See What Tomorrow Brings

Dad finally got into a room mid-afternoon in the Hamon wing which is for cardiac patients. His temperature immediately rose to 102. He was given some Tylenol, the fever broke and dropped to 100. He had some chicken noodle soup and stabilized.

After a long day with Dad at the hospital, Mary went back to the apartment to gather some things. (In the rush, Dad left without his glasses!) When she returned, Helen who had been there much of the day, left and went home. Mary planned to stay the night.

I spent the day making a beef stew (quite delicious if I say so myself!) I took servings to Mary and Dad at the hospital and smuggled in the remnants of a rockin' bottle of red wine. Much appreciated especially by Mary, who, like her Mother, starves herself in times of crisis and above all does NOT eat hospital food. Mom would always bring homemade meals to Dad which he always relished. The fact that he did not feel up to even a bite of the stew is a crisis of appetite that could only be described by the great P.G. Wodehouse himself.

Needless to say they continue to run tests. Confirmed symptoms include:

• Fever
• Low Blood Pressure
• Elevated Liver Enzymes
• High white blood cell count

Negative tests include:

• Simple influenza test
• CT scan of the liver
• Chest x-rays

Tests in progress include:

• A more in depth influenza test
• Culture for staph infection
• Culture for MRSA

And I might be forgetting something, but I think I got it right.

We had a good visit and he was resting comfortably when we left. Hopefully we'll learn more when the doctors make their morning rounds.

And Here's the Latest...

Latest news from the hospital:

Dad is feeling somewhat better. He is on antibiotics and is waiting in Emergency for a room to open where he will be admitted. Due to today's onslaught of Thundersleet, schools are closed and staffs are short-handed. Also patients are not leaving who would otherwise be leaving. So if you think hospital time moves slowly...

The urinary tract has been ruled out as a cause of infection, which is too bad because uti's are easily and quickly treated. He does have some congestion in the bottom of his lungs. When they asked him if he'd had a cold he said no, but I told Mary he'd had at least three, on one of which he went back to his primary caregiver for a second dose of Amoxicillin. Tests are underway. Currently the cause of the infection is undiagnosed.

Surgery has been postponed indefinitely.

Oops! Didnt' See THAT Coming!

The week following Dad's decision to undergo mitral valve surgery was relatively uneventful. His breathlessness seems to be worsening a rapid rate. His resolve to repair the issue is very strong. And that's huge.

Susan and I left Friday for a quick weekend together in New York City. And had a fabulous time, thank you very much. Well documented on Facebook. So we were out of the pre-surgery weekend picture.

Mary flew down from Salt Lake Saturday to be here for the week. They were scheduled to go for some pre-surgery tests this morning (Monday.) The weather threw the first punch by bringing in an inch of sleet in the early morning hours. Much better than freezing rain which is debilitating.

Dad threw the second punch by waking up with shaking spasms and a high fever. He woke Mary up who called an ambulance and took him to the emergency room. I spoke to her about 7 this morning and it looks like he has an urinary tract infection. A little rare in men, but he showed blood in his urine a couple of days ago. His doctors were somewhat laissez-faire since he was going into the hospital in just a couple of days. I'm not sure I totally understand that rationale since he was going in for heart surgery, but our inclination is always to trust the doctors.

Usually UTIs clear up quick with IV antibiotics. No decision had been made regarding postponing surgery when I talked with Mary this morning,

I'll post more as information becomes available.

Episode 2.3: A Meeting with the Surgeon. GAME ON!!!

In a zealous display of enthusiasm reminiscent of the late, great Ernie Banks, Dad has decided "Let's do TWO!" Two replacement valves that is. The 3-4 hour surgery is slated to be scheduled for Tuesday, 24 Feb at 7:30 am.  The final go-ahead will come after Dr. Platt reviews the images from a CT scan that Dad should be finishing right about now. He wants to make sure that things are just as him left them when he sewed Dad up back in July, 2011. It will also let him check on scar tissue.

Needless to say, our appointment went well yesterday. Dr. Platt is no nonsense, but listens well and has a dry, understated sense of humor. He is the surgeon who deemed Mom's cancer inoperable and who did Dad's heart surgery. We liked him then and we like him now.

The tone of the visit was set when he asked Dad, who was sitting on the examination table, to lift up his legs and lie down. Dad pivoted and swung his legs up and onto the table in perfect form, straight legs, feet together, toes down, just like a gymnast mounting a pommel horse.

"Well, you're certainly fit and in good shape!" noted the Doctor.

He only works out five times a week, we explained.

Several pertinent facts came out during the examination:

• Dad's heart is left-dominant, meaning that the heart itself is supplied by the arteries from the left side of the heart. Fairly rare.
• He has no blockages, the vessels are extremely clean.
• The replacement valve is working perfectly.
• The left ventricle has not diminished in strength since the last surgery. It was weakened then to the same degree that it is weakened now.
• He had moderate mitral regurgitation at the time of the last surgery, graded 2+.
• The leakage is worse now, graded 4+.
• He did not address the mitral valve then because the aortic valve and the aneurysm were more demanding problems. He thought that three procedures would have been to much to address in one surgery.

The plan is to use the same incision and route of entry as the last surgery. While he always looks to repair, he anticipates that the best course will probably be to replace the 90 year old valve. A replacement should work for at least  10 years. Dr. Platt sees no reason not to procede. Dad is in great shape, much better shape than most of his patients who are younger.

The most important factor is that Dad wants to procede. He was out of breath after bending over and tying one shoe.

"All I know is that I just can't go on like this!"

Warning: Contains Graphic Descriptons

If, like me, you have been browsing "mitral regurgitation repair" you have been seeing the term minimally invasive thrown about as a quicker low impact form of heart surgery. The term suggests something like an overnight or even a day surgery arthroscope of a knee or an elbow. In heart surgery land it just means that they don't 'crack' open the chest. To repair a valve, the surgeon has to get inside the heart and the only way to get there is to cut. Maybe less invasive is a better term than minimal.

If you want an illustrated step by step on "Minimally invasive valve sparring valve repair" just click.

We meet with the surgeon in a couple of hours and will certainly know more then.

Episode 2.2: A Visit With the Cardiologist

This morning we had our big meeting with Dr. Musselman to discuss the new diagnosis of 'mitral regurgitation' and what to do about it.

He said that when Dad first complained about shortness of breath, which was last fall, by his notes, he could hear a heart murmur, which was the first sign of leakiness. Last week the murmur had changed considerably which was why he ordered the TEE test on Monday.

The test revealed several things.

• The aortic valve which was replaced several years ago is working fine.
• The quality of the left ventricle muscle has declined.
• The leaking of the left mitral valve is severe.

What that means is that the left ventricle muscle is pumping but the valve is letting the blood pour back into the chamber. It requires multiple contractions to move the amount of blood that should be moved with one contraction.

There are several ways that medication can help mitigate the situation. He has added those medications and Dad said they seem to be helping.

The other treatment is surgical. Sometimes the valve can be repaired and sometimes it has to be replaced.

Without treatment, the condition gradually (or rapidly) deteriorates into congestive heart failure, heart attack or stroke.

Dr. Musselman indicated that he feels that surgery is possible and that a return to Dad's present level of health is possible. He recommended Dr. Platt, who did Dad's previous surgery, and said that he would provide information and details to him. We are to meet with Musselman again after meeting with Platt. And that was that.

Dr. Platt's office contacted Dad the same day and the appointment was set for Thurs, Feb 12 at 2:30.

We all remember Dr. Platt to be a formidable presence who doesn't mince words. It will be interesting to hear what he has to say. I was struck by the difference in opinion between the Doctor with whom I spoke Monday and Dr Musselman today. She was so pessimistic and Musselman seemed optimistic. I wonder if he is just letting Platt play the role of the bad cop and deliver the harsh news. We'll see.

I approach surgery with great trepidation. Surgery is discussed with a cavalier and commonplace attitude, like it is no big deal. But major surgery is a huge trauma. Dad doesn't remember how hard his recovery was three and a half years ago, but I think we do. It was extremely hard for him and it took a long time for him to fully recover to the point where he could really live by himself. I have my doubts.
     

Well, He's Got That Goin' For Him!

Dad saw his neurologist a couple of weeks ago.

"What's the deal with this Parkinson's?" he asked. "It never has gotten any worse."

"Well, there are your tremors," she said. "Hold out your hand."

He held out his left hand. Stiff as a board.

She put him through a number of the standard physical tests. And then told him about a new test which measures the dopamine output in the parts of the brain suspected of causing Parkinson's. Evidently the test has been used for some time in Europe, but was only approved two years ago by the FDA. It is most useful for distinguishing between 'essential tremor' and Parkinson's. And so she scheduled a Dat Scan.

And now he doesn't have Parkinson's. She is slowing weaning him off his medications.

AND, he's got THAT goin' for him!!!