James's Posts

Surgery was 4 weeks ago today. I can drive! All scabs have fallen off, leaving pink reminders. It still hurts in my sternum if I cough or sneeze. Otherwise my only real pain is soreness/stiffness in my shoulders and neck. My main pre-op symptom was shortness of breath. I can feel that decreasing. When I go upstairs, I am not winded and breathing heavily. Little by little...

After posting some summaries yesterday, I thought I’d post some details today about what to expect could be attached to you as you go through your hospital journey. I don’t know if what I experienced is standard or not, but hopefully you will find this helpful. ICU I don’t remember much about ICU. I have very fleeting memories of faces or scenes, but nothing in detail. I don’t remember the breathing tube, although I’ve seen a picture of me with it inserted. The good news for you is that you probably won’t remember any of this either. URINE CATHETER I remember waking up for my first lucid moments about 16 hours after surgery. I had a weird urinating feeling. I slid my hand down to check things out and realized there was a urine catheter in place. They had this under control of course. Whew. When it was time to move from the ICU to the CSU (Cardiac Surveillance Unit), the nurse removed my urine catheter. It was about a 6 on a scale of 10. You learn to classify all sensations as gradations of the pain scale. It was awkward, but mercifully quick and done with. Not something to repeat anytime soon. DRAINING TUBE There was a draining tube inserted about 6 inches below my incision. It was removed by Dr. Castro’s PA just before I moved from ICU to CSU. He told me to keep breathing while he did it because if I held my breath, it would act as a clench on the tube and make it more painful. So I breathed. I would say it was less painful than removing the urine catheter but much more awkward and nauseating. Again, quick and done thankfully. I now have a half inch horizontal wound healing there. A clip was installed to hold it closed. The clip was removed on my last day in the hospital, leaving a couple of small puncture marks around the larger wound. INCISION It wasn’t until I was in CSU that I got a good look at my incision, albeit via iPhone. A nurse gave me a sponge bath one day and I asked my wife to take a photo of my incision so I could see it. It’s 4 inches long. It hasn’t given me any trouble (referring to the external wound only). It looks a little crinkly and I’m hoping it smooths out over time. I’m not a beach body, so nobody is going to be seeing it anyway, so I guess it doesn’t matter. It’s a mark of survival as well. NECK CANNULA I have 2 puncture wounds in the right side of my neck. This is where a neck cannula was placed. It’s like you see on someone’s hand for IV access. There’s a tube that goes inside your carotid artery and it’s about 4 inches long inside you. On the outside, there were 3 receptacles through which they could draw blood or inject medication. So it’s sort of like a medusa device on the side of your neck. It’s cool that they have such ready access to your blood since they have so many occasions where they need it. This one gave me some trouble though. When I walked, I had to make sure that my gown and “heart hugger” vest (see below) were not conflicting with the cannula. I can’t imagine it would be a good idea to rip this baby out of your neck while you’re walking. I have a beard as well, so there was tape pulling on my beard and tape catching on the gown. This is an area to be carefully tended to. EKG Through my entire post-op in the hospital, I wore a portable EKG. The nurses said they could see the activity from my EKG at the nurse’s station. I never saw that of course, but it sounded pretty cool. So I had those sticky EKG leads stuck all over my chest. We’re all familiar with that; right? The wires came out of my gown and into a small EKG device. The EKG device was stored in a gown pocket or my heart hugger vest. Every morning, a nurse would come in and change the battery pack on the EKG. On my last day, the sticky tabs were removed. I was a little red and puffy underneath since those tabs had been stuck to me for a week. MOBILE EKG There was one day mid-through my stay where I was wheel-chaired to a chest x-ray. My EKG leads were removed from my little pocket EKG and plugged into an EKG machine that was attached to a wheeled pole. One person pushed me in the wheelchair while the other pushed the EKG pole. It was nice to go on a field trip through the hospital. OXYGEN When I was in ICU, I kept setting off breathing alarms since my breathing was too shallow. I learned when I heard the alarm, I could do a few deep breaths and turn off the alarm. Later when I was in CSU, I had one of those oxygen breathing tubes on when I was in bed. Out of bed, I did fine. CPAP I use a CPAP at home. We were directed to bring the CPAP on the day of surgery. Someone came and got it and inspected it. It showed up in ICU with an approval sticker on it. Someone from respiratory showed up every night to see if we needed any help with it. They attached the hospital oxygen to the CPAP so that I got an oxygen boost as well. PACEMAKER LEADS Just to the left of the draining tube wound is a small pair of punctures. There were 2 wires inserted here and sealed under tape for my entire hospital stay. These 2 wires were pacemaker leads attached to my heart. They would have been used if I needed an emergency pacemaker. Luckily, that never happened, so on my last day in the hospital, Dr. Castro’s PA removed the wires. He told me to cough. I knew that meant he was going to pull. I coughed and he held up the wires. They were out. He showed me the bare ends of the wires that had been attached to my heart. I couldn’t believe he was able to pull that out without me feeling anything, either in the wound area or especially no skipping a beat in my heart. Just another day at work for him, I’m sure. PILLOW I was given a small pillow to hold over my chest incision. I was told that the pillows are stitched by volunteers. I think that’s really cool. Mine is black with a baseball design on it. Thank you to whomever stitched my pillow! I still use it between me and the seatbelt when I ride in the car. HEART HUGGER Check out www.hearthugger.com. I was given one of these and told that some prefer just the pillow while others prefer the heart hugger. I loved my heart hugger! It can keep a cough in the 8-9 pain scale rather than blackout status. I would also hold it in place as I got in and out of bed in the hospital. INCENTIVE SPIROMETER If you google this term, you’ll see what this is. You exhale and then slowly inhale. As you inhale, you try to keep a steady flow and try for a maximum lung volume. My ICU nurse explained to me that areas of my lungs needed to be reopened after being on the heart-lung machine. Pre-op, I was at 3000. Post-op, I did 500 at first. When I left ICU, I was up to 1500. Over the next few days, I was up to 2500. Two weeks post-op, I’m at 2750. BLOWING TUBE I don’t know what the proper name for this thing was. It was Evil to me. It was about 8 inches long with a couple of tubes sticking out. It provides resistance in both directions as you inhale and exhale. I was directed to do 2 sets of 15 in/out pairs each hour with a cough between each set. The idea is that this device dislodges phlegm and junk in your lungs to help you bring it up and out. I was not a cooperative patient with this tool though. If I didn’t feel anything moving, I wouldn’t cough. That’s because a cough that brings up nothing is just as painful in your chest as a cough that brings up something. Why waste an 8-9 pain-scale cough on nothing? I don’t advocate being cranky about this device as I was, but I’m alive. URINAL After the urinal catheter was removed, I used a urinal. All of your urine is measured, all day, every day, for the duration of your stay. Get used to this happening. They want to make sure that your kidneys are functioning, you don’t have edema, your weight is ok, etc. So you pee in a jug and leave it for them to deal with.

When I awoke in ICU after the tubes were removed, I told my wife "It's my birthday!" In this context, I meant my re-birth day...a day of new beginnings, new heart valve, extra life. I posted a photo earlier of my old heart valve lying lifeless on the table after it was removed from me. I am so happy my surgeon let me have a photo of it. For me, that's a profound moment in my life. All of my life up to then was affected by that valve, either physically or mentally. When I was 11, I had a few fainting spells. Then in middle school, I was sidelined into "adaptive" P.E. (meaning chess most of the time), which made me "different", which I hated. I moved into regular P.E. in high school but my valve kept me from getting an ROTC scholarship to college. Over 40 years, there were so many trips to the doctor. Every new doctor would exclaim "you have quite a murmur!" How would my life have been if I hadn't had that valve? Would I have been more active? Who knows. So I looked at the photo with a sort of wistfulness. The valve was out of me now. It's over. I'm 52 years old and I have a porcine valve now. What will life be like with normal blood flow? I don't know. But that day was my re-birth day and I'm on the road to find out.