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Nora Balogh-83

Name: Nora Balogh
Email: norabalogh@sympatico.ca
Age at time of Dissection: 83
Type of Dissection: Ascending
Date of Aortic Dissection: 6 October 2015
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My 83-year-old Mom was very fit and healthy leading up to the events of October 6th 2015. She lived on her own in her own house, was a member of a number of bands and music groups and she was always out and about. She played badminton three times a week, did a lot of walking and race walking and went to the gym regularly. She did have a few age-related annoyances but no serious previous health problems. Her blood pressure had always been normal and she wasn’t taking any medications.

On the morning of October 6th, 2015, she was awakened out of sleep at around 6:30 am feeling terrible (“…as though I was about to die…”). When the feeling didn’t go away, she called an ambulance. Her friend and neighbor who was just heading out to work, accompanied her to the hospital and emailed me to let me know that Mom had been transported to Toronto East General, the local community hospital, by ambulance and that I should fly to Toronto as soon as possible. I made immediate arrangements and also contacted my brother and sister, who each lived thousands of kilometers away, so that they could also come. I knew it must be serious, but I didn’t yet know how serious.

Mom’s friend later told me that Mom had arrived at the hospital looking awful, with a lot of chest and back pain. Since her blood work showed that she didn’t have a heart attack, they ordered an MRI scan and that immediately revealed the problem: an acute type A aortic dissection that extended from next to her heart well down the other side of the aorta. Mom was initially told that they would prepare her to be transferred to St. Michael’s Hospital in Toronto for emergency surgery. She and her friend high-fived each other: they now knew what the problem was and it was going to be dealt with!

But then everything changed. The surgery was off. Apparently there was 100% chance of death from this surgery at Mom’s age, so it made no sense to go ahead with it. Unfortunately, bluntly put, Mom was going to die and it was probably going to happen relatively soon. All they could do in the meanwhile was to aggressively control her blood pressure to give her a little bit more time.

I arrived in the early afternoon that same day, my brother in the evening and my sister the next day. We were a good team together, taking turns staying with Mom overnight in the acute cardiac care unit and all three of us were with her during the day. Mom was alert, though she was full of intravenous lines and at times in a lot of pain – mostly severe back pain as a result of not being able to really move – and they had to use morphine a couple of times. Over the following 3 days, we shared information about my mother with the cardiologist. She knew that our mother was an unusually active and healthy 83-year-old. She continued managing Mom’s condition medically, a course of treatment that had been determined in consultation with the same specialist from St Michaels who had denied my mother the surgery.

At the start of the fourth day, Mom was still hanging in there and no terrible and irreversible medical events had yet taken place. There had been a change of shift and another cardiologist came on duty and took over my mother’s care. He talked with us, and my mother joked with him as he examined her. After assessing the situation, he then told us that in his opinion, Mom would in fact be a reasonable candidate for surgery and it would be very much to her benefit. He was willing to try and seek a second option about the surgical option. We knew it was going to be major, risky surgery, but then the current course of action was even more risky. We were all for it!

This cardiologist got on the phone and started calling around. I overheard him advocating for Mom, saying “Yes, she’s 83, but she’s a wonderful 83 and she really wants to live! The previous surgeon denied her purely on the basis of age and I don’t agree with that.” Two CV surgery specialists on duty at Sunnyside and Toronto General Hospitals both agreed to bring her in for assessment. A bed opened first at Toronto General and Mom was transported there by ambulance. She was assessed by the surgeon, with us sitting around the bed and listening intently to the interaction. Then he said in a low-key way “I think the surgery will be beneficial for you” and she signed the consent forms with a firm hand. Wow!!!!!

Mom received the 5.5 hour surgery about an hour later, as soon as they were able to get together the team and prepare the operating room. The long and short of it is that she came through it fine and no serious issues arose. Ten days later, she was released to a rehabilitation hospital and another month later, she went home. I moved in with her for the first month and a half after her release to smooth the transition and she’s now on her own with a little extra help (e.g. cleaning people coming in every second week, with several neighbours offering to help with heavier tasks as necessary). And I’m visiting for a few days every second week. Mom is functional and her recovery is coming along well.

Last week, 9 weeks post surgery, Mom had her first appointment with the cardiologist, the same one who advocated for her and found her the surgical space. It was quite joyful, I think on all sides. She was able to do 10 minutes on the treadmill for the exercise stress test, in other words, to walk rather briskly on an every-increasing slop uphill for a sustained period of time, with no cardiac abnormalities. The technician turned to me and told me part way through “We expected her to be able to do 1 or 2 minutes! Dr. … is going to be thrilled with this result!” And of course he was, saying “Look at you – you’re looking fantastic!”

Mom still has quite the road ahead of her to get back to where she was in terms of conditioning. But I think we can safely say at this point that she’s had a great outcome, all things considered.

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