OHS - The road to recovery

 

Open Heart Surgery is a traumatic event that for many patients has consequences for which they are unprepared. Doctors tend not to discuss many recovery details with heart patients. They simply say not to lift the equivalnt of a 2L milk container etc and don't drive. Each patient is an individual and so has their own unique journey to good health but there are common issues. This post looks at those and also my particular experiences. I hope this will be of assistance to those going through surgery or supporting others who do. Remember, it could happen to you, right out of the blue so no apologies for length and (sometimes graphic) detail.

For context: I had two open heart surgeries within 24 hours. The first was to repair (unsuccessfully) my mitral valve or replace it with a tissue valve (successful) If only that was the end of that stage. 

My second was an emergency later that day due to a blood clot and uncontrolled bleeding from the sac (pericardium) surrounding my heart. It was touch and go. That means twice my chest was opened, ribs spread, heart stopped while on the bypass machine and heavy anaesthesia, chest wired up. I spent 4 days in ICU instead of one and remember nothing from that time. Having to go through this brutal surgery twice really set me back. Once on the ward things started to get interesting.

Hallucinations

This can be as a result of the anaesthesia and heavy duty medicines. I thought I had pustules growing around and up my neck on the right side. I could certainly feel them - scabby mushrooms? So I started trying to pick them off. I had no mirror so I couldn't see anything. It amounted to self-mutilation under 'the influence'. The scabby bits, I worked out a couple of weeks later, were all the sticky residues from the ECG electrodes. I still have the scars from clawing at myself.

Even weirder was the bat. On a number of occasions I watched a tiny NZ bat swooping ever so swiftly around the ward. I could barely keep up with it but I suspect I saw it with my eyes closed. When I mentioned the bat to the nurses, they pointed out the windows didn't open so there was no way a bat could enter. Hmmm!  Hallucinations, nightmares and delusions are common in hospital and can continue at home. Someone said they could see Turkish dancing girls in their room, another had an Aladdin experience on a magic carpet. I blame the betablocker I am on for nightmares at home while not asleep.

Lizard

When I got home and had a close look at myself in the bathroom I was shocked by the state I was in. Muscle-wasting was extreme after three weeks confined to bed. My body looked 20 years older. The skin on my chest was peeling in sheets. Why? Apparently hair, skin and nails are the lowest priority for the body when in major repair mode. Too sore to touch, I left it to sort itself out.

The incision

This came as no surprise but it was still a bit hard to take that it was permanently a feature of ME and not someone else. You cannot know in advance what your 'zipper' will be like. You have to accept this less attractive addition to your physionomy, however it ends up, as the price for staying alive. It seemed to be healing up fairly well but often with women there is a large 'pouch at the top'. Someone said it was tissue pulled there to start the stitching process as on many of us there is mostly skin and bone and not enough to attach to. I don't know if that is true. This was never discussed by doctors in advance. Mine is still there at two months. It is supremely painful at all times, tender and hates anything touching it, like clothing, but needs protecting from sun. I understand that over time it will flatten out. I sure hope so. The rest of my chest is super-sensitive or numb. Muscles, nerves and ligaments have been cut so they need to grow back but this doesn't always happen in an organised way, not like when they originally developed in the womb. 

I am happy that my sternum seems stable. Some folks feel it move and pop despite the stainless steel wires holding things together. Along with the main vertical incision, I have four other 'holes' in my torso. There are two rather unsightly ones below the main incision that were used to drain my chest. There is another on my right side on my ribs where another drain was in for my lungs. On the left is a smaller wound where a second lung drain had to go in later to drain fluid accumulating on my left lung (pleural effusion). The local anaesthetic for that incision was very painful. I am currently experimenting with my home-grown aloe vera leaves - smearing the inside gel on semi-healed areas to see if that aids skin healing. Note, healed does not mean without scarring.

The fridge

In the early days you really need to be mindful of what you are doing every second. Case in point: I tried to open the fridge door but the fridge had migrated to the left and I couldn't get my hand down the side to pull it open so I did what I would normally do. I endeavoured to pull the entire fridge to the right with my left fingers. Yep, just for a nanosecond I forgot I had had OHS but I was reminded VERY painfully immediately afterwards and every day since. I definitely put my left side chest on the healing back foot with that instant of carelessness. I am hoping it will eventually heal but my left pectoral and sternum are still very angry every second of the day and night. In fact sternal pain per se is rather worrying at present so I am looking forward to discussing this at my next checkup at the hospital. i do hope I haven't stuffed myself up.

Damaged vocal chords

Being inturbated in ICU for four days instead of one has had a distressing effect on my singing voice. It is currently munted. If I can weakly find the note, I can't hold it, it cuts out and only silence is left. There is no power or volume control and certainly no tone, just sounds like cotton wool. No control at all, though if I push hard I can get the right note. I will have to be patient and seek advice maybe from a vocal coach as I need to be able to sing as before.

Exercise

This is a biggie. There was so much weakness from being confined to bed I found I could not get onto the ground or get up. Walking down the hallway was shaky, everything physical was difficult. The only solution is to keep moving. Walking is the number one method to gently get better. Despite the nausea and dizziness I made sure I went for a short walk most days, accompanied in case I fell over. Be careful reaching and bending in the first weeks but eventually you need to test what you can do and do it, gradually introducing small tasks. I simply don't know my limits until I reach them.

Problems with medications

This one is massive and the bane of my life. I came home with a pharmacy which I had to swallow for breakfast and through the day. They are powerful drugs and they don't like hanging out together. They made me very ill and set back my healing process. More on that further down.

Ineffective home help 

I was visited by an organisation designed to help folks like me in the community, especially those of us who live alone. It is free but limited. Someone would arrive once a day Monday to Friday to help with exercise. The first two days consisted of doing little exercises (such as lifting my leg) standing at my kitchen island. This was not challenging, rather it was boring. I told them I needed to walk so from then on, weather permitting, I would go for a 15 minute accompanied walk. It wasn't easy but each couple of days I would try to extend it by the space of a few houses. Some of the walkers were happy to take 'shortcuts' and bugger off asap.

Meal prep assistance consisted of a total of 20 mins cutting vegetables. There was no cooking. I found myself getting stressed trying to work out what the person could do that would actually help, what sort of meal should be done? I still had to cook it. When I suggested to one helper that they harvest strawberries and raspberrries they had no idea what a strawberry plant with strawberries on it looked like. They had no concept of a salad spinner or how to chop spring onions. I decided that cutting potatoes in half into a steamer wasn't really helping me much. I eventually told the organisation not to bother. They were too inflexible; would not reduce the days but increase the time allowance for me. If I had any appetite at all I would try to eat healthy stuff but meat was often too heavy and I would resort to the easiest thing I could find - crisps and homegrown fruit, yoghurt. Severe nausea and lack of appetite is common.

I would have preferred a nurse to visit several times a week to check my vitals and reassure me. Instead I regularly had to pay to see a general practitioner to even have my blood pressure checked. Over the course of nearly 5 weeks at home I only had a nurse check me three times on a home visit. He was very good though.

Re-admission

 Despite three weeks post op in hospital followed by almost 3 weeks at home, I found I wasn't feeling much better. Pain in my stomach, bowel and chest increased to unbearable levels. In the wee small hours of my 67th birthday I desperately called Healthline to enquire if I should call an ambulance or not. I didn't want to over-react but I was desperate. I found the service inefficient and distressing as the call centre only asked preprepared questions after I had waited a very long time just for my call to be picked up. There was only one nurse on for the entire country. I was in a queue. It was 40 minutes before I got through to the nurse who ended up calling me an ambulance. The Rolleston one was busy in Akaroa so I had to wait for one from Christchurch. The guys were well trained and thorough. The emergency department is spacious (they could cope wth another disaster) but lacks the staffing so even via ambulance there is a lot of waiting, then the covid test, then the IV is inserted. One doctor didn't like the fact I knew about stuff and understood medical terminology but a young cardiologist listened to me and the nurses were kind, even sometimes holding my hand to calm my distress.

After a chest Xray showed my pleural effusion was resolving itself there was uncertainty about what could be causing such pain and nausea. I suggested they investigate the gastrointestinal angle. It was eventually agreed that the mountain of powerful meds was damaging my esophagus, stomach and bowel. A senior cardiologist reduced my med intake by 2/3 but recovery would take time. I stayed in hospital 3.5 days while they trialled things and tried to get my motionless for 8 days bowel to operate. All the nasty stuff failed so in the wee small hours of the final day they resorted to the Fleet enema. That helped a bit. Wish they had done that at the beginning. The senior cardiologist felt I should now be on the mend to cope alone at home but that I would have good days and bad days (so true). "I think you're going to be dangerous," he said as he left. Weeks later I am still trying to imagine that.

Insomnia

This is a huge problem for me, possibly caused by one of my meds blocking my melatonin. Something also interferes with the workings of sleeping pills so begging for those hasn't been a real solution. I don't know what is, as I get no healing sleep and have to handle the chest pain 24/7.

Psychological healing

This is another important aspect ignored by medical perssonnel. I knew that anxiety, depression and PTSD are common for OHS patients but individual attention by 'someone' is needed, especially if you live alone and don't have access to hugs and cuddles in your dark moments. On one very 'dark' evening I had to call a friend. He kindly popped over for a chat. The next day I was feeling better but there are random days when waves of anxiety wash over me for no apparent reason. This recovery period can be quite tortuous. Platitudes by well-meaning folks don't help. Company is needed and a listening ear though I found this rather restricted by covid precautions.

Contributions by friends after my daughter had gone back home

I found this awesome. I have few good friends, having moved around a lot in my life. Through my music I have met some folks who genuinely want to help in practical ways and this has been a bit of a life-saver for me: driving me to appointments, taking me to get my groceries, helping with lawn mowing and gardening and housework, popping over for a jam session, accompanying me on walks around the block, dropping off a meal. These forms of assistance and caring really have helped take some of the huge stress off coping on one's own. I will never forget the help I have received from friends and neighbours and I still need some help as it is  early days. It took me a week to adjust emotionally from spending a week at home with my daughter looking after me. I missed her terribly because she is the only person with whom I have a close emotional attachment but the support of friends and neigbours kept me going. At least I now have my driver license back. I have had to learn to accept help but I will always prefer to be independent, of course.

I have a long way to go and things could continue to challenge my fortitude but I really want to get back to the active life I had, without constant pain though (as is currently the case), tending my garden, performing with my bass and making new friends. 

In all this journey, it is friends and family who prove they can be counted on that have made such a positive contribution to my healing. Thank you, literally, from the bottom of my heart.

OHS The main event

[photo not of me]

The day finally arrived when I was admitted to Christchurch hospital 3pm the day before my newly scheduled open heart surgery. I had already wistfully said goodbye to my current physical body, knowing I would not look the same again. I was not particularly nervous this close to things as I simply followed what staff told me to do and adjusted to being in hospital. I'd had more time to be nervous in the lead-up. It is risky. I find it annoying when people say "Oh you'll be fine. It's so routine these days." Bullshit! It is NOT routine for anyone going through this and surgeons know anything can happen. And it did.

I had a chest Xray, blood tests and an IV put in (uggghh!). I never noticed when I 'went under' in the operating room the next day. I just thought it was quite a big room with medical personnel preparing equipment. The next thing I remember hearing was medical staff discussing which day it was. I went under on a Tuesday. Apparently it was now Saturday. I  could not understand how I had lost 4 days. My surgeon and registrar later explained: Things did not go as hoped. My surgeon tried to repair my mitral valve but found it was too far gone (no surprise there). She decided a bioprosthetic valve needed to replace it. I had already said NO to a mechanical valve as I don't want to be on blood thinners the rest of my life. The surgeon completed her work and went home. I was sent to ICU. I have stainless steel wires holding my sternum together. They are probably permanent

However, a few hours later she was called back to the hospital in urgency. I had to be opened up again. There was a blood clot and the edge of the pericardium had uncontrolled bleeding. There was also a lot of fluid pouring from the drain in my chest. These issues were corrected and I was sent back to ICU for an extended stay (originally expected 1 day). My poor daughter had to go through a very anxious time to see if I would pull through.

By day 4 in ICU they exturbated me. No wonder my voice is a mess at present and my throat is still sore. I remember catching a first glimpse of my hands back on Ward 10. They looked like puff balls. I was full of oedema but the meds gradually sorted that out. My days consisted of swallowing a horrendous amount of medication, being tortured by phlebotomists/vampires - many of whom failed to get a vein the first or second times they tried. My blood pressure was consistently low so I ended up with a couple of blood transfusions. My chest hurt. A lot. The main drains had been removed, the bladder catheter was removed once I was back on the ward but they took out one of my side drains and an IV line. Mistake. A few days later I had to have a procedure involving an incision in the side of my back to insert a new drain after waiting for blood thinners to clear my system. The local anaesthetic was truly painful. I think I vocally let them know I was not passively being sliced into again. Half a litre of fluid drained off the lung sac within 30 minutes so it was certainly necessary. The drain remained in for several days.

You don't get any sleep in hospital. There is too much groaning, coughing, farting, medical observations to be done, and pain. I had some morphine and paracetamol, that's all and by the time I left 3 weeks later, all I was allowed was paracetamol. The nurses were generally very nice. I quickly learned to refuse more blood test attempts each day if the phlebotomist couldn't get the needle in properly by the second attempt. I told them to go away and get someone competent. Most of the time this worked but by 3 weeks my arms were packing it in - black and blue with veins running for the hills.

The food is better than expected and I learned to wear adult pull-up underwear as the laxatives kicked in. Any coughing or sneezing meant I had to hug a folded sheet to try to protect my split sternum from the pressure. Yes, it hurts a lot. This is the most difficult physical thing I have gone through in my life. Some have it easier, some worse. I was a bit unlucky but I have survived and I mean to get better/ fitness-wise than I was before. That is going to take a lot of time and work and patience.

Covid 19 means you cannot have friends and family visit - just one designated person. My daughter arrived from Palmerston North. She had hoped to be down to look after me for 3 weeks after my operation but my very lengthy stay in hospital (3 weeks instead of 5-7 days) meant she spent most of her time at my place, on her own, trying not to get covid. Such a shame.

Thank you to those of you who followed posts on my progress. Although I was too weak t participate on Facebook I did read the comments. My next blogpost will look at the process of going home and trying to rebuild body and psyche.

Photo not of me.

OHS-Leaving the old life for the new

 

 Being in a queue for open heart surgery requires emotional adjustments. It has been a long and challenging road from speaking to a heart surgeon in October, through months of no date for surgery, to a then cancelled date. Now I'm hoping it is finally going to happen.

Don't get me wrong, I am in no hurry to have my chest and ribs cracked open and all that goes with that. I like the way my chest looks and feels but I know that this current life is very finite. I feel the mortality growing each day as I become more breathless, lose more muscle mass and become more and more sedentary with lower quality of life. 

There is a lot of open heart surgery done in NZ and around the world but for ME this is not routine. I have no truck with platitudes and prayers. This is the most dangerous thing I have ever undergone. Statistics do not apply well to individuals so I joined a couple of Facebook support groups:  The Zipper Club   https://www.facebook.com/groups/2256590992/?hoisted_section_header_type=recently_seen&multi_permalinks=10159656997055993

Heart valve surgery support group https://www.facebook.com/groups/2256590992/?hoisted_section_header_type=recently_seen&multi_permalinks=10159656997055993

It takes a bit to get your head around this mortal thing where for the first time in my life, my heart will not be beating. It will be chopped, stitched and literally in the hands of a human being I do not know but who has skills and commitment to see me through. Hope, trust and faith in a large team of medical staff to work together for the best outcome is necessary.

I expect things to go well, that the team will perform their best work and that nothing untoward will happen. However, back in October, the surgeon did say she could have an 'oops' moment. In that case, if she destroys a coronary artery while trying to rectify the valve problem I will end up with an additional procedure -coronary artery graft harvested from my body. (See video below)

The vascular sonographer mapped my legs. I had already told her I didn't want any harvesting from my arms and chest as I am a bass player. She could see where I had had lower leg vein surgery in France years ago. "They've done a nice job," she said. I agree.  "What fine (petite) veins you have," she added. Yes, I know, it is often a problem. Upon investigation with her lubricant and transducer, she decided my left thigh offered the best vein to be harvested. She used a gangrenous green marker pen to draw the position, diagonally across the entire length of my inner thigh. That would be one hell of an incision. The sternotomy is more than enough, thanks. Let's hope it doesn't come to that but, hey, shit happens. When I had to sign the consent form I had to consent for an entire page length of consequences/problems, some of them fatal.

Unfortunately my delayed surgery date in February got cancelled so I have been 'babysitting' the drawing for the past 10 days: touching up the drawing with the marker pen the sonographer gave me, wrapping my thigh in gladwrap when I wanted to shower. So far so good.

The hospital told me I will be tested for covid on arrival. If I am positive I will be sent home. I thought the better part of valour might be discretion so I've been in total seclusion - seeing no-one, going nowhere. Titivating the garden, eliminating cobwebs in the garage, harvesting and processing from my garden and completing a 1000 piece jigsaw of the Fellowship of the Ring have kept me occupied. Covid means I am not allowed any support person with me when I check in. I don't know about visitors. They might be banned too.

I've needed to keep occupied as I deal with facing this on my own, getting my head in a good space. When my heart stops that's the end of my former life. When it starts up again it will be the beginning of a very new one. Like dying; to be reborn. I intend to fill the new life with lots more interesting experiences, I hope one day fate will allow me to visit France again while alive, I'm ready to progress my bass playing as far as others will allow me to go. Bring on the stadium rock gig, I say. I look forward to meeting new folks, new friends, to seeing Mon Paradis so much more established, accumulating new hobbies, revisiting others, learning, learning all the time - that's how you know you really are alive.

I will be in for a punishing physical time for a bit but one that, I hope, will ultimately see me fitter than I have been in decades. I must push, and be patient. Thank you to those who have kept in touch recently, checking up on me, letting me know I do not operate in a vacuum. What an adventure. I've had so many but this one is likely to be the biggest. I'm walking away from that old life I have documented in so much detail, walking in only one direction - to the new life I want. I mean to make it count!

I have added some videos in case you or a friend or family need to go through this at some stage.

Short video. https://www.youtube.com/watch?v=eDmlWAaDxVg

Longer video on hospital stay process https://www.youtube.com/watch?v=a7G8cAJchuw  

and another one https://www.youtube.com/watch?v=KjdgH8SNz08 

Coronary graft where heart is NOT stopped. https://www.youtube.com/watch?v=3U637W8ywao 

Revisiting Canterbury Museum

It has been decades since I visited the Canterbury Museum, Christchurch. Both the museum and I have had our share of adventures in the interim. I had memories of certain exhibits but expected some changes. There have been repurposing of spaces and renovations, of course.

It is still free (for the most part), a good thing. I was keen to revisit the old Christchurch Street replica. The horse and carriage are no longer there. Instead there is a horse designed to be 'resistent' to parents putting their children on it, which they do. No carriage. Charm considerably lessened. Most of the shops I remembered where still there. I know a lot more about Christchurch history and household items of the 19th century, both in NZ and France so it was interesting to compare. 

I especially liked the  plates and was able to look at the old rifle section with a bit of experience from seeing similar ones in France.

Somehow I didn't notice much in terms of paleontology and prehistory such as all the moas and fossils. Maybe they moved them or reduced the size of the exhibits. 

They had a temporary exhibition about one of Chrichurch's important past photographic studios. No doubt some visitors may have recognised themselves. I was more interested in a photo that showed High Street around the time of my late childhood and adolescence.

You can meet animals from all over the world in Fur, Fangs and Feathers. While I thought the exhibits were of very good quality I wondered what the point was in displaying stuffed animals from other parts of the world. I don't think we ever had lions and bears here in our breakaway from Gondwanaland. Quite a lot of space is given over to this. I would rather have seen more on NZ natural history. Perhaps this is only a semi-permanent exhibit?

 However, there are some of the tried and true exhibits I remember from my childhood STILL on display. They are timeless. Some joker had put a toy Christmas gnome in one of the exhibits. Rather incongruous and jarring so I couldn't really take a photo of the display.

The geology bits are rather shoved to one side and look like an after thought though quite interesting in view of the seismic activity Christchurch has been subjected to in the past 11 years.

A great deal of space was given over to a rather odd exhibition by a photographer with an odd bent for the bizarre and somewhat deranged. it was set up so that visitors could insert themselves into the scene and take pictures of themselves. I didn't though I imagine some visitors would enjoy this - Isolation Hotel is a multidisciplinary work combining photography, performance, installation and set design. Heather Straka, an Auckland-based artist, has recreated the look and feel of a 1930s German hotel foyer, once opulent and now run-down. I found it, again, rather incongruous inside the museum, taking up such a lot of space too. It's temporary so I don't know what will go back in its place.

I enjoyed the display of period furniture.It doesn't have much that is truly old though. Most is barely 100 years old. I could recognise household items (non-furniture) my grandmother had.

It was good to see the costume section with day-wear and evening-wear as well as military and clergical dress.

Around a corner I was surprised to come across an excellent exhibit on what it was like to have your photo taken in Victorian and Edwardian times. Nicely dressed display with genuine artifacts.

No doubt I will pop back to the museum another time to see if they have moved things around and brought out new/old bits from storage. It's an imimate place full of interesting info and things to see. It doesn't have to be impressive to be enjoyable.

 

Preparing for Open Heart Surgery

 I have a severely leaking mitral valve. Every time my heart beats much of the blood pumped from this valve between the left atrium and left ventricle flows backwards, requiring my heart to exert itself much more than it should. The left atrium receives oxygen-rich blood from the lungs and pumps it to the left ventricle through the mitral valve. The left ventricle pumps the oxygen-rich blood through the aortic valve out to the rest of the body. This would explain why  throughout my life my body never felt fresh and energetic. There is a significant murmur and I am now very fatigued, sometimes dizzy and have long-lasting palpitations. I have been told I need Open Heart Surgery now. Here are the things you need to prepare for Open Heart Surgery.

 A little over three months ago I had a meeting with the cardio-thoracic surgeon who would be sawing through my ribcage, putting me on bypass and stopping my heart to replace the defective valve. I was told I would need to choose between a mechanical or a tissue valve. Both options have post-op issues. Originally leaning towards a mechanical valve I changed my mind after doing considerable research. I have since signed the consent form for this, had an angiogram, spent a fortune on drafting a new will and enduring powers of attorney, and compiled an Advance Directive with the support of my GP in case things go wrong now and in the future. I have discussed all this with my daughter so she can understand what decisions to make on my behalf, if necessary. I hope she never has to use these documents (all except my will are available to medical staff throughout NZ to refer to) but we should all be responsible parents to help our children deal with bad things that inevitably come along. I considered contemplating my possible demise or incapacity part of my pre-op preparation.

I also met various surgical registrars including the one who will be wiring my chest back together and sewing me up, as well as a number of nursing specialists.

In addition, you must have a clearance letter from a dentist confirming there are no outstanding treatments such as cleaning, fillings, loose teeth, gum disease likely in the next six months as dental issues can result in serious cardiac consequences including death. I have done everything possible to be ready for surgery at any time.

Another part of the prep was having lots of blood tests, height, weight and blood pressure regularly recorded and also undergoing a transoesophageal echocardiogram

TOE or TEE transesophageal echocardiogram is done by inserting a probe with a transducer down the esophagus. This provides a clearer image of the heart because the sound waves do not have to pass through skin, muscle, or bone tissue. Echo shows the size and shape of the heart and how well the heart chambers and valves are working. Echo can pinpoint areas of heart muscle that aren't contracting well, detect blood clots and guide treatment for arrhythmias (abnormal heartbeats) and many other heart conditions.

Risks

• Damage to the esophagus, including bleeding or a tear (very rare)
• Reaction to the medication used to relax patients during the procedure, including nausea and difficulty breathing (see my recollections below)
  
• Sore throat after the procedure
   

  Before the procedure 
• The doctor will explain the procedure and offer the opportunity to ask any questions about the procedure
• You will be asked to sign a consent form that gives permission to do the test.
• Fasting prior to the procedure is required. 
  
• Notify the doctor if you are allergic to or sensitive to medications, local anesthesia, or latex
• Notify the doctor of all medications (prescription and over-the-counter) and herbal supplements patients are taking
• Notify the doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary to stop some of these medications prior to the procedure
• The doctor will require a blood test prior to the procedure to determine how long it takes the blood to clot. Other blood tests may be done as well
• Notify the doctor if you have heart valve disease, a congenital heart condition, or a history of endocarditis (infection of the heart valves) as you may need to receive an antibiotic prior to the procedure
• You receive a sedative prior to the procedure to help with relaxation. Patients need to arrange transportation after the procedure

My recollections are as follows: 

A luer or IV was inserted in my arm. I was wheeled to a small room where I was asked to hold a very viscous liquid in my mouth for at least 2 minutes and to gargle where possible, after they had already sprayed the back of my throat with an anaesthetic. I was then told to very slowly allow the gluggy stuff to slide down my oesophagus. 

I had to then turn onto my left side and a plastic mouth piece with a hole in the middle was inserted into my mouth. This can make you feel anxious, claustrophobic or make you want to gag because you know what's coming next. Fortunately they have the strong sedative kick in at this point. A tube with an ultrasound transducer is then pushed all the way down your throat and food pipe until it lies behind the heart (see links to detailed videos below).

I gradually woke up in the cath lab. I expected to be able to go home around lunchtime. Ha! They gave me a sandwich and a cup of tea. That was great as I hadn't had anything to eat for 15 hours. They took out the IV line. The registrar simply said that doctors were debating now whether to repair or replace the valve. Hey? I said I had always been told it was too severe a situation for repair and that I did not want a repair that would only last a few months or a year before I would be opened up again. " We wouldn't do that to you," said the registrar. But I know perfectly well repairs don't always hold well even though a good repair is preferable to replacement. I have received no details on my TOE/TEE at all. 

As I stood up to get dressed I became very dizzy and disoriented and vomitted rather violently. Nursing staff said no way could I go home like that as I was having a bad reaction to the anaesthesia. The nurses said I must have a new IV put in (I hate those painful things) so they could pump liquids into me asap to flush out the toxic sedatives and rehydrate me. After five additional hours I was wheeled down to the hospital entrance to be picked up and taken home, clutching a plastic container for my nausea. Sick as a dog it took about 48 hours to come right at home.

Open heart surgery is not for the 'faint-of-heart'. Yeah, silly joke but true. I have joined the Zipper Club on Facebook which is a group of people having OHS or their loved ones are living through it. While it may seem routine major surgery these days things go wrong more often than you would think and there can be some distressing ongoing consequences for some patients. I am pretty clued-up now on these.

Living alone as I do with no deep emotional relationship to lean on nor family nearby, spending most days of the week without human contact makes dealing with such a major event emotionally challenging. I have still not received a date for the surgery which I would have expected by now. I cannot plan to do anything, no-one feels they can count on me being around to play my bass and as a result musical opportunities (my lifeline) have evaporated. I am in limbo, indefinitely is how it feels. I try to see each day of this current life as a bonus and enjoy my sternum being pain free with no massive scar but I can't humanly keep that thinking 24/7. This situation is certainly one of the biggies for me.
Very quick snapshot https://medmovie.com/library_id/3190/topic/cvml_0186i/

For those of you interested in medical/scientific  details   https://www.youtube.com/watch?v=IU3TRfnO7tI

New tooth for Christmas

 All I wanted for Christmas was a new front tooth. Ten long months ago, on Waitangi Day, one of my front teeth snapped off. It had been crowned and then recrowned (due to a poor initial piece of dentistry) but had seemed perfectly solid. Alas, the peg inside was not.

I've gone through implant surgery, bleeding issues, gagged daily on my ghastly temporary tooth, faced my friends looking like the Wicked Witch of the West and so I have been keen to complete this lengthy, painful and expensive process.

Following discharge by the surgeon, I was then back in the hands of a dentist. I was told to come for an impression (mould) to be taken so that the new prosthetic tooth could be created. That should be easy I thought. Sigh! Will I never learn?

As I sat back in 'the chair' the dentist told me I would need local anaesthesia. Heh? I was not happy as I find this really painful, even though it may be necessary, but this time I wouldn't work out why it might be necessary. The healing cap would be removed, a long screw inserted into the implant while the mould was made and then everything reversed. No surgery was required. I felt every one of those injections all around the screw/implant socket, leg-trembling stuff. Taking off the cap and popping in a screw was easy. I was told the mould would take a while and the dentist would be jamming it in place and then holding onto it, my mouth would fill with impression and I would want to gag. "Please don't move or gag, just concentrate on even breathing to get through it," said the dentist.

It seems this sort of impression is more complicated than that needed to create a standard crown. The dentist inspected the end result and declared it useless - there was an air bubble. We'd have to start again.

I was starting to gag and cough this time, towards the end of the process. Then the lower jaw was moulded to get my 'bite' right. Xrays were taken and the moulds sent off the prosthetics laboratory where my new ceramic tooth would be made. The dentist informed me I would need to go to the lab and have them colour-match to the rest of my teeth. My painful gums and socket did exactly that the following day.

The dental technician was nice and knowlegeable. He showed me my moulds and explained the work is very technical and must be precise to the last micron. Every step of the implant process must be precise. Just the right amount of space needs to be on either side of the tooth to allow flossing, it must be at the right angle and the tooth needs the correct alignment with its neighbours. My bite is very close so I will effectively be biting on the location of the screw and socket. Because of this, the sexy veneer could only be applied to the front of my tooth.

The day came when my new tooth could be fitted. More nasty needles. The cap was removed again and the new tooth and screw were inserted, Considerable pressure was applied to secure everything in the socket. It was uncomfortable but this faded within 30mins. I was told my gum would turn white [which it did] but would gradually return to pink. The tooth colour was good and it fills the space well. I cannot say it looks exactly like my original tooth at age 17 before a Christchurch dentist massacred it. The gumline is not the same, the angle isn't either and there's a back section that annoys my tongue as it juts out further into my mouth than my natural teeth or crowns. 

However, it is permanent, I can eat what I want, I will not be gagging on a partial plate and I no longer look like a witch. I will be able to eat normally in front of others. I will also be able to go back to singing. Having this 'almost normal' option is likely to be the best way to protect my current and future heart health. 

Right now my gum and socket are pretty sore but that will subside. This is an horrendously long and expensive process and, for me, has not been without pain and trauma. It is not for the faint-of-heart but if you are a long-term planner and persistent it can be a good option.

For info on earlier posts detailing the beginning of this process check out posts for the past 4-5 months.

Bloody dentistry - implant complications

 I waited three months from my tooth implant surgery for a followup consultation to determine if the implant was successful. How do they do that? I thought it would be through some sort of Xray. Ha, too easy!

The maxillofacial surgeon put a tool in my mouth and seemed to be ratcheting away at the implant. " You might hear a clicking," he said, Well, yes, I certainly felt it too but it wasn't painful. "That seems to be holding," he said. Thank goodness for that after all the wrenching, I thought. He then informed me that my gum had grown over the implant a bit and would need to be trimmed off. I would need local anaesthesia. Always painful, those ones through the roof of the mouth are particularly bad. 

I reminded him about my defective heart valve. Well, I would have needed to be on antibiotics before my visit but now it was too late. How was I to know? Nothing for it but to do it intravenously. My heart sank. More pain and difficulties as my veins are finely engineered. He totally failed in his attempt to put a luer in my right arm. Better try the left one next. After some anxious moments he finally got that one. It took a fair bit of time to get the antibiotic in, in small increments.

The procedure was 'mostly' painless, no stitches and an Xray was taken. Time to take out the luer. The surgeon had his nose in his computer and the nurse had immediately walked out of the room. A bit more care was needed as I had to draw the surgeon's attention to the stream of blood running from my arm, down the chair and onto the floor. Surgeon called the nurse back to clean it up and apply a bit more pressure on the puncture site. I was discharged completely and sent home but my mouth was full of blood as I drove home and my jersey was stuck to my arm from leaking blood. Hmm.

As the hours ticked by the bleeding did not stop and my mouth was full of 'raw liver' clot. I was unable to eat or drink anything. All I could do was shove tissues in my mouth and distract myself by playing bass. Dislodging the tissues meant dislodging the clots. It wouldn't stop but I thought going to bed might be a good thing. Using an old pillow and a towel I tried to sleep but the 'liver," now very thick and fibrous, kept growing, along with the bleeding. I could no long talk so I wrote a cry for help on some paper and at 2.30am the next day I knocked on my neighbour's door. We contacted healthline who recommended going to A & E at the hospital.

A & E did not seem busy yet I had to wait in acute care for hours, bleeding. Nursing staff seemed intent on their computer screens. Not much else was happening. Eventually a doctor found me. He wanted blood tests done but insisted it must be done through an intravenous line. I'd had more than enough needles by this stage but I had to comply to check my blood was clotting OK. The nurse had trouble coaxing my terrified vein but we got there. Bloods were normal. A bizarre bruise appeared on my arm, some distance away from the IV. The doctor hadn't seen that reaction before so we ignored it. 

The doctor then took a look in my mouth. "I think the bleeding is slowing down but I'm not touching that clot, too risky," he said. "This is specialist surgery and I don't know anything about it," he said. I needed to wait a few more hours for outpatients dental department to open so, complete with IV still in my arm and my box of tissues I had to walk myself down the road in the cold wind to the big orange building. Check in and wait for a space.

The dentist on roster did not want to do much with the clot either. "I think it has stopped now but I won't touch the clot except to tidy up around it so you can drink something as you'll be dehydrated after nearly 20 hours of no food or drink." Sucking through a straw proved to be a bad idea so I suggested I drink on the opposite side via cup. Never has a juice been so appreciated.

My neighbour kindly came and picked me up and drove me to the chemist where I filled a prescription for tranexamic acid in case bleeding took off again. I could eat only liquid food, such as melted ice-cream and cold tea for a couple of days and then gradually got back onto my usual diet by day 5. I let the surgeon's office know there had been a problem and looked forward to an appointment with a dentist to complete the implant process.

More on that later.

By Alexmit art - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=99733632

Credit source of photo of implant scew in situ to show what an implant looks like at initial surgery. https://burbankdentalimplants.com/shaping-and-forming-gum-around-front-teeth-dental-implants-ramsey-amin-dds-reviews/  

Not the same as my gum tidyup episode.