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Thursday, May 18, 2017

Today is the day

Its about 3 AM and I have to report to surgery in a couple of hours. Still have to bathe with the special soap they gave me and to put some kind of ointment (Mupirocin) inside my nose to prevent getting staph bacteria infections.  Nothing to eat or drink, and can't even let any water from brushing my teeth from being swallowed.

Already talked with Marina and B a few minutes ago.  Kind of emotional for me as I wish they could be here, but circumstances won't permit that.  At least we talked, joked and played over the phone. Marina is still too young to understand the situation and its probably better as I don't want her to be scared or worried.  It will give me the incentive to get through this thing and spend a lot more time with them once its over.

That's it for this morning's briefing.  Hopefully you will hear from me in a couple of days after I get out of ICU and they let me have my tablet.  Whatever the outcome, its been a real honor to have friends and loyal readers like you.   Thanks for all your well wishes. 

Will still be tweeting until they take my phone away.  Follow me on @seven_winds or click on the link to follow.

Catch you all on the other side!

Day 3 - Meeting with the doctor

Met with my surgeon this morning (profile here).  Fortunately did not have to wait too long because he was available and not in surgery.  He went over my condition, which is that I have a mitral valve problem, but that problem may have also saved my life from a silent widow maker heart attack because of my constricted artery.  Its one of those conditions in which people will have no symptoms and can be in apparently good health, but can suddenly have a fatal heart attack without warning.  One would not have any indications without getting a catheterization procedure.  This procedure involves inserting a thin tube to your heart and then injecting an iodine dye before special cameras take pictures of the entire circulatory system close to your heart.  So in his words, the mitral valve diagnosis and repair saved me from a fatal heart attack situation which could have occurred at any time.

He also said that due to the bypass operation, the only solution is to have a full sternotomy.  No other options are recommended due to the location of the bypass and the risk.  His assessment is that this was going to be somewhere between an easy and medium difficulty operation.  The bypass part, he said, could be done by a third grader.  That gave me a lot of reassurance that the whole procedure was going to worth the risk.  100% chance of dying from a heart attack in the future or a very minimal chance of complications from the procedure.  He did say that these repairs would last my lifetime and that my heart and circulation should be better than it ever was.  It was easy to sign the consent form.

Anyway, just got word from the clinic that I will be reporting to surgery at 5:15 am.  Hopefully, by this time tomorrow afternoon I will be awake in the ICU all patched up and ready for the long haul. The road to recovery is next but at least there is hope for a much longer ride on this merry-go-round called life.

The takeaway for all of this for the readers of this blog should be to get your regular exams and make sure you follow-up on all the recommendations.  If it wasn't for the follow-up to my heart murmur after my annual physical at Bumrungrad, I would be a walking heart attack case which could have happened at any time.  Now, with the right procedure, I should be OK for a normal life with no other heart problems.  Doctor says I will likely die of something else...555

Got to get packing for a hopefully short stay in the hospital.  More tomorrow morning before I go into surgery.


Wednesday, May 17, 2017

Day 2 of Testing - The news is not so good...

Day two of testing is done, but the outcome is not as expected.  Aside from waiting a long time for the procedure due to an emergency case ahead of me, the results were not what I had wanted.  It looks like in addition to my mitral valve problem, I also have a moderately blocked blood vessel in the front on the heart which will require bypass surgery.  While its not severely blocked, its on the bordeline (70% blocked) and looking at the images, this may have been a congenital defect as well because the vessel is constricted in a small section only and all the other vessels around the heart are clean.  Its like a two inch pipe suddenly being reduced in size to a one inch pipe then expanding out to a two inch pipe again.  The blockage is not due to plague build-up, but the sudden reduction of size in the vessel. People don't normally have symptoms until around 80% blockage so I could have had this for some time without knowing it and the slightest buildup could have resulted in a 'widow maker' event.

With that news, its now a toss up if I will have a robotic repair or not.  The surgeon will have to decide that tomorrow during our consultation.  Its totally possible to do both robotically, and the doctor definitely has the experience and skills to do it, but it has to be weighted against the risk. A full sternotomy is the gold standard, but that too has its risks so it will be an interesting discussion with the doctors tomorrow.  Which ever the case, this complicates my simple little valve repair job quite a bit.

On the positive side, its good that we caught all of this early, in advance of an emergency cardiac event and before any damage has been done to my heart and body.  Since I was almost totally asymptomatic, I see it as finding out and fixing an engine problem before your car breaks down during a long trip on the freeway.  Its good to have the luxury of time and being able to pick the best hospital and doctors to do your surgery instead of the emergency room resident.  Will keep my fingers crossed and hope for the best tomorrow.

Taking things in stride, I went out to dinner tonight with family and friends in Little Italy.  Took Uber and it was both convenient and fast.  The weather was perfect today and it was in the 70s in the evening.  People were dinning outside on the sidewalk and the place was festive with Italian music coming from the various venues.  Had a great dinner at Trattoria on the Hill.  Huge pasta plates big enough for two meals and a great relief after fasting most of the day.  Hey, its time to enjoy life to the fullest until it time to go under the knife right?

Talking to the owner of the restaurant this evening, he asked me if I was scared.  I told him I wasn't and not only that, I feel very calm and relaxed - almost like I'm on vacation.  After all these months of waiting and research, and knowing that I have the best hospital and doctors in the USA on my case, what else is there for me to do that I haven't done already?  Oh yeah, I got anointed by my priest and also brought my Thai tree spirit just in case ...555 So it was such that I am resigned to whatever the outcome - preparing for the worse...hoping for the best.

More tomorrow after the consultation.  Maybe a visit to the Rock N Roll hall of fame in the afternoon before surgery.

Tuesday, May 16, 2017

Day 1 of Testing is over!

The first day of testing is over.  Reported to the registration station as scheduled at 8 am and went through the formal registration process.  Filled out all the paperwork about me and collected all my insurance cards and ID.  Guess they wanted to make sure they got paid for all the services I will be receiving.  My estimate is that this procedure will cost between 250 -300,000 USD dollars when all the cotton balls are counted.  Its a good thing that Medicare and my supplemental insurance will pay for all of it.  It will not pay my travel expenses, but that is a small exchange for this world class care.  Its time for me to finally get something back from the decades of taxes I've paid into the system.

After registration, I had an EKG, blood panel, and a chest xray.  At 10AM, I met with my assigned staff cardiologist.  He is from Ireland and is the head of his department.  Tomorrow I am meeting with the head of Cardiovascular research who will do my catheterization procedure and finally, the director of cardiac surgery will be doing my procedure.  Talk about lucky streaks, somehow I got the three top people in their organizations at CC on my case.  If these three renown doctors can't fix me up, no one can.

Anyway, the take-a-way from the morning session with the cardiologist is that my valve is indeed leaking, but the heart rhythm is ok.  I do have palpitations from an early firing of the left ventricle but that is not major - I am not going to drop dead tomorrow.  His early impression is that a minimally invasive procedure is likely unless they find that I need some kind of bypass surgery.  Tomorrow's catheterization procedure will give a more complete picture and determine the final approach.  That was great news for me as I was preparing for the worse case scenario - a full sternotomy where they crack open your chest to get to your heart.  My hope now is that I can get robotic surgery and save weeks if not months of recovery.  He told me that whatever approach, there would be pain and to not be macho and forego the drugs.  I know from first hand experience when I had hernia surgery that he was absolutely right.  

Found a great place for lunch at the hospital.  They have a huge Au bon pain bakery and restaurant. Same chain as the ones in the big mango, but much much larger in size and a huge selection of food. Had a great soup and sandwich combo to end my fasting.

Family and friends coming in tonight so I am in good care.  Plan on going to dinner at Little Italy tomorrow as they will likely be tired.  I personally feel as good and energetic as ever, doing my daily walk and having a busy day today.  Since tomorrow is a only half day of testing and so is Wednesday, I plan to keep the days full and might even go to the Rock and Roll hall of fame before my procedure. Strange situation feeling  so good going into an operation knowing that you will feel worse coming out on the other side in the short term.  Its the long term benefits that I am after and it will be worth it.

Finally thanks for all the well wishes from everyone!  I appreciate it from the bottom of my heart - its in need of a little tune up now, but its deep and full.   We'll be hanging out again soon.

Follow me on twitter at @seven_winds for live updates


Monday, May 15, 2017

In Cleveland

Posting from my room in Cleveland.  The trip over was very smooth.  Everything like clockwork starting from the airport shuttle.  Was lucky too as I was the only passenger in the Van. Traveling on mother's day was a blessing as the airport security was fast and the plane left on schedule.

Came to Cleveland via Chicago midway.  Haven't been here in years and it looks like they have expanded it a lot.  Was a zoo.  People everywhere and long queues for the dirty bathrooms.  Noticed that the gates were also packed with no seats to sit and wait.  Taking Southwest Airlines is like riding a bus...only this bus flies instead of rolling along the highway.  Sat next to a guy who brought his own hard liquor and virtual reality glasses.  He appeared that he was on another trip of his very own.

You call this a meal or snack? 

Also got a reminder about the lack of food on these flights.  I should have known as I use to take SWA once every other week on business.  But its been a few years and I've been spoiled by the great service of an overseas Asian airline like EVA.  Had a package of crackers and some peanuts for my meal...555.

Now that's what I call real food

But during the stopover in Chicago, I found this place called Real Burgers.  And boy where they real, and real good too.  Nothing compares to Midwest beef...must be the grass.

Got into Cleveland around 4:45pn local time and was met by the limo driver provided by the hospital. They provide two way limo transport for their patients from the airport if you are from out of the state. After checking into the hotel, I scanned the neighborhood for restaurants and stores.  I knew that there was a CVS nearby and both a Burger King and McDonald's too.  A Vietnamese noodle restaurant was within walking distance but it was boarded up and closed.   Walked to the CVS for some supplies that I did not want to pack and also bought some water and juice.  I was rushing to get back to the hotel because I had to eat before 8 pm due to a requirement to fast before tomorrow's testing.

Main Building of Heart Center at Cleveland Clinic
Starbucks is popular for both staff and visitors

From the hotel, I walked to the main building at the clinic.  Its a huge sprawling complex and within its bowels is a food court of sorts, two coffee shops, and a few gift shops.  Decided to have dinner at one of the food stalls called Moe's Southwest grill.  Mexican food, but coming from Kalifornia, it didn't meet my standards at all - plus it was expensive.  Too much junk food for today already.

Anyway, I'm back in my room chilling out and reviewing my schedule for tomorrow, posting on my blog and sending Marina off to school.  I'm one hour ahead of the LOS now and the data service on my phone is great so its just like being there.  

B's father went fishing at the pond across the resort this morning.  See his catch in the photo below.

Cousin Bow holds up fish as Marina looks on

More tomorrow after the first day of testing.

Sunday, May 14, 2017

One more day.....

Tomorrow is the day.  At 5:15 am the shuttle will arrive and I will be on my way.  In a way, I am glad the waiting in nearly over.  The initial contact with Cleveland clinic started back in January.  It took nearly three weeks after I submitted all the documentation before they got back to me with an offer to do the surgery. They then offered surgery in April, but I wanted a bit longer for a trip back home. Between then now, I had that nice trip back home to the mango and spent the time with family and friends.  The time there was priceless.  By this time next week, the surgery should be completed and hopefully I will be out of ICU and in a regular hospital room and maybe blogging again!

I've been reading up on what to expect from the surgery.  There is a book out by Adam Pick called "The Patient's guide to Heart Valve Surgery".  Its very helpful as he provides both clinical and well as personal information about his own procedure.  It seems like most patients go into surgery not knowing what to expect and thus will not be prepared for its impact on their lives.  

The main takeaway is that the surgery itself is the easy part as you will be asleep the whole time anyway. Its what happens after you wake up in ICU and the weeks of recovery afterwards that is going to be the greater challenge.  Most importantly, the people around you need to understand your limitations and challenges and must also set their expectations accordingly.  Being patient is the key.

Planning to go to mass this evening with my Godmother's family and then have a quiet dinner at home before going to bed early.  

Remember, starting tomorrow look for twitter updates also on @seven_winds.

Friday, May 12, 2017

Will also be using twitter when I am in Cleveland

Decided to use Twitter as well as blogger when I depart for Cleveland.  The reason for expanding is so that I can do less typing and keep my messages shorter.  Being the long winded person that I am, using blogger only encourages me to say more.  More is not always good, especially if its boring stuff or repeating the same old things.  

So while I am away for my surgery, you might want to check out what's happening at my twitter handle:  @seven_winds (underscore between the seven and winds). If you don't have a twitter account, that's ok as I will try to post what I can here on blogger.  I found that with twitter, I can do updates quite easily with my smartphone, PC, or tablet.  

Spent some time repacking again yesterday.  Looks like the weather in Cleveland is going to be nice while I am there having surgery.  It won't be so nice when I arrive, but later in the week, the temps are going to be in the 60s, 70s and 80s.  That creates a problem of what to pack as I was preparing for cooler weather.  But the best plan seem to be to pack layers so that I am ready for anything.  Its not quite so simple as the clothing has to be non constricting and if I have a full sternotomy, a shirt that buttons instead of being a pullover (i.e. Tee shirts).  Threw in a couple of Hawaiian shirts for some color and to brighten up the situation.

Lastly, word from home is that things are well.  The 'official' start of school is Monday the 15th, but Marina is in pre-school and not part of the National calendar.  Parents all over Thailand are rushing to raise money for tuition, uniforms, and other expenses.  I guess when you have to personally pay for your education, one values getting a good education that much more.  Even the public schools require parents to provide kids with their own uniforms and supplies so everyone has a stake in the success of the kids.  My big regret is not being home to give Marina a big hug and kiss before sending her off to school each morning.  But that will hopefully change when I get back in July.

Thursday, May 11, 2017

Busy but feeling good.

So far the week has been busy, but that's good as the weekend is rapidly approaching.  Didn't realize it was mother's day this Sunday, so that's a little bit more I have to prepare for before getting on the plane.  Made arrangements for pickup to the airport on Sunday.  Shuttle will be here at 5:15 AM and will be at the airport no later than 6AM, one hour before my flight.  Can you believe it costs $29 bucks for a one way, 10 mile trip on a shared shuttle?  Complain as we might about taxi scams, that 270 baht ride from Suvarnabhumi is really dirt cheap compared to the bay area.

Spent the last couple of days on business, including a visit to the now completed JV project. Business looks good at the center although one of the retail centers opted not to open a new store, but instead will continued to pay rent.  It seems like the company is short on capital and will likely be taken over by one of its competitors so they are holding off on new store openings.  Just as well because it will be less wear and tear on the property if they have to redo things.

Yesterday, I applied for a special shuttle program for seniors and ADA individuals in our area.  This program provides low cost door to door rides ($1) to anyplace in the city.  Don't know if I will need to use it, but I signed up for it at our local senior center anyway.  There is a free shuttle service called Emery-go-round that takes people to various points in town too, including BART so that will be the first option.  My hope is that I will be cleared to drive in 3-4 weeks after surgery.

Stumbled on a great blog post by an Alaska Expat that is living in Thailand that also had a heart procedure done at Cleveland Clinic a few years ago.  It describes his experience there in great detail and like everyone else, provides glowing compliments to the staff and doctors there.  The link to his blog post is here:  http://dswarthout.blogspot.com/2013/05/open-heart-surgery-at-cleveland-clinic.html

Look at all of those FAT frogs!

Talked to B last night and she says that it raining a lot upcountry.  It looks like the rainy season started a little early this year but its a welcome relief from the hot weather.  When it rains, that means it frog season to the locals.  During heavy rains, the frogs in the ponds and lakes come up out of the water and are easy pickings for capture.  B went out with her newphew and father to get some the last few days and they are having BBQ froggies every night....555.  I must say that these frogs are tasty when I've had them, but they are a bit of work to eat.  Delicious meat which tastes like mild, moist, fat free chicken...yum!

That's it for now.  Some housework, laundry, and paperwork scheduled for today.

Monday, May 8, 2017

First day of School

It was only preschool, but it was still school.  Yesterday was Marina's first day of school.  Can't believe that my precious little girl is at this milestone of her life.  It seems like just yesterday that she was a little bundle, just barely bigger than my hands in the hospital.  She will turn four in June, but we found a great preschool where they take younger kids and offer an exceptional program.  This is hard to find upcountry, but we found out about it through one of the other parents.  Its not cheap and thus the students are mostly from well off local or foreigner parents in the area.  The classrooms are very nice and well equipped and the student to teacher/teacher aid ratio for the young kids is an amazing one to one.  

B took Marina to school and stayed there a few hours to make sure she was OK.  Near the end of the morning, Marina was already telling mommy to 'go home and come back later' to pick her up when school was done..555 When I talked to her this morning, she had a big smile on her face and said she was looking forward to school again tomorrow.  She had brought home some stuff and was already doing some 'play homework'.

These twins are smart.  Can already read and write at second grade level

The other little girls in my life are my twin grand daughters.  They had their 5th birthday party over the weekend at a park near their home.  It was a 'Princess' party, where all the kids coming to the party are dressed as little Princesses.  A special appearance by Queen Elsa the magician was the highlight of the day.  It was so much fun to watch them as they were led through a host of activities on the grounds.  I am such a lucky guy with these special girls in my life.

Spent time with them afterwards and caught up with them on various things.  Agreed to a date for the red egg and ginger party for the newest grand daughter Kaitlyn.  After a dry spell of nothing but boys in the family line, we are now flushed with girls galore so everyone is overjoyed.  It will be the weekend before I return to the mango, and hopefully fully recovered from my surgery.

And finally yesterday, I attended the wedding of my nephew's son.  My nephew has just finished treatment for cancer, and the year before he had a heart attack that required bypass surgery.  Part way through the ceremony, one of the groomsmen passed out.  After he was revived and taken off by the EMS people, the wedding resumed.  Word we got was that he was fine (passed out due to hunger and exhaustion) and the rest of the wedding went off without further incident. Had one of the best roast beef dinners at a wedding in a long time or maybe I was just really hungry???

That's all for the weekend.  This week is crunch week already as one week from today I will be undergoing testing in Cleveland.  Lots to do in a short time, but better busy than sitting around second guessing and worrying about things.

Life is great...just go out and grab it by the horns and hang on for the ride!

Friday, May 5, 2017

A week already

Its already been a week since getting back to Kalifornia.  Needless to say, its been a busy one and rightly so as I get ready for Cleveland.  I've been shopping for things that I will need the next two months that might be heavy and hard to get as I won't be able to drive for 4-6 weeks after surgery. Not supposed to lift anything heavy either so that kind of limits what I can re-supply on my own by just walking.  Fortunately, this area is abundant with restaurants, stores, and facilities in walking distance. I even have an IKEA within walking distance of my condo.  That means the worse case scenario is Swedish meatballs for six weeks...555

Eating right - no fast foods for now

Also am preparing physically by walking 45 minutes every day and now on alternate days I hit the weights in the afternoon at the condo gym in addition to the morning walk.  I want my cardio and muscles to be in as good a condition as possible so that they won't waste too much when my activities are restricted.  Thank God, I have no symptoms that prevent me from exercising before the procedure.  I will take precautions to not overdue it and be rested by next weekend.  Also changing my diet a bit to speed the process of losing some unhealthy weight.

I'm reading a lot to also prepare mentally for the challenges after surgery.  They say its normal that I'm going to not have an appetite, be moody, and feel tired. I will second guess my decision to have the surgery if things take longer than expected and  I might even go into depression. Might even have hallucinations from the medication.  Knowing all those things in advance will help me deal with the situations as they come up - so all you readers be prepared too..555  Never know what kind of person will come out on the other side of the surgery!  For sure I know I will be bored already...being used to an active lifestyle and having to sit around a lot will really be a change. But in the long run, the outcome will hopefully be worth it.

Started packing some stuff yesterday and deciding on which bag to bring. The situation is compounded by the changing weather in Cleveland as its colder than normal. When I was working and commuting between Texas and Kalifornia, I got by a whole week with one roll-on suitcase.  The challenge is to go two weeks this time with even less weight and stuff.  The only solution is the perpetual bag approach, which is to bring clothing that can be quickly washed and drip dried.  But that also offers a challenge in that I may not be in the mood to wash and hang clothes after surgery.  Anyway, I will check on laundry service at the hotel as that will be my plan B.  Plan C is to ship the whole bag back from the hotel with UPS.

Everything going well at home.  Talk to B and the kids twice a day on video.  They like the new feature in LINE that allows you to alter your face during the call.  That's its for now..