Wandering Thoughts

July 27, 2008

Update

Here’s the run down.

There is no question that my aortic valve needs to be replaced. And there is no question that sooner rather than later would be preferable.

The two questions remaining are:

1. Is there active inflammation in the area at present.

and

2. Will my ascending aorta need to be replaced.

Active inflammation is an issue because actively inflamed tissue is harder to operate on.

For this reason alone it would be much better to go into surgery without the presence of inflammation. We could subdue any inflammation currently present via medication. The trouble is that, conveniently, the meds which might do this (Methotrexate, TNF inhibitors and Steroids) each have side effects which are unhelpful for people who hope to recover from surgery (respectively: immuno-suppression, raised risk of infection, inhibition of wound healing functions). My cardiothoracic surgeon’s opinion is that it is better to deal with the inflammation than the side effects from the meds. This contradicts some of the advice I have had from other doctors although the rheumatoligist, IIRC, agrees with him.

Do I have active inflammation in the area? No one knows for sure. The MRI scan I had indicates that there has definitely been inflammation there in the past (the walls of my aorta have thickened) but it can’t tell whether the past inflammation is still there. My CRP and ESR levels are currently normal, which suggests that there isn’t inflammation (these are inflammatory markers which will riase in the presence of large scale inflammation). Also, my arthritis is as good now as it has been in a very long time. Overall my body doesn’t feel particularly inflamed. On the other hand, the joints in my back, just below my shoulder blades, are still very definitely inflamed. From time to time they ache – leaving me with a crushing pain that radiates across my back. These joints are very close to my heart and this pain is as acute as any I have had during my illness. So something is still wrong and it is in the neighbourhood. Also, CRP and ESR levels may not always show track inflammation if it is confined to a small part of your body.

So we don’t know. Which is why I’m planning to have a PET scan on Tuesday – hoping that this will provide some answers.

Whether my ascending aorta needs to be replaced or not also matters because replacing an ascending aorta is a trickier job than replacing a valve (valve replacement is as good as it gets in the world of open heart surgery). If a large proportion of my ascending aorta needs to be replaced then the job becomes considerably more complicated. They can’t easily ‘wire up’ the heart lung machine (it ends up going up from your leg or something strange) and this means that they need to put you ‘on ice’ for the surgery to reduce the chance of brain damage. My ascending aorta is a borderline case. It is dilated but could perhaps stay. Hopefully, the cardiothoracic surgeon will have a better idea in terms of replacement when we next meet.

So the clock is ticking. Surgery may be only a few weeks away. But there’s still a lot to be figured out.

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1 Comment »

  1. […] MRI, where am I [Note: some of the info. in this post is out of date; I misunderstood – see here] […]

    Pingback by MRI, where am I « Wandering Thoughts — July 27, 2008 @ 10:37 am


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