NARRATIVES
TALK TO A
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28 April 1997
My 56 yr old husband recently survived an aortic aneurysm which dissected. The initial tear was in the upper aortic region (aortic arch) and it dissected all the way down. His symptoms were severe, excruciating pain, low blood pressure, low pulse, etc. He was taken to the emergency room of our local hospital and testing began. We spent 4 days with no diagnosis except a leaking aortic valve (which was a result of the aneurysm but not the main problem!)
The diagnostic test that ultimately found the problem was a "T.E.E.", a type of echo cardiogram. The cardiologist said "it came as a big surprise" to discover the aneurysm. When he did, he made the best recommendation he could possibly have made, which was to send us via air ambulance (from South Florida) to Houston to the Methodist Hospital. This facility and the doctors and staff there are absolutely, without question, the very best in the world at the type of surgery my husband required.
We arrived on a Friday afternoon and his 7 hr surgery was Saturday morning. They repaired and repositioned his valve, but most importantly a large section of the upper aorta was replaced with a Dacron graft. The lower portion of the aorta, which is also dissected, was not replaced because they felt that he would not have survived this additional work. However, they also feel that with appropriate follow-up CAT scans, he should lead a normal life span. What his recovery and future will depend on is maintaining a normal to low normal blood pressure, and all the other components of a healthy life style, including regular exercise, loss of some weight, no smoking, etc. The doctors want his blood pressure to stay in the 120-130 over 70-80 range. Jim did not have high blood pressure before this occurred — although it was "borderline".
A geneticist visited us who is doing a study in conjunction with Baylor Medical School. For this type of aneurysm, there may be a genetic component. The good news is that Jim is doing amazingly well and getting stronger every day. He spent 6 days in ICU, another 5 in the hospital and we finally came back to Florida via commercial airline a couple of days later. I am writing this exactly 5 weeks from the day of the "911" call.
Jim has very little pain, although he tires easily. The Houston doctors wanted his pulse to stay under 110 for a while and his cardiologist concurs, so his exercise hasn't been too strenuous. People who don't know what happened would not know to look at Jim today that he had surgery 4 weeks ago. His outlook on life is more positive than ever. He feels so lucky to be alive and realizes that a true miracle of modern medicine, involving the prayer of many, many family and friends has given him back his life. Our twelve year old son is very thankful, also that he has his Daddy back. We live each day to the fullest and truly have our priorities in order, if they weren't before!
I can look at Jim now and finally begin to put our nightmare behind us. We are told that a very very small percentage of people survive the initial attack of the kind that Jim had and then if they are lucky enough (how about strong enough) to survive, they may or may not be diagnosed in time. Then, they may or may not be fortunate enough to have the surgery and post operative care done where the success rate is extremely high. I may be rambling a bit here, but one reason that the Methodist Hospital has such a high success rate is the specialization of the operating theaters, the ICU and the cardiac care floor, as well as the surgeons and nurses, all dedicated just to aneurysms.
I hope that I can be writing an update in 6 months to tell you that everything continues to go as smoothly as it has since the operation.
Update 5 Aug 97
Jim's ct scan showed that the lower aorta had reduced in size and is now 3.5 cm (was 4 cm when we left the hospital). This is very good news! I had been afraid to ask what the chances were that not only would it not grow in the first three months, but might even start healing itself. However, the chest x-ray showed "something" on his lung which our local cardiologist suggested had to be checked out by a pulmonary specialist for possible lung cancer or other serious problems. When the chest x-ray was reviewed by the doctors in Houston at the Methodist Hospital, however, it turned out that this "something" had occurred as a result of the operation and the trauma the lungs had taken during the operation. It was nothing to worry about and is expected not to be there when the 6 month ct scan and x-ray are done.
Jim continues to get better all the time and says that he feels better now that he has for years! Due to taking all the homeopathic remedies for high blood pressure, keeping his stress levels low and his weight down and regularly getting cardiovascular exercise, he has maintained an acceptable blood pressure level WITHOUT MEDICATION. He is taking garlic, celery (yes, that's in a lot of the literature), magnesium, etc etc. and wouldn't give up any of it because we're not positive which is working the best!!!
At this time, he is a true success story and one that we hope will offer encouragement to others. He is leading a better than normal life, post dissecting aortic arch aneurysm surgery. We feel extremely fortunate that he did not have to have a valve replacement because he doesn't have to take blood thinners.
Update 22 Jul 2001
My husband is doing well at 4 years post surgery. The homeopathic blood pressure remedies, unfortunately, weren't successful enough to prevent Jim's ultimate need for blood pressure reducing medication. This is probably the most difficult part of the post surgery situation. He knows that he needs to exercise to keep his blood pressure down, but when he takes the blood pressure medicine, he feels too tired to do any meaningful exercise. His solution has been to take the medication in the late afternoon and try to do whatever requires physical energy (including exercise) in the AM. This has worked pretty well.
His followup CT scans have continued to show no change from the surgery - so that is a true blessing. His spirits and basic health are excellent and all in all he is truly thankful to have been one of the survivors in this "special club".
Update: 3 May 2007
We've had a wonderful 10 years; however, most recently we have been back in the surgical picture. Starting in the fall of '06, Jim had blockage in his right coronary artery, which required stenting. (4 stents) We chose to have this done in Houston at Texas Heart even though we live in Florida since that is where we feel the best heart team in the world is - Dr. Joseph Coselli and Dr. Jose Diez (who did the stents).
In February of '07, Jim had a stress test and our local cardiologist felt it should have been "better" based on the fact that his arteries were all open except for the one which was stented. We returned to Houston for a heart catherization and found that Jim's aortic root was dilated more than it had been in the fall of '06. Dr. Coselli felt it was time to operate on that. Also, the aortic valve was a possible replacement due to the fact that Dr.Coselli needed to have a solid foundation onto which to attach the new aortic root.
So I am happily reporting that surgery (8 hours) was performed at St. Luke's (Texas Heart) in Houston on Friday and Jim is doing great. He had: aortic valve replacement (chose a St. Jude mechanical valve), aortic root replacement with Dacron (he now has Dacron tubing for all of his upper aortic arch and descending aortic arch, plus Dacron for his aortic root) plus a by-pass of his coronary artery that was stented which had closed up 30% in 6 months. He is 5 days post surgery and doing absolutely fabulous.
What is really important here I feel is that Jim has never had a heart attack - his heart muscle is strong - 100% so and this has to be a factor in his recovery from this second aorta/aortic valve/ bypass surgery. He also lost 35 pounds in the last year so he was in really good health overall. However, this is probably the last time that his chest can be "cracked open" as he says.
I want to say that if you are in need of extremely complex surgery of this type, PLEASE get the very best care that you can arrange. The results are hugely different depending on who and where you have this done. I HEARTILY RECOMMEND DR. JOSEPH COSELLI. I am so happy to see that he is training some young doctors as well so the legacy will continue.
Best wishes to all of you facing this surgery, it's scarey but it can be very successful.
Update: 18 October 2007
After his April, 2007 operation, Jim was home about 5 weeks when he noticed that the tissue around his chest incision didn't seem to be healing and was, in fact, starting to look like a possible infection. After a few scarey days in the local hospital, a decision was made to go back to Texas Heart. There they decided that the most conservative approach was another surgery to determine the extent of the infection. Once they operated, they found that the infection was "superficial". He received extensive antibiotic therapy and removal of infected tissue; they also left his incision open for a few days until they determined that all was going to be well and closed him up.
I am writing this 6 months later when Jim had his first post surgical stress test and his cardiologist called tonight to tell him that it was EXCELLENT. We are so thankful again for the medical care that Jim has received and we know he is functioning normally today because we had the very best doctors and staff looking after him.
Our friends and family have supported us through this year with love and prayers and we couldn't have done it without them and Him. I look at Jim and know that he is indeed a walking miracle, once again.
Discussion, comments, or questions: Anne Tindell
© Copyright 1997 Ann Tindell
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