Jay's Journal

Post 2. Surgery Time. So my surgeon coordinated that my surgery would be on Tuesday August 26th and that I would be admitted on Monday the 25th to have Cardiac catheterization. Remember I am a 50 year old married male in good health with the exception of the endocarditis which caused all of this. Anyhow, they performed a left and right catherization. I checked in the hospital in the morning and they quickly took me to a prep room with my wife where an IV was started and I was placed in a robe. The doctor came in to discuss with me about the procedure. They finally wheeled me in to the procedure room. What was so calming was that they asked if I wanted to listen to music and what kind. I found listening to music played in the room really relaxed me. They then numbed my right groin and then gave a shot in the groin prior to inserting the cath. At the same time IV drugs were given to relax me, I did not go under-just relaxed. The doctor then explained and showed me on the monitor my arteries as the procedure took place. There were about 7 medical staff in the room. While I don't remember much due to the drugs I do remember the best news I had heard to date. After about one hour to do all the procedures the doctor said, "You arteries are clear, no bypass needed!!!!!" My surgeon and I talked a couple of weeks prior to the surgery about what was ahead of me. He advised that I "might" be able to have a less invasive procedure if 1. My bacteria infection was gone, 2. No bypass was needed and 3. when they performed the TEE (transesophogeal echo -an ultrasound transducer probe that is passed down the esophagus while under just before surgery ) showed no new issues. So I knew that I met 2 of the 3 conditions. This was great news. But as my surgeon told me, I really would not know if I had a sternectomy (traditional separating the chest) or if I had a less invasive approach (Thoractomy) through a smaller incision above my right breast. After the catherization testing, I was admitted and rolled to my room. Later my surgeon came in to discuss the following day procedure and said his intent was to perform the less invasive approach as long as the TEE was ok. Mechanical or Tissue? We also discussed mechanical versus tissue replacement. My surgeon had discussed the various benefits and drawbacks but left the decision to me. I spent a lot of time like most of you researching. What really guided me was that: 1. Being 50 I expect / hope to outlive my valve replacement and will need 1-2 more depending on how long they and I last. 2. I did not believe that near term alternative medicine would be available and did not want have constant blood testing and alter the diets. 3. The tremendous advancements in transcatheter aortic valve replacement and that this much easier approach would be available for me next time around. So I elected to go with a tissue (bovine) replacement. Needless to say, it was difficult to sleep that night. I was up at 4 am and took a shower with the disinfectant same as I did that night. By 5.30 someone came to my room to take me to pre-op. There I was asked a lot of questions and they shaved my body from neck to knee caps. It was here the weight of the surgery hit me. I became tearful but the nurses were very reassuring. Soon the Anesthesiology team came in and talked to me as well. They in fact were the ones that rolled me into the OR. This was a big, cold room where there was a large team of nurses and technicians. Laying next to me was the heart lung machine. The team helped me slide onto a small OR table and within a few minutes a breathing mask was put on me and soon after that I was asleep. The next thing I remember was waking up in the ICU with a tube in my mouth. This was not painful and not discomforting. I had a TEE at UCSD while awake but sedated which was also not painful. I could not talk and my wife says it was about 30 minutes before the tube was pulled. While I went into the OR at 6.30 my surgery did not start till around 8 I was told as they did the TEE, put in the various IVs etc. I was out of surgery by 11ish and was awake in ICU by 2ish. Again, this is what I was told, I don’t remember. My ICU room was a private room at Duke and the nurse was constantly there. Initially for the first 24 hours I had self-delivery pain medicine. Now this to me was the amazing part, later that evening they had me walking using a rolling walker where you lean your arms on as you walk. I did not go far but they really wanted me walking. Later that evening I began to feel a clicking types noise and felt weird by my heart. This made me nervous. The nurses assured me I had a tissue not mechanical device. I told them I was not worried about that just the feeling and noise in general. Finally the ICU doctor came in and let me know that the heart was surrounded by fluid which is normal and that was the source. It did subside and needless to say for the next couple of weeks you do have unusual feelings / sensations but nothing to be worried about. That was Tuesday. On Wednesday I was moved out of ICU to the heart floor. I had one chest tube pulled. I have to say, it was somewhat painful just while they pulled it. My lessen for the next tube was to take my pain medicine tablets 30 minutes prior to pulling. I worked with the nurse PA and she coordinated it for me. I had found that after 30 minutes of taking the pain medicine my body was relaxed. It worked. When a few days later I had the 2nd tube pulled, no pain! While I was in pain, this really helped to minimize the discomfort. It was also nice to know you can not over medicate yourself, the machine controls the dosage. The day after surgery was fairly uneventful except for nausea. I did not vomit but boy was I adverse to food and felt like crap. One of the nurses showed me a trick and took an antiseptic wipe which smelled very strong. If you sniffed on it from a distance for a minute it alleviated the nausea sensation. By day 2 after the surgery (Thursday) that had subsided and I had a bit of an appetite. I started to walk again, about 2-3 times in that day. I would try to sit in the chair a couple of times in the day if nothing else but to eat. I had surgery on Tuesday and by Saturday I was feeling so much better and stronger. I showered, wow what a great feeling. I was released on Sunday and though very tired was so grateful to be home. Every day being home I do the same routine. I weigh myself per the doctors for fluid retention, shave, shower, get dressed and try to keep busy with work and reading. I walk 2-3 times per day outside and walk around the house alot. I read that alot of people have difficulty sleeping. I make a point to stay downstairs all day and to take my pain medication before bed. I have slept well and better each day. My pain medicine now two weeks after surgery is minimal. Next week I go in for post surgery check up and get stiches removed. More to come. But remember, keep a positive attitude!

I am not one to post, but I felt so compelled to share my story. I am a 50 year old male who was in good health until this summer when I started to feel incredibly poor. I was diagnosed with Endocarditis and spent a very stressful journey like most of you trying to understand what I was about to battle as well as try to understand better the many choices in front of me such as mechanical or tissue valve etc. This site, Adams Blog was so helpful and instrumental. It truly made a very scary process so much easier to handle that I wanted to help in any way I could. So I thought I would share my story. As I said I am 50 years old and in relatively good health excluding being overweight (not any more!). I was diagnosed with endocarditis while on vacation in San Diego and was hospitalized for a week at UCSD Medical Center. I can begin to express how incredible the medical team was at UCSD-truly wonderful!! They got me in a position to travel back to Chapel Hill, NC to continue 4 weeks of IV antibiotics at Duke Medical Center through a picc line in my arm. This was no big deal, no pain. Luckily after 4 weeks the antibiotics cleared the bacteria though I had over 70% damage to my heart valve so I began a frantic search to understand what was in front of me and came to this wonderful site! Duke University actually has a world renowned heart program and I had a 3 person team of infectious disease doctor (for the endocarditis), cardiologist and the Cardiovascular surgeon. They specialize in this area and provided great support. I was very diligent to read all the stories on this blog including interviews by Adam with doctors. I also, if you watched youtube videos of patients undergoing heart valve replacement. Not so much the surgery itself but right after the procedure and recording their progress. That really helped to understand what to expect. My take away was in almost all cases by day 3 there was significant improvement. I will share with you if that was my experience. I took in every little detail and the one thing I came away with was that while we are all different, in the hands of a good surgeon and with support of your family, you will definitely get through this. But, it really depends on one person....YOU!!! A positive attitude is just so important. I looked at this as being the cards I was dealt and now what I am going to do with it. So I took the approach that this was a chance to continue to live and see my children continue to grow up and to be there with them - so I dedicated myself to be the best patient I could. My doctors told me to continue to exercise by walking (the endocarditis made me very weak), eat healthy and be in the best shape I could be prior to surgery. Well, its 2 weeks post surgery and I am doing great. Let me share with you some details in the next blog. Finally thanks Adam and all of my fellow patients for your contributions, it really made a huge difference for me!