Ed Whitlock Runs 3:41 Marathon at Age 82 – Link From Pauline (much appreciated). We all need inspiration from others from time to time!
Hi folks, welcome to my thoughts (maybe some feelings, but I’m English and can’t admit to that!).
Joe Fulton, endovascular surgeon, gave me my options for correcting the leak into my abdominal aortic aneurysm – the best of which sounds like open surgical correction. Now there’s a choice. Photo by FitOldDog, published with permission from Joe.
I had an interesting visit to the endovascular surgeon today, as a result of which I clearly have to decide between three major approaches to surgical correction for my growing abdominal aortic aneurysm and stent graft displacement, the best of which sounded like an open repair. Thought I’d run my benefit/risk equation for each option, but first I wanted to seek the input of my knowledgeable followers with respect to their experience of open abdominal surgery for aortic aneurysm repair. Once I obtain these ‘data,’ I’ll fine tune the analysis and report it here tomorrow – my goals are (1) survival, (2) an active healthy life, (3) continued Ironman training and to do a sub-13. This process will help me prepare for the discussion of my case in two days with the surgeon who I hope will do the job. All input would be much appreciated – guess I can’t do the NYC Marathon this year after all – bummer!
The left branch of my stent is clearly flipped back upon itself – my common iliac arteries are really short, apparently, which may account for this.
The choices appear to be:
- Close internal iliac artery with a single stent into the external iliac (I would lose a key blood supply to my gluts on that side – can’t imagine cycling with that, especially on hill climbs, or running for that matter). Don’t like that one!
- Put in a branched stent (extension) from the existing branch, into both the internal and external iliacs (Joe didn’t think that this would be a stable option for a cyclist, or anyone active for that matter). Don’t like that one either!
- Open surgical correction, involving removal of or transection of the existing stent (sorry Rupert), and inserting a full aortic graft (Dacron or polyethylene I guess?). This is the option I would probably elect, in spite of the risks and discomforts of open surgery – sounds like the most stable long term option.
I will run my equation on this question and report back, but any input on experience with open surgery would be much appreciated.
Anyone know who lives down there (about 2 inches diameter)? Ground squirrel? I just wondered, as I was out walking the dogs early this morning.
OH! YES! I nearly forgot the Shane Ellison debate currently going on in the comment stream of my blog post on the issue of his war on PHARMA (worth reading). I finally have opposing sides talking to each other (the road to mental health) – surely, deciding between different therapeutic approaches (pharmaceuticals, surgery, supplements, herbal medicines, etc.) should be ideal for my benefit/risk equation approach to decision making.
I (more excited than nervous, except for the damned Foley Cath) am so fortunate to have such great support from the UNC Endovascular unit, and from my family (scared) and friends (anxious), and three wonderful years of continued Ironman training from my remarkable stent graft. Did I push it beyond reasonable limits? Was it the recent bike wreck? I’ll be asking myself these questions as we improve the data base for the many others who will follow me down this road.
Enjoy this lovely day, it won’t be back, I suspect, but now I’ve got to go visit a site on near death experiences, recommended to me by my son, Nick, the other day (before we knew about this leak business, I hasten to add).
Life is interesting, if nothing else, and I love solving problems wisely.
-k @FitOldDog
I wonder how many of these procedures you doctor has performed and what the outcome was. That is something I would want to know. Xoxo. Glad to hear there are options!
Yep! I’ll want to know it too. I’ll keep you posted.
As you know, I love the Cleveland Clinic for anything Aorta related. I think they quote 1% or less with having issues during or after open surgery. No matter what you choose we are here for you.
Alan makes a good point.With rare procedures it is best to be in the hands of the world’s experts, if any way possible.
Thanks Alan, I appreciate that. I’m feeling pretty sanguine about the whole thing, and lets see what Thursday brings. Cheers, Kevin
Kevin,
I’m sure you will get good advice on which surgical option is best, and that the surgeons will make the down spout better than god’s, or evolutions, design.
I was very involved with my wife’s saga where she went for the open surgical correction. Perhaps it will sound strange, but the experience was extraordinary good. My following comments are based on your requirement for a “fit and healthy life”.
If you take this route, then you will be a useless stack of meat for many weeks – this is not all bad.
Firstly you will be so weak that you can’t pass gas without assistance. Therefore you will have lots of quiet time to clarify your thoughts with zero extraneous interference. The project you were planning, the nasty neighbours, the falling mutual funds, Syria…will disappear from your thoughts. You will likely focus and recognize what is truly important.
When the great day arrives and you can fly solo and pass gas you will still require much human intervention. Since not many are like me, and are cut from the same cloth as Mother Teresa YOU will have to develop a good bedside manner. Suddenly all the stuff you took for granted is now is in the hands of others. You will likely discover those who really care about you.
Depending on the characters involved you have the opportunity for major relational fence mending. With my wife our pitifully slow exhausting lap of the local mall was the stuff of first dates, and unbelievably pleasant. Unfortunately the sex left something to be desired!
How we live with others is in my mind a requirement of a healthy life. You will have a chance to reflect and perhaps refocus.
Bob
Thanks Bob, I appreciate your comments. In my experience there is always a silver lining to these things, but living in limbo waiting for my aneurysm to pop is not what I want. I still wonder how people are going to help me pass gas – do they use a tube or something. Foleys back and front I guess. OH! Boy! Here we go. Kind Regards, Kevin
Being as fit as you are will surely speed up your recovery time. Apparently you didn’t have the open surgical approach for the 1st stent? When will the blessed event take place?
For me the three choices would , in reverse order, be on a logarithmic scale. Survival sounds good – up to a point. The other two are life choices. However, you have to be alive to be able to make life choices.
I am English and remain so.
Unlike you I go for what FEELS right and do not trust rational analysis that much.
It’s your choice so best wishes and looking forward to reading your thoughts as they evolve.
I told FOD that I also go with my ‘gut instinct’, what feels right, and got the 3rd degree from him. haha. By all means, gather all the data, get all the input, then take a shower, or a slow swim, a nice sleep, whatever. Gives your subconscious time to parse all that data, and give you the answer, often in the shower or while doing something totally unrelated.
Hi Marsha, at the end of the day, with all the data available, gut instinct is really the key variable. The problem comes if one is completely out of touch with their body, which is why I recommend body awareness work. Cheers, Kevin
To help you pass gas maybe they will have to use the Heimlich manoeuvre.
Looking at that x ray, the disc near the bottom of the spine (L4, L5, I think, looks rather worn and much thinner than those above. I suspect a heavy landing on one leg of the other could burst it. This is not advice from a medic. But they do look similar to my discs (without the burst).
Take care of that lower spine.
Hi Trevor, I asked about that one, but on closer examination from other angles it was fine, just a small area of aging further up, which my surgeon, Joe (about 44 years old), said was healthier than his spine. Bigger fish to fry in my aorta. Can’t wait for the fix, rehab, and back on with modified training. Cheers, Kevin
Do you have a ‘fix date’?
Heading for Cleveland for an appointment on Nov 20th, with a surgeon who is also a marathoner, with which I am very pleased. -k