Hospital Day VIII (2)

No real news today. Zora is still in the hospital but should be released tomorrow, hopefully in the morning. Strangely, the delay was with the insurance. You’d think they would be fast to approve a switch from hospital care to cheaper home care. But that is not the case.

I assume I’ll have to borrow a car from one of my two driving friends.

None of this is made easier by the transit strike. Which is 15 minutes away from starting. They don’t seem to be making any progress. But at least our favorite NPR reporter and occasional Sunday-night dinner diner, Beth Fertig, on the transit beat, is reporting up a storm.

We made an appointment with another doctor, for Monday at 11AM.

If there is a strike, I think we’ll stay with our family friends on the Upper East Side Sunday night. We could then walk to the doctor’s office from there. What a pain. I may have to push Zora over the Queensboro bridge on her bike. I wish I were joking. The problem isn’t just the lack of transit (I mean, we’d probably take a car even if the trains were running). It will be the impossibility of getting a car and having that car get through traffic.

If only it weren’t for this potential fatal heart problem, I’d be kind of giddy at the thought of the transit strike, as I zoom around the city on my bike. But not this year.

There’s also this web-savvy Dr. Gammie in Baltimore. I sent him a question over the web last night. He responded quite quickly:

Dear User,

Your question was as follows :

Dear Dr. Gammie,

My 33-year-old wife is in the hospital with sub-acute endocarditis (viridans streptococcus). She was symptomatic for endocarditis for 2 months before antibiotics began. She has been on antibiotics for 7 days. The cause of the endocarditis is unknown (no previous IV drug use or surgery).

Because of the results of a trans-esophageal echocardiogram, doctors believe surgery is needed. The problem is on the mitral valve. There is “moderate to large” vegetal growth on the mitral valve. Leakage is considered “severe.” Yet she is not short of breath and outwardly symptomatic.

Given her age and overall good health, we would very much like to avoid valve replacement. Is surgery even necessary? If it is, could we wait till symptoms develop regarding the leakage and take our chances with the growth.

Assuming surgery is needed, can you offer advice on the possibility for repair, given both the leakage and the vegetal growth?

Yours,
Peter

Here is Dr. Gammie's answer:

Hi Peter:
happy to help; i have a very strong interest in this process; we do a LOT of mv surgery for endocarditis at the univ of md (i have done 55 cases in last 3 years); basically, the fact that mr is severe means an operation is necessary; if the vegetation is large and the infection is controlled (ie, no fevers etc) would move to operation rapidly, as there is a risk of embolization (ie, vegetation breaks off and causes a stroke or something else); the overall repair rate for mv endocarditis in the usa is about 25-30 percent, based on a paper i wrote in annals of thoracic surgery this year; in our experience at the university of md, repair rate is 70 percent; would be happy to take care of your wife, please call us at ...; if you can't reach me via that route, page me at ... hope this helps jim gammie


Please do not reply to this Email. Visit www.umm.edu to post any further questions.

Thank you,

Ask The Expert Administrator

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Seems a little strange to contact a doctor in a way you might ask for the best way to find a old bike frame or a cheap date. And he comes off a bit like a used-car salesman. But if he can fix Zora’s valve rather than replace it, I’ll buy the extended warentee. He also has a lot of posts on on-line medical posting boards (to other doctors). So I’m kind of hoping he’s just a tech-savvy geek. And I really like how his speciality is “Mitral Valve Repair” and not “Mitral Valve Repair and Replacement” like all the others cardio surgeons list.

I’ll call him in the morning.

I was able to bring Zora her e-mail and a copy of my blog. I just text-messaged Zora to ask if she had any more words to her fans. She replies: “Uh, rock on? I’m going to pee, and then maybe the strike will magically be resolved.” She adds in a 2nd message, “Do say thanks for all the nice emails and calls, especially from the super secret copy editors’ network.” Just for the record, her text messages are always perfectly spelled and correctly punctuated.

Oh, Grant and Victoria, Zora did get your flowers. Just as she was being wheeled out of Forest Hills a few days ago. The other flowers were left behind, but yours made the move as I was able to hold the box in my hands. So now those are the only blooms gracing her bedside. Funny, I’ve never bought my wife flowers (I’m not proud of this fact… I’m just saying). And they way people are sending them, I may never have to.

I also learned, thanks to that trusty dictionary, that vegetal isn’t quite the same word as vegetable. They just both come from the same Latin root, vegetare, to grow.

Now Zora text messages me: “Goddamn it. Stupid cardio guy just showed up to tell me I really shouldn’t leave, and then said he was trying to be mellow and balanced. I told him he was in fact the most alarmist of all the docs, especially thanks to his bad timing. But being mad at him just makes my heart rate go up.” Oh, and then she corrects a typo in her previous message to the copy editors.

I wish there were easy answers. She would love to be home. And would be healthier at home, especially if she’s got to go into surgery. And the risk of embolization is lower, as the antibiotic treatment goes on. But of course there still is a risk.

Her main complaint through all this is lack of good sleep. We also can’t get an answer as to just how big this growth is (more than 10mm would be very bad). What to do?