Keith's Journal

Hard to fish with so many deer in the way! -Hot Creek near Mammoth Lakes, CA.

Feeling great! Still working my way back to peak fitness. I feel like I am 90 to 95% of where I was before surgery. Will be having another echo in May. Very interested in how my heart has changed since the surgery. Has the hypertrophy reversed itself, etc.

At my post op appointment I asked Dr. Razzouk how hard I could work my heart and new valve. To paraphrase he said once you’re sternotomy is healed, give it hell........so I have. I have been averaging about 35 miles a week mountain biking. Climbed two California fourteeners (Whitney and White). I competed in a 23 mile mountain bike race. I play tennis twice a week, and try to work in strength training with kettle bells and calisthenics as well.

Since I have a mechanical aortic valve I have been on Coumadin since surgery. 4mg a day keeps me between 1.5and 2.0 which is where my Dr. wants me. I still hear my valve clicking away when I’m somewhere quiet, but it doesn’t bother me.

Get out there and exercise!

Keith

Selfie on top of Mt. Whitney.

Hello everyone! The 10th of August will be the 6 month anniversary of my AVR with an On-X mechanical valve. I feel incredibly blessed that my recovery has been completely free of complications. I am an avid mountain biker and hiker and have been determined to not just regain, but to surpass the level of fitness I had before my surgery. I can tell that my body is still recovering, and my cardiac system is re-balancing itself after the correction of my stenosis, but I am starting to feel that I will get there. When I was recovering after my surgery i decided to set a six month goal which would prove to me that my surgery and my stenosis was well and truly behind me. That goal was to day hike up Mt. Whitney for the third time in my life. It is truly an epic hike with a round trip distance of 22 miles and an elevation gain of over 6000 feet to reach the 14,495 foot summit. I am happy to say I was able to achieve that goal on August 1st!

Hello everyone. It has been a while since I last posted. Things have been going very well. I had my first post AVR echo about a month ago. Peak pressure was 22.8 mm and my valve area was 1.7 cm2. I was happy that both of those numbers are in the nominal range for a 23mm On-x aortic valve.

Posting this again because the site ate it when I tried to edit it. Safety tip.....save the text of your posts somewhere else when you post it.

Recovery is going great. My Dr. cleared me for all activity last Wednesday, so I can mountain bike and play tennis again. I celebrated by going on a bike ride with my son and several friends. They were real troopers and went with me even though the wind was 25mph plus. I lost a little more leg strength in two months than I expected, but the ticker performed flawlessly. We did 12 miles, max hr was 156 with 133 average. To top off the ride we saw a very large desert tortoise. Tennis is tomorrow!

Saw this big guy on our ride!

Celebrating 8 weeks post op with a mountain bike ride!

My aortic valve. 0.9cm2 and 40mm peak to peak gradient with LV hypertrophy.

First, I would like to give credit where credit is due for the success of my AVR. I feel incredibly blessed to have been guided to the fantastic cardio thoracic surgery team at Loma Linda. Dr. Razzouk is a truly amazing and gifted surgeon and leader. I can't imagine being in better hands.

Well, the time sure has flown! It's back to work on Monday, but just half days probably for the first week.

I can feel that my heart is working better and finding its rhythm again as each week goes by. My resting heart rate continues to decrease towards what it was pre-op. It's around 55 now, but I'm sure I'll be sub 50 again once I can get back on my mountain bike. My Working heart rate on my walks has decreased as well. I was able to do 7.7 miles yesterday and it felt great!

My INR level has stabilized at about 2.0 (I'm supposed to be 1.8 to 2.5). So 3 mg of Coumadin per day seems to be right for now.

My post op follow up was yesterday, 12 days after surgery. Dr. Razzouk and his staff are very happy with my recovery so far. They reduced my blood pressure med to once a day, and said I should be off of everything except warfarin and aspirin in 6 to 8 weeks. I found out the Dr. had to do extensive debriding of calcification on the heart. This makes the heart irritable for several months after surgery, resulting in the arrhythmia I occasionally experience. Dr. Razzouk released me to the care of my local cardiologist, no need for further trips to Loma Linda.

It feels good to be over the hump on recovery from surgery. Pretty soon it will be time to start rehabbing the heart!

I was told "no limitation on heart rate", just walking for now, but I can add in some hills. I should be able to ride my touring bike starting in April, and back on my mountain bike late April.

In my recovery chair with my recovery buddies!

Surgery was a week ago last Friday. Just finished my 4th full day at home since being released. As far as pain goes I'm doing very well I think. I took extra strength Tylenol the first two days and it controlled the pain I had pretty well. It is still mostly back pain with some sternum pain if I get too active, or cough. I almost sneezed about an hour ago and it terrified me! :-)

I'm still working to get my INR level under control. I am supposed to be 1.8 to 2.5, but hit 4.2 on Thursday. My local Dr. took me off Warfarin for a couple of days and we are checking INR daily. Because of the high INR I didn't want to take so much acetaminophen so I took an oxycodone before bed on Thursday. That is the last pain med I have had. I don't think I am going to need any more unless the back flares up.

My walks are feeling really good. I noticed feeling a lot better after my pacerone dosage was cut in half. It made it a little easier for my heart to throttle up a bit. I have had the new ticker up to a little over 90 bpm and everything feels fine.

My post op follow up clinic with Dr. Razzouk is next Wednesday down at Loma Linda.

My first walk after getting home. I am blessed to have been great condition prior to surgery due to my mountain biking affliction.

I forgot to mention that Dr. Razzouk confirmed that I did have a bicuspid aortic valve. He said it was pretty crusty and getting very tight. It was definitely time to get this done.

I received a 23mm ON-X mechanical aortic valve. I can hear it clicking away whenever I choose, but rarely hear it if I'm not trying to.

My heart seems a little unfamiliar to me right now. I'm an engineer not a cardiologist, but I think it's because my left ventricle has been conditioned for dealing with 40mm of back pressure from the stenosis. (I had significant LV hypertrophy) Now there is only 6.6mm, so the heart seems to rock and roll a bit. . I'll have to ask Dr. Razzouk next week.

Ok, let's try this again since the site lost my post before I hit "Post".

I wanted to post sooner, but Loma Linda guest wifi is not as world class as their health care, so I had to start a data plan for my iPad. Fortunately I bought this thing with a modem in it.

For purposes of reading this, first night is Friday and first day is Saturday.

Surgery was Friday AM. I reported at 0500. I was processed and wheeled off to the operating room by about 0700 I think.

Next thing I remember is waking up as the breathing tube was being withdrawn. I'm glad that memory isn't too clear. I'm pretty sure it wasn't fun.

One thing I wasn't prepared for was the severity of the back pain post surgery. It outweighed the incision pain by quite a bit. The pain was worst the second night as they were weaning me off IV narcotics and it took some convincing to get them to give me the good stuff. I think I was manning up too much on the pain scale so I finally told them I was 8+ and I got something that let me sleep. The back pain fortunately let go during day 2 so things have been better since.

I got my Foley catheter out during the second night. I had two drains. A big and a small. Big drain came out during day 2. That felt more weird than painful. Many people talk about how annoying the big drain lines are, I didn't notice mine that much. I think it was because the back pain was overshadowing it. I think the mainline in my neck came out at the end of day one. I'm supposed to get my remaining JP drain out today, as well as my heart pacing wires. All that will leave is a couple of IV ports and my ecg and oxygenation leads.

I was going to get released today (Monday), but when trying to achieve a bowel movement (which was successful) and avoid a scheduled enema, my heart went into atrial fibrillation (AF), which is common in 40% or so of heart surgery patients. I'll be on oral meds for a while after I get home to regulate it. My INR hasn't come up as fast as they would like either. I'm at 1.2 after 2 days of Coumadin and 4 heparin injections.

Dr. Razzouk and his team made their rounds as I was sitting here in AF, so great training opportunity for them. He says I should be out of here tomorrow providing my heart rate comes down, which it did a few hours ago.

That's it for now!

My zipper 2 days after surgery!

Me the day after surgery.

Well, my pre-op was this morning at 1100. We got a very nice tour of the ICU where I will be waking up and staying until I go home. I then had my pre-op with one of Dr. Razzouk's PAs. Everyone has been incredibly nice, and they all rave about Dr. Razzouk. I must say I was very impressed with him at my consultation appointment. It sounds like I could be released as early as Monday depending on how things go. I asked for pictures from the surgery, and my old parts back....the PA then asked if I was an Engineer. : )

I discovered yesterday from a friend that the cafeteria is meat free, so I might have to get an accomplice to smuggle something in from The Habit. I did check out the menu and they have some great sounding stuff, the smells at lunchtime today were pretty amazing.

Check in for surgery is at 0500 in the morning. I can eat and drink till midnight, so looking forward to a nice dinner.....haven't figured out where yet.

I'll post again as soon as I'm able after surgery.

Regards,
Keith

I was already convinced that this operation is necessary, but the last several weeks is removing all doubt. I am definitely noticing more exercise induced Dyspnea, as well as what I think is mild post exercise angina. I have cut out any kind of serious cardio. I am still mountain biking, but I've really dialed it back. I'm also still playing recreational tennis, and doing mild strength training. I just recently got a TRX Tactical trainer to add to my options. I hung it in the garage this weekend. My thinking is the better shape I'm in on surgery day, the quicker I will bounce back.

I've been trying to think of things to make life easier when I get back from the hospital after the valve replacement.

I got myself an iPad to help pass the time while I am recovering in the hospital and at home.

I purchased a hospital style rolling table to use while seated in my recliner.

I'm planning to cook up some of my favorite things and put in the freezer.

I need to get some comfy easy to don clothes. probably a couple of nice zip hoodies and sweat pants. and some warm socks.

Anything major I am missing?