Venkat's Journal

In my last post, I was looking forward to no longer having atrial fibrillation based on an EKG and stress test prior to beginning cardiac rehab. I was hoping to stop the coumadin an a few weeks once a 24 hour holter monitor test confirmed I was out of AFIB. However, when I started exercising during the cardiac rehab session, a heart monitor they attached revealed a heart rate of 130-140 beats/minute prior to exercise. They immediately had me stop my exercise and shipped me off to the nearest cardiologist in a wheel chair. They couldn\'t wait to get me out of their facility before something bad happened to me. The cardiologist indicated that I did not have Afib, my heart rhythm was regular, it was just racing very fast. The confusion was that my pulse rate measured by my pulse in my wrist or hand by a blood pressure monitor read a normal pulse of 60-70 whereas an EKG or heart rate monitor which directly measured my heart rate much higher. In fact the heart rate was exactly twice the pulse rate. It took a couple of cardiologist visits including a visit to a electro physiologist (EP) (a cardiologist who specializes in the electrical rhythm of the heart) to clear up this confusion. I had been exercising regularly every day, slowly building up duration and intensity and was feeling very good prior to this incident. So, I am not sure how long this problem had been going on since the surgery. The electro physiologist diagnosed the problem as atrial tachycardia. He said my this was most likely due to inflamation of the heart caused by the surgery which has not yet fully healed. He indicated it may take 2-3 months for the inflamation to heal. What I am beginning to realize is that with minimally invasive repairs (which I had) is that while the external incisions heal quicker compared to a full sternotomy, the trauma to the heart itself is no different and takes a lot longer for the heart to heal than the external incisions. The EP said he would first try to treat it with medication and if that is unsuccessful, then we would have to consider more invasive procedures like a cardio version or catheter ablation. He prescribed me a medication called flecainide acetate and started me on 200 mg. After only one dose, within half an hour, my heart rate came down to a normal 80-90 beats a minute, a veritable miracle. Hey are in the process of adjusting my dosage and I may be on this medication for a couple of months to make sure I don\'t slip back into atrial tachycardia. I have been asked not to exercise for a few days, which is a downer. Hopefully, I can resume the exercise in a few days once my dosage and heart rate is stable for a few days. The EP has also recommended that I continue the coumadin for another couple of months, just in case the AFIB returns, since it appears I am susceptible to heart rhythm problems. I have appropriated my wife\'s heart monitor. She is a dedicated spinner and exercise nut obsessed with her heart rate during exercise and am wearing it and montoring my heart rate frequently. This amply illustrates the point that Adam makes often in his book about the constant ups and downs during recovery and the need to be patient. I admit that I was down for a few days since this started to unfold. I am real pleased that the problem was diagnosed, a solution found which was effective for me. I have attached a few links on this problem and some related heart rhythm problems. http://emedicine.medscape.com/article/151456-overview http://www.webmd.com/heart-disease/tc/supraventricular-tachycardia-overview http://www.emedicinehealth.com/supraventricular_tachycardia/article_em.htm

Just celebrated my one month anniversary after surgery to repair my mitral valve (mini thoracotomy, port access). Just had my first cardiologist visit. As my surgeon predicted, the EKG indicated my heart was in sinus rhythm and that my Afib/flutter is no longer present. I got the same feedback from a stress test which was done prior to beginning cardiac rehab. Just to be on the safe side, I will wear a Holter monitor for 24 hrs later this week to confirm that Afib is gone. If this is confirmed, I will be able to stop the coumadin in a couple of weeks. Which is great news since my dosage-INR has not yet stabilized at the therauptic range of 2-3. At first it was too low (1.5), now it is too high (3.6) and having trouble getting it down. Both the cardiologist and my family doctor cannot hear any sign of a murmur, which is a good sign. I used to have a very loud murmur before the surgery. I had an echo the day after surgery and the next one is scheduled for early March. I seem to have contracted a case of superficial phlebitis, an inflamation of the veins in my left hand below my wrist probably caused by an IV or repeated blood draws from that location during my hospital stay. A venous doppler of the arm did reveal a blood clot at that location but my doctors are assuring me that this is not a cause for concern. Eventually the veins will establish new paths around the clot. I am just treating it with warm compresses. There is no infection. Just a minor inconvenience in the general scheme of things. I have started working from home half days and if everything goes well for two weeks, I will start work full time. I begin cardiac rehab next week. A little concerned if I am taking on too much too soon between the rehab and work. We\'ll see. I still have occasional shortness of breath and occasional minor chest pain and palpitations. But then there are days when I feel very good. I walk about an hour a day and have graduated from flat terrain to several hills. I feel very good while exercising. I still have some soreness/numbness in my right chest area where most of my incisions are. I feel the internal stitches pulling and tugging when I move my arms. I sometimes have shooting pain under my right nipple for short periods, my main incision is just to the right of my nipple. But I can\'t really complain compared to what some of the sternotomy patients go through. All in all, I am very pleased with my recovery so far.

I am now approaching the end of three weeks since my surgery. I am doing well all things considered. I am now walking 1/2 hr at a time twice a day. I am able to do light housework and cooking. I have been out to the grocery store a couple of times. I am able to take a shower by myself without Debbie\'s assistance. My incisions seem to be healing well, no infection. It does feel raw every so often and hurts when I cough, sneeze or run over bumps when I am in the car but not bad overall. I am not taking anything for pain. I still tend to get tired in the afternoon and need an hour nap. My appointment with my cardiologist is next week when I will find out if I still have AFIB. Once I meet with him, I will make a decision on when I can return to work. Currently, my medical leave has been approved through Jan 9. The biggest nuisance right now is getting my coumadin dose adjusted. My INR is still too low at 1.8, need to get it up to between 2-3 and my coumadin dose is 7.5 mg right now. Yesterday, I finally logged into my work computer, checked emails and talked to Nicole to get an update.

I am beginning my second week post surgery. I increased my walk to 15 minutes per walk. I feel very steady on my legs. I seem to have developed a skin rash on my back away from any incision site. I also have several black and blue bruise marks at multiple locations on my body. Some are explainable but some are not. I had difficulty sleeping at night for a couple of nights. I was taking a couple of Tylenol for pain before going to bed and it appears this was keeping me up. I stopped doing this and am sleeping much better. I do not have very much pain. Once I stopped the PCA (Patient Controlled Anaesthetic) I just swtched to two regular strength tylenol as needed and never started percocet or vycodin. This is most likely because I had the minimally invasive robot controlled mini thoracotomy I am having trouble finding a reliable and efficient Coumadin management facility in Columbus, OH. The main facility, McConnell, has a 3-4 week wait for new patients. My family care doctor is supposed to manage my coumadin (run test, alter dosage, provide new prescription) till McConnell can take me. I had a test Thursday AM and no one has called me yet Friday noon. What a huge difference in patient care between the Cleveland Clinic and the facilities in Columbus!!!

Thanks to the prayers and best wishes of my support group, the skill of the surgeons and the care of the nursing staff at CCF, I was released from the hospital on Tuesday, Dec 13. Sameer picked us up at Cleveland and we got home around 7:00 PM. I do have two complications, Atrial Fibrilation (AFIB) and decreased Ejection Fraction of 34 (55 before surgery). I was warned about these complications by my surgeon before surgery. Both of these should get corrected and improve during recovery. I would appreciate any feedback from others who developed AFIB after surgery. I cannot give enough thanks to my support group members including my wife Debbie, Bob and Sameer who transported me before and after surgery to and from Cleveland, Gil and Dixie Higgins and Sameer, Swati, Neal and Avanti who take care of our home and our cats while we were gone, Kristy who cam twice daily to give Smokey his insulin shots. Rest to follow in the next post.

It has been a hard week for Venkat but he made it through with flying colors....We are so looking forward to being home and continuing Venkat\'s recovery. Dr. Gillinov saw Ashok today and he said two things that stood out for me. One is the robotic surgery gave Venkat a 30 day jump on his recovery progress. The other is: Aterial Flutter is a normal reaction to the heart being worked on and people spend to much time worring about the it, The Flutter will probably be gone in 6 weeks.. Home Sweet Home Tomorrow Wife: Debbie

The Doctors are back in on Monday so I think we will get alot of added information. I feel Ashok is doing super. I know he feels tired at times but he is getting stronger. The Atrial Flutter seems to come when he sleeps and go away when he is active (like walking the halls). The nurse said 40% of the heart surgeries end up with this problem and most of the cases clear up within 6 weeks. Patience is what we need... Wife: Debbie

Progress is going well. Venkat has taken his first walk for about 7 min and he wanted dto go longer. His balance is good and his apetite is good. He gets a little tired but that is what happens after heart surgery, at least for a while. His Atrial flutter has come back but we will see what the Doctors think on Monday or later today. Venkat sends best wishes to all and he can\'t wait to get back to normal routine.. Wife: Debbie.

Venkat spent 48 hours in ICU. I was so glad to know he was getting his private room. The aterial flutter seems to have gone for now and hopefully forever. He can hold his food down so we are now on our way to healing. It has been a scarry couple days. He is probably on cumadon for maybe a month due to the aterial flutter, cumadon can help the heart keep its rhythm. Normally the mitral valve repair does not need cumadon. Anyway, forgive the spelling..I am too tired to worry about it. I wanted everyone to know Venkat is out of ICU AND ENJOYING SOME PEACE AND QUIET! Wife: Debbie

Things are going pretty good but...somehow Venkat can\'t keep food down.The right side of the stomach is just taking its time in digesting food so it just sits in the stomach. This has happened to more people than just Venkat so I am sure tomorrow will be better. We want everything to go good once Venkat is out of ICU so another day may be all he needs. Wife: Debbie

All has gone very well..Venkat\'s Mitral Valve was repaired not replaced. It was done non invasively. The chest bone was not broken. Dr. Gilinov went in under the arm using the robotic method. The surgery only took 2 1/2 hours which is fast! They thought it would take 3 to 5 hours. At 10 pm Venkat became consious enough that they were able to remove the throat tube and he is breathing on his own now. I talked to him for a while and he even was thinking clearly. Wonderful Day! I\'m off to sleep. Venkat\'s Wife, Debbie

The much awaited day is finally here. Had my shower with special soap and am ready to take the short walk over to the hospital. I want to thank everyone for their prayers and best wishes and will see everyone at the other end of the tunnel.

Today is the last day before surgery. All test results look good. Met with anaesthiologist and surgeon. Surgeon indicates chance of repair 97-98%.Most likely port access possibly using robot. Surgeon will make final decision in the OR. I have been asked to report for surgery at 10AM which is the second round or surgery (first round is at 5:15). Good part is I can sleep in, bad part is greater likelihood of delays if first round takes longer. We had met a couple here a couple of days ago. The husband had his valve surgery yesterday. I went to visit them. He was still in ICU. I was not sure I wanted to go into ICU and see what will be happening to me tomorrow. Finally screwed up enough courage to do so. We\'ll see if that experience helps tomorrow. This will probably be my last entry for a while. Any further entries will have to be made by my wife.

Heart Catheterization was done and there was no blockage of coronary arteries. This eliminates the last roadblock to having minimally invasive surgery, possibly robotic. Won\'t know till Ashok meets with the surgeon tomorrow.

My heart cath is scheduled for Tuesday, 9:00 AM. The procedure itself is about an hour but it may be several hours before I recover from sedative and am released. Venkat.

Finished the first day of tests. I thought the prestigious Cleveland Clinic would be different from other hospitals regarding logistics but mistaken. Had to provide insurance info and drivers license and answer the same questions before every test, and waited 2 1/2 hrs for my pre surgery echo. I guess that\'s why we are called \'patients\'. I guess I am complaining about minutiae. Met other patients awaiting surgery and that was helpful to know you are not alone. Several had travelled from out of town as I had so that was also reassuring. Venkat.

Today Venkat is getting tests run, electro cardiogram, cat scan & lab work. All is well but lines are long. These days prior to the surgery seem hard and worrysome but I know all is going to be fine.

Arrived safely in Cleveland. Our friend Bob drove us to Cleveland (Thanks Bob). We decided to splurge and are staying at a nice hotel on Cleveland Clinic campus. Went with Bob for lunch at Little Italy, an area of quaing Italian restuarants near Cleveland Clinic and Case Western University. Took a nap, then did my daily workout. Headed out for early dinner now.

It is one day before we make the drive to the Cleveland Clinic. I have been doing pretty good except on a couple days when i really think about what is happening. Reading everyones comments is a big help. I will keep everyone informed on Ashok\'s recovery.