Monday, July 29, 2013

Day 6 Post-Valve replacement/Cardiac surgery..

So what was done was still a little confusing to me but in the open heart surgery Dr.Mitchell took out the aortic valve, did an aortic root expansion (to be able to put in a bigger aortic valve size, better efficacy) and put in an Aortic-St.Jude Mechanical valve 21 size. Chest tubes where removed post-op day 2 (Thurs) and Ventilator was removed post-op day 3 (Fri) a.m. Right now they only have the EKG/Pulse-Ox monitors on (many leads, 6 wires) and as of this morning (mon) are only running Clindamycin 2x's per day (IV Antibiotic), while the blood thinner level(s) was within their target INR level today so the IV Heparin was stopped and oral Coumadin just continues daily. I off hand can't think of anything else that is being run through the IV but it is NICE to not be soooo tied down (I can semi-easily temporarily disconnect all the wires and so other than with PT this morning am going to go for my 1st solo walk in the hallways/around the hospital tonight!!! I am on isolation measures just like at UW though a different bug and so have to gown up in the pretty (kidding) yellow gown and wear gloves but still I can leave my room! Considering I am pretty well bending like normal, got myself dressed including socks and have semi-washed up (teeth, face, deodorant) I feel semi-human!

The past few days daily Chest xrays in addition to the daily Labs have been done. The Xray to look for heart swelling/retaining fluid, the labs to check INR (blood clotting-blood thinner levels) and tomorrow other tests will be added with the possibility of getting out Weds! Amazing actually considering I was a "high-risk" pt and Cardiol. thought i'd have a super tough post-op recovery! With staying on a very regular pain med routine and almost constant ice on my chest and neck I have been able to get the discomfort down to a 2!
As far as the future and meds my Cardiologist said it will take time for the heart to re-model as it is so thickened and the muscle so over-worked right now from the so severe aortic stenosis but we should be able to eventually remove some meds.. He thinks we'll be  able to wean most of the cardiac meds (minus the  new, daily blood thinner of course) though he expects this will take some time for the heart to return to a "new normal". I am just happy we may eventually get to get rid of or at least vastly reduce the Lasix and the other 2! Aldactone and Bisoprolol (water reducing med and for reducing strain on heart) these 2 meds though milder in nature (how they affect day-to-day life) would be great to remove to and so I can patiently wait! Dr.Earing did bring up about having to eat a semi-consistent diet which is something  I don't do and food in general is something I eat only when hungry vs regular meals as most do. Different diets can affect the Coumadin level and so by being consistent it helps the target level stay more consistent thus less dose switches, less having to think about the med and less eventual blood draws if we can get the INR to a stable day-to-day level. Yikes on that one! He recommended to his NP that Dietary come by and help sort this out as I admittedly have some learning to do on this med.
He also said despite the Mitral valve looking "awful" on Echo's that this appeared fairly mild on the trans-esophageal (not sure if that's the right name off-hand) Echo and he expects it will "(hopefully" as he put it) stay stable for some time now especially w the aortic valve fixed and the heart not having to work so hard.

One of the ironies of this week has been while I get the weekly enzyme replacement drug literally right across the walk-way in the Genetics clinic I apparently am not going to get the drug while in-patient for multiple reasons. 1 reason being they cancelled the normal Genetics Infusion clinic since I was having this heart surgery and so there is no nurse there (understandable) + I guess the floor nurses aren't comfortable infusing It (talked to the Head Nurse and she knew nothing about this, was going to page the Resident and if Pharmacy would do it she had no problem giving it! - She said they sometimes have other 'enzyme' kiddos they do while in-pt on the floor!. This is amusing bc we where always able to get the drug at UW for the past year now anytime I was in-pt (ordered by UW, paid for by Dean, sent to the Neurosurgery Pharmacists and run by the floor nurses.) Not a big deal. Genetics told the Resident it wasn't a big deal to miss on a week post-surgery given I was more susceptible to a reaction when my body may not be at it's top immune response wise (??).. Given I have had the drug literally probably a dozen times in this scenario I told the Resident I thought that was a crap answer and Genetics just wasn't wanting to deal with how I might get it infused while here. Sooo weird!!!! Not as if they have to do anything and someone would just have to walk the vials of drug over to my floor!

To be Cont'd.... Stay tuned and do plan to call my GC tomorrow to try and get her help to solve this as if the Floor Nurses will do it and HAVE done the similar drugs before then should be no big deal!?!
Thanks for stopping by,


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