Wow! The weeks have flown by as my life has rapidly returned to my normal routine. I’m full speed at work, which isn’t hard to do since it’s primarily a desk job staring at a computer with a little time driving around in a car. I’m now allowed to lift stuff over 10 lbs which lately has been my daughter who hasn’t been carried by me for 3 months!
TIME FOR LOBSTER
Since my Kaiser HMO doesn’t have cardiac rehab except for the worst patients, I’ve had to exercise on my own. This consists of run/walks of up to 4 miles on my hard days. I make sure I keep my heart rate at 70-85% of my max heart rate. On my easy days I make sure I walk 2 miles. I’ve started using light dumbbells for my upper body and have started core exercises like sit ups. The only twinge I feel is in the upper chest when I do a sit-up movement.
I usually zone out when I’m walking or running. Listening to the birds chirping, children giggling with delight in the playground, and goats braying in the field. When I do my upper body exercises and sit ups I usually think of my sternum cracking open like a cooked lobster, exploding my guts onto everybody at the gym! So I work out at home until I can get that thought out of my head.
I still have high resting heart rate of 94 to 96 bpm. I’m hoping it will go down to the low 80’s to make me feel like I’m getting back to my pre-surgery rate of 70 bpm. Fortunately I’m down to only one 81 mg aspirin per day. My Cardiologist said no need for beta blockers. My heart rate should go down as I gain endurance. It will take a few months though.
THE PERMANENT SPLINTER
A few days ago, I panicked when I realized I had an Edwards Annuloplasty Ring inside me holding my mitral valve together. I was overwhelmed with the thought of it inside my heart. I felt like I had a splinter on my hand I can’t remove. I turned on my computer and listened to meditation music to calm me down. I concentrated on how the ring is helping my heart function more normally and how this will extend my life. I also became comforted when I thought about how the art and science of valve repair and replacement will get better in the future……just in case I need to have surgery again. I felt much better.
So my mitral valve has trace to mild leakage. My surgeon and cardiologist said this is OK. I’m better than I was before and when I use a stethoscope, my heart beat sounds like……….a heart beat. Before it sounded like an automatic dishwasher…swoosh, swoosh, swoosh.
Immediately after the surgery I was extremely grateful to be alive. As time has gone on, I would forget I’ve had the surgery. Then I see my sternum scar and I remember my pre-surgery jitters. I become contemplative but appreciative for what I’ve been given. I’m determined to live the rest of my life to be the better person I know I can be. This is my “new normal” and it is great to be alive!
THE WAIT IS TOUGHER
I must agree with others that the wait before surgery is much tougher than the recovery. Before surgery, there were so many unknowns and fears. After surgery, you know what you have to do. Keep climbing your mountains to reach the surgery peak and slide down the other side!!!
Met with my surgeon’s physician assistant 2 days ago. Everything looks OK to him. Incisions are healing correctly. He reiterated that it would be 2 more months before my lifting restrictions will be relaxed. So for now no lifting anything over 10 lbs and no strenuous arm motions like mowing the lawn, vacuuming, tennis, golf, etc. However, I’m released to drive on Sep 13. Woohoo……..freedom!!!
Yesterday I met with my Kaiser primary doctor, Dr. Katsura. His demeanor was very cheerful compared to April when he placed a stethoscope to my chest and heard my severe mitral valve regurgitation. Wow, that day feels like a lifetime ago!!
Below are more notes on my recovery over the last 4 weeks since my surgery.
HIGH HEART RATE. Before surgery my resting heart rate was about 70 beats per minute. It is currently at 90 to 94 beats per minute. I haven’t been on beta-blockers and the rate has remained unchanged even after I stopped taking hydrocodone. The surgeon’s office said this is normal after surgery. It will take a few months for it to go down. It doesn’t bother me – I don’t feel like my heart is racing. I’ve been fortunate not to go into A-Fib during my recovery.
EXERCISE. DVB’s recent journal post on exercise is accurate for me. My first exercise routine the first few days at home was going up and down the stairs. What a workout that was – I’d get winded and light headed. At 4 weeks post surgery, I walk at my 2-year old daughter’s pace for about a mile in the evening. In the morning I try and do 1 or 2 miles. Below is a good link about walking for exercise:
CARDIAC REHAB. Egads!!!! My Kaiser HMO doesn’t have a cardiac rehab for me. I told my Kaiser cardiologist what my exercise routine was now and she says I won’t need it. She says to keep walking for another couple of months and increase the distance. This dovetails with what the surgeon’s office told me. After 3 months I can do my normal exercise routine – lifting weights, running, biking, etc. Little do they know that my routine months before surgery was opening the refrigerator door!!!
Kaiser referred me to Mercy General Sacramento for my surgery so I checked what the cost would be for Mercy’s cardiac rehab. It would be $320 per session. This would be for 1 to 3 sessions per week for 1 to 3 months. No thanks……I’ll do it on my own.
DIET. So far, I follow a mostly low-salt diet for most meals. When I cook, my wife says I need to use more salt. She sounds like my chef instructor when I was going to culinary school before dropping out for my surgery. Oh well, I gotta do what the doctor says. I'm also eating foods that have iron such as chicken and fish, leafy greens, and cereals.
Later this year I'm going to revamp my diet to more of an herbivore diet and try to avoid the excess sugars and carbohydrates that are so prevalent in our standard American diet. I was pre-diabetic before my surgery. This surgery has given me a second chance in life and I’m determined to stay as healthy for as long as possible.
PAIN, STICKY STUFF, AND DEPRESSION. I had an occasional stabbing pain from deep within my right chest the first week I was home. It would last about 1 to 3 minutes. That has gone away. For the last couple of weeks I have pain when I take a deep breath in my left upper chest. The surgeon’s office said it may take a few weeks to resolve itself.
Dang. Never thought having an inny belly button would be an issue. Keep pulling out the sticky stuff. Got me worried for awhile thinking that I was pulling out my intestines…
I find myself in a funk when I’m alone at home. Just kinda blue. To help me out of this, I do my walking and I’ve started reading books I’ve picked up from the library. Being allowed to drive also helps. I do a lot of my walks at the local mall before the shops open. There are 2 coffee shops open at this time and lots of other walkers. It sure is nice to be around other people instead of staying at home all the time.
WORK. At about 3-1/2 weeks I went back to work. My job allows me to work from home (yes…I have a desk job!!!) I had to get up a few times because sitting on a chair for long periods gets uncomfortable. But, it feels good to get back into my former life. When I wasn't working, I was happy I got my disability checks from the state - it helped me to pay some bills.
Thanks for you support everybody!!! Good luck to all those going into surgery and speedy recoveries for all.
It’s hard for me to believe that 4 weeks ago I was on an operating table with my heart stopped and my blood flowing through a heart-lung machine. It almost feels like a dream until I see my sternum incision or get a twinge of pain somewhere in my chest.
Being home has made a huge difference. It’s nice to know that a lab tech won’t wake me up at night to take blood samples!!!
The below are some experiences I’ve had (still have) over the past month.
PAIN PILLS. The first 2 weeks after surgery I was taking hydrocodone pills 3 times a day along with docusate (stool softener) 2 times a day, and 1, 325 mg aspirin per day. After 2 weeks, I decided to switch to Tylenol 500 mg 3 times a day and stop the hydrocodone and docusate. I also continue taking the aspirin. I can feel more sternum pain but it feels more like background pain and it has been tolerable. I’m able to do my breathing exercises and sleep without waking up in the middle of the night. I may have had withdrawal symptoms when I stopped taking the hydrocodone, but I’m not sure. I was sweaty for a day, but that could be because it was a hot day!!!
INCISION HEALING. My sternum is healing nicely. The sternum pain from moving around has been replaced by a more localized incision pain. Feels like a prickly pain. I bought the Incision Shield and that helps keep my shirts from rubbing on the incision. I must say the shield gets in the way of squishing a pillow to my chest when I have to cough or sneeze!!! The longest healing wound was where my drainage tubes were. It took 2-1/2 weeks for it to finally stop bleeding. Like a dog bite, it was best to wash this wound daily to remove any dangerous bacteria.
RECLINER VERSUS BED. Both for me!!! I have a bed upstairs that is way more comfortable than the hospital bed. The mattress is thicker but softer – great for when I roll on my side. I place a pillow under my back and this keeps me on my side. Lately I’ve been rolling onto my stomach. Ahhhhh. So nice since I’m a stomach sleeper. I definitely couldn’t sleep on my stomach for over 3 weeks post surgery. Downstairs I have the recliner. I get stir crazy a lot so it is nice to change from bed to recliner throughout the day.
I visited the surgeon’s office today. I’ll post what happened in my next entry.
– My birthday!!! Family visited and now there is a big birthday balloon in my room.
– Taken off blood-pressure medicine since my blood pressure was now consistently low.
– Taken off of insulin since my instant glucose readings were in the low 100’s. They were no longer near 200.
– Sternal bandage finally removed for good. Angry gash staring back at me in the mirror. Badge of honor achieved.
– Nurse Jennifer removed my catheter after midnight this morning. She said take a deep breath and count to 3 as I breathed out. She pulled on 1. White pain replaced by utter relief. Good thing she didn’t wait for me to count the whole way!!!
– First bowel movement. Major constipation before, but now the dam has broke.
– Except for 2 times this day, my heart was beating in normal sinus rhythm. Pacemaker was removed, but the wires remained as a precaution.
– Nurse Jessica requested vegetarian food for me from now on. I figure this will help increase the fiber in me.
– Arm IV put into my left arm. This is needed before the central IV in my neck is removed. The central IV is needed for emergencies or to give you medication (like magnesium in my case).
– Central IV removed from my neck. Also, removed were the pacing wires and stitches where the breathing tubes used to be.
– Freed from the hospital!!! Yipee!!! Wife drove home as I sat in the back seat. Familiar roads and sites seemed different, almost new to me.
– First full day at home!!! Feels great except for the pain.
My pain was well managed in the 2 days I was in critical care. Part of it was the anesthesia was still in my system and also my body hadn’t responded with inflammation and bruising yet. The nurses in critical care would ask my pain level (I said 6 or 7) and they would give me the maximum of 2 hydrocodone pills every time, day or night.
When I was moved to the PCU each nurse had a maximum of 4 patients. In critical care the nurses would watch you like hawks. In the PCU, the nurse would check you on a schedule. If you needed anything out of schedule, you could call her using the bedside phone.
My problems would come at night when I would be woken up and asked if I needed anything. So the first time I said no, I didn’t get any pain pills. I woke up later in the night and had sternum pain. I was on my back and couldn’t roll over!!! I was a beached whale!!! The phone to reach the nurse had fallen from the bed! I spent about 2 hours squirming around until my legs dangled off the bed and I slid off holding my heart pillow to my chest. During my squirming time, I was texting my wife to go ahead and buy a recliner ASAP!!!
When I left the PCU, the doctors, nurses, and me had a very good plan for pain medication for my home recovery. This hospital doesn’t let anyone go earlier than 4 days after surgery. Many go home at 5 to 7 days.
Below are my pain levels at their maximum. The format is similar to Thomas Hunt's except I had a full sternotomy and he had a right-side thoracotomy.
Pain Scale (1-10):
Breathing Tube Removal – I was unconscious – yippee!
Breathing Tube In Place – 2, when I breathed deeply
Cough – 5
Chest Tube Removal – 6
Catheter Removal – 7
Neck Line Removal – 1
IV Removals – 1
Blood Tests - 1
Sternum Pain – 1-7 (ongoing)
Catheter Angiogram – 3
Collapsed Lung – pneumothorax – 1-7 (ongoing)
Surgery Day and Critical Care - Aug 13, 14, and 15
Journal posted on August 20, 2012
My wife wrote the earlier journal on surgery day saying my surgery was successful. I arrived home on Aug 18 and went straight for the new twin bed we bought. Ahhhhhh………the bed and several pillows made me sleep like a baby. A new recliner is coming on Tuesday. I wasn’t sure we needed a recliner until trying to relax 6 days on a hospital bed, which was impossible for me, even with the travel pillow. Anyways I’ll post my hospital stay over the next few days starting with surgery day.
Control of everything is what I wanted before the surgery. I bathed the night before and the morning of the surgery using the special sponges the hospital gave me. Yeah, baby!!!! Squeaky clean. My wife woke up our daughter and we dropped her off wailing and screaming at grandma’s house and I drove to the hospital to make our 5 am appointment. I lead my wife telling her she will use the north elevators later to go to the critical care unit, but we’ll enter the south elevators now. We entered the pre-op room I’ve been to before, I stripped, got into the hospital gown, and lay on the bed. I felt strangely serene now as I had last night before getting a good sleep. A nurse who looked like Santa Clause came singing into my area and checked my vitals and started an IV line – one stab in my wrist and he was done. About 30 min later Santa Clause was pushing me with my wife beside me to the surgery area. My wife and I kissed and then I was wheeled into a central area. Around this area were the operating rooms. A nurse came to me and we just made small talk. Then I was pushed into my surgery room, which was a beehive of activity and people and slid quickly off my bed onto the cold steel surgery table. I said, “My, that is cold”. Then nothing. I lost consciousness and control. My life would irrevocably change forever.
Woke up to a woman speaking Tagalog, one of the languages of the Philippines. She said, “Lee, let Ate take care of it”. I noticed my hands were tied to the bed and I had a ventilator. Then nothing. I woke up again without the ventilator and one of the nurses was changing out the tape of my IV line. Couldn’t move. Didn’t feel like it anyways. Because of Adam’s book and all the HVJ journals I read, I new I was full of tubes and wires. I did turn my head left and saw an older gentleman who remained on the ventilator for a long time. He would still be on it when I left. I prayed for him as I was moved to the second area of critical care. They had to make space for the crowd of people coming straight out of surgery………
The new area was brightly lit, much quieter, and I had my own room. The nurses would have only 2 patients apiece. I would stay here for 1-1/2 days before moving to the patient care unit (PCU). I was told my blood pressure and blood glucose were high. Solid junction rhythm. I was on potassium, magnesium, a diuretic, a stool softener, hydrocodone, blood pressure pills, insulin, and protonics (for acid reflux). Rough here. Pain in chest. Couldn’t take deep breaths. Didn’t feel like moving off my back. Urine bag filling up like a balloon but I didn’t know why. Didn’t care. Just happy my nurse didn’t look like Santa Clause. My wife visited but stayed only a short time. This is the first time she saw me and I was very happy she was there.
Turning point came when they said I could move to the PCU. The nurse said do I want morphine before she takes out the breathing tubes and wires. Yes!!! Didn’t feel any different though. I tried to relax my stomach muscles and not tense up. I took a deep breath and she pulled on the exhale. Whoosh!!! Out came the tubes and then the wires. Damn!!! They were long!!! The pain was immediately replaced by better and deeper breathing. She cleaned me off, gave me some breakfast (cannot remember it), and I was wheeled off to the PCU which was right next door. To be continued……….
I am happy to announce that Lee's surgery went well. The posterior leaflet of his his valve was repaired and a ring was added. The prep time was about 2 hrs and the surgery was about 3 hours. I got a word from his tech 4 hours later after surgery that he was slowly gaining consciousness. He will be in ICU for a couple days.
Thank you for all your prayers and well wishes, It really means a lot to us.
Feeling calm now. Just doing some last-minute tasks around the house so I don't have to worry about them after surgery.
I had my blood and urine tests done at Kaiser last Thursday, Aug 9, and the pre-op on Friday at Mercy General. Tried out their cafeteria and decided it was not gourmet fare. I was nervous walking into the pre-op, but the nurses put me at ease right away. Very friendly with lots of smiles. Lilia was my nurse and she had a soothing way about her. I calmed down a lot.....almost serene. 2 vials of blood taken from a vein and 1 from an artery. Found out I'm type A+ blood. Shaved from head to toe (I look like the Michelen man!) Met with the anesthesiologist....told him I want to wake up after they take the breathing tube out! Got chest x-rays taken. Went home with my instructions, washing sponges, and an instructional DVD (circa 1990's fashion) to look at with more info. I have a blue bracelet around my wrist I'm not supposed to take off this weekend. It has the bloodbank info.
That's all for now. Relatives coming in a few hours. This will be the last time I can lift my nephews and nieces for awhile so I'm gonna have fun with them today!!!
Thanks for all you prayers and support......see you on the other side!!!
As I get closer to surgery, I thought about what makes my life so rich. Relationships top the list. Besides my family and friends, I cherish my wife and daughter the most. My sister took a photo of Nicole, my daughter and I added it to the photo section.
Surgery and recovery is a long road to travel, but it is nice to have a reason to live.
Yay!!! My carotid arteries are clear. I'm set for pre-op on Aug 10. From what I read on HVJ, it will be a 5 or 6 hour affair with lots of waiting.
So far, the cardiac surgical staff has been very efficient and businesslike. They smiled yesterday when I made an unannounced visit with a dozen cupcakes from a local high-end bakery. I just told them I appreciate their efforts to prolong my life and I thanked them for caring about me and others like me.
Today, my sister and Connie are visiting me and will stay a couple of days. I hope I can give off the good vibes to them as they are to me.
Today I had my carotid artery ultrasound. These arteries are located in the neck. During my visit to the the surgeon a couple of days ago, I mentioned I may have had a stroke back in 2010. I didn't go to the doctor because I felt better except for some stuttering. I'd talk and stutter......lasted about an hour after my dizzy spell. Probably a TIA according to Nurse Heather Cowan (nurse coordinator for Dr Slachman).
So she ordered an ultrasound. Very relaxing. My neck was lubed up and the device was moved all over. Sometimes the technician would turn on the sound and the squishy sounds of the pumping blood would lull me to sleep. Over in a few minutes. With reluctance I had to leave. I'll find out the results next week.
Good test. From what I read if you have had a stroke before, you are 10 times more likely to have another one compared to someone who hasn't. Because this surgery requires a heart bypass machine there may be procedures the staff can follow to minimize a stroke....
My wife and I met yesterday with Dr. Slachman for a final consultation. My surgery will be a full sternotomy. I'm grateful he was gracious to agree to this since I'm also a candidate for the Da Vinci robotic procedure (clear arteries and no other valves to repair/replace).
The initial effort will be to repair the posterior leaflet, sections P2 and P3. Since it is prolapsed, there may not be a need to fix the chord - just cut out the bulge with the broken chord and the adjacent chords should take the load. Most likely a ring will be attached for added strength. If I need a replacement, he pointed out the Edwards bovine valve as the best option.
Kind of weird chatting with him in a technical way - very dry and clinical. Not like the youtube videos of mitral valve repairs which always look to me like the surgeons are trying to sew 2 jellyfish together!!!
As I was leaving, I commented upon a photo of him atop Mount Aconcagua, one of the 7 summits (highest mountains on the 7 continents). This lit up his eyes since he has climbed all of them, including Mount Everest.....I felt we had a great bonding moment.
OK - my surgery date is now Aug 13. That's only 4 weeks away......woohooo!!! It will be with Dr. Frank Slachman of Mercy General in Sacramento. Full sternotomy. Kaiser HMO will cover most of the cost. From my TEE, it looks like a posterior leaflet and chord repair. I chose the sternotomy because I'm more interested in the 6-month outcome. Just open me up and take a good look my good surgeon!!! In other words, not as concerned about a quicker recovery since my job allows me to work from home full time.
Had a great video chat tonight (iChat for you Apple types) with my side of the family. It calmed me and I could feel the love and good vibes flowing through the ether. This weekend there was a family gathering with my wife's family and I felt the love and acceptance also. So my support group is there along with you guys in HVJ. Without you this journey would be very lonely and depressing indeed. Thanks Adam for setting this up.
Lastly, I'm much more spiritual now. As soon as I heard the diagnosis in April I wanted to get my affairs in order. Life insurance, bills to be paid, work to be finished....???? Nope. It turns out I got my spiritual house cleaned so I can fight the good fight with courage and dignity (so when I'm under anesthesia I may say something profound rather than blurt out a crude joke!!!)
Well got to go....my 2-year old daughter keeps slapping the keys with her hands. Taking me forever to type this...although she's singing while she does this and it's kind of cute.....
Well, yesterday I thought I had my surgery date set for Jul 25 with the nurse coordinator at Mercy General in Sacramento. She asked me if I can come in next week, but I said that was too soon.....I have to get some things done beforehand. I also thought to myself......hmmmm, not a long waiting list for surgery......I wonder if I chose the right place!!! So I let my boss know who said they need me that week and the first week in Aug since they will be shorthanded. He's going on vacation. Being the good trooper, I saluted and said, "yes sir!!!" Just like when I was in the military. I work in a small business and they are like family to me. It's nice to be wanted.....
OK. My catheter angiogram on Jun 28 wasn't bad. The 3 hour wait while several other patients went before me was the hardest part. I felt bad when they came back and some of them had to go for emergency surgeries (i.e., bypass surgery and aortic valve replacement or insert stents). Fortunately I have clear arteries. Now it's time to make up my mind about the procedure I want and the surgeon.....
Choices….choices. Today I met with the 3rd surgeon, Dr. Frank Slachman of Mercy General Hospital. I’m a potential candidate for the Da Vinci robotic procedure – a minimally invasive technique. There are 2 surgeons during the procedure. The other surgeon is Dr. Allen Morris. They have been doing the procedure together for about 2 years. I have to take a catheter angiography and perhaps a CT angiography to help with this decision. The 2nd surgeon I met on Jun 8 was Dr. Castro who specializes in minimally invasive techniques but without using the robotic procedure. Zero mortality since 2006 for mitral valve repairs. The 1st surgeon I met on Jun 5 was at Kaiser and he was very helpful in outlining my condition and course of action.
I’ll use this weekend to mull over my thoughts about the robotic procedure. The Mercy surgeons have done about 60 mitral valve procedures. At least my Kaiser HMO will cover most of the costs. Dr. Castro’s procedure uses a smaller incision through the sternum. Longer recovery, but outstanding outcomes. However, Kaiser will not cover the costs. My wife has Blue Shield, which I can transfer into but they are limited to hospitals in my area. I believe if I had to pay cash it will be around $30,000. I’ll have to put off buying that minivan for now!!!
It’s official. I’ll need surgery to correct my severe mitral regurgitation. I went to my Kaiser doctor on Jun 5, who told me I need surgery within 2 months. My left ventricle is enlarged. My symptoms of shortness of breath, loud heartbeat, and tight chest come and go. I left his office feeling the need to go to Starbucks for a Grande Café Mocha…..I drove the long way home, sipping my mocha, and contemplating…..everything.
For a 2nd opinion, I went to Sequoia Hospital on Jun 8. I met with Dr. Luis Castro (no relation to me!) He looked at the Kaiser tests (especially the TEE) and confirmed I’ll need surgery within the next 3 months. I found him by looking at heart-valve-surgery.com in the Cardiac Clinics section. I had to pay cash for this since it is outside my Kaiser HMO coverage, but it was well worth it. He explained how the heart works and my condition. He showed me my TEE (Kaiser provided a CD). One of the mitral valve leaflets looked like a flag flapping away in the breeze. I left feeling comfortable about having surgery.
Kaiser is an HMO and refers many patients in Sacramento to Mercy General Hospital. I’ll meet with Dr. Frank Slachman on Jun 21, hopefully.