Paul's Heart

Life As A Dad, And A Survivor

Yet Another Anniversary To Remember

No, I did not become a king of some small island country. This is not a crown.

This, is an artificial heart valve. To be exact, this is a replica of a “bovine” (cow) artificial valve, placed inside of my aortic valve, one of three impacted by long term side effects from radiation and chemo damage decades ago.

If you have followed my blog, you have then also witnessed the progress and improvement of technology of diagnostic and treatment of diseases, especially over the last thirteen year, and from decades ago.

But when I had my first (of three) heart surgery in April of 2008, it was known, that there were potential other issues with my heart. And what may not seem like a logical decision, to not fix everything while in there, it turns out that there is good reason not to.

The original diagnosis, was a major blockage of the LAD (left anterior descending artery, a main artery of the heart), and a considerable blockage of the RCA (right coronary artery). It also seemed that there were valve issues as well. The original plan was to leave the valve issues alone, because at the time, the surgeon, unaware of my radiation history (at that point I did not realize the correlation), the surgeon felt that the valve situation, as well as the RCA, would resolve themselves following a double bypass of my LAD.

I would later learn, that there was another school of thought to “letting things go”, basically until the time that they needed to be repaired.

Open heart surgery carries with it, many risks. And for Hodgkin’s Lymphoma survivors like me, from decades ago, treated with high dose radiation and ultra toxic chemotherapy, the surgery is not the only risk, but so is recovery. Bleeding and healing are two higher risks.

When I tried to pin down my doctor, not worried about the RCA or the valves, focusing only on the bypass, I asked, “so how long will this last?” A reasonable question, but one the doctor would not give a straight answer to, not even a ball park guess. So, after some research, looking up the method that was used to do the bypass (there are different arteries that can be used), using my mammary artery, the consensus I saw, was between 10-15 years. Which meant, at the age of 42 at the time, I would be looking at having an issue again around the time… oh SHIT! THAT WOULD MAKE THE MAXIMUM TIME NEXT YEAR!!! Not to worry, I know a secret that I will get to shortly.

So, long story short, I did recover (obviously), went through cardiac rehab, and then would discover all of the other issues created by my treatments. However, they do not apply to this post.

Just before the Covid19 pandemic hit, I was undergoing a routine follow up for my heart, and up to this point, everything had been routine. Comments were noted about my valves slowly getting worse over time, but I had been prepared to “watch and wait,” only doing something when needed to be done, something I call “the ticking time bomb” approach.

But this appointment had a familiar feeling to it. Following my treadmill test, I was being told I needed to see the cardiologist. There was another urgent situation. I was questioned why I had not said something sooner. My answer, “I didn’t feel anything wrong.” When I had my original heart surgery, I definitely did not feel well. I could feel something was wrong back then. But this time…

Well, remember the surgeon let that RCA go, thinking it would resolve on its own? Well, in a normally healthy person with just donuts and cheesesteaks as their problem, sure, it could. But for someone with cumulative and progressive radiation damage, the RCA would only get worse. And once again, I found myself at “defcon 5” and a blockage that could have had major consequences.

This time however, the surgery would be different. Scared at the prospect of a second open heart surgery, one that had increasing chances of not surviving, this repair would take place going up through my leg, trans catheter. To my knowledge, this was not something just years earlier, people with my history would not qualify for because of the complications.

And yet, that was exactly the plan, to open up the artery using a stent. Amazingly, I was sent home from the hospital the next day. Once again, went through cardiac rehab again. And of course, started playing the “how long do I have” knowing that stents only last about 10 years, never giving attention to my bypass which had now entered the 10-15 year window for my bypass. There would come a day, that I would need this stent replaced.

Again, follow up cardiology appointments continued. All appeared to be well, with the exception of the valves seemingly to worsen at a slightly faster clip. My doctor felt, at least one valve would require attention soon, as in 3-5 years.

Then Covid19 hit. The warning to me was simple with this unknown, and deadly virus. “If you get it, it will kill you.” My cardiologist was referring to one of the two major events of this unknown disease. Covid pneumonia, which with my lungs majorly compromised would certainly result in my demise, but blood clots that resulted, and with the condition of my heart, definitely lethal.

I still needed my follow up care, all the while, being cautious. Which is not to be confused with the political trope of “living in fear.”

My follow up appointment in 2020 resulted in a decision from my doctor, it was time to replace the aortic valve. Great, right in the middle of this pandemic. Not only having to deal with the virus, but then be in a building where the virus is populated with patients. A short detour however, as another scan pointed out another pressing issue, which resulted in something needing a higher priority than my valve, my carotid artery, also followed for years, was now at a stage that needed to be fixed. Though not what I want to discuss on this post, it was fixed. But then the attention needed to turn to my heart valve.

Just as my “widow maker” situation back in 2008, my symptoms had grown so much worse with my valve. Most notably, SOB (shortness of breath), a major sign of heart failure. I could barely make it from one room of the house to another and this symptom was rapidly getting worse.

The surgery would be the same process almost, going through my leg, and then into the heart itself, to place this crown-looking device, inside of my damaged aortic valve. When I came to hours later, the results were immediate relief. And again, sent home from the hospital the next day. I am currently wrapping up my 3rd round of cardiac rehab. I do still have issues with two other valves, but they are not near the level to require attention, and I have two other anomolies with my heart which I have only begun to learn about, as it is a condition that right now, does not require attention.

Today marks 3 months to the day, that this device, gave me heart relief like I had not felt in years. Sure, I am still dealing with my other health issues, but believe me, if your heart is not feeling right, your quality of life is not really what it should be. Gives new meaning about “putting your heart into things.” (Mick Jagger of the Rolling Stones went through a similar procedure back in 2019)

These devices are meant to last 7-10 years, and for someone my age, 56, that would mean likely, another surgery for the valve would be a guarantee for someone with a normal health history. And honestly, it is quite cool how they would do it, if able. You see, there are multiple sizes of this artificial valve.

Just like a child’s toy, as long as you did not start off with the smallest of the valves, doctors in theory will be able to insert yet another valve if needed, directly inside the replacement valve, which was seated inside the original valve you were born with (hence the children’s toy reference).

I am one of the lucky ones because I do have a valve the size that will allow another replacement if needed.

But here is my dilemma, math. And with the precision of a scientist tracking a meteor careening towards earth, there is a collision course likely in my future.

While my bypass has now passed the 15 year mark, and had not needed repair, it is continuing to fail again, with its current status at 40% blocked. I would estimate it is likely, to need attention, not waiting for it to reach “widow maker” status to repair, in approximately 7-10 years. Combine that with my RCA stent, and now my valve, there is the potential, if necessary, that all three things would need to be addressed at the same time, no easy fete, filled with all kinds of risks.

And if you read yesterday’s post, you will see I have another factor creeping up on my, the curse of my paternal longevity.

But I have one thing in my favor, a major goal. One that has me trying to do all the right things health wise that I can, most importantly, believing that I can get there.

Back when I first became aware of all of the late developing side effects from my treatments, there was only one thing I wanted, to live long enough to see my daughters grow. Never a doubt, my doctors share my desire, and with careful and diligent follow ups, each year becomes one milestone closer.

An 18th birthday so far. A high school graduation coming this year. Another 18th birthday next year. One in college in the Fall. Another high school graduation the following year. Another in college. Two college graduates. Two marriages. Hopefully grandchildren (at least one daughter has promised me many). These are all goals within my reach, I can feel it. Fourteen years ago, my doctor told me I was lucky to be here, it was “not a question if” I “was going to die, but when.” And that has been all I have thought about, every year, every health event I have had to deal with, and for the last two years, dealing with Covid19 all around me.

But I am doing it. And I am getting closer to my goals, one at a time.

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