Richard's Journal

I recently passed the four-year anniversary of my heart valve surgery. Since I also had exercise-induced AFIB in the weeks before the surgery, I also got the Maze procedure, which meant this was not minimally invasive, instead, I got a median sternotomy. But my surgeon, Dr. Vincent Gaudiani, did an excellent job. The details of that are all described here.

The major side effect I had in the first few months post-op was pericarditis, or an inflamed pericardium (the lining surrounding the heart). At first, this caused water around the lungs (pleural effusion) which made breathing more difficult. That was cleared up after a few weeks by a stout dose of furosemide (also known by the brand name Lasix). But I had an ongoing issue of an abnormally high resting heart rate, which took almost a year to completely go away.

Now, four years on, I am completely asymptomatic. I just did a major round of tests with my cardiologist that confirmed I no longer have AFIB, and also do not have clogged coronary arteries.

I'd like to say I am good as new but in some ways, it's even better, as my new valve opening is probably bigger than my original one ever was since it was bicuspid. So I'm fours years older, 68 vs. 64, with perhaps some accompanying slowdown, but that is compensated for by the better-performing valve.

The anniversary really made me appreciate what I went through (with the help and support of many people), and how far I've come, and how lucky I am it all turned out this way. I decided to do something special to celebrate. First, about a week ago I did I brisk 50-mile ride in the hills, which felt great. But I was looking for something even more special so have signed up for a century (100-mile bike ride) in October. I haven't done one of those in forty years so this will hopefully show the old boy has still got it (in the stamina department at least). And it will be a fun tour of rural parts of the Sacramento Valley I've never seen. (See the photo I uploaded above).

I am now at 18 months post-op and feeling great, healthier and fitter than ever! I had aortic valve replacement and cox-maze III procedure for afib on August 11, 2017, by my great surgeon Dr. Vincent Gaudiani. I struggled with some side effects for several months. First there was fluid around the lungs (pleural effusion) which require high doses of Lasix before it cleared up after a few months, then I had abnormally high heart rate which took almost a year to go away. But now all is well.
I just recently published a kindle book on Amazon called "Old But Still Moving" about my efforts to stay healthy and fit despite both hips being replaced at age 60 and the heart valve replacement at age 64. I hope it provides some inspiration.

Out for a brisk hike in Northern California...

Last Wednesday I did a follow-up and we found that water had accumulated in my lungs since I left the hospital (I was 8 days out of hospital, 12 days post-op at that time). I had also gained several pounds in those 8 days despite not overeating, so I'd retained water elsewhere also.
I think the problem was that they had me on a strong diuretic in the hospital, and sent me home with a weaker one which in retrospect was inadequate.
So for the last 5 days I've been back on a strong diuretic and hitting the spirometer religiously. Lost all the weight gain plus two extra pounds. I don't think the lungs are 100% clear yet because I still get out of breath under all but the slowest walking, but we're getting there.
I think I could have caught this a bit sooner when I noticed the weight gain and that my stamina was not improving. But I followed my discharge instructions to the letter, which said "call in if there is greater than 5 pounds weight gain in a week or 2 in a day", and I didn't quite hit those triggers. I think the lesson is: when in doubt call.
I didn't get discouraged by this, I figure the lung rehab got delayed a bit but the heart and sternum still kept healing on schedule

My surgery went extremely well. I was remarkably calm going in because I put my confidence in a great surgeon (Dr. Gaudiani) and his team. There were no complications during surgery so he got the combined valve replacement and Cox-Maze III done in 3 hours with a full sternotomy.
Later in the afternoon we had a scare: Excess bleeding was happening from my chest tube (a fairly common complication). A team of about at least five highly competent Doctors and nurses was buzzing around me for what seemed like an hour.I was relaxed about putting myself in their hands (the drugs still in my system may also have helped). But my beloved wife Karen was sitting in the corner with eyes the size of silver dollars. I was pleased to see that from time to time one of the team would go over and give her an update and reassure her. The worst case would have been they’d have to wheel me back in to surgery and open me up to find the bleeding source. Fortunately they avoided that by pounding in some units of blood and clotting factors.

Later that evening, anesthesia wore off and I was in significant sternum pain. It was knocked out with a tramadol, an oxycodone, and another tramadol (spaced out over several hours). That was the last time I needed narcotics for the entire stay. Only tylenol from then on! The narcotics remained on my chart "as needed" but I didn't have to ask for them. I don't know if I was just lucky or Dr. Gaudiani did an extra good job wiring the sternum back together.

I got a good night’s sleep probably because of the narcotics. I had trouble with sleeping all other nights, more on that below. The rest of the 4 day hospital stay went smoothly, checking recovery boxes off on schedule. The first slap in the face occurred when my PT had me go up a flight of stairs. I got out of breath going up one flight incredibly slowly. I think it is because of fluid retained in the lungs due to having been on the heart lung machine. I've been assured this symptom clears up after a couple of weeks, especially if you do a good job with your breathing exercises.

Everything looked good by postop day 4 so I was released. I went home grateful for the amazingly competent and compassionate care I had received from the nurses and other staff at El Camino Hospital in Mountain View, Ca.

The first few days home have gone well. The trouble sleeping persisted through the first couple of nights home. During a followup call from a nurse in my Drs office, she made the analogy of jet lag due to the stress your body has been through and the disturbance to your rythm in the hospital. She suggested no naps during the day and going to bed at my usual time. This worked and last night was my first good night's sleep.

Endurance is still ridiculously low, but I am able to stroll slowly more and more each day. I've noticed progress with the breathing exercises with the incentive spirometer, the level I can get to is creeping up. I think you really have to be careful about your mindset at this point if you've previously been fit, and not compare yourself to your former glory: "I used to be able to climb hard up hills for 2 hours and now I get winded going slowly up a flight of stairs? Are you kidding me?". Instead, focus on the "baby step" improvements and be assured you'll get it back in a few months.

One last point. I highly recommend the heart hugger. When coughing, sneezing, or anything else that might tug on the sternum, there's no comparison to squeezing the handles on this for support versus the "old school" way of hugging a pillow.

I have severe aortic stenosis (probably bicuspid, I'm 64) as well as afib. I met with Dr. Vincent Gaudiani in whom I have complete confidence. He will perform AVR (with bio valve) and do Cox-Maze III for Afib on 08/11/17. He feels this will give the best outcome. I know I have a bit of an ordeal in front of me but am trying to "reframe it" as an adventure. After rehab I'm looking forward to getting back to full athletic activity with no restrictions. I'm a pretty serious biker, hiker, and canoe and kayak paddler and the heart issues have been cramping my style!