Pumpy and a Better Blog Than Mine

A couple of weeks ago, while I was trying to process all of this crazy heart surgery stuff, a gift arrived in the mail.  This little guy is a "realistic" heart plush toy!!!  I think that is he is adorable!  I posted a photo to Facebook but nobody owned up to sending him to me. 

My kids asked me what his name was (which I hadn't really thought about) so I named him "Pumpy".  Too literal?  Probably but I liked it so it has stuck.

Pumpy the plush toy!

He's made by http://iheartguts.com/ and they have a huge array of toys, and gizmos for a ton of different organs.

My personal favorites are the tonsil and the colon!  How awesome is that???

I can think of a bunch of people that could use a plush toy of their offending body part!!

I also bought some button badges and a heart key-ring for myself (arriving soon).




Plush toys arriving from an unknown source would probably not be something that I would normally have shrugged and said "that's awesome" except that I have so many wonderful friends that might have sent him alone out of the goodness of their hearts!  I wasn't even really in search of the sender - just a little curious.  Just a couple of days ago, on of my best friends messaged me and asked if I had figured out who sent the push toy and followed the question up with a 😜 HaHa!  Yes I had my sender.  My buddy told me that he had seen a the toy on a blog that he had been recently reading and couldn't resist sending me one.  I *had* to ask more about this blog, so he explained that it was about a young scientist who found out that she had a congenital heart defect and required open heart surgery to have it corrected.  Of course, I got the name and started reading!

I have to say that my blog is mostly just random crap that is floating around my brain, but https://defectiveheartgirlproblems.wordpress.com is the work of a very clever and funny lady (Summer) who approached her surgery in a not-too-dissimilar way that I am.  She did a lot of research, learned about the options, asked lots of questions and blogged her journey along the way.  It was a fascinating read for someone of a similar age (ok she's 5 years younger) facing down a similar surgical procedure.  Reading about the run-up to her surgery is eerily familiar to my current situation and following her through the procedure, recovery, return to the civilization and the on-going challenges of dealing in a post-operative world.

There were a few bits and bobs that she shared that I have been dwelling on (more like noodling on).  One thing that she said was that she was going "science the shit" out of her experience by learning as much as she could about it and applying her scientific methods and understanding to each step in the journey.  The funny thing is that I had only just recently said to my wife that we needed to "project manage the shit" out of my op and recovery (and about how what assistance we'll need around the house, with the kids, etc). 

Something else she mentioned that she was "fucking pissed" at her heart; that her heart had violated the trust that she had placed in it all of her life to keep her alive. In her case, her heart was slowly getting worse but she had absolutely no symptoms so she didn't have a clue that there was anything wrong (beyond being told that the had a heart murmur in the past).  I had never really given much thought to my heart beyond just being a body part, but something at which I could have a semi-disconnected emotion towards.  But I totally get what she was saying.  

In her case, while the surgery was successful, she had some serious pain issues post-operatively and then was hit with PTSD a year and a half later, probably related to how clinical her approach to her situation had been which failed to fully embrace the emotional elements along the way. The emotional roller-coaster that she experienced ended up changing the course of her life and even made her rethink pursuing a PhD. 

Summer's blog really reinforced my own thoughts and feelings about the procedure and I'm hoping to learn from her experience and really attempt to address the emotional side at the same time as the medical/physical side.  In fact, a few weeks ago, I engaged a therapist to talk through my emotions with.  So far we've had some good sessions.  Being Irish, the idea of "getting a therapist" seemed counter-cultural.  Therapists are something in Hollywood movies (who always seem to hook up with their patients after the first visit). Seemed like a good idea to me!! When I told her that my Mother had indicated some concern that I would end up in an affair, she laughed and said she had a policy of no romantic or physical relationships with her patients!! 

Questions to Ask the Surgeon

Sleepless nights abound for the past few nights. Mostly because of the whirlwind of thoughts swirling around my head. I've found that my therapy is to put those thoughts out of my mind and into my blog. So probably most of the time, the posts are mostly a uninteresting, unintelligible mix of disorganized thoughts.

Over the past few nights I've been trying to assemble the questions that I want to ask the cardiac surgeon when I go to visit with him next week. It started out with just the things that came to mind to me, then I started looking online for other lists of questions to ask a surgeon. As you can imagine there are a ton of different sites that have plenty of questions, so I added the ones that I thought were relevant to me. In the interest of sharing I thought I'd write a blog with my question list so that I would add to the overall body of knowledge.

Here goes:

Questions to Ask Your Cardiac Surgeon

About Surgeon

• How many aortic valve replacements have you done? 
• What has been your success rate? Do you know about long-term success rates? 
• What area do you specialize in? 
• How many total heart surgery procedures are done at your hospital each year? 
• What is the overall mortality rate at your hospital? 
• What type of certification(s) do you have? 
• Do you, your team and hospital take my insurance? 

Alternatives to Open Heart Surgery

• What options are available in Bremerton? 
• What options might be available at in Seattle at VM or at Swedish? 
• What are the Risks, known effectiveness/record/longevity of the surgery that you are recommending?  
• Cardiologist’s description of newer methods. * 

Mechanical vs Bovine Valve

• Ongoing coagulation monitoring / management. 
• Likelihood of advanced procedures being available in the future to swap out bovine. 
• Deterioration of bovine valve in later life comes with similar symptoms to mine now? 

What to expect on the Day of surgery

• Normal timing 
• Get there at what time 
• How long from Pre-work until going to theater 
• Time between in OR and being placed under anesthetic 
• Time from ‘under’ to surgery completion 
• Time between completion and waking up 
• What prep work will be done to my body/hair? 
• How many people will be in the operating room? 
• Who will be doing the surgery? 
• Who will be the anesthesiologist? 
• How often will my family be given updates? 
• Urinary catheter? How long does that stay in during recovery? 
• What are the possible complications during surgery? 
• Will I need to fill out paperwork to suspend my advanced medical directive? 
• What happens to the valve tissue that is removed? 
• Can you take photos of the procedure for me? 

Recovery

• How soon can my family see me? 
• Can I have company overnight? 
• Estimated s duration of stay in hospital 
• What medical home-help requirements will I require? 
• What are the time estimates before returning to: 
• Being up and about in hospital 
• Walking (for as much as I amble) 
• Lay on side or front 
• No longer need assistance with daily life 
• Returning to Work 
• Driving a car 
• Having Sex 
• Feeling ‘normal’ 
• What will the pain management be during recovery. 
• What type of record keeping will I need to do (blood pressure, coagulation metering, etc.) 
• What doctors will be involved during Post op/Recovery in/out of the hospital: 
• Who? 
• How often? 
• Dietary restrictions during recovery? Low salt/extra fiber/prune juice? 

Post recovery

• Emotional support requirements 
• Post op visits (on going) 
• Dentist /strep throat implications 
• Long term lifestyle restrictions? 

Specific Concerns<Whatever concerns might be personal between you and surgeon>

* My cardiologist was not very enthusiastic (at my last visit) about the newer surgical methods. He noted a few of his recent patients who went off to Seattle and even to the Cleveland Clinic (top rated Cardiac facility in the country) and ended up with bad outcomes from the less invasive methods.

Simple Revelation

As you know, I'm currently in an infuriating holding pattern between being told that I need to have heart surgery and talking with the cardiac surgeon about what the next steps are (including when I should anticipate actually having the surgery and what form it will take). This is certainly a time where I'm just wishing that everything can be out of the way and for Dec 1st to just be here now.  To some extent it's tough because I'm sort of wishing this wonderful 4 day weekend to be over so that I'm just that little bit closer to finding out what's happening next.

During this past week, I believe that I have had an epiphany about how I'm feeling about the some of the situation. And that is that I just don't like being 'looked after'. It seems kinda petty but most of my career, I've been the problem solving guy, or the answers guy and I've rarely leaned very heavily on others to find solutions. Don't get me wrong, I've worked on some great teams and with some wonderful coworkers but mostly, I've been someone to propose a solution or solve a problem.  I'm just now coming to terms with the fact that when others are helping me (dishes, making food, carrying things, getting coffee, etc) I'm not in my element.

I'm now pretty much at the point where walking to and from the refrigerator causes me to be short of breath, carrying something somewhat heavy makes me breathe heavier than normal and breathing exclusively through my nose causes me to not be getting sufficient oxygen. My darling wife and kids are doing their best to stop me from over-stetching myself much to my own shagrin. I recognize that I need to accept their help and admonition but emotionally I'm not ready for that.

Today, I cooked our traditional Thanksgiving lasagnes. It's been something we've been doing for a while. Eat lasagne, stay in our jammies and have no great expectations for the day. This was the perfect setup for someone in our situation and we worked it to the end. This weekend comes time to put up the Christmas tree, without my help bringing the boxes down from the attic. I should probably feel more sad about that than I do (the part where I can't help) but perhaps this is a me focusing on the positives of being helped out!! ;)

I was helped out by my sweet 7yr old who did a remarkable amount of the tasks including peeling zucchinis and gathering all of the ingredients.

Today I'm thankful for my family and friends and for a short time between now and getting a new heart valve.

Medication side effects

There are things that still are weird to me after 16 years of living in the USA including the advertising of prescription medications on TV and Radio. In Ireland, it is not lawful to advertise prescription-only medications to the general public. That means that we lack the joy of the Erectile Dysfunction commercial while watching football during dinner on a Sunday evening ("Daddy what does 'an erection lasting 4 hours' mean..?"). Also, you don't get a chance to listen to the seemingly unending list of side effects (all sounding far worse than the condition that the medication is supposed to treat). You know what I mean... The commercial for toenail fungus medication which touts suicidal tendencies, all over body rash, limb numbness, toe amputation, and 'in rare cases' death...

Why am I thinking about this right now? Well because I've had a crappy night's sleep and mostly to blame is one of the side effects of my medication to control my blood pressure.

When I was first diagnosed with high blood pressure (just after the incident in Vegas), my doctor called in a prescription for a drug called Metropolol.  After just a few days, my blood pressure was almost always back in the 'normal' range.  A couple of weeks went by and when I diligently checked my blood pressure daily, I noticed that I was still not in the normal range on every read out. I called the cardiologist (by this time we were already going through the various testing etc with the cardiologist so I figured he was the person to make the call) and asked if there was something that could be done.  He just said to start taking 2 pills per day instead of one and that he'd call in a new prescription for the 2x dose (which I picked up later in the day).

Nerdy side note: These pills are absolutely tiny and the new 'double dose' pill was identical in size with just a different number printed on it. It just goes to show how much of the pill, even one as tiny as that, is filler. Doubling the dose had no impact on the size of the pill.

Anyhow, I started the 2x dose right away and within a couple of days, every blood pressure readout was normal! Yay.  I never spent much time reading up on the side effects of the medication, mostly because I didn't want to cause myself to start seeing problems where they really weren't an issue. However, after another couple of weeks on this new dose, I started to notice that it was hard to persuade myself to get out of the bed in the morning. In fact, I wasn't really all that enthusiastic about doing anything. My wife observed my lack of interest (and how hard it was to get me out of bed in the morning) and asked me if I noticed.  This gave me pause to review the side effects of the medication, and sure enough, nested in with 'difficult or labored breathing', 'inability to speak', 'short-term memory loss' and 'troubled breathing' was 'extreme fatigue' and 'lack of interest'...

'Lack of Interest' seemed like a pretty broad side effect and yet it seemed to sum up what my wife had observed.  Clearly this, along with a, now explained, extreme tiredness was not a long term situation with which we were willing to deal. So we decided to bring it up at the next cardiologist visit (a few days later). He was very understanding and immediately called in a prescription for a different medication that would still control my blood pressure, but wouldn't have those side effects. Truthfully, I believe that these drugs react differently with each patient so there is some guesswork associated with finding the pills that have the side effects that are livable with. 

As I picked up the prescription from the pharmacy, the person behind the counter asked if I had ever taken Lisinopril before. I said that I hadn't and they said that the most common side effect was a cough, and that it likely subside over time.  "A cough"  didn't seem too bad given the "not wanting to get out of bed" side effect of the first one so I went along my merry way.  After about a week on the new meds, sure enough, from time to time, I would get a tickling sensation at the back of my throat that caused a dry cough. It would just come on suddenly, and go away as fast. Sometimes the sensation would stay for a couple of minutes, other times it would go away after a drink of water. Annoying, yes but not a show stopper.

This might be too much information, but sometimes while cleaning my ears, I inadvertently poke the cotton swab too far into my ear causing me to cough. Yes, I know that they say very clearly on the outside of the box that they are not meant to be placed into the ear, but isn't that the reason we buy the damn things??  Anyway, I prodded too deeply into my ear last week and I immediately noticed that the sensation that caused me to cough was exactly the same as the medically induced cough. Now I don't know what caused my brain to move to the next step but, later in the day, I had urge to cough (from the medication) and I poked my finger in my ear and the sensation went away with no desire to cough!  Weird huh? Ever since then (where it wouldn't be totally weird to stick your finger in your ear) I've used this method to calm the urge to cough. It's not 100% but together with a drink of water, it seems like an effective way to control it.

Still not clear why this is relevant today at 4:30am on a Sunday? Well for whatever reason, my tickly medically induced cough was a real pain over night. It didn't matter how much water drinking and ear poking I did, it came back quickly. It woke me up several times and made it hard to get back to sleep. Now it seems to have calmed down again I'll hopefully get some sleep but I wanted to share this story with you because it was swirling around my head and I wanted to get it out!

Christmas Cards

In years gone by, November was a special time where I would assemble the 'machine' that was my Christmas card processing plant. This normally included last year's lists of sent and received Christmas cards, addresses, stamps, multiple years of printed address books, etc.  Each year I would work through relatives and friends until all of the folks are covered.

Suffice it to say that I previously endeavored to ensure that each card was crafted and customized toward the recipient to engage them and have them know that during the time that I was writing the card, I was thinking about them and their family.  Sometimes that meant a note about their life based on the updates from Facebook or the latest news via Mum and Dad from home. But it was always personal and never generic.

This blog post is, unfortunately, one that is saying that Christmas cards are not 'on the cards' this year. If you would normally receive a card from us, please accept this post as your card. There is plenty of news on this blog to take the place of the annual  obligatory Christmas letter. Please don't slot us into the 'do not send card anymore' category as we love getting cards (we hang them up in our kitchen), we're just not going to reciprocate this year.  (I realize that this is selfish).

To fill out the story beyond my crazy health concerns, dear wife is getting along great at work with union, teaching and college project work. The middle schooler is a straight A student and two youngest are excelling in their classes. We're blessed with wonderful workplaces and kids who love learning and are reasonably well behaved!

Yep, the purpose of this blog post is to let you know that we're not going to be sending Christmas cards this year. I don't feel great about it but I feel a certain relief in knowing that it is unilateral and definitive. I'm sorry if you expect a card every year, I'm pretty sure that you can catch up on our lives via our generally prolific Facebook postings. I'm sorry if you were hoping for a family photo but I've posted a million photos since last year. Know that right now getting all of the family into one room to have a family photo is beyond our hope of civil discourse.  But most importantly, know that I'm planning on going through my Christmas card lists during my impending surgery and recovery and will be looking for ways to reach out via email to each family to tell them that we're thinking about them and hoping for a wonderful holiday season for them and their families.

If you are still reading this post, have a great Thanksgiving, Christmas and/or whatever holiday you're celebrating at this time of year. We love you, are thankful for your friendship and wish you and your family prosperity in the future.

Calculations

I'm just mulling things over in my head and decided to put it down 'on paper' to try to clear my mind (or at least have a way to articulate it in the future and maybe get back to sleep).  In terms of outcomes of surgery, I feel like there are many factors driving the discussion about surgery methods and valve types.  Here are a few that are most critical to me:

Risk
I'm not sure what this means to me exactly. I guess it's the likelihood of something going (or not going) haywire during the procedure resulting in a significantly undesired outcome. I suppose that means how much of a chance that I might die, or be permanently injured in some way.

Success
In my mind there is something different to 'success' beyond the opposite or Risk. Perhaps success is more than just 'not dying' but the extent to which all of the expected outcomes have been realized. Things like that the surgery took the expected time, the valve replacement went without any issues, the surgeon had no problem with sewing me back together etc.

Recovery
This one is pretty straight forward. How long until I'm out of the hospital? How long before I can start moving around relatively normally? How long before I'm driving, exercising, feeling normal or
getting back to work? I don't know all of the milestones but will probably think about that in more detail soon.

Longevity
How long will the new valve last? Will there be the need for surgeries in the future for maintenance and/or replacement? What are the odds that future surgery can be done minimally invasively? Might the choice of valve type or surgical procedure now impact the ability to use minimally invasive techniques in the future? Does the new valve come with some limitations on me now or in the future (taking medication, avoiding certain activities etc)?

These factors are all critically important for me to know, but even more useful when evaluating the different surgical options. Do they have a weighing? Yes they do! (Thanks for asking.)  To me, if an element of procedure/valve type influences Risk, that is the least flexible of the factors. Meaning that I'm likely to gravitate to the combination considered least risky, even if the result is longer convalescence (for example). Recovery seems like a fact that could be considered selfish and short term thinking. I understand that I'm going to want to be on the mend fast, but not if it is at the expense of a lower risk, longer term fix.  Obviously Success is critical too but Longevity must be considered for future me who may have to undergo follow on procedures in my 60s... I'm going to lean towards the "we do this all the time, the risk is low, success rates are high and you'll never need additional surgery" over "this is a newer technique which is less proven and potentially higher risk, but if all goes well you'll be back on the golf course in 2 months until you have to have it replaced when you're 55".

I don't know if I have made anything clearer for myself but I know that it's not swirling around my mind so that might mean that I can get back to sleep.  Thanks for indulging me.  Feel free to comment below if you have any words of wisdom.

Hurry up and wait

Well, continuing the 'hurry up and wait' nature of my current medical fun and excitement, I visited with my cardiologist at the end of last week.  He seems very anxious to get the surgery scheduled as I appear to be having more and more difficulty doing the simplest of things without getting our of breath or tired.  The cardiologist's office called the surgeon and I've been given a date of December 1st for a consult with the surgeon.

Honestly, the 1st of December seems like months away from now (even though it's really only 3 weeks). Unfortunately we ran up against the Thanksgiving Holiday so that impacts availability.  If I were to be 100% honest, I'm not happy about another wait.  I can't drive.  I likely won't be able to drive for 6 months from my last episode of passing out. Just today, after attending the kids' soccer games, I came home and was so tired that I needed to lie down in bed for an hour.

My concern is that things seem to be changing rapidly.  The cardiologist said that people with my condition are "unlikely" to have any sort of heart attack type episode (but it's not out of the question).  I want to have this taken care of now.

I may have covered this in the past, but the main thing that we need to lay out with the cardiac surgeon is the type of surgery (and the type of replacement valve).  There are a few options that need to be considered.  For the procedure itself, the "traditional" approach is to have open heart surgery (pretty grueling procedure but is considered pretty routine, and the risks are well understood and normally well controlled). However, there are emerging treatments that allow for smaller incisions with more intricate tools to complete the valve replacement. Other options might be robotic surgery or valve replacement through catheters placed into your femoral artery.  The thing is, the newer treatments are less well-understood and are subject to more uncertainty.  The cardiologist told us a story about one of his patients who insisted on going to the Cleveland Clinic to have one of these newer procedures, but it went terribly wrong and caused lasting damage to the patient.  Let's face it, that doesn't sounds great either!!  

As for the type of valve, there are two main categories that are relevant for my situation.  The first is a big valve.  Yeah, where you get tissue from pigs that are grafted in during the procedure.  The drawback with this type of valve is that there is a limited life span.  A pig valve installed now would likely need to be replaced in 15-25 years. The advantage of this type of valve is that it requires no follow-on medication.  It's installed and then it works until it needs to be replaced.  The other type of valve is a mechanical valve.  This type of valve will last for the lifetime of the recipient. The drawback is that the valve tends to cause blood clots so the recipient needs to be on blood thinners for the rest of their lives (without any exception at all at any time).

My cardiologist is pretty clear on what his recommendation for me is based on my age: Open Heart Surgery with a Mechanical Valve.

These are the conversations that we will be having with the cardiac surgery.

I'm probably going to call the surgeon's office during the coming week to see if there are any openings before the Dec 1 time.

On an unrelated note, I need to cancel my scheduled colonoscopy and to cancel a visit to a genetic specialist about testing for a possible genetic condition from my Mom's side of the family.  Both of these appointments were scheduled for November but I'm not in any shape to be doing those things...

A Glimpse Into the Future?

Yesterday,  I was pointed in the direction of a friend of a friend (Patricia) who went through open heart surgery a couple of years ago and had posted a fair amount of her experience to her Facebook wall before the procedure and during her recovery. Patricia gave me permission to go back and read through her posts. It was a fascinating look into what I can expect once I get there.

In case you haven't caught up yet, I've been diagnosed with a congenital heart defect called Aortic Insufficiency (or Aortic Regurgitation). effectively it's a leaky heart valve. I was diagnosed with a heart murmur when I was a baby but doctors told my parents that it was nothing to worry about. I've lived all of my life with this leaky valve without many symptoms. In saying that, I've always thought that I had some sort of asthma (but was never diagnosed with it) because I frequently got out of breath with mild exercise. Frankly, I've always just thought that I was out of shape. Whenever I would get a cold or flu, it would inevitably end up in my chest and due to that I was prescribed an inhaler to help clear my chest. Earlier this year, I seemed to be using it more frequently, sometimes just to help me catch my breath. Once again, I just assumed that I was out of shape. What I have come to find out is that my shortness of breath is a actually a result of the leaky valve!

So how is that back story relevant to today's post? What I found fascinating about reading Patricia's account of her journey was that her valve problem also went undiscovered for years. In fact she had been diagnosed with, and treated for 15 years for Asthma!  Something that her doctors now say she probably never had. I wonder how many other folks are wandering around with, sometimes out of breath due to, a leaky valve...

Among the big takeaways from reading Patricia's posts were the reality of the length of the recovery and the gravity of the procedure.  She noted on her one year anniversary of her operation that she had been told that it was a one year recovery time, and that she sort of scoffed at that when she heard it first. Then, a year in, she noted that it really had taken the full year and that her recovery was still not 100% complete.

To me, this sounds a little daunting; to be looking ahead to a year of doctors visits and healing and setbacks. To be in the hospital for a week or more.  Eight (or more) weeks to let my chest heal from being cut open. Months of being exhausted by short walks. But yet I find that this morning, my mind turns to the years of life that this surgery will grant me. The time when taking the groceries in from the car doesn't make me short of breath. The ability to kick the ball around the back yard with the kids without having to take breaks every few minutes to catch my breath. Being able to drive again without worrying about losing consciousness.

An interesting side-note, when reading through Patricia's posts, I came across a few related links to support groups and recovery sites. One thing that caught me eye was some discussion about people who have been through this surgery (and specifically being in the artificial heart machine that they hook up your circulatory system to while operating on your stopped heart). The discussion noted a correlation between this situation and depression. And that there is a sort of brotherhood of survivors who have noted this depressive tendency years after the surgery. In fact, Robin Williams had open heart surgery in 2010 and it had been said that his depression (and ultimately his suicide) may be linked back to his surgery.  Now of course I'm trying to stay as positive as possible so this was merely an interesting factoid a at this point but nonetheless something to store in the back of my mind for awareness.

The good news is that Patricia is a few years past her surgery now and is playing golf and enjoying life. I'm looking forward to being there (although it would be a miracle if I was able to play golf, cause I've never played!). That sort of reminds me of the woman who broke her arm and while the doctor was putting on the cast,  she asked if she would be able to play the piano after her arm healed. The doctor told her that it wouldn't be a problem at all and she'd be playing like a professional pianist after 8 weeks of healing. She said "that's great news, cause I was never any good at playing in the past"... *groan*

Health Check in

The last time I blogged, I gave an update to my weird "almost passing out in Vegas" incident (http://badluckfoot.blogspot.com/2016/05/what-happens-in-vegas.html).  To catch you up on the post, I almost passed out on the way home from Las Vegas and was taken to the Emergency Room.  Everything looked normal and I was released to fly after midnight.  I got home late the following day and experienced the same "almost passing out" later that same day.  I went straight to the ER close to home and they also found nothing out of the normal.

After those events, my primary care doctor put me on medication to control my blood-pressure and referred me to see a cardiologist as a "just in case". The cardiologist ran various tests, I was on a 24 monitor, and then a 30 day monitor but everything was normal. I was also given a echocardiogram (essentially an ultra-sound of your heart) and they discovered that I had an abnormality with my aortic vale (the one that stops oxygenated blood from leaking back into your heart as it is pumped out to your body.

This condition is called "Aortic Insufficiency" and is a congenital defect of the heart. The valve in question is normally tricuspid (three leaflets making up the valve) and in my case, I only have 2 of the 3 leaflets. This "regurgitation" causes the blood that is supposed to be heading out to my body, to leak back into the ventricle and then have to be pumped back out again.

The cardiologist's recommendation, given that I didn't have any other particular symptoms, that it would be best to just keep an eye on it and visit with him every 3 months to check in. In the meantime, I was not to undertake any strenuous exercise and should limit my "working out" to brisk walks.

Since that time, I have noticed that if I am carrying heavy items, or if I am walking uphill (like I do 2 days per week heading to work) that I get very short of breath, very quickly. Also, about a month go, just before I started my walking routine on day at the YMCA, I had a recurrence of the "almost going to pass out" incident. I sat for a while, drank some water and felt better. I had decided that when I went back to the scheduled visit with the cardiologist (in mid November) that I would bring these up.

Fast forward to last Thursday, when I suddenly passed out completely (I'm not putting too many details up on the blog but you are welcome to message me if you are curious for more information). When I came to, I had no recollection of the previous moments and was daed and confused. I had no warning signs, no chest pain and none of the sensations that I had on the previous events.

I contact the cardiologist and they said that since I completely passed out, I needed to go straight to the ER to be fully evaluated. As you can probably guess, after most of the day in the ER, with batteries of tests and observation, there was absolutely nothing out of the normal with any of the readings.

I called the cardiologist back on Thursday evening but didn't hear back from them until Monday. They were able to fit me in the next day, and when the cardiologist heard the full story, he came to the conclusion that it was time to pull the trigger on permanently fixing my heart valve. As you can probably just guess from the sound of the procedure, this is not something that is done in an outpatient visit. In fact, the procedure to replace a heart valve is full-on open heart surgery (break the sternum, open out the ribs, by-pass the heart, stop the heart, replace the valves, restart the heart, re-divert the blood back into the heart, wire the sternum closed and sew it all up).

The first step in the whole process is to have an angiogram (which is where they pass multiple catheters up your femoral artery (through a puncture in the groin) and then snake all the way up into the heart where they release contrast dyes and take tons of x-rays to look for blockages). The rationale is that if they are going to have your heart out of your body for the valve replacement, they might as well take care of by-passing any blockages while they're at it). In addition, in my case, they would be able to watch the valve regurgitation (by releasing the dye into artery after the valve and watching how much of the dye leaks back into the ventricle).

So, my angiogram was today, and there are no blockages and the doctor shoed me on the screen how the blood leaks back through the valve into the ventricle (it was pretty amazing to see that in real time). They recon that on every heart beat, about 50% of the blood that is destined for me body actually leaks back. That is why I get short of breath! I'm at home now and have to rest for 2 days, then I can start doing some light walking and slowly get back to "normal"

Given that none this directly explains my passing out (it is not unheard of for people with this leaky valve to have feinting spells but it is not common) I am currently unable to drive or operate machinery. In addition, I have had to cancel my trip to Ireland that I was due to fly out this coming Friday :( While both of these things is a royal pain in the ass, it is for the best as a) I wouldn't want to pass out while driving on an open road with my kiddos in the back or b) be featured in the nightly news for causing a plane to have to redirect somewhere in the mid-atlantic.

So that brings you up to speed (if you managed to stay reading this long). I will need even more prayer and support after the procedure as the convalescence time may be many months.