Tom's Heart Valve Journal

Hello everyone. I had AVR April 13 and am struggling with fatigue. Dr. Castro did a partial sternotomy) and had a perfect technical outcome and excellent recovery. I went back to work June 15th (I felt fine but didn't have the energy to work a full time job before that). I wonder what others have experienced fatigue. I sometimes go home from work and sleep for 1-2 hours before dinner. This is frustratingly similar to what was happening before my AVR. I am healthy and exercising (weights and stair-climber). Is it because I am 58 yrs. old or somehow part of my longer-term recovery from OHS? God bless you all! Tom Fitzmorris, Palo Alto, CA

I have posted here earlier about the mystery of having had my sense of taste –and sense of smell—totally disrupted. Until one week ago I could not tolerate any strong smells nor any foods with any type of spicyness, or garlic etc. I had the taste buds of a four year old. I wondered if it was the pain medication, i.e. Tramadol or other meds, but my cardiologist said these meds are not known for causing such problems. I have heard the anti-biotics can cause distaste but did not believe that I had been on any antibiotics.
Well yesterday my wife drove me to my one month follow up visit to see my surgeon, Dr. Castro, at Sequoia Hospital in Redwood City, California. What I was surprised to learn was that (of course) I had in fact been given antibiotics—intraoperatively. He has his anesthesiologists administer vancomycin and Ancef (cefazolin) during all his heart surgeries. He says that without antibiotics the risk of patient infection from open heart bypass surgery would be significant. His patients rarely if ever get infections. Dr. Castro explained that these drugs vastly disrupt bacteria (“Flora”) in the body and that includes bacteria that naturally occur in the mouth, so it is not surprising that this would disrupt one’s sense of taste. Fortunately, and consistent with what fellow heart valve surgery patients have reported, now at four weeks post-surgery the worst is past; food sometimes merely tastes flat or non-tasty, but for the most part no longer tastes awful or unappealing.
ITEM 2: EXERCISE. "Whoa big fella."
A couple of weeks ago I was already walking up to an hour at a time and wanted to know what I could safely do to increase my exercise tolerance. My cardiologist said that if I wanted to, I could use a stair-climber machine at the gym. So over the past week I have started doing this; two days ago I stair-climbed for 30 minutes at an intensity level so that my heart rate was at 140. Yesterday I felt a bit funky and during my wife and my visit to Dr. Castro, my heart surgeon, he said that I should really keep my heart rate down at about 115 for the next several weeks, just to be cautious and let the heart more fully heal. After all with bypass they make a small incision in the atrium and insert the bypass tube, and another one in the ascending aorta downstream from where they replaced the aortic valve. All these spots are sutured back to close the wounds and therefore need time to heal.
My patient logbook from the hospital lists goals for how much daily walking the patient should strive for. In my case, my wife Jennifer quipped that these should be the maximum I do rather than the minimum, which is how, in my typical over-zealous fashion, I have approached my recovery task.
Today is May 13, my one month surgery anniversary. When I awoke after a blessed full night of sleep, I found myself in a low mood (I am not good with mornings). Rather than subject Jennifer to this, I threw myself out of the house to get some exercise, which usually cures the blues --I think we all find. I observed my anniversary by doing a walk around the very popular Stanford Radar Dish in the Stanford foothills here in Palo Alto. The circuit took 1 hour 10 minutes and it was a nice cool morning and the grass is still partly green (we have had a very cool April this year). So it was a nice way to mark the one month milestone. After lunch I slept for 2 hours, so while I am doing great I don’t imagine that I could work a full day yet. Dr. Castro says that the healing progress accelerates, so I look forward to being vastly stronger in a couple of weeks. Who knows, maybe a beer or glass of wine will even taste good by then! Then I will know that I am healed.

1 month post AVR walk at the Stanford dish

When we go on vacation we all think of going to nice places, eating good food, drinking some wine and beer and a few cocktails (at least I do). We engage in a variety of activities: sight-seeing, going for hikes or maybe visit an art gallery. And we are not working if we are really on a vacation(turn that work email stream off…).

After that warm pink haze of medicated hospital time plus one week at home with wonderful care-givers and family to help me I am now in the dreaded mid-phase of convalescence. In mid-phase I am:

no longer required to have someone walk with me but am not strong enough to do much more than walking
permitted to eat anything I want, but there is an endless list of interesting foods that I cannot tolerate: any garlic, onion, spices of any kind make me queasy just to smell. Fortunately sweeter foods are o.k.: fruit and cottage cheese, ice cream,eggs (if not seasoned) and fats (butter, oils) and certain soups and salads that avoid spices.
Alcohol of any kind is totally unappealing
That occasional cigar that I used to enjoy: yeech!
I have a semi-permanent set of symptoms like the flu: body-aches, chills,headache, queasiness, malaise and listlessness.
Perhaps as a result of all of the above I find myself with very little interest to do much of anything except read. So boredom is a big problem.
Sleeping at night has been difficult so I am afraid to sleep much during the day. When it is 3 am and I am wide awake I feel no more inclined to do anything than if it were 3 p.m. A few days ago I got up at 4:45, got dressed and walked for 2miles which felt good because at least I had accomplished something. The good news is that Jennifer gave me this fizzy magnesium drink the last two nights and that seemed to help keep me in bed. Thank you Jennifer and thank God!
Jennifer’s gardens around our house are beautiful and the weather is great, but how long can one look at a garden doing nothing? I am not allowed to lift anything heavier than about 8 pounds so all types of physical activity like gardening is tricky or simply unadvised.

Friends and physicians alike have all said, “take it one day at a time.” The advice is sound, but I tell you, if I could feel normal tomorrow I would go back to work immediately.

I know that this will all pass. But there is a further lesson buried somewhere in this whining I think. Perhaps it is to appreciate what you have when you have it, no matter what life brings to you. I try to keep my head focused on positive attitude: “this too shall pass”; and gratitude: “I am grateful to finally understand and fix the source of my fatigue and to have a wonderful wife,family and friends to support me.” The best thing that has happened is that I am meeting neighbors while walking the neighborhoods around my house, neighbors that I did not know until now. That social interaction is like water in the desert: scarce but highly prized. As an introvert I need to recharge my batteries by doing activities of a more solitary nature, but this is for someone who works with customers, other managers and team-members all day long. Now I work with no one and I find great pleasure spending time just to chat with people that I run into. Two days ago I walked past a creek here in Palo Alto (Matadero), which is still flowing with quite a bit of water. Standing at the bridge over the creek was a mom with her daughter, whom she had just picked up at the nearby elementary school to walk her home. In the creek where not one but two pairs of Canadian Geese: one with 3 goslings, the other with five (see my photos pages). It was so nice just to chat about what we were seeing below us and then say goodbye. "one day at a time, with gratitude". Tom

Canadian geese family in my local creek: a good conversation starter

Flowers for Shauna. Homage for Jennifer

By Tom Fitzmorris — Apr 23, 2015 2:57pm
(this is from one of my postings on Caringbridge.org that I thought this heart-valve-surgery community might enjoy):

Yesterday April 23, my eldest daughter Miriam and I visited Shauna, my ICU nurse to thank her. We made flower arrangements from our garden and made cookies (I chopped the walnuts).
"Guys I can't tell you how wonderful this is, I've been having such a tough day! And I was just saying yesterday how we never see the patients after they leave."
It was great to give a lift to Shauna's day.
Shauna was my ICU nurse and for three days and two nights she had complete control over me. I realize that our relationship came to be that of mortal and Goddess. For example, I would pray to her, “[Goddess] Shauna, please make my chest stop hurting” Shauna increases the amount of intra-venously-delivered phentenol, and suddenly stop hurting. Heck if I did not know about the phentenol I would have believed that she had powers of a theological order.
“[Goddess] Shauna, I thirst.” No, Tom you may not quench your thirst or you will heave your guts.”
“[Goddess] Shauna, yet still I thirst.”
“Very well. Tom,you may eat of the ice chips. However be sparing in your eating of the ice chips or truly you will heave your guts.”
Then Goddess Shauna left my presence. And then did I eat too much from the cup of ice chips. And woe was me as my stomach, surprised that anything would be ingested in its current shut-down state, prepared to do something about these unwelcome contents. I began to feel queasy. Now “queasy” is not the same as “nauseous”,but we all know one can lead to the other. In my case in seconds. Goddess Shauna and Brother Tony, my night nurse, were both out of the room when I realized that my stomach clearly had had enough. Realizing that I did not have time to search through my blankets for:
1) That ridiculously small emesis basin
2) that nurse call button/TV remote device that was always getting lost on my blankets or falling on the floor,
I resorted to first lines of communication, “I need a basin; I’m gonna be sick in here --now!”,I bellowed to the hall. My room was directly across from the central station of the entire 16 bed ICU, which was a negative when I wanted to sleep, as the nurses were always chatting up a storm out there, day and night. Now my location became a benefit because no nurse wants to be stationed next to the scene of vomiting. Their response was impressive and in-time by seconds.
Lesson: Woe to those who disobey Goddess Shauna as there will be consequences.
But to set the record straight I realize that my real Goddess is my wife, Jennifer. She is the true unsung hero, so here I will sing her praises. Jennifer has kept the whole household running while keeping up with her job and still visiting me in hospital every day. And now that I am home has lovingly helped me with what-ever I have needed, starting with reminding me to take my medications. The pain meds work so well that after taking them I forget to check on when I took them last, until I feel that truck tire rolling back onto my chest. And Jennifer cooks for me what-ever I wish(which usually is not much), and goes
for walks with me. Going for walks is actually a wonderful husband-wife activity that we have rarely done.
If I have learned one thing from this convalescence, I hope that it is to cherish my wife—and take her for walks. Heck, I certainly can’t go for a run or a swim with her because she would beat the pants off me, Jennifer is in awesome condition: she swims 1 mile workouts and does other high-intensity workouts with activities like boxing, spin cycling, tractor tire lifting, and running intervals. To have a wife that is such a stud, and a phenomenal cook, the devoted mother of our four wonderful children, and a truly loving mate and generous caregiver to not just me but everyone she meets, is to come very close to having the perfect wife.When I got home on Saturday, I told Jennifer, “Since I cannot compete with you I have decided to worship you instead.” “Ok, that would be fine”, she replied.
Meeting Jennifer was the luckiest thing that ever happened to me. Today is the anniversery of our first meeting, on April 23, 1977. We have now known each other for 38 --sometime hectic, years. I hope to spend the next 38 with her as well --that's where the worshiping comes in...
Grateful husband, Tom

with Jennifer my wife, whom I actually do worship

My wonderful wife Jennifer at our daughter's wedding September 2013

Day nine post-op I visited Shauna my wonderful ICU nurse and gave her flowers from our garden that my daughter arranged

I am curious to know from others' experiences how the recovery goes. I am not able to eat foods that have any spice in them or saltiness. I like to eat bran flakes, cottage cheese, fruit, ice cream, and minimally seasoned protein. Alcohol is completely uninteresting. I took a sip of my wife's very nice chardonnay and it tasted more like bile than wine. What is going on? how long does it last? what is it caused by? I have been taking bistolic (beta-blocker) tylenol and Tramedol. I suspect the Tramedol and think that I have taken my last one yesterday. Thanks everyone, Tom

with my Dad night before surgery

The night before my surgery with my 83 year old mother, who never thought she live to have one of her (8) children go through something like this

I just joined today. My name is Tom Fitzmorris. I learned about Dr. Luis Castro from Adam's web-site (thank you Adam for your work!), and had my AVR surgery on April 13, 2015--about one month after figuring out what had been causing increasing fatigue over the past few years. Surgery used a partial sternotomy approach, preserving the lower breastbone intact; I was on bypass for 40 minutes and 1 hour 40 minutes total surgery time. (Dr. Castro is reputed to be one of the faster surgeons around.)
Fun fact: I asked Dr. Castro durning my final pre-op consult what would be the most difficult and perhaps most unanticipated aspect of recovery in the hospital, and in the home? He replied that the first day I would feel as if a truck hit me (what he failed to tell me is that without scrupulous attention to pain medications, it will feel as if that truck came to rest on my chest). On day two I was sleeping while the meds began to wear off; I awoke and felt about a "4" on a 0-10 pain scale; within 15 minutes I was a "7"and climbing before my wonderful nurse Shauna, got a bolus of meds on-board.
Fact number two: Dr. Castro said that people at home can get frustrated with the pace of recovery, which can feel slow. So he advised "easy does it" (my paraphrase).
I am 57 years old, work in the medical products world, including past roles where I was the Cardiac Surgery Marketing Manager for Hewlett-Packard and Acuson ultrasound companies and logged a number of hours observing in open-heart surgeries ("Heart rooms") at places like the Cleveland Clinic, UCSF, Emory, U. of Chicago. So I am fortunate to have a good understanding of the world that I was about to enter..
I moved from the CICU on Wednesday 15th and then came home from Sequoia Hospital (Redwood City, CA) last Saturday April 18th. Still on 1-2 each 50 mg tramadol every four hours. I sleep a lot. And take walks. Pain is well managed though.I no longer need a pillow or a heart-hugger vest.
I am hoping for no need to stay on Tramadol much longer; what have been other's experiences?
til later...Tom