don's Journal

Since my previous entry, I was having more angina, to the point where I finally went to emergency here at home. I was admitted with unstable angina, but it took a full week before there was a place for me in Calgary for an angiogram, and I was sent up by a plane that flies for Alberta Health Services. That was yesterday, when the procedure showed that LAD coronary artery was 90% blocked. I was so relieved to hear the dr. say that it was a candidate for angioplasty! They passed me to another doctor within two hours who put in a stent. It is a drug-eluding type, so I have to have a daily dose of Plavix (or generic) daily for a year to reduce the chance of blood clot formation in this major source of blood for the heart. As do many on this website, i will have to try to avoid bleeding. Our whole family is rejoicing and thanking God for his answers to our prayers. I want to thank you who have prayed for me also.

After consulting with three physicians, I am convinced that the CT angiography I mentioned in my previous entry would likely only tell me that I have plaque in my arteries, something I already know. This past Sunday I had two episodes of a new type of chest pain. It felt like I thought a heart attack would feel! Fortunately, one spray of nitroglycerin under the tongue each time was sufficient to get rid of the pain. Today I saw my internist, and he agrees that there is reason for concern. He suggested sending me a for a catheterization angiogram, but wants to do another stress test first. The expected change in how long I can go on the treadmill without symptoms, compared to the stress test a few months ago, will be evidence that a new angiogram is necessary. Unfortunately, the stress test won\'t take place until the 30th, and who knows how long after that I will get the angiogram. Our medical service here in Canada is very good, but there is just too much delay! I will appreciate continued prayer for me. In the meantime I will have to take it even easier and keep the nitro handy!

It is more than 19 months since my surgery, I still feel terrific. However, I have seen no improvement since my last report in what I am able to do activity-wise without getting a hint of angina. And during the past few weeks, I seem to be losing ground in terms of how much activity I can handle without angina. I cannot walk briskly for more than a few minutes, let alone run, without sensing chest discomfort or even pain. I now have to stop every 50 meters of swimming to avoid angina. My internist did not want to send me for a catheter angiogram a couple of months ago, saying \"leave well enough alone\". But since then the symptoms are rapidly becoming worse, I hope to get a coronary CT scan done at a private diagnostic clinic, though that will be something not covered by the provincial heath care plan. I hope to have it done in a week. I\'ll do another entry here then. In the meantime, I\'d appreciate prayer about this. Don

Actually, it may be that it will be a year tomorrow since my surgery, but what\'s a day? I am surprised to see that I haven\'t added to this journal in seven months! Friends have told me that they assumed that was because all is well, and they are correct. I feel terrific almost all the time, and can swim and bike fairly intensely without any symptoms. The only disappointment is that my running improvement leveled off about four months ago. Consequently, I can\'t run much more than I could at my last report. I guess the heart has to work a lot harder to return blood to the heart from the legs when we are on our feet. So I didn\'t try any triathlons this past summer, and won\'t try any in the future until i can repeatedly run a minute and walk a minute without any symptoms. I am accepting the fact that that day may never come, though I haven\'t given up, as I continue to see gradual improvement in my swimming and biking. In the meantime, I am very thankful to God for how good I feel and how much I can do at age 77!

In my previous entry, I was excited about the evident weekly progress in my early running attempts. But after I got to 100m (120yds) run followed by 100m walk, I didn\'t see any further improvement for the next two weeks. If I tried to push more, I got some symptoms about like those I had before the surgery, including my legs wanting to stop just before the 100m point. In checking my heart rate, I found that it was never above 90bpm at the end of the 100m run. I reasoned that the beta-blocker, which keeps heart rate down, was preventing my heart from keeping up with my body\'s need for blood. So I decided to experiment: I cut the beta-blocker dosage in half, and within two days I felt good after each 100m run, and my heart rate was 115. I was pretty excited and expected to see rapid improvement after that. But for the next two weeks I saw no further improvement. I was a bit discouraged and decided I have been presumptuous about how much I will eventually be able to run at my age (77). But I am again seeing slight improvement, and see that the poor days were one of the \"one step backward\" times I have been warned about! But now I am more careful to say \"if God wills it\" when I speak so optimistically about what I hope to do in the future! PS: My cardiologist had told me that there was really no reason for me to be on beta-blocker except that it keeps the heart from working too hard. I would not want any reader to follow my example without clearing it with their cardiologist.

I am pretty excited about how fast my fitness is returning. I am at the point in swimming where I can start doing the same kind of workouts I was doing a year ago. (I have had no chest discomfort the last two swims despite pushing the pace.) I swam 1500meters on Mon., and plan to do that again today after my weight workout. I am sticking 30-40 second runs into my brisk walking, and will gradually increase the proportion of running. I can feel the improvement every week! And I can see my muscles returning (I was almost shocked at how little was left a couple of weeks after surgery). I still get some upper back muscle pain after bench pressing and a few other things, but it is lessening. Once in a while I feel pain around my sternum, but not while exercising; I feel it when I take a deep breath or exhale hard while lying on my back in bed. The way things are going, it looks like I will be able to do a couple of triathlons next summer! Thank you God!

Here are a couple more things that came out of my visit with the surgeon. He told me that my aortic valve leaves were more than 70% covered with calcium! It is surprising that the valve still functioned as well as it did. I asked him how long he would have me on the beta-blocker and vasodilator, and he replied: \"How about the rest of your life? They protect your heart.\" I guess that\'s a pretty good reason to continue them, even though I have heard they will slightly hinder my athletic performance. I told him my upper back muscles try to cramp after upper body exercise, and he said it is a side effect of the sternum-spreading during the surgery. It should pass, though may need physiotherapy if it continues. Has anyone else had this effect of open heart surgery? I have not slept well for several months, and wondered if the meds might play a role, since I have been on a beta-blocker since three months before my surgery. He said this is a common side effect of these drugs, and I might try switching to another beta-blocker. Have others of you had sleeping problems? (I slept in a recliner for the first 6 weeks at home, then started spending part of the night in bed, where I enjoy being able to sleep on my side. I recommend a recliner for the first few weeks after surgery.) I hope this isn\'t TMI. : -) Don

Saw the surgeon two days ago for the first time since leaving the hospital. I had tried a bit of running mixed with walking that morning, as well as some swimming; all very encouraging. When I told him how it went, he said he was not surprised, knowing my history. I asked him what healing I am waiting for, and he said \"nothing\". I just have to rebuild my cardiovascular system after such a long period of having to back off. He surprised me by asking if I had any pain on the right side of my sternum (where I suspected a bruised or cracked rib), because that is where he removed a vein to use to bypass a coronary artery, and he had no way of knowing if he had stitched a nerve. He wants to see me again in a year! And he said he \"expects me to get back to doing marathons\". So now I can gradually resume my triathlon training. I am really encouraged.

I am very encouraged. Not only am I able to make use of equipment in the fitness centre (cross-trainer, stationary bike, very light weights), but I am swimming again! I am being very careful, listening to my body. I don\'t do anything that causes pain, and back off if I feel any chest discomfort. The only time I was a bit discouraged was when I seemed to have some angina-like pain when walking home a few days ago. In response to my friend Bruce regarding depression. I shouldn\'t have used that word, I guess. I was just a bit blue just before bedtime as it somehow reminded me of the hospital stay. I don\'t get that anymore. I haven\'t been contacted about cardio rehab, and it is just as well, as I suspect I am already rehabilitated past the point such a program would be aiming for! People say to me, \"I thought older people recovered much more slowly.\" I answer that I guess it depends on what kind of shape you are in before the surgery. And surely having so many people praying for me plays a big role. Thanks to them and to my God who answers! Anyhow, I am very thankful to see the progress. I am pretty optimistic that I will be able to run again in a few weeks. Then you will hear me cheer from miles away!

What great advice I\'ve been getting in my guestbook! And it is just what i need. In the past my strength has been discipline, including pushing myself harder to improve my fitness. Now I require discipline to limit the progress I try to make and to be satisfied, even pleased, with slow but steady progress. And I do see progress. Yesterday my wife and I went for a 40 min. walk, following the course and pace of 6 months ago; i.e., faster than I could have managed the last couple of months before the surgery. Early on in the walk, I had to slow down for a while because of a burning feeling (in my lungs?). It is a lot like the start of angina several months back, but my GP says it should not be angina, as the causes of angina have been fixed. Perhaps I still have some fluid in my lungs. I had been noticing a bit of depression in the evening. I have been told that this can be a long-term effect of the anesthesia. Anyway, it is less noticeable every day. (I am putting lots of detail in the journal, not because I think all of you will be interested, but so others who go through this surgery can compare their experiences.) Logically thinking, it is unreasonable for me to be depressed. All I should have to do is think about all I have to be thankful to God for, and not just with regard to the successful surgery and recovery. I have such wonderful family and friends, and so many other blessings!

Just read Dawna\'s good report. I think I have just a bit more pain than she does, prob. from my (suspected) bruised rib. Still, I take acetaminophen only a couple of times a day to allow me to cough more freely. Saw my GP yesterday, and he was pleased with my progress. Even my lungs sounded clear, tho\' I still can\'t take repeated deep breaths without coughing. I had a bad day on Tues.; more chest pain and I was a bit depressed.I spent the day dozing and didn\'t even go for a walk. But since then each day is better. One new thing: for the past three days I have been feeling a click in my chest, just to the left of my sternum. I was afraid I caused it by doing something I shouldn\'t have. Dr. says it may be the end of a rib that got detached during the surgery, and will probably heal up over time; if not, it won\'t be a problem. A friend reminded me that recovery is often two steps forward and one step back. That describes this week, though I think I am working on three steps forward! I am surprised how much smaller my muscles look after three weeks of inactivity. (vanity) I had worked extra hard on them the two months before the surgery. I guess I can start to work them again in a couple of weeks. Comparing my progress to that of others with additional complications, I feel very thankful to God for my lot, and for answering the prayers of so many.

I think the fluid problem is licked. Although I have been unable to use the inspirometer as much as I should due to chest pain (see below), other signs of excess fluid in my body are gone since i doubled up on the Lasix (water pills) for two days. I can bear to cough some if I boost the acetaminophen dose a bit, so hope my lungs are improving. I guess I shouldn\'t complain, but I am disappointed that I feel a bit woozy after climbing stairs or if I speed up my walking. I suppose that is from the medications that keep my blood pressure down. The other thing that bothers me is pain around the sternum. My pain there has been just to the right of the sternum and about three inches below the collar bone. I asked a dr.last week why the pain should be so localized, and he said that\'s probably where they beat you up the most in surgery. (Remember, I was pried open twice!) So I now think I have a bruised rib, and can expect coughing to hurt for quite a while longer. (Have any others of you had this result?)

Such good notes in my guestbook! I really can tell you care about me. I can see by looking at my feet and ankles that I am still retaining fluids (tho\' taking Lasix orally), so assume fluid is still a problem for my lungs. I didn\'t cough all last night, so now am braver about using the inspirometer. I am following Fran\'s advice today: frequent use of inspirometer and will do some walking. (Yesterday was discouraging, as I felt weak after only 3 minutes of walking; probably because of fluid.) Yes, Dawna, sneezing is the worst, and hardly ever happens when I have the heart pillow in place (and even then, I automatically move it up to cover my face 2 out of 3 times !!!). I really think sneezing sets the healing back. I wish someone had invented a sternum splint that wraps around the upper torso and can be adjusted to maintain a snug fit. There are probably others who have thought the same thing but didn\'t follow up on designing such after they had recovered. I don\'t find that the regular heart pillow is much help. My son combined a larger, firmer pillow with a lumbar support that is curved in such a way that it wraps around the chest a bit. This gives pretty good stability to the sternum if my arms are wrapped across my chest. I have been able to cut down some on acetaminophen, and things are looking up! PS: Sorry for the time gap between my surgery and my previous journal entry. I had no wireless in hospital. I worked on a fairly lengthy entry the first night I got home, but lost it when the SUBMIT button got no result. (I know now to copy it before checking to see if it actually is on the journal page.) I was just too tired to redo it, and ended up in hospital a couple of hours later.

More info about my AVR. After closing me up. they observed that a chest drain tube was not draining, so they reopened me and cleaned out a blood clot. Of course this was unknown to me at the time, but added stress for my wife. While I was open (the first time!) they bypassed a coronary artery as planned, using a vessel from inside the thoracic cavity. After 1 day in ICU I was deemed ready to move to the step down unit, but there were no beds available. I ended up spending four days in ICU and then skipping the step down unit. The advantage to this was that I had my own personal nurse the whole time in ICU. I did a lot of walking in the halls, and was finally discharged 7 days after the surgery. I was so impressed with the hospital personnel. There are disadvantages to socialized medicine, but lax personnel is not one of them, at least not here in Alberta, Canada. The first night at home I was having trouble getting enough air, so went to emergency at our local hospital. It turns out that I was retaining fluids, including in my chest cavity, and so it was difficult to fill my lungs. Three treatments with Lasix by IV fixed the problem, and I came home again yesterday. I am so thankful to God for bringing me through this. I am now asking Him for the patience to get through the rest of the recovery. It will be so nice to be able to cough without strong pain. Every day there\'s a little less! Thanks again to those of you who prayed for me or otherwise expressed your concern.

Don wants you to know that God brought him through theAVR surgery yesterday, 24 Sept. He will be filling you in on the details in a day or two. Thanks you for your prayers & well wishes. from his wife, patty

We are in Calgary at the B&B less than 5 minutes (walking) from the main hospital bldg. I found out that my surgery time is 12:40, but I need to be at the cardio unit at 9AM. I had everything ready at home to bring, plus a few things that I might need. But when I got here I found I had left my toiletries kit at home, and it had most of the things I really need, including the beta blocker I was told to continue to take! We went shopping for some items, and then went up to the cardio unit and told them my tale of woe. After assuring I am who I said I am, and that I am supposed to have the medication, the head nurse gave me what I need for tonight and in the morning. My wife says I didn\'t need to tell all this, but I said you all need to know I am human. ( :-) Thanks again for your prayers and well-wishes. Don PS: My wife will try to add to my journal tomorrow after my surgery.

Because I erred a few days ago saying my surgery is on the 23rd instead of the 24th (I was right in saying Friday!), I looked at later journal entries and see that it might not be obvious. So now you know for sure that though we go to Calgary tomorrow, the surgery will be Friday AM. I won\'t find out the surgery time until I phone the hospital tomorrow at 2PM. I sure feel supported in this endeavor, by those of you who have written in my guestbook, and by all my family and friends that have said they are praying for me. I am in Good Hands!

We head to Calgary on Thurs., and will stay at a bed&bkfst across the street from the hospital. My wife will be staying there until I am discharged. Yesterday I had the same feeling in the pit of my stomach that I used to get just before starting a trip without my family. But today I am quite comfortable with the prospects of surgery. I am optimistic about the speed of recovery; i.e. to the point where I can run again. I have an acquaintance who had the same surgery at the same age I am now. I met him when he was doing his 4th Ironman triathlon within 10 months of the surgery! You can read about him in an article written after the third of those triathlons:  http://www.runnersworld.com/article/0,7120,s6-243-297--13297-0,00.html

Would you believe that I got as call this AM saying that I am scheduled for surgery next Friday (23rd)? (That\'s even beyond the date that I understood the surgeon was starting his one month break. And he is scheduled to do the surgery.) I am trying to limit my excitement, because I could get \"bumped\", but talk about a fast answer to prayer! All my family and some friends and some of you have told me that they were praying about this, and it is going to happen! Thank you Jesus.

I went to the preadmission clinic yesterday. One outcome is that when I told the physician who interviewed me (one if the team of anesthesiologists for cardiac surgery) how my symptoms have changed, he said I should get word of this to the surgeon. He added that it would not be wise to wait another 5-6 weeks. So I passed this on to the surgeon\'s receptionist this AM, only to find that the surgeon will be off for a month starting in three days! So unless there is a cancellation in the next three days, I will either have to wait 5 or 6 weeks, or go to emergency, in which case I will get a different surgeon. This would be a disappointment, as I have learned that the surgeon I have seen is considered, by personnel in the hospital, to be the very best . I am still trusting that God will work this all out for good. But it won\'t hurt if you pray that I will get in for surgery before my surgeon leaves.

On Tuesday the 14th I go to Calgary for my hospital pre-admission appointment. Still no date set for the surgery, but it\'s good to take this step. As I said earlier, I\'ve tried to maintain as much of my fitness as possible. Of course I can\'t do anything aerobic, but I actually think I\'ve added some muscle through doing weights. And by limiting carbohydrates, I\'ve halted the weight gain that started when I was forced to quit running.

Saw the surgeon in Calgary yesterday. He explained to my wife and me what is needed and gave us lots of material to read. He will do the valve replacement and while I\'m open he\'ll bypass one coronary artery. I will have to make one more day trip to Calgary for \"pre-admission\" routine, then wait patiently for a surgery date, which looks like it will be about 3 months from now. The surgeon\'s exact wording was \"hopefully within three months\". But if my condition doesn\'t change significantly during that time, I will be fine. As I said in my previous entry, I get along pretty well with the help of a beta blocker; but the valve stenosis is gradually getting worse, no doubt. Anyway, I am still feeling fairly content and trusting my Savior in whose hands I am!

I am now fairly content to wait for the surgery here in Canada. Some days I can actually do a bit more than I could two months ago without any discomfort. And it\'s only 8 days until I see the surgeon and will finally get on the waiting list for the surgery. My physician here in Lethbridge thinks I won\'t have to be on the waiting list for as long as the surgeon\'s receptionist estimated (3 mo.) I don\'t know why he says this, but I hope he is right! Meantime, I am happy to be able to spend time in the fitness centre here at the Univ. of Leth. I can do low effort movement (cycling, cross-trainer) and weights, plus lots of stretching and core strengthening. I want to retain as much fitness as possible so that getting back into triathlon shape after the surgery will be more feasible. Thank you to all who have said they are praying for me. I now believe this delay is for a reason (so far known only to God).

God is teaching me patience again. I have spent several days looking at ways to get this surgery done earlier than it looks like it will take place here in Canada, without clear guidance as to the direction to take. So now I am willing to wait until fall if necessary. God can change that, of course. In the meantime, it is comforting that my symptoms have gotten no worse since I have been on beta-blockers, and I can function normally (sans running or other aerobic activity).

The possibility described in my previous entry did not work out, as there is a means test to receive financial help from the VA. Our total income for last year is above the water mark set by the VA for qualifying for coverage. So right now the two options I am considering are going to India or waiting until Fall to have the surgery done here in Canada. We have been given wise advice from a pastor: Be sure both of you (my wife & I) have peace about the decision. We aren\'t at that state yet with regard to travel to India, even though I have complete confidence in the Fortis hospital and the surgeon (in Bangalore). More later if anything develops!

Just a couple of days ago a friend in California began to investigate whether I, having spent 4 years on active duty with the US Coast Guard, might be able to get medical coverage from the US Veterans\' Administration. If it should turn out that I can, I would ask to have my surgery done at the VA Hospital in Palo Alto, CA. That is in the area where I grew up and near where my sister still resides. In the meantime, I am learning more about the cardiology surgery at Fortis Hospital in Bangalore, India. In fact, tomorrow morning I expect to speak with the cardiologist there who would perform my surgery. Those of you who are praying for me: please pray that I will be guided in choosing among the alternatives I see.

A couple of people thought I wrote the quotation added to my guestbook from a lady who is going to Bangalore for her procedure. That was copied from another person\'s journal. I am still collecting information about alternative locations and procedures. (Although I did send an inquiry to Bangalore.) So far I have considered only Montana, Germany, and California. I am somewhat confused by how my symptoms differ from those of others. I simply cannot run or even walk fast without getting angina (chest pain), while a friend who had aortic valve replacement was able to run right up to the time of surgery! Perhaps the right surgeon can make a recommendation regarding the choice of procedure (repair vs replacement; full sternotomy vs less invasive procedures) based on my symptoms, in conjunction with the echocardiogram and angiogram results.

Some friends, hearing of my stenosis for the first time, expressed great concern. I appreciate that, but it reminds me that I intended to make it clear to all that I have complete confidence that God is in control. I belong to Jesus Christ, and so my life is His. I want to thank all who have said they are praying for me or sent well-wishes. I feel fine so long as I don\'t move too fast for more than a few seconds. Even then, I get discomfort which warns me to stop before painful angina results. I find I can use a couple of fitness machines so long as I keep the effort level below 70 watts. I can do weights at slightly reduced levels without feeling any effects. I have been on a beta blocker medication for about 8 weeks, so my blood pressure and heart rate stay low. So you can see my life is comfortable, but oh, how I miss running!

(Read \"My Story\" (left margin) before you start on these entries.) I have heard cost estimates as high as $240,000 and as low as $30,000. The high number would be way out of my range, but something like the lower estimate would be manageable, especially if I can get some reimbursement from Alberta health care. A nurse friend in Whitefish, MT, has generously offered to inquire with a surgeon in Missoula, MT, where there is a world-class heart institute. She will ask for a ball park figure of cost and scheduling. I also may look into having the procedure done in Germany, where prices are said to be 25% of what they are in the US.