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By Cranky Dog
They got me again! I knew it was coming, but this time they were much sneakier about it.
[TLDR at bottom]
I was told in late May that my heart valve was due to get replaced. I knew that day would come, being born with a faulty valve, but didn't expect till later. Eventually got the referrals by my cardiologist to get the tests and surgery, but everything takes many weeks, if not months. Meanwhile, I'm on short term disability, and slowly feeling more exhaustion with activity.
So I fly down to Quebec City from St.John's to enjoy a big family reunion (59 relatives altogether) during the first week of August. On the following Monday (August 3rd) I had a follow up echo-cardiogram for my slowly degenerating heart valve. I'm secretly hoping it will accelerate the process for me to get the heart valve surgery since I'm waiting for a call for a coronary angiogram (the radioactive dye + X-ray to see your blood vessels) for the following week.
It worked a bit too well. When some of the research personnel saw my echo results, they told me they'll show them to one of the cardiologist and maybe expect a phone call. Well right before lunch, they call me and tell me to present myself to the emergency ward as soon as possible. So I finish my lunch, pack several belongings for a stay in the hospital and my mother drives me to the ER waiting room. Again, the same hospital as last time with absolutely no internet access for patients.
Within the hour, I'm screened, admitted to the ER, measurements are taken, I get scheduled MRI (they're still as noisy and claustrophobic inducing as I remembered them), and soon get my room to spend the night there. They tell me I'll be getting my angiogram ASAP and the heart surgery likely the following week.
Next day (August 4th), they give me the documents concerning angiograms. Uhuh, catheter through wrists veins... otherwise through groin... local anasthetic... awake during procedure... groin area shaven (dangit!). All in all, it goes well! They were able to go through my right wrist, I have excellent arteries, no blockages, no need for bypasses and using veins from my legs.
About catheters that go through major veins/arteries. Since these are large blood vessels, to stop the bleeding, much pressure must applied, the basis of a tourniquet, to form a blood clot at the point of incision. And when they say MUCH pressure, they mean it! For my wrist, they had to put a sort of foam cylinder tied down tight with a plastic wrist band. How tight was it? Literally lost all feeling in my fingers for the whole hour I had it on at that extreme tightness. I wasn't allowed to make a fist otherwise blood would flow into the hand, but not out (like putting a rubber band too tight around a finger). So I was only allowed to move my fingers. Weird feeling to have to physically look at my hand to confirm that finger movement has occurred. After an hour, the nurse confirmed there was only light bleeding, so she was authorized to loosen the band, but still leave the whole apparatus there for another hour. At least I could feel my fingers again. After two hours, a simple bandage was enough. I was lucky, because another lady on the same floor had to wait for two hours before getting her wrist band loosened.
Rest of the week is minor tests, I'm on a wireless heart monitor for a few days until they notice that my heart rate goes unusually low, mostly at night and that the signal is "off". So they stop my heart meds that controlled my hear arrhythmia that brought me there three months ago, put me on a fully wired heart monitor and in a semi-intensive care bedroom where there is a nurse's office right next to several beds. It's on Friday morning (August 7) that they tell me I'll be getting a pacemaker. WTF?! It ain't just the heart meds? They keep me monitored during the whole weekend and I see myself the results. My heart rate could drop to 36-38 bpm and up to 60 bpm when still on the effects of the meds, and as my body slowly evacuated them, my heart rate rose from low 60s to 100s when active (with exhausted sensation due to failing heart valve, but I knew that part already). Still need the pacemaker because the calcification that's killing my heart valve is also affecting the central heart nerve that sends the signal down the heart. The signal is still getting there, but it's not taking the path it should, hence the pacemaker. And my pacemaker will be programmed to keep my heart rate at a minimum of 60bpm. If it's above that rate, it stays in standby. Battery should last 8-10 years, with checkups every 6 months.
Did I mention the dentist in all of this? Looks like people getting heart valve surgery are at much higher risks of viral infection to the heart if they have cavities. So I get to see the dentist. I curiously have a very anatomically schoolbook perfect dentition. The dentist was commenting to the assistant "look at the typical cusp on , notice the channels on the incisor". Oh yeah, one of my wisdom teeth has cavities below the gum line and we'll have to take it out, and HAS to be done before the heart valve surgery.
So the following Monday, dentist is ready, but since there might be an opening for the pacemaker surgery, we'll do the wisdom teeth right after. Turns out I don't get called for the pacemaker until nearly 2pm, and still wait for an hour on the stretcher in the block. And just as they're finishing their setup, THEN the surgeon asks me "You're right handed, yes?". I'm left handed, and pacemakers are usually installed on the opposing side. So they have to remove everything installed, move the equipment around, and start again. The surgery itself isn't really painful. Local anesthetic, mild sedative. I felt mostly they way you feel just before you wake up when you're half-awake and half-dreaming. I could feel movement in my shoulder, and feel them stitching my should back. Then it was back to my bedroom without moving for several hours. The pain was bearable with the right medication (Tylenol and codeine), but my right arm movement was limited. Not allowed to raise it over 90Â° for at least a week (don't worry, I'm in no mood for that), and no lifting with it for a month. The shoulder muscle *was* sliced open after all. As I write this, it's four days since the surgery, I can lift my arm without discomfort, somewhat limited shoulder movement, but the area near the incision is still sensitive and with a bandage. For those curious, pacemakers are about the size of a pack of matches, but twice as thick, and are typically placed in the upper shoulder area, just below the collar bone. I always thought it would be closer to the breast area, but a vein that goes directly to the heart is conveniently near the shoulder articulation. Then wires are placed in the right are of the heart and "screwed" into place. Screw to far and you puncture the heart (and nasty internal bleeding). More the reason to not do any heavy lifting until all of the internal punctures and cut muscle tissues fully heal over a month.
Now since everything took longer than expected, it was too late for the dentist. And the hospital dentist only operates on Mon-Wed-Fri. So on Tuesday (Aug 11), I spend the day just enduring the pain of the pacemaker incision. It took me a while to remember that I *can* ask for more meds to control the pain. Tylenol doesn't do much for me, but codeine works nicely. Luckily I'm not allergic to it like my mother and brother (gives them horrible nausea). On Tuesday, they take out the heart monitor telemetry, first time I don't have sticky pads on my body in over a week! I can finally rest without risking a wire coming off, sticky pad unsticking, or accidental hair removal. I and finally SLEPT. Genuine, unconscious, sheep counting, lala-land SLEEP instead of prolonged naps.
Wednesday (Aug 12), get to see the dentist. I already told them I take an unusually long time to get numb. So they do the injections, we wait a bit. Time to go to the rest room. Come back. Numb enough. And then the wisdom too comes out amazingly fast. Didn't even take 15 minutes by my estimate. First time I had a wisdom tooth out, it took a long time. First time it required specialized vices, extra injections to make me numb, three people working on my face and a nurse having to climb on my chest. This time, a simple fulcrum-lever system, a few gauze pads to bite on, and I was on my merry way. On my way back, it was also getting pretty clear I wouldn't be getting my heart valve surgery this week as several emergencies came in during that time. On the plus side, I may have temporary leave from the hospital until the next week, but they want me ta have a fixed scheduled date, otherwise I might get bumped off the list if I leave the hospital.
So this morning (Thursday, Aug 13), I got my appointment for Monday August 17, *and* temporary leave until then. I'll get a call during the weekend for further details. My mother lives within a 15 minute drive, and I feel sturdy enough to wait until then. As long as my heaviest activity is climbing stairs, I'll be fine.
TLDR: Spent ten days at the hospital for an unexpected pacemaker heart surgery. Still a bit sore. In a surprisingly good mood. Back there next week.
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.