I was sifting through some of my filing envelopes and came across a note I had written soon after my first heart valve replacement operation in May 2007. I thought it would be something I could write about as there are many people these days who may be, or are about to undergo heart surgery that might appreciate some extra information.
In my situation I was born with a heart murmur and as a child went to visit various cardiologists for check-ups. While I was living in Albury back in the 1960-70s I do recall my parents driving down to Melbourne to take me to the Royal Children’s Hospital to the Cardiology Department for a check over. I admit I was a little stressed even at that age at the thought that I may have to have some type of operation plus seeing other small kids their crying increased my desire to get out quickly if I could. Medicine has improved over the years as I do remember seeing kids that had a blue appearance which I found out later related to being blue babies. This basically meant their bodies lacked available oxygen which we call cyanosis in medical terms. I never had those issues as a child so I was quite lucky in that regard. After my appointment with the cardiologist at the Royal Melbourne Children’s Hospital my parents were told to wait in the waiting room till my medical situation was analysed by the medical profession. After sometime my parents were taken into the cardiologist room with me and were told that my condition would need to be monitored but won’t require any surgery till later in his life. Phew I was glad to hear that and was so glad to leave that place and just enjoy my life again.The diagnosis back then was that I had a hole in the heart but this was later in my life diagnosed as being a defective aortic valve with modern medical imaging technology such as the echo-cardio gram.
Throughout my life I never had any physical issues that caused me any problems right up until 2006 so that was a good innings I felt. I used to ride pushbikes as a child and teenager, swim, board surfing, walking, running, which never worried me at all. The only negative lifestyle habit I took up was smoking which I never did full-time but on occasions. However when I did smoke on occasions it was fairly full on plus I had a go at smoking a pipe which I thought was kind of cool at the time. Even today I sometimes think it would be cool to have a tobacco pipe again but haven’t gone down that track.
It was in early 2006 that I first detected some symptoms that made me take more notice of myself that needed further investigation. This related to becoming short of breath while riding my push-bike up a small hill which I had ridden up many times before but not as exhausted. It felt like I had only about 75% (percent) lung capacity as I would be struggling for oxygen at the top of the hill. A trip to my local doctor then became a trip to a cardiologist for further tests. The cardiologist confirmed that my heart will require surgery to replace my defective aortic valve and to do some minor surgical repairs to the mitral valve. Although I was ready for this news I wasn’t really ready in wanting to go through such an operation at this particular time in my life. I had just got accepted into nursing at university in the second semester of 2005 part-time and to have this news just seemed poor timing for my situation. I wasn’t quite sure what to think or how to plan my life around such an operation so I deferred my nursing studies at uni for a year till I was in a better frame of mind. I should point out that the medical textbooks imply that aortic valve stenosis may have stemmed from rheumatic fever but in my case I never had that as a child. In my case it was just a defect from birth restricting the hearts ability to function properly.
During 2006 I had to visit my heart surgeon for his evaluations and tests including seeing my cardiologist and local doctor. As a result the operation date was confirmed to be in May 2007 to which I had to attend a variety of tests to investigate my heart condition. These related to having ongoing tests which related to having chest x-rays, ECG, Echocardiogram, Transoesophageal Echocardiogram (T.O.E.), Coronary angiogram or Cardiac catheterisation, and blood tests. It was a busy time in my life leading up to my surgery and one that pleased many medical interns wanting to listen to my heart with their stethoscopes. I do recall when waiting to have my surgery in the pre-op ward of about 10 medical interns coming up to asking if they could listen to my chest. Inwardly I was trying not to laugh as when I agreed I had about six stethoscopes all at once being placed on my chest lol. I’m not quite sure what they accomplished but they looked satisfied and thanked me for their short listen. Stethoscopes are sensitive instruments and too much external noise or movements can affect the quality of the sound but I didn’t let them know that being a 5 month old nurse.
The day of my surgery arrived to which I was driven into The Canberra Hospital early in the morning as I had to arrive at the admissions by 6.30AM. After the paperwork was done I went to the pre-op dressing rooms to get ready for my surgery. This is where you get prepared for surgery by having a pre-op shave and shower plus get asked more questions from a range of health professionals which often were questions that were asked by other health professionals. It does get tiring answering so many questions that have been asked before especially when you just want to relax prior to surgery. After I was finished in the pre-op dressing rooms I then transferred to the theatre holding bay by wheelchair and popped up onto a bed. I was given a pre-med sedation tablet which helps relax you a little. The next port of call was that I was taken to the theatre holding clinic where they started preparing me for the operation. This was where the anaesthetist who saw me earlier explained what was going to happen in the next couple of minutes which would put me to sleep. It’s too late at that stage to say “hey let’s do this another day guy’s” so off to sleep I went. Initially I was told I would wake up in ICU later that day after my heart op so that wasn’t too bad I thought. However in my situation that wasn’t to be as my left lung decided to collapse in surgery causing some dramas for the surgical team I heard after my op. This impaired my recovery time as I was in ICU for three days and not the 12 hours I thought I would have had if all went well.
It was the three days in ICU that convinced me never to smoke again as every 30 minutes I would have this suction tube going down my throat to remove the mucous build up as I didn’t have the strength to cough it up at that stage. Every time the suction tube went down I would have this gagging feeling almost like a choking sensation and I was glad when they pulled it out again. But it was a necessity as if they didn’t insert the suction tube my mucous would have compromised my airway. I was most likely still drowsy from all my medications but made a deal with the ICU nurse who reminded me of Senator Amanda Vanstone in the way she looked and her mannerisms. I said what would I have to do to stop having the suction tube put down my throat? She looked at me with an astonished look and said “buddy if you can prove to me that you can give me a big cough and deliver me a load of mucous I will remove your oesophageal tube”. About five minutes passed and I gave my best cough with brought up a load of mucous and she sucked that load up and removed my oesophageal tube. That was the best feeling I could remember as I just felt free and less restricted and could take charge of my own breathing again. It made a big difference as after that I was then transferred to the cardio ward 6B to fully recover after my operation. In 6B I was placed in a small room with other heart patients being monitored around the clock from doctors to nurses and physiotherapists. The physiotherapists played a key role in getting me up on my feet again as they would get me to do a range of exercises in bed and have short walks to regain my strength again. I also had to carry a chest drain and wear a small cardiac chest monitor around my neck which recorded my hearts activity whilst I was recovering that was connected by a WiFi type of system that could relay my heart rate to the central monitoring station.
Discharged and back again…2007-08
After I recovered in 6B I could go back home again but in my case I stayed with family till I was fully recovered and capable to do things on my own again. A lot of post-op appointments had to be attended to such as attending a cardiac rehabilitation program to help me build up my physical strength again. The only problem was that post op tests revealed over the next few months after my heart operation that the mitral valve surgical repair was not successful which created this haemolysis turbulence action of blood from my heart. This meant if I over exerted myself too much physically it would reduce my ability to make red blood cells therefore reducing my haemoglobin levels (Hb) which would require a blood transfusion to boost my Hb levels back up again. I recall finishing a two hour nursing exam on Somology in semester one of 2008 of getting a phone call from my doctor to go into hospital for a blood transfusion as my Hb level had dropped to low. From memory it was around 69 Hb which surprised me as I had just finished a two hour exam and felt okay in myself. The positive outcome was that I passed the exam and survived the blood transfusion.
My cardiologist was tracking my heart condition since my first heart operation and felt that it was in my best interests to have a second heart valve replacement operation to replace my defective mitral valve. My cardiologist was sorry that I had to undergo another heart operation in just over 12 months after my first but felt there was no other alternative given my situation of reducing the need to have ongoing blood transfusions if I exerted myself too much.
In September 2008 I went through it all again but without the same experiences I had in the first operation. Luckily this time around I was in a much better condition post-op as I woke up in ICU a few hours after my operation feeling quite alert and responsive which surprised me. I was even trying to offer my mathematical wisdom to the ICU nurses discussing medication conversions even though I was still drugged up. They said to me I should be recovering and not worrying myself about such topics in a joking way. I was transferred to the cardio ward 6B the next day and felt much more at ease as I knew what to do and to expect from having been there before. As each day passed I became stronger and was discharged and allowed to go back home again. Of course I had to attend a variety of post-op appointments including the cardiac rehab program but I became much better as time progressed.
Current cardiac health
Today I am quite well in terms of my cardiac health however there are times when the heart will drop out of rhythm and go into fibrillation requiring cardioversion to reset the heart again. This has happened twice since 2008, once in 2009 and recently in June of 2013. Apart from that I am fairly well and need to be conscious of what I can and can’t do. My heart valves are mechanical and not biological as the shelf life of the biological valves is shorter so therefore I decided to go mechanical. With mechanical valves it does require you to take warfarin medication to thin the blood so no risk of blood clots will occur which means regular INR tests to monitor your levels. One area of life I should concentrate on and that is losing some weight which I should focus on throughout 2014. It would be nice to feel fit again but I will have to do it slowly as currently I am waiting to have a hernia operation done which looks like it will be done in August to September this year from talking to my surgeon recently.
I guess compared to the normal average student studying at university I am slightly disadvantage in dealing with some of my health issues but it just means a little longer and some patience in achieving the end result. If medicine had not advanced to where it is today I doubt I would be here typing this blog as I would have most likely have carked it long ago prior to my first heart operating in 2007. I have much to be thankful for.