional open surgery for an 11 cm AAA. Great praise goes to Dr. Theodore Hirokawa (the surgeon), Dr. Hirokawa's entire team at Highland/Strong Hospitals in Rochester NY, my father's cardiologist and his general physician. The team collaborated closely and came up with a game plan that seems to have been executed flawlessly. Our entire family also gives thanks to God for we believe that strong faith, great family support, and prayers from all over the country enabled the doctors to be so successful.
Dad began suffering heart problems due to a viral condition that led to calcification and severe weakening of the heart muscle function about 20 years ago. Over that time he has suffered massive congestive heart failure and only tests out to 28% normal heart function.
About 6 weeks ago, he began having back pains and was having discomfort when driving his cab and helping out at the church. He has been driving 6 - 7 days per week for 8-12 hours per day for years. The back pain led to an ultrasound which unveiled a defect 11 cm long and 9 cm wide. The defect also involved one kidney artery completely and came close to the other. The kidney involvement prevented the less invasive endovascular procedure that the medical team preferred. Of course, they were very worried about the physical trauma of traditional surgery and the surgeons initially declined to pursue the traditional surgery.
With no other good options, surgery was set for September 8th. We are 100% convinced that the choice of surgical procedures and the surgical team could not have been better. Surgery was performed September 8th by Dr. Theodore Hirokawa at Highland Hospital (affiliated with Strong Hospital and the University of Rochester). My understanding is that the procedure took about 4.5 hours and went smoothly. I did not talk to the anesthesiologist, but I am told that his heart, which my mother said had shown only 28% functioning in all the pre-testing, never faltered at all. The surgical team, along with the cardiologist, came up with a medications game plan which appears to have worked flawlessly. During sugery, Dr. Hirokawa repaired the main aneurysm as well as two smaller aneurysms on the arteries branching into the legs. Things were going well enought that he also repaired a hernia at the same time.
Kidney function was weaker than expected at surgery time, but both are functioning normally at this time. This was great because the aneurysm involved one of the kidney arteries and came pretty close to involving the other (which is the reason we did not do endovascular). They used very, very heavy sedation but I was able to communicate with my father in ICU about 20 minutes after surgery. He responded to questions and comments with vigorous head nods and grasped for our hands and held strongly. By early the following morning, he was pesky enough that the ICU staff removed the ventillator tube from his throat so that he could talk. That afternoon (less than 12 hours after sugery), he greeted me in ICU with a hearty song.
My father went home from the hospital on the 18th, just 9 days after surgery. He is in little pain and has good mobility and stamina, although he feels some soreness and slight discomfort. He walked up 2 flights of stairs without a problem just to get into the house.
I have nothing but praise for Dr. Hirokawa's team. I have never met a group of professionals with such a combination of skill, experience, empathy, and communication in any field. They all are incredible representatives of the profession.
I also want to thank the authors of this site and the following doctors and web sites. In particular, Dr. Tilson and Dr. Powell were very responsive and helped my family feel very comfortable and confident about the paths chosen.
Update 7 Apr 2000
I want to give the good and bad news of the update along with cautionary reminder.
As I stated in October, the Sept surgery went very well on my 72 year old father. His weak heart and kidneys held up extremely well, to the total surprise of the operating team who originally didn't want to operate at all because they were sure he would die on the table.
He was back to driving his cab about 6 weeks after the surgery and was very active and mobile, although he needed much more rest.
He continued in that vein until about January, when both his heart and his kidney took a dramatic turn for the worse. While they do not think it was because of the aneurysm, most of believe that he didn't allow enough healing time. Worse, he fell into some bad habits with respect to sleep, staying up all night gambling, and driving long hours in the cab. In short, he abused his body. So, right now, he is in the hospital getting some fluid drained that has accumulated due to his rapidly failing heart. We're hopeful that he will take another turn for the better.
The good news is that we've had some quality time due to the successful surgery. While it is OK to "know your own body", I urge anyone out there facing surgery to give their body some extra healing time. Better safe than sorry.
Take care. And may God be with everyone surfing this web site.
Update 18 Apr 2000
My father has indeed taken a turn for the better; once again confounding the doctors and also proving their skill. WIth experimentation, they found a combination of medicines that, via an IV in the hospital, took off accumulated fluid while not damaging the kidneys. He feels much better and is much more aware of the fragileness. I brought up his grandkids for the week and we're just having a blast. Please keep us in prayer. My prayer is that he will do the same for the people on this list.
Update 5 Sep 2000
I want to give another update on my Dad. He is actually looking better than he has in a year or two. The doctors had said that they were hoping to juggle heart/kidney medications to give him 3-6 more months, but they were not optimistic. This is now a year afterwards. His legs get more tired, but he is still spending a lot of time working.
Update: 02 Aug 2003
I guess it is time for another update on my father. As of July 2003, he is still going fairly strong. The previous problems I referred to took a toll that is probably irreversable so he ended up in congestive heart failure earlier this year. They put in a pace maker and that has seemed to do the trick. That is good and bad news. On one hand, he is fairly bummed out that he can't drive yet (maybe anymore). On the other, at least he won't continue to drive taxis to the point of exaustion.
I guess that is the most difficult part of any kind of limiting illness or condition. It can be very hard to stop doing the things that we are used to doing and that we like to do even if it is detrimental to our health. Some people find it easy to make the sacrifice to their style of living; while others would rather make the sacrifice to their length of life. But Dad is dealing with the restrictions pretty well now and still usually getting around OK.
We just continue to give thanks to God. If anyone has any advice or encouragement, please feel free to e-mail me or him.
Update: 27 Jan 2004
Last update on Mitchel Holmes
I have periodically posted to this site with updates on Mitchel Holmes, my father. Dad went home to be with the Lord last week, marking almost 4.5 years after his aneurysm surgery. Yes, we are sad, but we are still rejoicing for the life that he was able to continue leading. I am posting this last update not to disccourage anyone but to encourage all.
I still remember hearing from my Mother in September of 1999 that both the endovascular surgeon and the traditional vascular surgeon had rejected my Dad for surgery. I stood outside a PTA function on a poor cell phone connection talking for an hour with the Chairman of the vascular surgery department of the University of Rochester and one of the top vascular surgeon in upstate New York. "Your father won't have any reasonable quality of life IF he survives the surgery, and I can assure you that he will die on the table. Let him go home and die with family."
I thank God for the fact that Dr. Hirokawa listened closely to me and to my family, and he ended up believing that it was possible that the will to live could overcome these dire odds.
As I have posted previously, Dad has lived a bountiful life for most of the last 4 years, in spite of a failing heart condition that would have felled a normal man. The extra years led to much joy and spiritual growth both for him and for the family, especially the grandchildren.
A man who was supposed to have died from a deteriorating heart condition over 25 years ago survived and thrived after his "inoperable aneurysm" diagnosis. Good and caring doctors, loving family, belief in God, and a strong will to live made the difference. The diagnoses are not always right!
Good luck to all of you out there dealing with difficult situations. God bless.
Addendum
I just realized that I never gave information on the rest of the incredible team that was responsible for coordinating his care for all these difficult years and balancing the aneurysm, kidney, heart and general gerentology factors. Dr. Tom Campbell also of the University of Rochester (New York) is the GP who found a way to exceed even his own optimistic projections. He collaborated very closely with some of the best renal, cardiology, and vascular people around.