My family was startled when, on November 18th, at 9:30 am, Dr. Guadiani came to the waiting room and told them my surgery was completed in 66 minutes, cut to close and I was in ICU.
I don't remember much of the first day in ICU but by the evening, I was awake and spent much of the night talking with my assigned nurse.
On Saturday, they moved me out of ICU and into a Cardiac Recovery Room
Last Friday, I knew I had a problem with extreme shortness of breath when I lay down. X-rays and blood tests later, it was determined I have fluid in my lungs and coughing was not taking care of it.
My Cardiologist, Dr. McWhirter, prescribed Lasix and that seems to be solving the problem as long as I exercise 20 minutes a day by walking.
I"m now back to work part time (I publish a magazine from my home), that time being when I don't feel like sleeping or reading.
Hopefully, this is the end of the lung issue and I can start planning the start of my Cardiac Rehabilitation Program.
I feel I should mention the availability of a few somewhat new goodies and techniques that have helped me.
1. Heart-hugger - a wide belt that surrounds the chest and is pulled tight with two handles whenever the need to cough appears. Really a vast improvement over the pillow.
2. Breathing tool - dont' know what to call it but it is better than the plastic suction machine (and much easier to use, too). It is made up of plastic and in use, you breath in through it, hold your lung expansion at maximum for 3 seconds and then breath out. The nifty trick is the outgoing breath is regulated so after the first breath cycle, your lungs are kept at 10 cm of water pressure which keeps them inflated. You then do 29 more breath cycles and the exercise is completed. This only has to be done every 4 hours instead of hourly with the suction machine. I think most of the breathing specialists know about this machine but I cannot find it on the internet although there are some others that are close in function.
3. The hospital had a specialist who came and made me practice getting in and out of bed. Done correctly, this is completely painless (Adam, I noticed you had problems early on in this area). If this is news to folks, I may be able to find the instruction page and get it posted somehow.
4. I had my surgery done about 90 miles from where my cardiologist practices. I found out very quickly that terminology between doctors and hospitals isn't necessarily well understood. What constitutes 'full documentation' in one area does not in another. As a result, when I showed up for my day-before tests and consultation with the surgeon, the cardiologist and hospital where I had the angiogram done had not sent the video off to the surgeon. For a while, until we got a copy hand-delivered, there was going to be no surgery. So if you don't have everything done in one geographic area, make certain you understand what the terminology means.
On the other hand, my cardiologist assumed that the surgeon had given me lasix because it is standard where he practices. My surgeon didn't because he felt the cardiologist should be in charge of that if I needed it.
Ask more questions that I did. Although since I didn't undersand the entire process, that was not possible. Just don't hesitate to ask questions/ask for help when things don't seem right.
At 33 days since the operation, I'm driving, walking for 30 minutes and generally feeling OK as long as I don't attempt too much. Tomorrow I have to drive 120 miles because my 94 year old father is in the hospital and my stepmother needs some advice and hand holding. Actually, I think I'll ask my wife to drive so I can nap. :-)
At 9 weeks, I woke up one morning and realized I felt great! What a revelation! Now I just need to get my stamina back.
10 weeks and moving forward-
Started my cardiology rehab yesterday. It is held in a fairly small room in a hospital with maybe 20 machines and 5 ICU-trained cardiac care nurses.
I get wired with an EKG radio and then the head nurse takes me personally through the warm-up, the use of each machine and the cool-down. Because of my atrial fibrillation, she has a hand-held readout of my EKG.
At each stage in the exercises, a nurse, sitting at a desk and monitoring my EKG tells me when to speed up, slow down or stop working. Really easy exercises and they go on for about 40 minutes. By the time I get home, I'm tired and ready for a nap (which they warned me I would need). I get to do this 3 times per week and then walk at a moderate pace for at least 15 minutes the other 4 days.
I had looked into other rehab programs but they looked like cattle calls with maybe 50 patients working away on machines or laying on mats doing stretches. This one starts a max of 4 patients every 30 minutes so we have a manageable number of people in the room at a time and nobody goes unnoticed.
We had our first rain in a few months last week. I can tell you my chest bones may make a good weather station. I had a mild ache from one shoulder to the next across the back. It caused a little (very mild) pain when I'd take a deep breath. Nothing 800 Mg of Ibuprofen wouldn't take the sting out of.
Still trying to get the Warfarin levels high enough that my Cardiologist can perform a Cardioversion that will hopefully stop the atrial fibrillation which came about as a result of the heart surgery.
This is so much better than the cripple I was slowly becoming before the surgery.
Yesterday, March 6, 2012, Dr. McWhirter, my Cardiologist, performed a Cardioversion on me to cure the fibrillation caused by the heart valve replacement operation. 2.25 hours of prep and 15 minutes of unconsciousness and I now have a perfectly beating heart (disclaimer-appropriate for my age).
I also have two rectangular places on my chest and back that itch because they have been burned similar to a mild sun burn. Still itches though and they shaved my chest again so all the ends are once again catching in clothing. No gripe though! The regular heart beat is wonderful!
For the first time in 4+ months when I hear my heart beat at night, it is regular.
Hopefully I can now stop taking Warfarin and skip the every 2 week blood tests.
Wrong conclusion or my heart reverted to AF.
Saw the Cardiologist today. The Cardioversion did nothing and in fact, I think from the appearance of the EKG, may have made it worse.
So now the choice is to do nothing except continue with Warfarin or try rate or rhythm control with drugs and have another cardioversion in a few weeks.
The article my Cardiologist asked me to read is called "The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM)" found at: http://www.nejm.org/doi/full/10.1056/NEJMoa021328#t=letters
Given the risks involved with continued AF, I think I'll be trying the rhythm control medicine, Propafenone for a few weeks, followed by another Cardioversion.
Clearly I'll be on Warfarin for the rest of my life regardless of the outcome of all of this stomping through the minefield.
Well, Propafenone turned out to help the AF but the side effects threatened to put me in the hospital. I gained 7 pounds in 6 days, couldn't complete my cardio rehab exercises because of muscle fatigue, experienced shortness of breath and started becoming mentally confused to the point I had trouble with a map. I unilaterally decided to stop the medicine and within 2 days, I was almost back to normal.
I saw my Cardiologist today and he agreed that since I cannot tell when AF hits, I should just live with it and not try another round of somewhat risky medicine and treatment.
Big surprise! Two Saturday nights ago, I turned over in bed and felt like I had a classical heart attack. Pain from my jaw to my hips and out into my left arm. Off to the ER where 5 hours of testing demonstrated that the ole pumper was going strong and not the problem. Several more nights of nearly the same symptoms. Something clearly wrong here!
Hmmm. Last time I had massive pain, it was the result of a pinched nerve in my back. Maybe this was another symptom. Visited my Chiropractor. Adjustments made but nothing conclusive.
I discussed this with my Cardiologist and he immediately said the source was my Sternum and pain generated in/by the Sternum is somewhat normal as long as 2 years after surgery! I mentioned that common knowledge had the Sternum mending much sooner. He said that comes from Surgeons who typically don't follow their patients all that closely after surgery, that the Cardiologists take over and they know differently.
Live and learn I guess with the operative word being live.
Now it is almost 2 years since my surgery. The meds are finally stable so that is the good news. The bad news is that the chest still has some pain when I cough or sneeze. But it continues to decrease.