A MEDICAL ADVENTURE DURING SPRING BREAK - April 17, 2009

I usually spend my Spring Break traveling somewhere to check out the music scene, going to museums and historical sites during the day, pubs with live music during the early evening, and dance clubs late at night. But this year I had been fighting a virus for a month and was feeling tired, and I couldn’t think of any new place that I was excited to visit. I decided to divide my time resting, catching up on grading, and visiting a fraternity brother who lives two hours away. It was fortunate that I hadn’t made any airline reservations, since I ended up spending my Spring Break in the hospital undergoing medical tests followed by heart surgery the next week. I am now home in a slow recovery process that will take about two months. Here are the details if you are interested.

I went to the hospital on March 29, the Sunday before Spring Break. I had sharp abdominal pain that had been constant since lunch. Many tests were done, including a CAT scan of my abdomen, an MRA scan of my abdomen, an ultrasound of my chest, a chest x-ray, and blood tests. The ultrasound suggested a problem with the mitral valve of my heart, so they did a Transesophogal Echocardiogram, which required swallowing something to numb my throat so I could swallow a tube which could take a close-up ultrasound of my heart. That was not pleasant, but was extremely important. It confirmed that that my mitral valve was leaking severely. Instead of dub-dub, my heartbeat sounded like swish-swish.

The doctors also thought that they saw some vegetation on my valve, meaning a bacterial growth. They were concerned that pieces would break off and go elsewhere such as my brain. So they decided to schedule surgery the next week instead of putting me on antibiotics for six weeks first. They already had me on several antibiotics intravenously and did more tests to prepare for the surgery. They did an angiogram, which required putting a catheter in my leg up to my heart so they could put dye in my heart and see it flow through my arteries in an x-ray. It revealed that my major arteries are clear, so the surgeon would not have to do bypass surgery when he repairs my mitral valve. In bypass surgery, a blood vessel is taken from the leg and attached to the heart to bypass a clogged surgery. That surgery is three times as common as valve surgery. Valve surgery occurs more in tall thin people whom you would not expect to need bypass surgery.

To further check on my abdominal pain they inserted another tube in my esophagus but this time I was sedated. It was used to examine my stomach and found that it was mildly inflamed but not serious. In preparation for the surgery they shaved my arms, chest, abdomen, and legs, and had me shower with antibacterial soap to reduce the chance of infections. It was funny looking at my stomach and below which hadn’t been hairless since I was a pre-adolescent! Having less hair made it less painful later when they pulled off tape holding dressings and tubes in place!

My surgery was April 9. The surgeon cut through my sternum (the breastbone joining my ribs), pulled back the ribs, and made an incision in the right chamber of my heart to access the mitral valve in the left chamber. He found no bacterial growth. Instead, the valve was loose and flopping about like a parachute with a cut cord. It was the floppying that looked like vegetation in the ultrasound. He was able to repair my valve by tightening it up and inserting a ring, the best possible outcome.

A pig or cow valve would have lasted at most 15 years, while an artificial valve would have required being on a blood thinner the rest of my life, instead of just two months during the recovery period. When you are on blood thinner you can bleed or bruise easily and have to take frequent tests of your blood thickness to balance the amount of blood thinner with the green vegetables you eat since they promote coagulation. Now I will be able to travel and eat whatever I want after my recovery period without that concern!

The surgery started at 7 AM and lasted about six hours. That part was easy for me since I was sedated, but hard on my family members who were anxiously waiting for the outcome. I didn’t come out of the anesthesia until around 9 PM. But the anesthesia began to wear off before the medication that paralyzed me. I could see and hear, but I couldn’t move, which was very frustrating. I had a breathing tube in my throat that was uncomfortable and couldn’t be removed until I was breathing on my own. They shifted my head back on the gurney so my legs wouldn’t stick out, which made the breathing tube less comfortable, but I couldn’t tell them. Finally I was able to move my foot back and forth and I tried to signal them. They tried asking me a few questions, but didn’t think of the right one. When I kept shaking my foot they told me to calm down. So I lay still hoping they would remove the tube which they finally did at 10:15. My throat was sore and it hurt to swallow for two days, so I had to chew my food very thoroughly to get it down.

While in the hospital I had my cell phone which is able to receive and send email on a limited basis. This was my lifeline to the rest of the world. But the past few days at home I have been too tired to read email until now.

I was released from the hospital on Monday April 13. I am feeling very tired and having some chest pain. But it is great to have the various tubes out of my body and being able to sleep all night without nurses coming to take blood pressure or draw blood or change an IV. However, I must say that I was very impressed with the doctors, nurses, and other staff at Presbyterian Intercommunity Hospital in Whittier. The new Ed Shannon Tower is a wonderful facility with private rooms. If you need to be hospitalized, it is a great place to be.

During my recovery period, I am supposed to walk an hour every day, initially in segments of 5 minutes slowly building up to 20 minutes at a time. This promotes blood circulation and overall fitness while discouraging the formation of blood clots, a major concern after surgery. I am also supposed to use an inhaler ten times every hour. The inhaler measures the speed and amount of air inhaled, to encourage full expansion of the lungs. My left lung was collapsed during the surgery when I was on the heart-lung machine. If the lungs are not fully expanded, moisture can accumulate and host pneumonia, the other major concern during the recovery period. So far the x-rays have found my lungs clear.

I had a team of doctors in the hospital, including a cardiac specialist, an infectious disease specialist, the surgeon, and three others on the units who coordinated with the others. I had an appointment with the cardiac specialist yesterday. He said that the tiredness and chest pain were normal, and that he would only be concerned about shortness of breath and fever in regard to my heart. He said that my heart was fixed and that I was doing excellent! I also went to the Coumadin Clinic to have the thickness of my blood tested. The measurement indicates how quickly the blood coagulates. The target range for my surgery is 2-3 to prevent blood clotting. My reading was 1.5 which means that the blood is too thick, so I was told to increase the amount of the blood thinner Coumadin.

I need to return to the Coumadin Clinic next Tuesday to check my blood thickness again. I also have appointments next week with the surgeon and with my family doctor. And I will begin the Cardiac Rehabilitation Program next Monday, which lasts an hour three times a week for eight weeks. That program will have me on a treadmill and exercise machines while monitoring my heart.

My recovery should take about six to eight weeks. It takes that long for bone to heal. My sternum is wired together and the wires will stay there permanently. I also have some thin electrical wires that were used to hook up my heart to a pacemaker after surgery; they were clipped and will remain since pulling them out might cause my heart to bleed. Totally removed are the tubes in my arm and neck for intravenous administration of saline, antibiotics, and other medications; the catheter for urination, and the tubes for draining my chest cavity after surgery. I didn’t mind the intravenous tubes, but it was nice to be able to urinate normally, and the drainage tubes irritated my lung when I breathed deeply.

During the next two months I cannot lift more than 5 pounds, and I cannot teach. But I can do some computer work and I hope to do some of the grading for my courses. I appreciate the support of my colleagues and the college in covering my courses. I hope to attend Commencement on May 22 to see my students graduate, although I may need to be in the stands rather than parading in my gown.

My daughter flew home from Ireland to be with me; she has a month break in her teaching there. She and my wife have been taking turns walking with me and encouraging me to do the breathing exercises. My daughter sent an email to everyone in my email directory telling of the surgery, and I have received encouraging emails from friends all over the world. I have also received nice get well cards as well. I very much appreciate the concern and support. I have cool friends! Some have told me about experiences with heart surgery of their own, their parents, or their friends, saying that the recovery process is very slow, but people return with energy afterward. Some have asked for more information about the surgery, which is why I am sending this description which may give more medical details than some want to know!

Take care and stay healthy! Chuck