Jim's Journal

It has been 6 years from the OHS to replace the ascending aorta and valve. I recently celebrated my 77th. I get a CT Scan and echo cardiogram annually. The good news is the dacron graft is holding steady, and my EF is 55 to 60. There is a heart murmur, but nothing to be concerned about. I get short winded occasionally, particularly in an AFIB condition brought by an irregular heartbeat.

I take 100 mg of amiodarone daily. That prevents the AFIB, I have Sinus Rhythm with Wide QRS, per the Kardia mobile. I have tried to go off amiodarone under the cardiologist direction, but go into a arrhythmia state. I been warned of a potential for pulmonary fibrosis with long term use of the drug.

Just working to keep the blood pressure down, successfully so.

Coming up on the 3 years since the Bentall Procedure, replacing the Aorta valve and a new grafted (dacron) ascending aorta. A visit to the cardiologist on 2/24/23 turned out fine. She subscribed a different anti arrhythmic from flecanaide, with amiodarone, and replaced Bystolic with a generic. I would like to hear from anyone who is or was using amiodarone. The occurrences of an irregular heartbeat is less. So that is good. Life is good, but different, 3 years in.

Last Saturday, April 16 marked the second anniversary of the Bentall procedure, replacing the aorta valve and ascending aorta. In January, I stopped the beta blocker, Bystolic, eliminating the lightheaded symptoms. The only post surgery meds are a blood thinner and anti arrhythmic. In June are the annual cat scan and echo follow ups.

Thanks to Adam for sponsoring "Advances and Aorta Valve Surgery", so I have a better idea of what to expect as this Edwards Inspiris valve wears out or gets calcified. Not to worry, that is about 10 years out.  

Here is an update. In the past month, I had the 12 month follow up with the cardiologist and the thoracic surgeon. After reviewing the echo and ct scan, both said it all looks fine, and come back in a year. Apparently the new parts (aorta valve and aorta root) are working fine. Now, if they could just fix this aging thing........

Next April 14 will mark the first year anniversary of my Bentall Procedure. Recovery is doing fine with a few exceptions. I work out every day for at least 60 to 90 minutes, and generally stay busy. With the volunteer activities, there are up to 3 Zoom calls a week, in the evening, plus there is regular golf. One annoyance is the weight gain. When I came home I immediately lost 15 pounds, but got that back plus 5 more. That is really not much to complain about now is it? Late last month, the AFIB returned as an irregular heart beat. I have a relatively low heart rate, between 50 and 60 bmp, due to the BP meds I take. So, when it it starts its double tap followed by a single tap, it is noticeable. Navigating stairs in this condition brings on short winded-ness, Being in a 3+ story home, I am regularly up and down the stairs. Fortunately, the anti arrhythmic, flecainide, brings the heart back into sinus rhythm. This med is not intended for long term use, so when I get with the cardiologist in June we can go through the use case. All in all, I am probably better off now than before the surgery, considering the aortic valve was leaking and the aorta was bulging, close to bursting. One comment I read about lengthy surgical procedures was the impact on mental acuity. There is some concern that being under anesthesia for 8 hours or more can bring on some loss. I have noticed some memory loss, mostly short term. I don't know if this is from turning 72 or 8 hours of surgery. At least now, when my wife gives me a do list, and I forget it, I have an excuse. It is like going to the rest room then forgetting why you are there once you get there.... Now, if we can just get past the pandemic, life could get back to normal. By the way, I got both Moderna shots last month, with no complications. Take care Friends.

Last Wednesday was the follow up visit with the cardiologist, nearly 8 months after OHS. The EKG was normal so the Dr told me that the anti arrhythmic medication (flecainide) is no longer necessary, but to continue with Eliquis. Beside being an anti coagulant, it also helps to reduce any AFIB. Eliquis literature indicates that it should not be used for artificial valves, but the cardiologist says that applies only to mechanical valves, not biologics. Getting off the flecainade is good news. I have a Kardia Mobile app to check the heart rhythm on occasion, and half the time the ekg comes back normal, the other half is unclassified rhythm. He says that it is fairly normal to get those results. The QRS and T peaks are clearly visible, the the P wave is small, if at all. I complained about getting short winded going up stairs, but he responded by telling me to run the stairs in order to improve the wind. This was just his way of telling me to keep active and work at fitness, I am well on my way to some level of "normalcy", despite the restrictions due to the pandemic. My advice to those preparing for or recovering from surgery, keep a positive attitude and be patient, and stay with the recovery efforts. Going through OHS is not ordinary, and appreciate that fact. Your body will tell you how fast to proceed in recovery, so listen to it. Post surgery depression is a bit akin to PTSD, so get help with that if needed. I was in the ICU for nearly 3 days, and I am told I had hallucinations. I can recall a few scenarios from there, but I still do not know if these were real or imagined. That is no longer important as I am in the here and now. I go back to him next June for an electrocardiogram, so maybe I can quit the Eliquis after that. I will see the thoracic surgeon in April or May, after a cat scan. Hopefully then, there will be an all clear. What these surgeons and physicians can do is clearly amazing.

It is now six months later, and for the most part, all is fine (except for COVID 19 restrictions). When going upstairs, sometimes, but not always, I will run out of breath and need to take a minute or two to catch my wind. The same will occasionally happen when walking up a slope. I live in a 3 level house so transiting stairs is commonplace. I do 40 minutes on a stationary bike daily, and walk a mile or two regularly. Also, I will occasionally become light headed when going to a standing position after sitting. The feeling goes away after a minute or two. It seems to usually happen at around noon after a brisk workout and reading the news. Most often this occurs when the BP is about 105/55. Is it diet / hydration? Breakfast is a protein, berry and banana shake. Is anyone encountering either of these two? I am taking BP meds, Eliquis and flecanaide.

5/8/2020 Posting Three weeks plus a day...that is how long since the surgery on 4/16. Two weeks since coming home on 4/23. Recuperating takes lots of patience as the body does a lot of healing. I am past most of the pain and discomfort from the sternum, and I have a very nice 12 inch scar. The discharge instructions say to walk 30 to 40 minutes per day, so I am doing my best on that score. Marge took me out for a 20 minute walk on Paseo del Mar twice, so that will be a regular activity. We will go out later today. I saw both the Surgeon and Cardiologist this week, with thumbs up from both. The Cardiologist picked up some heart flutter on the ekg, so on 5/28 I go in for a cardioversion procedure to shock the heart back into a good rhythm, about a 10 minute procedure. Meanwhile, he has me on rhythm medication. The surgeon knew that correcting the afib was 50/50 in surgery, so there is no surprise that it only worked for a few weeks. The heart muscle changed its' geometry during healing, and the size and shape of the heart affects how the electrical signals transit. Now if I could just find a way to deal with the post surgical insomnia.......Thanks for all of your positive comments, they all help. 5/29/2020 FB Posting Well, it is about six weeks since the open heart surgery to replace the aortic valve, repair the aorta, an relocate a couple coronary arteries, plus some other stuff. I now have an Edwards Lifesciences Model 11500A 27MM aortic valve stitched in with a Dacron sheath to repair the ascending Aorta. Along with the Stryker chromalloy titanium left knee replacement, I am feeling a bit like the Arnold the Terminator, but without the muscles. Maybe next I can get an AI cerebral implant. A couple weeks ago, in a follow up with the cardiologist, Dr Carlson, he detected some atrial flutter in the EKG. He scheduled me for a cardioversion shock treatment on May 28, and prescribed the anti-arrhythmic Flecainide, a very powerful med. So yesterday, while anxiously awaiting my Frankenstein conversion, getting all plugged in and wired up, they ran the EKG, which showed no AFIB, so the cardioversion was cancelled. Quite the near end to a remarkable journey, which started on Jan 21 during my first visit to Dr Carlson, when he took one look at my EKG, and without pause, told me I was in serious trouble. I am now walking an hour a day, climbing stairs with ease, and starting cardio therapy (PT) next week, three times a week for twelve weeks. I am a bit short winded at times, but that will eventually go away as my conditioning improves. This has been a deep spiritual, emotional and physical experience. Marge has been a wonderful caregiver these past 5 weeks. Due to the virus situation, no visitors were allowed in the hospital, so I can only imagine how Marge and the family dealt with the sparse communications coming out of the ICU for two and a half days. I was very fortunate to have excellent cardiologist, surgeon and surgical staff.

Two weeks Ago…….. I thought a bit about doing this post, but decided to go ahead with it as most of my immediate family is quite aware, so this is reaching out to my friends. On 4/16, I spent 8 hours in the Cardiac Care OR at Torrance Memorial as the very talented team of surgeons worked on my heart in what is termed a “Bentall Procedure” to repair a blown out ascending aorta, aorta valve, etc. Search the term to learn more about the procedure. The Aorta had ballooned to 6.8 cm when a normal diameter is 2.5 cm. It was set to rupture at any time, so I was spiritually and mentally ready for whatever was to come my way, no fear, no trepidation, just Faith. After the Thursday Surgery I spend 3 days in the ICU and 3 days in post, getting discharged last Thursday. I am home now, recovering, a 4 to 8 week deal. Maybe I will be out golfing and hitting my driver in a few months!