Surgery and hospital recovery (17-22 Sep 2015)

During the run up to scheduling surgery, Dr. Macgovern told me that I would need a cardiac catheterization procedure to check my coronary arteries for any blockages, and if any were found, they would fix them “while they had the hood open”. So we scheduled the cath for Thursday morning, 17 September, then I would be admitted to the hospital for surgery early on Friday morning, the 18th.

The last few days at work were hectic, similar to going out on vacation. All of my team and management partners were very supportive. They wanted me to focus on getting through surgery and recovery and they would take care of the rest.

Since I have had allergic reactions to iodine, and the cath contrast is iodine based, I started on the hospital’s anti-allergy protocol the night before. 50mg of prednisone 13 hrs, 7hrs and 1hr before the procedure, along with 50mg of Benadryl 1hr before the procedure.

cathprocedure

Thursday morning I got to the hospital and sent straight down to the cath lab. Mom arrived after I was already in the prep area, but she sat with Fran during the procedure. I was given an IV drip and IV sedative (valium?) then sent into the main lab area. I was conscious, and I wanted to watch the procedure. They were going in through my right side groin area so I was propped up on my left side and had a pretty good view of the ginormous monitor set up in the room. Looking around the room reminded me more of a flight deck on a sci-fi movie space ship than an operating room. Lots of LCD stuff, equipment on multi-pivot arms. Lots of chrome, bright white, black and blue lettering. It was impressive.

The whole process is only about an hour long. I got to see them get the catheter up to my heart and felt then saw the contrast solution go through my coronary arteries. That was pretty cool.

The rest of the day was spent napping, watching some TV and just hanging out. Fran went home in the early evening.

Friday Fran came into my room early, around 5:00am. Surgery was scheduled 7:00am. Shortly after she arrived the pre-surgery vitals and IVs got started, and I got a strong sedative in the IV. I’m assuming this was also valium, but don’t know for sure. I vaguely remember getting taken out of the room, but nothing after that point. I’m told that my sister in law Sheryl, and brother Steve and my mom arrived while I was in the procedure. I was in the procedure about 4 hours. After the procedure, Dr. Macgovern gathered everyone in to the conference room and told them that everything went well, and they could see me in recovery. Afterward, they were told to go home as I’d be in recovery for several hours. At some point I started to gag on the ventilation tube, and they pushed me back under a bit longer as they were’t ready for me to come all the way out yet. Approximately 7pm, they did take the tube out and I do recall this, but only from the physically feeling, I don’t recall ever opening my eyes during that process. Fran called the hospital about 8 and was told I was awake and doing well. She zipped down to see me. I was awake, and sitting up in bed, feeling a bit out of sorts, but not as bad as I expected to feel. Of course I was pretty well hopped up on pain meds and still under the influence of anesthesia.

Boy was I happy to see Fran, and I could tell she was really relieved to see me sitting up and smiling. We visited for a bit, then she went home. I was really, really thirsty, but the nurse was strictly limiting my intake as I came more fully out of the anesthesia. I got ice to chew and that helped. I had problems with violent vomiting during my last surgery (hernia, 34 years prior) and did NOT want to go through that again. Any coughing I did was quite painful. I had three chest tubes in me draining out the lungs, one of which wrapped around to my back, and those would rub or vibrate when I had to cough, not to mention the shaking of my chest. I got the standard heart pillow to hug tightly to help cough. I did throw up just a bit, but it was very small. Always listen to the nurses. They do know best. My CICU nurse Lenore, was from Jamaica. Stunningly beautiful, wickedly funny and a total professional. I don’t think I could have been in better hands.

I could not see the clock very well, but I figured I was down in ICU for at least 30 hours. At some point Lenore got me up and sitting upright in a chair. Again, pain levels were no where near what I had expected, and I actually felt pretty good. Sore abs, like I worked my core way to hard. About 10pm while I was sitting up, my mom called. She was pretty upset and had clearly been crying. I knew that she was taking this whole process pretty hard, but she calmed down pretty quickly once she heard my voice and I could tell her that I felt pretty good.

There was a delay in getting room in the Gagnon Center so I hung out in the CICU. I think I got some jello and juice for breakfast, then I finally got the urinary catheter removed, and then transferred to a wheelchair and sent up to my room. I think I was in my final room by 2:00pm.

gagnonroom

The rooms at the Gagnon Center are all single rooms, and set up very nicely. They are visually appealing, spacious and some have halfway decent views of the woods behind the hospital. I’ve stayed in smaller, and much less attractive hotel rooms.

As usual with any stay in the hospital there was an entire team dedicated to my care, and dedicated to ensure I sleep no more than 45 minutes at a stretch. Lots of wake-ups to check vitals (BP, temp, pulse and pulse O2), administer meds and just to see how I was doing. At this point I had three IV lines in my body (each arm, and jugular vein). My meds included pain reduction, which cycled between morphine, percoset and tramadol. I don’t do well on opiates, and by Sunday I really wanted to be off of them. When they kicked in I could not keep my eyes open and all and would be sliding in and out of sleep for hours. Even when the meds were wearing off, I was groggy. They finally settled on alternating between percoset and tramadol, and then finally got off the percoset by Sunday evening.

At some point on Saturday I was weighed in my bed and was told I was up to 181 lbs. I don’t recall EVER being that heavy, but the nurse tech told me that this was all water weight gain. As I looked over my normally vascular arms and legs, I realized I couldn’t see a single vein. I was one puffy boy. But I was also on diuretics and they started kicking in about the time that I was told I could get up and move around on my own. The cardiac rehab nurse came in and had me get up and walk down the hall a bit and back to my room. After she observed this, and I didn’t experience any dizziness or cardio-respiratory issues, I could get up and walk on my own, and should do so a few times each day.

Truly, the most uncomfortable part of the process (besides trying to cough) was the drain tubes. The one that wrapped around the back (inside of me) was irritating nerves in my lower back on the right, and eventually lead to pretty serious referred pain into my shoulder area. There just wasn’t a great way to sit or lie comfortably to relive the discomfort.

But later Sunday afternoon I was told the drains would be coming out. By this time the nursing team and cardiology team were all raving about how quickly I was recovering. I was improving by the hour, and it was a testament to the fitness I was carrying in to the procedure. It also helped that I had no other medical issues, was on no other medication and was a good bit younger than any other patient I met in the hospital during my stay.

Once the drain tubes came out, I was a LOT more comfortable. Slowly the IVs came out as well, until I was just left with the one in my right hand.

Each succeeding night I was left alone for longer durations between meds and vital sign reads. I tried to get back to my usual bed time/lights out at 10:30, and then up by 6:00-6:30. Usually I’d be up earlier as the blood draws would be taken between 4:00-4:30am and I wouldn’t sleep much after.

Sunday and Monday I got to choose all my meals. While I had some appetite, it still wasn’t back to normal mostly due to the pain meds. Also, my lower GI wasn’t working well until late Sunday afternoon. While the food was OK, it wasn’t great and left a lot to be desired. For example, Sunday’s lunch was going to be a chicken Caesar salad. I assumed (wrongly) that it would come with dressing, at least on the side. What I got was cold chicken strips on a bed of dry lettuce with croutons. What I DID find out was that there was a small kitchen area with other food for patients to get as they needed. Simple stuff like jello, juices, sandwiches etc. So I was able to put together a decent PB&J on toast a little later.

cardiacathletes

I also had a great set of visitors stopping by to check in on me. Fran was a constant presence there with me every day. My brother Steve and Andy both stopped by, as did the pastor at our church, is also an old high-school friend. My triathlete friend Matt stopped by as did fellow cardiac athlete Laura. Mom stopped by and brought gifts of a book and a new Tommy Bahama shirt. During the whole time I was in the hospital, I was getting floods of emails, text messages and FB posts supporting my recovery. Friends from all over the world logged in to show their support, well wishes, prayers and simple words of encouragement. There were also a health doses of sarcasm, humor and ass-crackery as befits those who know me best.

zipperclub

On Monday, it was pretty clear that I was recovering well enough to be cut loose on Tuesday, so everything got accelerated. My meds were cut back again, my discharge paperwork started to make it’s way through the system, Dr. Macgovern stopped by to let me know that he was approving my discharge. We did discuss the situation that resulted in needing a sternotomy vs the less invasive process we agreed to post surgery. The explanation he gave indicated that once I was under anesthesia and was intubated, the esophageal echocardiogram showed a very minor leak in the aortic valve. While small enough that it didn’t warrant repair at this time, the drugs that would be used to stop my heart would swell the muscle and it could lead to worsening of the leak, if the muscle wasn’t protected well. He could not ensure adequate protection without going through the sternum, so it was a choice for safety. I have no problems at all with that choice, and given how well I’ve been recovering, I’m not sure it would have made much difference in the end.

Monday night was relatively peaceful. Tuesday morning came and my new RN Laura started gathering up all the info I’d need and we went through all the discharge and post op stuff I’d need once I got done. I did have some nursing students stop in for vitals, as it seems Tuesday is a training day for them. Laura mentioned that I’d be a good patient for the students, since I was doing so well and was positive and upbeat. That felt good to hear.

Finally the cardiologist stopped by to officially declare me “released” and I was able to walk out of the room about 90 minutes later.

Some key points I learned through this process:
The whole process is so much more advanced than I was really prepared for. From the cath process which used a new foam “filler” to close the hole in my vein, to the mix of meds to the total lack of post-op antibiotics, so much was different than I had expected.

Everyone on the med team was more than willing to help me learn about the process. They really wanted to make.

Nurses run the hospital. Ask them questions, listen to their answers and do what they say. They were completely committed to making me as comfortable as possible in order to get me out of the hospital as quickly as possible. I truly appreciated each and everyone of the team of nurses, techs and other staff that worked with me. Total professionals across the board.