BACKGROUND TO THE OHS & AVR

It was a dark and stormy night… when all of a sudden the phone rang!  OK – so much for the attempt at drama!

It was actually in the middle of the afternoon when I got the telephone call from Dr. Dan, my primary care physician at Kaiser.  He was calling to tell me the results of my latest test, a cardiac sonogram.  Essentially, he said that there was a defect in the aortic value (stenosis – a buildup of calcium) and that it was easily corrected by open heart surgery (OHS) for aortic valve replacement (AVR).  This was fairly common procedure and that there was nothing to worry about…

So, being the person that I am and the offspring of a hypochondriac father – I start to worry!  I think it would be fairly safe to say that I was catatonic for a brief moment or two as the words sunk into my mind and I digested the plausibility of what was to come.  I thought of those immortal words of Alfred E. Newman, “what me worry?” so indelibly etched into the minds of my generation who grew up on MAD magazine.  And, I knew the answer was – hell yes!! Worry – by all means worry and get your act together, now!

During my studies I remember vividly reading and discussing On Death and Dying by Elizabeth Kubler-Ross. According the Kübler-Ross model, there are five stages that a dying person goes through when they are told that they have a terminal or serious illness. The five stages go in progression through denial, anger, bargaining, depression, and acceptance.  In John Bowlby's pioneering trilogy on attachment and loss, he discusses the major emotional consequences of loss, including feelings of sadness, depression, grief, and bereavement.

Well, move over Liz… and John, save a seat for me on the bench.  I managed to go through all nine levels at least six times in the first 30 seconds of Dr. Dan’s call!  But, I digress…

Subsequently, I asked to see a leading cardiologist in the Kaiser system – someone that I had met previously through my partner Steve… Dr. Philip Lee.  He had graduated with honors and distinction from University of California at Berkeley with a BA in Biochemistry and received his medical degree from Washington University School of Medicine in St. Louis, Missouri, one of the top five medical schools in the country.  Dr. Lee then completed his internship and residency in Internal Medicine at Stanford University School of Medicine, and was appointed Chief Resident in Internal Medicine at Stanford University School of Medicine and the Palo Alto Veterans' Affairs Medical Center in 1990. During this time, Dr Lee supervised and helped train over 75 medicine interns and residents. His Fellowship in Cardiovascular Medicine (Cardiology) was completed at Stanford University School of Medicine in 1994.

Very impressive credentials… but, do I dare call him Dr Phil?

We had a consultation and discussed the facts of (cardiac life) and arranged for one additional test – the dreaded angiogram.  Now, I must confess that this procedure, for some reason, just scared the p’jeesus out of me, altogether.  Many years ago when I was living in Anaheim, my next door neighbor, Buddy, told me about his OHS for quadruple bypasses.  He said that the dye they injected into you was like fire.  So, what the heck – I don’t like anything incendiary going up in my face let alone in my personal plumbing system… so I was quite worried.

The day of the angiogram procedure was not all that complicated.  Basically, you show up at the appropriate location and at the agreed upon time and lay down.  They do most of the rest.  They gave me a huge hospital gown designed by Omar the Tent Maker… but it was most fashionable and did manage to hide my derriere as I sojourned down the hall one last time under my own steam before being wheeling into the testing facility.

They gave me a cocktail containing 5mg of Valium (obviously a generic as I was saddened that it was not the usual yellow tablet …but it managed to relax me none-the-less… and 25mg of Benedryl.  After they situated me on the exam table they put some sort of blue blanket on me that was absolutely the toastiest most wonderful feeling in the world.  I was in heaven.  All I needed now was a foot massage and a scotch!

I was so relaxed during this exam (they must have spiked the I.V. with something cause I just can’t believe that one tiny little valium tablet and an antihistamine would make me feel so wonderful).  Finally, Dr. Lee informed me that he was going to inject the dye and I might feel a “flushing” feeling.  Flushing – well, according to Buddy, it was more like the “fires of hell” than a “flushing” I was going to experience. 

OK – hit it Doc – and he did.  Well, knock me over with a feather… I was absolutely amazed.  No “fires of hell,”  no pain, nothing at all negative.  In fact – it was one of the most wonderful feelings I have ever experienced!  Honestly!!  Taking the bandage off my arm from the I.V. was the only pain I experience through this entire exam!  WOW. 

The results from the exam were good.  No arterial blockages to deal with and just the valve to contend with at this time.  The only downside was that based on the pictures and what I was experiencing physically from the dysfunctional valve, it would be best to get this done sooner rather than later.

I set up an appointment with my cardiac surgeon, Dr. Hon Lee (no relation to Dr. Phil) to discuss the upcoming event.  A wonderful and talented man!  He studied at Brown University and did his residency at Catholic Medical Center of Brooklyn and Queens Inc, Jamaica, NY.  He is also the Chief of Staff at Kaiser Medical Center.  Also, he wears a bow tie and that made all the difference in the world to me! 

I am most impressed with my medical team and their individual sense of commitment to patient care, and their willingness to spend as much time as needed with me to answer my question and reassure me.  Plus – they have a great sense of humor and are very willing to share it!

Dr. Hon and I talked about the procedure and what type of implant might be used to replace my defective value.  The options are somewhat limited – membrane tissue (cow or pig) or mechanical.  I opted for a mechanical valve due to its history of success, and longevity.  Tissue valve will normally have to be replace – who knows when – usually within a 9-10-15 year period.  The mechanical valve can go for 20 years or more without a hitch.  One person I’ve noted has had his mechanical valve for 40+ years!  (I should lived so long…).

Downside is that I will be taking Wafarin or Coumadin for the rest of my life.  That doesn’t seem too bad of a downside.  The nature of this mechanical valve is it is very effective in preventing a buildup of cells, forming clots.  In fact… this value is so good that it is possible that I might not have to take a “blood thinner” down the road – or at least a minimal amount of the medication.

Well… I think that I’ve about exhausted myself on this first blog entry.  I am sure that there will be more of my ramblings as time goes on.  Steve will keep the blog updated as things progress and provide everyone with the latest information and developments.  You can also post your own comments or questions on the blog – it is unrestricted in that regard and I welcome the opportunity to read them once I get on the mend.

Thanks for listening…

Layne