Open-heart surgery on June 4th!
Well, the Bear's latest heart scans¹ showed why he dipped into congestive heart failure last month: he'd lost another 12% of his heart's "pumping power" in a year. Since his heart attack in 1999 already reduced his heart's capacity by about half², this is a big deal & cause for some alarm. An EKG showed that he hasn't had another heart attack. The next easiest thing(s) to check & fix would involve blockage(s) in the arteries supplying the muscles of the heart itself. The stent he got in 2003 to open a previous blockage could also be clogged up, since stents aren't a permanent fix by any means. So L. went for an angiocath last Friday, with plans to do/re-do stenting at the same time if necessary.
Turned out his stent is still open & working great, but he's developed 4-5 serious (80-90% closed) blockages farther up the left anterior descending (LAD) artery & its branches.³ (There's also a lot of junk accumulating below the stent although that portion's not bad enough to require intervention yet.) He has a blockage in another coronary artery on the right side but that can be stented in a separate angioplasty in the not-too-distant future. The important part is, the cardiologists at the angiocath concluded that they couldn't place stents in the LAD successfully & recommended heart bypass surgery.
The heart surgeon on-call for the hospital came & talked with us that same evening, while L. recovered from the angiocath. He strongly recommended that L. take a week or 2 to rest & recover more from the lingering effects of pneumonia (namely, nasty coughing fits after he's lain down for a few hours). This particular doctor is also one of very few in Ocala who can do heart bypass surgery without having to stop L.'s heart & put him on a heart-lung bypass machine. By doing the bypass this way, the surgeon estimates L.'s chances of surviving surgery at 90% or better. Alternatively... well, there's a reason why artery blockages as bad & in the place L. has them are called widow-makers. Only 10-15% of people survive the sort of heart attack L. already had; his chances of surviving a second would be much less.
The extent & placement of the blockages in both branches of L.'s LAD, plus the fact that they built up so badly in only 5 years despite maintaining very low blood pressure & blood lipids/cholesterol, makes it likely that more blockages will occur quickly & that the vessel itself is damaged. When you consider that every single one of L's first-degree relatives have had heart attacks or coronary artery blockages, & a high percentage of his aunts, uncles & cousins have too, you can see he simply lost the genetic crap shoot when it comes to CAD (coronary artery disease). So I feel bypass surgery was more a matter of "when" than "whether," & L. will never be younger or healthier than he is now. His only major risk factor for the surgery (aside from CAD & heart damage, of course) is obesity. However, the surgeon advised us to proceed with surgery soon because he feels it would be too risky to wait while L. reduced enough to make a significant difference.
So, assuming L. feels well & doesn't have any symptoms of infection, he's having doubleª bypass surgery next Tuesday, June 3rd, at the Ocala Regional Medical Center (where L's supervising physician & the owner of his clinic know just about every doctor & hospital administrator :-). Surgery is scheduled to start at 7:30 a.m. If all goes well he should be out by 10:30 a.m. We have to arrive at oh-my-God-thirty for pre-op tests & crap so we'll stay in Ocala Monday night to avoid the 2-hour drive from St. Augustine. L. will be in Cardiac Intensive Care for about a day, then in a regular room for another 3-6 days, depending on how he heals & how bad the pain is. He'll be off work for 2-6 weeks after that while he recovers from having his heart beat up & his chest split like a butterflied pork chop. >¦-þ
We would very much appreciate your thoughts, magick, good wishes & prayers all during this process! I'll try to post details &/or send an e-mail after the surgery but I can't promise how long after. Assume that no news is good news & keep the positive energy coming, please! Because of L.'s reactive airway disease please don't send flowers. I'm sure L. would appreciate cards, tokens, books, music, movies or whatever other charm or distraction you can think of, especially during the recovery period at home when I expect him to be cranky & bored & a pain to live with--thankfully! ;-) If you want to lend us any of the above I promise faithfully to return whatever-it-is safely.
Thanks,
~Roberta
Some contact details: You can try calling my cell phone [(904) 540-1184] after June 3rd (I think I'll be too distracted to do much while L.'s in cardiac intensive care) & I'll call back when I can. The main number at the Ocala Regional Medical Center is (352) 401-1000 & their website is www.OcalaRegional.com. Our address is 3592 Red Cloud Trail, St. Augustine, FL 32086-5310.
Boring gory details (for those who could care less)
¹ Because L. is both large/muscular & obese, regular ultrasounds & even radioactive-dye scans don't always give accurate results. The most precise external tests are Doppler (color) ultrasound & MUGA scans, which he had 2 weeks ago. Results of scans before last year may have been off by as much as ±10% but the overall trends were accurate.
² The heart's efficiency in pumping oxygenated blood to the body is expressed as the percentage of the left ventricle's contents which is ejected each time it contracts. Generally a young-to-middle-aged healthy adult has an "ejection fraction" of 60-75%. When first measured in 2003 L.'s ejection fraction was around 35%, but it improved to 49% as soon as his stent let more blood get to oxygen-starved muscles. His ejection fraction may have been somewhat lower when it was measured after his near-drowning in 2005-not that his @#$%^&* cardiologist at the time bothered to check it out!-& his most recent result was 32%. Many people with an ejection fraction this small are on disability.
³ The LAD (left anterior descending) artery is the main blood vessel for the left ventricle (the chamber of the heart that pumps oxygenated blood out to the rest of the body), the septum in the middle of the heart & some of the right ventricle. The artery starts out near the top of the heart; L. has a serious blockage in this part. Then it splits into 2 branches as it "descends." One branch, which continues on fairly straight down the front ("anterior") of the heart, is where L. had a stent put in previously. The other branch angles off diagonally toward the back of the heart. L. has 3-4 blockages in this diagonal vessel.
ª Although only the LAD will be bypassed, it's called double bypass surgery because it involves both branches of this major artery. The surgeon expects to use sections of L.'s mammary artery (from inside his ribcage) & saphenous vein (from the lower leg) to bypass his blocked LAD.