What Happened To Randy In Medical Jargon

Written by Janell's husband Mike


As a doctor, I was asked to give a medical analysis of what happened to Randy. I was able to talk to his CT surgeon and see his operative report. I'll start from the beginning. Randy was working in Davis County when his aorta suddenly dissected. See Image. Basically, the inner lining of his aorta came loose blocking his coronary arteries and aortic valve; essentially causing a heart attack. It is unknown why Randy had this dissection as he has no known risk factors, but in the lay population it's most commonly caused by hypertension. A dissection such as Randy's is a surgical emergency and most patients don't survive long enough to make it to a hospital. Luckily, Randy did make it to the Davis Hospital despite significantly low blood pressure secondary to his heart attack. He was intubated at the Davis Hospital and a chest CT done at the time showed a Stanford type A dissection from the aortic valve to the aortic arch. He was transported by helicopter to the U of U facility and per oral report underwent cardiac resuscitation twice during that interval. At the U of U he was immediately rushed to surgery where the cardiothoracic surgeon gave him less than a 2% chance of survival to discharge. His subsequent 6 hour surgery involved a three hour cardiopulmonary bypass run and exactly 48 minutes of circulatory arrest where his body and brain temperature were dropped to 15 degrees Celsius. Circulatory arrest means that all systemic blood flow and oxygen exchange was stopped (including no heart-lung bypass machine). His native aortic valve was replaced with a 27 St Jude Mechanical Artificial Valve, his entire ascending aorta was replaced with a synthetic graft, and the origin of his left and right coronary arteries were reconstructed. No saphenous vein grafts were needed. The aortic dissection was successfuly repaired and the only known postoperative sequelae was a stroke to his Left Posterior Inferior Cerebellar Artery causing disequilbrium and dizziness. This was the best possible outcome and the minor stroke will likely reside with time. Randy will have to be on blood thinners for the rest of his life because of the artifical aortic valve. He is also significantly deconditioned secondary to the event, and it will take a minimal of several months if not years for him to return to his former activity level. It is currently unknown how much permanent damage his heart underwent, but he is being followed by a cardiologist. Because Randy had an aortic dissection, his likeliood of having another is significatly higher than the lay population and his blood pressure will have be under strict control for the rest of his life (i.e. under 120/80). Also, the likelihood of direct relatives having an aortic aneurysm is higher than the lay population. I hope this helps answer any questions and am happy to help out in any way that I can in the future.

Party time! Excellent!

Randy has been home from the hospital for almost a week. Today we did a little housecleaning (with a lot of help from Aunt Clytee) and welcomed some visitors. Clytee took Randy for his first walk outside, and he walked down to the street corner and back at least twice. He thinks his dizziness is slightly improving, although it is still there and still annoying. Tomorrow we have more physical therapy and another blood draw, hopefully that will not knock him back to square one.

Anyhow, aunts and uncles and cousins stopped by to share a gourmet dinner of French onion soup, homemade by Tyler and Andrea. We thought we'd feed him real food to help put the cookie memory behind him.

I have a 16-second video of dinner, mainly of people eating while Scott holds two stuffed kitty cats and people say "meow" a lot; at the end is a shot of the Buche de Noel (actual grammatical accents ommitted) made by Tyler and Andrea, just because it is always time for a Buche.

And now, the grande finale: I made Randy talk into the camera for a minute and a half. Enjoy!

Cookies of Death

I'm sure many of you are wondering why exactly this all happened, what was the triggering event. It seems today that the question can now be answered. Dad talked to Steve on the phone this afternoon, and Steve told him that on that most fateful Thursday, they had eaten cookies at lunch. Imitation Oreo cookies, "Crisco" cookies, $1 at the end of the grocery aisle cookies, that Barbara had purchased because they were out of homemade cookies. Apparently Steve and Randy did not really enjoy the cookies, although that did not stop them from eating the cookies (as of now, the quantity of cookies consumed is unknown). At some point afterwards, Randy called Barbara at work and left her a message, the gist of which was, "You've got to stop buying those cookies, they're going to kill us." Well, later that afternoon ... we all know what happened.

Addendum

Tyler and Andrea just stopped by to check in. Tyler was dispatched to Dad's truck to search for a hat, because Dad's head is cold from being frozen on the operating table. Tyler did not find the hat, but he did find Dad's lunch cooler, containing, yes, the remaining Cookies of Death. Randy has been making much of the Cookies of Death, feeling ill just thinking about them ("I ate the cookies, and I died.") (No word from Steve on whether he also experienced death). Warning: Viewing these next photos may cause death.

Still alive? Good.

Cleanse your mental palate with this picture of Scott and a bear.

Addendum 2 (from Logan):

Thanks for the Birthday Wishes! For my birthday April made me a snake cake of life!

The problem with wayfarin (sp? the bottle is upstairs)

In my last post I mentioned that we were expecting a physical therapist and a blood draw. The physical therapist told Dad that his first homework assignment is building up endurance. I think Dad was expecting a full-on exercise routine, which may come in the future, after he can walk in a straight line without assistance. He was told to walk next to objects so that he can touch them with a hand or leg, and to practice walking sideways for balance. He did all of this and was very pleased with himself.

Then we went for the blood draw. Neither of us knew that this was an orientation to the Coumadin Clinic (again, might have spelled that wrong, am tired) (and he is taking Wayfarin, the generic equivalent), of which he will be a member for the rest of his life, I think. Since we didn't know, it took a while to get the blood drawn, and then we had to wait to have the whole shebang explained, the INR test and levels and medication adjustments and such. Scott was very interested, he found a computer keyboard, some tape, and a room divider which he knocked over. Then he pooped.

After all that, Randy was back to square one for dizziness. Enough so that he mentioned how much he must have been improving, since it was now horrible and awful. We put him through a lot. He used Scott and the stroller as a walker on the way back to the car.

This morning did not start out much better (although he has been sleeping through the night). He was using his walker again. Barbara left him some phone messages to return and a bid to work on, but he couldn't focus his eyes for most of the day and didn't get much done before noon. He had some visitors to pep him up, and Scott and I bought him a balloon. Scott kicked the balloon around the house for Randy's entertainment. The good news for today is that his INR results were "great," and he does not need to be tested again until Monday. For the first little while they will be testing him every few days, to make sure the medication dose is correct. Eventually he will get down to once a month. He's feeling like a pincushion, so everyone think healthy level thoughts so he won't need daily tests. And no one bring him kale to eat! Apparently that is very high in Vitamin K, and Vitamin K really messes with the wayfarin/coumadin effectiveness. Not that it's a bad vitamin, he just shouldn't be eating a lot of it, and it mainly exists in dark leafy green vegetables. Like a cup of parsley? Too much. It's all in the handy booklet, in the handy color-coded chart.

The cardiac rehab center also called today and scheduled an appointment for him for next Thursday. I think that will begin some real workouts. Randy felt better this afternoon, so if he continues to improve he'll do well at rehab. Meanwhile, the physical therapist will come back tomorrow, and he'll have a chest x-ray and a visit with the surgeon on Tuesday to make sure everything looks good.

We've been having dinner brought to us, which has been great because Barbara has been working late at Randy's office and I'm not one for cooking dinner. Right now they are both working on finishing the bid; Randy needs Barbara's eyes to read some fine print. On Saturday Barbara shouldn't have to go in to work at all, so hopefully she can relax and enjoy Randy's "vacation" with him.

Still home, still alive

I'm a tired, lazy updater, but I can tell you firsthand that Randy is alive and well. I am fulfilling my nursing duties most excellently as he is not yet dead, and I even gave him medication today. Randy walked to the bathroom without his walker today, I think he was just showing off.

I just now got some pictures off my camera, so I will show you the farewell to the hospital room. Dressed and ready to go. We had lots to pack up because people had brought him so many goodies. Everything made it home, even the jello cups.

Yesterday we stayed in the house and watched the construction across the street. I should start taking pictures of that, too, because it will be one of Randy's strongest memories of the recovery process. Construction is fun! Right now they are putting in lots of footings to prepare the foundation (if I got that right, Dad's the expert but he's upstairs asleep).

We also hooked up the mp3 player to the stereo and blasted it so that we could listen to the band. Dad played his guitar along with the songs. I'm no professional music critic, but he sounded pretty good. Or maybe just better than I will ever sound. He said that he was rusty, since he hasn't played since before Thanksgiving. And since the little heart surgery/stroke thing. He tried to teach Scott how to play the guitar. Scott's response was to drag the guitar around the house and slap the strings. We tried the mandolin this morning, with the same outcome. Dad warned me that the mandolin can be an expensive hobby, so perhaps we will hide it behind the couch.

Right now Randy and Scott are napping, although I may hear movement from Randy. He is in the tv room for the first time and fell asleep while watching Matlock on Tivo. Do you have Tivo? You should, especially if you foresee recovery from heart surgery in your future (or recovery from childbirth, either one). We finally connected with the physical therapy people, and they should be coming to torture him within the next hour. Then later this afternoon we will have our first group field trip to the Sugarhouse Clinic to get Randy's blood drawn. This will determine if it is too thin, not thin enough, or just right. If he doesn't break a hip on any stairs, he will live to see tomorrow.

First day at home

I just got off the phone with dad, checking up on how his first day at home was. So far so good... much the same as yesterday in the hospital, only now he's at home and more comfortable. Janell is doing a most excellent job of keeping him alive.

Nobody came from physical therapy today. Tomorrow he's going in for some blood tests, and therapists will be visiting by the end of the week. I didn't get too much into his schedule, which is unfortunate because that's the first thing everybody wants to know.

He's still very dizzy, which is driving him absolutely crazy. Tomorrow he'll probably get his laptop out at some point. He's trying to write things down as he thinks of them, because the thoughts get scattered pretty easily. There wasn't much outside of lounging, eating and napping today. He said if getting a glass of water wasn't such an ordeal, it wouldn't be any different from a vacation. I told him that's why it's called "recovery" instead of "vacation." We got to see the amazingly fast part of his recovery after surgery, but he doesn't remember any of that. As far as he's concerned, it's just a long, slow, boring thing. I told him he's going to have to find some books or new hobbies to keep himself entertained. When I was in a long recovery, I learned how to shuffle cards. I can now shuffle 3 decks of cards at once. I was very bored.

Everybody at the house (except for him) had fallen asleep on various couches at the time I called (just before 10:00), and he was annoyed that now everybody was going to have to wake up to go to bed, and they'd probably wake up too much and be up for half the night. Yup. The dad we all know and love is officially back to reign in his castle.

Welcome home, Young father... welcome home!

Andrea made an uber-yummy lemon birthday cake for me last night, and we'd decided that we should share the calories as far and wide as possible. What better place to unload sugar and cholesterol than at a hospital!

Over the course of the day various reports came in. The dispatch nurse was getting his paperwork in order to ship him home. The cardiologists weren't sure, but thought maybe he should stick around. In the end, the physical therapists cast the deciding vote to kick him off the island... er, hospital.

We took the cake over to the house and puttered around cleaning a few critical pathways for him, and before we knew it, the car was pulling into the driveway. He was looking very well, and seemed pretty good on his walker, if maybe a bit shaky. He figured out the porch stairs quickly, and went straight back to the TV room and flopped onto the couch. Okay, so the flop was a bit less graceful than he was aiming for. More of a face plant, really. It was into a big pile of cushions, but it still hurt quite a bit. Lesson one: No face plants.

Several minutes and some birthday cake later, he decided it was time to move into the dining room. More spotting, but he was managing pretty well. His right foot isn't quite as responsive, so he kind of veers off course every now and then. Veering is particularly scary when he's on a tile floor, but fortunately he learned his lessons on flopping and managed to sit down properly in a chair.

After more cake he figured it was time for bed, so I watched nervously from behind as he brushed his teeth, leaning over the sink for balance. It was a pretty amusing posture, especially as he was going down to rinse his mouth.... on a side note, mom, get a cup in there for him to use! He shuffled carefully into bed, took his drugs, and fell fast asleep in his own bed.

Shortly after that, mom went off to a party with her friends! She totally deserves to go to a party, so it was nice to see her get out of the house. On her way out, mom turned to Janell and said it's now her job to keep dad alive. No pressure, Janell.


So.... the question people will be asking is, "Can we see him?" The answer is... ummm... sure? He was really looking forward to a couple of days of pure rest with no nurses poking him in the middle of the night, but he'll probably be up for company at various times through the day. We honestly don't know, so if you happen to stop by and he's asleep, don't be offended. At least you didn't drive all the way to the hospital! And who knows, if you're lucky there could be a slice of yummy lemon birthday cake involved.

Dad keeps threatening to throw a party one of these days-- something about near-death experiences tends to give people an extroverted streak for a while. When we know more about how he's getting around and how long he's able to stay awake, there may be more vague mentions of said party.


On a purely medical note, the doctors say the swelling in his cerebellum is going down gradually. His eyes are now pointing the same direction, which is usually a good thing. Physical therapists will be coming by tomorrow to torment him in various ways, and some sort of schedule will be worked out with them. He gets tired a lot faster than he thinks he should, but I think he's only a week and a half out of nearly dying and is expecting a bit much.

And thus concludes the hospitalization episode of Extreme Makeover: Cardiac Edition.