Trepidation

29 February 2012, a leap year day and the day I underwent what would be my first abdominal aortic aneurysm surgery and the one thing that scared me more than having a stroke did.  While having untreated high blood pressure has been described as a ticking time bomb, having an AAA is a bone fide, very real and literal bomb and one that may go off… or just sit there.  Maybe it’s not a bad thing if you don’t know it’s there but these things fall into that category of what you don’t know can not only hurt you, it can kill you, a point I was reminded of when that actor who played “Tommy” on “Martin” died because his AAA ruptured. I know, from experience, that knowing it’s there and understanding the danger is even more nerve-wracking and as I said when I first talked about this, they couldn’t schedule the surgery fast enough; in fact, when the doctor who told me about the AAA sat with me and explained the situation, I was preparing myself mentally to wind up on a table that night.

The repair was made, follow-up checks kept religiously and everything kept looking good but in the back of my mind – and after having read up more on this problem, the trepidation was still there because given the way it was repaired, eh, there were still some risks but mostly being around very powerful magnets or being subjected to blunt force trauma, like getting hit in the abdomen by a car.

15 November 2016… time for the yearly ultrasound… and I knew something wasn’t right when the ultrasound tech not only did the scan a second time but called someone else in to look at it as well.  I could see what they were looking at but I couldn’t see what had them what I’d call “concerned,” for lack of a better word.  After seeing my doctor and being told that a CAT scan was needed, I knew something was amiss – but I still didn’t know what and my doctor isn’t the kind of guy who’d give me information without it being confirmed first; he said he needed a more detailed scan so he could be sure of what he was looking at.  As I stood at the checkout desk, I’m thinking there’s something wrong with my implant… but, hmm, if it was something wrong and seriously wrong, I wouldn’t be standing here getting scheduled for a CAT scan and thinking about what he’d said:  “Once they scan you, you have to stay there while I look at the film so I can decide if another scan with contrast is needed…”

I learned, from an earlier yearly exam that he prefers I get scanned with contrast (he had a hissy fit when the radiology people mistakenly gave me contrast for a scan) so while I’m not worried, yeah, he’s got my attention.  I get home and I’m talking to Linda about this and we both agree that he – my doctor – wouldn’t order this unless he suspected something wasn’t right but, as he told us, not an emergency situation.

29 November 2016… and time for the scan from hell.  First, upon checking in, the radiology department said they didn’t have me scheduled for any scans even though the script I gave them had the time and date for the scan and when it was made.  Eventually, they found it but I was under the impression they weren’t happy about how the appointment was made – not my problem, though; I’m here to get scanned and, hopefully, once and find out what my doctor wanted a better view of.

On the table and, wow, just being in the area where there are machines with superconducting magnets still make me nervous since I know these are the kinds of magnets that can affect titanium – but I also know that as long as I’m not standing next to one that’s operating in a specific range  there’s no danger of my implant being made to move by these powerful magnetic forces.  These people are professional, they have my chart, and it’s not like they’ve never had to scan someone with an implanted endograft before.

First scan is done; why do they always seem to tell me to hold my breath while I’m in the middle of exhaling?  My doctor had ordered that I remain on the table until he could pull up the scan from his office but I went back to the waiting room, hoping this won’t have to be repeated… but no such luck:  Time for the contrast scan.

Shit…

I get taken back to another area so they can check my kidney function; they know I have polycystic kidney disease (the bad version) and while it’s not giving any issues, the radioactive iodine might cause an issue so I gotta be tested to make sure there won’t be a problem.  The test only takes a minute using a device that reminded me of how diabetics check their blood sugar levels – and we’re good to go.  The tech puts an IV line in, attached a syringe of contrast to a port, and in it goes… and I’m back on the table being scanned and told to hold my breath… while I’m exhaling again.

Now it’s off to my doctor’s office and it’s a bit of a hike from where I got scanned and it’s been a long day but we get there, check in and, before my butt even settled onto the chair, I get called back.  Blood pressure and temp gets checked and logged and a few minutes later, my doctor arrives… with another doctor… and now I know something is wrong and I’m about to find out exactly what’s wrong.

The short explanation was my implant was leaking, causing blood to flow back into what was left of the aneurysm sac and, as such, not allowing it to shrink as it should.  Not life threatening, he assures me… but this needs to be fixed but in a way that doesn’t cause some blood flow issues, like cutting off the flow of blood to my colon (very, very bad) or cuttingn the flow to my buttocks and giving me some pain similar to having peripheral artery disease – which I don’t have, thank God.

I love this guy and the way he explains things to me; he says, simply, that he needs to make the legs of my “pants” longer and I know what he means because the implant does look like a pair of shorts that can have legs attached.  So… I need surgery again and he cracks me up because he tells me this like I’m gonna tell him I don’t want it done; sure, I’m gonna diss what’s really life-saving surgery.  He’s funny in an annoying way but as a vascular surgeon, he knows his shit and I’ve already trusted him with my life once and have no reason not to trust him again.

Back at home and absorbing all of this and awaiting phone calls to confirm my surgery date but also wondering what he’s gonna do that it’s only gonna take a couple of hours to do it and maybe a day or two in the hospital.  No, I didn’t forget to ask – it was just that he said he had to think of a way to do this without giving me any problems so, okay, I trust that he’ll figure it out… but I’m still curious about this since, when I first got implanted, it took like six hours to do it and I spent three days in the hospital.

07 December 2016… it’s Pearl Harbor Day, the date Delaware ratified the Constitution, and it’s also my baby’s birthday.  I hadn’t wanted to get operated on this date but we were sure the doctor wanted this done before Christmas and, later, we learned that this was the first available date that the special operating room they’d need would be available.  In at the crack of dawn, signed in, prepped for surgery, operated on, spent a very miserable night in the hospital thanks to the out-of-control roommate I got stuck with.

It’s been almost three months since the surgery and I’ve already been scanned to insure everything is okay… but I was confused because like a week after the surgery, I get a thank you card from Preoperative Services thanking me for letting them take care of me (a really nice touch, I might add) as well as a card that has information about… and endograft device that’s different from the one I’ve been carrying since 2012?  Wait… what did he do?  Did he remove my original implant and replace it with another?  Yes, I knew they could be removed but, um, if it took six hours to put it in, how come it only took two hours to remove it and replace it?

Okay, I had to remember to ask him how he managed this magic trick but, in the meantime, I wanted to know why I had a different implant and, after some searching, I found that the way an endoleak is fixed is to implant the device so that the leak is stopped.  Okay, makes sense – he made the legs on my pants longer but with a different – and, perhaps, better device… still wanna know how he did it, though and I admit to being seriously impressed.

Come to find out that he didn’t remove my original device:  He added a second device inside the original one!  Still impressive given the precision this had to require.  The endoleak has been stopped, I’ll have to undergo more frequent checks… and the trepidation remains.  From what I read, the chances of another leak are slim but possible and I find myself hoping this doesn’t happen because it’ll most likely mean an extensive surgical session to remove the implants and effect a traditional repair… and that bothers me more than it probably should.  If it had to be done, well, I trust my doctor to get it done but, shit, I wouldn’t be looking forward to not only having my abdomen opened but also the inside of my thighs – I suspect that my longer pants legs now extend a bit further down into my femoral arteries.

I know, at this moment, I have nothing to worry about but I’m not quite sure why I’m worried about a possibility that wouldn’t be made apparent until my next scan in July…