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My heart valve replacement surgery experience Part One

I'm writing this post in order to help educate and prepare other men and women who are facing AVR surgery. AVR stands for Aortic Valve replacement. I also had repair of heart aneurysm on August 13th 2008.

I posted this yesterday at my home blog. Today I'm posting it at Wizbang, but under the fold because of the post's length.

Prelude- On July 30, 2008 I was admitted to the hospital with shortness of breath. The symptoms were like congestive heart failure, but not quite. I was suffering from aortic regurgitation as a result of a heart aneurysm. In the days ahead, I'd learn the heart valve I had was bicuspid rather than tricuspid. This is an all not too common birth defect. A cardiac catherization and cardiac echo gram confirmed all this. If there was good news, it was I had no heart blockages. My father twice required having heart bypass surgery.

The surgery I was facing was tricky, and I have other complications. The surgeon Dr. Lester has had limited experience in the surgery I needed, and was honest with the wife and I about this. Financial considerations kept me from travelling to places that do the surgery I needed. Gainesville Shands and Texas Heart were discussed. Considering I spent 16 days hospitalized, its probably good I stayed close to home.

I was discharged from the hosp. on August 6th, told to come back for pre-op on Aug. 11th, and told my surgery was scheduled for Aug 13th at 10 am. I'd have to report to the hospital at 6 am.

Before I had surgery, a ICU nurse at the hospital came to visit my wife Leonita and I. Her name is Zarah, and she's been our friend for a few years. Zarah gave me a good briefing on what I'd face after surgery, but there were still some surprises.

This is written all from memory. Neither Leonita or I took any notes. I was heavily medicated in the aftermath of AVR, so I'm sure there are many details I'm forgetting.

August 13th- I woke up at 430 that morning. Did a few last second things around the house before leaving around 5:40.

JFK Hosp is about 2 miles from my home. I was taken immediately into pre-op and went through all the preperations. It took two tries for a nurse to get IV in me or blood out of me. Don't really remember now. Around 7 am Leonita was shown in and stayed with me till I was wheeled down to the operating room at 8. I remember all the people in the room, and getting moved off the gurney to a table. Shortly after that I was off to la la land.

As I learned my surgery was complicated. Repair of the aneurysm and AVR. A St Jude mechanical valve was used. One problem- They had a tough time tubing me. That meant I had a tube down my throat for the first 24 hours. For the first 10 days or so after its removal, I couldn't eat certain foods(bread products for one) and needed the help of liquids to wash down the rest. Overall my appetite was good post-op. All those Outback Steakhouse commercials on American Movie Classics used to drive me insane.

My operation wasn't over till almost 6 pm. I was taken to CICU and my wife saw the surgeon. All I remember that night was Leonita saying goodbye(I couldn't open my eyes, but heard her voice), the tube and my inability to talk, being told I had a high temperature that got around 102 that night and that my nurse had just me for a patient. She spent most of the night seated at a table across from my bed.

Note- Zarah informed Leonita and I sometime during my hospital stay that in preparation for doing my surgery, Dr. Lester did no surgery for 48 hours before mine. That so he could be physically prepared.

And so began 9 out of my first 10 hospital days in the CICU. Both rooms I stayed in were right off the nurse's station and as a result noisy as hell.

As I began to wake up, I noticed the numbness in my right hand. It encompassing four of my five fingers at the time. I'm right-handed, and write for a living. This would be a major cause of depression the first few days for me. 5 weeks and 2 days post-op feeling is slowly coming back to my hand. It confined to three fingers now.

Aug 14- The tube was removed around 1030 am. My wife and her sister were with me then. I had some food an hour or so later.

That day I began to contract pneumonia, the main cause of my long CICU stay. My liquids needed to be restricted but at the same time I needed them to eat. Sort of a catch 22.

It was on the 14th I first remember getting hot flashes. They mostly involving my sweating profusely from the head. I'd continue to have them till almost the time of my discharge, though they gradually decreased after my transfer to the Cardiovascular unit.

Sometime on the 14th evening, I had something removed from me. That required me to be immobilized and my head tilted backwards. Maybe someone knows what this was, or I'm just dreaming from still being in la la land. All I know is I was struggling to breathe the night of the 14-15th. Before being put on a ventilator, I requested my wife be allowed to come to the CICU. JFK is pretty strict when it comes to ICU visiting hours, but your nurse can make exceptions. Leonita came and stayed with me till the ventilator came out late in the morning of the 15th. My nurse Tina sending her home for a rest.

Note- I liked Tina, who is from India, but used to call her Gina mostly. It was an incident mistake due to my meds and my health issues. Tina never seemed to mind.

My nurses and PCAs were almost always great during the time I was in the hosp. Ones that stood out were Gina, Jean, Jackilyn, Imelda and Mary Jane(members of the Filipina mafia like my wife), Evanna and others I forgot the name of. I even grew to like the one PCA who seemed to only annoy me on my first visit to JFK in late July.

I don't know what I would have done without Leonita. She's always had the patience of a saint, but it has been tough on her the last 2 months. I got the best wife.

Aug 15- I was taken off the ventilator. After a short time, the nurse ordered me lunch. Just my luck, it took 90 minutes for one inedible tuna sandwich to arrive(It was very dry and probably had little or no mayo).

Well I told Gina this, and asked if my wife Leonita could be called to bring me something. Then suddenly Gina bolted from the room. I'd learn later, her other patient tried to discharge himself and was walking out of the ICU!

I had my first bowel movement this day. On a commode, not in the bedpan fortunately.

Beginning Thursday or Friday, the night nurse would hand wash me in bed.

Aug 16-18- I got over the pneumonia but was generally feeling sluggish. All I remember is watching one Miami Dolphin pre-season football game, The movie Apollo 13 about 5 times, lots of the channel TNT and not much else. Leonita would bring me the newspaper in the morning, but other than wanting to know who won the last LPGA tournament, I showed little interest.

It was during this time, Leonita began to bring me breakfast daily. JFK's choices for this meal were either too hard to swallow or lacking in taste. Leonita would usually bring me scrambled eggs, but I ate a little French toast or English Muffin once my throat began getting better. These were all foods I was allowed to eat. Visiting hours at the ICU didn't begin till 10 am, but the nurses were kind enough to let Leonita come in around 630-645 to feed me. I was in no shape to feed myself with my right hand pretty useless. So my wife coming was helpful to the nurses. After feeding me, Leonita would leave before 730 and come back later.

That's about all I remember up through the 18th when I got sent upstairs around mid-day to the cardiovascular unit. I will continue my story tomorrow.


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Comments (12)

Jesus, Bill. Godspeed and ... (Below threshold)
Ryan:

Jesus, Bill. Godspeed and good luck.

It's a pain to have to go t... (Below threshold)

It's a pain to have to go through this, but you will be better off for having done it.

It reminds me of the time when my good friend Bob, also known as the Grinch, was having heart troubles. The MRI showed his heart to be as much as 3 TIMES too small. All of the kids laughed at him in his hometown of Whoville, PA, calling him 'heartless' or 'faint of heart' and such (you know how cruel kids can be).

Well, long story short, they replaced his heart with one 10 times as big! In the end, the whole town cam out and danced in the street and sang songs (they were weird like that) and Bob lived happily ever after. Just like you will!

Good luck, and God bless.

Bill,Fascinating r... (Below threshold)
al:

Bill,

Fascinating recollection. I spent two days in the hospital last year when my brain decided to reboot and I didn't remember as much as you do. OTOH the food was much better. Steak, lobster tail, yum.

Best wishes for a speedy recovery, al

You are truly blessed with ... (Below threshold)
epador:

You are truly blessed with wife and spirit. Good stOory, No need to dwell further on that past - LOK FORWARD!!! Get that hand and arm back all the way. It will come.

Best wishes to you and than... (Below threshold)
MM:

Best wishes to you and thanks for your story. My father had AVR (also mechanical) with an aneurysm repair in 2001. He is doing well. Its tough to monitor the blood thinner, but it could be worse.

I don't know if you have children or siblings, but after my dad' surgery, his doctor said it could be hereditary. I found out about my bicuspid aortic valve a few years ago. No treatment, thankfully, (and no aneurysm) but I've got repair/replacement in my future. I'm trying to hold out until its outpatient surgery!

Bill,Well-recorded, ... (Below threshold)

Bill,
Well-recorded, even in the face of your supposed groggy state for part of the time.

Your story is particularly interesting to me for several reasons. First my Duchess & I both retired from the #4 heart transplant center in the US....also home to transplants of lungs,livers, kidneys, pancreas (top 20 in US in each category) & a teaching hospital.

Second, my bride was the nurse-clinician over cardiac surgery when she retired. I the computer geek to the Chief Medical Officer.

With that background, I share my experience of a year ago (one year retired). I had a persistent cough. My GP said probably caused by one of my meds. Took X-ray as a precaution. Spotted a shadow on my lung. Off to MRI test.

I received the report when not with my bride and was concerned as it noted no problem with lung (it was a calcification); however, the print before my eyes said "ascending aortic aneurysm."

My boss (it is nice to work for the CMO) had my cardiologist, thoracic surgeon, and a vascular chief in his conference room with me that same day. They logged onto the hospital system with a laptop and reviewed the MRI. Verdict: no problem as my aorta is about 4.4 to 4.7.....Docs agreed no surgery until it reaches 6.0 or thereabouts.

Today's modern medicine and the near-daily advances provides us many chances to outlive our parents. I have had a 6 mo checkup MRI & no change.

Never in my life have I gone on such a wild up and down of emotions as during those few days.

Stay with it, Bill. You sound as if you are in really fine hands...and I am sure your recovery by now is nearing completion.

Good job Bill, I am glad yo... (Below threshold)
Imhotep:

Good job Bill, I am glad you are recovering well. It does take time.

The device they may have removed while having you tilt your head back may have been a Swan-Ganz catheter. It is a large IV (the size of a drinking straw), that is used to measure your heart performance and hydration status. Good thing you don't remember them pulling out the "chest tubes"....that's the worst.

Godspeed.

Bill, I've been f... (Below threshold)
Travis:

Bill,
I've been following your ordeal, and I'm glad to hear you're doing well. I'm sure the rehab will continue for quite a while, and I look foreward to following your progress through that as well. Did your anethesiologist ever tell you why it was difficult to put a breathing tube in you? Was it "anticipated" by what he/she saw during your pre-op exam, or was it a surprise? Only about 1% of difficult intubations are surprises, and those "unanticipated" difficult intubations are why anesthesiology has been described as "hours and hours of mind-numbing boredom, punctuated by seconds of shear blood curdling terror". People who are known, or at least highly suspicious of being difficult often have breathing tubes placed while they're still awake. And once they're in, it's a worrysome proposition on the correct time to pull a breathing tube out(it's not like it would be easy to just put it back in).
Also, can you tell us more about the numbness in your hand? Is it improving? Was it a specific nerve injury(like the ulnar, which is the most common nerve injury associated with surgery/anesthesia)?

Darn Bill, you've had a rou... (Below threshold)
Chuck:

Darn Bill, you've had a rough go with this. Godspeed for a complete recovery.

I, to a lesser degree, share your experience. 3 months ago I was the "proud" recipient of quadruple bypass surgery. No warning at all, just blacked out one morning from lack of oxygen to the noggin.

I have had zilch complications and feel 110 percent. Jeez, I hated that tube in the throat too but had it for only 14 hours or so.

I am confident in your full recovery.

Take care. You are so very, very lucky to have Leonita at your side.

Wow, Bill. That is quite s... (Below threshold)
LaMedusa:

Wow, Bill. That is quite some story. I am so glad you have made it through this physical turmoil thus far. You have a wonderful wife that loves you very much and is there for you. Just take it easy and rest. My prayers are with you for a complete recovery, as well as with your friends and family. God bless.

I have a hard time reading ... (Below threshold)
Syllabucks:

I have a hard time reading this because my mother went in for heart valve surgery and did not survive it.

God bless you with the best of health.

Bill, As a double ... (Below threshold)
Adam:

Bill,

As a double heart valve replacement patient (aortic, pulmonary), I'm glad to hear you are on the mend.

If you need anything, feel free email me or visit my heart valve replacement blog.

Keep on tickin!

Adam




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