Patient Love Stories
They Don't Make Heart Surgeries Like They Used To
Modern medicine has made the impossible not only possible, but almost routine. There’s a saying that “minor” surgery is only performed on someone else, but now even heart surgery is becoming less invasive.
Just 15 years ago Betty Krahmer of Poway, California had open heart surgery to repair a faulty heart valve. The procedure involved opening her chest, prying apart her rib cage and replacing her heart valve with a pig valve. She was 59 years old at the time and stayed in intensive care for a week. Her rehabilitation was arduous, requiring her to miss work as a transportation aid for special needs kids for several months.
Now 74 years old and retired, the normally active Betty was experiencing shortness of breath, a rapid heart rate, and had no energy.
“People were telling me I wasn’t myself,” Betty recalls.
She slept in her chair because lying flat in a prone position tended to make her heart race. Her quality of life was significantly impacted.
After a heart echocardiogram, she was referred to Palomar Health Interventional Cardiologist Dr. Rod Serry.
Betty says Dr. Serry told her, “You’re between a rock and a hard place.”
Her replacement heart valve was failing. She also had a leaky Mitral valve, separate from the replacement valve. Because of her age and leaky Mitral valve, she would be at high risk for not making it through the surgery if she had another open chest surgery.
After consulting with the specialized Heart Team of Palomar Health physicians, Dr. Serry recommended Betty have what’s called a TAVR procedure, which stands for Transcatheter Aortic Valve Replacement.
TAVR is a newer procedure for patients suffering from severe Aortic Stenosis who are not candidates for traditional open heart surgery. The procedure involves placing a new expandable artificial heart valve inside the native Aortic valve via a catheter inserted through a vessel in the groin. Proper blood flow is restored within the heart and the patient’s risk and length of recovery are greatly reduced.
“Before (when she had her first surgery) it took a few months (to recover). This time it was lickety split,” Betty said.
Betty’s TAVR procedure took place at Palomar Medical Center Escondido, performed by Dr. Serry. Betty raves about her care saying she loved her medical team. She said they answered all her questions and took excellent care of her.
“They get my top rating,” Betty said.
She was especially appreciative of Mary Russell, the nurse practitioner.
“Every time I was there (Palomar Medical Center Escondido) Mary was there. She hung on to my hand all the way to the surgery room. I was perfectly relaxed and very content before surgery because I knew I was in good hands,” Betty said.
She was released from the medical center after three and a half days and was shopping a week later.
“I saw a friend. She said ‘what are you doing in the store?’ I said ‘because I want to shop!’”
Two months after the surgery Betty says, “I’m feeling great, I’m looking great. I’m as ornery as before.”
She is now riding her stationary bike two times a day and building her stamina. She walks around the grocery store. She spends time with her family. Friends say her color has returned.
“It sure makes a big difference. I’m more of a talker. Friends are saying ‘you are busy, busy.’ I want to keep going.”
Many patients get similar results to Betty after having a TAVR procedure. Patients can expect to return to light activity within a few days and more strenuous activity within weeks. To learn more about whether a TAVR is right for you consult your cardiologist.
Palomar Medical Center Escondido has a team of medical specialists skilled in the treatment of all types of heart disease. Whether seeking surgical treatment or less invasive procedures we have the team of specialists available 24/7. If you are interested in learning more about the TAVR procedure or treatment of heart valve disease contact our Heart Valve Clinic Coordinator (Mary Russell) at Mary.Russell@PalomarHealth.org.
Heart Patient Judy Casillas Helps Others Heal
After a year of stress, healing and fierce determination, Judy Casillas has come full circle.
Last March, the 72-year-old Valley Center resident underwent triple bypass surgery at Palomar Medical Center. Today, she is once again on the cardiac floor of the hospital – but not as a patient. Now, she is volunteering as an ambassador for cardiac patients and families.
“Everyone was so wonderful to me while I was a patient,” Judy says.
“I wanted to pay it forward. I wanted to do something for others. So if I can answer their questions or make them feel better by telling them about my good experience, then I’m happy.”
Judy’s “good experience” began about a year ago. After she finished exercising, she felt a “dry, shortness of breath as if I was walking fast in a Santa Ana,” she says. “I just thought I was out of shape and it wasn't that bad.”
However, a high blood pressure reading and worrisome results of an EKG sent her to Palomar Health Cardiologist Christopher Gilbert, M.D., who discovered problems with Judy’s arteries. It was determined she needed an angiogram and possibly an angioplasty to open her arteries.
On March 27, in preparation for her procedure, Judy was stretched out on the table in the catheterization lab at Palomar Medical Center listening to her favorite Elvis Presley tunes. Suddenly, she felt that same breathless discomfort that she experienced after exercise.
Cardiac Surgeon Surin Mitruka, M.D., was called in and told Judy one of her arteries was 98 percent closed and he needed to perform open heart surgery the next day to repair her clogged arteries.
“My heart went pitty-pat. I thought, ‘Uh-oh, this is not good,’” Judy recalls. “But when Dr. Mitruka came in and we talked, I felt very calm. He has such a calming way about him. He explained things so I could understand it and I knew I was in excellent hands.”
As a cardiac surgeon, it’s Dr. Mitruka’s role to explain the procedure to the patient and to ease them into the proper state of mind.
“Through my experience, what I’ve come to appreciate is that the patient and the family are usually stunned at the diagnosis and in a state of disbelief. They have encountered the unexpected and are anxious and concerned about what it means,” Dr. Mitruka says.
“If I am abrupt and curt and use big words they don’t understand, it makes the situation worse.”
It’s been proven, he says, that surgical outcomes are better if the patient is calm and confident going into a procedure. So, he puts on what he calls a “Zen mask” and quietly and gently talks to the patient and their loved ones.
“I tell them I have all the information and I know the facts of their case and I say calmly, ‘So, here’s the situation,’” he says. “I never tell a patient that surgery is their only option. When they know they have options, you can see the calm and peace that descends on them. I told Judy, as I tell all of my patients, I was certain I could get her through this. But, the recovery would be up to her.”
After her successful surgery, Judy was in the hospital for six days. Her post-surgical adjustment wasn’t always easy.
When I got home, it was difficult because I couldn’t do as much as I wanted to do,” Judy says. “I have always been very independent and it was hard to let other people do everything for me.”
She admits she suffered from some mild depression after her hospital stay, which is common for patients after major heart surgery. For Judy, cardiac rehab was the ideal antidote.
Ninety percent of a patient’s recovery “happens in their head,” Dr. Mitruka says. “If you want to get better, you will!”
“It was so calming and reassuring to be in rehab with people who had gone through some of the same things,” Judy says.
Wendy Atchley, cardiac rehab supervisor at Palomar Health Downtown Campus, calls Judy “the model patient.”
“When she first joined the group I don’t think she knew how cardiac surgery was going to change her life. But she was committed to doing whatever she had to do to get healthy,” Atchley says. “Judy always attended class with a smile and personally met every new patient, giving them positive words of encouragement.”
Patients usually begin cardiac rehab a few weeks after their surgery, meeting three times a week for a total of 36 sessions. The purpose of cardiac rehab is to get a patient stronger. But it’s also about teaching patients how to prevent this from happening again.
“There are things you can control like nutrition, stress management, weight loss and quitting smoking. But you can’t do anything about how old you are, family history or gender,”
Atchley says. “We try to get patients to change the things they can in order not to have another cardiac event.”
When Judy first entered cardiac rehab, she wasn’t walking as fast as she wanted to. But by the time she finished rehab, “I could keep up with anybody,” she says, noting that she tries to walk twice a day for 30 minutes at a time.
Judy’s cardiac rehab group bonded and fed off of each other’s progress and success.
“Judy was that little piece of glue for the group, holding them together,” Atchley says. “Judy was definitely the ringleader.”
Cardiac rehab wasn’t like any gym Judy had ever experienced.
“I worked out but I wasn’t worn out, I was exhilarated! There was music and the camaraderie of people,” Judy says. “Every time I went to cardiac rehab I felt like I was going to visit good friends.”
Patients don’t always realize the psychological benefits they derive from cardiac rehab and how it can escalate their return to health.
“Patients often come in here depressed and frightened, but if they complete the program, we often see them transformed by the time they leave,” Atchley says.
The fact that Judy has made such an impressive recovery is no surprise to Dr. Mitruka.
“Judy is someone who loves life. She has a purpose and she wanted to get better and move on,” Dr. Mitruka says. “She has a family who loves her and this whole experience was just a minor bump in the road for her.”
Although cardiac rehab is not mandatory, Dr. Mitruka always encourages his patients to at least try it after surgery. He tells patients that cardiac rehab will help them, but most of all it will help them help themselves.
“Sure, rehab will get you stronger and back on your feet. But the underlying purpose is not physical because you would get stronger anyway,” Dr. Mitruka says.
“The real benefit of cardiac rehab is the psychological healing that needs to occur so you can move on with your life. Just like Judy has.”
Anyone who has met Judy agrees that her volunteer job as a cardiac patient ambassador is perfect for her.
“Judy sees her new role on the cardiac floor as what’s supposed to happen,” Atchley says. “She’s very inspiring."
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 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 was diagnosed 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.”
Do you have questions about Cardiovascular Services at Palomar Health in North San Diego County? Visit Patient Resources for more information, Contact Us or Find Our Location(s).