David's Journal

This will probably be my last journal entry, and I want to thank you for being interested enough to follow along with me. It’s been three months since my surgery, and I feel very much on schedule, except that my sternum still hurts a little with certain movements. Cardiac rehab at the RehFit Centre has been helpful in many ways and will continue for three more months. One way it’s helpful is the chance to compare notes with other people who have also had surgery, and a couple of us think that it was overly optimistic to say that bone healing would take 6-8 weeks or even to say that upper body resistance work could start at 12 weeks. I will focus mostly on lower body work and cardio until my sternum is more reliably comfortable. Actually, there are some scary stories on the web of patients whose sternums continue to hurt long after surgery, but the web is a ridiculously easy place to get scared, and I am pleased with my progress. My cardiologist said I should exercise just as though I’d never had a heart problem, and the only sign that I’d ever had a heart problem is my scar. I will have a meeting with my surgeon, Dr. Darren Freed, on August 24 and then continue with my cardiologist, Dr. Robert Kroeker, every six months and my family doctor, Dr. Lisa Dillon, every three months. I’m being well monitored and taken care of. On the plus side, Patti and I have been cycling a couple of times, which was fun and felt good, we go for regular long walks, and we’re back to socializing and planning some travel. I am looking forward to getting a follow-up echocardiogram (ultrasound video of the heart in action) in a few months, probably because it’s like a midterm test I know I’m ready to ace. They did one at the end of surgery, from which I know some of my measurements at that time. My “ejection fraction” was 55%, which means that each heartbeat empties 55% of the blood from the heart, and is normal – meaning that my heart is beating strongly. There is no thickening of my heart wall, which means that all the extra work the heart was doing to overcome the resistance from my calcified aortic valve did not cause any heart enlargement. The angiogram found no blockages in my cardiac arteries. And one direct measure of how well the new valve is working is called the “gradient.” If blood is flowing freely through the valve, the pressure on both sides of the valve will be close to equal and the “gradient” score will be between 2 and 4. A badly calcified valve is called “severe” at a gradient score of 40. I’m glad I didn’t know ahead of time that my gradient score last December was 52, which I overheard a doctor in intensive care describe as “morbidly severe.” Anyway, at the end of surgery, my gradient was 4. The surgeon told me, with some pride, that my new “stentless” valve looks just like a natural valve in the ultrasound, which doesn’t make any real difference but seems esthetically pleasing. I’m good to go. Thanks again for all your support and good wishes.

My healing is progressing about on schedule, although it’s about as much fun as a staff meeting. I get pleasure from experiencing measurable improvement nearly every day and being able to do something I couldn’t do the previous day. The main issue in recovery is the healing of my bones. I knew that they would split my sternum with a special saw (Call me crazy, but I just watched a YouTube video of the procedure.), spread it apart a few inches to give access to work on my heart, and then fasten it back together with fine wire (that will stay there, maybe raising issues at airport security). I was ready for that healing to be necessary, and I can feel my sternum getting stronger. At first, coughing was extremely painful for my sternum, and I worked out some weird-sounding growling tricks and sucked on Hall’s to avoid it as much as possible, but I can cough gently now. What I wasn’t ready for is that the procedure often results in some cracked ribs. Almost all of my pain now is intermittent and unpredictable upper chest and back pain in specific spots. It’s not completely unpredictable; exertion usually makes it worse, and it seems worst in the early evening. Every now and then, I’ll have a bad day that’s quite discouraging, but it’s never been more than one day at a time. But I’m complaining too much here; acetaminophen and ibuprofen have been sufficient to manage the pain, so I count myself lucky compared to many heart patients, and it really is getting better. In fact, I’m enough better that it’s been fun to have visitors for brief periods. I plan to go to the RehFit Centre on Wilkes Ave. for an initial assessment near the end of June and then start four months of cardiac rehab in their excellent program. There is good evidence that participating in a cardiac rehab program results in significantly better recovery. They have educational sessions, exercise facilities and programs, and a psychologist to consult. It’s a little strange to be so completely dependent, and Patti’s been wonderfully supportive, to the extent that I’ve only used my “ring for a drink” bell once. I’m still taking it easy and reminding myself that my job is to heal. I’ve taken comfort from the words of Dr. Luis Castro, “It is therefore recommended to ease back slowly into more vigorous activity over the course of a month or so… absolutely no reason to push hard on activity, as the entire body is in a recovery phase. There is plenty of time after a 2 month period of healing to get back into shape!”

I came home yesterday, Sunday May 13, five days after surgery and am doing really well, which seems amazing, since open heart surgery stresses every system of the body. In the early stages, I recovered quickly, partly because they used a spinal anesthetic rather than a general. The big disadvantage of a spinal, however, is that pain control is not as good immediately after surgery. By all reports, I had some rough times then, but I remember absolutely none of it. Oddly, I do remember talking with people then but not what we talked about nor what I was feeling. Our memory system has some really fine features. Since Patti\'s last entry there were a couple tough days, but I\'m right back on track with recovery. I probably will have to fight my tendency to push forward and to remember that recovery really will take two to three months. Anytime I even think about doing otherwise, my body sends me a sharp reminder. I really will take a five minute walk today and six minutes tomorrow. The St. Boniface Hospital staff and facilities were wonderful, and even though I can\'t really feel the new valve, I have a strong mental image of open flowing and my muscles and organs saying, \"Whoa, that feels better.\" Thanks to all of you who have been so supportive in so many ways. It really helps.

David had a wonderful day today. His pain is much reduced although it is aggravated by coughing and movement such as moving from bed to chair. He is lucid, cheerful, and joking around like his usual self. He\'s sitting up and eating regular food. He was moved out of Intensive Care and into the Recovery Unit about 4 pm, and went on two short walks this evening. Tomorrow they are planning 6 walks! He has a lovely private room with a beautiful view of the river. I think he will be able to do his own journal update tomorrow. We are all amazed and thankful. Patti

Hi all, this is Patti. David\'s surgery went very well today. He\'s in Intensive Care until tomorrow, possibly longer. Thank you for all your good wishes and prayers.

We just found out that my surgery is scheduled for tomorrow, May 8, 2012 at about noon (depending on how long the previous patient\'s surgery takes). Because I\'m getting the new \"stentless\" valve, I will have two outstanding surgeons working together; it has been tricky scheduling both of them together, and tomorrow just worked out. The surgery will take 2-3 hours and then I will be in Cardiac Intensive Care for about 24 hours and regular cardiac ward for about a week after that. Patti will post an update here Tuesday night or Wednesday morning; by then she\'ll know if and when I can have visitors. The surgery will be in the main hospital at St. Boniface, and my recovery will be in the new state-of-the-art Asper building for cardiac research. Because St. Boniface is the only emergency cardiac facility in town, I still could be bumped by an emergency but I hope not. When I come home, I will have a 2-3 month recovery period. I won\'t be able to drive for 6-8 weeks, while my sternum heals back together, but I hope to start cardiac rehab at the RehFit Centre after about a month. For my recovery, Patti has bought me a little bell that is hot pink and says \"ring for a drink\" on the side, and we have built me a little \"nest\" in the living room with an electric-lift recliner chair (I can\'t lift anything heavier than 5 pounds for several weeks), my computer on a swivel table, and a subscription to Netflix. I\'m set. Actually, I will be able to move around a fair amount, and my recovery will be enhanced by moving as much as I can.

I had my pre-op examination two weeks ago. Everything looked good, and they spent a lot of time educating Patti and me about how to prepare and what to expect. Now it\'s time to wait for a date for surgery. We have to be available in case a slot opens up early, so I\'m \"on call\" and could receive a call with one or two days\' warning. Otherwise, I will likely have a date in May. My surgeon does two procedures on the days he operates, and sometimes they have a complex, difficult case with whom they want to pair an easy case (like me). This is why a date might open up unexpectedly. I\'m excited to have been chosen to participate in a clinical trial of an improved valve that is somewhat new to Canada but has been used successfully in Europe for eight years and 15,000 implants. It is called a \"stentless valve,\" and its big advantage is that it permits significantly greater area for blood to flow through the valve, which should mean more energy and ability to exercise. I really appreciate the support and good wishes I\'ve gotten from so many of you.

It is routine for people getting aortic valve replacement surgery to first have an angiogram done. They are checking to see if there are blockages in the heart arteries that will also have to be fixed with bypass surgery while the chest is open for the valve replacement. I had my angiogram yesterday; they found no blockages at all, and the whole experience was easier than I expected. (Except for the long wait while patients ahead of me had to get stents put in and the sandwich that may or may not have been roast beef on dry bread.) Patti spent the long day with me and was a huge support. Dr. Roger Philipp was a good guy who threaded a catheter through an artery in my groin up to my heart so he could make detailed observations by x-raying the whole procedure. A local anesthetic at the insertion point took care of any pain; I was awake for the procedure and was surprised when he said, \"We\'re 2/3 of the way to your heart now.\" I thought he hadn\'t even started yet. I recovered quickly, although I\'m not allowed to lift anything over five pounds for the next week. Actually, I plan to milk this limitation for all it\'s worth. Like everybody else we\'ve talked to about this, Dr. Philipp said that my surgeon is the one he\'d choose for himself. He even said Dr. Freed is \"gifted,\" but we\'re not to tell him that. This first step is good news. In addition to my clear heart arteries, my blood pressure and heart rate are very good. I\'m pretty optimistic. The next step is to wait for the hospital to schedule my surgery, possibly in two to three months.