I've crossed the line into severe and need to make a decision

[Chuck C]

Day 3. Still in ICU but there is talk of releasing me soon to the general recovery.

Last night was difficult. My magnesium dropped and I went into a fib for an hour with heart rate between 130 and 150. Pretty tiring and painful. Fortunately they were able to restore sinus rhythm and it seems stable now. Hoping to get the tubes out today which should be a game changer.

INR is 1.9

 

[bizinsider]

Not fun, NO sir! We all feel your pain because we all had it! Hang in there - you're almost there. I promise. If not, lunch is on me!

 

[Unicusp]

I haven’t gained more than one or 2 pounds

That's amazing. I gained ~ 14lbs / 2 gallons of liquid that took about 1.5 weeks to get rid of. Was told it was normal too. Maybe the difference between full & mini. I don't know.
How many drain tubes do you have, 2?

 

[Amy]

Go, Chuck, go!

 

[Chuck C]

That's amazing. I gained ~ 14lbs / 2 gallons of liquid that took about 1.5 weeks to get rid of. Was told it was normal too. Maybe the difference between full & mini. I don't know.
How many drain tubes do you have, 2?

perhaps its more. I was 182 during my walk yesterday. that is close to my baseline.

I have 2 drain tubes. one is about to come out

 

[pellicle]

Maybe the difference between full & mini. I don't know.

dunno, maybe its something to do with general metabolism. I don't recall gaining much ... but maybe I just don't recall.

I've only ever had full sternotomies

 

[Superman]

dunno, maybe its something to do with general metabolism. I don't recall gaining much ... but maybe I just don't recall.

I've only ever had full sternotomies

Guessing it’s just surgical team differences. Some believe in pumping you full of fluids during the procedure. I put on 15 lbs of fluid while I was out. I didn’t eat anything during that time. Just bag after bag of IV fluid.

 

[bizinsider]

Guessing it’s just surgical team differences. Some believe in pumping you full of fluids during the procedure. I put on 15 lbs of fluid while I was out. I didn’t eat anything during that time. Just bag after bag of IV fluid.

Must be that. I woke up and was like the Pillsbury Dough Boy. My hands were gigantic. I must've gained 15+ lbs. Took a good week for things to reduce and many many many more weeks for my ankles to de-kankle.

 

[Chuck C]

first drain tube out. That was not fun, but not the worst thing either. The last one should come out today. Dr Shemin came by yesterday to see how I was doing. He explained that my stenosis was critical, so, it was good that I decided to get it done once the echo said I crossed the line and did not wait for symptoms. He had really clear photos as well, which was really cool.

He also explained why he replaced my aortic root and ascending aorta with a St Jude dacron hemashield. My root diameter was only 35mm, but he could tell from his experience that I have the type of tissue prone to aneurism, and, although it was not certain that it would need replacement in the future, he estimated that there was a good chance that it would. The textbook says you don't replace a 35mm aneurism, but I'm grateful that he relied on his experience. He is truly one of the very best.

My incision is remarkably small- only about three inches. It blows my mind the incredible dexterity needed to operate through such a small opening.

I had aFib off and on all evening, but between 70bpm and 130bpm which was tolerable. Again they believe it was electrolyte imbalance. Its been fine now that I've had a potassium IV. I think it was due to the diuretic both times. There is literature on this it turns out. Things have been flowing good so if they try to give again I'll insist that my cardiologist is involved. Other than the afib things have been good. I recommend not hesitating on liberal use of narcotics if needed. One suppository was all it took to remove any concern about constipation.

getting the exact adjustment for the bed for optimal comfort was key. I had the nurse write it down. for me, 22% incline with the softest setting. but I have grown to much prefer the reclining chair and may avoid the bed altogether going forward.

I think this will be a breakthrough day.

 

[bizinsider]

Excellent report. Congrats!

 

[Meanjellybean]

Great outcome. Get that aFib under control and its like it cant go any smoother.
Yes recliner chairs are the best to sleep in. That or like 10 pillows.
Stay on those pain killers. Your surgeon did a good job by the sound (read*) of things

 

[Superman]

Impressed with the surgeons call on the aneurysm. Hopefully it’s a sign of learning that fewer operations are safer regardless of what a measuring stick says.

It will be even better when they can nail the connective tissue component of BAV down to a specific gene and not have to wait and hope. Once one is needed, do both by default. If one does not test positive for the aneurysm gene, skip that part.

 

[Chuck C]

Just received a visit from the ICU physician. He says that I'm doing so well that they can release me on day 4, one day earlier than normal, dependent on whether they can keep my heart in sinus rhythm for the day. I was very happy to hear that and, honestly, surprised. I was thinking that it might be a little longer due to the atrial fib, but they say this is normal and do not seem as worried about it as I have been. They will give me prescriptions to normalize the rhythm and do not expect it to be a long term issue. It was such good news to receive. So, my next big decision might be whether to accept early release, as he said if they get the a fib in line it will be my decision. I feel more safe with an extra day in case of problems, but it will be nice to be home

 

[Chuck C]

Impressed with the surgeons call on the aneurysm. Hopefully it’s a sign of learning that fewer operations are safer regardless of what a measuring stick says.

It will be even better when they can nail the connective tissue component of BAV down to a specific gene and not have to wait and hope. Once one is needed, do both by default. If one does not test positive for the aneurysm gene, skip that part.

Agreed. That day could be soon coming

 

[Unicusp]

Agreed. That day could be soon coming

Yes, that was a great decision. Wish my surgeon did the same on my valve when he only changed out the aorta.

 

[Unicusp]

Just received a visit from the ICU physician. He says that I'm doing so well that they can release me on day 4, one day earlier than normal, dependent on whether they can keep my heart in sinus rhythm for the day. I was very happy to hear that and, honestly, surprised. I was thinking that it might be a little longer due to the atrial fib, but they say this is normal and do not seem as worried about it as I have been. They will give me prescriptions to normalize the rhythm and do not expect it to be a long term issue. It was such good news to receive. So, my next big decision might be whether to accept early release, as he said if they get the a fib in line it will be my decision. I feel more safe with an extra day in case of problems, but it will be nice to be home

Wow, that's fast. I vote to play it conservative and stay one more day.

 

[bizinsider]

There's no place like home. Congrats not the progress.

 

[Chuck C]

Wow, that's fast. I vote to play it conservative and stay one more day.

It is looking like I will probably be staying. Tonight I have been going in and out of a fib. What is interesting is that I am able to exert some control over it with deep breathing. When I can feel things start to flutter and the heartrate picks up, I do 4 or 5 deep slow breaths and this often gets me back into sinus rhythm. If this does not work, I walk around a bit and I get back into sinus.
They keep giving me Lasix, a diuretic. This is apparently routine for most cardiac surgeries. But, diuretics are known to contribute to a fib as they mess with your electrolytes, especially salt and potassium. Different team in the ward vs ICU. I think ICU had a fib controlled, with at least making sure I was getting replacement of magnesium and potassium if I was on diuretic. Transfer out of ICU and into the ward and the electrolyte IVs stopped. Just low dose oral magnesium. A fib returns after stability for the night. I told them I suspected my potassium and magnesium where low again and they re-tested at my request. Well, it turns out they were low. So, now I am getting them by IV again. It seems to have helped. Glad that I spoke up.
I think tomorrow is the day that I insist that my cardiologist be a part of the discussion if they want to do diuretic yet again. I am not retaining much fluid and, in any case, there does not appear to be any evidence for improved outcomes when low risk cardiac patients are put on diuretic. There does appear to be some risk however.
I feel good and can exercise well and lung capacity is returning. I can make the little ball go pretty high now. It is really nice to be out of ICU.

 

[pellicle]

Tonight I have been going in and out of a fib. What is interesting is that I am able to exert some control over it with deep breathing.

Interesting. I used a similar technique to lower my HR post surgery, but that was never classified as AF

can make the little ball go pretty high now.

The?
There isn't three?

 

[Chuck C]

Interesting. I used a similar technique to lower my HR post surgery, but that was never classified as AF



The?
There isn't three?

There are two. One measures inhale volume in ml the other measures how fast you inhale, with slow being better. I can inhale a much larger volume than before. So, I am doing better with the one that you want to go as high as possible. I am also doing better with the one that you want to keep low, which will only stay low if you inhale slowly.