Duane's Journal

Two years ago today was my mitral valve repair via sternotomy surgery, and two years ago on Monday was my stroke and intervention. Hard to believe it’s been two years. In some ways it seems like the far distant past; in other ways like yesterday. The bottom line is I’m doing great, and I am thankful to God for His loving care and healing. Sure, I proudly bear a faint “zipper” scar on my chest (want to see it?!), one you can only really see if you’re looking for it. I run 3-5 miles several times a week, plus do some light weight training at Gold’s Gym. I’m planning to run two 5K races in March and April. Last summer Peggy and I vacationed in Utah, Nevada, Arizona, and Colorado and did some great hiking in our spectacular National Parks, including an ambitious 8-mile round trip hike up to Observation Point from the bottom to the top of Zion Canyon at Zion National Park. Since my open heart surgery, we’ve welcomed two new grandchildren—one girl and one boy—making our current total ten. Things are busy with the church. In other words, life is good and is back to “normal” in almost every way. And yet, after open heart surgery, I feel like I’m a different man in some ways. I don’t think you can ever be the same after something like that. I don’t think you’re supposed to be the same. Pre-surgery, I mistakenly thought this was just a fluke, I would have the surgery, recover, and it would be over and done with. Wrong. I now know that I am forever a heart patient. I am on Coumadin for good. But worse things than these have happened. And I think after open heart surgery we’re supposed to be better people—more grateful, more aware of how precious life is, more attune to the people we love, closer to the God who carries us through. (I just wish I could get back the patience I felt during my recovery; that’s unfortunately long gone!) In some ways, the memories and urgency of those harrowing bumpy first days of surgery, stroke, recovery, and setbacks have faded, yet I cannot forget the words of my internist Dr. Otto to my whole family after the stroke intervention: “we have seen a miracle here tonight.” Sometimes I have to remind myself, but my life is a miracle. So is yours. For sure. Some of you may know that about a year after surgery in February 2011, I developed some symptoms which led to an ECHO, which surprisingly revealed moderate aortic regurgitation (new!). Since then I have been under watch for AI—Aortic Insufficiency. I had a follow up ECHO in April and again this past October. The ECHO reports have been reviewed by my local cardiologist Dr. Willard and my heart surgeon Dr. Accola. Thankfully, the last couple ECHO’s have been stable. My next one is in May. Obviously, I’d like to avoid a repeat performance! But I know I am in good hands, God’s Hands, and I trust in Him. “And we know that in all things God works for the good of those who love Him, who have been called according to His purpose.” (Romans 8:28)

It’s been a while since I posted an update and some have kindly been checking on the latest with my heart. A month ago today on 4/5/11 I had a follow-up echocardiogram since my last one in February showed a new concern with Aortic Insufficiency (AI) and some other (some scary) issues. I obtained the report from the echo for myself within a couple days (and self “read” it), but due to a rescheduled appointment with my cardiologist and the sending of the report and films to the surgeon in Orlando, did not consult with any doctor until April 20 and 21. Some positive things I, in my “great expertise” (scary, isn’t it?), noted in the latest echo: Ejection fraction back up to 60% No pericardial effusion Tricuspid valve leaflets back to “thin and pliable” NO “possible aortic dissection” (a very good thing to NOT have) AI or Aortic regurgitation (AR) constant at moderate Dr. Accola, my surgeon, was actually pleased with the echo and thought things looked a little better overall. He was definitely pleased with the ejection fraction and said the mitral valve looks great. His recommendation was to check another echo in six months (not three). Dr. Willard, my cardiologist, felt like everything looked about the same regarding the AI/AR in particular. He gave me the okay to continue running 3 miles (which I have been doing), to resume toning weight training (not heavy lifting which is harder on heart valves), travel, and hiking. Hoping to visit some western mountains this summer, so it’ll be interesting to see the effects of high altitudes. He even told me it was okay for me to ride roller coasters—well, that is, after I told him I already had! I was given another card to carry in my wallet that states I have Dressler’s syndrome (chronic pericarditis). So that goes beside my other cards—Coumadin patient, mitral valve annuloplasty ring serial number, and high risk for endocarditis. Be vigilant to protect against infections. He told me we could be monitoring this AI for 20 years before anything would need to be done. Only time will tell. All in all, go live my life and I’ll see him in 6 months for another echo and consult. It’s been a struggle, but I think I am in the process of accepting and coming to peace with the reality that I will be a heart patient for the rest of my life. For one who had hoped and thought it was an isolated episode that got fixed and was over with and behind me, it has been an adjustment. But, like the Bible promises, God’s grace is enough for me. And I feel His grace. Thank you, everyone, for your prayers and concern. I gladly accept these latest echo results as answered prayers and give thanks and praise to my Lord Jesus Christ. Hopefully I will not need to post again until my next echo in October. So I will (and you too) keep on ticking and fully living!

Just an update on my new era of watching waiting with my aortic insufficiency discovered about a month ago. It’s been a busy month, with lots going on. Lots of God’s finest blessings and joys. On my 52nd birthday March 12, we found out via a Skype call that our son Benjamin and his wife Bryanna are expecting their 2nd baby in September. Our son Jonathan and his wife Becca are expecting in October. So now we have TWO grandchildren on the way—numbers 9 and 10! Later that day I ran with my daughter Sarah in the Shamrock Walk & Run 5K in downtown Winter Haven. My time was 27:31 (an \"accidental\" 14 second improvement from my last 5K). Out of 215 total runners, I placed #96 overall and #7 in my category of males age 50-54. It was a blast to run together with Sarah! I ran without issues. Our son Andrew, his wife Nikki and their two children also arrived from Nashville that day and spent last week with us. Because of Andrew’s work with Bandit Lites, he took me to a Lady Antebellum concert in Plant City on March 13, and got us backstage. We even met the band and got a photo taken with them. The next day we went to Sea World with his family plus our granddaughter Gabrielle. I even rode the new Manta roller coaster, despite all the heart and surgery warnings. (Hey my doctors told me to just live my life and do what I do, and that’s what I do!) What a blast! Check it out @ www.youtube.com/watch?v=-8kfo39hmJI&feature=related. I’ll try to post some new pics. Oh yeah, I forgot, regarding my heart…Actually, I shared the above to illustrate that we are indeed just living and enjoying life. We’re doing well, feeling well, and we’ll face what we’ve got to face when we’ve got to face it. My next echocardiogram is scheduled for April 5, the first of three already scheduled to monitor for any interval change (followed by July 19 and October 18). I was surprised that my cardiologist went ahead and scheduled three; perhaps he’s trying to reassure me that there will be multiple checks in this watchful waiting phase rather than imminent surgery. Fine by me. Being the curious researching kind, I dug out and read through my surgery report from my mitral valve repair a year ago (1/28/10) to see if there was any reference to any other heart issues: “The aortic valve was normal.” “No other abnormalities were noted.” Obviously there were no other apparent issues at the time. My INR levels are still being a pain; yesterday it was 1.8. It got out of whack from some medication changes and is resisting consistency. I’m still trying to run 3 miles several times a week, but my family doctor has advised me not to lift weights, as that exerts a different stress on the heart. I’ve been obeying. That’s all for now. I’ll update after the April 5 echo. Thanks for your thoughts and prayers.

Say what? Sometimes I feel like I’m the HVJ problem child. My sincere apologies to all the other kids. Okay, you read the entry title correctly. Thirteen months after my mitral valve repair, I now have significant Aortic Insufficiency. My surprise recent bout with repeat pericarditis/pericardial effusion (described in my last entry) led to an echocardiogram on 2/21/11. An alarming interpretation summary was “possible aortic dissection.” Yikes, I had just seen that happen on Grey’s Anatomy (why do I always catch those episodes?)! This got me a ticket for a next day second full day at Bond Clinic, a visit with my cardiologist, a chest CT scan, and a very anxious couple days. The CT ruled out aortic dissection, thank God! But the other findings of the echocardiogram contained some new surprises, especially when compared with earlier echocardiograms on 10/27/09 (my first one 3-months pre-op) and my echo 3/9/10, 5-1/2 weeks post-op, my most recent one before now. Ejection Fraction decline: 69.5% 55% 50% Aortic Valve: Before— tri-leaflet, opens well, mild regurgitation, no vegetation Aortic Valve: Now—tri-leaflet, opens well, moderate or moderate to severe regurgitation, lambl’s excrescences noted (fibrous growths on the leaflets) Tricuspid Valve: Before—normal, trace regurgitation, leaflets thin and pliable Tricuspid Valve: Now—leaflets thickened and/or calcified but open well, mild regurgitation Small pericardial effusion, loculated pericardial effusion Now (not before): borderline left atrial enlargement, borderline aortic root dilatation With these stunning findings and with the confirmation of my family doctor, I scheduled an appointment with my heart surgeon Dr. Kevin Accola in Orlando to see what he advises. Peggy and I saw Dr. Accola on Monday 3/7. Not good news, but not immediate news, and, with our growing resume of experiences, not unexpected news. As always, he greeted us with hugs and he and his entire team are wonderfully professional, caring, and straight-forward. Dr. Accola examined the new echocardiogram and CT films and reports and compared the findings with the earlier echocardiograms. He is very concerned about the sudden aortic insufficiency/regurgitation and the lambl’s excrescence (fibrous growths on the aortic valve leaflets). He noted that it is highly unusual for the aortic valve to go from minimal to moderate+ regurgitation in such a short interval and is concerned that the valve may possibly have had an infection (endocarditis). No way to know for sure why or what happened. At times in this life we don’t know why, we only know that. All of my doctors feel that my running had nothing to do with this. I asked about the change in my tricuspid valve as well; he attributed that to me having heart valve disease which is progressive in nature. Dr. Accola instructed me to have another echocardiogram done locally in 4-6 weeks and send him the films for review. If nothing has changed, then I’ll have yet another in 3 months, and then about every 4 months, monitoring for interval change. If or when the aortic insufficiency worsens, I’ll meet with him then and we’ll go from there (aka I’ll likely be facing another open heart surgery). Big gulp! I asked how he felt about me having a second surgery. Obviously we’d both like to avoid that, but he didn’t deny that it’s a good probability that is what I’m facing, at least eventually. He’s confident I can take it (HE’S confident!). In the meantime, he told me to just do what I do and to live my life. I can go ahead and recreationally run, but perhaps dial it back a notch or two. Nothing overly extreme or too competitive. So now I enter a new period of alert watchful waiting, this time of my aortic valve and what about that tricuspid? Time will tell. Yesterday I saw Dr. Willard, my local cardiologist, and though he doesn’t seem to be as concerned, he is willing to proceed with Dr. Accola’s recommendations and has ordered another echo in 4-6 weeks. Believe me, I’m not campaigning for a repeat! I guess I just wonder what in the world’s going on with my heart? He considers me to have Dressler’s syndrome (chronic pericarditis) and will keep me on meds for it. Dr. Willard doesn’t feel I’ve had endocarditis. He reassuringly tells me, “don’t worry, I’ll keep my eye on you” (isn’t this doctor-speak for “you’re in deep weeds but I won’t tell you so you don’t worry your pretty little head until later”?). Dr. Willard also wants me to keep active. Obviously, this is not what we want to be facing. In many ways we just still can’t believe it. After all, I don’t look like a heart patient, don’t run like a heart patient, don’t act like a heart patient. After my early recovery roller coaster I’ve done so well. Mentally and emotionally, there is a sense of loss and adjustment we’re dealing with. Honestly, before this I always thought “I really don’t have heart disease, just a fluky valve; it’s been fixed, so that’s now over and done with and behind me.” Reality is that I still have heart valve disease and more to face. And whatever I have to face in the future, I know that Jesus Christ will be with me, and in that we are at peace. Bottom line: Peggy and I trust in God’s hands and in the hands of Dr. Accola, in whose hands God has placed us. I love it that Dr. Accola again reiterated to us at Monday’s appointment that after all, it’s God he works for. For now, we have much to do and are entirely too busy to worry about what it’s not yet time to worry about. Jesus said to take one day at a time and to seek first His kingdom. That is what we will strive to do, though I expect to have our weak moments. And so, in celebration of my 52nd birthday on Saturday, I plan to run the Shamrock Run & Walk 5k in downtown Winter Haven with my daughter Sarah. Running with Sarah will be really special. Don’t worry, my doctors are okay with me running, as long as I don’t push it too hard. And I would never do that; now would I?

In further praise of the rich comradery, support, friendship, and family dynamics of the Heart Valve Journals community, this past week Peggy and I had the wonderful opportunity to meet in person our third fellow HVJ couple. Richard & Susan Ingham from Maine were vacationing in Florida and we were able to share dinner together in our home Thursday evening. What a wonderful time we had together! They are great folks. Richard and I entered the hospital on the very same day, 1/27/2010, he in Boston, me in Orlando. My heart catheterization was during the day; his surgery was that evening; my surgery was the following day. His mitral valve was replaced; mine was repaired. We both had some complications and a longer than expected hospital stay. Several times I recall “coming to” from anesthesia and procedures and saying, “I’ve got to know what’s happening with Richard.” These kinds of experiences are deep bonds we share, and many on these journals have formed similar bonds with many others. Thank God for such a caring community as this! And thank you again Adam! You rock for all you do for us and the cause! My most recent posted photo is a new pic of our get together with the Inghams. Richard & Susan, love you guys! So we have personally met Fran & Pete Zilko (2x), Kevin & Eileen Kimmel, and now the Inghams. I’m pretty sure we will meet more of you over time, and that’s really exciting to me. I’ve spoken with many others over the phone, am facebook friends with several, and have corresponded personally with still many more. Thanks for the community, fellow valvers—Fran & Pete, Kevin & Eileen, Richard & Susan, Thomas & Kim, Captain Bill, Michael, Janet, Cheryl, Penny, Theresa, Susan, Patrick, David & Marjorie, Carla, Lori, Trevor, Kathy, Melany, Amy, Melissa, Joel, Steven, at the risk of leaving others out. Surprise, surprise, surprise (I’m thinking Gomer Pyle)! Two weeks ago I did a heavy amount of running, prepping for a March 12 (my 52nd birthday) 5K (3.1 miles) here in Winter Haven and just training in general to run a 10K (6.2 miles), concluding with some increasingly heavy weight training (really not that heavy, though I wish I could say so!) on Sat. 2/19. By Saturday night I was feeling some pressure and discomfort in my chest, along with some shortness of breath on Sunday (not ideal for leading worship vocally and teaching). Our planned President’s Day trip to the beach got trumped by a visit to my family doctor on Monday and my cardiologist on Tuesday, profuse with labs and diagnostic tests. Remembering the sensations from a year ago, I was not surprised when they discovered (via echocardiogram) some pericardial effusion (excess fluid in the pericardial sack around the heart). I took an antibiotic for 10 days (since my white blood count was somewhat elevated) and I was put back on Celebrex 200mg 1x per day. These med changes have interfered with my INR levels, which have ranged from 4.2 to 1.6 (my therapeutic range is 2.5-3.0), so for now I’m back to the anticoagulation clinic twice a week. Was this episode cause by overexertion or some sort of virus? That’s not clear. I guess I really (perhaps naively) thought, at 13 months post-op, that this was all behind me, but surpise! back to patchy chest shaving, leads, echos, and CT scans. I will keep you posted of any significant developments, but thankfully the symptoms have abated and I am well.

As unbelievable as it is, Friday marked the one-year anniversary of my open heart surgery (median sternotomy mitral valve repair) on 1/28/10 and today marks the one-year anniversary of my cardioembolic stroke (2 days post-op) and neurological interventional angiogram to dissolve the clots in my brain. It’s all still unbelievable to me! I may not always feel like it, but my life is a miracle from God. I am a miracle! (But then again, so are you!) At one year post-op, I am doing great. To celebrate this anniversary week, I ran in my very first race (well, since Physical Education in school) on Jan. 22, the Winter Haven Hospital Foundation Citrus Classic 5K. It was a benefit for the hospital’s Bostick Heart Center, where I did my cardiac rehab. So the convergence of the timing and nature of the event made it an obvious “do” for me. I had no problems running, and it was very cathartic to cross the finish line. My time was 27:45 (certainly no Olympics in my future, but hey). I placed #70 out of a total 142 runners, #49 overall male, and #5 in my category of males 50-54. Only two slots beneath medaling! I have posted some pix. It was so much fun I’m planning to enter some more races in the future. Who knows, maybe I’ll medal sometime? To all who are awaiting surgery or are early in their recovery, a year out most of you will be doing great too. Aside from some meds (warfarin and Crestor), some occasional medical appointments (haven’t seen my cardiologist since August and won’t until late March; monthly INR checks), and some precautions (heart rate monitor watch during intense exercise, diet), I wouldn’t even know I’m a cardiac patient. A long time ago I left my electric razor behind and returned to a straight razor; I rode my first post-surgery roller coasters in September; I got on my roof this month to clean out the dryer vent; I’ve been running and working out pretty much like before (with some performance reduction, but so what?). In other words, just living life. My scar has faded nicely. Though I will forever be a scarred man (aren’t we all?), you wouldn’t even notice it on the beach unless you were looking for it. I have posted a one-year pic of my incision. Our scars make us who we are. As I reflect on this past year I am quietly celebrating that, though it’s certainly been a difficult one, the journey has been precious and rich. Peggy and I have experienced God’s presence and peace as only you do when you “walk through the valley of the shadow of death” and have found at a new dimension that truly “the Lord is my Shepherd” (Psalm 23). All we can do is praise God for His peace, presence, healing and restoration! We will never forget Peggy repeatedly asking every doctor and nurse “so how much damage is there?” in the days following the stroke and consistently getting the response “no damage.” None! In the words of my hospital-appointed internist, Dr. Adrianna Otto, one year ago today after the stroke intervention, “we have seen a miracle!” My profound thanks to Dr. Kevin Accola (my heart surgeon), Dr. Frank Hellinger (my neurosurgeon), Dr. Otto, and the entire team of amazing nurses and staff at Florida Hospital, my local physicians Dr. Koilpillai (family) and Dr. Willard (cardiologist), my cardiac rehab nurses Bert & Ashley who helped rebuild my confidence, my loving wife, parents, and children who shared the roller coaster journey, my supportive church and network of friends, to Adam Pick for his incredibly helpful book and resources, and to this amazing heart valve journals community and family. Your support and comradery has been of incalculable worth. Like I said in a journal early on, we are “the Fellowship of the Valves.” I have made some dear and lifelong friends here. We are one. I love you guys! Thank you all! Please do keep in touch via Facebook or email. One year out, a restored and grateful man I am! Philippians 1:21

Wow, it’s been a long time since I’ve written a new journal entry. After your initial recovery, life goes on and you get busier and busier. I’m doing great! I haven’t seen my cardiologist since August and don’t see him again until late March. One year ago this week (the 21st) I had my first appointment with my heart surgeon, Dr. Kevin Accola in Orlando. Surgery followed 5 weeks later. Today I ran 8 miles, which matches my all-time high (if I recall correctly). I give all thanks and glory to God! I’m planning to enter the Winter Haven Hospital Citrus Classic 5K Run on 1/22/11, the week of my one-year surgery anniversary. Cool way to celebrate! Merry Christmas to all as we celebrate the birth of Jesus Christ, Emmanuel--God With Us. He certainly has been with me this year! To all who are waiting for their surgeries, to all who have recently had them, to all at some point on the recovery road, and to all the caregivers, Christmas means that God is with you too!

All of us who are members of the Heart Valve Journal family are experiencing shock waves, cold shivers, and shared grief today. One of our own, Lori B. from Austin, Texas, died yesterday at the way too young age of 39, leaving behind a wonderful husband Adam, himself a family physician, and 3 beautiful daughters under the age of 7. Like me, Lori was overwhelmed by a sudden and totally unexpected diagnosis of mitral valve prolapse and severe regurgitation. Like me, she went in for mitral valve repair surgery. Her surgery was last Friday, August 13. Things took a turn for the worse when the surgical team was unable to take her off the heart-lung bypass machine. Following that was a series of progressively compound devastating complications. The machines were disconnected yesterday. Like everyone else, I too am just shaking my head and shedding tears and offering up prayers for her family. The HVJ’s are more than a collection of heart valve patients posting; it is a close knit community, a family, and we have lost one of our own. Patrick said it best to me in a Facebook message: “it feels like we lost a sister.” Indeed. A few of us have had some pretty good scares in recent months, myself included, but Lori is an actual and tragic loss, and we all share in the grief and in the love and prayers we extend to her family. Lori posted the sweetest message in my guestbook on August 4 (look it up if you want). I didn’t know who she was, so I did a search on the journals and was unable to find her. Apparently, she hadn’t yet had the time to set up her journal as she was rushing to multiple medical appointments and struggling to process it all. Familiar territory for all of us. I was out of town last week and missed her journal entries leading into surgery and her family’s updates. Others’ posts yesterday alerted me that we had lost one of our own. Lori’s loss is a stark reminder that, though the medical community has profoundly miraculous results with open heart surgery, it is still life-threatening and is far from routine. The odds are in our favor, but the bottom line is any one of us could die from it. It’s a risk we all take to get well. A couple times during my complications I wasn\'t sure I was going to make it, and I thanked God that we had redone our life insurance and wills. We know it’s risky business, but it’s riskier not to. I know this is seriously troubling to all who are still facing their surgeries. You cannot let this tragedy dissuade you from what you need to do. Unless you have the surgery you would eventually die from the condition. Those odds are 100%. The odds of coming through your surgery fine are probably 98+%. So honestly, we really don\'t have much choice. Our choices come on timing, surgeon, and facilities. My advice is to prepare for the worst, but plan for the best. Arm yourself with information and preparation to make the best decisions you can control. Then, leave what you can\'t control in the hands of God. When I faced a series of complications, I was very concerned, not wanting to alarm or worry others still facing surgery. The last thing I wanted was for my open journal to dishearten or bum anyone out. I know that Lori would feel the same way. Lori would definitely not want any of us to be paralyzed by survivor’s guilt or to quit living or fighting because of what happened to her. We all have unanswered questions in life. Why’s we will never know this side of heaven. So much is out of our control. Probably the only thing we truly can control is how we respond to what happens in life. At many times in my life I have found comfort in the lyrics of the Amy Grant song “Somewhere Down the Road.” And so, for a family and community needing comfort, I conclude. Somewhere Down the Road by Amy Grant & Wayne Kirkpatrick So much pain and no good reason why You\'ve cried until the tears run dry And nothing here can make you understand The one thing that you held so dear Is slipping from your hands And you say Why, why, why Does it go this way Why, why, why And all I can say is Somewhere down the road There\'ll be answers to the questions Somewhere down the road Though we cannot see it now Somewhere down the road You will find mighty arms reaching for you And they will hold the answers at the end of the road

Hi Everyone! I have been in a very reflective mood this week as I marked the 6-month anniversary of my mitral valve repair surgery on Wednesday and of my stroke and intervention today, Friday. Hard to believe it’s been six months. It’s gone by really fast. As I worked hard at cardiac rehab this morning, thinking of six months ago, I thought, “how in the world could I possibly complain about anything?” Considering the what could have beens, here I was working out, thinking clearing, going out to work, and coming home to my wonderful wife and two of our precious grandchildren we are watching for a few days. It’s a wonderful life. “For to me, to live is Christ and to die is gain (Philippians 1:21).” I will be finishing rehab next Friday; only three sessions left. My life is pretty much back to normal—only more meds, less caffeine, more doctors, a bit less stamina. I can work out hard, but not as hard as before. That may take a long time, if ever. But that’s okay. I am a different man now in many ways. The scar continues to gradually fade; I have posted a picture to show how it looks at six months. We certainly have traveled a lot this summer, and on the trips I was able to do everything I wanted. To all heart valve patients pre-surgery and in early recovery: in six months you’ll likely be very much back to normal, even if your recovery has some bumps. It’ll go by fast too. We had a great trip visiting two of our sons and their families, including our three youngest grandchildren, in Panama City Beach and Nashville. Heartbreaking to leave the grandbabies!! Last week we were in south Florida for some meetings and were able to again visit with fellow heart valve patient Fran Zilko and her husband Pete. They are amazingly wonderful people and we feel fortunate to have personally met them twice now. Heart friends. I have posted a couple pix. I plan to post again when my rehab concludes and then to taper off, riding into the sunset of recovery. My heart will forever be with fellow heart valve patients and I will always be eager to offer any assistance and support I can.

Peggy and I returned from our Caribbean cruise around midnight the night of June 29-30. We had a wonderful trip in every way. It was amazing! I’ve posted a couple pix (I took over 6500 pictures—no joke!). The seas were slight the entire cruise. But, with a port every day, we did return pretty exhausted. After all, we are always among the first ones off the ship and the last ones back on. We did a lot of hiking, snorkeling, swimming, and touring. Driving in the Caribbean is always an adventure. I jumped into rainforest pools and under waterfalls. For the most part, I vacationed, ate (way too much), and acted like I wasn’t a cardiac patient, and that was great! I did wear my heart rate monitor watch for the biggest hike—4 miles roundtrip and pretty steep to Middleham Falls, the highest falls in the rainforest mountains of Dominica (spectacular). When the heart rate got above 150, I would slow down. I did great! After arriving home at midnight, I had cardiac rehab the next morning at 8:00. That was a tough one! I’ve been doing well at rehab the past week but I’ve been working my heart pretty hard. I’ve been experiencing some PACs—premature atrial complexes—and some PVCs—premature ventricular complexes, along with a little depression, which the cardiac nurse said is the heart not quite getting enough oxygen. The sensation is like a flutter or a skipped beat. My nurse said my heart is doing great and it’s no big deal, but that I am so fit, have such high exercise tolerance, and am so stubborn that I scare her. She knows me well. I’ve got to learn to pay attention when I feel this and back off a bit when I’m working my heart that hard. That’s all. Okay, okay. I found this information with some online research: “Premature atrial complexes (PACs) and premature ventricular complexes (PVCs) are abnormal electrical impulses arising either in the atria or the ventricles, respectively. These arrhythmias often produce palpitations, but in general have very little medical significance.” Today I finished rehab session 28 of 36. With some misses, it looks like I’ll finish the program Aug. 4 or 6. Great program! Last Friday my INR was at 2.5, so I don’t report back to the anticoagulation clinic for a whole month; a first for me! No vertigo episodes, no TIAs, no TMBs (transient monocular blindness) since May 26, thank God! So, I’m doing great, and we’re getting ready to go again on a car trip to visit kids and grandkids in Panama City Beach and Nashville. Grandpa’s coming!

Hey everyone! Big news for me this week: on Tuesday morning, I went for my first run since surgery. It felt so good and it didn’t feel so good. You know what I mean. Mentally it was just great, but it was physically more challenging than before. Duh! Don’t worry, I had gotten my cardiologist’s okay, along with guidance from my cardiac rehab nurses. I bought a Timex T5H891 heart rate monitor watch (55.95 at amazon.com) so I can monitor my heart rate carefully to get back into running, hiking, and more intensive workouts. The watch portion is great, but you have to wear a transmission strap around your torso about breastbone level. That’s kind of annoying, plus it kept popping off since I hadn’t hooked it right. It must be a glimpse into what women have to put up with wearing (strapless) bras. I wouldn’t know. It’s good to be a guy! As I jogged, any time my heart rate got into the 150s I watched carefully. When it hit above 160, I would just do walking intervals until it got back down into the mid-140s, and then I would resume jogging. I logged in 2 miles. Not bad for my first time back. I will take it appropriately easy, but Duane is on the run again! On Wednesday, after cardiac rehab, I had an appointment with my hematologist in Orlando. He’s the only Florida Hospital specialist still wanting to monitor me. All my other physicians are here in Winter Haven. He told me my blood work looks fine, and I’m doing great. I shared with him about the TIAs. He feels I am getting all the right tests and care for that, but reminded me I will be on warfarin “long-term,” aka life. Yup! Unlike all my other doctors, the hematologist does not believe I am anemic and told me not to be concerned with my low ferritin. Ain’t it fun when your docs don’t agree? I see the hematologist again in two months. Here are some recent labs: 5/27/10: Iron 95 (range 45-182) Ferritin 14.2 (range 22.0-322.0) HGB 14.9 (range 13.0-17.0) 6/16/10: HGB 15.2 (range 12.0-18.0) That’s the news for this week. Tomorrow after rehab and INR clinic, I’m ditching this heart event monitor. I am way beyond sick on wearing it. Our local family is all coming over to celebrate Father’s Day on Friday night. Immediately after church on Sunday, Peggy and I are leaving to catch a flight to San Juan, Puerto Rico, and from there to cruise on the Carnival Victory. St. Thomas/St. John, Dominica, Barbados, St. Lucia, St. Kitts, St. Maarten/St. Martin, and Puerto Rico, here we come! Duane and Peggy are on the cruise again!

My last post was May 10, so it’s been a full month I’ve been MIA. Sorry for the lack of communication. I haven’t gone AWOL. I’m just finding it increasingly difficult (impossible) to balance the demands of ministry, family, life, and health. Bottom line: I’m just not keeping up with everything very well. With the long interval, I greatly apologize that this is going to be a mega post, only for the hard-core or medically interested. Proceed at your own risk. With my last post, I was taking my first flying trip since surgery. No extra TSA checks due to sternum wire either direction. I did fine on the trip. Only on my return flight I nearly had to spend the night in the Atlanta airport. Due to weather delays, I missed my connection, so my only option was to try to make the last flight from Atlanta to Orlando that night. I was #41 on standby, virtually hopeless. But thank God, I was the second to the last person to board. Phew! I am now 4-1/2 months post-op, and my life is really pretty normal now. Back to work full speed. No afternoon naps (sad). Two exceptions: a continuing plethora of medical appointments and my physical stamina is not at pre-surgical levels, but it is definitely improving. About three weeks ago, I started mowing my own lawn again (just in time for the need to cut about every 5 days). It’s a non-propelled push mower on St. Augustine grass, so it’s a bit of a workout. Also about three weeks ago, I started pressing the nurses at cardiac rehab about pushing me harder. They did not want my heart rate to go above 122-125. Let me just say that I am not your typical cardiac rehab patient. Most of them don’t seem to want to push too hard, and it takes great effort to even get their heart rates up high enough to make the aerobic zone. Not me. My heart rate instantly jumps into the zone and they were always trying to hold me back to keep it from going too high. Well, after consulting with my cardiologist, the nurses got his okay to push me as hard as I want to go, as long as my monitored heart behaves itself. Since that time, they have definitely been kicking my butt! (Be careful what you ask for.) I have made quantum leaps in increasing resistance, and I now leave the sessions drenched in sweat. Yeah! It feels good to sweat again. My heart rate has been up to 160 or so, and it’s handling it well, with an occasional skipped beat. Tomorrow marks session 21 out of 36. I am so grateful, because without rehab and monitoring, I would never have had the courage to push myself this hard and start rebuilding my physical stamina. With absences caused by summer travels, I will be in the program well into August. I just can’t say enough good about it. Symptoms In previous posts I have mentioned some issues with vertigo and vision. It’s hard to describe the vision symptoms. Over the past couple months about 4 or 5 times I’ve had episodes where part of my peripheral vision in my right eye goes dark suddenly. It’s much like a shade being pulled down half way or a vertical blind being closed half way on the right side. If I move my eye’s focus toward the dark area, I can see, so it’s definitely peripheral. These episodes have only lasted 20-30 seconds. Another 3 or 4 times I’ve felt like my eyes weren’t focusing in synch, making my vision fields rather cross-eyed. I have just assumed these symptoms were in tandem with my vertigo issues. I haven’t had a vertigo episode for several weeks. At an April 28 appointment with my family doctor, he referred me to a neurologist. Neurologist appointment 5/26/10: • I was very impressed with the neurologist. We met in his office with him behind his desk, just like in the doctor commercials, only minus the cheesy fake dialogue. I had had all of my medical records from Florida Hospital faxed to him, so he thumbed through about 4” of papers, keeping what was relevant to him, and giving the rest to me. He spent at least 30 minutes with me and also took me into a side examination room to test my reflexes and motor skills. • Awesome news: He sees absolutely no residual or permanent damage from my 2-day post-op cardio-embolic stroke. He affirmed that we had absolutely done the right thing by going for the interventional neuroradiology angiogram which dissolved two clots in my brain using TPA. All I can say is, “Thank you, Lord.” He explained that the stroke was relatively mild and had been on the right side of my brain, thus affecting the left side of my body. That also explains why I was so alert and communicative throughout the stroke. Had it been the other side, I would have been less so. • The vertigo spells are not medication caused. My symptoms did not describe medication dizziness, but rather classic Vestibular Positional Vertigo. As disconcerting as it is, he explained that vertigo is not a serious medical condition. It is related to the fluid in the inner ears, which is key to our sense of balance. As we get a little older (ahem), the fluid can thicken somewhat becoming more viscous and sometimes forming tiny crystals and the tiny hairs in our ear canals become less efficient. Sometimes when these crystals break up, it interferes with balance signals to the brain, causing vertigo. Clear as mud? He gave me some exercises to do daily. It’s essentially lying on your side in the fetal position for 30 seconds to drain one ear; then switching sides to drain the other. A set is doing this five times. I have only done this once, since I have not had any vertigo episodes since the appointment. • The episodes during which I have temporarily lost part of the field of vision in my right eye are more alarming. Interestingly, I actually had one of the spells right there as we talked together. That’s the latest episode I had. These he said are TIAs-- transient ischemic attacks (mini-strokes). He also called them TMBs—transient monocular blindness. And then he threw one more label: Amaurosis Fugax. Timeout! Assuming these vision symptoms were part of the vertigo complex of symptoms, I was just not prepared for this and was pretty overwhelmed. He explained that with AF tiny clots break off from blockages in the carotid artery and move to the retinal artery. When this happens it results in the partial temporary loss of vision field. Thank God, the Coumadin is working by breaking up the clots. Thus the duration of only 20-30 second episodes. • The neurologist indicated the next step would be a CTA—CT Angiography—as an outpatient at Winter Haven Hospital. (I have since learned I can have this at my clinic, which I prefer.) CTA scans take x-ray pictures in the form of slices of the brain and the arteries in your neck. CT scans can show an area of the brain that has poor blood flow. Contrast dye is injected to make blood vessels visible on the x-ray image. CTA shows the arteries in the neck and head and will identify areas of arterial narrowing. He looked through my records from Florida Hospital again and noted that I had a CTA done there the day after the stroke and everything, notably the right carotid artery, looked clear. It would be highly surprising if just 4 months later, the carotid is blocked. But he felt a follow-up test was needed. • He gave me a prescription for some lab work he needed before scheduling the CTA and also recommended I see my eye doctor to have my pupils dilated to do a thorough exam and get a good look at the retina to see if there are any tiny clots. He also felt this was all unrelated to my stroke on 1/30. I just don’t know. Cardiologist appointment 5/27/10: • The next day happened to be a previously scheduled appointment with my cardiologist. • The results from my 24-hour Holter monitor test April 21-22 were fine; there were only a couple skipped beats in the 24-hour period; nothing unexpected. • He affirmed the switch from Pravastatin to Crestor and asked if I am tolerating it; yes. He wants my LDL under 70. I’ve got a long way to go. • He feels that my heart is doing fine and he reiterated pushing me hard at rehab, as I requested. • He gave me the okay to resume jogging-walking intervals, keeping my heart from going too high. I have purchased a Timex heart rate monitor watch so I can watch my heart rate during physical exertion. I plan to start jogging any day now (sounds like a cop-out). • My cardiologist continues to be greatly concerned about my low iron, worried there must be blood seepage somewhere; he prioritizes getting my iron level up and doubled my iron supplement back to twice a day. Also, I was directed to resume an 81mg aspirin once per day. • He is very concerned about the TIA episodes but disagrees with the neurologist’s diagnosis of Amaurosis Fugax; he feels that, with the clear CTA test from Florida Hospital on 1/31, it’s virtually impossible that the carotid artery is the source of plaque break-off and that another CTA is unnecessary. What do you do when your doctors disagree? Not surprisingly, when it comes to warfarin, he told me I was a lifer. He also considers me a very complicated case. I guess many people do. • I then went to the clinic’s lab to have several vials of blood drawn for tests. • Next I went (that same day, just an hour later) for a Brain MRI, which he felt was absolutely essential given my history. I concurred. Question: Why did I have to remove my pants for a brain MRI? The shirt stays on; the pants gotta go! Good news: NEGATIVE. I guess it’s good news when your brain MRI is negative. ;-) Given my stroke, I feel this is a miracle. • He set up a referral appointment with an ophthalmologist the next morning. • Finally, he put me on a King of Hearts Express Cardiac Event Monitor for 28 days. Great, I’m wearing two sticky electrodes 24-7 for a month. It’s really fun to add the four additional electrodes at every rehab session. The receiving unit is about iPod Classic sized and I generally wear it on my belt. At night I’m supposed to put it under my pillow, but there isn’t enough line to do that. Honestly, it’s more aggravating to me than it probably should be. I guess I’m just really tired of all these tests. Though it’s constantly monitoring my EKG, it’s also constantly overwriting the data. If and when an episode occurs, you hit “record” and it saves 30 seconds prior to that moment and an additional minute forward. You then send the data in over the phone. No real episodes so far. I don’t expect any. The episodes have never seemed to me to be cardiac related. I warned the doctor’s office that I would not be wearing the device the full 30 days, as we have a Caribbean cruise planned and I’m not going to take it. Ophthalmologist appointment 5/28/10: • My referral appointment was first thing the next morning, and the ophthalmologist dilated my pupils big time (it lasted all day; Florida sun alert!) and did a very thorough eye exam plus a field test of my peripheral vision. • He said my eyes look very healthy. • The eye’s small blood vessels look great; no signs of atherosclerosis. • No clots or emboli on the retina walls. • Peripheral vision good. • He noted no permanent vision loss or damage from the stroke. Again, praise God! • My symptoms do describe TIAs, but he sees nothing mechanical in the eye. He said TIAs are in the brain. He affirmed I’m on the right treatment taking warfarin. So there you have it. I’m doing great overall, but I just continue to throw a few mysteries into the mix. I’m still waiting to hear back from my doctors about their take on everything and my next steps. Again, what do you do when your doctors aren’t on the same page? Sometimes I wonder if I’ll ever get fully “out of the woods.” Honestly, probably not. I need to learn to accept it, and I sometimes struggle with that. A few months ago I thought I was in perfect health. Now I am permanently a cardiac and stroke patient. Fortunately for me, as a nature lover, I love the woods. And as a follower of Jesus Christ, I affirm my faith and hope in His control and plan for my life. With everything I’ve experienced, I have no right to complain. So, I am going to be as smart as I can, listen to my doctors (when they agree; if not, I’ll pick what I want to hear), do all the right things I know to do, pray, and then just live my life. I will not allow my life to become the glass menagerie; I will be active, I will travel, I will live. Caribbean cruise, here we come. Out of town children and grandchildren, Grandpa\'s coming soon. One final note: last Friday night, Peggy and I had the wonderful opportunity to meet in person fellow heart valve journal patient Kevin Kimmel and his wife Eileen. The Kimmels were on vacation in Florida from Pennsylvania and we met at an Outback Steakhouse for dinner. Wonderful folks. Great time. Kevin and I are about the same age (okay I’m a year older) and we actually both had our surgeries on the same day, January 28. I have posted some pictures. The support of Adam Pick, his accumulated resources, and fellow HVJ patients has been beyond words. I\'ve met two of you in person, spoken with several others and corresponded with many more. If you ever find yourself in central Florida, please look me up. Thank you everyone for your continued prayers, support, and friendship.

First off, I hope all you Moms had a wonderful Mother’s Day yesterday. You deserve it! After a good service at church, Peggy and I enjoyed being with both our Moms and our son Jonathan and his family. Days like that make me miss the years when all our children were young and at home. May 6 was Nurses Day and Nurses Week continues. My heart is filled with appreciation and awe for the amazing, skilled nurses who cared for me during my hospitalization at Florida Hospital. Top notch in every way. And my two cardiac rehab nurses are great. Here’s a shout out to all nurses! Right now I am at Orlando International Airport preparing to fly to Fort Wayne, Indiana for meetings this week. I am a member of the Missionary Church General Oversight Council. This is a big step for me, my first post-op flight or trip of great length. I’ve already had one question answered: when I went through airport security, my sternum wires did not generate any additional screening. I was fully prepared to bare my chest. No need. I will miss cardiac rehab all this week, but I hope to find time to exercise and walk anyhow. Rehab continues to go well and the nurses keep on increasing my time and resistance. Peggy and I still love our 3-mile daily walks. And on Saturdays I’ve been working out at Gold’s Gym with more focus on upper body weight lifting (light weights). After a week of no vertigo episodes, I had one on Friday and two on Saturday. I have an appointment with a neurologist on May 26, followed by my cardiologist on May 27. I was on amiodarone for 2 months (stopped April 7) and I was told it stays in your system for 8 months. I\'ve also been on Celebrex for 3 months now. Both of these can cause dizziness, so it is possibly medication induced. My stroke history makes everyone--my doctors, my wife, me--a bit more paranoid and perhaps overly cautious. Thus my family doctor\'s referral to a neurologist. I welcome the check. Have a great week, everyone!

This week marked the 3-month anniversary of my mitral valve repair surgery on January 28 and 13 weeks post-op. Unlike many others, I never felt that my recuperation was long and boring. To me, it seemed to fly by and here I am. Except for cardiac rehab, still frequent medical appointments, a lot more meds, and a lot less energy and stamina, “normal” life goes on pretty much as it was before surgery. Hmm, then again, that’s a lot of “excepts.” Mainly I’m doing very well and feeling good. Cardiac rehab is going great, and I am really enjoying and appreciating the program, though not necessarily the 8:00 hour (7:45 on Wednesdays for education classes). I am not one of those people who wake up eager and ready to go; I’m a slow starter. Today was my 8th session and the nurses have upped my time on each apparatus to the maximum and are increasing the weight and resistance levels. Yeah, progress! My heart is easily getting into target range above 110, and my cardiologist has given permission for them to exercise me over target, so I’m often in the 120’s. Today there was only 1 skipped beat, which they say is okay. The most I’ve had during any rehab session was 2 skipped beats. So far the classes have been on cholesterol, heart patient emotions, and hypertension. My favorite rehab moment happened today when one of the older men asked me, “so, how old are you, 15?” Right digits, wrong sequence. Man, I love that guy! I have learned the great secret of feeling young…hang around people much older than you! My last INR level on April 20 was 2.7, so I was given an almost 2-week interval to May 3. That’s instead of twice a week. Progress. On Tuesday I had an appointment with my Gastroenterologist. The capsule endoscopy study came back completely normal. So, ALL the oscopies from top to middle to bottom have been fine! I’m thankful to God for that. My anemia and iron count are showing signs of improvement. He said no explanation is better than a bad explanation. The results from my 24-hour holter monitor test from last week came back with no concerns—only 3 missed beats in the 24 hours. That included a cardiac rehab session plus a 3-mile walk. Peggy and I are continuing those (almost) daily walks and enjoy the time together. On Wednesday I had a routine 6-month follow-up appointment with my family doctor. It was the appointment 6 months ago at which he first detected the heart murmur. My how time flies when you’re prepping, having, and recovering from open heart surgery! My labs showed improvements in the blood counts and hemoglobin. Unfortunately, my cholesterol continues to be too high—total of 201, HDL 41, LDL 145! So, the doctor switched me from 2 Pravastatin per day (which I’ve been on about a year and a half) and started me on Crestor. Time for some bigger guns. Doctors want that LDL below 100, with my cardiologist wanting 70! Long way to go. One problem I have been having is some spells of vertigo. It’s very strange and hard to explain. But when a spell comes on my vision is suddenly like a strobe light with a rapidly shifting up and down angled horizon. I am immediately dizzy, nauseous, and clammy and have to sit or lie down immediately. I have checked my pulse during these, and the heart seems fine and steady. They have only lasted a minute or two. I have had several of these over the past weeks, three in one day, but usually only one every few days. I mentioned this to my family doctor, concerned it might be a neurological residual from my stroke. He agreed that needs to be investigated and has referred me to a local neurologist. I am praying this doesn’t transform into anything major. As a stroke patient, it’s probably wise for me to be established with a local neurologist anyway. Thanks for all you continued interest, support, and prayers. From Reader’s Digest 3/10: I’d just come home from my sixth medical appointment of the week with one more to go, so I was in a lousy mood when my daughter called. After I recited my woes, my daughter said, “Well, seven doctors is better than one coroner.” --Wendy Garrett, Dickinson, TX

I want to update everyone now that I’ve had two sessions of cardiac rehab plus one class. It’s great, and now I’m really excited about the program and the bridge it is creating for me back to exercise and fitness! Yes, it is very structured (though somewhat more flexible than I at first understood) and time demanding, but I so see the value. My program is the Winter Haven Hospital Cardiac Rehab, and it appears to be a great one! I have posted a pic that shows one angle of the facilities. I go to the earliest rehab offered every Monday, Wednesday, and Friday from 8:00-9:00 a.m. (plenty early for me), plus there is a class every Friday from 9:00-10:00 a.m. The two nurses who lead the program are awesome! One monitors the screen with everyone’s heart EKG readings and calls out instructions; the other circulates among the patients on the floor, taking blood pressures and offering assistance. There are six men in my class so far; right now I am (but of course) the youngest. I am the only heart valve surgery patient; the others have had bypass surgery or angioplasty and stents. Here’s an outline of a session for others facing Cardiac Rehab: 1. Arrive, weigh in, pick up a heart monitor belt, attach the 4 electrode pads in the locker room (I arrive pre-shaven), have your blood pressure taken and report your weight. 2. Warm up with 10 sets of several stretching exercises, then walk the small track around the room. 3. The core of the session is rotating between several exercise apparatuses, as the nurse calls out where you’re to be and at what level. During each segment, you call out how hard you feel you are working on the 0-20 scale (11-13 is considered optimal). The nurse strives to get you into and keep you working in your target heart rate. As you progress in rehab, the time and intensity on each exercise increases. Once during the whole session, the floor nurse takes your blood pressure while exercising. So far, I have rotated at about 5-7 minute intervals between the treadmill, water rower, recumbent bike, cable pulleys, airdyne bike and free weights. There is other equipment I have yet to use. 4. Cool down by walking the track and then sitting down for your blood pressure again. 5. Remove the electrode pads in the locker room, place your used monitor into the bin to be sanitized, then leave. The class on Friday, taught by one of the nurses, was on Lipids, featuring our own individualized lipid and cholesterol profiles and what we needed to target. Very good. In my first two classes I have done very well. I have easily been exercising up to my target heart rate of 114 and beyond to 124. The nurse told me she will have to get permission from my cardiologist for me to continue exercising beyond my target rate, but my heart has done great. No rhythm issues or any problems at all. My blood pressure after exercise has been around 94/60. They plan to push me more next week. It has felt great to exercise and sweat a little again. So much so that Peggy and I went to Gold’s Gym today. First time we’ve used our membership in 3 months. I was very careful and selective, but it was wonderful to be there again. The nurse encourages us to exercise on our own outside the sessions, but I am not allowed to jog yet. Okay. It has been very comforting and confidence-building to exercise while being closely monitored by people who know what they’re looking for and what to do if anything goes wrong. There is a red button in the room to push for the immediate attention of the ER. Hope I never cause or witness that! Otherwise this week, I e-filed my taxes on April 15. I pay quarterly estimated taxes and never get refunds, so why do it any earlier? Okay, that’s my excuse; my reason is, I’m a procrastinator! Plus I’m in absolutely no mood to give the government any money! My INR was down to 2.4 (my desired range is 2.5-3.0) on Thursday so they increased my dose slightly; back again this coming Tuesday. I broke off a piece of a tooth eating hard candy (guess I’m too old for hard candy), so it was a quick trip to the dentist. Guess I’m bored with just cardiac and GI issues. I need a crown (rats!). Due to being considered at high risk for endocarditis, I will need to take 2g of Amoxocillin 1 hour before any dental work. Coming attraction this week: 24-hour Holter Monitor of my heart Wed-Thu. I asked the nurse what kind of activity the doctor might want to monitor, including well, um, night activity? Yes that. Seems a little personal to be documenting in the written record, and you all know how shy and inhibited I am. Well, alrighty then, since he asked for it.

Well, it’s finally my time to go to rehab—cardiac, that is. I’m not sure what the delay has been for me since I will be 11 weeks post-op on Thursday. Guess I’m a late bloomer. The rehab nurse said it’ll just make me more advanced in the class. That stoked my competitive urges. My cardiologist never suggested it until I brought it up. Once I passed his exercise stress test, I was approved. And UnitedHealthcare approved me for up to 36 sessions. Today was my orientation at the Winter Haven Hospital Cardiac Rehab, and it literally took the whole morning. I was quite honestly surprised to learn how structured and rigid the program is. Are they all like this? It’s 36 sessions (wow, that’s a long time!). If you miss, you have to make them up. You have to attend extra classes on diet, cholesterol, stress, etc, so you can graduate. You have to go at the same time every time. Who has time for this? (Guess I do.) I know what I’m about to say may surprise those of you who don’t know little ‘ole me well (those who do will just nod in affirmation and say “oh yeah”). Being pretty free-spirited and decidedly unstructured (my personal style is people unstructured), at some levels all this rigidity just made me want to rebel. Yes, you read that right. Please don’t be too disappointed in me, being a minister and all. Really now, why can’t they be more flexible? Anyhow, I somehow managed to control my urges to protest and I see the value, so I’m going to tame the beast and just do it. My least favorite part today had to be having circle areas in my chest shaved yet again in yet different areas, and learning that shaving will be a regular part of my life for the foreseeable future. A renewable resource. My chest and stomach and abdomen are shaved, stubble, and hairy at so many different levels and in so many patches it looks like the aliens are trying to send messages in the fields (like in the movie “Signs”). Absolutely ridiculous looking. Just in time for Florida beach weather. I’m actually considering just shaving it all off myself until there’s a reprieve. Flashbacks of the pre-op full body shave! Might be empowering. At least it would all be at the same stage. It’s an “in” thing to do, isn’t it? We’ll see. I start tomorrow bright and early at 8:00 a.m. Now that in itself will be a miracle. Every Monday, Wednesday and Friday @ 8:00 for 36 sessions. There are up to 8 patients in each class. Being a seasoned exerciser, I found the introductions to all the familiar equipment and exercises (treadmills, bicycles, rowing machines, free weights) tedious, but I was with another older gentlemen who needed it. Surely I don’t need any instruction. ;-) (Rest assured, I was a good boy and very compliant and cooperative.) But I must say, it did feel really good to, even at a very basic level, do some of the exercises today. Another bridge to normalcy. Until I can confidently be more physical, I’m not being the same me. That has me really looking forward to it! I’m really hoping to build back up to where I was a few months back when I thought I was fit and in perfect health. Duane, come back, come back. Rehab, here I come! Yes, yes, yes.

Yesterday I marked 10 weeks post-op by having a Capsule Endoscopy study. Doesn’t everyone? As a result of the combination of warfarin, anemia, and a positive (for blood) stool test, I had the top and the bottom checked on 3/25 with an EGD endoscope and a colonoscopy. They scheduled me for a capsule endoscopy study yesterday to check the middle (the small intestines). Here I was thinking, “yeah, I don’t need another colonoscopy for 10 years!,” and I find out at the last minute that the prep is about the same for the capsule! Oh no, not again! So you know what my Wednesday prep day was like. Clear liquid diet. “Starvation” for 25 hours. Another bottle of “pleasing lemony flavor” magnesium citrate (I gag just thinking about it) and a short leash to the bathroom. Thursday I arrived at 8:00 am, only knowing I was going to swallow a pill camera. Surprise! Here comes the razor again (I’m really tired of this drill). Eight sticky patches and leads were attached in the stomach and abdominal area, one directly on my lower incision. The nurse told me I would hate her when she removed the patches later in the day. Hate is such a nasty word, but… I put my shirt on to cover and then was saddled up with a wide Velcro belt and suspenders, with a pouch for the receiver unit. I had to wear this getup for over 8 hours; I looked ridiculous! Then it was time to swallow the pill camera. It was larger than I expected--1” long by 7/16” wide (for those outside the USA 2.5 cm x 1.1 cm). I posted a photo if you want to see what it looked like. Thankfully I got the capsule down quickly without incident. Talk about a lump in your throat. She synched the receiver with the pill and a flashing blue light indicated that the capsule was on its journey through my digestive track, taking about 55,000 pictures that the doctor will view as an 8-hour movie. Now doesn’t that sound like an action thriller?! Amazing technology. I asked how much the pill cost. She told me they bill UnitedHealthcare $1500 and are paid $700+. I returned to the office at 4:15, and she was right about removing the patches! A pretty uncomfortable couple of days. I will learn the results at a follow-up appointment with my gastroenterologist on 4/27. Two good news items: 1) I do not need to retrieve the capsule when it passes in my bowel movement. 2) The capsules are not reusable!! (Think about it.) Aside from all these tests, I continue to do well. On Easter Sunday, just as it was time to begin teaching, I felt my heart shift into atrial fibrillation. I prayed for God’s help as I continued to talk. Thankfully I soon showed a 6-minute video clip, and I just tried to relax and breathe deeply. I focused on teaching about the resurrection. When church was over, I checked and was back in sinus rhythm. Must have been the excitement of the moment. Peggy and I still walk 3-mile loops virtually every day. We are loving the warm weather and sunshine! My INR was 2.6 today. I still feel a little pressure and sensitivity in my sternum and incision area from time to time, particularly when I’m bending over. Nothing major. Haven’t had any Tylenol even for a long time. I’m living a pretty normal life (plus ALL the medical appointments) except for running and working out. This coming Tuesday I have an orientation with Winter Haven Hospital Cardiac Rehab. I hope to start building up my physical stamina again; I’ve lost a great deal in that department. But I have gained so much—perspective, support, new friends. I am alive, with a mended heart, on a road toward full health, with no debilitation from my stroke. Even though I bellyache a bit (some in jest) about all these tests (I still have the 24-hour holter heart monitor coming 4/21), I really don’t have anything to complain about. I am a blessed man. God is good and the life He gives is good.

Hi to all my dear family and friends following my journal this beautiful Easter weekend. This past Thursday marked 9 weeks post-op for me. With Peggy being off school (she teaches 5th grade) for spring break this week, we decided to get away on a half week trip to south Florida, going to Miami Beach and Everglades National Park. It was a wonderful getaway! We had a great time at the beach, the Art Deco District of South Beach, and hiking and boating in the Everglades. Profound wildlife sightings of the endangered Florida crocodile and the not-so-endangered alligator (millions of them), plus all the great birds. For the first time really since the surgery, I felt normal. I didn’t think much about being a heart patient. We enjoyed what we like to do just like we normally do it. I drove the entire trip. Normal. I even drank some (limited) caffeine without it killing me (reminded me how much I like it). I highly recommend to fellow patients a getaway when you’re a couple months post-op. Leave the recovery behind, get outta there and do something fun. A special occasion on the way home was the opportunity to visit fellow heart valve journaler Fran and Pete Zilko at their home. Fran is only 3 weeks post-op, and she looks great! And the Zilkos are as wonderful in person as they are on the journals. Great visit. Check out a picture I uploaded of me with Fran. We returned home around 10:00 Wednesday night and I hit the ground running with medical appointments on Thursday at 8:45. Starkly contrasted with being away with my sweetheart and feeling normal, it wasn’t a good day. First up the Anti-Coagulation Clinic. My INR was a bit high at 3.8. We are readjusting the Coumadin dosage due to the tapering of amiodarone and celebrex. Next up was an Exercise Stress Test. More shaving, more sticky electrode circles. I hate it when they power drill those into your skin. My cardiologist watched the test the whole time. I did fine, and it felt good to actually get my heart rate up some. No heart rhythm issues with the exercise. Result? I am approved for cardiac rehab which I hope to begin next week. Why mine is so much later post-op than anyone else I have read about is a mystery to me. I am eager to begin the process of building back up physically. In the afternoon I called my gastroenterologist’s office. Thankfully, the stomach biopsy taken during my EGD on 3/25 was benign. I am scheduled for the Capsule Endoscopy study this coming Thursday, 4/8. All of this has been due to concerns with anemia (I was never anemic before surgery) and with the positive stool test for blood, especially with me being on Coumadin. Remember how excited I was that I didn’t need a colonoscopy for another 10 years? Well, I learned that the prep for the capsule is the same! Oh no, not again! I told the nurse, “don’t make me cry.” So on Wednesday, I drink another bottle of magnesium citrate (with its “pleasing lemony flavor”) and stay close to the restroom in preparation for the 8-hour capsule study on Thursday. When will all this end? Today was our church’s Community Easter Egg Hunt on our property. It was an amazing, if tiring, day, as we estimate we had over 1,000 people! Wow, we are not a large church, so how awesome to serve the community like that. Sunday Christians all over the world celebrate the resurrection of Jesus Christ. Easter is so much more than just a celebration of spring. May you all have a truly happy Easter! “Praise be to the God and Father of our Lord Jesus Christ! In his great mercy he has given us new birth into a living hope through the resurrection of Jesus Christ from the dead.” 1 Peter 1:3 (NIV)

By now, at 8 weeks post-op, I expected to be all better and pretty much clear of such a prolific number of medical appointments. Wrong! It’s not yet tapering, as you will read below. Who has time for all this? I guess I do. On Wednesday, 3/24 I had an appointment with Dr. Willard, my cardiologist. He: --started weaning me off some medications (which is fine by me). --reduced my Amiodarone/Pacerone to ½ tablet daily for 2 more weeks, then cease completely. --reduced my Celebrex from twice a day to once a day (there was still a small pericardial effusion at my last ECHO on 3/9; we want that gone, but he said it might not ever go away). --said my incision looks good and is healing well (I’ve posted an 8-weeks post-op pic). --had not (surprisingly) mentioned cardiac rehab, so I requested it since I feel it would give me the confidence I need to resume running and heart rate raising exercise. We continue our 3-mile walks, but I have hesitated to start jogging. UnitedHealthcare has approved me for 36 cardiac rehab sessions, which is so generous I doubt I will use them all. My next step before starting rehab is a routine walking stress test on April 1. --okayed moderate caffeine use if I choose to resume (still undecided). --advised I could resume any upper body activity I feel like doing with reasonable cautions. --gave me a card identifying me as a high risk for endocarditis, so I will need antibiotics with any and all dental appointments. I don’t much like that “high risk” label. I was more hoping for “you’re as good as new; do whatever you feel like doing; it’s as if you never had surgery.” --scheduled a holter monitor test on April 21 for 24 hours to check on my heart rhythm after I’ve been weaned off the Amiodarone/Pacerone. Oh boy, still more electrodes on my chest! --scheduled a follow-up appointment for April 26. I had two Anti-Coagulation Clinic appointments this week, with therapeutic range INRs of 2.7 and 2.5. As I wean off the Amiodarone and reduce the Celebrex, the nurses are expecting to increase my dosage of Warfarin/Coumadin (currently 2.5 mg alternating with some 1.25 mg days). On Thursday I had my first esophagogastroduodenoscopy (EGD), aka upper endoscopy, and my first colonoscopy, aka lower endoscopy, at Winter Haven Ambulatory Surgical Center. I reported for duty at 8:30 and was home by noon. This was all generated because of anemia (I’ve never been anemic before) and a stool test that tested positive for blood, and my PCP was especially concerned with me being on coumadin. Every colonoscopy veteran I’ve encountered says “the preparation is much worse than the procedure.” Everyone is right!! My preparation was throughout Wednesday evening and night and into Thursday morning, consisting of taking four Dulcolax pills and drinking two 10-ounce bottles of Magnesium Citrate. You can probably guess the outcome! I’m considering suing the makers of the Magnesium Citrate for false advertising on their label, which states “Pleasing Lemony Flavor.” Yeah, right! Don’t believe it! The prep truly is miserable, the procedures not bad. Thankfully, you sleep through it. Otherwise, how could you ever face those people again? As I came to, I was one very happy and talkative drunk! I think I remember it all, but oh boy! My results were good: EGD—normal. Colon—no polyps. Next colonoscopy in 10 years. That’s way too soon for me. For some reason (I was in no sane condition to ask the doctor) he did take a biopsy from my stomach and will call with the results next week. To get to the bottom of my anemia, he also wants to do a capsule study to examine the small intestine (he did the top; he did the bottom; now he wants the middle). I will need to swallow a capsule the size of a multivitamin pill that contains a camera with flash. This capsule takes 75,000 to 80,000 pictures as it passes through the digestive tract. It takes about 8 hours. More fun, fun, fun! He also wants to see me again in about one month. As I was watching the NCAA Basketball Tournament last night, recovering from my big day, a commercial comes on featuring Peter Yarrow (of Peter, Paul & Mary) doing a song called “The Colonoscopy Song.” How’s that for timing? Hysterical! If you want, check it out at www.cbs.com/cbs_cares/colonoscopy.

Today marks for me six weeks home from the hospital. I continue to make good progress, and things are gradually returning to normalcy. Yesterday was my third Sunday back in my teaching role, and I am steadily regaining my work rhythm. Good thing with our Community Easter Egg Hunt and Easter Sunday approaching! I still need some occasional cat naps. With the “sick stations” no longer needed (setups around the recliner and bed designed for my recuperation), we have been rearranging some furniture back to how it was. We are putting away my two spirometers and my two heart pillows. Hey, I love my heart pillows, but they clash with our bedroom palm décor! We continue to take our near daily 3-mile walks, and last week went hiking at Circle B Bar Reserve, one of our area’s premier nature preserves. That was awesome! Some huge alligators there. Medical appointments are still prolific. Is there time for anything else? Last week I went to the Anti-Coagulation Clinic twice (INRs 2.5 and 3.2), had a follow-up appointment with my hematologist in Orlando (things looking good, return for checkup in 3 months), and had a new patient appointment with a gastroenterologist. This week, I will have two Anti-Coagulation Clinic appointments, an appointment with my cardiologist, and on Thursday I will “celebrate” 8 weeks post-op with an esophagogastroduodenoscopy (EGD)—isn’t that about the most incredibly ridiculous word you’ve ever seen?—and a colonoscopy. Oh joy! Both will be done at the same time at the Winter Haven Ambulatory Surgical Center. As of now, I report for duty at 9:15 and should be released around noon. Everyone says the prep is worse than the procedure. Prep day is Wednesday. All these new experiences (I seem to be collecting medical “pins”)! This is one I can’t wait to get behind me! ;-) It has taken weeks, but I do believe the medical bills and insurance claims have slowed down enough for me to share the costs for my procedures, for those who are interested. I am blessed that my church provides excellent health insurance for me (thank God!). I have a high deductible ($2000) individual policy with UnitedHealthcare and the church helps offset that deductible with monthly contributions into an HSA—Health Savings Account. After the deductible is met, there is 100% coverage in-network. For comparison purposes, keep in mind that my medical expenses involved a 13-day hospital stay, 4 medical “events” (heart catheterization, mitral valve repair & reconstruction, interventional neurosurgery for my stroke, and the pericardial window and cardioversion), and 3 separate ICU stays (twice in CVICU, once in Neuro ICU), so these are probably not typical of a more “routine” experience. Total Medical Expenses (so far): Billed amount $320,599.29 UHC paid amount $131,045.36 Out of pocket $ 2,000.00 Florida Hospital Orlando: Billed amount $274,699.53 UHC paid amount $112,753.40 Dr. Kevin Accola (heart surgeon, MV repair only): Billed amount $ 10,102.33 UHC paid amount $ 4,428.68