There were a fair number of surprises.
The biggest by far was that I needed OHS at all.
First surprise: Thought I had pneumonia 12/9/07 and was sent home from ER with a diagnosis of pulmonary fibrosis (wrong!)
Second surprise: Was again at ER 12/10/07 and sat in waiting room breathing 50-60 times a minute for almost 3 hours because my oximeter reading showed 92% saturation.
Third surprise: Was admitted finally with "atypical pneumonia" with a 102° F fever. Again wrong (in part this time) diagnosis.
Fourth surprise: Was able to eat a 'hearty' blue taco meal (a patient favorite at St. Luke's Twin Falls MVRMC) while on 10 liters O2 with a Bi-PAP mask.
Then the final one before anyone figured out what was at the 'heart' of my troubles: I retained every single bit of fluid I drank or received by IV and gained 15 lbs. literally overnight.
An echocardiogram technician and I were the ones to figure out something bad had happened to my mitral valve-he actually showed me the screen with the blurred--lots of retained fluids already--image of my heart and I noticed how my mitral valve was flopping up way too high during systole (the doctors hadn't connected the dots yet). He agreed with my observation and got my wife (she's MD, but wasn't supposed to be the one consulted) and she concurred. She also was a mixture of very annoyed that the other doctors had missed this, and terrified because she knew what she was seeing.
Once they did get it....
The on-call cardiologist contacted the Idaho CDC because he was convinced that I had contracted a virulent heart-attacking disease of possible terrorist origin, and recommended that I be placed in isolation. He was furious that I had taken a high dose of antibiotics because of the diagnosis of pneumonia.
I didn't mind the arterial line put in my right wrist, and actually begged later to have it put back in when the blood sugar finger pricks became truly unbearable for me.
I didn't mind the Swan Ganz catheter being placed in my neck--didn't hurt and I liked hearing about what each probe and such did.
My IV needle in my right arm that was put in during my second admission to the ER stayed patent (as in working and open) for the entire duration of the OHS and recovery, only to be removed when I was released to go home.
Another surprise: On diuretics one can lose a lot of weight very quickly. I lost 25lbs. of water weight in just over six hours.
Also surprised I was actually too sick and unstable for a life-flight to Boise St. Luke's (12/11/07) until I got the same water weight off.
The two nurses (one of whom became afterward a very close family friend) who put in my Foley catheter did it wrong, and I leaked urine all around it and felt really uncomfortable in the prostate area. After I couldn't get anyone to help me I actually pushed it in the rest of the way myself until it 'felt right' and then blessed relief....
The retrograde amnesia for the Versed was welcome because I was told I struggled so hard that it took several people to intubate me successfully.
They had to drive me in an ambulance the 200 feet to the helipad from the ICU outside door late morning 12/12/07
I was briefly awakened (and still remember clearly) at Boise for prayer with the pastor and was surprised it was a woman (didn't know I had arrived in Boise and thought it was the male pastor from our local church).
Found out I was in such critical condition that they had no time to neatly prepare me for surgery; instead they just gave me a rough shave and made the first incision only 20 minutes after I arrived (about 5 minutes after the prayer--the Versed was turned on again so my memory was blank).
My wife was initially told I had a mechanical valve (On-X I think) put in, when really my mitral valve prolapse had provided enough tissue to compensate for removal of my torn central scallop of my leaflet, and thus a good repair instead.
My heart, upon its first 'taste' of blood, when the clamps were loosened, began to beat again spontaneously; it was raring to go after its 63 minute rest.
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She saw me just post-op, and saw readings on me, and from her ER experience, saw stuff that nearly made her faint as everyone else she had seen with the same readings had been dead within less than ten minutes--then told by the Intensivist that I had improved significantly already.
I questioned my "sickest patient in the CICU" status to the Intensivist and he matter of fact told me that it had been indeed true.
Because of the pulmonary edema, complicated by pneumonia, the doctors expected me to be intubated for at least three weeks and hospitalized for two months.
Because of God being deluged by 110 prayer chains, I was extubated after 1 1/2 days and released eight days after surgery to go home--surprised the hospital staff, but not me as much because I know God loves me.
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Because Laura said I had great PEEP ability (forceful coughing, etc.) I could deal with my own lung clearing. Lots of blood clots (my 'blood sausage' as it were) later, I was breathing easy.
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I passed my "chitty-chat" test without knowing it while on my first walk around the CICU--they wanted to see if I could talk and walk at the same time. I did.
While Versed was supposed to suppress all my memories, I distinctly recall being flipped over onto warm wet towels and rubbed and cleaned by some nurses, but my visual memory was of vague blurred figures in a gray, foggy shroud.
Laura told me that I had written on notepaper several times over the previous day, "Please extubate me." Of course no recall.
When Laura told me, within minutes of the Versed being withdrawn, that I had a "zipper" in my chest, my first thought was that I had some sort of strange surgical zipper put in my chest and sternum because of some precarious condition that might require getting back inside me in a huge hurry.
http://www.valvereplacement.org/forums/images/smilies/confused.gif I really had been glued and stainless steel sutured back together.
My bowels announced their waking up with a loud fart. I was a bit embarrassed, but the nurses told me it was good that I did that. Everything came out okay from that point onward.
I needed to hear running water after the Foley was removed so I could get my urinary sphincter to work again. Eventually it worked, and I never had to use the Foley again.
I had really fun and creative dreams. The ones I recalled and wrote down I have used as starts for several novels I'm working on.
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My first requests for moisture were met by some funny-looking barely damp bluish sponge-like things on the ends of sticks; it was almost a day before I got my first ice chips. Then I got a whole cup of chips and savored each one slowly.
I had three chest tubes. I was expecting pain when they were pulled out, but instead I felt this extremely weird "slithery" feeling as they were withdrawn--unpleasant, but not really painful.
The pacing wires were another story: When the first one was pulled, the pain was severe and I felt as if someone had pulled the ripcord on a parachute being yanked out through the same hole. Then the the second wire was like the reserve chute being dragged after it. I felt something else being dragged out that time, and saw a glistening piece of dark purplish red 'meat' on the end of that wire. I asked if it was a bit of my heart and the nurse, matter of factly said that it was.
When I looked in a mirror for the first time post-surgery I was shocked at how deep my eyes had sunken in and how badly my gums had receded; both returned to normal within about a month.
My worst part of the entire experience was the finger sticks for getting blood for the glucometer. They hurt. For the first four days I had blood taken from my arterial line, but after that the torture began. I burst into intense sweats that actually soaked my clothes and ran down my face to drip onto the floor, making small puddles--sort of like what Jesus may have been sweating like in the Garden of Gethsemane--whenever I was scheduled for a finger prick. This actually freaked out some of the nurses so they didn't come back. During the pricks my pulse rate rose alarmingly, and it was all I could do to keep myself from desperately kicking away the unfortunate soul who had to do the procedure, and run from the room. I even was willing to sign out against medical advise just to avoid them. Ironically, my fear made it worse because I would blanch and lose virtually all blood flow to my extremities; I actually went into shock with each stick, and frequently before it was attempted. Only Laura being there made it bearable, and even then she had to frequently hold and sooth me as I cried for several minutes or longer after most of them.
I enjoyed my first shower and really enjoyed being able to blow-dry my hair (it looked like dirty matted dog fur until that point).
I found that I had absolutely no desire to read anything at all at the hospital; normally I'm a voracious reader. I also found that I had no interest in watching television or playing any sort of board games. Conversation with Laura or medical staff filled my time.
My appetite returned very quickly and I really enjoyed the food, except at first I found it bland enough that for the first time in my life I actually enjoyed using hot sauce on stuff. By the last day I no longer wanted hot sauce, as I could taste the full flavor of the food without any more trouble.
Even more shocked to find out I had a 15% chance of outright dying after the successful procedure, and 50% chance of disabling brain damage. Turns out the figures were really 50% for death and 90% for varying types of permanent disability because of the combination of pneumonia and pulmonary edema damage to my lungs, but Dr. Huerd didn't want to scare me at the time.
I was surprised at how rapid my pulse remained despite heavy doses of Toprol (about 90-100 bpm), and eventually quit Toprol and metoporol because I only experienced a bunch of the side-effects and had no therapeutic response. Even now my heart rate seldom goes below 70 bpm despite my higher level of aerobic fitness.
The bed had massage units built into it that tipped me at random moments in all sorts of directions, making sleep difficult.
I liked the sleeves they put over my legs that massaged them; this felt a lot better than the bed did.
This was a surprise for the physical therapist: I was not supposed to be released until I could climb up and down a flight of stairs. I went a full floor up and a full floor down on my first attempt on day 6 post surgery, and showed him that I could lower myself to the floor and get off the floor without assistance and without use of my arms very easily. His only task was to teach me how to get into and out of bed without hurting myself.
My cough pillow was a teddy bear named "Sir Cough-a-Lot" and I used it a lot at first.
I found a method involving putting my fingers on certain places just inside my nostrils that enabled me to avoid sneezing for two months post-surgery.
My scar, which for the first month had seemed to be healing nice and small, eventually bulged out and starting itching a lot. Turns out I am allergic to the allegedly "dissolving" internal sutures used beneath the glued skin.
I lost much of my accommodation, and had to start wearing reading glasses for the first time post-surgery.
I have some aphasia that comes and goes, plus have slightly diminished problem-solving skills.
The scotomata I got post surgery was in two forms. One was severe visual field defects with large areas where I could only see the blue and purple end of the spectrum. My eyes ached a bit when I had those kinds, but they were rare and quickly went away. The other was more fun: cool-looking moving Moire patterns, sometimes rainbow colored, other times black and white. These would move, and amazingly I saw these kinds appear in some of the "cool dreams" I had during early recovery. Found out later that these were supposed to be migraine auras, but I never experienced a headache after any of these episodes.
The battle with depression has yet to be won. It's common post-surgery, and I've been trying various therapies for years with only partial success.
My posture improved due to my efforts to align my back by controlled slams against door frames, and hanging backward over the end of my bed in the weeks immediately following coming home from the OHS. The change appears permanent, as I was unable to lay flat without pain on the floor before surgery, and now I can. Because of this I may even be spared the condition that rendered both my father and grandfather unable to stand fully erect because of permanently stooped shoulders (my father is still alive at 79).
Balance and coordination is much better so I have been able to inline skate fast for the first time in my life and was able to take up Tae Kwon Do two years ago. Now I am only two belts away from black belt (advanced 8 belts so far).
Finally, I find that when I first exert myself I get very short of breath for a few minutes, then I catch up and am able to exert myself much more intensely. It's almost as if my heart doesn't realize I need more blood flow for a few minutes, then gets the idea.
I realize this is long, but I thought that at least some of what I went through could be informative and possibly helpful for other people who read this. Sorry for my long absence, but the depression I mentioned above has taken its toll on a lot of things.
Chris
