At 101, Patient Is Nation's Oldest Transcatheter Heart Valve Replacement

When Doris Snyder celebrated her 102nd birthday on August 10, she was that much closer to the expected birth of her first great-granddaughter who's due to arrive early September. She is very excited about the milestone, which might not have been possible were it not for a cutting-edge, experimental procedure that replaced one of Doris' heart valves weeks earlier when she was 101. The valve had been rendered useless by aortic valve stenosis hardening from calcium deposits that restrict the flow of blood from the heart.


"This procedure could be a major breakthrough for these patients, as they're generally told that nothing can be done for them," said Patrick M. McCarthy, MD, chief of the division of cardiothoracic surgery for Northwestern Memorial Hospital and director of the hospital's Bluhm Cardiovascular Institute and the Heller-Sacks professor of Surgery at Northwestern University's Feinberg School of Medicine.


McCarthy is a co-principal investigator for the clinical trial that provided Doris' new heart valve, which is formally referred to as the Placement of AoRtic TraNscathetER Valve, or PARTNER. The Bluhm Institute is among the trial's pioneering sites. The technique is being evaluated as a course of therapy for patients who are considered too weak to undergo conventional open-heart surgery. It uses expandable-stenting technology to insert a prosthetic valve while the heart continues beating, eliminating the need for cardiopulmonary bypass and its associated risks.


"Patients who are too weak to be surgically treated have very limited options for valve replacement," said Charles J. Davidson, who is also a co-principal investigator for the trial and a professor of Medicine at Northwestern University's Feinberg School of Medicine. Davidson says the procedure builds upon the balloon aortic valvuloplasty, but is a "more durable treatment."


Spry and amazingly keen, Doris had never encountered any major health issues. Moreover, the avid reader who's kept a diary for more than 60 years is usually game to tackle most things that come her way but open-heart surgery was not one of them. S. Chris Malaisrie, MD, a Northwestern Memorial cardiac surgeon and member of the site team evaluating this new procedure, said she wouldn't survive it.


"Doris exemplifies the fact that your state of health is not necessarily defined by your age," said Malaisrie. "She's healthier than a lot of people much younger than her."


Drs. McCarthy and Malaisrie are paid consultants of Edwards LifeSciences, makers of the experimental prosthetic valve.

Grey Turner' s Sign

Figure 1. Grey Turner's Sign.

Ecchymosis or bruising on the abdomen is rarely a good sign on physical exam. Grey Turner's sign is bilateral flank bruising or ecchymosis and is a classic finding of bleeding into the retroperitoneum around the kidneys and pancreas.   It is associated with severe acute pancreatitis but may occur following cardiac catheterization with bleeding into the retroperitoneum.

Unfortunately, abdominal wall bruising is common and not always Grey Turner's sign.  Location of the bruising really matters.  In blunt trauma (e.g. high speed motor vehicle accident), the classic "seat belt sign" is an indicator of potential intra-abdominal injury.    Physicians can easily be mislead by subcutaneous injection of insulin or blood thinning medications (e.g. low-molecular weight heparin).  These medications can result in impressive abdominal wall bruising that is usually self-limited.

Dr. George Grey Turner was born September 8, 1887 in North Shields, England.  As a young surgeon, he traveled extensively throughout America, Canada, and Africa.  He was a pioneer in cancer surgery of the esophagus.  In  1920, Dr. Grey Turner reported his experience with two patients that died after abdominal exploration for acute pancreatitis.  From his experience, he noted periumbilical discoloration (Cullen's sign) and bilateral flank discoloration.  He hypothesized that the discoloration was "direct action of pancreatic juice."

Figure 2. Image from original report by Dr. Grey Turner.

Reference:
White H. An Outstanding ISS/SIC Surgeon: George Grey Turner. World Journal of Surgery. 2003. 27:511-513.

Turner G. Local Discoloration of the Abdominal Wall as a Sign of Acute Pancreatitis. British Journal of Surgery. 1920. 7:394-395.

Tea pot shaped Mother's Day card

I created this tea pot shaped card for my Mom for Mother's Day. I dowloaded this cut file http://www.letteringdelights.com/clipart:tea_time_party-10903.html and uploaded it to my SCAL program. I then cut it out with my Silhouette Cameo and paper pieced it together. The tea cup is an svg file I found on google images. I also used an action wobble behind the flower to give it some fun action. I just loved how it turned out. Thanks letteringdelights!
Supples Used: Silhouette Cameo                        Lettering Delights tea time cut file                       Bazzill Cardstock                       Action Wobble                       Tim Holtz Button                       My Pink Stamper                       Stampin Up! Ink                       Stickles                       Hero Arts Lace                       ATG Gun                       Gel Pen                       Sizzix Tag die                       Hot glue gun




Grey Turner' s Sign

Figure 1. Grey Turner's Sign.

Ecchymosis or bruising on the abdomen is rarely a good sign on physical exam. Grey Turner's sign is bilateral flank bruising or ecchymosis and is a classic finding of bleeding into the retroperitoneum around the kidneys and pancreas.   It is associated with severe acute pancreatitis but may occur following cardiac catheterization with bleeding into the retroperitoneum.

Unfortunately, abdominal wall bruising is common and not always Grey Turner's sign.  Location of the bruising really matters.  In blunt trauma (e.g. high speed motor vehicle accident), the classic "seat belt sign" is an indicator of potential intra-abdominal injury.    Physicians can easily be mislead by subcutaneous injection of insulin or blood thinning medications (e.g. low-molecular weight heparin).  These medications can result in impressive abdominal wall bruising that is usually self-limited.

Dr. George Grey Turner was born September 8, 1887 in North Shields, England.  As a young surgeon, he traveled extensively throughout America, Canada, and Africa.  He was a pioneer in cancer surgery of the esophagus.  In  1920, Dr. Grey Turner reported his experience with two patients that died after abdominal exploration for acute pancreatitis.  From his experience, he noted periumbilical discoloration (Cullen's sign) and bilateral flank discoloration.  He hypothesized that the discoloration was "direct action of pancreatic juice."

Figure 2. Image from original report by Dr. Grey Turner.

Reference:
White H. An Outstanding ISS/SIC Surgeon: George Grey Turner. World Journal of Surgery. 2003. 27:511-513.

Turner G. Local Discoloration of the Abdominal Wall as a Sign of Acute Pancreatitis. British Journal of Surgery. 1920. 7:394-395.

Travel after Surgery

Your operation has gone well.

Time for discharge.

Ok, how do I get into my car and get home?  Where's my car? Who's driving?  Do I need help?  Do I have food at home?  With all of the excitement of discharge, you might forget about the process of leaving the hospital and getting home.

Recommendations for Driving Home:

1. Have someone pack the car.  If you have been in the hospital more than overnight, you will have more than you anticipate, such as clothing, dressings, new medications, and flowers.    
2. Have someone clean the house, buy groceries, prepare your sleeping area (preferably on the 1st floor).
3. If you did not anticipate staying in the hospital, call your family or friend to pick up the 1977 C3 yellow Corvette you parked in the garage.
4. Find someone to drive.  You cannot drive!
5. Take your time but leave before dark.  You do not want to navigate steps at home in the dark.
6. Wear your seatbelt but bring something (a blanket) to pad your belly if you had an abdominal operation.
7. Elevate your legs.
8. Take breaks every 2 hours and walk around.

Plan carefully for long distance travel (> 200 miles).  Plan ahead.  Beware of weather delays, construction, road safety, etc.  Identify several places that you can stop and rest.  If necessary, identify places you can sleep overnight.  Long distance travel can result in nausea, vomiting, dehydration, and unanticipated pain if you don't have easy access to medications.
In theory, prolonged car travel may increase your risk of deep vein thrombosis (blood clots).  However, if you take frequent breaks and walk around, this should not be a problem.
Remember:  If you have a dressing, cast, or health condition that prevents you from sitting in a passenger car, please discuss with your healthcare provider and arrangements can be made for safe transportation home.

Tea pot shaped Mother's Day card

I created this tea pot shaped card for my Mom for Mother's Day. I dowloaded this cut file http://www.letteringdelights.com/clipart:tea_time_party-10903.html and uploaded it to my SCAL program. I then cut it out with my Silhouette Cameo and paper pieced it together. The tea cup is an svg file I found on google images. I also used an action wobble behind the flower to give it some fun action. I just loved how it turned out. Thanks letteringdelights!
Supples Used: Silhouette Cameo                        Lettering Delights tea time cut file                       Bazzill Cardstock                       Action Wobble                       Tim Holtz Button                       My Pink Stamper                       Stampin Up! Ink                       Stickles                       Hero Arts Lace                       ATG Gun                       Gel Pen                       Sizzix Tag die                       Hot glue gun




At 101, Patient Is Nation's Oldest Transcatheter Heart Valve Replacement

When Doris Snyder celebrated her 102nd birthday on August 10, she was that much closer to the expected birth of her first great-granddaughter who's due to arrive early September. She is very excited about the milestone, which might not have been possible were it not for a cutting-edge, experimental procedure that replaced one of Doris' heart valves weeks earlier when she was 101. The valve had been rendered useless by aortic valve stenosis hardening from calcium deposits that restrict the flow of blood from the heart.


"This procedure could be a major breakthrough for these patients, as they're generally told that nothing can be done for them," said Patrick M. McCarthy, MD, chief of the division of cardiothoracic surgery for Northwestern Memorial Hospital and director of the hospital's Bluhm Cardiovascular Institute and the Heller-Sacks professor of Surgery at Northwestern University's Feinberg School of Medicine.


McCarthy is a co-principal investigator for the clinical trial that provided Doris' new heart valve, which is formally referred to as the Placement of AoRtic TraNscathetER Valve, or PARTNER. The Bluhm Institute is among the trial's pioneering sites. The technique is being evaluated as a course of therapy for patients who are considered too weak to undergo conventional open-heart surgery. It uses expandable-stenting technology to insert a prosthetic valve while the heart continues beating, eliminating the need for cardiopulmonary bypass and its associated risks.


"Patients who are too weak to be surgically treated have very limited options for valve replacement," said Charles J. Davidson, who is also a co-principal investigator for the trial and a professor of Medicine at Northwestern University's Feinberg School of Medicine. Davidson says the procedure builds upon the balloon aortic valvuloplasty, but is a "more durable treatment."


Spry and amazingly keen, Doris had never encountered any major health issues. Moreover, the avid reader who's kept a diary for more than 60 years is usually game to tackle most things that come her way but open-heart surgery was not one of them. S. Chris Malaisrie, MD, a Northwestern Memorial cardiac surgeon and member of the site team evaluating this new procedure, said she wouldn't survive it.


"Doris exemplifies the fact that your state of health is not necessarily defined by your age," said Malaisrie. "She's healthier than a lot of people much younger than her."


Drs. McCarthy and Malaisrie are paid consultants of Edwards LifeSciences, makers of the experimental prosthetic valve.