Joel Tjelmeland

The I'm Sorry's

Hello. First, I would like to apologize to our friends and family who've reached out to us over the past few weeks and have not received a reply, update or response from us. We've been a bit overwhelmed and I am sorry I have not done a better job in following up with each of you. I personally want to thank everyone who has sent cards, e-mails and words encouragement; but, most importantly, for your prayers. Keep them coming!


Anytime I have new information about our situation, I will make a blog post. To follow my blog postings, simply click on the right hand side of this page and click "follow" and follow the directions on the screen.

The Beginning

Let me start from the beginning...every 36 months, Joel has to go for his flight physical so that he can maintain his private pilot's license. As such, in February, he went in for what we thought was a routine exam which included an EKG. Shortly thereafter, Memorial Hospital called and left a voicemail on our home answering machine (which we rarely check) and indicated Joel "might want to follow up with his cardiologist." A little weird but not alarming...if it were something bad, they would have called and spoken to us directly, right? Hmm. Still makes me wonder how many people get voicemails like we did and disregard them. Secondly, Joel doesn't have a cardiologist. But, with some nagging from me, Joel made an appointment Dr. Mishkel at Prairie Cardiovascular. We've gotten to know Dr. Mishkel as he is Joel Sr's cardiologist. He is really second none at Prairie. I like him alot.

The Gut Instinct

I decided to go with Joel to his appointment although Joel repeatedly told me I didn't need to go because it would be a huge waste of my time. In all seriousness, Joel thought he was going to go see him and would get his medical records signed off and be released that day. Those you that know me well...know that I have highly sensitive intuition. Come hell or high water, I wasn't missing that appointment. I'm glad I didn't ignore my instincts.

The Waiting

We waited for about 45 minutes before they called us back. We were the youngest people in the waiting room by about 30 years!

Once in the room, the nurses did their assessments and then said the doctor would be in. More waiting. More Joel telling I was wasting my time. After about an hour, Mishkel came in and said he was really glad to see us. But, really was not sure why we were there. So, we explained...flight physical...voicemail indicated we should follow up and it seemed natural for us to call him since had gotten to know our family through caring for Joel Sr. He quietly sat at his computer reviewing all of Joel's medical records electronically for what seemed like an hour...a few times telling me to be quiet. ;) Then listened to Joel's heart and did a few more assessments. At that point, he stood up and said that he needed to go see a few more patients very quickly and that he would come back because he wanted to give us his undivided time and attention. RED FLAG.

The Confusion

Joel and I sat confused. We had just done 8 miles of biking, jogging and walking on Sunday followed by 4 more miles of jogging on Monday night. Furthermore, Joel has been on a diet since October of last year and has lost over 40 pounds. He has never looked or felt better.

The Initial Diagnosis

Upon his return, Dr. Mishkel informed us that Joel had severe Mitral Valve Prolapse (MVP) characterized by the displacement of an abnormally thickened mitral valve leaflet into the left atrium that was ripped both on the anterior and posterior. The MVP was also causing Mitral Regurgitation (MR), a valvular heart disease also known as Mitral insufficiency or Mitral incompetence, which is the abnormal leaking of blood through the Mitral valve, from the left ventricle into the left atrium of the heart. This in turn was causing the left chamber of his heart to be enlarged. Note: Joel was diagnosed with MVP when he was nine and it's really never been much an issue other than him having to take antibiotics preceding dental work.

The Recommendation

Due to the severity of the valve rip, both on the anterior and posterior, Dr. Mishkel indicated that he felt that we might be better served at Cleveland Clinic where they had more experience in repairing severe valve issues such as Joel's. Okay, wait, back up. Prairie is rated in the top 2 percent in the nation for being a leader in cardiovascular. Huh? You can't treat him here? That really freaked me out.

Mishkel indicated that because of Joel's young age of 42 he definitely recommended that the valve be replaced rather than repaired. He wasn't even sure if it could be repaired but if so, the number one specialist for valve repair was at Cleveland Clinic. The advantages of repair compared to replacement are many...high success rate of returning to normal, less likely to have to take a lifetime of medications like blood thinners, etc. Enough said.

The Next Steps

In order to make the referral to CC, there were two more tests that had to be done: 1. a TEE and 2. A heart cath.

The Boring Medical Definitions

The TEE an alternative way to perform an echocardiogram. A specialized probe containing an ultrasound transducer at its tip is passed into the patient's esophagus. This allows image and doppler evaluation which can be recorded. The advantage of TEE versus an echocardiogram is that TEE's usually produce clearer images, especially of structures that are difficult to view through the chest wall. The TEE results would show us how badly the valve was ripped and if there were any hopes for repair.

The heart cath is the insertion of a catheter into a chamber or vessel of the heart. This is done for both investigational and interventional purposes. Mainly, they wanted to ensure that Joel didn't have any blockage. This test was being done as more preventive in nature.

The Testing Day

Joel was admitted to Memorial on last Friday morning to undergo the test. Talk about a long 15 hour day of waiting.

The Results

The TEE results were actually good news. After further diagnostic testing, results indicated that Joel's valve was actually only "mild to moderate" rather than "severe". The specialist indicated he felt Joel was a good candidate for heart valve repair rather than replacement. Momentary sigh of relief and BIG praise to God.

The heart cath results were not as good. This test indicated that Joel's heart was weak and was more enlarged than what they first suspected. Furthermore, they felt that it was more genetic rather than being caused from the valve. To explain, doctors initially thought that his valve was causing his heart muscle to be weak and significantly enlarged and that repairing it would fix the issue. However, now, they are not sure. To clarify, they are not certain that repairing the valve would be a good option as with any surgery there are alot of risks involved and they don't know if it will improve the condition of heart because it is not the cause or root of his problem. Rather than having one issue -- he has three.

The I Don't Knows

Basically, Dr. Mishkel indicated he didn't quite know how to clearly explain the test results because Joel has several very concerning issues going on that were "far and above his pay grade". I appreciated not only his honesty and true compassion but also him readily admitting he didn't have the knowledge to make further assessment. That doesn't mean I liked what he had to say. All in all, there are LOTS of unknowns and Dr. Mishkel has reassured us that they will do everything they can to figure out what is going on and get us to the right place.

The Referral

We are in the process of being transferred to Cleveland Clinic. The letter was faxed to our insurance company today and I talked to Mishkel's office 3 times as well as CC. Everyone has been so wonderful and caring. I love the secretary at CC. Joel will be seeing Dr. Lytle at CC. Mishkel's office overnighted all Joel's records today and they will arrive at CC in the morning. The doctor at CC will then review Joel's record and then a consultation will be scheduled. I will let you know via this blog as soon as we get a consult appointment at CC. It should be within the week. They are NOT jacking around (a little Michelleism for you) with any of this.

The Hope

The Miller Family Heart & Vascular Institute at Cleveland Clinic is one of the largest cardiovascular and thoracic specialty groups in the world, treating patients with severe heart, vascular, thoracic and esophageal conditions. We trust that Joel will be in the best possible hands possible and that they will have options for us. Most importantly, we trust in God and know He listens to our prayers. Please keep us in yours.

With Love,
Michelle