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By Cranky Dog
[Trigger warning: Medical procedures, some concerning my digestive system, may be squick worthy.]
TLDR version at bottom.
Looks like I survived once more!
My brother posted this picture on Facebook.
So I wondered if I should also link a video of Gloria Gaynor's â€œI will surviveâ€ or Destiny's Child's â€œI'm a survivorâ€. Ultimately, it should be a YouTube cat video, because they have nine lives and I sure as heck used one of them this week.
So, to resume everything I've endured this month. I've had coronary angiograms (radioactive dye test + X-rays), CAT scans, MRIs, bone density scans, echocardiograms, electrocardiograms, chest X-rays, injections, countless blood samples, tons of pills, a pacemaker, a mechanical bi-leaflet heart valve, an ascending aorta replacement made of Dacron, a â€œMAZEâ€ heart ablation for atrial fibrillation. And after all this, I mostly feel like I strained my back the previous day and just a bit more tired.
Going back to last Sunday afternoon (August 16), I finally get the call to present myself at the hospital in preparation for my heart surgery on Monday at the end of the morning. So I pack my things and my mother drives me to the hospital. A bit later, I get told I'll be the first to get operated after all. Cool! No food/water after midnight (standard procedure). And then they have to shave my body hair almost fro head to toe. I shaved off my beard earlier in the day, knowing a catheter will go through my neck. Then they shave my chest, as expected. Part of the forearms, also expected for some other catheters and so they don't pull off as easily because of the hair. Then the groins area. Mostly expected, in case they need to pass a catheter through there in case the arms don't do. And finally the legs. Less expected. Normal for people with bypasses, as the go get some replacement veins directly in the shins. But technically, no bypasses are planned for me. So this is more of a precaution in case of an emergency bypass and they don't want to stop mid-procedure for a shaving.
I've also concluded that the orderly who shaved me is a man-hater. The way you use a hair clipper is not to dig the teeth in the chest as if you were scrapping crud off the bottom of a plate with a fork. Damn but those tiny teeth scratched something fierce. My brother used to be a sales rep for medical equipment. The way to use a hair clipper is to hold it like a pencil and glide over the skin. This wasn't what the orderly did. Hair kept getting pulled (remember the groin area? And that men also have nipples?). And of course she had to use the razor blade on my dry irritated skin as a finishing touch. At best I can accept that it was the evening, that she was in a hurry and wanted to rush me to the shower. Still a moment of Owies!
Monday morning comes by. The anaesthesiologistâ€™s team slowly prepare me with some injections, oxygen mask, saline solution, etc. So I'll be properly relaxed just moments before the knock me out for the surgeons. After this point, I have to trust what everyone else told me as I'm totally out. The surgery starts around 9am and ends before noon. During this time, I'm on an external respirator. And when I say I'm out cold, I literally mean that all autonomous biological functions cease. Heart stops beating. Lungs stop breathing on their own, no more digestion. EVERYTHING. IS. STOPPED. DEAD. COLD. My mother and one of my aunts (mom's sister) saw me as I exited the surgery. I wasn't breathing on my own, I was cold, and almost as green as the hospital gowns. A bit of background on my mother, she has been doing voluntary palliative care for over 22 years. So when she saw me, she saw all the signs of someone who just died. Now my aunt, who has no medical background, and confused the respirator's breathing with my own, thought everything was hunky dory and all positive. My mother who was still under the immediate shock of what she was seeing, just wanted her to shut up! Shut up! SHUT UP! Fortunately, the surgeons and nurses quickly reassured them that everything went as planned, that I was responding as expected.
So I get transferred to intensive care where I wake up mid-afternoon. First time I think of asking the time, it's just before 4pm. I still had tubes in my lungs, stomach, neck, a few spots on my chest. But I'm under so much morphine (or derivative) that I don't find them that uncomfortable. I had my full wits about me and had full understanding of what I just went through. During the evening, they make me stand up, and everything went fine. I got extubed on Tuesday, and to their credit, they have good techniques so it's neither difficult, nor painful. I've felt worse when suffering from the cold or flu.
I was surprised to learn I was going out of intensive care less than 24 hours after the surgery. I know they keep saying the whole surgery is far less painful than people imagine, but until you live it, you'd never believe it. They really know how to manage pain. You just have to remember that you're allowed to have more painkillers (up to a daily maximum) and that the staff aren't mind readers. They won't ask more often that needed. My real problem is that I was getting too many Tylenols and feeling hot is a side effect, and that I could've asked for more sleeping aids before midnight as one pill wasn't enough. And since we're going through a late summer and lived through a heat wave at the same time, I had many restless sleepless nights.
Until I cut down on the Tylenols, my mind was doing funny things during those nights. The dwarves of the Diggy Diggy Hole music video were having side-adventures with my memories. And on another night, one massive weird dream was mixing some movies that may or may not have ever existed. But Michael J. Fox's Doc Hollywood character was there, an Appalachian backwater town that smelled of cigarette butts (coinciding with real life some lung secretions) where the starring family's prized â€œlong term investmentâ€ was the completed VHS collection of an 80s action TV show that featured weekly car chases with the hero's white Lamborghini in Miami weather. There are several more details, but I'm trying to forget them, thank you very much. Even with the fan my mother brought pointed directly at my head, I was sweating bullets. These were quite unpleasant nights. I had a stiff neck/back as I couldn't really sleep in any other position than on my back, but as long as I stayed still, the pain was quite bearable and more pleasant than the dreams.
It's when they took off the bandages over my chest on Thursday that I finally saw the incision. A nice, nearly straight 10 inch slice in the middle of my thorax. In D&D 3.x/Pathfinder terms, the surgeon rolled a natural 20, x3 damage, with a scalpel of mercy (non-lethal damage). OK, technically I was helpless so it was a Coup de GrÃ¢ce and auto-damage. But it's a clean cut, very fine stitches, though I suspect much larger ones below the skin, especially considering that metal wires are used to close the ribcage. It's a bit tight, but no really irritating, save for the regrowing chest hair.
Equally, since my digestive system was on hold, and I had a urinary catheter, they had to give me meds to start everything up again as I was retaining liquid because of the heat and meds, quickly gaining weight, and they wanted samples of everything. There were no problems removing the urinary catheter, and I learned that a small bubble keeps it in place inside the urinary tract. But one problem, though not uncommon for people under morphine was that I suffered from oral thrush. The mouth dries, and a fungal infection sets in, wrecking your sense of taste and making the tongue sensitive to heat, ruining my appetite. A special mouthwash fixes in a few days, but the timing was bad as I was supposed to be gaining strength again. But that's not all! To encourage bowel movement, glycerin and stool softening suppositories were given to me. I couldn't really keep them in for much more than an hour. So they gave me more stool softeners in pill form later at bed time.
This... complicated things on Friday morning. I was getting stomach cramps and so many bowel movements that I had to reschedule an echocardiogram. And I ain't even finished with the â€œfunâ€ news! For now the staff believed I was having too many bowel movements, liquid or not. Those who know me, also know I've had many bowel movements every single day of my life. And if you give me strong stool softeners, cream of celery at suppertime, don't be surprised if there are explosive results. But since the medical staff don't know me personally, they saw it as potential symptoms of C. Difficile! And the standard protocol is to put me in isolation. In my own bedroom. My semi-private bedroom, shared with another heart valve patient, and shared toilet with another room. But because of the isolation, I have to use a portable toilet that's one size too small, in plastic bag, with scratchy toilet paper, with a curtain as the only form of privacy in a room with constant hustle and bustle from the staff. And the staff didn't seem in a real hurry to change the bag when it was used. If I wanted to walk in the hallway for exercise, I had to don a yellow oversized disposable hospital gown and surgical gloves. Anyways, even the evening staff quickly realized I probably had nothing from the few samples they took, but it takes two days to get the lab results. And we're already late Friday afternoon right before the weekend, so I'm not expecting any shortcuts.
Ultimately Saturday morning comes by, and the floor surgeons grants me my leave of the hospital, and I'm back at my mother's place before lunchtime. Finally, real coffee, real food, real beds, real air conditioning, real internet. Life begins again! We go to the pharmacy in the afternoon and it's quite a haul. Some of them are only for the next couple of days, some are iron/vitamin supplements to get my system back on track. A few Tylenols, and sleeping aids that I only take if required (haven't yet). And then comes the more permanent ones. Beta blockers to slow heart activity, baby aspirin and warfarin/Coumadin for blood thinning. These will be for the rest of my life (or next medical breakthroughs). I don't even feel that tired over all. A bit sore and stiff yes, low reserves of energy. Though I knew I wouldn't be anywhere near my 100%, I never expected I'd be over 50% from the get go. But to give me every chance possible, we've moved most of my things on the ground floor. I'll be using my mother's bedroom (she'll be in the guest room) in the meanwhile. I'm expecting a rather quick recovery, but it can still take up to three months. When I find that I can climb a flight of stairs in one go without feeling faint, I'll know I'm on the right track.
TLDR: Had final open heart surgeries. A bit sore and tired, but mostly fine.
By Cranky Dog
I LIVE AGAIN!
Ridiculously long post ahead (TLDR at bottom).
I say this because I just spent a week in the hospital after being admitted in emergency for heart problems.
In a way it started about three years ago when I was getting occasional heart flutters (skipped heart beat) and varying heart rate speeds, almost always at rest, and really messing me up when I tried to fall asleep. So they plugged me up to a Holter (heart monitor with electrodes stuck on me) that I carried around for three days. They gave me beta blockers medication, and all was well for years.
But since last March, maybe because on a trip I forgot my medication and didn't have them for a few days I don't know, but even when I started them up again, I was getting heart palpitations again. This time, my heart rate would skyrocket for several minutes. Stress? Maybe it aggravated the frequency episodes, but mostly it happened during relaxed times, during conversation, while just standing around or whatever. Only once a week at first, but since May 5th, it became more recurrent everyday. I knew I was leaving work on the 6th and traveling back home on the 7th to see the family just before a convention, and hoped it would get better. Just in case, I brought an "emergency kit" (tablet, cellphone, chargers, reading material, etc.) if I ever thought I'd need to go to the hospital and wait in ER.
And on the day I arrived to see the family, I was doing groceries with my mother, and felt the heart troubles were coming back and not going away. I asked her to bring me to the hospital (right after bringing the groceries home and grabbing my "kit"). This hospital is specialized in heart and lung diseases and I was a patient there before so they have my file.
Fortunately, I was admitted quickly. Within fifteen minutes the triage nurse saw me. I waited less than thirty minutes in the ER waiting room before a technician took an EKG (electrocardiogram). My heart rate changed at the last second she took the first EKG that she took a second one immediately after. After waiting again for 20 minutes, they brought in a stretcher and took me to the ER ward for observation. So electrodes on the body, heart monitor, blood pressure collar, and some over night waiting. That's when I saw my heart rate would instantly jump from 65-70bpm to 165-170bpm. And I'm not talking about a progression to that rate like when working out, but instant change from fast to slow. First time it jumped that high, red lights and alarms went on and emergency folk came to me to check my vitals. ALL NORMAL! Blood pressure normal (110-75 is "high" on me), no pain, no shortness of breath, no dizziness, no sweats, no confusion, nothing. Just a very fast heart beat. My heart wasn't necessarily beating harder, just much much faster. Fast enough that it is noticeable and you'd feel it more when lying on your back. It's a bit like running your car engine at high RPMs on neutral without necessarily flooring it. You know the engine can take it, but also know you shouldn't keep doing it.
So they took me to another room where I'd be under more direct observation where I had several more episodes (each time only lasting seconds to several minutes), took blood samples for testing and plugged me up to an IV solution that was supposed to "break" my heartbeat back to normal. After several hours of observation, even the emergency personnel and resident MD realized I was not in immediate danger (I was in an unusually good and chatty mood), so they put me back in the ER rooms with other patients until the cardiologist would arrive during the day. I didn't really sleep that night because I was on a stretcher with IV in one arm and a pressure collar on the other and had limited movement.
I thought my heart palpitations were total random occurrence until another patient in the ward near me went into respiratory distress and it triggered several episodes in a row. So stress/anxiety really was an aggravating factor. What I found funny was that when the ER ward had their shift change, the new crew didn't know that my episodes weren't immediately dangerous, so they'd run to me the first time, realized I was basically OK after checking all the symptoms, and relaxed more after every episode. I joked that they should put the heart monitor on mute.
When morning came, the cardiologist concluded that I'd need a heart ablation to fix my arythmia (tachycardia to be specific). Basically, a nerve cluster in my heart was over sensitive and I'd get an invasive surgery to locate the specific nerve cluster and burn it off with high frequency radio waves with a catheter through the groin and throat veins. Immediate downside it that we're Friday, so because of the weekend I'd have to wait on Monday for the surgery, probably, since I'm not in an immediate life threatening situation.
Still, I get admitted to my own semi-private room and spend the weekend in the hospital with many tests and monitoring devices on me at all time. Slightly bummed that there are no TVs in the room unless you pay $$$ for it (for the Foundation they say), nor any access to internet for the patients, nor a computer. So I can't cancel my flight, hotel reservation, conference reservation, since all of my info is on the internet. Still, with my sister's help on the phone, I guide her through my email account to find relevant phone numbers so I can call and cancel what I can. Couldn't really with the hotel because I had a special early reservation non-refundable fare, and can't get into contact with the conference because of the weekend. So basically I lost over 1000$. Though I may have automatic travel insurance that would cover them. Anyway, with the few games I have on my tablet, radio on my smartphone, and the Figopedia painting book, time went by surprisingly quick. I got along well with the floor personnel, my room neighbor, I was mobile enough to walk in the hallway many times, and the food was nice enough, though bland. I even asked my mother to "smuggle" me a salt shaker.
I had several episodes, even with the medication they gave me but they were of short durations. Since I had a wireless heart monitor on me at all times, the nurse station would get a call each time I had one and would check with me. Several times it would happen as I was strolling in the hallway in front of them, I'd wave "hi" to them and that yes, I felt it but everything was fine.
On Sunday, the auxiliary nurse came in to "prepare" me. They had to shave me where the catheters would go in. So with a hair clipper, he shaved my whole upper chest, and gave me one mother of a bikini wax cut (not Brazilian though). It looked almost as if a pair of shorts was waxed off my groin area. It gave me an unnatural smoothness of which I am not used to on my own body. And starting at midnight, no food/water until the operation on Monday.
I'm really a weird patient as I almost started dancing with joy when the stretcher came in at 2pm. So they bring me to the operation block, make me sign a waiver form after explaining all the risks (1:400 chance of this, 1:10000 chance of that, etc.), and strap me on the table. And when I say strap, I mean they tie my hands to the side and restrain my sides to avoid sudden movements. I'm fully awake and quite relaxed during the procedure with only an oxygen tube in the nose and local anesthesia where they poked holes into me. I would've loved to see the procedure on a monitor, but eye wear is forbidden and I have a blanket over most of my face. Still, I could hear the monitor with my heart beat as they probed different areas and I could hear go at different speeds. After less than an hour, they sewed me up, announce that it's over and that they couldn't locate the area and would try medication.
They take me back to my room where I have to spend at least four hours lying on my back without moving before I was allowed to get up. Hospital beds are quite uncomfortable. I had lower back pain, upper back pain, and near the third hour, I don't know if I passed out, slept or whatever, but as I came too, I felt extremely confused for a good minute. I knew I was supposed to be here, but couldn't figure out what it was, nor why I was here. Later I was finally allowed to get up with the help of the nurse, the groin area was sensitive (big compression bandage), but not unbearable. It felt like I received a hammer blow, but only hurt when moving. Throat area was also sensitive to movement, but nothing worse than I've felt in the past while sick. They gave me my dinner, but the earlier pain exhausted me, and I took a few breaks after several bites to lie back and regain some energy.
I managed to rest during the night anyway, and by morning the pain was much more bearable as I was able to move by myself, though slowly and without much flexibility. I didn't even need pain killers for it. They try the medication, observe for 24 hours, and while I'm there, I'll get an echocardiogram. You see, I've had a faulty heart valve (mitral valve aortal stenosis) since birth, and my last echocardiogram was over a year ago (missed my last one because of a move). Ironically, absolutely nothing to do with my arrhythmia.
So the cardiologist tells me the stricture in my valve reduced again, with micro calcification, and is now treated as "severe" but without symptoms, and that probably next year I'll need a new heart valve. Not surprising because I always knew it would slowly get worse no matter what I do, but only a question of when (1 month, 1 year, 10 years?). It will be a mechanical valve in my case because I'm so young (43, but young compared to regular heart valve patients). And that they would wait that I develop symptoms before I need the surgery (exhaustion, chest pains, shortness of breath, etc. the classic heart disease symptoms). I'm almost excited at the prospect because all my life I've had heart insufficiency with a leaky valve and back flow, but with a full functional heart valve, I'll have a better heart capacity than I've had in my whole adult life.
Back to my arythmia! From Tuesday to Wednesday, were noticing that my episodes are getting longer. Fifteen minutes during one morning that only stops when I go up to the bathroom in case they'd need to wheel me down to the ER or operating block again. Another one in the afternoon right before I go for my echocardiogram. They brought me a wheelchair to go there, and while I was waiting right next to the nurse station, they get a call from telemetry, hear her answer "he's in front of me", I wave an "OK" sign and wait it out. After three minutes, I'm bored, ask to get up, bend over and back to stretch and it stops. It's the last one that was a doozy. One hour forty minutes of 165 bpm. Nurse takes my vitals (again everything normal). They call the doctor on service (she really took her time, but I'm not the only patient here), she asks for another EKG, chest X-ray, blood samples and will ready a direct injection of something to break the arrhythmia if needed. It's while I have two nurses trying to get blood from me again (I got thin, deep and elusive veins, so I'm hard to draw blood from) and the X-ray technician next to me that one of the floor attendants walks in to say that telemetry called to say that it stopped by its own. It's then I noticed I did feel better but was too distracted to immediately notice. Now I like to claim that my arrhythmia is really love sickness (it's a heart disease, right?) because as soon as I got the full attention of three women, everything went well. Minutes later, I was strolling in the hallway, humming to myself, because I was to excited to fall asleep. Much to the surprise of the nurses to see me in such a good mood after all that happened. I never panicked or got nervous even once. Because really, speaking to the cardiologist and other patients on the floor who've had the same condition I've had, it's not that dangerous. I can't have a heart attack from this specific condition (though there are some that are life threatening), but it is annoying as hell. The worse that happened was a mild numbness in the lower arms, akin to going to the dentist.
Anyway, it was clear that the current medication didn't do squat and would try another one in the morning similar to what I took the years before, but with better arrhythmia control. And if the new pills didn't work, they'd try the surgery again with 3D imaging.
Anyway, come Thursday morning we start the new pills, and they work! No problems on the first day, save for almost getting blisters on my feet from walking in the hallways so much I really needed fresh socks). After 24, 36, 40 hours without an episode, I finally get my discharge and follow up appointments just in case I don't find a cardiologist in the city I just moved in (shouldn't be a problem as I've already started looking).
Several days after surgery, I'm still sore in the groin/throat areas where the catheters went in, and still somewhat easily tired.
Things that I've learned:
- I was surprised at how good my mood was all along, even without TV or internet access.
- Despite my veins being really hard to draw blood from or to install any kind of IV, I'm not afraid of needles. It's the painful hair removal and sticky residue when they remove the surgical tape that it the worse. Remember that compression bandage on my shaved groin area? Well the area behind my thighs weren't shaved, and plenty of hair was painfully removed at that time.
- Even while they were painfully removing that hair bandage, with teeth clenched, I offered the nurses a box of chocolate to thank them for their services. TIP for people who stay several days at the hospital and want to thank nurses, get a box of chocolate for each shift (day, evening, night), because a box of chocolate will not survive until the next shift.
- I really can't sleep on my back. But sleeping on my stomach meant I had that heart monitor (the size of a pocket book), wires and electrodes poking in my chest and hospital gown. Many electrodes got caught on the gown and torn off and needed to be replaced.
- At night there is *always* a bloody machine that will go beep-beep because it's not properly working (notably some IV pumps that the whole staff hates because it always blocks). It can be in your room or someone else's room. And the nurse station won't hear it because they're talking to each other, so it's the patients who call them to fix some other patient's problem (older patients who may not realize it's bothersome or that its someone else who called the staff).
- There are very pretty nurses on staff. The kind that can give very adult oriented thoughts and dreams... and the sudden realization that you're strapped to a heart monitor that will tell the whole department that will come to see if you're all right if your thoughts are less that chaste.
- If I walk the length of the hallway and back 40 times, it's roughly equivalent of 10,000 steps which is the recommended amount of daily exercise.
- There is not a single comfortable sitting position in a hospital room. Neither in the bed, neither with the bed legs/back raised or lowered, neither in the sitting couch they have. You'll always have back pain, leg pain, neck pain or marvelous combinations of all of them. But it's a hospital, not a hotel.
- My cardiologist is a gamer! When he noticed my Figopedia painting book he asked if I was a miniature wargamer or roleplayer. Himself with his friends, they played Warhammer 2e (old school), D&D and 13th Age.
TLDR: Went to the hospital for heart problems. Feeling better now.