Jim's Heart Valve Journal

3 Months after Surgery, Good News

June 14, 2012

Three months and a day ago (March 13) to the hour, I was exiting surgery at Mt Sinai, hooked up to many pieces of equipment and just beginning to emerge from the anesthetic blackout. I've come a long way.

My cardiologist appointment was this morning. Prior to the appointment I had an echocardiogram and a blood profile. Most important, no leaks for either my mitral valve or tricuspid valve, both surgically repaired. The other numbers from the echo are chiefly good. The ejection fraction, however, now stands at 45%. This news surprised me a great deal, as my post-surgery echo done at Mt Sinai hospital (March 16) reported 61%. Hearing 45% of course sounded really bad to me today; but my cardiologist is convinced that 61% was simply wrong – an error in technician measurement, transcription, or something. Last October I was in the mid 20s (dangerously low) when I learned about my dire circumstances, and immediately had an ablation to correct my atrial flutter. In late December a trans-esophageal echo showed that the ejection fraction had improved to 41%. I had no measurement between late December and the surgery, but the doctor said (and I’ve read) that valve repair surgery generally reduces the ejection fraction, because without a leaky valve the ventricle has to work much harder to pump all the blood in the right direction. My doctor had reviewed the NY echo report earlier, but did not obtain or view the video record. Bottom line: 45 is below the normal range for a healthy heart (55% or higher is normal) but it’s way better than what I had last year. God willing, it might improve further. I considered asking him to obtain and review the video record of the March 16 echo, but it does not seem a useful step – he’s completely convinced that my recent echo is accurate, and that there is no way that my ejection fraction has declined between March 16 and now.

My left ventricle also displays some structural abnormalities, which may relate to the ejection fraction; and which may or may not change.

Great news on the next chamber up from the aorta, the left atrium. I had severe enlargement at the time of the March surgery (7 cm), which has improved to 4.5 cm. Normal is about 3.7 cm. It’s been a long time since the LA has been as good as 4.5 in size. Before my first surgery at Emory Hospital (2005) it was 4.9, and an echocardiogram from 2007 reported it at 5.1 cm. This improvement, called reverse remodeling, is a huge plus.

Probably I’ll quit the warfarin (coumadin) soon. Right now I’m wearing a holter monitor, with 5 electrodes stuck to my chest. This will record my heart’s electrical activity for 48 hours, until noon on Saturday. We don’t think I have any type of arrhythmia, but before my cardiologist clears me to stop warfarin, we want to be sure. I’ll get the results late next week. It strikes me that he may be doing this as an excess of caution, but I’m fine with it. More information can only help.

As for other meds, I’m continuing on the beta blocker, carvedilol, in fact doubling my dose. I’m presently at 6.25 mg twice a day, which is near the low end of the range of what heart patients take. I’ll carefully monitor what the increase does with respect to heart rate and blood pressure (it depresses both) as well as how I feel. I’m going off the iron. My post-surgery anemia is gone. I’m staying on magnesium. I’ve been reading up on the topic. It seems like a high percentage of people have magnesium deficiency, apparently due to changes in the modern diet (including minerals in drinking water) over the past 50 years. Magnesium deficiency correlates to a host of health problems, including valve disease. My blood profile does not show a high deficiency (1.8) but it’s at the low end of the guidelines.

I’ve saved the best for last. I’m cleared to begin a running program Hooray! My plan, which we discussed, is to start out slowly and cautiously. He recommends beginning at a slow pace -- 9 to 10 minute miles – not pushing hard in terms of effort and distance; listening to my body. I’m planning at first to alternate running and walking at first. We’ll see how it goes.

It’s been an incredible three months since my Mended Heart Day in New York. I’m truly blessed by the amazing team of doctors and assistants who have taken care of me, and by the concern, prayers, and support of family and friends. Peace and blessings, Jim

Two months since Mount Sinai mended my heart

May 14, 2012

Hard to believe it's been 2 months already since my spring break "heart trip" to New York City. I'm now 2 months post surgery and feeling better than I have in years. My resting pulse is in the mid 70s and has not changed in the last few weeks. During the first weeks after my discharge, my heart was really really fast -- resting pulses ranging from the mid 90s to mid 100s. That, luckily, was normal sinus rhythm. Mid 70s is still high for someone who wishes he was in good physical shape, but at least it's heading the right direction.

I rarely use my heart rate monitor on workouts, but I did last weekend and noticed that I'm walking much faster than I did in the months prior to surgery, especially uphills, with heart rates that are much lower than pre-surgery.

I'm still only walking for exercise, with occasional trips to the gym where I ride the stationary bike. A few lower leg exercises, but nothing upper body so far at all -- the sternum isn't fully healed, they say, until three months. I'm trying to err on the side of being too cautious, rather than stray in the opposite direction.

Maybe I should have looked into cardiac rehab classes. But none of my docs recommended that for me, and I didn't pursue it. Hopefully next month, at my 3 month check up, I'll be cleared to begin my running program. I don't think it's possible for me to get into good aerobic shape if all I do is walk and ride a stationary bike, no matter how hard I try to push it.

No change in my drugs. My warfarin levels had been bouncing up and down since the surgery, but now they stabilized (INR of 2.7 last Friday; INR three weeks earlier of 2.2). So now the warfarin tech doesn't want to see me until four weeks. I'm continuing on my beta blocker, carvedilol - that is going well.

Take care, everyone - Jim

One Month Post-surgery Update

April 12, 2012

Tomorrow, Friday the 13th, I'll be one month on the right side of my valve repairs (mitral and tricuspid) and Maze procedure. But I'm jumping the gun and posting today, as this morning Donna and I went to my first appointment with my cardiologist, Dr Ouzts, in Athens GA since leaving New York, where I had my surgery on March 13 at Mt. Sinai hospital.

Here's what I learned, and where I am right now. Almost all is good news. Today's EKG shows normal sinus rhythm, which of course is what we were hoping for. Atrial flutter, possibly combined with atrial fibrillation, was what landed me in the hospital last October, thus beginning this journey. There's reason to hope that the normal rhythm will continue. The primary cause of my arrhythmia was having severe mitral regurgitation for a long time, and now that's totally gone.

No echocardiogram for me today. The doctor listened to my heart with his stethoscope, and it sounds perfect -- no hint of a murmur (unlike my first valve repair at Emory Hospital in 2006, when immediately after surgery a minor leakage was observed both on the post-surgery echo and was auditory). We also went over the report from my post-surgery echocardiogram done at Mt Sinai on March 16. Not only did it show no valve leakage, but highly important in my case is my LV (left ventricle) ejection fraction, which last October was 25 percent (normal range is 55-70 percent). Post-surgery I was measured at 61 percent. Dr Ouzts sees this as extraordinary good news. He said I had to have the surgery, but that valve surgery usually lowers a patient's ejection fraction, and that if my EF went down to the 30s and stayed there, my life would be drastically impacted -- I would remain alive, but would not be capable of sustained aerobic exercise.

An area of continuing concern is substantial enlargement of my left atrium, measured at 7 cm on the March 16 echocardiogram. This increases my risk of re-developing heart rhythm problems. There is hope that this will improve over time. The degradation process is called "remodeling" of the heart, and improvement is called "reverse remodeling." My surgeons told me this may happen. Dr Ouzts concurs. He mentioned that one of his patients was at 8 cm, and recovered to 4 cm (normal) post surgery. This will be measured at my next echocardiogram.

Some changes to my medications. My magnesium reading is still low, so my daily dosage will be doubled to 500 mg. I'm starting a beta blocker. The main purpose is to reduce the risk of heart rhythm disorder. It will also drive down my blood pressure and pulse a bit. Recently my resting pulse has ranged between high 80s and low 100s, and blood pressure between low 110s / high 60s and high 120s / high 80s. He wants me to monitor my pulse carefully, to make sure my pulse does not go too low.

As I expected, I continue on warfarin for the time being. That will be evaluated at my 3-month post-surgery appointment. He didn't promise me that I'll be off of it then, but that may happen.

I'm not cleared yet to begin (resume) a running program... major bummer (sigh). The doctor wants my sternum completely healed first; the guideline for that is 3 months after surgery. But I'm not required to be totally sedentary. I'm allowed to walk all I want, plus use gym machines (like steppers) that don't involve arm or upper body movement or work. I can make the walking as intense as I choose, including hills and trails. There is no risk that strenuous exercise will compromise the quality of my valve repairs, or my heart more generally.

Sorry for writing so much. Many thanks to all of you for your prayers and expressions of concern, before, during, and after my surgery. You have helped much more than you can possibly know - Jim

18 Days Post-surgery

March 31, 2012

We've been back home in Georgia since Monday evening. That's a great boost. I taught my first class post-surgery on Tuesday, and even though my energy level was not great, I'm happy I did it. The engagement of preparing for class and teaching is helping to dissipate my post-surgery brain fog. But I'm taking it easy, only working several hours a day and getting in a midday nap every single day.

My appetite has returned. Sleeping at night is erratic, but seems gradually to be getting better. Today I woke up at 4:25, could not fall asleep again, so I just got up.

My walking program is going well. I've completed my 2.9 mile neighborhood route twice this week, and shorter routes on other days. Plus Donna and I walk our daschund, Rylie, in the evening. But I really want to resume running, which I haven't done since last summer. My cardiologist has nixed running for right now (he's says I shouldn't have the bouncing that comes from running until there's more healing of the chest). I hope this restriction will be lifted when I have my 4-week post-surgery appointment with him on April 12.

In addition to coumadin, I'm taking iron and magnesium daily. Today I bought a scar healing topical gel called Mederma, which Adam Pick recommended in his book.

Returning to Georgia today

March 26, 2012

Today is Day #13 since my surgery (two repaired valves, one Maze procedure), seven days since my discharge from Mt Sinai hospital. Yesterday was my best day so far, and last night was my best night of sleep -- not normal sleep but moving in that direction. Last evening Mitch Friedman joined Donna and me for a farewell-to-New-York dinner at Ottomanelli Bros. restaurant on Lexington Avenue. We had a great time talking about out HV journeys and where we are headed.

Donna and I are flying to Atlanta this afternoon. Our daughter Kristin and Michael are picking us up at the airport to take us to Athens.

Cleared to Fly Home to Georgia

March 21, 2012

It's me, making my first post after surgery. Many thanks to Donna for the awesome job she has done keeping all of you informed via my journal since my surgery. She has also read to me all of your guestbook posts. I deeply appreciate your thoughts and prayers and advice and encouragement over the past week.

The past two days have had their ups and downs. Monday was great at first. I was discharged from Mt Sinai, but became very sick late Monday night. I started feeling better about 1 am this morning.

Donna and I spent the morning at Mount Sinai for my post-discharge exam. Everything looks good. My chest x-ray shows the lungs are clear, so I'm allowed to fly home to Georgia. I'll be on Coumadin for 3 months after my surgery. Today's blood test shows my INR is not quite at the therapeutic level, but it's close -- I'll have another blood test at the Mt Sinai outpatient lab on Friday morning to follow up on this. Dr Adams concluded that my sickness over the past two days is probably due to an infection I incurred while I was in the hospital (likely a staph infection). Rather than wait to confirm this with a culture, he has started me on a strong antibiotic which I'll take for the next three days.

Amazing new medical advance

March 20, 2012

The things researchers and doctors are doing today are just amazing. Scientists at Yale regenerated a totally new blood vessel for this child:

http://www.lifenews.com/2012/03/20/adult-stem-cells-create-new-blood-vessels-for-heart-issue/

--Donna Smith

best spring break ever?

March 20, 2012

Jim' out of the hospital--left yesterday around 4 p.m. We got back to the guesthouse-it was a beautiful day and we walked from Mt. Sinai (about 2-3 long blocks--4/10 mile). Jim showered and took a nap. Then we had burgers in the neighborhood--me, Jim and our daughter Nicole. However, he really paid for that good food by being sick all night. So note: don't over-do the first meal after the hospital. We even had felt guilty eating well while he was "incarcerated" and brought him a bagel earlier the same day. Maybe not such a great idea. He's better today. Also note: don't let the patient walk by himself (we didn't; except for that moment on the front stairs where he tripped and almost fell onto the railing)--there's still unsteadiness.
--Donna

Going home-to guesthouse-today!

March 19, 2012

Everything's good except low magnesium and they're still working on blood thinners. So they're letting him out today! We're flying back to Georgia next Mon.
--Donna

Echo results good!

March 18, 2012

Jim's echo came back perfect. We thought he might go home today; in fact, Dr. Adams and Dr. Chan stopped by yesterday (I missed Dr. Adams again! I think he may be a mythical figure, like a unicorn) and said that actually he was in good enough shape to have left yesterday but because the operation was such an intense assault on the heart (2 valves + a MAZE) they were keeping him in an extra day or two. Right now they want to work on his Coumadin levels--his blood's not thin enough yet. Another cardiac fellow stopped by and told him he has something called junctional rhythm; I had to google that one. All his tubes are out and his pacemaker is out. I think it's just watching and waiting, and working on the Coumadin.
Blessings,
Donna

Thank you Nancy!

March 17, 2012

Thank you so much for the poem Nancy! Team Jim loves it.! This means so much to Jim and to us.
Donna

Day 3 Post-Op

March 16, 2012

Dad is looking even better today; still very tired and sore of course. They just took his vitals again and all looks good (still on the temporary pacemaker for now). Yesterday afternoon, his HVJ (Heart Valve Journals :) friend, Mitch Friedman came by for a visit, which he really enjoyed. It's a rainy and cold day today in NYC so Mom and I are staying inside visiting. Nicole (my sister) is on the plane now in route to the city, so we'll see her later this afternoon.

He's scheduled for an echocardiogram this afternoon to check the results of the surgery. Thank you all for the kind words of support and encouragement - we're sharing them all with him.

Kris

A Dr. Adams sighting

March 15, 2012

I still haven't met Dr. Adams--we met Dr. Anwanyi--he was the one who came out (beaming) and told us the surgery went well. And Jim met Dr. Adams a few weeks before the surgery but I was sick and couldn't go. Anyway, today I saw a doctor who looked like him from the side and back (how many almost bald young doctors could there be in the cardiac unit at Mt. Sinai? lol!)--as I was getting off the elevators walking toward 7West, he was *running* toward the ICU, with another doctor following close behind. It was just like in ER or Grey's Anatomy!
--Donna Smith

Walked down the hall and back!

March 15, 2012

Jim looks like he feels better today--he got most of his tubes out too. Pacemaker still in but his natural heart rate is higher so that's good. Jeff and Carol Shebovsky stopped by to visit him today--that really meant a lot to us. I can't believe how good Jeff looks--you'd never know he had heart surgery a week and a day ago! Jim walked the hall to a cardiac discharge lecture (not that he's being discharged yet, but they give this talk only on Tuesdays and Thursdays).
Remember to sign your guest book entries!
And thank you for all the wonderful good wishes in this journal and by email--it's just overwhelming to know how much people care.
Blessings,
Donna Smith

In a regular room :)

March 14, 2012

We went to visit Jim this evening and found he'd been moved to a regular room on 7 West! He's very, very tired, and the place where his central line was removed is really sore. He was blowing into this breathing tube to help with congestion and to help his lungs. He did have to have a pint of blood transfused this morning because of low hemoglobin, but no transfusions necessary during surgery. His pulse had been down to 40 so they have a temporary pacemaker put it. (I'm not sure how or where)…but they're gradually removing stuff--they're removing the Foley catheter at 6 a.m. He's already asking us to bring back stuff we'd removed from his room before surgery--book, glasses…..so I know he's going to be fine!
--Donna Smith

Sitting up in a chair!

March 14, 2012

They removed the ventilator at midnight. First thing he remembered was the ICU nurse saying we're going to remove the ventilator. He didn't remember our visit last nite tho at the time he responded to us.
--Donna

Success!!

March 13, 2012

Jim's out of surgery and they fixed everything. Dr. Anwanyu came out and reported nothing negative! No leakage; repaired mitral, put in new ring, repaired tricuspid and did the MAZE. Surgery lasted from 12:01 to 5:30. We can't thank you all enough for your prayers. Praise God for his great mercy!

Surgery In Progress

March 13, 2012

Hi everyone,

This is Kris (Jim's daughter). We just found out my dad's surgery actually started an hour later than anticipated, at 12:00 EST, so we'll be waiting a bit longer than we thought.

Thanks for the continued support and messages! We will continue to keep everyone posted as we're updated here.

The Adventure Begins!

March 13, 2012

Well, they wheeled Jim in for surgery at 10:10 this morning--Kris, Eileen (Jim's MIL) and I were able to accompany him in the elevator to the 3rd floor where they left for surgery and we continued to the family waiting area. They give you a pager and then you hurry up and wait! The surgery was rescheduled to 11:00 a.m. because his "numbers were good", so I guess that's good--they leave the first spots for more serious cases, I guess. They will do 4 surgeries today, so Jim is number 3. His spirits are very good and he's ready for this.
All your prayers and thoughts are so much appreciated.:))
--Donna

Surgery Moved to 11:00 a.m.

March 12, 2012

So….it's hurry up and wait!
Blessings to all. Linda, it looks like you won the bet with Jim.
I look forward to hearing your story too.
Blessings,
Donna Smith

Thank you Adam!

March 12, 2012

Adam, thank you for your beautiful article and words about Jim and Jeff--that means so much to me; I read it to Jim and he was really moved so much, which was wonderful the night before his surgery. Bless you for starting this wonderful web site!
Love,
Donna Smith

Monday at Mt. Sinai

March 12, 2012

It's a beautiful day in New York today! Our daughter Kris uploaded some new pictures--from the window in Jim's room (view of Central Park that Jim's roommate has), a picture of Jim when he checked in last night, and Jim and Jeff Shebovsky together. Jeff is getting out of here today!
--Donna Smith

Checked into Mt. Sinai tonight

March 11, 2012

Jim was checked into the hospital tonight to get ready for all the pre-op tests tomorrow; he's hooked up to a monitor and is receiving a heparin drip. He's just down the hall from Jeff Shebovsky and talked with him, and earlier today Mitch Friedman came by our guest house at 102 and Lexington and visited, lifting our spirits! Now I (his wife), my daughter Kristin, and my stepmom Eileen are here and will go over tomorrow and visit. He's scheduled first on the list for surgery on Tuesday! So at 7:15 they'll take him down for prep, and the surgery begins 8:30. It's estimated to take 4-6 hours, but I don't know how much of that includes the prep. Thank you for all your prayers and good wishes--keep 'em coming!
Blessings,
Donna Smith

Top 10 Heart Songs #1…My Heart Will Go On, Celine Deon

March 11, 2012

Many of you have nominated "My Heart Will Go On," including Linda Dixon (my surgery mate on Tuesday). FIRST though was Jeff Shebovsky, who wrote in my guestbook more than a week ago, "Think about it....we ALL want our heart to GO ON...and ON and ON....just like she says in the song. It is also a beautiful song by a woman with a beautiful voice." The Major Award for the Top 10 Heart Songs contest goes to Jeff.

"My Heart Will Go On," the theme song to the 1997 movie Titanic, is Celine Dion's biggest hit ever. When I get to Mount Sinai later today, I'm going to ask if we can reschedule my valve repair to April 15, the centennial of the R.M.S. Titanic's going to the ocean floor. What could be cooler than having "My Heart Will Go On" at the top of my playlist on the centennial.

Below are lyrics preceded by youtube link to clip from the movie Titanic. But first, an Honorable Mention (okay, I know, in a sense this is cheating because I'm only allowed a top 10, not a top 11, but nevertheless…) Looking ahead to Tuesday's adventure in the operating theatre, "The First Cut is the Deepest," by Cat Stevens (1967) and covered by many, including Rod Steward and Sheryl Crow: http://www.youtube.com/watch?v=MaQLhTwC5BQ

Titanic (1997):
http://www.youtube.com/watch?v=zmbw8OycJrE

Every night in my dreams
I see you, I feel you
That is how I know you go on

Far across the distance
And spaces between us
You have come to show you go on

Near, far, wherever you are
I believe that the heart does go on
Once more you open the door
And you're here in my heart
And my heart will go on and on

Love can touch us one time
And last for a lifetime
And never let go till we're gone

Love was when I loved you
One true time I hold to
In my life we'll always go on

Near, far, wherever you are
I believe that the heart does go on
Once more you open the door
And you're here in my heart
And my heart will go on and on

You're here, there's nothing I fear
And I know that my heart will go on
We'll stay forever this way
You are safe in my heart
And my heart will go on and on

We've Arrived in New York City!

March 10, 2012

Donna and I are here in New York. Travel went smoothly. It's a cool, crisp and beautiful spring day here. Sunny but the sun has a winter feel. Pretty windy. The small apartment we've rented at the Bubba & Bean guest house is ideal, and it's very close to Mt Sinai hospital. I really enjoyed an afternoon walk through Central Park. Just got a phone call from the hospital. They'll let me know tomorrow about noon when I can check in' the exact time will depend upon when a spot opens up in a regular room

Top 10 Heart Songs #2...In a Little While, U2 / Hanson

March 10, 2012

"Slow down my beating heart" One day out from my check in to Mount Sinai. Then after a Little While, my heart will be "slowed down" on Tuesday. Donna and I are at the Atlanta airport now, leaving for NY in one hour.

Thanks to daughter Nicole for nominating "In a Little While." Bono wrote the song, released by U2 on its 2000 album "All That You Can't Leave Behind."

Normally I would not also credit a cover, but Hanson's 2005 cover of "In a Little While" is brilliant. More importantly for our purposes, Hanson's arrangement turns "Slow Down my Beating Heart" into the song's motif. Here are youtube links, first for U2 then Hanson. Full U2 lyrics below

http://www.youtube.com/watch?v=dkJu_lU3Tn4

http://www.youtube.com/watch?v=wtVAJEAWnlU

In a little while
Surely you'll be mine
In a little while... I'll be there
In a little while
This hurt will hurt no more
I'll be home, love

When the night takes a deep breath
And the daylight has no air
If I crawl, if I come crawling home
WiIl you be there?

In a little while
I won't be blown by every breeze
Friday night running to Sunday on my knees
That girl, that girl she's mine
Well I've know her since,
Since she was

A little girl with Spanish eyes
When I saw her first in a pram they pushed her by
Oh my, my how you've grown
Well it's been, it's been...a little while

ooh ooh ooh ooh ooh ooh

Slow down my beating heart
A man dreams one day to fly
A man takes a rocket ship into the skies
He lives on a star that's dying in the night
And follows in the trail, the scatter of light
Turn it on, turn it on, you turn me on

Slow down my beating heart
Slowly, slowly love
Slow down my beating heart
Slowly, slowly love
Slow down my beating heart
Slowly, slowly love

Top 10 Songs#3..If I Only Had a Heart, Tin Man, Wizard of Oz

March 9, 2012

Res ipsa loquitur. Easily one of the greatest movies of all time. I was blown away when my mom first had me watch the movie when I was a kid. Still am. And it didn't hurt to have fallen in love with Dorothy (Judy Garland). Here's the scene from Wizard of Oz (1939):

[Dorothy knocks on Tin Man's chest]
[Strawman, spoken] Beautiful, what an echo
[Tin Man, spoken] It's empty.
The tinsmith forgot to give me a heart
[Dorothy and Strawman] No heart?
[Tin Man] No heart. All hollow.

[Tin Man, Sung]
When a man's an empty kettle
He should be on his mettle
And yet I'm torn apart
Just because I'm presumin'
That I could be a human
If I only had a heart

I'd be tender, I'd be gentle
And awful sentimental
Regarding love and art
I'd be friends with the sparrows
And the boy that shoots the arrows
If I only had a heart

Picture me a balcony
Above a voice sings low

[Girl's Voice] Wherefore art thou, Romeo?

[Tin Man] I hear a beat
How sweet.
Just to register emotion, jealousy, devotion,
And really feel the part.
I could stay young and chipper
and I'd lock it with a zipper,
If I only had a heart."

Here's the film clip:

http://www.youtube.com/watch?v=6aE-nMS9Mnk&feature=related

"If I Only Had a Heart" is part of a famous trilogy, preceded by Strawman's "If I Only Had a Brain" and followed by Lion's "If I Only Had the Nerve."
Jack Haley, vaudeville and movie actor, is best known for playing the character of Tin Man. Originally the role was cast to Buddy Ebsen, but he suffered a severe allergic reaction to the aluminum powder makeup. He had to withdraw; Haley replaced him and was clad with aluminum paste instead of powder.

For all, I wish that you "stay young and chipper"
And I plan to ask Dr Adams to lock my heart in "with a zipper"

Top 10 H. Songs #4 How Can You Mend a Broken Heart, Bee Gees

March 8, 2012

"Please help me mend my broken heart and let me live again." What more can I say? The only thing I can't figure out is why this song is not number one on my top ten. But there are three more to come, including one that no one so far has proposed.

Thanks to my wife Donna for nominating this ballad by the Brothers Gibb (Bee Gees). Full lyrics:

"I can think of younger days
When living for my life
Was everything a man could want to do
I could never see tomorrow
I was never told about the sorrow

And how can you mend a broken heart?
How can you stop the rain from falling down?
How can you stop the sun from shining?
What makes the world go round?
How can you mend a this broken man?
How can a loser ever win?
Please help me mend my broken heart and let me live again

I can still feel the breeze
That rustles through the trees
And misty memories of days gone by
We could never see tomorrow
No one said a word about the sorrow

And how can you mend a broken heart?
How can you stop the rain from falling down?
How can you stop the sun from shining?
What makes the world go round?
How can you mend this broken man?
How can a loser ever win?
Please help me mend my broken heart and let me live again

Here's an early live version. To me, it sounds better than the studio single release.

http://www.youtube.com/watch?v=wOGODoE4qKc

Like many of the super groups, the Bee Gees transcended musical genres. They released "How Do You Mend a Broken Heart" in 1971, six years before they launched disco music with the soundtrack for the movie "Saturday Night Fever." Nothing defined late 70s popular music more than disco -- you gotta love it or hate it.

Rest in peace, Maurice and Andy

Top 10 H.Songs ... #5 Deep in the Heart of Texas, Perry Como

March 7, 2012

"The stars at night are big and bright
Deep in the heart of Texas.
The prairie sky is wide and high
Deep in the heart of Texas.
The sage in bloom is like perfume
Deep in the heart of Texas.
Reminds me of the one I love
Deep in the heart of Texas.

The coyotes wail along the trail
Deep in the heart of Texas.
The rabbits rush around the brush
Deep in the heart of Texas.

The cowboys cry, "Ki-yip-pe Yi"
Deep in the heart of Texas.
The doggies bawl and bawl and bawl
Deep in the heart of Texas.
Deep in the heart of Texas."

John Adkins picked this one in my guestbook. Written by June Hershey and Don Swander, Perry Como was first to record Deep in the Heart of Texas" in 1941. Many people have covered the song; the most notable are Ray Charles and Gene Autry, the singing Cowboy.

Here are several youtube clips for "Deep in the Heart of Texas." First, Perry Como's performance, second Gene Autry's from the 1942 movie "Heart of the Rio Grande." The song is regularly performed by the Longhorn Band at University of Texas home football games - that's the third youtube address.

http://www.youtube.com/watch?v=laKThepytbQ&feature=related

http://www.youtube.com/watch?v=-akgDjpcD2M&feature=related

http://www.youtube.com/watch?v=1hXYDkrHsgs&feature=related

Why "Deep in the Heart of Texas" at #5? I'm sure to draw increasingly heavy fire for my selections as this countdown continues, ending at #1 on Sunday. This slot came down to either "Deep in the Heart of Texas" or Tonny Bennett's "I left My Heart in San Francisco." Both great songs. Tough decision. Much as I like the city by the bay, Texas is my home. Also, leaving my heart behind (in SF, or New York City, or anywhere outside of my body) is not what I have in mind for next Tuesday, March 13. And the song is played at the football games of my beloved Longhorns.

If I had a do-over for my sequencing of my Top 10 Heart Songs, probably "Deep in the Heart of Texas" should have gone in the #10 slot, last Friday (March 2), which was Texas Independence Day. But maybe I can get off the hook because I picked "Piece of My Heart" by Janis Joplin as #10 for that holiday. Janis of course was, is and always will be a Texan.

HOOK EM HORNS!

Top 10 Heart Songs.. #6 You Gotta Have Heart, Damn Yankees

March 6, 2012

"You've gotta have Heart!
All you really need is heart!
When the odds are sayin' you'll never win,
that's when the grin should start!"

Thanks for suggesting this to Alan Cook and to Eileen (in an offline email). Those of you who know me well would be certain some sports song would crack my top 10.

You Gotta Have Heart" is from the play Damn Yankees, which opened on Broadway in 1955. And it's especially appropriate because I'm going to New York for surgery, and I'm an avid anti-Yankees fan. And it's a song of unbridled optimism. Here's a fine youtube link, followed by lyrics

http://www.youtube.com/watch?v=06103o2dv5c

[Coach, SPOKEN] Now listen to me, you guys.
This game of baseball is only one half skill,
The other half is something else, something bigger.

[SANG] You've gotta have Heart!
All you really need is heart!
When the odds are sayin' you'll never win,
that's when the grin should start!
You've gotta have hope!
Musn't sit around and mope.
Nuthin' half as bad as it may appear,
wait'll next year and hope.
When your luck is battin' zero,
get your chin up off the floor.
Mister, you can be a hero.
You can open any door.
There's nothin' to it, but to do it.
You've gotta have heart!
Miles and miles and miles of heart!
Oh, it's fine to be a genius of corse!
But keep that ol' horse before the cart!
First you've got to have heart! . . ."

GO WASHINGTON SENATORS!

Top 10 Heart Songs ... #7 Heart of Gold, Neil Young

March 5, 2012

"I want to live,
I want to give
I've been a miner
for a heart of gold.
It's these expressions
I never give
That keep me searching
for a heart of gold
And I'm getting old."

Written and performed by Neil Young, Heart of Gold came out on the 1972 album "Harvest." It was earlier released as a single, with Sugar Mountain on the B-side (for those of you too young to remember vinyl, B-side was the song not expected to be played on the radio and become a hit).

Two of you have proposed Heart of Gold: first my daughter Kristin, then Randy, who mentioned the song "might be cheaper, actually" (than, I take it, my medical bills payable in dollars when all of this is over ... the US should return to the gold standard).

Why this song at seven? All of us are searching, and we're aiming for a "heart of gold." The first lines "I want to live, I want to give" also explain why we've decided to have heart surgery. Here's the song:

https://www.youtube.com/watch?v=7fXaC07X5M8&feature=related

Many people have covered Heart of Gold. Although I'm partial to the original, the cover by Johnny Cash is great. Red Hot Chili Peppers are playing backup, and this video has nice images:

https://www.youtube.com/watch?v=zEH2CDinyaE

#8 Don't Go Breaking My Heart, Elton John & Kiki Dee

March 4, 2012

Top 10 Heart Songs: "Don't go breaking my heart
I couldn't if I tried
Honey if I get restless
Baby you're not that kind
Don't go breaking my heart
You take the weight off me"

Four of you have nominated this song in my guestbook. First to recommend was Jan Beale, who checks into Presbyterian Hospital in Charlotte tomorrow morning for her surgery. So this song is dedicated to Jan. Our prayers and thoughts are with you today and tomorrow. God Bless you and your family.

Written by Elton John and Bernie Taupin under pseudonyms and performed by Elton John and Kiki Dee as a duet, "Don't Go Breaking My Heart" was released in 1976. Here are two You Tube links, the first is the original single, the second is live from Madison Square City (NYC where I'm headed!) in 2003.

http://www.youtube.com/watch?v=WwJ_XuAgMNM

http://www.youtube.com/watch?v=uyYwmMddEy4&feature=related

If I could, I'd embed audio or video clips or photos within my Journal entries ... but I don't see a tool here to do this. Am I missing something? This would be a great feature to add. ... Adam Pick, are you listening?

Guys - keep coming with more guesses of the rest of the top 10. My list includes three that no one has mentioned yet, and it's quite possible that one of those will end up at number one (qualifying the guesser for the Major Award).

NOTE THE RULES: the song must include the word "heart," or a variant such as heatbeat, heartless, or heartsick somewhere in the lyrics. The word does not have to be in the title. Thus, the Supremes' great song, "Stop! In the Name of Love" is a candidate (maybe even a contender) because the lyrics go:
"Stop! In the name of love
Before you break my heart
Stop! In the name of love
Before you break my heart
Think it over"

On the other hand, the word "heart" in the name of the band isn't enough. One of my favorite bands is Heart, led by Ann and Nancy Wilson. One of my favorite Heart songs is "Dog and Butterfly" (1978) but I just can't find the word "heart" in the lyrics to that one. .... I like that song so much, maybe I need to carve out an exception to the rules.

UPDATE, I'M REVISING THIS JOURNAL ENTRY: Oops, I just made a huge mistake here. In one of the middle verses we have:
"We're getting older, the world's getting colder
For the life of me, I don't know the reason why
Maybe it's livin' , making us give in
Hearts rolling in taken back on the tide
We're balanced together, ocean upon the sky."
.... so Dog & Butterfly qualifies, fantastic. How could I have missed this. I need to focus. Uff da

Top 10 Heart Songs ... #9 Achy Breaky Heart, Billy Ray Cyrus

March 3, 2012

Refrain: "But don't tell my heart, my achy breaky heart
I just don't think he'd understand
And if you tell my heart, my achy breaky heart
He might blow up and kill this man."

Written by Don Von Tress, the song was first recorded by the Marcy Brothers in 1991 and was then titled "Don't Tell My Heart." Cyrus covered the song the next year, renaming it "Achy Breaky Heart." Catch a video at
http://www.youtube.com/watch?v=byQIPdHMpjc

I expect that many of the younger valvers in our community have not heard of Billy Ray Cyrus. To help you place him, today he is best known as the dad of Miley Cyrus.

So why does "Achy Breaky Heart" merit #9? .... I've been thinking about how much I really should tell my heart about the plans I've been making for the little fella. Is it best to keep him in the dark (so to speak) until he's exposed to the bright lights of the operating theatre, or should I start to explain, gingerly, what he should expect? Please advise.

Top 10 Heart Songs ... #10 Piece of My Heart, Janis Joplin

March 2, 2012

Reading Jeff Shebovsky's journal has inspired me. His entries show a highly organized and prepared man with tons of energy. Among his many preparations, he reports that he completed his surgery song playlist more than a week ago. I'm doing something slightly different. Right now I'm 10 days away from checking into Mt. Sinai hospital in New York, so I'm putting together a list of the top 10 "Heart" songs. Each day I'll announce the next song. I invite you to send song nominations to me on my Guestbook. The only rule is obvious: the song must include the word "heart" at least once.

I'm also making this into a contest. You're invited to guess what Song I will choose to be #1. Enter by telling me your choice in my Guestbook. Entries will close at the end of the day when I announce #3 (Friday March 9). In case of a tie, the first poster to make the correct pick wins. The winner will receive a Major Award.

A-MAZE-ING addition to my surgery plan

March 2, 2012

Pun intended. My surgical plan now has an addition: a cryo-maze procedure. This morning a bit after six o'clock I emailed my surgeon, Dr Adams, to follow up on email conversations that I initiated earlier between my Atlanta cardiologist, Dr Randy Martin, and Dr Adams. In less than 3 hours, one of his team members (a postdoc at the Mt Sinai School of Medicine) phoned my office. I was able to return his call before he entered surgery, and we had a conversation about cryo-maze, which answered all of my questions. The cryo-maze procedure will use a cold probe to draw traces over my left atrium, which will serve to interrupt re-entry circuits that can cause atrial fibrillation. Adding this procedure to my work order will lengthen my surgery by 15-20 minutes; not bad. The potential upsides are considerable. Many valve repair patients have some post-op AF. The real measure of success for the cryo-maze is 3 months out; the prediction is 80-85 percent success due to the cryo-maze. And a related advantage: if later intervention is necessary (e.g., ablation) a prior cryo-maze increases the probability of success. If anyone wants more info that’s available online, there’s an article, for which Dr Adams is a co-author, titled “Surgical treatment of atrial fibrillation using cryothermy in patients undergoing mitral valve surgery” in an Oxford Journal “Interactive CardioVascular and Thoracic Surgery.”.... Getting all this info so quickly has increased my already-very-high confidence level in the Mt Sinai team. We're continuing to move the ball forward. Surely we've passed midfield by now.

Last "Walk in the Woods" before Surgery

February 25, 2012

My apologies to Bill Bryson for borrowing the name of his book. Today was my last hike before surgery (we travel to New York a fortnight from today). Last year my daughter Kristin and I joined the Georgia Appalachian Trail Club. Actually, we paid dues and became "prospective members" because the Club requires the completion of three activities before admittance as a member. Today I completed my 3rd activity (second for Kristin, she still needs to volunteer for a trail maintenance outing). We picked a 4.5 mile hike through the trails at the Elachee Nature Center near Gainesville, Georgia. Rolling hills, well-maintained trails with wooden bridges over creeks and wetland areas. Brilliant weather - clear, in the 40s when we started, mid 50s when we ended close to noon. I especially like winter and spring hiking when the trees are leafless; you can see so much more. It's a very different feel than hiking in the South in the rest of the year, where you're in a green tunnel for a high percentage of the time. In My Photos I've added a pic from today's hike.

Exercise prior to Valve Surgery

February 22, 2012

Last October I discovered that I had atrial flutter, that my mitral regurgitation was severe, and that my left ventricle (LV) ejection fraction (a measure of pumping efficiency) was way too low. At the time I was not in good aerobic shape. I had not run effectively since May, and wasn't doing much else. After my atrial flutter was corrected by ablation in October, I was eager to return to running, but my cardiologist vetoed that plan. He encouraged me to exercise, but not exceed a pulse of 120 per minute. So I've taken brisk walks, usually 6-7 days per week, ranging between 30 and 75 minutes per outing, using a heart rate monitor. To stay under the target heart rate, I really have to slow down when I go up any hill of significance. On some days I use a stationary bike at the gym instead. Although I'm not happy with this limitation (one reason I want my surgery date to arrive fast), I realize the purpose: let my heart rest and hopefully recover some of its efficiency prior to the surgery, and hold down cardiac risk that might result from the stress of hard workouts.

Spring break can't come fast enough

February 17, 2012

Spring break starts on March 9. More than a few of my friends at the university have commented that I'm planning an unusual spring break trip! The days are going by so slowly for me (but not because of an upcoming beach trip). For awhile after my Feb. 1 consultation with Dr. Adams, I hoped that an earlier surgery date for me would open up at Mt. Sinai. But the hospital hasn't called, and at this point Donna and I have made all of our travel plans to New York, including renting a very small apartment for two weeks. Plus I've arranged my work schedule to make the March 13 surgery date fit, and my daughters and Donna's stepmom have made their NY travel plans as well. So if I get an offer of an early date now, I'll reject it. It's clear to me that medically, there would be no appreciable plus for having the surgery this month, rather than in March. It's just that I'm tired of the waiting. Luckily, I have full days at the university to occupy my time, plus plenty of chores to do around the house and yard (per usual, my list is long, and tends to expand rather than contract).

Jim

Risk of Atrial Fibrillation

February 11, 2012

One month from today (Sunday March 11) I check into Mt. Sinai Hospital. I wish it were sooner.

Yesterday I spoke with my cardiologist. Donna and I will stay in the NYC area for about one week after my discharge, and we've been looking at various lodging choices. I asked whether a few flights of stairs were okay. He said that's not a concern: "I don't know why people keep thinking that. Stairs are only a problem if you have orthopedic issues." This is the answer I had expected (and hoped for), as I'll be walking the hospital halls regularly before they let me out anyway.

A second point. My cardiologist wants me to check with my surgeon, Dr Adams, to see what if anything can be done to reduce my post-surgery risk of developing atrial fibrillation. He says I have significant risk because last fall I had atrial flutter (corrected in October by ablation), and he calls atrial flutter and atrial fibrillation "kissing cousins." A possibility is to ablate my left atrium (atrial flutter, in contrast, is usually treated by ablation of the right atrium, which was my treatment in October). The basic idea is that, as long as I'm opened up, the surgery team may as well perform multiple tasks -- mitral valve, and possibly tricuspid valve repair, and now possibly AF preventive work such as an ablation.

Well, the good news -- my heart catheritization, done in December in Athens, shows my arteries are clean as a whistle. No plaque, no blockages whatsover. So one thing that's clear -- no need to consider bypass or stents as part of the specs for work to be done.

Jim

Consultation with my Surgeon

February 10, 2012

Below is a note that Donna emailed last week to family and friends with info about my consultation with Dr David Adams and the Mt Sinai team:

Jim's scheduled mitral valve re-repair will be March 13 at Mt. Sinai in New York with Dr. David Adams and team. He met with Dr. Adams today. I just spoke to JIm and got lots of details (I wasn't able to go to NY because of this really bad cold). Jim's very confident after his meeting. We will be up there for about two weeks, because they like to keep the out of town patients in the area for an extra week; he will be in the hospital 5-7 days.

Dr. Adams said re-repair is preferable to an artificial valve or pig/cow valve in his opinion:

(1) Having your own valve back and repaired will just last longer. The animal valves would have to be replaced later (typical is 15 years).

(2) The artificial valves might have problems with clotting; and you have to be on anti-clotting medicine the rest of your life.

(3) There have been advances since Jim had his surgery 6 years ago. These days they don't let anyone off the table until there is 0% leakage from the valve; that's only been recently discovered as an essential "gold standard." When Jim had his surgery it was acceptable to let the patient go with very minor leakage, as was his case. His valve only lasted 6 years. In the intervening years, also, the annuloplasty rings that are put in with mitral valve repair have greatly improved.

There are surgeons who argue against re-repair, and Dr. Adams will be in a discussion with other physicians about this at a conference in a couple of weeks. I imagine that the objections are these, (although I'd like to hear the talk, which I believe will be taped):

(1) re-repair deals with scar tissue and therefore is a more complex surgery; plus,

(2) longer time on the heart-lung machine; the less time, the better.

(3) re-repair is a relatively new procedure--maybe 5 or 6 years or so--and there haven't been that many (although Mt. Sinai has done about 60), so there are no long-term studies. There are a couple of great surgeons in Europe who also do re-repairs.

The positives: At Mt. Sinai, the mortality rate in re-repairs has been 0.

They will do a replacement valve at the time of the operation if they get in there and find that it can't be re-repaired.

They will also repair a slightly leaking (possibly) tricuspid valve at the same time (not as important as the mitral valve repair).

Other things to bear in mind--Jim's valve disease was most likely caused by infection--rheumatic infection caused by strep. This is very common. The following is my opinion only, not something the doctor said, but tell everyone you know to get onantibiotics if they have strep throat; in our childhoods, that wasn't something that was automatically done if a kid had a sore throat, and it was in the early days of antibiotics back then. But today we have this emphasis on not over-using antibiotics--which is justified because the germs get resistant--but because of this people tend not to use them at all.

Random fact: Dr. Adams said the third-degree heart block Jim had a few days after his first surgery was caused by edema, not by beta blockers. So that's good news; he can go on beta blockers after his next surgery; this is considered a very good thing.

So March 13 for now; that's the earliest they can do it with this team--although we will definitely go earlier if there is a cancellation.

Thank you all for your concern and prayers--we are really optimistic. For more info. on heart valve disease, there is a blog started by a patient that is a great resource, and there's an interview with Dr. Adams (# 3 on this link): http://www.heart-valve-surgery.com/heart-surgery-blog/2011/12/28/top-blogs/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+AdamsHeartValveSurgeryBlog+%28Adam%27s+Heart+Valve+Surgery+Blog%29

Planning our trip to New York

February 9, 2012

Here's my first journal entry. Donna and I are now working on planning our trip to New York City for my surgery. We've booked a flight from Atlanta to NYC on Saturday, March 10. The next day, Sunday the 11th, I'm to check into Mt. Sinai hospital for pre-surgery testing and to begin a heparin drip.

Jim