Have a Heart

Friday, January 29^th Daddy had an EKG, blood work, Chest X-ray, Pulmonary function test-Spirometry, and Carotid Duplex Scan. It was certainly a busy day.

In between all of these things Mama, Daddy, and I met with Dr. Coselli’s Nurse Practioner, Kathy Loring, for quite some time – and then with Dr. Coselli for a brief visit between his surgeries.

We learned many things about hearts. One of Daddy’s problems is an aortic root problem. There are a few ways that they are going to address his aneurism and blocked valve. This is how I understood it:

They will go in through the front chest wall, where he had his previous surgery 17 years ago to have the mechanical aortic valve put in.  When the surgery begins they will have reviewed all of the test results, x-rays, echocardiograms, and the PET/CT scan that Daddy had done on January 21^st after the fluid was drained from his lungs. All of these things will help the doctor determine the best treatment and surgery once he opens daddy’s chest wall.

Depending on where the aneurism is on the artery will depend on whether they replace the St. Jude’s valve. If they do replace the valve then they will use a tissue valve (they are far more advanced than they were 17 years ago) and there is a chance that Daddy could stop taking the Coumadin! That would be great for sure.

They are going to replace the part of the aorta that is too large with a Dacron graft. As mentioned above the new valve will depend on where exactly the aneurism is located in reference to the valve. The doctor is also going to most likely take in internal mammary artery and attach it to the left side of Daddy’s heart where the blocked artery is and that will take care of the blockage. If there turns out to be a problem on the right side, there are a few things that they can do for that. The one most likely is that they would take a vein from one of Daddy’s legs and use that for a bypass to the right side of his heart. 

The entire process of prepping for surgery, anesthesiology, surgery, and then closing up, etc. will probably take about 6-7 hours. They estimate that the actual time he will be have the surgery itself is about an hour or little longer. They will put him on a cardio pulmonary bypass machine through his right shoulder for the actual operation itself.

Daddy’s probably going to be in ICU for about three days and then will move to the 10^th floor for up to about seven more days for his recovery.

As far as recovery, it will take about six months for the ablation to take effect and it must form scar tissue to get to a normal sinus rhythm.  Because there is scar tissue from his previous surgery and from the Proton radiation he received in 2008, the recovery could be a little harder. Nurse Kathy talked about something called “Dressler Syndrome” – which is an inflammation of the sac around the heart – it not uncommon for patients to have this after heart surgery. She said it sounded like Daddy had this the last time he had heart surgery too.

Dr. Coselli said that Daddy is a good candidate for this surgery because of the lack of signs of cancer [we have not been specifically told it’s in remission – but they say that the scans look good and there is no evidence of cancer] and also three other things: Daddy’s left ventricle is in good condition, his lungs are up to handling the recovery, and his physical condition is good.

One of the really cool things for his recovery pain is a thing he is going to have implanted just under the surface of his skin where the incision is. It’s called an ‘ON-Q PainBuster Catheter Placement’ and it will work for four days on it’s own and then the nurses just pull it out like a suture. It automatically administers a continuous, regulated flow of local anesthetic through a specially designed catheter to the site.

So – the surgery is set for Monday and Mama and Daddy will be there before 6AM!!!

Thank you for your love and prayers,  

Stan, Carol, Laura, Stacie, Kathryn, and Kenneth

Monday - is Surgery Day

Daddy's new cardiologist calls him "Doc" and made an appointment with the cardiac surgeon under the name Doctor Hall! All of you who know Daddy will totally understand. He is a take-charge kind of man and had already made some conclusions and decisions about what they were going to probably tell him - he had done his research on heart disease already.

The tests from last week indicated very strongly that Daddy indeed has congestive heart failure. His pulmonologist referred him to a great cardiologist (mentioned above!) and there is lot’s of action going on right now. There was a heart cath scheduled for Wednesday, January 27^th, with the understanding that most likely Daddy would be transferred to Hermann Hospital the same day, when it was completed, to have one or two stints put in. That plan changed quickly as you can see after reading on a bit.

Mama, Daddy, Kenneth, and I were at the hospital all day yesterday - January 27th. Dr. Oliverira went into Daddy's heart yesterday with the cath and found 80% blockage in one major artery -- but then they found a surprise -- he has a large aortic aneurism in that main artery feeding his heart. It's just above his mechanical (St. Jude's) heart valve. So they did not put in any stints and he's now been referred to a cardiac surgeon at St. Luke's Hospital - Dr. Coselli. He sees Dr. Coselli tomorrow morning/day sometime between the doctor's surgeries and then will probably have the surgery on Monday.  We have been told that Coselli is one of the best in the world. 

The doctors are looking at several options and may not know exactly what they do until they get in. They can replace the aneurism with a dacron graft, and do a stint on the blocked artery; they can replace the aneurism with a dacron graft, and do a bypass on the blocked artery; they can do the aneurism graft, and/or stint/bypass, and replace the 17 year old heart valve. So you can see that there are lots of possibilities. Part of this depends on the surgeon and how he feels Daddy can handle the surgery, how long daddy will be open, and other possible contingencies. Obviously the most optimum would be for the shortest time in surgery -- makes for the least trauma and a safer and easier recovery. They all have said that Daddy is in remarkably good condition for his age and so that helps with the surgery and recovery.

As far as we can tell from the other doctors that Daddy has seen recently -- because we have not heard this from the oncologist specifically -- Daddy's PET/CT scans are clear and not showing any evidence of the cancer at this time. So that is a good thing for sure. 

One of the best traits that my parents have, among their many others, is their unbelievable ability to look at life in the most positive light possible. Included in this is their always looking forward to new adventures and challenges, not back at life's mistakes. Sure there might be some -- but they always look forward to a bright and positive future. 

So, for those of you out West in Albuquerque, they won't be home for probably at least few more weeks. We will know more as Daddy recovers from the surgery and will keep you up to date.

Please keep Daddy and Mama in your prayers and thoughts and thank you for your love.

Laura

We know it’s been a while . . .

With our last update – nine months ago – you read about Daddy getting some surgery on his back.  I’ll sort of pick up there. The surgery to repair the fracture in one place was great for a very short time and then caused another fracture – so the cure is to leave it alone and not do any more vertebrae surgery!  Osteoporosis runs in the family and then the chemo/radiation just exacerbated the condition. With some pain medicine, Daddy is able to control it. He just has to be very careful not to lean over bathtubs to scrub and the backs of car seats to grab stuff – and things of that nature!

Daddy and Mama came back to Houston a couple of times for tests and consultations with the doctors. With the end of September visit, there was some fluid discovered on his right lung. He was advised to go back to Albuquerque and have it drained. Daddy also had a carotid artery ablated and because of some erratic heart activity – he had a pacemaker put in at the end of September. No more whizzing through security at the airports – that’s for sure.

Now for some fun news – in October three of their four kids and spouses if possible – were able to take Mama and Daddy on a houseboat adventure out on Lake Powell. Lake Powell has a very long history in our family. We first went there in the summer of 1970. It was love at first sight. In subsequent years Mama and Daddy bought boats, houseboats, jet skis, different boats, different other boats . . . you get the picture! So this was a real dream trip.

I’ve included just a few of the thousands of pictures taken by everyone combined – to show you how great the trip was.

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Piloting us out of the marina and into the wilderness!

Daddy coming up to the top of the houseboat for a look around.

The houseboat in a really ugly setting!!!

Daddy pulling Kathryn one more time while she skis!!!!!

Mama and Daddy enjoying one of our evenings at the lake.

Daddy - bringing the ski boat back to the houseboat!!!  Just like falling off a horse.

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After the trip, Daddy had his right and then left lung drained. The results came back great with no malignancy showing up in the fluid.

Mama and Daddy are in Houston right now. Their last appointment is this coming Monday, January 25^th. On the 12^th Daddy had all the tests run that they normally come for and then on the 13^th met with Dr. Blumenschein, his oncologist. Daddy had just recently – probably around the 9^th or so, been having more trouble breathing. The night of the 12^th, he ended up going to the emergency room – with no relief provided – because he could not get enough air. This is with him using oxygen most of the time. It turns out that both of his lungs had filled up again. Dr. B wanted Daddy to get a “Denver” catheter put in by a pulmonologist. So the appointment was set for Tuesday, January 19^th. Dr. Jimenez was very thorough and took a detailed history from Daddy. He ended up declining to do the catheter because his opinion at that time was that the fluid is due to congestive heart failure. That can be treated with medicine, and so the catheter may not be necessary. Tuesday Dr. Jimenez took x-rays and then did an ultrasound guided thoracentesis (drain the fluid) on the left side. Then the next day Dr. Jimenez did the right side. He had the results tested and his opinion is that the fluid is related to congestive heart failure.

Thursday, January 21^st, Daddy had the PET/CT scan again for his lungs and then today he had an echocardiogram and resting EKG. They have an appointment with a cardiologist on Monday to find out the results of the tests today and to determine a plan for treatment.

I believe that the results of the PET/CT scan will be talked about over the phone once Mama and Daddy get back to Albuquerque. They will be going home on Wednesday! 

Other than being very tired from a longer than expected trip – both Mama and Daddy are in really good spirits. We got to celebrate Mama’s birthday here in Houston and that was so much fun and an unexpected treat.

As a family we thank you for your continued and ongoing prayers. We know that they make a difference and so very much appreciate your love and concern.