Norm's Story so far, starting with recovery

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normofthenorth

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OK, I've been meaning to start this for days now, and here goes at last!

It's Monday, almost exactly 5 days after they wheeled me out of the OR last Wednesday. I was supposed to be home now, but I got "stuck" here overnight by a little SNAFU from different teams manipulating my INR in different directions.

Since I ended up with a Dacron "simplicity ring" on my MV, I need to have ACT for 3 months, while the patch and the stitches and the corners smooth out, to present a smaller target for clotting. The pro's forgot to mention the 3 months of ACT from the patch, and apologized to me post-op. What can you do? (Thank God I never make "misteaks", eh?)

Well, they'd been maintaining my INR in the 2.5-ish range, where they want me to keep it at home, too. The last measurement before they were going to yank out my pacemaker wires showed 2.3. Many people don't think that's a problem, but the 2nd-banana CSurgeon thought it was too high, and should be lowered before the yank. So I got some Vit. K in OJ, and THEN the wires were yanked a few hours after. Whatever.

Today, I was all dressed up in street clothes, all hoses and lines and wires removed, saying my goodbyes and doing some "work work" on the laptop, expecting to hear any minute that I could leave. Everything was done, and all the results were in, EXCEPT my last blood test. When it came in, at 2-ish, it showed an INR of 1.40 (leftover from the Vit. K), and they decided I should NOT go!

They say they can keep me safe from clotting in a number of ways (like with LMW Heparin), but those other ways don't raise INR, only Coumadin/Warfarin does that. And they don't want to cut me loose until I'm in my therapeutic INR range and stabilized there. The feedback on (oral) Coumadin is so slow, that even with a rush blood test, they can't prove that I'm "good" until tomorrow, so I'm stuck overnight.

The place and staff are tops in so many ways -- unfortunately the menu selection is the pits, and I've had WAY too much trouble sleeping in the fancy hospital bed!! And if I don't NEED to be in a hospital, I'd SO much rather be home. But no.

My overwhelming surprises, as I've posted elsewhere, are
(1) PAIN: that the whole thing didn't hurt a LOT more, or need a LOT more painkillers, and (2) I've been "ME" throughout, and cogently so, whenever I wasn't knocked out! I never (OK, maybe "hardly ever") felt mentally, psychologically, emotionally, or spiritually changed. Many, maybe most, people experience both of those things differently, and some WAY differently.

And here's a third: I feel like I've already picked up where I left things last Wednesday! My work has certainly continued right where it left off (at the computer), with a few days off in-between. Of course, I won't be driving, or bicycling, or walking fast or very far, the way I did a week or two ago. Of course, there's a long gradual sternum "heal" and a long gradual slide toward, and through, cardiac rehab. But it doesn't feel like the first day of the rest of my life in any profound way, and it's different from last week in a few obvious ways, but not in kind.

So the story thus far is a surprisingly happy one for me and mine -- touch wood!

I posted a LOT more detail on the pain stuff already, at www.valvereplacement.org/forums/showthread.php?36941-on-the-other-side&p=479995#post479995:
Basically, since coming out of the OR, I've had a total of ONE dose of any narcotic (2cc of Morphine), and a few Extra Strength Tylenols, maybe 5 total! Not trying to be a hero here, just not taking them unless they seem needed, and trying to keep my mind clear.

Other than my sternum, which hurts a bunch when I stress it in any way, my "second-place" "silver-medalist" pains are puny things. Some of the tubes and things hurt coming out. (I was asleep when most of them went in.) Every time I get stuck for a new IV or a blood test, etc., I look the other way or close my eyes! I'm a real wimp about needles -- it's one of the reasons I've pushed my pain threshold at the dentist!

I HATE the way the hairy-but-shaved parts of my body feel!

I'm generally surprised how good my old "holes" look and feel. E.g., I didn't think I'd be able to walk almost straight into a nice hot shower right after my IV line was pulled out!

I had maybe 20 "connections" -- yee-yikes. Good news is they soon started slowly being removed. When I got to my first shower, I was surprised that nobody had warned me that the hole from my "trip-alum" feed into my Jugular vein was VERY heat-sensitive!?! When the shower's hot water hit it, it BURNED! Two days later, it was bac to normal.

Of course, there are MANY parts of this experience that are weird, unprecedented, and HUGE! Like those connections! One of the tests they ran on me in CVICU, maybe twice, was a direct test of my hear't output, like pressure times volume. They took two of the connections that were already going into me, but capped, and connected them directly to each other, through a fluid-flow gauge! For a while, all the blood coming out of my heart was going straight outside my body, through this gauge, then straight back into my heart! SKIP the BODY!!

Sure, that's no weirder than the heart-lung-machine "pump", but I didn't get to experience that directly! I was wide awake and totally aware and cogent when all my blood was bypassed like that! Yee-yikes!

I had a few frustrations, one or two of which almost drove me nuts. I've probably already written TOO much about my experience "coming to", before I ditched the breathing tube. NOT my fave, 'nuff said.

Probably my biggest frustration happened shortly before the surgery, and got me way into the stress zone for a while. Two med. pro's (surg. nurses?) were in charge of fitting me up with the "connections" that patients get while they're still awake. That was mostly an IV line (back of a hand or back of a wrist -- I forget which, having had both since the surgery!) AND an "art" line, a line into a forearm artery.

The "art" line looked a lot like another IV, but it's different, and maybe always trickier. The nice young "couple" (1M, 1F) who were in charge couldn't make it work AT ALL for what seemed like FOREVER! They stuck it into an artery on the back of my right arm, then they tested it (I forget how) to make sure the artery was open and flowing all the way to the needle and not blocked. NOPE! It's not working. So they checked out the other arm. Then they came back to the FIRST arm! Then they had to go back to the OTHER arm again!! And each time took a while, and wasn't fun, either! (Did I mention I really don't like needles?)

Anyhoo, the combination of stressors was almost too much at the time:
  • I'm like 20-odd minutes from the scheduled start of my surgery;
  • This seems SO much simpler and easier than replacing a valve -- why am I so confident again, exactly?
  • Oh, no, here they come again, to stab me again!?!
  • Yeee-yikes!!!
Eventually, it worked, and I started breathing normally again. Soon enough to have a nice chat with Dr. Feindel, my world-class rock-star surgeon. Our chat was so friendly, light, and charming, that I even decided to confront him with the fact that he'd "fibbed" to me about the study that shows that the Perimount COW valve seems to have better hemodynamic performance than the Hancock II PIG valve that I was getting (and got). (What kind of idiot confronts his heart surgeon with something like this 10-15 minutes before his own open-heart surgery?? You're listening to him!!:D)

"Really? What'd I say?" he asked So I told him. (It's on here somewhere, if you search.) AND I told him he was a co-author of the study whose approach he'd misrepresented, and whose validity he'd besmirched! He kind of winked, and started walking away toward the OR, then turned back with a smile and said "I still don't believe that study!"

BTW, I have a hypothesis (based on NOTHING!) for how it turned out that way: the main author from Leipzig and the 3 Torontonians all started chit-chatting about valve hemodynamics at a big conference somewhere. The Toronto crowd (Munk Centre, Univ. of Toronto) were close to publishing their "Gold Standard" article proving for once and for all (or so it seems!) that the Hancock II PIG valve lasts longer than any valve has ever been demonstrated to last, including longer than the Perimount COW valve. The German challenges them to a "shoot-out" on hemodynamics. He will provide a small but random sample of cow data, and they will have their computer randomly search their large database of pig patients, to find the most perfectly matched "case-controlled" pairs, ideally differing in virtually NOTHING except the animal the valve came from! And they'd sum up (average) the hemodynamic data, and publish the results under all four names. (The order of names would presumably begin with the winner(s) of the bet.)

When the data came in, the Canadians got smoked, lost the bet, and apparently helped prove that their fave Gold-Standard most-durable Aortic tissue valve ever, has maybe 10-ish% WORSE hemodynamics than its arch-rival! Ouch!

Anyhoo, I'm totally speculating above, but it's definitely a weird and rare glimpse into that world of jet-set heart-surgery research, no matter what the truth really is.

My heart is weird! My heart didn't seem QUITE as weird today as it did yesterday, though I think the remote-monitoring board showed it was doing a bunch of PVCs today, maybe even more than yesterday. Not often >10/minute, but almost never 0/min, even for the past minute. It's also been beating unusually fast -- 90s resting, and over 100 when I do stuff (walking, getting up, sitting up -- BIG stuff!:D)

Neither the rate nor the PVC frequency concerns my team. But I seem to notice my heart "beating out of my chest" at least as much as pre-op, maybe more. Maybe more yesterday and less today.

I developed a nice simple plausible mechanism to explain it, or part of it, but I haven't heard anybody sign onto it, so maybe it's not so plausible. They just say "You're only X days after open heart surgery!" and "It'll smooth out," and stuff like that. Hope so.

Funny exchange today! I was always scheduled for an EchoCG today, and needed one as part of my checking-out. (Hah!:confused:) When the guy arrived with the wheelchair it was the absolutely worst timing. I'd just spent maybe 25 minutes turning their breakfast and a bunch of my good solid high-fiber food into a remarkable bowl of porridge -- steel-cut oats, good yoghurt, packaged "mixed-fruit" (like fruit cup), raisins, and enough of their skim milk to make it semi-liquid -- and I was about to sit down to start eating it. But NO!! I ended up taking it, and my coffee, on the wheelchair, and doing some breakfast in the halls and on the elevators.

When I arrived in the ECG exam room, the lovely full-grown Russian immigrant technician put my breakfast up on a safe high shelf, and I got on the table and rolled away and breathed as she requested. After maybe 10 minutes, I thought we were substantially finished, so I made a probing joke (hoping to get a report on my scans): "So, what do you think, should I buy green bananas, or not?" She didn't stay up with me first time, so I explained that a person should only buy green bananas, if they think they're still going to be around for a few weeks, until they ripen. She thought for a minute and then said earnestly "A person should always have some hope!"

About three times, I lost the struggle to stay still for the remainder of the exam, because I couldn't stop thinking of that response, and laughing!:D:D

The ECG seems to be fine, no regurg, no leakage or seepage at the sutures. She was going to tell me the exact size Hancock II I got, out of my file, but it didn't happen. Maybe I'll ask one of my nurse pals.

NURSES!! Nurses in general, and Hospital workers in more general, tend to be a good group. A few of my repeat nurses have been absolute delights, professionally and "socially" while we're chit-chatting (as I do, can you tell?) At least in THIS part of THIS hospital, all the staff seem to be happy to be working here, with this group, and for this organization. That makes life much better for a patient. My Dad stayed in several greater-Boston-area CC Hospitals and ES Hospitals, and they ran the gamut, from absolute Hell-holes (some of them with big bills and well-known names), to some of the best-run organizations of ANY kind I've ever seen. The Munk Center for Cardiac Care at UHN/TGH seems to rank with the best I've seen -- DESPITE their repeated failure to get my "art line" set up last Wednesday, and their failure to get me home today!

How to recognize the ~20% of Hospital Staff who found the RIGHT job!
During my first few days, when I was having trouble doing simple things like sitting up in bed, or getting out of bed (even with the motors), I found that there are about 20% of staff "who get it". I don't think I'd "get it", I think I'd be in the other 80%, so this DEFINITELY isn't about them not being as "good" as I am.

Here's what I have in mind:

Whenever any hospital staff enter your room, they usually have a problem: You're lying down and have to sit up, your pillow is in the wrong place, the table or the waste-basket is in the way of their machines, whatever. All 100% of them do a fine and quick job of solving that problem of theirs. Then they do their job, generally just fine.

THEN, if they're in the same "bottom" 80% as I am, they've solved all their problems, and they leave and probably close the door. If it's "Day 1", I can no longer throw things in the waste basket or reach all the stuff on my table, and my pillow's in the wrong place. The "top 20%" take the next step, do their best to put the things back where they were, and double check with the patient that they're in the right place.

I doubt that anybody is trained for that; I think it's just obviously important, to certain personality types -- the types that should be disproportionately hired in hospitals but maybe aren't!

Here's an example: When I first moved to the Cardiac Ward on Thursday, I was introduced to a nursing student, who would be responsible for me. She immediately distinguished herself as a member of "the top 20%", with flying colors. I decided to tell her teaching supervisor. When I did, she treated it is as if I'd given her evidence that the student was wasting time doing frivolous jobs, instead of getting straight onto the next patient who may need something IMPORTANT! Sure, I've done a lot of idle chit-chatting with the staff, so I'm not innocent on that one, but that's NOT what was happening here! I disagree!

I did have ONE weird neurological episode: Around midnight Friday night, soon after taking my first metoprolol (s-p?) beta-blocker, I found myself mentally handicapped. Not amused. I decided that I'd press the nurse-call button, but I hesitated, because I didn't think I could verbalize my problem. I lay there for a while, searching for words, feeling dysphasic (but I never could have found THAT fancy word!). Eventually, I pressed the button, and explained my problem, quite slowly, with the "script" I'd worked out -- first to the first nurse, then a second, and then a doctor or two. I'd done two medication things for the first time -- the metoprolol and some Vit. C -- and I suspected the metoprolol had cost me 40-50 IQ points.

The first nurse asked me the standard battery of "do you know where you are?" type questions. What's the date, what's this place, etc., etc. I knew all the answers, though I produced them quite slowly. Then the second, more experienced nurse came in and very soon asked me to spell the word "WORLD" backwards. I tried! GOD I tried. After about 5 tries, I might have finally hit it, maybe.

So we had a consult with the doctor or two, and I went back to sleep around 12:15 AM, and they went off to make plans for a brain CT for me in the morning. At about 1:15 AM (an hour later), I woke up, and felt 100% again. When the experienced nurse came in, she heard my story, and she let me spell "WORLD" backwards. Then she joked "And now we should let you spell 'Mississauga' backwards!" (It's the Native name for a Western suburb of Toronto.) I promptly spelled it backwards, while she wrote it down on my little white-board, to make sure she didn't miss a letter. I got it right -- YAY!!

The local post-op cardiologist and I still wonder if it was a drug effect, but all other eyes are on a TIA. The CT came up pretty clean -- one general faint "shadow" on my left side, but nothing defined. One of the nurses thought I was weaker pushing on my left side (which would implicate the RIGHT side of the brain), which I certainly never thought I was. (Maybe she was noticing the strength deficit in my left calf muscle after my recent Achilles tear?)

So far, that's the closest thing to a migraine or other cloudiness or fuzziness, and I don't need any more!

I think I mentioned in my Pre-op post that I told the anesthesiologists to try to avoid the drugs that cause amnesia and those that cause migraines. They agreed with the migraines (and thought the IV anesthetics would be safer than the inhaled vapors). They initially agreed on the amnesia, too, then suggested that I should change my mind, at least for a low dose of the implicated benzodiazepines, which I did. That was an interesting negotiation, which I'll slip in tomorrow. Getting tired now.
 

ottagal

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Thank you for the 'play by play' Norm! What a detailed and descriptive account of your hospital experience. I could certainly relate to some of them! I, too experienced a high heart rate post-op (even just getting out of bed elevated it to over 100 bpm). I liked the analogy one of the nurses used. She said "Your heart has been tinkered with and is 'irritated' with you right now. It is going to take time for it to settle down." :)

I was wondering if you did get the 'milk of amnesia' pre-op or not. Thanks for not keeping this part a cliff hanger...

Continuing my best wishes for a smooth recovery.
Hope you get home tomorrow!
There is no place like home.
 
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nngbwh

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Thanks for the update. WOW !!. Wishing you a smooth recovery.
 

buncle

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Glad your doing so good.Your story will be of great interest to all the newbies going after you.
 

Johan

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You seem to be doing very well to compile such a cogent report 5 days after OHS! I am now 18 months post op and tried your spelling questionnaire. Had dificulty doing "world" backwards without deep concentration, why must they use such a difficult word? :D, and of course I flunked Mississauga! Must be old age or pumphead.:)

Hoping you get home soon to embark on a steady and bumpfree full recovery.
 

normofthenorth

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OK, sleeping on the plastic-coated hospital mattress (interrupted by Lasix-enhanced wizzing) hasn't been a huge success, so here's some responses:
First, thanks all! One of the most remarkable things about our fascinating stories is how boring they are to most of our friends and loved ones! Mind you, I might have gone a bit over the edge even for the "in" crowd, but that's me!

Gal, the anesthesiologist and I negotiated a middle ground, a low dose but not zero. He hit me with some downsides of taking the diazapines down to zero. And he promised that the amnesia affect would only apply from the time of the injection onward, and should clear out very quickly as the drugs were flushed out of my system. The downsides went like this: "I've never actually had a patient wake up during OHS. [He might have been 35, IIRC.] But you should know that maintaining reliable anesthesia levels in a patient on heart-lung bypass is SIGNIFICANTLY trickier than on a patient whose circulation is working normally, so I can't give my usual assurances. The diazapines are helpful in two ways, in that awful-but-unlikely situation: They are anti-anxiety drugs, and they'll also keep you from having strong, lingering, or recurrent memories of that experience.

I think I slept through the surgery -- AFAIK!!;) -- and I've felt no ill-effects from the drugs. As I've indicated, I've felt "just like me" virtually since waking up. My typing wasn't great on Day 2 (or whenever Wendy brought me the laptop), but even then I could get by -- just had to correct more typos than usual. By Day 4 or 5, it seems to be back to normal.

Johan, I think the key of the "questionnaire" is to challenge the brain. I grew up winning spelling bees and such, and have been an Academic type etc. most of my life. "World" is a nifty word to spell backwards, because it's short enough that we should be able to grunt through it, but the "rld" are tricky enough that if you're brain is fried, it's almost impossible. ("Mississauga" is just me showing off!:cool:)

I just had a chat with some of the night staff, including my RN, and she thinks I shouldn't set my newly-repaired heart on leaving today, either! I took 750 (mg?) of Coumadin Monday afternoon, and there's no rushing the INR-raising effect it has. (There may or may not be any rushing of the blood-test results, either!)

I dunno, I may ask Wendy to bring a long rope! OTOH, she was never that keen on my returning promptly to our 3-story house, so she'd never do it!:) I just discovered that one of my new-neighbour buddies here -- but can I REALLY be pals with a MVR guy?:tongue2: -- is heading to St. John's Rehab Hospital in Toronto after he's "sprung", and he says another of our classmates is going there, too. Brian met with a Social Worker who recommended St. John's for a while because he's got 20-30 stairs at home between the kitchen and the bedroom. Me too. That's Wendy's fave plan, while she rattles around in the house by herself with nobody to drive her to distraction -- but where's the fun in that?

Brian reminded me that I was expecting some practice walking stairs, and there's been none. One of the nurses says they don't usually do that, it's up to the Physio. OOPS!! The Physio team here seems to consist of a nice young student and a pushy teacher who spends too much time in the "Just Plain Wrong" zone for my taste. When I told him how I treated my recent Achilles Tendon Rupture, he had a better way throughout. But when I mentioned that my PT applied ice (a fancy waterproof ice-and-water cuff) to my ankle after some irritating rehab, he lost it. "Not ice to control inflammation, HEAT!!" he shouted in a very heavy Russian accent! Well, I've been hanging out in the AchillesBlog.org crowd WAY too often and WAY too long, and I've never HEARD of anybody (1) recently using heat to control inflammation, or (2) objecting to icing to control inflammation. I used to hear a bit, including alternating H & C, but almost everybody has since switched to just plain C, usually with ice. (And because of evidence rather than just the latest fad, I HOPE!)

Anyhoo, I already KNOW that there are a bunch of PTs who don't read studies or who use quirky approaches, and I don't really want one this week, so I've been avoiding the guy -- like even skipping his class yesterday, after he came into my room insisting that I attend! (And yes, I even said "OK" to make him go away!)

So I may be trying to sneak out onto the stairwell by myself -- RH on banister, LH on my RH pulse! -- to see what stairs are like!

Gal, thanks for the thoughts on my heart being ticked off with me! As long as it's not angry enough to want to kill me, eh?:D;)
 
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normofthenorth

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BTW, assuming my body is telling me the truth, my sternum is a bit more solid than it was initially. E.g., I'm finding it easy to get out of bed pretty quickly, including rolling over on an elbow and pushing on the elbow, while gently pulling on something with the other arm. It's nothing like a normal person, but it's nowhere near as "stuck" as I was a few days ago. Serious coughs are still "splinted" with the pillow, and still hurt quite a bit, though only for the moment. But I think the intensity of coughs I'm doing has increased some.

Also BTW, my DW was suggesting that we disable the passenger-side airbag while I'm still so vulnerable,but the hospital says no. FIRST you survive the crash and stay away from the windshield, and THEN we see if your sternum is OK.
 

bluefields409

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Norm, it has been very interesting reading your account of your OHS experience. May your recovery continue to go well and your INR issues resolved as soon as possible.

Will looking forward to more stories :)

~ Blue
 

ottagal

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Gal, thanks for the thoughts on my heart being ticked off with me! As long as it's not angry enough to want to kill me, eh?:D;)
You must be on the road to recovery! I appreciated the morbid and witty humour. You gave me a good chuckle.

Here's hoping that the INR gets sorted out soon so that you can receive your 'get out of jail card'. ;)

Continuing best wishes,
 
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DebbyA

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Are you sure you had OHS? You are impressively cogent. Best wishes for continued good recovery and an imminent release from the hospital.
 

Greg a

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Well Norm you have not let us down in this thread and I can only hope the screenplay you are penning is as riveting when aired on PBS or TVO
 

catwoman

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BTW, my DW was suggesting that we disable the passenger-side airbag while I'm still so vulnerable,but the hospital says no. FIRST you survive the crash and stay away from the windshield, and THEN we see if your sternum is OK.
I rode in the back seat for a while post-op.

My husband won free membership in the Zipper Club when his car was hit head-on during icy weather. Impact set off the airbag, which fractured his sternum.
Sternum healed -- before he started showing signs of ruptured mitral chordae. The chordae ruptured during the crash. He enjoyed the pain from the fractured sternum so much that I insisted on his having a thoracotomy for his MV repair incision.

Soooooooooooooo watch those airbags!!!
 

normofthenorth

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I made it home, YAY!! INR was back up to 2.17 this morning.

Settled in now, though I've been EXHAUSTED most of the time I've been here. Getting from chair to chair to bed seems like plenty of work. Stairs weren't a problem. I DID take them 2 at a time, though quite slowly. (I've always found stairs take MORE effort if you have to hit each one.) Haven't gone downstairs again yet, but I think it'll be fine.

Thanks for the scary caution, Catwoman, though the Hospital folks might still be right on average, statistically. Maybe I'll ride in the back, with some padding on the shoulder belt. Or lap belt only?

My first impressions of the discharge procedure and the "handover" to my GP and my Cardiologist are negative. Esp. in my case, my (intentionally) unstable INR calls for prompt attention, so they've recommended that I see my GP TWO days after discharge, and get my first INR test then, this Thursday. Of course, they have my GP's name and address and phone and fax numbers on the computer. But it's MY job to phone her office for the appointment on Thursday! WTF? Is this because I have so much spare energy and cogency, or that the average soon-post-OHS patient does??

In my case, I got lucky: I had a phone in my room at the hospital, and I had a little time before "my ride" arrived. So I phoned my GP's clinic. Introduced myself, explained the situation. BUT NO!! She's only working after 1:30 on Thursday, and she's booked up! But if I phone in Thursday AM, they might have a cancellation! I feel like I'm back to the real world, except it doesn't work. I need my INR checked on Thursday, because they've only given me my Coumadin dosage 'til Wed. I also need to check in with my GP soon so she can take this over and some other routine stuff, based on the fat envelope of stuff I have for her. Maybe if the Hospital were making arrangements in advance, they'd have to be changed at the last minute, but that seems better than (a) relying on me to get around to it and (b) finding out there's No Room at the Inn because we're making an appt 2d in advance.

Maybe I'm being too picky (& not for the first time!), but it doesn't seem like a great system.
 

MarkG87

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When I was discharged, the PA from my Surgeons office wrote up all of the instructions and the nurses took care of everything, including scheduling my two week followup with the surgeon. When I had to go back in for 2 nights de to fever, they changed by followup appt to the next week, and again the nurses got it scheduled. However, my first appt never did get canceled and I got a call last night to confirm I was coming in today. Called in first thing this AM and got it taken care of. So I go back in a week. Drove for the 1st time yesterday. Had to OK to drive as soon as I was off of the pain pills and I stopped them Friday. Trying to do a little more everyday, but with the cold temps, outside walking is out of the question, so I find the the larger stores and go walking around. 8th grade son has a basketball game Thursday, so that will be one of my first big outings. Hard to believe it's only been 18 days since my surgery.
 

normofthenorth

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Mark, did they also get your GP/PCP and your Cardiologist involved, or did you stay with the surgeon for weeks after the surgery? These surgeons seem to be Very Busy People, and they seem happy to let the others do most of the lifting. I think I see my Rock Star surgeon first time at 6 weeks post-op.
 

MarkG87

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My PCP has had absolutely no role in this at all. Didn't even stop in to see me while an inpatient. i am supposed to go see him at 5 weeks after discharge only because the CT that was done pre-op showed an enlarged prostate. I also have not seen my cardio yet, see him 1/4. He will release me to return to work. All I have seen is the surgeon, and his PA's. Our cardiac Rehab is in the same buildong as the Surgeons and the cardio's, 1 stop shopping. I get to start that after my visit next week.
 

normofthenorth

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Some "Bumps", and more messy "handoffs" between Docs

Some "Bumps", and more messy "handoffs" between Docs

I've had a few adventures this week (some of them ironic), while generally continuing to recover and heal from the slicing and sawing.

After some errands and two parties last weekend (Dec. 18-19, ~2.5 weeks post-op), I came home coughing Sunday night. Pretty soon I couldn't stop coughing. Nothing exciting or "productive", just a dry hacking cough. Try to take a deep breath, and it turns into a "catch" or a "spasm" and a cough or three. I tried some DM cough-suppressant cough syrup that often works for me, but this cough just laughed at it. Tough way to get some sleep -- just ask my wife!;)

Next day I phoned my GP/PCP who phoned in a prescription for Codeine cough syrup. I coughed uncontrollably for a few more hours until my DW picked up the syrup, then I was instantly "cured", at least enough to sleep for a change. So I was slowly taking some of those doses of Codeine that I'd skipped in the Cardiac ward! When you need narcotics, you need 'em, and I sure needed that cough syrup!

And I slept. And I slept. Meanwhile, over the course of Monday to Wednesday, my temperature gradually crept up from below normal (where it had been hanging out, as I think it often does) to around 38.2C (100.76F), then back down to normal and below. I was mostly staying in bed, and not eating much.

I'd earlier gotten into the habit of starting the day with a small slug of coffee and an Ensure or Boost meal replacement, to tide me over until I made it downstairs for a real meal. For a couple of days, I skipped the "downstairs for a real meal" part, but had a "meal drink" per day to stay alive. Staying in bed and sleeping felt too good for me to want to eat much, though I did join the DW for one real dinner at home.

Ironically, after my temp returned to normal, when I got up, I felt AWFUL. Weak and semi-faint, not healthy at all. And I was mostly clammy, sweating a lot but more chilled than hot. Meanwhile, I'd also missed or canceled a couple of planned blood/INR tests and even a physical exam that I'd scheduled with my new GP.

Wed. afternoon ~4PM, my DW brought up a big thermos full of hot tea with honey. I filled a big travel mug and started sipping on it. Sat up in bed at first, then took it to the bathroom. I forget the exact sequence, but I sat on the closed toilet for a while, sipping and catching my breath. Then I "perched" on the counter near the BR sink for a while, still sipping and still hoping to feel better. Instead, I basically collapsed. DW was close enough to help me crumple gently and harmlessly to the floor. Nice floor, vinyl over radiant-floor heating -- if you HAVE to collapse on a floor, that's not a bad kind.;)

While I was still there, I phoned my GP. She suggested the ER, since I'd get answers faster than I would from her lab (which is right around the corner). I stayed on the floor for a while, not much energy or urge to move anywhere. After a while, I crawled back into bed and started making plans to hit the ER. Changed into a sweatsuit, gathered my health-cards, blindfold, and other bare essentials.

By the time we called the Ambulance, I felt recovered enough that I walked downstairs and out the door to the waiting stretcher. (BTW, the firemen came like INSTANTLY, and the EMS and Ambulance were maybe 5 minutes behind, tops. Pretty first-rate.) Spiffiest Ambulance I'd ever seen. Brand-knew, air suspension, "kneeling" so it went down to scoop up the stretcher, and all the comforts and equipment and supplies of an OR beautifully secured and organized inside! Impressive staff all around, too.

My HR was 150(!). I'd measured ~145 a few hours earlier, when I'd collapsed, so it had been crazy high for a while. We went to the TGH ER, attached to the same hospital where my surgery was done. ER was remarkably sane, nobody hanging off the rafters. I got into a critical-care (ER) bed pretty quickly. A bunch of "hurry up and wait", but I eventually got an IV line, gave some blood for tests -- including a blood culture that I requested, because I was starting to panic about Endocarditis.

Eventually I met with the ER doc, who gave me a shot of a Calcium Channel Blocker into my IV fitting. That brought my heart rate way down, but I was (still) in either A-Fib or A-flutter. (The difference is in the speed?)

Then there was contact with a member of the CV surgical team from upstairs (the team that had operated on me), who remotely ordered that I be given supplementary Magnesium. So they hung a bag of saline and a small bag of Mg, which slowly pumped away for an hour. After a few hours, I was ready for a washroom, so they just had me walk the IV across the ER area to a small public washroom, and back. I was OK -- except that I'd been back about 5 minutes when they told me they wanted a urine sample!:confused::confused: ("Murphy was an optimist!")

Eventually, the CV Surgeon dropped by, and we discussed a few things. He thought I probably had a urinary tract infection, even though I had no obvious symptoms, except having to pee ~1 per 2 hours. He also told me not to worry about my wimpy 1.23 cm2 AV area reading from my first post-op Echo. "A" it will improve over time, and "B" on a 27mm AV, the hemodynamics of the valve won't be what limits my CV performance. (Since I was playing very aggressive competitive volleyball with 0.9 cm2 area pre-op, I tend to agree.) We also discussed how my surgeon fibbed to me about the study on the comp. hemodynamics of the CEP Magna (cow) and the Hancock II (pig), and he LOL'd just where you'd expect, when I told him that Dr. Feindel was a co-author of the study!

By then, my DW had gone home to get some sleep, assuming that I'd be spending at least one night in the hospital. But no. By 3 AM, they'd decided to give me the boot. My HR was down, and they were giving me a prescription for Metoprolol beta-blocker, to keep it down. I was in A-flutter, but they didn't seem to be too concerned about that. And the results from the cultures would take a couple of days, which I might as well spend at home. (I'm about to phone the ER to see if I can get some results, since my GP has just gone off on vacation.)

So I had to wake the DW to come back to pick me up -- I didn't even have a house-key, and I'd let her take my winter coat home with her, so I was stuck.

After I was discharged and all dressed up ready to go, and while the DW was getting my metoprolol prescription (25mg 2x/day) filled in a 24/7 drugstore, I had a brainstorm:
For days, I'd felt too sick to shower, and my BO was driving me nuts. I also had a vague notion that it didn't "smell like me", but I couldn't place the stench. I attributed part of it to my still being "shorn" in the private parts, so I was closer to "diaper rash" than a mature hairy human usually gets. But suddenly it dawned on me that I recognized the sweet stench that I was reeking: Decades ago, I'd dated a lovely diabetic woman for about a year, my smell reminded me of HER smell!

Was I hyper-glycemic? Post-op, the nurses had been worried about my blood sugar, because it had been around 7, and they didn't relax until it dropped to below 6, which they told me is what's now considered upper-normal. And it did, and it was in the high 5-point-something range when I was discharged. Nobody'd mentioned my blood sugar to me this trip, so I assumed it was boring. But the smell made me curious.

So I asked my nurse if the tests they ran included blood sugar, and she said yes. Could she look it up and tell me what they got? OK. So she sad at the computer and dug it out. Nine, she said matter-of-factly. NINE?!?!? I responded? Isn't that worth mentioning? Like especially when I'm discussing multiple far-fetched theories for why I'm getting up to pee every two hours?!?!? Yes, probably. You should definitely discuss this with a doctor -- YOUR doctor, since you're discharged now(!).

Well! I do know that nine is not a catastrophic blood-sugar number for a diabetic, but it's the highest I've ever been measured, and that was hours after I collapsed, and by then I was feeling MUCH better. And IF my feeling rotten -- and collapsing, and maybe even having an out-of-control HR -- ARE related to an excessive blood-sugar level, then it makes perfect sense that it happened after a few days of eating mostly sugary meal-replacement drinks and then precisely while I was sucking back a big mug of hot honey-water!

I've been wrong before, but I think the Docs may have missed the story here. Meanwhile, they're mostly off, heading home for Christmas -- though I do plan to phone the ER folks to see if I can get some answers. I've cut out the sugary meal-replacement drinks, and I'm trying to eat low on the Glycemic-Index food chain. So far, I feel much better. (I THINK I smell better, too, though I'm showering again, so it's not a fair comparison.)

In addition to the blood-sugar question, I have no idea what's happening with a-flutter, though the metoprolol is keeping my HR below 100 and sometimes even below 80 or 70, which should be helping. (I do feel a bit listless and tired, but that seems to go with the territory.)

If any of you have REALLY been paying attention, the metoprolol I'm no now is exactly TWICE the dose that the rogue non-team-player post-op cardiologist ripped out of my file as I was being discharged on Dec. 7th! So I've now taken some of the codeine I skipped post-op because I didn't need it (which infuriated that same cardiologist!), and I'm making up for lost time on the metoprolol that she took me off "cold turkey" as I was going home. Kind of ironic.

And I'm feeling pretty good again, for the first time since last weekend. Still doing some loud dry coughing, but otherwise pretty solid. I've even SNEEZED a few times today, just over 3 weeks post-op, no heart-pillow support, and no pain or discomfort, which seems like a MAJOR breakthrough.

Any advice on the symptoms is always welcome, of course.
 

normofthenorth

Well-known member
Joined
Nov 1, 2010
Messages
862
Location
Toronto, ON, Canada
Based on my Googling, it doesn't look as if my theoretical explanation is a high-percentage "winner" -- that I collapsed because of high blood sugar. If there's any advice out there, I'm open.
 
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