Totally OT: the plan for my heart

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Since my heart murmur was discovered about 2 months ago, I have had
various tests:

  1. Ultrasound
  2. TEE (Transespohageal ultrasound)
  3. CT scan with and without contrast.

These revealed severe aortic valve stenosis with severe calcification
and an aneurysm of the ascending aorta.

I just finished a video conference with Dr. Samuel Youssef, a cardiac
surgeon at Swedish Hospital.

https://nam02.safelinks.protection.outlook.com/?url=https%3A%2F%2Furldefense.com%2Fv3%2F__https%3A%2F%2Fwww.swedish.org%2Fdoctors%2Fcardiac-surgery%2Fwa%2Fseattle%2Fsamuel-youssef-1639330475__%3B!!O_uxFMb7JX5IyXsN!vKMwRmyvqyEKlqwzZ_AxilyK1CenugkwkPUbGoe2OKmy9kIcg_t0-vuWT6DC1qp-ZgyyUesLfSeqxTGqBsIFo-U%24&data=05%7C02%7Craronin%40citytech.cuny.edu%7C51cc002d62b44f56eccd08dccc698314%7C6f60f0b35f064e099715989dba8cc7d8%7C0%7C0%7C638610000782149632%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&sdata=iH%2BO5o8ARU8OWL88y8R01MPb22yOjHXTfltMEM4lb7g%3D&reserved=0

Dr. Youssef and my cardiologist, Dr. Chang, agree that I will need
open-heart surgery (SAVR, or surgical aortic valve replacement) to
remove the heavy calcium buildup and replace the valve and aortic
aneurysm. This is a 5-hour surgery.

TAVR (transcatheter aortic valve replacement, a minimally-invasive
technique) isnā€™t an option due to the need to remove the calcium buildup
and replace the aorta.

The valve placed during SAVR will be significantly larger than a valve
placed by TAVR so I should have better function and also ability to
repair it later should that be needed.

Since I donā€™t have any symptoms the surgery isnā€™t urgent. Dr. Youssef
recommends a date in November. Heā€™s booked solid until then. It works
for me so I can fly east for my cousinā€™s wedding where the whole family will be together. (I will get vaccinated and exercise care since her sisterā€™s wedding in June was a Covid super-spreader event.)

Recovery will be 1 day in the ICU followed by 5 days on a regular
surgical floor.

I did 10 years of back taxes for a friend earlier this year. Iā€™ll call in the favor to house-sit my dogs.

DH and I will have to make a separate trip to Seattle before the surgery
for an angiogram and to meet with Dr. Youssef.

This plan isnā€™t a surprise to me since itā€™s exactly what I expected from the
test results.

Wendy

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Best of luck! (plus additional characters)

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Sounds like a solid plan.

If any replacement of other blood vessels is involved, most surgeons prefer to do open-heart so they have access to everything that might need work.

I had the same thing done in 2012 after a heart murmor since birth had snowballed into an enlarged heart and an aortic aneurysm resulting from high blood pressure caused by the heart pumping so hard to compensate for the aortic valve that wouldnā€™t fully close. The aortic arch was replaced with a Dacron sleeve sewed onto the new mechanical valve and back to the rest of the plumbing.

My surgeon also had an CAT scan performed of the heart so he had a complete 3D model to examine for weeks prior to the procedure so he was very rehearsed at exactly what he would encounter and what his game plan was. He also ordered a heart catheterization the day before just to get a final physical look inside before surgery. I was admitted around noon on a Thursday for the cath, stayed overnight, entered surgery around 7:30am, was out by 1:30pm, in an ICU until about noon on Saturday and was discharged Wednesday morning.

I had never had ANY surgery prior to that (nor any since) and I was very fortunate but my procedure and recovery were flawless. Never had any real pain from the incision or the sternum. Youā€™ll get a big red heart-shaped pillow (itā€™s like a law or somethinā€™ā€¦) when released to the regular hospital room to hold against your chest when coughing cuz there is a bit of dull pain for the first week or so from that.

Honestly, the most unnerving part of the entire process involved the removal of the chest tube and cardiac leads about 2 days after surgery. After any major heart surgery, the heart can sometime get ā€œconfusedā€ and its pacemaker can suddenly have trouble generating a steady rythm. To make it easy to correct that, leads are left connected to the heart after surgery. If you have problems, they can connect the leads and zap you to re-establish sinus rythm. After a day or two when itā€™s clear the heart is not having any problems generating its normal sinus pattern, the leads have to be removed. How? Well, theyā€™re not going to cut you open again. Two of the surgeonā€™s assistants will come in and (gulp) simply pull them. It wasnā€™t painful, but it did create a sensation that canā€™t be described. One second and done.

I walked the entire length of the hospital floor on my first venture out of bed on Saturday evening (first day in the non-ICU room). I imagine you will be ambulatory nearly immediately as well. The only other thing I found odd about the post-op care was that they had me on insulin, even though I was not needing it prior to the surgery or since. I think that is simply a precaution because they want fine control of blood sugars after a major surgery as a means of spotting other potential complications.

WTH

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Wishing you the very best care, a speedy recovery, and more handstands in your future.

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It sounds like the best of times to be alive. The good doctors can very constructively do a lot for you.

Letā€™s hope for a speedy recovery.

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I have had
Splenectomy, age 16. It was a little freaky when they pulled the drain tube out of my abdomen.
Hysterectomy, age 54.
Bilateral mastectomy and reconstruction surgery, age 61. I was sent home the next day and had to manage the drains myself. I sewed pockets into the inside of my tops so I didnā€™t have to deal with safety pins. Of course, the tubes were pulled out after they werenā€™t needed anymore.

My torso is covered with scars. The sternum scar will be in a spot where I donā€™t already have a scar.

Iā€™m glad to hear that you healed so quickly after your successful surgery.
Wendy

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My husbandā€™s bio-Bentall took about 6 hoursā€¦with just under 2 of those hours on cardiopulmonary bypass. The cardio thoracic surgeon who did the procedure had estimated a bit longer, but maybe was used to having to hack through a few inches of blubber and deal with coronary arteries in the sort of shape that mine are. I was there in his room first thing in the morning when they extubated him. That was a bit unnerving as I could tell he was a bit panicked at the choking sensation. Also, having come through the procedure well, the next thing to worry about after a period on bypass was ā€œPump Headā€. Staff mustā€™ve thought we were crazy as I immediately asked him who was the prime minister of Bangladesh (a bit of a joke as this is one of his ā€œtrickā€ questions when doing cognitive assessments on his encephalopathic patientsā€¦designed to break the tension for relatives) A big smile and a thumbs up reassured me there was no cognitive knock off. Removing the drains was the next hurdle.

I donā€™t think either of us were expecting him to be so debilitated for so long. I shouldā€™ve had a clue as the social worker kept coming to ask me to consider getting home nursing care. He was struggling for a good 2 weeks after his discharge. Fortunately didnā€™t need supplemental oxygen (always a possibility at altitude) Wasnā€™t long before he was back at work ā€¦even before heā€™d finished rehab.

Of course, donā€™t skimp on the pain meds, either. I wish you the very best. I donā€™t know whether itā€™s better to have it all hapen as an emergency without any real ability for decision making or to have time to thinkā€¦and fretā€¦for an extended period, but either way, looking back on a successful procedure is going to feel best.

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Good luck with the surgery, and wish you a speedy recovery

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Wishing you the best with surgery and for a speedy recovery.

Iā€™d offer to watch the board for you when youā€™re out, but we all know how that would end up. :grin:

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All the best, maybe a chance to enjoy the Seattle weather! Planning should pay off nicely!

weco

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@AlphaWolf thanks for the great laugh!
Wendy

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There is no question that having time to think and plan is much better than an emergency. My beloved younger sister will be able to fly from NJ to help DH take care of me. I will be able to cook and freeze some nutritious meals (such as my chicken soup with quinoa).

Iā€™m so into planning that a friend gave me a poster: ā€œI plan to be more SPONTANEOUS in the future.ā€

Thanks for sharing your husbandā€™s experience.
Wendy

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The surgery will be in November, the heart of the rainy season in Seattle. Then the place to be is in the rain shadow of the Olympic Mountains ā€“ i.e. Sequim, where we live.

https://www.olympicrainshadow.com/olympicrainshadowmap.html

Wendy

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Absolutely! My best wishes for a good recovery.

The Captain

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Oh man. I am about five weeks out from having been cracked open, so got some immediate thoughts for you. LOL. I was having extreme chest pain, (I have learned that it is nothing like heart burn btw) and then one night woke up in severe breathing distress and went to ER. They dismissed me as having a panic attack.
Sigh.
So, I got to my primary care and insisted on a stress test. I failed it in about two minutes.
One double bi-pass later and I am in recovery, and it has been the worst part. Like, I would take the one week of pain in the hospital recovery ward all over again just to get past this extended recovery where I cannot lift anything or work on all the summer projects around our land.

GAH.

Butā€¦here is what I have learned. The recovery restrictions post splitting open your chest are serious. I have caused my own extended pain/discomfort by trying to push, trying to force the healing. Our two dogs are a bit over 10lbs, but heck so are groceries, trash bags, solar panels, lumber (you need to get out of truck), etc. This is what is going to drive me batty, but I have created a situation where a couple of my ribs want to just pop around, in and out of the socket/cartilage on my sternum.

So plan for the down time. Mine is supposed to be SIX MONTHS until back to full power. Sigh. (They didnā€™t say six months before surgery, just the 10lb restriction for a few weeks.)

That chest pain is also from no lifting, so be aware of that too. Brushing teeth uses those muscles, tying garbage bags use those muscles, steering the car uses those muscles, trying to break down recycling uses those muscles. So many things that are not ā€˜liftingā€™.

My rehab was booked way out, so itā€™s going to be almost 9 weeks post surgery before I can get in. I have been getting more and more serious about the walking around the yard/neighborhood. I have incorporated very light band work outs (I found the GFā€™s workout bands in a box and figured those can be very light resistance). I also have been doing a bit more tai chi to work on my breathing. Seems I still need to work deep breaths even after I finished the work with the breathing regulator/exerciser thing.

I do work remotely, so I was able to get back to work before I was allowed to drive again. But still, I sit here looking out at the yard and all the projects I now cannot finish this summer.

Take your recovery slowly and try not to be as OCD/ADHD as I am. :slight_smile:

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Hope you are beginning to feel better.

Smart advice.

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Sounds like you and your docs have the best possible plan in place. I wish you a seamless surgery and full recovery.

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Thanks for your detailed description of recovery. This is valuable information. Maybe I should start booking rehab now since the surgery will be in November.

Wendy

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@dlbuffy ā€¦oh boy, did your account trigger a few more unpleasant memories. I certainly donā€™t think my husband was expecting such long term debilitating effects (over and above the pain)ā€¦or, for that matter, how severe and long lasting the post op pain was going to be. He found out the hard way that staying ahead of the pain was a valid principle of effective pain management and it applied to him.

I stayed in his room except for a couple of quick trips home so spent a fair amount of time in the elevators going up and down to the cafeteria. One thing that REALLY stuck in my craw was that the inside of the elevator doors were being used as a billboard for the Campaign Against Opioid Overuse/Abuseā€¦and were plastered with admonishments for folk to ā€œask their doctor if these drugs are absolutely necessaryā€. Which might very well be appropriate in some casesā€¦but probably not the express to the Cardiac ICU etc floor! I was traveling with the cardio thoracic surgeon one morning and asked him if any of his patients had asked him that question recently. He couldnā€™t think of one offhand.

@WendyBG ā€¦put adequate pain meds on your pre-planning list too. I had the extraordinary experience of almost running out with plenty of pain left after this recent lapiplasty. No problems in getting a few more days supply called in to the local pharmacyā€¦but their deliveries were so erratic that my husband had to call around to see which pharmacy had a supply in stock and then get a new prescription sent there.

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Good luck Wendy! In the meantime, eat healthy, exercise (gently), and all that stuff.