Decision Time

June 23^rd, 1998 HERE WE GO...

A year and a half or so goes by and we've kept up the quarterly check up. At each visit we discuss the surgery option and decide to put it off. Apparently nothing much has changed in my condition. However at this visit Wolfe seems a little more anxious. He says that he's been thinking about this, and reading that in some cases, if the aorta is replaced earlier in younger people such as me, it's possible the aortic valve could be in relatively good condition and be saved. He suggested that considering that, perhaps we should consult with the surgeon for his opinion. He said that it would also be good to take advantage of the fact that he could get me in to see one of the foremost experts on this condition, Dr. Tirone David.

He would set it up. I reluctantly agreed. Denial. Several months go by. No word. This is Canada, I remind myself. If this surgeon guy is that good, it takes time to see him. In the meantime I start asking around and find out that Dr. David really is 'da man. So here I am, once again thinking that either Dr Wolfe has great connections or I am really sick. Funny I don't feel sick, so it must be his connections. Ya that's what it is. His connections. He's got pull. Good ol' Wolfe. He gets me an MRI in less than a week and now he is going to get me into see the top surgeon (apparently) in North America for valve replacements.

Sept 7^th - Dr. Tirone David

So we get to his office at the Toronto General and my favourite part was that when his very nice secretary/nurse Susan asked me for my blue hospital card, I accidentally handed her my blue Air Miles collector card. Without looking at it she ran it through her card reader. Needless to say it didn't work and she looked and it and with a big smile said, "we don't give air miles here!" We all laughed and this took some of the tension off Dory and me. We were obviously very anxious about this meeting. While sitting in the waiting room, we both laughed about the thousands of air miles we might have earned. Let's see, open heart surgery, at one mile for every $10 spent. Hmmm..... Nice thought. Nice reward for the trauma my body will be put through. Well at least Susan will never forget who I am or get me mixed up with another patient. Just call me the 'air miles' guy.

After a short wait we met the doctor. A tall distinguished looking fellow in a fresh white doctor's coat. He took a quick look at the reports in my file and said that he suggests that my aorta and the aortic valve be replaced sooner than later. His firm confident manner, and matter of fact statement caught me off guard. (Still in denial) I questioned if perhaps the valve might be good enough to save. He took another look at the file and said that it did not seem so, but he could make a final decision when he was actually operating. But it was safe for me to assume it would have to be replaced. I asked what he meant by "sooner rather than later". He took another look at the file and said something like, it had to be done for sure within a year but preferably, as soon as possible. The enlargement of my aorta was an aneurism just waiting to burst. He said he was not available to operate until the beginning of November.

I was not really ready for this, but very calmly asked him to take me right away, the first week of November. I said let's just do it and get it over with. He confirmed that this was a good idea.

Then he showed us the synthetic material he would be using to replace the aorta with. It was a short flexible tube about 2.5 inches long and about � an inch wide. Looked sorta like a piece of pasta. I think it was made of Dacron, or nylon, or lycra, or was it velcro? Well, something like that. It looked good and strong, and he said it would be very easily accepted and last forever.

Then came the choice of the two different heart valve types. The artificial valve was a black metal ring about an inch or so wide with two black metal flap doors on tiny hinges. He showed us how the little doors open and close. This valve would last forever but there were two drawbacks. Every time the little doors slammed shut the sound of metal on metal would click. Unfortunately I'd be able to hear that clicking sound with every beat of my heart. Eventually people get used to it, but for insomniacs like me, it would not aid in my efforts to fall asleep. Drawback #2 was that I'd have to take blood thinners, for the rest of my life. Which would mean regular blood tests every 3-4 weeks forever. Also people on blood thinners are more prone to nose bleeds, and it takes longer for your blood to clot, resulting in cuts and bruises taking longer to heal.

The other option is a human valve or pig valve, a sample of which he happened to have encased in a plexiglass cube. No blood thinners would be required and of course, it would be silent. However, these valves are ultimately rejected and need replacement after 10 - 15 years. (A friend's father has had one now for 18 years, and he's 80 years old and feeling great).

We asked Dr. David which one he would go with. He did not want to recommend one or the other. It had to be a personal decision. So Dory put it another way and asked, "If it was your wife or your daughter that needed one, what would you recommend?" He then said he would go with the pig. Also for himself he would also go with the natural one, because he couldn't take the blood thinners, because of stomach problems. We agreed that the blood thinners were not an option for me either due to my stomach problems.

He also wanted me to have an angiogram beforehand so that he could see whether there were any other cardiac problems. (Like clogged arteries). I guess he did not want any surprises when he opens me up.

So that was that. He said they would line every thing up and would be in touch the Wednesday before surgery.

Back to Index / Part 5 - The Angiogram