Simply stated my life expectancy goal is to remain as active as possible for as long as possible. Of course I would like to live as long as possible, but the quality of life is important, and this objective drives me to exercise and eat healthy. My previous blog post provides much more insight on my views on this topic.
In June of 2019 my primary care physician diagnosed a heart murmur and referred me to a cardiology practice for further testing. In July 2019 I underwent an echocardiogram, and the heart specialist recommended a TEE. A TEE is a procedure, whereby, an instrument is lowered into the esophagus to obtain a clearer view of the heart valve. For various reasons related to insurance and referrals this procedure was never administered until January 2020.
During this time period I ran a road race in Stapleton, and although I placed first in my age group, I severely injured my Achilles tendon. The ache on the inside of my right heel was so severe, that I canceled all pickle ball and halted my running program. When the pain ceased to improve, I began attending physical therapy, and these sessions continued from September through November. July, August and September are my favorite months to fly fish, and my Achilles did not inhibit my stream time, so I was partially guilty of not pushing treatment for the heart murmur condition.
By October my Achilles improved, and I began a controlled return to running. Shortly thereafter the physical therapist approved a return to pickle ball, and I jumped at the opportunity. Unfortunately this action resulted in another delay in my return to fitness. During a pickle ball session in the middle of October, a short rain shower left the court wet. I circled back to the baseline for a lob shot, and when I planted my right foot, it slipped and moved twelve inches. I applied my muscles to prevent a fall, but the sudden action generated a popping sound. For the next several weeks my inside groin and the outside of my hip were extremely sore. I attempted to return to running and pickle ball, but the soreness after each session was significant, and I sensed that I was doing more damage than good. I returned to physical therapy in January, and the therapist diagnosed me with a severe right hip nerve impingement. Maintaining an active lifestyle during my aging was proving to be more challenging than I expected.
Also during this time period Jane and I booked two bucket list trips. The first was scheduled for May 17 to Kauai, as Jane and I never visited Hawaii. We also made a deposit on a June 6 boat and bike trip from Cologne, GER to Amsterdam, NED. The boat would transport 26 guests on European waterways. and the guests would disembark each morning and cycle for 20 – 25 miles and then return to the barge, as it floated down the river. Breakfast, lunch and lodging were provided by the boat and were part of the package. Needless to say we were quite excited about this new adventure.
By January the TEE was finally scheduled and approved by my insurance, and it took place on January 24. I called to make an appointment with the cardiologist who performed my procedure and learned that he was on vacation for two weeks, and the earliest I could meet him was four weeks later. Given the scheduled trips I did not wish to wait four weeks, so I opted for a different doctor. Within a week of my TEE, I met with Dr Decicco, and he informed me that I had a leaking mitral heart valve. The border for severe is 60 ml, and my leakage was 100 ml. My atrium, the heart chamber downstream of the heart valve was somewhat dilated because of my condition. I was shocked and dumbfounded by this news. I felt strong and fit and did not exhibit any of the leaking heart valve symptoms. Dr. Decicco told me that the rest of my heart was extra strong due to my fitness and compensating for the leak, but he advised that this could not continue forever. Eventually the condition would deteriorate, and in all likelihood the repair would be more difficult and the recovery longer. I agreed to pursue surgery, and Dr. Decicco prepared a referral. Another prerequisite to heart valve repair surgery was to undergo a heart catheretization. This step was necessary to confirm that the remainder of my heart was healthy, as the surgeons did not want a surprise.
Meanwhile my physical therapy was progressing nicely, and I resumed running and pickle ball. I began the running program by walking for three minutes and running for two minutes for a total of twenty minutes. Over time I increased the running over the walking and eventually the distance and time. I played pickle ball indoors, and my Achilles and hip held up well under the increased strain of my activities.
Concurrent with my fitness and health progression, the rest of the world began to display signs of distress from the corona virus. The first U.S. case was reported on January 20, so the timing of my heart valve evaluation roughly coincided with the covid progression in the United States. I scheduled the heart catheretization for February 7, and the procedure confirmed that my heart was very healthy other than the leaking mitral valve, and Dr. Decicco referred me to a doctor at CU Health, who was highly recommended, to perform minimally invasive surgery. Things were moving along, and I clutched at the hope of threading the needle with surgery without cancelling our trips.
I contacted the office of Dr. Rove at CU Health, and I discovered that she was out of network, but her assistant was very certain that I could be approved and treated as an in network patient. I made an appointment for February 18, but two days before the meeting, I received a call from my primary care office, and they told me the doctor visit was not authorized. I immediately assumed it was because of being out of network, but instead I was told that the referral was only submitted two days earlier!
Again wishing to expedite the process with the hope of completing our scheduled trips, I decided to pursue in network options. I did an online search for cardiologists who perform minimally invasive mitral valve repair, and as I did this, I cross referenced the doctors’ names to the United Healthcare provider search list. I found six in network doctors that could perform my necessary surgery. One stuck out to me, Dr. Daniel O’Hair, at Boulder Health. He did robotic minimally invasive mitral valve repair, and I experienced good results from robotic surgery on my prostate. I made an appointment with Dr. O’Hair and asked my primary care physician to generate a referral. Ultimately the referral for Dr. Rove was approved, and I ended up with back to back appointments with two cardiologists during the first week of March. In the end I elected Doctor O’Hair, because I liked the idea of robotic, and he was in network, thus, less risk of not being approved given my tight window before our scheduled trips.
The die was cast, and Dr. O’Hair’s office called fairly soon after my appointment to offer surgery on March 16. I gritted my teeth and signed up with the continuing hope of fitting the surgery and recovery in before our Kauai trip. During the week prior to my scheduled surgery my daughter visited from Portland, OR, and in an effort to take advantage of her stay, we spent a day skiing at Vail on March 9. On March 15, the day before my surgery, the rapidly rising number of covid cases in Colorado ski country caused the governor to self quarantine anyone who had been there in the previous 14 days. On Monday morning March 16 I reported to Boulder Community Health for my surgery. The receptionist in the cardiology area asked, if I had been in the high country, and I truthfully answered yes given our ski trip the previous Monday. She immediately tossed a surgical mask my way and asked Jane and I to sit down the hall, while she investigated the next steps since the protocols were only announced late on Sunday.
After a short time, however, Jane and I were ushered into a pre-op room, where I was asked to remove my clothes and get into a hospital gown. The nurse arrived and hooked my left arm up to IV, and I was starting to believe that I would sneak in under the wire. My optimism was unfounded, as a Dr. Ellis eventually appeared, and he told me that my surgery was cancelled, and that I needed to self quarantine for 14 days. In addition the hospital was discontinuing elective surgeries starting on March 17, so he was unsure when my surgery would be rescheduled.
I put my regular clothes back on, and Jane and I returned home. My stress level dropped considerably, but now what about the surgery. Given the progression of the pandemic, I was convinced that I would not be rescheduled until May or June. Did I even want to be scheduled for heart surgery during a respiratory virus epidemic? I decided to take advantage of the break, and I resumed my running and fly fishing. The Stay at Home order put a clamp on pickle ball, but outdoor activities remained in bounds when associated with social distancing. I continued to ramp up my running, until I was able to run forty minutes consecutively by April 14. When weather was cooperative, I managed five fishing trips to Colorado rivers and streams. I was making good use of my surgery hiatus.
On April 7 I was sitting in my home office, when the mobile phone rang. I answered and heard the voice of Beth, Dr. O’Hair’s assistant, who informed me that she signed me up for surgery on April 16, and was I interested? I told her the timing was perfect, but I was concerned about the safety given the corona virus crisis. She provided a host of reasons that the doctor and hospital felt it was safe, so I accepted the date. In the final analysis I felt that the hospital would not accept the liability, if they were not very certain that the risk was low.