Richard's Journal

Last week was the final session of 12 weeks of rehab, so I will no longer post any new journals. At one point I remarked to one of the physiologists or nurses that at times I had experienced more pain that at any other time after surgery! But I also made a surprise discovery a couple of weeks ago when I was able to complete a 1.1 mile circuit of a woodland trail on Roosevelt Island in the Potomac River without developing pain in the hip joints. It seems that all of those hours on a stationary bicycle lubed the joints in addition to toning the muscles. Now I just have to avoid losing all that I have gained, and my trainer is helping with that. I hope that my narratives oner the past 6 months have been helpful and informative.

I just completed week 2 of the hospital's monitored rehab program. It naturally emphasizes cardio-vascular exercises, but tailors it to the individual. In my case, Medicare allows 36 visits, and I attend three times a week, Monday, Wednesday, and Thursday at 10:00 am. The staff includes nurses and physiologists, the latter being the trainers. The facility is a well equipped fitness center, with treadmills, stationary bikes, arm ergometers, steppers, a rowing machine, and ellipticals. For weight training only light dumbbells, 1 - 15 lb. are used. IDuring my 75 minute session I don my heart rate monitor and its 4 electrodes and get a beginning BP check. I do 5 minutes warmup on an upright bike at the lowest level, then immediately do 15 minutes at level three. After that session I go over to the "armageddon" and crank that for 12 minutes at level two. (During my initial interview I had asked for exercises to counteract the lengthy period of avoiding stressing my upper body.) After each machine session I record my heart rate and assign a numerical rating of how I felt about the degree of difficulty. This information is used to decide what happens during the next session. Usually level or time, sometimes both, are increased. It's a gradual process. After 5 cool-down laps walking around the room, some stretching exercises, and a final check of BP, I am free to leave for home, less than 15 minutes away. Next week I have an echo cardiogram, then a week later I meet with Dr. Sherber, my cardiologist.

Not much new came out of the visit to my cardiologist. I have an appointment for yet another echo cardiogram to look at the new valve. That is on July 8, and the following week Dr Sherber will discuss it with me. I hope that by then I will be cleared to drive. I will be referred to the Inova cardiac rehab program in another month or so. The healing of the outside cuts is easy to see, and is almost complete. But I still have to be careful with the still fragile sternum. I do my daily walks, or do the various exercises left by the PT person if weather outside is not so good. I am up to double my initial baseline time for walking, and half of my route is uphill, so that is good. The limitation stems from how my arthritic knees are holding up. Day by day I keep feeling better and better.

Today is a milestone of sorts on my road to recovery. What a difference! My world suddenly collapsed around me, so each day became a concentration of effort just to get through it. There has been a series of visits of nurses and a physical therapist to my home. I had my post-surgery visit to my surgeon, chest x-ray in hand. I visited Dr Sileo, my internist a couple of days ago. I am down to perhaps one percocet per day to take care of the occasional pain that might otherwise interfere with sleep. Good news: I lost all of the two gallons of water pumped into me during surgery, plus an additional 9 pounds. The main focus now is increasing daily exercise periods to longer and longer walks, also doing more outside in the yard. I still devote time during the day to my incentive spirometer, and I maintain a daily log of weight and vital signs. I'm not back to normal strength and stamina, but time should take care of that. I am overwhelmed by the kindness of Richard and Lori Davies, down from Frederick, also Will and Allison Brent from Arlington when they gave me a day of labor cleaning up the left-overs of a hard winter. A mountain of leaves, debris, and fallen limbs is now gone, thanks to them. Spring is finally here, flowers are everywhere, and thankfully I am here to enjoy the display! Next up: I visit my cardiologist May 2nd.

Yesterday, April 7, 2014 was discharge day, so after almost a week away from home base I am finally able to update my journal. (Louise tried to do it for me, but nothing happened, so we shall see how it goes today.) My actual surgery day was the 2nd, and that was quite uneventful, according to Dr. Speir. My breathing tube came out around 5:30, and I later learned that I even had visitors in the ICU just before that event (I was completely out at the time, so I take their word for it.) I was actually standing by my bed just before midnight for changes of bedclothes and gown. And so began the next few days of hospital routine, during which I felt lucky to get more than a half hour at a time of catnaps here and there. Much to my surprise, I was pronounced ready for the cardiac step-down unit the afternoon after surgery. I soon discovered that It was easiest to stay in the big chair so I could easily stand up to walk to the bathroom, then walk a lap in the hall, then return to the room just in time for the next vital signs readings, weighing, blood sugar check, etc. no matter what time the wall clock said it was! I was one of the 30% of valve replacement patients who experience atrial fibrillation, which automatically added 24 hours to my hospital stay. I had to have additional meds to slow down heart rate, get blood electrolytes back to normal, and have close monitoring of pain. When my discharge was finally approved yesterday, the feeling of euphoria was short-lived, as it seemed to take hours, and even then a test was overlooked. So off we go this afternoon to get the echo cardiogram that was missed. I did get my new meds last night, so the next few weeks will be spent re-adjusting everything to get BP back to normal. I was amazed to find that I gained 16 pounds of fluid weight by April 3rd. Half of that is gone, but it could take another couple of weeks to take off the rest. Daily weighings continue to be essential to monitor progress. Next up are follow-up appointments with all sorts of people, so I will be reporting on those as they happen.

This appointment turned out to be a combination of an interview with a nurse and a session of lab work and a chest x-ray. The interview covered many of the topics in the comprehensive Patient Manual given to me at Dr Speir's office two weeks ago. I learned some new things during the hour-long chat. I acquired a wrist band with blood cross-matching information that was to stay in place until my surgery. I stop vitamin supplements today, also I am to avoid some OTC pain medications that I don't take anyway. Acetaminophen is permitted. Now I feel that the countdown is really on!

March 11, 2014. Today's session was more lengthy and complex than I expected. Pam Crippen, Nurse Practitioner, reviewed my health history, checked BP at extremities, and listened to blood flow through the carotid arteries. She decided to order an ultra-sound scan of the carotids, which was performed later, just before I left the office. She was able to answer almost all of the questions posed by Louise and me. A baseline test with a spirometer capped it off. Dr Speir had reviewed my most recent echo cardiogram just before he came in to see me, and he went over the results with me, also the results of the catheterization of two weeks ago. Two key dates were determined: a surgery date, Wednesday, April 2nd, at INOVA Fairfax Hospital, and pre-surgery tests on Wednesday, March 26th. So it appears that I will be in surgery, then intensive care for a couple of days, then in step-down care at the hospital for a few days after that. I left with a bundle of patient instructions and the Hospital's Patient Resource Handbook to help guide me over the next few weeks.

February 25, 2014 First stop after Dr. Sherber and I agreed that it was time to replace my failing valve was to check the valve itself, also look at coronary arteries. Dr Raybuck did that today at the INOVA Vascular and Cardiac Institute in Falls Church, VA, and found 75% blockage in one coronary artery and also confirmed findings of the latest echocardiogram that the aortic valve stenosis was severe. On March 11 I will consult Dr Alan Speir for type of surgery, type of replacement valve, and date for surgery.