Friday, November 25, 2011

Reconsidering my options (again)!

If you've been following my blog and feel like you've been riding a roller coaster lately, welcome to my past two months! Even after I thought I made a final decision, I find myself now reconsidering my options. As usual, nothing is definite; but I am, once again, thinking about having the surgery. Even though I have two recommendations against surgery and one for it, my gut is starting to lean back toward having it done as an extreme (but potentially life-saving) preventive measure.

This past week, I received a call from the interventional specialist at the University of Chicago who would be doing the stent implementation. He talked me through the details of the procedure and the associated risks, and he explained that it would be much like the cardiac cath that I had done last month at Northwestern. The difference here is that, rather than just observing the heart, this procedure would place the stent in the narrowed portion of my left pulmonary artery just past the aneurysm. When doing these stent procedures, the doctor explained that there is generally a very low risk (approximately 1 in 1,000) of an injury (or tear) to the artery wall. However, because my case is so unusual given the size of the aneurysm, he estimated that the risk of arterial injury here might be closer to 1 in 100, which is actually greater than the mortality risk associated with the surgery (less than 1%). I then asked him this question: “If there is damage done at or near the site of the aneurysm, what, then, would be the likelihood of my needing immediate surgery?” Because my case is so unusual, I understand why he wasn’t able to give me a definite answer. That said, however, this has added yet another piece to the complex puzzle.

While all the doctors I've met with seem to think that the likelihood of my pulmonary artery rupturing is quite low even with my overall level of activity, the lack of documented data cannot really allow them to determine the likelihood with much certainty. (And I surely don't want to be that first documented case!) Truth be told, I'm rather paranoid about it, especially given the active lifestyle I like to lead. I have even been a bit hesitant to exercise with any degree of intensity since first learning of the aneurysm and getting the recommendation for surgery back in mid-September; and I definitely want to feel comfortable and confident again going on future multi-day bike rides.

Just this morning, I emailed the cardiologists at Northwestern and the University of Chicago to ask for more feedback given my latest concerns. I also inquired about endovascular coiling, a minimally-invasive procedure I recently read about online for treating brain aneurysms. While I have no idea if this would be an option for my cardiac situation, I had to ask.

Stay tuned! I'm sure there will be more exciting adventures ahead, even though I don't yet know what they will be!

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