T minus 5…

Short Update:

I know it is really inconceivable for this blog to have a short update; but, hope springs eternal…

Surgery is definitely getting closer now and I have been working diligently on getting prepared. My ultimate goal is to remove as much stress from surgery and recovery as I possibly can. I figure recovery itself is going to be enough stress and I don't need "life" providing more. So I have been working down a long checklist of things to get done before Wednesday. Really deep things like: "get a haircut that requires minimal arm use to maintain" (It really is amazing the amount of administrivia that makes up life once you write it all down.)

Another item from that list was renting a lift chair which came this week. I did not have any recliners, and with all the raves from others who had a median sternotomy, I figured it would be a good idea to have one. I have to admit this thing is seriously comfortable. So at least from a pre-operative evaluation it seems great. I can get into it, recline fully flat, return to sitting, and get-out without using anything other than 10% of my legs. No arms, no core, no chest, no nothing. Seems like this is going to be great.  (Yes, it is true, I have sunk to the point where I am psyched about a motorized chair. I think my hair actually got 15% grayer just writing that paragraph. Seriously, I need to have my head checked…)

Surprise Evaluation:

I also had an unexpected (by me anyway) vascular ultrasound this morning . They were looking at the arteries in my arms. I knew that the most popular source of an arterial graft was the left internal mammary artery (LIMA) but my team did not want to harvest mine preferring to save it for later in case I needed it. The ultrasound surprised me because I was behind on my studying and had not read up on grafts. So, I just thought they would harvest a vein from my leg and that would be it. Pipes are pipes right? 

Wrong. Turns out the body really LOVES to specialize. 

Accordingly there is a much better approach than getting veins from the legs. For coronary artery bypass grafting (CABG) arteries are much preferred over veins. The reason was kinda obvious when I actually thought about the "plumbing" of the system for a second: coronary artery grafts carry arterial blood vs. venous blood. Arterial blood is "close to the pump supply" vs. veinous which is "end of the line return." So arterial blood is higher pressure than veinous. And, like any good plumbing system, the body only uses hoses rated for the specific pressure they are going to be carrying. So a high pressure rated artery is better at carrying high pressure arterial blood. (As mentioned in another post: even the DNA of the cells in the walls of the arteries changes in response to pressure. So arteries really are customized to their job. Cool system.)

So, when I spent the time to actually think, it makes sense that they would want to check the inventory of available parts and make sure it suited. I guess the arms are the best choice as the sizes of the arteries there are going to be closer to the coronary arteries as opposed to the ones in the legs or elsewhere.

I think I passed the inspection. No blockages. And, unlike my heart, no construction weirdness.  Both the superior and inferior arterial loops in my forearms and hands supplied blood to all my fingers; so I could do okay with one loop not working or not working 100%. 

Bottom line: looks like the graft(s) for the bypass will come from my arms, not legs. Which I guess means I am going to be able to walk without ouch. (+1 pt) But, probably at the expense of typing.  (-1 pt) 

Next…

The other useful event of the week was getting my paravertebral block scheduled at set up for the morning of Tuesday 2/16. I have to admit this one has me a bit nervous. Of course, none of the concern is due to anything rational. It is all "lizard brain" reaction stuff. (I keep trying to have a rational conversation with that little fear monger in the back of my head; but, he is listening to me with the same focus and attention that my adolescent kids exhibit when they are "staring at the abyss" – aka their iPhone screens.)

I guess just the thought of inserting catheters into my back and kinda interweaving them with my vertebra is…well…unsettling. You are not supposed to insert things into your spine. You are supposed to be careful and protect it. I am pretty sure I remember my mom being rather specific, and clear on, the topic. 

Of course the other aspect is that going to this appointment will mean that the surgery is less than 24 hours away. I will be glad for the relief the surgery will offer and the weight off my shoulders once the plaque(s) are addressed but… still…

Anyway, while talking to the nurse as we were setting up the appointment I learned that Stanford's approach to pain management is multi-modal. They really attempt to address pain from as many angles as possible. So the paravertebral block is only one dimension. They also use good old narcotics (hopefully less though thanks to the block) administered both after surgery and before. Even vitamins apparently play a role in pain management. I have instructions to take 500mg of vitamin C twice daily starting the day before the procedure – for pain. 

I guess I failed at keeping this post short.…not really surprised.

Next up holes in my back…