Thomas Hunt  Hi Holly,

Sorry for the slow response. Behind at work with all the time devoted to doc appts, nurse stopping by and cardiac rehab and has been tough responding. Still reading all the posts and guestbook comments though.

I am doing the dressings myself, although the first day I screwed it up when I sealed it with wound vac tape. The result was some green liquid at the incision. Nurse corrected my mistake and the wound has been doing much better each day. He is still stopping by twice per week to check on it, but almost there.

It was a blast at the party. I made at least half a dozen kids cry, but they all loved me in the end because of the candy I threw to them.

That really sucks that the wound has become infected and tunneled to the surface again. Have you heard back regarding your photos? Have you decided to go back to Mayo Clinic? I am so happy I followed your advice on the photos. I will post an updated one shortly. You can see in the wound there is some bubbly-looking flesh. The nurse says thats fine, but maybe you have another opinion?

Really hope this wound issue takes a turn for the better for you. Avoid the vac at all costs, but if you ever have to get it, I can send you my spare supplies.

Take care and as always, good luck Holly!

Thomas Hunt  Interesting. With 4 weeks to go, may try the airdyne again to see how it goes. Had my first day of running today with no issues, so hopefully they'll let me push it a little more.

Sounds like you are doing well. Great to hear from you! Thanks Deb.

Thomas Hunt  Thanks Holly. And yes, you are right on with the dates. 3.5 weeks out so I am happy to see the progress. The drainage is very low now. Even though the pump is making more noise, the canister looks almost empty except for a few drops (changed yesterday).

Posted one more pic of the incision site. From here on out it will probably take a few months before it looks different.

Just read the news about Denise. Not at all what I was expecting to hear. That is rough. I know from other here on HVJ, like Chris H and Barb, that reoperation is typically a 1 in 30 possibility, but really sucks when you hear about it happening to someone. Will say a prayer and send her a note shortly.

Thanks as always for all your advice Holly!

Thomas Hunt  Hey Holly! Great idea with the pics. Have gone ahead and uploaded a few with the vac. Still getting the dressings changed 3 times a week, Tu, Th and Sat. Asked the nurse today what he thought about switching to surface dressings in a week and he said maybe, but don't get too excited yet. Depth is down to 0.5 cm, but not sure when its shallow enough to switch over.

Have followed your advice on the photos of the wound site, but so far they all look similar so haven't posted any more. BTW, the nurse used to have a camera that could take 3-D photos and provide l/w/d readings without having to measure them. Cost him $750, but he had it stolen so he's back to the manual method. Not sure if you have heard of that type of equipment before.

Can imagine it must be frustrating to be so close to the finish after all this time. I agree letting the surgeon know about the timeframe. Maybe he'll have some advice that could help finish off that last bit of healing, or at least consider what might have contributed to the issue.

Great as always hearing from you and will keep in touch!

Thomas Hunt  Great to hear from you Karen. Glad to see you are doing so well with work and cardiac rehab.

The pic with my scar measurement is with a ruler/watch/calculator gift I got from a project I once worked on. Looks a bit goofy, but closest ruler I could find for the pic. :-)

The level 6 was on a recumbent bike, so not sure if that is much to boast about. They switched me to an eliptical now and I am going up to level 3 Monday. Cant wait to get the wound vac off and start jogging.

Hope to hear more about your progress soon. All the best!

Thomas Hunt  So that's what a fellow is! Well that does explain a lot. Hope your surgery went well! Looking forward to a Sunday update from you :-)

Thomas Hunt  Very interesting Denise. Never asked Dr. Gillinov who did the actual opening and closing, and still not sure if it was him or one of the fellows; probably was a fellow. Now I'm even more interested to hear what your surgeon has to say on Friday. Really hope it goes well and keep up the great attitude.

Thomas Hunt  Hi Denise! Thanks for the note. Sorry to hear you may actually have to get your seroma drained or incised. The doc here said that after a while, it forms a capsule, which makes it harder to drain. In his opinion surgery was the best solution. Not sure if your surgeon will agree, but will be interesting to hear what you find out.

On a side note, Trent mentioned that Dr. Ryan in Dallas tends to place the groin incision slightly higher to avoid these seroma issues. Not sure if that was a reason for this side effect, but coincidentally we did have the same crew working on us!

Congrats on getting back to work part time and hope you get to cardiac rehab soon. I was surprised how little this wound vac affects my movement and really enjoy that I can finally exercise and set some physical goals on my long term recovery. Hopefully you'll be cleared soon to begin the program.

Take care and good luck!!!

Thomas Hunt  Hey Deb. Thanks for the encouragement! I agree cardiac rehab is great. Went again this morning and realize I am still ramping up to the point where I feel some significant resistance. We increased the levels for all the excercises for Friday and will see how that goes. My BP was a little higher today, around 100/60. It was up to 122/62 midway through exercising, but dropped back at the end. Heart rate helpd pretty steady between 73 at the low end and 110 at the high end.

Sounds like your heart may be calming down now that you have a few more months from surgery. In the last few weeks has it hung around the 50's or 60's? Will say a prayer that your rhythm continues to stabilize with no more surprises.

Thomas Hunt  Hey Holly. Overall I can't complain. Was able to get the nurse to come out that Sunday afternoon to change it. You were right; the dressing change was not good, although I probably didn’t help it when I snagged it on a kitchen drawer :-) The incision does look relatively pink/red and no sign of yellow fluid in the area. You are probably right that it is just the lack of air and cleaning to the area that has been covered for almost a month. The depth measurement for the wound this past Saturday was 1.5 cm, but the nurse still thought I was 2 weeks away. Your prediction of a longer healing is coming true!! Should never have doubted your spot-on advice :-)

One great bit of news is I had cardiac rehab yesterday..woohoo! Felt so good to do some exercises and stretches. Hope this helps speed up the incision healing to as I got my heart rate up above 100 for an extended period of time. Today I'm getting those tiny sparks of pain where I assume the nerves are regenerating.

I am going to try and follow your advice and start taking photos of the wound starting today. I am sure that will help tremendously to see the progress. Thanks so much!

Guessing you are probably down to about 1 cm left on your wound, so the "all healed up" post must be close. Hope the good progress continues as soon as possible and will say a prayer that your last few steps down the mountain go smoothly.

Will update alter today and plan to post a couple of photos. Talk to you soon Holly!
-Tom

Thomas Hunt  Hey Holly!

Looked like the last blockage was due to my skin getting pulled into the suction. Had the nurse stop by on Sunday and change it and everything has been smooth sailing since. He says the wound is getting smaller, but I can't really tell a difference. I asked if he thinks we can get it off in a week, and he laughed and said it will probably be about 2 more weeks. Your prediction of a longer healing is looking more likely :-).

As for drainage (again you asked the key issue on our mind), it has significantly decreased. Would estimate the first day after surgery it was at 75 ml per day. Currently it is probably down to 10-20 ml. No sign of infection (fever, redness), but it gives off an interesting odor. Not sure if you noticed something like this. The nurse promises its normal, and that one of these days he will come and we will notice a big change in the wound. If I recall correctly, the depth was 4 cm when we started, so will be interesting to see how deep it is later this week.

Great journal update Holly! Glad to see you are getting closer and closer to finally fixing yours. Take care and thanks as always.

Thomas Hunt  Hey Holly! Wow again. Do you take Cigna? Can I send you my copay directly for the consultations? LOL. Seriously, if you are ever in the North Texas area, please send me a note (tom8hunt@yahoo.com) so we can take you out to dinner for all the helpful info you've provided.

In terms of the alarms, they were ongoing until Tuesday afternoon, when the new nurse arrived. I had no idea about the foam getting into the tubing, and with the lack of fluid drainage, you are probably correct regarding what happened.

The new nurse cut a much larger drape and hole for the sensing pad. Afterwards, he also placed much more tape around the area and didn't use the skin prep wipe (felt it didn't make much difference). Tomorrow will see if he's right, or my skin is on fire! So far though seal has been perfect; no leakage or blockage, and drainage is mostly yellow and steady, but relatively light. Canister is about 1/6 full (50 mL after 36 hrs).

The nurses and doc seemed to think that I should be healed in 2 to 3 weeks. One mentioned that healing is 80% quicker with a wound vac; have you heard that stat before? They are probably trying to keep me thinking positive, so it sounds like my goal of jumping in the pool on 8/4 (my daughter's b-day party) is wishful thinking.

Not sure if they will let me do the wet to dry dressings, but after watching the foam changes, starting to feel like I might be able to change them myself. The biggest problem, is the left groin location requires that I lie flat and its difficult to look into the wound without sitting up (maybe I could use a mirror?).

Doing my best to keep the area completely sealed and dry, and looking out for fevers. Hopefully I won't catch a bug. You are quite the trooper fighting off a staph virus for 5 days, while keeping such a positive attitude! Continued good luck!!!

Thanks again Holly and will post an update soon when I get a few minutes.

Thomas Hunt  Wow Holly! You are asking all the ideal questions. Will do my best to describe where I'm at right now.

First dressing change was interesting. Two nurses (one appeared in training) showed up Sat, My wife and I were surprised how deep the incision was, a good 1-inch. Length is about 1.8 in by 0.5 in. They did use the skin barrier wipes and that seemed to help when pulling tape.

On Sat night, started getting alarms about low pressure due to blockage. Kept my poor wife up all night, with the alarm going off every 10-15 min. Sun morning called the nurse. She was really nice and had me stop by her house to change the dressing again. She believes the problem was due to the foam being too small, causing it to be pulled away from the wound wall.

For the redo, the nurse placed a larger piece of foam. Up until tonight, everything was going fine, but around 9 PM blockage alarms started again. Have been adjusting tubing and my sitting position over the past few hours to try and get it to stay at 125 mmHg. Luckily tomorrow will have it changed again.

They set me on continuous suction but the nurse seemed to think there wasn't much of a difference. She gave me a backup unit that is pre-programmed to intermittent, so if the alarms keep up, might be switching it out. Let me know if you have any advice on the difference between the two suction types.

Not sure if this wound will heal as fast as I hope. Drainage seems to have definitely slowed, and hoping this is a good sign and not that the wound vac is no longer working. As you know, will switch to wet-to-dry dressings in about 2 weeks, so any advice on that step would be greatly appreciated as well!

Glad to hear your wound has made great progress. Will be looking for that update when you announce complete healing success! Thanks again for all the info and advice.

Thomas Hunt  Hi Janelle,

Thanks for the note. I'm originally from Chicago, but lived in CA (Bay Area) from 2000 to 2008 and have been in Dallas since.

As for Baylor, I went to the newer hospital in Plano. I believe the more well known hopital is the original one in Dallas. I get the impression this hospital was built within the last 10 years. The Heart Clinic was recently finished (2011?) and is state of the art. Every patient gets their own large room, with an individual bathroom, large flat screen TV and nice view from the 4th or 5th floor. I would describe the overall building as a mini-Cleveland Clinic, about 1/6 the size. Dr. Ryan is considered one of the best in the country and probably the most experienced in Texas. I had a consultation with him and it was a coin toss between having him do the surgery and Dr. Gillinov at CCF. In the end I chose CCF just based on the fact that they do the most surgeries in the US, offered mitral valve and it seemed the Dr. G had as much mitral valve repair experience as anyone. Going to Cleveland and getting away from home also let me focus on the surgery and not be distracted with work and other commitments had I stayed so close to home.

Not sure but Dr. Ryan may be able to do the surgery at the Dallas location or another hospital. Trent V. just had his surgery there and so far it seems like his surgery went perfectly.

Regarding the two recent procedures, they went fine. I haven't spent the night at Baylor yet. I had the impression the nurses were a little more experienced at CCF, but I wasn't dealing with the unit that does valve surgeries, and my second surgery was the morning after July 4th, which meant there were several staff on vacation.

I noticed from your journal you are from Paradise, so Dr. Vincent Gaudiani in Redwood City might be another great option. BTW, can you see Mt. Shasta from your house? I climbed it with a friend back in 2002...easily the hardest thing I've done physically. Hopefully after surgery I can do it again!

Best of luck in your search and feel free to send me any other questions.

Thomas Hunt  Hey Denise! Sorry to take so long to get back to you. Forgot to look at my guestbook for a couple of days. Coincidentally, I noticed you just posted an update.

So far so good on the surgery, but only time will tell with the results. The wound vac dressing will need to be changed several times, and then replaced with a wet-to-dry dressing, so we will have to wait and see if it heals up nicely without additinal fluid buildup. I'll try to post an update with some details shortly. Will also drop a note on your guestbook regarding your last post. Will be praying that your seroma is resolved quickly and painlessly, whether through surgery or other methods. Take care Denise. We will eventually make it through these final minor bumps on the road!

Thomas Hunt  haha...thanks for the push to hurry up and post. Been a bit lazy today. All is good and hoping in a few weeks I am "off the pump" and running laps on the treadmill at cardiac rehab. FYI, my classes at BHH will be at 8:15 am every MWF. Scheduled to begin on 7/23, so maybe I'll see you there!

Thomas Hunt  Hey Holly! Wow, this is great advice. So do you have a wound vac now, or are you only packing the wound? So far haven't had the dressing changed so that is the next interesting step. Wondering if all the skin that is taped down will survive these next two weeks!

May be sending you some questions as I go through this process, if you don't mind. Thanks for all your help and encouragement Holly and hope your incision heals up as soon as possible.

Thomas Hunt  Thanks Jerry!! Glad to read you are doing so well. Hoping to get back on track after this and match you in recovery!

Thomas Hunt  Thanks Cly Denna! Good luck to you in this home stretch. You will really like Dr. Gillinov. Will try to post a comment on you're guestbook shortly!

Thomas Hunt  Thanks Nancy! Yes, pretty much the same issue Holly is going through.

LOL regarding the pump. I am sure the client would love listening to the gurgling sounds during our contract negotiations :-)

Thomas Hunt  Hey Connie. If anyone is hero material, that has to be you...12 surgeries, oh my!

Really appreciate the thoughts and prayers. Will be sending the same your way now that you are in the final countdown for your mountain climb at CCF with Dr. Svensson. These last 11 days will really fly!

Thomas Hunt  Thanks Summer! Hoping you are right. So far so good, and keeping a positive attitude that this is the final bump in the road to a full recovery, although those happy thoughts may just be the hydrocodone side effects. :-)

Been reading your posts and hope those palpitations settle down now that you're in the final stretch.

Thomas Hunt  Hi Barb. Very nice to hear from you and thanks for the good thoughts. Sorry to hear about your diaphragm paralysis. How are you feeling now? Will you need to go in for another procedure, or is there a possibility it will correct itself. Feel free to send me a note back through valvereplacement.org mail. Will try to read up on it. Really hope you are feeling better as time goes on. And I agree that it seems like pretty much everyone has some type of complication, although some more minor than others.

Take care and will keep in touch.

Thomas Hunt  Thanks Trent! Hope you had a nice 4th of July. As long as you don't feel a bubble forming, I am sure its just the normal scar tissue and inflammation. Interstingly, it seems like most valve patients have great results at the chest incision and more issues with the groin incision.

Will keep in touch...

Thomas Hunt  Hey Denise. Really hope those compression pants work! Avoiding another procedure is the way to go. But if you do have to go in for drainage or surgery, it's really not that bad, just annoying. Good luck and thanks so much for the thoughts and prayers.

Thomas Hunt  Hey Holly. So here is the latest (will also post an update shortly with these details): B/c leakage at the incision is ongoing, the surgeon thinks this will continue unless another surgery is performed. The next step is to open up the upper two layers of skin at the incision again, cauterize some more capillaries, place more sutures and pack it with foam. A wound vac will then be attached to the foam to expedite closing and drainage of the wound. Will carry the wound vac for 2 to 3 weeks and have a home care nurse stop by every 3 days to change out the foam. Not sure how painful this process is, but have read that the use of the wound vac is usually very successful.

There are a couple of pinpoint openings along the incision where leakage is evident. Fluid is light yellow, so its clearly serous (lymph) fluid. My baseline pulse has not been affected and my meeting with the EP yesterday was great. He said my HR and Holter monitor results were as expected and no need to even consider a pacemaker.

How are you doing? Any updates on when you'll be 100% healed up? Glad to hear you're getting close. Hope you have a great 4th of July and thanks for all your encouragement.

Thomas Hunt  Thanks Jim. Although the lymph fluid at the groin incision is an ongoing issue, I understand that the most important thing is the successful results of the OHS. In the big picture, this is just a minor annoyance and I am very grateful that I only have trace leakage in the valve now. Hopefully one last surgery tomorrow (Thurs), a few weeks with a wound vac and that will be the end of the issue. Thanks for the encouragement and glad to read that you're doing well. Take care and Happy 4th!

Thomas Hunt  Appreciate the kind words Paul. Yes, still progressing, but definitely an issue that hasn't been resolved yet. Will post an update shortly on my latest upcoming surgery. Interesting how heart surgery was the easy part with no complications, but the groin incision is causing all the issues.

Have a happy 4th and hope your recovery continues smoothly!

Thomas Hunt  Hey Selma. Great to hear how well you are doing. Once I read your guestbook post I clarified a few confusing details in my update. It's my femoral incision thats causing all the trouble and the issue is yet to be resolved. Should be posting details in an update shortly. Have a great 4th of July!

Thomas Hunt  Thanks Karen. No good news on the incision, will post an update shortly, but thanks for stopping by to say hi. Great to hear from you and glad you are doing great. Have a Happy 4th of July and keep up the progress!

Thomas Hunt  Thanks Paul. Just met with the EP today. He says all looks good and no need to even think about a pacemaker!

Thomas Hunt  Hey Holly!

I am doing my best to keep it clean. I am actually worried about that issue since when I pulled the bandage off this morning the glue in my new incision seemed to come out. Have a call into the surgeon to see what he thinks. Will be keeping an eye on my temp tonight to make sure there's no fever developing.

$205K is impressive! I had a feeling robotic would be more, even though one of the cardios at CCF implied it was less expensive.

As for the echo, below is an update I left for Paul Rose on his guestbook. Plan to post these details on Thursday, which is my official 6-week post-op date. Hoping to be able to say the seroma is gone for good and no signs of infection.

"Heart function was normal, EF was 60 to 65%. The results were better than the previous week when I was on Metoprolol. This time I had no abnormal stops (previously I had a one instance for a few seconds where my HR dropped to 26 bpm). The latest readings showed a slightly low HR while sleeping (lowest was 47 bpm), with an average in the 60's. He also mentioned that at night there were a few instances where my heart switched back into junctional rhythm, which he explained means the heart beat comes from the center of the heart (AV node?)versus the top (sinus node). The Holter also recorded 1400 PAC's and 23 PVCs over the 24 hr period. It sounded like this is something that improves over time and does not affect the heart function. He is generally pleased with all these findings since we are still only 40 days from surgery, but as a precaution wants me to follow up with an electrophysiologist. At this point there is no indication I would need a pacemaker."

Thomas Hunt  Hi Denise,

Sorry to hear you are having a similar problem as I have had. The seroma drain line was removed today so I finally feel some freedom after 6 weeks! Mine showed up on Day 4 and grew immediately. The fact that it has been 4 weeks until it appeared with you, makes me think it could be something else, but I would definitely have it checked out.

My email address is tom8hunt@yahoo.com. Send me an email and I'll reply to you a photo of the seroma bulge. Didn't want to post it online since it's a bit of a strange looking photo.

Good luck and will be thinking of you!

Thomas Hunt  Man, I am so jealous Karen. Wish I was able to get in to cardiac rehab by now. I guess I shouldn't complain though. Now that the drain line is pulled, I have some residual pain in the area and can't imagine running for the next few days anyways.

Good luck with the rehab. Hope to hear your thoughts on the usefullness of the program.

Thomas Hunt  Thanks! Yeah it is mazing ho expensive the surgery was. Wonder what it would have cost if I had received the robotic repair. Have heard that that might be more expensive.

If you don't mind, please send me a note to let me know who wrote this..... unfortunately I can't see it without a signature.

Thanks again!

Thomas Hunt  Thanks Sam and Chris. Have been so excited to read about your recovery. Overall it ounds like ypur post-op couldn't be going better. Will continue to watch for your posts and may be sending you an email to check on the details of your repair. Tomorrow's a big day as we have or 1-mo echo diagnosis.

Keep up the great progress and have a safe trip home.

Thomas Hunt  Thanks Nancy. Feel like today I am finally free, with the drain line removed and no more bulge on the inside of my left hip. Hoping it doesn't return and its on to a full non-eventful recovery from here on out.

Hope all is well with you!

Cheers,
Tom

Thomas Hunt  Thanks Karen! Yes and maybe we can get one with both of us in our hospital gowns ;-). LOL.

Take care yourself and great hearing from you.

Thomas Hunt  Thanks Trent! Interesting how the timing may work out. Will keep you updated on my schedule through your guestbook.

Great post. Sounds like you are doing very well. I had the same issue with room temp at CCF. One degree seemed to make a big difference in comfort level and the thermostat seemed out of whack. Take care and talk to you soon.

Thomas Hunt  Hi Lee,

Great to hear from you. I am touched that you first followed my journal when you came across the site. As for the company, was it Bechtel that you worked for, or HNTB? I worked at Bechtel for 4 years in the Bay Area before returning to a company I had worked for in college. Had the opportunity to become an owner and couldn't pass it up! Seems like so many people I have run into over the years once worked for Bechtel.

We miss the Bay Area and look forward to our next trip back to visit. Let me know if you ever have any questions.

As for the seroma, looks like a Friday surgery will be the final step. Will post an update shortly with that info.

By the way, I did consider the Bay Area as one location based on the friends we have made over the 8 years we lived there. Of all the research I did, it seemed like Dr. Craig Miller at Stanford was one of the best in CA. FYI, if you haven't come across it yet, here is a list Adam Pick put together a few years ago:

http://www.heart-valve-surgery.com/heart-surgery-blog/2008/09/12/top-heart-surgeons-california/

Best of luck in your surgeon search and will look for your updates!"

Thomas Hunt  Hi Barb! Great to hear from you. Can imagine the diaphragm paralysis/SOB has been challenging. Is that something that will get better over time as nerves regenerate? Regardless, glad you are back out and progressing with recovery.

As for me, looks like the seroma is back and I'll be going in for minor surgery this Friday. Biggest challenge will be getting my PT INR level from 3.9 this morning below 2 by the time of surgery. Just another small bump in the road (hopefully) before getting back to normal.

Take care, best of luck to you and please keep in touch Barb!

Thomas Hunt  Thanks Jim. The seroma came back today, so looks like surgery is a go on Friday. I feel like I should be posting on SJ (Seroma Journals) and not HVJ with all the discussion I've noted here. Not too worried though. Just a minor bump in the road.

Great to hear you are teaching and cleared for running. I am looking orward to my first run, hopefully in a week or two.

Take care and continued progress in your recovery.