Five Weeks Today

Five weeks ago, January 26, was the date of open heart surgery.

Still slightly sore, still get tired easily.

Need to build up stamina - walking 25 minutes (not fast) a day.

Looking forward to resuming more "normal" activities.

No driving or heavy lifting for six weeks. Will still take it easy.

Doctor's Appointment Wednesday February 10

Kept my monthly appointment with the kidney specialist on Wednesday.

He said that I looked good for having had open heart surgery two weeks prior (on January 26).

Hemoglobin numbers are still low, so my procrit dosage was increased, and an iron infusion has been scheduled.

Protein number is low, so increased protein intake has been prescribed.

Coumadin (polite word for rat poison, Warfarin) is being adjusted for increase INR to prevent clotting around my new pig valve.

Most of the other numbers are looking good.

Still sore, and get tired easily. I sleep a lot too.

Anemia explains the lack of energy.

Still Sore but Less

Vicodin has been a companion, but not as frequently as before.

Nominally it's "Take 1 tablet orally every 6 hours as needed for pain not to exceed 4 tablets in 24 hours."

First three days home I took it as prescribed, taking four tablets in a 24 hour period.

The last three days it's not needed as much, and only took three tablets in a 24 hour period.

Still sore, but differently - I like to think that I am getting better.

Blood Pressure and Pulse Rate

As part of the Peritoneal Dialysis regimen, I record my blood pressure and pulse rate twice a day.

My blood pressure has DROPPED to a more "normal" 121/69 this morning, as well as my pulse rate, going from 80 -90 to 65 this morning - this suggests that my heart is now beating more efficiently and effectively - GOOD STUFF!

When I Sleep I Don't Move

I notice that I wake up in the same position that I had when I laid down to sleep - flat on my back at night, flat on my back when napping during the day.

This means that I don't move around when I am sleep probably because it HURTS to move, so I DON'T move.

Talked to "Dr. Sam" regarding my Coumadin. I will be working with him to maintain a specific level of Coumadin for the desired anticoagulant effects. Regular blood test tests are needed as well as an awareness of anything and everything that could affect the Coumadin activity.

The Mobile Phlebotomy Service will be coming to our house to take blood from me tomorrow morning.

Wikipedia says that it was a pesticide (sounds better than "Rat Poison", doesn't it?) that was discovered to have it usefulness when "...an incident in 1951, where a US Army inductee unsuccessfully attempted suicide with warfarin and recovered fully, studies began in the use of warfarin as a therapeutic anticoagulant..."

Got Home Today

Got to go home today

Kaiser Permanent has a group of dedicated people who work in the same place, but don't necessarily talk o each other and coordinate things.

The idea of being "discharged" was a good thing for Dr. Sidhu, the man in the turban and beard who liked the idea of being rid of me on Sunday. I don't know what was supposed to be communicated and to whom, but the nursing staff was asking me when I was being discharged. I gave them "1:00PM" as that was the ime that Dr. Sidu's assistance suggested me me. She was nice to me - instead of telling me to "hold your breath" and yanking the wires of the temporary pacemaker out of my chest, she actually CUT the stitches with tiny shart scissors and then removing the wires.

Got printed instructions on new, old and discontinued meds, and how to take care of me for the next six weeks. (keep things clean and dry, watch for signs of infection and heart failure, etc.)

No driving, no heavy lfting (five pounds or more!) for six weeks. no vigorous upper body activity - have to allow the rib cage to heal up which takes weeks.

While napping, sister Kendyl Lyn called - I returned her call.

Also, Esther Germany, Toastmaster friend called from France - at least that what the "country code" show in my Google Voice Mail - Thank You! for the call, Esther - you had some good news!?

Another new adventure is being on Coumadin, (brand name - polite word for warfarin, which is RAT POISON). This being an anticoagulant, I need to be aware of diet, what I am eating/not eating, ANYTHING that will affect my "clotting factors" and having regular blood tests to measure how much my "International Normalized Ratio" (INR) is.

Because of the Pig Valve, I need to watch out for my body's tendancy to react to it and form a clot. A normal person's INR is 1.0. I need to have an INR of 2 to 3.

Because this is done by blood test and we have stairs to go up and down in the house, we asked about the possibility of the phebotomist coming. The nursing staff had asked and found that this was not done. However, the Anti-Coagulant Pharmacist Rick said that this could be arranged!

Going Home Tomorrow (Sunday)

The cardiac doctor with the turban and beard said that I was good to go home on Sunday.

His assistant who came to check my incision (nice job with no ragged edges - Thank You! Dr. Pfeffer!) told me that I would be discharged about 1:00PM after all the paperwork, instructions, and medications are done.

I was told by one of the nurses that the two wires connecting my heart to a temporary pacemaker would be removed on tne day I go home. ("Hold your breath!" and YANK! as there's only a couple of stitches used.)

They try not to keep their patients too many days because they don't want the patient to get sick in the hospital.

They say that I did good.

Tuesday: Got the aortic valve removed and replaced, and two(?) bypass grafts. Went to sleep 7AM and was remember being awake at 7PM, although I'm told that I was in and out earlier Tuesday.

Wedneday: breathing tube removed and able to "talk". Able to "sit" uprightin a chair for total of seven hours (four hours in intensive care, three in intermediate care after chest tubed were taken out - "Hold your breath" YANK!). Moved from 3rd floor intensive care unit room (no bathroom with toilet) to 5th floor intermediate care unit room (got a bathriim with shower and toilet.)

Thursday: Walked up and down the hallway three times; passed on walking Wednesday as I had already seven hours of "sitting".

Friday: Big day for visitors - Bill, Gordon, Donna, Rick, Mom, Lily, Diana, Elizabeth,And Virginia. Smerke called on the phone.

There's cable television that we don't have at home.. Watched the Discovery Channel, National Geographic Channel, AMC, CNN, and the Kaiser educational video on coumadin (polite word for warfarin which is known as a rat poison.) which I will now be taking to prevent blood clots.

Movies and programs included bits and pieces of Alien 2 and Alien 3, The Fugitive, Terminator 2 (I nap in between the bits and pieces that I watch.)

What was really good was "The Night of the Living Dead" where the live people did not refer to the living dead as "Zombies," The final resolution of the zombie problem was the phone call to the U.S. Army phone number stencilled on the storage container containing the original living dead (Secret Project of the U.S. Army) that was mis-delivered to a body parts shop in Louisville, Kentucky.

The U.S. Army simply launched a low-yield tactical nuclear shell that resulted in 4,000 killls over a twenty-square mile area.

Clean and efficient!

Sent from my Peek

Today's Wedneday

Yesterday was the DAY.

Fell asleep before 7:00AM (Teresa gave me a couple pills to "relax" in addition to acid-gas reflux(?) pill plus another of something. Diana says she talked to me as I was falling asleep, AND I don't remember talking to her.

Means that I don't remember ANYTHING between 7 in the morning to 7 Tuesday night when I know I woke up and knew that I did NOT DIE. Good Stuff! People are praying for me from the East Coast to the West Coast and who knows from elsewhere.

I know that I did not die for real becuse the book did not fall out of Norine's bookcase.

I don't remember:

- having IV put into right wrist and left neck .but do know that the two were removed by Maria.

- a tube put my pee-pee to collect my pee but know that Vicky pulled it out after telling me, "take a deep breath!" It hurt!. It also hurts when I pee.

- anything about the operation itself - the evidence I have is pain in chest that hurts when I breath and cough, two tubes coming out of my chest draining bloody fluid and gas, and a BIG bandage on my right leg where Vicky says they took a vein for bypass graft.

I think I had the operation.

I was moved from the ICU to "intermediate" care room because I am doing "well." I feel like I got hit by a bus, hurting all over, can't breathe or cough without pain and discomfort.

I am "doing well" because I can talk and sat upright in a real chair for several hours, as well as not asking for pain meds beyond what give me without asking.

Tomorrow they say that they are going to make me WALK with all these tubes wires hanging off me.

I am in Room 5781 with phone number 323-783-5781, visiting hours 8AM to 8PM with age limit and no colds/influenza.

Sent from my Peek

(Yesterday was) the DAY

Written Tuesday 1/26, ~5:30 AM.

Today is the DAY.

Nothing by mouth after midnight – no food, water, or meds –nothing.

Woke up at 4:00AM.

Took a shower with the scrub soap as a pre-operation preparation.

Lily and Diana brought me to Kaiser to check-in at 5:20 and will stand by until I come out of surgery, approximately 1:00 – 1:30PM.

I will be put "asleep" at 7:00AM, and won't wake up fully until Wednesday, being in and out of it (consciousness) today (Tuesday) after coming out of surgery.

This blog entry is being emailed for me by Diana, who also writes:

He has survived surgery and is in ICU. Miraculously, he is also sitting up. The breathing tube has been removed from his throat, too, so his recovery is going very well!
--
Diana M. Jue, MIT '11
MCP, Department of Urban Studies and Planning
International Development Group
dmjue@mit.edu
(626) 616-9238

One More Day

Tomorrow morning will be IT - open heart surgery to replace an aortic valve and double/triple bypass.

I have been assured that I will "go to sleep" and "wake up" after its all done with no memory of the surgery. Might be better to have no memory of what happens, and not know what the surgeons actually say about the patient.

Had blood (four vials) and urine tested, chest x-rays (back and side), filled out paperwork for admission - just need to sign in at 5:15A.M. tomorrow morning.

I will be made to sleep at 7:00A.M., and should be done by 1:00P.M. or 1:30P.M. Then I will be drifting in and out of consciousness the rest of the day and fully awake Wednesday.

Probably will be in Intensive Care for one or two days, followed by intermediate care for five to eight days, and then home for three to six weeks of recovery.

Talked with the anesthesiologist who answered questions.

Daughter Diana will send out an email after I come out of surgery.

Two More Days

In two days I will have heart surgery for aortic valve replacement and double/triple bypass.

While I have no problems with dying (everybody dies, see "Memento Mori") what has me concerned is the uncertainty involved - statistically this procedure has 85% survival rate.

That is, if I were to have this procedure done 100 times I would die 15 times "on average".

(This means statistically if an increasingly large number of batches of 100 procedures were to be done, the average number of times of dying in 100 procedures would converge to 15 as the number of batches gets larger.)

On the other hand, there's the certainty of being dead in two years if I do not have the procedure done - it's a no-brainer as far as making the decision to have or not-have the surgery.

After surviving and recovering from surgery I plan on having my ear pierced as a symbol of surviving a life-threatening situation..

(This comes from the sailor's tradition of ear-piercing if he were to survive a shipwreck, along with other things such as crossing the equator for the first time, or to ensure a Christian burial if his body washes ashore after a shipwreck.)

Instead of black pearl, I had made an earring with a two carat canary-yellow simulated diamond in a bevel setting (sits lower on the ear lobe), and will probably go to Old Towne Pasadena to a tattoo and body piercing shop that I found on Yelp for the ear piercing.

Diana will have her ears pierced. We will do this in May when she comes back from school.

Sent from my Peek

edited 3:34PM Sunday, January 24, 2010

Got a Date with the Surgeon

Pat from Cardiac Surgery called.

My date for surgery is January 26, and I get to check-in on the 25th.

This will be done at Kaiser Hospital on Sunset Blvd.

As Good as It's Going to Get

"As good as it's going to get."

That's what the kidney doctor basically said - my test results (ELEVEN vials of blood were taken out of my arm on Tuesday!) showed that the numbers that they were looking to go up - hemoglobin and protein levelss - have gone up and are in their respective "normal" range.

Many of the other numbers are within the desired range for dialysis patient.

There were some adjustments to meds to handle the numbers that were not within normal range. A couple of new prescriptions were written and picked up at the pharmacy.

It's a "GO" for heart surgery. We will call the cardiology group on Monday to get things going.

I now understand that we want to have my heart surgery preferably before the end of January before Diana goes back to school so that she can see me come out of surgery successfully.

December 30, 2009 Health Update

The plan is for my surgery to be done in the latter part of January, after Elizabeth's birthday party, and after Diana's going back to school.

By then, the doctors expect my hemoglobin count to be at or above "normal" (it was slightly below normal when last tested), and my protein level (measured as blood albumin) to be "normal". My procrit (hormone that tells my bone marrow to make hemoglobin) dosage was increased from 4500 units twice a week to 5500 units twice a week, and I am continuing the protein supplement (30 grams of protein = 5 scoops of Beneprotein in a fruit smoothie) every night.

The surgery is to remove and replace the aortic valve in my heart with a pig valve. While they have my chest open and heart stopped, they will also handle a couple of partially blocked arteries while they are in there (kind of like your mechanic doing the main bearings on your car engine at the same time as the valve job since the engine is torn down anyways).

Because of the difficulty of opening up and working with a beating heart, the surgical team will necessarily stop my heart in order to do the work on it. This will be done through the miracle of Cardiopulmonary Bypass (CPB).

NOTICE that I did not write that the surgical team will kill me dead. They are only going to make my heart stop beating and me stop breathing.

The question, then, is this: since I am not breathing and have no beating heart, will I be "dead"?

I had this discussion with several people - will I remember being "dead"? At our family Christmas Eve dinner I told my niece, Noreen, that when I am "dead" that I would communicate with her. We agreed that I would cause one of her books ("The Lovely Bones") to fall out of her book shelf.


Disclaimer: SORRY - This is only what I know from my point of view. No lies, just what I see as the truth.

Meeting the Man and Getting Lasered - November 17, 2009

Went to visit the Chief Cardiac Surgeon that Lily saw Novembe 9 when I was in the ER. The good doctor wants to meet the people that he is going to cut into, and not just talk to the wife.

Plan on removal and replacement of aortic valve with a pig valve in late January - no urgency, need to have certain tests done and check things out. This include a neurological exam to make sure the muscle tremors I exhibit is not due to a brain tumor. (Don't want to waste a pig valve.)

Afterwards I went to the opthamologist to have the blood vessels retinas of both eyes lased (yellow laser) to stop bleeding into the eye. Right eye needed more work that the left - flashes of light while wearing a lens attachment on the eyeball (?!)

Results of Consultation with Chief of Surgery Regarding Angiogram

Results of October 13 Angiogram

Diagnoses: (taken from report)

Aortic Valve Regurgitation

CHF (Congestive Heart Failure)

Depression

Diabetes Mellitus Type 2 W/Complications

Essential Hypertension

Anemia

Coronary Artery Disease in Native Artery

Review Committee recommended surgery to replace Aortic Valve with pig valve and procedures to improve blood flow to the heart.

Good News: Operation would have 85% probability of survival.

Bad News: If I did not have the operation, I will die within two years.

Good News: Definite NO BRAINER! I will have the operation when my Peritoneal Dialysis situtation is stabilized, my hemoglobin blood count is increased, and I am stronger.

There is concern that if I wait too long I will not tolerate the surgery.

NOTE: The kidney failure is partly due to the "Diabetes Mellitus Type 2 W/Complications"

The Details - November 9 Visit to Emergency Room

On November 9, Monday morning I had a continuation of weekend vomiting, nausea, cramping/twitching.

Phone call to the Peritoneal Dialysis clinic resulted in a visit to the Emergency Room, my wife Lily being my driver.

Blood Pressure was 70/35 at one point, Blood Urea Nitrogen (BUN) value of 140 (normal range = 7 - 20). Admitted to Kaiser Permanente hospital.

Hemoglobin count 8; normal range 12 - 16.

Phosphorous 10; normal range 2.7 - 4.5.

Treatment: 24 hour a day continuous Peritoneal Dialysis Monday through Saturday.

Relevant test numbers gradually came down from high values, my numbers will never be "normal".

Received many phone calls and visitors.

Flirted with nursing staff, especially the young and pretty nurses. and annoyed the doctors.

Lost 15 pounds on four days liquid diet (ate nothing all day Monday) - Breakfast: herbal tea, broth, Jello cup, fruit juice; Lunch: herbal tea, broth, Jello cup, fruit juice; Dinner: herbal tea, broth, Jello cup, fruit juice. Began solid food Renal Diet at Friday Lunch.

Came home Saturday, November 14 with new instructions. Performing PD exchanges five times a day. Will receive training on PD Cycler on Friday Novemer 20.