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.
Monday, November 23, 2009
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.
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