Last Friday was six weeks since surgery. In the two plus weeks since my last post I've continued to walk. My best time for the 5K was just over 47 minutes, about 16 minute miles. Some days I would do that twice. On other days, I might get tired and do less. Recovery is not linear; there are some days where I just don't feel that sharp.
This past Monday the 21st, I had my six-week follow-up with Dr. DCM at Stanford. He was not at at all impressed with my exercise level. He said that the recovery handbook was written for 75 year-olds, and that it was time to start pushing my exercise. Actually, it was a little more nuanced than that. Dr. DCM thought my heart sounded great, my blood pressure was fine, and my scar and body were healing well. On the other hand, he was not happy with my resting pulse. Since going off a beta blocker medication at 30 days post discharge, my resting heart rate has settled in the 90s. When I was training for triathlons, it was in the mid 60s. Post recovery, it should be in the 70s.
Dr. DCM wants me to increase my exercise substantially, with the goal of reducing my resting heart rate. In terms of exercise, there are no limits in terms of heart rate or exertion level. Other than continuing to protect my sternum, I can do whatever I want. Those are doctors orders I'm happy to hear! Dr. DCM is giving me one month to increase my exercise and hopefully push my resting heart rate down. If it doesn't drop enough after one month, I'll need to go back on a small dose of some type of beta blocker. I'd like to avoid medication, so exercise it is.
Out of Shape
On Tuesday, I went to the gym. First, I did 20 minutes on the elliptical trainer. Then I did a 45 minute spin class. I used to go very hard in spin class, sending my heart rate toward 170 or so during the sprint portions of the workout. Now, it was hard to keep with the class because my conditioning had deteriorated over the past few months. There really is a difference between brisk walking and real cardio training. Yesterday, I did the treadmill for an hour with a combination of running and walking. I would walk at 16 minutes per mile pace for two minutes and then run at 12.5 minutes per mile pace for two minutes. That was a hard workout for me. I'll probably do more of that today. I'm a long ways from my typical 9 minute mile sustainable pace.
All in all I'm happy with my recovery from surgery. For the first time in a long time, I can push my heart as hard as I feel like. At 12 weeks, my sternum will be completely healed and there will be no limits on exercise.
I'll try to post more often. Happy Holidays.
Thursday, December 24, 2009
Friday, December 4, 2009
At Four Weeks
My surgery was exactly four weeks ago. At this time of the day, I was sleeping in intensive care and did not wake up until about 7:00 that evening. Three weeks ago I left the hospital. I've come a long ways since then.
From early walks of just 7 minutes, I've built up to between 1 and 2 hours of walking each day. Today I walked a 5K in the morning and in the late afternoon. My morning time was 50 minutes, 8 seconds, and my afternoon time was 52 minutes, 39 seconds. I'm not sure why the afternoon was slower. Perhaps I was tired because I did not take a nap today. On most days, I take a 1 to 2 hour nap, usually around mid-day. Three weeks ago I would not have predicted that I could do two 3+ mile walks at something close to a 17 minutes per mile pace so soon.
My scar continues to heal. It's about 8.5 inches long. A scab covers less than one inch of it. The remainder is a reddish color. On the incentive spirometer breathing device, I'm can easily hit the 2500 ML level. According to my discharge papers, the goal is 2900, so I need to work a little harder with that.
My need for medication continues to fall. I take 1 Vicodin on most nights. Some nights I don't need it at all.
I'm looking forward to the six week mark. At that point I can the stationary bike to my workout and I can drive if I'm off the pain medication. I have a follow-up appointment at Stanford with Dr. DCM on the 21st of December. Hopefully he will be as pleased with my progress as I am.
From early walks of just 7 minutes, I've built up to between 1 and 2 hours of walking each day. Today I walked a 5K in the morning and in the late afternoon. My morning time was 50 minutes, 8 seconds, and my afternoon time was 52 minutes, 39 seconds. I'm not sure why the afternoon was slower. Perhaps I was tired because I did not take a nap today. On most days, I take a 1 to 2 hour nap, usually around mid-day. Three weeks ago I would not have predicted that I could do two 3+ mile walks at something close to a 17 minutes per mile pace so soon.
My scar continues to heal. It's about 8.5 inches long. A scab covers less than one inch of it. The remainder is a reddish color. On the incentive spirometer breathing device, I'm can easily hit the 2500 ML level. According to my discharge papers, the goal is 2900, so I need to work a little harder with that.
My need for medication continues to fall. I take 1 Vicodin on most nights. Some nights I don't need it at all.
I'm looking forward to the six week mark. At that point I can the stationary bike to my workout and I can drive if I'm off the pain medication. I have a follow-up appointment at Stanford with Dr. DCM on the 21st of December. Hopefully he will be as pleased with my progress as I am.
Monday, November 23, 2009
Two Good Days
Today was a very good day. I walked to Starbucks with my mom in just under half an hour. After some coffee and conversation, we walked back. Then in the afternoon we did long walk of just over 3 miles in about an hour. My heart rate went up to about 88 which is okay. So long as my heart rate does not go up by over 20 beats per minute (compared to my resting rate), long walks are okay. I'm very pleased to be able to walk a 5K today. I would not have predicted this even a week ago.
Last Day in The Hospital
As you know, my final day at Stanford Hospital and Clinics was Friday November 13. I slept well the night before. Draining all that fluid made my chest feel much better and made deep breaths much easier. PA Y came by relatively early in the morning and asked if I wanted to go home. I said yes. She said I would need an echocardiogram to confirm that the fluid had not returned. If that were the case, she thought I could be released. Since nothing had shown up in the drain, the surgical team was confident that no fluid would be detected.
They brought a portable echo machine to my room. With just a few passes of the wand the technician and Dr. SS were able to see that no fluid had returned. Two more steps had to be done before I could leave. First the recently installed drain had to be removed. Second, the one stitch which was in the spot where my original drain exited my body (this was removed just before leaving the ICU) would also need to be removed.
With respect to the first drain, one of the nurses had recommended some pain relief, so I asked for some Fentanyl via IV. It may not have been necessary. Responsibility for removing the drain rested with the cardiology team who had installed the drain the night before. Dr. SS, under the supervision of a more senior Dr. K, removed the drain with no pain or issues. Dr. SS and K were fun to talk to. Dr. K asked if we understood the code about interns, residents, fellows, attendings, and other doctor terms. Meg and I got a quick lesson from him. I think the drain was removed before noon.
The final step was removal of the one stitch by by PA Y. Nurse J then put a small steri-strip over the wound and I just about ready to go. I think there was a final visit with cardiac nurse R. Discharge was around 2:00.
Future Posts
This post raps up my chronology of my recovery time at the hospital. I hope it's been helpful for potential heart surgery patients. Future posts are likely to be less frequent as my recovery for the first 6 weeks is largely limited to walking. There just isn't that much to say about taking walks. After 6 weeks I can begin adding in other exercise like the stationary bike. Eventually swimming and running will join the mix. I'll post more when that happens.
Last Day in The Hospital
As you know, my final day at Stanford Hospital and Clinics was Friday November 13. I slept well the night before. Draining all that fluid made my chest feel much better and made deep breaths much easier. PA Y came by relatively early in the morning and asked if I wanted to go home. I said yes. She said I would need an echocardiogram to confirm that the fluid had not returned. If that were the case, she thought I could be released. Since nothing had shown up in the drain, the surgical team was confident that no fluid would be detected.
They brought a portable echo machine to my room. With just a few passes of the wand the technician and Dr. SS were able to see that no fluid had returned. Two more steps had to be done before I could leave. First the recently installed drain had to be removed. Second, the one stitch which was in the spot where my original drain exited my body (this was removed just before leaving the ICU) would also need to be removed.
With respect to the first drain, one of the nurses had recommended some pain relief, so I asked for some Fentanyl via IV. It may not have been necessary. Responsibility for removing the drain rested with the cardiology team who had installed the drain the night before. Dr. SS, under the supervision of a more senior Dr. K, removed the drain with no pain or issues. Dr. SS and K were fun to talk to. Dr. K asked if we understood the code about interns, residents, fellows, attendings, and other doctor terms. Meg and I got a quick lesson from him. I think the drain was removed before noon.
The final step was removal of the one stitch by by PA Y. Nurse J then put a small steri-strip over the wound and I just about ready to go. I think there was a final visit with cardiac nurse R. Discharge was around 2:00.
Future Posts
This post raps up my chronology of my recovery time at the hospital. I hope it's been helpful for potential heart surgery patients. Future posts are likely to be less frequent as my recovery for the first 6 weeks is largely limited to walking. There just isn't that much to say about taking walks. After 6 weeks I can begin adding in other exercise like the stationary bike. Eventually swimming and running will join the mix. I'll post more when that happens.
Saturday, November 21, 2009
Late This Week and Late Last Week
Been away from blogging for a few days. Sometimes someone else has the computer at the end of the day; sometimes I just get a little tired. First, I'll catch up on the last few days and then I'll talk about the procedure on November 12 to drain the fluid around my heart.
This Week
I've been building up my walking each day. On Thursday I did walks of 17, 26 and 28 minutes. I visited my cardiologist in Sacramento, Dr. M. He did an echo which verified that no fluid had returned to my heart. Good news. He thought my recovery was going well. We discussed easing off of the pain medication. As of Thursday, I no longer take Oxycontin (which I had been taking every 12 hours). Instead I take Vicodin at night, and sometimes during the day if my pain is significant.
On Friday I did walks of 26, 37, and 26 minutes. Today, I was little tired and did just two walks of 37 minutes each. For now, my goal is going to be 3 walks a day, each one at least a half hour, with one longer walk of about 45 minutes. Until six weeks I can't really do any other kind of exercise because the bones in my sternum are still healing. After 6 weeks, I plan to add the stationary bike to the exercise mix.
Thursday November 12
Thursday was the key day. First off, this was the only day where I woke up feeling worse than the day before. Generally, each day had been better than the last. Today was different. Everything was a little harder from getting out of bed, to walking, to bathing. I had an echocardiogram later in the morning. It confirmed that I still had fluid around my heart. Around lunchtime Dr. DCM came by and explained that the fluid was still there despite the diuretic drugs I had been taking. He said that best option was to drain the fluid. It was slowing down my recovery which otherwise was going well. The procedure to drain the fluid would be done in the cath. lab. by a cardiologist. In the meantime, I would be NPO (nothing to eat or drink) before the procedure. I visited with the kids in the afternoon and then waited to be taken for the procedure. Later Dr. SS, a cardiologist, came by to further explain the procedure and get my consent. She explained that a catheter would be inserted just below my existing incision and then guided a short distance to my heart to drain the fluid. The only real risk was another chance for infection. Later, the nurses explained that I would be moving to a different floor after the procedure because my body would retain a catheter to potentially drain more fluid. Patients with drains were handled on the first floor, not the 3rd floor where I had been for almost a week. They came to get me around 5:00.
As I've said before, the staff in the cath. lab are upbeat and give off a happy vibe. Once they had me at the right level, I was able to slide myself onto the table from my mobile bed. Some medicine to relax me was provided through the IV. Some antiseptic stuff was applied to my chest to make the field sterile. The attending, Dr. T, called in the fellow, Dr. SS and she started the procedure. First I was given a local anesthetic. I barely felt it at all. Then they made some sort of puncture and inserted the catheter. Again, I could barely feel this at all. Within 2 minutes the catheter was in the right spot draining the fluid. They drained a total of 530 ML of of fluid. That's over a pint which was in an area no more than a 1/2 inch thick surrounding my heart. No wonder I was having trouble taking deep breaths. As promised, they left the drain in to see if more fluid would emerge over the next day. This is the standard protocol.
By 6:00 I was in regular room on the first floor. This time a private room. Meg found me soon as did my Aunt Marlene. This next hour represented the one mix up which occurred during my time at Stanford. Essentially, no new orders had been written. The standing order of NPO (nothing by mouth), which was correct before the procedure, now made no sense since the procedure had been successful. It appears that the surgical team, which had been in charge of my care on the third floor, assumed that the cardiology team would write new orders depending on the outcome of the procedure. Meanwhile, the cardiology team assumed I was still under the orders of the surgical team. My aunt worked on this issue for about an hour. Also, one of my nurses from the earlier in the week passed by and recognized me. She was working the first floor tonight. She knew which doctors to contact from the surgical team. It got sorted out. Eventually they brought me some dinner. Once Marlene was sure that things were on track, she said good night. I thanked her for all her help. Meg visited with me into the early evening.
Generally, I felt better by evening time. Because I still had the drain attached, I had to ask for assistance to move around and use the urinal. This was a significant change from the 3rd floor where I had come to feel more independent, able get out of bed myself. Tomorrow, I'll write about my last day in the hospital.
This Week
I've been building up my walking each day. On Thursday I did walks of 17, 26 and 28 minutes. I visited my cardiologist in Sacramento, Dr. M. He did an echo which verified that no fluid had returned to my heart. Good news. He thought my recovery was going well. We discussed easing off of the pain medication. As of Thursday, I no longer take Oxycontin (which I had been taking every 12 hours). Instead I take Vicodin at night, and sometimes during the day if my pain is significant.
On Friday I did walks of 26, 37, and 26 minutes. Today, I was little tired and did just two walks of 37 minutes each. For now, my goal is going to be 3 walks a day, each one at least a half hour, with one longer walk of about 45 minutes. Until six weeks I can't really do any other kind of exercise because the bones in my sternum are still healing. After 6 weeks, I plan to add the stationary bike to the exercise mix.
Thursday November 12
Thursday was the key day. First off, this was the only day where I woke up feeling worse than the day before. Generally, each day had been better than the last. Today was different. Everything was a little harder from getting out of bed, to walking, to bathing. I had an echocardiogram later in the morning. It confirmed that I still had fluid around my heart. Around lunchtime Dr. DCM came by and explained that the fluid was still there despite the diuretic drugs I had been taking. He said that best option was to drain the fluid. It was slowing down my recovery which otherwise was going well. The procedure to drain the fluid would be done in the cath. lab. by a cardiologist. In the meantime, I would be NPO (nothing to eat or drink) before the procedure. I visited with the kids in the afternoon and then waited to be taken for the procedure. Later Dr. SS, a cardiologist, came by to further explain the procedure and get my consent. She explained that a catheter would be inserted just below my existing incision and then guided a short distance to my heart to drain the fluid. The only real risk was another chance for infection. Later, the nurses explained that I would be moving to a different floor after the procedure because my body would retain a catheter to potentially drain more fluid. Patients with drains were handled on the first floor, not the 3rd floor where I had been for almost a week. They came to get me around 5:00.
As I've said before, the staff in the cath. lab are upbeat and give off a happy vibe. Once they had me at the right level, I was able to slide myself onto the table from my mobile bed. Some medicine to relax me was provided through the IV. Some antiseptic stuff was applied to my chest to make the field sterile. The attending, Dr. T, called in the fellow, Dr. SS and she started the procedure. First I was given a local anesthetic. I barely felt it at all. Then they made some sort of puncture and inserted the catheter. Again, I could barely feel this at all. Within 2 minutes the catheter was in the right spot draining the fluid. They drained a total of 530 ML of of fluid. That's over a pint which was in an area no more than a 1/2 inch thick surrounding my heart. No wonder I was having trouble taking deep breaths. As promised, they left the drain in to see if more fluid would emerge over the next day. This is the standard protocol.
By 6:00 I was in regular room on the first floor. This time a private room. Meg found me soon as did my Aunt Marlene. This next hour represented the one mix up which occurred during my time at Stanford. Essentially, no new orders had been written. The standing order of NPO (nothing by mouth), which was correct before the procedure, now made no sense since the procedure had been successful. It appears that the surgical team, which had been in charge of my care on the third floor, assumed that the cardiology team would write new orders depending on the outcome of the procedure. Meanwhile, the cardiology team assumed I was still under the orders of the surgical team. My aunt worked on this issue for about an hour. Also, one of my nurses from the earlier in the week passed by and recognized me. She was working the first floor tonight. She knew which doctors to contact from the surgical team. It got sorted out. Eventually they brought me some dinner. Once Marlene was sure that things were on track, she said good night. I thanked her for all her help. Meg visited with me into the early evening.
Generally, I felt better by evening time. Because I still had the drain attached, I had to ask for assistance to move around and use the urinal. This was a significant change from the 3rd floor where I had come to feel more independent, able get out of bed myself. Tomorrow, I'll write about my last day in the hospital.
Wednesday, November 18, 2009
Hospital Recovery: Monday to Wednesday
Today
Today is Wednesday November 18 and I may have overdone things a little. I did four walks earlier in the day. The total minutes from all the walks add up to over an hour. My longest individual walk was 21 minutes, all the way to the fountain near the Laguna Town Hall, if you know our area. Right now I feel a little warm after so much activity. I also got some blood work done and had coffee at Peets with Meg. While at the hospital, Dr. DCM encouraged me to increase my activity by 50 percent each day. I'm still trying to figure out how much to add. Tomorrow and I can talk about exercise goals with my cardiologist, Dr. M. in Sacramento.
Recovering Monday 11-9 Through Wednesday 11-11
In general each day I got a little better and stronger. I tended to get more sleep at night. I had a shower one day and that felt great. I did it myself with Meg handing me things that I needed. I did the four short walks each day around the floor. Sometimes my first walk was early in the morning after vitals were taken, but before the team made rounds. Sometimes the San Francisco Chronicle was available and I would pick up a copy.
On Monday and Tuesday, progress was steady. Things like getting out of bed, walking, and using the urinal became easier as time went along. Many times each day I was supposed to use a breathing device(called an incentive spirometer) to measure the volume of my breaths. Though I was active in terms of walking, it was difficult for me to get to 750 ML on the device. Even today (Nov. 18), the most I can get is just over 2000.
Wednesday, in contrast to the slow but steady progress of the earlier part of the week, was a day of ups and downs. I started out strong. I did my walk. But I still couldn't take deep breaths. The kids arrived around lunch time and it was great to see them. Because of H1N1, most hospitals, including Stanford, require children to be at least 16 in order to come inside for visiting. With Sean at age 13, we decided to meet Zoe and Sean in the garden area in front of the main entrance. It was good to see both of them while I stayed in a wheel chair. They had lots of questions. I showed them the top of my scar, which they were curious about. Both now tell me a I looked a little gray, and they had expected me to look better. I did look better (or at least felt better) earlier that day. But by lunchtime when they arrived, I was very tired.
Sometime on Wednesday morning PA Y stopped by. She said that I was still retaining too much fluid and would not be going home that day. My weight was still significantly higher than when I checked in. At some point that day I had a chest CT.
Later that day the cardiac rehabilitation nurse visited us, and I had trouble keeping my eyes open. On the one hand, she noted I was doing very well in terms of my activity. On the other hand, deep breaths were difficult and I couldn't register much volume on the spirometer. Later, the physical therapist visited me and we a had good session which included climbing some stairs. As a reward, she found some chocolate ice cream for me in the refrigerator. The day ended on a high as I perked up in the evening. I remember spending at lot of time with my mom that night.
Tomorrow, I will write about the events of Thursday November 12, which turned out to be the key to my final hospital recovery. As I finish writing tonight around 9, I actually feel pretty good.
Today is Wednesday November 18 and I may have overdone things a little. I did four walks earlier in the day. The total minutes from all the walks add up to over an hour. My longest individual walk was 21 minutes, all the way to the fountain near the Laguna Town Hall, if you know our area. Right now I feel a little warm after so much activity. I also got some blood work done and had coffee at Peets with Meg. While at the hospital, Dr. DCM encouraged me to increase my activity by 50 percent each day. I'm still trying to figure out how much to add. Tomorrow and I can talk about exercise goals with my cardiologist, Dr. M. in Sacramento.
Recovering Monday 11-9 Through Wednesday 11-11
In general each day I got a little better and stronger. I tended to get more sleep at night. I had a shower one day and that felt great. I did it myself with Meg handing me things that I needed. I did the four short walks each day around the floor. Sometimes my first walk was early in the morning after vitals were taken, but before the team made rounds. Sometimes the San Francisco Chronicle was available and I would pick up a copy.
On Monday and Tuesday, progress was steady. Things like getting out of bed, walking, and using the urinal became easier as time went along. Many times each day I was supposed to use a breathing device(called an incentive spirometer) to measure the volume of my breaths. Though I was active in terms of walking, it was difficult for me to get to 750 ML on the device. Even today (Nov. 18), the most I can get is just over 2000.
Wednesday, in contrast to the slow but steady progress of the earlier part of the week, was a day of ups and downs. I started out strong. I did my walk. But I still couldn't take deep breaths. The kids arrived around lunch time and it was great to see them. Because of H1N1, most hospitals, including Stanford, require children to be at least 16 in order to come inside for visiting. With Sean at age 13, we decided to meet Zoe and Sean in the garden area in front of the main entrance. It was good to see both of them while I stayed in a wheel chair. They had lots of questions. I showed them the top of my scar, which they were curious about. Both now tell me a I looked a little gray, and they had expected me to look better. I did look better (or at least felt better) earlier that day. But by lunchtime when they arrived, I was very tired.
Sometime on Wednesday morning PA Y stopped by. She said that I was still retaining too much fluid and would not be going home that day. My weight was still significantly higher than when I checked in. At some point that day I had a chest CT.
Later that day the cardiac rehabilitation nurse visited us, and I had trouble keeping my eyes open. On the one hand, she noted I was doing very well in terms of my activity. On the other hand, deep breaths were difficult and I couldn't register much volume on the spirometer. Later, the physical therapist visited me and we a had good session which included climbing some stairs. As a reward, she found some chocolate ice cream for me in the refrigerator. The day ended on a high as I perked up in the evening. I remember spending at lot of time with my mom that night.
Tomorrow, I will write about the events of Thursday November 12, which turned out to be the key to my final hospital recovery. As I finish writing tonight around 9, I actually feel pretty good.
Tuesday, November 17, 2009
Recovering In My Hospital Room--First Weekend
Today
It's now Tuesday and I've been home in Elk Grove for three nights. Today I've done three 15 minute walks and will do one more with Sean when he gets home. I'm in very little pain and gaining mobility every day. I walk up and down the stairs frequently and talk on the phone easily. Showering is relatively easy as is dressing myself. Below are some memories of my early recovery in my room at Stanford.
Saturday November 7
After the elevator difficulty, things smoothed out a lot. I knew the elevator story would freak people out so I kept it to myself for a few days. I don't remember a lot about Saturday evening but I a saw a lot of friends and family. My mother arrived that afternoon and my friend Howard brought her to my room. I remember visiting with both of them. Howard mentioned that Stanford, hosting Oregon that day, was currently upsetting the highly ranked Ducks. My father, my stepmother and my uncle were actually at the game. Later in the day, they visited as well.
For that evening and night, my pain relief medications were limited to Vicodin and Percocet. I remember having some kind of low salt dinner and not eating very much of it. I still felt bloating pressure so burping and farting were still important. I think I went for a very short walk in the hall (maybe 40 feet) while supporting myself on the portable IV roller. I think most of my visitors went out for dinner while Meg stayed with me. They are pretty easy going about having one quiet visitor stay past regular hours which end at 8:00. I didn't sleep very well that night, aware of pain in my chest. Still it felt much better than the night in the ICU.
Sunday November 8
This day went much better. At Meg's urging my pain medications were changed and I started feeling better. The preferred approach is to use lots of medication so that you feel well enough to walk around. Walking is the key to recovery. The change in medication helped me feel better and I was able to do three short walks. Each walk was a "around the triangle" shape of the hallway. This would take me about 4 minutes going very slowly. I was able to use the urinal relatively easily. I don't remember the meals, but I still wasn't very hungry. I would tend to eat fruit and small bits of other offerings. Although more mobile and feeling better, it was still very difficult for me to take deep breaths. I was on oxygen at night. I saw my mother and Howard that day. Meg was there much of the day and stayed with me into the evening.
It's now Tuesday and I've been home in Elk Grove for three nights. Today I've done three 15 minute walks and will do one more with Sean when he gets home. I'm in very little pain and gaining mobility every day. I walk up and down the stairs frequently and talk on the phone easily. Showering is relatively easy as is dressing myself. Below are some memories of my early recovery in my room at Stanford.
Saturday November 7
After the elevator difficulty, things smoothed out a lot. I knew the elevator story would freak people out so I kept it to myself for a few days. I don't remember a lot about Saturday evening but I a saw a lot of friends and family. My mother arrived that afternoon and my friend Howard brought her to my room. I remember visiting with both of them. Howard mentioned that Stanford, hosting Oregon that day, was currently upsetting the highly ranked Ducks. My father, my stepmother and my uncle were actually at the game. Later in the day, they visited as well.
For that evening and night, my pain relief medications were limited to Vicodin and Percocet. I remember having some kind of low salt dinner and not eating very much of it. I still felt bloating pressure so burping and farting were still important. I think I went for a very short walk in the hall (maybe 40 feet) while supporting myself on the portable IV roller. I think most of my visitors went out for dinner while Meg stayed with me. They are pretty easy going about having one quiet visitor stay past regular hours which end at 8:00. I didn't sleep very well that night, aware of pain in my chest. Still it felt much better than the night in the ICU.
Sunday November 8
This day went much better. At Meg's urging my pain medications were changed and I started feeling better. The preferred approach is to use lots of medication so that you feel well enough to walk around. Walking is the key to recovery. The change in medication helped me feel better and I was able to do three short walks. Each walk was a "around the triangle" shape of the hallway. This would take me about 4 minutes going very slowly. I was able to use the urinal relatively easily. I don't remember the meals, but I still wasn't very hungry. I would tend to eat fruit and small bits of other offerings. Although more mobile and feeling better, it was still very difficult for me to take deep breaths. I was on oxygen at night. I saw my mother and Howard that day. Meg was there much of the day and stayed with me into the evening.
Monday, November 16, 2009
Thanks to the Stanford Medical Team
Reading over the blog, I've only mentioned a few members of the medical team and the nurses. Many individuals contributed to my care. I don't remember all of them and will continue to refer to medical staff, which I can remember, by their initials. I want to thank all the staff at Stanford for my care. My contact with some of the people who helped me is described below.
I had more nurses than I can remember, usually working in 12 hour shifts. Some nurses had me in subsequent shifts. They all cared for me very well.
Every day I saw Physician's Assistant (PA) Y, often more than once a day. She asked about my condition and kept me informed about what was going on. I actually met her on Thursday before surgery, so she was a familiar face post-surgery. In addition, I often saw PA DJ on most days. The surgical team headed by Chief Resident S also usually visited me each morning, but some mornings they checked in with the nurses and did not speak to me directly. After Saturday, I remember seeing Dr. DCM on two additional occasions, the last being on Thursday. I also worked with a physical therapist, two occupational therapists, and the cardiac recovery nurse. PA Y and Nurse J removed my last stitch on Friday before departing.
I also had one more procedure to drain fluid around my heart on Thursday November 12. This was done by cardiologist SS, under attending cardiologist T. They were supported the heart cath. lab staff, who like their contemporaries in Sutter Sacramento, are a lot of fun to be around.
There were also many others in the operating room that I want to thank but never met. Bottom line, thanks to ALL at Stanford for my care.
I had more nurses than I can remember, usually working in 12 hour shifts. Some nurses had me in subsequent shifts. They all cared for me very well.
Every day I saw Physician's Assistant (PA) Y, often more than once a day. She asked about my condition and kept me informed about what was going on. I actually met her on Thursday before surgery, so she was a familiar face post-surgery. In addition, I often saw PA DJ on most days. The surgical team headed by Chief Resident S also usually visited me each morning, but some mornings they checked in with the nurses and did not speak to me directly. After Saturday, I remember seeing Dr. DCM on two additional occasions, the last being on Thursday. I also worked with a physical therapist, two occupational therapists, and the cardiac recovery nurse. PA Y and Nurse J removed my last stitch on Friday before departing.
I also had one more procedure to drain fluid around my heart on Thursday November 12. This was done by cardiologist SS, under attending cardiologist T. They were supported the heart cath. lab staff, who like their contemporaries in Sutter Sacramento, are a lot of fun to be around.
There were also many others in the operating room that I want to thank but never met. Bottom line, thanks to ALL at Stanford for my care.
Sunday, November 15, 2009
Back Home Again and Catching Up
Note: this is actually written by Todd!
We returned to Elk Grove yesterday afternoon. It's good to be home. It's now Sunday morning and I actually feel pretty good. I've done one 6 minute walk earlier today and will do more walking later in the day. I have a lot of blogging to catch up on, and will do so over the next few days. The remainder of this post was actually written last Friday evening, the day I was released from the hospital:
Hmmm. Just tried to paste-in and post and it didn't work. So I'll just retype it:
First Thoughts After Leaving the Hospital
Thanks. It's Friday evening around 10 p.m. on November 13th in Atherton. I was released from Stanford Hospital and Clinics this afternoon around 2:00. My purpose tonight is simply to record some of the thoughts and feelings which I may soon forget. Before turning to that, I want to thank all my friends, family, and especially my wife Meg for all your love and support. I've been touched by kind thoughts and words from more friends and colleagues than I can ever thank, or even knew that I had. Most of all, I need to thank Meg for making everything so easy. She did all the worrying and logistics so I didn't have to.
Many readers may find the following a little boring or even a little gross. One of the things that helped me prepare for surgery was reading the detailed blog of another patient of Dr. DCM who also had a Tirone David valve sparing aortic root replacement. Her blog and recollections helped me, so my goal below is to provide more information for future patients. So here goes on memories that are now about a week old.
Early in the Morning of November 6th. I did not sleep much on Thursday night, not overly worried but never drifted off into restful sleep. Got up at 4:00. Had one more shower with special soap and drove to the hospital with Meg, arriving a little after 5:00. I signed in and was soon given ID bracelets for both wrists. They brought me back around 5:30. I undressed, put on a gown, got weighed, and then waited in a curtain area on mobile bed. The nurses asked some questions, most importantly, my reason for surgery that morning. Meg was brought back to wait with me. Next, my chest was shaved. Then I meet with both the resident and the attending anesthesiologist. The resident started an IV in right hand and they explained that more IVs would be added later. We talked about my concerns about waking up while still intubated. They said the tube would be removed in the ICU soon after waking up, if not before. I don't remember when this conversation ended. My last recollections before surgery were being in this curtain room around 6:30 a.m. I do not remember being wheeled into surgery. (Meg later told me that I left this room around 7:00 and that some of the drugs applied to me at that time are associated with memory loss.)
Surgery Day. I have no memories of the day. Meg got lots of updates on my progress and she has already posted some of this information.
Waking Up Friday Evening. I remember waking up in the ICU and seeing Meg and then my father. (Meg tells me this was around 8:00 and that earlier that evening, she and my father had observed me while still sleeping around 5:00.) I did have a tube in my throat and was aware of pain in my chest and throat. Soon after waking up they said the tube should be coming out. They asked me to blow out and perhaps I did. In any event the tube was out within a few minutes of my waking up. I then remember hearing and seeing Meg and then my dad. I think I gave them a thumbs up. Meg spoke to me and held my hand. I do recall learning that my surgery had been very successful in terms of repairing the aneurysm and saving my valve with a tight seal. I don't remember speaking to Meg that night but perhaps I did. I mostly remember listening with minimal talking on my part.
Overnight and Morning in ICU. Mostly, I remember being on the edge of sleep with a very sore throat and feeling like there was a brick sitting on my chest. I was attended overnight by one nurse. I remember asking for water or ice for my throat. I was given ice but told to take it easy on water consumption because my stomach was still waking up and an not ready for water. Eventually I did throw up, but it was relatively easy and the ice for my throat was worth it in my view. At some point I became aware of daylight through the window on my right. Besides chest pain, most of my discomfort had to due with bloating in my abdomen which tended to blend in with the feeling of a brick on my chest. Without getting too graphic, the best way to relieve this pressure was through burping and farting.
I believe that Meg visited me that morning and afternoon about every 2 hours for a half hour. I remember conversing with her and confirming that my surgery had gone very well. (Meg tells me that she actually was with me from about 10:00 a.m. until I was released from ICU. I'm sure Meg is right, it just differs from my drug impaired recollection.) I also saw my father and stepmother in the ICU.
Dr. DCM came by around noon. He said everything went very well and that I would be transferred to a regular room later that day. Good News. We talked about my pain, and he said the gas and pressure would eventually work through and reduce. He also suggested a procedure for easing pressure by putting a tube down my nose into my stomach. Although this was not fun, it sounds worse than it is. Unfortunately, most of the pressure was actually below my stomach so the procedure did not help very much. Still I was very happy to be heading to a regular room.
Transfer to a Regular Room (You will not believe this anecdote
I can't remember exactly when the transfer happened but it was sometime around 2:30. The following sounds crazy but it happened. My transport bed and my two attendants got stuck in the D elevators. The elevator doors barely closed and then would not open, meanwhile the elevator did not move. We rang for security. Security called back and dispatched some help. I felt smart at this point for asking for oxygen during transport. I didn't really need it, but it lowered my anxiety level. My 4 minute transfer ended up taking closer to 12 minutes. I'll close my writing this evening (the actual post will be another day) by saying I got the aisle bed (not the window) in Room D338. Future posts will cover my in-room recovery.
We returned to Elk Grove yesterday afternoon. It's good to be home. It's now Sunday morning and I actually feel pretty good. I've done one 6 minute walk earlier today and will do more walking later in the day. I have a lot of blogging to catch up on, and will do so over the next few days. The remainder of this post was actually written last Friday evening, the day I was released from the hospital:
Hmmm. Just tried to paste-in and post and it didn't work. So I'll just retype it:
First Thoughts After Leaving the Hospital
Thanks. It's Friday evening around 10 p.m. on November 13th in Atherton. I was released from Stanford Hospital and Clinics this afternoon around 2:00. My purpose tonight is simply to record some of the thoughts and feelings which I may soon forget. Before turning to that, I want to thank all my friends, family, and especially my wife Meg for all your love and support. I've been touched by kind thoughts and words from more friends and colleagues than I can ever thank, or even knew that I had. Most of all, I need to thank Meg for making everything so easy. She did all the worrying and logistics so I didn't have to.
Many readers may find the following a little boring or even a little gross. One of the things that helped me prepare for surgery was reading the detailed blog of another patient of Dr. DCM who also had a Tirone David valve sparing aortic root replacement. Her blog and recollections helped me, so my goal below is to provide more information for future patients. So here goes on memories that are now about a week old.
Early in the Morning of November 6th. I did not sleep much on Thursday night, not overly worried but never drifted off into restful sleep. Got up at 4:00. Had one more shower with special soap and drove to the hospital with Meg, arriving a little after 5:00. I signed in and was soon given ID bracelets for both wrists. They brought me back around 5:30. I undressed, put on a gown, got weighed, and then waited in a curtain area on mobile bed. The nurses asked some questions, most importantly, my reason for surgery that morning. Meg was brought back to wait with me. Next, my chest was shaved. Then I meet with both the resident and the attending anesthesiologist. The resident started an IV in right hand and they explained that more IVs would be added later. We talked about my concerns about waking up while still intubated. They said the tube would be removed in the ICU soon after waking up, if not before. I don't remember when this conversation ended. My last recollections before surgery were being in this curtain room around 6:30 a.m. I do not remember being wheeled into surgery. (Meg later told me that I left this room around 7:00 and that some of the drugs applied to me at that time are associated with memory loss.)
Surgery Day. I have no memories of the day. Meg got lots of updates on my progress and she has already posted some of this information.
Waking Up Friday Evening. I remember waking up in the ICU and seeing Meg and then my father. (Meg tells me this was around 8:00 and that earlier that evening, she and my father had observed me while still sleeping around 5:00.) I did have a tube in my throat and was aware of pain in my chest and throat. Soon after waking up they said the tube should be coming out. They asked me to blow out and perhaps I did. In any event the tube was out within a few minutes of my waking up. I then remember hearing and seeing Meg and then my dad. I think I gave them a thumbs up. Meg spoke to me and held my hand. I do recall learning that my surgery had been very successful in terms of repairing the aneurysm and saving my valve with a tight seal. I don't remember speaking to Meg that night but perhaps I did. I mostly remember listening with minimal talking on my part.
Overnight and Morning in ICU. Mostly, I remember being on the edge of sleep with a very sore throat and feeling like there was a brick sitting on my chest. I was attended overnight by one nurse. I remember asking for water or ice for my throat. I was given ice but told to take it easy on water consumption because my stomach was still waking up and an not ready for water. Eventually I did throw up, but it was relatively easy and the ice for my throat was worth it in my view. At some point I became aware of daylight through the window on my right. Besides chest pain, most of my discomfort had to due with bloating in my abdomen which tended to blend in with the feeling of a brick on my chest. Without getting too graphic, the best way to relieve this pressure was through burping and farting.
I believe that Meg visited me that morning and afternoon about every 2 hours for a half hour. I remember conversing with her and confirming that my surgery had gone very well. (Meg tells me that she actually was with me from about 10:00 a.m. until I was released from ICU. I'm sure Meg is right, it just differs from my drug impaired recollection.) I also saw my father and stepmother in the ICU.
Dr. DCM came by around noon. He said everything went very well and that I would be transferred to a regular room later that day. Good News. We talked about my pain, and he said the gas and pressure would eventually work through and reduce. He also suggested a procedure for easing pressure by putting a tube down my nose into my stomach. Although this was not fun, it sounds worse than it is. Unfortunately, most of the pressure was actually below my stomach so the procedure did not help very much. Still I was very happy to be heading to a regular room.
Transfer to a Regular Room (You will not believe this anecdote
I can't remember exactly when the transfer happened but it was sometime around 2:30. The following sounds crazy but it happened. My transport bed and my two attendants got stuck in the D elevators. The elevator doors barely closed and then would not open, meanwhile the elevator did not move. We rang for security. Security called back and dispatched some help. I felt smart at this point for asking for oxygen during transport. I didn't really need it, but it lowered my anxiety level. My 4 minute transfer ended up taking closer to 12 minutes. I'll close my writing this evening (the actual post will be another day) by saying I got the aisle bed (not the window) in Room D338. Future posts will cover my in-room recovery.
Friday, November 13, 2009
I am happy to report that Todd is officially out of the hospital and should return this weekend as chief blogger, and he will be able to fill in all the missing gaps and give his perceptions about his many experiences during this past week.
In the meantime, to wrap up, yesterday's procedure to drain excess fluid (over two cups!) from around his heart was very successful. He was immediately able to breathe more easily, helped with his pain and he just felt better overall. Last night he also lucked into a private room on a different floor in a cardiac care unit so he got some more rest there.
In the meantime, to wrap up, yesterday's procedure to drain excess fluid (over two cups!) from around his heart was very successful. He was immediately able to breathe more easily, helped with his pain and he just felt better overall. Last night he also lucked into a private room on a different floor in a cardiac care unit so he got some more rest there.
Of course, discharge took forever, but he was done and in the car by mid-afternoon. We finished the day with a wonderful meal made by his aunt and uncle.
Thursday, November 12, 2009
Sorry, my phone sent this before I was done! This may double post, too, as I am having trouble getting a strong signal. Anyhow, Todd is still 5 pounds too heavy, and the echo showed a lot of fluid accumulated around his heart, which keeps his pulse rate too high and makes him feel tired. He could continue to take the strong diuretics that he has been on for a few days, but Dr. DCM felt he should have a procedure instead that will drain the excess fluid before sending him home. He is having that done this afternoon. I will visit him after I have dinner with the kids. Hopefully this will do the trick and he will be out tomorrow afternoon!
It's been nice having the kids rejoin us. They had a great couple of days seeing their Nana before she left this afternoon. The three of us slept about ten hours last night. It is so cozy and comfortable at Todd's aunt and uncle's, and they keep us very well fed and entertained.
Thanks again to everyone for your comments, good wishes, and incredible support.
Day 7. Todd had a good day yesterday that included taking a shower by himself, spending a half hour off monitor visiting the kids outside the hospital, and having a nice evening visit with his mom. He also had the energy to do some serious joking around with our friends, Kathy and Shannon.
Today he had an x-ray and an echocardiogram and was pretty tired when I got there around 10.
Wednesday, November 11, 2009
Today's the big day - a few final tests etc. and then Todd will be discharged from the hospital. He had a tiring but productive day yesterday but now is able to do a lot more for himself. The kids will arrive and we are looking forward to a quiet and restful weekend together as well as beginning the 3 month process of getting Todd back to where he can begin athletic conditioning again. We know he can do it! And he also hopes that this weekend he will return to writing this blog himself. :)
Monday, November 9, 2009
At this point, the less I post the more progress Todd is making. He had a busy day today that included a few short walks, a shave and wash/shampoo that perked him up for a couple hours, a massage, and his first brief phone calls with the kids, who will arrive, courtesy of our dear friends Kathy and Shannon, on Wednesday. His discharge is on the horizon and he is beginning to receive instruction for his three months of recovery on diet (low sodium!), how to groom himself, walking, etc. We will continue to meet with various folks tomorrow. He will hopefully be discharged Wednesday or Thursday if he continues to make progress and will stay at his aunt and uncle's for a bit afterwards. The kids can hardly wait to see him, and us them! Hopefully we will all be back home in Elk Grove sometime early next week.
Sunday, November 8, 2009
Another brief post from my iPhone. Todd continues his steady improvement. Much of the last 24 or so hours has been about a combination of better pain control along with moving more. I was able to be present at this morning's rounds and was able to discuss my concerns about his pain with the doctors. They were finally able to come up with a combination of things that are better at controlling his pain more consistently while also not exacerbating other surgery induced conditions. Todd is now walking a little, eating a little, and working on his breathing exercises to re-expand his lungs. He is more able to have short conversations and also to simply rest more comfortably. His mom has spent quite a bit of time with him today, which is great, and I took a much needed break this afternoon.
Saturday, November 7, 2009
I don't have my computer with me today and am updating by text, so I will keep this brief. Todd continues to improve today although he is still very tired/sleepy and is feeling some pain. He was moved to a room on the intermediate ICU this afternoon and will stay on this unit until he leaves the hospital. His mom arrived a couple of hours ago and is sitting with him as he sleeps. If all goes as planned, he will take his first short walk this evening.
Friday, November 6, 2009
A short note at the end of a long day
At 2:30 we got our final call from Nurse J. that Todd was almost done with surgery, so we went to the cardiac ICU. We waited until almost 5:00 because it took them a bit longer to wrap things up and get him a bed in the ICU. His surgeon came and talked to us and told us his surgery was a great success, and he felt he achieved an excellent repair, even tightening down his aorta so that it seals extra well now. He confirmed that this had been the right time for surgery, and is hopeful that Todd will never have another surgery.
His dad, stepmom and I visited Todd briefly a little after 5:00. He was asleep and still intubated, and he looked surprisingly good with decent color. I said goodbye to friends Howard and Elaine, both of whom helped me through this long and exhausting day of waiting. Thanks, you guys. We left the hospital and Todd's uncle took us to dinner. He has been such a great host to us.
After dinner, Todd's dad and I went to the ICU for the 8:00 visiting hour. We waited a few extra minutes because they were extubating him. Todd's dad visited for a few minutes and I stayed on until after ten. Todd was uncomfortable for the first hour I was with him, mostly from tube irritation and chest pain brought on by breathing, but he settled down and was mostly asleep by the time I left at 10:30. His vital stats were excellent and he began breathing exercises, which he did well.
I will see him again tomorrow when visiting hours begin at 10 and I expect he will continue to recover quickly.
Thank you, everyone, for all your support today.
His dad, stepmom and I visited Todd briefly a little after 5:00. He was asleep and still intubated, and he looked surprisingly good with decent color. I said goodbye to friends Howard and Elaine, both of whom helped me through this long and exhausting day of waiting. Thanks, you guys. We left the hospital and Todd's uncle took us to dinner. He has been such a great host to us.
After dinner, Todd's dad and I went to the ICU for the 8:00 visiting hour. We waited a few extra minutes because they were extubating him. Todd's dad visited for a few minutes and I stayed on until after ten. Todd was uncomfortable for the first hour I was with him, mostly from tube irritation and chest pain brought on by breathing, but he settled down and was mostly asleep by the time I left at 10:30. His vital stats were excellent and he began breathing exercises, which he did well.
I will see him again tomorrow when visiting hours begin at 10 and I expect he will continue to recover quickly.
Thank you, everyone, for all your support today.
12:30 Update
Todd is doing well and on track. Dr. DCM is currently in the process of repairing his aorta and valve, the most intricate part of the process.
Mid morning update
I just heard from Nurse J. Todd has had all his surgical prep in the operating room and they are about to begin the actual surgery. Dr. DCM (based on the echocardiogram just done in the operating room, I believe) is now proceeding with the valve sparing surgery, so it looks like he will not need the tissue valve.
I will get another update around the lunch hour.
I will get another update around the lunch hour.
The ICU phone number
The phone number for the cardiac ICU is 650-723-6081.
Todd is in surgery now and the anesthesiologist reiterated that he won't be out until 4:00 or 5:00 this afternoon, so he'll be recovering in the ICU this evening and tomorrow.
Todd is in surgery now and the anesthesiologist reiterated that he won't be out until 4:00 or 5:00 this afternoon, so he'll be recovering in the ICU this evening and tomorrow.
Thursday, November 5, 2009
And Meg takes over for awhile
Looks like I will be Todd's voice for the next few days. I will post tomorrow as I receive information; however, I don't expect to hear much before at least 5:00. Surgery starts around 7:30 or so, and Nurse J told me that the surgery should take about 8 hours. The surgeon will talk to me when it's over and I'll have an opportunity to see Todd once he's in the cardiac ICU. I'll try and post the ICU number tomorrow; anyone can call, 24 hours a day, except during shift changes from 6-7 am and 6-7 pm. However, be forewarned: they list every patient there as "critical," and that's totally normal, so don't be worried.
I will also post brief updates as I get them on Facebook, as it is somewhat easier from my iPhone than blogging.
I am also grateful to all of our friends and family for all the encouragement, love and support you've offered us through all of this. We couldn't do this without you.
I will also post brief updates as I get them on Facebook, as it is somewhat easier from my iPhone than blogging.
I am also grateful to all of our friends and family for all the encouragement, love and support you've offered us through all of this. We couldn't do this without you.
Preoperative Stuff and "Blandork"
Meg and I are at a Starbucks on the corner of Stanford and the El Camino Real. Our morning at the surgical admit. unit took longer that we thought. First we learned a lot more about the procedure, visiting policies, and aftercare from Nurse J. My day tomorrow starts at 5:00 a.m. Nurse J thought I would be in surgery for about 8 hours, so there may not be much news until late afternoon or early evening on Friday, after the surgeon talks to Meg.
After nurse J, I returned to the waiting area to be called in for blood work and an EKG. They called out the name "Blandork," and that sounded too messed up to be me. Five minutes later they called out "Blandooor." This time I stood up, and indeed, she was looking for me. About a half hour later I was done with blood work (five vials) and an EKG. Then we met with the physician's assistant who talked more about the procedure, my health history, and current health. She also did a minimal exam including pulse, blood pressure, and listening to my heart and lungs. She complemented me on my strong stomach muscles :)
Next Nurse J came back and asked if I would like to be part of a study regarding the causes of aortic tissue disorders, to which I agreed. Next we visited with the anesthesia coordinator for a few minutes. I asked about waking up with the breathing tube, and he said about one in three times patients wake up with it, giving my a 2 out of 3 chance of still be asleep when it's removed. For some reason, this is the only aspect of the time in intensive care that I'm concerned about. We were then dismissed with instructions to get a chest X-ray downstairs.
By now it was 1:00, and we were hungry so we stopped at the cafeteria first for lunch. The x-ray was quick, and we were on our way by about 1:50. We then went to Whole Foods before finding this Starbucks. We parked at the corner of Yale Street and Stanford Avenue. Meg took a picture of me under the corner street sign. We'll see if we can post it.
This is probably my last post for a while. I want to thank everyone who has sent me kind wishes. I really never knew till now just how many friends I have.
After nurse J, I returned to the waiting area to be called in for blood work and an EKG. They called out the name "Blandork," and that sounded too messed up to be me. Five minutes later they called out "Blandooor." This time I stood up, and indeed, she was looking for me. About a half hour later I was done with blood work (five vials) and an EKG. Then we met with the physician's assistant who talked more about the procedure, my health history, and current health. She also did a minimal exam including pulse, blood pressure, and listening to my heart and lungs. She complemented me on my strong stomach muscles :)
Next Nurse J came back and asked if I would like to be part of a study regarding the causes of aortic tissue disorders, to which I agreed. Next we visited with the anesthesia coordinator for a few minutes. I asked about waking up with the breathing tube, and he said about one in three times patients wake up with it, giving my a 2 out of 3 chance of still be asleep when it's removed. For some reason, this is the only aspect of the time in intensive care that I'm concerned about. We were then dismissed with instructions to get a chest X-ray downstairs.
By now it was 1:00, and we were hungry so we stopped at the cafeteria first for lunch. The x-ray was quick, and we were on our way by about 1:50. We then went to Whole Foods before finding this Starbucks. We parked at the corner of Yale Street and Stanford Avenue. Meg took a picture of me under the corner street sign. We'll see if we can post it.
This is probably my last post for a while. I want to thank everyone who has sent me kind wishes. I really never knew till now just how many friends I have.
In Palo Alto
We arrived in Palo Alto last night. Had a nice dinner at Straits, an Asian/Fusion kind of restaurant. In a half hour we head over to Stanford Hospital and Clinics for preoperative stuff (blood tests, whatever). Meg will be doing most of the posting for the next few days. She's much more tech savvy than I, and a lot of her posting will be via her I-phone. (I'm one of those uncool blackberry users.)
Tuesday, November 3, 2009
Triathlon Stuff
It's Tuesday morning. I just finished a 5K in 29:48. Since my heartcath, my exercise has been limited, but not eliminated. The doctors like me to keep my heart rate at about 130 when I exercise. Before my condition was diagnosed, I tended to do my longer running workouts with a heart rate in the 150s, and in the 160s for short workouts like a 5K. My best 5K earlier in the year was about 24:30, or just over 8 minutes per mile. That would send my heart rate into the 160s. My longer distance pace is more like a 9 minute mile, putting my heart at about 150 to 155. In order to reduce my heart into the 130s, I had to slow my run pace to about 11 minute mile for 3 miles. I also limited all my workouts to no more than 3.5 or 4 miles. Since the initial "slow down," I've been able to get closer to 10 minute miles, like today. Tomorrow morning will probably be my last run before surgery. I wonder a lot about my recovery. How long until I can walk a 5K? When will my first 5K run take place?
Triathlon Goal for 2010
My goal for 2010 is to finish Vineman 70.3. I've completed the race twice before, in 5:56 in 2003 and 6:19 in 2008. About two weeks before the race in 2009, I had to withdraw. I've already registered for the race which takes place in Sonoma County on July 18. I have confidence in my doctors and in myself. :)
Triathlon Background
I started triathlons at age 40 in 2002. In my teens I ran cross country and ran on and off all through my adult life. Before 2002, I hadn't done any "competitive" swimming since I was 12 years old on the JCC swim team. I hadn't cycled much since my teens. I did some some little races in 2002. 2003 was my best season, I did an under-marked (the swim must have been less than .9 miles) Olympic distance triathlon in 2:33. That was good enough for 18th out of 30 men in their 40s that day. (An Olympic is a 1.5K swim, a 40K cycle, followed by a 10K run.) My 10K in that race was in just under 48 minutes. I'm very proud of that race and run. At the finish, my heart rate was approaching 180 (back then I wore a monitor).
Various minor injuries over the years have slowed me down some since then. I've never been below 2:40 for any Oly since that year. My greatest accomplishment was finishing Ironman Coeur d'Alene in 2006 with a total time of 15 hours and 30 minutes. The race is a 2.4 mile swim, a 112 mile bike, and a 26 mile run. I mostly power walked the running portion. On that beautiful 90 degree day, 2200 started the race, 1900 finished, and I finished about 1600th. Depending on the level of competition, I'm usually in the back third or back quarter of the finishers. At my level, triathlon is about racing against my own goals and expectations, not the other amazing competitors.
Triathlon Goal for 2010
My goal for 2010 is to finish Vineman 70.3. I've completed the race twice before, in 5:56 in 2003 and 6:19 in 2008. About two weeks before the race in 2009, I had to withdraw. I've already registered for the race which takes place in Sonoma County on July 18. I have confidence in my doctors and in myself. :)
Triathlon Background
I started triathlons at age 40 in 2002. In my teens I ran cross country and ran on and off all through my adult life. Before 2002, I hadn't done any "competitive" swimming since I was 12 years old on the JCC swim team. I hadn't cycled much since my teens. I did some some little races in 2002. 2003 was my best season, I did an under-marked (the swim must have been less than .9 miles) Olympic distance triathlon in 2:33. That was good enough for 18th out of 30 men in their 40s that day. (An Olympic is a 1.5K swim, a 40K cycle, followed by a 10K run.) My 10K in that race was in just under 48 minutes. I'm very proud of that race and run. At the finish, my heart rate was approaching 180 (back then I wore a monitor).
Various minor injuries over the years have slowed me down some since then. I've never been below 2:40 for any Oly since that year. My greatest accomplishment was finishing Ironman Coeur d'Alene in 2006 with a total time of 15 hours and 30 minutes. The race is a 2.4 mile swim, a 112 mile bike, and a 26 mile run. I mostly power walked the running portion. On that beautiful 90 degree day, 2200 started the race, 1900 finished, and I finished about 1600th. Depending on the level of competition, I'm usually in the back third or back quarter of the finishers. At my level, triathlon is about racing against my own goals and expectations, not the other amazing competitors.
Friday, October 30, 2009
Love from My Aunt and Uncle
In a lot of ways, I've been lucky. First, the aneurysm was discovered before it reached a critical stage. Second, my aunt and uncle are both on the medical faculty of Stanford University. My aunt is a pediatric cardiologist. My uncle is a neo-natologist. From the beginning of my diagnosis, Aunt M. helped me understand my test results and provided wise counsel. Both of them encouraged me to see their surgeon colleague, Dr. DCM. They explained that he had extensive experience with valve sparing operations the best chance of saving my valve was to go with Dr. DCM. On their advice I had my test records sent to Stanford. After reviewing my file, Dr. DCM's team arranged an appointment to discuss my case on October 5.
Trip to Stanford
The night before the appointment, Meg and I drove to Atherton, CA where my aunt and uncle cooked a wonderful dinner after welcoming us into their home. We had a nice visit with them that night.
The next day I had new Chest CT and echocardiogram. The imaging technology at Stanford is so advanced that the Chest CT could actually show my healthy coronary arteries. I actually got a color picture showing my heart, the aneurysm, and the healthy coronary arteries. At about 5:00 p.m. Dr. DCM met with me, Meg and Aunt M. He said that my aneurysm was between 4.7 cm and 5.0 cm. He did not think my leak was as severe as Dr. M had concluded after my heart cath, but agreed that it was clearly visible from the echocardiogram. He said that I could wait for surgery and have periodic testing (maybe every 3 or 4 months) to monitor my aneurysm. In the meantime, I would have to stop competing in triathlons. Although I am in no hurry to give up triathlons, I considered it for a moment if it meant no surgery. I asked if waiting meant that surgery could ultimately be avoided. Dr. DCM said no. I would eventually need surgery, perhaps in a few months or maybe a few years. The only way that surgery could be avoided would be if I first had a catastrophic event. :( He showed me a risk chart which had me in the edge of the "green zone" for risk of such an event. Green meant the annual risk was just under 4 percent. It appeared that any enlargement would move me into the more risky yellow zone.
I had some thinking to do about the pros and cons of proceeding. However, just about everything pointed to proceeding. Dr. DCM is a recognized leader in the specialty of performing valve sparing operations. After showing me pictures of how the operation is done, he shared some pictures of former patients who had the same operation. These included a current NBA player, a geologist who climbs mountains, and baseball star Aaron Boone.
Meg and I talked about my options with my aunt and uncle that night. My aunt described the complexity and invasive nature of the procedure. But we kept coming back to the concept that there was no way to avoid the surgery. The next day I called Dr. DCM's nurse practitioner and told him that I wanted to proceed with surgery. I said that my goal was to recover from surgery, finish Vineman 70.3 in July 2010, and send a race day picture of me with my finisher's medal to Dr. DCM. I hope he puts my picture in his computer slide show between the geologist on Mt. St. Helens and Aaron Boone hitting a home run. :)
Surgery was quickly scheduled for November 6th. I have pre-operative procedures on the 5th. Exactly one week from now is my surgery. By that evening I should be in intensive care.
Trip to Stanford
The night before the appointment, Meg and I drove to Atherton, CA where my aunt and uncle cooked a wonderful dinner after welcoming us into their home. We had a nice visit with them that night.
The next day I had new Chest CT and echocardiogram. The imaging technology at Stanford is so advanced that the Chest CT could actually show my healthy coronary arteries. I actually got a color picture showing my heart, the aneurysm, and the healthy coronary arteries. At about 5:00 p.m. Dr. DCM met with me, Meg and Aunt M. He said that my aneurysm was between 4.7 cm and 5.0 cm. He did not think my leak was as severe as Dr. M had concluded after my heart cath, but agreed that it was clearly visible from the echocardiogram. He said that I could wait for surgery and have periodic testing (maybe every 3 or 4 months) to monitor my aneurysm. In the meantime, I would have to stop competing in triathlons. Although I am in no hurry to give up triathlons, I considered it for a moment if it meant no surgery. I asked if waiting meant that surgery could ultimately be avoided. Dr. DCM said no. I would eventually need surgery, perhaps in a few months or maybe a few years. The only way that surgery could be avoided would be if I first had a catastrophic event. :( He showed me a risk chart which had me in the edge of the "green zone" for risk of such an event. Green meant the annual risk was just under 4 percent. It appeared that any enlargement would move me into the more risky yellow zone.
I had some thinking to do about the pros and cons of proceeding. However, just about everything pointed to proceeding. Dr. DCM is a recognized leader in the specialty of performing valve sparing operations. After showing me pictures of how the operation is done, he shared some pictures of former patients who had the same operation. These included a current NBA player, a geologist who climbs mountains, and baseball star Aaron Boone.
Meg and I talked about my options with my aunt and uncle that night. My aunt described the complexity and invasive nature of the procedure. But we kept coming back to the concept that there was no way to avoid the surgery. The next day I called Dr. DCM's nurse practitioner and told him that I wanted to proceed with surgery. I said that my goal was to recover from surgery, finish Vineman 70.3 in July 2010, and send a race day picture of me with my finisher's medal to Dr. DCM. I hope he puts my picture in his computer slide show between the geologist on Mt. St. Helens and Aaron Boone hitting a home run. :)
Surgery was quickly scheduled for November 6th. I have pre-operative procedures on the 5th. Exactly one week from now is my surgery. By that evening I should be in intensive care.
Thursday, October 29, 2009
Heart Catheterization Procedure
My heartcath was scheduled for July 23rd. In my case, the purpose of the test was to get a better sense of the magnitude of the aortic regurgitation, the size of the aneurysm, and a look at my coronary arteries. The only reason to read this post is if you want to understand the procedure from the patient's perspective. Otherwise it's kinda boring.
Preparation
I arrived at the hospital at 2:00. By about 2:20 I was in the preparation and recovery room with the other patients. My nurse was very nice, but unfortunately, I've forgotten her name. After weighing me, I went to my bed and curtain area and changed into the gown. Meg was with me for the start, but was asked to leave while the nurse prepared me. The preparation in included a partial shave on both sides of the groin and then an IV was started in my arm. I was also connected to heart and blood pressure monitor. Meg was invited back into the curtain area to wait with me after all this was done. We watched a video about the procedure and then had a chance to ask questions. The nurses all encouraged me to get an angio-seal. Instead of a clamp, the angio-seal uses a collagen to seal the opening made in the femoral artery near the groin. They said that the bleeding stops much faster and that you may be able to go home within 2 hours. Although I was ready to go by about 3:20, they didn't take me into the procedure room until about 5:00. Before going down to the room, I was given some benadryl in the IV to relax me.
The Procedure
The room is very cold. You get even colder when sterilizing solutions is sprayed on both sides of your groin. After about another 10 minutes Dr. M was about ready to start. They asked if I wanted more general pain relief. Dr. M said I probably wouldn't need it so I declined. He then said I would feel a pop as he set up the puncture of the artery and put in the "introducer sheath" which is a tube through which the catheter can be inserted into the artery. It didn't hurt much at all. Then in just a few seconds the catheter was inserted and it was right up next to my heart. I could watch it on the giant monitor. I could not feel the catheter inside me. Then the catheter was moved into my heart. All of a sudden my heart rate went to 180 on the monitor and I could feel it in my chest. My heart was really racing. Within about 30 seconds I felt much better. The doctor said that was because the catheter was no longer inside my heart. I looked again at the monitor and could see this. Again it was moved into my heart and it started beating faster but not too fast to continue with the test. Die or "contrast agent" was injected through the end of the catheter. The die went all over the chamber, documenting the regurgitation (leak) in my aortic valve. Next I believe the doctor switched catheters, which I did not feel and took only a few seconds. Now Dr. M was trying to get die injected into my coronary arteries to check for heart disease. It took a few tries but eventually he hit it right and the screen showed my entire coronary artery filled with die. This was good news meaning no blockage or any sign of heart disease.
Angio-Seal (AS)
As advised by the nurses, I asked for the AS. Another nurse came in to do the sealing procedure. After being essentially painless since the original puncture, this actually hurt a lot and I began to raise my leg at the knee. They told me to lie flat or they would not be able to do the seal. I got through it, but now regretted my earlier choice to skip the additional pain relief. I was then wheeled out of the procedure room, about a half hour after being wheeled in.
Recovery
For the first hour they ask that you lie very still and not move your legs. In the recovery area I was back in my original curtain area and Meg was with me. Everything went fine for the first hour. The nurse checked my bandage for bleeding and there was none, just some tenderness. I was given a little morphine via IV. After an hour they propped me up in bed and I had something to eat and drink. After that I was asked to get out of bed slowly and walk 30 feet and sit back down. If you can do that three times about 15 minutes apart without having your heart rate crash or faint you can be discharged. I felt a little wobbly getting back into bed and within a few minutes my heart monitor alarm went off, my blood pressure dropped to 80 over 40 and my heart rate dropped below 50. They leaned me all the way back to flat in the bed and slowly I started to feel a little better. In the meantime, a lot more people came into my area because of the alarm. The staff talked to me and said a lot of the young guys faint. I love being called young! The nurses all encouraged me to drink more and urinate. I did all this but it wasn't easy if you know what I mean. Later I tried another walk. Meg thought I looked terrible again after that 30 foot walk. My heart did not decelerate, but I did need to lie back down again. At this point it was moving on toward 9:30 and the heart cath area was closing. My very kind nurses had already stayed past the end of their shift. They arranged for me to be admitted to the hospital for a few more hours of observation.
I ended up with a private room upstairs around 10:00. After about 45 minutes on the 4th floor I started to feel a little better. I made a 25 foot walk and came back to bed feeling okay. Just two more walks and I could go home. By about 11:30 I had completed my walks and was discharged just before midnight.
Recovery at Home
The next day you are tender in the groin area and need to take it easy. No driving that day and I stayed home from work. The next day was Saturday and I was feeling much better, able to walk with no pain, just an awareness of tenderness in the groin area. The bandage came off and it looked fine with no bleeding.
The next day was Sunday and I began a college visiting trip to Southern California with my daughter. We shared the driving and the trip went fine.
My only advice to other patients is to accept more pain relief at the beginning of the procedure, especially if you get the angio-seal.
Preparation
I arrived at the hospital at 2:00. By about 2:20 I was in the preparation and recovery room with the other patients. My nurse was very nice, but unfortunately, I've forgotten her name. After weighing me, I went to my bed and curtain area and changed into the gown. Meg was with me for the start, but was asked to leave while the nurse prepared me. The preparation in included a partial shave on both sides of the groin and then an IV was started in my arm. I was also connected to heart and blood pressure monitor. Meg was invited back into the curtain area to wait with me after all this was done. We watched a video about the procedure and then had a chance to ask questions. The nurses all encouraged me to get an angio-seal. Instead of a clamp, the angio-seal uses a collagen to seal the opening made in the femoral artery near the groin. They said that the bleeding stops much faster and that you may be able to go home within 2 hours. Although I was ready to go by about 3:20, they didn't take me into the procedure room until about 5:00. Before going down to the room, I was given some benadryl in the IV to relax me.
The Procedure
The room is very cold. You get even colder when sterilizing solutions is sprayed on both sides of your groin. After about another 10 minutes Dr. M was about ready to start. They asked if I wanted more general pain relief. Dr. M said I probably wouldn't need it so I declined. He then said I would feel a pop as he set up the puncture of the artery and put in the "introducer sheath" which is a tube through which the catheter can be inserted into the artery. It didn't hurt much at all. Then in just a few seconds the catheter was inserted and it was right up next to my heart. I could watch it on the giant monitor. I could not feel the catheter inside me. Then the catheter was moved into my heart. All of a sudden my heart rate went to 180 on the monitor and I could feel it in my chest. My heart was really racing. Within about 30 seconds I felt much better. The doctor said that was because the catheter was no longer inside my heart. I looked again at the monitor and could see this. Again it was moved into my heart and it started beating faster but not too fast to continue with the test. Die or "contrast agent" was injected through the end of the catheter. The die went all over the chamber, documenting the regurgitation (leak) in my aortic valve. Next I believe the doctor switched catheters, which I did not feel and took only a few seconds. Now Dr. M was trying to get die injected into my coronary arteries to check for heart disease. It took a few tries but eventually he hit it right and the screen showed my entire coronary artery filled with die. This was good news meaning no blockage or any sign of heart disease.
Angio-Seal (AS)
As advised by the nurses, I asked for the AS. Another nurse came in to do the sealing procedure. After being essentially painless since the original puncture, this actually hurt a lot and I began to raise my leg at the knee. They told me to lie flat or they would not be able to do the seal. I got through it, but now regretted my earlier choice to skip the additional pain relief. I was then wheeled out of the procedure room, about a half hour after being wheeled in.
Recovery
For the first hour they ask that you lie very still and not move your legs. In the recovery area I was back in my original curtain area and Meg was with me. Everything went fine for the first hour. The nurse checked my bandage for bleeding and there was none, just some tenderness. I was given a little morphine via IV. After an hour they propped me up in bed and I had something to eat and drink. After that I was asked to get out of bed slowly and walk 30 feet and sit back down. If you can do that three times about 15 minutes apart without having your heart rate crash or faint you can be discharged. I felt a little wobbly getting back into bed and within a few minutes my heart monitor alarm went off, my blood pressure dropped to 80 over 40 and my heart rate dropped below 50. They leaned me all the way back to flat in the bed and slowly I started to feel a little better. In the meantime, a lot more people came into my area because of the alarm. The staff talked to me and said a lot of the young guys faint. I love being called young! The nurses all encouraged me to drink more and urinate. I did all this but it wasn't easy if you know what I mean. Later I tried another walk. Meg thought I looked terrible again after that 30 foot walk. My heart did not decelerate, but I did need to lie back down again. At this point it was moving on toward 9:30 and the heart cath area was closing. My very kind nurses had already stayed past the end of their shift. They arranged for me to be admitted to the hospital for a few more hours of observation.
I ended up with a private room upstairs around 10:00. After about 45 minutes on the 4th floor I started to feel a little better. I made a 25 foot walk and came back to bed feeling okay. Just two more walks and I could go home. By about 11:30 I had completed my walks and was discharged just before midnight.
Recovery at Home
The next day you are tender in the groin area and need to take it easy. No driving that day and I stayed home from work. The next day was Saturday and I was feeling much better, able to walk with no pain, just an awareness of tenderness in the groin area. The bandage came off and it looked fine with no bleeding.
The next day was Sunday and I began a college visiting trip to Southern California with my daughter. We shared the driving and the trip went fine.
My only advice to other patients is to accept more pain relief at the beginning of the procedure, especially if you get the angio-seal.
Saturday, October 24, 2009
Aortic Heart Valve Issues
My diagnosis is that the aneurysm is primary, and due to its expansion, my aortic valve cannot close properly and blood leaks back into my heart (the secondary effect of my condition). Both problems need to be fixed. The aneurysm needs to be repaired to avoid the possibility of rupture or aortic dissection. The valve needs repair because the leak causes the heart to work harder which can eventually lead to an enlarged heart. The aneurysm fix is fairly standard. The damaged portion is surgically replaced with a Dacron tube. The aortic valve must also be repaired or replaced.
Valve Replacement Options
There are two replacement options, each with advantages and disadvantages. The first option is replacement with an artificial valve made out of plastic and metal. Dr. I showed me one of these valves. The advantage of an artificial valve is that it lasts forever. The downside is that you must take blood thinners, such as Coumadin, for the rest of your life. The other option is a tissue based valve from a cow or a pig. This type of valve does not require blood thinning medication. However, in "younger" patients such as myself, the valve will only last 10 to 15 years. For me that would mean another surgery at about age 60.
Valve Repair
A final option is valve repair, or more formally, a valve sparing aortic root replacement. This surgery was developed by Dr. Tirone David (currently with Toronto General Hospital), and the procedure carries his name. It is a complicated operation that adds about an hour and half to the more standard valve replacement approach. The obvious advantage of this approach is avoiding the need for blood thinning medication and hopefully future valve replacement.
Valve Replacement Options
There are two replacement options, each with advantages and disadvantages. The first option is replacement with an artificial valve made out of plastic and metal. Dr. I showed me one of these valves. The advantage of an artificial valve is that it lasts forever. The downside is that you must take blood thinners, such as Coumadin, for the rest of your life. The other option is a tissue based valve from a cow or a pig. This type of valve does not require blood thinning medication. However, in "younger" patients such as myself, the valve will only last 10 to 15 years. For me that would mean another surgery at about age 60.
Valve Repair
A final option is valve repair, or more formally, a valve sparing aortic root replacement. This surgery was developed by Dr. Tirone David (currently with Toronto General Hospital), and the procedure carries his name. It is a complicated operation that adds about an hour and half to the more standard valve replacement approach. The obvious advantage of this approach is avoiding the need for blood thinning medication and hopefully future valve replacement.
Confirmation and CT Scan
To confirm and measure the aneurysm a Chest CT was scheduled for Monday July 12 at Radiological Associates of Sacramento. The test is relatively simple. First you have an IV placed in your arm. Then you lie down, and an arch-shaped machine passes over you for the scan. During the scan you are asked to hold your breath for about 18 seconds. During one of the scans, die is injected through the IV line. They warn you that the die will make you feel warm and flushed, perhaps like you have wet yourself. This is a good description of what it feels like and the feeling passes quickly. After about 5 minutes you are done with the entire scan.
I met with Dr. M on July 16. He said my aneurysm was about 5 cm in diameter (normal would be 2 or 2.5 cm). As I understand it, ascending aortic aneurysms over 5.5 should be repaired surgically ASAP, due to the risk of a "catastrophic event." For aneurysms between 5 and 5.5, surgery is needed but not immediately. (The numbers are different for descending aneurysms and I am no expert on any of this.) Dr. M got me an appointment with a surgeon, Dr. I, the very next day. Dr. I suggested scheduling surgery at my convenience sometime over the next six months. He advised me to exercise minimally--walking and maybe swimming a 100 yards. Prior to surgery, I would need an angiogram also known as a heart catheterization or heart cath.
I met with Dr. M on July 16. He said my aneurysm was about 5 cm in diameter (normal would be 2 or 2.5 cm). As I understand it, ascending aortic aneurysms over 5.5 should be repaired surgically ASAP, due to the risk of a "catastrophic event." For aneurysms between 5 and 5.5, surgery is needed but not immediately. (The numbers are different for descending aneurysms and I am no expert on any of this.) Dr. M got me an appointment with a surgeon, Dr. I, the very next day. Dr. I suggested scheduling surgery at my convenience sometime over the next six months. He advised me to exercise minimally--walking and maybe swimming a 100 yards. Prior to surgery, I would need an angiogram also known as a heart catheterization or heart cath.
Friday, October 23, 2009
Tests and Diagnosis
Late June 2009
So, I have a heart murmur. Lots of people have heart murmurs. I really wasn't very concerned and continued with training for Vineman 70.3 (a 1/2 iron distance triathlon) scheduled on July 19th. On June 13th I did my longest training run for 2009, 10 miles in 1 hour 33 minutes. That's a pace of about one mile every 9 minutes and 20 seconds. I was pleased, not quite thrilled with my time. At the end of the workout my heart rate was 156, fairly typical for me for this type of workout. On June 17th I visited my primary care physician who confirmed that I had a heart murmur and gave me a referral into cardiology. My doctor said I could continue to exercise. Sutter Cardiology scheduled me for an appointment on July 5. On July 3, I did my longest brick (that's a bike/run combination workout). I cycled for just under 3 hours (about 47 miles) and then ran 7.5 miles in 1 hour and 7 minutes. I was very pleased with my run time which was faster than earlier long runs.
Seeing the Cardiologist
On July 5, I saw my cardiologist, Dr. M. After listening with his stethoscope, he said that he could hear either "substantial" or "significant" regurgitation (I can't remember his exact words, but it was one or the other). Essentially, regurgitation is blood flowing backwards within the heart that results in turbulence which can be heard via the stethoscope. Just from listening he believed that there was a significant leak in my aortic valve (blood leaking backward from the aorta into the left ventricle). He also said that I might need valve replacement surgery, probably sooner rather than later. I was stunned. I was training hard and feeling good. I was only 47. Everyone in the waiting room was much older!!! This made no sense to me. Dr. M said the next step was an echocardiogram (essentially a sonogram of the heart) to confirm his diagnosis. I asked if I could continue to train. He said yes, but to listen to my body. If my heart started to race or felt odd, I should stop the training. Still not really believing this was happening, I worked with the very helpful cardiology scheduler who got me in the next day for an echocardiogram after learning of a cancellation. This test takes about a half hour. The practitioner puts some lubricant on your chest and moves the wand over your chest at different angles. They take lots of measurements on the viewing screen. It's painless and easy.
The News
On July 7 I did my usual swim of 1300 yards at the gym, followed by a spin class workout of about 45 minutes. On July 8 I ran five miles in the morning before work. At 9:00 I received a call from Dr. M's nurse. She said that I had an ascending aortic aneurysm and that I should stop triathlon training. Again, I was stunned. I did a lot of googling that morning trying to figure out what all that meant. In a nutshell, the aorta is main artery leaving the heart from the left ventricle and bringing blood to the rest of the body. The aorta heads upward at first (the ascending aorta) and then makes a u turn (the aortic arch) and then heads down toward the legs (the descending aorta). My aneurysm was in the ascending portion just after leaving the heart. An aneurysm is a dilation of any blood vessel caused by disease or weakening of the vessel wall. Fortunately I had an appointment the very next day with Dr. M to go over these results.
So, I have a heart murmur. Lots of people have heart murmurs. I really wasn't very concerned and continued with training for Vineman 70.3 (a 1/2 iron distance triathlon) scheduled on July 19th. On June 13th I did my longest training run for 2009, 10 miles in 1 hour 33 minutes. That's a pace of about one mile every 9 minutes and 20 seconds. I was pleased, not quite thrilled with my time. At the end of the workout my heart rate was 156, fairly typical for me for this type of workout. On June 17th I visited my primary care physician who confirmed that I had a heart murmur and gave me a referral into cardiology. My doctor said I could continue to exercise. Sutter Cardiology scheduled me for an appointment on July 5. On July 3, I did my longest brick (that's a bike/run combination workout). I cycled for just under 3 hours (about 47 miles) and then ran 7.5 miles in 1 hour and 7 minutes. I was very pleased with my run time which was faster than earlier long runs.
Seeing the Cardiologist
On July 5, I saw my cardiologist, Dr. M. After listening with his stethoscope, he said that he could hear either "substantial" or "significant" regurgitation (I can't remember his exact words, but it was one or the other). Essentially, regurgitation is blood flowing backwards within the heart that results in turbulence which can be heard via the stethoscope. Just from listening he believed that there was a significant leak in my aortic valve (blood leaking backward from the aorta into the left ventricle). He also said that I might need valve replacement surgery, probably sooner rather than later. I was stunned. I was training hard and feeling good. I was only 47. Everyone in the waiting room was much older!!! This made no sense to me. Dr. M said the next step was an echocardiogram (essentially a sonogram of the heart) to confirm his diagnosis. I asked if I could continue to train. He said yes, but to listen to my body. If my heart started to race or felt odd, I should stop the training. Still not really believing this was happening, I worked with the very helpful cardiology scheduler who got me in the next day for an echocardiogram after learning of a cancellation. This test takes about a half hour. The practitioner puts some lubricant on your chest and moves the wand over your chest at different angles. They take lots of measurements on the viewing screen. It's painless and easy.
The News
On July 7 I did my usual swim of 1300 yards at the gym, followed by a spin class workout of about 45 minutes. On July 8 I ran five miles in the morning before work. At 9:00 I received a call from Dr. M's nurse. She said that I had an ascending aortic aneurysm and that I should stop triathlon training. Again, I was stunned. I did a lot of googling that morning trying to figure out what all that meant. In a nutshell, the aorta is main artery leaving the heart from the left ventricle and bringing blood to the rest of the body. The aorta heads upward at first (the ascending aorta) and then makes a u turn (the aortic arch) and then heads down toward the legs (the descending aorta). My aneurysm was in the ascending portion just after leaving the heart. An aneurysm is a dilation of any blood vessel caused by disease or weakening of the vessel wall. Fortunately I had an appointment the very next day with Dr. M to go over these results.
Where to begin? How about my (benign) brain tumor?
As the title indicates, this blog is mostly about my diagnosis, surgery, and recovery from an ascending aortic aneurysm. This first post is written exactly two weeks before my scheduled surgery at Stanford Hospital. The purpose is to explain how I got here. So where do I begin? With an unrelated health problem.
June 2008
One day at my office I became dizzy and nauseous. I ended up vomiting in the bathroom and unable to stand. After about an hour of turning down help from my concerned co-workers, a nurse from the Capitol was called, and later an ambulance took me to the emergency room. There I was given anti-nausea medication and a series of tests. A head CT showed a small mass just inside my left ear. I was released with some anti-nausea medication and told to follow-up on the unknown mass with neurology. I saw my own personal physician that day and an MRI was scheduled. I felt fine the next two days. However, on Friday of the same week, I had the same thing happen all over again. Dizziness, unable to walk, vomiting, yuck. I had forgotten to bring my medication, darn!!
My wife was very concerned and pressed my physician to move up my MRI to the very next day. I had another similar episode the following Tuesday but this time the medication limited the spell to dizziness and nausea with no vomiting. Following the MRI, I had an assessment with Dr. C. (a neurosurgeon). He concluded that the mass was benign, most likely an epidermoid cyst or a fatty lipoma. It may or may not have contributed to the dizziness. Absent any more symptoms, his recommendation was do nothing and have another MRI a year later. I did have a hearing test which documented some hearing loss in my left ear.
June 2009
After the three episodes in June 2008, I had no recurrence. In July 2008, I completed the Vineman 70.3 half-iron distance triathlon in 6 hours and 20 minutes. As suggested, I had another MRI in June 2009 and met again with Dr. C. He concluded that the cyst had not grown or moved and he was not at all concerned about it. He did suggest another follow-up MRI in 1 more year. Before leaving he did a very brief physical exam. Just before finishing he put his stethoscope on my chest and said "anyone ever talk to you about that heart murmur?" I replied "no." He then said in a somewhat self-deprecating manner, "Well if the brain doctor can hear it, anyone could." This marked the beginning of my time as a heart patient.
June 2008
One day at my office I became dizzy and nauseous. I ended up vomiting in the bathroom and unable to stand. After about an hour of turning down help from my concerned co-workers, a nurse from the Capitol was called, and later an ambulance took me to the emergency room. There I was given anti-nausea medication and a series of tests. A head CT showed a small mass just inside my left ear. I was released with some anti-nausea medication and told to follow-up on the unknown mass with neurology. I saw my own personal physician that day and an MRI was scheduled. I felt fine the next two days. However, on Friday of the same week, I had the same thing happen all over again. Dizziness, unable to walk, vomiting, yuck. I had forgotten to bring my medication, darn!!
My wife was very concerned and pressed my physician to move up my MRI to the very next day. I had another similar episode the following Tuesday but this time the medication limited the spell to dizziness and nausea with no vomiting. Following the MRI, I had an assessment with Dr. C. (a neurosurgeon). He concluded that the mass was benign, most likely an epidermoid cyst or a fatty lipoma. It may or may not have contributed to the dizziness. Absent any more symptoms, his recommendation was do nothing and have another MRI a year later. I did have a hearing test which documented some hearing loss in my left ear.
June 2009
After the three episodes in June 2008, I had no recurrence. In July 2008, I completed the Vineman 70.3 half-iron distance triathlon in 6 hours and 20 minutes. As suggested, I had another MRI in June 2009 and met again with Dr. C. He concluded that the cyst had not grown or moved and he was not at all concerned about it. He did suggest another follow-up MRI in 1 more year. Before leaving he did a very brief physical exam. Just before finishing he put his stethoscope on my chest and said "anyone ever talk to you about that heart murmur?" I replied "no." He then said in a somewhat self-deprecating manner, "Well if the brain doctor can hear it, anyone could." This marked the beginning of my time as a heart patient.
Subscribe to:
Posts (Atom)