I am posting this for all the people considering, or having to consider, heart surgery including a valve replacement. This is an anxious time, I know, this is a major life decision. I had to make this decision myself two years ago.
I have posted my story on this blog during my “adventure.”
But this post is not about me, it is about Brent and Carolyn, who are friends of my sister who lives in Ogden, UT. Brent was very sick but the specter of major surgery was so daunting that he continually put it off. (Does this sound familiar?) As you can imagine his fear was immense, as was mine at one time.
My sister and I talked on the phone about Brent’s position and his concerns, which were major. I advised my sister to have Brent or his wife check out this website and the support it offers. Action reduces fear. Know as much as you can. See what other people went through and what they are saying. Read my journal and everyone else’s that seem to apply to your situation.
Eventually, Brent and Carolyn did visit this site and read a lot of what everyone was saying. Brent decided to have the surgery that was advised by his surgeon. A bit of his post-surgery story is recorded below.
I hope that Brent or Carolyn will start a journal of their own and share their story more thoroughly. As you know, part what this site does is to help reduce your fear.
Brent and Carolyn, thank you for your courage. Gerrine, thank you for sharing this story on their behalf.
We had lunch with our friends, Brent and Carolyn last week, so I thought I would update you on the results of his surgery. I think I told you before that after seeing the website you had sent regarding the minimally invasive aortic replacement surgery, Brent did call a surgeon in Salt Lake listed on the website as performing that surgery. He already knew he needed the aortic value replaced, but had been worried about doing it.
He made an apt for Tuesday, 4 weeks ago. He was sent out for tests the next day. We test results in, the surgeon told him that he needed four bypasses and that one of them was on the back side of his heart. That would mean the minimally invasive surgery would not work for him, they would need to do the full chest open, open heart surgery to be able to reach the bypass behind the heart.
The surgeon leaned forward and said to Brent, “I know that you’ve known for a long time that you are in need of this surgery and you’ve put it off now as long as you possibly can”. Brent agreed. The surgeon then spent some time putting fears to rest and informing them of what he would do, what they should expect from the process…and he told Brent he would have little or no pain in his chest after surgery.
Then he offered Brent a spot on the following Monday, and Brent took it.
Tests had shown that both of Brent’s carotid arteries were at least 85% blocked, and they would clear the worst one along with the aortic valve replacement and the 4 bypasses on that Monday.
The surgery lasted for 10 hours, a lot of the time being spent on the carotid artery which I think was actually 95% blocked. Brent had been told to expect 3 days in the ICU, and the first night there Brent was gotten up to walk. He walked to a recliner where he was more comfortable. The next day they actually moved him to a regular room. He was at home again by Saturday morning.
Brent looked absolutely great at lunch. His complexion is pink and healthy. And he told us he has not had any pain in his chest. He has been in physical therapy, and will have the other carotid artery unblocked in his 6th week.
Carolyn has read your journal. They would like for you to publish Brent’s story so that other people can see that he was a person who did not want to have surgery in a very big way. He waited a long time. The surgeon told him he needed even more done than he had thought (carotid arteries). But he also took time to give Brent encouragement of what he could expect and what he wouldn’t have to live with any more. And he relieved his fear of pain from the chest incision. So, Brent went from insurmountable heart health problems a month ago, to walking around the block, physical therapy and Christmas shopping.
Next summer his physical therapy will consist additionally of golf and lots of it. He looks like a happy camper to me.
I am healthy and happy. I've just been to a Dr Fuhrman's Seminar on healthy eating. Stopped at McDonald's on the way home (Just kidding). Got some good information there.
Anyway, the number one positive result I have had is that I am not dead. That, all by itself is enough and I am happy for it. But on top of this, I still feel better, physically and mentally, than I have in a long time. By a long time I mean decades.
Anything negative? Well, yes, but it is a trade off that is well worth it in my opinion.
I still have visual anomalies. I still see shooting stars from time to time and have learned to ignore them. It looks funny if you don't. There is also, from time to time, an electric looking orange blob that crosses my vision. It lasts for about two minutes and then is gone.
I still get, from time to time, an odd feeling in my chest when I drink something real hot of cold, mostly cold. It does not last long. At one point the esophagus runs right past the aortic valve and I'm probably giving it a "brain freeze".
Since my surgery, and going through what I have, I do not suffer fools as easily as I did in the past. I will not put up with this and will tell them so. Hey, I am on, not borrowed but special time. Extra time that I was not originally allotted and I mean not to waste it. My analogy is from "The Lord of the Rings" when Gandalf wakes up after defeating the Balrog. He is now Gandalf the White and will not put up with a "Fool of a Took"!
I seem to be a lot more philosophical now too, and more emotional. At least emotions come on quicker and with less motivation. Like getting all misty eyed at movies, "No I was not crying"
It's been about eleven months since my AVR surgery.
After I finished my cardiac rehab last January I started exercising at the gym at work. At that time I mentioned that when the new YMCA by us opened that I would join that too, so I could continue exercising over the weekends and at home. This would help especially during the winter months.
Well it finally opened and I signed up on the family plan.
Now I have to make use of it!
Over the summer I went through a six week period with with what turned out to be antibiotic resistant bronchitis. It took a while for the docs to finally give me the correct antibiotic to get rid of it. This was pretty wearing and I am still trying to get back to where I was in May.
I also just got back from a week in Bogota, Colombia. It's a fascinating city. It's also at 7,500 ft. The altitude did affect me if I did anything strenuous but for normal activities I was just fine.
Next month is my one year anniversary and I am looking forward to it.
I am very glad to be here. I feel like should change by birthday from June 5th to October 10th, the date of my surgery!
Virtually no remaining symptoms no even the visual ones that I had like "shooting stars" and such. Even my small scar is getting hard to notice.
The new thing that I learned since my last post was that prior to all the medical devices that they have to diagnose you now, the doctors had to rely on a physical examination. This is from my GP. He said that they would look for things like the condition of your toenails, or hair getting thinner, or the skin not rebounding when they would press their finger on the inside of your shinbone. Mine would take more than 3 minutes to rebound.
Anyway, what he said was that the lack of oxygen from the bad heart valve caused conditions in you body that are similar to what people feel when they are undergoing chemotherapy. The cells and tissues in your body that rapidly replicate are most affected.
Hair, nails, lining of the digestive tract, skin texture, etc are affected. Sound familiar?
For me a lot of these things are reversing themselves now that I have an adequate supply of oxygen to all parts.
During this past warm spell I fount that I was able to ride a bicycle again. this was a surprise to me not only because I had the strength to ride but the balance. It has been a long time since I have been confident enough about my balance to make the attempt to ride a bike.
I rode on a bike path that was about a mile long and had small hills and valleys.
It was so cute, my son Joey, who is seven, chased after me on roller skates to see if I was OK. He fell twice trying to catch up with me. Joey skated up to me in the parking lot where I stopped, breathless, and told me the story. I had never looked back and did not see him.
Five months out and I'm still doing well. I found that, even though I felt good at home, taking on work full time was difficult. That difficulty is now behind me and work is much easier, but still work. I am finding that I am actually able to take on more work at one time and keep it all straight.
I'm still exercising every weekday, usually over lunchtime. It has not yet become "fun" yet but maybe that is still in the future.
We took the kids to Springfield, IL this weekend. They had a good time but I saw a bronze bust of Lincoln that I connected with. It was Lincoln with his head bowed down and a look of grief on his face. I felt like this prior to my surgery and periodically since. These periods of disconnection are occurring less often and do not last as long when they do occur.
Slowly the remnants of problems from my valve and valve surgery are fading. If you can please excessive. It really helps!
My first quest was to find a convenient place to exercise and the second was actually to do it.
For the last two weeks I have exercised every weekday. This includes three sessions with an exercise physiologist. My general fitness level came back as "very poor" so I have nowhere. To go but up!
On Another subject, last week my friend and neighbor Chris Malik had a stroke. (He has a journal on this website) At first he could not talk or read but he is slowly regaining some of these abilities. So, in seven months he has had a heart valve replacement and a stroke. He is a career police officer and a father of two young children.
Please, if you have some time, leave him a message on his journal. I'm sure he will appreciate it very much. I will read them to him when they come in.
I finished up my 36 cardiac rehab visits Wed (Jan 18). Disappointed, no cap and gown. Fell stronger than I have in years. Need to keep this going. There is a fitness center in the building where I work and I have signed up there. Company subsidized down to $20 bucks a month. At that rate I can get a secondary membership near home. There is a new YMCA going up a mile from my house. I think I'll sign up there for the weekends and other time off work.
After three months of recovery I am feeling better than I have in years. I can do more physically and I am more mentally alert than at any time in recent memory. (Twenty years?)
I have no physical pain or any self imposed restrictions due to any inabilities physical or mental. This is not to say that I don't still have times when I would like to sit quietly on the side for an hour or so. What the name for this feeling is I don't know but it is not being "tired". It's just a need for a pause in the hustle and bustle for a little bit.
I really do feel good. Gone is the tendency to over think every thing in terms of my heart. The feeling of Living life as a "heart patient" is falling away and being replaced by just my life as me. I guess I can't explain this feeling well either. It's almost like having a limp that outlasts the leg injury. You limp because you DID have an injured leg. The limp is the last part of the injury to leave.
I went to rehab on Friday, January 6th and the nurses questioned me about the dizzy spell. They ended up calling my Cardiologist's office and making an appointment for me for a little later that morning.
After examining and questioning me she told me that these types. Of things are pretty normal experiences after surgery. They need to be lived through but they are not concerning. A few things contributed to the experience. I had bent over, to pickup my shoes, and then stood up. I was probably dehydrated, from my CPAP machine, overnight and the surgery itself.
The surgery cuts small nerves that take time to reconnect. Signals become misrouted. When bending over and standing the body has to compensate for blood pressure and flow needs. Some nerve impulses end up activating the wrong things. Some deadhead and go nowhere.
I have had all these experiences before but just not all at the same time or with this intensity. That is what made it concerning. Anyway according to my Cardiologist they are not a worry.
While dressing to go to rehab today I bent over to pick up my shoes and experienced a bout of vertigo. I ended up have to lay back down in bed for about 15 minutes to let it subside.
I have had some residual effects on and off for most of the day today. Along with the dizziness I have had visual disturbances too. I had these before the surgery too. They are migrant warnings or precursors.
In the past I have had them once or twice a month but today I had them five or six times in one day. Maybe by tomorrow, after sleeping it will have cleared up.
The week before the Christmas I took as vacation as part of my original recovery plan. That Friday I ended up with a sinus infection that ended up in my chest (lungs). The cough was bad enough that I ended up pulling muscles in my chest, although I didn't know it at the time.
That chest pain was concerning to me. I couldn't breath without pretty strong pain. Eventually went to the doctor and ended up with antibiotics and cough medicine and things are getting better.
This was the first episode that I have had since the surgery that really scared me. Another note, when you go the ER or "prompt care" and tell them you have chest pain and recently had open heart surgery, you go straight to the front of the line. It really gets their attention!
Anyway, I'm doing much better and can enjoy my time off.
I hope that all of you are enjoying your Holidays and feeling better.
Friday was the first time I had cardiac rehab and work on the same day. This was much harder than work or rehab alone. By two o'clock in the afternoon I was ready for a nap. The rest of the afternoon took forever. I suspect it will get better as time goes on.
Yesterday (12/1) was my first day back at work. I was more concerned about the drive in to work than the work itself. It’s about 62 miles one way. Racine, WI to Chicago and back each day. The traffic is heavy and fast.
Everything went well. I fell right into the old pattern pretty quickly. I work in an office and most of my passwords for everything I use had expired and I had to get them renewed. Not to bad. Even got some work done. I was tired by the time I got home but it felt good to be back in he saddle.
Each work week will still be punctuated with time for my remaining cardiac rehab sessions, Monday, Wednesday and Fridays through mid-January. When rehab is over I need to find a way to continue the exercise. I don’t want to lose what I have gained.
I believe that more people read journal entries than they do the guestbook entries of others. Because of this, I’d like to share these two viewpoints, that were written to my guestbook, with a wider audience. We all need the maximum amount of information going in to a major decision like heart valve surgery.
I would like to repost here two guestbook entries that offer opinions that differ a bit from my own. I encourage you to read and take to heart what they are saying.
Both of these gentlemen have gone through heart valve surgery as we all have, or shortly will. They both have had full Sternotomies, if I understand properly. Their opinions are based on first-hand knowledge and their own experience.
These responses are honest and sincere statements of truth from their perspectives. They both have done, and are doing what they feel are the best things to do for themselves. I don’t believe that either gentleman would change their decisions, given the chance, after reading the journal entries I’ve posted here.
Friday, November 18, 2011
So great to see you are doing so well Joe. I've followed your journal for some time now as I too had heart surgery recently. The best advice you write in my opinion is exploring all options. I got 3 surgical opinions before having the procedure in Cleveland with the first surgeon telling me that I would need a mechanical valve and a life of blood thinners to the surgeon who completed the procedure repairing the aortic valve instead of replacing it. They also replaced a section of my ascending aorta. I did have a full sternonomy because of the procedure so I wanted to add for those that read your journal and may read your guestbook that your depictions of it are a bit off my experience. I've had very little pain from the procedure and at 4 weeks I'm able to walk 2-3 miles a day with no problem, push myself out of a chair by my arms, lift any household items, and just today was cleared to drive around town. I don't write this to brag but to inform you and others that in my experience, the easiest procedure for the urge on may also be the safest and best for the patient. As you wrote, information and multiple opinions are the key. Hope all continues to go well. Thanks, Bill
Friday, November 18, 2011
Hi Joe. I'm 7 months post OHS for mitral valve repair. Not minimally invasive. For me it was all about managing risk since I was otherwise healthy and asymptomatic. Folks that are in good shape and whose recovery would be expected to go better than average, likely want to focus on the risk of an adverse surgical outcome and discount recovery risk. Then the shorter time on bypass, the larger workspace and better view afforded by OHS can be deciding considerations. Also which valve is being repaired, since the surgical complexity varies. As MI techniques improve and experience builds it will become a better choice for more and more patients. I think different patients have different risk exposure and will want to manage their risks accordingly - so there is no "one size fits all" best choice.
My experience was like Bill's in that I had very little pain once various tubes were removed. I was up and walking miles around the ICU ward within a few days and was playing sports again at 6 weeks post-surgery. I credit this mostly to being in good shape going in.
That said, you are like your Dad - providing experience to surgical teams with minimally invasive techniques and thereby improving future patients outcomes. You should be proud!
Brave too. Facing this and now well down the road to recovery with a lifetime ahead to share with your family. Life is sweet!
Keep the beat.
As is stated in these entries, there is no “one-size-fits-all” surgery. No surgery is best for everyone. The main thing is that you choose what fits you best. Myself, I am not a person that finds security in the “tried and true”. With something this critical I want the best procedure, for me, done by the best surgeon. I want the best surgical outcome for me and I want to get “back to normal” as quickly as possible.
The healing, like other aspects of heart valve surgery, is relative to the patient. If you are a fast healer you will heal faster than similar patients around you regardless of the type of surgery you have. Recovery rates are connected to the surgeon and the surgical method. If you are a fast healer and you choose a surgical procedure that offers a faster recovery rate you will be back to normal even faster. As examples, I was up and walking the afternoon of my surgery and I was cleared to drive a car when I left the Hospital, once I was off the pain medication; this amounted to about a week from my surgery date.
I’d like to say too that minimally invasive heart valve surgery is not an experimental procedure that includes higher surgical risk, but it is a less practiced procedure. This is a medically accepted procedure. Risk is relative to the surgeon, not the procedure. The choice of a surgeon is crucial. If you were having a hip or knee repaired would you look at minimally invasive procedures?
I’d like to encourage more people to feel comfortable considering the minimally invasive procedures. Of course, this may not be for everybody. Many people will not qualify or there may not as yet be a minimally invasive procedure developed for the surgical treatment you need. But please at least inquire.
I still do encourage patients to inquire about minimally invasive heart valve surgery when it is appropriate for them. Your insistence will encourage more surgeons, over time, to develop teams to perform this surgery.
My sister wrote a guestbook entry to me the other day that really made me think.
“Joe, after reading your post of this morning, and then reading the notes of people who have responded to your journal I am overcome by emotion.
“I wish Dad and Mom, Dad especially, could see what you have come through these past months. Dad would be so grateful for the advancements in heart surgery that you were able to take advance of. In some ways he is one of the forerunners that gave surgeons experience to make the huge changes that were available to you. He helped through his surgeries to give you the chance at extending your life so that you could be there for his beautiful grandchildren.”
“Circle of Life. I couldn't find the purpose before, but it seems obvious now.”
Dad had a multiple heart valve surgeries in the early to mid ‘80’s. My sister reminded me that he helped me in more than one way. His surgeries gave experience to the surgeon, which helps to perfect the process. He also gave me the example of how difficult it is to endure the standard surgical method. His example was my motivation to find another way when it was my turn.
I had to find an alternative to the type surgery he had, if one existed. (And it does.) To paraphrase an Einstein quote, I could see farther because I was standing on my Father’s shoulders. My Father helped me and I want to help others if I can.
It’s “Quality vs Quantity.
The techniques for operating on the human heart have changed a lot since the 1980’s but the surgical technique to get to the heart, in my opinion, have not had the same level of advancement, generally (Sternotomy). Not everyone can physically qualify for a minimally invasive technique but everyone should try for it. Don’t “settle” it’s too important.
I think that some of the institutions and surgeons are true caring pioneers and some are followers just like a cross section of us regular people. Some just want to do as many procedures as possible to make the money, the patient’s quality of life be dammed.
The heart surgery itself affects the surgeon’s success rate. The entry method affects the patient’s quality of life. A “Full Sternotomy” makes it easy on the surgeon and hard on the patient. This is my layman’s opinion.
Please, don’t accept good care when excellent care is available. Don’t accept 6-8 months of recovery if 2-3 month recoveries are available to you. The difference in recovery time is not the surgical work on the heart; the difference is the method the surgeon uses to get to your heart.
Dad helped me to search for a pioneer, and I found one. I would like someone to use my personal experience to make their experience better than it might otherwise be and then pass it on. Let the next person stand on their shoulders.
I want to change the Circle of Life into an Upward Spiral of Life.
While I've going through all of the personal trials that heart valve surgery puts you through I finally realized that I have become to inwardly focused. Whether I’m doing well or doing poorly, I’ve become focused solely on myself and my recovery. I’ve gotten better enough to start to look outward to the people that have helped get me through my surgery and recovery.
No one can get through something like this without the help of others, Help beyond the medical people that have performed this semi-miracle. I’ve written journal entries about my surgeon the hospital and the cardiac rehab that I am attending, but I think that this is still fairly self-centered thinking. Beyond this group of medical specialists there are many people that have helped me get through this.
My wife has been with me in this since before the beginning. She has borne the brunt of all the anticipation, anguish and pain She lived with my symptoms long before I was diagnosed. She was the person who pushed me to get checked out. Without her pushing me I would still be doing nothing about it. Sometimes men are stubborn to the end. My wife would not allow this to happen. She’s been with me all through the surgery and hospital stay and she is here now pushing (helping) me through my recovery and rehab. My wife has walked with me into this “undiscovered country” and she will live with me there.
My sister flew in to be with me and help out during the potentially worst portions of the surgery and recovery. Also, the journals that were written while I was not able to write were written by my sister. She not only put her personal life on hold but she put her business on hold to come and help me. This is help way beyond the “Call of Duty” and this help is deeply appreciated. Thank you.
One of my daughters rearranged her work schedule to be with me at the hospital. My wife, sister and daughter held vigil over me during and after the operation. They stayed all night sleeping in chairs to watch over me, Thank you!
I’d like to thank my two young kids, 6 & 7 years old, for being so good during this time. They went to school every day, did their homework and listened to their sitter. You both did a great job, and allowed me to get through this without extra worries, thank you.
My oldest daughter, her husband and my brother and sister in law spent time with me at the hospital too and I am grateful for their attention. Their visit was during a time when I was still pretty out of it but I know that they were there and I have taken it to heart. Thank you for making the long drive and spending the time with me.
All my grown daughters came over the weekend before my surgery to visit. I had a great time. The time they spent checking in on me makes me feel very loved. Thank you very much for doing this.
Thanks also to the friends, family, neighbors and colleagues that have called and written to check on me, all the prayers are cherished.
I’d like to thank the people who have taken time to sign my guestbook too. Being part of this community, this contact with people that I don’t know but who are going through the same trials as I am, has been very helpful to me and I am grateful.
If you or someone you know is looking ahead at heart valve replacement surgery please check out surgeons that use the “port access procedure”, if you have the time, it will be well worth it. Please take the time to check it out.
This information is from my own life, the procedure I’ve gone through, what I experienced and how I feel. If you do the research too you will find that most of the difference between possible heart valve replacement techniques is how the surgeon gets to the heart to work on it.
Types of surgical access to your heart.
Sternotomy (The full Monty)
Partial Upper Sternotomy
Mini Thoracotomy (The Port Access Approach)
See pages 45-46 in Adam’s book, or look these terms up online. There is a lot of information out there to be had quickly.
If you look at the names of these procedures, all but one use the term Sternotomy. Sternotomy means cutting the sternum (chestbone, breastbone, etc). All the procedures that use the term “Sternotomy” cut the sternum, some fully and some partially.
Please note too that there is one procedure that does not use the term Sternotomy, the Mini Thoracotomy or “Port Access Approach”. This procedure does not cut your breastbone, or indeed any bones at all. This is the procedure that I had done and it is not a robotic procedure. This surgery relied on the training and skills of the surgeon and his team.
I did a lot of research on this subject prior to deciding on what was best for me. I know that not everyone has this kind of time. But if you know you have a problem and are being monitored by your Cardiologist you have some time to check things out. Use this time to your own benefit.
This is about pain and suffering. From first-hand knowledge, I can tell you that bone pain and tissue pain after surgery are very different. Bone pain during surgical recovery is more intense and long lasting than tissue pain alone. It is my opinion that avoiding having your sternum cut is well worth any time and effort you put into the research phase of your treatment plan.
I already had pretty good second hand knowledge of the Sternotomy, watching my father go through this procedure twice in the 1980’s. Yes, I know that was a long time ago but it is still vivid in my memory. I won’t describe it here as this was thirty years ago and every type of procedure has progressed a lot since then. I can tell you that was a horrendous experience for our whole family, especially my Father.
Every time I go to cardiac rehab I see and talk to other heart patients who are living with the aftermath of the Sternotomy approach to heart valve replacement. The added pain and mental anguish that they endure is very visible to me during the classroom as well as the exercise programs.
This summer I also witnessed a neighbor and friend go through a valve replacement procedure including a full Sternotomy. I witnessed his hospitalization and recovery for months prior to my own procedure.
My friend is 15 years younger than I am. He has 6 months more recovery time under his belt. And he was in better physical condition prior to the surgery. At one month out from my surgery (11/10) I am in less pain, on less medications and have less limitations and concerns than he has.
As luck would have it a health care provider gave me a lead to Dr. Balkhy. I did my due diligence on Dr. Balkhy and the procedure he provides. Information was hard to find as not many surgeons offer this procedure, yet. The one big thing that caught my attention was that he did not cut the sternum. That cemented my interest while I learned more.
During my inquiries I checked with Hospitals and surgeons in Wisconsin and Illinois including the Chicago area and no one else offered this technique. The decision was, at that point, obvious to me. Now I had to personally qualify for this procedure. (Not being a smoker helps a lot.)
To qualify, I had a physical exam and personal history taken by Dr. Balkhy, a heart catheterization and a CT scan, in addition to the echocardiogram I already had. Luckily I passed the qualification tests, everything was in the right place and there were no other disqualifying concerns.
What does a port access incision look like? Mine is three inches long, between the ribs just below my collarbone and to the right of my sternum. I have another incision that is also three inches long in the right side groin area. This is also a “tissue” only entry point. No bones are cut, not even partially. I will add a photo of my chest incision to my journal pictures. (Chippendale’s beware!)
Why am I telling you all this? If one person out there, who qualifies, opts for Port Access vs a Sternotomy of any kind, writing this journal has been worth it for me.
Today (11/8) I had my first appointment, with Dr. Balkhy, the doctor that did my surgery, since my release form the Hospital.
The appointment went very well, I’m feeling better all the time and getting stronger.
I’m already feeling better than I felt prior to the surgery although I still get tired and most days need to rest quietly for some part of the day. I am already mentally more clear, less swollen, less fatigued, more interested in my surroundings and the goings on about me than I was prior to the surgery. I am still healing from a major surgery.
I can tell you that this team cares deeply about you, about how you feel and what your life will be like during and after the surgery. They have your best interest in mind. To me they prove this with how they treat you and with every decision they make with you and for you. As an example, I was given a biological valve and do not need to be on a blood thinner the rest of my life. This is a major benefit.
I also learned, that the type and size of the valve that was implanted was important for future considerations. The valve they gave me was sized in part, to make any future procedures, such as a catheter based procedure.
I still think though, that your body needs to take some time to fully rebound to its “new normal” situation. It took years for your body to adjust to the lack of proper blood flow; it stands to reason that it would take your body some time to get used to its return. I fully expect that I will continue to feel and function better yet, bit by bit, as the next year unfolds.
I mentioned in an earlier journal that I was given a “Life Long” restriction, when I left the hospital, regarding exercising outdoors when the temperatures were above 80 or below 20 degrees F.
I discussed this with Dr. Balkhy and his staff. It turns out that this restriction was a generic one written by the Hospital and does not apply to the type of surgery that I had (Port Entry). I was assured that I have no permanent or temporary restrictions on physical activity, regardless of temperature, of course common sense applies.
This was a very positive meeting. I came away with no added medications, no limitations and no restrictions, including no restrictions on travel or flying.
Yesterday (Sat 11/5) was another step up for me. It was the first time that I was able to be reasonably active and do some physical activity.
I walked a mile for the first time since my surgery. The walk I take is pretty much on the flat and is on level pavement. (Less chance of stumbling.) The weather was great here in southeastern Wisconsin, which helped a lot.
Then I mowed my lawn with the lawn tractor. I felt good enough after that to repair my fertilizer spreader. With the spreader working my wife bought eight bags of fertilizer and I spread them on the lawn. Eight bags at 36 pounds a bag. I haven’t done this much in a month. It felt good!
No ill effects either. I feel about the same as I did on Friday after rehab. The trend is still up!
I’ve been away from this journal for a few days. This is a sign that I’m doing better too. I’m sleeping later and no longer have the 3 or 4 o’clock in the morning sessions on the computer because I can’t sleep.
I’ve got rehab three days a week and that is going well. Monday was the first day of rehab that I actually felt stronger. I felt that I could do more (and did) than they were asking me to do. Prior to Monday I had been just kind of “getting through it.”
As an example, on the first day of rehab I was bent over and leaning on the treadmill for dear life just to stay up right with a white knuckled grip on the bar. Wednesday, yesterday I was able to walk on the treadmill without balancing myself at all for about a quarter of the time. I could walk upright and swing my arms. That has been a real change.
I still spend much of my day resting but when I am up and going I can now work on doing normal things. Driving, shopping, library, etc. Just getting up and out of the house feels good. Much of the time that I’m out of the house it is just to get out on my own. There is no real objective, it just feels good to be an independent actor on my own behalf.
As an example, Monday my wife’s car was backed into in the grocery store parking lot. I was able to get in my car and go there and help interface with the police. Since then I’ve been able to go to the police station and get a copy of the police report, work through the incident with both insurance companies and made contact with autobody shops to start the process of getting the car fixed. This was over three days. Activity like this would have been impossible two weeks ago.
Some of my memories of this time in my life are fading and that is one reason that I wanted to write about them as soon as I could. There have been a number of things though that I have remembered since coming home and starting to add to this journal again..
The Pre Op Heated Cover
Before I left my room in the hospital to head for the operating room they put a heated cover on me to me warm. This cover had heated air running through it but it wasn’t like an electric blanket. It was more like a two layered jacket (with only a front) that had warm air running between the halves. That was nice as the operating room seemed cold.
The Shower Head
There is one thing that I would change about the hospital. This is an admittedly small thing which will give you an idea of how well they do their jobs.
The showerhead in the hospital shower put out small needlelike jets of water that actually hurt, especially around and on my incisions. My skin was so sensitive all over that it was difficult to take the first shower.
The Orange Stuff
This is the stuff that they paint you with before surgery. It really takes a lot of scrubbing to get it off. Also this orange stuff ends up in places where you usually don’t care to scrub. It takes a while to get all of it off. The only thing that is harder to get off is the residue from the tape and the round adhesive pads they use to attach the monitor leads. This took weeks to get off but the spots were easier to get to.
In the past I have had sneezing fits almost once a day where I would sneeze six or eight times in a row. The warnings about sneezing after surgery had me worried. It’s odd but I am at about three weeks post op and I have not sneezed once so far. (And I’m glad)
I was told prior to and after my surgery that I was swollen, especially my arms and legs. I didn’t think so, they looked “normal” to me. After surgery they gave me a diuretic to make me get rid of the extra fluids. I lost 9 pounds during this time, that would be over a gallon of water. I looked at my arms and legs and they looked like sticks to me. I guess I was swollen after all. I’m hoping to get some muscle tone back during rehab.
I have had a number of guestbook responses to my saying that I had been given life-long restrictions on doing work outside when the temperature is too high or too low. So far no one else has told me that they have been given these same restrictions. Please let me know if you do have this prohibition, I am curious.
I have an appointment with my surgeon on Nov 8. I will find out as much as i can about this then. I'll report back to this journal anything I learn.
I signed up for the 8:00 am session. I got in about 15 minutes early, dressed, put my monitor on and registered it. The monitor uses the same round disks that they used in the hospital. There are four wire leads and each of them is color coded and goes to a specific spot. You fill out a slip of paper with your name and the ID number of the monitor you chose and give this to the nurse at the monitor station. She identifies the monitor to you. As I was early I got all of this done prior to the class.
There is classroom instruction at the start that lasts for a half hour. Today’s class was on “Dining Out.” This was useful as I travel a lot for work. The instructor gave us good information on making better choices when you eat out, watching fat and salt.
At the end of the class at 8:30 we started the exercise portion of the day. As I was already set up I got a quick start. The nurses first check and record your blood pressure and pulse. Then the get you started on an exercise machine. This first one was like a stair-stepper that you sit on instead of stand on. That lasted for about 20 minutes. Half way through the nurse checked my blood pressure again.
The nurses keep track of you very closely. There is a nurse behind a desk that watches everyone’s heart monitor. The other nurses are assigned to individual patient’s. They do a “round robin” from one to the next, keeping tabs of everyone’s condition and progress.
As my balance is a little off, the next station for me was the treadmill. This is in place of walking the track. The treadmill has handles to help me keep my balance. This was a 10 minute exercise with a warm up and cool down periods. All the time I was on the flat, no inclines or speed changes. Half way through the exercise a nurse checked my blood pressure again.
The next session was doing stretches that cover your whole body, neck to feet. These stretches give me some trouble as I am not very flexible. I’m hoping to improve on that. The next exercise was working with a “stick” or broom handle. The actual exercises remind me of weight training but just with the bar. I’m assuming that this part will turn into regular weight training over time.
Once done with that I started through the check-out process. You sit down and a nurse again checks your blood pressure and pulse. Then they want you to sit still until your pulse drops to “normal.” Now the monitor leads can come off (ouch) and you turn in your monitor and can dress and leave.
Actually, overall, it was an enjoyable experience. The nurses are great. They are caring and attentive. My rehab schedule is three times a week schedule, Monday, Wednesday and Friday. Also I chose this time of day to make me get up and get out of the house on a schedule. Another slight move toward regaining a “normal” routine.
I was very lucky, I came home with no additional permanent medications. Only pain medication and an antibiotic, both temporary. I’ve read the journals of others and I’m finding that this is not always the case. It is a life enhancing not to be on permanent blood thinners or medications for heart rhythm, etc. (I have a “bio” valve vs a mechanical valve.)
I do have a lifetime prohibition on going outside and doing work, when the temperature is too high or too low. (Above 80 or below 20 degrees F.) I’m not sure of the details of why this is but I’ll find out.
My first day of cardiac rehab was mostly registration, testing, question and answers and an overview of procedures and how things work.
Each day will have a class segment and an exercise segment. Class first then you hook yourself up with the four electrodes for the monitor. They watch these from a central station. Then they take your blood pressure and heart rate manually. Once this is done they start you out with warm up exercises and stretches. There are whole sections of things that I can do now that most people there cannot because I did not have my sternum cut. More benefits of the minimally invasive procedure. I am ahead of the curve at the beginning of rehab. The real rehab routine will begin for me on Wednesday.
After my heart catheterization procedure the Invasive Cardiologist told me that I probably had had this (Aortic Stenosis) my whole life. So, next chance, I asked my surgeon, why, if I have had this problem more or less my whole life, why is it becoming critical just now? How can this go from an unknown thing to me to life threatening in two years?
The response was, “Mitigations.” Mitigations are adjustments made in the face of a problem. If you have a water shortage you conserve water. When the rains come back, when the problem is over, you revert to your old practices of using water.
The heart itself can make adjustments to mitigate the bad valve. Your body in general can make adjustments to help the situation. And you make adjustments in how you live your life to accommodate the valve problem. These are the mitigations that I have made to make up for my bad valve. All of these I was unaware of at the time.
But what if the problem is permanent and worsening and not temporary? Mitigations can keep you symptomless and unaware for a long time but eventually their affect runs out. It’s like the drought. If the drought is permanent not temporary, then no amount of mitigations can help, in the long run. You can’t conserve water to zero usage.
Eventually your worsening valve overcomes whatever you, your body and your heart are doing to offset it. The bad valve starts to express itself over top of the mitigations. Sometimes the adjustments themselves become problems in their own right. Your heart’s adjustments become an enlarged heart. Your body’s attempt to keep blood in the organs as a priority creates swollen legs. You lower the expectations of your life to live within the shrinking bounds.
As the mitigations fail, the stenosis can go from mild or moderate to severe in two years. Without help the life you can expect from there out is 2 to 4 years. You can creep up to the end without even knowing it. It seems like this happened quickly but it didn’t. It just came to your attention in the last hour.
Once you know you have this problem don’t fool around with it. Your knowledge if this situation is new but the problem is not. Please take care of it right away.
Leaving the hospital as are most things connected to Heart Valve Surgery, is a Catch 22. Freedom means doing all these things for yourself now. As you get better you gain the facilities to do more. I’d like to warn you, if you have not been through this before, that every day is not better than the last. Most are, but there are days when you feel like you have fallen back a notch. I am warning you about this because it makes you feel like you are falling back into an abyss. You are not. The larger trend is up, always up, but there are days when you backslide. I don’t really know why. Maybe as you progress you use more energy. Sometimes you use all your energy. Maybe you go into a “funk” to recharge your batteries. Don’t worry about this. In any case, my message to you is don’t ignore these backslides but don’t read too much into them either. The trend is up!
Being with family is the best thing but be aware of the work load you are bringing home to them too. Within your ability fend for yourself. Organize your own medications, get your own drink of water, get yourself to the bathroom and take your own shower. If you can do this to your ability it will give you strength and lessen the burden on your family. This lowering burden will help all of your relationships. Don’t be more needy than you have to be. I give you this advice because, of course, I was doing this wrong. In the hospital you had a “Nurse call button” always available. This does not go over very well at home as you can imagine.
Pain medication at home. Of course, I am not a doctor. But pain interferes with your recovery. That is why they send you home with medication. Don’t “try and be brave.” This is not the time and place for it.
I can share with you how I handle pain medication at home. I follow the instructions on the bottle exactly, most of the time. Mine said, “One to two pills very four hours.” Within these terms I found my own balance. I find that the 8, 12 & 4 cycle works out best for me. It’s an easy to remember cycle. I started out with two pills on this schedule. As you recover and improve you can halve the amount of medication but keep on the same schedule. After a couple of days at home I dropped the dosage to one pill every 4 hours but kept on this time schedule.
The thing is, don’t get behind. Don’t skip times. Don’t tough it out. If you lose it and the pain catches up to you it takes a long time to put things right again.
I am now at about two weeks post op. This morning I have started to cut the pain pills in half but (another halving of dose) but I am sticking to the same time schedule. The eventual reward for getting off pain medication is getting back the (legal) ability to drive.
Personally I am doing much better. I’m not likely to go out and mow the lawn but I’m day to day functional and alert. I’m going to make pancakes for the kids this morning and I plan on taking some walks outside during the weekend. The next hurtle, and it starts this coming Monday is Cardiac Rehab.
Every day of my recovery I think through my pain and wonder what I would be feeling right now if I had had my sternum cut. Most of the people that have this problem (Aortic Stenosis) end up with their sternum cut. I have a neighbor and friend who is travelling this path. The complication that he is experiencing is that his sternum is not healing together because the two halves are not close enough together. This is my understanding.
Many people I’ve talked to have experienced long healing times (compared to say a broken arm bone) and the feeling of, if not the actuality of, movement. If they don’t actually experience more pain, then they experience pain over a longer period of time. There has got to a better way to do this than the one we use today.
I was watching my two young kids putting together a puzzle on the kitchen table. It struck me that when they were done you could pick the puzzle up as a piece, it would stay together. Of course everyone knows why. When the puzzle picture was cut up during the manufacturing process they used an interlocking cut. That is, the form the pieces the picture was cut into would create a physical lock between all the pieces. It is essentially a checkerboard where each of the squares is locked with the ones surrounding it.
In a puzzle, the pieces are flat and thin. The material has a grain and is somewhat flexible and delicate. The pattern of the cut holds this picture together without clips, screws or adhesive. The puzzle surface is two dimensional. The sternum cut is one dimensional. Therefore we don’t have to cut up a surface into interlocking pieces we just need to cut a line into interlocking halves. Woodworkers have been doing this for many hundreds of years.
Give a cabinet maker “two one by threes” and ask him to join them along the long edge and he will give you back this type of interlocking joint. Some of them look like little fish tails, one to the left then one to the right and the pattern repeats. If the human sternum was cut in this way the two halves would, when put back together, create a physical lock that would not allow any separation or movement between the two halves. Adhesive, screws, clips, etc. could then finish off the job. This join would be better able to support movement of the body including breathing, while it was healing. The two cut edges would be kept in physical proximity to promote the mending of the bone.
Cutting a pattern vs a line in the sternum is a problem. Surgeons use a “circular saw” to cut the line they cut today. They would need the medical equivalent of a jigsaw and a pattern follower to create the interlocking cut. Harder for the surgeon but better for the patient.
This low grade fever would end up costing me three extra days in the Hospital. Antibiotics were hung back onto the IV tree, more than one kind. The blood draws doubled or tripled. Some of these were drawn into what looked like Tabasco “Hot Sauce” bottles (aerobic and anaerobic cultures). This was torturous, as I said earlier, I was a hard person to draw blood from.
The cycles for everything seemed to come around more often. The blood draws, especially. Antibiotics on the IV gave me a tether at the same time they were trying to reduce the water I was retaining. That was a rough combination.
So this cycle ran about every two hours, breathing, walking, blood draws, bathroom, medications and the taking of vital signs. All this time my temperature fluctuated between 99.5 and 101 degrees, not all that much if this was a leg or shoulder. When the organ involved is the heart things can get critical quickly.
This fever had its upside also. While the hospital staff and the infectious team tried to isolate the source of the fever, I was able to more fully recover in an excellent environment. This extra time in hospital allowed me to be in a much better position by the time I did go home. At some point I could feel the fever leave and not come back. Things cleared up more for me. But I had to wait for another 24 hours to leave. I had to hold this fever at bay for another day.
I did hold off this fever and when I was told that I could go home, it was like I had just scored a touchdown. I wanted to spike my urinal. This is great, I get to go home!
After the removal of the breathing tube and the catheter the rest was pulling myself together enough to go home.
There were a number of important things that I needed to work on every few hours. Breathing exercise, sleeping, getting myself to the bathroom on time, every time, eating something and watching episodes of “American Restoration.”
The breathing exercises were the most difficult, and it hurt. I would do more of this when the pain medication was at its high point (No pun intended.). This timing and then the little red heart pillow made it possible. If you have never done this before I’ll describe it to you.
You don’t blow into it to exercise your lungs, you draw breath through it to inflate your lungs to their maximum, then you breathe out slowly and very completely. Then do it again, about ten times an hour. This breathing machine was my Nemesis. This is just the kind of thing that is most needed at a time when you least want to do it.
To this routine of things add nurses and techs coming in to draw blood, check vital signs and give you medications. One of the items that they were monitoring was surgical diabetes (my term). They would check my blood sugar and give me a shot of insulin periodically. Another was my weight. When I was diagnosed with Aortic Stenosis I weighed 259 pounds. I checked into the hospital at 239. By Tuesday I weighed 251 without really eating anything.
I was holding on to the water and starting to swell. It made it even harder for them to draw blood from me. This is where they started to give me IV medication to make me pass the water. I was then on about a 10 minute cycle. It was very difficult to say the least.
As I got better medications would come off the IV tree and turn into pills. Some things would disappear altogether. Things were looking up for my anticipated Wednesday release. Then Tuesday afternoon I started to run a fever.
Monday October10, 2011 my family and I got up early, about 3:00 am.
(I did ask for the earliest surgery time, and I got it) Even though we were early things started to roll pretty quickly. They took us to what would be my room for the next six days. Room C226 or was it 227? Well anyway I’ll never forget it.
The hospital staff installed us into this room and got me ready with gown and such. I think that they take your street clothes away so that you can’t run out at the last minute. It wasn’t long before they came in and jacked the bed up and the bed and I left the room. (unknown or unremembered time.)
Here might be a good spot to talk about one of the things that TWHH does differently. The patient, me, never leaves his room once he gets there after surgery. No ICU, no recovery room, X-Ray etc. Any person or device that you need comes to you, you don’t go to it. So I woke up in my own room, 226 or was it 227?
I did not wake up very much or for very long (I was told). The first hurtle was the removal of the breathing tube in my throat. Up to this point I was in the soft, warm and quiet that was the new pain medications and the residual of the surgical anesthetic. The removal of the breathing tube did not last long, just a couple of seconds. Please remember that this journal is from my point of view and may not be technically accurate.
I don’t know if you have been in a car accident but that is a similar, all over body pain that I use as an example for myself. Everything was hurting more as I became more aware. Of course this was the staff’s way of telling me who was boss, in advance. Really, that is trading some additional pain for more awareness. It was a good trade.
At that point there were still a lot of tubes, hoses, wires, blinky lights and a thing that sounded like Darth Vader in the room, that was me. (I refuse to say, “Luke I am your father”.) I’d like to mention the Catheter. It was the next mountain.
I kept needing to go to the bathroom, well, and then it was gone. After a while it came back and I meant to tell someone that I need to go but I kept forgetting to say anything. This device creates a “love-hate” relationship. Pain is increasing, awareness is increasing the longer they wait to pull this thing the more I’m going to know about it. The sooner they pull it the sooner I’m going to have to take care things by myself.
Time to rest. For the people that are taking the time to read this, thank you. This gives me a way to talk to you, a way to check on my own thought processes, and an historical document for me for the future.
I’ve written about the surgeon and is team, this time I would like to tell you about the hospital where my procedure was performed. It is not at all clear to me where the dividing line is between the surgical team and the hospital team. If I misplace something, well, I just didn’t know.
The Wisconsin Heart Hospital has all the normal “bits and pieces” that you would expect a hospital to have. They use these pieces and processes in different ways and they do them very well. TWHH, as the name implies. does cardiac cases but also other thoracic procedures, so basically “Heart & Lung” procedures. I was told that they will be expanding this list to add other procedures.
Beyond what I’ve said, TWHH is a beautiful place to be under adverse circumstances. They truly care, to a person, they truly care. I know this from my own industry that you can’t teach concern, you have to walk in the door with it. Choosing the right people to work here must be a priority for them.
Talking about the hospital is different than talking about the surgeon. For the most part you are unconscious when he is doing his best work. No way to write about this first hand. The hospital is different in this regard. All of your time post-surgery is spent with the hospital and staff. (The one regret that I have is not having more accessible veins!)
No matter what time of day it was the care was excellent. The doctors (I had been running a fever and specialist in infections was brought in.) nurses, techs and all were top shelf, even when they told me that I couldn’t yet have what I wanted (more pain medication).
This excellent service includes the meals. The “menu” was a real menu as from a restaurant. The food was good, highly controlled, but good food. I was on an “on order” basis from the menu. You call with you selections and in a half an hour you had your meal. It was correct and still hot. Other times that I've ben in a hospital yu had to tell them a day in advance what you wanted. By the time you got it you no longer wanted it and it was cold.
I have to tell you about one more downside, daytime TV sucks. But once you are well enough to realize how annoying this really is it is a sign that you are getting better. (I did get to watch 24 episodes of "American Restorations, OK 6 episodes, 4 times each,) This facility has raised the bar others.
With this background I can, in the next journals, begin to tell about my experience from my point of view. This point of view has a major gap, the surgery itself.
I’d like to use this journal to thank Dr. Balkhy and his team.(Hi Sue) of people around him for what they have accomplished for me. From our first meeting, Dr. Balkhy and team have been top notch. Thank you to Dr. M for the referral to Dr. Balkhy.
I can tell you that I can into our first meeting with a major case of denial. Dr. Balkhy talked me down out of my tree in a very nice way. Once on the ground, our discussions made me confident in him and in the procedure (Port Access, minimally invasive aortic valve replacement surgery), Please do not think of this as “robotic” surgery. This is the surgeon’s own hand. Of course my qualification for this procedure was not guaranteed.
I can tell you from firsthand experience that bone pain and tissue pain are very different. Your pain and personal recovery time will be much less, maybe half, if your sternum is not cut.
Besides performing these surgeries, Dr. Balkhy teaches this procedure and promotes its use.
Do you need a referral? I think I just gave you one.
Joe had been running an elevated temp which is be treated with antibiotics. He was within normal range this morning so they want to keep him here until he has had a normal range temp for 24 hrs.....so it is thought he will go home tomorrow.
He will have few restrictions when he gets home. They told him one week of pain medication, then he will stop taking that and can drive at that point. There are really no restrictions as to activity except as common sense would dictate and no prohibition on picking up weight because the incision is so small.
He will start physical therapy in two weeks. Joe looks great and is walking regularly around the nurses station. I think from here on out his progress will be impressive!
This is your foreign correspondent (from Utah) signing out. Duty accomplished!
Joe has a slightly elevated temperature so he won't go home today. But he has been walking, and eating more and will be able to shower this afternoon which will make him feel so much better. Otherwise everything is quiet and good. More later.
Joe had a quiet night last night, but this morning begins the work of walking, and breathing. His chest drain tube is coming out at this moment which will make him feel better overall. It will make walking easier too.
Jim and Cielo (I hope I've spelled her beautiful name correctly, if not I apologize) are coming to the hospital and I know that Luz Maria is very glad for that, Joe will be so glad to see them also.
Joe has taken two walks today. The first was down a short hall and back, the 2nd was completely around the entire nurses station and back. That was at least an hour ago and he has been sitting in the recliner since then.
Dr Balkhy and Sue came in, he thought the chest drain might be able to come out this evening. Many other pieces of equipment have been removed today. Pain management is watched carefully, and the breathing exercises and coughing to avoid pneumonia. Joe willingly does all that he has to even if it's uncomfortable. He is visibly more himself each time he wakes from a nap. More later!
Last night shortly after 6, they removed the vent from Joe and we were able to see him. My last experience with heart surgery was 27 years ago with our dad, but Joe looked veery good to me, even at that early point. The plans were that he would get to a point in the evening where they would have hi dangle his feet off the side of the bed.
Jodie and I left for the hotel before that happened, but Luz Maria called to tell us that had happened and that he had stood for bit of time on his feet. She was elated, and told us he was doing very well.
This morning Joe is very awake, was having some discomfort but that is handled quickly. He is able to respond to questions with a deeper version of the Joe voice than yesterday. And there was one comment he made that was accompanied by the look sideways to see if I got the joke. Priceless!
There is a list of things they will be doing today. He will stand more, he will be sitting in the recliner for eating (" everybody eats sitting up"). And he will have less and less attachments. From my vantage, Joe looks good, his color is normal, hivce ice is appreciably stronger today, the puffiness from yesterday is quite reduced. More later
My 12:30 update evidently did not get submitted so to recap: they call frequently from surgery with progress updates which really helps us waiters. They had called to let us know first that they we beginning to stitch in the new valve, then they called to say they were finished putting in the new valve and were beginning the process of taking Joe off the heart lung machine. Awhile ago the surgeon came in to say they were done, the surgery went well, and to explain to us the process once they brought Joe back to the room. There would be a flurry of activity getting him settled and they would move us to the waiting room. Their goal is to remove the ventilator as soon as possible
It is currently 230 and they have just brought Joe back to his room. The door is closely and there several people bustling around in there. They recovery nurse Tammy has told us it will be a couple of hours until he can have anybody back in the room. Luz Maria will go and we will here to be her support. More later
We are getting frequent updates from surgery. At 1130 they called to say they are stitching in the new heart valve now, and everything is going well. They expect the surgery to be done around 1pm. And his recovery nurse has been moving various machines into Joes dedicated room in preparation for his return. We will have more frequent updates until he is back here. Then his recovery from anesthesia will occur in here. While that happens we will retreat to the waiting room. Luz Maria will come back in as allowed. Jodie and I will be her support.
This morning Joe and Luz Maria were up at 3am preparing for the drive into the Wisconsin Heart Hosptial in Milwaukee from their home in Racine. Joe drove so that he could show me, his out of state sister the route we will be using while he is recuperating.
The hospital is quiet and beautiful. We were escorted to Joe's dedicated room immediately. From this room all of his admin work and pre op work was taken care of. It is also the room that he will return to directly after surgery. It is 9:00 and we have already had two updates, the first from Dr Balkhy, Joe's surgeon. He explained that they were still working on installing all the lines and monitors required for the minimally invasive surgery he will have. The dr thought they would finish with the prep In short order, which they did, and within about a half hour his nurse came in to tell us that Joe was already in surgery. The next update from the dr will come at about 10:30, so we will post more news at that time.