Significant Descending Aortic Dissection
30 December 2001
Actually, I am writing this as a thank you. For about two weeks in September, I would come home from the hospital and log onto this website about midnight just to get some information and maybe a little bit of hope. The good news is that almost four months later, my husband is well and happy - and I thank God and St Jude and all of the people who prayed for him.
Significant descending aortic dissection - Those were the words the doctor used and they have changed our life - for the better.
My husband is a stockbroker. He was about 2 and 1/2 years into his own business - a bit of a workaholic - a CPA, a part-time teacher at a community college. He is 56 and we have raised five children. He has had HBP for about 15 years and was on medication for that. He doesn't smoke, has an occasional glass of wine, and was maybe 15-20 lbs overweight.
September 17th was the first day the stock market opened after 9-11. He was very concerned about his clients. In addition, we had lost a young friend, our oldest daughters age, in the WTC; and with the rest of the country he was deeply affected by the terrible losses of that day. And all of that may have contributed to his blood pressure, we don't know. The doctors have told us that they think the dissection was caused by a combination of a weakness in his arteries and a spike in this blood pressure
What we do know is that on Sept 17th he was sitting at his desk, alone in his office, and had a terrible pain in his upper back, radiating into his chest and his left arm. He called 911 and was taken to a local ER. They put him on morphine and nitro, and did some preliminary testing. The ER doctor felt it was his heart but not anything so serious that he could not be transferred to our own hospital for further testing. Hours later he was transferred 15 miles to our home hospital. He had further testing there.
The ER doctor had recommended a cardiac cauterization be done but the blood results showed no signs of a heart attack so instead the next day on the 18th my husband underwent a STRESS TEST (remember that his aorta had dissected by now more than 24 hours ago). If that showed nothing (or in retrospect hadn't killed him!) he was to be released that afternoon. Nine months before, my husband had had a very slight hypertensive stroke. He had undergone a huge battery of vascular and cerebral testing at that time. So the doctor had a lot of pretty current information at his fingertips regarding his heart.
The doctor was suspecting that it was a back problem more than a heart problem. My husband has always had a lot of back pain - kind of goes with a desk job and not enough exercise. Normally he has suffered a lot of lower back pain but for the few months before this happened, he had a lot of pain in his UPPER BACK BELOW HIS LEFT SHOULDER. What I have learned since then is that upper back pain in that area is a CLASSIC symptom of an aortic dissection.
Anyway, the doctors reviewed his stress test and did see something that indicated that he should have a cauterization the NEXT day. I had gone back to work and planned to return to the hospital late in the afternoon. I was concerned about the cauterization but based on all the testing that had been done the previous January showing no blockage, etc., I really thought he had a back problem!!!
Aortic dissections are very easy to diagnose but are so uncommon (thank God) that the patient often dies immediately or before their dissection is diagnosed. My husband had a guardian angel with him, because that same afternoon of the second day, the cardiologist (Dr Jo) who came to see my husband (by the way his name is Al), asked him some questions about his back pain, ordered a quick catscan (I think) and diagnosed him immediately.
That's when I got the call at work from his doctor: "We are airlifting Al to Lahey Hospital. He has a significant aortic dissection. He will be having major open heart surgery tonight!"
The whole family arrived at the hospital to see him before the surgery. We spoke with the surgeon (Dr Richard D'Agostino - a truly great surgeon and an exceptional person) and placed him in God's hands.
The prognosis was not good. Surgery was necessary without it the aortic dissection (which is a splitting of the aorta - the lining separates from the wall) would rupture and he would die. In 99% of people this happens within the first 72 hours - Al was going on 36 hours by now. It was 8pm. I was praying that the surgeon was a lot more alert than I was after a full day of office hours!! Dr D'Agostino was NOT very encouraging. Of the people who made it to surgery, at least 10% did not survive the surgery; then there was the extremely dangerous 24 hours after the surgery, a lot didn't survive that; and then the next two weeks; and then the next two months before I could really take a deep breath and say I think he is going to be all right.
Well he has survived and more.
There were a lot of little and not so little complications after 8 hours of surgery. During the first week, there were problems controlling his blood pressure and heart fibrillation and he had two TIA's. He was discharged after about two weeks and went back in by ambulance the NEXT DAY(he coughed and passed out!!! - first time I ever dialed 911 on purpose!) He had accumulated a liter of fluid around his heart! The team of doctors at Lahey didn't agree that was the problem for a few days (one of them diagnosed it the first day - a Dr Kanoonin) but fortunately they were able to aspirate the fluid without surgery and he stayed in the hospital for another week.
Since he has come home, he has gotten better day by day. (I want you to know that in the hospital he really didn't think he would survive this) I put him in God's hands, stopped worrying and focused on each day, not the next - that would have been too hard. By the way, he now has a St Jude aortic valve and his upper aorta has been replaced. His abdominal aorta is still dissected and we will have to keep an eye on that forever. It is imperative that he keep his blood pressure under control. So to that end, he is walking about 2 miles every other day and has semi-retired.
He is learning with help to de-stress his life - trying to lower his A personality to at least an A-! Today he is on his way with a friend to bring home Goldilocks - our newest addition - part Golden Retriever, part Sheltie. Between our five grown kid, six and a half grandkids, and Goldie, he has enough to keep him pretty busy forever.
His prognosis is good. The noise of his valve does bother him from time to time, but I love to hear it - it sounds strong. He will be on coumadin forever because of the valve. But that is the only drug that he is still on besides his blood pressure medication - Dr D'Agostino says he has a lot of adrenalin in his veins!!
During September, I felt that my life was a little microcosm of the nation after the attack on our country - the shock, the uncertainty, the fear, the prayer, the love and the thankfulness. So much good has come from our experience as a family and as a nation. My husband lost 20 pounds and has a valve with a life time guarantee! He jokes that he wouldn't recommend it as a weight loss plan! But even though I would never wish this experience on anyone, I am so thankful for the richer more meaningful life that it has given us the opportunity to enjoy. (And I highly recommend Lahey Clinic in Massachusetts and the doctors and nurses of 6 East)
Discussion, comments, or questions: Christine Kinnon
© Copyright 2001 Christine
Kinnon
All Rights Reserved - Fair Use
acknowledged
