John's Journal

I had an appointment with my cardiologist yesterday. I'm still in sinus rhythm, knock on wood, thanks to Amiodarone, which I'm tapering off slowly: next week I go to 200mg/day. My INR is still fluctuating a lot, so I need to get a blood draw on Thursday, and presumably pretty frequently until I can get started with home testing. I can begin cardiac rehab at the end of the month, and my cardiologist says I can return to work at the beginning of March.

Unfortunately, I have another mild to moderate pleural effusion. My cardiologist has decided that rather than drain it right away, I'm going on Furosemide for a couple weeks, then another chest X-Ray. If pleural effusion is still present, it will be drained.

Today I feel pretty good -- probably the best day since I got out of the hospital.

I got some good news from my latest echocardiogram, which was done here in the hospital. Four weeks after surgery, my ejection fraction was measured at 58.5%, which is normal, and my left ventricle is returning to a normal size. It was enlarged before my surgery.

I will go home later today. My heart has been in sinus rhythm since early yesterday morning.

My AFlutter resolved overnight at the hospital, because of Amiodarone, so no electrical cardioversion today. I’ll be on Amiodarone for a month or two, to prevent a recurrence of the AFlutter.

I’ve been admitted at CPMC Mission Bernal in San Francisco (formerly St. Luke’s) for AFlutter and tachycardia. Maybe cardioversion tomorrow.

A little irregular heartbeat this morning, like AFib but not fast. It resolved after half an hour or so, but it made me anxious.

I'll call my cardiologist on Monday. Given the brevity and lack of tachycardia during the episode, I don't think it warrants a weekend call.

The surgeon drained 650ml of liquid from my pleural cavity, using a needle through my ribs in back. I was given a shot of local anesthetic beforehand, so the experience wasn't painful. I'm told it's possible but unlikely that I'll need to come back for another draining, knock on wood.

Turns out I have a mild to moderate left side pleural effusion, and I'm going into my surgeon's office tomorrow to have it drained. This condition may explain my evening temperature spikes.

I went in for my cardioversion today, for my atrial flutter, and they ran a 12-lead EKG first. It turns out I was already in sinus rhythm! I must have spontaneously cardioverted back to sinus rhythm on my own sometime since my last appointment with my cardiologist. Let's hope it lasts, but for now, no procedure required.

My results came back from my PT/INR test on Monday, and it turns out it's only 1.7, too low for cardioversion for my atrial flutter. My cardiologist wants it above 2, so he's increased my Warfarin dosage again. I haven't been eating giant kale salads -- really, I haven't!

I've been having moderate temperature spikes in the late afternoon/early evening, but my cardiologist and surgeon tell me that if I don't have some scary symptoms in addition to the mild fever, it doesn't warrant an ER visit. I had my white blood cell count done on Monday, too, and I'm having a chest X-Ray later this week. I haven't seen the WBC results, but my cardiologist has.

I had really good sleep last night and the night before -- no long wakeups! I'm finally sleeping as much or more than I did before surgery.

It turns out I have AFlutter, which is similar to AFib, but apparently it's less likely to resolve spontaneously than AFib. I'm scheduled for electrical cardioversion on Thursday, January 30th. My cardiologist believes it's likely to work, but if not, maybe another cardioversion or perhaps catheter ablation. He says the arrhythmia is "small potatoes" compared to what I've already been through. That comment made me feel a lot better, as I was feeling a bit down about the AFlutter. I don't have many noticeable symptoms, except that sometimes I get a little dizzy if I get up suddenly. Is that a real symptom?

Other than that, I'm sleeping somewhat better, I continue going for walks, using my spirometer, and trying to eat a healthy diet. Because of the arrhythmia, I've cut out alcohol and caffeine. I'm OK with no alcohol, but I'm a coffee fiend and a home roaster. I guess I'll roast some beans for my loved ones and enjoy them vicariously.

I was mostly vegan ("chegan") before surgery, and now I'm basically ovo-lacto vegetarian, but I told my cardiologist that I'd eat a steak if it would help with my post-op anemia. He said that wasn't necessary, and that the anemia would take care of itself. He told me that it might be a good idea for me to stick with the vegan diet in the long run, because I have zero blockages in my arteries.

I spoke with another cardiologist from my cardiologist's practice the evening of January 20th, and he explained to me that his instructions were a little different from the discharge instructions they handed me at the ER. I'm to double my dosage of Carvedilol (Coreg), start taking 0.25mg of Digoxin every evening, and also slightly increase my Warfarin dosage, taking extra half-pills every other night. He's talking about potentially doing electrical cardioversion to shock my heart back into sinus rhythm. I think the medicines are already working, because before I changed them, I would hear fast clicks from my valve when it was quiet. Tonight, after taking the increased medicines, each click matches a pulse that I can feel in my wrist.

I'm curious about electrical cardioversion: how safe is it? How was the experience for those who have been through it?

It turns out I had to go to the ER for AFlutter (since Saturday morning) and a fast heart rate. I'm still in AFlutter, but my heart rate has come down, due to the medications they gave me at the ER. The ER was the same hospital where I had my valve replaced, and they consulted with my surgeon and cardiologist. I'll follow up with my surgeon and cardiologist as soon as I can.

Still having an irregular heartbeat (AFib) -- it's been about 18 hours now. I'm not sure it's technically AFib (others more knowledgeable can weigh in), because my heart rate isn't particularly fast. It's still at my post-op normal, which is 80-90 while I'm resting. My pre-surgery RHR was in the high 50s/low 60s, and this experience almost makes me feel as though my old, slower RHR is trying to take over again.

I'll call my cardiologist's office, and my surgeon's office, on Tuesday. Monday is a holiday, the birthday of Martin Luther King, Jr.

I'm having another episode of AFib today, very much like the last one, although this one has lasted longer. Although I understand intellectually that it's common and although the PA told me not to worry about it as long as my heart wasn't racing (it isn't), I still find it rather disturbing.

I had my post-op appointment at my surgeon's office yesterday, and things seem to be going pretty well. I'm getting basically constant migraine auras with no headache -- normal-ish, I guess. Transient AFib not a big deal, according to the PA at my surgeon's office. Sternum is not fully healed yet, but looking good. Resting heart rate is elevated (80s-90s, was high 50s), although exercising heart rate seems to be the same as before -- RHR should go down. I'm a little anemic post-surgery, but I don't need to take any specific measures to address it. It should go away on its own. Small pleural effusion -- should go away on its own. I think I'm tensing my shoulders to keep pressure off my sternum, because occasionally, my shoulders hurt quite a bit. For pain, I'm taking a safe amount of Acetaminophen -- no more than 2600mg/day.

INR is currently 2, with a guideline of 1.7-2.5 for my St. Jude Regent mechanical valve. That guideline surprised me because it's so low, and I want to get more documentation about it.

I'm transitioning my care to my cardiologist -- I have an appointment in a week. I need to find out when my next INR test is, and transition to self-testing. I also want to get on the schedule for cardiac rehab, although the physical therapist in the hospital told me I'd be the youngest one there and max it out pretty quickly. Still seems worthwhile.

Today I'm relaxing at home. I sent out my applications for state and employer-provided short-term disability. That was my "work" for today. I slept over five hours last night, the most since surgery! Today is better than yesterday.

Thanks for the supportive messages, all! I had an episode of atrial fibrillation yesterday afternoon/evening. When I called the surgeon's office, the PA suggested some more tests tomorrow at my post-op visit, but was reassuring. Apparently, the main risk of Afib is increased risk of stroke, and since I'm already on Warfarin, I'm already mitigating that risk. The Afib resolved on its own before midnight.

I've been home for a week and a day, and mostly, I'm feeling pretty good, knock on wood! I'm taking lots of short walks, but since I live on the top of a hill, I haven't ventured off it yet. Sternal pain is not too bad, and I've been handling it with Acetaminophen/Paracetamol/Tylenol. Occasionally, I get some unpleasant tightness in the scapulae, which hurts a lot more than my chest does. I've got a low-grade temperature, just as I did in the hospital: 99F/37.2C just now, first thing in the morning. I've been getting frequent, short-lived migraine auras for the past few days, so I called my surgeon's office, and the PA told me that's a common symptom. I have an appointment at Dr. Egrie's office tomorrow (Wednesday).

Sleeping is slowly getting better. I wake up at 2 or 3 in the morning every night now, and I take an acetaminophen, and eventually go back to bed. Last night and the night before I got about 4.5 hours in two shifts each night, so that's not too bad. My normal, pre-surgery time asleep is about 5.5 hours. In the hospital, I was getting less than 3 hours/night, and one of the nurses told me that was more than most cardiac patients.

Our friends have put together a food train, so we're getting home cooked meals every night! It's wonderful. I've been trying to eat a healthy diet with plenty of vegetables ("dose the diet"), and my once and future running buddy came over for a walk and made us a delicious salad for lunch yesterday.

My parents are in town from New York State till the end of the month: it's so nice for us to spend some time with them. They've been truly helpful, and I can hardly imagine getting through this process without their help.

I'm home! My parents are in town to help out with my recovery, and friends have put together a food train for us. I'm full of gratitude, especially for the support of Sara, my wife, who stayed with me in the hospital.

I got my chest tube out today, and I might go home tomorrow! The physical therapist came by and had me do a brisk, five-minute walk around my floor, then I tried some stairs because we go up a flight of stairs to get to our condo. I'm taking no more than acetaminophen for pain, because opioids make me feel yucky. Overall, I'd say things are going pretty great, knock on wood! One of the nurses told me that recovery is not always a smooth trajectory upwards, so I'll be patient. All the best to the members of this community, and thank you for the support!

On a walk around my hospital floor this morning.

Surgery went smoothly. Some pain and nausea, but not too bad. I got a mechanical valve.

CTA scan was yesterday -- it was hard to relax, so they gave me beta blockers to get my heart rate below 60. They probably could have done it with noise canceling headphones, pleasant music, and a closed curtain.

Pre-admit testing is Monday, and surgery is scheduled for Tuesday the 7th.

I have my CTA scan scheduled for Thursday, January 2nd, and then I'm supposed to prep for surgery on Monday, the 6th. I have to arrive at CPMC Van Ness at 5:30am on Tuesday the 7th for surgery.

I have to wrap up a bunch of stuff at work, too, before I go on medical leave, so I don't overburden my colleagues.

My parents are in town and are staying through January to help out while I'm recovering. My sister and her sons (15 and 19) are here for the holidays, too. It's been a nice time. My own kids are 12 and 14, and they're all a lot of fun at this age. Last night, they were up late singing and playing "Creep" and "Boulevard of Broken Dreams" on the ukulele and guitar.

I met with Dr. Egrie yesterday, and I'm scheduled for surgery on Tuesday, January 7, 2020.

I just got the results from my cardiac MRI, and it looks like I'll be having aortic valve surgery in early 2020. No date just yet, but I'll find out more info soon.

I've known about my AR since 2011, and when I had my transesophageal echocardiogram in August, my cardiologist determined that I had a bicuspid aortic valve.