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Harden My Heart
Mar. 10th, 2025 02:10 pmIt’s been five months since my stroke, and four months since my last blogpo about it. But Friday was another big milestone, and well worth another update.
It’s been a long road getting here. My stroke required a four-day hospital stay, and since my discharge, I’ve:
The Amplatzer Talisman Patent Foramen Ovale Occluder!!!
- Visited my PCP twice and consulted with him online once
- Visited my cardiologist twice
- Visited my neurologist once
- Visited my hematologist once
- Had two lab blood draws and work-ups
- Wore a heart monitoring device for a month
- Consulted with a nutritionist three times
- Had my cardiologist perform an in-hospital procedure called a “TEE test” where a camera was sent down my esophagus to observe the condition of my heart
- Had an in-hospital radiologist perform an ultrasound to examine my legs for evidence of blood clots
At least that’s the ones I remember, and that doesn’t include another dozen-odd phone calls and emails, plus lots of wrangling with my insurance company over coverage and claims. Fun times!
All that work was intended to determine why my stroke occurred. But it didn’t.
In cases where there’s no smoking gun, cardiologists look at a specific feature of the heart called the foramen ovale. That’s a small hole between the heart’s two atria that allows blood to bypass going to the lungs before a unborn child begins breathing on its own. After birth, that opening usually closes and fuses shut.
But for one in four adults, that opening doesn’t fully close, which allows a small amount of unoxygenated blood returning to the heart through the veins to bypass the lungs and go straight back into the blood stream to the rest of the body. For most people, this isn’t a problem, but if a blood clot sneaks through that side door and travels to the brain, it can cause a stroke. So it’s one of the things that cardiologists look for when an otherwise healthy person has an unexplainable stroke.
Needless to say, that TEE test I had confirmed that hole in my heart, called a “patent foramen ovale”, or PFO. Ideally, if one could seal that opening between two chambers of the heart, it would prevent any possibility of that defect causing another stroke.
Amazingly, not only is PFO closure something modern medicine can actually do, but it’s considered low-risk and pretty routine. A thin catheter is inserted into the major femoral vein in the groin and up that vein directly into the heart itself. A collapsable metal device – it kind of reminds me of a mesh kitchen strainer – is sent through the catheter and deployed inside that hole, sealing it shut. Visually, it’s like a disc the size of a dime on one side of the opening, and another the size of a quarter on the other side, connected by a very short rod in the middle. See the goddamned photo (it’s not my favorite thing to look at, I’m afraid).
In order to ensure this all goes well, a second catheter – this one bearing a microscopic camera – is threaded up the femoral vein on the other side of the groin. And in my case I think a second camera was sent in through my arm, as well. Throw in an IV for fluids and anesthesia, and that’s a whole lotta jabs!
As I say, this is now considered pretty low-risk and routine. Patients are usually walking and sent home a couple hours later, and I was apparently the third PFO closure that my cardiologist had scheduled that day.
But from the patient’s (my) point of view, having a chunk of metal surgically implanted permanently inside my heart isn’t something I’d consider “routine”!
So leading up to Friday’s procedure, I had a fair share of anxiety about heart surgery and metal implants. It sounded like a whole lot of expense and effort just to reduce my chances of a stroke, especially when there was no clear evidence that this is what caused mine. I’ve been blessed to have never relied on the medical industry very much, so my nerves were pretty highly activated in the lead-up to my surgery.
Fortunately, I had my partner Inna to lean on, plus a number of friends who took an interest and expressed empathy and compassion, including but certainly not limited to Carolyn, Helen, Sally, Robie, Rhonda, Ben, and some of my PMC riding buddies. I might be going through some medical trauma, but I didn’t feel like I was doing it all alone, and that made a huge difference.
Happily, the procedure seems to have gone well, at least from the perspective of a couple days post-op. So now my concerns and preoccupations are focused primarily on the somewhat-involved process of recuperation.
Short-term, I’ve got some annoying restrictions, mostly so I don’t rip open those incisions into major veins. That means no driving, no flying, no lifting, and virtually no exercise. Those restrictions will ease over the coming weeks, but this will curtail and require a major reset for both my cycling and my kyūdō practice. For more on how this operation will impact my cycling, see the companion post on my cycling blog.
So for now I’ll be getting back some free time, which will be put to use catching up on some low-priority projects that I’ve deferred for ages: things like revising several bits of old computer code I rely on, cleaning up my personal online archives, and the like.
From a cardiac perspective, the most important short-term concern is to rabidly guard against any possible infections that might lead to endocarditis. Not only does that mean frequent washing with antibacterial soap, but more aggressive precautions. I’m literally not allowed to see a dentist for at least 6 months, and will need to take antibiotics before every dental appointment – even just cleanings! – for the rest of my life!
And of course there’ll be more medical followups. At minimum there’ll be another cardiac ultrasound to verify the work, plus followup meetings with my cardiologist and PCP.
But things seem under control at the moment, and hopefully I’ll be making a full recovery, after giving things a month or two (or six) to properly heal. And now I look forward to getting back to posting some less dramatic and more typical content!
