Friday, July 22, 2011

A Year Ago

Memories

Hard to believe that it has been almost a full year since my surgery. But as I walked up two floors of stairs to my office this morning, I remembered that a year ago I would have had to stop half-way up each flight, I would have been out of breath and really gasping, and my heart would have been pounding from the effort.

Now, I took the stairs two at a time, feeling some complaint from my thighs and knees, but arriving two floors up without stopping and without gasping for air. One deep breath, one deep exhale as I opened my office door, and my respiration was back to normal. No pounding heart. No lack of energy. Amazing.

No doubt the recovery process is still continuing, although at a much slower pace than in the first 3 or 4 months after surgery. My resting heart rate is lower now than it was a year ago. When completely at rest back then, I was doing well when my heart rate was in the low 70s. Now, I usually am in the low 60s at rest and sometimes into the 50s. My heart is obviously pumping much more efficiently and maybe it will become even more efficient. I recover more quickly after exercise; it takes less time for me to catch my breath and for my heart rate to slow. I'm having a harder time keeping my weight down and I'm finding I have to eat much smaller portions. Some of that may be due to my metabolism slowing down with age, but I think it must also be because my heart is not having to work as hard and so I'm just using fewer calories now than I was before surgery.

On occasion, when I twist or stretch a certain way, I feel a slight uncomfortable tug or pull - a twinge - in my chest area and around my left pectoral. I guess it is probably scar tissue that is complaining a bit from being asked to move against some internal resistance.

Overall, though, it is quite fantastic to be in the state I'm in today. I'm thankful to have had a health care system and medical professionals who diagnosed the problem, corrected it through quite spectacular surgery, and helped me with the recovery. Thankful to be able to do once again the kinds of activities I struggled with only a year ago. Thankful to have family and friends who cared and helped and supported through this year. Thankful to be regaining strength and stamina. And thankful to be able to enjoy life still and to still be around on this "mortal coil." Thankful to have the prospect of some good years ahead.

Tuesday, November 23, 2010

Brrrr

Deep Freeze

It's a glorious world, isn't it, with such wonderful diversity in people and places. So, while folks in the southern hemisphere may be enjoying the summer months, in the north we're having winter. And for the past week, southern Alberta has been cold and snowy. I mean minus 25 centigrade. Brrrr. And a good 20 cm of snow. Brrrr.

This is the first blast of cold and snow this winter. Such weather is not entirely a surprise at this time of year. But, still, it is a shock to have to put on extra layers of clothes, to plan for extra time getting places, and to need to put the snow shovel to work.

I've heard that often there is an increase in heart attacks when a snow storm hits. People who may be out of shape and who are normally sedentary are outside with their shovels, digging, lifting, and tossing shovel-fulls of snow to clear their walks and driveways. Heart rates and blood pressures go up with the effort and, if there's a build-up of plaque in the heart arteries, the extra physical stress from the shovel-work can end up in a blockage.

I was pretty cautious, then, with my first shovel work since the surgery. Mostly, I think, I'm out of shape. Those arm, shoulder, and back muscles are not yet restored to the strength and vigor I had before this valve problem. Despite the cardiac rehab fitness classes I'm doing, I found I had to pause often to catch my breath and to rest.

One fellow in the fitness class maintains that we shouldn't be shoveling the snow at all. The rehab nurses, on the other hand, say that it's OK - it's good exercise and strengthens the upper body. So long as we don't push it really hard.

I've found the whole shoveling experience to be annoying and tiring. So much so that I'm getting a show blower. Wonderful machine. Will be very helpful. One more toy ... er ... tool, I mean ... to get because of my heart.

Sunday, November 7, 2010

Exercise

Walking along the path of recovery

Right from those first groggy moments out of anesthesia, walking has been the main fitness activity to go with my recovery.

In the first days after surgery, it was a few tentative steps hanging to to the physiotherapist. Then it was a turn down the hallway with a physiotherapist at the ready in case my balance was off. Then it was a stroll around the unit with F. Then two laps. Then a flight of stairs and a couple of laps every few hours.  

When I was discharged it was first just 10 minutes out on the sidewalk in front of our house. Then 15, 20, 30, and then up to 45 minutes. Now I've progressed to around an hour and about 5 kilometers every day or two. 

Mostly I'm aiming to walk at a good pace, swinging my arms quite a bit (though not quite with military drill precision or height), making sure my heart rate gets up and I work up a bit of a sweat. This has been great heart exercise. I feel my stamina improving. My breathing is deeper and stronger. My legs have been sore at times but after a slow day or two I recover and can push a bit further.

One weird thing has been a numb feeling and a sharp tingling sensation at times in my left pectoral. Dr. M. explained that they took the vein for my by-pass from this area and so, of course, there was some nerve damage from the harvesting. Now some of those nerves are growing and reconnecting and reactivating and the result is the tingling. A fellow in my exercise class has a similar feeling in his leg (where they removed a vein to do his bypasses) which he describes as a burning. It's a bit uncomfortable at times and a little annoying but certainly not debilitating.

Speaking of exercise class, this is the main source of information and motivation for my recovery fitness program. The class is part of the Building Healthy Lifestyles program of Alberta Health Services. This is the physical activity part of the Cardiac Rehab program I wrote about earlier. After the initial information sessions, a one-on-one session with a cardiac nurse, and an evaluation session to determine my base level of fitness, I'm now into hour-long classes two times a week.

I never was the jock type and I've never done a group fitness activity ever before, but I'm finding that I really enjoy these classes, and even look forward to them. We meet at the Soccer Center. We do some warm up laps around the indoor playing field, under the watchful eyes of some Cardiac Recovery Nurses, one of whom is our leader. She (and one he; they all take turns giving us direction) keeps time for us and tells us what to do with our arms as we walk: punch straight in front, roll our forearms as if we were hitting a small punching bag, make small circles with our arms straight out to the sides, make big circles, move our arms as if doing a forward crawl, do the backstroke, flap our arms up and down like a bird. It's quite amazing how much of a sweat you can get just by working against gravity. After the warm up laps we do about twenty minutes at a higher level cardio work out where we get our heart rates up. Then we cool down and do some low impact strengthening exercises and some stretches. We track our heart rates and the nurses help make sure we do the exercises in the proper way and have good information about how they're helping our recovery.

And I'm feeling fitter and stronger. Not Charles Atlas, by any means. But certainly much better than I've felt in a long while.

So these classes are twice a week. On other days I usually walk around the park and lake just a block away from our house. And most recently I've taken to using walking poles from Mountain Equipment Co-Op (or, I guess, more properly, trekking poles). The weather has been really great so it's been great to be outside. The poles are adjustable to the right height and they add a good extra bit of a work out to the upper body. 

So now I look like a fitness geek, even if I'm not Charles Atlas.

Tuesday, November 2, 2010

Check Up

Visiting surgeon for the first time since the BIG CUT

Had my first follow-up visit with the surgeon. It's been three months since my surgery. The bottom-line? "Good, good, good" ... those were his words.

However, things are not 100% perfect. I guess I'll never have the heart of a 30 year old again (ha).

There is still a small leak from the mitral valve. They did tell me this after the surgery. I knew about it when I left the hospital. My question to him was about the long-term prospects for my heart given that the valve is continuing to leak. He said, first, it was a minor leak, whereas before it was a real gusher. Second, when they checked after the surgery and found it was still leaking a bit, his judgement was that going back in to try to fix it would have the potential to cause further damage and weakness and be harder on me and the valve than if they just left it. Third, he said I was a "young man" (ha). He implied, I think, that I'm not in any imminent danger and that my body can handle this leak and there's no need to worry about having to go back for further work soon, say, within a year or two.

I do wish F had been there too. It would have been good to have her interpretation and memory of what he said. I feel now that I should have asked more specific questions. I didn't ask, for example, how he would quantify the leak. Is it 2%, 5%, 15%? I also didn't ask if the leak means I'm going to have to continue to be on various heart medications for the rest of my life. Right now, I'm sure that the medications I'm on are helping to reduce stress on my heart so as to be sure it heals well. But will I need to continue on them even after I'm well-healed?

He said he wants to see me next in a year. I guess I'll save up my questions until then. And we'll see how things go. I'm doing the cardiac fitness rehab class and it feels good to be doing a bit of a work-out and to have a bit of soreness in my muscles afterwards. My blood-pressure and heart-rate are good during exercise. I'm not concerned about hurting my heart ... and it's not like I'm training for a marathon!

Monday, October 25, 2010

Driven further

Canada is a large country

Maybe it's encoded in the Canadian experience from our history of couriers des bois and explorers like David Thompson, Peter Fidler, and Anthony Henday.  Or maybe it's a result of trips in the family Volkswagen camper van when I was growing up. Or perhaps I should blame my misspent youth playing country music in bars and roadhouses across the country from Ontario to Alberta.  Whatever the reason, I find there is something primal and satisfying in travelling for days over the long stretches of the Trans-Canada Highway.

The reason: daughter number one lives in Ottawa.  We live in Alberta.  Daughter number one wants to come home.  But she doesn't want to fly over the country from 30,000 feet; she wants to see it at ground level.  I offer to drive out to pick her up.  And she thinks it would be great to go on a road trip across the country with her dad.

So two weeks ago I saddled up our '09 Volkswagen Jetta TDI (the diesel model) and in three and a half days drove nearly 3500 kilometers from Alberta to Ottawa, our nation's capital, rested up for a day, and then drove nearly 3500 kms back.

Heart surgery?  Pah!  What's a little thing heart surgery to stop a man from a good drive?

It was a great trip.  The car was wonderful (its first long trip), the highway was good without too many delays for construction, traffic was not too bad (most of the summer holiday crush of trailers, motorhomes, and overloaded cars had disappeared), the truckers were well-behaved and professional, the weather was perfect, the scenery spectacular, and the company outstanding.

The only worry about the trip I had was how it would affect my circulation.  I wasn't particularly concerned about driving or having to stay awake from boredom.  But during my recovery I'd been used to walking a bit every day.  Plus my usual day to day activities involved moving around.  I wasn't used to sitting in one place, like a car, for 8 to 10 hours in a row.

A doctor my wife knows suggested that I should stop every hour and walk for just 3 minutes.  I adjusted that to stop every 100 to 200 kms and to walk and stretch for 5 or 10 minutes.  It made all the difference.  I didn't become fatigued (or, as fatigued) and I had no circulation problems at all.  I was tired by the time I stopped for the evening but, after a good night's sleep, I was refreshed and ready to go the next day.

It's a good technique.  I'd probably use it whether or not I'd just had heart surgery.

The best part of the trip was spending three and a half days with my daughter, enjoying the tunes we listened to, watching our country's spectacular scenery, and being there with her as she learned more about the land and the road that threads across it through the forests and prairies.

And the moose is an old friend of her mother's and mine ... we just had to set up the camera for a photo.

Wednesday, September 8, 2010

Drove, Driven, Drive, Driving

6 weeks and I've got wheels again!

Funny that driving should be a big deal.  But it is.

When I was discharged they told me "No driving for 6 weeks!  Because of insurance."  I accepted that.  Guess it made sense.  I was through a pretty serious surgery and I was still feeling the effects of the anesthetic and was full of various medications (all prescribed).

Seemed fair enough to think I might pose an increased risk on the roads.  Perhaps my incision would leak and I'd be distracted by blood on my chest and not see that stop sign.  Perhaps I'd lapse into a Beta blocker induced swoon and fade into the next lane only to side-swipe an on-coming car.  Perhaps my blood pressure would go through the roof from road rage the first time I encountered some idiot who cut me off without signalling and I'd burst my by-pass.  Who knows what carnage I might cause if I was behind the wheel in any of these scenarios.

So I have been good for the past six weeks and I've honoured the insurance industry's risk assessments.

But today is six weeks.  I drove!!  Still remembered the rules of the road and how to shift gears.  Got M to school and myself to my second cardiac rehab session.  Nothing to it.

Funny though how much more independence I feel now that I'm on the road again.  Years ago we lived without a car for a long time and it was no big deal.  It was occasionally inconvenient but we didn't really miss it.  We walked a lot and were probably more healthy for it. But now we're more suburban and the places we need to go are farther away.  And time is often short.  It sure is good to have wheels.

Six weeks without driving though makes me think I could cut back some.  I'd save a bit of gas, spew a bit less carbon dioxide, and get a bit more heart-healthy exercise.  Those would all be good things.

Incidentally, did you know that space shuttle and space station astronauts are also prohibited from driving for six weeks after they return to earth?  Imagine that.  They can fly the space shuttle to a landing but they can't drive their car home afterwards.  I like having something in common with astronauts, though.

Sunday, September 5, 2010

Body Works

and another trip to Calgary

Only this time it wasn't for my body ... it was to see the Body Works exhibition at the Telus World of Science.  Here's the link to Body Works in Calgary.  (Hope the link still works after the exhibition closes.  Here's a link to the main Bodyworlds site if not.)

Though this exhibit focused on the Brain, there was plenty of other information on the skeletal system, the nervous system, and the cardio-vascular system.  I am even more amazed at what they did to me now.

The heart muscle is surprisingly small.  About the size of a loosely clenched fist.  For some reason I was imagining something a bit bigger, say, two hands worth.  And it squirts blood throughout the body some 2 billion 943 million 360 thousand times during a lifetime (2,943,360,000 ... say, an average of 70 pumps per minute times 60 minutes per hour times 24 hours per day times 365 days per year times, lets be generous, 80 years.)!  Wow!

Even more amazing to me is that the surgeon went inside that little muscle of mine and repaired one of the valves, something that opens only about as much as the diameter of my thumb at the first knuckle.  Now that's some fine needle work!

For the exhibition, donated bodies are prepared by exchanging all of the water in the tissues for a synthetic polymer.  The polymer, which hardens to about the same density and weight as the water it replaces, then essentially 'plasticizes' the tissues and preserves them.  Body worlds is noted for artfully presenting the results by posing the figures in life-like actions that reveal the interior workings of the body.

Dramatic stuff.

The exhibition also displayed other plastinated body parts so that, though brain stuff dominated here, it wasn't the only thing to see.

I was, of course, drawn to displays which showed the heart.

And there it was.  A heart which had suffered a heart attack.  You could see where some of the heart muscle was damaged.  Another was shown in cross section which revealed that an artificial mitral valve had been installed.  Amazing to see the little flapper-valve in place.  And to think that might have been my heart if Dr. M. hadn't been able to repair mine.

I was surprised at the number of little fibers inside the left ventricle.  Those are the cordae tendinae that hold the loose ends of the mitral valve and connect it to the interior of the heart muscle walls.  There were a lot more of those little fibers than I had expected.  They looked almost like the stringy bits you pull out the inside of a pumpkin when you carve it up for Halloween.

I wonder what my heart looks like?  Not that I'm ready to have it plastinated just yet.  I hope there are still another billion or so squeezes left in the old pump.