Anthony's Journal

I had my aortic valve replaced at the Cleveland Clinic almost 11 years ago. I opted for an on-x mechanical valve. Recent blood test showed that my hemoglobin was low and further blood test suggests that my heart valve is damaging my red blood cells. Had any one else experience anything like this?

It is been 7 years since my surgery and the website had me journal my recovery and led me to write to my own blog over the years. I have now finished my book about what me and my partner have been doing since my surgery. You can purchase our book Running All Over The World, Our Race Against Early Onset Alzheimer’s. You can learn more about it and purchase at RunningwithCat.com Thanks Adam Pick

Turns out the stomach aneurysm, right iliac artery, needed to be repaired. I choose the Harbourview medical center and on April 18th I had it patched up through my groin. Others wanted to do an open procedure that would have required a 6 month recovery. Knowing me that was not acceptable and I was back running 1 month after the surgery. It took a lot out of me and for some strange reason I kept thinking it was only going to be a procedure but it turns out it was just as difficult to recover as my open surgery almost 3 years earlier. Hope to hold off my next operation for at least 5 years when they will have to go in and repair the aneurysm above my heart on my Aorta. I turn 62 years old tomorrow so happy to be above the grass and still able to run even though a bit slower. The picture was taken in Madagascar where I ran another half marathon last month. Off to Sonoma for another half marathon the middle of July and training for another one in Petra Jordan in August. No moss growing here.

Turns out the Aorta leading to the heart measurements came in at 4.0 which is above normal but was the same number I had prior to surgery. Unfortunately the stomach showed that one of my arteries was a bit large so being referred to a specialist. This is like whack a mole.

Well I am 2 and 1/2 years since my Aortic valve was replaced with a mechanical valve and found out that my Aorta Diameter is now 4.8. The usual top end range is 3.7 and was above that when I went into surgery to replace the valve. My surgeon felt that do to my height nothing to worry about. The two Echo's since my surgery had the range around 4.0 but this last August it was up to 4.8. As it was explained to me something will need to be done if it approaches 5.5. So more tests are being performed over the next two months to see how things look. On the positive note since I do have the on-x valve the INR has been lowered to a range of 1.5-2.5 from a previous 2.5-3.5 so I can now start taking less Warfarin. All this said it is not going to slow me down. Off to Cuba next week to run another half marathon and plenty of races and travel planned for 2017. Thanks Tony

2 YEARS It has been two years since I had my faulty Aortic Valve replaced during Open Heart Surgery. A lot has transpired and changed in my life since that time. The operation has put things into perspective and caused me to make some major life choices. I retired from a job I loved after 27 years at the same company and we sold our home and put everything into storage. My life partner, Catherine and I became nomads and we have been running all over the world. Since my operation I have run 12 marathons. I ran my 64th marathon last month in Prague, Czech Republic, and have completed a race in 21 different countries. Health wise, I feel great and very satisfied with my decision to have my valve replaced with a mechanical one. The daily dose of Warfarin and the weekly testing of my blood has become pretty routine for me. I use Cardiac Remote Services to help monitor my International Normalized Ratio, (INR) and have only had one mishap where I ran out of testing strips while in Europe. I was able to go to a nearby hospital in Madrid and they did the testing for me. I really don’t think about that part of my life, back then, since I am much too busy living life to the fullest. The operation has taught me that we truly don’t know how long we have on this earth. Both my parents lived long and productive lives but that does not mean I can expect the same. I no longer take life for granted and try to inspire until I expire. The only thing that I have noticed is that I do bruise easily and that is what I was told before the operation since I will be on Warfarin for the rest of my life. I can bump into something one day and see the bruise the next. It really is no big deal since that all heal rather quickly. My problem was noticed on a routine flight physical that I was getting as a pilot two years prior to the operation since I had no other symptoms and it first presented itself as a heart murmur. I remember wondering, why me. Was it hereditary or something I might have done to cause the leaky valve. I ran into someone that does a lot of work with athletes and she mentioned that it is not uncommon for people that participate in a lot of endurance sports to get a heart murmur since the valve does not have to work as hard, most of the time. You can say it gets lazy. Whatever the reason may be, I am very grateful for the great work of the team at the Cleveland Clinic in general and my surgeon, Doctor Gosta Pettersson, M.D., Ph.D, in particular. The heart-valve-surgery.com website was also a great benefit and thanks once again to Adam Pick for putting it all together. The ability to post ones thoughts before and after the surgery was very therapeutic and reading the writings of others, my heart brothers and sisters, on the subject was extremely helpful. I currently post to a blog called, Run All Over The World, on my own website, PlayHard-HaveFun.com. Catherine and I have been on the road for the past 18 months and are currently traveling in South America after finishing up a 1/2 marathon on Easter Island. We land in Rio De Janeiro in a few hours and that will be stop number 157 for us with no end in sight. Here is quote that I do live by. Hunter Thompson wrote: "Life should not be a journey to the grave with the intention of arriving safely in a pretty and well preserved body, but rather to skid in broadside in a cloud of smoke, thoroughly used up, totally worn out, and loudly proclaiming "Wow! What a Ride!"

ONE YEAR On June 12th it will be one year since my open heart surgery. It might come as a surprise to some but it has been one fantastic year. Back in 2012 during a routine FAA medical it was brought to my attention that I had a heart murmur. Up until that point I was the picture of health and had no idea something was wrong. I was running marathons like there was no tomorrow and had just completed an Iron Man Triathlon a few months prior. My world was turned upside down but in reality nothing much changed. I still kept running and we were on a wait and see when it came to a future operation date. I kept track of all my vitals and was told that my running was good for me. During the next 2 years I ran 13 marathons in 6 different countries and 7 different states. I was slowing down but that did not matter to me since it was in my blood to run. In April of 2014 it was decided that it would be best to have my Aortic Valve replaced and everyone pointed me to the Cleveland Clinic and that was the best decision since I still feel they did a fantastic job. Even though they do these type of operations hundreds of times a month they made me feel like I was their only patient and in most ways like family. My surgeon was also a runner and biker and understood how much running meant to me and even worked with me to pick the best date to coincide with my race schedule. On the day of my surgery I had 8 different holes in me at the same time. I had my heart stopped, valve replaced with a mechanical one and then started back up and my Mini Zipper chest incision closed. It still is hard to believe that all that took place. I often joke that running a marathon is like child birth. If it was not no one would do it more than once. You only seem to remember the great parts of a marathon and not how much it sucks during the actual event. Having open heart surgery is similar except I choose a mechanical valve so that I would not have to ever do it again. They say a tissue valve would only last about 15 years and with my active lifestyle I decided why take the chance of blowing out another valve. Granted there have been some down side to that choose but I have no regrets. The biggest is the fact that to prevent blood clots around the valve I now have to take a blood thinner once a day but looking back it really has been no big deal. I have a meter and take one drop of my blood from my finger once a week and call in the results. I consistently eat well and take my meds and so far so good. I have noticed that running or at least staying active helps a lot. I am no spring chicken, turning 60 next month but over all this whole episode has helped me to appreciate life more and it probably the major reason I choose to retire from UPS where I was a well respected Pilot/Manager with 26 years at the company and 37 total years flying airplanes all over the world. Now as the anniversary of my operation comes and goes I am presently preparing to go on a week long cruise on Windstar Cruises out of Tahiti. After that I am going to spend a month in Tahiti and then on to Australia for the Outback Marathon. That will be Marathon number 59 for me and the 7th since my operation. I was back to running a mere month after my operation and ran the Berlin Marathon 2 months later. I love to set goals and that fact has kept me motivated over the years. As I said I turn 60 next month my goal is to run my 60th Marathon in Bordeaux France in September. I did a 50 miler when I turned 50. Ran 55 miles in two days at 55 so it seams fitting to finish 60 marathons at the age of 60 and open heart surgery was not going to stop me. No telling what goals I will set in the coming years or what obstacles will be placed in my way but I hope that running will forever help me achieve those goals. I was walking the afternoon of my surgery and my level of fitness was credited for my fast recovery. Why mess with success. I often hear people tell me that they no longer run because of their knees or other bothersome body parts but the facts don’t lie. Those that run and stay active have fewer complaints than those that don’t. It has been a very interesting journey and I have enjoyed the ride. No telling what the next 20 or 30 years will be like but I know one thing for sure. I will not be the one sitting on the couch watching it go by.

108 Days post AVR surgery Modern medicine is amazing. After only 108 days I was able to run my 53rd Marathon in Berlin Germany yesterday. All the stars were aligned. The weather was perfect and the course was flat and lined with over a million folks cheering us on the entire way. Not only did my heart perform just as I had hoped but also the rest of my body parts cooperated. That is not always the case when trying to cover 26.2 miles by foot. It was not my fastest time but I wanted to enjoy every minute so I did the marathon exactly according to plan. Started out slow and slowed down through out the race. This was however my post surgery personal best and I think I can improve on that time in my next upcoming race. You know me, I love setting goals for myself. In contrast the Men’s world record was shattered by over 30 seconds at a time of 2:02:57. That was nearly one third of my overall time. As a added bonus I can say I ran at the same Marathon where history was made. When I would have usually hit the wall, at mile 20, I started taking pictures and waving at all the well wishers. I felt great. I must credit the skilled surgeons and team at the Cleveland Clinic lead by Dr Gosta Pettersson, M.D., Ph.D. We had all along planned for me to be in position to run this Marathon when my surgery was scheduled back in May for the June 12th surgery date. I followed their instructions to the “T" and I am so grateful to them for helping me achieve my goal. Moving forward I have one more Marathon planned in Des Moines, Iowa in the middle of Oct with a half Marathon a week later in Miami. Next year is booked solid with 10 marathons on the Calendar to far off lands like Tokyo, Japan in February and Ayers Rock, Australia in July. I appreciate all the support along the way from beginning to end. Adam Pick has done a fantastic with his vision for this website where we all can connect through out the process. The well wishes have been up lifting and the ability for me to express my inner most thoughts was very therapeutic. This, however, will be my last journal entry as a slide back into normal life as just another runner. The mini zipper scar which is quickly fading away will be my only reminder of what has transpired over the last 2 1/2 years when I my General Practitioner first mentioned to me. “ Do you know you have a heart murmur.” My life has forever changed and in my opinion for the better. One of the things I hope will always stay with me is patients. Going from a type “A” personality, someone that had never spent a day in the hospital to where I am today has taught me that. It even played out during the race yesterday. I use to look at my watch the whole way and try to improve my times but with what I have learned, be patient and enjoy each and every moment. Wishing you all the best. Tony Copeland-Parker AKA TCP Toni Anthony MZ for Mini Zipper MM for Marathon Man

Pure Skill and Determination Part 2 This is where the rubber meets the road. This being the rubber of my running shoes on the road in Berlin Germany. Throughout the process I have talked many times of achieving my goal of running my 54th marathon a mere 108 days after open heart surgery. I have prepared myself as best I can both before and after surgery and that is the skill part. I know what it takes to run 26.2 miles and I put a recuperation and training program together to achieve my goal. It is not like I could go out and by a training program off the shelf and apply it. I am sure few people have attempted such but one thing you can say about me is that I definitely one of a kind. I am still waging a battle with the FAA to let me fly a few more times before I retire. At least they can’t stop me from running so with both my Cardiologist and General Practitioners blessing I have arrived in Berlin today. The race is not until Sunday and knowing me it will take around 5 and 1/2 hours to complete. The weather is looking to cooperate with a low around 50 and high in the mid 60’s so no excuses for me not to put my best foot forward and get “R” done. In my mind the hard part is behind me. This is my third Marathon this year with 7 accomplished last year and one more to do in Oct in Des Moines to round out 2014. I feel that I am very in tune with my body and plan on starting out real slow and slowing down all the way to the finish. I want to be able to keep my head up and enjoy the tour of the city by foot and try my best to keep a smile on my face. This is where the determination part comes in. There are going to be miles where I will second guess myself. Doubt my abilities and have every part of my body beg me to stop. It is Berlin and I am sure there will be cold beer at the end and I will use every fiber of my being to cross the finish. I would ask you to wish me luck but as you know. Luck has nothing to do with it. It is pure skill and determination. I will update sometime after the race. Thanks Tony

Happy trails to you Here is my 8 week post AVR update. Health is doing great and I am ahead of schedule for the Berlin Marathon in 51 days. I sometimes have to remind myself I even had surgery. The return to work was not that bad and it actually felt like I had never left. This whole experience made me think more about retirement and I have decided that March 1, 2015 I will take the plunge and start the new chapter in my life. I have been working steady since I was 14, delivering papers ,and feel 45 years is long enough. I have been blessed with an outstanding career in Aviation so there is no time like the present to turn the page in the book of life. I have not finalized my plans but the title of this chapter will be, Run all over the world. I have met some great people over the years and don't be surprise to get a message from me that I am running in a town near you. Don't worry about leaving the light on a nearby Marriott will do just fine with lunch or dinner on me. I am going to hold off giving any more updates with the last one being how it felt to run marathon number 53 in Berlin. I truly appreciate all the support and look forward to reading the stories of others as they go this road less traveled. sharing of our collective experiences has helped immensely and hope that my adventures have also helped others. Tony

All systems are go for my return to work tomorrow. Had my thread mill stress test today which I aced. I must admit that I trained for it. Ran a 5K on Saturday, did a 5 miler on Sunday and 3 miles on Tuesday. Everything looked good and my Cardiologist gave me the green light. My INR is finally in range at 3.2. I knew it was going to be a good number when they pricked my finger and they did not even have to squeeze my finger to get plenty of blood for the test. I still don't have my FAA medical so I can't go back to flying but that is only part of my job so I guess I will be flying a desk for awhile. This will be the first time in my 37 year career. Undecided on how long it will take to get my medical back. My FAA doctor, which I see next Wednesday, does not think it will take long but others feel it might take 3 to 6 months. Don't see what the hold up could be since my old valve was not doing such a great job and as long as I was not having any symptoms they let me fly. This one is doing great but maybe it is the old stop and start the heart thing that has them concerned. No big deal I will take it all in stride. The count down continues for the Berlin Marathon in September, 66 days to be exact and now the training begins in earnest. Good thing for me since I have already done 52 of them I don't have to do the dreaded long runs. Eight mile will probably be the max and maybe I will throw in a half marathon sometime between now and Berlin just for the fun of it. Already planning on another Marathon in October. Des Moines should be a good place to visit that time of the year. It is funny to realize that I really have nothing on my calendar after January. Maybe it was because I was not sure I was going to be around then. Now that everything is looking good health wise it is time to put a few more great adventures on the calendar. I have managed to keep some sort of exercise going so far this year. We are on day 204 in 2014 and I have managed to get in at least 30 minutes of some sort of exercise each day. That would entail 310 miles walking, 440 miles running and 81 miles on my bike. That would include 98 miles walking, 33 miles running and 11 miles on my bike since my operation 6 weeks ago. The only other thing left to do is to get my own INR testing equipment. I have a letter from my Cardiologist saying that regular testing is a requirement so I hope to convince my insurance company to bypass the 3 month waiting period and get a unit right away. Right now it is taking about an hour out of my day to get it done in the doctor's office. Speaking of insurance it looks like the final bill is going to be around 150K for the valve replacement. Not meaning to get into a debate about insurance but can't imagine what my choices would have been with out health insurance. I have heard it be said that the filter between your mouth and your brain has a tendency to malfunction from time to time after open heart surgery. It seems to be working fine now but I will put it to the test when I return to work tomorrow. I was pretty outspoken before hand so no telling what is in store. I am sure I will always treat others as I want to be treated. That is how my Mother raised me and in her memory of her passing a year ago this past Sunday I will try my best to think about that before I open my mouth. Tony

Well I can easily say the worst is behind me and I am well on my way to a full recovery. I was able to get a full night's sleep last night and looking forward to a day without having to take a nap. My energy level is almost back to normal and I have settled in on a weight a few pounds shy of where I started but what seems optimal for me right now. My INR number is hovering around 2.1 which is a bit below the desired 2.5 to 3.5 range but I might be one of those that requires the max dosage of Coumadin each day. Another check on Monday along with the required Echocardiogram to see if my Ejection Fraction is back up to the recommended 55-60%. If so then I should get clearance to start back running. I must admit that on Sunday as a birthday gift to myself, while I was out for a 4 mile fast pace walk, I did jog on and off. It felt great but I could tell that the current medications I am taking had some negative effects on my performance. I am currently taking Beta Blockers and Ace Inhibitors to lower my blood pressure and slow my heart rate to enhance the healing effects for my heart but the down side is when you ask for more output from the heart it is if the heart has a governor and no matter what it will not go above 90 beats a minute. So you have to be real careful or you can get dizzy or even pass out if you over do it. I meet with my Cardiologist next Friday and hope that my Echo looks good and he can start to cut me back on the Meds and let me return to my normal exercise routine. As I pilot I love numbers and here are some for reference. 28 days since my AVR surgery 190 days that I have completed 30 minutes of exercise each day. That would include 3, 10 minute walks in the halls the day after my surgery and including a 5K race I walked on the 4th of July in 45 minutes. 79 days until the Berlin Marathon which I am on track to complete. I might need the entire 6 hour and 15 minute time limit to complete but I have yet to DNF, did not finish, a race I started. Last but not least, because of this new valve, which by now I can hardly ever hear click closed, 360 days until my 60th birthday. Thanks to all of you that have followed me along the journey. I have decided to update less frequently unless there is a grand milestone along the way. I appreciate everyones' support and well wishes but it is getting real close to getting back to the work a day world and all the fun stuff that goes along with it. If all goes as planned I will be returning to work in two weeks. I hope I adjust well to getting back into the routine but if not I guess others will have to adjust to me. I realize that this is an over used phrase but after having 8 different holes in me at once not including the Mini Zipper and the whole heart stop and restarted reality. LIFE IS TOO SHORT Tony

Time does fly when you are having fun or when you are on the other side of surgery. I do remember how slow the days went by in preparation for surgery. My health seems to be improving just as expected. I am now having many more great hours than just okay or bad hours. I am now able to take two walks a day for a total of 2 miles and my pain as it were is under complete control by just two doses of Tylenol, regular strength, a day. I am still unable to sleep all night and require only one nap during the day. That desire for a nap hits me like a ton of bricks. On minute I can be wide awake and the next I can't keep my eyes open. Still can't sleep on my side or stomach as before. My INR took a dip yesterday to 1.7 so they have upped the amount of Coumadin to 10mg for yesterday and Sunday with another finger prick scheduled for Monday. I was able to talk to the nurse and also received information in the mail about a portable testing unit so after 90 days I will be able to do it myself at home or on the road. I must admit the blood thinning situation is a bit worrisome but I am sure we will get the number steady in the 2.5-3.5 range in awhile. In an effort to help move the number in the right direction I will cut out all salads for the time being. It does seem counter intuitive but I can simple replace those veggies for others. I also noticed that my Centrum Silver over 50 men formula has Vitamin K, 200% of vitamin C and and E. The B-Complex that I have been taking also has 500% of C. CoQ10 is also on the do not take list even though the hospital had it on their approved list of vitamins for me. I will have to go back to the drawing board on my vitamin selections and be more careful as I move forward. My numerous entry and exit points including the MZ, mini zipper are all healing nicely and only have an occasional cracking sensation of the chest wall during my daily activities. I was happy while in the hospital not to actually hear the clicking noise of the valve but now that I am home while I am trying to sleep I can hear it. I guess the noise of the AC system while in the hospital was able to drown it out. No big deal, I will now just put some music on while going to sleep and understand after awhile I will adjust. It is much better than the sound of the murmur just prior to surgery and I was able to get use to it. Going to try to go some extra distance on the walking this weekend. On Saturday going to try a two mile walk with a 20 minute a mile of faster pace. Sunday up the distance to 3 miles but at the same pace. Along the route I will make sure there will be somewhere I can cop a squat if necessary half way thru. I was able to get 1.75 in during my morning walk in 30 minutes so all is well on the exercise front. It still stings a bit when I see someone run by me but I will wait until I get clearance from my Cardiologist when I go see him on the 18th of July. My weight is coming back at a rate of 1/2 pound a day. Have to be careful since one sign of heart problems is putting on 3-5 pounds in a short period of time. That is a sign that ones heart is in trouble and starting to take on water. So much to do and remember. Good thing I don't have to go back to work for awhile. Actually I could not imagine trying to do my job in my current condition. I guess I will get a good idea when that might be when I go see my Cardiologist. The only other question to answer is what hoops I will have to jump through to get my FAA Medical back so that I can continue flying once I get back to work. Tony

There is no place like home Especially if you have completed the once in a life time Hospital Endurathon. Glad I trained for the event and was rather young. Got a PR, personal record, first time out and do not ever plan on doing another one. Usually I get a medal and T-Shirt on such endurance events. In this case my heart pillow will substitute as the T-Shirt and my brand new On-X #27-29 mechanical valve will serve as my medal. There were a number of things I never thought I would learn. Not in any particular order. How to snap and tie a hospital gown with one arm hooked up to an IV. How to ask for more hospital food. That I would lose 10 pounds in a week without dieting. Judge the blood draw staff on promptness, courtesy and overall effectiveness. I even got out of bed and asked why the 4 am stick was running late. Over a dozen ways to tell someone that what was going to happen was going to hurt all while smiling. How to escape in my mind from a hospital. The chopper daily and nightly schedule. The importance of having fresh spare noise cancellation headphone batteries. What INR, International Normalized Ratio, stands for and how it's movement varies widely from person to person. That the surgeon that you have is always the best one on staff. It is quicker to go from fully dressed to ready for open heart surgery then to go from hospital gown to your car on discharge. How great sunsets really look. How sweet the words "wake up" can sound. That being cold is relative but being hot is unbearable How to operate a multifunction hospital bed with one hand with eye shades on. That pain is truly temporary. How great the sound of two beeps after hitting the pain pump in ICU is. That it is harder to forget what you don't want to remember than you thought. That your heart is pretty smart and after surgery it knows that it is now time to get some rest all by itself. That I would fear being at home not hooked up to all the machines. This one caused a panic attack on the first night at home. The trip home wore me out and got all the information to when call their 24/7 number and when to call 911. Blood pressure and heart rate were both up and my entire chest and left shoulder blade hurt. The spiral began. Did they let me go to soon,etc? After nearly two weeks of being tested, observed, monitored etc it was now time for me to figure it out all by myself. I had read stories of others ending up at the ER and I feared that was where I was headed. Sleep deprivation did not help matters. I managed to calm down took two Tylenols and crashed for 10 hours. Felt much better yesterday and hope that I am well on my way to recovery. I am sure there will be some twists and turns along the way. I have read how people have decided when to go back to work. Right now I am figuring that if I can't run then I should not subject others to a hostile work environment. Went to get my blood checked today and my INR number was 2.1 with a goal of 2.5 to 3.5. Only a drop of blood from my finger was needed so my arms were very happy. While there I scheduled my 7 day post op with my GP and my 4 week post op Echo and office visit with my Cardiologist. Hopefully by then my heart will no longer need the rest and that my Injection Fraction is back to near 60% as before surgery. Only decision to be made now. Second half of World Cup Soccer or Nap Time. Tony

Rehab in the Hospital Not exactly what I had planned but I will take this delicious dish on a silver platter any and every day as opposed to the alternative. My INR numbers are slowly climbing and I actually got 5 hours of sleep last night during 3 well timed naps. I did dream each time so I was glad to know that I was able to reach deep sleep. I did not realize how much I took sleep for granted. I would get in bed watch a little TV and off to sleep I would go. I did not have to set an alarm because I knew that 7 hours later I would be waking up. Something else that was pointed out by an comment to one of my posts is how I underestimated the how the lack of endorphins was going to effect me. I simply thought that if I was able to get out and walk the halls a dozen times a day for a total of an hour or so that I would be okay. NOT With those pieces of valuable information I will now be able to understand as to why I am not my totally positive self. What I am going thru is simply temporary and right now is somewhat out of control. However my attitude is something I can control and I am going to start working what I can control more, look to the future more, and stop dwelling on the present and the past. Yesterday the manager of the floor saw me out walking with my favorite running shoes on and suggested that I go to the Rehab facility near by my room today and I am like a kid waiting for my parents to wake me up on Christmas morning. They are open from 10- Noon so have my entire day planned around being able to go and maybe even take my heart rate up a notch or two. My original rehab plan was to wait until after I got home and then sign up with the local hospital after a week so this is great news. It was as good as I had hoped. With my vitals up on a screen for the folks to review and Blood pressure taken every 5 minutes I was able to get in a slow walk for 20 minutes straight and around 6/10's of a mile. I now have a goal for tomorrow. Do a little bit better. My heart rate drooped a bit after my mid day nap and blood pressure is also more in line with what it was prior to surgery. Icing on the cake will be an afternoon walk on the roof top lounge. Oh happy day. It did not matter that it was 90 degrees out the fresh air was worth its weight in gold. I had some fun when a chopper landed near by so I imagined they dropped in to pick me up and get me out on the day that I had originally hoped. I did have a good laugh with that one. During the time on the roof I was also able to reflect on the fact that only one week ago I had the major of all major surgeries and by all accounts I am doing great. Decided to name my scar MZ for Mini Zipper so you can tell that my positive attitude is back in full bloom. Thanks to all that have read my ramblings and that have sent me much needed words of encouragement. I also look forward to read the stories of success, setback, sidesteps, etc of others that have gone down this road or by those that will be soon be hearing the sweet sounds of the words, wake up because in reality you were only sleeping. Now for something to think about for those that have their date set and are now counting down the days. Here at the Cleveland Clinic they give you an online password to what they call Guided Imagery. I also went online and found a great meditation application called, take a break! Meditation Oasis. I highly recommend both. With Guided Imagery they have several different meditation sessions. One for general use for you or family members and also one pre operation and one post operation. I found the pre operation sessions particularly helpful. It asks you to think of the perfect experience that is easy to remember and just prior to surgery while they are hooking you up go to that happy place. It really works. When asked my level of stress while getting ready for surgery on the scale of 0-10, I was easily able to answer ZERO. Thanks Tony

I don't want to use the term bad news but in this case my hopes of being able to leave the hospital tomorrow have been dashed. The good news is that I had my heart pacing wires removed today. They were actually up against the heart and are used to either increase or decrease ones heart rate. They did not actually have to use them but were there just in case. My heart rate has been a very steady 70 or so beats per minute however is about 15 beats faster than it was pre-operation. I guess I will either have to adjust to the new resting rate or work on it, when able to start running again. Blood pressure is in the high normal range so they also have me on Beta Blockers to bring it down. My usual level of exercise will also help to keep it in the normal range. Now the not so good news. My INR number, the International Normalized Ratio, is normal for a person without a mechanical valve. Right now it is 1.1 but the blood clotting factor needs to be between 2-3. The blood thinner, Coumadin or as we see on TV a lot warfarin, has not kicked in yet so I will be hooked back up to an Heparin IV for awhile to help get the number up. Needles to say I cannot leave the hospital until they get the number to the acceptable range. There are a number of precautions while taking Coumadin, which I will have to do for the rest of my life, but still feel that they are worth not ever having to do this again. Right now just taking it one day at a time and will always remember when the nurse asked me to wake up and I realized I was alive. Actually your hearing is the first to come back and clear vision the last so when I heard her I first thought they were trying to bring me back to life but realized that they simply wanted me to wake up so I could breath on my own.

No sleep in stepdown for that matter. I expected to be up after the operation in ICU but had no idea how difficult it was going to be to get a good night sleep while in step down in my hospital room. I am not much of a day sleeper so catching an hour nap is about all I can muster. I usually get 7-8 hours of sleep a night and I am a very light sleeper so the nightly rounds are starting to catch up with me. Two things I have noticed is a headache that won't go away and I am a bit cranky. Here is the routine between 10pm and 8am Oral medication plus a stick to the belly at 10pm Vitals check at 11pm More meds thru a intravenous line at 12am Someone sticks their head in and asks how am I doing at 1am Vitals at 3am Someone checks 4 am Blood draw at 5 am More meds thru intravenous line at 6am Vitals at 7 am More oral meds plus shot to belly a 8am That does not include the several times I have to get up to use the rest room. All fluids in or out most be measured. I asked for a sleep aide last night so at least instead of staying awake between pokes and prods I was able to fall back to sleep most times. That helped the headache and hopefully I will return to my cheerful self after a nap sometime today. I also should have tried to sleep on my back prior to this operation. That is a required skill. Needless to say I am a side or belly sleeper which I have not been able to pull off yet. Before hand I could only sleep on my right side since my murmur had gotten so loud it would reverberate off my ribs and keep me awake or wake me me up if I turned that way. You live and you learn but hope to never have to use this experience again. Tony

No pain no gain Being a runner you hear that a lot. However going thru this I must say that for now I have actually had no pain. Some discomfort from time to time but I have managed to be able answer, zero, when asked about my level of pain. Sort of worrisome since I expect it to creep up me at anytime as the drug dosage is deceased. I am truly learning to be a patient patient. Just finished a 10 minute walk around the area and think I might do another loop in a few but a doubt it since I don't want to overdo it. I did learn something after surgery and that is, there are several ways to replace my valve and I was completely wrong on what I thought was going to occur. It is my fault since I really did not want to know how the sausage was made. I figured they were the experts so just went with the flow. My surgeon said he was going to do a mini incision and I thought that meant I was getting Minimal J Incision Aortic Valve Replacement Surgery. That was crack pot research on my part before hand. In my mind I thought it was a horizontal incision right below the breast bone or port access. We had discussed 2 months ago full median sternotomy which is vertical down the chest. Turns out he was talking about minimally invasive sternotomy which is about 1/3 the size. So far so good but I did learn a valuable lesson when it comes to your body. If you have any doubt keep asking questions until the doubt is completely gone. I usually go with the thrust hut verify approach but lent more on the trust side in this case. No harm no foul since it all worked out in the end. Tony

I'm writing this for my brother, Tony, at his request. He's out of surgery, out of recovery. When they took the breathing tube out his words were "things were perfect in every conceivable way." He's resting, hopes to be able to write his own posts very soon. Thanks to everyone for their messages of support and encouragement!

Had a great 3 mile walk this morning after a very restful 7 hours of sleep. It might be awhile before I can get back to walking that distance but I I have learned that I will need to be a patient patient. My body is going to need to heal and if I over do it that would not prove to be very productive in the long run. I am ready and have prepared myself as best as humanly possible. I guess I won't need this anymore. 2 hours and 41 minutes remaining until AVR But I will now look forward to this one. 107 days and 15 hours remaining until Berlin Marathon. Tony

Met with everyone today and got clearance for my surgery tomorrow. All the test showed clean arteries and great blood work. Also it was decided that I will only need Minimal J Incision Aortic Valve Replacement Surgery. I still need to be flexible just in case. The plan now is for me to report at 10am. With 2 hour prep and 5 hour surgery followed up with 2 hours of recovery I should be all done around 7pm. They gave me plenty of advance warning that things could change so I will need to be patient. Thanks Tony

Pure skill and determination That was part of my canned answer when someone would say "Good Luck" to me. Luck has nothing to do with it. It takes pure skill and determination was always my answer. I have decided to modify that answer when someone says good luck about my up coming operation. In this case it will be pure skill by the entire team at the Cleveland Clinic and determination by me. As you might have noticed I have a tendency to compare a lot of life lessons to running a marathon. When trying to complete a marathon I feel 90% is mental. Your perpetration, training and planning is important but your body is trying in every way to tell you to stop but your mind must convince your body to continue. In this case I have decided to take this operation to my advantage and come out of it stronger and better than before. The modern advantages of medicine will be used in this case to help fight off the disadvantage of getting older. We all know that as time marches on cells just don't replicate as they use to but In my case I will have a faulty valve replaced by a brand new one that will easily out live me. I saw on the news this morning that a 91 year old woman had set a new record for completing a marathon at that age. My plan is not to break any records but after this operation I can now be the best that I can be. No more worrying about my heart. Just think what I can now accomplish without the distraction and use the 90% mental power to my advantage in all aspects of my life. With one week left I will now transfer my thoughts to not the surgery and recovery but more so what what I want to do with myself when I am now better than ever. So much left to do. So many goals to set and mark off as time passes on. Putting my thoughts down on paper for all interested parties to read has proven to be very theraputic. Not sure how it will work out on the other side but you can be sure I will not simply tell you that I walked around the block. I have had folks that I don't even know leave me messages of encouragement along with tidbits of advice. One guy gave me a name of a book that he read that proved helpful, by the name of Living Life to the Full. I am not much of a book reader but this one is planned to be finished before my surgery. It is about a woman that had done many triathlons and always wanted to do the ultimate triathlon which is the Iron Man event. An Iron Man triathlon is started with a 2.4 mile swim in open water, 112 mike bike ride and finish with a 26.2 mile marathon. Her goal was to do that 8 months after her surgery. I completed an Iron Man event back in 2012 and did some calculations. My goal is to finish the Berlin Marathon 3 months after my surgery which is approximately 1/3 of what she was able to achieve. So in my mind that should be an achievable goal. On the other side of the coin some coworkers gave me another book to read, called The Last Train to Paradise. I love a good laugh and I am still laughing about this one. It is a story about a rail system that was built down on the Florida Keys but I am sure I will not hurt anyone feelings if it simply remains on the coffee table as a conversation piece. It is somewhat appropriate since I always try to live my life to the fullest as if it was my Last Train to Paradise. Here is quote that I do live by. Hunter Thompson wrote: "Life should not be a journey to the grave with the intention of arriving safely in a pretty and well preserved body, but rather to skid in broadside in a cloud of smoke, thoroughly used up, totally worn out, and loudly proclaiming "Wow! What a Ride!" Tony

You always here the phrase, time flies when you are having fun but the opposite is true while waiting for you surgery date. With two weeks to go to AVR surgery these last 6 weeks seemed to have taken forever. I hope my recovery is not the same way. I like to make lists and I have a ton of thinks still to do but now seems like most of them are on the post operation side of the calendar. I really seem to worry about germs more so than usual. I understand that the operation could be postponed for a simple cold so I find myself washing my hands with sanitizer several times a day. I am sure there is something I forgot to put on my list but I guess I will just have to punt if that happens. It is very strange for the first time in my life to have to prepare for several different senerioes. We all know what the possibilities could be but the one I am concentrating on is back to work in 8 weeks after the operation and running my 53rd marathon in 122 days from now. I am a very goal oriented person and I always have several goals set on the horizon. I feel without a goal you are aimlessly going through life. Some of them might be considered lofty and there has been only a few that I have not been able to achieve. When that has occurred I just adjust and move on. I have gotten a lot of support from family and friends and it will be an adjustment for me to have to relay on others but I am sure that will only be for a short period of time. The count down clock starts for real. 13 days 11 hours and 28 minutes Tony

With 4 weeks before surgery in preparation I have exercised at least 30 minutes each day this year. That is to this point 136 days straight. Some have been a simple 15 minute pace walk and other days were a bit more complex. So far this year I have also done 2 marathons, 2 half marathons, 1 ten miler, and a 10K. Several years back my New Years resolution was to exercise for at least 30 minutes each day for the entire year. Some days to get it done I started at 11:30 pm and continued to 12:30 am to get two days done. This year started out as a challenge with some running friends as a 100 day challenge. When it was determined that I would require heart valve replacement surgery I decided to extend it to the day of surgery if I was able. If all goes well that will be 165 days. Sometimes I had to use my imagination and walk the terminals in different airports while waiting for my next flight. I read in runners world magazine the other day where they compared running a marathon to open heart surgery. In both cases no one wants to hear the gory details. Since I have done 52 marathons so far this operation should be a piece of cake. NOT One thing have learned from running marathons or raising three kids, expect the unexpected and be flexible when things do not go as planned. I will keep both in mind before and after my AVR surgery.

People that know me might even say that I am insane. I can surely tell that the wait for surgery is a bit much but this past Saturday a little more than 6 weeks out I finished my 52nd Marathon. I feel that running keeps me sane. It seems to put things into perspective. The stresses from work and now this up and coming surgery seem to melt away when I am out breathing the fresh air and watching the world go by step by step. There are numerous great running quotes out there and here is one that I saw recently that sticks with me. You don't stop running because your old, You get old because you stop running. Dennis signed my guest book the other day and I can sure say that this is a motto he lives by and he will be my inspiration as I travel down this road. Dennis is 76 with 35,000 miles and 23 marathons to his credit and looks forward to the day to run another marathon after he has fully recovered from his surgery. I have seen people with one leg, cancer survivors, and even one guy in a traditional wheel chair at running events. I had a chance to speak to the gentleman in the wheel chair at the finish of the Little Rock marathon and I mentioned that he was such an inspiration and he turned the table and said that mere fact keeps him going. I would have never thought of it that way. We all have our stories to tell and must admit this journal and reading many journals of others has truly helped. Sometimes I worry that maybe I should have had the surgery done sooner rather than later but at the time I had so many ducks I wanted to get in a row and hope that the wait was worth it. I am sure that my case is somewhat unique in the fact that outside of the obvious sound of the murmur and regurgitation shown by the echocardiogram and even the buzzing sound I sometimes feel in my chest I have no outward symptoms. If like others, I found it difficult to climb a flight of stairs or get dizzy when I stood up then the answer would have been different when it comes to setting a date. Only time will tell and by being a runner I am very in tune with my body and if I feel the slightest of changes then the date can easily be moved up. I might not be able to get the same surgeon that I have selected but I am sure anyone at the Cleveland Clinic will do a fine job. I fly airplanes as a profession and in my line of work it all comes down to trust. I am use to trusting others on a daily basis so in my mind this is no different. 44 days, 23 hours, 58 minutes and 35 seconds but who's counting.

One of the thoughts that always comes to mind is why me. Is there something that I could have done differently or in other words is it something I did in the first place. We often look at heredity as a factor in longevity and for me my father suffered a heart attack in his 70's and is still alive at 93. My mother passed away at 89 last year from cancer and had an Aortic aneurism in her abdomen in her 70's. One thought for me was that I had an aneurism in my descending aorta which might have caused the problem with the aortic valve. Closer look by the folks at the Cleveland Clinic is that for my size, 6 foot 6, that just might be normal for me. Hopefully when the have the hood open they can take a closer look and do some patch work if necessary. Even earlier in this process I went through a battery of test for Marfan Sydrome. That was also brought on by my height and the fact that I am often referred to as lanky. Those test are somewhat subjective but came back negative. Once again a closer look might provide more insight. During my Iron Man competition in Louisville Ky the swim portion was in the Ohio River and 3 months later I noticed a sore on my scalp that was later to be diagnosed as MARSA skin infection. Infections have been known to cause valve problems but we have no direct proof that was he cause even though the first indication of the murmur was noticed 5 months later. Last but not least is the amount of endurance events I have participated in. Am I simply blowing out my valve. No one has told me to stop running but I must admit I no longer do long runs while training for a marathon. I have done so many I feel that 8 miles is far enough in preparation. I actually took two months off from all exercise after my 50th Marathon last October and I felt terrible. Still no symptoms but I seemed to obsess over my condition and was on a downward spiral mentally. January 1, I took part in a 100 day challenge where a group of us decided to exercise for at least 30 minutes each day for 100 days. The 100 days were up earlier this month but decided to keep going until the day of my operation. I had once done an entire year several years back. I feel great but I guess the answer why might not ever be answered.

I am a runner not because I run fast or sometimes not even long. I am a runner because I say that I am. For the past 14 years I have run over 50 marathons in 34 states and 8 countries and for me to be getting open heart surgery in 2 months is a kick in the gut. 2 years ago during a routine physical my doctor first heard my heart murmur. 6 months earlier I had finished an iron man competition so this was a surprise to me since I felt I was in the best shape of my life. I continued to do marathons usually 5 to 7 a year but did start to notice that my heart rate would get up in the upper 150's so I just started to take longer to get them done. My cardiologist would say that in 20 years or so I would need to get an operation but was not sure exactly what the operation would consist of. As time progressed and more trips to the doctor to see how things were going the decision was made to consider an aortic valve replacement sooner than later. The local surgeon first thought that it needed to be done right away but then decided to take a wait and see approach. I decided to get a second opinion thru the online services the Cleveland Clinic and after getting all the test to them it was further decided I should make a trip to see them in person. I must admit even for their size they do a fantastic job. Everyone there makes you feel like you are the only one they are going to see today. A surgeon was selected and the date is in the books. Other had mentioned that they were told to stop exercising but so far no restrictions for me. Except for the fact that I can feel the rumble of the murmur in my chest I have no symptoms. I have one more marathon to complete in 2 weeks and crazy as it might sound I have another one planned in Berlin Germany 15 weeks after my surgery. I am very goal oriented so I am hoping having something on the schedule will help with my recuperation. Worst case I still go and watch others run the marathon. I must admit I have seen people worst off do a a marathon so my plan is that I make it out of the hospital I will be on the starting line late September.