Friday, December 28, 2007

Family Comes First

diagram Wikipedia.

My Dad Is Having Open-Heart Surgery Today

My father, John Wendel, Ph.D., emeritus from The University of Arizona (German Studies), is having open heart surgery this morning at Denton Regional Medical Center in Denton, Texas, about 30 miles north of Dallas.

Yes, this is the Dad I didn't speak to but once in nine years. Whatever.

Family comes first.

Dad's mitral valve is leaking.

The mitral valve is on the left side of the heart, between the left atrium and the left ventricle. It's shown on the right of the above diagram, as if you were looking at a person directly across from you.

How blood flows through the human body:

Santa Barbara City College, diagram McGraw-Hill Companies, Inc.

1. De-oxygenated blood from the body flows through the veins into the right heart (into the right atrium through the tricuspid valve into the right ventricle) where the right ventricle PUSHES it out the pulmonary valve into the lungs.

2. At the lungs, carbon-dioxide (CO2) goes out, and oxygen (O2) passes in to the blood, in the capillaries as the blood passes next to the warm moist lungs.

3. The oxygenated blood flows to the left heart (into the left atrium, through the mitral valve, into the left ventricle) where the left ventricle PUSHES it out the aortic valve into the body.

4. Once in the body, oxygen (O2) goes out and carbon-dioxide passes in to the blood in the capillaries as they pass next to and through the tissues and organs of the body.

And we start all over again. (Go to #1 above as de-oxygenated blood...)

Because Dad's mitral valve is leaking, there are some issues which follow:

  • Not as much oxygenated blood is getting to the rest of his body as should. Therefore
  • his left heart has to pump harder to get enough oxygen out to his body. Therefore
  • like any muscle, his left heart grew a bit bigger with the extra use. This isn't good. An enlarged heart needs more oxygen itself and is more prone to failure. But it didn't get too big, as it was caught fairly early.
  • The leak spilled backwards, causing 'fluid in the lungs' or 'Pulmonary Edema.' This has been mostly fixed with oxygen and reducing his overall fluid level.
After taking a look-see Wednesday (a cardiac catheterization), the docs are happy that his arteries are nice and clean and the rest of his heart looks good. All there is to deal with seems to be the leaky valve. But they can't quite tell how badly damaged it is till he's opened up on the table. If it isn't too badly damaged, they'll just repair the mitral valve. That would be best.

If the valve is too damaged, they'll replace it with a porcine (pig) valve. These valves typically last 10-15 years, meaning my 72 year old father would probably need another round of open-heart surgery at 82-87 years old, assuming they haven't figured a new way to handle this better by then, or assuming his naturopathic physician can't help extend the life of the valve.

The alternative replacement was a metal valve and daily blood-thinners for life plus an increased risk of stroke. Dad decided (and I agree) that a porcine valve is the better choice. Plus his own valve may be able to be repaired, which is what we're hoping.

Dad is in amazing physical condition. He hikes all over the mountains ranges of Utah for days at a time, year after year after year. Every other physical sign he has is that of a man in his mid 40s to early 50s.

While there is always the possibility of stroke, sudden cardiac death, and infection -- as with any open heart event (less than 10% chance of morbidity for this procedure, and that includes the really sick people) -- this is as much of a routine surgery as one gets during open heart work.

Dad's spirits are good. He trusts his surgeon (who does this procedure very often) and his cardiologist, both the best in the region, according to friends and colleagues. Dad is optimistic about the outcome, as am I.

I'll talk to him again first thing this morning. His operation is scheduled for 11 am Central Time. It will likely take a while, plus then he'll be in recovery before going to the CICU, and I may well not know anything till after all of that.

As soon as I know something, I'll update this post.

In advance, thank you for your thoughts, prayers, and best wishes for my father.

Update 11:30 AM PT/1:30 PM CT:

Dad's doing fine in surgery; no major issues so far.

His mitral valve was not repairable.

Dad is still on the heart-lung machine as the surgeons put in a porcine valve. He should be on the pump for about another 30 minutes. Then the surgical team will restart his heart, close up his chest, move him to recovery, and then to the CICU.

Next update roughly in three hours.

Update 2:45 PM PT/4:45 PM CT:

Dad is out of surgery and in the ICU. Post-op, he's damn near perfect. *grins*

He'll remain sedated on a ventilator with the breathing tube in, probably overnight. Will come off the vent tomorrow and start doing breathing exercises. Getting his lungs back into full working order is a big part of rehab for post-pump patients.

Should leave the ICU in a day or so to the step-down unit, where he'll go with other cardiac cases into a monitored bed, for about 4-5 days. Lots of breathing exercises and the start of his rehab work, so he can exercise his lungs and his chest, getting up and moving about, get everything working properly again, and the docs can make certain everything is put together properly and very important, that no infections spring up.

Then it's home and about a month of out-patient and then several months of in-home rehab -- increasingly longer walks, continuing the breathing exercises (very important), and at the end of it all, back to a normal life.

All is going well right now. Dad is resting comfortably and in as good a shape as anyone can in an ICU.

I talked directly to his personal ICU nurse. She has been on shift since he came out of the recovery room. He came out precisely on time -- indicating the surgery went as planned -- and there have been absolutely no issues since. I could recite a long list of negatives the nurse and I went over, including that his lungs are clear and he has urine output, both important given what he had going on with him -- but really, there's nothing to say except he's recovering properly and well from surgery and everything is fine, no issues.

*does happy dance*

Another update tomorrow.

However I can't leave for the day, without thanking all of you.

All day long I've felt the enormity of having all of you waiting with me.

Thank you, each of you, for your outpouring of love and support. It has made an enormous difference to me, and to my father.

Thank you. Thank you so very much.

Updated Saturday 12:45 pm PT/2:45 CT:

Dad's in wonderful shape.

Being transfered from CICU out to a monitored bed as I post this.

Middle of last night, I spoke with his night-shift nurse. She took him off the vent, took the tube out of his lungs, got him up and walking around. He was doing good then, even better now.

Just now, spoke again with his day-shift nurse, the same one he had yesterday. She's blown away with his progress. He's all active, talking up a storm, terrific progress.

His temporary pacemaker is hardly being used anymore, and most of the tubes and stuff are already disconnected. I should be able to talk with him later today or tomorrow, once he's in his new room.

Dad will likely be at the hospital another 4-5 days, and then head home for a month or more of rehab.

This is my last update. It's been a text-book case.

Thank you everyone for your care, concern, and for having been there.