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.
Today:
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!
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.
Today:
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!