T
tomkanis
If you asked me in January of this year what my problems were, I would have said they are mostly orthopedic. I was plenty tubby from travel and smoking cessation, and therefore on a diet, but the rest was bones: Plantar faciieitis, osteoarthritis in both knees, two sagging lumbar discs with Sciatic involvement, and magnum carpal tunnel. But when our health insurance went through the roof in January, I felt confident enough to dump the expensive short-term disability. All I planned on doing was two more carpal tunnel operations, maybe, this year.
I had a physical in February, and my internist told me that despite dropping 38 lbs, my A1C readings were up to 6.8, so she says that I?m now a Type 2 diabetic. Oh, Joy. My Mom was Type 1, and it killed her.. My older brother beat me to Type 2 by 6 weeks. Also, the echo said that my AS was now moderate to severe. It had been moderate for years.
I had been told previously that I?d need a valve, but ?way off in the future?. In March I saw a Cardio of the internists? choice, and he immediately wanted to do a Catheterization. He also said that he would consider nothing but a mechanical valve for me because of my age (I?m 58). I thought he must have the wrong records. I thanked him for his time, left and called my internist. She said not to worry, that her Cardio only wanted to ?keep an eye? on the AS. I told her he sounded like a sub commander keeping an eye on an enemy freighter. I then called a Cardio I know socially, and trust. He ran a Doppler echo and told me that the first guy was right about the Cath. The AVA was 1.7 CM^2, and that he, too wanted to run a Cath. I was absolutely stunned, since I?m totally asymptomatic.
My Cardio friend ran the Cath, and told me that the pressure across the valve was 70 mm of mercury, and that action was indicated above 50 mm, and oh, by the way, I had two coronary arteries that were getting tight, ?but don?t let anyone talk you into a bypass?. He wanted to have me see a surgeon. I was totally flattened by this, and didn?t do it for three weeks. The surgeon gave me the same story, and of course wanted to do the two bypasses that the Cardio wanted to stent eventually. I had three pages of questions for him, and he was patient with me. The big question was mortality and his answer was 2-4%. It doesn?t sound like much, but it?s 2-4 times that of the average for a healthy male.
I?ve checked out the surgeon through other Cardios and OR docs I know, and they all respected him. One said he ?is at the height of his power.? I asked my Cardio if I should get a second opinion, and he was non-committal: ?you can if you want to?. The surgeon only does the full-sternotomy style AVR, and told me my on-pump time will be about 3 hours, out of a 5-hour operation.
My Cardio tells me that it?ll be OK to wait until October to do the Operation. He said I could enjoy the summer and then do it. I?m not really enjoying anything, including two business trips to England last month, and it occurred to me after talking to the Mended Hearts folks, that being asymptomatic will probably make me an ungrateful patient. We not gonna fix anything that?s bothering me, and were gonna make a mess doing it. Additionally, we gonna use up my accumulated vacation to do it, and I?ll have to work from the house via phone and fax after three weeks of recouperation.
So, I?m making preparations. First, the legal stuff: Will, Durable Power of Attorney, Medical Power of Attorney, and, given my luck so far, funeral arrangements and a burial plot.
In July, I?m getting my teeth cleaned (surgeon?s idea) and in August get my knees re-filled with sinoveal fluid, so I can walk in rehab. Get the house professionally cleaned and make arrangements for a nursing service for the first week back, since I?m single and live alone. I sure wish this was after I was 60: my military insurance would cover a lot.
I still don?t know if I should get a second opinion, or if I should just let the surgeon do the two bypasses, but I?ve got a couple of weeks to figure to out. What ticks me off is that I know my Cardio want to suggest a course of action to me, but that his insurance won?t let him do things like that.
Tom in Cincinnati
I had a physical in February, and my internist told me that despite dropping 38 lbs, my A1C readings were up to 6.8, so she says that I?m now a Type 2 diabetic. Oh, Joy. My Mom was Type 1, and it killed her.. My older brother beat me to Type 2 by 6 weeks. Also, the echo said that my AS was now moderate to severe. It had been moderate for years.
I had been told previously that I?d need a valve, but ?way off in the future?. In March I saw a Cardio of the internists? choice, and he immediately wanted to do a Catheterization. He also said that he would consider nothing but a mechanical valve for me because of my age (I?m 58). I thought he must have the wrong records. I thanked him for his time, left and called my internist. She said not to worry, that her Cardio only wanted to ?keep an eye? on the AS. I told her he sounded like a sub commander keeping an eye on an enemy freighter. I then called a Cardio I know socially, and trust. He ran a Doppler echo and told me that the first guy was right about the Cath. The AVA was 1.7 CM^2, and that he, too wanted to run a Cath. I was absolutely stunned, since I?m totally asymptomatic.
My Cardio friend ran the Cath, and told me that the pressure across the valve was 70 mm of mercury, and that action was indicated above 50 mm, and oh, by the way, I had two coronary arteries that were getting tight, ?but don?t let anyone talk you into a bypass?. He wanted to have me see a surgeon. I was totally flattened by this, and didn?t do it for three weeks. The surgeon gave me the same story, and of course wanted to do the two bypasses that the Cardio wanted to stent eventually. I had three pages of questions for him, and he was patient with me. The big question was mortality and his answer was 2-4%. It doesn?t sound like much, but it?s 2-4 times that of the average for a healthy male.
I?ve checked out the surgeon through other Cardios and OR docs I know, and they all respected him. One said he ?is at the height of his power.? I asked my Cardio if I should get a second opinion, and he was non-committal: ?you can if you want to?. The surgeon only does the full-sternotomy style AVR, and told me my on-pump time will be about 3 hours, out of a 5-hour operation.
My Cardio tells me that it?ll be OK to wait until October to do the Operation. He said I could enjoy the summer and then do it. I?m not really enjoying anything, including two business trips to England last month, and it occurred to me after talking to the Mended Hearts folks, that being asymptomatic will probably make me an ungrateful patient. We not gonna fix anything that?s bothering me, and were gonna make a mess doing it. Additionally, we gonna use up my accumulated vacation to do it, and I?ll have to work from the house via phone and fax after three weeks of recouperation.
So, I?m making preparations. First, the legal stuff: Will, Durable Power of Attorney, Medical Power of Attorney, and, given my luck so far, funeral arrangements and a burial plot.
In July, I?m getting my teeth cleaned (surgeon?s idea) and in August get my knees re-filled with sinoveal fluid, so I can walk in rehab. Get the house professionally cleaned and make arrangements for a nursing service for the first week back, since I?m single and live alone. I sure wish this was after I was 60: my military insurance would cover a lot.
I still don?t know if I should get a second opinion, or if I should just let the surgeon do the two bypasses, but I?ve got a couple of weeks to figure to out. What ticks me off is that I know my Cardio want to suggest a course of action to me, but that his insurance won?t let him do things like that.
Tom in Cincinnati
You've quit smoking and you're on a diet! Hooray for you! Your heart and lungs (and virtually every other body part) will benefit from not smoking, your knees and your diabetes will benefit from the diet, and your arteries will benefit greatly from both of those major lifestyle changes! Hip hip hooray for you! It's 2006 and AVR is not a walk in the park, but it's a very successful surgery from which you will, in all likelihood, recover quite nicely! And if all that's not positive enough, you have a job that you can do over the phone with the help of a fax machine! (My hubby happens to be doing that right now, while he recovers from pelvic surgery--it's working just fine.)
