Skip to content

Endarterectomy – This One’s Straight Off Personal

January 8, 2016

Most of us stagger through life a little off-balance believing that it will almost always happen to the other guy.

I have been blessed with a Ken and Barbie existence for over six and half decades. I have watched for years as the other guy became a victim of disease or misfortune. I have been a spectator, the collective audience of one. Then at long last it was my turn.

On May 28 of last year, I was driving back from the Asheville Airport after changing our return tickets to Italy. About half way home, my right eye simply went completely blind. It was though someone had slowly pulled down a shade over the eye. I rubbed it thinking it was just some local pollen. Nothing. I still couldn’t see out of the eye but I drove the rest of the way back home just the same. When I got to the house, the blindness went away but the eye looked like it had been dried out. It was strange to say the least. As we were heading back to Italy in two days, I made a hurried appointment with a friend and ophthalmologist just to be cautious. He confirmed that I was fine but that I had suffered an amarosis fugax, which is a small TIA stroke that usually affects only one eye. Basically, a piece of plaque or blood clot had broken off from my carotid artery and blocked the artery to my right eye before dissolving. I figured (erroneously) that it wasn’t a biggie so off we went to Italy for five months. Fortunately I did select the precautions to take an 81 mg. aspirin once a day in addition to cutting all caffeine from my diet. When we got to Italy, I began doing a little research and I was surprised at the serious nature of what had happened. Basically the amarosis fugax I had experienced was a warning shot over the bow. They are quite often followed by major strokes.

After we returned to the U.S. in late October, I immediately saw my primary physician who ordered what seemed to be about a million tests. The first test was a carotid ultrasound which showed that I had more than a 60 percent stenosis (narrowing) in my right inner carotid artery (ICA). This is the big boy that feeds the brain. An echocardiogram followed to rule out a similar problem with the arteries of the heart. The next major test was a CTA which is basically a cat-scan of the carotid artery with contrasting dye to show the exact severity of the blockage. This test came back and stated conclusively that I had at least a 90 percent blockage. The left carotid artery and heart were fine but that right inner carotid artery was a stubborn threat to my life. That’s when things started to get really serious in my mind.

I was immediately referred to a vascular surgeon. After studying my tests he recommended an operation called an endarterectomy. A what? He explained that I needed an operation whereby the surgeon cuts open my neck and then the inner carotid artery. At that point, the plaque is removed and everything is sewn back up. It sounded scary to me but actually simple enough. Why not do an angioplasty and a stent? The surgeon explained that I wasn’t really a candidate for the less invasive procedure and that the huge blockage posed a risk of catastrophic failure with just a stent. I am a lot of things but dumb isn’t one of them. My next question was simply, “Can we do this tomorrow?” It turned out that the first available surgery time just happened to be on New Year’s Eve which is also the eve of my wedding anniversary. Time was surely of the essence so I immediately said yes.

My surgeon does this procedure differently than most other surgeons. He wanted me completely awake as to assess any possible stroke or other problems during the surgery. Also, he explained that a general anesthetic can cause major swings in blood pressure levels. For these safety reasons and total communication with the patient, he prefers to do the operation under local anesthetic. I always thought a local anesthetic was pretty much just for dental procedures and sewing up minor wounds. It took me a bit to wrap my head around the fact that I was going to be completely awake for the whole event. Then I did what I should not have done: I looked up the procedure on Youtube and watched. Yikes! It looked more like a video of a hog butchering festival. Sometimes our modern media world is best left alone. I must say that after the initial shock, the video did help me to understand what I was facing a bit better in the end.

I showed up at six in the morning and by 7:30, I was in the operating room with a bevy of people: two doctors, an anesthesiologist and numerous support staff. They knocked me out just long enough to inject a good dose of local anesthetic into my neck and then they woke me back up. It was show time! I didn’t feel a thing until the surgeon went into the deep layers of the tissue that surrounds the artery. Ouch! I thought I could actually feel the scalpel. The team shot some more local anesthetic into my open neck and off we went again. When the carotid artery was clamped off, I was tested for neurological responses to make sure that the clamping had not adversely affected overall blood flow to my brain. During the whole procedure, I was constantly talking to the surgeon, the anesthesiologist and anyone else who would listen. I became a chatterbox, cracking jokes and generally keeping the entire bunch entertained as I heard the faint clatter of clamps, retractors, and instructions going across my chest. Shecky Green would have been proud.

The normal procedure calls for the clamping of the common, external and internal carotid arteries, the isolation and then opening of the inner carotid artery. The plaque is then removed, the artery is resewed, blood flow resumed and things are put back together like the straw man in the Wizard of Oz. However, when the surgeon removed the plaque he had some unexpected news. My artery was basically shot. It was ulcerated in two places and the plaque that had blocked it had been pushed up from a blood clot resting on one of the ulcerated areas. If the artery was left as is, it was a surety that I would have major complications, very likely including an aneurysm, stroke and death. At this point, I had my carotid artery clamped in three places and I was fully conscious. Before I could comment, he had snipped out the bad piece of the artery. The surgeon then proceeded with a resection made from a Gore-Tex Anpra graft. I was amazed that I was awake to take all of this in. He had to repair a few tiny leaks in the graft after the blood flow was restored. This took a bit of time. The wound was closed internally and then the skin was sutured. Tah-dah! The 35 minute procedure had churned on for two and a half hours but it was completely successful.

As the anesthesiologist was wheeling me off to ICU, I asked the surgeon to tell my wife that she needed to cancel her one-way ticket to Boca Raton…. I was going to be around awhile longer. I always try to keep my sense of humor intact. However that sense of humor was tested a tad when I got into bed in ICU. I needed the urinal but as I used it in a prone position, I completely pissed myself. I thought I had enough experience in these matters. I had to go through the embarrassment of being cleaned-up like an infant; not a pleasant thing for a grown man. The next time I needed to go, I used it over the toilet. As I proceeded, I heard the liquid leaking into the toilet bowel. When the nurse came back in the room, I said with a childish smile, “I told you I knew how to use one of these things. The trouble is, this one has a dime sized hole in the bottom!” I was laughing so hard as I got back into bed, I thought I would surely piss myself all over again.

Lunch was the jello variety we know all too well in the United States. It’s odd that Italy has never heard of Jello; they prefer to offer up red wine in the hospital. It may well be a better alternative. However, when dinner arrived I was surprised to see Spaghetti Bolognese on my plate. Maybe it was because my last name ends in a vowel. Chi sa? Later that night in the still of the ICU as the world was ushering in another new year, I was overwhelmed by the fact that it was my 34th wedding anniversary and but for the extreme skill of my surgeon, I probably wouldn’t have seen another. Thanks to him, I will spend more years with my wife Rachel. I would like to thank him here publicly: Dr. Stuart L. Glassman of Pardee Surgical Associates in Hendersonville, North Carolina. I have to believe he is one of the very best vascular surgeons around. I would also like to thank the Pardee Hospital ICU nursing staff, especially Connie and Jane. The whole staff provided excellent acute care.

So, that’s my story in brief. I am writing this after being discharged from the hospital yesterday. My hope here in publishing this post is that some of my readers may benefit from my experience. You don’t have to look or feel sick to have atherosclerosis. If you have any symptoms of a TIA, get them checked immediately. Get regular check-ups and listen to your doctors. Be very thankful for what you have in your life; it’s a one-way ticket. Lastly, don’t ever lose your sense of humor. Oh yes, one last thing: Don’t get on the plane for Italy as a ticking time bomb…. it’s definitely not a smart idea. Capisci?

The photo above is of my dissected right inner carotid artery Courtesy of Dr. Stuart L. Glassman.

Please follow this blog by clicking follow below. Your comments are always welcome.

Read author Allen E. Rizzi’s latest books available at Amazon.com

Books JPG

Advertisements
5 Comments
  1. Cent’ anni. Hope all continues to go well. Your luck fell into place in so many ways (timing, doctor, etc).

    Liked by 1 person

  2. Joan Garby permalink

    Interesting and informative read, though scary! So happy the outcome proved positive and you will be around to experience many more years of this journey we call “living”!

    Thanks for the birthday card and for remembering it! So thoughtful of you!!

    Love, Joan

    Like

Trackbacks & Pingbacks

  1. The Christmas Blog | allenrizzi

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: