Open Heart Surgery for Beginners

Arriving for heart surgery July 2010  - Clay Loges   UPS'68

What do You Mean?   Me? 
Heart Surgery?

When I learned that heart surgery was in my future, I was clueless about what was ahead for me.  Since this is a burgeoning diagnosis in our population, I thought it would be helpful to share a few tips and thoughts from my experience.   

With much pressure from my wife, I ended up in the emergency room for a minor TIA (which is a very low form of a stroke) that caused a temporary numbness in my left arm.  My wife's insistence proved to very likely be a lifesaving action.  While in the ER a nurse noticed a murmur in my heart.  Without this "early alert", I'd likely experienced big problems down the line, because I had no outward symptoms to alert me to my heart condition.  In fact my heart surgery for a valve repair was scheduled on a stand-by basis, because I was considered to not be in immediate danger and there were no negative effects on my daily activities.  

When I did get the "available opening" call, my cardio surgeon, Barnhart at Swedish Hospital's Cherry Hill campus, went in to do a repair on my mitral valve, and during surgery it proved to be a difficult circumstance and they were not able to repair the valve.  The result is that I came out of surgery with a replacement valve, and I spent a longer time on the operating table than expected.  The time on the operating table was not a big deal to me, because I was "out" and on the heart/lung machine.  But the extended time was nerve wracking for my wife and children who were just outside the operating room during the surgery. 

In regards to the surgery, I did not find the either the surgery or the recovery to be painful.  Having my chest sawed open and then wired back in place was certainly disabling for a period, but it was not painful.  Roy Yates '61 had similar surgery a few weeks before me, and he reported somewhat similar experience.  But I must say that the surgery is such a shock to your body, that it does take some time for recovery and to regain your physical confidence.  For example, your chest is without structure after being sawed open, so it is quite dangerous to ride in the front seat of a car for the first month or so, because an air bag going off is near certain to crush your chest and render you lifeless.  Post surgery the inability to be mobile from the waist up really limits you. First, with your compromised chest, you can’t lift any meaningful weight or use your arms to lift, push, or pull for weeks.  Without using my arms, I found it difficult to get upright to get out of bed; therefore I needed assistance from my wife or son for several weeks before I found a way to do it myself.  Taking a shower became a fearful activity, because any unsteadiness would be very damaging if you tried to catch yourself to avoid a fall.  I did learn how to do a lot more things with my legs (including getting upright to exit bed), because your lower body is not impacted by the surgery.  So you tend to rely on the lower part of your body that remains healthy, functional and fit. 

So my first words of advice to anyone facing heart surgery is to keep yourself fit, because you can bounce back better if you are in good condition.  Fortunately I had good strength in my lower body which made a big difference as I began the walking exercises.  By the way, the hospital staff had me on my feet walking (tentatively) by the third day.  And they sent me home on the fifth day with Advil as my pain medicine.  The home nursing did weekly checkups, and they sent a physical therapy person to my home during the initial 4 weeks of recovery. 

Around week six I began a Cardio-rehab program at Swedish – Cherry Hill that I did three times a week for an hour over an 8 week period.  Part of exercise therapy is to get you out of the "competitive exercise mode" and to get you to focus on exercising for cardio benefits.  They wire you up and monitor your heart function every second during your exercising.  It drives Type A patients crazy to learn that there is no race to be run or record to be surpassed.  Presently (at seven months post surgery) I continue to exercise daily for over an hour - and my goal is cardio improvement and not muscle development. 

I left my heart surgery thinking that recovery from the heart surgery was my only goal.  And, I'll readily confess that it took me a good six months to get back to feeling “solid” physically and to regain my typical mental acuity.  (From the "how are you feeling" questions, I quickly learned that one of the big medical concerns after the heart surgery is depression.  Fortunately I'm a positive outlook kind of guy, so I avoided that downer experience.)  The anesthetics really dull your thinking processes, and it takes several weeks to get the cobwebs out of your head (I’ve heard this from several people in addition to my experience.)  The post-op symptoms are slowed mental processing of information and challenges to your memory.  Don't try to do business as normal for at least several weeks, because your head will not be able to keep up....no matter what you think at that moment in time.  Trust me that your mental "edge" will not return for weeks. 

For me the physical recovery has gone well.  But it was a huge setback to learn that my heart did not automatically adjust to the new valve and bypasses.  So I was crushed to go to the cardio doc a couple of months after the surgery to learn that despite my physical recovery doing very well, my heart was not functioning to its new capability.  It turns out that I needed assistance in “remodeling” my heart despite my good recovery from the surgery.  So the past few months, I've been on a daily exercise routine along with consuming a regimen of prescriptions intended to “entice” my heart to remodel its operations to take advantage of the new valve and bypasses.  (By the way -- Once they know they will be entering your chest to operate on your heart, they look for any maintenance needs such as by-passes.  It's kind of a -- "while we're in the neighborhood what else can we do to improve things".  I ended up with triple by-pass as an "extra".) So the past few months I been exercising on machines that give a readout of my heart beat as I exercise.  The goal is to get my heart to work more efficiently and more effortlessly. I use a home blood pressure machine that I bought from Costco, so I can monitor the daily results of my heart's remodel.

It is interesting that I (and those around me) focused on my physical recovery from the surgery when the key goal is to get the heart to work better.  Right now (month seven) my heart’s new capability is still greater than its performance. 

By the way, my heart surgeon team was led by Barnhart at Swedish.  And my cardio doc is Rachel Wyman who is with Eastside Cardio next to Evergreen.   One of my old neighbors on Hunts Point, Jim Schneider, is one of the owner/docs at this practice.   Jim was out of town when I first began this heart saga, so I began working with one of his partners and have continued to do so. 

The real nightmare is the post operative dance between the medical services and the insurance company.  It is stressful to be the person/paitent stuck in the middle as the medical services try to properly handle the billing, and the insurance companies seem to discover various reasons to avoid paying a number of miscellaneous bills.  My advice before heart surgery is to find someone to assist in brokering between the medical services and the insurance company, because it is a foreign experience for most of us patients.  And if we pay a bill out of ignorance or frustration, then neither hospital or medical group will put forth any further effort to get the bill paid properly by the insurance company.   It is the most disappointing and stress-inducing part of my surgery experience -- quite unnecessary from my point of view.  Less regulation and more competition would significantly improve this big-money sloppiness. 

The good news is that more and more heart surgery is being done without sawing your chest open.  My valve is good for ten years, and I've been assured by the doctors that as my time for a replacement valve rolls around in ten years that I will probably not face a repeat of my 2010 open heart surgery process.  It won't be a walk in the park, but it will be less invasive.