aorta know better

Genectics - being racially profiled.

Went to cardio rehab today and it was the day the attending doctor came around to talk to us. Very enlightening for me in particular. At the start he said there were 3 types of people in the room. No one was type 3 which is lucky cause I don’t remember what that was. Type 1 was essentially those that got stents in a heart artery (heart attack, not open heart surgery) and type 2 was valve problems (open heart surgery). Most were type 1 with only a couple being type 2. I was kind of type 2 (they did something to my valve) but also had the dissection so of course I asked - what about me. It seems I was a special case in the group. Wonderful. He asked where I was from originally, I said New Zealand, and he straight away said that if I’d come in to see him with high blood pressure then he wouldn’t have been surprised about the dissection. He basically racially profiled me. He wanted me to stay back after so he could make sure I was involved in some kind of aortic study. It was then that he explained that he had seen alot of Maoris who had high blood pressure and degraded veins/arteries. Could I have done anything about this? Maybe kept an eye on my blood pressure… they like it to be under 140/80, for everyone not just me. I probably didn’t need to be 106 kgs, I’m now 94 which seems to be a good weight. I’m thinking about 90. Apart from that I exercised and ate okay so in the end it looks like genetics has hit me with a good hip and shoulder. As they say in Masterchef, my three top tips for not having heart disease if you’re a Maori man in your 40’ s or 50’ s, 1. know your blood pressure level, 2. get to know your cholesterol level and 3. lose weight. The same tips apply to Maori women in their 60’ s or 70’ s.

To be honest you should just remove the word maori because the same tips apply to everyone. I don’t like to racially profile.

I feel good dada dada dada dum

Yeah I do feel good. I woke up this morning, nothing hurt and more incredibly I wasn’t even a little depressed.

That’s really saying something after the way I felt yesterday. We went to the Cardiothoracic specialist Dr Nixon, the doctor who operated on me, to get the results of the CT scan I had last week. It wasn’t exactly the news I was hoping for.

You know it’s not going to be fantastic news when he starts by saying,

“The first thing I want to say is that everything we did is 100%”….

You just know there’s a big but coming.

“but there’s is still a false lumen and small tears in the arteries at the top of the aorta that we’ll need to have a look at.”

To say I was devastated is putting it mildly.

I briefly shut down after that and started thinking that they were going to open me up and I would have to go through the last 6 weeks all over again, if I made it through.

So first he explained what he did in the operation. The 100% part.

The good news

If you have a look at the diagram of the aorta,

• from just above the diaphragm (the part that looks like a butt) to where the Ascending aorta arrow points is where they put a dacron graft in.

Dacron graft

• Then they also put in a stent in from the ascending aorta arrow all the way around to just after the aortic arch becomes the descending aorta. 

This picture shows exactly what they did with the stent.

So with the explanation of the operation out of the way he told us what they found with the CT scan.

The bad news

I still have a false lumen which is basically the tear in the aorta wall that diverts the blood flow from its natural course. This is situated just after the last of the three arteries that are at the top of the aortic arch. 

—- just as a happy note the doctor said that sometimes these false lumen’s on the descending aorta can tear all the way down to your belly button… lovely —-

Anyway… there also seems to be some tears in one or more of the arteries.

The stent is doing its job but that is making the false lumen bulge outwards. They need to address that before it causes too much pressure. He didn’t say what would happen but you can guess… kaboom!

One good thing though is that it’s not bulging inwards and blocking the normal flow of blood down the aorta.

Another doctor joined us and said that the tears in the arteries are okay as the blood is not flowing up to the head (or something) so there’s only a 1% chance of stroke (bloody hell).

are they going to operate again?

No thank goodness. They said that they should be able to address this with another angiogram. That’s what the other doctor was called in for… he’s going to do the angiogram and also the fixes (more stents this time in the arteries).

That was basically it. They took my mobile number and said they/he would call this week when he’s found a time to do the procedure.

I’m not really looking forward to the angiogram. They’re going to stick another catheter in my femoral artery which means they’ll open up my “just healed” scar to do it. I remember that hurting or being a little uncomfortable when they pulled it out so I can imagine what it’s going to feel like going in. 

Bastard.

Shit…

I’m depressed again…

Damn you blog!

Good couple of days

I’ve had a great couple of days.

Yesterday I had lunch with Adam R and Zandi, today I had brunch with Janet  and the little cutie Charles, then I had lunch with Tim and Ben and to top it off I went back to St Vincent’s and said a very emotional thank you to the doctors and nurses on ward 4.

Great!

I’ve been neglecting my blog

It’s amazing how recovery has just become my normal day now.

• Get up and shower,
• have breakfast and pop first round of pills,
• go out for a walk, maybe meet someone for tea/coffee if I’m lucky,
• have lunch, maybe with someone if I’m lucky,
• go home and rest
• pop pills
• wait for Andie to get home

So there hasn’t been a hell of a lot to write about. Yep, I’m healing really well… the sternum is almost there, the scar is well on its way to forming real scar tissue, and nothing else hurts. My cardio is still terrible but that’s to be expected I guess.

So now mundane aspects of life have started to creep back in;

• cook,
• do the dishes,
• wash, dry and fold clothes,
• clean the rooms,
• tax, bank accounts, insurance, yadda yadda.

So next week I have a few extra goals for my recovery just to shake it up;

• start physiotherapy at St Vincent’s,  
• do some stretching classes back at the gym, 
• start the deep water running with Ben.
• post my time lapse pictures of the scar healing.

Hopefully the following week will see me well enough to do some work hours from home to keep my brain engaged.

Light at the end of the tunnel?

It’s been three weeks since I woke up in Intensive care… wow, it’s amazing how time can go so fast but also seem to crawl. That’s what it’s been like for me.

Andie went back to work today and I must admit that I wasn’t looking forward to being by myself but when I was in the shower today I coughed a “proper cough” and it barely hurt at all!! My sternum must be almost done healing. It’s funny how the little wins turn your day around.

So now I’ve taken my drugs and I’m off to the supermarket to get some food, maybe have a coffee and then come home and watch a movie.

Now that was a good cough!!

The therapeutic value of friends and children

Andie and I went out today with our oldest NZ friends we have in Australia and their children. I have to admit that the last few days have been the hardest for me. I’ve been cold, sore, tired and depressed. Today was exactly what I needed. Thanks Andie, Jo, Hayden, Liz, Pete and the kids. You really cheered me up.

Nice side-effect

There’s been at least one happy outcome to the surgery. I no longer snore!

Now if I can only get Andie to stop.

pain killers

I thought it might be a good idea today to go without my pain killers to see how I’m really going.

Not the best idea I’ve ever had.

My chest is still so sore! It’s a little depressing actually :(

Now where’s my drugs?

The penny drops…

We just got back from the doctor and he has kindly restocked my painkillers. He also provided some insight into what actually happened.

I told him that I’d come away from hospital with really only a vague notion that the ISD event was caused by high blood pressure. However, all blood tests that were taken never showed any evidence of high blood pressure.

He said that it was most likely a cholesterol deposit on the aorta that, under pressure, tore away at the aorta wall.

This actually makes alot of sense. My diet, while mostly pretty good, did include:

• lashings of bacon (with eggs every Tuesday with Tim and most weekends),
• eggs, lots of eggs (in fresh pasta particularly recently, fried, boiled, poached, you name it, I ate it),
• steak,
• chicken,
• butter in cooking (damn you MasterChef!!).

He also took my blood pressure (from my right arm) and said it was very good which was nice to hear.

I asked him about the pain in my shoulder blades and he said it was because of the rib spread, just as I had assumed. Gentle massage will help that so volunteers are welcome. :)

I also asked him about the wound in my groin and he said that it was because they did a full coronary angiogram and so had a catheter inserted into my femoral artery. (They’d obviously taken that out before I woke up in ICU).

There was also the urine catheter that went straight into my bladder.

I said that I still have two weeks before I’m due to see the physiotherapist at St. Vincent’s and then three weeks after that before I see the specialist again so what should I do between now and then?

He told me to:

• drink lots of water,
• take lots of walks,
• and to try deep water walking.

The deep water walking will help me since my right calf is causing me a bit of grief at the moment.

So this is the plan.

Keep an eye on high cholesterol foods in my diet, collect volunteers to give me a gentle back/shoulder massage, keep walking and check out Melbourne City Baths.

All good to go starting tomorrow.

Progress

So what still hurts? 

• chest - 3/10 normal, 9/10 coughing,
• shoulder blades - dropping off to maybe 2/10,
• lats - same as the shoulder blades,
• right calf - we’ll see after this mornings walk, 
• groin - I haven’t spoken much about this wound. It’s still big.
• neck - just stiff,
• throat - aches 1/10,
• my cardio is zero 

Keep going.

I’m off to the doctors today to see if he will restock my supply of pain-killers. I hope so.