My first night at home, Sunday, was perhaps my most mentally draining. It’s a close call with Friday night in the hospital, when I was dealing with my highest pain level. I went to bed at 10:30 on Sunday night and immediately began coughing blood. The first sputum came from my lungs, and the discharge was a blend of clear phlegm and blood. This scared me. Over the next three hours, while I attempted to sleep, I coughed up blood seven additional times. Each viscous collection after the first was a deep maroon color. I checked the instructions on my discharge papers, and the physician’s assistant noted that I should call him off hours, if I experienced “heavy bleeding”. Was my coughed up maroon phlegm heavy bleeding? I am a chronic worrier, and needless to say, this sequence of events was not aiding my attempts to sleep.
In addition to the blood, I was coughing. Did I contract corona virus, and now I was faced with a battle for life? These thoughts sound ridiculous now, but at 2AM on Monday morning while lying in bed with no access to medical assistance short of an emergency room visit, one’s mind can wreak havoc on a positive mindset. Somehow by 2:30AM I fell asleep, and a repeat of coughing blood never reoccurred. On Monday I called my doctor, and his assistant speculated that the blood was related to beginning my blood thinner treatment. A visit to the anticoagulation center on Tuesday confirmed the likelihood of this theory, as my blood thinner index increased from 1.5 in the hospital to 3.3 by Tuesday. In theory the thinned blood resulted in some bleeding in my nose, and that in turn created the nosebleed like sputum.
A highlight for Monday was my first bowel movement since my admission to the hospital on Thursday, This may seem like an event not worth chronicling on a blog such as this, but it was worth celebrating for me. If you ever experienced surgery and anesthesia, you will appreciate my joy at this turn of events.
The greatest challenge of my early days in home care was finding a comfortable chair and cushion configuration. Jane and I experimented with the kitchen chair, couch, office chair, and a large overstuffed armchair, that Jane miraculously hauled up from the downstairs recreation room by herself. I am still amazed that she managed this feat without getting injured. The main source of discomfort was the groin incision and the associated swelling. Any seat that was too soft aggravated and stretched the incision. Slouching and keeping my knees elevated and bent seemed to provide a modicum of comfort, but this position eventually induced lower back pain. I never found a complete answer to the dilemma, but a combination of a firm seat and several large pillows to support my back yielded the most tolerable position.
Throughout these early at-home recovery days, Jane was amazing. She was by my side at all times. In hindsight my balance was fairly wobbly, and I needed Jane to prod me to use the walker constantly. She prepared all my meals, helped me get comfortable in the chairs, and endured numerous trips up and down the stairs to transport my toothbrush, electronic devices, water cup, and everything one takes for granted until a time of need. She assisted with my showers and helped me dress and undress. Jane was on top of my drug dosages and helped take my temperature, blood pressure, heart rate and weight on a regular basis.
Speaking of drugs I was taking a diuretic, potassium chloride, and cuomadin on a regular daily basis. At night I started out taking extra strength Tylenol, but after two nights of restless sleep, I took the narcotic, norco, for three consecutive nights at bedtime. The stronger painkiller seemed to improve my sleep in the first five hours, but I struggled with an annoying tickle and cough each morning at 3AM, that made returning to sleep a problem. Finally by the sixth night at home I reverted to Tylenol and the coughing disappeared, and these were welcome developments with this recovering patient.
On Wednesday I had my first visit with the at-home physical therapist, Vanessa. She was very pleasant and asked me a batch of questions, before she implement a series of tests to evaluate my endurance and balance. First I walked in circles around the dining room and kitchen with the walker for eight minutes. Next she had me stand and balance, while she applied light pressure to all sides of my body. I walked in a straight line from the kitchen to the front door and back, and during loops three and four I repeatedly looked up and down. On the fifth and sixth passes I looked left and right. My final challenge was to scale the first flight of stairs and then return to the bottom, while she looked on. Vanessa turned my cardiac rehabilitation over to her assistant Jeffrey, and he visited me three times over the next two weeks for controlled exercise sessions.
Throughout the first two weeks my Drive walker became an indispensable aid to my mobility. The sixty dollar investment was money well spent. Having the smooth rolling conveyance allowed me to conveniently move from place to place with the convenience of a small storage bag and a seat to rest on should the need arise. Nice weather during my second week at home allowed me to complete my daily walks with the trusty Drive walker supporting my every step and available for rest stops. I highly recommend one of these devices to anyone undergoing significant surgery.
On Tuesday April 28 Jane and I drove to Boulder Heart for my follow up visit with Dr. O’Hair. In order to minimize trips from Denver to Boulder, I combined the doctor’s visit with chest X-rays and my anticoagulation appointment. During this visit the physician’s assistant, Ann, and Dr. O’Hair detected atrial fibrillation (a fib). The monitoring equipment in the hospital showed a similar event on Saturday. Dr. O’Hair told me that 30% of mitral heart valve repair patients experience a fib, and in most cases it self corrects, as the heart mends and recovers. He prescribed four weeks of monitoring with the hope that my body would resolve the erratic heart beat condition. If not, I will have an appointment with a cardiologist who specializes in issues with electrical impulses of the heart. I was not pleased with this turn of events, but I have little control so resolved to move forward with positive thoughts.
I am now in day 16 of my recovery and feeling reasonably good. I completed a 1.1 mile walk with the walker this morning, and I felt fine afterward. Climbing two flights of stairs in our house remains a challenge, and I generally stop to rest on the landing and then at the top before resuming. The physical therapy exercises prescribed by Jeffrey are a priority, and I resumed my finger, wrist and elbow exercises routine from my pre-surgery days.
Throughout the ordeal communications with my friends and relatives have been a significant positive. Each email that arrives in my Gmail inbox provides a mental boost. In addition I resumed reading novels, and several days ago I felt strong enough to migrate downstairs to my tying desk to whip out some flies. Today for the first time I successfully worked in my garden, and with Jane’s assistance I planted some leaf lettuce, beets and carrots. It felt great to do some productive outdoor activities.
The a fib concerns me and my incisions have not totally healed, but I am beginning to see a future, where I gain strength and return to a life more akin to my pre-operative state.