This is a few years old, but it turns out Dr. Chris Burke at the U of W who will someday be doing my surgery with Dr. Gabe Aldea also at the U of W. He’s a leader in the Aortic Disease and I am thankful that Dr. Burke was able to have a fellowship and learn under him.
Well, I finally met with Gabriel S. Aldea M.D and wow is all I can say! I have seen many doctors my days, but he was head and shoulders above any of them for just sure confidence, competency and knowledge. I came away from there knowing that when it comes time for my aortic root and valve and possibly replacing my old dacron tubing, that Dr. Gabe and his partner will do the best possible surgery for me.
I am so relieved. OMG…………..Look at the notes he wrote about me below. I am just going to stay on the 6 month ECHO testing and keep all my stuff with Dr. Gabe and Catherine Otto. Dr. Sherene Shalhub is my vascular doctor and it was her advice to finally reach out to Gabe, granted the Echo Team said I needed to start looking and had actually cancelled on Gabe one time. I am SURE glad I didn’t this time. He’s got to be the most skilled and confident surgeon I ever met. His attention to detail and showing me my CT results and Echo stuff and where things were and what needed to happen blew me away.
My results: This is the kind of expertise the U of W team offers!
|Outpatient Consultation: Mr. Tinsley is referred to us by Dr. Catherine Otto. HISTORY OF PRESENT ILLNESS:Mr. Tinsley is a 56-year-old man status post type A aortic dissection treated by Dr. Brevig at Providence Everett in 2003 with an interposition graft. The patient is very involved with connective tissue disorders and ascending aortic aneurysms in the area and is very well known for his activism in this area on the entire west coast. He has been followed for a long time by Dr. Catherine Otto, most recently by Dr. Samir Gafoor at Swedish and has been seen at Stanford, Cleveland Clinic, Swedish, Overlake amongst others. He presents with increasing fatigue. Most recent echocardiogram demonstrates moderate aortic insufficiency. His ejection fraction is 56%. This is a bicuspid valve. Left ventricular and diastolic dimension is mildly increased to 5.9 cm. The maximal dimensions of the sinuses by my measurements are 48 mm. The graft is heavily calcified and terminates below the innominate artery. There is a chronic type A dissection that extends into the innominate, left carotid and left subclavian and descending thoracic aorta. The descending thoracic aorta is nonaneurysmal. PAST SURGICAL HISTORY:Significant for type A dissection by Dr. Brevig with an interposition graft in 2003 Providence Hospital and for varicose vein stripping. PAST MEDICAL HISTORY: 1. Moderate aortic insufficiency with a bicuspid valve.2. Root aneurysm with no dissection.3. History of type A dissection, status post ascending aortic replacement.4. Persistent dissection and descending and abdominal aorta. Most recent echocardiogram demonstrates mildly depressed ejection fraction. I believe by echocardiogram the sinuses are overly estimated to be 54 mm in diameter. By CT axial measurements they were only 48 mm. CT scan demonstrates normal right and left main coronary anatomy. Annular dimensions measured by TAVR protocol CT performed at Swedish demonstrate massively enlarged annulus to over 1000 sq mm. The patient had a stress echocardiogram performed by Dr. Gafoor. This demonstrates no evidence of aortic dissection. He has got reduced exercise capacity for age. He was asymptomatic. Again, ejection fraction was estimated to be 59%. The aortic valve is sclerotic and by echocardiogram is thought to be trileaflet rather than bicuspid. The vena contracta is 0.4 cm. The PISA radius is 0.8 cm. Regurgitant volume is 58 mm. Flow reversal is noted in the descending thoracic aorta. With exercise the vena contracta measures 0.86 sq cm. TAVR CTA was performed and was evaluated by me. Coronary artery heights are 26 mm on the right and 14 mm on the left. The LVOT diameter is massively enlarged to over 930 sq mm. At the annulus it is 1000 sq mm; 3 mm below the annulus it measures 930 sq mm. The graft appears to be very heavily calcified. There is chronic dissection in the innominate, left subclavian and left carotid arteries. The maximal dimensions of the sinuses are 48 mm with no evidence of dissection. CURRENT MEDICATIONS:Aspirin 81 mg a day, Lexapro 20 mg a day, metoprolol ER 100 mg a day, multivitamins and telmisartan/hydrochlorothiazide 80-25 mg p.o. daily. ALLERGIES:THE PATIENT IS ALLERGIC TO AMLODIPINE, MENTHOL AND LISINOPRIL. SOCIAL HISTORY:The patient is a lifelong nonsmoker. He has an occasional drink per week. FAMILY HISTORY:Negative for aneurysmal disease. Father has diabetes. There is no evidence of type A dissections. PHYSICAL EXAMINATION:VITAL SIGNS: Blood pressure is 140/60, pulse is 64. Patient is afebrile. His BMI is 27.9.HEENT: There are no transmitted carotid bruits or JVD or adenopathy.CHEST: Well-healed sternotomy incision. Clear to auscultation. No rales or wheezing.HEART: Regular rhythm with a 2/6 systolic murmur with a diastolic component.ABDOMEN: Soft, nontender with active bowel sounds. Pulses +2 and equal throughout. ASSESSMENT AND PLAN:I have had a very lengthy discussion with the patient. I have also offered to speak to his wife and parents who are very involved in his care. I believe the patient will come to a surgical intervention in the next year or so. He is scheduled to have another echocardiogram with Dr. Otto in 6 months. He is reaching absolute indication for surgical intervention at this point in time as he has moderate but symptomatic aortic insufficiency, reports increasing fatigue with exercise, currently can only play tennis as a doubles where he was playing singles before, but more importantly the left ventricle appears to be mildly dilated to 59 mm and in diastole and there is flow reversal in the descending thoracic aorta. The operative plan and goal for the surgery will be completion Bentall procedure. Of note is that the right coronary artery is very high and makes an acute bend. The left coronary arteries and the sinuses are both ample and I do not think are going to be an issue. The RVOT is close to the retrosternum and reentry I think it will be fine, but probably not going to be problematic, but either axillary or femoral artery and vein catheter-based access should be obtained. In addition, we have also discussed possibly replacing the entire calcified graft and considering debranching the innominate artery to facilitate future endovascular interventions if his arch or ascending aorta dilate over time. I do not think this is very likely given the fact that he is now nearly 16 years from his type A dissection and the arch and the descending thoracic aorta appear to be very stable. I have quoted the patient a 20% risk of morbidity including myocardial dysfunction, stroke, respiratory, renal, pulmonary, vascular, infectious, bleeding and arrhythmia complications. I believe he is fit and an excellent candidate for intervention when the timing is right and I believe we are nearing that point soon. The patient has finally decided to seek care at the University of Washington. I do not believe a Davidprocedure is an option for this patient given the fact that the valve is asymmetrical, the annulus is massively dilated and the patient is leaning toward a bioprosthetic rather than a mechanical valve, knowing that a future intervention is likely, most probably as a valve-in-valve TAVR. He has also had some discussions over the Inspiris Edwards valve versus the traditional Magna Ease valve if we proceed with Bio-Bentall. TIME-BASED EVALUATION: Duration of evaluation is 55 minutes. Thirty minutes were used in counseling. I told the patient if we proceed with surgery, will do it with my faculty colleague, Dr. Christopher Burke as we manage redo roots and completion Bentalls together to maximize outcomes and minimize risk.|
Gabriel S Aldea, MD at 7/30/2019 2:30 PM
|Dictation #1MRN:U2347635 CSN:1838920829|
Illness and hospitalization are the one family concern that no one wants to happen, but for the family of Kevin Hall of Anza, that misfortune struck Nov. 24, only a few days before Thanksgiving.
The Anza Valley Outlook heard of the plight in a letter written by Gina Hall and her friends. The family’s dilemma is best explained in Gina’s own words.
“Many of you know that on Nov. 24 Kevin had an aortic dissection and needed emergency open heart surgery. He was life flighted from Temecula Valley hospital to UCSD in La Jolla. He had the surgery and it went picture perfect but a few days of him not waking up from the surgery led Dr’s to do further testing.
“They found that he had multiple strokes throughout his brain and so it was a sit and wait until he started to wake up. For three and a half weeks my husband was in a coma not waking up. I had no idea if he would ever wake up and all I could do along with our five children was pray. He has had many complications during those three and half weeks. His heart stopped three times.
“He had more strokes, he has gone into repository distress more times then I count. I have seen him struggling for his life as he was drowning in his own blood when he first got there and that is an image that will haunt me forever. After almost a month he finally woke up and as great as that is, things have become very tough. He is paralyzed on his right side and he has to learn how reuse everything. His mind is good as far as thinking and memory but he is having some trouble with getting his words out.
“He has a feeding tube still and he’s getting intense therapy a few times a day. He will have to go into a long-term rehabilitation center for a long time, they said anywhere from six months to a year. Our family is more than grateful that he has come so far and that he is still with us.
“We are however in financial trouble as Kevin has always provided for us working dawn till dusk six days a week. We have an autistic 5-year-old who requires full time care and so I have always stayed home to care for him. Many have been very kind and donated to our Go Fund Me and we are more than grateful for that as it has paid our December rent and utilities and gas.
“Still, I have been going back and forth from Anza to La Jolla 85 miles one way. I am in the process of getting disability started and once the application is processed it will be six months before we see a dime. I am really starting to panic as we are out of money and as of Wednesday, Dec. 19, our hospital bill is at $450,000 and that isn’t the helicopter ride or Temecula Valley Hospital’s bill. I am not one to ask for handouts and I never take when I don’t need it but right now I have no choice. Thank you to all that have been so kind and generous.”
Written by Gina Hall.
The Kevin Hall recovery information in on the family’s GoFundMe page at http://www/gofundme.com/gina-and-kevin-hall-recovery.
Tony Ault can be reached by email at firstname.lastname@example.org.
Watch this great video.
I just found out this week that my aortic valve(bicuspid valve) is now leaking at the moderate/severe level and that my left ventricle is enlarged due to the overloading. Also, I was informed that my aortic root was at 5cm and my cardiologist, Dr. Otto at the University of Washington said it was time to start looking.
What was interesting is that they scheduled me to get another echo in 6 months, but said they would schedule me with the surgeon Dr. Ed Verrier.
So, I am waiting to see what that appointment will be. I also have another surgeon there Dr.Gabriel Aldea, that I want to see. As well as I have appointments with Dr. Paul Ryan at Swedish and also with my original surgeon Dr. James Brevig at Providence.
My decision to where to have my surgery is going to be based on who is the most qualified and which surgery institution has the best success rate. I am a bit leary of going to a teaching hospital such as the U of W, but my logic is simply I don’t want students assisting my surgery. I want the well run team that works well together. I am holding a bias only because I personally don’t know if my statement is actually true. My research has led me to wanting to do it at Swedish with Dr. Paul Ryan whom actually assisted Dr. James Brevig 15 years ago in Everett.
My existing Dacron tube will be removed and from what I gather, a longer piece will be required to cover the aortic root and in harmony, my leaking aortic valve replaced at the same time. Dr. Otto seems to think Ed Verrier is the most qualified. But, she’s biased for wanting her institution to do it. I am sure it would be a great learning experience as I doubt they have this many of my type of surgery requirements. I actually emailed Gabe at the U of W last night about my situation and will be interested to get his response. Gabe got back to me and he said both him and Ed could do the surgery.
I also reached out to Mr. Starnes at USC who is considered on of the top surgeons in the world regarding heart stuff. I hope to hear from him too.
God Bless, Jesus is coming soon!
I could really use a donation to help me out. I am honestly drowning in debt and trying to claw my way out. My depression has caused my to have this “gotta have it now” type of mentality only to realize that I have to pay for it and end up running up my credit cards. I am sure I am not alone and know everyone is tight with their finances. And… I know that everyone else has their own families to care for financially as well too. I completely and 100% get it and that is always a top priority.
If I could go back and realize that my spending was tied to my depression and that the “instant gratification” was only for a short time and get to the root of my problem, depression, I would be much more better off. I am almost 55 (October 2017) and live paycheck to paycheck. It’s not your problem, it’s my own and with my son leaving for college in the fall, but my credit card bills, I am ONLY able to live day to day with my financial stress. However, I am a grown man and basically have fallen into this viscous cycle of debt. I am trying slowly but surely, but If I had a person(s) out there that was interested in helping me out, that would be a GODSEND. I know that EVERYONE is struggling and I can’t expect people to feel sorry for me or for that matter am depressed that I am even writing this post on my site. I can’t turn back the clock and the financial stress that I have brought upon myself is MY OWN fault and problem.
You can donate if you like here, but……….. do not do it out of pity for me, I am an honest Christian person, just struggling to get by.. But.. God willing I will be pulling out of this slump soon.
I hope you are doing well and I hope too that if you have an aortic condition, you are feeling better and stronger. If you have any questions or need answers, I can help get you them.
God Bless You.
Remember this too, I am thankful to everyone for their support.
I wanted to put together some very interesting series of videos. I would just ask if you even are NOT a Christian and don’t believe, PLEASE at least take time to watch these and SEE how GOD is ready(very close) to sending Jesus back to get the Church out of his way and to begin the events that are necessary to fulfill the time Line to bring the Millennium Kingdom in. Oh… “You are crazy Brian… .that’s just hogwash!” Well, at least do me a favor and give yourself the chance to make another decision (if you have ignored Jesus Christ) in the past… Take one more look at becoming part of GOD’s kingdom (Church age) and be able to escape God’s wrath. Please… just have an open mind and watch these, then… it’s up to you to decide if anything makes you change your mind to become a Christian. God Bless Brian 🙂
How to get saved:
How to Lead a Soul to Jesus Christ- Robert Breaker
The Gospel of Salvation
September 23, 2017 – Part 1: The Revelation 12 Sign – Unlocking Daniel’s Sealed Prophecies
September 23, 2017 – Part 2: The Jupiter-Nibiru Incident – A 1-Year Prophetic Warning (Very Very interesting) must watch……
September 23, 2017 – Part 3: World War 3 Ignites Before September 2017
September 23, 2017 – Part 4: Jacob’s Trouble – The Final Seven Years: Episode 1
September 23, 2017 – Part 6: The World in 2017 – The Economist Front Cover Tarot Cards
September 23, 2017 – Part 7: Jacob’s Trouble – The Final Seven Years: Episode 2
September 23, 2017 – Part 8: Jacob’s Trouble – The Final Seven Years: Episode 3
The Rapture: Part 1 – The Authority of the Church
The Rapture: Part 2 – Understanding the First Resurrection
I haven’t posted anything in quite a long time. I am presently getting ready for my left hip resurfacing surgery on 6/23/2015. Dr. Pritchett will do my surgery, he’s done over 4,000 of these operations. I am kind of nervous, but just had a friend (tennis buddy) have his today. I am to the point that I can’t put my left sock on or tie my left shoe, or have a really tough time getting into my car as it’s too low to the ground. I can’t afford a newer car that is taller, but might take over my sons car for a while. My daughter is finishing up at the U of W in June, just paid our last tuition payment. I am so broke and in need of a financial miracle! I am hoping that perhaps someone that is way better off that me and my family might find it in their heart to make a considerable donation. I might may $1.00 every two days if that with my Google Adsense and Amazon, even worse. So, the ability to use this site to help raise any money via those two methods hasn’t work period 🙂
I hate to ask for any help as it really hurts my pride. I am trying to figure out how I got into this situation, I finally think it’s due to my “depression” that I was diagnosed with after my surgery. I am taking 20 mgs of Lexapro per day, but still find myself depressed now due to my financial situation.
I am praying for a financial miracle and hoping GOD might send someone who might be interested in helping me and my family out.
I have a donate page as well as you could always send payment to my home also found on the donate page.
I understand as well that I got myself into this mess and it’s my responsibility to get me out of it. It’s just going to take me a long time to do it and the stress of it isn’t good for my blood pressure.
I hope that someone out there might find it in their heart to want to help, not asking or demanding by any means, ONLY if you feel it in your heart and you feel no obligation, it’s just a person willing to perhaps share the love with us.
Hospital admissions for acute aortic dissection were highest during peak flu season November-March, according to research presented at the American Heart Association’s Scientific Sessions 2014.
Acute aortic dissection (AAD) is a life-threatening condition in which blood leaks from the aorta, the major artery that carries blood from the heart to the body. The leak is often caused by a tear in the inside wall of the aorta. The most common symptom of aortic dissection is sudden and severe chest or upper back pain.
Researchers at the University of Texas Health Science Center at Houston compared national flu activity from the U.S. Centers for Disease Control to monthly admissions for AAD at their center for 2001-13. They found:
Doctors treated 869 AAD patients at UT-Houston during the period.
Admissions for AAD were highest in November-March (3.1 per month during this period compared to 2.1 per month for the remaining months).
Flu activity (percent of office visits for flu-like illness) averaged 2.6 percent during the peak AAD period (November-March) compared to 1.1 percent in the remaining months.
A mathematical model showed statistically significant seasonality and showed type A dissection and flu activity moving cyclically and generally in synchrony throughout the period.
Type A dissection was significantly linked with peak flu activity.
Type A dissection, the most devastating type of AAD dissection, involves the ascending aorta and/or aortic arch and possibly the descending aorta. Type A generally requires surgery.
“We suspect that flu creates an inflammatory reaction that could theoretically increase chances of dissection in susceptible individuals,” said Harleen K. Sandhu, M.D., M.P.H., study senior researcher. “While more research is needed to further explore this association, we suggest at-risk patients, such as older Americans, should get seasonal flu shots.”
Dawn DelMonico was at her husband Stephen’s bedside for the past month.
Fortunately, the recently launched St. Francis Open Heart Surgery Program at Good Samaritan Hospital had in place an expert cardiothoracic surgical team from St. Francis on-site at Good Sam. Within moments the team was mobilized to perform life-saving surgery on Mr. DelMonico.
A New Jersey resident, Mr. DelMonico spends two nights per week at a Babylon motel to cut down on commuting to his Deer Park job. On February 18, while in his motel room, Mr. DelMonico experienced severe chest pain. An ambulance brought him to Good Samaritan where his condition was assessed as extremely critical.
That night, Chairman of Cardiothoracic Surgery and Director of the St. Francis Open Heart Surgery Program at Good Samaritan Christopher La Mendola, MD, was confronted with one of the most challenging cases in cardiothoracic surgery.
“I have seen about 50 aortic dissection cases out of more than 5,000 open heart surgeries I performed during a 20 year career at St. Francis,” said Dr. La Mendola. “Presented with one of the most difficult dissection cases I’ve ever seen, I am very proud that everyone on the team at Good Samaritan used their incredible skills and experience to save Steve’s life.”
So serious is aortic dissection, the condition that killed actor John Ritter that many of its victims die before reaching the hospital and about 25 percent that do reach the hospital do not survive surgery. Just four weeks after the operation to repair the tear in his aorta, Mr. DelMonico was transferred from Good Samaritan to an intensive inpatient rehabilitation facility in New Jersey to continue his recovery closer to his home and family.
“My doctors rebuilt me. I was going to die,” said Mr. DelMonico. “I believe if I had not been on Long Island I would not have survived.”
Dawn DelMonico was at her husband Stephen’s bedside for the past month.
For more information on the open heart surgery program at Good Samaritan, please visit www.good-samaritan-hospital.org or call (631) 376-4444.
Good Samaritan Hospital Medical Center is a 537-bed (including 100 nursing home beds), voluntary, not-for-profit hospital located in West Islip. The medical center, which has more than 3,500 employees and 900 physicians on staff, had nearly 28,000 patient admissions and nearly 100,000 emergency department visits in 2012. Good Samaritan is a member of Catholic Health Services of Long Island. Visit the website at www.good-samaritan-hospital.org.
The medical center supplies residents with the tools necessary to maintain good health. This includes community lectures, screenings, health fairs and other community programs and services.
It’s hard to know where to start to make this a coherent narrative because if I included all of the twists and turns that I took (internally and externally) from May 7th-17th it would be a long time before I could stop, and we’d all be left with more questions than answers. At least, that’s how I feel today. In truth, every day brings more answers, moving me slowly towards whatever passes for my new normal life.
One of my surgeons told Krista and my sister that it was unlikely that I would remember anything other than being at a t-ball game. Unfortunately for you and me, that wasn’t the case at all.
May 7th was supposed to be memorable because it was my first day training my replacement at OUS. It being her first day, we didn’t get too much done, but I assured her that, “Tomorrow we’ll get a great start and really get into the guts of this job.” Ha, ha – she had no idea the lengths to which I would go to avoid weeks of training.
May 7th was also Krista’s last day out of town at the OSU College of Business awards ceremony. It was her first ‘big’ trip in her new job, and the kids and I were excited to hear how things went.
May 7th was supposed to be – and was – Mia’s guitar lesson. After which, we headed to Subway, grabbed a sandwich and the kids and I went over to Alex’s t-ball field for a game against the Orioles. During the game I was coaching the pre-school first baseman on the finer points of his position –
“Ok, Emmet, what do you do when the ball gets hit? . . . That’s right, run to first base and point your glove at – ” And then there was a popping sensation in my gut followed by excruciating, unrelenting pain.
May 7th was not supposed to include any type of stabbing pain. Now on the sidelines, nothing that I could do would make the pain go away or even abate to any meaningful degree. I remember thinking that – despite the pain – this had to be something simple and stupid. Gas pains? I didn’t have any idea what was causing it, but to turn on so abruptly, without any precursors or precipitating event, it couldn’t be anything serious. Still, I’ve hurt myself a lot in my life, and this was beyond any of those bumps, bruises or contusions
Which brings me to the first silver lining of my adventure, the grandmother extraordinaire of Alex’s teammate Quincy. Did I mention that she is also a nurse? Because, despite her other qualities, that’s the reason I decided to take a little walk over and sit next to her. The best compliment that I could give at this point is that, minutes later, I was getting into my car (my sister at the wheel) to head up to the hospital. I remember thinking that it was a good thing we didn’t bike to this game because it would have been a much longer ride by bike (ha, ha).
At this point, I still thought that – painful as it might be – it couldn’t be ‘a big deal’. Alex was still playing in the game, and in those few minutes I couldn’t even see where Mia was (playing with one of her friends as it turns out). Some of our friends on the team were going to look after them, and anyway, wasn’t I probably going to be back soon anyway? Why worry them unnecessarily? I’m glad that I’m telling the version of the story that ends with many more hugs and kisses and chances to show them that I love them rather than the version where I just disappeared in the middle of the game. The same with Krista – at this point still in Portland at the awards banquet. It seemed like a big – painful – ado about nothing.
We pulled into the wrong bay at the hospital, but I assured my sister that I could walk in while she parked. No lines (hooray for a slow day in the small town of Corvallis), and before I knew it I was scrambling for my insurance card in my wallet. Krista left me a copy of her new card on the banister rail at home. I could picture where I left it that morning because I would just grab it later. I pulled every single card out of my wallet before I finally found my insurance card.
The doctor at the ER asked quick – apparently revealing questions – and shuttled me right into a CT scan. The pain was, if anything, growing and getting harder and harder to think straight through. I finally knew that something was wrong when the doctor came back and said that the CT scan revealed an aortic dissection from my heart down to my hip. Yeah, I didn’t know what it was either: http://en.wikipedia.org/wiki/Aortic_dissection. I knew that it was serious when he deferred all of my follow-up questions to the cardio-thoracic surgeon who was, “coming in right away”.
The kids were at the t-ball field. Krista was up in Portland. My sister was at my side, and my dad was on the way. I asked the nurse for a pen and a paper because what else do you do at that point? Mia is 7, Alex is 6. I tell them I love them every day, but think of all of those other things that have gone unsaid so far. What about everything else? Things that I was saving until they were older. Things that I just hadn’t gotten around to yet. Heck, Krista and I are celebrating our 10-year wedding anniversary this year; not nearly long enough.
So I wrote. At the end of my first page the surgeon arrived. This was too big for them to handle in Corvallis. They were going to get me on a life flight helicopter up to Portland. What was the prognosis for this operation? How long was recovery? What else should I know? She deferred those questions to the surgeons up in Portland.
I called Krista at this point. She’d gotten the high points from my sister, and there’s not much to say about that call. I wanted to say everything, and couldn’t say nearly enough. She would meet me at OHSU.
So I wrote some more. Another page of the same. What else could I do? I had to assume that the very earnest doctor and other ER folks were doing their jobs well (they sure were), and my best bet was to stay as calm as possible and write. It didn’t feel like a death sentence, but it didn’t not feel like one either.
They gave me morphine for the pain, and the pain chuckled and kept right on going. I got bumped from their first choice of locations at OHSU. Historical note – this was the second time I was bumped from a helicopter trip. The first was at MassMutual when we were going to take the helicopter in to NYC. Bad timing for me on that one as well. At MassMutual our #2 option was taking the train. Fortunately for me, the ER doctor found another available surgeon at Legacy Emanuel in Portland. The Life Flight folks would take me up right away.
One of my nurses in the ER was the father of one of Mia’s soccer teammates. I’m sorry to say that I didn’t even notice until I was being wheeled out, but looking back it was amazing how many friends and acquaintances were looking out for me every step of the way. It was like a bucket brigade except that’s a terrible analogy because that would mean that I was passed friend-to-friend along the line until they threw me into the fire. Hmm… I’ll have to work on that one.
Trundling along in a gurney out to the helicopter. If you’re over 5’10” you don’t fit in one of these helicopters. I was folded up accordion style and was wedged into the passenger bay. My feet – legs doubled up – were pressed against the forward bulkhead. I asked if it was ok for my feet to be pressed against it, and was told, “Yeah, that’s no problem. Just don’t push on it.” That gave me something else to focus on not doing. Pain started spreading into my back at that point. Under normal circumstances I would have said that it was due to how I was contorted, on my side, on a stretcher for half an hour. I was reassured by someone letting me know that it was possibly the dissection getting worse.
The Life Flight company Reach sent us a survey about their performance. On it, they asked if I would recommend them to my friends. I guess that would have to be an enthusiastic, ‘yes’. If you’re ever in need of emergency transport from Corvallis to Portland, don’t book on Southwest, fly with Reach. Sure, it’s a little more expensive (about $45,000 before insurance, and worth every penny), but they gave me in-flight morphine and even called Krista on departure and arrival. When we were leaving they told my dad that they would be up to the hospital in 24 minutes. He said, “So about a half an hour?” They said, “no. 24 minutes”. Service!
In all honesty – I wasn’t in the best state of mind to judge such things, but they fly low, they fly fast and the trip was remarkably smooth (again, morphine didn’t seem to touch the pain, but it couldn’t have hurt the ride).
The helicopter arrived at Legacy Emanuel and – after jimmying me out – I was rolling through the hospital doors and …. into a construction zone? On unfinished drywall in front of me was a sign made out of blue painter’s tape, ‘OR ->’. Super! I guess we’re headed in the right direction. Down a long under-construction hallway. Past some guys in scrubs hanging out in a doorway (no door in sight), but the sign there said X-Ray. Then through the doors to the operating room. It was 100% due to my trip through the construction zone, but the OR was shiny and bright and looked like it was set up in a garage. That’s not a fair statement at all – nor is it true, but my impressions of the room were what they were. And those impressions didn’t extend to the folks standing, scrubbed, under those bright lights. What I knew with complete certainty was that my life was completely in their hands. Fortunately, as with so many other people at every step of this story, that faith was entirely deserved and subsequently rewarded.
Other minor things happened (although it’s hard to believe that I’ve left any details out of this story), but they got right to work and the curtain dropped on the pre-operation half of my story.
The story could have ended there. Or at least taken a different, much sadder, turn – told by a different author. Facts are facts. For me it was just like a light switch turning off in my head.
The surgery was 6+ hours, my unconscious recovery for a while longer. I know that so many people came together around my family during that time, bridging many gaps in many ways. I feel like I’m selling those efforts short with such a fleeting mention, but I couldn’t possibly do them justice and I don’t know half of what everyone went through. In a very real sense, I wasn’t there to experience those good deeds. I had the easy part; I just slept.
Until I woke up again. I couldn’t breathe. I was choking on something. I don’t remember much pain, although I’m sure it was there. I do remember not being able to breathe. I thought it had something to do with the tube stuck down my throat, and tried to fix that problem. That’s how my arms got tied down. Eventually (may have been the next minute, might have been the next day) Krista told me that the tube wasn’t stopping me from breathing, it was helping me to breathe. And in a moment of clarity I remember thinking, “Oh, yeah, that makes sense.”
When I was lucid I remember clawing my way back to steady consciousness only to have it slip away. I kept forgetting that I could open my eyes. I had fitful dreams.
Then I started to recover.
I was awake for longer periods of time. Aside from Krista and my parents who were a constant presence at my side, I remember a stream of friends and family – Rebecca, Alex, Mia, Ginny, Kim, my in-laws (who made the trip from MA on a moment’s notice to watch over the kids). So many more people sending care to me and my family.
From there it got easier, but for me this whole period is pretty hazy. I counted time by the number of tubes that were removed from various locations on my body. I was transported out of the cardiac ICU onto a regular ward. But only for a day or two.
Then things turned south again.
I’m an unreliable narrator at this point. The more compelling story during that time – and really from the moment I went under the knife the first time – will be told by Krista in part 2.
The story above is mostly details, details, details. The tapestry on which all of these details were stitched is rich with loving family, terrific friends, compassionate medical professionals and a caring community of which I am fortunate to be a small part. Many things have changed in my life since the events chronicled above, but all of the vital constants in my life have remained. I appreciate every moment of bonus time that I now have to share with you all, and look forward to many more memories to come.
Mayday: The Aortic Dissection Story, Part 2
It’s astounding how quickly – in the matter of minutes – life can change. Life as we know it, life as we’ve built it. And life that doesn’t always go as we’ve planned it. One minute, I’m sitting in a banquet hall at the Downtown Marriott in Portland, satisfied that our event has gone off without a hitch; the next minute I’m being paged over the loudspeaker, ushered out of the room, and told in that grave tone you never, ever want to hear, “There’s a phone call you need to take.”
One minute I’m talking to Nathan on the phone, trying to tell him everything I ever wanted to tell him, but rushing to get off so he doesn’t hear me burst into tears; the next minute I’m sitting in the ICU waiting room listening to Dr. Hill say sternly, “This is extremely serious. If I don’t go operate on him right now, he is going to die. And even if I do operate on him right now, he could still die.”
The six plus hours we sat in the waiting room while he was in surgery were easily the worst six hours of my life. I sat staring at the door, waiting for something to happen, breaking down every time a “code blue” was called (we’d later learn that they’ll never call a code blue for someone in surgery, but didn’t know that at the time). I was physically ill – sick to my stomach, as I spent six hours trying to figure out how the hell I would to tell the kids that their dad was gone; and how the hell I could be strong and carry on so I didn’t screw them up for the rest of their lives. And I spent six hours refusing to read the good-bye letter he had written and given to Rebecca to give to me.
I learned over the 10 days Nathan was in the hospital that the single best feeling in the world is relief, followed closely by hope. When Ben, one of our favorite ICU nurses came in around 5 a.m. to say that they were stitching him up, there was that glorious feeling of relief – he made it. When he said his vitals looked stable, there was that glorious feeling of hope – this could work out. We were by no means out of the woods yet, but that little bit of relief and hope were enough to push me through until the next big questions – did he have a stroke? and is he paralyzed? – were answered.
Dr. Hill came out and talked with us, and seemed pleased with how the surgery went. I remember noticing how much his demeanor had changed. He was hopeful that Nathan would be able to exercise again, although he would no longer be able to play basketball. He told us how Nathan was put on the heart and lung machine, and his body was cooled (to 82°F) while they performed the Bentall procedure. He informed us that part of his aorta was replaced with a Dacron sleeve, and he now has an aortic valve that we’d be able to hear tick. He mentioned Marfan Syndrome as a likely cause, and although that has since been cleared of being the culprit, we took a bit of comfort in knowing a possible answer to the question “why.”
I was surprised at how quickly we got to see Nathan after surgery. His mind came out of the anesthesia quicker than his body, and he did not like the breathing tubes in his mouth, but he was not yet breathing on his own. I remember telling him not to try to pull the tubes out, and getting a huge eye roll – and right then, I knew his mind was A-OK. We had to get him breathing on his own before they could take the tubes out. We learned so much (more than we ever wanted to know) about all the machines and equipment. When the output was grey on the screen, he was breathing on his own. I would tell him to breath, and I could tell on the screen he was listening to me and breathing on his own. At one point I said “hey, he’s listening to me!” and with his eyes closed he held up his thumb and his pointer finger as if to say “just a little bit.” And that small gesture was huge – it meant that the Nathan I know and love, was right there with me.
The next day and a half was a flurry of activity in the ICU. Dr. Hill was happy Nathan didn’t need any blood transfusions, and everything seemed to be going great. The first 12 hours in the ICU after surgery were busy, and our nurse, Nelia, was on her toes the entire time. Nathan still had the breathing tube in his mouth when she was signing off of her shift, but he made a point to sign “thank-you” to her to show his appreciation.
Slowly machines and tubes were removed from his body, and he was moved from the ICU to the cardiac floor on day 3.
We (I always had some combination of Gary, Susan and/or Rebecca with me) obsessed over every blip, beep, bell, test and measurement they took. Nathan got up to go for a walk. He went to the bathroom on his own. He was pretty coherent, and pain was manageable. It seemed to be going well until the evening of the fourth night.
Nathan was in excruciating pain. He couldn’t stay in one position, he couldn’t get any rest, and he wasn’t super coherent. He would try to sit up to get comfortable, and his oxygen levels would tank. I was running out to the nurses station every fifteen minutes – this couldn’t be right, could it? How could the pain be getting worse, and not better?
At one point, I was told to keep encouraging him to take deep breaths, so I did what I was told: “NATHAN, YOU HAVE TO BREATHE!” I yelled – this was serious business. He hadn’t said anything in hours, but he mustered up the energy to whisper back, “Krista. I didn’t lose my hearing.” Even through all this, Nathan was the one keeping it real and making me laugh.
The next day, his blood pressure continued to drop, as did his oxygen level. They tried everything to to help, including tipping him upside down in the bed. The nurses finally called the doctor in and they decided to re-admit him to the ICU. We were on high alert again, and all the anxiety and fear started rushing back. I remember crying to the doctors and nurses, and asking them if I needed to have my kids come see him right now (they were scheduled to come see him the following day). I knew this was a horrible question to ask and a terrible position to put them in, but I needed to know: did they think he was going to die? Something was definitely going wrong, and they weren’t quite sure what yet, but they kept me calm. They always had a plan, and as a planner, that made me feel better. In retrospect, I’m thankful I stayed away from Googling all this stuff until after I got home, because I probably would have had my own heart issues if I had done so.
At this point in the story, I need to give a huge shout-out to all the amazing doctors and nurses that helped us. We were told by numerous people that Dr. Hill was one of the best doctors in the country at performing this particular surgery (the phrase “world famous” was used). Dr. Hill also kept telling us that he had a scheduled day off, yet we kept seeing him – either in scrubs coming out of surgery, or making rounds checking on patients. He finally decided to take a well-deserved day off, and Dr. Dubose filled in for him. When Dr. Dubose came in to take a look at Nathan, he presented me with this little sandwich baggie with flower petals in it:
He said he was with his 4-year old daughter when the call came about Nathan, and he explained to her that he had to go help a daddy and his family, so his daughter picked those flowers to give to us to make us feel better. So when I say we had amazing service, these are the kind of things I’m talking about.
Turns out it was worse than anticipated – Nathan was experiencing cardiac tamponade;
basically he was bleeding internally into the sac that surrounds his heart, and he needed to be rushed back in for another emergency open heart surgery to repair it. I had only a minute to talk to Nathan, and was at a loss for words. I was trying to have a “moment” with him, in case it was the last, but what do you say? I started with, “Nathan, you are strong -” and before I could get any further, he interrupted in song and continued “no one can tell us we’re wrong….searching our hearts for so lo-ong.” So on that note – singing Love is a Battlefield – he was swept off, leaving me half in tears and half cracking up.
This surgery went pretty quickly. We were waiting in the family lounge off the wing of the Dr. Jonathan Hill “Hall of Hope” – Dr. Hill even has his own hall named after him for all the contributions he’s made to the hospital and treating cardiothoracic traumas.
Photo in the “Dr. Hill Hall of Hope”
I was sick to my stomach (again), so at one point I got up to go to the bathroom,and I heard someone whistling walking down the hall….I turned and saw it was Dan, another one our favorite nurses, coming to look for us. I thought to myself that he couldn’t possibly be coming to deliver bad news if he was whistling, but still braced myself for the worst. He said everything looked stable and they were sewing him up – relief. Shortly after around 8 p.m. on May 11, Dr. Dubose came out with a great OR report – everything went really well – and I don’t know if it was sheer exhaustion or what, but the feeling of relief was so great I almost felt intoxicated I was so happy. He explained that it’s very rare for someone to have cardiac tamponade 4 days post-surgery (if it’s going to happen, it usually happens within the first 48 hours following surgery), but it was all fixed. Yay!
When we went back to Nathan’s room in the ICU there was the flurry of post-op activity, but it was different, and the euphoric feeling faded pretty quickly. His chest tubes were bleeding – a lot – and there was someone there specifically “milking” the blood through the tubes to keep them clear. This went on for hours through the night, and things didn’t feel right. They gave him blood transfusion after blood transfusion (or FFP for “fresh frozen plasma” as those of us in the know call it). It was not going well. We peppered the nurses with questions, and I remember hearing Dan say “get Dubose on the phone, I need some answers.” The directive was clear – his bleeding needed to slow down significantly by 5 a.m., or they were going to have to take him back in.
We watched helplessly as he continued to bleed, all night. Finally at 4:30 a.m., Dr. Dubose came back and told us that he couldn’t wait any longer, and they needed to take him back into the OR. He wasn’t sure what was going on, but the only thing to do was to open him up and find out. Dr. Dubose asked how I was holding up, and I was a wreck. I could see that he felt horrible – he had just left us telling us everything was going great, and there we were again, less than 12 hours later, having to say goodbye before they cut open his chest and break open his sternum (although there probably wasn’t much breaking involved by this, the third time).
Nathan still had the breathing tube in his mouth, a central line in his neck and was pretty heavily sedated, so he wasn’t able to speak, but as I said goodbye and told him I loved him, he held up his fingers in the shape of a “W” and with that I knew exactly what he was saying: All I do is win. It was his way of telling me everything was going to be OK. So again, in the middle of a life-threatening issue and he’s trying to make ME feel better. Pretty amazing.
The third surgery took a bit longer than the second. When it was over, Dr. Dubose came out again, and worried he’d lost some credibility with us, tried to convince us that it truly went well. He said there were a few clots he cleaned up, but other than that, everything looked good. He left Nathan open for some time just watching his heart beat, and made every doctor and nurse in the room come over and look at it to ensure he didn’t miss anything. He told them, “I have to go back out and face that family again, and I need to make sure everything is OK here.” Relief was a little harder to feel after the roller coaster we’d been on, but that news was the single best Mother’s Day gift I could ever get.
Nathan seemed to bounce back after that surgery. Maybe I’m exaggerating a little, but that’s what it felt like. It was literally night and day – he came around pretty quickly, all his vitals looked good, his bleeding was normal.
Chest tubes with “normal” blood flow.
Thank goodness, as this was the day the kids were coming up to see him. Originally we planned on them coming that day because we thought Nathan would be close to going home, and we hoped he’d be feeling well enough to walk around and talk with them. We didn’t anticipate surgeries #2 and #3.
When Mia and Alex got there, he had been out of surgery for a few hours, and while he was doing “great,” he still had machines hooked up all over him. I had to prep the kids with what they were about to see. I explained to them that daddy just had another surgery, and he had a tube down his throat so he can’t talk very well or very loud, he has a lot of machines hooked up to him, and he’s still very sleepy.
Even with the preparation, it was still scary to see the person who is the rock of our family like he was – I could see the tears in Mia’s eyes. Alex thought it was pretty cool that Nathan had a “glowing finger.” Apparently he had been bragging that his dad is now a cyborg (due to his mechanical heart valve).
Nathan was able to say hi – but just barely. If you talked to him, he’d open his eyes and try to respond, but not long before he fell back asleep. It was good to see them – Nathan and I have never both been away from them for more than a night. So to suddenly be have both of us gone for a week was hard. It was also hard for them to imagine what was going on, so it was good for them to see him with their own eyes. The good news is that I got to see my mom and my kids on Mother’s Day – not under the circumstances I would have liked, but we are all about the silver linings.
In the ICU “suite”
The next day things were going good and Nathan wanted to try to stand up. He got up successfully, but as he was sitting back down, he mentioned his heart felt funny, and at the same time all the alarms started going off – his heart went into atrial fibrillation. I really started to question how much a human body could take (his physically and mine mentally). Dr. Dubose explained and reassured us that the heart is really resilient (the brain? not so much. but the heart can “take a joke”). We were told that this was a really common complication that is an easy fix. At that point Susan and I had to get out of the room for a bit just to take a break and try to eat something. Gary stayed with Nathan while Susan and I went to the cafe – and it was within an hour that Gary sent a text saying his heart clicked back into rhythm and things were looking good again. Ahhh, relief.
That was Monday, May 13th, and the last major complication. They talked about moving Nathan out of the ICU, but they were waiting for a bed to open up. It was the perfect scenario – he was well enough to be moved, but he was still under the ICU care.
He was finally moved back to the cardiac floor on May 15th. Things were going well – his kidney and liver function had suffered due to all the blood loss, but the numbers were on the rise with every test. Echocardiograms and CT scans all looked good. He was eating. He got to shower and shave. We were happy.
The last trick was to get his INR level (blood clotting factor) up….but they agreed we could give Nathan injections at home for that (and by “we” I mean “Nathan” – I think we all know how I am with needles). He was finally released from the hospital on Friday, May 17th. Hallelujah!
At-home recovery probably deserves a blog of it’s own – it was not easy. It was super scary to go from round-the-clock care to nothing. I think we ended up back at the hospital the following week 3 different times, just because we weren’t sure what constituted normal healing vs. something to be worried about.
One of the most amazing parts, though, is how much support we had. My parents and brother jumped on a plane as fast as they could to come out and stay with the kids. Friends started a meal train for us, and we had meals delivered to our house every night for over a month. Nathan got a brand new La-Z-Boy, our house got cleaned, the kids got picked up and taken out, people sent cards, gifts, messages and prayers. The list goes on. It was simply amazing, and I’m not sure what we would have done without our village.
It’s hard for me to reconcile – even to this day – how something like this can happen to someone like Nathan. Nathan, who has never smoked a cigarette in his life, who drives exactly the speed limit, who exercises regularly, who eats a vegetarian diet, who doesn’t even drink coffee, and who lives his life always trying to “do the right thing.” But one thing is certain – all the positive choices he’s made in his life combined with his champion attitude all came into play when it counted the most.
On a final note, I truly can not say enough about the team Nathan had Legacy Emanuel. Dr. Hill and Dr. Dubose were amazing, but in each surgery, there was a team of other doctors/specialists (cardiologist, anesthesiologist, nephrologist, PA’s, etc) that all played an important part. Many of those people we never met, so the following is only a partial list. A huge thank you goes out to:
Lauren Ciolli (Dr. Dubose’s PA)
Scott Frazee (Dr. Hill’s PA)
Dan (who we had 4 times)
You are all amazing!