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Sunday, May 18, 2014

To have surgery or not, that is the question

Doctor's note clearing me to return to work
By Ted Slowik

This is an obligatory follow-up post to last week's cliffhanger. In that episode, regular readers will recall, I was going to see the cardiologist to find out if I was healthy and strong enough to return to work and whether I still needed to wear a defibrillator.

Good news and bad news. The good news is I'm cleared to return to work. The bad news is I still need the defibrillator.

I'm certainly no expert, but in the 13 weeks since my near-fatal heart attack I've learned enough about the heart and medical terminology to carry on somewhat intelligent conversations with doctors. And I've learned the ejection fraction (EJ) is the percentage of blood pumped by the left ventricle of your heart.

In a normal, healthy heart, the EJ is 50 percent or greater. Mine's 35 percent. They'd like me to be at least 40 percent to be free of the defibrillator. Since my heart is weak, I'm at a higher risk of having another heart attack. The next time, I might not be so lucky. The defibrillator can shock me back to life.

You've seen defibrillators on TV. In shows where someone shouts, "Clear!" and then puts paddles on someone's chest and shocks them, and the body jumps, and the patient's heart either starts beating again or it doesn't. In real life, automatic external defibrillators are becoming much more prevalent in public places.

They're as critical a life-saving device as you can imagine, as important as someone doing CPR. Since my massive widowmaker on Feb. 17 I've been wearing my own personal defibrillator. The paddles are strapped to my chest at all times, in a bra-like wrap called a Zoll LifeVest. I carry a battery pack. I can take it off to shower, otherwise I wear it constantly.

Now that it's been three months since the heart attack and I still have a weak heart, I'm a candidate to have a defibrillator surgically implanted. It's not a pacemaker, it's a defibrillator. There are many varied types of heart disease and heart damage, and different devices, procedures and medications treat various conditions. I had a stent put in to clear a main artery that was 100 percent blocked, but I didn't need open-heart surgery.

Insurance will now cover the cost of having a defibrillator surgically implanted, which runs at least $50,000. On Tuesday, I consult with a specialist about the procedure and other options.

When I met with my cardiologist last Wednesday, I was leaning toward the option of delaying surgery another month or two. I'm only one month into a three-month cardio rehab program of intense physical exercise. I'd like to give that regime a little more time to see if my EJ number will improve. Mind you, I've been doing all I can to be more healthy: losing weight, eating a more nutritious diet, exercising an hour or more every day, not using tobacco, and taking medication for cholesterol. I've also learned that heart damage is reversible. Diseased hearts can become healthier over time when patients live healthier lifestyles.

Doctor says the cardio rehab won't really affect the EJ number, that only time and rest and medication will do that. Three months is typically the point where you're EJ determines whether you still need a defibrillator or not. Apparently I still do. It may be false hope to believe that my EJ can somehow improve in the next couple months, but I'm willing to continue putting up with the nuisance of wearing an external defibrillator all the time if it turns out I don't need one.

On the other hand, I could have a defibrillator surgically implanted, and not have to worry about it. Maybe they have to check it every so often, but it would be peace of mind. After all, my personal defibrillator is an insurance policy. It could save my life if I have another major event, so who wouldn't want one, right? If you look at it one way, it's a slam-dunk no-brainer. Have a life-saving device put in you that will keep you alive and you don't have to think about it? Well, duh...

But surgery is surgery, and no matter how minimally invasive they make it sound there's always some risk, right? Surgery is one good option, but it's not the only one, and it's often viewed as the most serious and last-resort option. Why, just this month I was reading about some people in Indiana who are suing over defibrillators they may not have needed. There's a great deal of debate in the medical community about the necessity of surgically implanted defibrillators, with strong arguments on both sides. Some say up to 25 percent of people walking around with implanted defibrillators may not have needed them!

Keep in mind heart attacks are like earthquakes. They're very difficult to predict. You never know exactly when, or even if, one will occur. I may be at a higher risk of having one, but that doesn't mean I will, especially if I keep doing things to reduce the risk.

So that's my current dilemma. Thanks to all for keeping me in your thoughts and prayers. I'm excited about returning to work Monday! Go Blackhawks!

Selfie in Evanston May 17