I just received a great email from Dale about sternum and shoulder clicking after open heart surgery.

Dale writes, “Hi Adam – I had my surgery on November 2, 2009. The surgeon replaced my bicuspid aortic valve (with a bovine tissue valve), the root aorta, and grafted a large piece of my ascending aorta. I have a question… I have some very occasional clicking in my sternum. However, I also have clicking in my right shoulder. It has become more intense, frequent and uncomfortable. Is this normal? Thank you for both the book and this blog! Dale Pfeiffer”

This email from Dale brought back some distinct memories from my early recovery.

Like Dale, I did experience sternum clicks from time-to-time as my sternum healed. In fact, one night I had Robyn (my wife) listen to my chest – as it clicked – to confirm that I wasn’t going crazy.

To ensure the “clicking” was not problematic, I discussed this noise with Dr. Starnes, my surgeon, who calmed my fears with two words, “That’s normal.”

Unlike Dale… I did not experience any clicking or pain in my shoulder. However, after I started cardiac rehab, I did meet several patients, including Ted, that often complained of shoulder pain.

What is very interesting about the timing of Dale’s email, is that two other emails in my inbox – from Brian J. and Craig R. – are also asking about the exact same issue… shoulder pain.

That said, I did some quick research. It appears that shoulder pain, like chest pain, is normal for patients. According to the University of Southern California Keck School of Medicine, “Some heart valve surgery patients experience pain in their chest and shoulder areas and become alarmed thinking it may be angina. This pain is usually due to muscle and bone aches.”

Still, I am curious to know how many, if any, of our patient readers can relate to Dale’s, Brian’s and Craig’s shoulder pain. So, my questions to you are, “Did you experience sternum clicking? Did you experience shoulder clicking? What about shoulder pain?”

To leave a comment, please click here. In advance, thanks for your help in our discussion of this topic!

Keep on tickin!

Emotions can be undeniably strong and turbulent as patients and their support groups experience heart valve surgery.

On one hand, I experienced a profound sense of appreciation and thankfulness during my recovery. Like many of you, I found myself swirling in waves of emotions that often triggered tears. In fact, the running joke with Robyn (my wife) is that my human donor valve was definitely taken from a female because I became much more “emotionally available” after surgery.

On the other hand, I also encountered emotions (e.g. fear, uncertainty, doubt) that were, at times, daunting. Recently, I spoke with a former patient who told me, “I was downright angry at times… I was only 45 years old and dealing with heart surgery!”

Incidentally, that patient was Dr. Randolph Chitwood, a leading heart valve surgeon who practices at the East Carolina Heart Institute in Greeneville, North Carolina. Doctor Chitwood, who is a specialist in minimally-invasive robotic valve surgery, required cardiac surgery several years ago. Later in our discussion, Dr. Chitwood said to me, “I can relate to what patients are going through – mentally and physically.”

Dr. Randolph Chitwood - Heart Valve Surgeon And Patient

On this topic, I just received an email from Dorothy in New Jersey. Dorothy writes, “Hi Adam – I had mitral valve replacement surgery 4 weeks ago and since then I have experienced several bouts of severe atrial fibrillation for which I have been hospitalized. My question to you is about anger. I feel I no longer know the person inside of me. I’m snapping at everything and everyone. At times, I feel evil. Is the anger a normal reaction to the surgery or is it because I have not had time to fully accept what has happened to me?  Prior to this, I was perfectly healthy, saw my cardiologist every 3 months and I was happy. Now, I am sad all the time and have this anger building inside. Any thoughts? Dorothy”

First off, I can definitely relate to Dorothy. For me, I became incredibly frustrated during the early recovery when my expectations became muddled with sternum pain and cardiac depression. For example, I was told I would be driving three weeks after surgery. It took seven weeks. Also, I was told I would be back to work in eight weeks. It took sixteen weeks.

This expectation mismatch conjured an anger that negatively impacted me and those around me. I constantly found myself thinking, “What the heck is wrong with me?”

I would later learn, during the research for my book, that anger and frustration can be common feelings among heart valve replacement and heart valve repair patients.

Second, it is very critical to remember that each patient case is unique. I have interviewed other patients which report no issues with anger throughout their surgical experience. (My gut tells me these patients are actually Zen Masters with an extraordinary ability to transform lemons into lemonade – at will.)

The key to minimizing anger, in my humble opinion, is awareness and proper expectation management. Patients and caregivers should be aware of the potential twists and turns of heart surgery, especially during the recovery. For example, it would have been nice to know about cardiac rehabilitation before surgery as a preventative measure against cardiac depression.

As we have seen in Dorothy’s note (above) and other patient stories referenced in this blog, the “Road To Recovery” is not always direct. Unfortunately, complications can and do occur.

Please Note: The Road To Recovery Is Not Always This Direct

At this website, we are very lucky that many of our readers are former patients. That said, I would love to hear your thoughts on anger and heart valve surgery. My question to you is, “Did you feel angry or frustrated at anytime during heart valve surgery?”

To leave a comment, simply click here.

In advance, thanks for your help!

Keep on tickin!

Here’s a great recovery tip from Keith about using both hands after open heart surgery. Keith writes…

Hi Adam,

We have traded emails several times before. I have mainly asked you for contacts of other patients (like myself) who needed heart valve replacement following radiotherapy for Hodgkin’s lymphoma.

I had my aortic valve replaced exactly one week ago now (with a bovine valve) at the Mercy Hospital in Auckland, New Zealand. I came home after five nights and I’m surviving on just 4 paracetamol a day!

I thoroughly enjoyed reading your book. Your experience, research and patient stories helped prepare me for the surgery and the recovery. So you know, I was really concerned about the day-to-day challenges during the early recovery.

Well, one week into recovery, I would like to echo your thoughts with my own recovery tip for your readers. Here it is, “DO EVERYTHING WITH BOTH HANDS TOGETHER.”

Whether you are opening the fridge door or flushing the toilet, use both hands and both fingers together. This will ensure that the movements within the sternum and rib cage are symmetrical. For me, when I tried to do something with just one arm, the whole rib cage became twisted. That is when I would experience pain.

I hope this helps! Thanks again for your heart valve surgery book and your blog.

As you say… Keep on tickin!

Keith Ebden
New Zealand

P.S. To leave a comment, please click here.

I really, really, really encourage patients to attend a cardiac rehabilitation program after heart valve surgery.

As I personally learned during my early recovery, cardiac rehab can greatly enhance the physical and mental well-being of patients while minimizing post-operative issues like cardiac depression.

New medical studies and patient stories (e.g. Charles Harrall) continue to illustrate the positive effects of cardiac rehab programs for patients following a cardiac event – heart attack, CABG or valve surgery. Still, research suggests that cardiac rehabilitation is under-utilized by the patient community.

As another source of encouragement for patients to enroll in cardiac rehab, I just found this interesting video which discusses the benefits of these programs. Simply click the “play” button in the video above and please make sure the sound on your computer is on.

I hope this helps you further understand the benefits of cardiac rehab.

Keep on tickin!

I just received a great question from Jenny about sleep after heart valve surgery.

Jenny writes, “Adam, I had mitral valve replacement seven days ago for regurgitation. I’m struggling a bit as I deal with the some of the post-operative challenges you address in your book. I’m really having an issue getting a good night of sleep. Sleeping at the hospital was tough enough. But, it’s gotten worse since I came home. I feel like a Zombie. And, the night sweats continue. Is this common? Thanks, Jenny”

Over the years, I have spoke many patients – especially tummy sleepers – that have expressed several sleep problems following heart valve surgery. Some of those problems include:

• Inconsistent sleep, waking up often
• Insomnia
• Night sweats
• Discomfort getting in and out of bed
• Heart pounding noises
• Mechanical valve replacement clicking

Finally, some patients may have an adverse reaction to medication intended to enhance sleep. Personally, I had a very, very, very strange reaction to Ambien. One night, after taking a 10mg Ambien pill, Robyn (my wife) found me sleepwalking through our house. When Robyn approached me, I responded to her as if I was a character in a book that I was reading. When I woke up the next morning, I had no memory of the episode. Needless to say, that was the last time I took Ambien.

As many former patients read this blog, maybe they can share their thoughts on this topic. Did you experience any problems sleeping after heart valve surgery? If so, please click here to leave a comment.

I hope this helps Jenny (and perhaps you) learn more about sleep after heart surgery.

Keep on tickin!