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

[Luckyguy17]

Congrats Chuck C on getting to the other side Rather smoothly, with a few incidental speed bumps.

i have to thank you for a well documented personal study in this thread, as well as your process to date.
It truly does provide very good information to the up and coming AVR ohs patients. Also a hats off to the many very good contributors to this thread . It is a very fine example of community assistance, as well as providing realistic and reassuring very useful information.
thank you and smooth sailing hereon.
Gil

 

[bizinsider]

Chuck, you don't need me to to tell you this but your attitude is to be admired.

 

[Chuck C]

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.

"I woke up and was like the Pillsbury Dough Boy."

Ok, you owe me! I just read your post again and laughed hard when I read this! It hurt!
It did not help things that it has been 5 hours since my last pain medication. I have learned that whether you stay ahead of the pain has a lot to do with the pain medication philosophy of the nurse practitioner working your ward. Most believe in staying ahead of the pain, but they all have different ideas of what works and different ideas of how much input the patient should have.

 

[Chuck C]

Chuck, you don't need me to to tell you this but your attitude is to be admired.

Thank you Bizinsider.
You always were willing to help me in any way you could when I had questions or concerns. All of the help from you and others here on this forum really helped me go into the surgery with the right attitude. It is really hard to imagine how different it would be if I did not have this forum to help me through this process.

 

[Chuck C]

Day 5 of recovery update.

Today was a very mixed day but ultimately ended very positive.

Originally, this was the day that I was going to be released. On Thursday, despite a couple battles with afib on a couple of days, the ICU physician told me that he was going to allow my early release on Friday, if I wanted to, as I was recovering so well.

But, the afib came back and I could not be released on Friday.

With the help of some meds that restore rhythm it went away Friday after about an hour and the new release date was targeted for Saturday, which was the original plan. BTW, they are very clear ahead of time that you may not be released on the planned day, as complications can happen.

It was good all night, but then came back Saturday (today), so there would be no Saturday release. They also decided that because the afib has been so stubborn that they want to see it gone for 48 hours before I am released, so now looking at Monday release at the earliest.

The good news!:

After a couple of hours on Amiodarone, used to restore rhythm, it restored to sinus rhythm, the one you want, and has remained there for almost 5 hours.

So, I am probably looking at a Monday release if it stays in rhythm. I have a good feeling that this time it will. But, I do tend to lean optimistic

The plan is that if it returns again and is still there on Monday they will do a procedure which resets the electrical of my heart. You know, kind of how sometimes with your computer you need to turn off the power and restart it, lol. It is kind of a big deal and I will be out for it, so hope that it does not need to happen.

I have felt great all day, even when the afib was happening. There is a very noticeable daily improvement of how I feel. Honestly, I feel almost normal today. I was not expecting to feel this well this fast. When I first woke up, the lungs needed some expansion. But, after some breathing exercises and some laps around the ICU, they had opened up and I felt great.

The pain is less and less each day and is very tolerable now and easy to stay ahead of, which requires good communication with the ward nurse practitioner. I have learned a bit in this area and will do an extended post on the subject in the next couple days (hey I have the time) that hopefully will help others who have upcoming OHS.

I am very happy with INR level. They test daily and the readings have been
Tues1.6
Weds 1.9
Thurs 2.8
Friday 2.8
Saturday 2.9

They kept me on Heparin, as a bridge anti-coagulant, until the 2.8 INR reading on Thursday.

Having the support of all of you folks here really means a lot and has helped me. Thank you!

 

[pellicle]

They kept me on Heparin, as a bridge anti-coagulant, until the 2.8 INR reading on Thursday.

Glad it settled in nice

I got held in over a weekend over an infection, and if the useless ******* had done their job properly then I probably wouldn't have needed the two admissions and "Rape&Scrape" surgeries a year later...

 

[Chuck C]

I got held in over a weekend over an infection, .

So you hold warfarin when you have an infection?

 

[Chuck C]

Day 6 morning update

I have a good feeling about today. I have found that when you first wake up you don't feel as well because the lungs have not opened up yet. Once you do some breathing exercises and start walking you feel better. To those going into OHS I would suggest, again, breathing exercises often and walking often.

Today we will be watching closely my heart rhythm. I managed to stay out of afib evening and all night. So, this is a big victory. I need to stay out of afib for another 34 hours and then I get to go home! I had one day free from the IV pole. That was great! That means I was able to move all over without pulling that darn thing around. To have that ball and chain, so to speak removed was freeing and I took advantage of it. Well, now I need to have a drug administered by IV called Amiodarone. It helps to keep the heart rhythm stable. So, hello to the IV pole for another 6 hours, which I call the ball and chain. Still, much better than ICU where you can't go anywhere without your nurse helping.

They are an hour late on my pain meds right now and I am a little ticked about it as I can feel that the pain is catching up- and I had been ahead of it mostly the last few days. The reason they are late is that yesterday's nurse practitioner insisted on switching me from Oxy to Narcos. Pain had been managed great on Oxy, so why fix something that is not broken? She was persistent, although she could not give me any reason why. But, I figured if oxy was working that narcos would work and agreed to go this direction. It would be 2 narcos evey 4 hours. She did not do her math. Narcos include hydrocodone and Tylenol. The daily limit on Tylenol is 3,000mg and the dosage she gave me put me at about 4,000mg. As they are giving you your pain meds, they have to first enter it into the computer and the computer calculates your usage in the past 24 hours and tells her if there is a problem. So, 3am last night, I was in some pain and she tried to give me my 2 narcos as it had been over 4 hours since my last dose. But the computer rejected it, calculating that this would put me over 3,000 mg of Tylenol. So, we are now waiting for today's NP come up with a solution, which is very obvious- go back to Oxy instead of Narcos. It is nuts to be in pain and fall behind on the pain meds because of getting too much Tylenol.

As part of the transition to narcos, she wanted to get me on Gaba, a drug approved to treat pain from shingles. She really wants to start weaning me off of narcotics and, apparently, her favorite way is with Gaba. So, I tried 300mg of gaba yesterday. I did not like the side effects. I was having a conversation with my wife and I started zoning out- could not carry on a conversation and concentration was clouded. Then I suddenly felt the need to get in bed. It knocked me out. It was weird. I did not sleep, but felt like I was sort of in a paralysis coma, but was still aware. It did not totally take care of the pain, but it is like you are so zoned out in this semi coma state that you just accept the pain as you don't want to move.

So, I didn't take another dose until evening, figuring that I would give it one more try and perhaps this coma state would be fine just before going to bed. I did not like the way it made me feel again. I have started to really pee out the excess water in my system, had to go 6 times last night and the gaba made it difficult to get myself out of bed each time to pee (I hate using the urine bottle in bed) So gaba is out. It certainly is not the kind of med you want to take in the daytime, because you just want to lay there, as if in a coma, when you should be walking about and doing breathing exercises. They like to use it to wean people off of narcotics, but for a patient recovering from surgery, who needs to move and do breathing exercises to speed their recovery, that is a bad trade off.

I think once I get moving some more today I am going to feel even better than yesterday. Crossing fingers that the afib does not return.

 

[Chuck C]

Had a visit just now from the nurse practitioner who works directly with my surgeon. She has more say over my care, because she is actually on my surgical team, so to speak. We got it all worked out with the pain meds and she set me up with the pain med prescriptions that work well for me. The new NPs can't come in with their own agenda or personal philosophy on pain management and screw me up, without talking to her first. She can override any changes that they try to make. It gives me plenty, if I need it, and allows me to self wean, which, of course, I already have been doing and will continue to do. It is nice when they treat you like a grown up.
She shared with me, and I have heard from several other nurses, that younger men have more nerve endings in there sternum and more chest muscle tissue and it is normal to feel a little more pain than older folks. Apparently, as you age your sternal nerve endings deaden a little.

 

[bizinsider]

She shared with me, and I have heard from several other nurses, that younger men have more nerve endings in there sternum and more chest muscle tissue and it is normal to feel a little more pain than older folks. Apparently, as you age your sternal nerve endings deaden a little.

Finally - age on my side! Glad to see you are your own advocate.

 

[Chuck C]

Finally - age on my side! Glad to see you are your own advocate.

Yeah, we might not feel it at all if we need this procedure when we are in our 90s

 

[pellicle]

So you hold warfarin when you have an infection?

No
After my 2011 surgery, the day I was to be released, there was already a sign of infection, they held me back from being released while they tested

 

[pellicle]

Apparently, as you age your sternal nerve endings deaden a little.

Very interesting...

 

[Chuck C]

If they don't let me out of here tomorrow, here is what is happening;

 

[Beach77]

Hi Chuck,

You’re doing great!! Impressive actually! I can relate about the hospital not releasing you and the frustration.

Reading about your hospital stay sounds similar to my stay. I had severe bicuspid valve replaced with an on-x valve Dec. 2nd 2020. I was one day in ICU, then on my 2nd day in the cardiac recovery room, I was going to be released because I was doing so good! The doctors/nurses were all amazed! Then, that morning I had a severe afib. Four or five people came rushing into my room, just as I was going to push the button for help. I was given oxygen, meds, then after 5 mins I wasn’t responding to the meds. I was given another dose. Still no-change. They called the doctor, who had to prescribe the next step, but he said to wait a few mins more until given it to me. Thankfully, my heart settled down. That cancelled my departure home. Like you, they told me I had to go 24 hours without one. My other afibs in the hospital didn’t require meds through the IV port but they kept me from going home. They did add Amioda and Metoprolol to my daily meds. On the 7th day in the hospital, also my birthday, I kept asking to go home. No visitors were allowed in hospital (COVID) but they called my husband in to meet with my doctor’s cardiac nurse. I think they wanted to see how well he would be able to take care of me. After our meeting, she discussed with the doctor and I was released! Come to find out, the hospital’s cases of COVID were going crazy and they wanted me away from the hospital. I finally made it home just before 7 pm on my bd! Yay! But the next morning I had another afib that was scary. I had an oximeter, so I knew what was going on. We talked about calling 911 but it wasn’t the range the nurses said to watch for. I called my doctor’s office and talked to the nurse. Within 15 mins, my doctor called (on his way to surgery) to see what was going on. He didn’t think I needed to go in. After that one, there were only a few minor ones during the next few weeks. My thyroid levels went crazy during the time in the hospital and the month of Amioda and Metoprolol made it worse! When the 30 days of amidoa and metoprolol were finished, I was one HAPPY person! Those are tough meds and I did not like them! Now it’s been almost 4 months postop and I’m doing great! I wore a heart monitor a couple of weeks ago for 2 weeks and only had one afib, turns out it was an SVT. My doctor said if I get anymore to call him. Happy to say no more problems and I think the SVT was because of my thyroid levels. They are just about back to normal. Yay!

It takes time for our heart to mend after being traumatized from surgery!

The pain meds in ICU were terrible for me! When the 2nd dose was due, I fought hard for Tylenol! I would have liked something a little stronger but did not like the choices they gave me. I’m not sure what I wanted but I knew what I didn’t want.

Unlike you, I wasn’t allowed to leave my room to walk unless someone was with me. (COVID) But I was free to move around my room. (my room sounds like your room too) I had an awesome view, which really entertained me! Did lots of video chats and tons of texting! A week in a hospital room wasn’t the best but I felt safe and well taken care of! Besides childbirth I had never spent the night in the hospital. The nurses were amazing and worked so hard! On top of that, they were all so nice! I was at Sharp Memorial hospital, San Diego.

Hoping you get to go home tomorrow!

 

[Chuck C]

Day 6 - evening update.

The atrial fib has not returned. I have to make it 16 more hours without afib returning and I get released from the hospital!

Today I felt even better than yesterday, which I suppose would be expected. Each day it has amazed me how much better I feel. As noted in the morning, the lungs need a little work to feel right for the day. But, after a few breathing exercises and a few laps walking around the ward they felt opened up. The remarkable thing about today was that I felt like I was just going for a walk, as if I had not had the surgery. I walked and walked and walked and it felt better and better.

It seems to me that getting the lungs opened up is one of the very most important things to rehab.

 

[Humboldtgrrl]

If they don't let me out of here tomorrow, here is what is happening;

 

[Humboldtgrrl]

RUN, CHIEF, RUN!

 

[Chuck C]

Day 7 of surgery recovery update. COMING HOME YEEESSSSS!!!!!!


Woke up feeling better than the day before. Mornings are a little slow until I expand my lungs and get the blood flowing. But, it was not as slow as the day before.

Did 10 breathing exercises with the inhale/blow device.

Got the blood flowing by walking about 5 laps around the cardiac ward. With each lap I felt better and better. By about the third lap I noticed something. I felt totally normal walking. I was not breathing any heavier than I would have before the surgery. I checked my pulse on the device, connected to the electrodes on my chest at all times, that you keep with you day and night: pulse was at 70-75 as I was walking at a very normal walking pace.

I guess at some level I had a little of concern that I might not regain full cardio function. With so much cardio ability restored in just 7 days, I am feeling very optimistic that I will return to my full previous capacity.

But, more than just feeling good walking., I felt good all day. I did not feel like a person who had just gone through OHS 7 days ago, not that I have any basis for comparison. So, lets say I feel much better than I ever imagined I would feel. If someone could use one of those little devices from Men in Black and erase my memory and then told me that I had had open heart surgery 7 days before, I would not believe them. I really can't believe that I feel this well. I am so grateful to my surgeon and his team and all the hospital staff in the cardiac ward that took such good care of me. I could not have dreamed of a better outcome. I had some bumps in the road with the stubborn atrial fib, but that is very common, and apparently, nothing to be worried about. They know how to treat it until you restore your normal sinus rhythm.

I learned from my nurse that my surgeon, Dr. Richard Shemin, is the only one in the cardiac unit that uses glue to keep the incision closed. They all have their own person preferences. To be clear, he uses wire to tie your sternum back together. But after that he uses glue to keep the wound closed. She told me that in many patients of his that she has seen, a year out from surgery they don't even have a scar. I had no idea that this would be the case and it is not that important to me, but, hey, I'll take it! The only downside is if I get into one of those one-upmanship conversations in which we are comparing old battle wounds no one will ever believe me



No atrial fibrillation!!!!

I have not had afib since Saturday. The nurse told me that my surgeon's nurse practitioner had reviewed all of my data from the morning, including vitals and labs and heart rhythm from the night and that everything was ideal. Dr. Shemin gave the green light to be released! Yes!!

Such a joy to be home! Such a joy to feel great! So glad that I made the decision to get the valve surgery now, rather than wait for symptoms, which was the question that was the genesis of this thread. I believe that the fact that I did not wait for physical damage to my heart to occur before getting surgery has everything to do with my quick recovery. Others with upcoming future valve surgery may want to take note. Perhaps even more important, now that we know that my valve was in critical condition, one stage past severe, at the time of surgery, per my surgeon, I was a ticking time bomb and could have dropped dead at any moment. Yeah, I would say that it was the right decision to get the surgery sooner rather than later.

It is great to be able to sleep in my own bed tonight. I could really use the sleep. I am very sleep deprived. It is next to impossible for me to sleep in the ICU and very challenging in the hospital at all: alarms going off all the time; checking vitals or taking blood at all odd hours.

But, ironically, I feel so energized being home that I'm not sure that I will actually be able to sleep well.

 

[pellicle]

COMING HOME YEEESSSSS!!!!!!