Health Issues (Part 2 of 3): You’re not going to believe this!

In New Zealand with my friend, Steve Pittendrigh, early 2016. It was on this trip I noticed being out of breath when hiking.

Face it, at my age (69), a primary topic of conversation with friends relates to health and our various ailments. When younger, this drove me nuts. I swore to myself I would never indulge this sort of behavior. But that was before I knew I’d have health issues that would trump nearly everyone else.

My 1965 open-heart surgery, at just short of 16 years of age was a success.  The constriction was fixed, holes were found and sewed shut and over the next few years, my body came back into line. I had been the beneficiary of a massive amount of medical progress in open-heart surgery during the late 1950s and early ’60s.

A brief history of open-heart surgery (feel free to skip the next 3 paragraphs):

Until the mid-1950’s most pediatric heart operations were on or around a closed, beating heart. The challenge was to stop and restart the heart and operate safely inside it. Early on, hypothermia was the preferred method to interrupt blood flow during intracardiac operations, but it had to be fast and there were complications. In 1953 they begin testing various sorts of cardio bypass technics, with a roughly 25% survival rate. At the time, this was good and motivated others. Early by-pass approaches were done on children with a parent serving as an oxygenator, cross-circulating the parent’s arterial blood into the recipient. This lead to the belief that a temporary cardio bypass might be feasible and work to find a suitable pump and mechanical oxygenator was on.

The world’s first successful open-heart procedure was carried out at the University of Minnesota hospital in 1952. Using the technique of hypothermia and inflow occlusion, Dr. John Lewis did open repairs of atrial septal defects without severe complications in about 20 patients in 1952 and 1953. This, along my aortic constriction, was a key element of the operation they would do on me.

The University of Minnesota heart hospital was a leader in advanced cardiovascular surgery. From 1950 to 1967 an incredible amount of innovation occurred. This was due to, 1) having a unique and privately funded 80-bed heart hospital (the Variety Club Heart Hospital), where I had my surgery; and 2) the Department of Surgery was chaired by Owen Wangensteen, MD, a leader who created the environment for great achievement and considered the “mentor of a thousand surgeons.” My surgeon, Dr. Aldo R. Castaneda, MD was a student of Dr. Wangensteen and went to become president of The American Association for Thoracic Surgery.

Surgeons believe once they fix something, it stays fixed. So, after my five-year follow-up, they sent me on my way. Then in 1995 at 44 years old, I got a call asking me to participate in a follow-up study of patients who had had aorta repairs at the U of M between 1950-1970. Retrospective studies indicated individuals having these operations, had a greater incidence of hypertension, premature coronary artery disease, stroke, aortic valve abnormalities and dilatation of the aorta and bicuspid values. Could they check me out? After two days of exams and tests, they told me I had 3 of the 4 problem areas. I was put on a mild medications and told my heart would need a valve job when I reached my sixties, and to check with a cardiologist every few years to measure my progress.

In January of 2016, on a motorcycle trip in New Zealand which involved hiking, the alarm bells went off when I was unable to keep up — a total shock. Even in questionable physical shape, I was always able to keep pace with pretty much anyone. But not now. Back in the US, my cardiologist suggested it might be time to visit a surgeon, cautioning me, “Now don’t go to the appointment if you’re not prepared for the surgery. They’re surgeons and they’ll want to cut. It’s what they do.” The next month I met with Dr. Patrick DeValaria, a surgeon at the Mayo Clinic in Phoenix who did, indeed, want to cut. And on April 13, 2016, he replaced my bicuspid aortic valve with a bovine/carbon fiber model and also replaced my ascending aorta with an artificial one – something that looked sort of like a small vacuum cleaner hose but was guaranteed to never break or stretch. I was out of bed the day after the surgery and soon making laps around the nurse’s station. Released to go home after five days, I felt pretty good and couldn’t wait to start my cardiac rehabilitation program – which I sailed through.  Everything was great, and Maggie and I made plans to take an extended cruise on Holland America to celebrate.

But then the weirdness began.

Next chapter (Part 3 of 3): “Oh, oh, something is wrong – no, really wrong.

Health Issues (Part 1 of 3): You’re not going to believe this!

If I do this right, you’ll not be bored. Having Open Heart Surgery at 15 years old in the summer of 1965, I became somewhat of a medical anomaly. As unusual and traumatic as that was, I managed to up the ante 50 years later and heart issues have been my primary concern the past few years.  I’ve broken this story into 3 short bite size “parts.” If things medical turns you off, just hit delete. But it’s a pretty cool story. Here goes:

Just short of two years ago, in April of 2018, at the Mayo Clinic in Rochester MN, I underwent an 11-hour open-heart surgery. This highly complex, risky surgery occurred just two years after another open-heart surgery (in 2016) at Mayo Hospital in Arizona where they replaced my ascending aorta and aortic valve. Medical technology and my history have overlapped. Things began when I was 15 years old.

One hurdle to signing up to play football in Fairmont, Minnesota in the 1960s was having an approval form signed by a local doctor. After my ninth grade classes one afternoon I kept an appointment with Dr. Kramer, who had an office a few blocks from the junior high school. After a few minutes in his waiting room with old copies of Family Circle and Life Magazine, I entered the exam room, stripped to my underwear and a routine physical exam commenced. Doing the blood pressure test himself, Dr. Kramer seemed to be having an issue with mine. He asked if I’d run to his office from the school, maybe afraid of being late for my appointment? I said no, I’d been in no rush. He had me dress and asked me to sit in the waiting room for a few minutes. I did. A half hour later he called me back and he began again. Still, no luck finding blood pressure readings that made sense to him. As my mother was a nurse at the local Fairmont Hospital, Dr. Kramer knew her well. With me in the office, he picked up the phone and explained to her what the blood pressure tests were saying to him. He said he wanted a colleague specializing in heart issues to examine me and see what he thought.

A couple of weeks later I had another appointment, but this time my parents both came with me, my first clue that something might be amiss. After an exam that included lots of listening with a stethoscope, blood pressure attempts on my arms and legs and questions about my sports participation and things I could do easily and ones I found difficult, he announced he was fairly certain I had a coarctation of the aorta. This is a constriction or narrowing of the aorta, the large blood vessel that branches off from my heart, delivering oxygen-rich blood to various parts of the body. The constriction forced my heart to work harder to force blood through the narrowed part of my aorta causing an enlarged heart and chest, blood circulation and pressure was very high in my arms and above my chest but almost undetectable in my legs. He also heard some murmurs, indicating there likely were some holes between the chambers of my heart. He said he would call colleagues of his at the pediatric department at the University of Minnesota Heart Hospital and recommend me for open heart surgery to correct these issues. A few weeks later I’d been scheduled for open-heart surgery in August of 1965, a month before my 16th birthday. I was happy, the surgery wasn’t to occur until near the end of summer, not the beginning. At that age, my summers were far more important and interesting to me than the school year.

Next: Health Issues (Part 2 of 3): Yes, they operated on kids back then.