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.

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.

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!

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.

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.

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.

I'm in Rehab!

Cardiac Rehab, that is

Had my first rehab session today.  And, no, it is not a 12 step program.  It's for folks who have had some sort of cardiac intervention.  And, no, it isn't about getting us to go through some other kind of 'intervention' of the psychological type.

I thought for sure I'd be the youngest one there.  But, no.  I was probably right in the middle.  The oldest was 88 and the youngest 49.  Six men and 2 women.

I was the only one who had not had a heart attack.  Turns out that for all of them, it was a complete surprise.  My surgery, of course, wasn't a surprise given that I'd known about the problem 6 months before it was fixed.  But for all of them it was something out of the blue.  One day they were feeling good, healthy, normal, and fit as a fiddle ... the next, they were in the hospital, on medications, being anesthetized, and having blocked heart arteries fixed with stents.

All of them spoke about denial; they didn't believe it was happening to them.  They thought the hospital had it wrong and they weren't the ones who needed to go to Calgary.  All talked about having a variety of symptoms that were strange but that they thought were not related to the heart.  Sore, numb, achey arms; sore backs; aching jaws; nausea; pressure in the chest.  No one felt at the time, ah ha, this is it, I'm having a heart attack.  Most of them lived with the vague symptoms for a day or two before they went to emergency.  Only one took an ambulance ride.

So most of the class was about how the heart works, what a heart attack is, what the cardiac team did in response, and how medications (and we were all pretty much on the same ones) help the heart to recover and to prevent things from getting worse.  I guess I was fortunate in that I'd learned about my problem from doctors and my own research well before I ended up in the operating room.  For these folks, though, it all happened so quickly that perhaps this was their first opportunity to learn more about what they'd been through.

Why would it make sense to provide this information after the fact?  They'd already had a heart attack; why learn about heart attacks?  A friend of mine (who'd been through the experience years ago) was told that about 50% of patients who have blocked heart arteries repaired end up back in the cardiac unit later needing to be repaired again.  They don't make the lifestyle changes needed to keep their arteries clean.  They don't stop smoking, they don't change their diets, they don't exercise, they don't keep their weight down, they don't manage their stress.  So, I guess if education can help keep 75% or 90% from a return trip for further repair, then it would be good - big savings to the health care system and more healthy people.

We all should know the risks for heart disease: smoking, being over-weight, high fat and high salt foods, lack of exercise, too much stress.  But we also don't believe that these things will affect us.  We maybe smoke a bit (or a lot), we let our weight go, we indulge in those high fat meals and desserts, we are too tired or it's too hot or too cold for exercise, and we let our busy lives rule.  And nothing happens.  We get away with it.  Until, BAM, there are those vague symptoms and we end up in the hospital with a heart attack. Or dead.

We in this class are the lucky ones, I guess.

The moral of the story: don't smoke, keep the weight down, eat heart healthy food, avoid fat and salt like the plague, exercise, and relax.  Otherwise you may end up in the morgue too soon.  Or you'll be lucky, like me and my rehab classmates, but with a scar on your chest and an insiders view of the cardiac health-care system.

Three weeks out

Recovery in the slow lane

The first week home was great.  My own bed!  My own clothes!  My own food!  There was a kind of euphoric afterglow from the surgery.  I had a cold beer and it was glorious.  I had come through fine, as far as I knew, with flying colours.  My incisions were healing very well.  My chest hurt a bit when I coughed but extra-strength Tylenol was keeping it under control.  I was outside for walks in the wonderful sunshine.  I felt pretty strong and like the repair had made a difference. I was fixed and better than ever!

The second week was more of a downer.  I'm not entirely sure why.  Maybe the adrenaline from the first week dropped off.  Maybe the residual effects from the hospital medications wore off.  Maybe my repaired heart started to adjust to not pumping so often and so hard.  Whatever the reason, I felt blue.  I had less energy.  I had long naps both in the morning and in the afternoon.  Getting motivated to go for a walk was hard.  My healing sternum hurt when I moved, when I coughed, and when I took a deep breath.  I didn't seem to be recovering fast enough.  I wasn't as vigorous as I expected, I guess.  Maybe the beta-blocker medication was slowing me down too much.

A friend who'd recently been in for surgery to correct a blocked artery with a stent reported a similar sort of high followed by a low.  After his procedure he said he'd felt full of energy and vigour.  But by the second week he was feeling discouraged and down at the slow pace of his recovery.  He said it took a few weeks to get through his 'blue' period.

Now, three weeks after, I feel on more of an even keel.  It is taking a while for the sternum to heal but I'm resigned to that.  My blood pressure and heart rate are quite a bit lower than before the surgery.  I'm settling into a slower pace of life.  Someone reminded me that open heart surgery is pretty traumatic for the body and perhaps I shouldn't be surprised at the slow pace of recovery given the violence of what I've been through.  That makes sense.  I also think that some of my medication doses need to be adjusted.  I see my G.P. next week.

On our way home

Happy to be leaving

I was darn near ecstatic when Dr. M's resident told me I was doing good and the plan was to send me home the next morning.  I was relieved.  The surgery had been a success, I was fixed, and I was going home.

Not that I wasn't enjoying the care and attention provided by the nursing staff.  But Mr. D.A. was really getting on my nerves and the food was getting a bit boring.  And I was feeling pretty good about myself.  I was walking the unit with no problem.  And I'd even done a flight of stairs under the watchful supervision of a physiotherapist.  All other body functions were operating as required too so I certainly felt like I was fit to be discharged.

My nurse that evening said I could disconnect the heart monitor leads and the two 'jumper cables' they'd installed before stitching me shut which were connected to my heart and ready to be used in case I needed a temporary pace maker.  I hadn't needed any pacing by this time so out they came.  It felt sort of like a big ingrown hair sliding out of my skin as she tugged them out of my chest.  A band aid over the two small holes and I was good to go.

And now, finally free of all wires and sensors, my skin was my own.  It was time for a shower!  I was pretty stiff and sore but it felt glorious to shampoo my hair and to scrub away at some of the sticky tape residue from the dressings.  I felt like a totally new man when I was done.  Even the fresh set of hospital duds felt good.  I was a new man ready for home!

The nurse showed F how dress the incisions that were still a bit oozy.  My very own Florence Nightengale.  Then ... one more sleep ... and I'd be ready to go.

It was tough to sleep, actually.  I was excited.  I woke up a couple of times and took circuits around the unit.  The lab blood-drawers woke me up one last time for a sample at 1:30 a.m.  Finally it was morning.  A great day to go home.

The shift changed and I ended up with a male nurse.  Damned if he wasn't as good looking as the female nurses.  F agreed.  He got me going on the paperwork and juggled signing me out with another patient who was also departing and Mr. D.A. who managed to find something to whine about for attention whenever the nurse passed by his bed.

It took a while, making sure I had prescriptions, a copy of the discharge note, and all of the other bureaucratic necessities to exit hospital responsibility. It felt great to dress in my own clothes.

And then we were away shortly before lunch (one less hospital meal).  I walked out on my own steam and into the sunshine and fresh air.  A great day to have a properly pumping heart.  I felt wonderful.

The drive home was uneventful with a couple of rest stops to stretch my legs and to keep the circulation going.

We arrived to an auspicious sign ... the yucca plant was in bloom!  It was a clear signal that all was right with the world.

And how great it was to be able to cook a good meal ... BBQ'd chicken (low fat, low salt, of course) and rice.  And wonderful to sleep in our own bed.

Ahhh, great to be home.

Food

Not bad ... Could be worse

Hospital food.  A subject ripe for complaint and criticism.

But you know, I've noticed that many of those who complain probably enjoy a diet more likely to put them into a cardiac unit than to keep them out.  Some folks just eat too much food and there's just too much fat on their bodies.  That's hard on their cardiovascular system.  Add too little exercise and the problem is compounded.  As well, many people consume foods that are too high in fat and, especially, cholesterol. We know that such a diet contributes to heart disease.  Finally, most people take in too much salt.  It's hard to avoid when a diet comes primarily from processed foods or from restaurants.  So, if you are used to eating a lot of pizza, hamburgers and french fries then, yes, I expect that you will complain about hospital food.  But the hospital food is certainly better for you.

That being said, though, feeding thousands of people in hospitals around the city of Calgary does definitely present challenges.  The food has to be safe, transportable, re-heatable, nutritious, healthy, and tasty.  That's a tall order and not an easy task to achieve with an industrial scale system.

Nevertheless, I found the food was not too bad.  The bread and buns were fresh.  The oatmeal was a good consistency and tasty.  The soups were good.  The green beans weren't too soggy or stringy.  The veggie burger I had one day was nicely spiced.  The rice was done perfectly.  I kind of looked forward to meal time, to tell the truth. And I was able to make choices and to try a variety of different entres and side dishes.

On the other hand, the coffee and tea were both incredibly bitter. I stuck with water.

Overall, given the industrialized systems approach to food production and delivery, I thought it wasn't too bad. Three stars.

But ... the night before I was discharged I was up at about 3 a.m. to use the bathroom.  I went for a walk around the halls to stretch my legs.  And I caught the nurses.  They were updating records on computers and getting ready to do their rounds while, up on the counter in plain view, was a big bag of ripple chips and two kinds of dip.  Embarrassed, they said only on the night shift would they ever do such a thing.  Never during the day shift on the cardiac unit would they eat such high fat high salt treats!  But I discovered their little secret. And took two chips in exchange for keeping quiet.

Though the food was OK, it was very very nice to finally get home and to have a fresh crispy salad and to fire up the BBQ for some grilled chicken and fish.  Not having to mass produce thousands of easily transported and re-heated meals makes a huge difference.

Friends

Visitors from Home

Hospitals ... or, anyway, this hospital ... was not a bad place to be.  The nursing care was great and I always felt well looked after.  There was always something going on so, as I recovered and my reality became less obscured by medication, it was interesting to learn the procedures and routines of the cardiac unit.  Of course F. was there too, twice a day usually, and that was fantastic.  I felt pretty lucky compared to those who didn't have many visitors (and especially when compared to Mr. D.A. whose visits resulted in spats and tears).

But I especially appreciated visits from two friends who drove up to spend an hour with me.

So thanks a lot Bobby G.

Glad I could be an excuse for you to take the bike out on a road trip. It was sure good to see your friendly face and to share a few laughs.

And thanks a lot Jamesy.

It was good to share the high of recovery with ya.  Thanks for taking the time to come up and to spend a couple of hours. And for the cool Mag too ... it helped to pass the time.

Having visitors certainly helped me keep a positive attitude and kept me focused on getting out and back home to continue the recovery.

Thanks guys.

On the Advancement of Knowledge

Doing my bit for science

One of the great things about having my repair done in Calgary is the Libin Cardiovascular Institute. It combines an integrated program of cardiovascular wellness, health care, research and education. This is one of the cutting edge heart programs in the country.  So, given my academic side, I was interested when Dr. M. asked if I'd consider participating in a research project.  

It was about a new kind of ring, more anatomically correct, for use in mitral valve repair.  Typically after the surgeon reconstructs the mitral valve, a prosthetic ring is attached around the opening of the annulus, the 'mouth' of the mitral valve, to help maintain its shape and support the proper functioning of the valve flaps.  This new ring, the Sorin MEMO 3D Annuloplasty Ring for Mitral Valve Repair, has been available for some time on the market but has not been studied enough to measure how it compares with the traditional annuloplasty ring.  The new MEMO 3D ring not only forms a circular ring but also dips in the middle (kind of like the Saddledome roof).  As well it is made with newer smoother high-tech materials and it better maintains its shape.  

Here's a link which has a funky animation of the ring and the mitral valve opening and closing like a mouth. 

Anyway, I agreed to participate in the study.  The risk seems to be no greater with the new ring than with the old.  It might even be better ... actually sort of looks to me like it ought to work better.

So, I'll do my bit for the advancement of science.  I think I'll even claim this as research activity on my professional activities report!

I want to SCREAM!

My Dumb Ass Roommate is a Jerk

What's the best motivation to get out of the hospital?  A Dumb Ass roommate.

I didn't pay much attention when he moved him into the Step-Down room.  I think I was still too doped up and spacey from the anesthetic.  But after my first day there, he was hard to miss.

First off, his wife / girlfriend / partner showed up with some of their kids (I overheard him claim to have 9 children altogether).  Nice.  A family visit.  Bring the kids to see Daddy in the hospital.  They were a little rambunctious but not bad.  Dad and Mom got into a fight, though.  Hard not to overhear when there's only a cloth curtain between you and the flying accusations. Where am I going to get the money?  You said!  She said!  He said!  I said!  Tears. I was happy when they left.  

But then, after a bit, the fight continued via cell phone! At least this time I only heard one side of the conversation.   That was bad enough.  I gave you the money!  You said!  She said!  He said!  I said!  Click. I didn't mind when they moved him out into the regular ward room.  

When it looked like they might be getting close to moving me out too, I asked about the private or semi-private room that my insurance would pay for.  Any available?  None just yet.  So, of course, I was moved into the same room as Mr. Dumb Ass.  At least my catheter came out before I moved. One less holding tank to drag around. It was really very nice to feel a full bladder and to pee when I wanted, even if I did have to go into a container to measure my 'output'.

In the evening, after the nursing shift changed, Mr. Dumb Ass picked it up a notch.  He began to whine and complain to the nurse about wanting to get out outside for a smoke.  A smoke?  What the?  He's just had heart surgery and he wants a smoke?  I overhear that they've already put a nicotine patch on him.  It doesn't work he complains.  The nurse finally gives in to his whining.  OK, he can go out.  But he pushes it further.  He wants to be disconnected from his IV drips.  Apparently he's on an IV blood thinner and it really can't be stopped.  He whines.  He complains.  He pleads.  He argues.  It was impossible not to listen.  Eventually she gave in, unhooked him, and let him go.

It wasn't long before he was back.  Apparently he'd made it to the front door and only then realized he actually didn't have any smokes with him.  So, not to be denied, he shambled off toward the nearest convenience store on 16th Avenue, a block away, until security stopped him, turned him around, and sent him back.  Smokeless.  Right.  Go for a smoke without smokes.  Dumb.  He wasn't just an Ass, he was a Dumb Ass.

Thank god for itunes and headphones.  I was finally able to shut him out with a relaxing mix; just needed to keep the volume loud enough to drown his whining out.

The next day was not much better.  More phone calls.  More fights.  More complaining.  More whining. To everyone.  To the nurses, to the food deliverers, to the lab staff who came to draw blood (Ow! I bruise! Unnnh! Ow!), to the physio-therapists, to the doctors.  This was too much.  I asked again about a private or semi-private room.  

Finally, late afternoon, about 24 hours after moving our of the step-down room, they wheeled me into a semi-private room.  And -- Bonus -- there was no one else there!  Luxury.  And even better, they took out my remaining chest tube (an interesting feeling, sort of like a sharp stab in reverse) and gave me fresh dressings.  Ahh ... I felt like a new man.  I was free of containers and IV poles.  I could go to the bathroom on my own.

I was so looking forward to a good night's sleep.  And I had just gone deep when the lights came on.  It was about 11:30.  Commotion.  There was racket.  Someone bumped into my bed.  I was wide awake.  They were moving in a roommate.  And, who was my new roommate? Mr. Dumb Ass!  I'd recognize that whining voice anywhere.

I'd met the charge nurse earlier in the evening.  So now, about 1:30 a.m., I tracked him down and let him know that I wasn't happy.  In the end, though, I figured turning myself into another whining complaining patient wouldn't help and so I would live with it and try to maintain my composure and positive energy, no matter what Mr. Dumb Ass did.  But thank god for itunes and headphones.

The nurses were very patient and professional with him.  They kept listening to everything Mr. Dumb Ass said, offering options for every complaint, offering strategies to deal with his demands, setting up meetings with doctors, psychologists, social workers, physiotherapists.  Those who prescribe to the 'squeaky wheel' theory might feel that all of this help proves that he was getting more care than others of us who were, say, quieter and more reasonable.  He was certainly getting more attention.  That seemed to be what he wanted.  But I don't think he was getting more care.  

Afterall, they discharged me before him. 

Steppin' Down

A trip down the hall and around the corner

I don't know what they put in that popsicle, but shortly after finishing it and after about 2 days since this process started, they rolled me out and down the hall to the 'Step-Down' unit. Here there is slightly less monitoring and about 3 or 4 patients for each nurse.

There was some kerfuffle about the bed being ready for me and a had to wait a few minutes until I could shift over into my new digs. Seems the flow of folks home from the cardiac unit was not quite in sync with the flow of folks going into surgery, coming out of surgery, going to the step-down unit, and into the regular ward. There was some grumbling from the nursing staff with the juggling that was going on, but it all seemed pretty smooth to me. Maybe that was the pain medications talking.

I was still pretty loopy and having a hard time focusing. I took quite a bit of pain medication overnight ... why not? My back was pretty sore, especially on the left side where the last remaining drainage tube was still doing its thing. Plus they said my heart was 'rubbing' against the pericardium both from already being enlarged and from swelling after the procedure and this was causing irritation. All I know is, with some hot blankets rolled against my back and the pain meds, I ended up with a pretty good sleep.

Next day I was able to do a bit of walking, a lot of sitting-up, some reading, and eating. It was nice to be able to focus pretty well (though it was still a challenge to draw a circle around the menu choices for the next day's meals. Who knows if I ended up with what I asked for! I was still fuzzy so couldn't remember what I ordered anyway.).

The nurses were great. They were very professional, knowledgeable, skilled, compassionate, and ... too true to ignore ... cute.

I was still pretty uncomfortable ... sore back, catheter, chest drainage tube, incisions and tapes starting to itch. But, overall, it felt pretty good to have a repaired heart and to be conscious and able to smile after a major surgical procedure. I could see no reason to complain.

Unlike one of my roommates.

Dancing after cardiac surgery

On Waking Up

About 24 hours after I went under they began to bring me around.

I, of course, had remained blissfully ignorant of all that had transpired over the past 24 hours.

But now, as perception began to dawn, I began to hear various electronic bells or alarms. I think I heard voices.

The last thing I had worried about before going into surgery was getting to the hospital on time. As consciousness slowly returned I was convinced that I needed to get up so that we could get to the hospital. I had a surgery to get to!

The alarm was going off. I could hear it. I was covered up. I had to throw off the covers. I needed to get up. It was time to go!

In my efforts to throw off the covers, apparently, I turned into a bit of a flasher. I doubt anyone was impressed. F says it was quite funny.

After struggling for a while, F pointing out that all I wanted to do was get up. The the nurse in charge said, fine, if he wants to get up, let's get him up. A physiotherapist was called for this delicate operation.

She got me to my feet. I was having a heck of a time focusing my eyes properly so I don't much remember what she looked like. She was very cheerful and positive though.

Then she passed me off to F for a few steps. Shuffle to the right, shuffle to the left, bend your knees, lift your feet. Oh, it was fun.

And the dancing helped. It gradually began to dawn on me that, if I was dancing in heaven then why was F there? I didn't think dancing was part of the pre-operative plan, so then this must be post-operative. And, hey, if I was up dancing, then the operation must have gone well.

I asked F, "Am I done?" I was still pretty stoned. It hadn't really sunk in. F assured me, yes, I was finished with surgery. "Whoo Hoo" I said. Party animal.

The nurse asked about pain: "Does it hurt." "Only when I breathe," I said. I was trying to be funny.

It gradually became easier to focus, though the world was pretty fuzzy. The nurse was funny. I remained on supplementary oxygen and various intravenous pain killers and such.

A huge highlight was the popsicle. It was nice and cool and refreshing. And almost real food.

Ahh, good to be alive.

OK this is it

Really ... this is it

Wednesday July 29. No false alarms. I was the first procedure of the day so we had to be there at 6 a.m. Not much traffic then. Nice.

Same as last time, when we arrived there was paper work to do and washing with the special antibiotic handi-wipes. It was only a short wait until it was time for my 'Happy Pills'.

When the stretcher showed up I was feeling no pain. I wasn't feeling pain before, really, but at this point I was happy to climb onto the stretcher. Take me away! Cut me open! Fix my heart! All was good.

I was wheeled to the hall outside the Operating Room by a nice scottish lady who was impressed by the scottishness of my name. I said good bye to F and then I remember nothing. Not a thing. I don't have a clue.

They say now I'm fixed and everything went well. I guess. I do have some interesting wounds on my chest. But as to what happened after I made it to the Operating Theatre, I don't have any idea.

This is what they say happened.

Here's a animation of a leaking mitral valve (thanks to the Mayo Clinic).

And here's an animation of a typical repair.

In my case, apparently, the surgeon trimmed out some of the bulging tissue from the offending segment and then sutured the good parts back together (as in the video). Then he placed a ring (sort of like in the video) around the valve base to help support it. [More about the ring in another entry.]

He also bypassed the partially blocked artery on the outside of my heart and, I guess, put me back together. They added a couple of drainage tubes to carry away blood and fluid from around my heart, a typical procedure.

F says I came out of the Operating Theatre around 11:30 a.m. However, I was still bleeding quite a bit more than I should have been, so they kept me under anesthetic. They ended up having to insert another drainage tube under my left arm to take care of the excess. They kept me out through the night to help me stabilize and just in case they would have to go back in to tighten something up.

So, although the surgery didn't take that long, I was out for just over 24 hours.

Blissfully ignorant. Sleeping like a babe. Out cold. Dead to the world.

False Alarm or False Labour?

Almost but not quite

July 19. Finally, we thought the big day had arrived.

I had called Dr. Maitland's office the week before and was told to be at the hospital on the 19th. We were booked to be the second surgery of the day.

I thought that ought to be a pretty good tee-time. By mid-day or so the coffee should have kicked in and, as long as the surgical team hadn't been partying too much on the weekend, then I'd be in good hands.

It was very exciting to finally have a date, even if it was six months after the problem became serious. The excitement was tinged with fear because, well, they'd be cutting open my chest and my heart and trying to fix something that never used to be fixable. Plus, this was a serious operation ... I mean, I could die.

So, we drove up to Calgary on Sunday and had a good evening. I slept reasonably well and we showed up at 9 a.m.

A very nice nurse led us through the paper-work and then handed me the fashion of the day. While changing I had to wipe myself down completely with these anti-bacterial wipes which was not at all unpleasant. They were warm, thick, soft, pleasant-smelling and, after I knew I was really clean.

Then we had to wait. And wait. And wait.

If it hadn't been for sudoku, I'd have gone crazy.

About 11-ish, a person in OR scrubs who was an anesthetist came to explain that they were running behind but that they'd probably come for me around 1-ish.

More waiting, and waiting, and waiting. By this time I'm getting hungry. I haven't eaten anything since the great piece of roasted salmon I'd had about 7 p.m. the night before. I was starving.

Finally, around 2-ish, Michelle, the nice anesthetist (who looked not much older than Elizabeth) came to put us out of our misery. My surgery was postponed. Disappointing, yes, but at least I could have something to eat. The hospital chicken-salad sandwich tasted pretty good by this time.

Dr. Maitland dropped by to offer his apologies, things hadn't gone as planned, and his office would be in touch next week about a new date.

So, a let-down for sure. But I'd certainly rather have a surgeon and a surgical team who were awake and on top of their game than tired and grumpy at the end of a long day.

My friend Tom says it must have been kind of like false labour ... all the build-up but no baby to show in the end.

What's broke

Simple Anatomy

I'm the kinda guy who, when a body part breaks, wants to know more about what's going on. Just in case you might also be curious about the inner workings of the human heart (your heart included), here's a bit of what I found out.

A heart is a pretty amazing pump. It collects blood with low oxygen levels from

the body and then pumps it into the lungs. Breathing adds fresh oxygen to the blood which then returns to the heart to the Left Atrium. When enough blood is there and the pressure is right the Mitral Valve opens and the oxygenated blood is pushed through the valve into the Left Ventricle.

The Mitral Valve shuts and stays closed (ideally) while the Left Ventricle gives a powerful squeeze and shoots the red blood through the aortic valve into the Aorta and throughout the body.

Stinking amazing how all of the parts and pieces work together opening, closing, squeezing, relaxing in a constant coordinated cycle. It is really quite a stunning piece of equipment.

So what's up with a severe mitral valve regurgitation?

The basic problem is that the valve isn't shutting properly. When the left ventricle then goes to squeeze blood out through the aorta to the body, the mitral valve allows some back-wash. Some of the oxygen rich blood which was waiting to be sent off from the atrium ends up being pushed back into the atrium.

This means the body gets less oxygenated blood. Ah ha ... which explains why I felt like I wasn't getting enough oxygen; it wasn't my lungs, though, it was my heart.

Why does this happen? The short answer is that we really don't know for sure why it happens. It possibly has something to do with genetics. It has little, if anything, to do with lifestyle. Dr. Maitland suggested that there's nothing I could have done differently to have prevented this. It was just the luck of the draw.

That's actually comforting to know.

Me and Danny Williams

Meanwhile ...

While all of the waiting was going on ... waiting to go from the GP to the Internist, from the Internist to the Cardiologist, from the Cardiologist to the Cardiac Surgeon ... there was a story in the news I followed with interest because it was also about mitral valve repair.

In late February, it came out that Danny Williams, the Premier of Newfoundland and Labrador, had a mitral valve repair at Mt. Sinai Medical Center in Florida earlier in the month. There was a fair amount of discussion about his actions and whether or not this indicated a rejection for the Canadian medical system, a 'rat jumping ship', or merely a choice made by someone who was in a position to advantage of an available option.

In typical feisty fashion, Williams responded to critics of his decision by saying: "It's my heart, it's my health, and it's my choice." His actions generated quite a bit of press which I followed with interest since, of course, my mitral valve was in the same (or very similar) condition as his had been. I knew, however, that I'd not be going to Florida for my repair, but to Calgary. Did this mean I was condemned to have poorer quality work done? Was the Canadian medical system letting me down?

Andre Picard, columnist with the Globe and Mail had an interesting and well-written take on the issue: "Williams's heart surgery choice was based on ignorance." Picard's point was that "Had Mr. Williams asked his questions of the right people, he would have learned what procedures are offered in Canada, and that cardiovascular outcomes in this country are as good as in the U.S., and often better." Picard concludes: "Mr. Williams’s sin was not in going to the U.S. for surgery, it was in acting on partial information, uttering untruths about the availability of care, and smearing – however inadvertently – Canada’s health system in the process."

At the time I wasn't sure what I thought. Now, after I've been through the process, I do have some ideas.

First, I feel confident that I obtained the best possible care for my condition, and, although I might have experienced a different kind of procedure with a different surgeon in a different location, I couldn't have expected anything better than what I received. It was state of the art work with a proven and experience surgeon who performed a challenging surgery with minimal risk to me.

Second, Mr. Williams' point about "my heart, my health, my choice" assumes a particular view of humanity and human liberty. It is one that is primarily individualistic. And although I wish for people to have as many freedoms as they can, I think Mr. Williams' statement betrays a view of humanity that is flawed.

First, Mr. Williams' heart is not only his individual and personal heart, but it is also a human heart. His heart is the very same as mine. It has the exactly same kind of mitral valve that my heart has. His was leaking just like mine was. His heart was broken in the same way mine was. There is a universality, then, to the human heart. A heart is, in effect, our heart ... not just my individual heart.

Thanks to this universal quality, heart research and heart surgery is not individualistic. The knowledge, treatment, and techniques applied to one heart are applied equally to another. It cannot be, then, just "my heart, my health, my choice."

Second, Mr. Williams' heart is not just his individual heart, it is also a Canadian heart. Mr. Williams had access to the same health care system as all Canadians. It doesn't matter whether you're Danny the Premier of Newfoundland Labrador or Dave from Canmore or Bruce from Lethbridge, you will be accepted into a system which will not discriminate or even care about who you are. It will simply try to provide the best health care for your needs.

This doesn't mean that there aren't problems with the system which need to be addressed and changes that need to be made. But this is normal for any developing and improving human system.

To be sure, Mr. Williams' heart is a Williams heart, not a MacKay heart, a male heart, not a female heart, a Newfoundland heart, not an Alberta heart. So, Mr. Williams, yes you are an individual, but you are also a human being and a Canadian. "My heart, my health, my choice" express facets of your individuality admirably (in classic American-style terms). But sadly it diminishes other facets and it ignores a crucial universal aspect of our common humanity and the critical feature of equality that derives from that universality. Your view describes a diminished and impoverished vision of humanity that is disappointing, though not uncommon.

Either way, I guess, we both have had our mitral valves repaired. I suspect that my repair is just as good as yours. One thing's for sure; my repair did not cost me near as much as yours did you.

Beginnings

All fall I was feeling generally more tired and run-down than usual. I thought, oh well, I'm about to turn 55, I must be getting old. It would show up especially when toting my electric piano on the way to practice or to a gig. I'd find I couldn't get my breath; I was weak like I'd lost muscle mass and tone. Again, I thought, "So this is what 'old' feels like."

Then in January I found myself waking up at night, my heart racing, short of breath and having to gulp air until I calmed down. I was not sleeping well. Neither was F.

I thought maybe I had pneumonia. The doc took a chest x-ray which showed the lungs were clear but that my heart was enlarged. Plus he heard a pretty substantial heart murmur. He referred me to a specialist in internal medicine here in town ... since we don't have any cardiologists.

The internist sent me for an echo-cardiogram and prescribed some medication to reduce blood pressure to make it easier for my heart to pump. The echo (which is quite an astounding application of sonar-like technology -- thank you military-industrial complex for something useful other than bombs) showed that I had a severely regurgitating mitral valve. Despite this disappointing news -- I had a broken heart -- I was happy to learn more about the problem.

The internist referred me to a cardiologist in Calgary.

There was a wait, of course. In the meantime I tried to take it easier that usual. The heart medication was amazing stuff. It enabled me to breath again, I could go up a flight of stairs (not two at a time, mind you, but much better than before), and I could sleep through the night. I lost a bit of weight but, overall, I was able to continue on pretty much as before.

After a couple of months we went to Calgary. There was another echo-cardiogram. It was remarkable to see the internal functioning of my heart, without someone needing to cut me open to view the innards at work. They took a bunch of images, movies, measurements, and other mysterious stuff. We met with the cardiologist later. He confirmed the diagnosis: a severely regurgitating mitral valve.

I was scheduled for an angiogram and we went home.

After another couple of months we were up again, this time for a more invasive procedure to gather more exact pressure readings from inside the heart. They also took images of blood flows through heart arteries.

The results didn't add much to what we already knew about the mitral valve - it was leaking badly - but did show that in addition I had one heart artery which was about 60% blocked. Aggh ... the dreaded coronary artery disease, well, at least in one artery. That wasn't bad news, actually, since the blockages weren't widespread and this one could easily be fixed.

So, the next step was for a referral to the cardiac surgeon.

After another number of weeks we were back to Calgary to see Dr. Maitland, the surgeon. We reviewed the evidence, discussed the options, made a plan, and decided to aim for a date in June or July.

Good to have that much decided, finally.

Umm ... Why?

Why Blog about my mitral valve repair?

I suppose one reason is because I can tell the story here and not have to keep repeating myself to whoever asks about the surgery. I don't have to keep track of who's heard it and who's not. I don't have to make sure that whoever I'm telling it to isn't getting bored, or grossed out, or worried. It gives you the chance to read it if you want (hear the story) or to ignore it if you want; either way I won't know. I won't be offended and neither will you. The pressure's off.

Second is that we took a few pics during my time in Calgary (photos? ewww, gross!), and this is a place to put those pics. I don't have to fill up your email boxes, or make copies, or presume that you want to see photos of blood and gore if you don't really want to. I don't have to decide which are the really good ones worth sending along and which ones are going to be uninteresting even to the most polite listeners among you. Again, the pressure's off.

Third, in fact, some of you may have a healthy curiosity, let's say a "scientific" interest in medical procedures and, well, you'd honestly like to know what it was like. Others of you might have a kind of morbid curiosity, a Frankenstein-esque attraction to medical procedures which take a person close to death, open up a human body, make changes, and return to life a new and improved human, me, in this case. Or maybe you fear the unknown and can envision this or a similar repair happening to you in the future. You'd like to get an idea of what to expect.

Finally, when you end up deep within the medical system, it sets a guy thinking. And, well, there were a number of situations during my own personal experience which connect to broader issues. These bear some consideration.

You see, the reasons are multiple. Who am I to judge you for wanting to read about it or not. All I can do is offer it up here in this format in the hope that some of you might find it interesting or entertaining.