Sunday, April 3, 2016

A Healed Heart

            My husband Levi, had heart surgery.
This sounds pretty intense and crazy to believe for a healthy, young, and very fit man, but it’s true. But not as scary as it might sound, or maybe I’m na├»ve. With the technology available to us today it is amazing that he could have “heart” surgery that he didn’t feel afterward and was up moving around as soon as the anesthesia wore off. The next day the only signs of the procedure were the sticky residue left behind from patches stuck to him for monitoring. He was out mowing the lawn in the beautiful sunshine and working on a fence he built.
(Beautiful fence Levi built)
                Now to catch everyone up to speed: Years ago, while we were living in Idaho, Levi had a nose operation to try and correct a severely deviated septum. He couldn’t even breathe through his nose. When he woke from the surgery his heart rate was in the 30s. This freaked the nurses out. We tried to assure them that it was due to his genetics and being very fit. He had hernia surgery shortly before this with the same nurse attending but the sports Doctor who knew Levi, was not at all concerned with his low heart rate. But this time the nurse wouldn’t be swayed. They called for an ambulance and had him transferred from the surgery center to the hospital for testing.
(Post nose surgery on his way to the hospital. Funny years later he would be working on the other side of the gurney.)
                He was strapped to an ECG machine and it immediately picked up Wolff Parkinson White (WPW) syndrome. WPW is basically an extra electrical pathway that can affect the pacing of the heart. This was the first time we had ever heard this so we were a bit concerned. He was referred to a heart specialist and in the end since he had never had a symptom, the Doctor said he wouldn’t do anything about it yet. He did caution Levi that being an athlete, he might be excluded from certain competitions (like the Olympics) due to his heart condition and it being risky. The Doctor was surprised Levi hadn’t had any ECG’s before especially being a Division 1 college athlete. I think testing every athlete’s heart should be mandatory to compete in college athletics. It just might save a life for those with a serious heart condition. We took the information and continued on with our lives, pretty much forgetting he even had it.
(WPW heart pattern)
                Fast forward to 2013, Levi submitted a video and was selected to take part in American Ninja Warrior. He traveled to Venice Beach to compete and advanced to the finals in Las Vegas. We were excited. He traveled down earlier for filming and I a bit later. On my way down I received a call from him. They were doing ECG’s on all the competitors. He sounded worried. WPW was back fresh in our minds. The Doctor strapped Levi up and checked his heart. He then began asking Levi a series of in depth questions. Levi answered honestly but knew why he was being asked. The Doctor finally gave him the go ahead to compete, since he was asymptomatic.  
(American Ninja Warrior 2013)
                In 2014, the gym where Levi and I worked at closed its doors for good, but three days earlier Levi officially started his dream job as a Firefighter for the City of Tukwila. He had applied well before he knew the gym was closing so the timing could not have been any more perfect. God’s hand was definitely in that one. We were excited for the opportunity. He passed all the physical tests no problem. Then there was one last thing, the ECG. There it was on the screen, WPW. The Doctor asked Levi about it and he told him he knew he had it. He went on to explain his history, Doctor visits to specialists, and never having a symptom. The Doctor asked Levi more questions and eventually cleared Levi fit for work. Being an elite athlete helped as he had tested his body time and time again in grueling practices and workouts and never once had a symptom.
(Levi Keller in his Class A's)
                Then in 2015 Levi got his first structure fire. He was pumped. He was battling the blaze in a walk out basement. He threw things out of his way, sprayed and moved piles of burning material, and stomped through debris. He was on fire…er, well he felt unstoppable. He was on the nozzle dealing with an inch and three quarter line with a lot of pressure, inside tight spaces, knee deep in debris, or in lay terms, he was working very hard. After the fire was out, he went through gross decon (they spray you with a hose to get the big stuff off) and went into rehab (where you rest, eat, and drink). He was moving around, eating snacks, drinking water, and feeling pretty stoked about his first fire. The Firefighters got checked out by EMT’s 10 minutes after getting in recovery. An EMT came over to Levi and checked his pulse and blood pressure. His heart rate was abnormally high. He thought he must have messed up so took it again. It was still very high. He called a Medic over. The medic took his pulse and got the same reading and put a 4 lead on him. It showed 192 beats per minute. He went to get the 12 lead. Oh no, was all Levi could think when he saw it. He knew what the machine would say. He told the Medic to hang on a second that he was just really excited after his first fire. He took a few deep breaths and got his heart rate down to a reasonable heart rate (in the 80s). The Medic didn’t like that either. That wasn’t normal. So they put the patches on and sure enough WPW came on the screen.  Levi told the Medic he knew he had the condition and that he had seen several Doctors and was cleared. The Medic wasn’t convinced and needed to follow protocol. As a courtesy he told Levi he could walk to the ambulance instead of going via gurney so as not to draw attention. However, as they pulled out, the guy driving turned on the sirens and took off, so much for leaving quietly.
                If I had to put this in perspective it would be like finishing a steeple race. Crossing the finish line, drinking some water, walking off the track, back through the marshaling areas, sitting at my bag, eating a granola bar and still having my heart as high as in an all out sprint held at the very end of a race.  
(Training)
                Levi was transported to the hospital where he had to stay for a few hours. They did an EKG and it showed he had WPW. They also did blood work and found he was very dehydrated, which is to be expected after fighting a fire and leaving the rehab area. They gave him two bags of fluids to fix that. The cardiologist came in and talked to Levi. He told him that he wouldn’t be cleared to go back to work until the next cycle. He also recommended that he set up an appointment with an electro cardiologist. The electro cardiologist did an EKG and asked Levi a bunch of questions. Levi asked if it would be possible to get a Doctor’s note to have on him at work so if this happened again he would not have to miss work and be transported to the hospital. The Doctor said he wouldn’t do that without doing more tests but that he thought it was reasonable. They talked about doing an EP study, where they map the heart and test its pathways. In the meantime Levi got a second opinion and the Doctor concurred with the original Doctor. Levi set up an appointment for an EP study with the intent to ablate. An ablation is a surgical procedure to burn or freeze the unwanted pathway via a catheter inserted in each leg. They wouldn’t know until they did the EP study if they would be able to also ablate the accessory pathway during the appointment without seeing where the accessory pathway was. It is rare that the accessory pathway is right next to the good pathway which would make an ablation too risky to perform.
                Levi was mostly awake during the procedure and during it found out that he is “unique.” His accessory pathway was right next to the good pathway and the Doctor did not want to attempt the ablation. Since Levi was asymptomatic the risk didn’t seem worth the possibility of the procedure causing heart block meaning Levi would need a pace maker for the rest of his life. The Doctor decided to monitor his heart for two weeks with an external monitor taped to Levi’s chest. Oftentimes they do this first but in most cases if you are asymptomatic it won’t show anything that you don’t already know and going in to ablate is usually a simple procedure.
                We were in MT visiting my family about the time the Doctor called Levi with the results. Levi hung up the phone and I asked what he found out. He responded, “Basically everything that could be bad is.” During the monitoring Levi was in fact having “symptoms.” He wasn’t feeling them but his heart was trying to go into SVT. It was trying to conduct at 250 bpm. Not all of the beats were going through, luckily, but it was getting in the high 190s. For some reason Levi never felt any of this. Maybe it was happening during workouts and he was attributing it to working out hard. Who knows? The next option would be taking medicine to treat his condition. But during the monitoring they found Levi’s resting heart rate to be extremely low. It measured 21bpm at the lowest! The low heart rate was not a concern it’s probably part genetics, part fitness. But due to such a low heart rate the option of taking a pill that would lower his heart rate even more was off the table. So now the only option was an ablation. At the time this didn’t seem like a great option since the first time they went in they found his accessory pathway to be in a very hard spot to operate on. Levi would meet with the Doctor in person to discuss things further. In the meantime, he had his Doctor also send the results of his monitoring to his second opinion person.
                The second opinion concurred with the first Doctor again saying that after looking at his two week heart study he felt an ablation was definitely needed.  Levi had his appointment with his first Doctor and discussed the option of simply waiting. As you age, the symptoms can get worse but the odds of Levi’s first episode being fatal were low. Levi had a long refractory period which meant his heart had less of a chance of conducting in a bad way that could be fatal. The Doctor told Levi there was a surgeon in Oklahoma that took the really hard cases. He didn’t think Levi was to that point yet. He wanted to do go in to ablate it while using a more precise mapping instrument. The mapping tool the Doctor used on the first EP study is what is typically used as cases like Levi’s are rare and the reason for not using the other tool is cost. The other instrument is over $30,000 more.  The Doctor had never caused heart block in a patient in his 30+ years of doing the procedure and he wanted to try Levi’s but ultimately was leaving it up to him. He told Levi if he opted to wait until he was older to have an ablation he couldn’t in good conscious recommend him to be a firefighter. In his profession the risk is too great of having an episode become fatal. Like if Levi was to have a symptom and pass out during a fire. Levi took some time to think things over.
                In the end he decided to schedule the ablation. There are two options for ablation, a burning and freezing technique. They chose to do a freezing technique. This way if they accidentally touched the good tissue they could simply wait for it to thaw back out and not cause heart block. If you burn it, it is permanent meaning the good tissue cannot come back and you end up with a pacemaker. It would take several freezes on the accessory pathway to stop it from conducting and there was no guarantee they would be able to get it all.
               
(Levi and my brother John, who made the day of
Levi's procedure easier)
March 30th Levi went in for his procedure. It was hard figuring out what to do at first with the kids. His check in time was at 6:30am. In the end Levi drove himself to the University of Washington and parked there. The plan was for my brother to take the light rail from downtown Seattle to the hospital after he got off work and drive Levi in our car to his house where Levi could stay and rest. This made things a lot easier. I try to be optimistic about things like this but for some reason leading up to his procedure I was expecting the worse. I didn’t tell this to Levi and kept it to myself but I could read doubt from Levi as well. I figured they would go in, say they couldn’t perform the procedure and we would have to figure out what options were next. A trip to Oklahoma perhaps? During breakfast as Lily, Eve, and I sat eating our oatmeal, I looked at the clock. It was just after 8am. Levi was scheduled to be starting his procedure. I stopped and said a prayer out loud and realized that by preparing myself for an unsuccessful surgery I was lacking faith. I talked to God and told Him I had complete faith in the outcome. For once, I was feeling optimistic about it. Yes, I prayed for a successful surgery but ultimately I prayed for God’s hand in this, whatever the outcome. If the news was anything otherwise we would go from there. I felt much lighter finally surrendering and giving this to God. I know it seems so small but until I let it go I didn’t realize the weight it had been on me. There was nothing I could do. WPW was something out of Levi’s control, he didn’t do anything to cause it and the outcome was out of my control. It was God’s and God’s alone. But even in a small way it opened my eyes to surrendering to God and how often I hold back in my day to day life without realizing it. This was a good reminder.
                I talked to Levi shortly after his procedure but things were a bit fuzzy. He told me they thought it was a success but that he had to have a follow up to make sure. He had been knocked out for 5 hours and had received 500 mcg of Fentanyl and some (10) Versed which apparently is a lot! Levi remembers them injecting him and not getting knocked out so they did some more. When he was more alert I got more accurate details. The procedure was a success! At one point the Doctor sat and watched his heart for 40 minutes after freezing the accessory pathway because it looked like the accessory pathway was still trying to conduct. It didn’t. Before he left the hospital they did another ECG on him and for the first time in Levi’s life the letters WPW did not show up!
(Looking pretty good the day after heart surgery)
                The Doctor told him it was a tough procedure, one of his most challenging. He said he really prepared for this one. He got up and got his exercise in before 5am to get his mind and body ready. I definitely have respect for a Doctor who uses exercise to prepare for his work! Levi will go back in for a follow up but the Doctor said after watching his heart during the procedure and having a normal ECG he is confident he is cured and the accessory pathway won’t be able to conduct any more.
                It is strange to have Levi “cured” of something he never even exhibited symptoms of. How he originally only found out he had it by accident as a result of being a fit individual with a low heart rate.  It is amazing the technology we have today, that Levi could get heart surgery via his veins near his groin in each leg and the biggest possible risk being bleeding at the insertion site. He said it was like getting an IV, only a slightly larger tube and in your leg not your arm. The day after his procedure he was out working in the yard. The sun was shining, the girls were out playing, and I couldn’t help but smile watching him work. Who would have thought three little letters could make such a difference? Though our lives seem unchanged and will go on as they always did, under the surface, everything is different and that is why I smile. 

(Out playing while Dad works)