Harding Mccain

Former boxer faces a new challenge, and with a little help in his corner, wins the round

When he looks back now, Harding McCain is amazed that he's alive. A medical time bomb was ticking in his chest, but there really was no indication of anything amiss.

He only went to see his doctor because a nagging cough bugged him so much, he finally had to see someone about it. The news he got was more than he bargained for.

That was in August 2003.

A former amateur boxer, Harding was used to ducking punches in his younger years. That day, he received a blow he couldn't sidestep. After running tests, and ordering X-rays and chest CT scans, Harding's doctor made a startling discovery. The otherwise very healthy 80-year-old patient had a potentially deadly bulge on his aorta, the main artery leading out of the heart.

"I never had a symptom or a clue," Harding says. "No shortness of breath, no chest pain, nothing. I was even walking up to five miles a day, and I felt good."

That bulge in the wall of his aorta was an aneurysm, which could have ruptured at any moment.

The aorta is the largest artery in the body, about the thickness of a garden hose. It runs from the heart through the abdomen and splits into two arteries that feed the legs. Most aortic aneurysms form in the abdomen. More rarely, as in Harding McCain's case, they form in the upper chest near the heart.

Aortic aneurysms grow slowly, usually about a quarter of an inch a year. The trouble is, they do so silently. They seldom cause symptoms and are difficult to detect. As an aneurysm grows, the risk for leak or rupture increases. And ruptures are fatal about 90 percent of the time.

To prevent rupture, surgeons typically consider repairing aneurysms that measure 5 cm or more in diameter. At 6.5 cm, the aneurysm in Harding's chest was dangerously large. His doctor urged him to find a specialist for immediate treatment. But after consulting two local surgeons, Harding couldn't find one willing to operate.

"Because of its location and size, and my age, no one wanted to touch it," he says. His doctor suggested he try Mayo Clinic.

The next day, Harding and his wife, Virgle, made the 80-mile trip from their home in Daytona Beach, Fla., to Mayo Clinic Jacksonville. He knew the clock was ticking, and he needed quick action. He knew he was up against the ropes and needed the best people in his corner to make it to the next round.

Treating the whole patient

Harding first met with Mayo Clinic internist West Paul, M.D., who referred him that same day to Lawrence McBride, M.D., a cardiothoracic surgeon. Aside from the immediate need for surgery, there were other cardiovascular issues to address, so cardiologist Ramon Castello, M.D., joined the team. Harding had high blood pressure, and tests revealed that he had blockages in his coronary arteries as well as a leaky heart valve.

Over time, high blood pressure and fatty buildup (called atherosclerosis) can weaken and damage artery walls. The constant pressure of blood flowing through weakened artery walls gradually causes a section of blood vessel to stretch and bulge.

After reviewing all of the tests, Dr. McBride told Harding that surgery was his only option. At its size, this aneurysm could rupture at any time, and that was far riskier than surgery, even at his age. Harding also needed coronary bypass surgery and a new heart valve to improve blood flow to his heart. He and his wife drove home to think it over. But his decision was swift and clear. The next day, he called Dr. McBride to tell him he was ready.

A few days later, Harding underwent five hours of surgery. Dr. McBride replaced the leaky heart valve, repaired the aneurysm, and bypassed two clogged heart arteries. "It was a lot of surgery for a man his age, but his outlook is good," Dr. McBride says. "Mr. McCain impressed me as being a vigorous 80-year-old who still enjoyed life. I felt surgery was appropriate for him."

Harding awoke to a hospital room full of family. Two of his sons and their wives had hurried to Jacksonville to lend support and cheer their father on. They had a lot to cheer. Harding had beaten a silent killer to the punch. "I came out of surgery and I was walking those halls the next day," he says.

Finding the strength to fight back in tough situations is something Harding learned as an amateur boxer when he was in the Marine Corps. A Chicago native, Harding also worked as a network operations manager for Illinois Bell Telephone Co., for 37 years. But his passion was always boxing. Even after he was too old to climb into the ring, he continued to be involved in boxing, working for 30 years as a licensed judge for the state athletic commission.

When Harding and Virgle retired to Daytona Beach in 1983, he helped establish a boxing commission in Florida. Now, though, he sticks to watching the sport on television. And thanks to Mayo's teamwork, he'll be around a little longer to do so.

Team approach, early intervention

"Patients like Mr. McCain benefit from the team approach we practice at Mayo Clinic," says Dr. Castello. "Often, several specialties work together to tackle each aspect of the patient's disease. In this case, Mr. McCain had an internist, cardiothoracic surgeon and cardiologist working together to treat his acute condition in a timely manner."

Dr. Castello also notes that although Harding had little warning, other patients can benefit from Mayo's capabilities in early detection, monitoring and treatment to help slow aneurysm growth and prevent rupture. "People diagnosed with an aneurysm near the heart need periodic testing to monitor growth and detect valve problems before they become deadly," he says. "And getting their blood pressure under control is essential."

At Mayo Clinic, patients also have access to innovative surgical techniques and devices used in repairing aneurysms, thanks to Mayo's commitment to research. Mayo surgeons are continually examining new ways to make surgeries to repair aneurysms safer and more effective.

As in other areas of surgery, less invasive procedures are the trend. Traditional "open" aortic aneurysm repair requires a large incision in the chest or abdomen. Like most major operations, open aneurysm repairs typically involve a weeklong hospital stay, about six weeks of recovery at home, and the risk of heart and lung complications.

Surgeons at all three Mayo Clinic sites also have extensive experience using a less invasive procedure called endovascular surgery to repair some abdominal aneurysms. Because it does not require a large incision, endovascular repair can shorten hospital stays to two or three days and reduce risks for more serious complications associated with traditional abdominal surgery.

During an endovascular repair, surgeons make a tiny incision in the groin and thread a long, flexible tube called a catheter through a leg artery and upstream into the aorta. At the tip of the catheter is a small woven mesh tube called a stent or synthetic graft. The surgical team carefully positions the graft inside of the aneurysm. Sometimes hooks are necessary to secure the graft to the aorta and the arteries above and below the aneurysm. The graft then reinforces the weakened section of the aorta and prevents the aneurysm from rupturing.

People who undergo endovascular repair require follow-up CT scans for the rest of their lives to ensure that the aneurysm has not enlarged, and that the graft is still in place and not leaking. But overall, the procedure allows surgeons to offer more options to people who might normally be ineligible for major surgery due to age and other risk factors.

Depth of experience

Collectively, Mayo Clinic Jacksonville, Rochester and Arizona completed about 140 endovascular repairs of aortic aneurysms in 2003. In September 2003, Mayo Clinic Rochester opened an operating room specially designed for these procedures. And Mayo Clinic Jacksonville is among a select group of medical centers that has an investigational device exemption from the Food and Drug Administration to custom-build synthetic grafts used in endovascular surgeries for high-risk patients.

For people like Harding McCain, whose aneurysm was located near the heart rather than in the abdomen,traditional surgery is still the best option. But there's no question that he and many others will continue to benefit from Mayo's emphasis on teamwork and surgical research.

"It gives us a tremendous amount of depth," says Dr. McBride. "Knowing you have access to experts and resources in multiple areas allows you to tackle some of the more difficult problems and take care of patients like Mr. McCain."

Meanwhile, Harding is slowly getting back into his old routine. Three days a week you'll find him walking a three-mile course with neighbors. Following Dr. Castello's recommendations, he's also watching what he eats, taking medications to manage his blood pressure, and attending a cardiac rehabilitation program.

And the nagging cough that saved his life? It turned out to be a minor condition that disappeared after a course of antibiotics.

"The rest is history," says Harding.