Cathy Casteel has had more than her fair share of health scares during her 48 years.
“Every day is a bonus for me,” says Casteel, a wife and mom to two teenagers. “I should not even be here right now, but I am, and I get to breathe each day. I get to make my kids’ lunches, I get to be at my daughter’s volleyball games, and I get to help my son get ready for college.”
After surviving lymphoma in her late teens, she couldn’t imagine that the radiation treatment, which helped saved her life at the time, would lead to heart and lung issues that would threaten her life once again, and possibly take her away from the most important people in her life.
She credits their love and support, along with the heart and lung team at Missouri Baptist Medical Center, with why she is still here today.
How it began
Casteel, who played high school and college soccer, was just 18 years old when she was diagnosed with Hodgkin’s disease (lymphoma) following a chest X-ray that showed cancer of the lymph nodes.
“It was devastating, but I was strong mentally and fit and healthy because of soccer. I went through the cancer treatment, including radiation, and went on with my life,” she says. Casteel married Ray, her husband of 20 years, and they have two children, 17-year-old Dylan and 15-year-old Hannah. She had a career in marketing and communications but retired recently due to her health.
“It’s believed that my upper body was weakened because of the radiation, and problems started showing up years later,” she says. “I had some thyroid issues and loss of lung capacity. I was really never the same.”
In early 2013, Casteel went to a St. Louis-area hospital for what she thought was bronchitis and underwent a CT scan.
“I went to work and got a call that I needed to come back to the hospital because there was a blood clot on my lung. I wasn’t surprised because I have a family history of blood clots. I thought they’d just put me on heparin for awhile and that would be it,” she recalls. “But after additional tests, the hospital found out I had an infection on at least one of my heart valves, and I went through six weeks of IV antibiotics.”
With growing concern about her weakening heart valves, Casteel began researching heart specialists in the St. Louis area and scheduled an appointment with Michael Mauney, MD, cardiothoracic surgeon with the Heart Center at Missouri Baptist, who would go on to care for her over the next several years.
A journey of the heart
“Radiation saved Cathy’s life as a teenager, but it gave her long-term problems,” Dr. Mauney says. Because of the radiation’s long-term effects, Casteel suffered permanent damage to her heart tissue and lungs, leading to coronary disease and two valves diseased from radiation that could not be repaired.
By May 2013, Casteel underwent her first operation at Missouri Baptist following a whole cardiac workup.
“Two of the main coronary arteries were blocked by radiation scar tissue, so we bypassed both arteries and replaced both valves,” says Dr. Mauney, who added that Cathy chose mechanical valves over tissue valves because they would most likely last the rest of her life.
Dr. Mauney says they discussed the fact that mechanical valves do require a vigilant life of taking daily blood thinners. Patients must be careful about what they eat and potential interactions with some medications.
“I don’t remember much about the first week after that surgery except, on the first night, I did get quite sick and Dr. Mauney came back to the hospital late at night to check on me and make sure I was okay. I was barely conscious, but I knew he was there; that meant so much to me,” Casteel says. “I went home a couple weeks later, but it was a difficult recovery, and I was depressed. Eventually I went back to work, and things went somewhat back to normal for awhile.”
Searching for an answer
On the last day of 2016, Casteel thought she had bronchitis again and went to another area hospital’s ER. When they were unable to help her, she returned to Missouri Baptist and Dr. Mauney’s care.
“We decided to do a CAT scan, where you could see that fluid had been around Cathy’s lung long enough that it kind of settled and precipitated, creating a peel around her lung. The lung was trapped, and it could not inflate,” Dr. Mauney explains. “After the effects of radiation and heart surgery, her right lung was her better lung, and here it was trapped. We had to free up that lung and take the peel off.”
Casteel underwent a six-hour lung operation through an incision between her ribs to strip the peel and allow her lung to inflate. It required 24 hours on the ventilator to help re-expand the chronically trapped lung. Her chest X-ray showed a good result before discharge.
Following this procedure, Casteel returned home, but remembers still not feeling like herself.
“At the time, we thought Cathy’s valves were okay, but over springtime when she came back to see me, you could tell she was still struggling to breathe,” Dr. Mauney says. “Her cardiologist, Dr. David Sewall, was good at following her, and her echocardiograms during this postoperative phase began showing a pattern that one of the valves in particular seemed to be getting worse and worse and was failing.”
After further tests, it was determined that there must be a clot forming on her valve. The care team decided that rather than re-do surgery, a clot-busting drug often given to stroke patients would be administered to try to break up the clot.
“Over three days, we gave Cathy four different doses of the clot-busting drug in the ICU in a very carefully monitored setting. Repeat tests showed one of the valves improved, but the other one didn’t,” Dr. Mauney says. “It looked like half of the valve was stuck, and that was an impending emergency. We had to operate.”
A life-or-death procedure
Casteel and her family met with Dr. Mauney on May 3 at 5 p.m. to discuss a heart surgery that he could not guarantee she would survive.
“I asked him when are you going to do this, and he said, 'tomorrow.' He told me I had a 30 percent chance that it would be successful like any other aortic valve repair. I had a 30 percent chance that I would survive, but would have some complications, and there was a 30 percent chance I would never wake up,” she says.
“I said I don’t think I have a choice, you have to do it. I thanked him and said if I die, thank you for trying everything. I’m so grateful.
“I told my son and daughter that I would do everything in my power to come back to them, and that I knew Dr. Mauney would do everything he could to make sure that I did,” she recalls. “I learned later that my son ran after Dr. Mauney and hugged him and thanked him for giving our family the last four years with their mom.”
Casteel says she’s a little fuzzy about everything that took place that night, but she does remember that a large contingent of family and friends all came to see her.
The next morning, as Casteel was being wheeled to the operating room, her mom told her to look up, and she saw all of her visitors who had been there the night before. “They came back to the hospital, all 40 of them, even my mom’s priest,” she says.
When Dr. Mauney and the surgical team went in to see what needed to be done, they found that there was a clot on Casteel’s aortic valve. They believe the clot had been trapped following the clot-busting drug procedure. Fortunately, it did not travel to her brain, where it might have led to a massive stroke, or to another area of her body.
“We thought how lucky is this? We hope these drugs melt the clot and don’t break it off, but I think in her case a big chunk broke off,” he says. “When we pulled that clot out, her valve started working. She was very lucky and this time she really does feel better.”
When Dr. Mauney describes Casteel, he calls her “a life force.”
“She required a lot of specialized care during her time at Missouri Baptist from all of her physicians, to the nurses who cared for her in the cardiovascular recovery unit and on the cardiac surgery floor,” he says. “I am just lucky to get to do this and have patients like Cathy. We have a great team that we work with here at MoBap. None of it works without everybody else here.”
Following her surgery, Cathy returned to the cardiovascular recovery unit and woke up the next day asking to have the tube removed from her throat and requesting ice chips and food.
“It was a miracle, and I felt great. I am so grateful to Dr. Mauney for being brave enough to do the surgery. I was told he agonized talking to me that day, which says so much about him,” she says. “Everyone in his office, his colleagues, and all of the people at Missouri Baptist are amazing, kind and compassionate.
“I am so lucky – so many people love me and care about me. My odds of living to 85 are probably slim, but I don’t really want to know my odds. Every day is a bonus for me.”