DadTate's Surgery Looks Like a Go

We met with Dad's surgeon *finally* today... 'we' being Tom, Emily, Susan, and David. Long story short, it looks like surgery may be as early as next Thursday or Friday. It's a long and complicated story but it's after midnight now and I am exhausted, so I'll write briefly here and then post more later.

It boils down to this: if Dad undergoes the surgery, he has a 15% chance of not surviving it. If he does not undergo the surgery, he has a 40% chance that he will die from his condition in the very near future. He might survive as long as two years, but they have not heard of anyone surviving longer than that with this condition (aortic stenosis) because the more months go by the worse the stenosis becomes until the valve is completely blocked, and then survival rate is zero. Right now the valve is open only 0.8 centimeter; at 0.5 they consider you have days to live.

They went over every risk carefully, in full detail. Some of the biggest risks entailed:

• Post surgical bleeding. That's why they had to take Dad back in to surgery right after the bypass surgery; it will be an increased risk now that it's a "re-do."
• Another risk is renal failure. The irony is that the kidneys are nearly maxed out because they aren't getting enough blood supply from the heart; so after the valve has been replaced the kidneys should be able to recover, BUT the surgery itself will be very taxing on the kidneys so they expect him to go into a "transient" kidney failure immediately after surgery.
• Another risk is of a clot breaking off during surgery and escaping notice by the surgeon, and making its way to the brain where it would cause instant death. That is also a risk if dad does NOT do the surgery; he could experience a clot 'event' at any time. (For those of you who know Dr Nuttall, that is precisely what happened to him; he experienced a clot 'event' and has now been in a semi-coma state in ICU for the past four weeks, and prognosis is not good.) During the surgery it is part of the procedure to break off and vacuum out calcifications/clots, and the risk is that a piece might be hidden that would break off later, or a piece breaks off but hides from the vacuum and flushing procedures.
• And of course there is the risk of pneumonia after surgery.
• A special note to Sherry and Robin: The doc reminded Dad of all he would have to go thru during the recovery period. Dad's response was that he has the greatest support group/caregivers in the world. I think Dad does not remember part of it; i.e., all the pain and the helplessness... and the Doc said that is normal, a type of amnesia occurs, and it will probably be harder on the caregivers than on Dad during those first several weeks. Dad also discussed the amnesiatic effect of the anesthesia which he experienced before, and the doctor said yes, that will happen again and it is a permanent loss, but assured and reminded Dad that what he loses he won't mind losing... and he will be able to remember again just fine within a few days.

There were of course other risks but those were the biggest. Then Dad told the surgeon (Dr Nelson) that he definitely wants the surgery. The doc asked when, and repeated that it is up to Dad; he can delay it as long as he wants. Dad responded he wants it as soon as possible. They will be calling us later this week to set up the surgery date which they at this time they expect to be Thursday or Friday of next week.

Tomorrow Dr Nelson is going to review Dad's cat scan, angiogram, echogram, blood work, etc etc etc all again to be sure there isn't any more diagnostic testing to be done prior to surgery, and they want to reaffirm that his kidneys are back up to par as well.

The good news is in the choice of valve... a mechanical valve (metal) would last a lifetime but it will also require lifetime use of a blood thinner like Coumadin. This is not good for someone like Dad because Coumadin has some serious side effects which we don't want to inflict on him. A tissue valve used to be harvested from a pig, and had a life span of about 8 years. They don't use those any more. Now they use a valve from a cow, plus they have better ways of treating the tissue before it is inserted into a human, so there is absolutely zero chance of rejection by the body, PLUS it has a life span of 15 to 20 years. The only downside is FITTING the bovine valve; if there is too much calcification or if the human valve is too stenotic sometimes they cannot get a good fit on the ring, so they have to revert to a mechanical valve or a 'backwash' effect happens with the new valve, allowing blood to flow in the wrong direction. Dr Nelson said that from what he can see on all the scans and 'grams, he should be able to get a good fit for Dad.

There's more but I think I have hit all the high points. Dave, did I miss anything? If anyone has a question, just holler and I'll do my best.

Dad is in good spirits. Nervous, certainly. Worried, naturally. But absolutely determined to do it, and positive that he can get through the recuperation period. What a will. I admire that man more and more every day. I hope I grow up to be just like him.