My apologies to Bill Bryson for borrowing the name of his book. Today was my last hike before surgery (we travel to New York a fortnight from today). Last year my daughter Kristin and I joined the Georgia Appalachian Trail Club. Actually, we paid dues and became "prospective members" because the Club requires the completion of three activities before admittance as a member. Today I completed my 3rd activity (second for Kristin, she still needs to volunteer for a trail maintenance outing). We picked a 4.5 mile hike through the trails at the Elachee Nature Center near Gainesville, Georgia. Rolling hills, well-maintained trails with wooden bridges over creeks and wetland areas. Brilliant weather - clear, in the 40s when we started, mid 50s when we ended close to noon. I especially like winter and spring hiking when the trees are leafless; you can see so much more. It's a very different feel than hiking in the South in the rest of the year, where you're in a green tunnel for a high percentage of the time. In My Photos I've added a pic from today's hike.
Last October I discovered that I had atrial flutter, that my mitral regurgitation was severe, and that my left ventricle (LV) ejection fraction (a measure of pumping efficiency) was way too low. At the time I was not in good aerobic shape. I had not run effectively since May, and wasn't doing much else. After my atrial flutter was corrected by ablation in October, I was eager to return to running, but my cardiologist vetoed that plan. He encouraged me to exercise, but not exceed a pulse of 120 per minute. So I've taken brisk walks, usually 6-7 days per week, ranging between 30 and 75 minutes per outing, using a heart rate monitor. To stay under the target heart rate, I really have to slow down when I go up any hill of significance. On some days I use a stationary bike at the gym instead. Although I'm not happy with this limitation (one reason I want my surgery date to arrive fast), I realize the purpose: let my heart rest and hopefully recover some of its efficiency prior to the surgery, and hold down cardiac risk that might result from the stress of hard workouts.
Spring break starts on March 9. More than a few of my friends at the university have commented that I'm planning an unusual spring break trip! The days are going by so slowly for me (but not because of an upcoming beach trip). For awhile after my Feb. 1 consultation with Dr. Adams, I hoped that an earlier surgery date for me would open up at Mt. Sinai. But the hospital hasn't called, and at this point Donna and I have made all of our travel plans to New York, including renting a very small apartment for two weeks. Plus I've arranged my work schedule to make the March 13 surgery date fit, and my daughters and Donna's stepmom have made their NY travel plans as well. So if I get an offer of an early date now, I'll reject it. It's clear to me that medically, there would be no appreciable plus for having the surgery this month, rather than in March. It's just that I'm tired of the waiting. Luckily, I have full days at the university to occupy my time, plus plenty of chores to do around the house and yard (per usual, my list is long, and tends to expand rather than contract).
One month from today (Sunday March 11) I check into Mt. Sinai Hospital. I wish it were sooner.
Yesterday I spoke with my cardiologist. Donna and I will stay in the NYC area for about one week after my discharge, and we've been looking at various lodging choices. I asked whether a few flights of stairs were okay. He said that's not a concern: "I don't know why people keep thinking that. Stairs are only a problem if you have orthopedic issues." This is the answer I had expected (and hoped for), as I'll be walking the hospital halls regularly before they let me out anyway.
A second point. My cardiologist wants me to check with my surgeon, Dr Adams, to see what if anything can be done to reduce my post-surgery risk of developing atrial fibrillation. He says I have significant risk because last fall I had atrial flutter (corrected in October by ablation), and he calls atrial flutter and atrial fibrillation "kissing cousins." A possibility is to ablate my left atrium (atrial flutter, in contrast, is usually treated by ablation of the right atrium, which was my treatment in October). The basic idea is that, as long as I'm opened up, the surgery team may as well perform multiple tasks -- mitral valve, and possibly tricuspid valve repair, and now possibly AF preventive work such as an ablation.
Well, the good news -- my heart catheritization, done in December in Athens, shows my arteries are clean as a whistle. No plaque, no blockages whatsover. So one thing that's clear -- no need to consider bypass or stents as part of the specs for work to be done.
Below is a note that Donna emailed last week to family and friends with info about my consultation with Dr David Adams and the Mt Sinai team:
Jim's scheduled mitral valve re-repair will be March 13 at Mt. Sinai in New York with Dr. David Adams and team. He met with Dr. Adams today. I just spoke to JIm and got lots of details (I wasn't able to go to NY because of this really bad cold). Jim's very confident after his meeting. We will be up there for about two weeks, because they like to keep the out of town patients in the area for an extra week; he will be in the hospital 5-7 days.
Dr. Adams said re-repair is preferable to an artificial valve or pig/cow valve in his opinion:
(1) Having your own valve back and repaired will just last longer. The animal valves would have to be replaced later (typical is 15 years).
(2) The artificial valves might have problems with clotting; and you have to be on anti-clotting medicine the rest of your life.
(3) There have been advances since Jim had his surgery 6 years ago. These days they don't let anyone off the table until there is 0% leakage from the valve; that's only been recently discovered as an essential "gold standard." When Jim had his surgery it was acceptable to let the patient go with very minor leakage, as was his case. His valve only lasted 6 years. In the intervening years, also, the annuloplasty rings that are put in with mitral valve repair have greatly improved.
There are surgeons who argue against re-repair, and Dr. Adams will be in a discussion with other physicians about this at a conference in a couple of weeks. I imagine that the objections are these, (although I'd like to hear the talk, which I believe will be taped):
(1) re-repair deals with scar tissue and therefore is a more complex surgery; plus,
(2) longer time on the heart-lung machine; the less time, the better.
(3) re-repair is a relatively new procedure--maybe 5 or 6 years or so--and there haven't been that many (although Mt. Sinai has done about 60), so there are no long-term studies. There are a couple of great surgeons in Europe who also do re-repairs.
The positives: At Mt. Sinai, the mortality rate in re-repairs has been 0.
They will do a replacement valve at the time of the operation if they get in there and find that it can't be re-repaired.
They will also repair a slightly leaking (possibly) tricuspid valve at the same time (not as important as the mitral valve repair).
Other things to bear in mind--Jim's valve disease was most likely caused by infection--rheumatic infection caused by strep. This is very common. The following is my opinion only, not something the doctor said, but tell everyone you know to get onantibiotics if they have strep throat; in our childhoods, that wasn't something that was automatically done if a kid had a sore throat, and it was in the early days of antibiotics back then. But today we have this emphasis on not over-using antibiotics--which is justified because the germs get resistant--but because of this people tend not to use them at all.
Random fact: Dr. Adams said the third-degree heart block Jim had a few days after his first surgery was caused by edema, not by beta blockers. So that's good news; he can go on beta blockers after his next surgery; this is considered a very good thing.
So March 13 for now; that's the earliest they can do it with this team--although we will definitely go earlier if there is a cancellation.
Thank you all for your concern and prayers--we are really optimistic. For more info. on heart valve disease, there is a blog started by a patient that is a great resource, and there's an interview with Dr. Adams (# 3 on this link): http://www.heart-valve-surgery.com/heart-surgery-blog/2011/12/28/top-blogs/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+AdamsHeartValveSurgeryBlog+%28Adam%27s+Heart+Valve+Surgery+Blog%29
Here's my first journal entry. Donna and I are now working on planning our trip to New York City for my surgery. We've booked a flight from Atlanta to NYC on Saturday, March 10. The next day, Sunday the 11th, I'm to check into Mt. Sinai hospital for pre-surgery testing and to begin a heparin drip.