Jim's Journal

Good morning, all! It is stunning to believe it has been six years since my mitral valve repair. You have to be kidding me! I recall in the months leading to the MVR surgery all thoughts and actions focused on the procedure and a good outcome. Once I woke up in CICU, my thoughts immediately turned to recovery, a goal of improved heart heath and the desire to pursue a long, active and meaningful life. At the six year mark, I am extremely grateful. Travel adventures, home selling (2 homes!) and buying (one home only!), relocation and a continuation of a rewarding professional career are a few of the activities that were made possible after the mitral valve repair. Dr. David Adams and his team at Mt. Sinai Hospital, NYC, were excellent. My Boston-based medical team was and is invaluable. Adam's patient advocacy, HeartValveSurgery, com and the HVS patient and supporter community was a daily source of education and encouragement leading up to and after the surgery. I have so many wonderful memories of the HVS Class of 2013 and so many other post-surgery patients. We helped one another throughout a pretty rare heath journey. My best to my fellow classmates! And, most importantly, all the best to everyone with upcoming surgeries. I truly hope that this community continues to meet your needs in ways it did mine. For my running buddies in the community, this guest blog reports on my latest running endeavors. The link is: https://www.heart-valve-surgery.com/heart-surgery-blog/2019/11/12/track-and-field/ My best to all!

Hello all: Wednesday, 11/5/14 was my 1st anniversary and I was so busy I did not have time to write a journal entry. That's the sign that the surgery was a rousing success. Let me share an update with you. How am I feeling now? The very best that I have felt any time post-surgery and better than I felt for several years pre-surgery. I just feel good. So, what is different? I really do have more energy. My schedule has been extremely busy and I have more energy and endurance and recover faster. Plus, my exercise tolerance has certainly improved. How long did it really take to recover? I would say the whole 12 months. Plus, I will not be shocked if I move to another level of recovery over the next few months. My heart just feels different. It seems settled, stable and steady. Also, when I run I do not get out of breath to the degree that I did pre-surgery. What worked for me? Having a great cardiologist and surgeon along with their teams was essential for this result. They shared their talents and I am the beneficiary. A daily focus on recovery. I did what I could do every day starting right after surgery. The big improvement for me happened at cardiac rehab - walking and then running, relaxation techniques, yoga and nutrition. After rehab I was able to get back to running and road races and also keep up with yoga and some strength training. Was recovery smooth sailing and really easy? Ah, actually no... Any thoughts for someone facing surgery? This site is invaluable due to Adam's commitment to the community. I received tremendous support and help from members. Just ask and share. The process is doable - not always easy but doable. Surgeon selection does matter. What really is important in the long run, in my opinion, is the quality and durability of the surgeon's work. We really do get better. Who do I want to thank? Everyone. Adam for HVS. All my cardiac buddies on this site. All the friends and family that were there for me. Dr. O'Gara and everyone at the Brigham. Dr. Adams and everyone at Mt. Sinai. And of course, Lise, my wife. Without her I would still be wandering the streets of New York City wrapped in a hospital blanket dragging an IV stand behind me. Really. What's next? Well, tomorrow I visit my mother and sister and make sure I get to go for a run. That seems like a good plan. Then I get to focus on year 2! My best to all. And here is to good health for all of us.

Hey all: Just a quick note to everyone on a snowy New England Sunday afternoon. Almost 12 months ago I had mitral valve repair surgery. Last Sunday I finished 1st in my age group in a local 5K race. I have been able to shave 3 minutes off of my 5K time as compared to my first post-surgery race in July. There is still a ways to go but I sure am grateful with the continued progress. My very best to all that are facing or recovering from surgery. There really is a better life on the other side of surgery.

Good morning, everyone! It’s a beautiful summer day here and I thought it would be good to offer up a nine-month update. Quite a bit has happened since my last post at the three-month mark. Here are some highlights. I’m feeling quite well. Fortunately I avoided any setbacks during my recovery. I give the credit to my surgeon and hospital staff for their excellent work. I have been back to work full-time since January and am busier than I have been for several years. I’ve noticed meaningful differences physically-I have much more energy and am much less likely to become fatigued. I was able to run two 5K races in July after a one-year hiatus. I ran the same two races that were my last races last year presurgery. Even though I was operated on in November 2013, I didn’t want to make the surgeon’s job any harder so I stopped racing in July 2013. For our runners on the site, I entered the two races with no idea as to what I would be capable of. As we know, racing times can be important to many runners. Surprisingly, I ran each race this year only one minute slower than last year. Given the fact that I had an interesting and complex surgery followed by three months of no running and then a gradual increase in exercise I exceeded my expectations. I have posted a photo of the finish of the second race. I like to be able to measure some progress using numbers. I purchased a FitBit in January 2014 and checked on my progress today. Believe it or not, I have walked and run over 2 million steps or 1,153 miles this year. That’s amazing to think how much distance can be covered in seven months. Two other HVJ buddies-Lynn in California and Dan in Florida are FitBit friends. We compete weekly for the honor of first place. Lynn has the edge for this week. I have a few thoughts to share with HVJ members facing surgery. These suggestions are based upon my experience. I hope they are helpful. They are: 1. Find the best surgeon and hospital you can. I was fortunate to find Dr. David Adams and Mount Sinai Hospital. 2. Line up your cardiac rehab before you undergo surgery. I’d encourage cardiac rehab if you can afford the co-pays. I found tremendous benefit from the monitored exercise which allowed me to push myself in a safe environment. I also learned the benefits of stress management, yoga and nutrition. I have continued the lessons learned for the past three months after graduating rehab. 3. Anticipate the transitions. The first month post-surgery was by far the most challenging month of my recovery. Do whatever you can during that month but be patient with yourself. Fortunately, our bodies know how to heal, which is great, but the first month has some challenges and changes that it can be at times difficult. Understand, starting in the second month, it tends to gets better week by week. 4. The second big transition for me was completing cardiac rehab. I had to take all the good lessons learned about nutrition, stress management and exercise and continue to improve. I’ve been able to do that but I had to focus on the best ways to continue the routines independently. I wish the very best to everybody regardless of where you are in this journey. I also want to thank everybody for their support throughout and especially thank Lise, my wife, who was been extraordinary! Finally, good luck to the HVJ racing team in its debut race in Virginia Beach this month. Team, I’ve got my racing shirt and I will be following your posts. Sorry I will miss the event this year.

Hey folks. I passed the three-month mark and wanted to share some insights with you about cardiac rehabilitation. My rehab is at Newton-Wellesley Hospital here in Massachusetts. It's a 15 week program that consists of 30 two hour sessions. The first hour is devoted to monitored cardiac exercise. For me, that means the treadmill. The second hour varies. Once a week we do gentle yoga. Once a week we have either a session on nutrition, exercise, stress management and relaxation. I began cardiac rehab eight weeks after surgery and have completed my 11th session today. I have begun running some during the last two weeks. My goal is to continue to build up my running over the next weeks. The most unusual thing to get used to is the elevated pulse rate during exercise. It's considerably higher pre-surgery. Everything I have read however tells me that it will go down over time. My primary observation is that I believe cardiac rehab would be perfect for anyone who has undergone valve surgery. From a healing perspective, I believe cardiac rehab enables us to most rapidly attain our optimum post-surgery heart health. In addition, I have found that the nutrition strategies have improved my food practices by about 15%. The stress management tips, although they're hard to put into practice, also have been helpful. What really has been useful, as you can imagine, is to be in the same room with a group of nine other open-heart surgery patients. You build relationships around the shared experience of surgery and the fact that you are all roughly the same age. Yoga has been quite interesting. As an old-school runner, yoga has never been part of my life. This gentle yoga, designed for cardiac rehab patients, has been quite helpful. I even went to the next step of purchasing the yoga CD created by the hospital's physical therapists. We use it at home. The stress management classes are led by a woman who has co-authored several books about stress management. She works with the cardiologist who authored "The Relaxation Response". I downloaded this book from Kindle and am currently reading it. A fellow patient referred me to another book entitled "The Blue Zones". This book is a detailed study of small communities around the globe that have high percentages of centenarians (folks over 100 years of age). I'm also in the process of reading this book and picking up tips (I hope to finish this book by the time I'm 100). I'd strongly encourage any of you that are facing surgery to obtain a referral from your cardiologist for cardiac rehab. The physical, social and lifestyle benefits are incredibly worthwhile. If you have time before your surgery, I would encourage you to visit the cardiac rehab center in order to be able to start rehab as soon as you are able. I found that there is a waiting line for the best centers. On a most important note, I am so pleased to see how well Rachel has progressed. I certainly hope that she will be home soon. All the best to those of you heading into surgery and those of you that are recovering.

Happy 2014 to all. Good health and well-being this year, folks! With the end of one year and the start of a new one there are always changes. For me, the changes now include working full time (to pay these medical bills!) and starting a 15 week cardiac rehab program. This means a big transition in my post-surgery recovery. At the same time, so many folks are joining the HVJ community as they begin the same journey I started here last August. What does this mean? Well, I am transitioning. This is not goodbye but an acknowledgement that this is the perfect time to pass the baton to the newer members as they run this race. Although I plan to post less, I will post occasionally to share any major developments, milestones and new insights. This is certainly a good time to say thanks. I owe a great deal to so many. It has been a fabulous experience. Thanks so much to Adam who had the vision and fortitude to transform an idea into this thriving community of fellow travelers. The value to me has been immeasurable. Thanks to Dr. O'Gara and the team at the Brigham and Dr. Adams and the team at Mt. Sinai. Thanks for investing your talents and experience in my health. Thanks to all you HVJers who took the time to share, support, encourage and provide information. I have made great friends here during such an important time in all of our lives. The support, banter and humor has been priceless. Thanks to friends and family who took time to be with us during the surgery, sent cards, delivered food, called and supported us in so many ways. You truly are great friends. Your ongoing support was needed and appreciated, I assure you. Thank you. And, of course, thank you Lise. You have had a chance to meet her on these pages. I am not sure what the outcome would have been without her but I can assure you it would not have been pretty! She has continued to impress me each day with her constant concern and willingness to set aside her own life for now to care for me. She has been my number one supporter and advocate. I can not say enough about her help. Thank you, Lise! I want to wish the best of success to those of you preparing for surgery and for those of you recovering. And, the very best to Rachel - let's get that new heart real soon, Rachel. Keep chasing those gold stars. All the best, my friends.

Good morning all! I want to wish you a prosperous and, most importantly, healthy 2014. Many of us have had some pretty interesting surgery this year. Here is to our long term health. Eight weeks after surgery I have settled into a routine. I purchased an activity monitor, FitBit Zip from Amazon. It costs about $50. Since using it during this last week I have seen that I have walked about 3.5 miles per day with a high of 4.3 and a low of 2.7 miles. It includes a food tracker. The first day of food tracker use showed that I eat too many carbs and a bit too many calories if I want to lose some weight. It syncs wirelessly, and easily, to my laptop and to certain newer models of smartphones. I like it. On other fronts, I am now able to sleep in bed without the pillow wedge. One normal pillow and one heart pillow gets it done. I don't have sternum pain in the morning. No Tylenol has been needed during the day and I am working. I am also back driving and seem to have more energy the last few days. This is all good. I was delighted to see Rachel's first post-surgery post yesterday. Good for her!!!! I hope she got her gold star for the day - she was advocating for it. (see her post) Happy New Years, folks!

Happy Christmas Eve all! Here are the health highlights of the last few days. On Sunday I prepared a lentil soup using a recipe from my cardiac rehab nutritionist. In short it was superb. I will be asking for more recipes from her soon. The soup burned away the negative memory of Saturday's beef stroganoff debacle. Lentil soups are incredibly filling! (think oatmeal on steroids) I was still full Monday morning. The recipe is a keeper. Monday morning we visited with my PCP. Everything is fine. I will see him again in a month. He remarked that he admires the work that Dr. Adam did (as do I). Today we met with Linda, the cardiac rehab physical therapist. It was an informative meeting. Here are the highlights. Based on last week's stress test I will start out exercising at or below 121 BPM. This will be interesting since I am now on a beta blocker. The beta blocker keeps the BPMs low so the heart will continue to reshape and heal. During rehab exercise I will self report the level of perceived exertion. They use the Borg Scale RPE (Rate of Perceived Effort) which ranges from 6-20. (don't ask me why it starts at 6. I would have to research it!) The number 6 is a very, very light effort. 20 means you just flew off the back of the treadmill and out the window. I will avoid 20... It will be interesting to see how the BPM and my Borg perceived effort correlate given the effects of the beta blocker. I start rehab on January 7th. It is twice a week for 15 weeks. I will begin (most likely in my pajamas) in the 7am class since there is an opening. I'm not really a morning exercise guy. I will switch to 4pm when they have an opening which works much better for me. I am cleared for the gym immediately. Aerobic activity only. I need to get one of those new fangled heart monitors quickly so I can monitor the BPM in the gym. Well, that is the latest and greatest. Lise and I want to take a moment to wish you all a wonderful Christmas with friends and family. This year is certainly a little more special for so many of us. Enjoy the day!

Good morning, all. You may like a bit of humor to start your day. On Wednesday, we met with the cardiac rehab nutritionist. She provided us lots of heart healthy diet ideas. On Thursday, we had a completely unrelated event. We replaced our 25 year old gas stove. On Thursday, Mayo Clinic emailed a Heart Healthy recipe for Beef Stroganoff. Hmm, I like beef stroganoff. Yesterday, we bought all the ingredients and at 6:00PM I spent 45 minutes whipping it up. What was the best part of the meal? The end. What did it taste like? Road kill. What did we do with the rest of it? Garbage disposal.How does the stove work? Wonderfully. I can see we have a ways to go to find heart healthy recipes that we enjoy and can actually swallow. We have already made some changes to our diet this week but we need to solve dinner. If any of you have some ideas please feel free to fire away! Today, I will try two recipes from our nutritionist. Lentil soup and granola. Hopefully these will be winners. Have a great day all!

Today was busy. Some work and then a trip to the hospital. Met for 1 hour with the cardiac rehab nutritionist Meryl. She knows her stuff. Lise and I learned a great deal in a short period of time. We already have some ways to improve our diets, organize meals and eat during the day. Meryl will meet with the group regularly during the 15 week period so there will be more nutrition to come. I'd like to lose some weight and improve my numbers so this is all good. The second stop at the hospital was for the cardiac rehab stress test. I have done stress tests for two decades but I was apprehensive about this one due to the surgery. This pre rehab stress test has a lower goal of 75% of maximum heart rate so they know where to start you in rehab. To place this in context I achieved 102% of max heart rate for my last pre surgery stress test. Once Gail, my medical guide for the day, explained that the stress test is less rigourous I relaxed a bit. The test was the Bruce protocol. I went 9 minutes, hit 76% of heart rate and stopped. I could have continued longer. It felt fabulous from minutes 7-9 because the BP exceeded 120/70 and I was actually breathing a bit hard. This is the first time since surgery I have had a chance to exercise the heart other than walking. I have been on beta blockers for the first time in my life the last 6 weeks. She said the beta blocker drowsiness I have experienced is quite common and often goes away in 2 months. Interestingly, when you are able to get your systolic BP over 120 with exercise the drowsiness disappears. That is why minutes 7-9 were so good for me, I felt normal. I was more than encouraged. Nothing happened odd during the test. I felt better as the test went on. She said I would be a star in rehab and will likely be able to begin running during rehab. This is the first time that I felt encouraged and confident that I will be able to return to running and do well. I needed some evidence and the test provided it. So this was my moment of hope. I'll take it. As you all know, recovery at times can be lonely, isolating and include doubt. To counter that, these are the moments that you memorize and rely on. Interestingly, I saw my former cardiologist, Dr. Sidd, in the cardiology waiting room. He retired 5 years ago and just happened to stop by his former hospital at the same time we were there. I was able to bring him up to date. He's a great guy. And it proves that we do have a really small world indeed! We grabbed a relatively heart healthy lunch, walked 30 minutes and then headed home. Not a bad day! Well, that's it for now. Heal well everyone!

Hey folks. A few quick thoughts and an update 6 weeks after surgery. This week is a week of medical appointments, tests and part time work. On Monday I began working with clients again. It took 2 hours to get back into the flow of things. It's good to be back. On Monday I also traveled to the Brigham with my driver Lise for an echo. Hospitals, by the way, are not bad places to get in an hour of walking. Or to pick up dinner. I guess we are into time management. My cardiologist sent me the echo results this morning. I will do a longer echo post this weekend but here are a few points. The echo results show a heart in the process of healing from complex mitral valve repair. Some measures are quite encouraging. Other measures I would like to see improved in the months ahead. Again, I will be more specific this weekend as I compare three Echos , one in July, one at Mt. Sinai post op and yesterday's echo. The heart goes thru significant, ongoing changes with a complex repair. Tomorrow, I will meet with the nutritionist as part of the cardiac rehab preparation and also undergo a stress test so they will know where to start me at the beginning of rehab. I still can not sleep in the bed. I tried again last night with the wedge and was uncomfortable. Back to Mr. Recliner tonight. Whatever it takes for a good night's sleep. The very best to Rachel today. I am so pleased to hear of her progress . The very best also to those in the hospital or soon head to the hospital to undergo surgery.

Hey folks. Now, 5 weeks later the Mt. Sinai NYC surgery has morphed into a dreamlike experience. This week has been a week of transitions. On Monday, I started back in the office part time. It has been great to get back into an environment that is stimulating. I am working several hours a day which is fine. My back knotted up the first 2 days which shows how muscles weaken when unused. On Monday, my physical therapist discharged me. She gave me more exercises. I now have 15 exercises and told me to do them 3 times a day. She also increased the walking to 30 minutes three times a day. That works out to about 2.5 hours of activity a day. Today, my visiting nurse discharged me. In the afternoon we met with the nurse for the cardiac rehab. Looks like I will start at some point after the holidays. It looks like a good program. Things are progressing. Interestly, I have found that this week I have more energy which is encouraging. Let's see how the rest of the week goes. My best to Rachel as she heals and to her family. They have been incredible. My best to all heading in or in the hospital and at home recovering.

Hey folks, one month ago I was in the operating theatre at Mt. Sinai out like a light. They say I joked with Dr. Adams before the surgery. I don't remember a thing so I hope he liked my material. Now, it is a month later. My recovery certainly has been slowly incremental. No sudden huge jumps in recovery or "I feel amazing" moments. I have focused on walking 3 times and doing 3 PT routines per day. To be honest, some days I do not hit this mark. I am walking better now then several weeks ago. My VN and PT have been essential. Both will stop working with me next week. The next step is cardiac rehab. I need to meet with the nurse, therapist and nutritionalist and have a stress test before I start rehab which means rehab will start in Jan. It is reported to be a solid program. The boredom factor for me for the first month was pretty high and at times painful. That was predictable. Take a mentally and physically active person and shut them down physically. It is not pretty. My mind was already alert and active in CICU. My body is VERY slowly catching up. It will take some time. Next Monday I will start up in the office part time. The next week I will remain part time but will start to work with clients by phone. That should help. I suggest to those awaiting surgery to identify things that will stimulate your mind. Early on, you will have a great deal of physical downtime, way more than you are used to, which is quite a jolt to your mind which is looking to be active and stimulated. I have become a mall rat. Lise has driven me to the mall 3 times this week and I walk for 45 minutes broken up in 15 minute intervals. I complain regularly about her driving from the back seat and she threatens to drop me off on the side of the road. All in all, it is a fine time for both of us. BTW, the Salvation Army came today to pick up some furniture. Lise mentioned putting me out with the other items so they would take me. It seems like the caregiver role is getting a bit stale for her! Last night I headed back to the recliner. I tried the bed for 6 nights. It did not work for me. Lots of sternum and rib pain in the morning. I think the wedge pillow angle, firm mattress and inclination to sleep on either side compressed my sternum. Lots of dull pain resulted. It will be the recliner for a while. Well, that is it for now. Thank you, Lise! Also, I am thinking of all of you that are or will be in the hospital. The best of success. Certainly, Rach and family you are always in our thoughts. To continued healing, my UK friend.

You know what is interesting? I do not think I ever gave much thought to recuperation after surgery before Nov. 5th. Pre-surgery my laser-like focus was on the surgery. And that probably makes good sense. Recovery has been different than I had anticipated but exactly as advertised. You do feel like you have been hit by a truck. And that feeling lasts for a few weeks, at least in my case. I was amazed at what I could not do easily. Some days were good and some days were so bad (I felt really weak) that I thought something had gone wrong. So, how am I now? The last 3 days I have felt stronger. I walk a total of 45 or more minutes over 3 daily walks. I do 2-3 rounds of PT. Each round takes 20 minutes. I have been getting out for the first time for non medical trips, including the mall today. I may have moved to a new level in my recovery. What has helped me most for this 4 week period? - the incentive spirometer. Once an hour. I got up to 3,500 . ( I retired it today) - taking daily vitals. (weight, BP, pulse, temp.) I have stopped this as of today. - visits to my PCP and cardiologist. Both visits were confidence boosters - sleeping in the recliner for 3 weeks after returning home. Moved to the bed recently. - Tylenol only for the last 3+ weeks. No pain meds. That worked for me since I was not feeling pain. - my visiting nurse Wendy. The 2 times per week check in and reassurance was valuable. - my physical therapist Zelia. We have worked on balancing and strengthening. This sets me up much better for cardiac rehab. - walking 3 times a day and doing PT up to three times a day. - my wife Lise. It has been invaluable beyond words to have her as my caregiver. Recovery would have been much, much harder without her I can guarantee you. - many friends that sent cards, called, dropped off great food and offered other types of support As an example, our good friend Vicki stopped by today with some great food from Russo's a well known Italian market. Her husband Mac was kind enough to buy these items on his way home. So, as many have said, this is doable. It may take longer than we like but healing do takes place. My best to Rachel as she recovers. And my best to all of you going in over the next days.

Before my surgery date I asked the group what to bring to the hospital. See the guest book for all the great responses. The result? I packed my back pack with 15-20 pounds of well thought out items. What did I actually use? Nothing. Here is what actually happened. I used the hospital stuff. Two gowns, one in the front and one in the back. One hospital bathrobe once they saw me walking the halls with a blanket around my shoulders. ( I was making a pitch for not having any money to pay my bill.) I must have looked fairly interesting. Gown, blanket and a 6 day beard walking the halls in the upper east side of Manhatten. Truly a child of the sixties. I wore their socks all the time including to walk. I did not feel like reading or posting on the Internet. As a result, I never asked Lise to bring me anything from the bag which was at the hotel. That is my experience. My suggestion is that you pack what you think you may want. You may want to keep it off site till you want something. You move to so many rooms it becomes one more thing to keep track of. On the other hand, I have used the pillow wedge, blood pressure monitor, thermometer and scale daily at home. Plus the airplane pillow. All great purchases. Later I will post a 4 week update. Ciao

Weekends at the hospital are different. Fewer staff and a slightly slower pace. We began discussing a discharge date. Dr. Percy Boateng visited several times and was a great doctor. He was the one that opened and closed me and did such a great job. It was a pleasure to visit with him. On the weekend there is just one PT for the floor. I kept asking for a moment of her time and she visited me Saturday afternoon. One unassisted trip around the floor, my second time walking, was all I needed to have the confidence I could walk. After that, I walked at all times during the day and night, including at 3am. Walking was good. I Had many fine nurses during my stay including Lordes and Ryan the last few days. They were both great. Sunday was a big day. They took the last stomach tubes and pacing wire out. The pacing wire did not release from the heart muscle. They snipped it so I still have a bit of wire in my body as a reminder of the procedure. They did not want to pull the wire hard as it would have created some bleeding. My second event occurred after they pulled the two stomach tubes. I sat back in my chair and after a few minutes my heart rate went to 145 bpm and Ivhad a-fibs. Back to bed I went. They gave me potassium and magnesium and after a while I was fine. During the a-fibs I really did not feel anything but the monitor lit up and folks came running. A bit unnerving as you can imagine. This was my second and last event in the hospital. I believe we all have hospital event stories. I am not sure OHS hospital stays are event free.The a-fibs may have been caused by the copious amounts of Lasix I consumed plus the tube removals. It resolved quickly but it was memorable. Monday I took my first shower and shaved off a week of facial hair. I looked like an 19th century California gold prospector before I shaved. Even the nurses thought I looked quite spiffy after I shaved. Joe Kusiak, a HVJ member visited. We walked and talked. I will post a photo of us next week. He visited 3 times. A truly gracious man. Tuesday was discharge day. It was a bit nerve wracking. They do an EKG, x-ray, vitals, rounds, etc. and leave you with the feeling you may not be getting out. At that point I had no reserves left. I wanted out! Food service came for my lunch and dinner orders. I wondered, "what do they know that I don't". I was plotting my jail break simply because I could not stay another day. In the end we had talked everything out, Lordes reviewed the discharge papers with Lise and me, transport was called and off I went! We exited on the 5th Ave. side and drove to the Marmara Manhatten to overnight before heading back to Wellesley. Well, as they say, that is my story and I am sticking with it!

Today I am most grateful for a newly repaired mitral valve, two fine hospitals and staff, Lise, family and friends and my great friends on HVS! Thank you all! Every year we travel to a town next to the famous Plymouth, MA to spend the day with our dear friends Scott and Ann Marie, their 5 children and other friends. Sadly, we will miss what is a most excellent time and wonderful food this year as I recover. (Ann Marie was with us at Mt. Sinai) We will be home today and celebrate as a young married couple that has only been married 25 years. Where has the time gone? All the best to all of you and Happy Thanksgiving to Rach and family, your friends across the pond continue to hold you in our thoughts. Get well soon.

My chauffeur Lise drove me to the Brigham this morning to meet with Dr. O'Gara for the first time after surgery three weeks ago. We got there early,did some walking and met with the good doctor. The conversation could not have gone any better. He said that Dr. Adams was very pleased with the surgerical result. Dr. O'Gara was very positive about my heart-he has zero concerns about the heart. He said I avoided the common big complications. What a relief! He did say the recovery is right on track. He said the surgery does make you feel like you have been hit by a truck. But, walking, healing and cardiac rehab gets you back on track. Dr O'Gara said that I literally could start cardiac rehab next Monday if I wanted to. And I can start driving next week. We will move on cardiac rehab quickly. We will not go back to NYC for the final post op check in. That will be done at the Brigham which is great. I will have an echo in December and visit the Brigham again in March. Meds may be adjusted over time based on how my body adapts and adjusts. We had lunch at the hospital, bought a pumpkin pie and headed home. What an odd sensation to hear that you are doing well, that your heart is healthy and that you are on track. I move from being "on alert" to having the confidence in my body that we are really on the right track heading toward a full recovery. I start thinking now of the future and a return to normalcy. It feels a bit anticlimactic. This is all wonderful. I will take it. My best to all. Rachel, continue to heal well. A very Happy Thanksgiving. So, this is my early Thanksgiving. I am grateful. Cheers.

Friday November 8th presented a dilemma for me. Remember how I told you that I had 20 plus additional pounds in fluid in my body? Well, you can not be that big without some issues. Regardless who you are, you will run into something. This example may help you to problem solve. When I woke up I had a serious urological issue that was causing me a great deal of pain. I knew it was a reportable event. Dr. Arora stopped in on rounds and I briefed him. He immediately said let's get a urologist to run some tests. The cause could be simple and easy to address or complex. Late that day I traveled to the lab, they ran tests and fortunately it was simple. We dodged a bullet that sometimes can be caused by the catheter. Dr. Arora also had the urologist come up the next day to discuss the situation which was reassuring to me. This was an example of prompt and excellent patient care. I was highly impressed and grateful. Now remember the fluid retention? They have a real simple solution for that. 80 mg of Lasix a day. They gave me three urinal bottles that hook into the side of the bed. I felt like Jack Palance in Shane. I had those bottles flipping around my back, over my head, etc. I can not tell you how quickly I filled the bottles. OK, it was quick. They ran a shuttle service to empty them as quickly as they could. They measure everything so they were recording every amount. Lasix ultimately led to another problem a few days later that I will discuss in the next post. The major takeaway from this incident was clear: Immediately tell the staff if anything is amiss. They have protocols to address the stuff that comes up. I will post more hospital adventures later.

It is hard to believe that it will be three weeks post-surgery tomorrow. In some ways it seems like yesterday. In other ways it seems like a dream. The weekend went well. My daily activities are quite straightforward. Three walks (short for now) and three rounds of PT. Use the spirometer hourly. I am as high as 3000-3250 right now towards the end of the 10 reps. The incision looks great. Once it heals it will look quite nice. Today it was tough to get going. A very low energy start. Had VN at 900am and PT at 1100am. Not much pain at all , more just a tightness where the incision is. After PT I felt a bit more with it. Last night I started to find phlegm accumulating in my throat. It has been on and off since then. That is new. Drinking a lot of mint tea right now. Have cardio on Wednesday so we will report it if still happening. Lise still provides expert care. I have not seen her on Kayak surfing for a ticket for a foreign city so that is an excellent sign! On the other hand she continues to agitate for a raise! (hey, I get it!) My best to all. I know Carlos and Tara may still be in hospital and I know others are going in shortly. Good health to all also that are recovering. Tamara, great news on your health! Rach, you are in our thoughts today.

A big move from ICU to step down cardiac. Two days after surgery at about 730 pm they moved me to 7 west. It was a semi private room. They actually moved my room mate in right behind me. The room was 710. The team swept in and got me oriented and hooked up. They electronically monitor you at the nurse's station and respond immediately to any issues. You also have a monitor at your bed. You can not see it but guests watch it. Lise looked like an air traffic controller staring at it (not me) to make sure my head did not spin off and go rolling down the hall. I could have been swinging off the bed doing one arm handstands and I don't think she would have noticed. The monitor captivates. I had moved from my warm, quiet single room cocoon on 6C to a noisier floor with lots of beeps on 7 west. I was still what I would call paranoid or highly anxious. Pre-surgery, my concerns were focused on the procedure. I had such confidence in Dr. Adams however that I knew that I would becoming out with a repair. Post surgery however I worried whether the repair would hold. I worried about endocarditis. My attitude was not calm. Lise left and then the protocols took over. During third shift, blood is taken, pills are explained and given, and vitals are taken. Dr. Amit Arora stopped in early on. He was my primary doctor during recovery and he was sensational. Here is why. He was engaged, concerned and not rushed. He connected with me. I told him of my concern of infection undoing the great work Dr Adams did. He said let me see what I can do. I found anything I discussed with him he took action on. BTW, I did not mind the middle of night nurse visits. The nights are long and I am a social being so it gave me a chance to chat. The night went uneventfully. My call button and TV control did not work but the staff kept after it until it was fixed. I found that my appetite returned with a vengeance. I did not expect that to happen for 2 weeks. I ended up eating more and more food each meal. Joe Kusiak turned me onto the jello so I ordered it as an addition to each meal. From that point on a meal was good when they gave me dessert AND jello. However, My dining experience was down graded when the kitchen substituted the jello for dessert. These dastardly fellows failed to see that I was counting on and fantasizing about the dessert AND jello since the previous meal. The next day they moved me to a private room,702, with a window that looked out at 5th Ave. and framed upper Central Park. I think dr. Arora displayed remarkable sensitivity to my concern of infection. Once you get endocarditis you do become really sensitive to infection. The window was a great indicator of my progress. Initially the staff would come in and rave about the Central Park view to encourage me. I would politely agree. (but I was utterly indifferent about anything on the other side of the glass) The truth was that I had no interest in the view at this point. I felt completely isolated and separate from what was happening on the other side of the window. It was not part of my world at all. I was completely in my own world. It was me and anyone that I interacted with. That is it. As the days went by I became more curious about what was going on beyond the glass. I would stand and watch the action in Central Park and on 5th ave. Now the view was spectacular. I did start watching TV though which was an improvement in my condition. First, I watched Mt. Sinai videos on heart health. After Lise told me to knock it off I moved to other channels. Over time, I moved to college football and the NFL. Each bed has a white board. Your nurse, personal coordinator, day and date and shift information are listed. That was extremely helpful. You lose track of date and time easily. This covers my initial placement into 7 west. A few takeaways for me are: Tell the medical team how you are feeling and what you are thinking. I was amazed at their responsiveness. Get in the chair and start walking as soon as possible. Pascal took me on my first walk around 7 west. I could only do 1 lap but I felt great getting that under my belt. My legs were still sausages. I had 20+ extra pounds of fluid in my body. This caused an unexpected problem that I will discuss in my next post. Heal well my friends.

Thursday and Friday were interesting days. On Thursday, my chauffeur Lise drove me to Dr. Levin, my PCP. He has been following my MV prolapse for over 20 years and has been encouraging me to get it repaired. We both were quite glad to see one another post surgery. It felt like two survivors of a battle reuniting. He has been a great guy over the years and we have formed a solid relationship. He did an EKG, drew blood and did an exam. He seemed quite pleased. We discussed the common post surgery experiences, including depression. It was a great visit. Next appt. will be a month from now so this is good. Slept well last few nights. Today, I had PT. She was pleased with my balance. She took me thru another set of exercises that I will do 3 times a day. Spirometer is now a high of 2750 with an average of 2500. Getting better. Walking is Real slow though. We got down the street and went around the corner up the next street. It was like I ran a 10k. Poorly. Underwater. It will take time for my energy to return. Hey, overall, I have nothing to complain about and a lot to be grateful for. All the best to all that are healing. Rach and family my deepest wishes for contupinued progress. You are in my thoughts always, my friend. To all heading in, great success. Carlos, God speed. Cheers.

At some point I shifted from Tree. I was still monitored but not as intensely. I was awake. My biggest need was for water. They started me out on ice chips. I somehow talked them into giving me ice water. All tasted good going down. And, all came up a total of three times. I learned that the stomach shuts down for this surgery. They gave me meds to get the stomach going again. I am not sure I slept at all that night. I recall talking aloud constantly, giving a moment by moment, unfiltered monologue thru the night. It was as if they had given me a truth serum. The colors I saw were fluorescent. Greens, purples, etc. strong drugs. It was the longest night of my life. Early in the morning they gave me a sponge bath and asked me if I wanted to sit in the chair. My answer was "you betcha". I got up and my legs were swollen like sausages. I had added over 20 pounds of fluids during the surgery. I remember them bringing the breakfast and encouraging me to eat something. Yeah, like that's going to happen. I had zero interest in food.Ii lived off ice chips, ice water and ginger ale. Dr. Fisher stopped by and checked in. Sadly, I had become anxious, which may be common. I worried whether the repair would hold or if I would need a reoperation in the future. I may also have worried about infection. I had become, I think, a bit paranoid. Again, this may be standard fare for the process. He answered my questions as best he could. Mt. Sinai is a teaching hospital so the students made rounds. It seemed one student was responsible for each case. They stopped outside my bay and said, " here is a 61 year old male...." I was not totally engaged in the conversation. My first solid food was jello. I found it was tough at times for me to hang in there for the first 72 hours especially at night. each night was the longest night I had ever experienced. The CICU was incredibly noisy and busy. Late on the 6th they moved me up to another ICU 6C that was so much more quiet. I had a private bay with a great nurse who gave me a helpful pain med 101 lecture. I enjoyed a peaceful night and remained here until the evening of Nov 7th. I learned to get up and stay up in the chair during the day to assist recovery. I started eating some food each meal. I had no interest in TV or reading. No walking yet. Just moving from bed to chair. Legs still swollen. Some of my lessons learned? Sometimes ice chips are a good place to remain rather than rushing it. The team follow a protocol that works so you can relax. Don't get carried away with large, long term, out of your control fearful " what ifs", just focus on the moment. Get out of bed and into the chair. Tell them exactly how you feel. Tell your caregiver what you are thinking. If you have lost perspective he or she can help. Make sure your pan and call button are within reach. Always. Finally, hang on. The first 72 hours can be extremely challenging. The great news is that you really do get better each day. Well, that is all for now. My next post will cover the step down unit (7w) and discharge. Cheers.

Today was an interesting day. I had two visits, walked two times outside and will dovtwo PT sessions. My visiting nurse came at 9 am. For me that meant up bright and early. Tough getting to sleep last night. Yesterday I was really tired till 3 pm then gained energy until 11 pm when I was wide awake. Did not go to sleep till 1am. Just too awake. Up at 7am today. I am into a ritual of taking vitals, showering with assistance, then breakfast. I can not apply water directly on the incision. Cleaning is done indirectly to make sure it heals. Ha Had breakfast and then met with visiting nurse. She was pleased with vitals and progress. She shared heart healthy diet tips. A quick 1/2 hour nap followed by a first visit by a PT professional. She is a 20 year professional and is quite capable. She did a hour assessment. Her General findings were that I am doing extremely well. My left leg is weaker than my right. Surprising since I am left dominant. She provided me exercises to strengthen the left leg and to assist in overall balance. I am to do these 3 times a day. She also has me walk to the end of the street 3 times a day. It is amazing how little walking that is. I will need patience for the next 2 or so weeks. She explained that the heart and the body are getting used to one another now that the heart is fixed and working properly. I think again the biggest adjustment is to realize my heart is healing and that whatever I may consider slow and short very well be too much, still too fast or long. That is quite a mental adjustment to make. It is like going from 80 mph to 5 mph. I received some beautiful flowers today from a client. Family friends sent a gift certificate for a local gourmet restaurant. Lise and I will use that once I recover. This weekend, Mary C dropped off some superb French macarons she made that are absolutely delicious. Thank you all. This is the upside to surgery. We have a lot of folks in the community that are active. Rach, I look forward to you rejoining us as you awake. You have quite a global fan club. To all going in, in , or out and healing my very best! Off for more PT exercises. Ciao.

Let me share with you what I remember after just after surgery in CICU. I hope this helps the folks awaiting surgery. I showed up in CICU early to mid afternoon. My first recollection was an Asian gentleman in his 30s (later identified as Tree) talking to me. He was monitoring me exclusively using a portable monitoring device. I knew nothing of this. All I knew is that I periodically opened my eyes, saw Tree talking to me and then closed my eyes. It was like a series of snapshots. The next thing I remember was waking up and listening for clicking. The game plan was to repair the valve. Dr. Adams was confident he could do it. But my fear was that it may not work out. I heard no clicking and relaxed. Then I opened my eyes and saw Lise. She did not talk to me but rather played a poor game of pantomime. She put her fingers to her lips. She took both hands and motioned downward as if she wanted me to slid into 3rd base. I kept shrugging my shoulders since my arms were tied. Here is the confusion. Tree asked her to not talk to me since he thought I was getting agitated. Actually I just wanted to hear how the procedure went. A suggestion for you. Work out with your loved one how to communicate that info verbally or non verbally because that will be the first thing on your mind. About 700pm or so Tree removed the breathing tube. My eyes were closed and I just responded to his instructions. In my case it was no big deal having it in when I first awoke ( i never noticed it ) or having it taken out. It was a non event. The fact is was I was so heavily sedated it did not even register. I do recall talking to Lise and to Ann Marie after the tube was removed. I do not recall a word of the conversation although everything was upbeat. This brings you through the initial hours of the CICU. My important takeaways were, first, they have got this. They have the personnel, experience, minute by minute protocols and technology . Second, I can be comfortable understanding this and relax. No pain and I experience hourly progress. Third, discuss how to initially communicate with your caregiver. I will post more in the coming days.

I feel better today than I would have anticipated 13 days after surgery. Lise has said that I look like I never had surgery. Now that can be taken two ways! My brain is now fully awake and wants to get going. My body is saying , "hey pal, not so quick!" Went on 3 walks today outside. The goal is to do 3-4 walks daily as possible. The visiting nurse came. I think she was quite happy with how I looked and was really impressed with the 4" incision. The exam went well. Dr. Percy really has a work of art there with the incision. We resumed mail service and I received quite a few humorous get well cards. Up on the mantle they go. Thank you all! Beautiful day here which makes walking outside here quite nice. I have stayed away from TV so far except for football. Will watch a bit of MNF tonight. Tomorrow I will need to pull out some good business books and engage Mr. Brain. Thanks so much for all that have posted notes. I enjoy hering from everyone. If you read the guest book yesterday, you will see that Ernie was getting a bit pissy with Dan. I thought that Adam moderated this site ??! My very best to all who have surgery this week. Rach, you keep right on fighting my good friend. And to all that are recovering, full speed ahead!

Good morning to you all. I should be using Dragon Dictation to post this entry but not quite yet! I want to share a detailed update to keep you informed and to perhaps help those who will be operated on soon. Before I provide an update let me continue to share my deep desire that Rachel regain her health. I know everyone is praying for Rach and her family. Good morning, Rachel, we are with you this morning in full support, caring and love. Also, in the next few days, I want to add two more hospital stay journals, one for ICU and one for step down. I will ask Lise to do the same. This would provide both the patient and family perspective for those awaiting surgery. Here is the S + 12 day update. First, I feel much better than expected. No pain. I take 2 mg of hydromorphone every 4 hours. I am taking all my medication religiously. Today I may try to stretch out the hydro to every 5 hours to see how that goes. I am an anti pill guy but with this I am absolutely compliant. My legs are as strong as pre-surgery. I have walked in the driveway yesterday and will do so today. Plus will walk down the street for the first time. (if I walk by your home please just turn me around!) Right now Lise and I have entered into a cocooning stage. No desire to get in the car, be in public, etc. I am using the spirometer hourly and am teasing the 2500-2750 mark. It feels good to use it. I told Lise that my breathing at rest seems so much easier than pre-surgery. It felt that I was gulping air when sitting, now not at all. I have a 4 inch scar. It looks really good and I think I will heal well. The scar real bothered me as I contemplated this for 5 years. Now it is no big deal. My chest feels tight and stretched in the shape of a T. Tight as the skin pulled or the muscles having been manipulated. Just what you would expect. The pain meds relax me but that is it. No adverse side effects other than constipation. I have been dowsing myself with prune juice, milk of mag, fruit! Etc. It takes double what you would think to get results. My back muscles not bad. Left glute however knotted up last night. I tried to work it out unsuccessfully. Applied some heat and that helped. Vitals through yesterday were good. Eyes are off a bit with reading glasses but I think that is due to meds. I just read without glasses for now. Here are a few more items that have helped. I bought a wedge pillow that is quite comfortable in bed. I took a nap with it yesterday. I also bought a travelers horseshoe pillow. I recommend both. Monday night I will try to sleep in the bed for the first time. I gave my caregiver a bit of a fright yesterday. My Electronic mailbox had gotten full while I was in NYC. I was in the home office with the computer on going to town deleting emails. First, she could not find me. Second, she thought I had already gone back to work and was not terribly happy. I assured her I have not! I have found that I now have gotten to the point where I can and want to read a book. A friend bought me Wolf Hall, an interesting read. Thanks, Ann Marie. The Greater Framingham Running Club, my running club since 2002, sent me a superb Edible Arrangement. This was unexpected but deeply appreciated. It is fresh and healthy. Also, thanks to Vicki J, Lori and Joel for delivering food. Much appreciated! I have found my mind has now started to occasionally drift off towards future "what if" worries now that the surgery with hospital is behind me. You know, the what if worries that never occur 99% of the time but keep us fully engaged. I plan to go to Dr. Adams site today to center my mind on all of the calming, positive, and helpful content that is available to offset the what ifs. Well that's it folks. Thank you everyone that has left messages. I enjoy keeping up with all of you in our virtual community. The very best to all of you today!

Hey folks, for those of you heading in for surgery I wanted to share a few tips for your home setup when you return. Right now we are living on the 1st floor only. I bought a great digital scale through Amazon. It is EatSmart Precision Plus Digital Bath Scale. It is extra wide which is good for me. I also bought an Omron 7 Series Upper Arm Blood Pressure Monitor. We have a digital thermometer so we are good to go. In the morning I take all the vitals. I created a paper James D Jones vitals log ( modified a Word template) And I use this paper log to record everything. Tracking meds can be tough. I have 13 items that I am tracking. I found an app that works quite well on the App Store called MedCoach, version 1.8. I have used it for 3 days. It has worked well for me. I would suggest that you consider some app because it can get confusing quickly. Hope these tips help. Here are a few funny hospital stories. Two nurses on separate days said I sounded like Nicholas Cage. Flattering. One aide, after I ate my entire meal for the first time agreed after my prompting that indeed I had won the daily meal contest and was entitled to a trophy. In the early days you have no or few inhibitions at all. For example, They encourage you to burp and pass gas at will. Do not hold back. You would have thought I had won a trip to Disney! From that point on I was in what is for a man, heaven! One day in step down, I was walking down the hall at 4pm entering large, high traffic common area and was cold. I asked Lise for a blanket and proceeded to wrap myself in the blanket and trundle down the hall past doctors, well dressed NYC visitors, etc, in a gown, socks and blanket. A professionally dressed and quite proper staff member smiled broadly when she saw me and asked me if I wanted to trade blanket for bathrobe and I told her I felt like I was being treated like a VIP. I truly looked " down and out in Beverly Hills". Well, there you have it, a few stories. Ciao.

At 5am, Lise, Ann Marie and I left the hotel and preceded to the hospital by way of East 96th and Madison Ave. It was a cold, clear evening and the dog owners, runners and early risers were out on the street. I love NYC. Regardless of time, the city pulses with life. We arrived at Mt. Sinai and oriented Ann Marie on the hospital layout. We arrived on the 5th floor as the first patients before the office was opened. Fast paperwork. Off to the prep room. Quick procedure to get you in hospital garb, have an IV port added and otherwise prepped. Moved from there to holding room. Said goodby to Ann Marie at elevator. (Either she or I had tears in our eyes, not quite sure. I could not see her that well) Arrived in holding around 6:30am. The room was waking up. My OR nurse was wonderful, a veteran nurse. Over 40 years at Mt Sinai. Did Dr. Adam's first case years ago. Now she does his first case each day. Lise and I had a chance to visit with her. I met another doctor and then Dr. Gregory Fisher arrived. A terrific and wonderfully skilled anesthesiologist. I was honored to have him on my case. We had a chance to meet one another and chat a bit. I met Dr. Percy Boateng who was the co-surgeon that opened and closed me. We had met in July. A doctor that I have lots of confidence in. I was Then shaved but not as much as expected. The woman remarked on my bear like qualities which was spot on. Lise and I said our goodbyes and I headed into the operating theater. We both well quite well until the OR nurse asked us how long we had been married. Neither of us could get that answer out. At all. Off to the theatre. The OR is interesting. Lots of equipment, cool tempature and narrow table. Dr. Greg explained to me the reason for the narrow table. It permits the surgeon to directly lean over the table without being at an awkward angle. They did some prep work, snuck me something and I went out like a light. Dr. David Adams did the Barlow's repair. I was told his work took 2 hours. The ring he used was a 40. I had never heard of a ring that big. Some feedback about the operation included these comments "it could not have gone any better", "it was a textbook case", "it was an ugly, mis-shaped valve" , "the degree of difficulty was 8-9 out of 10", "it was a very complex repair". It was my exteme honor to be treated by Dr. Adams, Dr. Fisher and Dr. Boateng, and the entire team. They have opened a path for a much healthier and longer life. All I can say is thank you for your investment in my life. I will provide more posts about my hospital stay in the coming days. Ciao.