GERRY HOFMANN - MY STORY

Gerry, with wife Sue and daughters Michelle, Katie and Geraldine

I was born in Sydney Australia on 6 October 1945. My parents, who were both born and raised in Vienna,  had come to Australia in 1939 as refugees to escape the war in Europe.

 I grew up in Sydney, went to school and University and got married there. I graduated from university as a civil engineer and married my teenage sweetheart Suzanne (Sue), in March 1968. After working in Sydney for 3 years, my employer transferred me to Perth in Western Australia. Sue came with me and because she was a teacher, had no trouble finding new employment there.

 We have lived in Perth ever since and have raised three lovely daughters here - Michelle, Katie and Geraldine. They are all redheads, like their mother.

 At school, the main sports were rugby and cricket - sports in which I found no interest (or skill). However, I played tennis and loved it. I have played tennis ever since and, whilst I have never achieved the highest standards, I have won many tournaments and competitions at the club level. Since turning 45, I have played actively in seniors events, culminating in being a member of the winning Australian team that won the Phoenix Challenge tournament at Palm Springs in 1998. In January 2000. I was a member of the Western Australian mens over 55 team that won the Australasian teams competition in Adelaide.

 I have always kept fit and active and in my spare time I love building things - anything from laying bricks to building a roof. I have undertaken a number of home renovations and extensions myself.

 In 1996, during a routine annual medical checkup, my doctor noticed a faint sound in my chest. He referred me to a cardiologist who performed an echo cardiograph. I was informed that I had mild aortic stenosis with mild regurgitation. It was likely that I would need an aortic valve replacement operation within the next decade. I was shattered. Never a sick day, very fit and active, beating 18 year olds at singles during 110 ^o heat waves, gym twice a week, no symptoms, etc etc etc - and suddenly I’m a heart patient?

The only consolation was that as this was a one-off test, I may have been like this for years and the disease was stable? I was also advised that as the future symptoms were self limiting, I could continue to play competitive tennis. (If I overdid it, I would run out of breath and be forced to slow down).

 Anyway, the prognosis was annual monitoring by echo, which I did. In 1997 there was a marginal deterioration, as was 1998 and 1999. By the time I came to have my annual test done in June 2000, I had stopped even thinking about it - it was fairly stable and something way off in the future. Wrong! This time, there was a serious progression of the stenosis, now warranting monitoring every 6 months.

 My 78 year old mother, who still lives in Sydney (my father died in 1970), insisted I come to Sydney to get a second opinion from a “big city” cardiologist. (She has a very low opinion of technology and expertise in Perth). So to please her, I went to Sydney in July 2000 and saw a cardiologist who had been recommended by a doctor friend. After an hour and a half with him, he concluded that I would require an aortic valve replacement within 1 to 5 years and that I should cease competitive tennis singles. This really got my attention!

 On return home to Perth, I decided that living in Perth and having a cardiologist in Sydney (2,000 miles away) was not very smart. I was not very happy with my existing cardiologist in Perth because I felt that after 4 years, I had not built up any rapport with him and that I needed somebody who would communicate better with me. Apart from the first test in 1996, I was told that I would have to ring up my family doctor to obtain feedback from the annual test each year.

 I therefore asked my family doctor to refer me to another cardiologist, one who (a) was younger than me (one does not want one’s cardiologist retiring on you prematurely), (b) could communicate well with me and (c) could empathise with my active lifestyle.

 In the meantime, I started researching the topic and during this research I discovered the wonderful world of Valvereplacement.com.

 On 30 July 2000, Sue and I went to see Dr Philip Currie, my new cardiologist in Perth. He is eminently qualified, having worked for 14 years in the USA, including the Cleveland Clinic and the Mayo Clinic. But just as important, he understands and can relate to my lifestyle and is a superb communicator.

 His advice to me was simple : my disease is advancing at such a rate that a replacement valve is a certainty. Therefore, for me to “sit” around waiting for and worrying about the event would serve no useful purpose apart from lowering my quality of life. My tennis has already been heavily curtailed which I find very difficult as I have always only had one speed - full. He recommended talking this “problem by the horns”, gritting my teeth and “going for it” so that I can start rebuilding the rest of my life as soon as possible. He also recommended the St Jude mechanical valve as it is commonly used here in Perth and elsewhere in Australia. He also advised me strongly to consider the after-care side of things - being here at home with my family and in familiar surroundings. This was in response to my question about travelling further afield to have the operation at a more “famous” hospital.

 So here I was, facing the three most important decisions of my life : When should I have the operation, where should I have it and what type of valve should I go for? All three questions were linked and the answer to one depended on the others.

How did I  proceed? In the short term, I felt I needed to find out more about Homograft valves. I had found out a lot about the St Jude Mechanical valve and the Warfarin that would be necessary to take with it, but I needed to get the same amount of information about the viable alternatives.

 So I started detailed researching and talking to many of the people who I met through the Valvereplacement.com Forum. I also saw one of the top cardiac surgeons in Perth, who also recommended the St Jude valve. He told me he used to do Homografts but stopped when the re-do rates became unacceptable.

 Through reading and contacts, I became aware of an eminent cardiac surgeon in Brisbane, Dr Mark O’Brien, who was one of the world’s foremost authorities on valve replacements. He worked with Sir Donald Ross on the world’s second valve replacement operation in the UK in 1972 and was the main developer of the cryo-preservation technique used today for harvesting and preserving human Homograft valves.

 I therefore made an appointment to see him and on 12 October 2000 I flew to Brisbane and back in the one day and spent 90 minutes with Dr O’Brien. He ran me through the various options and concluded that in his opinion, the Homograft would be the best option for me, considering all aspects of my condition, my age and my lifestyle. But I was left with no illusions of this being a “perfect” solution; the actual operation is more complex than for a mechanical valve, there is no guarantee on how long the Homograft valve will last (Dr. O’Brien showed me a graph which indicated that for someone my age, the chance of a re-operation within 20 years was about 15%) and it would mean having to wait for a suitable donor valve to become available. Also, it would mean having the operation done in Brisbane, the other side of the country, with all the logistical complications in getting there and back as well as family and medical support post-op. 

 But I was swayed, not only by Dr. O’Brien, but also all the correspondence and advice that I had been getting which lead me to conclude that this was the right choice for me. I drew up a chart of pros and cons of a mechanical valve done in Perth versus the Homograft valve done in Brisbane. One of the factors that influenced me to go with the Homograft was my father-in-law. Four years ago, at the age of 75, he had a 6 x bypass here in Perth. Apart from having post-op problems with his legs (from where the replacement veins were taken), he got through the whole ordeal remarkably well and made a full recovery. This indicated to me that if I could get 20 years out of a Homograft, then another operation when I was 75 was not going to be the end of the world and if that was the price I had to pay for getting 20 good years out of a Homograft, then I was prepared to pay it. Also, the way technology was advancing, open heart surgery in 20 years time should be far less traumatic, with more options, than today. I therefore made my choice with open eyes.

 But there was one more hurdle to jump - my cardiologist in Perth. Would he try to talk me out of it or throw additional problems into the equation? 

On 30 October 2000, Sue and I went and saw my cardiologist and he asked whether I had made a decision. I told him that I would like to have a Homograft operation by Dr Mark O’Brien in Brisbane, and to my relief, without hesitation, he jumped up and said “great decision!” I showed him my chart of pros and cons and he said that while factually the chart was correct, in the hands of another patient, the result may well be different, depending on the individual’s fears, preferences and lifestyle. But for me, my decision was “right”.

 I therefore went ahead and made arrangements with Dr O’Brien in Brisbane. I had to wait for a suitable donor valve to become available. In late December 2000, I was advised that a suitable valve had arrived and by mutual agreement, we chose the date of Wednesday 14 February 2001 (Valentine’s Day) to have the operation at St Andrews War Memorial Hospital in Brisbane.

 My cardiologist arranged for me to have a catheterisation (Angiogram) done here in Perth on Friday 12 January 2001. This went smoothly and showed that my coronary arteries were all clear. That was good news.

 On Monday 12 February, Sue and I fly to Brisbane and spent the afternoon shopping. That night we had a sumptuous seafood dinner with a friend - the condemned man ate a hearty meal. The next morning, we changed apartments to one more comfortable for Sue and closer to the hospital. Then at precisely 11.00 am, we walked into the main entrance of the hospital, registered and were shown to the cardiac ward (4E). That afternoon I was bombarded with a veritable procession of visitors from the hospital - nurses, ICU doctor, blood tests, x-ray, body shaver, anesthetist, surgeon, physiotherapist, etc. Fasting started at midnight that night and I slept well.

 The morning of Wednesday 14^th February 2001 (Valentine’s Day) arrived. I was due into surgery about lunchtime, following the first surgery by my surgeon on another patient that morning. I showered and washed myself with the iodine wash and put on my surgical gown, complete with uni-sex paper pants. About mid morning, I was given a pre-med in the form of 3 tiny tablets. I then lay in bed talking to Sue and our close friend Pattie who had flown over from Perth the day before to provide support for Sue. The very next thing I remember was waking up in ICU on Thursday morning, the operation behind me.

 The surgeon told Sue that my valve was certainly ready to be replaced and that the operation had gone very well, about 4 hours with about 1.5 hours on by-pass. The Homograft was implanted as a root replacement with re-implantation of the coronary arteries. 14 hours after surgery, they had me on my feet and walking, complete with all the array of tubes and wires attached to me. There was no pain in ICU - more discomfort due to lack of sleep and disorientation due to the morphine. Over the next 24 hours, tubes and wires were progressively removed and at lunchtime on Friday, some 42 hours after surgery, I was transferred back to the cardiac ward and my own private room. 

 Pattie flew back to Perth on the Friday and on Saturday our 3 daughters all arrived.

 Recovery over the next 2 days was uneventful as I started eating meals and had the dressing and last of the tubes removed. I also was able to get out of bed and walk the corridors of the hospital without assistance.

 Exactly 1 week after surgery, I was released from hospital, after a very successful echo-cardiogram, which showed that my new valve had an opening size some 4 times that of my own diseased valve. The next day, we traveled by car to Noosa, a seaside holiday resort on the Sunshine Coast, about 100 minutes drive north of Brisbane. We spent a lovely week there in a villa unit backing onto our own private beachfront on the Noosa River. Recovery went well and I was able to go shopping, walk on the beach and go to restaurants. In between, I relaxed on the patio overlooking the river, listened to music, watched TV and read a book. I also still kept having my afternoon naps each day. On the weekend, my brother, Francis and his wife Robin came up to visit us from Melbourne and we had a lovely time together.

 One week later (8 days after discharge from hospital), we drove back to Brisbane and boarded a flight back to Perth, via Melbourne. We arrived safely and I was back home, having had what the medical profession call an “uneventful” recovery.

 My recovery continued at home, mainly centred around walking.

 There is no doubt that the “ease” at which I got through the surgery was in no small way aided by being fit and healthy going into it as well as a very positive state of mind. I had done my research, I had total faith in the medical team, I knew what to expect and I knew what questions to ask. During the last few weeks, I actually started to look forward to the surgery, because I realised that it was going to herald in the start of my new life and that the sooner I got into it, the sooner I would be on the road to recovery. I also received an enormous amount of support from members of vr.com, both before and after the operation; that helped me enormously.

 I now have the “project” behind me and my task now is to rebuild my levels of strength and fitness and to resume my life without the worry of this disease hanging over me. I will continue to have annual echo-cardiograms and I will now appreciate the gift of time and life all that much more.

 I have bought myself time to live and I will make every effort to use that time well for its intended purpose; life is for living.

 Gerry Hofmann

March  2001