Friday, December 5, 2008

DH's Thoughts

The mission was to get the line cleared.  And we succeeded.
I must admit, however, I would not be eager to do this particular drill again.

We got it done, thanks to the power of prayer, some planning  and a very resourceful surgeon.  The surgeon, Dr.Sidney Guo, is a young Chinese man, who is also an accomplished violinist.

I liked him instantly; he reminded me of Michael.

Departing from the usual practice,  we did the carotid artery operation without general anesthesia.  This was done primarily so I could signal the surgeon immediately if anything broke loose.

In effect I was serving as another monitoring instrument.  The operation went on for about two hours,  During this entire time I was either conversing with or exchanging signals with the surgeon and his surgical nursing staff  to keep them apprised of the fact that nothing had gone amiss.

The purpose of the operation to clear the carotid artery was to prevent any future TIA's.   A TIA would require discerning the threat and responding within minutes.  The down side of the surgical remedy was the fact that the operation could knock some plaque loose and thereby  precipitate a stroke, disability or death.

I assured the surgeon that although I did not fear death, I was in no rush. In any event we decided to "go for it".  Thanks to our resolve and steadiness, the surgeon's skill and the grace of God, we succeeded with this major operation under local anesthesia.  Rounding out the plan, was  a nap after the operation in the Recovery Room. And after my nap I was ready to go by 5 PM on Wednesday. 
Prayers are always welcome; even now when we are "out of the line of fire" and well along in the recuperation phase.

Dr. Guo came by Thursday morning to cut off the bandages and remove the drain.  The surgical site was drained of about 30 or 40  cc's of  blood during the night.

I walked in to the hospital  at 8AM on Wednesday.  The operation "teed up" at 9:30 AM Wed. and  I walked out at Noon on Thursday.

All that remains now is a half dozen butterflies and some tape over the wound.


Thursday noon I made my escape from the hospital after a 30 hour marathon effort including a very successful operation.

  Was helped by lots of  prayers, which were very effective

  I will be working from home on "light duty"  probably through Monday.

  If you ever need to know how it feels to be awake and alert and conversing with the surgeon during a major operation I can now tell you from first hand experience.

  My left carotid  artery was operated on yesterday morning.  During the two hour operation I was totally awake and "working with" the surgeon. Through his questions to me and my responses and pre-arranged signals back to him and the surgical nurses, he could track "live and in real time" the effects on my brain and thinking ability of his excising, reconnecting and reinforcing a damaged spot in my left carotid artery.

   An interesting experience. 
   A close call.
   And a clear success.
   Deo gratias


Here is a walk through of some recent medical adventures, during which some valuable lessons were learned.

At the overview level the story is as simple as  A, B, C
A.   A Transient Ischemic Attack (TIA) in 2006.
A TIA is a temporary and mild stroke that passes within  a short time: ranges from a few minutes up to a few hours.The TIA does no lasting damage to the brain.  A stroke however does inflict lasting damage up to and including  death.   A TIA is a warning sign that something is amiss.  A TIA may be followed by a stroke, particularly if the TIA prompts no changes.

In 2006 in response to the urging of a friend, I reluctantly went to the Emergency Room about 2.5 hours after a TIA started.  Generally we have about 3 hours to respond to a TIA or stroke.  I wasted 2.5 hours in denial and delay.
In 2006 I made four classic mistakes:
1. not recognizing the TIA,
2. denying it was happening,
3. dismissing it as unimportant and
4. delaying the response of going to the ER to get help.

I did two things right:
1. I was, and still am, lucky
2. I listened to a friend who insisted I should go to the ER and should do so now. She probably saved my life either in 2006 or 2008 or both.

The take away was:
1. I now knew what a TIA was;
2. I had a good set of 2006 base line tests (MRI, Echocardiogram, Carotid Doppler and so on) from the tests the ER people did.
3. I also now knew where to find an ER that could handle strokes.  It was Fair Oaks Hospital; convenient, new and well equipped, with well trained staff who were ready.
B. I  Learned about TIA, strokes, etc. 2006- 2008
Doctors, books, newsletters, hospital literature, Internet and so on
C. A second Transient Ischemic Attack (TIA) on Nov 2, 2008.
Because of the learning that occurred after the 2006 TIA I knew how to detect it, how to preliminarily diagnose it and how to take preventive and remedial action.. Again the TIA came and went with no adverse effects.

But this time I decided to follow through and correct the underlying situation.
Preliminary diagnosis of TIA or stroke is simple.  Here are three tests that are easy to do when we sense a TIA might be underway:

1. Smile looking in a mirror.  If your smile is asymmetric (drooping down on one side) take an aspirin at once and go immediately to an  Emergency Room equipped to handle strokes

2. Raise both arms. If you can not you failed the test and should go immediately to the ER

3. Say a simple sentence like "No ifs ands or buts"  If any part of the sentence is garbled or unclear you should go immediately to the ER

Failing any one of these tests is a signal to get to the Emergency Room.  Within two minutes of sensing the onset of the TIA at about 6:40 AM on that Saturday morning I had done these three tests. Within three minutes I had taken two aspirin and awakened Mary. Within 5 minutes I was on my way to the Fair Oaks ER. Within 15 to  20 minutes from the onset of the TIA I was in the Fair Oaks ER.
The aspirin I took within two minutes knocked down the TIA within the first hour.  That stabilized the situation and we then made contact with the  ER staff.  The ER doctors, nurses and tech staff  repeated all the tests that we had done  in 2006.  Now we had the 2006 baseline and a second 2008 reading.

Again we were lucky and there was no lasting damage.  However, this additional info persuaded me to take corrective action and started me on a round of preparation including seeing my family physician, getting his referrals to specialists, interviewing surgeons, doing tests and finally scheduling the surgery for Dec 3, 2008. The surgery to clear a carotid artery blockage  was successful.  The improvement was immediate and dramatic.  To prepare for and consolidate these gains we are now well underway  on a new regimen of medication,diet and exercise.

Some of this info may be helpful to you and others.  Feel free to share it.
The penalty for either not recognizing a TIA; or not knowing what to do; or not doing it can be severe, up to and including disability and death.
I was lucky in 2006;

...I was ready and lucky in 2008

Was also praying more in 2008; that always helps.

Having been lucky twice, the new game plan is to move proactively to prevent any recurrence.