Cardiologist becomes heart patient

Toledo doctor learns what it’s like to be health-care consumer

3/19/2012

Dr. Khaled El-Syed, left, Dr. Christopher Riordan, and anesthesiologist Mohamad Almasri monitor the functioning of the valve newly implanted in Dr. Todd Monroe.

THE BLADE/JETTA FRASER
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Dr. Todd Monroe joked with colleagues while opting for a sedative-free catheterization of his heart, watched the catheter’s progress on a screen in the same room in which he had done the procedure on a patient hours earlier, and compared techniques with fellow cardiologist Dr. John Letcher while lying before him on the table.

The heart catheterization at ProMedica St. Luke’s Hospital gave further confirmation that Dr. Monroe was born with a two-leaflet aortic valve that was badly leaking. It also showed essentially no coronary artery blockage, a prospect the 52-year-old Dr. Monroe feared after years of being sedentary, eating poorly, and being overweight — all conditions he would advise his patients to avoid.

Ten days later, Dr. Monroe underwent open heart surgery just like any other patient, with cardiothoracic surgeon Dr. Christopher Riordan methodically removing the defective valve and replacing it with tissue from a pig. The possibility of having a stroke or losing mental capacity because of the operation was on Dr. Monroe’s mind.

“There’s a small fear of dying, but I don’t really have that fear,” Dr. Monroe said. “Probably the biggest thing is the loss of control.”

Doctors, nurses, and other health-care providers need medical services like everyone else.

They also know better than anyone else what will happen when they do.

Dr. Monroe, who is 6 feet tall and once weighed 332 pounds, readily admits doctors such as himself illustrate the adage “do as I say, not as I do.” Looking back, Dr. Monroe said symptoms including discomfort in his shoulder blades when going up stairs quickly probably started a year or so ago, but he ignored them.

“I guess part of me, knowing what I do, I didn’t want to know,” Dr. Monroe said, “and that I had to go through what I put everyone else through.”

Now, through his experience, Dr. Monroe wants people to better understand what heart patients go through and learn from his mistakes.

The cardiologist

Dr. Monroe is an interventional cardiologist with Northwest Ohio Cardiology Consultants who has practiced in the Toledo area since 1993. Besides doing heart-catheterization procedures at St. Luke’s, he implants cardiac stents, does diagnostic tests, and sees cardiology patients.

Still, when it came to his own heart, having a two-leaflet aortic valve instead of one with three — the most common congenital heart defect — escaped his notice. But the condition, which occurs in roughly one of every 100 births, normally doesn’t become a problem until later in life, he said. “I had never listened to my heart,” Dr. Monroe said. “I have a doctor, and I see my doctor regularly, and he noticed I have a murmur.”

And Dr. Monroe passed on the chance at the office to have a 64-slice CT scan, technology that easily could have picked up cardiac blockages from years of poor habits. After treating patients for blockages who run daily and appear healthy, he would have obsessed if he had discovered blockages, he said. “I never volunteered because I didn’t want to know. I really didn’t.”

Donna Tennant, critical-care director at St. Luke’s, said some health-care professionals such as Dr. Monroe often don’t seek care until their conditions become serious.

“These doctors — they just keep working,” said Ms. Tennant, one of several coworkers who checked on Dr. Monroe’s catheterization two weeks ago.

She added: “When you think about it, their patients rely on them.”

Helping patients

Although patients would get a sedative for a heart catheterization, Dr. Monroe did not have one so he could better explain the procedure firsthand.

He did not, however, decline anesthesia for open-heart surgery at St. Luke’s.

“I don’t want to remember anything about the surgery,” Dr. Monroe joked.

Last week, to expose Dr. Monroe’s heart, Dr. Riordan and his team made a large incision, cracked open his chest, and opened and picked up the doubled-walled sac surrounding his heart.

A heart-lung machine temporarily took over for those organs after Dr. Monroe’s heart was cooled and stopped, and Dr. Riordan replaced the valve with a series of sutures that also got a sealant.

Dr. Riordan, anesthesiologist Dr. Mohamad Almasri, and Khaled El-Syed, a cardiovascular surgical assistant, watched images from a probe sent down Dr. Monroe’s esophagus to ensure the replaced aortic valve was functioning.

More than three hours after the initial incision was made, two nearby holes were made for chest tubes used for drainage. Medical wire was used to close Dr. Monroe’s sternum and will remain in place to stabilize it.

Some patients needing valve replacement also need to have their aortas replaced during open-heart surgery, further complicating the procedure. They also would be more likely get a mechanical valve instead of one from human, porcine, or bovine tissue and to be on blood thinners for life, Dr. Monroe explained.

After surgery

It theoretically will be five weeks before Dr. Monroe can return to work.

Three days after surgery, with pain controlled by Tylenol and a day before being discharged, Dr. Monroe predicted the delay will be longer. He occasionally squeezed a strap around his chest used for support and to ease pain.

“It’s a big surgery,” Dr. Monroe said. “I feel a lot more tired than I thought I would.”

He added: “Just taking a shower today, I came back and took a nap.”

Dr. Monroe said he has a better appreciation for the staff at the heart center, where family and friends have rallied around him. Such support is vital for patients, he said.

His son, 20-year-old Ian Monroe, was on spring break last week from George Washington University. He and his sisters, 14-year-old Ilaina Monroe and 16-year-old Isabel Monroe, were with their father before surgery and visited him in the hospital.

One of the nurses, Keli Gulch, painted Dr. Monroe’s toenails pink with black smiley faces to greet him after surgery, a touch he proudly displayed. She followed the advice of Dr. Monroe’s girlfriend, Sandy Bechtel, and didn’t use red polish in case he initially mistook it for blood.

“We love him,” Ms. Gulch said. “He’s good to us, so we like to be good to him.”

Still, having a cardiologist as a patient is kind of odd, Ms. Gulch said. “You’re used to taking orders from them, and now we get to boss them around,” she said.

That includes sitting up in a chair and walking around the unit four or five times a day to build strength. As Dr. Monroe walked last week with the help of Ms. Bechtel and his nurse, Kristi Weber, one of his patients called out a “thank you” from another room.

“He’s been a great patient, truthfully,” Ms. Weber said. “When he came in, we thought ‘Oh, he’s going to be ornery.’ But he’s followed everything to the ‘T.’?”

Becoming a patient

A year and a half ago, Dr. Monroe had a small stroke in his left eye, which could have been caused by a small blood clot or piece of calcium off the defective aortic valve, he said. Tests then and a year later before back surgery showed the problem.

Ironically, results for that second echocardiogram weren’t read until after Dr. Monroe’s back surgery. That surgery may not have been done if the results were known beforehand, a lesson for patients to always check to make sure their results are in, Dr. Monroe said.

People shouldn’t ignore heart symptoms, either, Dr. Monroe said. He now is trying to eat more healthfully and hopes to exercise in preparation for hip replacement, likely his next medical need.

Subconsciously covering for cardiac symptoms is easy to do, Dr. Monroe said.

“A lot of people who have vascular heart disease, or any kind of heart disease, they know how far they can push themselves before they have symptoms,” he said.

Contact Julie M. McKinnon at: jmckinnon@theblade.com or 419-724-6087.