Wednesday, December 6, 2017

Heart By-pass Surgery

Location: New Rockdale RV Park; Mansfield, Louisiana

Here is the typical advisory to readers about this post: Although this blog is primarily about RV travels, it is also a means to document some important events in mine and my family's lives. It is my hope that my grandchildren and their children will be able to read it in the decades to come. This post is another update on the medical issues of my youngest son, Brandon. The posts in this blog, even those that are not travel related, are open to anyone to read and on which to make comments. The comments are encouraged. Just letting the readers know that this post is not about travel.

The last post was dated about a month ago. At that time, we were waiting for a heart cath to be performed on Brandon. It was to be the last test before he would be placed on the "active" waiting list for a kidney/pancreas transplant. After he had passed previous tests, including a stress test, we thought the heart cath would be a mere technicality, although in the back of our minds we are never sure about anything. 

Brandon had the heart cath on November 15th. Afterwards, the cardiologist showed us the video and gave us the bad news. Two of the three main arteries of the heart were 99% blocked. He would need at least a double by-pass and possibly a triple. Brandon was essentially living on one artery. If that one failed, death would be almost instantaneous. The good news was his heart was strong and had suffered no damage since there was never a "heart attack". This was one of the "unexplainable events" (miracles) that happened over the last month. We told the doctor that Brandon had walked into the hospital for the heart cath and he had been power washing the back patio a week prior. When asked if he had any chest pain or shortness of breath, Brandon said "no". The cardiologist appeared shocked that there had not been any symptoms or why he had not had a heart attack.

Since Brandon was taking Plavix, an anti-blood-clotting drug, he would have to wait 7 days for the plavix to leave his system before any major surgery. They immediately admitted him to the hospital and assigned him to bed rest while waiting for the 7 days to pass. The bed rest was required due to the doctor's concern about a possible heart attack from any physical activity.

The kidney doctor was worried about Brandon's elevated creatinine level which meant his kidneys had indeed taken a hit as a result of filtering out the dye used during the heart cath. To prepare for what he thought would be a kidney shutdown, the doctors installed an "emergency/temporary" hemo-dialysis port in Brandon's chest. Although the peritoneal dialysis catheter was installed a month prior to the heart cath, it was still not usable. The kidney doctor wanted to perform a hemo-dialysis prior to the surgery but the heart doctors were too concerned about the dialysis stressing the heart so much that it could cause a heart attack. The kidney doctor deferred to the heart doctors but continued to monitor the kidneys. Each day that went by, and each blood test taken while waiting for the surgery, showed either a small improvement or no change in his kidney function. Now the kidney doctor was surprised just as the heart doctor had been after the heart cath. Unexplainable. The dialysis port would remain and they thought for sure it would be needed after the surgery since the kidneys would again suffer from the heart and lungs being shut down during surgery.

The by-pass surgery was scheduled for November 21st. The surgeon told us that Brandon's case was so unusual that he had consulted with four other cardiac surgeons. The recommendation of two of the four was to NOT do the surgery. They did not say what else to do, just that the surgery was too risky. They were concerned about heart attacks and strokes while on the operating table. Fortunately, our surgeon was confident the surgery was possible. He hoped to be able to use two arteries in the chest as by-pass vessels. This would negate the need to remove veins from the leg for that purpose. It would depend on the condition of a possible third blockage. The doctor would make that call during surgery. This may seem minor, but in Brandon's case it was a major deal. If they had to cut his leg open to find usable veins, this would cause recovery problems since they would be cutting on his one good leg. In addition, the arteries near the heart would last 30 to 40 years, while veins from the leg would last half that time. Again, good things happened. The surgeon was able to use the arteries near the heart since there were only two blockages. He said the stents that were installed about 10 years ago were totally blocked and that they had never seen that before in all of the by-passes they had performed. He was still amazed that Brandon had not had a heart attack or showed any symptoms.

After surgery, Brandon had all arteries leaving the heart now flowing full. The kidneys rebounded even more with the new blood flow and the emergency/temporary hemo-dialysis port was removed after never being used or needed. Chances are he will need dialysis sometime in the future, but will be able to do the peritoneal dialysis instead of the hemo-dialysis. 

Brandon was released from the hospital on November 29th and sent home. He was offered some in-patient physical therapy for the residual effects of the previous strokes but he declined. He had been through 2 sets of those in-patient PT programs in the past and didn't think it would be of benefit to him. He is now recovering at home with his 5 dogs while waiting to begin cardiac rehab. 

Partial summary of "good things" that were part of a bad deal:
1) had he not have had the heart cath as a part of the kidney/pancreas transplant review, he surely would have had a massive heart attack. If he would have survived that attack, his heart would have been severely damaged. 
2) although the doctors anticipated it, his kidneys did not shut down as a result of the heart cath or the by-pass surgery.
3) the heart surgeon was able to use the arteries in the chest for the by-pass instead of harvesting veins from his leg. 
4) while he was only using 1 of 3 main arteries prior to the surgery, there was no damage to his heart. 

Through it all,,,, Brandon attitude remained, "it's just another thing". Remarkable. He has been an inspiration to so many in the way that he dealt with this bad news as well as bad news he has received in the past. 

The cardiac surgeon, who has performed hundreds of these by-passes, explained it best when he said, "he could not scientifically explain many of the things about Brandon's case."
Olivia giving Uncle Brandon a hug before surgery.

Me talking to Brandon after the surgery.

Brandon's first steps after the surgery.

Brandon being wheeled out of the hospital one week after open heart surgery.

Ya'll take care of each other. Maybe I'll Cya down the road.