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Physician Update - Pushing the Surgical Boundaries for Seniors

Physician Update Winter 2010

Pushing the Surgical Boundaries for Seniors

Date: January 31, 2010

Fisher Howe exercising
Back in action again, Fisher Howe says he could even play tennis if he wants to. The only thing stopping him now is a recently acquired condition he calls FOF, “fear of falling.”

When Nick Fortuin sized up the cardiac patient who stood before him in the early spring of 2009, he held his skepticism in check. The man was 94. “But my goal,” the man said, “is to make it to 100.”

The Johns Hopkins cardiologist knew some basic things in advance of his new patient’s visit. The patient had survived a multivessel coronary artery bypass in 1988. When the bypasses began to give out in 2008—a common occurrence 20 years after the surgery—he was hospitalized twice, emerging with two new stents aimed at restoring lost blood flow.

But the patient still couldn’t walk across the room without gasping for breath. Physicians near his home said they were running out of options. At 94, they believed, he was clearly not a surgical candidate.

Most patients in such a circumstance might have packed it in. But most patients are not Fisher Howe.

You could make the case that Howe had already lived nine lives, and then some. He was a career diplomat. He’d graduated from Harvard, served in naval intelligence during World War II, kept ascending the ranks in the State Department to a position as deputy head of intelligence, later becoming the deputy chief of mission to both Norway and Holland. He followed that up with a turn as an assistant dean at Johns Hopkins’ School of Advanced International Studies and finally “retired” as a management consultant for nonprofit organizations, authoring four books with his gathered wisdom.

In his spare time, Howe took up tennis. And not just any old tennis. Into his 90s, he’d placed third in his U.S. age group.

So when Fortuin assessed this particular patient’s dangerously narrowed aortic valve and considered surgery, he also took in the remarkable character traits of an individual with an uncommon zeal for life. He respectfully disagreed with the physicians who had encouraged Howe to settle for a shorter lifespan, telling Howe, “I think you’ve got the stuff to do it.”

After a further assessment with Hopkins cardiac surgery chief Duke Cameron, the obvious risks were at least enough to give Howe pause: up to a 4 percent risk of death and up to a 10 percent risk of stroke. And, added Cameron, at the very least Howe would be in for an arduous recovery.

Despite the well-intentioned skepticism of family and friends, Howe made the leap. “I really wanted to hit that 100 mark,” he says. “My valve would deteriorate if I didn’t do something.”

During the operation, Cameron replaced Howe’s heavily calcified trileaflet aortic valve with an animal valve and rebypassed a badly narrowed coronary vessel. Howe needed a balloon pump to sustain him after the procedure and required extra time on the respirator. Afterwards, he spent 13 days in acute care, 10 days on a rehab floor, and a month in a rehab facility near his Washington, D.C., home.

To Howe, it was worth it. He feels good again. He exercises daily on the rowing machine, the treadmill, the elliptical unit.

Fortuin says Howe’s case is a way-shower. As the population ages, he says, cardiologists are seeing more patients with age-related aortic stenosis. And increasingly, many who are rejected for surgery because of age are reconsidered at Hopkins. “I’ve seen three 90-plus patients in the past year who were turned down elsewhere,” Fortuin says. “All three had great surgical results here.”

Call 410-583-2666 to refer a patient.