Well, it doesn't seem possible that six months ago I was posting my Pre-Operation fears and jitters. My surgery was October 28, 2009, so next Wednesday will be my 6 months anniversary. What a difference six months makes!
I can truly say that I feel better than I've felt in years! I have been back to work since February first, and have grown steadily stronger. While I still get tired by the end of the day, there isn't really anything that I would be afraid to do. Yesterday I worked in my garden and dug footings to put in some rain barrels under the deck. Who would have thought I could use a pick and shovel after only six months? I have sore muscles this morning, but my chest didn't hurt, and I didn't have shortness of breath. It feels GOOD to work as hard as I want without worrying about my heart.
It's spring in Iowa, the flowers are blooming, the robins are singing and it's good to be alive!
Several people have asked how I was doing since returning to work, so I thought I'd write a report. I returned to work full time on February first. The first week was fairly slow, with sales considerably below normal. Even so, I found myself getting really tired by the end of each day. The second week, sales were much stronger, (apparently my selling skills haven't suffered from surgery) and consequently I found it much more difficult to get all the physical work done. I've always been one to keep myself positive, but honestly it was a struggle just to keep going. I guess after being off work for four months, I've gotten pretty soft! I can see in my head what I want to accomplish, but my body can't quite deliver. I guess I shouldn't be discouraged by this, since Dr. Hockmuth warned me that it could take a full year to recover all my strength. Anyway, I'll keep plugging away, and I'm sure that in time, I'll be back 100%.
Well, that went well! I was pleasantly surprised at how well I felt today as I got back in the swing at work. I didn't have any major difficulties, although I was getting pretty tired by noon, and feeling ready to hang it up by 4:30!
But I didn't hit any roadblocks with lifting or moving pallets. Pat (who has worked my territory while I was away) worked with me today, and we were able to call on 8 stores. That's a pretty good days work even if Pat did a little more than his fair share. :-)
If I'm not too sore to get out of bed in the morning, I think I'll do it again tomorrow.
I feel like tonight is a time for reflection. Tomorrow morning, I will return to work - the first full day since my heart surgery.
I just went back and reread all my journal entries since the beginning... In a way, it seems like a long time ago that I learned I would need surgery. In another way, it seems like just yesterday.
I originally thought I could be back to work by the first of January, but scheduling open heart surgery and going through all the pre-op testing took much longer than I anticipated. There were so many options to be considered - so many pros and cons. By the time it was all done, my surgery was a month later than I had originally expected.
I also underestimated the time it would take for my sternum to heal. Even now, I have some residual soreness in my chest, but I'm hoping increased exercise will help rather than hinder my progress. I'm not sure if I'm really ready for the stress and the manual labor of my job, but it's time to find out. I'll know by this time tomorrow! :-)
I want to thank everyone again for all the support and encouraging words during my recovery. Until you've been in this situation, you can't imagine how much that's worth. I hope I'll be able to pass that encouragement on to other people who have similar experiences in the future.
To all my new friends here at Heart Valve Journals - I have read every word of every journal posted here -- including the guest book entries from your friends who I don't know at all. I feel a strong connection to each of you, and I will continue to remember you in my prayers. Wherever you are in the process, there is light at the end of the tunnel so stay positive.
Well, I haven't posted for a while so I thought I should catch everyone up on what's been happening with my recovery.
I finished my cardiac rehabilitation classes and received a nice certificate saying I've learned all I need to know to stay healthy now. I posted a picture of it to prove to you all how "worthy" I am of graduating from such a prestigious class. :-) I continue to walk on my treadmill at home every day.
On a more serious note, I saw my cardiologist, Dr. Christenson last week. I was concerned because the nurse at my cardiac rehab class had heard a murmur - exactly what my surgery was intended to fix! Dr. Christenson ordered an echo and a bubble test. The echo was to get clear pictures of my heart valves and to measure their function. The bubble test was to determine whether there was any leakage between the chambers of my heart. In both cases,my heart was working perfectly! The murmur that the nurse heard was a result of having my aortic valve tightened by the surgical repair. There is no regurgitation, and the repaired hole between chambers has healed completely. My heart was functioning at about 40% before surgery, it's now at 55% and improving.
My sternum continues to mend and my lifting limit has been increased. I'm now allowed to lift up to 50 pounds, provided that I do so "carefully". I've been working on some upper body strengthening exercises.
I've been released to return to work with full activity beginning on February 1, 2010. I guess by the end of that first day of work I'll know if I'm really recovered! It's hard to believe that it has been 4 months sine my life was "normal." I'm looking forward to getting back to it!
Until next time,
Ok, I guess you can't read the picture so here's the translation:
CERTIFICATE OF COMPLETION
As a matter of record, this document attests to the undersigned's diligence in pursuing a standard of excellence and the fulfillment of all exercise sessions and education classes associated with the completion of
PHASE II CARDIAC REHABILITATION
This individual, by undergoing intensive exercise training and education classes, has indisputably proven to be worthy of all rights and privileges in correlation with the conclusion of the aforementioned course.
My surgery was October 28, 2009. Ever since that time, I've intended to post a recommendation for Dr. David Hockmuth on Adam's Heart Valve Surgeon Database. This morning I finally got it done. It was much simpler than I expected - only took a few minutes, and I hope someday someone going through the process of selecting a surgeon will benefit from my experience.
I just thought I'd put in a plug for the Heart Surgeon's Data Base. Adam has offered a tremendous resource for anyone contemplating heart surgery, but it only works if we patients do our part.
Don't procrastinate like I did. Post your surgeon's information - you never know who may need that information today.
The link is at the top of the page.
Well, everybody needs a hobby, right? So I've decided to collect doctors. It started by accident, really. By the time I realized what was happening, I was well on my way to an unabridged set.
Actually, until I was about 50, I didn't need a regular doctor. I always just borrowed someone else's for special occasions. But Mary convinced me that I should have MY OWN doctor to take care of those routine things that need to be done when you're over 50. So I found Dr. Grandganett.
Then, not much later, a throbbing molar reminded me that someone over 50 should probably have a regular dentist, too. I called Dr. Niesch who promptly set about repairing what I had neglected for years. (Insert dazzling smile here!)
Meanwhile, back at the Ranch, Dr. Grandganett found my heart murmur, and referred me to Dr. Christenson, MY cardiologist. In time, Dr. Christenson referred me to Dr. Dotoni for a second opinion. They (MY cardiologists)agreed that I should see a surgeon.
First, I met Dr. Prabahkar who discussed all the options with me and helped me decide on a Ross Procedure - but that's a procedure that he doesn't do... so he referred me to Dr. Hockmuth for consultation. Dr. Hockmuth became MY surgeon.
I thought my collection of doctors was complete, until I started cardiac rehabilitation a few weeks ago and developed severe pain in my feet from walking on the treadmill. My physical therapist, Patti, suggested I see a podiatrist, so this morning I met Dr. Erin Nelson, MY podiatrist. Hopefully, by the time I'm "rehabed" enough for my chest to return to work, my feet won't prevent it!
So, however unintentionally it came about, I find myself associated with seven highly trained and proficient physicians. While I value each of these associations, I find them somewhat expensive to maintain. I can't help but wonder if the prestige of association is worth the expense?
What to do? Perhaps a referral service? Anyone in need of a good doctor?
Well, Thursday afternoon, I had my FINAL appointment at my surgeon's office. I only saw Dr. Hockmuth briefly, but his assistant, Erika, spent about 30 minutes with me. Thankfully, everything checked out fine. My heart beat is stable, my heart rate is fine, and best of all my valve is no longer leaking!
I was concerned about still feeling some movement or "popping" in my sternum. Erika said this movement could be from a slightly cracked rib or movement in the unhealed joints between the sternum and ribs that were broken during surgery. She checked me over and, in general, said I'm healing fine. Because of the "popping", she recommended that I refrain from upper body exercise or lifting over 25 pounds for another 30 days. AND, on the bright side, She cleared me to resume driving. :-)
The only down-side is that I'm REALLY sore today as a result of her "prodding and poking!"
Today, I had rehab again. I'm now up to 40 minutes on the treadmill each morning supplemented by another 40 minutes in the afternoon at home. The nurses have asked me to keep a record of my at-home exercise and a log of everything I eat for the next 3 days! (I think they may be more dedicated to my losing weight than I am!)
Also connected with my cardiac rehab program is a series of classes presented by various educators. These include "Risk Factor Management," "Stress Management," and "Healthy Eating." I'll have the first of those next week. I expect them to be very helpful in avoiding the factors that could lead to damaging my heart again.
So... it's been a productive week. I'm ready for a relaxing weekend!
Yesterday I had my first Cardiology appointment since surgery. I had my regular Rehab session first, then went upstairs to Dr. Christenson's office for my checkup.
There was some concern from the nurses in rehab about my elevated heart rate during exercise. Dr.Christenson increased my Metroprolol from 50 to 100 mg daily to keep my heart rate more stable. Otherwise everything seems to be progressing fine. He said my incision was healing "beautifully". Since nothing else about me could be classified as "beautiful", I figure that must be an improvement!
Here is my current list of heart medications:
Metroprolol: 100 mg daily
Nifedical XL : 30 MG daily
Aspirin : 81 MG One daily
Iron Supplement: 65 MG One daily
Tylenol Extra Strength as needed for pain
I'm pleased that the list of drugs is slowly shrinking. I'm starting to feel like I'm in pretty good shape for the shape I'm in!
My next appointment is with my surgeon's assistant on Thursday of this week. Hopefully I will get permission to resume driving, and perhaps a relaxed lifting restriction.
I just returned from my Wednesday morning rehab session. Today I walked 32 minutes on the treadmill at 3.0 miles/hour on a 3% incline. I'm able to do more than twice as much exercise as I could do only 2 weeks ago. It feels great to know that I'm getting my strength back and my repaired heart valve seems to be working perfectly.
Tomorrow Mary and I will achieve another goal - hosting Thanksgiving Dinner for about 20 of our family and friends. We are truly blessed, and we have much more than usual to be thankful for this year!
Yesterday morning, I went to Mary Greeley Hospital in Ames to begin their Cardiac Rehab Program. We spent about an hour and a half filling out paperwork, reviewing my health history and recovery since surgery. Then I walked on a treadmill for 10 minutes with a heart monitor to see how I was reacting to exercise. All was well, so this morning I returned to join my regular class with 6 other heart patients.
I will attend 18 sessions in all - Monday, Wednesday, and Friday for 6 weeks. We'll work up to 45 to 50 minutes of exercise.
Today I walked 25 minutes on a 3% incline. I'll supplement that with another 25 minutes at home this afternoon.
Does anyone have any idea how long it takes for the sternum to heal enough for upper body exercise? I've work my heart-hugger almost continuously since surgery, but I still occasionally feel a little movement in my chest - like the sternum is slipping. Anyone have a similar experience?
All in all, I feel very positive about my progress.
Well, I continue to make progress. I've been feeling good most days although I've had some difficulty sleeping at night.
On Saturday evening, Mary and I had dinner out with my team from Kellogg's. It was good to see everyone, and I really enjoyed the opportunity to get out for a while. I was pretty tired by the time we got home, but it was definitely worth it!
Today both Mary and Jenny returned to work, so I'm home alone for the first time since surgery. I did 20 minutes on the treadmill, then fixed my own lunch (microwaves are a wonderful invention!) Now if I can make it through my afternoon nap unsupervised, I'll feel positively self-sufficient!
Tomorrow morning, I'm scheduled to begin rehab at Mary Greeley in Ames. I'm looking forward to the opportunity to have a structured plan for rebuilding my strength. I'll let everyone know how that goes.
On Friday, Mike and Chris delivered a treadmill that they are loaning me for rehab. I've been walking on it each day for 15 minutes at a time at a relative slow setting. I'll gradually increase my speed and exercise time as I grow stronger. So far, 15 minutes is about all I can manage.
In another week, if all continues to go well, I will start the official heart rehab program at Mary Greeley in Ames. That should help me rebuild my strength and endurance to the point that I can eventually return to work. The 10# lifting restriction continues to keep me from doing much of anything productive!
I'm continuing to feel great. There's the lingering deep soreness, but I suppose that will just take time to heal. The only "real" pain I have experienced is on Friday evening when I sneezed. It felt like someone hit me in the chest with a sledge hammer! So I think I'll continue to quarantine myself for my own protection! :-)
I'm trying to be patient and let the healing process take it's time.
I wanted to take a couple of minutes to write about a few tools that have been invaluable to me during my hospital stay and recovery.
1) The spirometer. As many people have said already, this device is indispensable in keeping the lungs clear. It also hurts like some invention of the Spanish Inquisition - but only for a few days. :-) I've used mine everyday since surgery - and finally today I could inspire the full volume of the cylinder for 20 reps. Felt like a major victory!
2) The Heart Pillow. This is a big red pillow that I hug to my chest when I get in and out of bed. It was very helpful throughout my hospitalization. I don't need it anymore, but I had my entire care staff sign it, so it will be a long-term reminder of all the wonderful people who helped me through my operation. I have pictures in my photos.
3) DVT stockings. Deep vein thrombosis compression stockings. I wore these for several days in the hospital to prevent blood clots in my legs. They inflated and deflated regularly to massage my legs. They also got INCREDIBLY hot one night as Mary already told you. :-) The picture of me sitting in the chair in ICU shows me wearing the DVT stockings.
4) Hearthugger Sternum Support Harness. I wasn't aware of this device before my surgery. When I developed a little "popping" in my sternum following surgery, Dr. Hockmuth prescribed one to stabilize my sternum until it knits properly. It is an elastic band harness that fits around the chest and has 2 handles in front, one on each side of the incision. I can squeeze the handles together to tighten the band tightly around my chest during times of stress like getting in and out of bed, up from a chair, etc. The "popping" is gone from my chest, so I assume it's working as advertised. I have several pictures - front and back. There is a web site if you'd like further information: www.hearthugger.com
I hope this is information that can help someone else that is preparing for heart surgery.
Dr. Hockmuth’s surgical nurse Deb had told us on Sunday that Joel could go home on Monday, so when this day dawned we knew it was the last in the hospital. I still was apprehensive about caring for Joel at home, but I also felt like we were ready to go.
Joel walked quite a bit in the morning with the Cardiac Rehab staffer, even walking on a treadmill for a while. Lindsey, another of Dr. Hockmuth’s nurses, came in about 11 a.m. and went over Joel’s medications and instructions for home. She said she would fax Joel’s prescriptions to our pharmacy in Ames and gave us a written one for the pain medicine because narcotic prescriptions have to be handwritten. Joel told her about the “popping” sound and she ordered a CT scan. That left us hanging, wondering if Joel would indeed be going home or if he’d be going back in for more surgery.
Lunch came and went and there was no word. Naps came and went and there was no word. It was after 2 when Dr. Hockmuth came in and visited about the results of the CT scan. He said the bottom tip of the sternum is partially overlapped, but that he believes it will heal completely anyway. He ordered a “Heart Hugger” for Joel to use to help him get in and out of bed. It is an elastic band with suspenders that clasps in the front and has handles in the front so the patient can hold on to the handles to keep the chest stable while getting up and down. We’ll post more about this with a picture later. So at that point Joel was completely released from the hospital; just the paperwork had to be done.
So we waited.
A long while later one of our favorite Cardiac Rehab staffers stopped by and was surprised to see us still there. He went and checked on the status of our release and came back and said it would be at least a couple of hours and we should order supper.
And so it was that just as we were finishing up our supper, the nurse walked in with the final release papers. She took off Joel’s heart monitor and gave us final instructions. Joel got dressed (of sorts – he went home from the hospital in his pajamas just as Adam did, but with a coat overtop since we live in Iowa) and then we waited for his “ride”. When his wheelchair arrived he sat down and we were off to the races. I barely kept up. It was down the elevator and then they had to wait at the front door while I went to get the car. He was no more out of the wheelchair than it was gone in a flash and I was left to help Joel get into the car. The wheelchair drivers clearly get paid by the speed at which they do things.
Halfway home I realized that we were so late getting out of the hospital that we were going to be getting to our pharmacy very close to closing time (which I thought was 6 p.m.). I called the pharmacy to make sure they would stay open a couple of minutes for us only to find out that they were closed at 5:30 p.m. that day. Panic! What to do – they hadn’t sent any meds home with Joel. We finally realized that all of his meds were morning meds except for the pain pills and we had the prescription in hand for them. So we went to Walgreen’s and filled that prescription and will pick up the other prescriptions early in the morning.
It was 7 p.m. by the time we finally walked in our own back door. We were tired, but we were very happy to be home. Bedtime came early. The wedge pillow that Joel read about in someone’s journal worked very well and Joel slept comfortably.
Joel continues to gain back his strength. Today he walked up and down the halls without a walker and his pace got quicker and steadier each time. He continues to use the spirometer regularly, also, and that has made a great difference to his oxygen levels and breathing in general. His oxygen level was 96 this morning and, after walking the halls without oxygen, it remained at 96. That was the magic point for leaving him off the oxygen machine.
That left only the arterial IV port in his right hand and the nurse took that out in the afternoon. Finally Joel was almost just himself, no attachments. The only things remaining are the electrodes and monitor that send Joel’s heart telemetry to the nursing station for analysis and monitoring. That won’t come off until he is released. And the electrodes aren’t invasive, they’re just stuck on and the battery lives in his gown pocket. More a nuisance than anything, but a lifeline if anything was to go wrong.
Joel was alert most of the day today. He took some phone calls, had some visitors and watched some television. His appetite is back and he is eating better. He said the food is tasting better all the time and the metallic taste in his mouth is diminishing. He has lost 3.5 pounds since he came to the hospital. That is good – it means he isn’t retaining fluid or leaking inside.
One thing Joel has noticed as he is taking fewer pain medications is that he feels a “popping” in his chest sometimes when he moves just right. He has mentioned it to several different nurses and a doctor and they seem to agree that it is probably the sternum grinding against itself at the point of incision. They say as the bones knit it will go away. We will ask Dr. Hockmuth about it when he comes in next.
Joel is very emotional right now, probably as a result of the anesthesia and pain killers and the overall stress of the surgery. He doesn’t seem to be depressed, in fact, he seems very upbeat and positive. However, depression is a common side effect of this surgery so we’ll try to keep watch for that and avoid it if possible.
I wrote about the rubber leg wraps that kept Joel so hot and miserable the second night and there were some questions about what I was talking about. The leg wraps, which aren’t really rubber but felt hot like rubber that night, are fabric air pressure cuffs that go from your ankles to your knees and gently massage your legs by building air pressure and then releasing it. They have tubes attached to them that hook to an air pressure pump/regulator that is attached to the bottom of the bed. The technical term for this is DVT (Deep Vein Thrombosis) Prophylaxis System. The use of this system greatly reduces the possibility of developing Deep Vein Thrombosis or blood clots. Joel found them to be minimally problematic except that one night when he was so hot and they made him hotter. Otherwise, he said they were actually comfortable and they certainly serve a good purpose.
This was a relatively quiet day followed by a quiet evening and a good night’s sleep.
A good night’s sleep can make a remarkable difference in how one feels. Joel is moving much easier today. He can move himself in bed and actually lean forward without a lot of pain. Some of this, of course, is due to the better pain meds he’s getting, but he’s also getting stronger. Will’s comment when he arrived at 8 a.m. that I looked worse than Joel this morning was perhaps the most telling comment about how good Joel is looking. (I refuse to take it any other way! LOL).
During the afternoon one of Dr. Hockmuth’s surgical nurses checked on Joel and removed the drainage tubes in his chest that had been in since surgery. The tubes had collection bulbs at the end and the nurses measured the liquid that came out each day. Once the amount coming out had diminished to a certain level, the tubes could be removed and the body will absorb whatever fluid still remains/is created. Getting the tubes out made Joel a lot more comfortable, plus it was good to know that another threshold of recovery had been reached.
That leaves oxygen as the only support system he is still on. He continues to take walks with the Cardiac Rehab staff and also with family members and uses the spirometer religiously. Those are two of the most important things he can do to recover his strength and prevent secondary infections like pneumonia. He has maintained a really positive attitude throughout and hasn’t complained even when the pain made him most uncomfortable.
Joel’s appetite is returning a little. There are still some foods that don’t taste good to him. It has been interesting to note which foods tasted good from the beginning and those that have started tasting good at different stages. Grapes and milk have always been good. Apple juice tasted sour at first but a couple of days later tasted fine. Same with applesauce. Vegetables have tasted “awful” all along, even though they look appetizing. The only food he has really been excited about was the beef and noodles he had for supper tonight. I assume that taste buds start working in stages after surgery, just like the rest of the body.
By evening Joel was stable enough that I felt comfortable leaving so I went home to sleep and left Will and Jenny with Joel overnight. They had a party and stayed up late watching the World Series! Joel said it was a good game and he stayed awake through the whole thing. That’s another sign of recovery – staying awake. That probably reflects lessened pain and therefore lessened pain meds and adequate sleep.
Joel started Day 3 miserable: he was in too much pain to sleep during the night and his body was starting to register the effects of the surgery. One of the ICU nurses had warned us that Day 3 is the toughest day and that every day after that will show improvement. I kept reminding myself of that all morning: this is the worst it will get; it gets better after this.
And relief did come -- morning shift change brought a new pain medication regimen. This allowed him to walk frequently with the Cardiac Rehab staff and use the spirometer without too much discomfort, and, most importantly, to finally sleep. A sponge bath, hair wash and shave made him feel almost human again, he said. By afternoon Joel was resting comfortably and we both took long afternoon naps.
Because Day 3 turned out to be such a nice quiet, peaceful day without much excitement, I believe Joel went through the “Day 3 is the hardest” mostly between midnight and noon and by afternoon was sailing in calmer seas. He felt so good he visited with his Mom on the phone in the evening – the first real phone visit he’s felt like.
The only hitch in this good day was when they removed his catheter, but he was glad to have it gone once it was. Afterward he slept well the rest of the night.
The first night started out as a painless morphine haze for Joel, but with the shift change at 11 p.m. came a change in pain medication. The second half of the night was much more uncomfortable than the first part, largely due to a long staff delay in giving him pain medication.
On a happy note, though, he was up by 3:30 a.m. sitting in a recliner, dozing off and on, nestled in a bed of tubes and monitors. By morning, he had taken one very slow stroll up and down the floor. In spite of the pain, he was looking much more like himself and was feeling better. His condition was improving the way children grow: almost visibly.
Dr. Hockmuth came on morning rounds and said Joel was doing so well he could be released from ICU and sent to a private room. This started a barrage of testing, taking samples, making X-rays, etc., and then finally detaching tubes and machines that took several hours. In the end, Joel was moved to a private room and started taking walks up and down the floor. We learned that a move out of ICU is not a quick thing.
Joel’s moving van turned out to be a wheelchair. I expected them to move him bed and all, but instead they put him in a wheelchair with all his attachments and drove him helter-skelter through waiting rooms and hallways to the main elevators and then up to 7th floor.
Once installed in Room #739 Joel’s life started revolving around numbers: oxygen levels, spirometer uses, temperature, heart rate, etc. His oxygen levels are measured before and after Cardiac Rehab staff take him on walks. Joel uses the spirometer 10 times every hour he is awake.
The real measure of how well he is using the spirometer of course, is how his x-rays look. They’ve come in each morning to take an x-ray in his room using their mobile x-ray machine and so far his lungs look clear.
Night the second day was a miserable affair. Joel was very hot and uncomfortable because of the rubber leg wraps they use to prevent blood clots. Also, his back was hurting a lot and the pain medication he was on just wasn’t helping enough. I don’t think he slept at all that night. To make things worse, they re-catheterized him around midnight because the first catheter had been taken out too soon. Altogether not a fun time.
The Chronicle of Joel's Surgery and Recovery: Day 1
Journal posted on October 30, 2009
This chronicle of the days of Joel’s surgery and recovery will hopefully give an outline of events to others approaching this type of surgery. The scariest parts of this journey have been the vast amount of unknowns. I hope by describing our experience to dispel some of the fear of the unknown that is part of this process.
Day 1: Surgery
We arrived at Mercy Hospital in Des Moines at 5:15 a.m. Wednesday, October 28 in a group. There is definitely comfort and solace in facing something like this with your friends and loved ones by your side. When we walked into the front lobby Joel grabbed the first friendly passerby to snap a picture of his 5 A.M. Support Group: our children, Dave, Chuck, Will, Sara, and Jenny; our niece Chris; Joel's sister Leah, and me. That was the last light-hearted moment of the day as we settled in to the serious business of checking into the hospital. The reality of the impending surgery was inescapable at that point.
Finally all the paperwork was signed and at 5:49 a.m. Joel was taken to Pre-Op. We were allowed two persons in Pre-Op with him, so Dave and I accompanied him. The rest of the group gathered in the Operating Waiting Room. During the day more people joined our group: Pastor Lynn, Pastor Mitch, and friends Betty and Don.
In Pre-Op Joel changed from street clothes into hospital gown. A changing cast of nurses and technicians and other medical personnel began prepping him for surgery. His vitals were taken, blood samples were drawn, pills were given, and the dreaded full-body shave was administered. An IV and a catheter were inserted and drugs were started. Joel was hooked up to oxygen. About 7 a.m. Dave and I said our goodbyes to him as he was wheeled out of Pre-Op toward surgery. We lose the story here because Joel doesn’t remember being taken to surgery and we, of course, were not present.
Dave and I joined the rest of the group in the waiting room. The Operating Waiting Room attendants were wonderful. They kept us updated every hour and made sure they knew where we were at any time in case we were needed. That is how we know that at 8:17 a.m. they made the first incision and at 8:45 a.m. they placed Joel on the bypass machine. And it was at 10:15 that we were given the report that “they were closing him up and were very happy with how it went.” We were ecstatic because this meant that Dr. Hockmuth repaired the valve and didn’t have to perform the Ross Procedure which would have taken up to 5 or more hours longer. This was the best possible outcome and one we had been praying for from the beginning.
Around 11:30 a.m. the entire entourage of Joel’s Support Group was taken to see him in his ICU room. Joel was still under anesthesia and was connected to a huge array of machines. The ICU nurse explained what all of the machines were doing/measuring/displaying and the expected course of Joel’s stay in ICU. After that first instructive visit, we were restricted to two visitors in Joel’s room at a time.
Joel slowly became more and more awake over the course of the afternoon. He spent much of the time sleeping and was given morphine for the pain. He began using a spirometer (an instrument for measuring the volume of air entering and leaving the lungs) to reduce the fluid in his lungs. Using the spirometer causes a great deal of chest pain, but is essential to prevent complications like pneumonia.
During the night his pain medication was changed from morphine to Vicodin, which wasn’t nearly as effective. There was a delay in being given one dose, also, and that resulted in a pretty miserable night.
I won't leave you in suspense -- Joel's surgery went very quickly and very successfully. Dr. Hockmuth repaired the defect in Joel's aortic valve (it was two-leaved instead of three-leaved) and so it wasn't necessary to do a valve replacement. This shortened the surgery time considerably: they made the first incision at 8:17 a.m. and by 10:15 a.m. they were closing him up. Hopefully this will translate into a quick recovery, also.
I will post more about the details of the day, but wanted to get the good news out.
Well. No more procrastination - I have to be at the hospital for surgery at 5:00 am tomorrow, so this will be my last post until I return home. I think Mary will be able to post an update from the hospital to keep you all informed on my progress for the next few days.
I can't say I'm not a little jittery about the surgery, but basically I'm peaceful. I've done all I can do, so now I'll leave it to God and my surgery team. I have confidence that all will go well.
I can't begin to thank everyone for all the support and encouragement I've received so far. I couldn't begin to answer all the mountain of cards and letters I've gotten and all the phone calls and the posts here in my guestbook. Please know that every one of them brought a smile and brightened my day. I just want you all to know how much I appreciate all your kind thoughts and prayers.
So, I will spend the rest of today on last minute details and errands. The next time I post, I will have had my mainspring rewound for another 56 years. ;-)
I spent the morning at Mary Greeley Health Center in Ames having more tests and blood work done. They did a CAT Scan of my chest, and an Ultrasound of my carotid arteries. They gave me a CD of the tests to deliver to Mercy next week when I check in for surgery.
I joked with the lab tech that by my count, he now has taken more of my blood than I have left!
I received my official blood donor card in the mail yesterday. I'm looking forward to a time following my recovery when I'll actually be able to donate for the benefit of another patient.
My surgery will be one week from tomorrow. Until then I'll concentrate on staying healthy.
Today I scheduled my final tests. Next Tuesday, October 20 I will have a CAT Scan and an Ultrasound of my carotid arteries, as well as final blood work and pre-surgery lab tests.
My surgery is scheduled for 7:00 AM on Wednesday, October 28. I have to check in to Mercy Medical Center in Des Moines at 5:00 AM that morning. If all goes as expected, my surgery should be complete by noon.
Thank you all again for your support encouragement and prayers.
Yesterday I made my final deposit in the Blood Bank of Iowa, so now all I have to do is wait for October 28 to arrive.
So Mary & I were talking about setting some goals so we can measure my progress during recovery. We've done our homework, so I have every expectation that the surgery will go well.
1) The average hospital stay for a heart surgery patient is 5 days, so my first goal will be to return home by Tuesday, November 3. I'm already looking forward to getting out of the hospital, and I haven't even gone in yet!
2) Once home, my goal will be to regain strength each day. We'll measure this by walking a little more every day and by keeping up with all the exercises that are recommended by my doctors. I plan to enter a cardiac rehab program as soon as my medical team thinks it's advisable.
3) On November 26, we will host our annual family Thanksgiving celebration, with many guests remaining (or coming and going as the case may be) through the weekend. We will have more than usual to be thankful for this year!
4) Long term, I hope to be strong enough to return to work by Monday, January 4, 2010.
I'm sure there will be additions and adjustments along the way, - maybe even a setback or two... But I'm determined to look at this as a bump in the road rather than a brick wall. :-)
Thank you all for your encouragement, support and prayers. I can't begin to tell you how much that helps!
Yesterday afternoon, Mary and I met with Dr. Prabahkar again. He was very patient to answer all our questions - and we had a LONG list! He seemed amused when I said the process seems a lot like buying a used car! :-)
We had a long discussion about the Ross Procedure, and Dr. Prabahkar recommended that we speak to his colleague, Dr. David Hockmuth.
Dr. Hockmuth had already reviewed my diagnosis, since I had expressed interest in the Ross Procedure in our consultation with Dr. Prabahkar last week. Dr. Hockmuth talked with us for a long time and we feel sure now that this is the right surgery for me.
We came away with 2 very important pieces of information:
1) Because I have a bicuspid valve (news to me!)the first order of business will be to attempt to repair the valve. If the valve can be repaired, then the rest of the surgery can be avoided. If the valve is damaged beyond repair, then he will continue with the Ross.
2) He recommended that before surgery, I bank 3 units of blood to be used in the event that I need blood during the operation. I was under the impression that I could not do this, but apparently I can save my blood for my own use - I just can't give it for someone else...
So I feel like we're making progress. We have a plan in place: I will begin this week banking blood. We will schedule surgery as soon as that is done. Dr. Hockmuth will perform my surgery at Mercy Medical Center in Des Moines.
I'll let you know when I have a date set for surgery.
I will have my second consultation with Dr. Prabahkar this afternoon. In the last week I've tried to research my options and weigh the pros and cons of each. As Dr. Probahkar said last week, "There is no perfect solution. Each option has a few drawbacks." So I've tried to analyze each one.
Adam suggested that I make a list of pros and cons. That suggestion was very helpful. Here are my thoughts so far...
1) Under normal circumstances, I should be able to live another 25 to 30 years. I see no reason to plan for anything less.
2) Neither Porcine or Bovine valves are likely to last more than 15 to 20 years. The symptoms that I have now, (shortness of breath, tiring easily) would probably recur before then. If I go with a bovine valve, I will probably need another surgery later in life. That's not an appealing prospect.
3) A mechanical valve will last, in Dr. Probahkar's words, "Forever, in theory." The reality, however, is that there are many possible side effects - including but not limited to those resulting from taking Coumadin for the rest of my life. While my life expectancy would probably be more than 20 years, I worry that my quality of life would decline continually during those years.
4) My other option is the Ross Procedure. There are many fewer Ross surgeries done in Des Moines, so I might need to travel to Mayo Clinic in Rochester for surgery. Dr. Prabahkar doesn't do this surgery, so I would need to consult with another surgeon. The Ross is usually the choice for younger patients. I'm 56 years old, so I'm not sure if I'm a candidate for it. If I am, this seems to offer the best outcome in the long run.
5) And most of all, I have a strong faith that regardless of which surgery I choose, I am ultimately in God's hands. I have every confidence that I'll be fine.
6) I have the greatest support network that I could ask for. This is worth more than anyone can know until they are in this situation.
So.. I hope to make some decisions today. I'll write more later.
So... my first big decision is what valve to select. The mechanical valve lasts "forever" - until you die from the effects of the coumadin.... With the porcine or bovine valve you can live a normal drug-free life - for 12 to 15 years until you need another new valve. Maybe by then it can be repaired through cathaterization. or maybe not.