Saturday, July 19, 2008
Yesterday July 18, 2008 was the first anniversary of my stroke. The lecture was about my personal experience with illness since 1986, the year when I had a mild heart attack, the replacement of the aortic valve with a mechanical valve and a double bypass surgery in 1987, followed by my enlarged prostate in 2001, aortic aneurysm found in 2002, kidney cancer (renal cell carcinoma) treated with a partial nephrectomy surgery in 2005, and stroke in 2007 following my prostate surgery in Montreal. May 12, 1986, I recall waking up in the middle of night, having heard a coarse voice mocking me in my dream along with my father’s tender voice to go to the hospital. I was having severe angina. At Toronto General Hospital Dr. Michael Sole, FRCSC, at the time research director. professor of medicine at U of T, and chief cardiologist at TGH, diagnosed my case: a mild myocardial infarction (heart attack) due to an enlarged aorta and a thickening of the blood arteries. The aortic problem damaged my aortic valve and enlarged my heart. He warned us that without the replacement of the aortic valve, I would die within 2 years. On January 13, 1987 I underwent a successful heart surgery: aortic valve replacement with a mechanical valve and double bypass surgery carried out by Dr. Hugh Sculley, at the time an icon in valve replacements. The mechanical valve required me to take daily an anticoagulant called coumadin, to prevent formation of blood clots on the valve. From 1987 to 2001 I was followed up regularly by my family general practitioners Dr. Alyanak to 1993, and from 1993 Dr. Shields - both at Mount Sinai Hospital. (by the way, last year Dr. Shields was recognized for 50 years excellent services by the Hospital). From 1987 to 1992 I was seen by Dr. Sole once a year who informed me that another mild heart attack may have occurred in February 1987. But overall the valve was working fine, and from March 1987 there has been no change in my heart. I have been doing an echocardiogram every year to check the valve and the aorta. In late 1990s due to an enlarged prostate I started doing the PSA blood test which could indicate whether there is any malignant tumor. In January 2002, Dr. Shields surprised me that my PSA is fine but an X-ray shows my aorta enlarged. He immediately consulted Dr. Sole whom I saw in March of the same year. Dr. Sole’s echocardiogram report said that there is an aortic enlarged aneurysm of 6-7 cm and being alarmed he sent me in the same day to Dr. Sculley to have a an aorta repair surgery in less than a week (I knew later that Dr. Sole was top student at Harvard medical school). In meeting with Dr. Sculley, I asked him to postpone the surgery for a couple of months to allow me to participate in the graduation ceremony of my son Christian from St. Michael’s Choir school at the end of June 2002. Dr. Sculley agreed. I personally did not want to go through another heart surgery so I started calling Dr. Sculley in August, but he was already having a problem with his hands that eventually prevented him from performing any surgery. My file was then transferred to Dr. David, known as the greatest heart surgeon in Toronto and one of the top in North America. In my first meeting with Dr. David, he explained that this is not my first heart surgery, and that it is complicated by the fact that the aortic aneurysm is in the ascending aorta. He gave me a survival chance of 60-70%. I said “Thank you but no. I would rather not do it.” In mid 2004, Dr. Shields following on my enlarged prostate found a strange thing in the left kidney based on the ultrasound test and decided to send me to a urologist from Mount Sinai by the name of Dr. Juda. Dr. Juda sent me for more medical tests and when the results came back, he diplomatically announced to us that there is probably a cancer in my left kidney and he said “I am sending you to a top shotgun-Dr. Jewett at Princess Margaret Hospital”. Dr. Michael Jewett, FRCSC, is probably the top urology surgeon in Toronto. He is professor of surgery at U of T and a top researcher with 188 papers on prostate cancer and other urology illnesses. was Chairman of urology at U of T and head of urology at UHN. Dr. Jewett said he was sure I have renal cell carcinoma (kidney cancer) in the left kidney that required removal but refused to perform the surgery since I have a large aortic aneurysm. I went back to Dr. Shields hoping to convince Dr. Jewett or find an alternative surgeon. He did! But Dr. Jewett first offered the services of one of his students to perform it laparoscopically. The answer was no by the surgeon so I returned to Dr. Jewett. On January 25, 2005, I had my partial nephrectomy surgery performed by Dr. Jewett himself. He removed 40% of my left kidney to ensure that no cancer will spread. Since then I do a yearly checkup on the kidney. While recovering from the surgery I had bleeding from the kidney due to my anticoagulant. It took me back to the hospital for another 20 days. In April 2006 I had the first urinary tract obstruction due to my enlarged prostate. On and off using a catheter, I asked Dr. Jewett about any procedure that would relieve it. He said they do in Toronto the traditional TURP surgery which carries a risk of bleeding, but a new method called HoLEP is used by Dr. El-Helali, a top prostate surgeon, in Montreal. I went to see Dr. El-Helali in May 2007 and had my prostate surgery at Royal Victoria Hospital performed by Dr. El-Hilali on July 10. His assistant urged me to take my anticoagulant which I had stopped before the surgery as required but I thought that I do not need bleeding in Montreal. “I will come back to Toronto in 3 -4 days and can then restart my anticoagulant.” On July 18, 2007 I felt dizzy- My wife Samia called 911 and immediately they transferred me to North York Hospital. I was treated there from stroke. They said that a clot formed on the mechanical aortic valve when I did not take my anticoagulant. It travelled to the brain and caused the stroke. Thanks to God, it was a microembolism. My speech became slightly slurred and my writing became difficult but other than that I had full memory, comprehension, and all the motor functions intact. The stroke however reset my systolic blood pressure to less than 100. My beta blocker had to be reduced which caused my heart beats to go over 90 per minute. It also caused me stress and resulted in extra heart beats. I was seen by Dr. Sole in early October. He did an electrocardiogram to check my heart, an echocardiogram to check the aortic aneurysm, and a holter monitor to check my extra beats. He saw me again in November and did a blood pressure monitor to ensure my blood pressure is not hypotensive. The results were amazing: My electrocardiogram showed no change in the heart electricity since 1987. My echocardiogram showed no heart failure, and no change in the aortic aneurysm. It is even less, measuring 5.8 cm. My holter monitor showed that my extra beats are benign. They are the type that results from stress and will disappear eventually. My blood pressure monitor showed my blood pressure is exactly what it should be – not hypotensive that could induce a stroke, and not hypertensive that could cause cerebral hemorrhage -about 105-65. Dr. Sole said to me “You fell on the right side” The stroke has corrected the risk of my aneurysm rupturing. And Dr. Sole said this to me “God is smiling on you”! When I look back at 22 years of illness, I am amazed that not only have I survived the 2 years ultimatum for an enlarged heart, but also survived the kidney cancer, the dangerous aortic aneurysm, and the stroke. Everything worked together to give me life, even though I did not deserve it. My great sins and pride did not stop the hand of God to work through those genius physicians. In all these events, God intervened to rescue me from death. The cause is simple: God loves. Christ loves. I cannot fail today one full year after the stroke, to recognize the miracle that God has worked for 22 years in my body. I am a living miracle.