Wednesday, 10 April 2013

My Heart Op

We don't know the reason for the stroke that I had in 2011.

It could be high blood pressure: my blood pressure is high, but not very high. Blood pressure is responsible for a third of strokes, and may be caused by excess dietary salt. I've been trying to reduce my salt intake, and I'm also taking Ramipril daily. My blood pressure has come down somewhat, but it's hard to get consistently accurate measurements.

It could be a Patent Foramen Ovale (PFO) - a hole in the heart that's supposed to close at birth. In about 25% of people, it doesn't close properly. However, 50% of people who have an early stroke have a PFO. It's possible that a clot forms in the hole, then escapes and lodges in the brain, for example.
PFO closure is a simple, day operation. Imagine pushing a tiny cocktail umbrella through the hole, then opening it up: but it's a more sophisticated bit of kit than that! It can be inserted through a large vein in the leg. It's a very safe operation, and there's some evidence that it really can reduce recurrence of Transient Ischemic Attacks (mini strokes, whose effects last only a very short time).

There are three studies that show a reduction in adverse events in the five years after the operation. None have shown a statistically significant effect, but adverse events turn out to be very rare, so larger studies may be needed. It may be that aggregating the statistics from the three studies would demonstrate a statistically significant result. Anyway, having declined the operation after the first study was published, I've now decided to go ahead with it.

I was very pleased to be given a choice of dates for the operation. I turned down May 1 (the day before the County Council Elections) and May 8th, the annual meeting of Lewes District Council. Instead I've elected to have the operation on May 15th. They only do it on Wednesdays, it seems.

I still have the altered sensation in my left side: often pain, but generally hypersensitivity to cold, heat, pressure, and so on. I think it's probably going to be permanent.

Edited to add: Yesterday (16 April), I got a phone call to say that the 15th May date isn't actually available. I had a choice of 1 May, or to go back on the waiting list. I chose to go for 1 May. Also, my wife and I watched a Holby City staff member (Tara Lo) die on the operating table, which is discouraging, even if entirely irrelevant! The letter that I got from the hospital says that my consultant has performed this procedure 260 times, and not had serious adverse affects. Tara's operation, in contrast, was (a) a high risk procedure, (b) on a brain tumour, and (c) fictional.