FOLLOW UP TO MANY CHANGES IN MY 75th YEAR: THE BROKEN HEART: This followup is made to be funny and informative. It is also a tribute to caregivers–in this case those who took such good care of me while going through my TAVR procedure.

Firstly, I am home and fine and hoping to have this valve last a long time, maybe not long enough to have to be replaced, but long enough that the bovine creature did not lose his valve for nothing.

My appointment for the procedure was on International Sticky Bun Day. I did ask a few medical people in the pre-op room whether they had eaten a Sticky bun that day to loosen them up a bit. It worked well, but I gotta tell you, not many people know about International Sticky Bun Day. Pre-op tasks included two showers the night before with a special antibacterial soap. At first they told me to take one at night and one in the morning but when they scheduled me for 6 am, they said take 2 at night and another when you get to the hospital. OK, pretty simple. The antibacterial soap actually feels like it takes a layer or two of skin off but does not hurt.

Upon arriving I was checked in promptly and walked to the pre-op room. I was given a bed and directed toward the shower. The nurse told me she started the water in the shower so it would get warm–I was grateful. Finished up and got back in the bed when I was informed that the anesthiologist was caught in a traffic jam and procedure that was supposed to start at 7 am would not start until 9 am. I told myself it was OK. Dr. Shahani, one of my doctors came down to chat. He was born in India and since I had traveled there a few times we had a good conversation about places and people. When I told him that I had never been to one of the greatest wonders of the world, the Taj Mahal, he said I must go. He then told me the story of the cleaning of the masoleum. It looks brand new as it was built: totally white. The extra two hours went quickly.

Joe, the anesthesiologist, arrived. He was coming from near Barclays Center in Brooklyn and there was some tie up on the bridge that day. He was a very young man. There were 2 nurses and a physician assistant in the pre-op room and they were friendly and informative.

At 9:05 am I was wheeled into the operating room. I was fully awake and cognizant of the amount of people in that room. Firstly there were two doctors, two physician assistants, two men from the companies that made the devices being used. I didn’t know about this but my great niece Nicole tells me that everytime they use a device in the operating room, a representative from the company must be present. In this case, it was one of the reasons that the surgery was delayed by a week, they needed to get insurance company to agree to pay for the extra device.

In this case the extra device was two cup screens that would be inserted in my carotid artery to catch any plaque that was scraped from the aortic artery. They inserted those devices through my right wrist. It was very similar to the procedure that I had had a few weeks ago to take a peek into the arteries. I am amazed by this stuff. I really research it better when its over and then say to myself “THEY DID THAT TO ME, WOW.” I actually asked whether they were left in or taken out–I was informed they are gone.

I was semi awake throughout the surgery. I really wished it was similar to the anesthesia received when getting a colonoscopy or endoscopy–you get injected–they wake you up when done. I have always reacted well to those procedures and to the anesthesia. Joe told me he only sedates people as much as he has to so patient does not move and does feel anything. He explained all the million reasons why that is better for the patient. I understood all, intellectually agreed, and knew I wanted to be out cold. OK. I did hear everyone chatting and talking about how the insertion of the equipment was going–a little to the left; a little to the right; looks good. I am unsure what I would have done if they indicated something was not going well or God forbid said “oops.” I am sure Joe put me out enough that I could not jump off the table.

The only pain I felt in this surgery was the last 15 minutes. There was a man kneeling on the operating table with my right leg between his knees pressing and squeezing on my groin with as much force as possible. He had his full weight behind him because he was on the table. Think about when you see a TV show and someone has a gunshot wound; everyone yells “press the wound, press the wound to stop the bleeding:–well that is exactly what he was doing. I can only describe it as barbaric. They really really need to find a different way to do that.

I will ask if that was necessary when I have my follow up visit. I wonder now whether more anesthesia would have made this less painful. Hopefully the feedback will be useful in other cases. I am certain Joe did not want me to feel pain if it wasn’t necessary. My thought was Joe lived in Brooklyn, he had to be a good guy.

The surgery was over. They wheeled me to the Cardiothoracic Unit. It is a small unit with probably around 12 rooms. The rooms are large with many monitors, equipment, a bed, a recliner chair, a TV, a commode, a sink and a roll table. There are sliding glass doors and curtains you can pull for quiet and privacy. There are a number of nurses, physician assistants and aides on this floor. It is well staffed. When I got to the room, the nurse, Samantha introduced herself to me and said she would be there until 11:30 at night. She had a twelve hour shift and I was her only patient. I felt comforted. She was caring and fussed to make me comfortable. We talked about her children, our interests and subjects that took my mind off staying in one place. After this surgery you need to stay on your back with your legs stretched in front of you and never have your head/back raised more than 30 degrees. Samantha continually asked whether I needed water or to be moved a bit to get comfortable. She also explained to me about this device which will allow me to pee without moving and without a bedpan. I will not go into the details here but it is a great improvement over a bedpan or being tubed.

I was uncomfortable but not in pain; my back hurt from being in one position for such a long period of time, but what the hell is a little discomfort when I got a new valve out of this.

Before Samantha left for the night she introduced me to Danielle, the next nurse who would have my care in her hands. Danielle would also work 12 hours. She was energetic, caring and informative. Really–you cannot ask for more. Both Danielle and Samantha had children; the latter with 3 young ones and the former with two almost teenagers. I thought how hard it must be to care for patients all day and then go home and care for your children. Amazing women!

Since Danielle and I had talked about the painful process of “stopping the bleeding” she gently explained that they would do that to me again tomorrow. I must have had the face of a petrified person as she went on to say that the pacemaker that was inserted in my right groin that checked on whether the bovine heart valve was working, would need to be removed. But of course femoral artery being what it is, they needed to put that amount of pressure to make sure the bleeding stopped. OH WELL, good reasons for sure, but horrifying as well. She also mentioned that I would need to be on my back about two hours after that. so right now I have been on my back without moving for more than 20 hours since the initial surgery.

When morning came which included breakfast, I was hungry, but really not able to eat while reclining. I thought to myself, it’s OK maybe I would lose a pound or two and have a great time eating it back on. I thought it might not be a good idea to eat before someone was going to press on my groin for 15 minutes or so.

Then Bill, the physician assistant arrived. I had met him the day before and he might have been the one to do the original press–not sure about that since I was what they might call semi-conscious. Not semi-conscious enough not to feel it, but semi-conscious enough not to scream out in agony.

So he introduced himself, apologized in advance of my pain and said he would need to kneel on the bed so he could apply all his weight to my groin. As usual for me, when knowing something painful was on the way, I would find a mantra. This time it was “Our Lady Queen of Peace pray for us.” Ukraine and the war in Gaza has weighed on me lately so I could deal with 15 minutes of this mantra.

At one point, Bill said he was going to let up to change hands because his hands were hurting and he needed to apply the pressure. I grimaced but was glad to have information on timing. He said he was half finished. I went back to my mantra. After Bill was done and said he had been successful, he repeated I would need to stay on my back for another two hours. At that point I was tired and happy to just lay back and do absolutely nothing. I bid Bill farewell and thanked him for his care; I also asked him if his wife knew he pressed on women’s groins for part of each day. He replied that she was a nurse and understood care. I liked Bill.

Two hours passed and I was finally going to get up. I wondered how I could possibly sit up and push the bottom half of my body–legs first–out of the bed. The nurses had another idea. The bed gets raised from the back so it is standing at a 90 degree angle and you just kind of stand up on your feet. Very neat indeed.

I was sore but I was able to walk slowly and deliberately. I had an escort from Physical Therapy and walked up and down the hall a few times. It felt good to be up, but that short walk made me incredibly tired. I was glad the heart valve was working.

I was hyped and realized that I probably would be going home now–they would discharge me because the deal was one overnight. If I could walk and get around, home would be better for me. I called Mike and he was ready to come get me–he decided he would park and come up. I got partially dressed while waiting for the discharge papers. Nurse came by and said I needed to have one more EKG. Fine, no problem, I could see the monitor since I had a heart monitor on as well as a pressure machine that kicked off every hour to take my pressure. My numbers were good, low but good. I have a very slow heart rate because I exercise. Normal for me is about 52 bpm. The EKG nurse did her job and now I decided I would get fully dressed. Mike came in and I indicated I was just waiting for the discharge papers. Then BOOM, a snag. I saw Blerta, the physician assistant, who worked closely with my doctors walk in–indeed, looking sad. She said there was a problem with the EKG and that the Doctor said he thought he noticed a “bundle branch block.” This is a complication from TAVR procedure. It refers to a condition that arises from a blocked electrical pathway in the heart, causing the left and right sides of your heart to beat out of sync. I would need to stay another day to be monitored. After initial disappointment [I thought I would be having a cocktail that afternoon] I realized that this needed to be sorted out before I could go home. At least I could walk up and down the halls and get in and out of bed myself. I binge watched MSNBC and wished I had my computer to start this story. At this point I was very happy the dietician took a dinner order for me even though I told her I definitely wouldn’t be here. It was a thin pork cutlet lightly breaded and I was hungry.

The long night began after dinner and I listened to some podcasts to catch up on my favs and had MSNBC on the TV. If anything I would be well informed when I left this place.

I knew they would give me another EKG to make sure that there was no Bundle Branch Blockage before they would discharge me. I was going to be patient today and not dress until I had a clear understanding that I was going home. I did not want to get my hopes up if I wasn’t going home and I worried what would happen if the blockage was there. I thought I remembered someone said that a pace maker would be inserted if that was the case. I put it out of my mind because I really had no control over it–you can worry or you can pray. I always choose prayer. The EKG technician came in at about 5:30 am to do the test.

Breakfast came shortly after that and I was hungry. Today it was easy to eat since I was able to sit up and breakfast is my favorite meal. The eggs were not as soft as I would have made them but my body craves protein so I devoured them. I did find out that salt is not served on a cardiac floor, so I heavily peppered my eggs and they went down fine. I thought about being home and having bacon and knew that would come soon.

Liana insisted her nose was her ugly spot. Meir joined in on noses and told us the story that when he was born his mother was grateful that he had a great nose. I took a look and said his mother was right….he had a good nose. I assured them both that their noses were fabulous and we laughed as we walked the hallways and the stairs. I liked these two a lot…..they were a comic relief to the other things going on.

The walk was over and now I waited to hear about the EKG. Soon the doctor arrived and assured me the EKG showed no Bundle Branch blockages and he was okaying my discharge. I told him I danced for a while and brought my PVCs up to make sure the new valve worked. He mentioned that I should have made a video and he could use it to advertise successful TAVRs. I laughed but inside I was so grateful that this was over.

I was told I needed to wear a MCOT monitor for one month. I had done this before and it’s annoying but not a big deal. It provides valuable information on what your heart is doing at all times. It comes with a phone that you use to monitor anything different you feel. There are categories to select from–I always select “other” because what I always feel is Afib and that is not listed. They do call you on your phone if they see something terrible happening with your heart. They did call me the first time I had Afib and I told them I knew what was happening. I guessed if I was having a heart attack they would let me know. The nurse helped me put on the monitor and I packed the box with my other “take home” items.

Mike was on the way and arrived downstairs shortly. I told him not to come up and that I would meet him in front of the building. I could watch through the window and would know when he was there. A nurse walked me down. I was grateful to be outside. It only took us about 15 minutes to get home and I was tired when we arrived. Funny, I hadn’t really done anything for the last 3 days but I felt totally exhausted. I think it was a mix of mental and physical exhaustion. I was tired because I hadn’t really walked or done anything and mentally because I had been stressed since this ordeal began in December.

It has been 3 weeks since the surgery. I have been back to the office 3 times–I have been told that everything is going well. I have explained at each visit that I don’t really feel myself and that my afib is worse than before. Everyone listens carefully and says it takes a while sometimes more than 6 months for the heart to get used to the valve and the new beating sensation. Sometimes I feel my heart beat heavily in my chest and at times I have afib without feeling it although if I check my Apple watch, I can figure it out. Sometimes I just don’t feel great.

There are a lot of sometimes here and I sometimes have to remind myself that I am only 3 weeks out of this surgery and it was a bigger deal than I imagined or made it out to be. I just thought, going through the groin and not cutting open my chest would be easy. I never thought about threading tubes or whatever up from both sides of my groin to my heart and then scraping calcification from my valve and then putting a new valve to replace it. Actually I try not to think about the process at all.

I trust my doctors….if I didn’t I would not have gone through with this procedure. I trust that I will feel more myself every day and although I might never feel exactly what I felt before, I am still here living the life.

I am thankful for all those who cared for me during this time. Caregivers are super.