Cardiovascular Patients at Palomar Health 

How John Metz Beat an Abdominal Aortic Aneurysm

It all started with a little backache, the kind many of us experience when we overdo it at the gym or sit too long at the computer. But, several hours later, when John Metz’s pain became so severe that he screamed out in agony and begged his wife to call 911, he suspected his life was in danger.

“The pain was relentless,” says the 62-year-old Poway resident. “I thought I was dying.”

John was suffering from a ruptured abdominal aortic aneurysm, often called a “triple A.” And, in fact, he easily could have died if it weren’t for the quick and skillful procedure performed at Palomar Medical Center by vascular surgeon Alexander Salloum, M.D., and his team.

An abdominal aortic aneurysm (AAA) is a weakened and bulging area in the lower part of the aorta, the major blood vessel that supplies blood to the body. A ruptured AAA can cause life-threatening bleeding, just as John was experiencing.

The aorta lies on top of the spine, so when the aneurysm ruptured, John felt the pain in his back, Dr. Salloum explains.

“About 90 percent of patients with a ruptured triple-A die before they get to the hospital. Of those 10 percent who do make it to the hospital, half will die within 30 days,” Dr. Salloum says. “The odds were definitely against him so we had to move fast.”

Paramedics took John to Palomar Medical Center, where a team of experienced vascular experts awaited him. Meanwhile, John’s wife Julie was being prepared for the worst. “I was told that John’s chance of survival was very slim. When he went into surgery I thought it would be the last time I would see him,” she says, getting emotional when telling the story. “When Dr. Salloum came out (of surgery) I expected bad news. But all he said was, ‘he’s all fixed.’ That was it. And, that’s when we all started cheering.”

John and his family were amazed not only by the speed of the procedure, but also by the fact that John’s life-threatening situation was remedied without one incision.

“Within two hours from the time Dr. Salloum got the call about John’s emergency, John was fixed,” Julie says. “It was a miracle.”

The “old school” repair for a triple-A rupture is to open up the abdomen and repair the problem directly. Another surgical procedure often used is to make incisions at the groin through which a catheter is inserted into an artery in the leg to deliver a repair.However, Dr. Salloum chose the most minimally invasive technique possible – a percutaneous repair, in which there are no incisions.

The percutaneous approach involves a tiny needle puncture at the groin through which a stent graft is delivered, which “relined or repiped the hole inside the artery,” Dr. Salloum explains. The percutaneous access allows for faster recovery and less risk of infection and other post-surgery complications. And, because the procedure was minimally invasive, no general anesthesia was used.

“His blood pressure was so low, that I knew if I put him to sleep, he wouldn’t have made it. So, we used a local anesthesia instead, and it worked out well,” Dr. Salloum says.

Dr. Salloum credits the advanced technology at Palomar Medical Center, along with the experienced surgical team with being able to treat John so quickly and effectively. Palomar Medical Center offers a hybrid room, which is both an operating room and a cardiac catheterization lab.

John’s recovery period was only three or four days and without much discomfort. In fact, the only pain medication he took after the surgery was an acetaminophen. Although John will have to be monitored once a year because of the stent placement, he doesn’t have to live his life any differently. Today, he says he feels “great, and very lucky.”

“Except for the pain (leading up to the surgery), everything about the experience was great. The hospital is a great place and Dr. Salloum really knows what he’s doing,” John says. “Dr. Salloum is a wizard of a surgeon. It’s a miracle that I’m still here, all thanks to him.”

John and Julie are also quick to sing the praises of the nursing staff on the 6th floor. “They were the most fantastic nurses. They were helpful and friendly and always had the time to talk and explain things,” Julie says. “The hospital, Dr. Salloum and staff turned our nightmare into a miracle.” 

How Ron Got His Beat Back

Ron Flores, 60, felt his first symptoms of supraventricular tachycardia (SVT) in mid-2012, when his heart started racing and he felt light-headed. The Encinitas resident shrugged off that first episode as a case of too much caffeine.

I’ve never had a thing wrong with my heart,” Ron says. “I’ve always been pretty active, hitting the gym two or three times a week and bike riding.”

Soon the episodes were weekly, his heart galloping at 200 beats per minute for two hours or more. Once, it happened while he was driving on the freeway. When it happened on a bike ride, his frightened wife called the doctor.

Ron’s doctor conferred with a cardiologist, who recognized the symptoms and immediately referred him to Navinder Sawhney, M.D., an electrophysiology cardiologist and medical director of the new Electrophysiology Lab at Palomar Medical Center.

Ron’s heart behaved normally during treadmill tests and an electrocardiogram (EKG). He resisted wearing a heart monitor for a month to capture the unpredictable episodes, but promised to head to the closest hospital next time it happened.

It was a Sunday. The ER physician was able to record the runaway electrical activity. But to stop Ron’s heart from racing, the rhythm was reset by briefly stopping and restarting his heart with the drug adenosine. “It was a horrible, horrible experience,” Ron recalls. “I was awake and it was very painful.”

Ron was told medication could control his arrhythmia but there was no guarantee he wouldn’t need another reset. “There was no way I could live with that,” Ron says.

Dr. Sawhney suggested that Ron try a procedure called radiofrequency ablation (RFA), where a catheter is inserted into a vein in the patient’s leg and guided into the heart.

"Once the problem is found, the catheter delivers a radiofrequency energy to heat up that area of heart tissue to ablate (cauterize) it so it stops behaving abnormally,” Dr. Sawhney says. “The patient will usually go home the same day of the procedure or the next day, depending on the type of arrhythmia that was ablated.”

Ron arrived at for his procedure at Palomar Medical Center at 5:30 a.m., and left by 4 p.m. Three weeks later, he was strapping a kayak to the roof of his car before an outing with his wife and grandchildren.

“I feel so much better physically than I have for the last year,” Ron says. “I was feeling pretty awful while the episodes were happening. Thank God, I’m doing quite well now.”

“If you have SVT, one option is to take medications for the rest of your life,” Dr. Sawhney says. “Another option is to go to the hospital for a day and be cured for the rest of your life.”

Interested in learning more about the treatment of SVT? Contact us today.

How Nancy Got Her Beat Back

Nancy Healey, 73, underwent radiofrequency ablation at Palomar Medical Center in March to treat the atrial fibrillation she wasdiagnosed with four years ago.

She had been taking blood thinners and sotalol, a medication to improve heart rhythm. Then symptoms worsened.

“I sing in a choir and, oddly enough, it would usually happen in church,” Nancy recalls. “I would feel faint and break into a cold sweat.”

She was prescribed a second drug to help regulate her heart rate. But that slowed her heart too much and made her miserable. “It took away the fainting feeling but I felt horrible – slow and tired and not thinking clearly,” Nancy says.

A heart monitor she wore for 24 hours showed an abnormally low heart rate while on the medications. Her doctor suggested RFA and referred her to Dr. Sawhney at the EP Lab. Nancy was familiar with RFA.

“Some of my friends have had it,” she says. “When Dr. Sawhney said I wouldn’t be awake for the procedure, I said, ‘let’s do it!’ ”

Nancy stayed overnight at Palomar Medical Center after the procedure. She recalls the first couple of days as a little “intense” but soon felt well on her way to a full recovery. After her procedure, a cardiac monitor she wore for two weeks recorded no abnormalities.

“I’m very glad I had it done,” Nancy says. “I feel fantastic. My energy level is unbelievable. I swim laps, which I couldn’t do before, and can keep up with the things I want to do. I can vacuum again – for better or worse.”



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