Technical Aspects of the Surgery

A month ago, I had open-heart surgery to replace the aortic valve.

Ever since being scheduled for surgery, I have been interested in the technical aspects of the procedure. I didn't want to watch the surgery, as I don't really like the sight of my own blood, but because of my work as a technical writer, I have been intrigued with the actual technical procedure. So, with all that said, the following is what I observed and learned from information received from interviews and questions to both the surgeon and the critical care nurses before and after the surgery.

On the day of the surgery, and in a separate room before the surgery, two technicians prepped me for surgery by cleaning and shaving my chest, and shaving my groin area and my right leg, in case the surgeon needed to go into my leg for a vein to make an unexpected repair, which fortunately he didn't need to do.

When they wheeled me into the operating room, I noticed a white board with my name and abbreviations of the symptoms I've been experiencing. I didn't recognize most of the abbreviations, but the last one caught my eye -- the abbreviation was "S.O.B.". As they were helping me onto the operating table, I mentioned to one of the nurses that the surgeon shouldn't have the perception that he was cutting into the chest of a guy he thought was an "S.O.B.". The nurse, somewhat amused, said that the abbreviation stood for "Shortness of Breath", but just before the anethesia took affect agreed with me that maybe an "S.O.B." was going under the knife.

According to Nana Pam, the operation lasted about 5 hours, during which time I understand the following occurred:

When I was completely anethetized, a tube was inserted down my throat and I began breathing with the assistance of a heart-lung machine.

The surgeon, using a scaple, cut a 10 inch long incision along my breast bone. Once the sternum was acccessible to him, he cut through it and spread open my split sternum and my ribs to reveal my beating heart.

I'm not sure which came first at this point, stopping the heart or connecting the flow of blood to the heart-lung machine. I think the surgeon would have connected me to the heart-lung machine first to continue blood flow before stopping the heart from beating.

After the heart-lung machine was connected and the proper tubes were in place to deliver the flow of blood to the rest of my body, the heart was stopped. After the heart beat was stopped, the surgeon clamped off the aorta about two inches away from the heart, and clamped off the main arteries into the heart itself. At this time, there now existed the possiblity of dislodging a piece of arterial plaque that could travel to my brain once all was complete and the heart beat was restarted. If I had been awake, now was the time I would have started to worry a bit.

At this point, the heart-lung machine was pumping my blood and doing my breathing for me, and the actually procedure was about to commence.

The aorta was separated from the heart to expose the faulty heart valve, which was removed using a combination of scaple cuts and a tool the surgeon told me was similar to a small-sized wire cutter. The artificial heart valve had been manufactured in about three sizes, and the surgeon had previously decided that I would need a "small" or "medium" size. However, he found that neither would fit properly - the "small" was too small, and the "medium" was too large. A large amount of calcified material had built up in the valve cavity and had to be cut away to make the "medium" artificial valve fit properly. This took extra time and I'm glad that the surgical team didn't really have any place they needed to be later that morning. What the surgeon had to do to make the new valve fit brought a whole new meaning to the term "wingin' it".

The artificial valve was sewn, or "jury rigged", back into place, the aorta was sewn back to attach it to the top of the heart, and the clamps were removed. A localized electric shock was given to my heart to "wake it up" and tell it start beating again, which I'm happy to say it did. Before closing the chest up, the surgical team tested the heart to ensure that all was well, that the artificial valve was working properly, that the heart was delivering proper blood flow, and that there were no leaks in areas that had been disturbed. I hope now that these guys did a FOD check and ensured all their tools were accounted for before closing me up.

Now, at some time during the surgery, wires were connected to my heart and fed through my chest, just to the right and below the heart. These were to be connected to an emergency defibrillator if needed during recovery. Also, three tubes used to drain fluid that accumulated during and after the surgery were insert through my skin just below the sternum at the center of the belly. And at some point, a thing called a "Foley catheter" was inserted through my urethra into my bladder to drain urine during recovery.

After the heart was put back together and it was confirmed to be working properly, the sternum was positioned back into place and "wired together" - that's the term used by the surgeon. I saw these "wires" later in an image of a chest xray - they actually are three large staples holding the sternum together during mending. I should be able to feel them, but to tell you the truth I don't want to just yet - it's too soon. After the sternum was put back together, the incision of the chest was sewn up using dissolvable stitches. The drainage tubes, defibrilating wires, catheter, and the heart-lung tube down my throat were left in place.

All this in five hours. Obviously, it took a lot longer to do it than to describe the procedure.

Afterwards, I was transported to the critical care unit for the first part of recovery.

They left me intubated during the first part of recovery. My first memory after surgery is of being partially awake and feeling the tube in my mouth and fighting against it. It was soon removed and I fell back to sleep.

I have few memories of first waking up during recovery. I know my family members were allowed to visit me in the recovery room, but I have no memory of when this actually happened, and no memory of what was said. Right now, the first visit almost seems days after the surgery, but I know it was only hours.

In fact, my memory during the first two weeks is rather fuzzy, and I remember very little during these first two weeks. Nana Pam told me I had some visitors while in the hospital, and I vaguely remember them. She said that a lady from work visited once and stayed and talked with me for a couple of hours - I'm sorry that I don't remember the conversation, and in my mind that couple of hours seemed like only a few minutes. According to Nana Pam, I was coherent and talkative, but I sure don't remember any of the conversation. And she said that the program manager, my boss, visited twice on different days while I was in the hospital - and again I don't remember any of the conversations, and I would swear that the two visits were actually one visit.

At some point early in recovery I was given a teddy bear, the intended use of which was to hug it tightly against my chest whenever I had to cough or sneeze. Coughing was severely painful in the middle of my chest at first and the teddy bear helped keep my sternum from popping open - at least it felt like it was going pop open. But I never sneezed while in the hospital. The first time I sneezed was at home during the second or third week of home recovery - and I thought the world was coming to an end. The pain was so great it brought tears to my eyes and I began weeping and I didn't want to do anything for pretty much the rest of the day. After week five of recovery, the pain from coughing is tolerable. But, sneezing still ain't a favorite thing on my list.

The teddy bear was a constant companion while in the hospital. When not hugged during coughing/sneezing, I kept the silly thing between my legs covering up what the hospital gown readily exposed. The teddy bear was not only my constant companion to guard by sternum when I coughed, it also served as a kind of "crotch guard" during visitations (if you know what I mean).

So, at this point, I had two wires coming out of my chest, three drainage tubes protruding from my belly which were hooked up to a collection device, and a "Foley catheter" in my . . . you know . . . (don't make me say it). These stayed in for at least two days after the surgery. Although I don't remember the exact day, these were all removed while I was still in the critical care unit. And even though I don't remember the exact day, I DO remember quite clearly the removal process. Not much pain was involved, but I most certainly remember the event. The process was quite simple: a nurse pulled the tubes and wires out one at a time. The wires came out easily, but the tubes required aggressive pulling. Like I said, not much pain was involved, just a weird feeling of discomfort. One of the drainage tubes didn't come out at first, and the nurse told me that if it continued to be a problem, a surgeon would have to "go back in" to surgically remove it. Well, I didn't want to be cut open again, so I told her to try again and if necessary to have Nurse Burley to come in and help. After about the fifth time and with even more aggressiveness, the tube finally came out.

Now, as for the "Foley" catheter, that was last to come out, and it was the weirdest of them all. I won't explain the details of the removal, let's just say that all sexual thoughts were completely absent from my mind. I'm just glad I wasn't awake when they inserted the thing.

There are some things I do remember about my stay in the hospital, things like the room service type meals, that were absolutely fabulous. And I remember sleeping a lot. And I remember needing a shower after five days without one. And I do remember being discharged from the hospital and getting home exactly seven days after the surgery. One week. When I was a kid, any body who was admitted into a hospital for a surgery of any kind was admitted for at least a month, or so it seemed. It's remarkable just how much things have improved over the years. Maybe it is just good living on my part, but it seems I left the hospital sooner than expected. According to the nurses taking care of me, most patients having open-heart surgery are carried into the hospital on a gurney and are bed-ridden during their entire stay of two or three weeks, and then have to be wheeled out of the hospital to undergo hired home health care for a few months more. In my case, I walked into the hospital, had surgery, stayed a week, then walked back out. Except for the occassional trip when Nana Pam had to drive me to followup reviews and procedures during the first four weeks, I have been able to take care of myself at home. And according to Nana Pam, the recovery at home has been easier on her than originally expected - she originally thought I would need a lot more care and attention.

As I said, I can pretty much take care of myself at this point. The doctor told me earlier in the week that although I can now drive, I still need to limit any rigorous exertion, and that I'm still limited to 5 pounds lifting, pushing, or pulling for at least two more weeks. And I'm real careful about that - I'm not too bashful about letting Nana Pam open doors for me. The last thing I want is for the sternum to not mend properly. I have found that although I have muscle aches in the upper chest and back (due to the rib cage being spread open during the surgery), I feel much better and the blood flow is much better.

Hey, an open-heart procedure ain't elective surgery, but if you need a new ticker or a valve job, I highly recommend the Oklahoma Heart Hospital to do the job.

Synopsis

To recap, this is what has been happening:

A year and a half ago, I went to the cardiologist for a routine checkup. At that time, everything was hunky-dory. The heart valve causing the heart murmur was closely looked at and determined to be just fine. The doc said that the valve was in “racing form” for a good long time. Apparently, though, I failed to check the oil, because about six months later I started experiencing some odd symptoms, not real bad, but enough for Nana Pam to notice a change in my “performance” (if ya know what I mean).

Now, Nana Pam is a hypochondriac. But over the years of living with me she has learned that, regardless of any of her symptoms being real or imagined, I simply don’t care, that I truly am the apathetic and self-centered doofus I successfully pretend to be. So, to compensate, Nana Pam has become a “Hypochondriac-by-Proxy” -- if she reads about a cure for an ailment I ain’t got, I should try the cure anyway to ward off the ailment I ain’t got.

And so it was about these particular symptoms. Nana Pam thought I had, or didn’t have enough of . . . well, you know, she was thinking I had . . . Low T.

Hey, it’s nuthin’ ta be embarrassed about -- a lot of men my age have . . . you know . . . Low T.

And long story short (no pun intended, by the way), she thought I should . . . you know . . . . “do” something about it.

So, I went to the doctor - not the cardiologist, but my general practitioner - just for a checkup. He politely listened to the symptoms, and, being a good doc, informed me that, with the heart condition and the sleep apnea, before he prescribed something for . . . uh . . . you know . . . Low T . . . I needed to go see a hormone doctor, an endocrinologist, just to make sure. And then he said, “What does your cardiologist say?”

So, on I went to see the hormone doc. And he set me up on this regimen, see, and did all these tests on me, and after a couple of months, concluded that my testosterone levels were indeed slightly down. But so was my adrenaline level. And my thyroid function was down. And my pituitary output was off. In fact, virtually all my hormone levels were down. Taken alone, none were really serious, but all of them taken together seemed pretty odd. And then he said, “What does your cardiologist say?”

And all the while the symptoms kept getting worse and worse. I couldn’t keep my mind focused, I was irritable and short-tempered, there were times I couldn’t even work or drive, I was always short of breath.

So, I took the not-so-subtle hint and made another appointment with the heart doctor, which just so happened to be a year after the previous appointment.

Well, what started as a routine checkup with the cardiologist soon turned into a day I won’t forget. The doc found that the heart valve had closed off to less than half what it was a year earlier, resulting in a loss of adequate blood flow to the rest of the body and making the heart work harder than it should. That was what was causing all the other symptoms.

So, I told him to give me a pill for the problem and I would be on my way.

And after looking at me like I had two heads said, “You don’t understand. Within the next few months you have to have surgery to repair your heart valve, otherwise it’s kaput for you.” (He didn’t really say that, but you get the gist).

That was just before Nana Pam and I were leaving for a romantic trip to the Appalachians for our anniversary. But, as soon as she learned about the real situation, she opted to remove the “romantic” from the trip and we went to eastern Oklahoma instead. She figured that if I was going to die along the way, the kids should be within driving distance so they could enjoy the spectacle, too. (Did I mention that one of the symptoms was also a sort of paranoid cynicism?)

Anyway, when we got back from the vacation, I got scheduled for the first test to get ready for surgery. And I fully expected the testing to go on for a few months, and that I would have the surgery sometime in the late fall at the earliest. But, with each test, they kept finding crap, and the next thing I knew I had surgery scheduled within the week.

So the bottom line is this: The heart surgeon told me that the operation is to be this Thursday, May 14th. And he explained in detail what he was going to do, how he was going to do it, what type of pliers he was going to use on my heart, and his latest golf score.

And as we say in Oklahoma, “It’s OK, could be worse.” (Talking about his golf score, of course)

It's T.E.E Time!

Today, I had a Trans Esophacal Echocardiogram (or T.E.E.).

Now, that was the most PLEASANT experience of my entire life - it was like entering Valhala. I wish I could DO IT AGAIN.

- - NOT! - - (With a capital N-O-T and double emphasis)

I'll back up a bit.

Yesterday, I got a call from the doc wanting to do a Trans Esophacal Echocardiogram on Monday. Since this entire heart thing needs to be expedited, I agreed. There was suspicion that there was damage to the aorta, and the T.E.E. was necessary to show the surgeon what special prep would be needed for the surgery.

So, long story short, I went to the heart hospital today and got-r-done.

And I'm telling you with no exaggeration that it was the most HORRENDOUS procedure I've ever had - not that I've had a lot of procedures, but this was the absolute worse.

I just got back from the hospital still feeling groggy and I'm not ashamed to say I still feel like crying like a little girl.

But, God bless America and the heart hospital and all the nurses and staff. My reaction to the procedure is not their fault - it's not their fault that they had to call in Nurse Burley and her big sister to hold me down, and give me a triple dose of the esophagus numbing medicine (which didn't work by the way). I was fully awake for the whole procedure in spite of the fact that they gave me the required "knock-out" injection. At one point I even involuntarity grabbed the doc, for which I am truly sorry.

But, the doc got the needed images, and now has all the information needed for the surgery, which I swear has GOT to be easier than what I just went through.

From the T.E.E. images, it doesn't look as bad as originally thought. The valve looks a mess, and the aorta looks bad, but not as bad as thought last week. Looks like the heart surgery will be a straight-forward type of operation with no surprises.

And I'm ready to get through with all this. I just hope that on the day of the operation everyone will have had a good night's rest with pleasant dreams, and a good day. It's important for everyone involved to have a good day. I want everyone to be in a good mood when they open me up.

I hope I don't sound too pessimistic. These are just the first words that fall out of my head. I trust in the one true God, and I trust the physicians and nurses and surgeons. I trust that all the preliminary procedures give the right info. And though I may not be looking forward to this surgery, I'm not really dreading it either. I'm looking forward to feeling better. And I'm looking forward to spending some quality time with the wife during recovery.

[Note from Nana Pam: Did he just say "quality time" . . . WITH ME . . . "during recovery"?! Five weeks of "RECOVERY"?! Someone kill me now . . . or at least give me heavy sedation.]

It would be a dumb cliche to call this "Heart to Heart"

OK, it has officially started. I went yesterday for the first of the preliminary procedures to check out the heart to provide the surgeon with a “road map” for the main surgery.

Yay.
But, first, for those of you who don’t know, I’ll flash-back to just six weeks ago . . .

In March, 2015, I went to the doctor for a routine checkup and was told, much to my dismay, that the heart valve being monitored through the years is failing, specifically it’s closing. The situation is kind of like what happens when you put a thumb over a garden hose -- you now have a restricted flow of water with which you can spray your car or your wife - a bit of fun with the wife, but not so much with the blood flow.

From scientific analysis of an ultrasound, the doctor concluded that the heart valve that allows blood to flow into the aorta has closed off over 50%. Instead of a steady flow of blood through the heart, I now have blood that is spurting into the main aorta at an increased speed but at a reduced rate, and he needs to "go in" to get a better look see, hence the arteriogram.

Now a little biology: The human circulatory system is a closed system, meaning that when all is well the blood is pumped around and around through the arteries and veins without interruption, with a stop-over at the lungs to pick up oxygen molecules. But, in my case, the main valve from the pump doesn’t open fully, restricting the blood out of the heart and causing the blood to be forced back into the lungs through another normally closed valve, damaging that valve and making the pump, i.e. the heart, work harder.

This causes numerous symptoms: The restriction of oxygenated blood to the rest of the body causes light-headedness, blurred vision, increased anxiety, muscle weakness, and lowered hormone generation, which in turn results in lowered testosterone, lowered thyroid function, lowered adrenal function, lowered pituitary function -- essentially all bodily functions are not working up to snuff right now. If left untreated, the blood will backwash into my lungs enough to rupture the capillaries there and I will start to cough up blood, the heart will want to pump harder, and the circulatory closed system will no longer be a closed system.

The only fix for all the problems is to replace the recalcitrant heart valve with either an artificial valve, or a "biological", i.e a valve harvested from a pig.

I’m opting for an artificial valve, primarily because I don’t want to be referred to as “Pig Boy” by the folks at work (and by the Big Sis in Bixby).

After the bad news, I asked the doc if I could continue hiking. He said - and I’m not kidding here - he said, "Yes, you can still hike, but NOT uphill." (He either needs to get out of central Oklahoma more, or this was a sarcastic way of saying I shouldn't go hiking at all).

The arteriogram I had yesterday is similar to the angioplasty I had in 2005 and the angiogram in 2010, except that this time two catheters are inserted, one in the femoral artery and one in the nearby vein, both to accomodate small cameras that are snaked into both sides of the heart to take "home movies" to see how much damage has already occurred to the entire heart. I’m sure some of the pictures will be used to entertain guests at a subsequent party of other cardio-surgeons. I can only hope they find them as boring as other home movies -- if they find them entertaining, then I’m in more trouble than I think.

I don’t know exactly what the second procedure involves, but I’ve been assured that it will not be invasive. Some sort of electrocardiogram thing.

But, I’m not looking forward to the third procedure. It has been described as follows:

A tube will be inserted into my throat and a camera sent down for pictures. I didn’t really follow the purpose of this procedure - I kind of got lost in thought after the doc said "inserting a tube down the throat". But, since the procedure was considered necessary by the attending surgeon, the one who will soon have my beating heart literally in his hands, I didn’t want to appear unenthusiasitc.

What really concerns me is the "main event", when the surgeon cracks open my chest to expose the beating life within me. I haven’t been told what to expect, not by the surgeon at least. But, I have an acquaintance who has had this surgery and he told me what to expect, and it ain’t pretty. He told me he doesn’t have any pictures of the "main event", but that the beginnings of the recovery was horrendous. He told me after a few days recovering at home he was able to walk across the room, and it took him "only" two minutes(!) But, he did say that now he feels better than ever. He just can’t do some of the things he used to be able to do, things like running marathons, and extreme weight lifting, and swimming with sharks, and wrestling grizzly bears and such things as that. I figure I can give up those activities pretty easily. I just hope Nana Pam isn’t expecting too much in the bedroom (if you know what I mean) -- past experience tells me that would be a heck-uv-a workout.

Anyway, I digress.

The arteriogram is now behind me, and it went really smooth, except that they did find the heart valve much more restricted than indicated by the ultrasound a couple of months ago - not so bad as to have to have emergency surgery, but the situation has now changed to "urgent" and I need the problem fixed as soon as the surgery can be organized. One thing that threw the doctors off is my surprisingly good physical condition (no kidding). Apparently, at this point I should be writhing on the floor unable to control my own bladder and expecting to die at any moment. I guess I’m a testament to clean living - either that or the copious amounts of adult beverages in my system made me oblivious to the situation.

For the next trip to the hospital, I should be prepared for a "sleep over" -- and I don’t mean a sleep over with scantily clad nurses each with a tray full of jello-shots dancing to the tunes of the "Mighty Mighty BossTones"; I mean I should expect to be "entertained" by "Nurse Burley and the Probing Quintet" for a few nights.

Believe me, with the picture of "Nurse Burley and Probes" floating around in my little pea-brain, I’d do most anything to avoid a long stay in the hospital, up to and including hijacking a wheelchair and pretending to be sweet little demented Miss Beasley rolling lazily down the hall; Or making my way to the elevator pretending to be a gay male nurse collecting stool samples from all the other poor saps on the floor; Or even putting on a burka and yelling "General Akbar" at the top of my lungs while running down the stairs.

OK, OK, so maybe I’ve watched too much "Star Wars", so what? The point is, I don’t want to be in the hospital any longer than I have to be, even after a third party goes into my chest cavity to say "Hello to my Little Friend".

All right, enough of the movie references already -- it’s just my way of dealing with the situation. I don’t really want this to be happening to me, but I know it’s inevitable, that it's second hand news. I know I will be feeling all right when it's done, but, don't misunderstand me, I also know just how painful and uncomfortable I’m going to be for the next few months. The thought of the whole process turns me a whiter shade of pale, and I just hope they give me enough pain killers to make me comfortably numb. I don’t want cocaine or anything the pusher could provide, just something to feed my head and to think I’m chasing rabbits and to give me a feeling of deja vu for a day or two.

I’ll write more later - I have an inexplicable hankerin’ to listen to some music right now. Maybe something soothing, like "Fendal’s Cave" from the Peer Gynt Suite. Or maybe a bit o’ Led Zeppelin. (Hmmmm, "Black Dog" . . . . ).