Appt with the Surgeon

August 29, 2012

 

On Friday one of the cardiologists that I met with on Thursday called me with an update.  He discussed the cardiac MRI with me.  He told me that it showed my septum defect to be large just like the previous test proved.  He also talked to me about pressures in my heart.  He explained how a normal healthy adult has a ratio of 1:1.  (To my understanding)  This is the ratio of blood flow to the lungs versus blood flow to the body.  A normal ASD patient typically has a ratio of 1.5 :1.  This makes since if you think about the mechanics of it.  A hole in the heart allows blood to cross over that isn't suppose to cross.  Therefore, it increases the amount of flow or pressure in that area.  That area for an ASD patient is the lungs.  My MRI showed that my pressures are 3:1.  This means that 3x the amount of blood that flows to my body flows to my lungs.  My lungs are getting 3x the flow of my blood as compared to my body.  So there is definately some increased pressure issues.  The cardiologist said that this could be due to some pulmonary vein issues.  Meaning that some of the veins that carry the blood back to the heart from the lungs have wrong connections.  These veins may be entering my heart and depositing blood into my right atria.  Remember it is the enlarged one that receives blood from the body.  Now it is also receiving blood back from the lungs.  This causes the heart on that side to work more hence the enlargement to compensate.  It is working hard to keep all that blood flowing right to left in the heart.  This hard work (and the Good Lord) is what is keeping me from being symptomatic.  No shortness of breath, no blueish tint of my skin, no chest pains, no intolerance to exercise, nothing!  So after all the education over the phone he told me that I would have all my answers on Wednesday when I saw the surgeon.  He reassured me that I was healthy enough to wait until Wednesday.  He also stated that the surgeon would have special time set aside to walk me through my plan of care.  I was still anxious about waiting so long, but I trusted him and waited.  and waited.

Over the weekend, Jay and I traveled to Paoli Peaks for another 5K mud run.  Of course I did not run.  I was once again on the sidelines as his cheerleader.  It was perfectly fine with me when I saw the race.  It was a beast and really kicked Jay's butt.  He went up and down those ski trails like a champ.  A very winded champ, but he did it.  I was so proud of him as he blew right through the obstacles.  After the race we checked into our Bed and Breakfast for the night.  It was just after lunch, but I took a nice long nap.  Jay watched the Little League World Series and let me rest.  We went out later in the evening for dinner and a walk around the town.  It was a relaxing night.  Sunday we were given a scrumptous breakfast and then we headed home to our babes.  Max and Mary Kate had enjoyed a weekend with my brothers and sister in laws.  I am not sure who was more tired: the kids or aunts and uncles.

Today Jay and I met with the cardiothoracic surgeon that will be taking on my case.  He was very quick and to the point with his description of the surgery.  He basically said you have a very large hole that we have to fix with open heart surgery.  He reviewed why the previous cardiologist could not close it with a device through my groin.  Then he talked about how he planned on closing it.  He will take a piece out of my pericardial sac.  This is the sac that your heart rests inside of in your chest.  He will then sew that piece into the hole and stich up the donor site in the sac.  When I questioned him about the pulmonary veins he stated that he didn't see that in my MRI.  He said he would study it again, but regardless it wouldn't change my surgery.  He would still do the same procedure but just add in the correction or "baffling" of the pulmonary veins too.  We discussed approaches or incisions he could use.  He told me that he would attempt the "princess cut" which is under the breasts.  This will be easily covered with a bathing suit or bra.  It will only be visible at the sternum area.  The alternative approach is one like we have all seen.  It is the "zipper" or cut down your sternum.  He said this one's recovery time and pain is less, but it is a highly visible scar.  I made sure that he understood that I wasn't concerned with a scar.  I want him to use which ever approach makes the surgery the easiest and most successful for him.  He believes that he can do it with the princess cut.  He told us that after I am asleep with anesthesia they will perform another TEE to visualize the area.  This will be used to guide them during the surgery.  If at any point he feels that I would benefit more from a sternal incision he will move to that plan. 

Dr. Drinkwater told us that we can expect to be in the hospital for four days.  This will include one day in critical care and three days on the cardiac floor.  When I questioned him about the ventilator he told me that many times patients are breathing on their own by the time they leave the operating room.  He told Jay that if by some reason I am still on the ventilator after surgery it will only be for a short period.  The patients usually come off within a few hours of surgery.  He also discussed chest tubes, catheters, and other things that will be attached to me following surgery.  He did an adequate job in painting the picture for us without going into too much detail. Of course I had all the details to fill in the blanks from my friend, Google.  He talked to us about lifting and returning to work at approximately eight weeks following surgery.  Overall he didn't add any new information, but his calculations of down time and hospital time were much less that I had learned from my research.  I find this to be very encouraging.  He also talked about how this procedure had a very low mortality rate especially since I have had anesthesia in the past.  We know I have no problems with anesthesia.  He also informed us that he has done thousands of  these closures before with many of them being babies.  He laughed and said that if you had to have open heart surgery this ASD closure is the easiest to perform and recover from.  Yay.  Right.  Sounds fun.  Wanna see if I gan get a BOGO deal?

Sign me up.  Jay and I discussed it and consulted with my cardiologist from the hospital and decided to go with next week.  Dr.  Drinkwater said their was no urgency in the repair.  It needs to be done, but doesn't have to be done tomorrow.  We are proceeding with next week so that we can get to the recovery side of it.  The diagnosis has tortured us for a week now and we want it fixed before I become symptomatic.  I am scheduling the surgery for Wednesday morning at 8am.  This date gives us the week to prepare mentally and get all our plans in order for the kid-os.  Again, we have our trust in God that he will bring us through this.  He never promised it would be fun, but I know he will walk with me all the way.  I like a statement a friend said, "Girl, God had big plans for you.  He never would of gotten you the xray if he didn't have bigger plans for you."  I am very nervous and anxious.  I have had my moments and I am sure I will continue to, but I plan to "walk by faith even when I can't see."  Please continue to pray for us as we travel this difficult road.  We can already feel the love we are surrounded by.  I (well maybe not me, but someone) will post updates as we know them.  Thank you for your friendship and concern.