Jim's Journal

Interesting information for all of us. Mechanical Versus Bioprosthetic Aortic Valve Replacement in Patients Aged 40 to 70 Years: A Systematic Review and Meta-Analysis. http://www.ncbi.nlm.nih.gov/pubmed/26794881

What a great 4 month post-op echo report looks like: Summary 1. Left ventricle: Size was normal. Systolic function was normal by visual assessment. Ejection fraction was estimated in the range of 55 % to 60 %. There were no regional wall motion abnormalities. There was mild concentric hypertrophy. Left ventricular diastolic function parameters were normal. 2. Aortic valve: A bioprosthesis was present. It exhibited normal function and normal motion. The leaflets appeared normal. There was a normal-appearing sewing ring and no rocking motion of the sewing ring. There was trivial aortic regurgitation. There was no significant perivalvular aortic regurgitation. Valve peak gradient was 12 mmHg. Valve mean gradient was 7 mmHg. The aortic valve obstructive index (by VTI) was 0.68. 3. Aorta, systemic arteries: The root exhibited mild dilatation, but represents proximal aortic graft after reconstruction of the proximal ascending aorta.

I was in Philadelphia last week for my first post-operation medical evaluation. My first post-op echocardiogram since discharge was completed and I met with my cardiologist. Everything looks very good. My new aortic tissue valve is performing beautifully with no leakage and low gradients. This is good news. MY next appointment with my cardiologist is set for January, 2017. I am continuing cardiac rehabilitation, walking, and working with weights combined with stretching. The idea is to ward off becoming frail with age.

In addition to my daily walks, I've started an exercise program that incorporates some exercises recommended in a recent issue of the AARP newsletter...stretching, body weight squats, touch your toes, etc. I'm combining that with a couple of exercises recommended by my scuba diving insurance company that are designed to improve upper body strength. I use two 20 lb hexagonal dumbells. The two exercises are pullups and pushups both done from a bent-knee position in the deck. Then I add some overhead lifts with the dumbbell one arm at a time, and some curls. I'm hoping that the body weight squats help improve the muscle tone in my left leg, which is somewhat atrophied due to a long ago bout of sciatica and arthritis in the knee. I'm trying real hard to stick to my low carb diet. My weight is good at about 190, down slightly from where I've been in recent months after my surgery. I stopped Warfarin last Tuesday with the blessing of my cardiologist so now the only pill is a daily aspirin. That made me happy. I have my first post op echo in a couple of weeks, but the valve seems really good. I have no palpitations or other symptoms and it really pounds shut. I know it's working, that's for sure! Finally, Monday I start cardiac rehab. I'm getting a late start due to the move to the summer cottage but I at least want to try some sessions to see if they are helpful.

I'm feeling physically pretty well. This week I plan to start the ball rolling on joining a cardiac rehab program. It may help me to improve my conditioning. I want to try anyway. The results of my 24 hour Holter heart monitor were excellent with no arrhythmia or other abnormalities. My cardiologist took me off Amiodarone, of one of the remaining two heavier medications I'm taking. In three weeks I can stop the other (Warfarin) as long as I don't notice any palpitations or other irregularities. Then I will be completely off medications save for a daily aspirin and multivitamin. For the most part, I have made an amazing recovery from a very traumatic operation. I'm still working through mental and emotional thoughts and feelings that come with surviving such a trauma, compounded by the loss of my beloved dog, Bradley, while I was in the hospital. As I wrote at the time of my surgery, the whole experience has a surreal quality for me, and I often don't feel like I fully comprehend what happened and what the implications going forward are. This is not uncommon for heart surgery patients, The good news is that I am not debilitated or suffering from extreme depression. Hopefully things will straighten out for me with the passage of time and the loving support of my wonderful husband, who has always been there for me.

Here's another comprehensive essay on aortic disease written by my surgeon, Dr. Grayson Wheatley at Temple University. http://badaorta.com/an-open-letter-to-patients-with-aortic-disease/#comment-181

Seven weeks post-op and doing two hour-long walks a day usually 6 to seven miles total. My afternoon walk yesterday: Apr 10, 2015 Walking 3.32 mi Distance 3.32 miles Time 53:18 16:04 minutes per mile

A 13 day hospital day and two trips to the OR in February not withstanding, I'm doing well five weeks out. I'm walking three to four miles a day and meetings with my surgeon and cardiologist went well. I can drive again on Wednesday and my list of meds is down to just a few. No matter how tough your surgery is or how weak you feel afterward, you will get better and stronger if you believe in yourself and keep a positive attitude.

Just a day shy of three weeks since my second trip to the OR. With the good weather I'm outside doing two hour long walks a day. My INR is in range, no pain, still struggling with strength and endurance issues, but slowly making progress. You gotta be in for the long haul.

It's been two weeks since my second of two trips within five days to the OR. Medically things seem OK, no issues with my new valve or all of my surgical repairs, heart rate or BP, etc. I just had no idea how weak I would be and how painfully slow and difficult getting any strength back at all would be. I haven't felt quite strong enough to go out of the house yet, but with all of the snow and ice and cold here in Philadelphia I couldn't go anyway, so I have a major dose of cabin fever. It's supposed to warm up this week and I have my first follow-up appointment on Tuesday so hopefully I'll feel better after i finally get out and get some fresh air.

Just completed a 30 minute walk in the house sans walker. It wasn't that long ago that I couldn't even get out of bed. I have some puffiness in the ankles, but other than that I have no complaints at all. I haven't taken a pain medication in a week. If I can continue to improve a little at a time like this I'm optimistic that I'll be walking outside soon...if Old Man Winter will give us a break here in the Northeast.

My stamina all of a sudden leaped to the point where I can walk a lot and even climb steps! I never thought I'd get back to this point. So the insurance denial doesn't matter...the hospital has cleared me to go home later today! Tears of happiness I gotta tell ya.

Waited all day today for insurance approval to enter acute rehab only to be denied. So the next option is to enter sub acute rehab at a different facility maybe as early as tomorrow. I am medically stable and feeling good just not strong enough to go home.

My Afib spontaneously converted to normal sinus rhythm last night so I didn't need the dc cardioversion. May enter acute rehab tomorrow or Saturday. It's been a long, tough haul.

Spent some time with physical therapy today. Bowels are working finally. Afib and high heart rate are issues the doctors are working on. Will be making arrangements to go to a rehab facility upon discharge. Sorry I cannot be as actively supportive of everyone here but you are all in my thoughts.

Well,.tubes are out and I am medically stable, I think. The Afib that I developed when they took me off Amiodarone due to liver concerns continues to rock the boat and is very noticeable. I have zero strength and get winded at any activity. I met with physical therapy today and they are recommending discharge to a rehab facility. I know I can't go home in my current state if extreme weakness. Thanks everyone for the continued love and support. I am glad this thing is not ad bad for most of you as it has been for me.

Thanks everyone for all of the support. My numbers are improving. Two chest tubes were removed this morning...two remain. My swan neck arterial line from Fridays second surgery is supposed to be removed today also. No appetite and taking meds to get my bowels to move. But slow progress is being made I think. Patience is necessary. Love and hugs to my heart sisters and brothers. Jim

Still in ICU day 7...trying to get heart function improved...outlook trying to keep positive...at least one more day then maybe I can try to sit again...thanks for keeping me in your thoughts

Still in the ICU since Monday. Had a second full steroenotomy Friday to relieve fluid backup behind heart Original surgery was 7 hours valve, root, ascending and two cabg...been a tough week...hope I have turned the corner

This is Dan, reporting for Jim Kelly-Evans. He had his surgery today, correcting the valve, the aorta, aortic arch and two arterial bypass procedures. He is in recovery at the ICU now and appreciates your concern