Man, you sound like you have a very interesting life there in Canada. I'm your neighbor to the south in Minneapolis. To address your final comment in your email first, I can assure you the dying from an aortic dissection is not easier than living with it. I had a complete Type A1 aortic dissection in 2015. I now have an artificial aortic graft which is 30 cm long and 30 mm in diameter. Life's good. The surgery is no walk in the park, but if it's planned and scheduled it's imminently survival and you can live a great life thereafter. The recovery is tough but I suspect mine was particularly bad since my aorta burst out of nowhere and obviously completely unexpectedly. I had absolutely no inkling that I had a problem until I had a problem. For you, that's not the case. You know you've got a problem and you know that you can deal with it. The trick is not waiting. If you're at 5 cm or above, you're likely candidate for surgery.

If you're up in the north woods that's a tough call. If I knew then what I know now, I would never be more than five minutes from an emergency cardiac care center that could do a complete aortic thoracic repair procedure on 42 minutes notice. If this dissection happens to you and you are out in the middle of nowhere, it's likely that you would die before medical personnel could figure out what was wrong with you and surgical personnel could get you open to repair it. It is about as complicated as surgery as you're going to get outside of brain surgery. This is not a broken arm. You need cardiac thoracic experts who have all of the necessary, medical equipment and supplies on hand to cool you down, open you up, keep the oxygen levels going to your brain through ECMO, and replace your aorta. The time pressure is extraordinary given the fact that you are exsanguinating. So, if it were me, knowing what I know, (and I know a lot since I survived a dissection by the skin of my teeth) I would opt to have the surgery sooner rather than later. I certainly would not take the position that I'm going to just wait till I dissect to have the surgery. That's akin to getting up to 38,000 feet and saying I'm gonna keep flying this thing until this engine blows out and then figure it all out on my way to the ground. That's not a strategy. It is a plan, I'll give you that. But it is not a plan I'd ever execute.

So let us know what you need on this listserv and come back and update us to tell us where you wound up. Peace.