The symptoms of heart problems crept slowly into Jim's life. He continued doing the things he always did, but found he had less and less energy as time went on, and required frequent rest periods and naps. He attributed this to old age, after all, he was 73.
In early November we undertook a week long project of land clearing using a tractor to pull small trees from beneath big trees. Jim would then chain saw off the larger limbs from the fallen trees, and then we would chain the tree to the tractor, pull it to the sink hole, and together we would then throw the tree, then the limbs,into the hole. We were both quite tired by the end of each day, but we deserved to be tired. I had torn my medial meniscus during our pre-tractor work, and saw a doctor about that on Nov 11. I elected to opt out of reparatory surgery, believing my knee would self repair once the tractor work was done, and I could rest it.
On Nov 24 Jim went to his regular bi-yearly doctor appointment and took with his his list of complaints. Nestled in his list of physical complaints among things like frequent nighttime urination, and tiredness, was chest pain. The doctor jumped on the chest pain and ordered an EKG. Because the EKG showed an irregular heartbeat, she arranged for him to see a cardiologist in the next county that very day.
The cardiologist set up appointments for December 3 and December 9 for an echo exam of the heart, followed by a cardiovascular stress test. Following the stress test, the doctor came in and suggested further investigation with a cardiac catheterization. We scheduled the catheterization for Dec 17.
We went into the catheterization with the understanding that if blockages were found, stents would be placed within the arteries to open the blockages. I waited somewhat patiently in the waiting room, appropriately reading a book about how the body works by Sherwin Nuland. Eventually the procedure ended, the doctor came out to tell me the blockages were too severe for stents, so nothing had been done, and that the next stop was open heart surgery. I was then allowed to be with my husband. He was somewhat awake, and the fist question he asked was what happened. I told him about the need for open heart surgery. Jim had to lie still for 5 hours, while I emptied the urinal, then he was able to walk to the bathroom. I read to him from the book. The anesthesiologist came in to talk to us and he was thoughtful enough to show me a drawing that was stuck in his file. It showed four blockages, 80%, 90%, 90% and 90%. Jim drove us home that afternoon. The next morning we went in again for a Transesophageal Echocardiogram (Tee) test. This test confirmed the need to replace the aortic valve.
Things progressed slowly after this. Our next appointment was for Dec 29 and the Christmas holiday seemed like eternity for us, as we felt any wrong move might bring on a heart attack. Still, we managed to put up some Christmas lights
and my 5 grandchildren came from Wisconsin to visit the day after Christmas.
I used this time to research open heart surgery, and I decided that
endoscopic vein harvesting was essential. I would have like
off pump surgery as well, but off-pump is not a option when the aortic valve is replaced in addition to bypass surgery. The local newspaper had an article on endoscopic vein harvesting that week, and I went to the doctor's offce to make a special request to have the man featured in the article do the harvesting.
We greeted Dec 29 with high hopes that surgery could finally be scheduled, but the doctor simply told us to see a dentist to be sure there was no existing dental infection. We drove directly to the dentist who scheduled an emergency appointment a week away. That appointment showed no infection, the results were faxed to the doctor, I called a short time later and we scheduled surgery for Jan 15.
Because Medicare does not pay for overnight stays before surgery, we were scheduled to go through a pre-admission the day before, go home and shower using a special soap, then show up at 5:30 am the next day. We were given a room where Jim was shaved (neck to ankles) with a electric razor, then asked to shower again using the special soap.
An IV was inserted near his wrist, and he was given medication, and tagged.
This all went very slowly, as the cart to take him to surgery did not arrive until 9:30 am. I walked him down to the corner where the ICU waiting room met the hallway that led to surgery. I waited in the waiting room for the
call that would indicate surgery had begun, and when it came the caller was either unable or unwilling to answer any of my questions. I had also asked if my camera could be used in the surgery room so this web page could be more informative, but my request was denied. I was told surgery would last between 3 and 4 hours. Five hours later, at 3 pm. the doctor came out to tell me he had replaced the aortic valve with a cow valve, he had bypassed three of the four blockages, and that the man I had requested had not been available for the endoscopic vein heavesting. A half hour later I was called in to see my husband. This is what I saw:
The next day, after the intubation was removed, our son and I peeled back his hospital clothes and took this picture
I took Jim a bear and placed it by his breathing machine to remind him to use it.
Stoke is a very common side effect of open heart surgery, caused, I believe when the aorta is unclamped and emboli are released into the brain which triggers a stroke. Emboli can travel elsewhere, and I believe the kidney damage sustained by my husband was also caused by emboli. There is an emboli filter but my doctor says it's more trouble than it's worth. Now I have to wonder. Jim had a series of
renal scans which
showed improvement each time. The
I spoke to the surgeon about an aortic emboli filter I had discovered on the web. I showed him the printout and he said that one problem was that it had to be placed in the aorta by catheretherization, and the other problem was that it had to be cut out of the aorta, which in itself causes problems. I didn't think the first problem was a problem, because they usually do cardiac catheterization before open heart surgery anyway.
Another thing that went wrong was a deterioration in his vision. He could read the newspaper headlines but not the newsprint. He mentioned this to many nurses and doctors and nobody seemed concerned. I called his optician and he said to come and have his vision checked two weeks after surgery. Eventually I got around to looking this up on the web and found After Surgery, A Guide for Patients" which says: "If you notice any blurring of vision after surgery immediately call your doctor or nurse and tell them about it. They will take steps to identify and start any treatment they think may be helpful." This did not happen, perhaps because it was such an orphan after surgery symptom it was overlooked by hospital staff.
All the time in ICU Jim never recognized me as his wife, and he has no recollection of anything that happened in ICU, and very little of what happened after his transfer into a regular room. About the third day in his regular room the doctor asked him what year it was and he said 1994. So later for fun I asked him how old I was and he said 70. I asked him to try again and he said 80. At one point he was 21 years old and living in Illinois.
Jim was having very bad nights, and I was asked to stay with him nights. He had a hard time controlling his urine after the folly catheter was removed, and I was constantly cleaning up after him, and as I write this, 21 days after surgery, he sprays rather than streams, and he says there is pain, although not when he urinates. On his bad nights he would talk irrationally, sink his head into my breasts and rock. He would bounce between bed, couch and chair, then roam the halls. I saw it as a bit of psychosis. I got very little sleep during this period.
On January 22 Jim was released from the hospital and moved to rehab facility a few blocks away. Because he slept in the chair, I slept in the bed. After the first night I left him there alone the nurses asked me to say nights, and bribed me with a 6-pack of root beer. I stayed every night at the rehab center. Then on Sunday, Jan 25, I brought him home. I had 24 hours in which to finalize my decision, and around midnight I relinquished control and returned him to the rehab hospital, primarily because I didn't have any pain medication for him. Because I had been awake since 4 am and half the night, I went home to sleep. At 3 pm the rehab center called to say he had been taken to the emergency room by ambulance. Apparently he had gone to therapy and developed profuse sweating, shortness of breath and chest pain. I raced back to the hospital and stayed with him until midnight, then returned home to sleep some more. At 3 am he was transferred to cardiac medical with a diagnosis of pneumonia. There he was pumped full of the antibiotics Zithromax
and Levaquin. Jim was given a lung scan to check his lung for damage.
Jim was released to rehab on Janury 29, but because Jim's room at the rehab hospital was taken by a new patient, we had to find a new facility for rehab. On January 29 we moved him to a nursing home 11 miles from home. I soon discovered that my time and his recovery were not compatible with this nursing home, so I pushed for release. I first brought him out for 6 hours on Feb 1. We visited a friend and went shopping at Wal-Mart. He paid a bill online. On Feb 2 I took him out at 2 pm and planned to keep him overnight, but the nursing center called at 11 and said he had to be back by midnight or Medicare would not pay for the day. So we went back. February 3 the doctor signed his release and he came home for good.
Jim has Medicaid as well as Medicare, and Medicare will pay for a bed to be reserved for 8 days while it's occupant is hospitalized. This did not happen with his first rehab center. They gave his bed away after 3 days.
Jim's release forms did not include opt-patient therapy at the nursing center even though we later learned the doctor had included it in his release report. But that nursing home is 11 miles away, and there is one 4 miles away that would help us save gas money so we're going to see if we can change that.
This story will be continued here
. Later in
ICU he was placed in a chair.
A day after surgery he had an
TIA stroke on his right side. His nurse called me at 6:10 am to tell me about the stroke and to tell me a cat scan had been order to check the damage. He was started on morphine for his pain, and later downgraded to Darvacet, and he came off the morphine with a violent episode. His violent episode started bringing him out of the stroke because he was striking out with both arms. In the bear picture you can see where I placed a wet cloth for him to use under his right hand, and I encouraged him to wipe his mouth with his right hand.
