Pill Popper

Thought I'd share my prescriptive perspective for those who care to know. My meds have changed since my surgery. I was obviously on a few more right after I got home. They actually prescribed some heavy pain meds (Vicodin), but I didn't even fill the scrip. I got by with good old fashioned Advil. The pain really wasn't bad. Sure glad I got the minimally invasive procedure versus having my chest cracked open. 

A) Furosemide, 20MG, 1 Tab orally for 5 days (lasix/water pill). I don't remember what this one was for. Certainly something post-op-related since I only took it for 5 days. 

B) Colace, 100MG, 2x daily as needed for constipation (a TMI side effect of surgery...it was almost a week till things got back to normal)

C) Naproxen, 500MG, 2x daily for 5 days (Aleve, for pericarditis and pain)

D) Baby aspirin, 81MG chewable, 1x daily. Blood thinner. I'm still on this one, even though I didn't have a replacement valve, only a repair. Need to find out if and when (if at all) I'll stop taking this. 

E) Metoprolol succinate, 50MG, 1x daily (Toporol XL). To regulate BP and heart rhythm as my heart adjusts to the new flow of things. No more Lisinopril, which I was taking before the surgery. They just changed this last month. After an echocardiogram, my first since the surgery, it showed that my heart wasn't "squeezing strongly enough". I don't feel any symptoms, but my ticker isn't ticking as loudly as it should. They switched me to Carvedilol, 3.125MG, 2x daily. 

F) Atorvastatin, 20MG, 1x daily at bedtime (Lipitor). For cholesterol. When I had my heart cath in Indy, they said my pipes were clear. When the Cleveland Clinic did it, they said there was a little plaque in there (not much). In December, when I went in for a check up/blood test with my regular doc, my good cholestol was too low. Overall, my cholesterol was "fine", as it always had been. They put me on Zocor at that time, which I'm still taking as of June 2009. 

G) Omeprazole, 20MG, 1x daily for two weeks (Prilosec). For ulcer prevention. Acid in the stomach is common after surgery. This was supposed to help combat this. 

H) Potassium chloride, 10 meq tab, 1x daily for 5 days with Lasix. I forgot what they said about this one, but looked it up... "Prevents reduction in potassium in the body if you are taking a diuretic. Potassium is necessary for function of the heart and other systems of the body." Actually, this site has some good info about all the drugs heart patients may have to take after surgery. 

CURRENT MEDS. Even though I'm taking fewer meds, I'm still using my old-man daily pill container so I can remember WHEN I took WHAT. I'm still taking the bupropion (Wellbutrin XL) as an antidepressant. But heart-related meds, I'm down to two in the morning and two at night. AM: baby aspirin and Coreg. PM: Zocor and Coreg. 

A NOTE ABOUT MY CRAZY-LOW HEART RATE. I've always had a slow, very slow, heart rate. Low 40s per minute. Whenever I gave blood in the past, they would ask if I was a runner. Which I was not. When I started running, my heart didn't get any slower. It was already as slow as you could get. After my surgery, my HR went up to the 55-60 range. I figured my slow rate was attributed to my prolapsed mitral valve. That my heart's been compensation in the amazing way the human body always does. Guess not. At my last check up, the nurse (a new nurse) was concerned that my HR was 40. She started to check again. I told her it was normal. Guess I'm just wired that way. 

Random Thoughts, Part II

Okay, so this is only 7 months late. I started this blog before my surgery so I could chronicle my journey. But once I had the surgery, and things were fine, I just stopped. I kept telling myself that I was going to "sew up the loose ends" and add some literal closure to my saga, but I didn't do it. So here I am, needle and thread in hand. The main reason for this/these final posts is for anyone who is searching the web for information about the MVR surgery. The site was read mostly by friends and family, but I was surprised to find other random readers who were in the same boat. 

I guess it makes the most sense to divide my final posts by subject. Here goes...

The patient room

After my time in the ICU, they wheeled me into my room. I think the hospital rule has it so you can't be in the OR/ICU for more than 24 hours, but I think I was just over that amount of time. By the time I got to my room, I was fully awake and feeling okay. Trying to get my bearings and remember things I couldn't remember seemed to be more of an issue than the pain.

Dream a little dream.

For the first few days, I was having bad dreams. Weird, gross dreams that involved gross things (I'll spare you the details) that I normally don't dream about. And they were very vivid. I didn't ask the docs about it (maybe I should have), but it seemed to be related to my heavy pain meds. (I think I was on Vicodin). The dreams went away when I stopped taking the heavy stuff. Thankfully.

And then things got complicated.

I would have been home sooner from the hospital, but 1) my surgery was delayed two days and 2) I had some complications.

First, I had post-operative/subcutaneous emphysema. This is where air gets trapped around the lungs as a result of the surgery. More info can be found here. Either I didn't remember or they didn't tell me this could happen. I'm sure it was in the paperwork they handed to me in the two-inch binder, but I wasn't clear as to the complications that might occur. The next time I have any surgery, I will definitely ask the complications that may occur. Obviously, death is the worst of complications. But I wish I would have known what to expect versus learning after the fact. Actually, in order to get the air out, they had to put the tube back in my chest. In the patient room!! Without anesthetic!!! It was the absolute worst pain of my entire life. Either the pain was horrible (which it was) and/or I've never had to experience pain that often in my life. Come to think of it, I haven't had that many "stereotypically" painful experiences in my life: kidney stone, appendicitis, broken bone, gunshot wound. Just your run-of-the-mill sprains and lacerations/stitches. When they put the tube in, and I was yelling out in pain, I could feel the air go from my mouth through my chest/lungs and through the tube out my side. Very weird (and did I mention painful?) sensation.

Next complication: Crepitus. I think this complication sounds like a heavy metal band, don't you? It is defined as "a crackling sound resulting from subcutaneous emphysema, or air trapped in the subcutaneous tissues." When the doctor or I or some other person would press on the skin around my chest, it would feel like "rice krispies". Their words. Another very weird sensation. Mine wasn't a very bad case. You couldn't even see it with your eyes. Some severe cases you can see with your eyes and the patient even has trouble breathing.

Pulmonary edema. According to Wiki, is fluid in the lungs. When they went in on my right side with the surgical instruments, they had to deflate my lung to get to my heart. Crazy. When the surgery was over, they reinflate the lung. However, sometimes the lung doesn't inflate completely. I pictured a pool toy being blown up and part of it is stuck together so that part doesn't inflate. That's basically the idea. I needed to do breathing exercises to help reinflate the lung and, therefore, get the fluid out. Technically speaking, it's called a collapsed lung or pneumothorax.

"Why is daddy glowing??"

I asked at one point, but I don't remember now, but I think I had a total of 13 chest Xrays after surgery. They wanted to check the pulmonary edema and the pneumothorax. This is what kept me from being released. It's also why I wasn't allowed to take a plane ride home. We basically ate our tickets and rented a car. Otherwise, we would have been stuck in Cleveland until I was allowed to get on a plane again...in 6 to 8 weeks.

Stir crazy...and I don't mean the movie.

By the time it was time for me to go, I was really ready to go. Actually, this is one of the few knocks against the Cleveland Clinic. I had to wait on the doc to release me, and I thought I was going to be released in the morning. It was after 1 when we left. I know this is common for most hospitals, but they either need to fix the problem or manage expectations better than they did. After having some rental car problems (some rental places don't take debit cards), we hit the road. I was supposed to get out of the car and walk around every hours, but we still made pretty good time. We really wanted to get home. And we did, finally, on Sunday night. It was awesome/wonderful/emotional to see the kids. My mom (or sister, I don't remember now) made some homemade chicken n' dumplins. It was the best comfort food I have ever had in my life. Thank God we're home.

Random Thoughts, Part 1

Random thoughts and addendums: 

• We never made it to the Rock Hall. Delays. Changes in plans. We had planned to go on Sunday before my surgery, but changed our plans when we learned the Browns game would be letting out and Bruce Springsteen was performing a free concert in downtown Cleveland. Things were hopping in Cleveland this day, and we didn't want to have to deal with the throngs of people. 

• I arrived at the CC on November 4 for my surgery. Standard questions. Vitals. Gowned up. They even shaved my chest. Ready to go. Not yet. A doc and a nurse came in and told me that Dr. M had an emergency come up and that I was going to be bumped till Wed. They said there was a chance that I could get bumped, but I didn't think I'd get bumped TWO days. 

• Since I wasn't having surgery, we had a nice lunch at Claddagh (factoid: they do serve beer on election day in Ohio...not sure if they still prohibit it in Indiana or not).  

• The patient rooms at the CC has 42-inch flat screen TVs. But a lot of the effect was lost because the sound still came out of the crummy, bed-side, drive-in-movie-theater-like speaker. Man, I'm a whiner, don't you think?

• Lots of ways to improve efficiency, even at one of the best hospitals in the world. 

• We had to drive back from Cleveland because I had complications with my lungs. Note: make sure the rental company takes debit cards BEFORE you reserve a car. 

Addendum I

A couple things I forgot to mention from our meeting with Dr. M:

1) He said there's only a small chance (I think he said 10 to 15%) that I'll have to have my valve fixed again during my lifetime. 

2) He said there's a less than 1% chance that they'll get in there and have to replace my valve instead of repairing it. Therefore, he said I needed to choose what type of valve I would like: mechanical or biological. Mechanical would require that I take coumadin (blood thinner) the rest of my life, and be careful not to get too bruised (due to the blood thinner). He also said there would be a 2% chance, each year, of having some sort of issue that would require hospitalization of some sort. The biological (pig valve) is the preferred method these days because there is no need for blood thinner and the overall risk is less than the cumulative risk of the mechanical. Not that I'm going to need it, but I chose the biological. 

Delay of game

Well, I got a call from Dr. M's office last night and learned that my surgery will be bumped until Tuesday. Drat. He didn't get through all his patients/procedures on Friday, which pushes everything back a day. 

There's a chance it could even get moved back up, but we won't know until the last minute (the day before). Stay tuned. 

Meeting the surgeon...

It's been a pretty stressful week, as you can imagine, so we took advantage of our quiet, kid-free accommodations and slept in till late morning. The only thing on our schedule for the day was to meet Dr. Mihaljevic, my surgeon at 1:00. 

As I said in my earlier post, the hotel is very close to the hospital. We left our room around 12:50 and were on the fourth floor of the hospital at 12:55. We, of course, wanted to be on time because the surgeon's time is very limited and we didn't want to miss our chance. As it turns out, he got stuck in surgery and didn't end up seeing Dr. M until 3:00. You would think that the ladies at the desk would have told us that he was running late, but they didn't. Only when we asked did they mention it. Once we found that out, we were able to get a beeper and go down to the cafeteria to get something to eat. 

One of the things Juli and I have been noticing is the variety of types/colors of scrubs at the CC. As in most hospitals, the colors represent the occupation. We're making it a game (trying to pass the time) to guess what color went with what job. One of the reasons this is on Juli's mind is that she will soon be in nursing school and is "upset" that the scrubs the nursing students wear are "clown red". At the CC, we notice a lot of people wearing all white, which, to me, look like they were employed at some sort of mental asylum. Not that I've been to that many mental asylums, but it always seems to be the standard "funny farm" outfit in movies and cartoons alike. 

Bear with me, this IS going somewhere. 

While we we sitting in the cafeteria eating our lunch, I noticed a guy at the table across from me in an all-white outfit. For some reason, I noticed that we was wearing white dress shoes (not tennis shoes). I guess the fact that he was wearing white shoes (and black socks) kind of caught my attention, and I wondered to myself (not aloud) if this guy was an orderly, a nurse, or a janitor. Again, killing time does allows your brain to wander in goofy directions, but I noticed that even the people in the cafeteria had their own colored uniforms. I joked to Juli that they could really make themselves sound important by saying..."Yes, I work at the Cleveland Clinic...(under his breath) in the food court." 

After lunch, we head back upstairs and find out that it won't be too long until we see the surgeon. We get called back, wait in the room for a few minutes, and in walks the surgeon...the same white-shoe, black-sock-wearing man I saw in the cafeteria. I find out later that Juli had seen him walking in, in his all-white garb, and thought he might be a janitor or something. 

Sorry for all the preamble, but here's the important part relating to our meeting with the surgeon:

• Even though we had preconceived notions of this man as anything but a world-class surgeon who probably makes a million dollars per year, he blows us away with his knowledge, his demeanor, and his unassuming personality. He's from Croatia, has a slight accent, but has has an air (but not an arrogance) about him that is very soothing. 

• He said that, after the tests, that they confirmed that the leakage is severe, that I've had this condition for a long time and, as a result, my heart is enlarged. The fact that I'd stopped running for a few months would not have made my heart reduce in size because it's taken years for this to occur. 

• He says that the robotically assisted surgery is even better (with even smaller scars) than the traditional minimally invasive surgery. He also says that one of the great things about mitral valve repair surgery is that it's the only surgery that brings the patient back to his/her normal life expectancy. Other surgeries improve life expectancy, of course, but this one brings it back to normal. After all, the valve is fixed, therefore the heart is fixed. Cured. 

• Once my recovery is over, I can do ANYTHING a normal person can do. I wasn't sure if I was going to run again after the surgery (just to be safe), but there's no reason for me to worry. I think I'm going to register today or tomorrow for the Mini Marathon, which happens in May, but usually sells out in November. 

• Juli and I were talking about this before, so I asked Dr. M to describe how the heart/lung machine works. This may not be 100% medically accurate, but I'll do my best. They run a line in and out of my femoral artery and vein (in my thigh, near the femur). They then inflate a balloon in my aorta, which stops the blood from entering the heart (and the heart from pumping the blood). The heart/lung machine then circulates my own blood in and out, oxygenating in along the way. Then they stop the beating of the heart (kinda tough to operate on a moving object) by  injecting some potassium in/on the heart. Juli asked Dr. M how they keep the heart tissue from dying, and he says they "bathe" the heart in the nutrient-rich blood every ten minutes or so. It just blows my mind that this is even possible. In total, my heart with be shut off (asleep, according the the doc) for 60 to 80 minutes. Once the blood starts flowing, and the potassium wears off, the heart starts beating on its own. Sometimes, they have to give it a little jump start. Simply amazing.