12/2008 ~ Quadruple Open Heart Bypass

These are the emails that my dear Deanna sent to family while I was in the hospital:

Date: 12/10/08

Hello Everyone! Merry Christmas!

Lee went into the hospital yesterday. After we had been there six hours they finally started the medicine that the Dr. wanted him to have before his surgery. It's an IV drip medication. It was kind of frustrating to be there for over 24 hours and not have anything done. But they made up for it today. He went to x-ray for a chest film. He had another EKG done. He had an ultrasound of his carotid arteries. He spoke with a dietician, respiratory therapist, and the nurse. The nurse gave him a demonstration of what his surgery will entail. Then the surgeon came in and talked with him some more. He got his legs shaved so that they could operate in a clean environment (when they take the blood vessels from his leg to put them in his heart. He also had an enjoyable visit from his son Trevor, and his grandchildren Jordan and Addie who also had the demonstration of the heart operation from the nurse. The Jordan said it was weird. The only person that Lee has not talked with yet is the anesthesiologist. So I think he is ready for tomorrow, or as ready as he can be to undertake by-pass surgery.

I really want to thank everyone that has called or e-mailed. We have a wonderful family and friends that support and love us. WE appreciate you all. I will send updates daily. We love you all!

Date: 12/11/08

Well, it has been a very long day. I arrived at the hospital about 9:45. Lee went into surgery at 1:55 about an hour later than we were told. They called me about 4 pm to let me know that he was on the heart-lung machine and they were going to start the by-pass surgery. I got a phone call at 6:30 from the nurse in the OR letting me know that Lee was off the heart-lung machine and that they were going to start to close. She also informed me that Lee had requested pictures, which they gladly accommodated him with. The nurse brought them out to me and told me that the surgery went very well. I then started to call the kids to let them know that everything was all right because I knew they would be worried and concerned. The surgeon came out about 8:00 and talked with me. They did a quadruple by-pass instead of a triple. The surgeon again told me that everything went really well. Dr. Jones also told me that he spoke with Lee's kidney doctor to let him know how things went and received some orders from Dr. Lambert so they can protect his kidney. Before the surgeon came out, the nurse from the ICU came out to the waiting area, introduced himself and talked with me, prepared me for the tubes and equipment that I would see. At 9:15 I got tired of waiting and called in to the ICU to see if I could see Lee. He was still on the ventilator but they want to get him off in 7 hours or less. He was getting medicine for his kidney, insulin because it helps to prevent hospital acquired infections, and an antibiotic, and I can't remember what else. He had a couple more bags of fluid hanging by his bedside. He has a Swan-Ghantz catheter in his neck to monitor fluids and heart pressure, he has a Arterial line in to monitor blood pressure. He has a catheter so they can monitor urine output. He has chest-tubes in, Rachel - remember those? Lee will have the chest tubes for a couple of days. They want him to wake up ASAP. I asked the nurse if he could hear me and he said probably. So I talked with him and he started moving his head, but his eyes were still closed. I stayed about 20 minutes and then came home. The nurse thought Lee would still be in the ICU by tomorrow afternoon, so I am planning on going up around noon.

I will continue to keep you posted unless you tell me otherwise. We appreciate all the love and concern that has been expressed and the many prayers offered in our behalf. Thank you all!

Date: 12/12/08

Wow, what a difference a few hours makes. When I got to the hospital at noon, Lee was sitting in a chair at his bedside eating lunch. He was making a good effort at eating a full liquid diet, but he didn't eat much. They had him sit up in the chair for an hour. They switched him from a Morphine pump to Dilaudid and that was keeping him more comfortable. He was very drowsy, but he was very comfortable too. At 2 pm they came in and told us that they had transfer orders, but we would have to wait for a bed to become available. Lee started using his incentive spirometer to help him expand his lungs and he did really well with that too. At 4 pm they started to disconnect some of his monitors and then they were told that the bed went to an ER patient, so we waited. At around 5:30 they came in, removed the Swan-Ghantz catheter from his neck, they removed the arterial line from his arm. They removed the room EKG monitor and hooked up the portable monitor. Then we were off to the races, a tortoise race. They wanted Lee to walk from his ICU bed to his new room. He kept up a slow and steady pace, but HE DID IT! He was awesome. He pushed a wheelchair to help with his balance, and the wheelchair was available if he needed to sit down. He is doing so well, I am amazed. He really surprises me with how much he can tolerate and withstand. In the transfer he missed his dinner tray but they brought him some soup and Jell-O and he ate it all.

I don't know what the plan is going to be. It was easy before~~come in for IV medication for two days prior to surgery, have surgery, go to ICU, leave ICU and go to the thoracic floor. Done, now what! I'm sure they will get him up walking more, advance his diet as tolerated, get him off the pain pump to oral medications and then discharge to home.

Lee has had some real wonderful nurses and care providers. So far, it has been a pleasant stay. I just hope he keeps improving like he has been.

Thank you again for all your concern and prayers. I'll keep you all posted on how he is doing. Love to you all!

Date: 12/13/08

Hello Everyone!

Lee called early this morning and startled me out of a very deep sleep. In fact I hit the alarm on my radio before I realized it was the phone. He told me he didn't have a very good night and he wanted me to come to the hospital. I quickly showered and left. When I got there, he was doing better he said. I'm not sure exactly what happened but he was having a hard time breathing and then a hard time getting comfortable. He has gained over 10 lbs in fluid and that may have contributed to the breathing difficulty, they also repositioned him in bed and the chest tubes where causing a lot of discomfort, and therefore contributed to breathing difficulty.

Lee was sitting up in bed when I arrived. He had finished his breakfast. The nurse was trying to get a medication from the pharmacy for him. One of the nephrologists came in to check on him. Lee told the Dr. that he thought the fluid buildup was causing the breathing problems, and asked if he could have some Lasix - a diuretic to remove fluid from the body. It took about an hour and a half to get the Lasix drip going. I think Lee had about 700 cc of liquid out within an hour after they started the Lasix.

His lunch came, he ate really well. The nurse came in to change his dressings. They took the ace wrap off his left leg where they removed the graft vein. I thought Lee was just going to have two incisions in his leg, one on each end of the vein to be grafted. But there were about five little incisions going down his leg from about an inch above his knee to about three inches above his ankle. The dressing on his chest was next to be changed. The chest incision looked really good, she did not put another dressing on the steri-strips. She then took the dressing off from the chest-tubes and redressed them. She wrapped a Vaseline gauze around the base of the chest-tubes where they were inserted and said that was to keep air from getting in. She then put some gauze over the Vaseline-coated ones and taped them down. Then she put the pacer wires on top of the gauze and taped them down too.

Scott and Lindsey came with the kids. Little Avery was quite concerned about Grandpa and was really happy to see him. I am glad that today he had some good coloring so it didn't concern the kids. They made get-well cards for grandpa and brought them to the hospital. Avery got to watch grandpa get a insulin shot, and I showed all the kids Grandpa's Owie. It was so good to see them and I know Lee was very happy that they came.

I just called Lee to see how he is doing. He had a bed bath, and he said that felt good. Cardiac rehab got him up walking in the hall. He walked 225 feet, the therapist told Lee he did really well. He had a regular dinner tray ~ steak, mashed potatoes, carrots. He said it tasted good. He said he was feeling ok. I will go up tomorrow about 10-11:00.

I came home after Scott and Lindsey left. I crawled into bed, and was snuggled by "the girls". I slept for four hours. I guess it is all catching up to me now. I am so relieved that Lee is doing so well after the surgery and that he is out of the ICU. I told Lee yesterday when I saw him sitting up in the chair in the ICU that I was glad I was his wife. He said "What do you mean?" Then I told him that I was glad I wasn't his widow. We have been blessed! I know the blessing that Scott and Trevor gave him, and all the prayers offered in our behalf have blessed us. My husband is amazingly strong and I am so thankful that he is. Those trials of dialysis has strengthened him to be able to tolerate the trial of cancer and its treatment, and this surgery and its recovery. Again we thank you for your love and concern. Love to you all!

Date: 12/14/08

Hello Everyone!

Lee had a pretty good day today. Sometime either during the night or very early this morning his heart rhythm changed from normal sinus rhythm to atrial fibrillation. I don't know what the significance of that is. Its been a long time since nursing school and I've not worked a lot with heart rhythms. But they did try to convert his rhythm by giving him some medication. They gave him a bolus of Amorodione and Lee did not tolerate it very well. It caused pain in his hips, chest, back. It took a while to get him comfortable again. By the time I got to the hospital he was doing much better. When I left he was still in atrial fib and still receiving the amorodione by IV.

Lee walked in the halls twice today. He still doesn't have much of a appetite but he is trying to eat. His meals actually look pretty good for hospital food. He had a dressing change again. He received some more Lasix and has really good urine output. He got out of bed and I gave him a bath, I can't call it a bed bath because he wasn't in bed, but he didn't sit in a tub either. He went for over two hours without using his pain pump. And he says he is feelnng good.

Lee had some visitors today. First, Trevor and Becca and the kids came. They looked at grandpa's owie too. Addie didn't like seeing the bloody drainage from the chest-tubes, but was fascinated by Grandpa's heart pictures even though she called them gross. Second, his niece Sarah and Jared came with Eli and Ava. Third, was his nephew Elliott and Julie and their girls. Lee was drowsy when they came and not very companionable, but I know he appreciates the visits and the concern expressed.

Lee has had the same nurse now for two days in a row. That has been very nice because she knows us and his history and we don't have to keep repeating it. She will probably take care of him again tomorrow. She explained to us that they will take his chest tubes out when his drainage is below 200 cc for the day. Today it was 220, so he's getting pretty close. She said that next to be removed would be the Foley catheter. The last to be removed would be the heart pacing wires. We're still hoping that Tuesday will be the day he is discharged. I can't think of a more appropriate birthday present than to have him home.

Hope you all are doing well and that you are all ready for Christmas. Take Care!

Date: 12/15/08

Boy oh boy, what a great day Lee had today! He loved his breakfast, Belgian Waffles. He had a good walk in the hall. The respiratory therapist said she didn't need to check on him any more because he was doing so well with his incentive spirometer. They removed his chest-tubes. Gosh those things where huge and long! They switched him from IV pain medication to oral pain medication. He is still on the amorodione, but they took him to the cath lab and did a synchronized cardiac conversion, so now he is in normal sinus rhythm. While he was medicated for the cardiac conversion, they removed his foley catheter. So he had a great day.

He had a couple of visitors today and because he isn't on the pain pump he was a lot more alert. I still do not know when they are going to let him come home. I was hoping it would be tomorrow, but no one has said anything. The nephrologist still comes in every day. He says that Lee's kidney is doing well. That was a big concern when we started this process, keeping that functioning well. But everything is looking great.

I still can't believe how well Lee has done. Only today did he mention that he had felt a little discomfort in his sternum. He has not complained of any discomfort in his leg where they removed the graft. I hope he does as well at home. We are concerned about the dogs. They are going to be so excited to see him, and we don't want them jumping on him. Shadow's excitement I am sure, will be elevated 100 decibels. Already my ears are hurting.

We had a little more snow today. It looks so pretty when it is fresh, but I still hate driving in it. Hope you and yours are all doing well. Love to you all!

Date: 12/16/08

Hello again!

I am not going to the hospital today. It is snowing, so I'm going to clean up around here.

Lee called. His surgeon came in this morning. They are going to remove the pacer wires. He is still in normal sinus rhythm and doing well that way. Urine output is good. His hematocrit is low, they are going to give him two units of blood today. And the big news is that he will be discharged on Thursday.

I'm going to go to work tomorrow, that will be my only shift this week. I won't go to work again until next Tuesday.

Hope everyone is doing ok. Take Care!

Date: 12/17/08

Well, I think this will probably be the last e-mail that I send about Lee and his surgery. He will be coming home tomorrow! I stopped by to see him after I got off work today. His dinner arrived while I was there. Again it looked pretty good for hospital food. Then the nurse came in and started talking to him about his medications. He is so ready to come home, and I am so ready to have him home.

Thank you all for your visits, your calls and your e-mails. It means a lot to Lee and me that you would take the time to write or visit. We love you all and wish you all a Merry Christmas and a healthful New Year!

Date: 12/18/08

He's Home! He's Home!

We got home about 4:45. I was all set to get him this morning, but he was not feeling good. Apparently they give some medication that is really long lasting while they are in the operating room. They neglected to inform us of that and that it would be wearing off. So Lee experienced more pain this morning than he has the entire previous week. So it is under control now, we know that the pain is normal, and we know that he will feel this off and on.

Just thought I would let you all know that he is home now. Take Care Everyone and Merry Christmas!

12/31/08

This is an email I sent out to family and friends after my operation.

Hi everyone,

As many of you already know, I had open heart surgery last week. Deanna sent out emails on a daily basis to many of you, but in looking at the list of people she sent email to, some were omitted because she didn’t have an email address, or she didn’t know would be interested in receiving them. But it wasn’t because you weren’t important. So I have attached a word document (Lee’s Heart Operation), which includes all the emails that she sent, giving the day by day updates. If you haven’t read them, now’s your chance - you can get all the gory details. Which got me thinking – who cares about the details? I would, so I am guessing that some of you may also want to know more about this operation. I think it is just fascinating that I go see a doctor because I get tired walking the dogs, and I end up having my chest split open, put on a heart lung machine, have my heart stopped, having veins cut from my leg and attached to my heart, then get sewed back up again. But hey – that’s just me. Yet telling this story would be pointless if it was nothing more than trying to elicit some sort of feeling from you. Therefore, I am including some advice as I tell this story.

___________________________________________

I am home now and feeling much, better. I am still sore, tired and weak, but at least I’m comfortable at home, and I have the best in-home nurse you could ask for. I get tired very easily, I’m on a lot of drugs so I feel like I’m walking in a light fog, and I feel like I have a 20 lb weight pressing down on my chest all the time, even when I stand up. I feel like I am in slow motion all the time. But believe me, I am better than I what I was. I’m still not as well as before I went into the hospital, but I am better than when I left.

Here are just a few details…

Symptoms: (in case you were interested, these are not included in Deanna’s updates). I started feeling tired while walking the dogs, or trying to hike to get some good photos. The tiredness just kept getting worse and worse. Not heart pains, but just shortness of breath. I could still do everything I used to be able to do, but I just got tired sooner. Not a big deal. But - I made an appointment with a cardiologist just to be sure. In fact, I made the appointment just to make sure there was nothing wrong so that I could try to build up my endurance, even if I felt pain. And as the saying goes: No Pain – No Glory.

Advice: Don’t be afraid of getting a checkup for the smallest of symptoms. I have had three angioplasties, and all three were as a result of not know what was wrong, but just feeling that things weren’t right. Same thing happened this time, only the remedy was a little different than expected. So don’t wait until you have a heart attack before you get heart symptoms checked out. Listen to what your body is trying to tell you, and get a second opinion.

Tests: They did a Thallium Stress Test to see how well my heart pumped the blood through the heart. The test were negative – no problems. But I kept getting weaker and weaker. So I went back in and they did an angiogram, where they put a probe up the artery of your leg into the heart to see if there is any heart damage. They found some, so they inserted another (I already had four) stent, to keep the artery open. They were hoping that would solve the problem, but it didn’t. There were two other vessels that were blocked, but they couldn’t get to them. So three weeks later they did another angiogram. Before they did the procedure, they told me there probably wasn’t much they could do, and that I would just have to live with the shortness of breath, and change my lifestyle dramatically. After the angiogram they found another major vessel that was 70% blocked, so they didn’t fix anything this time, but rather told me that I would need to have open heart surgery.

Advice: Even if the tests come back negative, if you are still not feeling well, go back and have another checkup. This was the hardest part for me. I had just been to the doctor. They had run all the tests, and the tests said I was fine. But I didn’t feel better. When I finally did go back, I talked to the doctor some more about it and he said that the tests are only indicators, and are wrong about 10% of the time. But given a person’s health history, genetics, and symptoms those tests can be overridden and a more accurate, albeit more expensive test can be done. This is why I had the first angiogram – to verify that there was or wasn’t a problem. Even after that angiogram, and the resulting angioplasty, they were unable to ‘fix’ two small arteries. They were hoping that by fixing the large one I would be better. Once again, I wasn’t so I went back again. I don’t know what I was hoping for, I just knew that there was still something wrong. Bottom line – don’t give up. Stay in touch with the doctors. Go back again and again until you find a solution.

Operation: They ended up doing a Quadruple Coronary Artery Bypass Graft open heart surgery. Basically they cut my chest open through the sternum, spread my ribs apart with a rib spreader, then hooked me up to a heart and lung machine, stopped the heart, took some veins from my leg and connected them to the heart’s artery and bypassed the blockage points and attached the vein the heart chamber that needed more blood flow. Then they started my heart again, took me off the heart lung machine, attached my chest together with bailing wire, sewed me up, and I was done. Deanna’s logs will let you know the details after this point.

Advice: Be aware of what they are doing and why. They will tell you everything they are doing and why. Talk to the nurses and the doctors about what is going on. I had several occasions to disagree with my treatment simply because I know my body better than they do. I won’t bore you with the detail (ha, ha), but on one occasion I insisted on having some Lasix (a diuretic water pill to eliminate water). The Physician’s Assistant tried to tell me that water gain was common on this type of operation and that I didn’t really need it. I told him that I had it as part of my daily medications, and that I was having a hard time breathing because of the extra water. He finally relented and I got the relief that I needed. The next day we had to go through the same thing. When I asked him for some more, his comment was, “Looks like you have a fixation for Lasix so I guess we can give you some”. RUDE! After that I didn’t need them, and I didn’t ask for them. But don’t let them intimidate you. At the same time you need to listen to the doctors and reasoning behind what they are doing. After my little run in with the PA, I had a good talk with my Nephrologist / Internist. He was able to listen and explain much better and became my source of well being and for knowing what was really going on.

I guess a successful outcome comes down to three words: Talk, Listen, and Communicate. You can do one, two, or all three. Both you and the doctors have to do all three.

Recovery: I can’t lift anything heavy (more than a few pounds), or drive for 6 weeks. What I can do, and what they encourage me to do is to walk. They say it will take 2 – 4 months before I am back to normal, which will be really nice since I’ve never been normal before.

I have included some pictures if you are interested. Warning: They are very graphic. Some are from inside the operating room, some are from Deanna’s cell phone, and some are from Deanna’s camera. I was going to put them on a slide show, but then you would have to see all or none, so I am just attaching them with a description so you can decide if you want to view them.

There you have it. I hope you have learned something. Let me know if you have any questions.

Thanks to everyone for their thoughts, prayers, cards, and flowers. It is very helpful to know that there are people who care!