An Im-port-ant day

Ready Set…

Home stretch now. With less that 24hrs left I am as ready as I can be. Another bridge patient that I had connected with early on, "swissdots," mentioned that today was going to be a busy day of tests and information and she was so very right.  

The morning started off with my 6:45am weigh in. I had set a goal for myself to lose 20 lbs by the date of surgery to help reduce risk and speed recovery. I hit the goal last week and have been managing to hold the line since. Still have about another ~10 lbs to go to get to my perfect weight but still pleased with the progress. (Especially, since I pulled it off without any exercise at all – thanks to the symptomatic bridges.)

Eating Paleo, with extra cardiac modifications, works well for me at least.

Then came the "surgical scrub" shower. After which I had absolutely no doubt that I was the cleanest that I had ever been.  (I still have an extra sponge. hmmm…wonder if I can get the teenager to use it after practice…)

A quick Uber after scrubbing and I made it to the 8:30am check-in at the oh so glamorously named E25: Surgery Reception for my paravertebral block procedure – with time to spare. The first step was full on hospital registration complete with double wrist bands, allergy warning bracelet (I am allergic to tetanus vaccine), and of course double confirmation of insurance and billing information. This was more like the cath-lab visits than the other procedures.

After a short wait in reception it was time to head back to the general surgery pre-op area to get my high fashion hospital gown and warm socks. The most unexpected part of the visit was that while I was answering registration questions my surgeon stopped by and updated me on the latest plan for tomorrow's procedure: 

1. Unroof as much of the LAD as possible.
2. Unroof the Ramus bridge. (which I found out is about 1cm - 2cm long.)
3. Bypass the plaque in the Ramus.
1. Final bypass plan, is to go with my initial understanding, and use a vein from my leg.
2. Thus saving both the LIMA and the radial arteries for future needs (just in case since I do have a calcium score of 217. Stupid genes.)
4. But, best of all, is that the above should be possible without Heart & Lung bypass. Hurray!

So surgery is set.

…Block

After my surgeon left the anesthesiologist fellow dropped by to chat about the paravertebral block.

Short summary: This procedure was used much more frequently in the 1970's but then went out of favor. However, it has been making a comeback recently.  Today, it is most often used for mastectomies and thoracotomies but Stanford has been experimenting with it for median sternotomy patients, specifically Myocardial Bridge patients. Apparently, bridge patients have more post-operative discomfort than others whom undergo median sternotomies.  Possibly because of age (we tend to be younger than other cardiac patients) or just due to other strange aspects of bridges. (An example: I really can't sleep on my left side anymore as it hurts; which is totally strange to me, but also is apparently pretty common for bridge patients.)

Okay, this is where I would usually recount the procedure and my experience of what happened: but not this time. Honestly, I just plain don't remember anything.

All I do remember is: I was wheeled to a different part of the pre-op room where there was some more space for the team to work. They inserted an IV and asked me to roll onto my stomach. After which they started mapping my spine assisted by ultrasound. Simultaneously, they told me they were going to place some sedation in my IV.

I remarked that my head felt fuzzy…      and…       that is the last thing I remember – until the doctor was asking me to roll back over onto my back because they were done.

Better living through chemistry.

Things do become clearer after that point: they injected some contrast dye and shot an x-ray to double check placement. Then flushed the dye with more saline.

Now, remember that the targeted paravertebal space is where the nerves from the front of the chest join to the spinal column? I learned (the hard way) the additional fun fact that if that space is smaller than normal and you compress the nerves, say by injecting a bunch of fluids, they activate. The contrast made my chest uncomfortable and the saline flush elevated "uncomfortable" to "very painful."

I must say it really was a strange experience: the pain "told me" that my chest hurt – something was wrong there. Yet, I "knew", that there was nothing wrong at all: it was just that the nerves that signaled "chest pain" were being directly manipulated; but, I still had a real strong urge to tap my chest to find the source anyway.

The good news: this proved (as also confirmed by the X-ray) is that the blocks are perfectly placed. The bad news: it hurt.

That was solved easily enough by running in a little of the medication that will be used tomorrow. It quickly dulled the pain for awhile. 

As I write this entry, about four hours after the procedure, my chest still hurts plus my back hurts too from the installation of the ports through the muscle.  However, I am confident that this really is going to be a valuable pain management tool tomorrow (and for 2 - 3 days after that) even if it is not very comfortable now. (Update: 2/17 night before surgery 2:45am – this discomfort still is around. So, not that it was going to really happen anyway, but sleeping tonight is pretty much over. My little malevolent lizard brain is busy: so his senseless ramblings, plus the discomfort, woke me for good after about 2 hrs of sleep.) 

A fellow journeyer:

Lastly, if you have been following this blog since the beginning, you might remember the E.R. nurse I mentioned in an earlier post that also had a partially unroofed bridge that was becoming symptomatic again? Well, it turns out he did decided to join the Stanford bridge clinic. And, in fact is scheduled for surgery tomorrow as well. He was in the bay next to me getting his block set up. (His surgery is scheduled immediately after mine is finished.)

Bring it!

Tomorrow morning at 5:15am I report to registration for surgery. I think I am feeling the appropriate amount of apprehension. But, more importantly, I feel good: I have done everything that I can to get ready, I am calm, and I am really at peace with what lies ahead.