Valve Job

I listen to Car Talk regularly, and any time the diagnosis suggests that a valve job is the cure, the Tappett Brothers apologize for the bad news and the associated high costs. I’ve been lucky so far, and haven’t ever needed a valve job on a car.

On my body…that’s a different story.

I’ve just returned home from having aortic valve replacement surgery at Sequoia Hospital. My surgeon was Vince Gaudiani (previously described as “Dr. G.” in Decisions on Incisions). He was assisted by colleagues from Pacific Coast Cardiac & Vascular Surgeons – I don’t know all their names, but one was a fellow RPI graduate, Adam Harmon, as we discovered while chatting as I was recovering in the ICU.

Diane and I drove up to Redwood City on Thursday, January 13th, for pre-operative testing and paperwork. The first step, of course, was the walletectomy; after that, they drew blood and took a chest X-Ray at the hospital, then I went up to the surgeon’s office. The first step there was a meeting with a volunteer from Mended Hearts; she’d had six open heart operations and four atrial valve replacements (both biological and mechanical) over her lifetime, starting at age 10! Then I had my legs examined (I’m not quite sure why at this point – I guess it was to look for places to harvest veins if need be) and met with one of the physician assistants. I was surprised when they asked me if I’d brought my angiogram CD with me – I hadn’t even thought of it. Fortunately, I’d saved a disk image of it on my MacBook Pro, so I was able to burn a new copy on the spot, but it could have been a problem.

By the time everything was done, it was 2pm, and we were very hungry – luckily, Redwood City has a lot of good restaurants, and we let Yelp steer us to Paradise Kebab House. After lunch, we returned to the hospital and checked in to the Sequoia Guest House. We spent a quiet afternoon, getting a quick walk in before the rains came. For dinner, we went to New Kapadokia – I’d been advised to eat lightly, so we split an entrée and skipped the wine, but probably made up for it with dessert!

Then it was back to the Guest House to shower, disinfect, and try to sleep; I’d asked for a prescription for Ambien, just in case, but I had no trouble falling asleep without help.

The alarm sounded at 0430; we walked over to the hospital and got to the “Short Stay Unit” just before our 0500 checkin. They were ready for us, and almost before I knew it, I was out of my clothes and on my back, being shaved from chest to ankles (though certain areas were skipped, somewhat to my surprise). Then another shower and disinfection, and it was time to meet the anesthesiologist (who I’ll have to call Dr. K., because I don’t remember her full name!), who gave a brief explanation of what she’d be doing for me. And then it was showtime. Diane and I said our good-byes, and I was wheeled to OR.

I’d watched Dr. Gaudiani’s videos on Valve Replacement Surgery (part 1 and part 2), so I knew what the OR would look like; there was a little chatter among the team as I was wheeled in and they said “hello” to me; then Dr. K. started doing her magic, and that’s all I know.

I woke up many hours later in the ICU; they had told me to expect to awaken with a breathing tube, but if I did, I’ve lost that memory – my first solid memory from ICU is seeing Diane and being able to talk with her. I was in some pain, but not much – perhaps a 4 on the 10-point scale they asked me to use throughout my stay. I was being given oxygen through a nasal tube, and there were lots of wires and tubes elsewhere on my body. They gave me ice chips and a little water; time passed in a blur. I even slept some, but at some time during the night, I felt a few pinpricks in my heart – I’d gone into atrial fillibration, and they used an external pacemaker to restore me to normal (sinus) rhythm. This happened twice that I know of.

I was pretty uncomfortable during the night – the nurse wanted to slow down my intake of fluids from the ice chips, and that made me even less happy. They kept medicating me, but it didn’t help much – I felt hungry, but they didn’t want me to eat yet. Eventually, they were ready for me to try a little food and gave me a breakfast tray; I surprised them by eating more than a slice of toast and a good bit of the eggs, as well as all of the liquids they let me have. And I surprised them even more by keeping it all down. My discomfort level dropped from 5+ to 2 as soon as I’d eaten, too.

After breakfast, Dr. Harman was ready to remove my chest tube; the Mended Hearts volunteer had said that would be an uncomfortable experience and advised me to ask for more pain medicine. Dr. Harman said that I’d be fine as I was, and he was right; I felt a tiny bit of tugging, but that was about it. That was the last step before I was ready to leave ICU, but we had to wait for a room to become available in the Cardiac Surveillance Unit (CSU), which took a couple of hours.

I was transferred to CSU just before lunch – there was no nonsense about limiting my fluid or food intake in CSU, either, and I polished off most of what I was given (one note about Sequoia: the soups were uniformly tasty, usually the best part of the meal). Diane was even allowed to bring me fruit and candy from outside (I suspect they would have disapproved of salty foods).

I won’t go into great detail about my stay in CSU; it was mostly uneventful. I watched videos, read books, did a crossword puzzle, ate, slept (some), got awakened when necessary, learned how to get in and out of bed without using my hands, walked around the floor as much as I could, did breathing exercises, and, basically got better. The one complicating factor was that I was retaining some fluid, so my weight was up – they didn’t want to let me go until I was back to my pre-operative weight. They used diuretics to make that happen – it was pretty convenient until they took off the catheter; after that, I got lots of practice getting in and out of bed. My weight dropped back to the desired level by the Tuesday early morning weigh-in, and when the doctor visited, I asked if he was ready to discharge me. He was.

That started another flurry of activity; first, he had to remove the pacer wires from my heart (an interesting feeling – not painful, but very very odd) and put me back in bed for an hour of observation. While I was in bed, the patient educator visited to tell me a few things I needed to know before I left (probably not optimal timing, especially since I was also eating lunch and had a visitor!). Then a chest X-ray, followed by a return to the room for the removal of my central line, which required another hour or so in bed for observation.

And that was about it. Diane came and packed up my stuff; I put on real clothes for the first time in more than four days; they put me in a wheeled chair (not to be confused with the kind of wheelchair they used when I was taken to X-ray as a patient) and brought me to the car – and off we went, into the setting sun (and rush hour traffic).

I haven’t named everyone who helped me while I was in the hospital; in some cases, I don’t know their names. Everyone who worked with (or on) me was terrific and clearly interested in making my experience as painless as possible. The nurses were, of course, the people I interacted with the most; Erin, Kelly, Sev, Sharon, Melissa, Sonya, and Jin, you were all wonderful (I don’t remember the names of my first few ICU nurses). I got lots of help from Jenny in PT, Carlos and Carla in Respiratory Therapy, and many others who made my stay easier. Thank you all.

I’m very glad I chose Sequoia and Dr. Gaudiani and the PCCVS team.

In case you’re tuning in late, you can read all the postings about my Aortic Stenosis experience here.