Tuesday, March 18, 2014
Sunday, March 16, 2014
It All Started With a Cough
Ask me anything about aortic valve replacements. I know it all. Not enough to do one, of course, but enough.
So Jay had been sick. Not debilitated, exactly, but sick. His back finally healed in mid-January and then he started actually feeling worse. Achy, coughing, fever. Assuming it was just a virus he tried to wait it out but just didn't feel better. He went to his doctor, who thank heavens was very aggressive and proactive with his response - he assumed it was a virus but did some tests to rule a few things out. Surprise! He found something called endocarditis, an infection that attacks the heart. Jay went on IV antibiotics and had a few tests run to check his heart heart function. Those tests showed that he had something called a Bicuspid Aortic Valve, which is a fairly common congenital heart condition. His valve obviously worked fine up until now - he is 47 and never had a hint of a heart issue. But the endocarditis attacked his valve and damaged it, causing blood to back flow into Jay's heart.
We met with an infectious disease doctor and a heart surgeon, both of whom told us that Jay needed surgery to replace his valve sooner rather than later. He felt OK (the antibiotics did a good job) so we originally thought that we would do the surgery around April 1st. A series of circumstances (the surgeon being out of town and Jay realizing he didn't really want this hanging over his head for a month) led to scheduling it for Tuesday, March 18th.
Unfortunately, Jay was getting worse. He developed a terrible cough and his shortness of breath got worse. He tried Lasix to ease his breathing problem and it helped, but not before causing him to break out in hives. He was a mess. He was trying to work and was just not getting better at all.
On March 10th Jay went to his GP because he was not sleeping and his breathing was labored. His doctor took a chest xray, called Jay's surgeon and said, "you've got to replace his valve now." His lungs had fluid in them. Basically he was going into heart failure. So we drove down to Salt Lake on Monday night. After Jay was admitted the PA said they'd probably do surgery Wed or Thurs to give his lungs a chance to clear. But then they did an echo of his heart which showed his valve was flapping around and not doing anything. His surgeon decided at 11:30 at night to put Jay on the schedule for the next morning.
On Tuesday, March 11th Jay had open heart surgery. It went well. His lungs weren't in great shape which caused him to stay on the ventilator longer than normal and his right lung to collapse, but his heart was good as new. Better than new, actually, because this valve is not only not infected it is correctly formed. He was in ICU until Thursday morning. He slowly is becoming more disconnected to the hospital. As of tonight (Sunday, March 16th) he only has a chest tube and some pacing wires to remove. The pacing wires are put in just in case they need to regulate your heart's rhythm with a temporary pacemaker, which they didn't have to do with Jay. His chest tube is still draining fluid from his chest - they don't take it out until you are draining less than a certain amount. It's a pain but better to stay until they are sure he is fine and ready to be released. The last thing you want is to leave too early and have to be readmitted with pneumonia. So we're fine waiting.
Going forward, Jay just needs to recover from surgery. He will be off work for a few weeks but will probably start working from home a bit. The hardest part is that he can't drive for six weeks. Sigh. Luckily Jay works about 10 minutes from home so it won't be too bad. The driving part isn't because they think you will faint or anything - it's that your chest wall and rib cage need time to fully heal before you try to support a steering well. It's fine - he'll be well so that's all we care about. He has to start the clock over on his IV antibiotics as well. Once he comes home he'll do 5 more weeks of daily antibiotics through his PICC line. He already knows the drill so it's not a big deal to do and they deliver all the medicine and supplies right to our door so it's easy. Once that is over, he should be good. He'll have a yearly echocardiogram with our new favorite doctor, Dr. William Caine of the Intermountain Heart Institute.
For the record we can't say enough good things about Intermountain Medical Center and the Heart/Lung Center. The staff is amazing and we are really happy with the care Jay has received. It is amazing to us that people are trained and can fix problems like Jay had. We are incredibly grateful that we had such a good outcome and to all of the people who took such good care of Jay.
Talk to me in a month however. I may be good and sick of driving him around by then. If you see Jay catching a bus to work, you'll know that we the chauffeur hat didn't fit me as well as I would like.
So Jay had been sick. Not debilitated, exactly, but sick. His back finally healed in mid-January and then he started actually feeling worse. Achy, coughing, fever. Assuming it was just a virus he tried to wait it out but just didn't feel better. He went to his doctor, who thank heavens was very aggressive and proactive with his response - he assumed it was a virus but did some tests to rule a few things out. Surprise! He found something called endocarditis, an infection that attacks the heart. Jay went on IV antibiotics and had a few tests run to check his heart heart function. Those tests showed that he had something called a Bicuspid Aortic Valve, which is a fairly common congenital heart condition. His valve obviously worked fine up until now - he is 47 and never had a hint of a heart issue. But the endocarditis attacked his valve and damaged it, causing blood to back flow into Jay's heart.
We met with an infectious disease doctor and a heart surgeon, both of whom told us that Jay needed surgery to replace his valve sooner rather than later. He felt OK (the antibiotics did a good job) so we originally thought that we would do the surgery around April 1st. A series of circumstances (the surgeon being out of town and Jay realizing he didn't really want this hanging over his head for a month) led to scheduling it for Tuesday, March 18th.
Unfortunately, Jay was getting worse. He developed a terrible cough and his shortness of breath got worse. He tried Lasix to ease his breathing problem and it helped, but not before causing him to break out in hives. He was a mess. He was trying to work and was just not getting better at all.
On March 10th Jay went to his GP because he was not sleeping and his breathing was labored. His doctor took a chest xray, called Jay's surgeon and said, "you've got to replace his valve now." His lungs had fluid in them. Basically he was going into heart failure. So we drove down to Salt Lake on Monday night. After Jay was admitted the PA said they'd probably do surgery Wed or Thurs to give his lungs a chance to clear. But then they did an echo of his heart which showed his valve was flapping around and not doing anything. His surgeon decided at 11:30 at night to put Jay on the schedule for the next morning.
On Tuesday, March 11th Jay had open heart surgery. It went well. His lungs weren't in great shape which caused him to stay on the ventilator longer than normal and his right lung to collapse, but his heart was good as new. Better than new, actually, because this valve is not only not infected it is correctly formed. He was in ICU until Thursday morning. He slowly is becoming more disconnected to the hospital. As of tonight (Sunday, March 16th) he only has a chest tube and some pacing wires to remove. The pacing wires are put in just in case they need to regulate your heart's rhythm with a temporary pacemaker, which they didn't have to do with Jay. His chest tube is still draining fluid from his chest - they don't take it out until you are draining less than a certain amount. It's a pain but better to stay until they are sure he is fine and ready to be released. The last thing you want is to leave too early and have to be readmitted with pneumonia. So we're fine waiting.
Going forward, Jay just needs to recover from surgery. He will be off work for a few weeks but will probably start working from home a bit. The hardest part is that he can't drive for six weeks. Sigh. Luckily Jay works about 10 minutes from home so it won't be too bad. The driving part isn't because they think you will faint or anything - it's that your chest wall and rib cage need time to fully heal before you try to support a steering well. It's fine - he'll be well so that's all we care about. He has to start the clock over on his IV antibiotics as well. Once he comes home he'll do 5 more weeks of daily antibiotics through his PICC line. He already knows the drill so it's not a big deal to do and they deliver all the medicine and supplies right to our door so it's easy. Once that is over, he should be good. He'll have a yearly echocardiogram with our new favorite doctor, Dr. William Caine of the Intermountain Heart Institute.
For the record we can't say enough good things about Intermountain Medical Center and the Heart/Lung Center. The staff is amazing and we are really happy with the care Jay has received. It is amazing to us that people are trained and can fix problems like Jay had. We are incredibly grateful that we had such a good outcome and to all of the people who took such good care of Jay.
Talk to me in a month however. I may be good and sick of driving him around by then. If you see Jay catching a bus to work, you'll know that we the chauffeur hat didn't fit me as well as I would like.
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