Well, I'm not dead yet.
I just returned from consultations at the Mayo Clinic and the Texas Heart Institute. The advice I received from thoracic surgeons at both locations - contrary to the advice I'd received in Colorado - is that the risk of open heart surgery requiring circulatory arrest currently exceeds the risk of my ascending aortic aneurysm rupturing. Therefore, the plan is to manage my blood pressure via drugs to keep the pressure and rate in the low-normal range and to stay away from weight lifting, then to monitor my condition again every three months with a CT scan, primarily to measure the rate of change of the aneurysm. In short, I still have a live grenade in my chest, but the risk of putting the pin back in currently exceeds the chance of it going off unannounced. At least for this first period of waiting, this puts me in an awkward �state of limbo, for if there is a statistically significant change, surgery will be warranted at the end of that period. Pragmatically, this means little change to my lifestyle, though I'll be disinclined to plan international travel far away from medical care I could trust until I have a better baseline of my condition and the first derivative of change.
My sincere thanks go out to the many of you who have written me offering your thoughts and prayers.
Along this journey, I obtained a crash course in the physics of the heart. The underlying principle that dictates my condition is Laplace's Law: there's a limit to the tension that aortic tissue can absorb, and as the size of the ascending aorta grows, there's a point beyond which the risk of rupture grows exponentially. The precise mechanism that causes such aortic defects is not fully understood, although there is some correlation to genetic defects such as Marfan's Syndrome (which I don't have), a condition that affects the body's connective tissue.
The insidious thing about my condition is that it's essentially asymptomatic until it ruptures, and when it does, it's often misdiagnosed in the ER as a heart attack and unless you happen to be lying on an operating table with your chest cut open at the moment of rupture, it's almost always fatal (as in the case of John Ritter).
Kevin Helliker of the Wall Street Journal wrote a series of articles regarding his discovery of an aneurysm of the ascending aorta. Kevin and I corresponded, and he's put me in touch with a researcher tracking the genetic connections to this condition. In addition to John and Kevin, I'm in some interesting company: Albert Einstein died of a rupture abdominal aortic aneurysm (a condition that's easily treated today) and Laura Branigan died of a brain aneursym in early 2004. Though not aneurysm-related, I was amused to see on the wall of one of the thoracic surgeons I visited the photos of various clients he'd treated for vascular issues, including Captain Kangaroo aka Bob Keeshan and Governor Schwarzenegger.
I've essentially lost a month, having been blindsided by this condition in early December and so, enough of these non-software architecture issues for now.
Physics of the Heart
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