Some Conclusions

I've decided that my Mitral Valve Prolapse surgery was a little Eco-Tour, one of those full-immersion, hands-on, discovery adventures. You know what I mean: Eco-Tours are those vacations people take through the jungles, living with the natives, paddling a canoe they honed out of a recently-fallen tree, staring down the cobra that wandered into the tent, and conquering their fear of heights by rappelling down the cliff next to the thundering waterfall. Not as fun or safe as a Disney vacation or as relaxing as a Caribbean beach, but stimulating and afterwards you are better able to face the world.

On this very participative journey I learned volumes about a part of life of which I had essentially no prior knowledge, but suddenly great interest. My wife and I did research (Jan initially found the minimally-invasive procedure) and determined the pros and cons of the different options. We talked to various professionals. We identified the best surgeon and facility for my particular circumstances. We evaluated the minor opinion differences we heard. We timed the surgery to the surgeon's availability followed by my wife's (that is, my personal nurse). We planned what we were going to do, right down to how to expose it all to my elderly Mother ("no, Mom, I'm not having a transplant"). We took control of my life and accepted the responsibility for that, whether the outcome was good or bad. But we also took all rational steps to assure a positive outcome.

Fortunately money wasn't an issue. My attitude was to first determine the best way of handling the medical problem and then apply a financial model against it. The good news was that our medical insurance would cover the operation, even out of state. We had to consider selling the house to pay for the surgery. This is my heart we're talking about. I'm the major breadwinner and if I were dead in a year because I didn't have surgery, then four other people to whom I am closest would have a very different future. It is far easier to figure out how to pay for an operation than to figure out how to live the next 10, 20, 40… years with the father dead and no substantial income. I do not know how much any mitral valve repair costs, but my understanding was that utilizing the skills of Dr. Chitwood and the da Vinci machine cost on par with any other traditional mitral valve surgery. I'm certain my hospital stay was much shorter and my follow-up much simpler than possible with a full sternotomy. And I am certain it was less pain and trauma to my body.

For my particular ailment (mitral valve prolapse) for which there happens to be a truly minimally-invasive surgical option (robotically-assisted) in the hands of a superb surgeon (Dr. Chitwood), I was able to have a remarkably fast and easy recovery from a very sophisticated, yet well-understood operation. I attribute this to a few key things:

• Truly minimally-invasive surgery
• Excellent general health
• Dedicated, highly qualified, medical staff
• Support

And the results were excellent.

Cut down the cuts

Most significant was the trauma experienced by the body. I attribute 80% of my quick recovery to the minimally invasive procedure. I can't emphasize the significance of the tiny cuts of my surgery. Don't fool yourself, this was a complex operation and even it includes plenty of trauma. My heart was stopped, cut and sewed back up while under general anesthesia as a heart-lung machine kept my brain alive for hours. Don't try this at home.

However, the first part where most people have their rib cage disassembled (cut 8-10" up the sternum to splay the ribs) and the last part where most people await their bones, muscle, and tissue to grow back from that first part, were essentially eliminated. Less skin, tissue, muscle, blood vessels, nerves, bones and cubic inches were disturbed, and therefore so much less to heal. Small cuts, small pain. Large cuts, large pain. Small cuts, easy closure. Large cuts, large exposure. Are you following the cause and effect, here? If not I can sum it up quickly: minimally-invasive is best. See how pretty my chest looks afterwards.

Robotically-assisted, minimally-invasive surgery is a remarkable advancement of medicine blended with technology for the robotic machine that allows the surgeon to extend his skills beyond what is otherwise possible. But to do that while affording the patient vast improvements in comfort is fantastic.

What more could you want than to reduce the fear and trepidation of prospective patients by reducing the pain and the duration and extent of the recovery? There is risk associated with any medical treatment, but minimizing the psychological aspects and providing a more humane treatment can have only very positive benefits. Reduce "fear of doctors", fear of the hospital, fear of pain, and concern of expense.

Exercise and stay healthy

I'd put 20% of my quick recovery to my general good health. From the blessing of a healthy body to eating balanced and right-sized meals to exercise, I have an advantage. Yes, I need more sleep, and like anyone in modern society I live with some stress not described in the Garden of Eden. While your parents may give you certain physical characteristics, there are still many lifestyle choices that we each make that give us a significant advantage or disadvantage.

Even the townspeople, folks we later ran into at restaurants, seemed to know who Dr. Chitwood was and that he was advancing medicine worldwide, from their very community.

The facilities at East Carolina University were well run. The nursing staff was attentive and well trained. There were untold numbers of medical personnel who made the surgery possible, and successful. I don’t even know who they were (though I did get bills from some of them). But there may have been two or three anesthesiologists, someone running the heart-lung machine, people monitoring my precarious condition during the surgery, and who knows how many other people setting up, sewing up, and cleaning up. Everyone we met was very friendly and helpful.

Personal support

The fourth thing that I'll highlight as contributing to my rapid recovery was the support I had, support aside from the medical community. My wife and three children were with me all the way, even if the kids may not have been sure why they "had" to take a week out of their teenage lives to be with me while I was having surgery. They were very encouraging and uplifting when they came to see me. As mentioned elsewhere, just having them around, being themselves, gave me a feeling of familiarity in unfamiliar surroundings. If you're going into the hospital, roust up some friends and family to come see you.

You don't need fancy presents, you need a view of the outside, the real world. Siblings and family had all offered any assistance needed during the surgery. I knew they were there for me.

The weekend before I left for surgery, my wife had a party for me. She called it an early 49th birthday party (by a few days). I called it a "going away" party. She had gathered up quite a group of old friends of mine (I'm going to emphasize "old" here). Many of these fine folks we hadn't seen in quite a while (nee, years) because, well, you know how it is: we're too busy to break away from the kids, or the office, or the routine – or it's just too hard to coordinate schedules – to get together. But it was great to see all the old friends and refresh old lies, and to see their interest and concern in my little health problem. Even if we can't get it together for a movie, when the chips were down they came out in droves (and the free barbeque).

Even co-workers and business associates came out of the woodwork. I'd sent a notice out the day before I left work and I got back a barrage of emails from people wishing me well. People you wrestle with over sticky business issues, people you work with weekly, people you hear from twice a year; all express their concern and good wishes. Sometimes you wonder if anyone reads email – apparently they do.

It is very heartening (an appropriate term) to know how many people are concerned and care that you are still on this earth. And it helps you through the "hospital time". I appreciate everything that everyone did for me.

There was a man in the next room who had had a bypass. He was alone all day. It turned out this poor fellow’s wife had to work – she couldn’t get off from work during the day, or couldn’t afford to, to be with her husband while he recovered. It was pretty sad that she could only be with him in the evening.

Successful Surgery

Was my robotically-assisted minimally-invasive MVP surgery successful? Absolutely! My story hasn’t changed now, 5 months after surgery (probably the last that I’ll update this document). I’m happy and healthy. Every indication is that my surgery did just what it was supposed to. I take no medicines.

My lifestyle has changed only in that I would make careful considerations before starting skydiving or scuba diving, train before trying to run a marathon or spending the entire day skiing, and put a little extra effort into staying healthy, like drinking lots of water and not letting my body get too run down. That is, don’t do anything stupid. You’re not 18 any more so don’t think you can wear yourself out doing something crazy and recover by sleeping it off the next couple of days. But that’s it.

I’m good, healthy, and doing everything I want to. I’m very grateful to Dr. Chitwood and his team, and to God for making this all possible. If you have mitral valve prolapse, consider this type of corrective surgery. It’s a breeze.

Tom Starnes
January 2004

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If your body doesn't regularly have access to the right balance of water, foods, vitamins and minerals then it can't function at its peak any more than a car can when given bad gasoline, dirty air, old oil, blocked exhaust, a weak battery, and worn parts. Excess weight is just fat that taxes the cardiovascular system to squeeze a little more blood a little farther distance, and creates greater distances for the scalpel to traverse and more tissue to heal. Any body weakened by recreational uses of alcohol and other drugs is simply starting from a worse point for any healthy or health-restoring activity. The harmful effects of smoking would severely compromise a person's starting point on any surgery. Even with the minimally-invasive surgery, I'd hate to endure the violent burst that a cough would impart on the recovering heart, lungs, bones and chest cavity.

Time and again doctors and nursing staff commented that my comfo rt and recove ry progre ss was so good because of my excellent general health. I've always been in excellent health. I always ate a variety of foods without excluding any group (other than lima beans, cranberries, and beets). I essentially never was sick short of a cold. I never drank or smoked, seeing no benefits to either but instead great risks to both health and function from their consumption.

I exercised only as a secondary effect of things I liked to do: hike, outdoors activities including yard work, and occasionally running just to be running. Mostly I have always enjoyed bicycling: to work, long rides on the street, organized or individual, and on trails where the rugged terrain affords close-up views of the Texas hill country and challenges the mind and body to keep the bicycle rolling maneuvering around obstacles, make it up the hills and rocky outcroppings, and keep from crashing into trees and rocks. The heat doesn't bother me.

Most weekends I ride my bicycle on organized rides around the area. I'm not in the front group clipping along at 20+ miles an hour, but holding my own around 14. I ride a hybrid bike, without the drop-down handlebars that reduce wind resistance (I want to see the scenery better, don't mind the extra exercise, and can use the same bike on the trails). I rarely ride the longest routes, but put in 25-45 miles at a clip, time allowing. If I go more than a week without a good ride under my belt I can feel my muscles atrophying and get great urges to get out there and ride.

Ultimately all this aerobic activity gave me a good cardiovascular system. Curiously, even with a heart valve that was lucky to keep half the blood flowing in the right direction, I was still able to maintain a vigorous active life. I never considered myself to be short of breath or tiring. Yes I huffed and puffed going up the hills, but most people do. There are some really stiff hills I have to crank up on the 2 mile ride home from work, but you pick the right gear, catch the rhythm, and grind away. It's actually rewarding to know that you made it up that hill in 4th gear.

The body is an amazing system and in my case did an excellent job of adjusting to the demands made on it. If the blood doesn't flow well enough, pump harder and increase the volume. Somehow my body found a tolerable balance. With a 50% enlarged heart, it was still doing OK, but apparently that wasn't going to last for long. That is why the surgery was necessary. But it was amazing that I did so well without severe symptoms for so long.

Medical team & facility

The third factor determining the outcome of a surgery such as this is the medical staff and facilities. I can't say enough good about my experience here. All along the way I had good advice, from my local cardiologist to the second opinions to the laboratory staff to the folks performing the diagnostic tests to the ultimate surgeon and all of his staff. Some ways of looking at the robotically-assisted procedure might lead some to see higher risks, but I saw the procedure as being essentially as safe as the full-sternotomy access but with huge improvements in patient (that's me) comfort.

I was predisposed toward the robotic-assisted minimally-invasive surgery because of its comfort benefits to me the patient. I was also looking forward to repairing my valve rather than replacing it with an animal or mechanical valve. But I'm no fool. I was OK if we needed to back down to a Plan B: a mini-sternotomy or full sternotomy, or an animal replacement valve or man-made valve.

I wanted a surgeon that was similarly motivated to the use the robotic surgery and perform a repair, and willing to put forth extra effort to attain these goals, but who also knew when to switch over to one of the alternatives. The more I looked into Dr. Chitwood and his team the more pleased I was. All very professional. All very practical. Yet all very personable.

Everyone who worked there had the same enthusiasm and interest in what they were doing, which seemed to focus on giving better care to their patients and to support Dr. Chitwood. Every step of the way I was encouraged by what I saw and heard – and that I had made the right choice in both the surgery and the surgeon.