In parts 1 and 2, I discussed the original diagnosis of my aortic valve regurgitation (heart murmur); later referral from my internist to a cardiologist; various tests and examinations performed during regular visits to the cardiologist and, his conclusion that "at some future time," I would need to have my aortic heart valve replaced. Well, that time is now.
Today I would like to discuss some of the psychological aspects of living with the diagnosis over the past few years, especially the past six months: my last visit to my cardiologist; my visit to the heart surgeon, and a preview of the pre-surgery tests that were required. First, let's talk about what I have been thinking about for the past six months or so, at least as it relates to my heart.
As I have mentioned before, the usual symptoms of valve regurgitation include fatigue, shortness of breath, ankle swelling and episodes of rapid heart beat, among others. I have had none of these (more on this later). In fact, I have continued my normal routine of three hours of various cardio activities every morning, along with weight training twice a week.
When my wife, Wendy, and I play golf, we always walk and pull our clubs if the course so allows. Most vacations center around hiking, biking and other outdoors activities. However, over the past six to nine months, since Dr. Berger told me I will have the valve replaced, most likely within the next year, my brain has been searching for symptoms.
Wendy and I are walking on the Lake Michigan lakefront path in downtown Chicago (which we do all the time, usually for 10 to 12 miles) in January. It's about 20 degrees, snowing, with 20-plus mph winds. At about three miles, I feel lightheaded. Even though I was recovering from a sinus infection and a course of antibiotics, I immediately think "heart valve." I have a quick vision of Wendy having to call 911. I very reluctantly tell Wendy I need to turn back.
I relay this to Dr. Berger during my next visit. He says, "not your valve." The biggest episode came at Thanksgiving when our family was in Hilton Head. Wendy and our daughter Amanda (a gym rat, herself) and I rent wide-tire bikes to ride on the beach. Its about 10 miles one way to the end of the beach. We head out against a very strong headwind. I'm dying. Its getting harder and harder for me to keep up. I'm peddling for all I'm worth and I'm getting a little breathless.
We stop and rest for a minute at the 10-mile turnaround. I see that I'm much more tired than they are. I start to think about where Wendy can pick me up with the car, because I don't want it to be an ambulance, as it's surely my heart valve. As we start to bike back, I hear a funny noise coming from the front of my bike. My front tire is completely flat! I have been peddling on the sand, against the wind with a flat tire. Not my heart. I have had several of these instances. In addition, sometimes when I have had a particularly hard morning workout, I might fall asleep on the couch for a short nap in the afternoon. Normal for a 64-year-old? Heart valve? Who knows, but its an unpleasant "side effect" and I will be glad when I have a new valve.
So, I went to Dr. Berger last Monday. We started with an echocardiogram (which I detailed in a previous part). Dr. Berger reviewed the results and came in and told me it's time to replace the valve. Based not on any symptoms that I might or might not be having, but rather, on technical parameters such as heart size (the regurgitation makes the heart work harder which makes it bigger... think muscles) and heart efficiency. He asked me when I wanted it done. I outlined all our travel plans for the summer and suggested October. He said he was thinking either next week or the week after! So, since we have a big trip planned for the end of July, we scheduled for next Tuesday to give me maximum recovery time before the trip. He made an appointment for me with Dr. Somers, the surgeon, for the next day.
My visit to Dr. Somers was for me to be able to meet him prior to the operating room, and to ask any questions I had. He and his nurse explained the procedure and my choice of replacement valves: animal or mechanical. Animal are the most widely used. They used to be mostly from a pig, and last 10 to 15 years, but the newer ones are from a cow and last 20 years or so.
Mechanical valves last "forever" but require daily blood-thinner medication for the rest of your life to avoid clotting. Easy choice: cow (plus, we figure that in 20 years there will be a pretty simple replacement procedure available). Most of my questions concerned recovery times: walking, driving, sex, golf, weight-lifting, biking, etc., not in that particular order.
The answers were generally three (driving) weeks to 10 (golf) weeks. More specifics in a later post after I have the actual experience. I will also discuss details about the surgery in a future post, but, generally, it takes two to four hours, then four to five days in the hospital, the first two in intensive care. Not really much pain anticipated, just a bit from the incision. The biggest thing that I will suffer is fatigue. I won't sleep much in the hospital, I won't have any appetite and my body will be working hard at healing. He said to expect to be very tired in the afternoon for several weeks.
I needed a dental release to make sure I didn't have any infection from recent work, a new blood work-up, and three new tests on my heart prior to surgery. The tests were a carotid Doppler to check out the condition of my carotid arteries; a CT scan of my chest, to ensure there was no damage to my aorta caused by the regurgitation; and an angiogram, to ensure I had no blockages in the arteries leading to my heart. The good news was that if I did have any of these problems, they could be fixed at the same time as the valve replacement surgery without any addition to recovery times. More on these tests next time.
One last thought. Although I don't think that I have had any symptoms, both Dr. Berger and Dr. Somers said that I might be very surprised six to 12 months from now when I realize that I actually feel and perform better than I did before the surgery. Its like the frog analogy: if you put a frog in a pot of cold water and turn on the heat, he will stay in the pot as it gradually heats until it boils and he dies, but if you put a frog in a pot of boiling water, he will jump out. Its just possible that this frog has been living in a gradually heating pot.
See you after the surgery.