Doctor Daniel Beckman

TEE Test Update

My Transesphogeal Echocardiogram test went really smoothly yesterday. It’s a relatively painless procedure and all I have is a slight sore throat now which I’m sure will go away soon. And they drugs they give you to knock you out are fantastic. I felt really good after the procedure. I apparently asked Doctor Trippi the same question ten times, but I felt good asking it. Fortunately Stephanie was there to hear all the answers, or I’d be wondering today what the heck we talked about.

It was a little more complex than I expected; they stick you in a hospital bed and wheel it around from the cath holding area to the cardiovascular area to do the test. Any time you have to put on their clothes and they start moving your bed around, you realize this is a real hospital thing and not a simple “visit the doctor” thing. They also made me stay and eat dinner, which was pretty cool, except I was still high and ordered odd combos of stuff.

The results of the test: I cannot get out of open heart surgery. The valve I need repaired is my mitral valve, and some of the experimental catheterization surgeries they do are for other valves, like the aortic valve. So despite my insistence, they will still have to crack me open.
Also: exercise is bad for me, and I can’t do it before surgery. Elliptical machine? Bad. Lifting weights heavier than a pound? Bad. Walking up more than a flight of stairs? Bad. Carrying boxes of books? Bad. Opening stuck jars? Bad. Moving groceries into the house? Bad. Anything that involves strain? Bad. Short, casual walks around the neighborhood are okay.

The reason is that the mitral valve is anchored by strings of tissue that act like the cables of the golden gate bridge, or like the lines of a parachute. The keep the valve from being open permanently. Over time, because my valve doesn’t close correctly, these anchor strings stretched out, and one of them has snapped. The others are ready to do so, and will if I put pressure on my heart. If they do, I’ll be in the emergency room asking them for surgery as soon as possible.

Thank god I didn’t start tearing out the spare room and extra bathroom that I planned to work on this spring. Thank god I went to the doctor for a routine check up so they found this. Thank god I’ve been lazy and used the elevator instead of the stairs at work.

We weren’t able to talk to a surgeon and find out when they want to do it; it was too late in the day for that. But Dr. Trippi said that waiting around for a long time is a very bad idea. I need to get it done in the next couple of months. I have to say I agree, because if I can’t exercise or do anything I’m used to doing, I’m going to be bigger than a frickin’ house.

We have an appointment to talk to Dr. Beckman, who will be my surgeon, early on Tuesday morning to find out all the details of surgery, recovery and what day and time we need to do this.

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Transesophageal Echocardiogram Today

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I go in for my Transesophageal Echocardiogram (TEE Test) today at 3 at Methodist Hospital downtown. I had a big breakfast because I can’t eat 5 hours before the test, since they stick a tube down my throat to do an ultrasound from inside my body. They also have to sedate me, so Stephanie’s coming with me for the test so she can ask intelligent questions (which I’ve written down) and drive me home, since I’ll be loopy. After the test I should know a lot more about my condition, including when I would need to have surgery and what recovery will be like.

The main question I want to ask is whether I have to have open heart surgery, or if I can do some of the other heart catheterization surgeries that they’re doing for valve repair. I don’t deny I need to have something done, but if I can avoid having them crack me open like a walnut, I’d prefer that. I know Dr. Yee said that they couldn’t do the less invasive surgery because there are two valves, but I want them to go into detail about that.

I also want to know a lot about the surgeon. Like a complete biography, and how many times they’ve done the surgery. And if they’ve ever had someone die on the operating table. Because if this is someone who’s going to drastically alter the course of my life, I don’t want it to be some stranger I meet the day before and then never see them again.

It’s strange, because first I feel much better about this whole thing, but then I’ll get scared and start crying at really weird times, like right before going into a meeting at work. Which is just so graceful. I pick the strangest, most inconvenient times to fall apart.
There are some things I’ve done to prepare for all this though. Since I’ll be preoccupied and won’t be able to write regular scathing remarks about how retarded George Bush is, I took my little flight suit George Bush doll and hung him upside down and stuck pins in him. Not in anyplace vital, just his knees and elbows and stuff. That should hold him until I feel better. If we find out Bush suddenly has erectile dysfunction, you know who to blame.

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Stuff you read on the internet that scares the crap out of you

From this page:

Expectations after surgery:
The rate of success of heart valve surgery is high — and increasing. The operation provides symptom relief and prolongs life. The death rate varies depending on the heart valve and averages 2% to 5%. Approximately 2 of every 3 patients who received an artificial mitral valve are still alive 9 years after the surgery. Life-long anticoagulant therapy is necessary for patients with artificial heart valves. The clicking of the mechanical heart valve may be heard in the chest — this is normal.

2 of every 3 patients? 9 years? Oh my god. Okay, wait a minute. That’s for valve replacement, not repair. And, this make me feel much better:

Conclusions– Mitral valve repair using Carpentier’s technique in patients with nonrheumatic MVI provides excellent long-term results with a mortality rate similar to that of the general population and a very low incidence of reoperation.

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Open Heart Surgery

I’ve waited a bit to write about this, because I need to talk to my family and friends first. It appears that I will need to have open heart surgery to repair my defective heart valves. I’m hoping to get some other opinions and information on less invasive types of surgery, but that appears to be what I know currently.

After I had the stress echocardiogram last week, that was the analysis the cardiologist (Dr. Yee) gave me about what he is seeing. His conclusion is that my heart valves, especially my mitral valve, are failing, and eventually I will have heart failure, possibly in the next two or three years. If I go in and get the valves repaired now, I have a prognosis of living a normal, long and healthy life. The sooner I get the procedure done, the better, because it will be a repair of the valves, rather than a replacement, and my heart will not enlarge to fight the valve failure.

After I get the TEE test that I wrote about earlier, the surgeon will be able to tell me whether I need the procedure next month, or if I can wait a bit longer, like six months. But Dr. Yee is saying that I will need surgery this year.

What’s interesting is that this is the reason some of my shoes don’t fit any more. My feet are swelling because my circulation is poor. It’s also the reason I haven’t been able to lose weight easily while exercising, because I’m just not able to burn enough calories before I get tired and out of breath. So this surgery could help me lose weight.

Obviously, if this is the surgery I need to have, it’s a pretty scary thing, because they crack open my chest and put me on a heart & lungs machine to circulate my blood while they stop my heart to work on it. After the surgery, I’ll be in intensive care for several days. The recovery time is significant and for a little while after I come home I’ll need someone with me to watch me 24 hours a day.
Stephanie is already making plans to move in for a while to be with me, which worries me a lot, because this is a huge burden to fall on one person. She will need to go home twice a day to feed her cat, and I’m hoping my family will help and support her if they can. I’m also very worried about the hospital not recognizing her as my spouse and letting her visit me, and I want to make sure that they know she is the number one person I want with me, along with mom.

The following links about open heart surgery are not from my hospital, but they do cover some basic information about what the surgery and recovery are like.

On the bright side, according to this page, I’ll be able to resume fishing after 6 weeks, and firing small caliber pistols after 2 months. Woo hoo!!

This link seems to have a lot of good information: from Brigham and women’s hospital

Open Heart Surgery – What to Expect
Heart Valve Repair Surgery
Mitral Valve Repair
heart valve surgery
Mercy Hospital Open Heart Surgery

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Transesophageal Echocardiogram

More health-related googling and blogging for me.

Transesophageal Echocardiogram

TEE or Transesophageal Echo

Basically, I have to have one of these soon to see what’s actually going on inside my heart.

Today I went to the cardiologist (Dr. Yee, Cardiac Care Center, Methodist Hospital) to talk about the results of my recent echocardiogram. While I was there, he was interested in finding out how my heart reacts to stress, so he had me stay and and do a stress echo, which is the same thing as last week, only with exercise. Basically they do an echo, then the put you on a treadmill to get your heart rate up as high as possible, then they lay you back down and do another echo while your heart rate is way up. It wasn’t as fun as the last one; it was exhausting.

They were able to learn a lot more about what’s going on, but they don’t have a really detailed picture of the architecture of my heart, which is where the Transesophageal Echocardiogram will come in. Unfortunately, what that involves is sticking a tube down my throat and doing an ultrasound from inside my body, which means I have to be put under and on an IV, etc. I have to have some one take me and pick me up from the hospital, etc. More complicated and stressful.

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Heart Update

I got a call from the nurse… my cholesterol is down from last time I had it checked. It’s 181, which is considered normal. All my other bloodwork is good, too, including my potassium and calcium levels, so the doctor is quite happy with that, and I need to keep eating healthy and not let anything get worse.
181 – total cholesterol (optimal: below 200)
133 – triglicerides (optimal: below 150)
110 – LDL (optimal: below 100, Near Optimal: 100-129)
44 – HDL (average: between 50-60)
So I still need to lower my LDL and raise my HDL cholesterol a little bit.
The echocardigram shows my pulmonary valve stenosis is now considered moderate, which is worse than before. The mitral valve prolapse is apparently the same. So I need to go see a cardiologist. They’re setting up an appointment for me at Methodist downtown. I’m not sure if that means anything at all, or if it’s any sort of problem. I guess I’ll find out from the cardiologist when I talk to them.

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Echocardiogram fun

I had my test yesterday, but I don’t find out the results of it for a couple more days. It went really smoothly, though, I think. It was very interesting and I want to write more about it when I get some time. I’m hoping that I can write enough about it to make a decent article for IndyScribe.

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Heart Matters

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Heart DiagramWhat an echo-cardiogram is.

Also, the dangers of Endocarditis, also known as heart valve infection.

I’m googling these things because I have to go get an echo-cardiogram for the first time since I was a kid. I have a congenital heart murmur, which has apparently gotten worse in the last two years.

More specifically, I have two problems: a pulmonary stenosis, which means my pulmonary valve is too narrow and doesn’t pump blood efficiently. And I also have Mitral Valve prolapse, which means my mitral valve doesn’t close completely and allows blood to flow backwards into the previous chamber, causing a whooshing sound or “murmur.”

Apparently my murmur has gone from a grade 1 to a grade 3 on a scale of 6. It’s possible that this increase in the murmur may be a result of age, or as a result of a heart valve infection that occurred when I had my appendix rupture.

Interestingly, this site mentions as symptoms two things that I do recall having: fatigue, exhaustion, and light-headedness (may result from low cardiac output) and shortness of breath when lying down (orthopnea). Hmm.

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