Home Recovery 05/02/2020 Photo Album

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.

In my previous post I neglected to mention that the nursing staff moved me from the intensive care unit to a regular hospital bed around midday on Friday. Prior to this move they removed the hated drainage tube, but by this time the groin incision pain far outweighed the drainage tubes as a source of torment. After a torturous night on Friday in my new room, I awoke on Saturday morning with a slightly increased appetite. I also noticed that my new room contained a huge picture window with an amazing view of the fresh snow blanketing the Flatirons.

I ordered another breakfast of plain Greek yogurt, honey and strawberries; but on Saturday I supplemented it with a banana muffin and a banana along with a cup of black tea. The combination hit the spot, and after breakfast I called Jane and checked in with her. Talking to my wife after the rough unending nightmare of Friday night was reassuring. Jane informed me that a fly-by was scheduled ahead of the Air Force Academy graduation ceremony, and sure enough around noon the sound waves were shattered by a supersonic aircraft. I am always awed by the power exuded by powerful jets.

My day on Saturday consisted of further transitioning from hospital existence to self sufficiency, although I was a long way from that status. The physical therapist came to visit, and I completed several walks during the day. My goal was to get out of bed and walk for five minutes four times a day, and the nurses made sure I succeeded in achieving that goal. In the early afternoon an occupational therapist arrived to observe and guide the nurses in the completion of my first shower. They helped me undress, and I sat on a bench and sprayed my body with warm water from a hand held nozzle. The shower actually felt good, but it took an eternity afterward to reattach the wires and IV’s, and I developed a severe case of the chills. My thighs began to shake uncontrollably, until the nurses assisted me back in bed and covered me with warm blankets recently removed from an oven. These shivering episodes would plague me throughout my hospital stay, and I never heard a solid explanation of the cause.

My dinner on Friday night consisted of broiled salmon, broccoli, and rice. It actually tasted decent given my mental state at that time. For dinner on Saturday my appetite was absent for any sort of protein or salad, so I ordered some chicken noodle soup along with bread and more yogurt. The soup was salty, but overall it hit the spot. My caregivers on Saturday night were the same pair as Friday, but I was more aggressive in demanding narcotics, and the night was as pleasant as could be given the circumstances. The pace of time continued to drag at a glacial pace.

On Sunday morning I received a notification on my phone that Trump was backing the groups that were protesting the Stay at Home orders in response to the covid pandemic. With a daughter and daughter-in-law working in physical therapy and having spent four days under the devoted care of health care workers during the corona virus epidemic, I viewed Trump’s position as a huge middle finger directed at our most courageous people. I actually got teary-eyed over this action. Maybe I was in a fragile emotional state due to the drugs, but I think it was a reaction to the callous uncaring nature of our president.

On Sunday morning I was once again visited by a physical therapist. The young lady grabbed a red Drive walker from a neighboring room and showed me the capabilities. When she mentioned that it would make walks outside in nice weather more manageable, I was sold, so I texted Jane, and she immediately ordered one on Amazon for Tuesday arrival. This proved to be one of my better purchases. The stable walker easily supports my weight, as I roll about the house or outdoors, and it features a padded seat that lifts to reveal a small storage compartment. A padded carrying handle folds down to become a backrest for the seat should I temporarily tire. I was told that cup holders can be added as an accessory. Geriatric crowd, here I come.

I took another shower on Saturday morning, and the chill was controlled better than Saturday, but I made the mistake of ordering a strawberry banana smoothie for lunch. Unlike my mango smoothie on Saturday, the Sunday version was solid like frozen yogurt. Upon completion of the yogurt my body went into shiver mode, and I had to request two layers of blankets to regain my temperature equilibrium.

After lunch and a visit by Dr. O’Hair and PA Mark, the nurses began to prepare me for discharge. The first step consisted of removing me from the oxygen supply to which I had become somewhat dependent. Even after I was at home for several days, I imagined that the oxygen hose was still hooked into my nose on my upper lip. I transitioned off my oxygen dependency for two or three hours before my release.

Finally at 4PM Jane called to say that she was outside in the parking lot. She stopped at the pharmacy along the way to purchase a batch of cuomadin, since I was on a daily dosage for eight weeks. Because of the corona virus situation, Jane was not allowed to enter the hospital, so the nurses helped me dress and then wheeled me down to the curbside pickup area. Jane helped me climb into the passenger seat, and we returned to Denver. Cars were circling through the drive through area in front of the main entrance while displaying yellow banners in support of the health care workers. I was pleased to see this counter to the Stay at Home protesters.

Sunday was a pleasant day with the high temperature in the mid-sixties. I was very pleased with this circumstance given my recent history with chills. We opened the window, but for the first fifteen minutes of the drive I felt that I was verging on being out of breath. I suspect this was part of being weaned from the oxygen supply in the hospital room. In an effort to counter the slight oxygen debt feeling, I began taking long deep measured breaths, but this quickly led to light-headedness and a case of mild hyperventilation. Eventually I adjusted, and the last fifteen minutes of the drive were uneventful. It was quite a boost to be home and under the care of my loving wife. Phase one of mitral heart valve repair was behind me.

My second scheduled day of surgery arrived. My first on March 16 was aborted because of an ill-timed ski trip to Vail on March 9, which triggered the high country self quarantine. On Thursday morning, April 16 amid unfavorable driving conditions Jane and I cautiously made our way to Boulder Community Health. When I checked Apple maps, I noted that the Boulder Turnpike was yellow from just west of I25 until the exit on Foothills Parkway. Fortunately we allocated sufficient time and arrived at our designated 6.45AM check-in. We answered questions about exposure to corona virus and travel, and then proceeded to the check-in kiosks. My number appeared on the sequential appointment screen, and I approached the registration person. After answering some basic questions she looked at me from six feet away and said I was not authorized, and would I be willing to sign a waiver stating that I would pay the cost, if my surgery was not approved by insurance. My leaking heart elevated with this surprise turn of events. I quickly rejected this concept, as thoughts of a $200,000 bill rumbled through my brain. The receptionist jumped on the phone and talked to someone, and when she hung up, she said the system was corrected, and we could proceed. I heaved a sigh of relief knowing that my surgery would not be cancelled for the second consecutive time.

Jane accompanied me, as we made our way to the cardiovascular unit on the second floor, and we were ushered into a pre-op room. As was the case on March 16, I removed my clothes and stuffed them in a bag I brought along and slipped into my hospital gown. Hospital gowns come in one size; extra large. Unlike the previous aborted trip, I knew in advance that Jane would not be able to visit me in the hospital, so my bag contained a bath robe, toiletries, an iPhone, iPad, charging cables, and three magazines. I was traveling light for this engagement. I got situated on the bed, and one nurse pushed a vaseline substance up my nostrils, while a pair of female nurses got out the tools. The tools I speak of are razors. Because I would soon be the proud bearer of an infinite number of tubes, wires and hoses; the women began to remove hair at an unprecedented clip (get it). The nurse and anesthesiologist meanwhile occupied my mind with questions, while the hair removal assault continued. This pretty much ends my recollection of the morning, as the drugs were released through the IV tubes, and the surgical staff had their way with me.

My next recollection was around 4PM on Thursday afternoon, at least I think I was told that time. I was on my back in the intensive care unit with numerous faces staring down at me. It reminded me of one of those fisheye lens photos that folks sometimes impose on the public. I think someone phoned my wife, and I uttered some incoherent gibberish, but I would not swear to it. Apparently the removal of my intubation tube was in progress. A person kept asking me a question, but it was impossible to reply with a large tube in my mouth. Can anyone explain the logic of this? It was kind of like the dentist asking you something with his hands in your mouth, only much more uncomfortable. Eventually my major hindrance to voice was removed, but my mouth and throat were an irritated mess.

My next focal point was the drainage tubes that poked me in my back. It felt like I sat on a sharp stick that had been gnawed off by a beaver, and I was forced to hold that position for twenty-four hours. If you ever get invited to such a torturous state, please decline. In an effort to encourage me the head nurse told me that I would feel much better when the tubes were removed on Friday around midday. The effect on me was not positive, as all I could think about was eighteen additional hours of pain. One positive, however, was to divert my attention away from the burning, pinching pain emanating from the groin incision, where the heart machine had been connected. You will hear more about this later.

A certain recipe for laughs in our family is to bring up Dave’s incoherent speech after undergoing anesthesia, and Thursday night was probably no exception. In our family storytelling forum I recount my version of what I was saying, and my wife or guest then refutes my thinking and reveals my actual muddled mutterings. If you have never done this, you should undergo a surgery just to engage in the fun practice. In this case, however, Jane was not allowed to be present, so I was unrestrained. I often wonder what sort of a fool I made of myself. I can only remember that my savior throughout the night was ice. The head nurse constantly dropped nugget ice in my mouth, and without it I am not sure I would be alive to tell this story. As it so happens, during my working career I was the VP- Finance of ICE-O-Matic, an ice machine manufacturing company. After one session that included three mouthfuls of ice, I decided to lecture the nurse on the various ways of making ice. I wonder how that came out? I suppose I will never know, but I swear I was perfectly lucid.

The number one goal for Friday morning was to get out of bed and into a chair. The thought of it made me queasy, but with adequate assistance from my nurses I made the move. You may be surprised to learn that hospital lounge chairs are no more comfortable than beds. While I’m on the subject of hospital beds, let me rant for a bit on that topic. The bed can be controlled by some arrow buttons along the side, and it moves in two ways. The legs can be elevated or the back can be tilted. The one section of the bed that cannot be directly controlled is the butt section. Aside from the drainage tubes, my next source of excessive pain was the two inch incision in my groin between my abdomen and the inside of my right leg. The slightest stretch or movement in my leg elicited a sharp burning, pinching sensation. When the nurse elevated my legs, my butt section sank deeper in the hole, and this placed increased pressure on my groin incision. Raising the back of the bed simply brought my abdomen forward so that my body was in a folded position with my upper body and legs raised. That hurt. I felt like a human being folded into a taco shell. The best the attending care givers could do was to stuff old fashioned pillows in various positions, until I found a point of least pain.

In order to test the mettle of hospital occupants even more, somebody came up with the idea of a hospital gown. Mine was at least five sizes too big, and it came with a small pocket on the right front. Every time I got out of bed, the nurse moved a 6″ X 4″ X 3/4″ heavy electronic module from the side of the bed into the sole pocket on the gown. Guess what? Inevitably the heavy box would sag down to my groin and rest against or bounce against my incision. There must be a better way.

After I accomplished the amazing feat of getting out of bed and dropping into my chair, I ate my first breakfast (Greek plain yogurt with honey and strawberries, a cup of black tea and an untoasted bagel with margarine that would not melt because the bagel was cold). By the noon hour someone decided that it was time to remove the drainage tubes. I looked forward to this event all night, but now I can barely recall it. I remember that some pain disappeared, but I think the groin incision and my impossible position in the bed or chair dominated my thoughts, and the tube removal boost never materialized. I would compare it to opening a Christmas gift and discovering that you already knew you were getting it.

On Friday afternoon I requested my electronic devices, so I could open up communication with friends and relatives. I Face-timed with Jane (I think I was coherent), and I sent a few text messages. I remember getting extremely frustrated, as my addled state of mind, poorly functioning digits, and predictive text and spell check were absolutely abusing me. These hindrances combined with a person, who writes every communication as though they are submitting a term paper for an A is a recipe for irritation. I can only hope that the nurses in the hallway could not hear my less than cordial language.

Friday night was a nightmare. The head nurse and assistant changed shifts, and eventually I would grow to like the new crew, I was not pleased with them on Friday night. They were professional and efficient, but for some reason my previous attendants seemed more caring. Maybe it was the preponderance of ice from the Thursday night guy that won me over. Has anyone else ever noticed the glacial progression of time during nighttime in a hospital? Can’t someone install a booster in the clocks? At any rate Friday night, April 17 was certainly the worst night of my life. Somehow I let the pain get ahead of me. I was quasi-lying/sitting in an uncomfortable position that stretched my groin incision beyond tolerance. Have you ever over inflated a football to the point that the internal bladder is visible between the seams? My groin was the bladder and the seams were the incision. The center of my chest felt like someone rammed it with a digging bar, and the right pectoral area was so sore, that it was numb. I reclined in my least painful position in the bed and counted throb after pinch. It was incessant, and I began to wonder, if a person could die from pain. The prospect of constant future pain is what really demoralizes the mind. and the clock hands seemed to be frozen in time. At one point the nurse came in to check on me, and it was dark and felt like 3AM, and they told me it was 8:30PM. I was a grumpy, stressed mental case, so I did what any red blooded man would do, I began begging for morphine. Well, I’m not sure I specified morphine, but I asked for relief. They asked my pain level, and I didn’t even lie and uttered 8. Several doses of morphine got me through the night, but it was the longest ever. What happened to the fun part of doing drugs? All I ever felt was the negation of pain, but I was thankful for that.

I made it through my low ebb, and the next installment will cover the final night and two days in Boulder Community Health.

Simply stated my life expectancy goal is to remain as active as possible for as long as possible. Of course I would like to live as long as possible, but the quality of life is important, and this objective drives me to exercise and eat healthy. My previous blog post provides much more insight on my views on this topic.

In June of 2019 my primary care physician diagnosed a heart murmur and referred me to a cardiology practice for further testing. In July 2019 I underwent an echocardiogram, and the heart specialist recommended a TEE. A TEE is a procedure, whereby, an instrument is lowered into the esophagus to obtain a clearer view of the heart valve. For various reasons related to insurance and referrals this procedure was never administered until January 2020.

During this time period I ran a road race in Stapleton, and although I placed first in my age group, I severely injured my Achilles tendon. The ache on the inside of my right heel was so severe, that I canceled all pickle ball and halted my running program. When the pain ceased to improve, I began attending physical therapy, and these sessions continued from September through November. July, August and September are my favorite months to fly fish, and my Achilles did not inhibit my stream time, so I was partially guilty of not pushing treatment for the heart murmur condition.

By October my Achilles improved, and I began a controlled return to running. Shortly thereafter the physical therapist approved a return to pickle ball, and I jumped at the opportunity. Unfortunately this action resulted in another delay in my return to fitness. During a pickle ball session in the middle of October, a short rain shower left the court wet. I circled back to the baseline for a lob shot, and when I planted my right foot, it slipped and moved twelve inches. I applied my muscles to prevent a fall, but the sudden action generated a popping sound. For the next several weeks my inside groin and the outside of my hip were extremely sore. I attempted to return to running and pickle ball, but the soreness after each session was significant, and I sensed that I was doing more damage than good. I returned to physical therapy in January, and the therapist diagnosed me with a severe right hip nerve impingement. Maintaining an active lifestyle during my aging was proving to be more challenging than I expected.

Also during this time period Jane and I booked two bucket list trips. The first was scheduled for May 17 to Kauai, as Jane and I never visited Hawaii. We also made a deposit on a June 6 boat and bike trip from Cologne, GER to Amsterdam, NED. The boat would transport 26 guests on European waterways. and the guests would disembark each morning and cycle for 20 – 25 miles and then return to the barge, as it floated down the river. Breakfast, lunch and lodging were provided by the boat and were part of the package. Needless to say we were quite excited about this new adventure.

By January the TEE was finally scheduled and approved by my insurance, and it took place on January 24. I called to make an appointment with the cardiologist who performed my procedure and learned that he was on vacation for two weeks, and the earliest I could meet him was four weeks later. Given the scheduled trips I did not wish to wait four weeks, so I opted for a different doctor. Within a week of my TEE, I met with Dr Decicco, and he informed me that I had a leaking mitral heart valve. The border for severe is 60 ml, and my leakage was 100 ml. My atrium, the heart chamber downstream of the heart valve was somewhat dilated because of my condition. I was shocked and dumbfounded by this news. I felt strong and fit and did not exhibit any of the leaking heart valve symptoms. Dr. Decicco told me that the rest of my heart was extra strong due to my fitness and compensating for the leak, but he advised that this could not continue forever. Eventually the condition would deteriorate, and in all likelihood the repair would be more difficult and the recovery longer. I agreed to pursue surgery, and Dr. Decicco prepared a referral. Another prerequisite to heart valve repair surgery was to undergo a heart catheretization. This step was necessary to confirm that the remainder of my heart was healthy, as the surgeons did not want a surprise.

Meanwhile my physical therapy was progressing nicely, and I resumed running and pickle ball. I began the running program by walking for three minutes and running for two minutes for a total of twenty minutes. Over time I increased the running over the walking and eventually the distance and time. I played pickle ball indoors, and my Achilles and hip held up well under the increased strain of my activities.

Concurrent with my fitness and health progression, the rest of the world began to display signs of distress from the corona virus. The first U.S. case was reported on January 20, so the timing of my heart valve evaluation roughly coincided with the covid progression in the United States. I scheduled the heart catheretization for February 7, and the procedure confirmed that my heart was very healthy other than the leaking mitral valve, and Dr. Decicco referred me to a doctor at CU Health, who was highly recommended, to perform minimally invasive surgery. Things were moving along, and I clutched at the hope of threading the needle with surgery without cancelling our trips.

I contacted the office of Dr. Rove at CU Health, and I discovered that she was out of network, but her assistant was very certain that I could be approved and treated as an in network patient. I made an appointment for February 18, but two days before the meeting, I received a call from my primary care office, and they told me the doctor visit was not authorized. I immediately assumed it was because of being out of network, but instead I was told that the referral was only submitted two days earlier!

Again wishing to expedite the process with the hope of completing our scheduled trips, I decided to pursue in network options. I did an online search for cardiologists who perform minimally invasive mitral valve repair, and as I did this, I cross referenced the doctors’ names to the United Healthcare provider search list. I found six in network doctors that could perform my necessary surgery. One stuck out to me, Dr. Daniel O’Hair, at Boulder Health. He did robotic minimally invasive mitral valve repair, and I experienced good results from robotic surgery on my prostate. I made an appointment with Dr. O’Hair and asked my primary care physician to generate a referral. Ultimately the referral for Dr. Rove was approved, and I ended up with back to back appointments with two cardiologists during the first week of March. In the end I elected Doctor O’Hair, because I liked the idea of robotic, and he was in network, thus, less risk of not being approved given my tight window before our scheduled trips.

The die was cast, and Dr. O’Hair’s office called fairly soon after my appointment to offer surgery on March 16. I gritted my teeth and signed up with the continuing hope of fitting the surgery and recovery in before our Kauai trip. During the week prior to my scheduled surgery my daughter visited from Portland, OR, and in an effort to take advantage of her stay, we spent a day skiing at Vail on March 9. On March 15, the day before my surgery, the rapidly rising number of covid cases in Colorado ski country caused the governor to self quarantine anyone who had been there in the previous 14 days. On Monday morning March 16 I reported to Boulder Community Health for my surgery. The receptionist in the cardiology area asked, if I had been in the high country, and I truthfully answered yes given our ski trip the previous Monday. She immediately tossed a surgical mask my way and asked Jane and I to sit down the hall, while she investigated the next steps since the protocols were only announced late on Sunday.

After a short time, however, Jane and I were ushered into a pre-op room, where I was asked to remove my clothes and get into a hospital gown. The nurse arrived and hooked my left arm up to IV, and I was starting to believe that I would sneak in under the wire. My optimism was unfounded, as a Dr. Ellis eventually appeared, and he told me that my surgery was cancelled, and that I needed to self quarantine for 14 days. In addition the hospital was discontinuing elective surgeries starting on March 17, so he was unsure when my surgery would be rescheduled.

I put my regular clothes back on, and Jane and I returned home. My stress level dropped considerably, but now what about the surgery. Given the progression of the pandemic, I was convinced that I would not be rescheduled until May or June. Did I even want to be scheduled for heart surgery during a respiratory virus epidemic? I decided to take advantage of the break, and I resumed my running and fly fishing. The Stay at Home order put a clamp on pickle ball, but outdoor activities remained in bounds when associated with social distancing. I continued to ramp up my running, until I was able to run forty minutes consecutively by April 14. When weather was cooperative, I managed five fishing trips to Colorado rivers and streams. I was making good use of my surgery hiatus.

On April 7 I was sitting in my home office, when the mobile phone rang. I answered and heard the voice of Beth, Dr. O’Hair’s assistant, who informed me that she signed me up for surgery on April 16, and was I interested? I told her the timing was perfect, but I was concerned about the safety given the corona virus crisis. She provided a host of reasons that the doctor and hospital felt it was safe, so I accepted the date. In the final analysis I felt that the hospital would not accept the liability, if they were not very certain that the risk was low.

Until recently I tried to avoid thinking about aging. The human body will inevitably break down, but I set a goal to remain as active as possible over my lifetime. My strategy included daily exercise, running, and an abundance of outdoor activities. My eating habits since childhood have generally been exemplary. My father always planted a large garden, and fresh vegetables were always available. I was the rare child that did not need to be prodded to eat my vegetables. I am lactose intolerant, so that eliminates fatty dairy products from my diet, and I elect to avoid red meat on a regular basis.

In 2010 I acquired an iPad, and at the time my weight had ballooned from the 120’s of my twenties to the 155 mark. I would not consider myself overweight, but I began to experience difficulty getting up when I fell on skis, and my impact while running was noticeably heavier. I decided to try a calorie counter app and downloaded FatSecret to my new iPad. I set a goal to finish each day at negative 500 calories. Later I discovered that a cumulative negative 3000 calories over time translates to a loss of one pound of weight. Counting calories was a significant eye opener. Early in the game I discovered some quick hitters to cut my calorie intake. First came sugary beverages. I was amazed at how many calories could be avoided by shifting from Gatorade to water or unsweetened ice tea, so that was an easy move. I regularly ate a whole bagel for breakfast, so I reduced that to one-half, and once again a small change in diet resulted in significantly reduced cumulative calories. While I was still working, I had a small scone along with my cup of tea during a mid-morning break. Can you guess how many calories a small scone has? I stopped buying scones. I am an avowed pretzel lover. Pretzels are actually a relatively healthy snack, but they are a carbohydrate, and they do provide calories.  Previously I could binge on a half bag of pretzels at one sitting. Once I understood the calorie impact of my addiction, I limited myself to two servings at snack time.

In the three months after acquiring my iPod I reduced my weight from 155 pounds to 135 pounds. Since that period of time I have been in maintenance mode. I continue to track my calories, but rather than be in a net negative position each day, I target to balance intake and burn. It is not unusual for me to tabulate my position after dinner with the hope that I am negative 800 and, therefore, eligible for an evening snack. Counting calories made me appreciate the value of my running program, as running burns significant calories in a short period of time. Running translated into more snacks for Dave. In addition, running along with cycling and hiking improved my cardiovascular strength and allowed me to enjoy outdoor activities that were out of reach for others my age.

Of course there are no guarantees in the game of life, and in 2016 I faced my first obstacle to a continued active lifestyle. I was diagnosed with prostate cancer in November 2015 and survived a prostatectomy in January 2016. The operation and recovery were a bump in the road, but I survived and eventually elevated my fitness back to levels before the operation. The next four years were golden years, as I maintained my weight and fitness and achieved record years in fly fishing accomplishments. I was retired and in good health, and Jane and  I maximized our opportunities for travel, hiking, camping, cycling, running and fly fishing. I was living the dream.

My Medicare plan provides for an annual “in home” check up, and during this event in November 2018 the nurse heard a heart murmur. She advised me to confer with my primary care physician, and I followed up with a physical in June 2019. My doctor confirmed the heart murmur and referred me to a cardiologist. In July 2019 an echocardiogram revealed a leaking mitral heart valve, and a TEE procedure in January 2020 refined the diagnosis, and my valve leak was placed in the severe category. In spite of this condition I remained without symptoms, and my cardiologist attributed this to my superb conditioning.

I was reluctant to proactively go from a healthy sixty-nine year old male to a rehabilitating heart patient, but the cardiologist reasoned with me. First there was the chart that showed that the life expectancy of a man with a repaired mitral heart valve was the same as a man without a heart valve condition. On the other hand, the life expectancy curve diverged rather rapidly when comparing a male with no heart valve problem compared to a man who failed to correct the condition. Facing death is always a sobering experience. In addition, I was a candidate for minimally invasive repair, and this procedure is far more desirable than invasive repair or even heart valve replacement.  Aging increased the likelihood of the latter developments, and aging also made recovery longer and more difficult. I was convinced and made the decision to undergo minimally invasive heart valve repair. My next post will resume the story from here.