John Page was born in Lawton, OK on Feb 14, 1937 and entered the US Army from Fort Worth, TX on Feb 22, 1954. His military assignments included Japan, Germany, Hawaii, and Viet Nam. As a medical NCO, John served as a member of the army air-evac burn team at Ft Sam Houston, TX from 1962-1969. He was a faculty member at the US Army Academy of Health Sciences (AHS) 1971-1976 and again from 1979-1982.
Sergeant-Major Page retired in Sep 1982 at Fitzsimons Army Medical Center (FAMC) and accompanied his wife, Colonel Peggy Page, ANC (army nurse) to Tripler Army Medical Center (TAMC), Hawaii. There he studied philosophy at Chaminade University of Honolulu and received a BA degree in 1984... he since has earned a graduate degree (MSA) in health services administration (HSA) at Central Michigan University. John's wife, Peggy, retired from the army in 1994.
John and Peggy Page now live in Mocksville, North Carolina where they are involved in many community activities and members at First United Methodist Church. Their two sons are attending college. John (20) is a junior at Pfeiffer University and J.R. (18) is a freshman at Brevard College, both located in NC. John also has three married children and eight grand-children scattered from TX to KY.
John's email address is SGMJohnny@aol.com and he is always glad to hear from anyone to share and exchange information... or just for fellowship...
AAA Endovascular Repair... The Easy Way
19 October 1999
The following narrative summary relates my personal impressions and experiences after I was diagnosed with an abdominal aortic aneurysm (AAA). The AAA was first diagnosed at a Veterans Administration Medical Center (VAMC) in Salisbury, NC in 1994 during routine imaging of my spine for degenerative disc disease (DDD)... the 3.1 cm AAA was periodically evaluated every 6 months as it progressively increased in size...
Jul 22, 99... Results of a CT-scan at Durham VAMC revealed my aneurysm was 5.0 cm, a size when AAAs are generally considered for surgical repair.
Aug 12, 99... Discussed surgical repair of my AAA with Dr Papas, chief of surgery at Durham VAMC. I was eligible for surgery at the VAMC hospital and was also covered by TriCare (CHAMPUS) insurance which provides surgery coverage at most medical facilities. I had heard of a less invasive endovascular procedure and was curious about availability of this option.
Aug 13, 99... Searched the www and found Dr Maples web site... he replied to my email inquiry and recommended that I read the AAA entries included within his web site. Dr Maples also suggested that I contact the following:
LTG Gene Sterling had undergone one of the earlier AAA stent-graft procedures in this country two years ago and his excellent documentary, "I Went The Endovascular Route", provided most of the information that I was seeking. Gen Sterling responded to my email inquiry and answered a few questions that boosted my confidence in the AAA endoluminal procedure.
Dr Alex Powell, an interventional radiologist with extensive experience inserting AAA endovascular stent-grafts, responded to my email inquiry and provided definitive answers to several specific questions. Dr Powell also explained the risk factors involved with experimental surgical procedures; But most important... he recommended the endovascular route for healthy individuals, something that more cautious (and less informed) physicians have discouraged. Dr Powell concluded that he would personally opt for the endovascular route if an experienced professional was performing the task.
Aug 18, 99... Telephoned the department of vascular surgery, Wake Forest Medical Center (WFMC), for info on their AAA repair options; the chief of vascular surgery informed me that they were not currently participating in AAA endovascular trials and he recommended that I elect the traditional surgical repair because of the many complications associated with the endovascular approach. He also suggested that Duke University Medical Center (DMC) may be doing the AAA endovascular repairs.
Aug 19, 99... Telephoned Dr Richard McCann, chief of vascular surgery, Duke University Medical Center (DMC). He suggested that I send him a brief medical history and my most recent CT-scan for his evaluation. He explained that the measurements of the proximal and distal necks of my AAA must match up with the dimensions of the Baxter stent-graft before he could consider including me in his up-coming phase II trials.
Aug 24, 99... Email from Dr McCann saying he had studied my CT-scan and determined that I may be a good candidate for endoluminal repair. He asked that I call his personal secretary, Margie, for an appointment to see him at the Duke Medical Center Outpatient Clinic.
Aug 27, 99... First appointment at Duke University Medical Center Clinic. CT-scan imaging of my abdomen and pelvis were sent for evaluation, by a radiology laboratory in Utrecht, Netherlands, to calibrate specific vascular measurements. Routine blood specimens were drawn, and then my first appointment with Dr McCann. He explained that the final approval on my acceptability for the AAA endovascular stent-graft must be determined by the manufacturer* of the Lifepath endograft system.
*Baxter Healthcare Corporation, in Irvine CA, makes the LifepathTM AAA endovascular graft system, developed by Geoff White, M.D., and Weiyun Yu, M.D. of the Royal Prince Alfred Hospital and the University of Sydney, Australia. The Lifepath balloon-deployed system was FDA approved on 9/11/99 for phase II trials.
Sep 11, 99... Received a spreadsheet, FAXed from Dr McCann's office, revealing that the morphological calibrations of my AAA were in sync with dimensions of the LifePath stent-graft. Margie called that day and confirmed my tentative acceptance by Baxter to proceed with the plan.
Oct 01, 99... Final wrap-up appointment at the Duke clinic to sign all of the consent forms and releases required for experimental medical procedures. Dr McCann showed me a CD ROM that vividly displayed my heart and great vessels in three-dimentional graphics. He rotated the image on the monitor to view my anatomically duplicated AAA from several different angles. He pointed out on the graphic model that the configuration of the distal aspect of my AAA would require a bifurcated stent-graft to reduce the possibility of endoleak occurrences. I asked to be the first case scheduled on the proposed day of surgery.
Oct 09, 99... Attended morning church service (United Methodist) with my wife, Peggy, on this beautiful Sunday morning and an unexpected event happened during our "faithful workers" Sunday school class. At the close of the Bible lesson, Ralph Atwell, our teacher that morning, walked over to stand near me during our closing prayer. Ralph laid his hands on my head as he included me in the special prayer and invited other class members to do the same. It was a dynamic experience as my Christian family gathered all around to lay their hands on me and praying for my successful surgery on the next Tuesday. I was touched... both physically and spiritually.
Oct 11, 99... Peggy and I drove to Durham, NC and checked in a hotel across the street from Duke University Medical Center. We went out for dinner since my food and fluid intake would have to end at midnight.
Oct 12, 99... Up at 5:00 a.m. and checked in at Duke hospital's surgery receiving area at 6:30 a.m.; was surgically prepped the same as those having open abdominal surgery; briefed by the anesthesiologist and swarmed by medical residents there to observe the rare and unusual surgical procedure.
Dr McCann and his primary team arrived in the OR prep-room shortly after 7:00 a.m. and he introduced me to his fishing buddy, Dr Glenn Newman, the interventional radiologist, and Dr Weiyun Yu, the noted vascular surgeon from the University of Sydney, Australia, there to assist in phase II trials. Now I understood why they declined Peggy's request to accompany me in the operating room... there wouldn't be breathing space for another person in that OR.
I was hoping to remain alert enough during surgery to take personal mental notes but I was put out like a light. The next thing I remember is waking up in the Surgical Intensive Care Unit (SICU) at 10:30 a.m. feeling better than the day before surgery. My only discomfort was pain surrounding two surgical incisions in my inguinal groin area where bruises and some bleeding persisted. I was soon moved to a private room where Peggy and I stayed overnight in the hospital.
Oct 13, 99... Got up at 6:00 a.m. and the nurse removed all my tubes which included an epidural line, indwelling foley catheter, and several intravenous caths. I felt fine except for my groin incisions and a slight headache from the anesthesia. After a hearty breakfast, I got up and shaved at the sink, showered and waited to be discharged. We left the hospital and stayed another night in the nearby hotel because I had a clinic appointment the following morning. Peggy and I went out for dinner that evening and slept well throughout the night.
Oct 14, 99... Up at 6:00 a.m.; checked out of the hotel and seen by Dr. McCann at Duke clinic @ 9:00 a.m. Everything went like clockwork, according to Dr McCann, and all three sections of the tri-modular stent-graft were guided into exact locations and balloon-deployed in position as planned. My first follow-up appointment and CT-scan is scheduled at Duke University Medical Center on Oct 28 99. We drove the 2 hour trip home to Mocksville and I feel as good as new.
NOTE: Dr McCann has agreed for me to use information from his own narrative summary in my first update after my follow-up appointment îat Duke on Oct 28 99... will also have a color photo image of my AAA.
Update 30 Oct 1999
Oct 22, 99...First follow-up clinic appointment at DUMC... Dr. McCann says all my lab results are within normal limits and the CT-scan reveals that my aneurysm no longer exists... the Baxter Lifepath system is in correct position with no endoleaks or other complications... Since the AAA was repaired, I seem to have increased circulation in my legs... more energy and stamina than I've experienced in years... and already back to doing my own yard work and working out at the YMCA 3 times a week...
Update 8 Jan 2002
I regret that I have put off writing this update but many things have occurred in my life during the past 2 years since my AAA Endovascular Repair at Duke University Medical Center that I never got around to it until now. Although the medical care at Duke is great, their administrative staff did a terrible job handling my patient account records, including double billing my insurance company for expensive CT Scans and erroneously billing me for charges that should have been paid either by my insurance or by Baxter Laboratories. They twice sold my account to collection agencies after I had spent many hours explaining that I didn't owe the billed charges.
The Chief Vascular Surgeon at Duke, Dr. Richard McCann, notified me recently that many of the stent-graft types that he used in his clinical trials during the past two years have proved to be defective. He stated that about 30% of the more than 100 endoluminal devices that he has implanted during the clinical trials at Duke University now reveal fractures in the wire framework within the stent-graft. He also assured me that these broken wires did not involve all of the coil-like structures and that he did not anticipate danger unless several wires failed resulting in a collapsed graft and subsequent blockage of the aorta.
Now I must opt either to have the graft replaced by scheduling another endovascular surgical procedure (more complicated that the original graft placement), or to have a traditional open abdominal surgical repair to remove the defective device and replace it with one of the standard stent-grafts that have been proven to be reliable over the years. I must add that Dr. McCann has given me a third option of doing nothing and taking the chance that my particular device may last for years without a problem.
I will be evaluated next month with a series of CT Scans to determine if my graft should be replaced. I will write a follow-up report after that determination is made.
Update: 21 Jun 2002
I haven't made a decision as yet about what to do about the defective graft; however, I have a new vascular surgeon, Dr Kiell, from Frye Medical Center, here in Hickory, that is in process of reevaluation to determine if I should have a second stent placed, by the endovascular route, inside the defective one, bypassing the original stent completely. Of course another option is to do the traditional open abdominal surgery, removing the defective stent and replacing it with the old reliable type...
By the way, I have had other vascular concerns including a stroke on 15 April 2002 followed by a surgical procedure where they removed plaque blockage from my right carotid artery on 28 May, 2002... Dr Kiell performed this procedure and will follow up by doing the other side perhaps next month... so you see I've been quite busy.
Update: 28 December 2004
It has been more than 5 years since I first contacted this site for information and advice concerning my AAA. It was only through the site's information and recommendations that I was the first patient in NC to have AAA indovascular surgery. Dr McCann has since did hundreds more at Duke Medical Center and they are using an improved stint model.
I continue to read the new narratives/updates. The site has been a blessing in so many people's lives and continue to provide information and encouragement for hundreds of affected families. I hope that this finds all of our aneurysm family enjoying the holiday season and resisting all the tempting holiday food and drinks that seem to metabolize immediately into layers of lipid tissue around aging male waistlines. This has been my primary health problem since my surgery in October 1999. I have not been successful in getting my weight below 250 lb. I have had some success with Adkins, Lo Carb, and have dropped 20 pounds from my top weight of 270 pounds that I carried this time last year. My scales seem to have locked in on 250 now, no matter what I eat or don't eat.
My goal is to get down to 230 lb. (I'm 6'4") and stay that way by eliminating sugar, white flour, and Irish potatoes from my diet permanently. I eat only meat and vegetables without bread and occasional small servings of rice and fruit. This is the only diet that I can stick to and it works when I add in some daily exercise.
A recent CT scans reveals several broken wires in my AAA stint graft. This was no surprise since Dr McCann informed me in 2002 that this was a problem with 30% of the stints that he had placed up until that time and he gave me several options that I mentioned in my last update. I decided to do nothing as long as there was no danger of blockage of the aorta. My current vascular surgeon recommends that he follow it closely with CT scans q6mos and do traditional AAA surgery if the need occurs. This defective graft may last longer than I do...
In Christian Love... John Page
Update: 5 March 2006
The old stent graft is still patent and doing what it's supposed to do, although it has several broken wires revealed on recent CT Scans, so I plan to do nothing unless a life threatening situation develops. Dr. Kiel, Chief Vascular Surgeon at Frye Medical Center in Hickory, assures me that it is best to wait and see if this graft will continue to endure, with the broken wires, because there is no accurate way to determine how long it may hold up.
My overall health remains good and I continue to do my own yard work and other physical activities. Peggy and I traveled to Europe twice last year and we cruise about three times a year. We recently returned from a 12-day Caribbean cruise that debarked from Norfolk, VA.
I feel great and don't even think about my aneurysm. It currently presents no pain or discomfort, and I certainly don't want any unnecessary surgery, so we will continue to get CT scans every six months just to be certain everything is okay.
I appreciate the support and encouragement I have received from my aneurysm family.
Discussion, comments, or questions: John Page
© Copyright 1999 John Page
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