Heartfelt Story

It looks like I will be having heart surgery sometime in July.

Perhaps I should stop there...it is a pretty dramatic statement isn't it.

Perhaps you want to stop here, as you wonder why I feel compelled to tell you this. It's OK if you do.

For those of you still with me, I need an aortic valve replacement. The one I got (at a very good price at the time) is leaking. I asked about the guarantee, but it is up.

I consult my GP, the thorough Scott Orenberg in Maplewood, twice a year just for fun. Late last year he mentioned that, since there is heart disease in my family and since I am getting to be an old f...let's just say old...I should see a cardiologist, just to be sure which is what Dr. Orenberg likes to be.

I went to Dr. Levy in Florham Park, and I had a nuclear stress test (run on treadmill, inject dye, take MRI pics) and an echocardiogram.

I received a call from Levy's office that the stress test was good, but I needed to make an appointment to see the doctor to discuss the echo.

OK, I can't make phone calls. OK, I get distracted.

I made an appointment in March (by fax I think).

At the appointment, Dr. Levy said everything looked pretty good...hmm...but...say, has anyone in your family ever had an aneurism?

Only my maternal grandfather...does that count.

Dr. Levy told me to come back in for some more echo pics.

One these, he felt there was a significant change since the December pictures. Change or not, my aorta was enlarged and my left ventricle was also fattening up.

But, he said, the situation did not quite meet the guidelines for a valve replacement...I guess he was afraid that some insurance company would think that it was elective surgery that I had done for cosmetic reasons...confusing my heart with my nose which so many people often do.

Levy sent me for another test which he said was "like HDTV" which is definitely the only thing he had to say to me.

In the cardiac biz we call it a TEE test for Trans-esophageal echocardiogram. Yes, those of you with quick minds, it means stick a transducer down your through until it is in proximity of the heart and taking picture with a receiver on the outside.

The report said moderate to severe regurgitation. That has nothing to do with gagging (oh, another sweet high like the one at a colonoscopy). We cardiac experts call the leaking of blood back through the valve regurgitation. (Stick around, you'll learn more).

The test also showed that I had a tri-cuspid valve with two of the leaves fused together with calcium. This ruined a fantasy for me because I hoped it would show that I was born with a bi-cuspid valve, thereby giving me an excuse for never excelling at anything that involved physical exertion.

(I should also point out that, in my artistic way, I had Joan take me to the wrong facility in the morning and my having to beg a ride from the security detail there...they let me sit in front but did not let me turn on the blinking lights. I also had to redirect good friend and default John O'Reilly when he picked me up.)

Still, Dr. Levy did not think this result was conclusive enough to say I should have surgery.

I had accidentally given Dr. Levy the impression that I was asymptomatic. As family members may attest, I come from a line of loud stoics. It's an odd combination. Always a lot of noise but a downplaying of anything may be remotely important. When asked if I felt any pain I would say (loudly), oh, just a little tightness. I withheld the detail of gasping for breath halfway up the stairway of the Whitehall subway station.

Also not sharing that I nearly died when son-in-law Nic and I carried the family heirloom wooden swing up the backyard slope.

So he sent me for another test. I forget the name of this one but in it they use a drug to cause your heart to beat faster. The deal is that all the other test look at the heart after stress, but at a time when it is at rest.

This test showed that the pressure on the valve when my heart was beating at 134 bps was twice as much as when my heart was ticking along at 60 or 70. It should be the same. A valve that doesn't close all the way also doesn't open all the way.

When I saw Dr. Levy after that, we both agreed that there was finally a good enough story to tell an insurance auditor.

Debby, Joan's cousin and a nurse, told us that all of the nurses' fathers with heart problems went to Dr. Brown at Morristown Memorial hospital.

I went to see him today. He has a wall in his office that had to be reinforced because of all the certificates on it.

He does about 400 heart operations a year and about 200 of those are valve jobs.

(I have a second name from Dr. Levy, but I really don't want to go through that second opinion stuff to come up with the same decision. I have had four tests that all say I have a problem. So there is no second opinion about that. I hear the hue and cry from many of you. Dr. Brown took time with me. He is the chief surgeon there. He does 400 operations a year. He designed the cardiac exhibit at the Liberty Science Center. I am going with him.)

We discussed the kind of valve, mechanical or biological. For someone my age (I am speaking of my biological age and not my mental age) a mechanical isn't a bad idea. Biological valves (and let's get things right...it is not a valve from a pig or a cow, it is a valve fashioned from a layer of tissue from a pig's or cow's heart) tend to wear out in 15 or 20 years. A mechanical valve never wears out unless you take it skydiving or something.

Trouble is, with a mechanical valve, you have to take anticoagulants for the rest of your life. I am ok with that. I already have a pretty well-developed aspirin habit. (Hmmm, reminds me of a phase my mother went through where she was having me drink lemon juice because it "thinned the blood," but that has nothing to do with what I am writing about.)

So I went into the office, notwithstanding a strong recommendation from my PLM Joe Brennan that is has got to be bovine or nothing else, thinking that I would like a mechanical valve, please.

Then Dr. Brown lays this on me: You will have to go for a blood test every three weeks. The anticoagulant needs to be adjusted (it sound like he was saying cumin. but that couldn't be it) constantly.

NO THANKS! I can't even remember to change my undies every three weeks...but maybe that's too personal.

So, Joe, it will be a biological valve. Bovine? Not sure. We Poles are quite fond of pork.

Another idea about the bio valve is that by the time it wears out there will probably be new technology that will allow it to be replaced using a catheter through the groin. (If "groin" isn't too personal.)

Since niece Zydico Diane Baas is getting married on 6/19, I don't want to have the procedure before that. Lucky too, because they are now only selling tickets for July performances.

I may also defer the whole thing to after August 5 because our week down on Long Beach Island starts on July 31. If I can make that work, just think of the attention I will get down there (with the only competition being bro'-in-law Jerry Stropnicky's knee replacement).

(The warranties are definitely expiring.)

When the time does come, I will spend the first day in the hospital having a heart cauterization {or however it's spelled). If that shows up any blockages, the surgeon will do a bypass along with the valve replacement. That's SOP because there are just so many time that you want to open the box and fiddle with what's inside. The actual surgery will occur on the second day.

If all I need is the valve, they will make a relatively shot thoracic cut. A bypass will need a longer cut.

For someone in my condition, this is not a particularly risky procedure. Nothing like this is risk free, but I am not afraid of it. I am a little weirded out by it. But not afraid.

I hope some of you don't feel I have imposed too much information on you. Family members, you can pass this info around if you care too...I have fewer email addresses in my contacts than I thought.

Be real,

Hap (or Walter or whatever you want to call me but never Wally or Bojsh)