Heart Has History, Too

Family History...!

I had a great talk with my Auntie Ann today. She filled me in on cardiac issues that existed in two branches of our family tree — Tedlock (Uncle Victor and cousins all died of heart attacks and Bertie [nee Marshall], my grandmother, had angina) and Smith (three generations back, both branches, and Aunt Trudy). So genetically, I am disposed to heart problems. Oddly enough, my father does not have coronary artery disease, but he did suffer twice from rheumatic fever, leaving him with a heart murmur that has not slowed him down (he’s 93 y.o.). He gets periodic cardiac ultrasounds and EKGs. Genetic dispositions can skip a generation; I suspect this has happened in my case.

At least in these times we have wonderful medical diagnostic techniques, mitigation protocols (drugs, knowledge of good lifestyle changes) and fine invasive interventions. I should live a long time — just like my Dad — with good health management — both by myself and health professionals.

The family history is essential to my being able to stay in good health. Knowing this is very helpful. It indicates to me that I will probably be having regular cardiac ultrasounds and catheterization/angiograms. Note that there is a 30% occlusion in my right coronary artery — not too terribly bad, but it needs following. (Dr. Boateng mention it during my presurgery consult.) I do need to change out my statin, though; Lipitor (atorvastatin) makes me dizzy and has more interactions than the newest one (the name of which escapes me right now).

I had such a wonderful experience at Mount Sinai that I'm going to try and get my psychiatry there. WNYC featured a half-hour segment (don't remember what the show was) on research that had been done on the possible psychiatric benefit of three psychedelic drugs (ketamide, LSD, and a popular marijuana derivative). What I heard indicates to me a psychiatric section at Mount Sinai that is willing to think "outside of the box" — very important as regards the treatment of Adult ADD.

I might even consider transferring all of my care to Mount Sinai. That way, I could get the benefit of their fine Attending Physicians, rather than just their rotating residents and fellows (for the most part) that come from their medical school programs through Elmhurst Hospital Center. I'm getting more frustrated with the administration of this particular NYC-HHC hospital. Their policies are unhelpful and, I think, becoming unhealthy to deal with, especially mentally. Too many apparatchiks.

Knowledge is power — in medicine, too!

Lotsa Heart...

Wednesday and Thursday, October 14-15

I had my one follow-up appointment with Dr. Boateng and the follow-up surgery team. I am doing incredibly well; we all came to the conclusion that I’m in about the 90^th percentile of good recovery of heart surgery patients. This is only two weeks and two days after bypass surgery!

I’m going to miss all of the medical professionals at Mount Sinai. I’ve never had such a wonderful experience in hospital. The level of knowledge and skill, the kindness and appropriate firmness with which they treated me, the fine attention to infection control — all contributed to my being able to head home and continue what is a fine recovery.

I was able to nail down some concrete limits for heart rate, weight limits to bear on my arms, and a better timeline of recovery. I am going to have to rein myself in a bit and be especially careful of stressing the chest pectoral muscles and the sternum before they are ready to bear more of a load. This is something I have experienced before, with my hip, but my hip was screwed together. My sternum is held together with glue...!

Also, there is extensive healing going on under and in each pectoral muscle, necessitated on the left by moving a large artery and repurposing it to feed my heart and on both sides with the need to open my chest to access the heart. The total timeframe is about three months (probably a bit more) with possible additional physical therapy once the chest has sufficiently healed. The idea is to get blood moving without stress in the upper body, and using the lower body to deepen breathing and gradually get the heart beating faster over a period of several weeks.

One more PT visit, then I’m on my own. I see Dr. Sternheim, my Cardiologist, at Elmhurst on 10/20. Check shortly after that for another post.

You Gotta Have Heart... Lots and lots and lots of heart...

Out of the Hospital and Into Recovery (10/1 to 10/15)

10/1 — Second day with the physical therapist. Today, a pain volume control decided to click down a few notches. I had to tell the PT to let go of the device (a more robust version of the four-legged walking aid, with wheels) so that I could push it along on my own. Surprise! We got along well after that.

Both of my roommates watched Fox. I watched a good deal of MSNBC in retaliation... :-o Now the bed is empty. Wonder if it will be filled?

Later on — Got a new roommate. Watches sports. African-American guy who called me out in my reaction to a patient in another room yelling for assistance. He rightly asserted that I don’t know what this lady (also African-American) was calling for and how she was feeling, and that I was prejudging her. We discussed this a bit, and I apologized. After that, we had a great relationship. I do know that my reaction was too much tinged by my prejudice about young, “loud-mouths”. It’s always best to stop and think before reacting when you do not know all of the facts.

10/2 — Don’t really remember much about the day. The food is still good, but I’m having trouble eating because of constipation (normal after a major operation). Had a couple of good dumps today, and ate like a horse, getting hungry overnight.

During the day, the social worker and another PT came by (different person) to assess my needs at home when discharged. I waved off the walker which was offered; I felt (rightly) that my balance and strength were such that I could walk without any assistance. I did so a couple of times when evening came — to the bathroom, and taking a good walk around the hallway outside the room.

10/3 — Discharge. In a way, I’m sad to leave, but I’m ready and well-prepared to go home. Ray and his wife picked me up, we stopped by the pharmacy, and then Ray helped me by bringing my heavy backpack (items inside that I never used — five books!) into the apartment and setting it on my freezer. Shame he had to see my dirty nest, but maybe I can get some cleaning done in the next few months.

10/6-8 — Woke up and got up after two days of sleep, punctuated by bathroom runs followed by snacks and bowls of cereal. Actually had chili with Parisi’s bread for a good meal. Got outside to pick up groceries (o.j. & milk). Started a log of health measurements recording temp, pulse, walks, bike spin, and comments. Keeping the comments mostly clinical. Want to have this as a tool for visiting nurse and visiting physical therapist.

Over the next several days, I slept from 14-16 hours every day, leaving not that much time to reply to email and phone calls, eat, and get a decent walk (usually to the grocery). I’m not bored, but I do get concerned that I can’t get back to everyone in a more personal manner. I only ask that everyone be patient; father and sister get priority as does my recovery — food and sleep (14 hrs/day) included!

You Gotta Have Heart

Wednesday, September 30

Well, I had my “procedure”. Why I use that word instead of “major operation” reflects the skill and smooth transitions that I made from operating room to recovery to ICU to the cardiac care unit.

Like the doctor’s said, they took an artery from under my left pectoral muscle and redirected it to the left ventricle of my heart. There was no need to graft or redirect any other vessels.

My heart was stopped for about an hour. They wanted to make sure that my right atrium had sufficient blood supply. Apparently, there were some marks on the right ventricle which could have appeared as a result of lack of blood. However, when the doctors took the clamps off the arteries, the right atrium appeared to look quite healthy.

I was pretty fortunate not to have had more than superficial damage to the heart. Around the areas of the occluded portion of the left coronary artery, there was some surface scarring, but not too thick. Yes, I did have an infarction, a “heart attack” — but I don’t know for sure when that happened. I do know that there was enough blood redirected through the right coronary artery to really minimize any damage to the heart muscle and to promote healing of some damage that did occur.

Recovery has been quite painful. And I don’t know what gets into these physical therapists; mine was absolutely brutal. I know he needed to have me walk, but the way I was feeling, I didn’t need to make a full circuit around the central desk on the floor! Outside of that, I have pain in around my chest, my back, and my shoulders, primarily.

Most of the pain seems to be muscle pain. I’ve been successful in avoiding pulling on the sternum — which was the “access” point to my heart once they sawed it open...! And Mount Sinai has been pretty good about pain management. Today, Wednesday, I was in horrible pain in the morning; I had not kept up with the meds, and my roommate had the television on all night, keeping me awake. Well, I slept some this afternoon, and I’ll probably fall right off when I go to bed.

One of the main bothers has been the amount of mucous accumulating in my throat. I am unable to get it out, and it builds up until I finally am able to expel it. My lung capacity is fairly low right now, because the lungs collapse and don’t fully reinflate for a while. And it hurts to cough!

In fact, it was hurting when I made any motion with my body. I expected that and was somewhat prepared for it, but it was still a bit more pain than I thought I would have at this point. Also, the body’s reaction to the major, big-time surgery that I had is as extreme as the surgery itself. Wrenching the sternum apart and spreading the rib cage open is pretty serious stuff!

With that, I wish you Sweet Dreams and a Good night!