In 2001, Bill Bean and Arnie Dyck engaged in a friendly cycling competition, an off-the-cuff dare to see how many kilometres they could total over the final four months of the year.
They'd leave post-it-notes on each other's computer screen – boasting of daily distances covered, suggesting new routes, and issuing tougher challenges. Riding on average between 30 and 40 kilometres daily through the city streets and rural areas of Kitchener and Waterloo, there were times when Bill and Arnie's respective odometers surpassed the 100-kilometre mark in a day.
Seemingly in excellent cardiovascular shape after finishing the challenge, Bill was at a party in early 2002 when he felt an intense pain in his groin.
"It felt like somebody had kicked me," recalls Bill, speaking from his hospital bed on the fourth floor of the Peter Munk Cardiac Centre (PMCC). "Within a matter of hours, I was doubled over in pain, in tears, and wanting to vomit. I had never experienced pain quite like this before."
At St. Mary's General Hospital in Kitchener, Bill underwent a CT scan in an effort to seek out the source of pain that had caused him such anguish. The doctors said they believed he'd had an iliac dissection.
The iliac artery is formed when the aorta branches in the lower abdomen. It serves as the major blood supply to the leg and pelvis on each side of the body. An iliac aneurysm can be life-threatening, as the interior walls of the artery tear – commonly referred to as a dissection or rupture. If blood breaks outside the iliac artery wall, consequences can be dire.
As Bill would later learn, he escaped that by only the slimmest of margins.
"After the dissection, blood was flowing down both sides of Mr. Bean's iliac arterial wall," explains Dr. Thomas Lindsay, Head of the Division of Vascular Surgery at the PMCC. "If the artery had broken through the wall and into his lower abdomen, Mr. Bean could have very well bled to death.
"As it turned out, the dissection fortuitously broke back into the main artery."
Back at home after learning of his prognosis at St. Mary's, Bill, a journalist by trade, began conducting his own investigative research into iliac dissections, and who might be best able to manage what Dr. Lindsay later would go on to describe as a "medical anomaly."
His initial path led to Dr. D. Craig Miller, a Professor of Cardiovascular Surgery at Stanford University, specializing in cardiac valve and thoracic aortic surgery.
"When I got in contact with Dr. Miller, informed him of my diagnosis and symptoms, without hesitation, he said, 'Tirone David at the Peter Munk Cardiac Centre is the guy you want to see.'"
A world-renowned surgeon, hundreds of his colleagues from around the globe visit Dr. David's operating theatre every year to learn under his guidance. Dr. David replied to Bill's inquiry and put him in touch Dr. Kenneth Wayne Johnston, a vascular surgeon at the PMCC.
The largest referral centre in Canada for highly complex cardiovascular treatments and procedures, it is not uncommon for specialists from other health care centres across Ontario and Canada to refer their most challenging patients to the PMCC.
A comprehensive imaging assessment was performed on Bill upon his arrival to the PMCC. It was decided that the risks of surgical intervention on the aneurysm were too great, and Bill would have to make alterations to his lifestyle that ensured his cardiovascular system would not be placed under stress.
"I wasn't permitted to partake in any activity whereby my heart rate would rise above 100 beats per minute," says Bill. "I also could not lift anything heavier than 40 pounds. I could still bicycle and wear a heart monitor, but the risks of complicating the matter via surgical intervention were greater than leaving the dissection alone."
From 2002 onwards, Bill made annual visits to the PMCC so that imaging specialists could monitor the aneurysm. If it increased in size, doctors would have to ultimately remove the dissection. He was placed on beta blockers, a drug used to keep his heart rhythm down.
"The imaging folks were amazing – very accommodating, kind and gracious," recalls Bill. "No one ever hurried me or pushed me along. I always felt a measure of confidence and security in their ability to interpret results and make informed decisions."
Fast forward to November 2014. Dr. Lindsay was now overseeing Bill's care.
"We had been monitoring the size of Mr. Bean's iliac aneurysm for quite some time," recalls Dr. Lindsay. "We arrived at a point whereby the decision was made to remove the area of the dissection – it had grown too large in size and the risk of rupture was now greater than the risk of repair."
In January, Dr. Lindsay and a multidisciplinary team consisting of vascular surgeons, cardiac anaesthesiologists and perfusionists performed a bi-iliac aortic repair.
"Although Mr. Bean's dissection was in the iliac artery, the aorta above the dissection was also enlarged and required repair," explains Dr. Lindsay. "A synthetic graft was used to replace the enlarged segments removing the area of previous iliac dissection. Red blood cells lost during the operation were processed and given back to Mr. Bean, avoiding the need for transfusion."
The expectation is that Bill will make a full recovery within three months.
As for what he's most looking forward to?
"I have two grandkids," Bill says, tears welling up in his eyes. "One of them is over 40 pounds. Before, when she wanted grandpa to pick her up, I couldn't do it, and she didn't understand why. And the next one is growing fast as well. This is what I'm really looking forward to – being able to pick them up, give them a bear hug, play with them - that's important to me."
As for his cycling ambitions, Bill plans to begin light training again when given the green light by his doctors. He knows it will be a long road to recovery, guided by his own efforts and the extraordinary vascular and nursing team at the PMCC.
This summer, Bill will be a volunteer at the 2015 Pan American Games, assisting with the cycling competitions taking place at the Mattamy National Cycling Centre in Milton, and drawing inspiration from the athletes to pursue his personal goals.
"I'm looking forward to being a member of the cycling community again," says Bill. "I'm incredibly thankful for the care I received at the Peter Munk Cardiac Centre – the doctors, nurses, imaging specialists – they were compassionate, knowledgeable, and attentive and always made me feel like I was in good hands."