This will be a short description of Nancy\u2019s open heart surgery.\u00a0 I\u2019ve used notes from the surgeon and information taken from the internet.\u00a0 I\u2019ve changed most of the medical terms to simple English and in the process reduced the accuracy.\u00a0 I\u2019ve added links where I\u2019ve found helpful drawings and information.<\/p>\n
When the operation was completed Nancy had a new valve and two replaced sections of artery leading to parts of her heart.<\/p>\n
This link shows the location of the parts of the heart. \u00a0Note the location of the \u2018left atrium\u2019 because that is how one approaches the mitral valve.<\/p>\n
http:\/\/en.wikipedia.org\/wiki\/Mitral_valve<\/a><\/p>\n The heart needs oxygen rich blood that is provided by arteries and when these become narrowed by disease the muscle of the heart suffers or dies.\u00a0 Two arteries needed to be replaced.\u00a0 One of the larger heart arteries is called the \u201cleft anterior descending\u201d (LAD) coronary artery.\u00a0 Its location is shown on this page:<\/p>\n http:\/\/www.texheartsurgeons.com\/cad.htm<\/a><\/p>\n From the main arteries are branches or \u201cdiagonals\u201d and one of these also had reduced blood flow from clogging.<\/p>\n To get to these arteries and the mitral valve Nancy\u2019s chest had to be opened.\u00a0 This is done with a reciprocating saw with the same basic design of a wood worker\u2019s tool you buy at the hardware store.\u00a0 The design is more refined and the blade is short \u2013 it only has to be slightly longer than the breast bone (sternum) is thick.\u00a0 The location of the sternum is shown here:<\/p>\n http:\/\/en.wikipedia.org\/wiki\/Sternum<\/a><\/p>\n A photograph of one brand of sternum saw is shown here:<\/p>\n http:\/\/www.terumo-cvs.com\/products\/ProductDetail.aspx?groupId=6&familyID=114&country=1<\/a><\/p>\n You will sometimes hear of \u201cbreaking\u201d the chest bone but the instrument of choice is a saw and not a hammer.\u00a0 Here is a link to a video that shows the chest being opened.\u00a0 There is some blood, but not a lot, and you get a look at a beating heart.\u00a0 If you feint at the sight of blood skip this or sit down in a comfy chair.<\/p>\n http:\/\/www.youtube.com\/watch?v=r7RsB0BA4EI<\/a><\/p>\n Once the surgical team gets the chest open the blood flow to the body is maintained by bypassing the heart with a \u201cheart lung machine.\u201d\u00a0\u00a0 The concept is shown here:<\/p>\n http:\/\/biomed.brown.edu\/Courses\/BI108\/BI108_2004_Groups\/Group03\/HeartLungMachine.jpg<\/a><\/p>\n And here is a picture of the real thing.<\/p>\n http:\/\/heatherwritesablog.files.wordpress.com\/2009\/06\/heart-and-lung-machine.jpg<\/a><\/p>\n Much more complex.\u00a0 The issue is to take the heart \u201coff line\u201d and repair it while maintaining blood flow to the rest of the body.\u00a0 You can read about it here:<\/p>\n http:\/\/en.wikipedia.org\/wiki\/Cardiopulmonary_bypass<\/a><\/p>\n An issue in all of this is that you do not want the patient to get blood clots while doing the surgery so an anticoagulation chemical is necessary but you then need to put the parts back together with sufficient clotting ability in the blood so that they don\u2019t leak around every suture.<\/p>\n Nancy managed to complicate this already complex issue because of her serious allergic reaction to heparin, the anticoagulant of choice.\u00a0 For her they used a chemical called Angiomax.<\/p>\n The next issue is that the heart will be stopped and disconnected from the blood supply and both the patient and her heart will fare better if all this is done at a lower temperature.\u00a0 So she was cooled from a normal 98.6o<\/sup> F. to 86o<\/sup> F. (37o<\/sup> C. to 30o<\/sup> C.).<\/p>\n Her heart was stopped by using cold blood (with added potassium) put into it by way of both the main artery and vein and kept cold by repeating this every 10 minutes.\u00a0 This is called \u201ccold potassium blood cardioplegia\u201d with the last word meaning \u201cparalysis of the heart.\u201d<\/p>\n A vein from near the surface on the\u00a0 inside of her left leg, above the ankle, was \u201charvested\u201d and used to replace the \u201cdiagonal\u201d artery.\u00a0 The vein used is called the \u201csaphenous\u201d vein (clearly seen) as it is close to the surface of the body and can be seen under the skin.\u00a0 When the body is too hot the body shunts blood from the deep veins to the superficial veins, to facilitate heat transfer to the surroundings.\u00a0 Normally this vein doesn\u2019t get a lot of blood volume and so can be removed without harm.<\/p>\n Next the \u201cleft anterior descending\u201d or LAD\u00a0 was bypassed.\u00a0 For this they used an artery found within the chest cavity called \u201cleft internal mammary artery\u201d or LIMA. \u00a0There is also one on the right side.\u00a0 These unique blood vessels run along the inside edges of the sternum, sending off small branches to the bones, cartilage, and soft tissues of the chest wall. For unclear reasons, the IMAs are remarkably resistant to cholesterol buildup and thus a good choice for replacing an important heart artery.\u00a0 Read more about the IMAs here:<\/p>\n http:\/\/www.hsforum.com\/stories\/storyReader$1491<\/a><\/p>\n To replace the mitral valve the left side of the heart has to be opened.\u00a0 This is called \u201cleft atriotomy\u201d —\u00a0 meaning cutting open the upper chamber on the left side of the heart (the atrium).\u00a0 Nancy\u2019s mitral valve was in need of replacement and (apparently) dead bacterial \u2018vegetation\u2019 from last summer\u2019s endocarditis was also found there. The attachments that make the valve work were shaved some to make them work better. \u00a0The old valve was cut out and a replacement from a pig (a 33 mm Hancock II porcine prosthesis) was set in and sutured into place.<\/p>\n With the new valve in place the surgeon than had to close the opening in the heart.\u00a0 As they worked their way back out of the chest cavity they re-warmed Nancy\u2019s entire body and sent warm blood back into the heart.\u00a0 Her heart came back to life with a single electrical shock.\u00a0 It started with a normal rhythm, which in medical terms is called \u201csinus rhythm\u201d but the use of the term \u2018sinus\u2019 likely derives from a mistaken idea and so has only historical context for its continued usage.\u00a0 She was on the heart-lung machine for 100 minutes.<\/p>\n On a normal patient the surgery would be about over at this point.\u00a0 But for Nancy there was a long wait ahead.\u00a0 The blood thinning issue meant she would stay in danger of excessive bleeding for some time.\u00a0 With all the major and minor cuts and sutures in her chest cavity there were lots of places for something to leak.\u00a0 So they waited.\u00a0 First they waited for 3 hours with an open chest, watching and monitoring the instrumentation, and testing the clotting time (ACT = activated clotting time). Then they closed the chest and stayed with her in the operating room for another hour.\u00a0 She spent from 9 in the morning until about 4 in the afternoon with the operating team.\u00a0 Then she was returned to the ICU, a room full of instruments, and watchful nurses.<\/p>\n The operation was on a Tuesday.\u00a0 Watchful waiting lasted into Thursday.<\/p>\n Then the ventilator was taken away and slowly other sensors and monitors were removed.\u00a0 About Friday Noon the ever-vigilant nurses started to relax.<\/p>\n Nurses from earlier days, doctors, and many others started coming by, standing at the foot of her bed, smiling, and giving her 2-thumbs up.<\/p>\n","protected":false},"excerpt":{"rendered":" This will be a short description of Nancy\u2019s open heart surgery.\u00a0 I\u2019ve used notes from the surgeon and information taken from the internet.\u00a0 I\u2019ve changed most of the medical terms to simple English and in the process reduced the accuracy.\u00a0 I\u2019ve added links where I\u2019ve found helpful drawings and information. When the operation was completed … Continue reading “UNDER THE SAW AND KNIFE”<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[6],"tags":[],"class_list":["post-193","post","type-post","status-publish","format-standard","hentry","category-surgery"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p72iNf-37","_links":{"self":[{"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=\/wp\/v2\/posts\/193","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=193"}],"version-history":[{"count":4,"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=\/wp\/v2\/posts\/193\/revisions"}],"predecessor-version":[{"id":6430,"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=\/wp\/v2\/posts\/193\/revisions\/6430"}],"wp:attachment":[{"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=193"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=193"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=193"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
![http:\/\/biomed.brown.edu\/Courses\/BI108\/BI108_2004_Groups\/Group03\/HeartLungMachine.jpg<\/a><\/p>\nAnd here is a picture of the real thing.<\/p>\nhttp:\/\/heatherwritesablog.files.wordpress.com\/2009\/06\/heart-and-lung-machine.jpg<\/a><\/p>\nMuch more complex.\u00a0 The issue is to take the heart \u201coff line\u201d and repair it while maintaining blood flow to the rest of the body.\u00a0 You can read about it here:<\/p>\nhttp:\/\/en.wikipedia.org\/wiki\/Cardiopulmonary_bypass<\/a><\/p>\nAn issue in all of this is that you do not want the patient to get blood clots while doing the surgery so an anticoagulation chemical is necessary but you then need to put the parts back together with sufficient clotting ability in the blood so that they don\u2019t leak around every suture.<\/p>\nNancy managed to complicate this already complex issue because of her serious allergic reaction to heparin, the anticoagulant of choice.\u00a0 For her they used a chemical called Angiomax.<\/p>\nThe next issue is that the heart will be stopped and disconnected from the blood supply and both the patient and her heart will fare better if all this is done at a lower temperature.\u00a0 So she was cooled from a normal 98.6o<\/sup> F. to 86o<\/sup> F. (37o<\/sup> C. to 30o<\/sup> C.).<\/p>\nHer heart was stopped by using cold blood (with added potassium) put into it by way of both the main artery and vein and kept cold by repeating this every 10 minutes.\u00a0 This is called \u201ccold potassium blood cardioplegia\u201d with the last word meaning \u201cparalysis of the heart.\u201d<\/p>\nA vein from near the surface on the\u00a0 inside of her left leg, above the ankle, was \u201charvested\u201d and used to replace the \u201cdiagonal\u201d artery.\u00a0 The vein used is called the \u201csaphenous\u201d vein (clearly seen) as it is close to the surface of the body and can be seen under the skin.\u00a0 When the body is too hot the body shunts blood from the deep veins to the superficial veins, to facilitate heat transfer to the surroundings.\u00a0 Normally this vein doesn\u2019t get a lot of blood volume and so can be removed without harm.<\/p>\nNext the \u201cleft anterior descending\u201d or LAD\u00a0 was bypassed.\u00a0 For this they used an artery found within the chest cavity called \u201cleft internal mammary artery\u201d or LIMA. \u00a0There is also one on the right side.\u00a0 These unique blood vessels run along the inside edges of the sternum, sending off small branches to the bones, cartilage, and soft tissues of the chest wall. For unclear reasons, the IMAs are remarkably resistant to cholesterol buildup and thus a good choice for replacing an important heart artery.\u00a0 Read more about the IMAs here:<\/p>\nhttp:\/\/www.hsforum.com\/stories\/storyReader$1491<\/a><\/p>\nTo replace the mitral valve the left side of the heart has to be opened.\u00a0 This is called \u201cleft atriotomy\u201d —\u00a0 meaning cutting open the upper chamber on the left side of the heart (the atrium).\u00a0 Nancy\u2019s mitral valve was in need of replacement and (apparently) dead bacterial \u2018vegetation\u2019 from last summer\u2019s endocarditis was also found there. The attachments that make the valve work were shaved some to make them work better. \u00a0The old valve was cut out and a replacement from a pig (a 33 mm Hancock II porcine prosthesis) was set in and sutured into place.<\/p>\nWith the new valve in place the surgeon than had to close the opening in the heart.\u00a0 As they worked their way back out of the chest cavity they re-warmed Nancy\u2019s entire body and sent warm blood back into the heart.\u00a0 Her heart came back to life with a single electrical shock.\u00a0 It started with a normal rhythm, which in medical terms is called \u201csinus rhythm\u201d but the use of the term \u2018sinus\u2019 likely derives from a mistaken idea and so has only historical context for its continued usage.\u00a0 She was on the heart-lung machine for 100 minutes.<\/p>\nOn a normal patient the surgery would be about over at this point.\u00a0 But for Nancy there was a long wait ahead.\u00a0 The blood thinning issue meant she would stay in danger of excessive bleeding for some time.\u00a0 With all the major and minor cuts and sutures in her chest cavity there were lots of places for something to leak.\u00a0 So they waited.\u00a0 First they waited for 3 hours with an open chest, watching and monitoring the instrumentation, and testing the clotting time (ACT = activated clotting time). Then they closed the chest and stayed with her in the operating room for another hour.\u00a0 She spent from 9 in the morning until about 4 in the afternoon with the operating team.\u00a0 Then she was returned to the ICU, a room full of instruments, and watchful nurses.<\/p>\nThe operation was on a Tuesday.\u00a0 Watchful waiting lasted into Thursday.<\/p>\nThen the ventilator was taken away and slowly other sensors and monitors were removed.\u00a0 About Friday Noon the ever-vigilant nurses started to relax.<\/p>\nNurses from earlier days, doctors, and many others started coming by, standing at the foot of her bed, smiling, and giving her 2-thumbs up.<\/p>\n","protected":false},"excerpt":{"rendered":"This will be a short description of Nancy\u2019s open heart surgery.\u00a0 I\u2019ve used notes from the surgeon and information taken from the internet.\u00a0 I\u2019ve changed most of the medical terms to simple English and in the process reduced the accuracy.\u00a0 I\u2019ve added links where I\u2019ve found helpful drawings and information. When the operation was completed … Continue reading “UNDER THE SAW AND KNIFE”<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[6],"tags":[],"class_list":["post-193","post","type-post","status-publish","format-standard","hentry","category-surgery"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p72iNf-37","_links":{"self":[{"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=\/wp\/v2\/posts\/193","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=193"}],"version-history":[{"count":4,"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=\/wp\/v2\/posts\/193\/revisions"}],"predecessor-version":[{"id":6430,"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=\/wp\/v2\/posts\/193\/revisions\/6430"}],"wp:attachment":[{"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=193"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=193"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=193"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}](\"http:\/\/biomed.brown.edu\/Courses\/BI108\/BI108_2004_Groups\/Group03\/HeartLungMachine.jpg\"){kind=link}
![http:\/\/heatherwritesablog.files.wordpress.com\/2009\/06\/heart-and-lung-machine.jpg<\/a><\/p>\nMuch more complex.\u00a0 The issue is to take the heart \u201coff line\u201d and repair it while maintaining blood flow to the rest of the body.\u00a0 You can read about it here:<\/p>\nhttp:\/\/en.wikipedia.org\/wiki\/Cardiopulmonary_bypass<\/a><\/p>\nAn issue in all of this is that you do not want the patient to get blood clots while doing the surgery so an anticoagulation chemical is necessary but you then need to put the parts back together with sufficient clotting ability in the blood so that they don\u2019t leak around every suture.<\/p>\nNancy managed to complicate this already complex issue because of her serious allergic reaction to heparin, the anticoagulant of choice.\u00a0 For her they used a chemical called Angiomax.<\/p>\nThe next issue is that the heart will be stopped and disconnected from the blood supply and both the patient and her heart will fare better if all this is done at a lower temperature.\u00a0 So she was cooled from a normal 98.6o<\/sup> F. to 86o<\/sup> F. (37o<\/sup> C. to 30o<\/sup> C.).<\/p>\nHer heart was stopped by using cold blood (with added potassium) put into it by way of both the main artery and vein and kept cold by repeating this every 10 minutes.\u00a0 This is called \u201ccold potassium blood cardioplegia\u201d with the last word meaning \u201cparalysis of the heart.\u201d<\/p>\nA vein from near the surface on the\u00a0 inside of her left leg, above the ankle, was \u201charvested\u201d and used to replace the \u201cdiagonal\u201d artery.\u00a0 The vein used is called the \u201csaphenous\u201d vein (clearly seen) as it is close to the surface of the body and can be seen under the skin.\u00a0 When the body is too hot the body shunts blood from the deep veins to the superficial veins, to facilitate heat transfer to the surroundings.\u00a0 Normally this vein doesn\u2019t get a lot of blood volume and so can be removed without harm.<\/p>\nNext the \u201cleft anterior descending\u201d or LAD\u00a0 was bypassed.\u00a0 For this they used an artery found within the chest cavity called \u201cleft internal mammary artery\u201d or LIMA. \u00a0There is also one on the right side.\u00a0 These unique blood vessels run along the inside edges of the sternum, sending off small branches to the bones, cartilage, and soft tissues of the chest wall. For unclear reasons, the IMAs are remarkably resistant to cholesterol buildup and thus a good choice for replacing an important heart artery.\u00a0 Read more about the IMAs here:<\/p>\nhttp:\/\/www.hsforum.com\/stories\/storyReader$1491<\/a><\/p>\nTo replace the mitral valve the left side of the heart has to be opened.\u00a0 This is called \u201cleft atriotomy\u201d —\u00a0 meaning cutting open the upper chamber on the left side of the heart (the atrium).\u00a0 Nancy\u2019s mitral valve was in need of replacement and (apparently) dead bacterial \u2018vegetation\u2019 from last summer\u2019s endocarditis was also found there. The attachments that make the valve work were shaved some to make them work better. \u00a0The old valve was cut out and a replacement from a pig (a 33 mm Hancock II porcine prosthesis) was set in and sutured into place.<\/p>\nWith the new valve in place the surgeon than had to close the opening in the heart.\u00a0 As they worked their way back out of the chest cavity they re-warmed Nancy\u2019s entire body and sent warm blood back into the heart.\u00a0 Her heart came back to life with a single electrical shock.\u00a0 It started with a normal rhythm, which in medical terms is called \u201csinus rhythm\u201d but the use of the term \u2018sinus\u2019 likely derives from a mistaken idea and so has only historical context for its continued usage.\u00a0 She was on the heart-lung machine for 100 minutes.<\/p>\nOn a normal patient the surgery would be about over at this point.\u00a0 But for Nancy there was a long wait ahead.\u00a0 The blood thinning issue meant she would stay in danger of excessive bleeding for some time.\u00a0 With all the major and minor cuts and sutures in her chest cavity there were lots of places for something to leak.\u00a0 So they waited.\u00a0 First they waited for 3 hours with an open chest, watching and monitoring the instrumentation, and testing the clotting time (ACT = activated clotting time). Then they closed the chest and stayed with her in the operating room for another hour.\u00a0 She spent from 9 in the morning until about 4 in the afternoon with the operating team.\u00a0 Then she was returned to the ICU, a room full of instruments, and watchful nurses.<\/p>\nThe operation was on a Tuesday.\u00a0 Watchful waiting lasted into Thursday.<\/p>\nThen the ventilator was taken away and slowly other sensors and monitors were removed.\u00a0 About Friday Noon the ever-vigilant nurses started to relax.<\/p>\nNurses from earlier days, doctors, and many others started coming by, standing at the foot of her bed, smiling, and giving her 2-thumbs up.<\/p>\n","protected":false},"excerpt":{"rendered":"This will be a short description of Nancy\u2019s open heart surgery.\u00a0 I\u2019ve used notes from the surgeon and information taken from the internet.\u00a0 I\u2019ve changed most of the medical terms to simple English and in the process reduced the accuracy.\u00a0 I\u2019ve added links where I\u2019ve found helpful drawings and information. When the operation was completed … Continue reading “UNDER THE SAW AND KNIFE”<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[6],"tags":[],"class_list":["post-193","post","type-post","status-publish","format-standard","hentry","category-surgery"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p72iNf-37","_links":{"self":[{"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=\/wp\/v2\/posts\/193","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=193"}],"version-history":[{"count":4,"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=\/wp\/v2\/posts\/193\/revisions"}],"predecessor-version":[{"id":6430,"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=\/wp\/v2\/posts\/193\/revisions\/6430"}],"wp:attachment":[{"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=193"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=193"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/rocknponderosa.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=193"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}](\"http:\/\/heatherwritesablog.files.wordpress.com\/2009\/06\/heart-and-lung-machine.jpg\"){kind=link}