Franz Kirchheimer, born 1947 in Constance, southern Germany, grew up in Freiburg, and lives now near Hannover, northern Germany. Family: Married since 1972, 2 sons. Work: Originally a mathematician specialized in Algebra (with Ph.D. and 'habilitation' in mathematics), I work since 1982 in the oil exploration industry. Medical: Survived pancarditis caused by second stage borreliosis (1972), hypogonadism diagnosed and under control since 1998, inflammatory aneurysm of the abdominal aorta diagnosed and fixed by conventional surgery (Y graft) 2001.
I am male, 54 years old, smoked for 40 years (although I stopped it completely in the last year) and have just as long a history of (moderate) alcohol abuse. Some time ago I thought I was under quite good medical supervision, having a general exam every two years and an urological one twice yearly. I am under testosterone replacement, hence the Urologist did regular ultrasound scans and blood tests.
In the fall of 1999 I experienced growing pain in the lower back and was examined in December by an Orthopedist who took two X-rays of my spinal cord, did not find much wear nor damage to those parts and treated the condition with accupuncture and the occasional Ibuprofene which in combination subdued the pain. Had I better looked at his X-rays, I probably had gone for a second opinion ...
January 2001 I happened to visit our rural hospital instead of the usual Urologist and the new GP found after some minutes of ultrasound scanning a 7.5 cm aneurysm of the abdominal aorta. Seeing that thing on the screen was one of the worst moments in my life. He continued the checks and seemed a bit puzzled that apart from the aneurysm there were no traces of atherosclerosis (especially considering my smoking history).
After the first round I got the Orthopedists X-ray from the archive and it actually showed the aneurysm quite clearly.
Referral to the vascular unit of Henriettenstift, Hannover was made immediately along with CT the next day. The CT images confirmed the impression from the ultrasound that both iliac arteries were affected but the renal ones were not. But it was clear that the chances for a stent graft were nil. This was confirmed in the interview with the lead surgeon, who actually practices the conventional and (together with the radiologists) the stent versions. Luckily there was an opening in her operating schedule by February 19.
So, after spending a day flushing my bowels and smoking my last cigar by ten in the evening, I checked in at five in the morning and was made ready by eight. The Anesthetist was about to call off the action because of my coughing (had got a cold), but I appealed to his and mine machismo (only a complete softy would be deterred by a little coughing with a freshly cut belly) and got him to continue.
I had expected 90 minutes of surgery, then 4 hours in the ICU, so I began to wonder what had happened when the time there did not end. Of course I was too hazy and also physically not able to ask. But I remember that at the first opportunity I checked all toes for mobility and sensitivity and was very happy that nothing was amiss. The first time I regained full consciousness was 36 hours after entering the theatre.
Later, I was told that the aneurysm was of the rare inflammatory variety and the operating team had worked 4.5 hours to clean up this mess. The absence of Atherosclerosis actually was a hint that the aneurysm was not the ordinary one. The Anesthetist proudly reported that nevertheless he had done without external blood transfusions and had recycled more than 5 litres (so at this moment every single blood cell in me had been at least once recycled).
Off from ICU I was no longer on Opiates, and the first night was less than comfortable. Especially, coughing with an open belly is indeed a macho thing. At least the stomach and urethral catheters were removed, so I could swallow a bit of liquid and was forced to get up and go to the loo. There is no better method to get a person with fresh surgery walking than to turn up the central infusion to 3 litres per day - this means at least 4 forced walks to the toilet.
After 3 days I could boost this infusion with a little food and Zinfandel which improved my sleep more than tranquilizers. After 5 days all tubes were gone. The last was the central infusion going down deep into the jugular vein. This is indeed a very comfortable way to have an infusion (compared th earlier occasions where an arm vein was used), although a bit disconcerting. Without those tubes I was able to walk a bit into the city. Exactly one week after surgery I was back home - the last thing done to me was the removal of 43 steel clamps that looked like a very weird piercing.
At home I went back into the care of the GP. The blood recycling had left me with a bad case of anemia, so in the first weeks I was extremely weak and needed a lot of sleep. After 3 weeks rapid recovery set in and early in April when we went to Madeira for hiking I could do 500 meters height difference in an afternoon hike. Back to work 6 weeks after the surgery.
Now, nearly one year later I am completely recovered and enjoy the usual toys like motorbike and chain saw without restriction. I have given several technical talks at conferences and travelled a lot. The dreaded sexual side effects of the surgery have not materialized, on the contrary, along with the pain in the back, some (not all) of my erectile dysfunction has gone.
Having stopped smoking actually improved my lung function, and a couple of weeks ago I got the cleanest bill of health I ever had.
There remain just 3 things to remind me that I had a narrow escape and would be dead now, were it not for immense luck:
1. Sometimes, when I awake, I realize that an essential part of me is just artificial plumbing, and the idea that 'it could become loose' threatens to become an obsession.
2. The scar on my belly is rather unesthetic, just Frankensteinish. But now that I am sensitized, I have seen that many other persons are similarly disfigured and so I actually do no longer mind exposing myself.
3. By German law I am now an accredited 'severely handicapped' person with all legal benefits such as extra days of vacation. This is absolutely crazy considering my present condition.
Update: 14 Jun 2002
Yesterday, 16 months after my AAA surgery I was once more asked about the scar on my belly and actually managed to answer: 'Oh, some minor surgery about a year ago'. This is how I feel now, pedaling daily 10 miles through Cambridge (England) , where I am to work for a year.