3 weeks post surgery

I continue to improve - less pain, less coughing, more energy for activity.  I had a small set back on pain last week when shoulder muscles become less swollen putting more pressure on incision, but continuing Tylenol on 4 hour basis has worked.

Now if it would just get over 50 degrees here (we are being unseasonably cold) I could try walking to the end of the block and back again.  I want to see the daffodils and other spring flowers that have sprung despite the temperatures.

Taking stock, 14 days post surgery

All indications are that I am doing very well:

• The incision that was superglued closed has healed up well without ugly wormy look and the external bruising has disappeared
• I am down to taking 1 acetaminophen every 4 hours as I sleep so my pain is almost gone
• All fluid is staying off
• I can dress myself and take a shower which means I have no problems lifting my arms over my head
• My appetite is fair but that is ok
• I have no problems doing the exercises that the physical therapist recommended
• The cardiologist gave me ok today to start taking vitamins and fish oil again
• I am able to do crossword puzzles again which means I have thrown off all the fuzziness caused by the pain medications
• I get tired but not as easily as before the operation, part of that is the ferrous sulfate I am still taking

So, I credit the wonderful doctors and nurses and all the good thoughts and prayers of family, friends, and acquaintances.  Thank you all.

Feeling connected

I didn't realize how much I feel tethered to family and friends with my iPhone until I didn't have it until Wednesday evening after my surgery.  My sister and nephew brought it up and I breathed a sigh of relief.  I had tunes; I had text messaging to my daughter; I had email; I could read BOOKS.   

My fingers were still swollen and stiff with fluid making it awkward to use the keyboard but not impossible if I held it in landscape mode and swiping thru books was easy.  My sister had brought my iPad too but I had her take it back home as it was too heavy for me to hold for long periods.  Fortunately, Penn Presbyterian Medical Center had a guest WIFI network so I was in business and connected again.

There was a TV in the room that I could have used for a small daily fee but I never turned it on.  I had NetNewsWire to get news and I was glad that in the cooler medium of print I could read about the tragedy as it unfolded in Japan.  As it was, even reading about it was upsetting enough and invaded my dreams, which was not conducive to getting healed.

My only complaint about using the iPhone in the hospital was that the cord for recharging was really just six inches too short.  As the battery got low, I could have the staff scoot the reclining chair back sufficiently to go on reading but that didn't work for the hospital bed.  I am sure I could have purchased a longer one if I had thought of it ahead of time, but I didn't.

Someone else's hero

Penn Presbyterian is a teaching hospital, which means that on weekends, nursing students from area schools get to practice what they learn in the classroom.  I had one student nurse on Saturday and a team of two on Sunday.  They all made me smile. 

It turned out that I had a personal link to their supervisor so I got VIP treatment.  In the seventies and eighties, my Mom had gone to college and taught as school librarian/media specialist at a rural school in  a farming community in Cumberland County NJ that had may be 100 books when she started.  She established the library as a real part  of curriculum for that elementary school and brought in computers (the first were Commodore 64s).  An addition was added to the school and it included a dedicated library where each class had some time each week with my Mom, who supplemented their course work or added books that answered their questions.  The nursing student's supervisor was one of those students - now with a PhD and lots of responsibility for a nursing educational program.  And, he credits my Mom with (direct quote) "making me what I am today" by opening his mind to broader ideas and possibilities than following the expected career of becoming a farmer, to which he is totally unsuited.  It would have been a waste of an inquiring, caring mind.

So, it was a week of identifying heroes (more properly heroines) with my son writing a  sweet tribute about me and my encountering someone whose life had been deeply touched and improved through my Mother's dedication to being a librarian who made a real difference that ripples still through many others' lives.

On medications

In the hospital, some of the medications are administered intravenously and others by mouth.  The diurectic, which was removing all the excess pounds of fluid, was given intravenously.  Fortunately, they had inserted the intravenous portal before any surgery as my veins are small and - "nurse tech talk here" - they roll when you try to put a needle in them.  I, of course, knew this as I have had blood taken since I was 17 and had appendectomy.  I also knew they were really terrible because once I tried to donate blood - my type is semi-rare being A negative - and after 4 attempts to fill a pint bottle, the Red Cross people told me never to come back again.

So, the medications I was taking meant they had to test my blood sometimes twice a day, potassium loss from the diuretic being a biggie.  This was a trial because the workable veins are hard to find in the beginning and with all that fluid they seemed to disappear.  I still have many bruises in my arms and hands from failed and successful attempts.  The worse part was after 4 days, they need to put in a new intravenous portal to prevent infections and clotting.  There were numerous attempts by the "best" nurses and only 8 hours after the "due" date, one nurse succeeded.  Of course, I was still losing fluid which made it possible though still difficult.

One evening I started to feel like I was about to hiccup - it was my heart doing an atypical rhythm called afib for short.  The heart monitor told the nurses it was happening and they immediately came to administer intravenously something to get me back to normal sinus rhythm.  I am still taking medication for it at home.  The doctor calmed any fears by reporting that 40% of aortic valve replacement patients have this occur, which is why patients have to wear a heart monitor throughout the hospital stay.  Fortunately, I will not have to take this pill forever as it makes me a bit woozy.

At home, I am taking less prescribed medications but, after discussing it with the medication nurse specialist, I added back in some things they were giving me in the hospital and my allergy medicine now that I am home with the cat.  The meds I continued that were not directly prescribed are a stool softener, an acid reducer (Pepcid in particular), and Cepacol throat lozenges.  My stomach throws a lot of acid back up my throat (acid reflux) in reaction to medications so the Pepcid helps it not be so corrosive and the Cepacol soothes my irritated throat.

The biggest medicine topic for me is that since I chose a tissue rather than metal/plastic valve, I do not have to take Coumodin (warfarin).  Clumsy as I am, this is a big plus not to have to be careful about bruising, falling, or worrying about blood draws not clotting.

The only thing I will have to take is an antibiotic before any dental work or cleaning.  I can easily adapt.

warning - plain talk of poo and pee

The nursing staff has smelly, disgusting work as each patient recovers from their major surgery and the anesthesia.  Anesthesia shuts down the digestive track and sometimes has to be shocked into working correctly.

The excess fluid in my body made me very clumsy and unable to work my fingers very well. So the first time the foley bag was out and I peed into the cup (urine output has to be measured), I couldn't even blot myself.  That was embarrassing to say the least, but the nurse assistant was so gentle and took it all in stride.  Another day, he was back just to see how I was improving and put his hand softly on my shoulder - it felt like a healing touch and reminded me how often my father would put his hand on your shoulder just like that to say he was there to help if you needed it.  Thanks, Delmar.  It meant a lot.

So, for a couple of days, I needed assistance to get in and out of bed just to pee and they would often have to unhook me from the oxygen and the leg cuffs that massage to keep circulation and muscle tone up.  I did get able to blot after a couple of trips to the toilet, thank goodness.

The fluid pervades everywhere including into your lungs and so you have to breathe into this contraption that encourages you to expand your lungs (ouch) 10 times an hour when you are awake and it encourages you to cough up the fluid.  Well, about Thursday, I had plenty of bowel tones and smelly, smelly gas but no action so they gave me laxatives twice along with the stool softeners I was already getting.  The stool softeners are because they are giving me iron as ferrous sulfate and that causes constipation.  So I am getting lots more gas and just as I was getting ready for bed, we had success with a bowel movement on the toilet.  The nurse and I thought all was good, and I feel asleep.

A couple of hours later I woke to a coughing spell and promptly pooped all in the bed before I could ring for the nurse.  What a mess!  Cleaning me off was problematic because the ferrous sulfate makes the poo green black and sticky and the stool softener make the poo soft enough to get in the nooks and crannies that women have.  It must have taken half and hour to clean me off and remake the bed.  This time they put a diaper liner under me just in case.  That was a good thing, because it happened again closer to morning.  At least this time, there was a diaper to dispose of instead of all new bed linen.

Fortunately for me, they removed the drain and cat whiskers on Friday and I was able to take a shower.  It felt heavenly.

I was still retaining too much fluid as they increased the dosage of diuretic each day but on Sunday, I finally peed out more than five pounds of fluid and my weight was back to normal.  This was key to going home.

My chest sprouted cat whiskers?

Before I left ICU on Tuesday, they had to remove several things: (1) inter venous line feeding me fluid and food and (2) Swan-Ganz catheter.  However, they left in several long wires that they could have used to regulate my heart rhythm if needed.  I looked down and it seemed I had sprouted cat whiskers.  They also left in place a drain bulb that was collecting excess fluid from the pericardium - the sac containing the heart.

Removing the Swan-Ganz catheter started me down a slope of pain and acute nausea, which wouldn't completely clear up until Thursday.  I consumed unsalted top crackers so I could take my medications.  Most of the nausea was from pain medications.  After morphine, Percocet (oxycodone and acetaminophen) is normal but I can't take it without feeling sick.  Next we tried acetaminophen with codeine but that just made me sleepy and slightly sick so that food smelled and tasted awful.  I needed to be able to eat to get my strength back.  And, I needed to relieve the pain from the deep bruising etc to heal.  It's been proven by studies in the 1980's that if a patient is spending all their effort to ignore and deal with pain, they don't improve or heal as quickly.

Finally on Thursday, one of the nurses suggested moving me to Motrin (Ibuprofen) because I was still so swollen around the incision.  And, voila, nausea was gone.  Unfortunately, it made me more of a pin cushion as the ibuprofen had to be monitored relative to my kidney function but for me, it was a better choice.  

Waking up after surgery the pain was horrendous -- in my thumb!

The last thing I remember was the anesthesiologist telling me not to panic if I was still intubated when I awoke again as they taped a surgical cap to keep my hair off my neck.  I was still intubated (breathing assist tube down your throat) as I awoke to the sounds of the beeps in the ICU so I could not tell the nurse of the awful pain in the thumb on my left hand.  Half an hour later they removed the tube and I could complain but that was a long half hour.  Turns out, they had taped the pulsimeter (measures heart rate and amount of oxygen you are breathing in) to my thumb at such an angle to activate the arthritis pain I have in the joint at the base of my thumb. 

Soon after giving me a chip of ice to ease the soreness in my throat, they got me out of bed to do two things, sit up for awhile and most importantly, weigh me.  They had weighed me going in and were weighing me know to find out how much extra fluid the heart-lung machine had left in my body.  Turns out I was an overachiever at 20 pounds.  This excess fluid was what so distorted my face that my sister didn't recognize me when they let her into the ICU before she had to go back to NJ.  This is common but a friend of mine told me that the ICU nurses often don't warn family that their loved one will not look normal because of the fluid as it happened to her when her father had a mitral valve repair.  She said, "you are sure this is my father?", as she checked his wrist identification band.  Interesting that we hide more as we "fatten" than as we slim down.

So I sat up for several hours as the morphine wore off and they tried to give me some food and water and other pain relief.    Close to midnight, I was transferred to a room on the surgical recovery ward.  The ICU nurse had let my daughter know so everyone family wise breathed a sigh of relief.

Home is where the heart is now

I survived the surgery, which went very well, now just making one day at a time through the long recovery procedure.  I want to thank the superb staff at Penn Presbyterian, who work well as team and individually to make the patient experience as positive as possible.  As complicated as recovery is from heart surgery, they had an answer for every contingency.

In following posts, I will let you in on what happened but here is a little tease.  How come my own sister didn't recognize me a couple hours after the surgery?

Got my final instructions for surgery on Monday Mar 7th

The scheduling nurse just called.  I need to be in there at 6am.  I go into Penn Presbyterian at the Cupp Building, then follow the signs to the Wright Saunders building.  Then I take the elevator to the third floor and find the Heart and Vascular Unit.  I am to bring no valuables or cash.  The clothes I wear in will go home with my sister as I will not be able to have anything in the ICU after surgery.  That means I will have to pack a bag with going home clothes for her to bring in later in that week.

I am not to eat  or drink after midnight nor take any pills.  No brushing of teeth or swilling of water in my mouth.  I hate morning mouth, oh well.