Wednesday, August 23, 2006

Guest Post: Uncle Ron on Heart Surgery

My Uncle Ron, an engineer living in Austin, TX, had heart surgery recently to replace an aging replacement valve that had been giving him trouble. He's recovering well, and wrote a great letter to his relatives about it. "I found the combination of low tech (sawing thru the bone, needle and thread) and hi-tech (carbon fiber valve and the computer with megabytes of mememory in my chest) very interesting," he said. He's given me permisison to post the letter here, and I hope you find both his description of the procedures and his personal reaction to them as compelling as I did...
Friends and family,
If you did not know, Wednesday I had heart surgery. I
am home and feeling great. I don't have a real blog,
so I'm sending this email about what happened.

The reason I had the surgery is that there were a
couple of indications that the aortic valve
replacement I had in 1988 was was getting worn and
caused my minor stroke in March. So we decided to
replace it with a new one of new design and new

When Dr. Oswalt opened things up on Wednesday morning
there was lots of scar tissue including some that had
grown over the artificial valve. So immediate proof
the the surgery was needed. Dr. Oswalt removed the old
valve and cut a nice opening to fit the new valve. He
stitched the new one in place making tiny stitches in
the muscle of the heart to hold the valve in place. In
a couple of places these stitches where in the scar
tissue, but all was fine until he was almost finished.
Then one of the stitches in the scar tissue tore
lose. Not good! So he took it lose and started over.
The only alternative was to make the stitches where
there was scar tissue a bit larger. Not a problem but
surgeons really take pride in their tiny stitches!

As it turns out the signal from the brain to cause
the heart to beat arrives at the upper chamber at a
transmission point and is sent to the muscle in the
upper chamber via some transmission cells. A nerve
runs from these cells to anther set of transmission
cells that delays about 1/5 of a second and sends the
beat signal to the lower chamber where the aortic
valve resides. In fact this second set of transmission
cell is right next to the aortic valve.

Dr. Oswalt had a quandary. If he made the stitches
larger he might injure this second set of
transmission cells. I did not want to live with a
leaky valve, so I voted we worry about that later and
get the valve sewed in. So he did, and the rest of the
surgery went well.

It is standard practice to attach a temporary
pacemaker during heart surgery just is case the
trauma of the surgery causes an irregular rhythm.
After surgery it showed that in fact the second set of
transmission cells in the lower chamber were not
functioning. The pacemaker compensated by sending a
beat signal of its own to the lower chamber.

There is a real possibility this condition is
temporary and the transmission cells are just stunned.
By Friday they had not improved. Huddle time. We
decided to put in a permanent pacemaker. This one is a
small computer only about the size of a silver dollar
and sits just under the skin next the collar bone.

Actually the device they put in is misnamed. It is
really not a pacemaker, it is a pacemaintainer. It
watches the transmission cells in the upper and and
lower chamber. If the upper transmitters fires and the
lower ones do not, it steps in and sends the signal to
the lower chamber for it (with the 1/5 second delay).
Pretty neat, huh?

Now here is the really cool part for a computer person
like me. As it watches the signals sent by the
transmitters in the upper and lower chamber, it
stores a record of it in the computer's memory. So it
maintains a history of every heart beat for the life
of the computer (it must be replaced every 2 years or
so). So if I go in to my doctor and say, last
Thursday afternoon I had this strange heart beat
sensation. They can just wrap a small wand around my
neck and plug it into a laptop and create reports and
graphs of just what was happening to to the heart last
Thursday afternoon. They can then search the
computer's memory for any other similar occurrences. I
can imagine a day when everyone has a similar device
connected to all your major organs.

Anyway, I am home now recovering not from the valve
replacement or the pacemaker install, but from the
injury they had to do to my lungs and chest to make it
happen. It is already starting to happen, but one
day soon this will all be done without they bone
breaking they do today. Bypass and valve replacements
will be done with only a few days recovery.

As a repeat customer, I can notice the improvements
they have made in the last 18 years. I don't remember
to many specifics, but I know I am feeling much better
than I did one week after my first surgery. I walked
three brisk miles in the hospital yesterday. I'll have
to have someone haul me to the mall to do my walking
today. 100+ degrees is too much for me.

I hope this finds you well. I am going to have plenty
of time to answer email, so don't hesitate to respond.

The really neat thing about this is, I am feeling
great but can't do any work, so I am just forced to
catch up on my reading. Darn!

Waiting to hear from you,

Cyborg Ron

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