What we know so far

What we know so far

(click here to listen to or read today’s scriptures)

I think it’s TV correspondents that use the phrase when there’s a crisis or celebration, and it’s only just begun. What we know so far …And rather than belabor you with extraneous “knowings,” I think I’d better just make a list with as many dates as I can, important to our family as moments that Margaret’s heart and mine have been threatened. Over and over, from 1952 to 2026 we have become more and more grateful for God’s generous response to our constant prayer:

Create in me a clean heart, O Lord.

THE LINKS are to longer descriptions and devotions about this history. It’s a lot, the ALREADY … and the important stuff (the NOT YET) is down at the end …

1956     Margaret’s parents took her to Louisville and her heart’s mitral valve was replaced in an open heart procedure. She was one of the first pediatric patients to have this done. Decades later, in his conversation with Margaret, her surgeon Dr. Neely realized his dad would have performed this surgery on Margaret in 1956.

Years and years later …

2017     Margaret’s doctor sent her to a cardiologist, who after a heart cath told her that her mitral valve needed to be replaced. (The valve that had lasted since 1956, when it was replaced the first time). The surgery was successful, and her recovery was uncomfortable and relatively long. And now there were two scars on her sternum, one old and small, one new and not so small.

2020     Dr. Deem ordered a stress test for me. I thought I passed the test with flying colors; for once in my life I experienced a second wind and felt wonderful as the treadmill speed increased. But the doc thought differently and ordered my first echocardiogram, and then sentme to get my first heart catheterization.

Just as we were beginning to move part of our stuff to Austin in December and the first year of covid 19 closed in all of us – my first heart cath by Dr Reddy in Illinois, who surprised Margaret and me when he told us, “David’s right coronary artery is 100% closed, and new arteries have taken over its work. No interventions are necessary now.” Of course, as he pointed out at the time, the future was not without potential tornadoes.

2021     Margaret’s heart became infected by an unclosed dental procedure during covid, when dental offices suddenly closed to prevent covid from killing more people. We were in Illinois then, and several months later in Austin, she was rescued nearly at the point of dying. That 44-day-plus-much-more is a long, amazing story, and this kindle book Finding Her Way Toward Healing is full of the story and great pictures of family, friends and strangers loving her back to life.

Restore unto me the joy of your salvation.

2023     Dr Deem noticed a murmer in April in Illinois. In Austin,  Dave’s heart cath, decision to have TAVR rather than open heart surgery, pulmonary embolisms, quick recovery and rehab. The 100% blocked right artery continued to be replaced by newly created arteries. New meds helped make me feel healthier than I had in a long time.

2026     One thing we’re blessed with is a medical group with the same doctors that got to know us over the years we’ve been in Austin …and with Dr Deem in Illinois and his thorough records, evenng phone calls and willingness to work with the Austin folks across the country.

4/7      Echocardiogram measuring ejection fraction by Dr Liu. The measurement was lower than last year, and low enough (like 35%) for Dr Liu to skip a stress test and go straight to a heart cath. Puzzled as to why the meds I’m taking were not helping control this ejection fraction number.

4/20    Heart catheterization by Dr Mark Pirwitz, who used the TAVR procedure to replace my aortic valve and put in one stent in 2023. A blockage he saw then had grown a bit. It was as impossible to stent now as it had been then.

4/27    Dr. Josh Grimm recommended quadruple bypass surgery. It’s really all we can do, he said. He described what would happen before, during and after the surgery and we began to schedule the next few months.

I’m hoping our new chiropractor Dr. Owen is able to release the cramps and pain that keep me from bending over or getting out of bed. Without that, the recovery after this surgery would be much more difficult. So that has to be first and is going on now, three times a week. Progress! I’m feeling a little better each time.

After Memorial Day our family is planning a reunion, like our time in Tahoe in 2015. This time it will be in Texas at Port Aransas. It feels pretty precious to be together again this year. So the doctor agreed that we should postpone the surgery till this trip is done. Monday afternoon he left us alone with Savannah his scheduler to set up some dates.

May 6  Carotid and vein mapping ultrasounds (3 pm). The search for embolisms began awhile ago, in 2021. It postponed my surgery in 2023. What will happen this time?

June 8                 Pre-admission meeting

June 15 Ascension Seton Medical Center surgery at 7 am by Dr. Josh Grimm and his team

Dr Grimm described what would happen during and after the surgery …

About the surgery

• Planned operation: open-heart coronary artery bypass grafting (CABG).
• Graft sources discussed: vein from the leg and the internal mammary artery from the chest wall.
• Surgical approach: open the breastbone (sternotomy); internal mammary artery is harvested (branches clipped) and connected to the LAD.
• Additional bypass targets discussed: OM (lateral wall artery), right coronary territory (expected “biggest bang for the buck”), and a diagonal artery.
• Reason stent was not used for one blockage: location was unfavorable (across/near the diagonal).
• After surgery: chest is closed with wires; drainage tubes are left in; temporary pacing wires are placed (not permanent) to help speed the heart if needed post-op.

Right after surgery (ICU & hospital stay)

• Immediate post-op plan: ICU with breathing tube in place; sedation turned off on arrival; extubation once oxygenation/lung function is adequate (lungs often “beat up” for the first 1–2 hours after surgery).
• Expected hospitalization/recovery: ~5–7 days total; ~2–3 days in ICU and ~2–3 days on the floor (estimate may be less depending on course).
• Therapy and discharge readiness: physical/occupational therapy before leaving; education on arm movement precautions and activity guidelines.
• Follow-up: return visit in ~2–3 weeks after discharge.

Heartbeat rhythm issues (AFib) & stroke prevention

• Rhythm history: no known atrial fibrillation; nurse noted possible irregular beats—described as likely PACs (premature atrial contractions).
• AFib risk estimate after surgery (given age): ~35–40%.
• Stroke prevention plan related to AFib: surgeon plans a prophylactic clip on the left atrial appendage (described as the main source of clots in AFib) to reduce post-op AFib-related stroke risk to near zero.

Main risks & pre-surgery checks

• General surgery risks discussed (approximate): death 1–3%; stroke ≤5%; serious bleeding ~5% (may require return to the OR). Carotid ultrasound may be checked if not recent.

Scheduling & planning

• Scheduling/logistics: surgeon will coordinate with Mark to set a surgery date; patient can call/text surgeon if questions arise or if family has questions.
• Timing preferences: patient interested in scheduling around upcoming family travel/reunion; discussed possibility of early June (e.g., June 1) but flexibility offered if patient changes mind.
• Travel/recovery considerations: discussed leaving town weeks after surgery; driving typically after ~4 weeks; long trip should be with someone.

Symptoms & other notes

• Symptoms at time of discussion: no chest pain reported; fatigue/tiredness noted; nitroglycerin available.
• Miscellaneous conversation topics: Enneagram personality testing mentioned; brief family/personal discussion; closing remarks and next steps to schedule additional pre-op studies (e.g., vein mapping) as needed.

Enough for this time. I’m writing this out as much to get it straight in my own mind as share it with you. Thanks for listening … to what we know so far.

Cast me not away from thy presence, and take not thy Holy Spirit from me.

(Acts 12, Psalm 67, John 8, John 12)

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