My surgery

 

My account of the surgery and my time in hospital


Getting prepared:


I was feeling very calm going into the hospital, which is very unlike me when it comes to surgery.  I was freaking out about my knee surgery, stressing about my wisdom teeth, and scared of my mouth operations.  This time, I was completely calm.  We’d asked so many questions, spoken to a heap of doctors, nurses, and other heart surgery “survivors”, and knew what to expect. Most importantly for me, I knew I was only going to get one IV in my hand under local anaesthetic, then everything else would be placed while I was knocked out.  For someone like me who hates needles, that was very comforting!  Just one sting of a local anaesthetic, then I’d be waking up again.


I had confidence in my surgeon, Dr D Craig Miller, who is one of the best in the world, and I knew that being 27, that I had a better chance of the surgery going well, and if something went wrong, I had a good chance of recovering better.


Knowledge is power as far as I’m concerned - the unknown is a lot more scary then something you understand well.  If you’re getting something similar, find out as much as you can to make you feel comfortable, without scaring yourself silly.


Before I knew it, surgery day had come.


Thursday - day of surgery:


5:15am - Checked into the hospital

~7am - Got wheeled into OR and knocked out - I wasn't even ready for it - one minute I was being wheeled into the OR and looking at the lights, next minute I was gagging on a ventilator

4pm - They finally closed me up

5pm - Andrew got to see me in ICU - I remember opening my eyes and seeing him, and getting peeved at the ventilator

6pm - After much gagging and frustration, they finally took the ventilator out - apparently it normally takes about 4 hours to get you off the ventilator, so my 2 hours was pretty good

Through the evening - That night I don't think I slept at all.  My mouth was so dry, and I was so bored.  The nurse was nice though, so I talked (rasped) to her throughout the night.

The nurses would roll me from side regularly to make sure I wasn’t in one place for too long and it was horrible.  It was so painful, and I would cry out in pain every time they tried to move me.  They would both pull me back up the bed, and roll me to the opposite side.  The pain through my chest was almost unbearable, but at least it was only while they moved me - once I was in place, it was fine.  I couldn’t move much otherwise, even lifting my hand was a huge effort, and all I could move was my hand and feet.  I believe I had an IV in the back of each hand, an arterial line in my wrist, and a central line in my neck, as well as the chest tube draining fluid from my chest cavity, and the external pacemaker wires.  They have these wires wrapped around your heart that hang out of your chest. I believe if they need to restart your heart, they use those rather than a defibrillator.  Not sure exactly how it works.


I have pretty good memory from that night.  I got told I wouldn’t remember much, but I remember seeing Andrew when he was allowed in while in was intubated, I remember them extubating me, I remember hearing the doctor talking to the family of the guy next to me saying he pretty much had no chance of living, and recommending they turn off the life support.  That in itself was kind of traumatic.


Friday:


~7am - Doctor did her rounds and was very happy with my progress

~8am - FINALLY got a drink and a liquid breakfast - I swear that chicken broth and jello was one of my best ever meals for my poor sore, dry throat!

~10am  - Andrew and our good friend Shona came in and I was feeling pretty good by this stage, just tired.  Shona got me a Sprite and it was so good!  My throat was killing, and that was heaven.

midday - The nurse assisted me to a sitting position to have lunch.  The sandwich was way too dry and scratchy for my sore throat, but I could force some food down.  It was nice mentally to be able to sit up - it made me feel less “sick” that I could sit up and eat normal food.

2:30pm - I was discharged from ICU and moved to the "Intermediate care" Unit where I stayed the rest of the time.  I was lucky enough to get a private room which was good.

Evening - I was still fairly uncomfortable and couldn’t find a good position to sleep in, so barely slept. I also had nurses coming in regularly to check on me, and while I had a private room, the supply closet was next door, which banged loudly every time it was closed, and the machine that sucked the fluids from my chest was really loud as well - sounded like a loud aquarium.  Andrew stayed with me that night, which was comforting.


They were checking my blood sugars from Friday onwards - it took a few days for them to get back to normal, had to get a few shots of insulin (not diabetic, just reaction to surgery)


Saturday:


7am - Sat in a chair beside the bed for breakfast.

8am - The dressing came off the wound - it was longer than I expected, but no external stitches or staples.  It truly is amazing...  Apparently the artery they wanted to use for the heart lung machine wasn't strong enough, so they went higher up my chest.

11am - Went for my first walk around the ward.  It was slow, but pretty good otherwise

12:30pm - They took the catheter and chest tube out - I was surprised at how minor the tube coming out was, even after being told it was quick and painless.  You’d expect something that thick to be more uncomfortable.

1:30pm - Dr Miller came by to say hello.  It was great to see him, and I was very pleased he made the time on a Saturday to drop in to see me.  He was very happy with how the surgery went, and is confident it will all last me a long time.

2pm - Went for another which was easier, due to having less tubes hanging out of me.  I was able to get in and out of bed unassisted as well which was great.

Evening - I sent Andrew home to sleep since I didn’t feel like I needed him there at night, and he was also exhausted - no use having both of us not sleeping properly!


Sunday:


Oxygen levels were pretty low while lying down, but fine sitting up.  I had some air and fluid in my right lung which is slowly going down.  It was gurgling when lying down, which was quite disconcerting, and doesn’t help when trying to sleep.


I felt pretty low in the morning - I was anaemic from the surgery (which was expected), which probably was contributing.  They gave me some iron shots (or something), and I think just knowing that was the part of the reason helped me perk up again by midday.  By the afternoon I was beginning to get cabin fever and sick of being in the hospital.  My walks were becoming much easier,  and I was feeling much better.  My blood sugar levels were still all over the place.


My IV line had to be changed since they only last about 4 days, and when the nurse went to flush one of my lines, it leaked out...  They took out both IVs, and were going to put in a large gauge IV into a “deeper” vein so it could be used for my CT angiogram the next day for when the radioactive dye is injected.  My veins were all in hiding, and didn’t want to be poked.  The first 2 nurses gave up, and a crisis nurse was called.  He spent over half an hour just trying to vein that he could use - it was pretty stressful for poor little me who HATES needles with a passion, wondering how many times he was going to have to poke me.  Luckily once he found a vein, he got it on the first go.


By this stage, the only actual pain I was getting was muscular.  My lower back was aching from the beds - the problem with the hospital beds that bend is that you slide down them, so your back ends up bending in a position that isn’t at all comfortable.  As well as that, my chest and shoulder muscles were aching.  Apparently they don’t like being ripped apart when the chest is opened.  Funny that.


Monday:


Still not getting any sleep (4:30am blood draws every morning doesn't help...), so pretty tired, but otherwise feeling good.  Generally in the morning I was very tired still, and would try to nap at around 10am once all the doctors had been through for the morning. 


The big event for the day was getting the external pacemaker wires out.  I had no idea they'd be so long!  It seemed like she'd never stop pulling.  It was the most odd sensation, and I was about to yell at her to stop when she got them out.  I don't think it was pain that made me want her to stop, I think it was just that odd feeling.  I don't know!  I’d guess that the wires were about 30cm long.  The end of the wires were kind of coiled as well so when that bit came out around my insides and through my chest, it felt very weird to say the least.


I also had a CT angiogram and everything looked good.  I was due for my painkillers at the time I went for the CT scan, but hadn’t had them, so having to lay down flat on hard bed was stretching my chest, and I also had to put my arms over my head for the scan which was also pretty painful.  By the time I got back to my bed I was in agony, but I got IV and oral drugs I think which helped.


My lungs still had some air and fluid, but were getting better.


I got a massage in the evening by one of the hospital massage therapists.  For anyone who goes through a similar surgery, I highly recommend a massage.  It really helped my lower back, my shoulders, and my neck which was super stiff.  I felt a million times better after that massage.


Tuesday:


By this time I was absolutely sick of hospital.  I was still not sleeping, so exhausted, and getting cranky and starting to snap occasionally at people.  Especially when they brought me gross food or give me painful anti-anaemia shots.  Andrew brought me some rice with gravy from the cafeteria for lunch which was fabulous.  Warm, soft, and palatable.  That was all I needed!


I went for an echo which looked fine.  It was hard to tell the difference, except the aorta was a bit brighter at the edges where the Dacron graft was. 


By this time I was off the painkillers during the day pretty much.  I was just needing them at night.


The big achievement for the day was having a shower for the first time since I first went to hospital.  I had to wait until the chest tube and pace wires were out which happened the previous day.  Andrew had to shower with me to help wash my hair since I couldn’t do it myself, and to be able to stand under the water and let it run over me was just heaven.  It’s the little things that matter when you’re in hospital.


Wednesday:


The doctors came by in the morning and said they were happy with everything, and I was right to go home once they had all the paperwork completed.  Yippee!


Then at 11am - I checked out and went home!


We actually went via Safeway and got prescriptions filled.  We walked around Safeway for about 15 minutes getting a few bits and pieces, and I started getting tired, so sat at the Pharmacy area until they had the prescription ready. 


What they found:


As for the surgery itself, apparently the aorta itself was "cheese-like", and certainly deteriorating.  The bigger problem when they went in was seeing that the sinus of valsalva was paper thin.  It should be 1.5mm thick, it was .5mm.  Apparently they could see the blood through the tissue pumping away.  Apparently only an MRI would pick that up (and even then it's not easy), and they didn't think mine would be that bad, so didn't specifically look for it I guess.  So I feel very lucky that I got it fixed when I did, and that everything is fine now.  They saved my valve which I am so pleased about!  With any luck, this should be a once in a life time procedure.  My own valve may not last a lifetime after being fiddled with, but it should last a very long time.


There’s some photos from the surgery here.


Post surgery recovery


I was amazed to get out in less than a week and be feeling so good.  I was warned of the “Day 2 downers”, but I really didn’t get that.  The only time I got down in hospital was toward the end, and it was more exhaustion, and getting sick of being there.


Going home I felt great, and was doing 20-25 minute walks no problems.  I felt I could have gone longer, but didn’t want to push it.  Within a week of getting home, I managed a slow 45 minute walk.  I was warned of needing to sleep during the day because I’d get tired, but I felt as though I had a fair bit of energy.  I’d get weary and a little more achy towards the evenings, but that was near bedtime, so that was fine.  Night time was painful.  Getting a good position to sleep in was hard, and I would get stiff from being in one position, and have to turn over which felt like my chest was splitting apart.  I had a couple of nights with Percocet, then dropped down to Ibuprofen and within a few nights, I was painkiller free both day and night.  After that, I would just take an Ibuprofen every now and again as needed.


I knew that whenever my breathing got laboured I had to take an Ibuprofen as it generally meant that my chest muscles were aching, which was stopping me from breathing normally.


On Sunday after I left hospital (1 1/2 weeks post surgery), I noticed my breathing was a little off again, I was feeling very tired, and I was becoming increasingly aware of a super strong heartbeat.  The next day was worse.  I had absolutely no energy, my heart rate felt all over the place, but I discovered it was more something twitching like mad in my chest really hard which felt like my heart beat.  It was hard to distinguish between my heart beat and the chest twitching, but I finally discovered I was having a couple of double heart beats here and there.  I also discovered that it got worse with even a small amount of exertion.


Tuesday I went in to see the cardiologist, and he said it was just atrial fibrillation which is common after heart surgery and it would sort itself out - no need to worry about it.  All the symptoms - tiredness, short of breath, increased awareness of heartbeat - were of atrial fibrillation.  They do nothing for it, and it was good to know that it wasn’t considered anything remotely major.  My cardiologist laughed and said that nobody was allowed a perfect recovery, and I’d been doing way too well. :-)  He checked my heart, lungs, and did a quick ultrasound, and everything looked perfect.  Luckily, the atrial fibrillation only lasted a few days.


My muscles get quite achy still, and that will take a while to sort out, but that’s about the worst of my complaints.  I found that whenever I do a bit much, I get really tired, and my muscles get more achy, so I sleep badly, and get more tired, at which point a day time nap is in order.  There’s definitely good days and bad days, but a lot more good days. 


I have come to realise that the recovery of a younger person is very different to the recovery of an older person.  Everything I’d read to be prepared for was much easier than I ever expected.  I hope that other younger people out there who have to go through something similar will read this and go in with a positive attitude ready to face the challenges head on.  I’m sure my positive attitude toward the surgery helped me.  Knowing that I would have that worry off my back once it was fixed also really helped.


If you have any questions about cardiac surgery and you think I can help, please feel free to email me at sarah@pollock.id.au.


I will update more about my recovery as it happens!