I'm still here...

It's been a long time coming, this here heart operation. I've known about it since 1980, when my physician "found" it. Apparently, it was a defect I had from birth, a heart murmur, which was so unimportant that my parents forgot all about it. Sooner or later, it was going to catch up with me.

Well, the first time the murmur got in my way was when I tried to enlist in the US Navy. For reasons of insanity, I signed up for the "special warfare" division, the Seals to be exact. While in the dive company, in basic training, we were all under the microscope and underwent many medical tests. And it might've been because I picked such an arduous discipline that they made it such a big deal. In any case, it got me removed from the service.

Since then, over the next ten years or so, my Kaiser doctors have been monitoring the degrading condition of my valve. We all knew that it was just a matter of time, before I would have to have that bad valve replaced or repaired. For a number of reasons, I've always been a big proponent of getting it done sooner than later 1) Statistically, younger patients recover better and faster 2) Right now, I have great health insurance and with the way health care is going in this country, I'm not sure how my coverage would be in the future, nor can I be certain where Emily or I would be working.

For reasons of economy and liability, it's in the best interest of the HMO to delay the procedure as long as possible. I would estimate that the surgery cost around $500,000.

I had many open discussions with my physician and he explained to me all the conditions to be concerned with, before the operation would happen. Basically, I had a bad leaking valve, my aortic valve, that was creating about 15-20% back-leakage. That's kind of an important valve, in that it's supplying blood to all the major organs, including the brain. Because my valve was leaking so badly, my heart had to work harder to compensate for the "lost" blood- basically, my heart had to work 20% harder. Because my heart was working so much harder, my heart was getting larger, more muscular, and that's not a good thing- a larger heart means that there is less room in my chest cavitity for it to function.

For patients with bad valves, there are basically two options 1)The valve can be replaced with a mechanical valve, which has a great chance of lasting the lifetime of the patient, but blood thinner would be required for life 2)An organic valve can be used in the operation, usually that of a cow or pig. No blood thinners would be required, but the valve won't last all that long, so re-operation is most likely.

My doctor suggested that I might be want to look into the Ross Procedure. This is actually a two-valve operation, where the surgeon replaces the aortic valve with the patient's own pulmonic valve, which is harvested during the surgery. Usually a human cadaver valve will replace the pulmonic valve. The major advantages of the Ross Procedure are that the acceptance of the new aortic valve is practically guaranteed, it is roughly the same size, so it will function the same as the damaged one, and because it's an organic valve, blood thinners are not required after the operation.

Every year, I've been going in to get an echocardiogram, basically a sonogram of the blood flow through my heart, to check out its function and to see if it was getting larger. All muscles have the ability to atrophy back to its normal size, if the muscle doesn't stretch too big and the heart muscle is no exception, but if it gets too large, then it will lose that elasticity. That was one of the major deciding factors of when to do the operation.

So earlier this year, I went in to see my doctor to do my usual annual thing. This time he tells me that it's time to start looking for a cardiologist. Finally, the plot thickens...

At first, I didn't really think much that we were taking the "next step", other than it was a means to an end. After my consultation with my cardiologist, he told me that we were definitely going to need to get this job done soon, within two year's time. I told him that I would prefer to get it done sooner than later. I also asked him about the Ross Procedure, which he seemed to be a little hesitant about. We immediately set up an appointment with a highly respected young surgeon in the Oakland Summit Hospital organization, Dr. Lee.

My visit with Dr. Lee was succinct. He wanted to make sure I knew what was wrong with my heart and I wanted to see if he would do a Ross Procedure on me. He explained that the Ross wasn't a very popular surgical procedure, mostly because it was a lot of work for the surgeons, having to spend two to three times longer on their feet in the operating room. Also, there was more risk involved for the patient, being on the heart/lung [pump] machine for such a long period of time. He did point out the benefits of a successful outcome and he acknowledged that the outcomes are usually successful, although there hasn't really been enough data to note long term successes, since the procedure is still relatively new (1968). He said that he didn't do Ross Procdures, but he didn't try to talk me out of one either. Instead, he referred me to one of his collegues at San Francisco Kaiser, Dr. Flachsbart.

A short time later, I took a drive out to San Francisco to visit the good doctor. He was a smilyey slim, older-looking gentleman, with a short crown of white hair on his head, bald on top, and a white beard to match. We talked about the same things that I had discussed with Dr. Lee. It just so happened that the Ross Procedure was one of Dr. Flachsbart's specialties. (As it turns out later, I found out that he's one of the top five Ross Procedure specialists around the country and he is Chief Surgeon at this Kaiser facility). He agreed to do the Ross and we set a date- about six weeks off in the future. As soon as Thanksgiving was over, I would be reporting to the hospital for the surgery.

Now, as routine as heart surgery is, nowadays, I was still quite worried about the outcome. Since my dad had such a nasty history with haprin (the commonly used blood-thinner used during heart operations), I was a little freaked-out. Suddenly, I realized how much I needed to get done in my life!  What would happen if I were to die? I didn't have a will or living trust in place! What would happen to my remains? I needed a advanced health direct at the very least, in case something went array in the hospital. What about all those things around the house that needed to get done? Even if I survived the surgery, I won't be much help around the house for months afterward! Fall was ending and Winter was coming fast. Those last minute yard chores needed to get finished. So much to do, so little time.

Monday, the day before the actual surgery, I went in, with Emily and both my parents, to do the preliminary consultations, having to do with anesthesiology, the surgical procedure and other odds and ends. They took some blood samples, I signed some papers and after being there for most of the day, we were done. It was time to get a good dinner and get some rest for the day of surgery- I needed to be there at 6:30am, and that was an early drive. We all took a drive down to Half Moon Bay, where we could enjoy looking at the ocean one last time before my surgery, then we had a nice quaint dinner at Barbara's Crab Trap for some excellent New England style clam chowder and some sandwiches.

The next morning came too soon. I only got about four hours of sleep. We were the first ones at the hospital- matter of fact, I was actually surprised that there was someone there at that hour. The nurse took me in and checked out all of my vital stats. My blood pressure was out of control! It was something like 185/120. It's never been like that before! They got me dressed in a gown and isolated me, preparing me for surgery. Emily was with me most of the time. The doctor came in and went over the procedure one last time. We discussed a contingency plan, in case the Ross Procedure was a no-go. I decided on an organic aortic valve as my second choice. My folks came in to visit one last time and the it was time for everyone to go. They gave me an IV and that was the last thing I remember.

I remember waking up....I was in a room that seemed to have no windows. There was a really large Timex clock on the wall right in front of me. The time was about 10:30. I hadn't realized that I had already had surgery yet. I fell back asleep.

About ten minutes later, I woke up, again. This time, I started to figure out that I was already done with the procedure. Then I realized that it must've been successful or I wouldn't be there having those thoughts. I could feel the breathing tube shoved down my throat- it was bothersome, uncomfortable. The two nurses who were attending me in that CVICU gave me a sponge bath, probably trying to clean me up from all that surgery goop that was till left on my body. I tried to get more rest, but kept waking up every few minutes.