Tuesday, July 13, 2010


So in my last post I stated there was a reason I was doing a replacement ride for this year’s Headwaters 100, and that I’d explain later was it was. Well, here it is; many of you already know of the situation, but I’m finally putting it on the blog:

I’ve dealt with a chest wall birth defect my entire life known in the medical community as “pectus excavatum”. It is basically a dent in the chest. In my case, it is a severe dent. What causes this is rapid, non-normal growth of the cartilages supporting the sternum. This progressed while I grew up, and eventually my sternum has ended up in a position where it has rotated near 90 degrees, with the right side of it now pointing to my spine. Not quite right, huh? Plus, it is very recessed, and as you can imagine, this places unwanted pressure on my heart and lungs, particularly the right ventricle of my heart. As far as symptoms go, this has shown itself the most in the form of exercise fatigue, and a reduced ability to be competitive at the outdoor activities that you all know I spend most of my time off doing. Bad mixture. This is because cardiac output, as explained by my surgeon, is essentially determined by three things: blood available x heart beats per minute x expansion of the heart (right ventricle). You can see the problem right there. My heart can’t expand, and this puts me at an obvious disadvantage. Correcting the deformity would solve this. Not correcting it would mean continuing impairment, as well as the possibility of heart arrhythmias as my heart beats against the hard surface of my chest wall while it is meant to have more expansion volume. I have been in no immediate life threatening condition over the years of dealing with my pectus excavatum, but it has been determined medically necessary to correct with surgery at this point. The way surgery is determined to be necessary is by a pectus or “Haller” index, which is measured via chest x-ray and c-t scan. It’s essentially the ratio of a persons chest depth and width. A normal persons index is 2-2.5, they recommend surgical repair at values of 3.2 or more, and I exceeded 4. It needs to happen.

I am ready to have a “normal” chest to say the least. I have become very sick of having the impairment, and am excited to breath and circulate without restriction. I can’t wait to feel the difference over time. And I would be lying to say that the appearance of the deformity has not been a point of bother through my life. You haven’t seen me at the beach much, have you? I have through the years made an awkward peace with the way my chest has looked, but it has always been tedious explaining to everyone what my condition is, and I’ve always wished it wasn’t there. I didn’t choose to have a giant hole in my chest, and I know that nobody I care about judges me for looking considerably different, but people are people; I’m no exception, and we all suffer the mental capacity for embarrassment when we are “different”. It will be nice to “feel normal”. But by far, the improvement of heart and lung function is the main reason for going through the surgical repair. If it was an issue of cosmetics, there is no way I would put myself through the surgery I am facing. Additionally, I feel it worth pointing out that many people have considerably worse deformities/injuries/sicknesses, and I feel very fortunate that this is the worst of my health and appearance concerns. This should pass.

As for what the surgical process involves, you may read this paragraph if details of medical procedures do not bother you, or you may skip to the next if they make you uncomfortable, but I felt I would explain what I’m going to experience as many would like to know. I will be undergoing the Ravitch procedure for pectus excavatum repair. It involves an incision over the center of my deformity (the examples I’ve seen look like an upside down smiley-face), where the deformed cartilages are then removed. My sternum will then be positioned where it should have been all along, and a stainless steel bar (I’d prefer titanium so as to not set off every airport alarm, but no luck) will be placed behind my sternum to support it in it’s correct setting. Then they zip me back up.

I’ll be in the hospital for 2-3 days for observation/pain management, and then I’ll get to go home. I’m scheduled off work until somewhere around the first week of August to recover, and then I’ll go back to the office. A “full recovery” is estimated for somewhere around six weeks. This is referring to normal day to day activities for a regular American, not a cyclist/backpacker/rock climber/generally dissatisfied with sedentary pastimes type of person, or in other words me. I’ve been told it will be 3 or so months before returning to light cycling, and around a full year until I can start to ease back into climbing or backpacking. Ugh. Plus second surgery will have to happen (outpatient), to remove the bar will follow anywhere from 3 to 12 months after the initial surgery, when new cartilage has developed in the right places to support my sternum, and I’ll have to recover from that one too. My cams are going to get dusty hanging in the closet, but they’ll be waiting for me when I get strong again.

On another note for those of you in the aviation community- I am relieved to have been told by several AMEs and AOPA that this will have no grounds to affect my airman medical certification, barring any complications. It’s treated no different from breaking a bone and healing up again. Good news.

I’ll try to post some “pre” and “post” pictures at some point in the future, and myself or Alison will keep everyone updated on my progress as things move along, but for now I’ll leave you with an example shot of what my chest currently looks like. I have many, but I picked out a picture that also happens to have a nice background- Parriot Mesa in Castle Valley, UT. Beats looking at me in some boring documentation-type picture taken in my apartment.

I appreciate all your thoughts and prayers, and I’ll blog more on the recovery side of this…