Tuesday, February 21, 2012

Monday, February 20, 2012

DAY 1 Pre-Op

Twenty-two years after leaving New Orleans some things still stick, so me and my Mardi Gras beads will head to the hospital at 4:30 tomorrow, Mardi Gras morning, but there'll be no parades and debauchery for me. At that time of day I'm sure not going to be awake enough to write a post before I leave. Then again maybe I won't sleep a wink tonight because of what I'm facing, either way this is it. This is my last posting before they cut open my heart. If I do have any extra time before I walk out the door in the morning, I'm going to use it by standing in front of a mirror admiring my d├ęcolletage because it will never look the same again. I'm hoping the doctor can make the scar look like cleavage. I want to cry. I so want to cry. Really, someone should tell me to put on my big girl panties and stop whining about this when there are far worse things. Some people lose limbs. Women are losing their breasts. Some people completely lose their minds and never find them again. I need to gain some perspective on this whole thing. Well anyway, this is my last post for quite some time. Actually if I don’t make it through this surgery, this will be my last post forever, like finished, done, gone. In that case, you will never ever hear from me again.

I expect to be hospitalized for a week, with my first couple of days in the limbo land of Intensive Care. I won't be taking my computer so you'll be left wondering for about seven days if I'm coming back or not. I hate to leave you hanging, but of course, a little tension is always good for a story. That's about as accommodating as I can be about this.

Meds:  Namenda, diuretic, beta blocker, vitamins and supplements, 3rd and 4th Enoxaparin Sodium injections, use Bactroban nasal ointment, scrub body from neck to toes with Hibiclens (antimicrobial soap)

Sunday, February 19, 2012

DAY 2 Pre-Op

I'm at peace with all aspects of this upcoming open heart surgery except for how my throat will fare.  Other times when tubes and scopes have been placed down my esophagus and trachea I've suffered a killer sore throat for at least two weeks.  Of course my throat would only hurt when I swallowed, talked, coughed or breathed. 

Even POCD (post operative cognitive decline/dysfunction) no longer looms large in my mind because I'm fortunate enough to have a surgeon who is really on top of these things.  Recognizing that I'm at risk, he added a psychiatrist who specializes in this syndrome to my medical team.  The psychiatrist has taken aggressive preventative measures that have calmed my fears. 

Advanced age and a history of depression put a patient at risk.  Also a lower level of education. Darn, I should have finished those last two years of college! Several potential causes have been identified. The length of time on the pump oxygenator, also known as the heart-lung machine, is one.  Microscopic cell debris and bubbles generated by the machine are under suspicion. The rate at which the body is warmed may enter into it, but no one knows for sure.  

Nicknamed "pumphead," POCD can surface immediately or even years after open heart surgery.  It can worsen over time and persist for years.  Some of the symptoms are memory problems, confusion, personality changes, inability to focus and overall mental decline. Geez, I have some of those already! 

Ongoing stress triggered by anger, anxiety, guilt, worry or fear, is a major contributor to a decline in cognitive function even when someone isn't facing surgery.  Developing a positive outlook, feeling hopeful, compassionate and caring, appreciative and loving, improve the way our nervous system and brain function.  Philippians 4:8 provides some good advice:  Whatsoever things are true, whatsoever things are honest, whatsoever things are just, whatsoever things are pure, whatsoever things are lovely, whatsoever things are of good report; if there be any virtue, and if there be any praise, think on these things

Everyone knows that heart problems wipe out more men in our country than any other disease.  If you think the numero uno killer of women is breast cancer, you'd be wrong because, for women too, it's the old heart that takes the lead.  Most men get the sudden stabbing pain in their chests and down their left arms that screams, "Get me to the hospital, PRONTO!   But women are more vulnerable because our symptoms are usually wimpy, like shortness of breath and sometimes nausea.

I hope I've done an adequate job of making you aware of several aspects of heart disease symptoms, causes and ways to deal with them. You just never know when you might need to know some of this stuff.  With ongoing research and the development of new technology the future of heart care continues to unfold more options in treatments, medication, and solutions for healing broken hearts.   

So Tuesday morning I'll be joining the ranks of Bill Clinton, Barbara Walters, Regis Philbin, Robin Williams and half a million other Americans who annually undergo open heart surgery.  Only 1 to 2 percent don't make it.  That's 5 to 10 thousand obituaries added to newspapers every year.  I hope I'm not one of them.  

Meds:  Namenda, diuretic, beta blocker, vitamins and supplements, last day for anti-depressant, give myself 1st and 2nd Enoxaparin Sodium injections (blood thinner)

Saturday, February 18, 2012

DAY 3 Pre-Op

I feel a need to defend myself here, least you make a judgment call that I've brought this whole broken heart thing upon myself by a total lack of discipline in lifestyle and eating habits. OK, so I'd never convince any jury of my innocence if they saw me sitting on a bar stool at Elmo's Pub stuffing myself with a triple bypass burger and a large order of hot just-out-of-the-grease homemade potato chips.  It's also probably not the best evidence knowing that if you dangled chocolate covered bacon in my face, I'd follow you anywhere and everywhere.  But, Your Honor, let me explain.  Recently a friend said, "If YOU can have a heart attack, anyone can have a heart attack."  She said this while standing before my 123 lb, 5-ft 6-inch body.  (I'll pause here to give you ample time to hate me.  No, I don't starve myself, actually I don't do anything, apparently it's a by-product of having my father's French genes. Go ahead, hate me even more.)  I was a runner, never smoked, a veggie lover, as a kid I could eat my weight in spinach, carrots and asparagus (I had lutein coming out of my pores, how did I end up with macular degeneration?) and I drink all the right juices.  OK, so sometimes I dilute them with a little vodka, but how bad can a clear liquid be?  So what more could a heart ask for? 

Two years ago when I called the pulmonary specialist because I had such shortness of breath I couldn't walk up a flight of stairs without taking a couple of breaks, both the lung doc and my husband told me to get my sweet self to a cardiologist.  Immediately!  That said cardiologist said I had to go to the hospital immediately.  Hospital?  Immediately?  No way, I had things to do.  The cardiologist said I wouldn't be doing anything if I was dead.  Since he put it that way, I said OK.  He said it was A-Fib (atrial fibrillation), an irregular heartbeat, an arrhythmia.  So my heart doesn't have the proper rhythm. That explained a lot.  There really was a legitimate reason why I couldn't dance, why people around me looked at me funny when we clapped to the beat of music, and why I couldn't make a Clapper lamp go off and on.  Whatever happened to that marching-to-a-different-drummer thing?

The cardiologist said I had to take lots of meds. I said I'm not big on taking lots of meds. He said Coumadin and I said no.  Way too many side effects.  Instead, I agreed to take a full-strength aspirin.  The meds plus the aspirin did OK for some time. I also consulted with my brother-in-law who is a cardiologist in Nashville. Then I moved to a new city and got a new cardiologist who replaced my aspirin with Multaq, a newly minted med.  It did fine for a while, but not for long and I ended up in the hospital two more times.  A cardioversion was done the second time. The electric shock burned the heck out of a spot on my back, but it brought my heart back to perfect rhythm … for all of 15 hours. After that things started getting bad, fast.  The doc and I were tossing around different ablation procedures.  A raging infection in a molar that recently had a root canal and new crown couldn't be controlled by five rounds of four different antibiotics, in addition to oral surgery.  My heart was not handling this well.  Since it's known that oral infections can play a role in heart disease, and even though I had invested $3300 (my hot tub money) in this molar, extraction was the only option.

What an improvement!  Why, oh why, hadn't we yanked out that tooth much earlier?  My heart returned to perfect rhythm, but I still couldn't dance.  I don't know about the Clapper light because I'd already taken it back to the store since it didn't work.  Well, actually it worked for my husband and sons, just not for me. 

Two weeks later I was planning to run a victory lap around my cardiologist office while telling him we could forget about that ablation stuff, but he stopped me in my tracks, telling me my heart was still in A-Fib.  Some people really know how to bring you down.  Admitting that my heart was way too stubborn for his expertise, he referred me to a cardiologists' cardiologist in a nearby state.  There we kicked around Tikosyn, considered the drug of last resort.  I'm generally a risk taker, but this med was way beyond my comfort level.  Initially it must be administered by a doctor specially trained in it's application, not many are, and it must be done in a three-day hospital setting.  We got back to thinking about ablation since we were running out of options, so the cardiologists' cardiologist referred me to a cardiothoracic surgeon. 

The least invasive ablation is non-surgical, using a catheter through the groin to gain access to the heart. I nixed that one because of its lower success rate, especially with my A-Fib being chronic.  It often needs  to be done multiple times and  I really wanted the person doing it to be able to see what they're doing not going through my leg to get to my heart.  A minimally invasive surgical ablation, where several smaller incisions are made along both sides of the chest wall instead of a large incision down the front of the chest and where the heart does not have to be stopped, looked like the path to take.  It’s sometimes not recommended for women because the incisions have a rough time healing since they are positioned right along the bra line.  That would be no problem for me since I rarely wear a bra. 

All that sounded well and good.  I was excited that we had a plan and I was thinking we were finally on the fast track to a cure when the cardiothoracic surgeon noticed something going on with my heart that all the other cardiologist overlooked.  He brought in another specialist and after more testing, it was determined that one of my four valves was messed up.  There it was, in a video on the computer screen, live and in color, plain and clear.  This malfunctioning mitral value could be the root cause of my arrhythmia.  Wow, now we were getting somewhere!  We were high-fiving all around.

The docs suspect I had undiagnosed rheumatic fever as a child and it caused damage to this valve.  After hearing from my cousin last night, I'm wondering if it could be genetic, although with mitral valves that usually isn't the case.  Almost everyone in my family dies of strokes, many at an early age.  My cousin shared that her mother and our uncle both had valve problems. My uncle declined surgery and died shortly after being diagnosed, her mother had surgery and lived another 15 years. 

Repairing the valve, rather than replacing it, is the better option and my surgeon feels certain he can accomplish that.  He'll also clamp off the atrial appendage as a prevention for strokes and do the Cox Maze III ablation procedure to bring my heart back to proper rhythm while he's in there. He gives me a 95% chance of success for a full cure. Pretty good odds, don't you think?  However he won't give me any guarantees that any of this will improve my dancing or my ability to operate one of those clap-on clap-off lights, but hey, an old gal can hope.

Meds: Diuretic, beta blocker, anti-depressant, vitamins and supplements

Friday, February 17, 2012

DAY 4 Pre-Op

If all goes well the surgery will take about 3 1/2 hours.  That's ok, I have 3 1/2 hours that I don't mind using for this purpose. But really, I can think of about a bazillion other things I'd rather be doing than having my sternum sawed in half and cracked open.  That, my friends, has a high level of suckitude.  But wait, there's more.  I could potentially be under anesthesia for a total of six or more hours because prior to the surgeon making his grand entrance, I'll need to be chilled down to about 82 degrees while they hook me up to a heart-lung machine.  In some rare cases, not mine I hope, the brain is completely unhooked for a short time.  I draw the line right there.  If you suspect I'm squeamish about having my brain messed with, you got it.   So you see the preparation can add another couple of hours and then when it's over they have to warm me back up and I have no idea how long that could take, although I do like to think of myself as a pretty hot mama, so maybe it won't take so long after all. 

Meds:  Last day for Pradaxa (blood thinner)

Thursday, February 16, 2012

DAY 5 Pre-Op

I've been through a lot the last three years.  In addition to my husband's car getting totaled by a  truck that rammed full speed into us while we were stopped at a stop sign, my son's Ford Explorer spontaneously self-ignited several hours after he got out of it, burning it to a crisp and burning the back half of his girlfriend's car and igniting a corner of her house.  Ford accepted no responsibility.  We lost my father-in-law, and several dear pets, I was diagnosed with macular degeneration, my 24-yr old son died a violent death, our house burned down with a beloved pet inside, and my 21 yr old son was attending school in Bangkok when the riots broke out, spreading throughout the city toward the area of his apartment building. It seems like there was more, but geez, I can't remember everything.  I'm sure some good stuff happened too, but like I said I can't remember everything.  The cardiologists said I had a heart attack some time in there, but I was too distraught to notice. 

So heart surgery is no big deal.  Just add it to all the other stuff I've survived. If this keeps up I'll be well on my way to surviving damn near everything. Does the Guinness Book of Records have a category for that?   But once again I have to look at the big picture, look deeper and past myself and also beyond this First World country.  Compared to those surviving war, cancer, concentration camps, starvation ... man, I'm just a piker.  From that perspective, me setting a record is so out of the question. I'd be eliminated in the first round.   

Meds:  Last day for fish oil (it has a blood thinning effect)

Wednesday, February 15, 2012

DAY 6 Pre-Op

I don't want anyone to be feeling sorry for me this coming Tuesday morning when I'm heading to the OR.  My part is easiest of all, I just have to lie there.  Heck, I won't even know what, if anything, is going on. Feel for the medical staff.  Think about them having to deal with all that gore.  Sure, we look all pretty and well put together on the outside, but it gets really messy on the inside. On second thought, don't feel sorry for them either.  They'll be so darn busy trying to avoid killing the patient (that's me) that their time's going to slip right by.  Three and half hours will be over before they know it.  The person you really need to feel sorry for is the family member, in my case my husband, Darryl, who is sitting out there in the "waiting for patients" section of the waiting room, because he's already had too much bad hospital coffee and a numb butt from sitting on a straight back, under-stuffed chair through 3 hours of the operation prep and is facing at least another 3 1/2 hours until the surgery is over.  

I've been spoiled by the public and private hospitals in the Raleigh and Asheville NC areas.  Grand foyers, clean beautiful waiting areas with high ceilings and mammoth flower arrangements, can't tell the hallways from ritzy art galleries, sparkling clean lounges with comfy lounge chairs, interesting magazines, not Family Circle from 3 years ago with all the good recipes already torn out, agile volunteers who bring  flavorful coffee, a smile, and offer blankets and pillows, spic and span clean, soothing piped music, and did I mention how clean they are?   Well, in SC at this particular hospital and one other I've been to,  not so much, not even close.   My husband said it's about me, not him, but still.  To be fair, I must add that this SC hospital has a stellar staff and I know management is putting their money where it counts most and it's all about my heart.

Meds:  Pradaxa, diuretic, beta blocker, anti-depressant, fish oil, vitamins and supplements

Tuesday, February 14, 2012

DAY 7 Pre-Op

My appointment for final pre-op testing and preparation, scheduled for one week before the surgery, happens to fall on Valentines Day, the day of hearts.  How appropriate. I'll be reporting at 10:00 am today to the same hospital in SC where it all happens next week.  It shouldn't take more than a couple of hours. No food or water since midnight. If any infection is found In my body, it will be necessary to postpone the surgery. Must bring all meds with me today, including an Rx from the psychiatrist for Namenda, a drug used to treat dementia associated with Alzheimer's disease.  I will be taking it both pre and post-op in an effort to ward off POCD (post-operative cognitive dysfunction/decline). While there are a few things in my life I'd like to forget, I certainly can't afford to get senile.  Then how would I ever beat my husband at Upwards and Scrabble?  

Meds:  Pradaxa, diuretic, beta blocker, anti-depressant, fish oil, vitamins and supplements

Monday, February 13, 2012

DAY 8 Pre-Op

I'm ignoring the fact that today is the 13th because I'm not even one miniscule bit superstitious.  Besides it's Monday, not Friday. The surgery itself is not going to be pretty, but hey, it's only the heart, not the brain.  The cerebrum, now that's some serious sh*t.  (Please note that I will always use a star when I spell sh*t because I'm a lady.)  You can't be too careful around the cerebrum. The surgeon hiccups, the knife slips ever so slightly and boom there goes your vast memory storage of chicken jokes, just like that.  Now with the heart, there's a bit more room for error so one unsuspecting hiccup won't totally wipe out your whole entire life, or could it?

Meds:  Pradaxa (blood thinner), diuretic, beta blocker, anti-depressant, Multaq (discontinued several weeks ago because it no longer controlled the A-Fib), fish oil, vitamins and supplements