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Surgery update

post #1 of 46
Thread Starter 
Update - these are from Andrew's blog

Thursday, 03 January 2008

Post-op, Day 0

I'm exhausted, but very relieved.

The important news: the operation was a success, the surgeon, Dr D. Craig Miller, bless his cowboy boots, managed to spare the aortic valve (he'd given us a 99% probability of being able to do so beforehand), so we don't have to be concerned about pig/cow valves for now, and mechanical valves later. He was reluctant to say that her own valve will last her the rest of her life, but it should last a "long time, long enough to have a family".

When I left the hospital, Sarah was in intensive care, extubated, conscious, and talking to me, but very very tired. She's got a daunting array of things coming out of her at the moment (a lot of which I couldn't see because she had blankets over her). It's been a long day, so I decided to head home, rather than potentially keeping her awake for the next two ICU visiting times tonight.

Here's the time line that I recorded:

05:15 - Arrive at the hospital to go through the admissions process

06:35 - I leave Sarah shortly before they're going to wheel her off to the operating room (I'll get into my fun at the end).

09:30 - I ask for an update, and they tell me she's going on bypass

10:30 - It looks like they can save the aortic valve

12:25 - Still doing the valve stuff, making a new sinus of Valsalva

14:15 - I ask for another update, everything is going okay, someone will come out to talk to me

14:55 - Still going, at least another hour until they start to close up

15:15 - Closing up, surgeon will be out to talk to me

16:10 - Surgeon comes out to talk to me about how the operation went

16:50 - I got to see Sarah briefly in the ICU, she was still intubated, but conscious and seemed to respond to my voice

~18:15 - Extubated. Spoke with her briefly. She was very tired, and I decided to let her rest for the remaining visiting times and go home and get some rest myself

So what the surgeon had to say for himself was very interesting indeed. He didn't end up doing exactly what he'd said previously, based on how things looked once he actually got in there.

He said that the sinuses of Valsalva were paper thin. So thin, you could see the blood flowing through them. They were about 0.5mm thick, rather than the normal 1.5mm thick. Sounds a bit like a disaster waiting to happen. Apparently it's not possible to detect this with imaging, you have to get in there and see it for yourself. He didn't end up removing as much of the aorta as previously planned (specifically the part around the transcending arch) as whilst the diameter was a bit bigger, the tissue apparently looked healthy. He said the part of the aorta he did remove (preceding where the braciocephalic, left common carotid and left subclavian arteries branch off) was "cheesy" in consistency, so it's not like she just happened to have an enlarged aorta, no aneurysm, and way too thin sinuses of Valsalva. There was definitely some unhealthiness to the aortic tissue, just not as bad as thought from the imaging.

So it's all good. I think she'll spend a day or two more in the ICU before getting moved to a normal ward, but it's too soon to say what's going on with all of that. There's some elevated risk of stroke due to blood clots for the next 24-48 hours, but she's on blood thinners, so it shouldn't be a problem.

The day was pretty crazy for me. I'm not sure if it was stress, or the stomach bug that's been doing the rounds, but I went to bed last night at 11pm, was up again at 1am, with shall we say, a gastrointestinal upset, and up again at 3am, throwing up. We got up at 4:15am to get to the hospital.

I felt really nauseous all morning, and was an absolute wreck while I was in with Sarah when they were putting a peripheral line in her before they wheeled her off to the OR, so I bailed about 5 minutes early and just made it to the bathroom in time to throw up again. I haven't eaten all day, just tried to keep the fluids up. I'm debating having some plain boiled rice for dinner, or waiting until tomorrow to have something easy on the stomach. I definitely felt a lot better as the day progressed, but my stomach is still pretty tender. Sarah and I ate pretty much the same stuff yesterday, so I don't think it can be food poisoning. She tends to have a very sensitive stomach at the best of times, so I'd expect her to be showing problems before me if it was food poisoning.

But enough about me, I'll live. I hope it's not a stomach bug, as I don't want Sarah to come down with it as well, now that she's on the road to recovery from this surgery.

ICU visiting hours are every even hour between 10am and 10pm, for thirty minutes at a time, so I plan on spending all day at the hospital tomorrow. Hopefully I can find a good spot to get some wireless coverage, so I can update things as the day goes along, rather than at the end of the day when I get home, like I had to today.

Hopefully I'll sleep better tonight than I did last night.

Friday, 04 January 2008

Post-op, Day 1

I just called the ICU for an update before I head in for the day. She's apparently doing well, and can probably transfer out of the ICU later today, although apparently beds are tight in the ward.

Update 1

I've managed to find somewhere with wireless access, so I can update this in between ICU visits.

She's looking really good this morning. She asked for some 7up, because her throat's really dry and sore from being intubated. She had something to eat at 6am. She hasn't had much sleep though, because the ICU has been too busy. She's getting turned every two hours, which isn't terribly enjoyable, but her pain is manageable. She's such a trooper.

Update 2

Sarah's continuing to do well. The nurse sat her up on the side of her bed for lunch, and had half a roast beef sandwich and some fruit. Her throat's still pretty sore, and she's really preferring the liquids. Apparently her blood sugar is a bit high (something that can happen post-operatively) so they gave her some insulin before lunch.

Getting her back down again looked a bit painful, as did shuffling her up the bed.

Apparently there's a bed with her name on it in the intermediate ICU, so as soon as the doctor's order comes through to move her, she'll be moved. They'll also take out the central line and one of the peripheral lines at that time.

Update 3

Last update today. Sarah was moved out of the ICU and into intermediate intensive care (where she'll remain until she's discharged) at 2:25pm. She got a private room again, which is very fortunate. It's nice and quiet, so she should get a good night's sleep. I can stay the night as well.

One of the doctors from the team looking after her came by at about 5:50pm. She said the chest drain can come out in the next day or two. They took another x-ray this afternoon to check on some pleural effusion that they were worried about. When we asked the doctor about it this evening, she described it more as trapped air than trapped fluid, and that it should work itself out in the next few days. The x-ray showed that it was "stable", in that it hadn't really changed from the x-ray in the morning. They'll take another x-ray tomorrow morning to see how it's going.

Other than that, she's continuing to do really well. The pain seems manageable. She got up into a chair for dinner (with help). They didn't give her any more insulin beforehand, so I presume her blood sugar is settling down again.

Saturday, 05 January 2008

Post-op, Day 2

"Day Two Downers" be damned, Sarah's powering along like a freight train.

Neither of us had a terribly fantastic night's sleep. Her chest drain is attached to this big box thing that has some sort of water seal in it, and with the suction going through it, it bubbles and makes noise like a massive aquarium. But she did get some sleep, and said she felt better this morning for it.

The doctor came by at 8am, and took the incision dressing off, and we got our first good look at it. It's big (i.e. long). It runs from about the top of her breastbone to the bottom of her sternum. 20cm at my estimation. She said that she thought the chest tube could come out today, and sure enough it came out at about 12:30pm. They also took her urinary catheter out at that time, so now all she's hooked up to is oxygen. Her blood sugar levels were acceptable at breakfast time.

Oh, the reason the incision ran so high was because they elected to do the bypass attachment to an artery in her neck, rather than further around the aorta, because the tissue was fragile and they didn't want to risk a dissection. Not doing the bypass in the aorta also left them the option of removing some of the transcending arch if they determined it still ended up being necessary.

Sarah got up and had breakfast in a chair again, and was generally feeling pretty mobile. She moved between the chair and a wheelchair (and back) when they came to get her for another x-ray, without requiring any assistance.

She took her first walk around the ward at 11am. I'd popped home for a shower and to check on the cats, and so I missed it.

Doctor Miller dropped in at around 12:30pm to see how she was doing, and that was good as Sarah got a chance to talk directly to him about how the procedure had gone. He was very positive and said she could put this whole thing behind her now.

At 2pm, she went for another walk, this time sans two thirds of the tubes from her first walk, and got in and out of bed unassisted.

She took her last walk of the day at 4pm.

Apparently her blood sugar is still on the high side, but within the range that they don't feel the need to give her insulin. Her chest is apparently looking better on the x-ray they took this morning. They took a second one after they removed the chest drain, but we haven't heard anything about how that looks yet.

She's continuing to do extremely well, most of this less than 48 hours out of surgery.


I've got some internet access so thought I'd properly update you. Basically I'm fine. my incision scar is a lot higher than we expected (will post pic after we get home), my lung function still isn't very good - need oxygen constantly, my chest muscles are a bit sore, so moving in bed is a little tough which makes sleeping hard. i still haven't had a good night' sleep since before we came to hospital. I haven't slept more than about 1 1/2 at any time!

All the most gross things have been taken out of me (chest drain, arterial line and central line from y neck), just have a couple of IVs left and an external pacemaker.

I was feeling very average this morning - I'm a bit anaemic, and I wasn't breathing very well all night which completely wore me out and didn't have much of an appetite. I'm feeling much better now tough, hopefully things will continue to do well. It sounded like my aorta wasn't in very good shape so I'm very glad to have it over and done with!

Anyway, thanks for all the well wishes. It's great to know I have so many people thinking of me.

Ooh DH just said he uploaded a couple of pics - this is showing my incision. If you're a bit squeamish, scroll past!!! I think it's actually pretty impressive considering how invasive it is!

post #2 of 46
The incision isn't as bad as I thought it would be!

I'm glad you're doing so well....hopefully Andrew can now not have to worry so much.
post #3 of 46
So glad to hear you are doing well! (Gentle and )The scar isn't that bad. You should see the one from my gall bladder surgery.
She hasn't had much sleep though, because the ICU has been too busy.
I can sympathize. I once spent 3 days in SICU and could not get any restorative sleep due to the bright lights and noises.

And I know by now you are missing the girls.
post #4 of 46
Nice to see you posting, Sarah. I have to say you look pretty good for someone that had heart surgery just a few days ago. I hope you continue to improve and can get some sleep.
post #5 of 46
So glad to hear you are doing well!!!!! May to get even better!!! Sendilg lots of love and warm wishes!!
post #6 of 46
It's fantastic to hear from you personally Sarah - even though we're really grateful for Andrew's updates from his blogs that have been posted here.

I can't imagine what it must be like to go through such surgery - but wow! what a job you're doing of recovering You have so many people here thinking of you and wishing you well, continued good vibes for a swift recovery (and a good night's sleep)

Keep up the good work
post #7 of 46
Sarah it's lovely to see you!. It's not a bad scar at all, and you've got some colour in your cheeks
post #8 of 46
It's great to see you posting a bit Sarah The scar is not so bad sweetie- i'm sure in time it will heal up and fade a bit too! I hope you feel even better tomorrow!!! Take it easy on yourself, you'll be up and feeling better in no time! I have to add- your hair looks great considering you just had open heart surgery
post #9 of 46
P.s - no worries about the scar. Without it you would not be alive. Be thankful for it, and proud to show it!
post #10 of 46
Yay! It's Sarah!!! It is great to see you, sweetie, and the others are right - you look great considering what you just went through!
post #11 of 46
hey its good to hear from you...Im happy you are doing well!! Sending many your way for a safe and happy recovery for both you and Andrew!!
post #12 of 46
Originally Posted by flisssweetpea View Post
It's fantastic to hear from you personally Sarah - even though we're really grateful for Andrew's updates from his blogs that have been posted here.

I can't imagine what it must be like to go through such surgery - but wow! what a job you're doing of recovering You have so many people here thinking of you and wishing you well, continued good vibes for a swift recovery (and a good night's sleep)

Keep up the good work

I've been checking in but wanted to say that I've been sending many . I'm one of the squeamish one's so I only looked very quickly at the pic.
post #13 of 46
Glad to see you doing so well, Sarah.
post #14 of 46
You have a scar like mine

Glad to hear you are recovering well! Good luck vibes to a speedy healing process!
post #15 of 46
Im glad the surgery went well for you and I dont think the scar looks bad at all!! I must agree that you look GREAT for someone who just had open heart surgery!! Your hair looks good, face has color, I think you look great and it sounds like you're doing just great too! keep up the good work!
post #16 of 46
Originally Posted by AbbysMom View Post
Nice to see you posting, Sarah. I have to say you look pretty good for someone that had heart surgery just a few days ago. I hope you continue to improve and can get some sleep.
You look great Glad to hear you are doing well!
post #17 of 46
Wow Sarah, you really are a trooper girl! That is so major and you made it through Way to go I think scars are kind of cool..like battle wounds
post #18 of 46
You look great, Sarah. Glad to hear about the aortic valve.

Do cardiac surgeons in the Bay Area all wear Cowboy boots?
post #19 of 46
Good to see you, Sarah! We knew you'd come through with flying colours, but it's oh so nice to be proven right! Please take care. Keeping the flowing for quick and complete recovery.
post #20 of 46
Sarah, I have to agree with everyone else and say you look GREAT! Lots of color in your cheeks, your eyes are bright.

As for the scar it looks good as well. It will fade in time. I'm so glad things are progressing so well.

I remember my Dad's by-pass and he felt he didn't have a good night sleep until he arrived home after surgery. At the hospital it was just too busy he said.

I'm so glad you were able to post personally today!
post #21 of 46
You look really good Sarah.
There is a sparkle in your eyes.

I am a member of the zipper club too.
My surgery was in 2002.
It was a challenging recovery but well worth it.

Keep up the good work and you will be better than ever before you know it.
post #22 of 46
How can you possibly look so pretty right after major surgery?

I'm so glad it all went well! And your husband is great to explain it all for us -- he writes like a doctor himself. You both must have learned so much through this process!

It's wonderful that this is behind you now. And now it won't be too long before you can go home to your kitties!
post #23 of 46
So glad to see you posting Sarah!

Your scar does look good, considering the kind of surgery it is for. I am impressed. And I am also impressed with the amount of colour in your complexion - I was kinda expecting you to be pale. You look so good!

Continued vibes for your recovery!
post #24 of 46
So glad to hear from you, Sarah. Like the others have said, you're looking pretty darn good for someone who's had open heart surgery a few days ago!

Lots more vibes for your continued improvement.
post #25 of 46
Glad to hear that you are doing so well!

Given what the doctor said, I'm really glad that you had the surgery now and didn't wait!

As a nurse it's quite interesting to read Andrew's perception of what was happening and his descriptions of the equipment IE: the chest tube set up.

The incision looks very clean and healthy. In time you should hardly have any scaring. It looks like they used sutures intead of skin staples?

I'm still keeping you in my thoughts that your recovery continues to go well.

If you have pain, make sure you are asking for something for it. Don't try and be stoic and "live with it". Pain medications at this point are your friend
post #26 of 46
OMG Sarah, somehow I missed all of this!

I cannot believe how great you look after what you just went through! You've got SUCH a great attitude about it. I didn't know you were considering waiting on the surgery - but after reading through all of this, I'm really glad you didn't wait.

I am SO glad things went so well - and I'm just sending huge amounts of vibes for a speedy and complete recovery with no complications!

post #27 of 46
Wow! Like everyone has said, you look so good! I hope you can get some rest there soon. I don't know that I could sleep well at a hospital at any point! I'll still be keeping you in my prayers!
post #28 of 46
Glad to see you looking so well in such a short time, continued recovery, Best Wishes to you also
post #29 of 46
I think you look wonderful, I can beleive how well you are doing, you are amazing
post #30 of 46
Adding my well wishes for your continued swift recovery!

I agree with everyone else...you look great!
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