Plugging the Leak

Inspired by my friend Bruce who blogged about his below the knee amputation See Left Leg Lost, I thought I would record what up til now is the biggest medical challenge I have ever faced.  While this is old news to the world of Facebook, I still think it deserves a blog post for posterity.

Two years ago I went to see my PA because I had a head cold.  I will never forget the day, January 13, 2012.  My co-worker Cecilia had passed away and I went to her funeral, but I had this cold I couldn't shake so I stopped at the doctor's office to get some drugs.  Not only did I leave with antibiotics, but I also left with the discovery that I had a murmur in my heart.  He told me not to worry because a lot of people have murmurs and I should get an Echocardiogram (ECG) just to be on the safe side, but it probably won't reveal anything major.  Well.......

It turns out I have Mitral Valve Prolapse and I had "moderate" regurgitation.  Basically, my mitral valve leaked and as it pumped blood into my ventricle chamber, a "moderate" amount of blood was leaking back into the atrium.  But my Cardiologist said there was no baseline for how it would play out.  It might always stay that way, or it could get worse.  I would just need to check in every six months, maybe get an ECG every year and we'd monitor the problem.  My awesome Cardiologist Dr. K told me that on a scale of 1 to 4, with 4 being severe, I was at a 2.

At the end of 2012, I went in for another ECG and it showed that the leakage was a little worse, but I was asymptomatic and really wasn't having any problems.  In early 2013, I went in and everything was about the same.  I was bragging to Dr. K about how I can climb the "big hill" in Santiago and not even get out of breath.

October 17, 2013, I was supposed to go with my friend Bobby to do a Career Day at his daughter's Spanish Schoolhouse, but I had my ECG appointment and I didn't want to miss it, so he graciously allowed me to bow out.   Dr. K came in after the ultrasound and said, "Well........ we've got a problem"....  The leakage had reached what he called a "severe" level and my heart was starting to enlarge, 6mm to be exact, but it was a sign that my precious organ was starting to have to work harder to compensate for the leakage.  I was floored.  I actually felt better than I did before I was diagnosed.  I had gotten into a diet and exercise regimen and had lost about 30 pounds.  This couldn't be happening to me!

October 24, 2013 I went to the hospital for an outpatient procedure called a Trans Esophageal Echocardiogram (TEE) where they put me to sleep and Dr. K sent a probe down my esophagus to look at my heart and it confirmed that it was time to talk surgery.  Dr. K referred me to Dr. C.  I saw Dr. C on November 14th.  After looking at my tests, he was certain he could repair the valve.  I learned that to do the best possible repair he was going to crack my chest open (which freaked the $h@! out of me) but it was a procedure that he had perfected and performed a million times.  He had an opening November 19th, so I booked it and sealed my fate.

My Ladyfriend Kirsten took me to the hospital that chilly Tuesday morning.  They had my pre-op bed ready for me and even had a welcome sign for me.

Here I am trying to remain calm.

My pre-op nurse, Nurse L, was actually the same nurse I had when I had my TEE and she had done my pre-registration the day before.  Small world, it turns out my friend and co-worker Debbie, was a good friend of hers.  Here we are posing after a little blood typing.

Another tech came in and shaved my chest and then I met with my OR Nurse, we'll call him Nurse R.  He was from the Philippines and we talked about the recent Typhoon but luckily his family was ok.  He joked that I had the Asian connection today because my Anesthesiologist was from China and of course my surgeon Dr. C, was from Viet Nam.  I was given some Versed to calm me down, said a teary goodbye to Ladyfriend, and was wheeled away.  I remember the surgical suite looked like an auto repair shop with all sorts of tools neatly organized and there were two nurses in there next to what looked like tanks of helium, but I imagine they were something else.  They raised the bed and asked me to scoot onto the table, told me to relax and then I went to sleep.

I thought since they were going to stop my heart and put me on a bypass machine, I might see the light or have some sort of out of body experience.  I was hoping I would see my recently deceased dog Beau.  Sadly, I had neither (I hope this isn't a sign of the status of my salvation, as I try to be a good Presbyterian).  The next thing I remember is hearing my sister crying and the voice of my friend Peter.  I was in ICU.  I could hear everything and I remember I squeezed my mom and my sister's hands, but I couldn't open my eyes and my breathing tube was still in my lungs.  I was terribly uncomfortable and thirsty, but not in any pain.  I think it took about 30 minutes or so after I had shaken off some of the anesthesia, and my eyes were open and the Respiratory Therapist took the breathing tube out.  It was such a good feeling.  

I was immediately thirsty, but all they could give me were ice chips.  My friend Vicki came back to see me and fed me ice chips as I came around.  She snapped this photo, which I vaguely remember her taking (and she got in trouble for doing it too).

  

Within no time, they had me up and in a chair which was much more comfortable.  After the shift change, I was allowed to have visitors and Ladyfriend and Vicki sat with me while I devoured ice chips and water.  I went a little over board on the water and proceeded to throw up into a bucket (which Vicki took as her queue to leave).  I had never been so thirsty in my whole life.

 I learned that my surgery had been a little more extensive than we had originally planned.  It ended up taking about 5 hours.  Dr. C got in there and found that my chords that open and close the valve (chordeae tendineae) were shot so he replaced them with synthetic chords (a medical advancement that wasn't even possible two years ago).  He sewed a ring around my mitral valve and kind of folded over my flappy leaflets that were causing the leakage (not bad for five and half hours).  But the good news was there was no more leakage.  He told my family that as I recovered, I would be aware of how much better I feel as I realized what my body and heart were compensating before to cover my leaking valve.

My ICU nurse, Nurse M, was great though.  I was his only patient that night so he took very good care of me.  He was from Kenya, and I remember telling him that I voted for Obama (twice).  Lord knows what he thought of my ramblings.  He gave me a pillow, actually all heart patients get one.  It's for me to hug when I have to cough or sneeze or laugh since that is terribly painful after you have your chest cracked open and then wired shut.  It came with a sharpie for people to sign.  Ladyfriend couldn't spend the night in ICU, so she left around 10pm.

Nurse M was great with the morphine shots every couple of hours.  I slept off and on.  I had my iPhone with me and was able to read some emails and also catch up on Facebook.  I was so floored from all the support and concern my friends and family were passing my way via social media.  My Cardiologist, Dr. K came by at 4am (he makes early rounds) and checked on me.  My urinary catheter was removed (it actually didn't hurt, but I sure as hell am glad I was already asleep when they put it in) and some of my IV's were taken out.

Ladyfriend and my friend Mehrnoosh arrived around the same time.  Noosh is one of my oldest friends.  We've known each other since the 9th grade back at Hillsborough High School in Tampa, FL (Go Big Red!) and she is my only friend from the old country who lives local.  She's also an ER doctor, so she probably understood a lot more of what was going on than I did.  Dr. C, the surgeon came in to check on me and then they had me get up and using a wheelchair as my prop, I walked around the ICU.

Later that morning after Nurse M's shift ended, Nurse R got me ready for my move to the Cardiac Care Unit down the hall, the next step down in my level of care.  This first day was the hardest pain wise.  I was uncomfortable and still kind of out of it.  Ladyfriend said I was very serious and I looked bug eyed.  My family was there for a while and my friends Kiko and Dave stopped by with flowers and chocolates.  A rather aggressive nurse told me if I didn't start to pee, he was going to put the catheter back in, so I began what was a very painful, but in the end successful attempt to urinate.

What looks like a maxi-pad, was actually an adhesive bandage covering my incision, which was glued shut.  I also had two drainage tubes that had to be emptied every couple of hours with what looked like cherry Kool-aid.  I  had two wires going in to my chest as part of an external Pacemaker, to make sure my heart was in the correct rhythm.

Thursday was all about visitors.  Of course my family and Ladyfriend were there, but I had some friends from work stop by that morning.  My friend Bobby and his wife Robyn came and their kids had made me a huge get well sign.

Two other work friends, Juan and Catherine also came by.  Juan had to wear a mask because he was getting over a cold.  Two of the pastors from my church came to visit and we all said a prayer of thanks for a successful surgery (I figured being a Presbyterian and being in a Presbyterian hospital gave me brownie points with the Big Guy).  Later that day my friends Scott and Mary Jo came by to babysit while Kirsten ran errands and then my friend Kristi came, but I was so tired and doped up that I slept thru most of her visit.  I did the same when my friend Melanie came by later that night.  My sister and brother in law came and walked with me around the nurses station.  To my surprise, my surgeon said he thought I could be released by Friday afternoon.

Ladyfriend was planning on going back to school on Friday so my friend Vicki came up to stay with me.  I felt bad because I was so warm I kept the air on full blast and froze her out.  That next morning, Dr. C's PA came in and told me that I could be discharged that afternoon.  While I had been hesitant the day before, I was ready to get the hell out of the hospital.  The staff were great, but I was tired of being woken up every two hours to have tests run or blood pressure taken.  I wanted to go home.  The worst part of this whole ordeal came when the PA took out my external pacemaker wires. She cut the stitches that were holding the wires in place and then began to slowly pull them out of my stomach.  I could feel the wires brushing against my heart and it hurt quit a bit and made me dizzy.  If the process had taken any longer, I think I would have fainted.  So then I was anxious all afternoon because I still and to get the drainage tubes taken out.  That ended up being ok, but it was still a weird sensation as you felt the tubes leave your body.  I then got to take my first shower in three days.

The last central line was taken out and just as the sleet started to come down outside (it was terribly cold) my dad drove me home.  Kirsten was going to be staying with me for the next week while she was on fall break.  The first few days I just kind of laid around.  It was too cold to go walking, so a friend suggested that Kirsten drive me to a large indoor place so I could walk around, so we went to Kroger.  I used the shopping cart as my prop.

One of the great things about having an operation is the friends and the food and the presents.  I've had lots of people come by to visit and of course they bring food!  My friend Anne, who jokingly refers to herself as a "Culinary School Dropout" was one of many who brought some delicious food for me and Kirsten.

I got lots of different flowers and balloons, edible arrangements, and gift baskets. I wish I had taken more pictures of all the gifts.

So here I am, a little over three weeks after open heart surgery.  Still sore, but I am able to drive and am back to doing light cardio to get my strength up.  I can pretty much do everything on my own except lifting anything over ten pounds and will still be off work for about another 6 weeks.  Prior to this, the only surgery I had ever had was my wisdom teeth removed back in college.  I guess if I am gonna do something like have surgery, I start out big!

I have no way of knowing what life will throw at me health wise, but I hope this repair lasts the rest of my life because I would never wish something like this on anyone.  The concept of repairing a valve versus replacing it completely is still only about a decade old, but I am hoping this lasts a lot longer than a valve replacement which get's you about 15 to 20 years.  For the first time in my history as a working adult, I am out of work and it's a strange experience to not be working (but I am not complaining).  

That being said, I am blessed and happy to have chosen the surgeon that I did (you know it's a good sign when everyone you meet at the hospital says that if they ever have to have heart surgery, they want Dr. C).  I was very impressed with the state of the art hospital I was in and the caring staff that helped me.  I am fortunate that my family is local and I had so many caring friends willing to step up and help and most of all I am fortunate to have a wonderful girlfriend who dropped everything to nurse me back to health.