Tag Archives: PFO

Update from the heart

We had a visit back to the hospital yesterday, for another echo cardiogram, as it is now a month since Liz had her operation.

It is routine to apparently check on these things, and although there was some confusion over whether the check would be a normal ultrasound or the more unpleasant trans-oesophageal echo (TOE), fortunately only the former was required.

The appointment was for 11am and luckily we were a little early as they were running to schedule. I accompanied Liz into the room for the scan, although the doctor was not keen and throughout the procedure consigned me to a chair in the corner, and warned me of the pain and suffering I would experience, for all eternity, in the event I moved from this position. Her caring NHS attitude clearly didn’t extend to mere husbands, and she quite obviously felt she could do a better job of supporting my wife than I could!

Cardiac Ultrasound

The procedure itself involves the injection of an agitated saline mixture into the bloodstream while monitoring the heart with an ultrasound probe from just underneath the left ribs. The view of the pumping heart, with the valves in perfect detail is remarkable. This was also the first view we had had of the Amplatzer device that had been fitted and the view, thankfully, was that it looked secure and perfectly positioned.

After another couple of injections with the saline and a manoeuvre Liz had to perform to tense up to put additional pressure on the heart for a second or two, it was all over.

The doctor then proceeded to inform us that she had seen 20 bubbles pass from one chamber to the other, indicating a ‘leak’ around the device. Given she had earlier explained that the sealing process for the device would probably be complete but in rare cases there was a problem (and in even rarer cases open heart surgery is required to correct the issue), this came as a bit of a shock.

She further explained that David Ward does not normally see people before 6 weeks and 3 months is the normal case for review, so we were at least comforted by the fact that we are still at an early stage.

So, we are back to the stage where we are waiting, anxiously again, to see what the future holds.

Life seems to be throwing everything it can at us at the moment, what with Liz’s stroke, then the Operation and now our house chain is looking decidedly shaky and my foot problem is refusing to show any signs of reacting positively to my regime of rest and icing for the past few weeks.

I wonder what is going to happen next to throw us off our charted course!

The Day Of Reckoning

The day had arrived.

Coleen had very kindly offered to come down from Wales and help with the children during Liz’s procedure to close her PFO, or patent foramen ovale, aka ‘hole in the heart’, so we said our goodbyes to our kindly saint before getting on our way – thanks Col; you’re a star!

The travel to St. George’s Hospital in Tooting at 6:15 in the morning was easier than we had anticipated, so we arrived just after 7:00 o’clock. The ward was not yet open, and unfortunately neither was the coffee shop (bad planning on their part, as I’m sure they could make a killing from people arriving early for their day ops!)

Anyway, marketing opportunities aside, we reported to the Belgrave Ward where we had a momentary scare when they said we were ‘not on the list’ but we were quickly restored to ‘A-list’ authorised to proceed status, after they found an ‘updated’ schedule’.

However, we still had to wait.

PFO closure

They had a day room with comfy chairs, but because they are refurbishing the kitchen next door, all the white goods seemed to have migrated to the day room, so we sat for some time staring at a couple of fridges, while the ward porridge was warmed up in the microwave. A bizarre start to the day. Still, after impromptu repairs to the television (aerial and source problem!) we were sufficiently distracted and were called just before 9:00 for pre-op checks.

Liz has always had trouble when giving blood, seemingly irrespective of the experience and prowess of the medical staff. Today was to be no different. The nurse, struggled apologetically for some minutes with the veins in her wrists, which she ultimately declared as having swelled up as no blood was forthcoming. Eventually a successful insertion of the cannula, just to take blood, was managed in Liz’s right elbow.

The increasingly apprehensive patient was moved to bed 4 on the ward and after a touch more waiting, and a few more normal tests, she was whisked off. That was about 10:30.

And so the medical science was left in the hands of the miracle workers…..

Gore Septal Occluders

Left on my own for a couple of hours I visited the coffee shop again and updated a few bits and pieces of my training plan and records, but before I knew it a groggy Liz was being wheeled back into the ward. Β She had apparently been ‘conscious’ for the last 30 mins or so having come round about 11:45.

The whole process, from application of the anaesthetic, insertion of the cannula sheath for the catheter and trans-oesophageal echo equipment for the ‘camera’, the actual insertion of the device (which apparently takes 20 minutes, and the revival from the anaesthetic only took 1 hour 10 minutes. The device which has been inserted is known as a Gore septal occluder.

The rest of the day was spend with Liz resting and drifting in and out of her world of drowsiness, during a succession of post-op ECGs, blood pressure and stats monitoring and finally the removal of the cannula ‘sheath’ from the femoral vein – a procedure which itself involved successive reduction of the pressure applied to the puncture in the leg, after extraction of the Β needle, but which luckily no longer requires the nurses to apply said pressure manually, as it was in days of old. Ironically, this process took longer than the procedure to insert the device in the first place!

As I write this, we have just heard that Liz will be allowed home! πŸ™‚

Procedure Dates and Habits

I had interviews to do today at work – interviewing for a short term business analyst position. The process seems to take as long as the engagement itself!

No more Aspirin

Anyway the upshot of that was that I had to be in work this morning, but had to also be home to take Liz to see her consultant for a review. With the interviews over I returned via my normal route but the peculiarity of travelling at midday meant that the normally crowded tube showed no signs of the packing and shoving I expect to experience at rush hour. In fact it was bordering on civilised πŸ™‚

After a quick tea at home we strolled off to the Royal Surrey County Hospital where the car park was decidedly less civilised – 2:30 is obviously visiting hour.

The appointment was delayed a bit, but when we got to speak with Liz’s consultant she was full of reassurance that everything was fine with all the blood tests they had done, and on discussing the upcoming procedure to close the PFO stated that she would also, in the same situation, recommend having the closure carried out.

Liz is now off the aspirin and has been given to all clear to drive if she wants to. The consultant also explained that many victims reported feelings of tiredness and fatigue after suffering a stoke but, interestingly, they still do not understand the reasoning behind these feelings.

So for now all we have to wait for is the pre-op on the 18 May and the actual PFO closure procedure on the 24 May. It could be a long three weeks πŸ™

Monday’s is swimming night; first Joshua and Morgan have their half hour, currently from 6:30-7:00 and then I have a session from 8:20. J&M had a good session – their strokes are fantastic at the moment, a real pleasure to watch them going back and forth from the edge of the pool. I’m sure my stroke is not so appealing πŸ˜‰

I chose to do another run-swim-run this evening, and Liz was happy for me to go a few minutes earlier, so I managed to get in a bit of a country route up Pewly Hill to the base of St Marthas, before turning back towards the urban sprawl. I had a beautifully timed view of the sunset as I was climbing the hill which gave me shivers inside and reminded me of why I endure the hours of training through the cold winter and early mornings.

Happy days are coming πŸ™‚

New Shoes

It has been overdue for some time, but I have today received some new shoes!

Inov8 Terrafly 303

Rather I should say that I bought some shoes of a new type – Inov-8 Terrafly 303.

I have had quite a few pairs of Inov-8 shoes before as they seem to be perfect for my shape and size of feet. They are also one of the original shoe manufacturers to consider more natural running several years ago, and although some of their trail and hiking shoes have a significant amount of protection and cushioning, they also have other shoes which are very minimalist.

They also have a number of feature which they incorporate in varying degrees which help the transition to more natural and barefoot running.

Over the last few months I have been wearing a combination of vibrams, vivo barefoot evos, both of which are as minimalist as you can get, and the pair of Inov-8 Talon 212, which are not really designed for road running but are minimally cushioned performance trail shoes (which I wore at Leadville incidentally). So, of course these new shoes have more cushioning than anything I have worn for nearly the last two years and consequently they feel like slippers! πŸ™‚

The beauty of these shoes is that they are designed as a cross between road and trail shoes, so they’ll be perfect for the majority of my runs around Guildford and the surrounding countryside. It may be a bit different on soft sand or looser surfaces such as scree, and gravel, but it remains to be seen if they will be suitable for the MdS next year – after all, you can’t really tell if a pair of shoes fit until you’ve run 75 miles in them.

Liz's Friend Mustapha (#2)

Talking of which, the competitors at the Marathon des Sables are having a well earned rest day today, although the last few arrived at the bivouac just after 4:00pm this afternoon. Half of the field were in before 1:30am this morning, having been out in the desert for over 16 hours traversing the 82km presented to them.

Tomorrow they have the ‘Marathon’ day, but they will all, no doubt, be thankful of the rest they will be getting tonight.

Liz is pretty much fully recovered from her ordeal now, in that her body has all but recovered from the symptoms, but she still gets tired a lot, which is presumably an indication that her body is actually still recovering. We still do not have a definitive date for the operation, and so at this stage we are expecting it to be in May. The children will be back to school next week, so that will give her a chance to rest properly, which is just as well as I have to go away with work to Washington DC for a conference.

We’ll still have many people helping out though, for which I am very grateful.

The Surgeon’s View

We visited the hospital again today, where we met Mr David Ward, from St Georges hospital.

He is the surgeon who is suggesting that Liz has the procedure to close the PFO (Patent / Persistent Foramen Ovale) in order to reduce the risk of her having another stroke, via the same mechanism in the future. He was at pains to point out, however, that there are no guarantees that she would not have another stroke, but the evidence suggests that correction of the so called atrial septal defect (ASD) or hole in the heart caused as a result of the foramen ovale remaining partially open after birth, will lower the chances of a stroke.

He explained that he had been involved in the closing of over 600 PFOs over the last few years, and with his partner they had performed over 1200 procedures, and that throughout all of those procedures they had only once had a problem (which was not a permanent issue).

The device he proposes to use is called an Amplatzer PFO occluder, which is a wire device made of an alloy of nickel and titanium, which gives it elastic ‘memory’ properties; in other words, it allows them to ‘stuff’ it into the thin catheter to transport it through the circulatory system to the heart, where it can then be automatically expanded to it’s former and correct shape and size to ‘plug’ the hole between the right and left atrium.

httpv://youtu.be/rhGt1dWdqiw

 

We deliberated for a while as he further noted that there were two options with the procedure, either to do it under sedation or General anaesthetic. With the local anaesthetic and sedative option, two catheters are used, one in the right thigh to deliver the ‘device’ to the heart and the other in the left thigh to insert an echo device to assist the ‘view’ of the operation. With the general anaesthetic the device is still inserted with a catheter up through the inferior vena cava to the heart, but a TOE,Β i.e. a the down the throat endoscope, like Liz had last week is used for imaging of the heart and positioning of the device.

The good news is that procedure is a short one; he was at pains to explain that it was so quick, that actually the general anaesthetic takes longer to take effect, and substantially longer to recover from. Nevertheless, Liz still feels, as I suspect would most of us, that to do it under sedation would be a little too much for her.

The bad news was that they only do this procedure once every month or so, booking in 4 or 5 patients requiring the same process to be carried out on a morning, and so we will have to wait until at least the end of April, and possibly the end of May for Liz to received her treatment.

With the alternative being a lifetime prescription of drugs to thin the blood and repetitive checks on amounts, effects and care to be taken to ensure cuts and bruises are attended to with extra caution (as the blood’s clotting ability is deliberately reduced), it seems like a no-brainer as to whether to have this procedure carried out or not.

Liz is at least happy that the pills she is taking at the moment will reduce the immediate chances of a repeat of the events of three weeks ago, and so is fairly comfortable that the delay is for the best to allow her to gain further strength and recover.

She’ll also be able to run a mere couple of weeks after the operation. So really, good news all round.

Adding Meaning to the Words

I was back to work again today, but at least the trains were playing ball this morning.

Savannah’s friend’s Mum, Kate, very kindly picked them up and took them to school, so Liz was able to rest after the initial mayhem of the morning! She also brought them home in the afternoon.

Work was busy today, as Wednesday’s tend to be, but doubly so at the moment with everything that is going on both at work and at home.

We haven’t heard anything else from the hospital or doctors, surgeons or consultants today, but I have spent most of the day explaining to work colleagues what they have deduced from all the tests they have been carrying out on Liz. Most of them have been astonished at the findings. All of them have been supportive beyond words. Something that has been true of all our friends.

Otherwise it was actually a fairly normal day, believe it or not.

Liz also found this on the web, which explains everything that has happened, and is going to happen, very well.

httpv://www.youtube.com/watch?v=N9yX2oLxuyM

PFO – Patent Foramen Ovale

Today’s was always going to be a hectic day.

Getting the children to school, getting Liz to the hospital for her TOE (transesophageal echocardiogram) procedure, then back to Pewley Down school to be with Savannah on her ‘science’ trail, before going back to the hospital to wait for Liz. All before 10:30am.

The TOE procedure is basically a more enhanced bubble echocardiogram, which is carried out in the same way (see previous post), but is somewhat more intrusive in so much as the probe was lowered down through her throat, a process which was undoubtedly as uncomfortable as it sounds, and which in the end required mild sedation to perform.

Transoesophegal echocardiogram

Liz was having this while I was looking after Savannah at her science trial, which consisted of a myriad of ways and tools for teaching the 4-5 year old children about numbers, addition, subtraction, grouping, repetition, etc. We went round a half dozen different tables with plastic bears to ‘grab and group’, dry-wipe clocks to practice the time, skittle and bean-bag games, and shape cutting, to name but a few. It is amazing how quickly time goes when you are following three 5 year olds around – I was volunteered to chaperone Izzy and James, two of Savannah’s friends, as well as her πŸ™‚

After saying goodbye to Savannah, which she was grumpy about, as I think she thought I was there for the day, I made it back to the hospital in plenty of time and waited for the NHS to finish their magic.

The Doctor who attended her procedure was fantastic – such a nice lady, calming style and communicative in the best possible manner for patients anxious about the whole test.

It turns out that Liz does have a PFO, Patent Foramen Ovale or ‘hole in the heart’ which they now consider to be the prime reason for the stroke. It is clearly fantastic news that they have found the reason behind the stroke, and also that they can do something to minimise the chances of a recurrence of the problem. However, herein lies the dilemma since as a result of the findings the doctors have decided to ‘close’ the hole which will be a fairly major operation, which is likely to happen in the next 2-4 weeks.

Liz is booked in to see a surgeon from St Georges Hospital in London a week tomorrow, and she still has to reconcile what this means in both the short and long term.

The children were busy for most of the day, Luke and Savannah were kindly fetched by Cecilia again and Morgan and Joshua had Judo and then stayed for after-school clubs as I went to Kingston to try to get my iPad fixed (No joy!) They have all been informed about the impending operation, and seem relatively calm about it at the moment, but I’ve no doubt that the questions will mount up over the next couple of weeks as the reality sinks in.

Liz clearly has mixed feelings about the outcome and results of today’s test and the impending operation, but I’m certain that she too will ultimately come to terms with it, and hopefully in a few weeks things will start to get back to normal.

I don’t think our hectic days are over just yet.