Aortic dissection, aortic aneurysm - The aorta - Life after an aortic dissection
My wife and I were about to embark on a 6 mile hike in Arches National Park in Moab, Utah when I lost sight in my right eye. The rangers gave her directions to the local community hospital that was about 2 miles away. It took the hospital staff about 20 minutes to determine that my condition was too severe for them to treat. They called a Medevac helicopter that transported me to St Mary's Hospital in Grand Junction, Colorado. It was Sunday. The Chief of Cardiology and Thoracic surgery was the doctor on-call. He arrived shortly, studied the data that had been collected, and gave me 2 options to correct what was thought to be my problem: 30% long-term survival with medication or 80% with surgery. I chose 80%.
While I was being taken to surgery the doctor told my wife that I was in extremely bad condition and that she needed to say goodbye to me. The surgical team was shocked to discover the extend of damage that had actually occurred when they opened my chest. I was immediately placed on a heart-lung machine with critical blood flow resumed. The aorta was dissected from heart to pelvis. The 3 arteries at the arch of the aorta were loose or disconnected. Clots had settled in the right arm and leg and paralyzed that entire side. The surgeon stepped outside the operating room to tell my wife that there was virtually no chance for my survival at that time, but they would still perform surgery. I had critical problems with heart rhythm throughout the first night in ICU. The surgeon indicated that they were monitoring me closely; almost by the minute. My survival was still close to zero percent. The second day he reported with a smile and upward nod that to his amazement I might actually survive, but the next few weeks would be critical.
Surgery took 8 hours to repair the aorta from heart to pelvis, reconnect the three arteries, and implant a mechanical St Jude aortic valve. My age determined the choice of valve. Blood thinning medication for life was thought to be a better trade-off for future surgery in my 80's. I regained the use of my right leg, ankle, and foot within a few days while still in ICU. My fingers started to respond the second week in Telemetry. Fortunately, I am left-handed and could eat, write, and eventually use my iPod. I was walking with a walkers the third day in rehab. I gave up a cane two weeks after I returned home in October. I continue to have some problems with my right shoulder, hand and fingers, but estimate that I have recovered 80% to date.
I was in hospital for 5 weeks (1 in ICU, 1 in telemetry, and 3 in rehab). We drove the 1,800 miles home to Atlanta, GA upon discharge. Rehab was continued at Emory University School of Rehabilitation Medicine from October 2009 through April 2010. Botox injections (12) in January to the right forearm considerably improved the use of my wrist, hand and fingers. I started Feldenkrais therapy in May and will complete group sessions in mid-November. My strength and endurance continues to increase. Feldenkrais has provided the most improvement. It took me about 6 months before I could walk the 2 mile round trip to our post office, but now I do this almost daily. I resumed driving in April. Tennis may not be an activity again, but I intend to resume golf, even if initially with one arm, in the coming months.
INR tests were started in October at the Emory Coumadin Clinic and continued through mid-April. The mechanical valve qualified me for the CoaguCheck XS Patient Self-Testing equipment and supplies and are provided through Medicare. Tests results have been more consistent with home testing. My target range is 2.5 to 3.5. I have maintained 2.7 to 3.2 for the past 6 months. I eat a few leafy green vegetables and don't drink any alcohol except an N/A (1) beer most nights. Ice cream has become a favorite and helps keep my weight more stable.
An echo cardiogram was performed in mid-November, approximately 14 months after the dissection. The result showed that there was no area of concern. A Cat Scan will be performed in November 2011.
Cheers, Deryck Muehlhauser
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