Posts Tagged ‘Surgeon’

New way to create an ASD!

February 20, 2010

Here’s a report of a novel procedure that will hopefully come into use soon: creating (or enlarging) an Atrial Septal Defect (ASD) without breaking the skin.

I had a small ASD at the time of my first surgery but it needed to be larger. Back then (1967), ASDs had to be created or enlarged the old fashioned way – with a scapel. This was known as the Blalock-Hanlon Procedure, and it was pretty straightforward: cut into an Atrium, look for the ASD, and enlarge it. If you couldn’t find an ASD, make one.

Surgeons don’t perform the Blalock-Hanlon very often these days. (When I read my operative notes just a few months ago I had never even heard of the Blalock-Hanlon, much less knew that I had one!) Today the majority of ASDs are created by a balloon atrial septostomy, which is done by a catheter.

But this new procedure wouldn’t cut the skin at all. Histotripsy is “tissue liquification by ultrasonic wave” – the same technology they use when your uncle has his gallstones crushed. The suffix “-tripsy” is a Greek word that means “to massage” or “to crush.”

This was a small study of only ten dogs. Ultrasound was used to locate an appropriate point for an ASD and then the defect was created by Histotripsy. In nine out of ten cases, the shockwaves created an ASD, and later examination showed that there was “minimal damage” to surrounding cardiac tissue and no damage to the outside of the heart.There is also evidence that Histotripsy could be used for some cardiac ablations.

Much more research needs to be done before this becomes an accepted procedure, but the initial results are promising!

Not for me!

January 19, 2010

I love innovative heart surgeons and techniques, but I’m not so sure about this one. Dr. Wes has blogged about a surgeon who is performing…

Hold your breath….

WIDE AWAKE Open Heart Surgery!

The mere thought of it sends chills down my spine! Let me go on the record right now, if/when I ever have another operation, I want to be OUT. I want to be so far out that I am practically in the next county. Not because of the possibility of pain, but because there are sounds in an operating room that the patient just isn’t meant to hear.

Bone Saw, anyone? I didn’t think so! Maybe this is not such a great idea after all.

Experience

January 14, 2010

All the families – including mine – were gathered in a small conference room just down the hall from Surgical Waiting. Surgeon Albert Pacifico flipped through a handful of index cards; consulting them to refresh him memory. Pacifico was fast and he had a system; he often completed six heart operations or more in a single day.

“I will speak to you last,” he said to my parents. My mother gasped and began to cry.

“That’s not the way we handle that,” the surgeon’s assistant said, but there was no reassurance. Something was up, they could tell.

Finally it was their turn. There was scar tissue in my chest, a lot of scarring. More than had been anticipated. They had unintentionally torn it making the incision and suddenly blood was everywhere. Pacifico had used every trick he knew – and even made up a few new ones on the spot – and I had needed twenty units of blood, but things were stable at the moment. If we chose to go ahead, he would continue the operation.

It was what he didn’t say that hung in the room. If we go ahead, we could easily tear something else and it could happen again. And we may not be able to stop the bleeding this time.

Just because Daddy told him to call it off didn’t mean it would be any easier. Everything in my chest was being held together with baling wire and bubble gum; he had to make the repairs more permanent and leave the operative field in some type of order for the next surgeon, if anyone ever tried again. Although it would be a good 24 hours before I turned the corner and started getting better, I made it through.

The selection of a surgeon is the most important thing when going into heart surgery. Every surgeon is good, he or she wouldn’t be holding the knife if they weren’t. But when you are talking about operating on an infant with a heart the size of a plum and blood vessels measured in millimeters, “good” just doesn’t exist. This is working at a level that is well beyond the capacities of the average person.

So how do you pick the right surgeon? There’s a good rule of thumb that I often quote: The doctor you need does not practice in a town of 5,000 people.

That’s right – if you live in a smaller town (my hometown has less than 500 people!) you aren’t going to find the doctor that you need. You can make a quick determination just by observing the doctor on the first examination. If they are thrilled to see your child because “They are just so unusual!”… grab your kid’s arm and RUN. You’re in the wrong place. What you need is a doctor who has seen enough heart defects that they are almost boring. And those doctors work in prominent medical centers that see a lot of patients. Ask how many operations they do every year on children like yours, and the higher the number, the better. Post-operative care is just as important as the surgery itself, maybe more so.

(There’s always an exception: If you are at a hospital connected with a medical school, your physician may bring several of his students around to examine your child and learn about their bad heart. Medical students are a good thing; they may remember your child and use what they learned to save a life later in their career!)

Not only do you want a large hospital with lots of surgical experience and a surgeon who is experienced, you want the right type of surgeon. The doctor who did granny’s triple bypass is not who you are looking for. Rarely does a bypass specialist go digging around in the heart, you want a Congenital Heart Surgeon. Adults who need surgery for a Congenital Heart Defect may be surprised (and worried!) to learn that the best person to do their operation is a pediatric surgeon, but most Congenital Cardiac Surgery is performed on children.

You can’t control everything, and you may have to make some snap decisions, but following these simple rules (Major Medical Center, lots of operative experience, surgeon with lots of Congenital Heart Surgery experience) can tilt the odds in your favor.

The Reverend

December 17, 2009

We met him in 1977, while in the hospital at the University of Alabama at Birmingham (UAB). “I’m not sure we’ve met,” he said to my dad. “I’m Reverend E.W. Harris, a couple of my members are patients here. And you are….?”

“We’re the Funky Heart family, our son Steve is here for a heart operation.”

“Where are you from?”

“South Carolina.”

“I won’t hold that against you.”

And so began a friendship that would last nearly 20 years. Rev. Harris was a Methodist minister, but he took a bunch of Baptists a long way from home under his wing and became our “second pastor.” He didn’t know us, had no connection to us, and by most standards had no responsibility towards us. At least by Man’s standard. A higher power told him otherwise.

Did my parents need a car? Yes you do, no arguing. You look like you need to see something besides these hospital walls for a few hours. Borrow mine. It’s ok, I’m planning to be here most of the day. My wife will take you around the city.

His wife was his chauffeur; Reverend Harris was born with “tunnel vision” – an ailment that limited his vision to only what he could see directly in front of his eyes. Look through a couple of paper towel tubes and you will get a good idea of how he saw the world.

But he always had a smile and an encouraging word, and jokingly let us know that as far as he was concerned, the Methodists would get to Heaven a few moments before the Baptists would. “I’m hurt,” he pouted when my dad told him that my pastor from home was flying in for my surgery. “We pray to the same God. But my prayers get there a little bit faster.”

How do you figure that?

“God has a summer home in Mobile.” (Alabama city on the Gulf of Mexico, for my non – US readers.)

He was there during that first surgery and my recovery, and there again when I went to surgery in 1988. He was there when the surgeon told my parents “I will speak to you last.” Dr. Pacifico’s skills and Reverend Harris’ prayers got me out of that operating room alive.

Our friendship continued for years after that, long after my doctor moved and I found care elsewhere. UAB is a great hospital, but it is a long way from home. My favorite doctor was now in Greeneville, North Carolina, a lot closer. It continued until that day a few years ago when the call came; the call you begin to expect when friends reach a certain age but never want to answer.

And Reverend Harris had one last surprise for us – he wanted a Baptist to speak at his funeral!

“Looks like you were right, E.W.,” Dad said that day. “You made to Heaven before the Baptists did!”

SurgeXperiences 312

December 12, 2009

We open this edition of SurgeXperiences with an explanation and an apology: Apparently the software behind Blogcarnival.Com – the company that gathers submissions and forwards them to the carnival host – had a hiccup and vaporized all of the SurgeXperiences submissions.

So most of the posts that appear in this edition were selected from the blogs that appear on Jeffery Leow’s blogroll. If you sent in a submission and it does not appear here, I apologize. And if you did not submit, or submitted something else, again I apologize.

Our first post is  CHD is my life, an account of life with a Congenital Heart Defect written by Lauren, a 22-year-old Survivor who blogs at Lauren’s Heart. Every day she sees her scars – and is reminded that without those scars, her voice would be silent.

Over at Joey M.D., Joey’s mom was unfortunately cartwheeled by a motorcycle and needed hip replacement surgery. She’s fine, thankfully, but it got Joey to thinking about the different types of hip replacement surgery available.

Mike over at Adventures in Anesthesia (get Funky with it, Mike! Put an exclamation point on the end of that title!) reflects about his job on the night shift at a Level One Trauma Center. Some nights are busy while others aren’t. There’s no rhyme, reason, or pattern; that’s just the way it is. And he wouldn’t have it any other way.

ERP, who usually blogs at ER Stories but is working a shift in Whitecoat’s Call Room, is working on the first Ice Day of the year. Foot meets ice; arm meets pavement, patient meets ERP. It’s a logical progression, just like day follows night and indigestion follows a spicy meal.

Gizabeth of Methodical Madness attempts to reassure a patient, but it backfires. As my father is fond of saying, “Minor surgery is any surgery that happens to someone else.”

Grab your Phaser, blaster, ray gun, or whatever you happen to have lying around, the Israelis are going to show us how to close an incision with a laser. Dr. Rob of Plastic Surgery 101 is still scratching his head about it.

Josh is back! His blog The Alley finds him in Afghanistan, healing both injured military and local citizens. A wounded Airman needs blood and he needs it quickly, and within minutes the donors are lining up. No one stands as tall as the one who kneels to help.

“It’s bad, Doc,” the Paramedic tells StorytellERdoc. He was wrong; it’s not bad, it’s horrible, and the only thing StorytellERdoc can really do is to hold the phone for the most important call of a burn victim’s life.

Orac of Respectful Insolence takes a look at the new USPSTF guidelines concerning Breast Cancer and Mammography and makes a point that has nothing to do with healthcare reform or politics: They don’t work for African-American Women.

Button, button, who’s got the button? Oystein of The Sterile Eye has the button, and he uses it as a “Child Distraction Device” to get the perfect photograph. I wonder how you code that for billing.

Ramona Bates of Suture for a Living submits a case report of cystosarcoma phyllodes that includes an eye-opening photograph. You almost have to ask: Farmer Jones, didn’t you notice  something about your wife that wasn’t quite…. normal?!?

One pissed off dude. One loaded shotgun. Bongi of Other Things Amanzi is there to pick up the pieces.

Dr. Alice, who blogs over at Cut on the Dotted Line, receives some “friendly” advice while she’s in the middle of a laparoscopic case. A lot of advice! Thankfully her back seat drivers didn’t distract her too badly!

Don’t you just hate school reunions? At least you can quietly smirk when you realize the sports hero now has quite a bit of a waistline. Dr. Cris of Scalpel’s Edge attended her medical school 10 year reunion and realized that achieving your goals could mean a lot of compromise.

KC of Mothers in Medicine gives us a moment by moment look at  an (average?) day in the life of a Neurosurgeon… and at the end of the day, wonders if this is the life for her. She sounds like an excellent doctor. Hang in there, KC; the world needs more like you.

And finally, Steve of Adventures of a Funky Heart! invites you to step into his Time Machine as he takes you into a 1967 Operating Room. But not just any Operating Room – Steve is the patient! Stand close and watch as Dr. Vincent Gott shows you they did heart surgery in the good ol’ days.

The archives of SurgeXperiences are stored here (Season 2) and here (Season 1), along with a schedule of dates and host sites. You can also subscribe via RSS or email to SurgeXperiences over at this link. And of course, you can submit your best VIA THIS FORM.

As the curtain comes down on this special CHD edition of SurgeXperiences, your host would like to remind you that 1 child out of every 125 is born with a Congenital Heart Defect… but through advances in Congenital Cardiac Surgery and Congenital Cardiac Care, we’re living longer and more productive lives!

We thank you so much for all you and your colleagues have done for us;

With Special Guest Star….

December 11, 2009

Coming up on Adventures of a Funky Heart!….

On Sunday, December 13, 2010, Funky Heart! will host SurgeXperiences, THE premier Surgical Blog Carnival! Be sure to stop in and read the very best writing by Bloggers who really know how to make a cutting remark! As far as I know, this will be the first time that someone with no medical training hosts SurgeXperiences!

And on Tuesday, December 15, 2010, we’ll feature an interview with Heart Warrior and award-winning musician Paul Cardall! Paul is recovering from a recent heart transplant and writes the blog Living for Eden. His latest album, Sacred Piano,  recently spent 20 weeks on the Billboard New Age Music charts and reached #5!

All that and more, so stay tuned!

Computer Assisted Fontan Surgery

December 4, 2009

I just don’t “get” the Fontan. At all.

I was recently asked by a CHD organization to write an article about the Fontan Procedure for their newsletter. I had to turn them down; I had to say that no matter how many diagrams I studied, and how many textbooks I have read, I just don’t see how that operation works. Thankfully there are people who are a lot smarter than I am who know how to explain it, and a few of them understand how to surgically alter a defective heart to make the Fontan work. Thank goodness for that, because if they didn’t, there would be a lot fewer of us around.

I was scheduled for a Fontan in 1988; that surgery went completely wrong and they barely got me off the table. I never got the Fontan, but many others from that time period have needed a Fontan Revision or Fontan Conversion. (After clicking the link, pay close attention to Section V.)

One of the difficulties in understanding lies in the fact that the Fontan has several variations, and is almost “customized” for the patient. Now there is a new computer simulation available to test various versions of the Fontan on a defective heart. The simulation will help determine blood flow patterns to help surgeons choose which variation of the Fontan works best for that patient.

The two researchers who developed the computer simulation have also designed a Y-shaped graft to be used as part of the Fontan. The Y connected will be used to join the Inferior Vena Cava (The major blood vessel leading to the heart from the lower part of the body) to both branches of the Pulmonary Artery, not just the single connection that is used now. According to the Abstract, the Y graft “is expected to be put into clinical use within a few months.” I am not sure if that means it is ready for clinical trials or has passed the trials and is ready for real world use.

Either way, these developments look promising!

Seminole wind!

November 30, 2009

So blow, blow Seminole wind,
Blow like you’re never gonna blow again.
Take me down to the Big Bend
To meet some new Heart Friends.

That’s where I’m headed – I’m going to be a part of Broken Hearts of the Big Bend‘s Regional Forum on Congenital Heart Defects! It is going to be held in Tallahassee, Florida, on February 13, 2010. The event begins at 8:30 AM at Sittig Hall in downtown Tallahassee. You can get more information and register for the Forum by clicking HERE.

Two of the top Pediatric Cardiologists will be in attendance – Dr. Mark Bleiweis, the director of the UF Congenital Heart Center and chief pediatric Congenital Surgeon; and Dr. Jay Fricker, who is the head of Pediatric Cardiology for the University of Florida College of Medicine. I’ll have my laptop and hope to be liveblogging the forum; but if that isn’t possible I’l have a notebook and pencil and blog about the event later. (I hope there is Wi-Fi, it’s much better when it is live and in color!) Dr. Fricker and Dr. Bleiweis will participate in a panel discussion, and later on experts will show us how to advocate for your child at school, in the doctor’s office, and in the hospital. I’ll be on a panel of Adult CHD Survivors scheduled for after lunch, and possibly even speaking to the group.

The event is FREE but they do ask that you register, probably so they will have a good count for the Happy Hearts Reunion, a gathering of CHDers that will follow the event. You can register by clicking the link on the information page.

It promises to be both fun and informative, and you’ll get to meet other heart families who are fighting the same battle that you are.

Hope to see you there!

What really happened

November 25, 2009

Back in August I blogged about faxing a HIPPA compliance form to Johns Hopkins Hospital to get some medical records from my 1967 heart surgery. I already had the records, actually, but I had managed to misplace several of them. So I filled out another compliance form and faxed it to the Medical Records office.

Hopkins responded by sending all of my medical records from that first surgery, not just the 12 sheets I already had. I returned to Hopkins several times for check ups until I was about five years old, but none of those records are included. So now instead of 12 sheets, my stack is about an inch thick. This was a lot more information than I expected, and every bit of it is interesting.

I have Catherization reports, – one of which destroys a family legend; I always thought that we arrived at Hopkins at roughly 10:30 PM, but the Cath report says that I was brought into the Cath Lab at 6:16 PM. Daddy says we arrived at Hopkins about 3:30 pm, and the surgery itself began at 10:30 PM.

There are Radiological reports but no X-rays. I wonder if they deteriorate over the years. Possibly they are filed away in a different place, since all my records are copies, most likely made from microfilm.

Quite a few pages of Nurse’s reports (I can – and probably will – make an entire post about those!) and –

Oh my goodness…

The title of the sheet is OPERATING ROOM REPORT. And this is the entire report, not just the summary and the little bits and pieces of my operation that I assume from what I already know.

After the temperature was down to 32 degrees we used inflow stasis and during a three-minute period of inflow stasis dissected a sizable portion of the Atrial Septum.

I was too small for the heart/lung machine, so the surgical team stopped my heart temporarily by hypothermia – They literally put me in ice and cooled me until my heart stopped. During a three minute period of no blood flow doctors cut into my heart and enlarge an Atrial Septal Defect (ASD). For the heart to work (and its owner to survive) blood has to be able to complete the Cardiopulmonary circuit: flow from the body into the heart, move from the heart to the lungs, then back to the heart, and once again out to the body.  Because my normal pathway is blocked my blood “escapes” through an Atrial Septal Defect (ASD), and that earlier Catherization had revealed that my ASD wasn’t quite big enough.

…at the end of this part of the operation we proceeded to prepare the vessels for a right Pulmonary Artery anastomosis after the technique of Glenn.

This is a phrase that I type often and Funky Heart readers are probably tired of seeing: I don’t have the Glenn Procedure that is currently in use. That’s known as the Bi-Directional Glenn, because blood is rerouted to both lungs. I have the original version of the operation, the “Classic Glenn” or sometimes called the Unidirectional Glenn. In my version, the right branch of the Pulmonary Artery is cut and sewn into the Superior Vena Cava, so the majority of my blood flows into my right lung. CLICK HERE to see the best drawing I have ever seen of the Classic Glenn Procedure.

Chest was closed in layers with #00 catgut and skin with Dermalon. The patient tolerated the procedure well.

(Signed)

Vincent Gott, M.D.

Wow. Just…wow.

Mark and the Cardiac Kids!

November 5, 2009

“How long has it been since you posted those cool videos?” a friend asked me. “You ought to post them again. When you showed them the first time there were about five people reading Funky Heart. You’ve got lots of new readers since then.”

She could be right… I can’t recall when I posted them. And trust me, if you’re having a bad day, this will cheer you up. And another video will follow on Friday!

Put on your headphones and turn the volume UP; here is Mark O’Shea and the staff of the Pediatric Cardiology department of Vanderbilt Children’s Hospital with the song, Look at You Now!.