Thursday, February 3, 2011

The good, the puzzling, and the OOPS!

Oops first:  Just like Group Health and Virginia Mason in Seattle, Penn Medicine is an alliance of hospitals (University of Pennsylvania Hospital, Children's Hospital of Pennsylvania, Penn Medical Center), clinics in Pennsylvania and New Jersey, and associated satellite practices in Pennsylvania and New Jersey.  So when I called the patient registration office back to clarify where I was going, they said, "The Hospital."  Due in at 7am, with an hour's drive ahead, we left at 5:30am to ensure we could get there on time despite the freezing rain storm that had occurred overnight.  Having never been there,  it took a bit of maneuvering in the dark to actually find the entrance to the parking garage but I made to the hospital admissions office before 7am.  They didn't have me listed.  They asked what I was having done and sent me across the street to the Heart and Vascular Center. 

No one was in yet because of the storm but just before 8am, that receptionist showed up and I wasn't listed for a procedure there either.  That's the center that does heart transplants.  Turns out I was supposed to the at the Penn Presbyterian Medical Center, which is about 8 blocks away.  The receptionist, Patrick, was very helpful and thoughtful.  He called over and told them I was coming and then wrote out directions for us because of the one-way streets around the hospital.  He even escorted us to the parking garage to point out the streets and to validate the parking so we wouldn't be charged.

By 8:30am, I made it to the Heart and Vascular Center for outpatients of Penn Medical Center, which is nothing more than a makeshift nurses station in what is an older Federal style brick building as you often see in down-town Philadelphia.  What an adventure when you are hungry, thirsty (I had been fasting since midnight, no water either), and sleepy.  Who sleeps well anticipating a medical procedure and worrying that the alarm won't go off?

Puzzling next:   There are two puzzles actually. One, do I have the tissue or the plastic/metal mechanical valve? Two, what is causing the subtle finding of lower oxygen content between the aortic chamber and the aorta blood vessel itself?

Regarding the first puzzle, I am in a gray area with respect to the AMA and FDA guidelines because of my relative health and age.  If I choose the tissue valve, it will wear out in ten to fifteen years and need replacing and so I would face another major surgery.  Of course, the procedure may have improved dramatically by then and not be so difficult.  Just think how heart vessels by-passes have changed over the last twenty years.  If I choose a mechanical  valve, I will need to take Coumadin (warfarin rat poison) for the rest of my life to prevent clots.  By take, I mean faithfully the same time every day, no skipping for forgetting.  The Coumadin will also make me prone to bruising from my clumsiness and make any other surgeries including dental somewhat tricky.  So, the surgeon told me the decision was mine to make.    So, I have some research ahead of me.

Regarding the second puzzle, the surgeon who did the heart catherization told me that the finding could mean I have a benign blood vessel that is connecting the aorta to my heart or that there is an aneurysm that needs to be repaired before it blows out causing a stroke or heart attack.  I will be having a CT angiogram to help the surgeon determine what is the cause.  If there is no aneurysm, the valve will be replaced with a minimally invasive procedure without cracking open my chest.  If there is an aneurysm, I will have the full blown surgery so they can effect a repair.  Of course, I am hoping for the first case as the other one is just plain scary.

The good:  Everyone - the nurses, nurse practitioners, and surgeons were so nice, thoughtful, competent, and worked as a real team.  That gave me confidence I am in the right place for this work.   For example, when the nurses moved me from the gurney to the operating table, I piped up and said I had had a back operation and I would need a pillow under my knees, the response was "coming right up" and the anesthesiologist piped right in with "Then I will give you more pain blocker and less sedation to prevent any back spasms."  Just picture a surgeon with a long piece of metal wire in your heart trying to find the hole formed by a valve and then the person's whole body spasms from a heavy duty back pain.  And to show their thoughtfulness and competence, all my pre-op testing (chest x-ray, ekg, blood and urine samples) was completed before I left the hospital yesterday.  When you live an hour away, that is a huge time and hassle saver. 

Secondly, the test showed that the aortic valve opening is very small and there is no question that I need the replacement.  The other valves operate normally.  So, no hassles with insurance for 2nd opinions or justifications.

Thirdly, the blood vessels of the heart are all clear so there is no need for any stents or other work such as a bypass.  This keeps my odds of dying during or right after the surgery in the 3-5% range.  I will take those odds any day.

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