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Mother 68

My name is Michael Olson and I am 39 years of age and this is my first encounter with aortic dissections. My Mother who is 68 years of age is the patient that has been diagnosed with the dissection. My Mother has never been one to go to the hospital for anything and avoids them like the plague. She is from Chile and legally came to the United States in the late 1960’s. She lives alone and is in fairly good health by staying active, eating healthy, and watching her weight.

This past Christmas Eve she called me up complaining she had trouble moving her left leg. She previously went to her general physician and they diagnosed her with having some high cholesterol and did an MRI on her legs to see if there were any problems. Nothing was found with her legs and my Mom was getting frustrated that there was obviously a problem that would come back every so often. Some recent conversations on the phone with my Mom sounded as if she was slurring words and didn’t make sense and I questioned her on this and she brushed it off that she just woke up or it was nothing. She also had a recent fall in the last year where she split her knee open on a cement walking block in the front yard requiring numerous stitches. Another item I noticed of the years was a slightly drooping eyelid that I attributed to older age.


With all of these symptoms in my mind I went to pick up my Mother and take her to an urgent care clinic. They weren’t able to help because they required authorization from her GP. They recommended we go to an Emergency Center at a hospital and the one they recommended in the area was San Antonio Hospital in Upland, CA. We spent Christmas Eve in the Emergency Center and my Mom checked out fine and they were about to release her with no findings until I provided them the symptoms I have noticed with my Mom over time. They one item that caught the attention of the doctor on staff was the slurred speech. He sent my Mom in for a CT scan and discovered she was having TIAs or mini-strokes. He referred us back to her GP for immediate follow up to try and locate where these TIAs were coming from.

A trip back to the GP and my Mom was then referred to have a scan of here carotid arteries to see if there was any blockage. None was found and the next step was for my Mom to have an angiogram to examine the other arteries. She was referred to a Dr. Nabil Koudsi (http://www.sach.org/home/Search/Physicians.aspx?id=4294972852) and he scheduled the angiogram for my Mother on 1/29/2013. My Mom didn’t want me to miss work and insisted a friend would take her to the hospital for the procedure that day. I live about 55 miles away from my Mother and have a younger brother that lives in Portland, Oregon. After the angiogram was complete I spoke to my Mom on the phone and she sounded fine and was recovering. I went to the hospital that evening and discovered she had a stroke at some point. The doctors told me it occurred after the procedure they suspect.

The stroke wasn’t a major one and she recovered from it physically in a couple of days fortunately. My Mom ended up staying in the hospital until 2/9/2013 because of all of the complications she encountered. She has an elevated heart rate they had to control, fluid filling into her lungs that they had to drain once with a needle to the back, and some concern from her kidneys with the dye they used for the angiogram I’m told. After they had all of the items under control, they focused on my Moms blood pressure because it was high. The results from the angiogram weren’t encouraging and initially I don’t believe I was given very clear findings. They informed me that my Mom had an aortic arterial dissection that started in the lower descending aorta and extended to the middle of her chest. The internal medicine Dr. Bilal Reyas (http://www.sach.org/home/Search/Physicians.aspx?id=4294972963) informed me that surgery was likely for my Mom and it was going to be 2 ways to go about it. One way was similar to the angiogram process and a stent would be applied or the other way was going to be more invasive and equivalent to open heart surgery. The vascular surgeon would make the call and it might be a good idea to call my brother down. We held off on telling my Mom the news until we heard from the vascular surgeon because she was weakened at this point and would not have been up for a surgery. In fact she kept asking to go home and wanted to know why she she was being kept in the hospital for so long since she though this would have only been a 1 night stay initially.

The next morning (2/2/2013) the drive to the hospital was a dreaded one because of the news I might have to share with my Mom. Fortunately another vascular surgeon was called in to review my Moms case and his name was Dr. Joseph Vanderlinden (http://www.sach.org/home/Search/Physicians.aspx?id=4294973068). He discussed his findings with my Mom and myself and had some interesting information. My Mom didn’t quite understand everything and i did what could but he stated there were some complications from the angiogram but thought my Mom was going to be able to heal on her in time with medication and there was no need for surgery. It was great news and I pulled him aside to get some reassurances and ask a couple of questions. I asked what he meant by complications from the angiogram and basically he said that my Mom had a lower dissection before the angiogram but was extended to an upper dissection because of the angiogram. He said the radiologist that performed the scan was experienced and this was not like him. He was very informative and gave me his personal cell phone number and has called and texted me several times with status and results related to my Mom.

My Mom was released from the hospital on 2/9/2013 with blood pressure medicine she takes daily to keep her blood pressure in the range of 90-120. She is to rest and not do anything that can elevate her blood pressure. Tomorrow she has an appointment with her vascular surgeon Dr. Koudsi and I’m going to be taking her to this appointment. We aren’t sure what to expect and can only assume it is for a follow up. She also is scheduled to have a scan of her mid section this week as well as a follow up to her GP (http://www.drtat.com/)

My Mom is religiously taking her medicine, eating healthy, and documenting all of her blood pressure readings 5 times a day. She hasn’t been sleeping to well at night and complains of pains in her chest and back. She says its equivalent to a stabbing sharp pains that tend to go away when she rubs the area. These pains are more prominent at night and started a couple of days after coming home from the hospital.

My Mom has numerous questions such as:

What is the pain she currently is experiencing?

How long will she be on meds?

How long is the healing process?

Will she return to “normal”?

Will this reoccur?

My Mother is very scared, pessimistic, and has probably had high blood pressure for some time but never did anything about it. This is all new to her and me and very worrisome because I lost my father about 10 years ago to bladder cancer and my Mom and brother is all I have for family. I’m the closest one to my Mom location wise and she has numerous friends and neighbors checking in on her. She has refused to come live with me because she thinks she will be an added burden. I work two jobs so my Mrs. can look after our 2 year old son and have limited time. Your website has been a relief to find and any recommendations you have would greatly be appreciated. I discovered your site at work today and will read more of it as I get a chance. Thank you and all the best!

Regards,

Michael

Answers:
Briefly here are the answer to the questions:

Not sure about the origin of the pain, but the combination of recent type B aortic dissection and body pain is always a red flag and need evaluation by knowledgable aortic specialist.

Likely that she will be lifelong on blood pressure medication, because once the dissection happens, there is no return to “normal” status. The remaining aorta is always abnormal.

Chance of reoccurrence is there but not very high if she remains compliant with blood pressure medications and is followed up by an aortic specialist.

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Those are all very good questions and your mother should definitely ask her vascular surgeon to address them for her since he will have all of the information regarding the case. You should accompany when she discusses these issues with the surgeon to make sure you both understand the answers. Don’t be afraid if the explanation is not clear to ask for a clarification. As a physician we often forget that knowledge we take for granted is not something the usual patient ever thinks about.

I can try to answer the questions but they will have to be general answers since I do not have details of your mothers case.

1. Chest and back pain are always worrisome after a dissection as signs of extension of the dissection or enlargement of the weakened aorta. There are of course other sources of pain and muscular pain certainly come to mind if they are relieved by rubbing, but I would keep a low threshold to do a CT scan to monitor the progress of the aorta and dissection.

2. Blood pressure control will always be important for you mother going forward. If she had hypertension that was not being treated then she will likely need medications for high blood pressure from now on.

3. The aorta is at its weakest in the first 6-9 months after a dissection. In that time the dissection can heal completely if the flow in the false lumen(space between the layers of the wall) stops and the blood clots and is reabsorbed or if the blood flow continues int he false lumen the body will put down fibrous tissue to try to strengthen the aorta. During this time it is particularly important to limit the stress on the aorta by keeping the BP tightly controlled and avoiding strenuous activities. Close monitoring is also important during this time with imaging such as CT or MRI to make sure the aorta is not expanding too rapidly and at risk of rupturing. If the dissection does not heal completely can still stabilize and enter a phase where it may grow very slowly and can be safely monitored for many years if not decades.

4. I don’t know if she will ever be “normal” again, but there is a good chance she will return to a near normal quality of life, but she will always need medications for her blood pressure and regular follow-ups.

5. A dissection can occur again most commonly in another portion of the aorta. The most important steps in preventing that are controlling the BP and identifying the factors that lead to the first dissection and addressing them

++++++++UPDATE+++++++++

Just an update, I took my Mom to her first follow up appointment today to her Vascular Surgeon. He was the one she first consulted on having the Angiogram and met with her daily while in the hospital. he had some interesting and good news for us. He stated my Mom was completely healed. I questioned him and said I thought she was diagnosed with an aortic dissection? He said yes your Mom had a dissection but it has healed, otherwise we wouldn’t have let her leave the hospital. I again stated that the dissection was from her groin area and extended to? He said it extended to her upper chest. I then asked if any part of her dissection was there before the angiogram? He responded with a “No”.

So I guess we can assume the angiogram was the cause of the dissection and it has completely healed? We were happy with the news but told him my Mom was having some chest pain and some back pain sometimes. My Mom said she would usually ‘burp’ and it would go away. The doctor was still concerned and ordered my Mom to have a scan performed in the coming week.
We have some more appointments with her GP and a cardiologist this week and we will have to see what they say. Thanks for your ear and support and we will likely get a donation out to you later this week. All the best and we will catch up come more later.

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