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Rated: E · Chapter · Medical · #1446066
Survinig heart failure, surgery, and recovery in lay person's perspective
Chapter Two   

  {If I learned anything about myself during my heart failure and the process up to surgery, it’s that I don’t heed warning signs. That has been evidenced so many times in my life. My heart had been failing, but I kept on going on until I actually went into heart failure, unable to breathe or move without extreme effort. And then I let the physician's assistant tell me it was the flu and suffered all weekend before going to the doctor again on Monday. I should have gone to ER. I know that my health, and welfare, my death and my eternal life are in God's hands. Knowing where I’m going when this life is over makes a difference in how I live this life now. But I'm not ready to end the process yet. This life is all I know. Everything else is a dream, so I want to hold on to this. } reworking

    I could have been bitter about all that I was going through. Poor me, why me? I was too young. But complaining didn’t seem like a good option to me. Bad health just happens in most cases. I hadn’t brought this on myself, nor had anyone else. It’s just life. A non-believer would think it sounds like nonsense to say "His grace was sufficient for me". But somehow it was. I felt as though God was with me in every step. I never felt fear or anger or regret. I really was lifted up during this particular trial.

    Heart valves regulate the direction and amount of blood flow. While women generally have mitral valve problems, and men, like Arnold Schwarzenegger, have aortic valve problems, both my mitral and aortic valves failed. One was too weak to close (insufficiency, allowing regurgitation); so the blood leaked back into the chamber it was trying to leave. The other was too hard to open all the way (stenosis), not allowing enough blood to pass through. The valve with stenosis caused a backup leading to an enlargement of one of the chambers of the heart. To round out my situation, I had a pronounced irregular rhythm.

    Whoa. You ask, "What's an enlargement?" Well, in lay language an x-ray would show that one chamber is slightly out of whack, only a minute difference. The muscle of that chamber has thickened from working too hard, making that part seem larger.It makes the heart slightly less effecient; it's an undesirable condition, but there are worse things.

    I trusted my doctors and believed them when they promised me I would feel ten years younger. One of them said, “You just haven’t realized how run down and tired you were feeling. But after your recovery you’ll notice a big difference.” I would remember that later. During this time, my family really proved what good and caring people they are.  I will be forever grateful to them.

    The day of the surgery was another early start. My husband and I arrived alone. The same brother who came for the catherization showed up before I was wheeled away. This time he brought my mother. Everything always turned out okay when Mom was there. We all assured each other that everything would be okay.

      When they put you under for these kinds of serious surgeries, they really put you under. You don’t hear anything, you don’t feel anything, you don’t smell anything, you don’t remember anything. And it takes days to get over the anesthesia, with nausea and vomiting eventually setting in. The throwing up is one of the things they don’t tell you about in advance.

    In intensive care afterward, I couldn’t open my eyes, and I couldn’t speak, but I could hear. One family member at a time is permitted into the room with you. In order to breathe properly during the surgery, they put a big plastic tube down your throat, after you’re passed out, of course. It's still there when you wake up. They can actually vacuum out the excess saliva. At one point, I felt like I was choking, so I did the only thing I could. I started pushing what felt like bubbles out of my lips with my tongue. My brother noticed that I seemed agitated, and that I was foaming and asked the nurse what that was about. “Good,” I thought, “He got my message.” The nurse vacuumed my tube and I felt better. I heard her telling him that younger patients have more problems than older patients with choking or the sensation of choking.

    Your throat is sore for a few days after the tubing is removed. After the surgery, they keep you in intensive care until you can lift your head. Apparently, my surgeon came by. I can’t remember hearing him, but I heard the nurse telling me to show Dr. Armitage I could lift my head. I struggled, but it didn’t feel like I was moving. She said, “OK, try again and hold it.” I struggled, but I felt like I was in cement. I really wanted that tube out of my throat. I was upset that I couldn’t get my head up.

      My mother was with me. Later, when I was out of the hospital, we talked about it. She told me the doctor had been stroking my arm. He did that a lot, or maybe he’d stroke your feet if you were up on a bed when he talked. She said, “You thought you couldn’t move your head, didn’t you? But you did. And you held it up. I knew you thought you couldn’t, and it was upsetting you.” You can’t hide anything from a caring family.

    He made me wait a little while longer before they removed the tube, and then finally sent me up to a private room. (I love the private rooms at Mary Washington.) The staff on the heart ward works as an enthusiastic team with an emphasis on getting the patient ready to go home to heal. They give you a heart-shaped pillow to hold against your chest when you sneeze or cough. It lessens the impact to your newly sawed bones. The nurses and aides next door applaud when you cough. They make make all heart patients cough regularly to keep the lungs clear.They get you on your feet as soon as possible and walking down the halls, dragging your IV on wheels, with monitor wires dangling off your body. As you go down the hall, usually with a relative or visitor, the clerks at the desk cheer for you or comment on your improvements.

      Only you don’t feel like getting up and walking, or coughing, or brushing your hair or even dressing properly. Not only are you nauseous and groggy from the anesthesia, your back, shoulders, and upper arms are in extreme pain by the second day, another thing they don’t warn you about. During the surgery, they can’t risk any involuntary movements. Plus they need to have your rib cage spread far apart. So your arms are stretched straight out and down and are strapped down tightly. The longer the surgery, the longer your body is in this contorted position. New nurses and aides learn immediately, backaches are the number one complaint on the heart surgery ward.

        The surgery I only know about from my reading. All open heart surgery is bypass surgery, since the blood will have to bypass the heart and lungs during the surgery through a machine. When most people use the term bypass, however, they are talking about a particular heart surgery that reroutes your blood. The circulatory system resembles a highway system. When a section of road or roads becomes too congested or slow-moving, a bypass is built to route the traffic around the “blockage” but still allows traffic to reach the final goal in a better time frame. When vessels around the heart become blocked or clogged, a section of vein (usually from the leg) is grafted in to allow the blood an alternate route, or bypass. A triple or quadruple indicates the number of bypasses needed (or the number of blockages).

    I did not have bypass surgery. But like the bypass patients, a tube was put into a small hole in my neck to allow my blood to be siphoned off. It then flowed into a bypass machine, where it received nice, fresh oxygen, and was recycled back into a second tube and into a vein in my neck. My lungs and heart did not function at all during this entire time, but everything that normally requires oxygenated blood got it.

    An incision was made in my skin. The doctor promised to make it as low as possible, but I have a high collar bone, so it had to be fairly high. Then the rib cage, or the sternum, was sawed open. They used big clamps to separate the rib cage and keep it propped open while the doctor did what he had to do, which was to properly install two metal valves so that they wouldn’t fall out. Then he tried to put everything back like he found it. The bones are wired together. My x-rays still show the wires. I still hate to show my scar, which faded a bit after the first few years.

    The valves are registered with St. Jude’s. I have a 99 year guarantee on each one. I got to hold a sample in my hand in the surgeon’s office. They have to be individually sized for each patient’s heart. They just look like some flaps in a ring that overlap, and you can push them open, and they’ll fall back into place. In Planet of The Apes, Charlton Heston found a heart valve in the staircase of the subway station. I never caught it the first time around, but it suddenly had meaning after my surgery. The unbelievable part is that he recognized the serial number as belonging to a friend of his. It would take a big computer to quickly i-d a valve serial number found in an odd place. 

    The Sunday after my surgery my mother was back in town with a different brother. While he and his wife went down to the cafeteria with their kids, Mom sat with me rubbing my arms below the elbow. I was exhausted. Who sleeps in the hospital? Especially when you need a lot of special care! I don’t know what made her do that, but I really appreciated it. Years later, I asked why. She said she thought I needed it. It was wonderful. Sometimes when I’m tired or sick, I wish I could have her sit by my bed and rub my arms again.

    I knew several older people who had had bypass surgery who were home on the third day. They kept me 8 days because of complications. The doctor released me finally, he said, because he couldn’t stand to see my husband looking so sad any more. Later he told me he was getting as worried about him as he had been about me.

    But my husband was a trooper in many ways. He was there every day after work. He reminded me to go walking when I didn’t want to. I didn’t care how I looked I felt so bad, but he would get me a robe to go around my wires and brush my hair. He tidied up my room and would nag me to drink something. He fed me if he was there at meal time. I was able to do it myself, but I didn’t have an appetite. He and my faithful baby brother (he could get more blocks of time off from work than the others) went with me to training classes about how things would be when I left the hospital and didn’t have medical people around any more.  They remembered a lot of things later that I forgot.

      When I finally went home, I felt panicky inside. What if something went wrong? That went away after a day or so. My husband fixed my medicine for me every morning; he put the chair in the bath tub so I could shower before he left for work. (No standing in the bath tub, strict hospital orders.) He made sure I got dressed ok, and put surgical stockings on my feet. All heart surgery patients have to wear them, but can’t put them on alone because of the delicate state of the chest bones.

    I couldn’t take that huge magnesium tablet without gagging, so the nurse had told me to grind it up and put it in applesauce. My husband ground it before he left for work. He walked the dog and fed her and stoked the fire. The house was in good order, and I had everything I needed to spend the day alone. If the home nurse was due to come, he had vacuumed the night before. This went on for the whole two month recovery

    My youngest brother had bought low-sodium and low-fat crackers and juices and diet sodas and other things for me while he stayed the first few days. He was great at exercising the dog for me. And he was good company for us both. I believe he even helped rake the leaves. 

    The second week home was Thanksgiving. The two younger brothers had extended family obligations, but my oldest brother and parents brought Thanksgiving to me. They came in separate vehicles. Jack brought deli items to last a good six weeks, salads, fruits, bread. Mom brought a traditional Thanksgiving meal: turkey, dressing, gravy, cranberry sauce, sweet potatoes, homemade rolls, and dessert. We ate like kings all winter.

    Dad, Jack and I sat in front of a football game. I still hurt to move around. My mom and my husband found their way around the kitchen, setting the table, heating things up, making ice tea. They washed dishes together afterwards.  I enjoyed watching that from my seat in our A-frame great room.

    I felt like a millionaire that day. My mom’s usual huge Thanksgiving meal was served in my own home. It was so inconvenient for them. They traveled so far with a fully-cooked meal, properly stored, to be with me. It would have been so easy for them to say, “We’ll call you and tell you how the day went,” and promise me they’d come up later. If they’d stayed home, they probably would have seen their grandchildren. But they spent the day with me! And loaded me up with goodies. Could anyone be as blessed as I felt? It was one of the best Thanksgiving days I’ve had, pain or no pain.

    As I continued to recover daily, I spent time slowly riding my exercise bike and reading the Old Testament. I then took my applesauce with the mineral supplement and any other medicine I was due. If I dropped something, I couldn’t bend over to pick it up and I hadn’t gotten much exercise since before the surgery so my legs didn’t squat too well for a pick up. I had it drilled into me not to press down or lean on anything, so I couldn’t grab onto something to pull myself back up. I worked on bending my knees without touching anything, picking something up-a tissue or a fork-and slowly standing, only using a fingertip straight ahead for balance until my legs got stronger. I didn’t want to pop any wires loose. I could hear bone scrape against bone and that was bad enough.

    The hospital gives you homemade heart-shaped pillows to hold while you cough or sneeze. I kept mine handy at home because of allergies. (Some hospitals just let you use a folded sheet.) After a few more weeks, I’d go out by myself on dry days for a very short walk. I took that pillow and would go a few blocks for fresh air and brief exercise. Eventually, I tried taking the dog, too. I held her very firmly, she was rambunctious, and she was pretty good. Once I got down the steps without her pulling me. I figured we were ok. The neighborhood was not built up yet, so there was very little traffic, just lots of trees and wildlife. I liked it like that. It was peaceful.

    I did drive home for Christmas, despite orders to the contrary. I did not like my husband’s driving and felt safer doing it myself. The only risk would have been an accident throwing me into the steering wheel. Thankfully, it all went ok. We took all the presents I had wrapped before the hospital visit.

    After Christmas, we continued the same routine with me getting a little stronger each day. When it snowed, and it did quite a bit that year, my husband couldn’t work. We sat in that great room looking at the birds on our front deck looking for food, and looked up into the trees showing in the upper level of windows above us. With no neighbors in front of us yet, we would leave the drapes open and stoke the fire and enjoy the scenery. That was a great house for a boring recovery. It was peaceful and quiet. And I smelled the roses like the surgeon ordered for as long as I could.

    As the time wore on, I stopped having wild dreams (from the anesthesia?) and began to sleep better. I read a lot and watched a lot of TV. Dinner was ready when my husband got home, but it was always simple, no real cooking. The home nurse came less frequently, then finally not at all, and the surgeon released me back to my regular cardiologist. The surgery saved my life, but it didn't make everything good as new. I still had an irregular rhythm, and the cardilogist suggested one more attempt to fix that. I wish that I could say I had a happy ending and I did get to feel ten years younger, but it never happened that way. I will tell you I went back to work and soon had another chapter to face. 

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