Good morning, everyone! We left very early this morning to get to the hospital by 5:30. Dad told us that for his last antibacterial shower this morning, he was told to sing "Happy Birthday" twice to allow the soap to stay on for a minute before washing off. Well...he deviated slightly and instead sung "Oh, What a Beautiful Morning" from the Oklahoma! musical. Sounds like he was in good spirits!

Mom got to join dad for his surgery prep and met the whole team again. So many smart people are involved to make this procedure successful -- it's good to have a great team! We just got a text on our nifty pager that the surgery is underway and all is well, so please continue to keep the prayers and positive thoughts coming.

-Andrew, Abby, and Leslie

Hello everyone! Just a note that from here on, Abby and I will be posting the updates. Our family really appreciates all the prayers and positive vibes -- keep them coming!

It's the last day before surgery; today I'll find out what time to come in (probably 5:30 a.m.), I'll take two antibacterial showers (and two more in the early morning), and I'll stop eating. My last regular meal was an everything bagel with lox -- a personal favorite! I'll get my hair cut, and I mean REALLY cut, since it will be hard to get my arms above my shoulders for a while. I call this my "camping cut."  It scares Leslie a bit but she is ready for it. 

Pastor Mark Fowler from church is planning to stop by this afternoon to chat and pray with Leslie and me, so that will be nice of him to do. Speaking of praying, if you have an inclination, the person to pray for tomorrow is the surgeon, Dr. Nilto De Oliveira. I only have to show up; he has to do all the work! There are probably a few hundred tiny stitches that he has to do, so I am all in favor that he and the surgical team are ready and excited to see me tomorrow. 

Also pray for Leslie and Abby and Andrew and all the family, who have to sit and wait for however long this takes. (They say maybe 10 hours.) It is probably harder to watch your loved one do this than it is to do it yourself, so please be thinking of them. I'll be taking a nap. ;-) 

Today seems pretty mundane in a way, but on the other hand, tomorrow is going to be a unique day in my life. When you think about it, it is an amazing thing -- a miracle -- that your heart beats every minute of every day of your entire life. Tomorrow, for me that won't happen for a time. A machine will keep the blood and oxygen flowing instead of my own muscle. After the repairs, I'll get a restart and put everything back on the right track, for another 20 or 30 years without another rest. It takes a lot of people and technology and prayer support and science and love from family and friends to make all of this happen. 

Thanks as always for all your support! 

Surgery is coming soon, and this weekend was productive as I had the chance to finish up a lot of chores around the house in advance. After Thursday, I won't be fixing any bookcases for a while.

Leslie and I also had the chance to work on a jigsaw puzzle, in practice for one thing I WILL be able to do after surgery. I think we will finish in time! This one was a toughie, but as we say, one piece at a time. 

Abby and Andrew got trained for doing blog posts while I am out of commission, so there will be regular updates during and after surgery. I know many people will be interested to know what is happening that day and the days afterward. I look forward to being able to get back on myself! But for a few days, they will keep everyone posted here. (This helps our non-Facebook friends to be able to see everything as well.) 

Thanks for all the kind wishes and thoughts and prayers!  

With six days until surgery, I had the chance today to do my pre-op workup, which included a lot of blood testing and meetings with the logistics nurse and one of the surgery assistants. Everyone was more than competent and answered every question we could come up with. (PS It is OK that Leslie and I went to Purdue but the surgery is in a UWisconsin hospital. And yes, of course I asked that.)  ;-)  

The details on the valves are interesting to me, though they may be a bit information-rich for some folks. Here's the choice: I could opt for either a carbon-titanium artificial valve, or a polyester-silicone-cobalt-chromium-cow valve. Both are manufactured, but the second one has the valve portion made of pericardial tissue from a cow. It's not the actual heart valve, but similar, and more durable for the long run. This is known in short as a biological or bovine valve, but obviously there is plenty that is not biological.

Some of you may ask, I've heard about pig valves? Apparently pig valves are not used as much anymore. Pigs do have hearts that are similar to human hearts, so the valves from pigs were used as replacements in humans, but my best understanding is that they didn't last as long as the new bovine/cow valves. 

The advantage of the artificial carbon-titanium valve is that is never wears out. That seems like a logical choice, because having the surgery once is bad enough. However, the artificial valve has a tendency to bruise red blood cells, and that creates a tendency for blood clots, and blood clots are not good at all. To combat that, artificial valves require a lifetime regimen of coumadin, or warfarin, which is a drug that helps prevent blood clotting. Warfarin takes some monitoring to keep the right dosage, and also causes some challenges for certain foods such as kale, brussels sprouts, dark greens, and cranberries, among others. And I like all of those, especially cranberries! 

The other challenge with warfarin therapy is that there is an ongoing 1-2% annual chance of an "event" that causes neurological damage or worse. That is not something that sounds good to me, since over 15-20 years those small percentages start to add up.  

The bovine biological valve doesn't require warfarin, but it also may wear out over time. What that means is hard to say, because the data we have now is from pig valves that were done 10-20 years ago, or more recent data from bovine valves. In short, there is a high chance of having another surgery to replace this valve in, say, 15 or 20 years. But much can happen between now and 2037, so I am opting for the bovine biological valve. 

It feels very strange to me to try to decide between two options that have different, but negative, long term possibilities. Most of the time, I know we don't get to choose, so I suppose that is a blessing. Both the warfarin therapy and the valve replacement therapies could change a great deal in the next decade or two, so that adds to the uncertainty. For me, the best choice is to avoid the warfarin if I can, get the best biological valve available, and hope for great progress in cardiac surgery options for the future. 

​Thanks for reading! 

It may be a little surprising that I have such a big piece of surgery without having much in the way of visible symptoms. Trust me, it has been something of a surprise to me as well! 

My diagnosis is Aortic Stenosis, which is the narrowing of the valve from my heart to the aortic artery, the main artery that sends blood to the rest of my body. The cause of the diagnosis is that I have a bicuspid aortic valve; that is, I have two flaps to my valve rather than the normal three flaps. This affects about one or two out every one hundred people, and is a birth defect that can be inherited. I don't know if I have a specific inheritance or just got lucky, but the effect is the same. Over time my aortic valve becomes narrower, and calcium deposits start to interfere with the action of the flaps, or leaflets as the doctor would refer to them. 

As the aortic valve gets narrower, less oxygenated blood gets to the artery, and in severe cases people have problems such as fainting and heart attacks. A small minority of people, about 15%, are like me and really don't have any symptoms. I have been watching this for several years now and waiting to see if anything would happen! I may have benefited slightly by also having a bit of a "leak," what doctors call a regurgitation. 

Fortunately for me, medical technology can see all of this in considerable detail through ultrasounds and other tests. At this point, it is also easy to hear in a stethoscope: instead of a more normal "lub-dub," my heartbeat goes more like "lub-swish." My cardiologist says it is a little bit like when you put your thumb on the end of a garden hose; the jet is a little stronger and makes a different sound. 

The garden hose also explains another issue: my aorta is starting to get larger. That is because of the increased pressure from the blood exiting the valve. When  the aorta gets larger, that is what is called an aneurysm, which is not a good thing. An aneurysm that bursts is a really really bad thing, so that is why I will also probably have to have my aorta repaired or replaced as well during surgery.  

For a bit more anatomic detail, check out some of this information. Otherwise, avoid it! Some find it interesting, others, not interesting at all.  

The good news is that once everything is replaced, I should be perfectly fine with a new valve and new aorta. I can jog again and pretty much do whatever I want after the recovery period of 6-12 weeks. I will be looking forward to that day soon!  

Today's countdown is 13 days until the surgery.  More information soon!