You can’t really say that I buried the lede on this one. I was born with a leaky heart valve, often called a murmur. A doctor re-found it on a routine physical around 1993 and when I told my mother that I had a murmur, she just said “Oh yeah, you had that when you were born!” and from then, I’ve been getting it checked each year.
I’ve recently been looking for what this whole surgery experience is like, because I like to know going in, and I really couldn’t find much information outside the tragic. So I’ll write about my experience, with the usual caveat, I’m not a doctor, this is not medical advice and all other situations may be different. I’m just writing about my experience here. Also, I’ll do my best to get the medical stuff right, but no guarantees on that.
Each year, I’d visit a cardiologist and get an echocardiogram which is a type of ultrasound. They can easily look inside the heart and see how the valves are doing. As blood returns from the body in veins, it needs to be re-sent to the lungs to be oxygenated and then pumped back out to the body in the arteries. There are different chambers of the heart that ensure this flow keeps going in the correct direction and between the chambers are little doors, or valves. When the doctor first heard my murmur, it was in the aortic valve. That’s the last valve blood passes through when it leaves the heart with oxygenated blood to the body. The heart is basically done with its job at that point and wants the blood to go out through the body. If that door, or valve (aortic valve) is left slightly ajar when the heart pumps, some blood leaks backwards, into the heart and into a chamber that should be empty. It’s this ajar door that makes for a leaky valve, or a murmur. When you listen to a heart without leaks, you often hear the distinctive lub-dub, lub-dub sound. Blood coming in, blood being pushed out. But until recently, mine sounded more like lub-swoosh, lub-swoosh, as a lot of the blood was leaking back in, because the valve just wasn’t completely closed. Why did that happen? I don’t know, as Lady Gaga says “I was born this way!”
One problem with leaky heart valves is the heart doesn’t work as efficiently as it could. And to make up for the efficiency, it grows larger. Eventually a too-large heart just stops working. This is what we were keeping our eye on, how much blood was leaking back through this aortic valve and how much my heart was growing, due to the extra work. Every year it was the same, get the echocardiogram done, see the cardiologist for 10 minutes, he’d say everything still looks ok, see you next year. Every year for about 25 years. Every year, the cardiologist would say “hopefully this isn’t something you have to deal with for another 30 years and by then, the technology will be such that the surgery can be done easily through a leg vein or something.” Yeah, hopefully.
Then came my appointment in October last year. I expected more of the same. However this time, the doctor called me. He explained that he’d like me to come in sooner than my appointment because the numbers had gotten concerning. I went in and he showed the annual increase and how those metrics indicated that the amount of blood leaking backwards had increased from “moderate” to “severe” and my heart had grown into the “severe” stage as well. He wanted me to speak with a cardiac surgeon. Uh oh.
The Search for a Surgeon
I did meet with more than one surgeon and settled on one that I really liked. He took the time to answer all my questions and all his answers really made sense to me. However, during this process, I realized something. They were now talking about two valves. I realized that they were now talking about the aortic valve and the mitral valve in my heart. Here’s a picture, from Wikipedia:
Both the mitral valve and aortic valve are shown near each other here, on the pink side (yes “pink side” is a medical term that doctors use all the time). The mitral valve is inside the heart and helps blood to flow in the right direction through the heart as it pumps. Again, we don’t want blood going backwards as that creates inefficiency and causes the heart to grow.
It was during one of these visits that I was just like “Wait, we’d only ever talked about one valve for years, but now there’s two on the list. What’s going on?” Fortunately I had with me about 10 years of reports and the doctor went over all of that with me, showed that the mitral valve really hadn’t been any concern at all until very recently. But now it is.
Figuring Out the Surgery
Some heart valve surgeries can be done through a cathether run through a vein in the leg. So yes, I want that! I don’t want my whole chest opened up (Oops, I revealed that spoiler already) However, the mitral valve just can’t be repaired all that easily (in my case) through a vein. We want it done right, so we need to open up. And while we’re there, we’ll do the aortic too. Heck, they even checked me for arterial blockages (stuff that causes heart attacks – another doctor term) as he’d fix that too while he was in there. Why no just get the full 100,000 mile tuneup? Fortunately my arteries were clean, no tuneup needed, just the two valves.
As we caught this relatively early, I’d only this year moved into that “severe” category, my valves didn’t have much damage and were deemed to be potentially repairable. This was scary the first time I’d heard “we can probably repair the valves” and thought it was weird that it was in a tone of “this is good news!” because why the “probably”? Is the alternative to not be able to repair them and then “Well, sorry and good luck with the rest of your life!” But no, the doctor explained that the options are repair or replace. Ohhh, much better. If they are able to repair my valves, then nothing more would need to be done ever. I’d have heart valves that are just like everyone else who wasn’t born with leaky valves. So yes, let’s do that! Then came the “but”. The surgeon explained that he was near certain that the mitral valve is repairable and will not need to be replaced, but the aortic valve, that one’s a bit tougher. I’m still not exactly sure why, but he said there is a chance it could be repaired, but he told me the likelihood is about 50/50. Ok, I’m good with those odds, because what he also added is that after the mitral is repaired, if the aortic needs to replaced again, it can likely be done through a vein in an outpatient appointment, probably 10-15 years from now. This is sounding better and better. I just need to get through this first surgery.
In addition to the external echocardiogram, the doctors wanted me to get a Transesophogeal Echocardiogram (TEE). This is an outpatient procedure where I think I checked in around 8 am and was leaving the facility by 10:30. During the approximate 30 minute procedure, I was sedated. Allegedly still awake, though I don’t remember any of it. They put a camera in a tube down my throat and got more pictures of my heart that way. I guess they get better pictures without having to look through the skin, ribs and lungs. That procedure wasn’t that bad, but I was loopy for about six hours after.
With all the prep done, I picked a day and scheduled the surgery. I put it about a month out as I wanted time to wrap things up at work and ensure I’d have a place for my dog to go. The estimate was that I’d be in the hospital for 5-7 days, including the one extra day when they wanted to check that my arteries were clear.
On the morning of my first procedure, I checked in at about 8 am. I got my wristband and said goodbye to normal clothes and any inklings of modesty for the next week. I only wore the hospital gown and some socks they gave me. I was first on the list for the artery check. The doctor performing it came to see me and laughed when I answered his “so you know why you’re here question” with an honest “Not really.” I knew I was getting a cardiac catheterization but really didn’t know what that meant. Did it mean they’d shoot dye into me and take pictures when I glow, or will they actually thread a camera through an artery and feed it all the way to my heart? It was the latter. I got to the examination room which was like an operating room a little bit, but darker. I was told that I’d even be able to watch the proceedings myself on the TV screen in the room, which seemed kinda neat. This was another procedure that has some sedation to it and in hindsight, the details are fuzzy. I do remember things like “You’ll feel a pinch, that’s the numbing agent” as they injected my wrist and I remember looking over at the TV screen a couple times and seeing what usually passes for pictures of veins or arteries. After about 45 minutes, I was done and wheeled back out to where I started. So wait, I just had a camera inside my heart? I was told, yes.
Surgery was scheduled for the next day and there’s a few hours to wait out the sedative, so the hospital just kept me overnight. I thought this was great, like being in a weird hotel room. Get room service food (I had pizza!), free TV, internet, so much fun! I was told that again, I was the first of the day, scheduled for 6:30 am. But there’s some prep for that. I didn’t go to bed too early, but figured I’d be getting lots of sleep in the coming days.
Surgery scheduled for 6:30 means you’ll get wheeled into the operating room at 7:15 am, or thereabouts. You could get picked up and brought down to the holding area any time from 5:30 to 6:30. But before you go, they make you take a shower with a disinfectant soap, especially focusing on the area where the surgery will be. So I dutifully scrubbed my chest for the recommended three minutes with that soap. I was done and back in my gown ready to go at 5:45. I wasn’t picked up until almost 6:30 am. When I got to the pre-operative area, it was already bustling with all types of medical professionals, working on all different types of patients, not just cardiac. When I heard one doctor say to one patient “We’ll just reset the bone…” I stopped looking around and just stared at the ceiling.
They ask you lots of questions, well really just a couple questions, over and over again: What is your name? What is your date of birth? What are you here for today?
I got really good at answering these.
In the pre-op area, lots of body parts get shaved and lots of needles get inserted. A couple doctors come by and introduce themselves, but really soon, you go for a ride to the big operating room. It does look just like those on TV with the big lights and lots of towels and instruments. They parked me right next to the operating table, again asked me the three questions, and then asked me to slide myself over onto the operating table. Once a doctor had me confirm that I was centered on the table, I remember nothing else, until it was time to wake up from my 3-4 hour procedure.
During my surgery, I was on a heart/lung bypass machine, which means a machine was doing the work of my lungs and my heart. I was also intubated, and while I have had procedures before for which I’d been intubated, I never remember them coming out. This time, that was the first thing I remembered. My first foggy memory is with my eyes closed, feeling a tube coming out of my throat, feeling my mouth and throat full of mucus and a man’s voice forcefully saying “Patrick breathe! Cough it out and breathe!” or something like that. I was waking up in the Cardiac Intensive Care Unit. I’d always said that if I woke up, after heart surgery, I win, and I remember thinking that pretty early in the process. I won.
Eventually I was able to breathe and open my eyes. There were two nurses overseeing me and my cardiologist stopped by to check on me as well. But then I looked at the wall where the daily calendar was. It showed “May 20.” Wait, what? I went under around 7:30 am on May 19 for a 3-4 hour procedure. Why does the calendar show May 20? Is this someone’s joke that I missed a whole day? And it’s light out, so it’s not even right after midnight or something like that. Here’s what happened:
Remember that my surgeon said repairing one of the valves was a near certainty and repairing the other was probably a 50/50 shot? He made good on his promise and went the repair route (instead of replacement) on both and sent me to the recovery area. But they keep you knocked out for a while, until they see that you’re doing ok. Turns out, that second valve didn’t want to be repaired, it wanted to be replaced. They said that it was bleeding a lot, so around 8 pm, I was sent back into the operating room for my third valve operation, to replace the aortic valve, which took until after 10 pm, and then back to the ICU for recovery. It was at that point that I think I’ve been told that I wasn’t giving good indications of being able to come off the breathing tube too quickly, so I was kept under until the morning. Leading to that wake up.
A Day in the ICU
I spent about a day in the ICU which was tolerable due to a heavy amount of painkilling drugs and keeping me pretty loopy. I’m guessing I took a lot of naps as I don’t remember a lot of it, other than fragments and pieces. The doctors and nurses were great, just chatted with me the whole time and I remember one embarrassing moment where in my head, I was at home with my daughter. One of the nurses asked me a question and I pictured it as my daughter asking, but I hadn’t quite heard it, so I asked “What’s that, baby?” Yeah, I called one of the ICU nurses “baby.” Fortunately I realized it pretty quickly, apologized and explained that I thought I was talking to my daughter. I’m sure the nurse has heard far worse thing from people coming off anethesia.
Let’s Continue the Recovery
On the second day, May 20th, around 6:30 pm when I got to my hospital room and out of the ICU, which I thought was pretty great. I had a room to myself as did everyone else on the cardiac recovery floor. I was attached to an external pacemaker, an EKG machine and a big collection unit for the chest drainage tubes. So I definitely wasn’t very mobile. The nurses change on twelve-hour shifts at 7 am and 7 pm. I had a new nurse (and nursing assistant) immediately after getting to my room. They coming to check vital signs around every 3-4 hours, which doesn’t lead to getting solid sleep, though the pain and discomfort of it all will also play a big part in that. Fortunately, pain medications are also a part of that frequent update as well.
Some Oozy and Gross Stuff
One of the first victims that I saw in the hospital was my own modesty. I was only wearing the hospital gown but for the number of times that doctors or nurses needed to check various body parts, eventually I just gave up on even trying to be private with privates. Just let them do and see whatever they need to. One of the first times with that was when the urinary catheter needed to come out, which is about as straightforward as you’d think. A nurse comes in and just gently pulls it out.
Then there was the next day when the Nurse Practitioner came in to remove the chest drainage tubes. They were being held in place with tape and a stitch, she said. The most painful part of that was when she peeled the tape from my skin. Pulling the chest tubes themselves out just felt weird, not really painful. However, before she did it, she did say that she was going to take off her jacket so as to not get fluid all over it. And when she was done, sure enough, her shirt had gotten a little wet from the chest blood/fluid. Yuck.
Going for walks are also important. The nurses liked to get me up as soon as I could and I think it was Saturday (post op day 2) when one nurse asked me if I could go for a walk in the hallway. I said I’d try. I was still attached to an external pacemaker and EKG, so she carried those as I took my steps. We got out into the hall and I took a couple steps when she reminded me, “However far you go, you gotta make it back, too, so only go halfway!” At that moment I started feeling really hot, my head was pounding, I was sweaty and dizzy. I figured let’s not push this and turn right around. I think I made it about 10 feet in my first walk.
The following day (Sunday, post op day 3) the nurse asked if I could try going for a walk again. I was feeling a lot better than the previous day, and I picked out a spot on the floor and made that round trip. It was about 50 feet! Hugely successful. Sunday was my last day that I took the heavy painkillers as I was feeling pretty good and decided to stop taking those and just stick with good ol’ Tylenol. Coming off the narcotics let me clear my head and remember more things. But it also meant sleeping less and sleeping worse.
Monday was when my pacemaker could come out. In my instance, the box was external and it just had four wires attached to my heart. So the nurse practitioner could just pull these out. Oh ok, no proble…wait. Did you say they’re attached to my heart? And you’re just going to pull them out? Yep, that’s exactly how it works. There’s a “weak stitch” holding the wire to the heart and just some light tension will release the wire and let its whole eight inches or so come out, with not a lot of pain, but definitely more than the chest tubes. It definitely wasn’t a pleasant experience. After that, I was required to stay in bed for at least a one-hour observation window because there is a “one in 10,000 chance” that tugging on the wires would damage my heart and they’d need to go back in…again. Fortunately that hour passed without incident and right at the end of it, a physical therapist arrived.
The physical therapist’s job was to give me an exercise program for home and to evaluate me in the hospital for my walking and stair climbing/descending ability. So she took me out in the hall, this time we walked the full hallway of about 100 feet. We also went up and down about 8 stairs and she declared me capable of taking walks around the floor on my own. No nurse’s assistance needed and I had my exercise program for when I get back home.
It was also around this time that I was allowed to take my first shower. Before this had been just cloth baths. But along with the visit to the shower meant removing the bandages from my chest and being in front of a mirror in the bathroom. I finally got to see my chest scar for the first time and it was definitely worse than I’d expected. It was redder, thicker and longer, and there were a number of other cuts all around it. Plus the additional incision sites where the chest tubes and pacemaker wires had been. The doctor didn’t use stitches or wire, but there’s some kind of glue that they actually use to hold it all together, and the glue is watertight. It’s ok to get the incision site wet in the shower, they said just make sure I don’t scrub at it. That really wasn’t a problem as at this point, anything making contact with the incision site hurt, a lot. Even water dripping over my shoulders and running down my chest hurt. So I sure wasn’t going to scrub it. This pain lasted about three days and now I can put soap directly on it, albeit gently, and let the shower wash it the site directly.
Finally on Tuesday, I got the official word, I get to go home! My surgeon visited around 9:30 am and said he’d just needed one last chest x-ray and I can go. They must have been pretty backed up in the radiology department as I finally got down there at 4 pm and was being wheeled out of the hospital at 5 pm for the ride home and a night’s sleep in my own bed! My sleep schedule was still a little messed up and I was still a bit sore at home, so the first night in my own bed was far, far better than any in the hospital. I think the last couple nights, I only got 3 hours sleep each because I was off the heavy medications and the bed just wasn’t comfortable. But my first night home, I think I slept four hours, one hour awake, one hour sleep, 3 hours awake, two hours asleep. But now I have been about to get that much closer to a solid 8 hours through the night with just a little bit of awake time.
I will say that I went into this underestimating the impact of the surgery on me. I’d been running upwards of five miles in a day and thought, why will I be so tired afterward to even walk 10 feet? I understood that they would literally open up my chest and perform an operation on my heart (twice), but I still underestimated it. So now I’m just sticking with the plans they give me which is currently to walk around for 10 minutes, 3-4 times a day. Yep, that’s all they want me to do. So that’s what I’ll do. Here’s to the recovery!
I may continue to update this post as I progress through the summer.
Every day is feeling better. I’m doing a lot of walking, usually around the neighborhood. It’s at a pretty slow pace, but I’m doing anywhere between 10 and 20 minutes up to three times a day. I think that’s making a lot of difference. I’m also using this spirometer device, which helps to re-expand my lungs.
I still have a little bit of a cough and the visiting nurse said the bottom part of my lungs aren’t fully awake yet, but it’s getting better. I think this was in part due to being on the respirator for about 24 hours and I need to be a little gentle with coughing.
Another thing that I’ve noticed is I’m more temperature sensitive now. I feel like an old man because I’ll need a sweater if it’s 60 degrees out. When I was in the hospital, I thought they were doing a bad job of temperature regulation in my room. I felt like there were 10 degree swings where I’d go from shivering to sweating in a short period of time. I’ve since learned that it wasn’t the hospital, it was me. I know this because I still do it at home, when I have full control of the temperature. I can see there are no wild swings, but the same thing is happening, especially at night, before bed.
When I came out of surgery, I’d gained 17 pounds of fluid weight. When I first checked in to the hospital, I was 170 pounds. My first weigh-in after surgery was 187. They put me on Lasix to help drain that out, and it’s worked. Fortunately, they told me that I’d likely even go 5-10 pounds below my normal weight before I start putting weight back on. My home scale is generally a couple pounds lower than others, but today’s weigh-in was just under 160, a full 10 pounds down from my pre-surgical weight. Time to do some eatin’!
Still going well, wound is healing well, there’s not a lot of pain if I stay on Tylenol and even without Tylenol, it’s a dull ache. Just had one min-scare yesterday as my right arm had pins-and-needles tingling for a few hours, and a little numbness. One of the post-surgical concerns is a brain clot, leading to a stroke, and one of the signs is numbness in an arm. Fortunately, I did not have any other signs of a stroke. I called the visiting nurse who came over, did some tests, reported back to my surgeon’s office. The physician’s assistant said that is a relatively common thing involving nerves in the shoulder. This also made sense considering I had a lot of upper-back/shoulder pain when I was in the hospital. For now, the tingling comes and goes. Off to do another walk!
Had my first post-op follow-ups with both my surgeon’s office and my cardiologist.Both said I’m progressing well. One very reassuring thing to hear was in the surgeon’s office (I met with a PA) who asked at one point, “Ok, so what are all the weird things you’re feeling?” and then went on to list some that were right on point. Things like decreased appetite, not being able to eat as well, slight nausea after eating, and the one that I brought up is frequent ocular migraines. I’ve always gotten these, but it might be months in between each one. If I ever got two in a week, that felt extremely frequent. Since I’ve been home, I get 3, 4, 5 a day. I was told that this is common and that the PA had just met with someone else who noted the same thing, or even frequent “floaters” which are just seeing things pass through your field of vision. Sometimes they might look like a little bug flying by, sometimes they flash like a meteor.
I was also told to continue with the spirometer, even though my lungs sound clear and full, but I do still have the lingering cough. This cough is an indication that there is still a little more fluid deep in the bottom of my lungs. I put more effort into using it yesterday and after some coughing fits (sorry to be gross) I could feel more fluid come out and my breathing did feel better.
My cardiologist did add a new medication because my heart rate, at rest, is a little high. That’s weird to see because I remember some surprise one night in the hospital when my heart rate was between 49 and 53. Now it’s 85-90, even while just sitting or when I first wake up in the morning.
Lastly, when I got up today and lifted my shirt, it looked like a snowstorm. There’s a lot of skin flaking off now, not just from the incision sites, but from my whole torso. I’m guessing that’s due to a combination of all the tapes/adhesives that were on me for about a week and the alcohol that I’ve used to try to remove all the adhesive residue.
My weight hasn’t come back yet, but I can see that as tough to do when I’m eating less and doing a lot of walking. I think my walking mileage per week might even be higher than my weekly running mileage before the surgery.
Four weeks post-op. I got discharged from home physical therapy visits and home nursing visits. The glue on my incision is almost completely gone. I don’t need daily naps, but I still get pretty tired and naps are occasional. I am still on the Tylenol, every 8 hours, and my chest reminds me when I forget to take it. I’ll notice an overall ache and soreness. I’m also impatient. Originally, the doctors said I’d be doing well after 3 months and back to normal by 6 months. I thought that to be pretty quick, but here I am 4 week out and want to feel all better. But at least I’m on pace to be cleared to drive again in 10 days. I’ll still have the “no lifting more than 10 pounds” restriction until the very end of July though. In general, things are going well, doing 2-3 miles of walking per day, back to work at my job (a home desk job) and able to sleep pretty well at night. Still have a little bit of a cough and I might need to see a dentist as there’s something in my mouth that feels like a nerve is exposed. It’s has felt the same since the hospital and I just always thought it’d get better. I also still have some surface numbness in my neck, around where one of the IVs was. My temperature swings are better, though I do still get cold faster (maybe it’s the blood thinner), which isn’t a bad thing in the summer.
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