Adam is the first family visitor to our new home!

We got to have Adam for Thanksgiving, our first family visitor to our new home in Leisure World.

While taking one of our walks around the ponds we walked by the men who sail boats.  Probably all of them are grandparents, and they immediately asked Adam if he would like to steer one.  He did.

He helped us pick oranges.

We went swimming:

Vicky fixed a turkey

 And pumpkin pie

And we ATE!

Went hiking

 And cycled on the tandem

It was over before we knew it.  He'll be baaaacccck.

8 weeks out of open heart surgery: Thanksgiving Day

Well, let's see, what do I have to be thankful for?   (bad joke).

Thanksgiving marks 8 weeks, to the day, that I opened my eyes and had a variety of new parts in my heart and tubes sticking out everywhere.

My aneurysm is healed.  I no longer live with a time bomb in my chest.  So, what do I have to be thankful for you ask?  How about life?

I am thankful that I am an American.  I am proud of it.  There are problems in this country, of course, but there will always be problems in every country because of the simple fact that countries are made up of human beings.

We spent our Thanksgiving with something else we are thankful for:  Our grandson Adam.  He is out visiting us.  He is a joy, funny and interesting.  Pleasant all of the time.  He is a good person, insightful and compassionate.

This week he heard about a school where the principal made an announcement that several students had been killed that morning in a car crash.  Later it was announced that it was not true--some folks in the school had decided that this was the best way to get students to not text while drive. 

He talked with us about this, recognizing that it was wrong.  He realizes the importance of kids being able to trust adults, and that this was a violation of that trust.  We had an adult conversation.

And, of course, we have done fun things, like going swimming.  We have a camera that we sometimes take hiking when it looks like there might be rain.  It is waterproof.

We've had it for a few years, but yesterday decided to try it underwater---it is designed for that.

I couldn't go swimming because yesterday I cut myself.  And because of the Warfarin it took longer than usual to heal.  Gotta get off this stuff--interferes with my life too much.

Here is Adam and his 68-year-old grandmother trying to keep our noddle under water:

 Can you believe this?  68 years old and out in a pool playing like she's a kid?  Somebody needs to tell her she's too old to be to do this, but as a matter of fact, she isn't.  She had a blast.

Then she made a terrific dinner for us.  Here she is with the upside down Turkey.  There is a reason why it is upside down, she explained it to me, but I forgot.  I don't really need to know because she cooks the Turkey, not me, and my job is more in line with my skills--I take out the trash after dinner.  And repeatedly say "Yum!"

She is wearing my grandmother's apron, a prized possession:

As I have been telling anyone who can't get away from me fast enough:  If you have a lifestyle issue that could one day result in open heart surgery, CHANGE it.  You DO NOT WANT open heart surgery.  It is brutal.

For me, if it wasn't for a handful of people in my life (and you know who you are) like Adam I simply would not have done it.  Having them to look forward to, and being able to contribute to their lives is the only thing that makes this brutal journey worth it.

We are glad to have Adam here.  Always glad to have any of the grandchildren, of course (and our children, siblings, nieces/nephews, and in-laws--in other words our family).  But this year it is especially meaningful--he sort of represents all of that family that makes this a terrific Thanksgiving.

(He brought a game with him, Madden NFL-something.  He beat me 105-28, and we only stopped because he thought we should have a mercy rule.  Told you he is a nice boy.  Tomorrow's another day:  I am going to challenge him to a rematch)

Seven weeks out of open heart surgery: The heart of a cowboy

Today marks seven weeks since I had open heart surgery.  I continue to improve, rapidly.

I will need another surgery to correct an abnormal heart beat--what is called an Atrial Flutter, but the worst that can happen is that it isn't successful and I have to take Warfarin the rest of my life.  I hate the stuff because it limits our activities somewhat, but it's also a life-saver so I can forgive it.

The doctor who will perform this surgery is a specialist in the electrical system of the heart.  Within the specialty of medicine there is a specialty of cardiology, and within the specialty of cardiology there is a specialty of what he does.  Can you imagine the years of training he has needed to be able to enter the operating room for me?

Now, I need to admit, what I am going to have isn't officially a surgery.  Instead, it is termed a "procedure."

Here is what he will do.  At 2:30 in the afternoon in a few weeks he will stick a couple of tubes into a vein in my groin and through there will wind its way up to my heart.   With one of them he will penetrate the upper chamber of the right side of my heart and will inflate the hole.  What he explained, to our amazement, is that he will actually be able to see the electrical impulses in that chamber and can see where they go awry.

I would love to see that myself.  I can't imagine being able to actually see this.

Then what he is going to do is create some scar tissue in one place in that chamber, which he called an isthmus.  Then when the signal comes from my sinus node it won't just keep going round and round in that chamber but instead will be blocked and will shoot back to another node that activates the lower chamber.

I will rest awhile, and then go home.  Puncture my heart, burn it, and it's safe to go home within a few hours.

And I don't care what they call it, Vicky and I think this qualifies as surgery, don't you?

In my world of miracles, this is another.  I have a piece of plastic in my ascending aorta that fixes the aneurysm that was there, and a valve made from artificial material and a cow, and now I will have my heart punctured and will have scar tissue created that will fix my abnormal heart beat.

If it is fixed, then no Warfarin!  And Vicky and I could get a few more years of having our adventures free of the worry of falling and bleeding profusely.

As all of the people who know me know, I am a huge fan of 1950s western films.  Not only was television in those days filled with westerns, but so were movies.  And my father liked to take me to them, so we went quite often, in Stillwater, Oklahoma (of all places) which 100 years before had been the heart of the Comanche empire.  I remember many of those westerns from that experience.

I had a six-gun, a Davy Crockett musket, the hat, and all of the trimmings and played being a cowboy a lot.  I had a huge set of miniature cowboys and Indians that I played with inside.  All boys did.  We traded pieces with each other.

The best western film I ever saw with my father was The Searchers, with John Wayne.  I remembered it vividly as an 8-year-old, and even had one of my miniature figures that represented Ethan Edwards (played by John Wayne).  Over the years, this film has grown in stature, to the point where now it is rated by the American Film Institute as the 12th best film of all time.

This film also happens to be my favorite film, by a long shot.  It is different from other western films in that it was brutally honest about the hatred and racism directed toward the Comanche Indians of Texas.  The Comanches were the most powerful of the tribes, having driven first the Spanish, then the French out of Texas.  They also drove the Apache tribe into New Mexico and Arizona.  They were the real deal.

One way the Comanches excelled was their horsemanship.  A Comanche boy was put onto a horse before he could walk.

In fact, contrary to what is seen in most movies, the Comanches were (as I recall) the only Indian tribe that actually fought from horseback--they were the only Indians with a cavalry.  Other Indians tribes used horses, but when they fought other tribes they were basically mounted infantry.  They would dismount to fight.  Comanches were renown for their horsemanship, being able to fire arrows from under the neck of their horses in such a way that if their horse was shot they could quickly dismount at a run.

They also took captives and either kept them or ransomed them.  They were a fearsome force to the settlers of Texas.  That the settlers in Texas weren't invited there is certainly a valid point, but that part of things doesn't trouble me as much as it does some.  The settlers had no other place to go.  They would find a few barren acres that looked like they weren't being used, and farm and ranch them to feed their families.  None of them could see the bigger picture of what was happening and what was to happen.  They were just desperate, poor, short-lived folks trying to provide for their children.

Additionally, the land did not originally "belong" to the Comanches anyway.  The Comanches are an off-shoot from the mountain Shoshones.  They basically ruled a huge swath of central and southwest Texas, Oklahoma, and Colorado by driving out other Indian tribes.

It's how the Indians were treated later, and currently, that troubles me.

The Texans, understandably, hated the Comanches because they stole their cattle and their children and wives and killed many settlers.

The Searchers is the only film of that era that shows this hatred and racism.  In most westerns, Indians were portrayed as one-dimensional.  The typical western needed a battle with a (historically inaccurate horse mounted) tribe of Indians, and typically the reason the Indians were on the "warpath" was because some bad white people violated the terms of the treaty.  In other words, the Indians in those films were not just seen as marauding bad people, but as victims of white aggression and betrayal.  They were just the back drop to whatever the real story of the film was.

There are a few goofy parts to The Searchers, but it is necessary to remember that the film is brutal and hard, so the director (John Ford) and writer (Frank Nugent) likely introduced those goofy parts to offset the violence and hatred. 

And John Wayne is awesome in it.  He plays an embittered man in love with his brother's wife--a woman who likely chose his brother over him because Ethan is such a hard man.  There is nothing civilized about Ethan.  It is all understated, unlike films today, so you only catch glimpses of the feelings between Ethan and his brother's wife.

Here is the critical part of the film.  It is a stunningly beautiful scene, well-acted, moving, and sad.  That's it.  That's all you need to see to understand what drives John Wayne's character, Ethan Edwards.  Martha, his love, handing him his coat--the same coat he will later wrap one of Martha's daughters in to bury her after the Comanches kill her.  The last scene shows Martha and Debbie watching Ethan ride off, knowing nothing of the tragedy that will befall them that evening. 

The music by Max Steiner is awesome.  He uses a civil-war song called Lorena as the base for the sound track.  Watch it:

The Leaving:  Scene from The Searchers.

The shot of Ethan when he realizes they have been tricked into leaving their homes and families unprotected is acting at its best.  You can see the anguish in his face:

So, Ethan embarks on a 6-year odyssey to find the only survivor of the massacre--Martha's daughter Debbie.  This search has historical origins.  It is based upon a real search by an uncle of Cynthia Ann Parker whose family was slaughtered by the Comanches and who was taken captive by them.  The author of the book the movie is based upon (Alan Le May) did extensive interviews with this uncle before writing it as a series of short stories in the Saturday Evening Post called the Avenging Texans.  I have the entire series--a prized collection I have never seen anywhere.   The uncle searched for years for her, unsuccessfully.  She was "found" by other people and "returned" to white society, where she lived a miserable and short life.  She did not want to be "rescued," and did not want to leave her children.  Some "rescue," huh?  After all of the searching, the uncle never saw her after she was "rescued." 

But, in the film and book the film is based upon, Ethan's search isn't really for Debbie.  Instead, it is to kill the Indian chief (Scar) who killed his Martha.

This film does something that no other western I am familiar with does.  It is set up in such a way that you expect a showdown between Ethan and Scar, but it doesn't happen.  Instead, Ethan meets Scar in a teepee and Scar talks to Ethan about his hatred for white people--a hatred he has because they have killed his children.  Scar is a bitter, angry, revenge-seeking Comanche.

In other words, after a six-year search, Ethan finds that his enemy is just like him--both dealing with loss in the only way they know how.  By revenge.

Scar and Ethan never have that showdown.  Instead, it is the young boy who accompanies Ethan on the search who does---very unexpected.  This boy uses six years of his life on this search to protect the daughter from Ethan, who wants to kill her because she is the "leavings of Comanche bucks, sold time and again to the highest bidder."  Harsh, brutal, and vile language, especially for a film of the 50s.  But it was how people felt and talked, and probably how the Comanches talked about the settlers.  John Wayne's character is not a "hero" in any sense of the word, and the quest by Ethan is not heroic.  It is for the ugliest of motives--racism and revenge.

Told you it was brutal, honest, and powerful.  It is a modern movie that doesn't make the Indians into victims but instead portrays them as ordinary people, with human feelings and motives, just like the settlers. 

So, where am I going with this?  The family was slaughtered when John Wayne and the other men were out looking for cattle that had been stolen.  The character who was engaged to Martha's daughter who was killed was played by Harry Carey, Jr.  He also dies at the hand of the Comanches in the film.

Harry Carey Jr. later wrote a book titled A Company of Heroes, and in it he tells stories about the filming of The Searchers and other John Ford westerns in Monument Valley, Utah.  The area is a Navajo reservation, and the Indians apparently loved John Ford because he frequently cast them in his westerns and gave them work.  The Indians in John Ford westerns weren't a bunch of white guys dressed up with warpaint. 

I bought this book over 20 years ago.  Today, Vicky was looking through it and found where he autographed it.

I had been telling the (admittedly bad and silly) joke that since my heart valve was made from bovine tissue that I can finally, after dreaming about it since I was a young boy, be a legitimate cow-boy.

The heart of a cowboy.

For the past seven years, Vicky and I have spent two and a half of them (in total) wandering the same desert southwest where Ethan searched for Debbie.  In our camper, hiking everywhere, and occasionally visiting areas that had been Comanche strongholds.

In Nuestra Casa (our new home in Mesa) we have a room where we have hung a number of reminders of our childhoods, Vicky came up with the idea to have one section devoted to my life-long interest in westerns and, in particular, in The Searchers.  Hanging there is a poster from the movie, and a facsimile of the type of cavalry shirt that John Wayne wore in the film.   This section also has my "Indian-like" quiver of arrows--something I used almost every day as a child in the fields and woods near my home.  "Hunting" I don't know what, and mostly losing and having to replace arrows.  There is also a bridle that represents Vicky's long history with horse-riding.  It belongs with the other western items.

Harry Carey Jr., an actor from a movie that when I watch it reminds gives me sweet memories of my father, signed a book to me 25 years ago that captured an important part of my childhood (and now my life with Vicky) and which, ironically, anticipated my joke:  "The heart of a cowboy."

The climax of the search is when John Wayne goes to kill Debbie but can't.  Instead, his love for her takes over.

The final line of the film, when he holds her protectively in his arms, is "Let's go home Debbie."

When I was being released from the hospital, six and a half weeks ago, I used this line from The Searchers:  "Let's go home, Vicky."

Six weeks out from open heart surgery: Everything except my heart getting back to normal

Today marks six weeks since I have had open heart surgery.

Almost everything has gone as planned.  One thing hasn't:  I am having problems with irregular heart beats and a rapid heart rate.  Why this is the case is unknown.  One idea given by my cardiologist is that my heart had adapted to the bad valve, and now that it is fixed it doesn't know how to behave.  That makes it sound like I should send it to time out, which I'm about ready to do if it doesn't shape up.

So, this means a basically endless procession of meetings with health care professionals.  This week we will have FOUR such meetings.  Today's meeting was to get something called a Holter.  It is a 24-hour device to monitor my heart.  I have all kinds of sticky things on my chest, and have to carry a little device around with me.

I never could have anticipated this, but oh well.

We are now in Mesa, AZ.  We came here because there were more opportunities for me to rehab here---it is sunny so we can take a very pleasant 3-mile walk every day (or twice a day), and we have a pool and gym almost right outside our door.  We have taken advantage of all of these opportunities.  We purchased an inexpensive tandem bike, and started riding it today:

We have started going to the pool, and I am using a,.,,,,,gasp..... noodle.  I never saw myself as a noodle person, but I need to use one so I can gradually work my way back to more strenuous activities.

We go to the gym to ride the exercise bikes.  For the past few days the screens on our bikes have been advertising a luncheon with the title:  "Improve your quality of life and gain bladder control."  I can't wait.  I hope we don't have other plans at that time.

The doctors we need are within walking distance--about a mile and a half.  No more needing to spend 6-8 hours for a single doctor appointment.  No more ferry.  No more long drive.  No more getting up at 5:00 in the morning to avoid rush hour.  We have walked to all of our appointments here.

I thought that by now I would be back to normal, and I am anything but.  I should have known, however, because when you start having heart problems they can evolve and require on-going care.  I just don't want to admit it is happening to me, that's all.

We have more appointments to try to figure this heart rate thing out.  It's kind of unfair in a way (whining alert!) because my actual heart muscle and arteries are excellent, and excellent in particular for someone my age.

Heart---GO TO YOUR ROOM!

We watch Marina’s cross country race & Stella plays the clarinet for us

We have usually flown south with the hummingbirds by the time fall arrives and are deep within our beloved deserts by this time.  Here are three of the good thing about being home now....

If we had not been home this fall while Dan was recovery from heart surgery, we would have missed Marina’s excellent cross country race:







And we would have missed seeing and hearing Stella play beautiful music on her clarinet:




And we would have missed having our last dinner with them at Patron's:



These are three of our happy memories of this fall.


addendum:

The next spring we got to go to one of Stella's band concerts:

Five weeks after open heart surgery: Movin' on

We are gradually getting back to normal, very gradually (and we actually were never that normal anyway).

My chest and back still hurt, and probably will for two more months.  The heart is apparently healed, although the issue with it beating irregularly will be something to monitor for the future.  The Atrial Flutter comes (grrrr) and goes, so we'll have to see about that.  The sternum takes a long time to heal.

We are leaving for Mesa, for Nuestra Casa, tomorrow.   It is getting colder and wetter in the Pacific Northwest, and it is a necessity that I can get out and walk (a lot) every day.  We can do that better in the warm Arizona sun.

We also have a pool nearby, about a 10 minute walk, and I can rehab in it.  I'll have to use one of those noodle things, which I promised myself I'd never do, because I can't exert any effort with my upper body for another two months.  So, I'll look like an old person at the pool, even though we all know I'm not really an old person.  I'm just a 70-year-old person---the age I always thought was old until it applied to me, and then the rules changed.

For one month I have done little except sit in front of our windows and look out at our woods.........and walk.  It's a wonderful sight out our windows, but other than the occasional deer to break the monotony, it is getting a little old.  Before my surgery I put up some bird feeders because I thought we might attract some native birds, and I love watching birds.  Yesterday I brought the feeders and seed back inside--hardly a seed was eaten.  We need to see something else.

We have been going to the park every day for the past three weeks to take walks.  We have worked up from 1.3 mile walks to 5.25 mile ones.  There are about 3 miles of trails in this local park, so to get in our 5+ mile walks we have to repeat a lot of them.  We are very grateful to have something this nice this close to us (about a mile from our home).

Since I was discharged from the surgeon, three weeks and two days ago, we will have walked just under 100 miles, almost all in these woods.  It's been great for my recovery.

Us in our local woods:

To get the one mile to these woods I sit in the back seat, with my heart pillow protecting my sternum, and Vicky has done all of the driving.  Come to think of it, Vicky has done all of the lots of stuff these past five weeks.

 She does all of the driving.

 Hauls wood:

 

Makes food, does laundry, and the list goes on and on.  All cheerfully.  My bionic, cow, plastic, metal, sutured, repaired heart belongs to her.

Four weeks out from open heart surgery: The beat goes on......but irregular

A common after-effect of heart surgery is an irregular heart beat.  I had a bout of something called Atrial Fibrillation while in the hospital.  For the first two weeks I was home my blood pressure and heart rate were normal.

However, out of the blue, my heart went out of whack--it started racing, my blood pressure dropped, and my blood pressure cuff said I was experiencing Atrial Fibrillation again.

So yesterday I met with my cardiologist who did an EKG and reported that I had something called Atrial Flutter.  As Vicky said, "Flutter" sounds better than "A-Fib" because "Flutter" is like what a butterfly does and "A Fib" is what bad people tell. 

We discussed options and decided I would get a procedure where my heart was given a mild electrical shock.  So I had that today.

It sounded like it was pretty straightforward---just go in and I would lay down and they would put me out for a couple of minutes, give me the shock, and I'd be on my way.  However, it is more involved than that.  I had to fast for 10 hours, report to the SURGERY center (again),  dress up in hospital garb, get an IV, and (worst of all) wear the little yellow booties and shower cap.   Vicky teases me about the shower cap---I can see why.

Aren't I the cute patient?  Like my shower cap? 

Anyway, four weeks from the day of my surgery I was back at the hospital's surgery center, which gave us a mild, slightly unpleasant feeling of deju vu.   The cardiologist administered a mild shock and the heart beat went into "sinus," or was "sinus," or something with the word sinus in it, which means good.

Of course when we first heard about this procedure we both imagined it was like in the movies where someone holds two big paddles to someone's chest, yells "CLEAR," and then the unfortunate victim bounces a foot off of the table. Like they did with Frankenstein.   But actually it is a very mild shock (and they didn't yell "CLEAR!")....and even though  am now up and walking around, I'm not Frankenstein (even though I do have a bunch of metal in me like he did, poor guy).

The staff at Virginia Mason were once again excellent at explaining things and providing me with information.  I was shown a print-out of the EKG before, during and after the procedure.  I asked if I could have a copy, so they provided one.  It's very interesting.

I have divided the output into before shock and after shock.  This one shows my Atrial Flutter, and then the mild shock, where everything goes nuts:

The next one sort of overlaps with the first one, starting with when my heart got excited from the shock, and then it immediately went into that sinus thingy, which is good.  The whole thing was done in 15-20 heartbeats, or about 15 seconds.  Absolutely amazing.  The cardiologist said that sometimes it requires several shocks, but it was one for me.  I had hoped this meant something better about my prognosis, but she indicated it didn't.  Still, I"m proud--only one shock to my heart!!!

And I am taking a new medicine to reduce my heart rate.

All solved?  No.

It is a big unknown, which I have found the aftermath of open heart surgery to be.  Although my heart immediately went into its appropriate rhythm, this is the usual outcome for this type of shock procedure.  The problem is that there are no predictive factors regarding how long it will last.  Could last a day, could last forever.

So for the foreseeable future, I am going to be quite anxious about it.  But the only way to deal with these things is to meet them head on.  I had the option of trying only medicine, and that would have been easier.  However, having the "Cardioversion" (i.e., shock) is a more reliable way of getting the heart beating appropriately right away, which has its advantages, so we decided to do that.  The sooner you can get the heart beating appropriately the more likely it is that you can prevent the heart from "learning" to beat inappropriately, or something to that effect. 

I got to drop one medicine yesterday, but added another--the one to lower my heart rate.  If I would take about 10 of these every day my heart rate might be where Vicky's is naturally---she's like a highly trained athlete in that way (and others, actually;  she's quite amazing).

All par for the course.   I am much better physically this week than I was five weeks ago before the surgery.  Although at that time I had no abnormal heart beat and was not in pain from having my sternum opened, I had a time bomb in my chest.  

So we deal with the after-effects.  I may have them never again, have them for awhile, or have them forever.  I feel fortunate that I get to deal with after-effects--some people don't. 

But, man is this type of surgery ever a journey that doesn't seem to end.  For both of us.  I can't imagine taking this journey on my own.  I am very grateful.

Three weeks out from open heart surgery: When being an obsessive-compulsive is a good thing

Today marks three weeks out from open heart surgery.

I'm amazed at the body's resilience.  I still have many weeks until I am healed, and some challenges until that time, but it is mind-boggling that someone can feel as good as I do after only three weeks after being torn apart as I was, much less just simply survive this type of operation.

Make no mistake:  I experience a lot of discomfort and at times pain.  And feeling good comes and goes, alternating with being very tired.

I should have, but didn't, realize that there is another stage to this recovery, in addition to healing my heart and healing my sternum.

That stage is the 'what medications will I have to be on for the rest of my life' stage.  That's the one I am in now.

Right now I am taking a blood thinner, a statin to reduce cholesterol (which is already low), and a medication to modulate my heart rate.

That's in addition to some prescribed over-the-counter medications.

The medicines are designed to prevent blood clots, which means to prevent strokes.  How many of them I will need to take for how long is to be determined.  I hope none of them, but we will adjust to whatever is needed.  Small price to pay for living.

Although I have been told by doctors that red wine doesn't interfere with these medicines, I have decided to forego alcohol until my system becomes stable, however long that might be.  This means none of my precious Chianti.  Ouch.  With all of my medicines my liver is also working overtime, so it seems best to cut it some slack.

I'm not even sure whether some amount of red wine might help--I just don't know and count on my cardiologist for this information. 

We do medications twice a day.  When we do that I am reminded of my watching my parents carefully taking their medicines.  We too are very careful.  We have a list, we don't do anything else at that time which could cause a distraction, Vicky hands me the pills (child tamper proof bottles are also post-open-heart-surgery proof bottles), and we both read the label out loud before I take any.  After I take one, she moves it to the "taken" container. No mistakes allowed.

Our plan is to take everything precisely as prescribed so the cardiologist will not have to guess whether a certain reaction I am having or not having is due to the medicine or because of not taking the medicine correctly.

And not taking one's prescribed medicines is a huge problem for physicians, with some studies indicating 50% of patients with serious illness are not compliant with their medication prescription.  Here are some other facts, stolen from an on-line article:

-Approximately 125,000 people with treatable ailments die each year in the USA because they do not take their medication properly.

-Fourteen to 21% of patients never fill their original prescriptions.

-Sixty percent of all patients cannot identify their own medications.

-Thirty to 50% of all patients ignore or otherwise compromise instructions concerning their medication.

-Approximately one fourth of all nursing home admissions are related to improper self-administration of medicine.

-Twelve to 20% of patients take other people's medicines.

-Hospital costs due to patient noncompliance are estimated at $8.5 billion annually.

OK.  What gives?  Actually, nobody knows.  Some factors have been identified (e.g., understandably more difficult for the very elderly; sometimes the cost is prohibitive), but frankly nobody knows for the majority of cases.  People just don't do it right a whopping percentage of the time.  I can't wrap my brain around this---not taking medicines that can keep you alive? I remember reading, years ago, about a form of childhood leukemia that was something like 97% curable if medicines were given to the children  appropriately.  But a huge percentage of parents were non-compliant with the medicine regime.
Again, I ask, what gives?

It's been three weeks now and I have not missed a pill.  If it is prescribed, I take it.

Not only that, but I do a twice-daily "systems check."  I take my blood pressure (cuffs are very inexpensive), pulse, temperature, weight, and amount of air I can suck through my little gizmo that is designed to inflate my lung sacs.

Since pain pills are something that is individually determined, we keep records, detailed ones, of the time of the day I take my acetaminophen. We know, to the mg, the amount of pain medicine I have taken since discharge.

Be sloppy about getting oil changes in your car, if you have some unmet need to be sloppy, but not about medicines. 

I just went through hell with this surgery, fear, pain and all of the rest.  And to then not take medicines that are prescribed is unthinkable.

There are times and places in one's lives to be obsessive-compulsive.  This is a major time for that.

We have also been following the Doctor's "prescription" to "walk as much as can be tolerated."  We have a park nearby with terrific trails (flat, wide, graveled, absence of roots to trip over), and we go there every day for our daily 'long walk."  We also take shorter walks in our driveway, to spread the walking out over the day.  Our long walk is now up to 3.5 miles.  And for several days now I have exceeded 10000 steps.  We will keep it at that level for a few days, and then kick it up a bit, which is what we have done since discharge.  While walking I stop periodically and just stand still, to make sure everything is OK, that I'm not dizzy or anything.

It is flu season.  I stay away from people.  We wash our hands several times a day, we use an antiseptic hand cleaner, and I stay out of all stores except the grocery store.  While in the grocery store I wear a mask.  And all I do is help pick out a few groceries.  When the cart is full I leave.  I avoid people whenever possible. 

The take-home point is that I, with Vicky's help, am being meticulous about every detail.   Every.......single.......detail.

And 50% of people don't take medicines as prescribed.

I am also instructed not to lift anything over 10 pounds.  I haven't lifted anything over 5 pounds, just to play it safe.  I also avoid a lot of unnecessary stretching and bending.  This means, of course, that more of this falls on Vicky, but that is fine with her.  She knows my "job" is to heal, and hers is to make it so that can happen.  She happily has taken on more during this period of our lives.  But I have too---I had this surgery to give us more years together.  Team effort.  Go team!

There is so much that seems out of our control, but these things are within our control.

During the surgery and while recuperating at Virginia Mason I expected that every professional we dealt with was obsessively meticulous.  And it is clear they were.  There is a reason for that level of checking/double-checking/etc.  So we are following their model while at home.

If something goes wrong now, and it still could, I will know that it is simply something beyond anyone's control.  It won't be because of Virginia Mason, my doctors there, Vicky, or me.  We have all done our best. 

Two weeks out from open heart surgery

It has been two weeks since the surgeon opened my chest by cutting through my sternum, deflated my lungs, stopped my heart, and then cut into it.  Two new pieces were substituted for the two pieces that were going to kill me.  And then a series of wires were used to reconnect my breast bone.  In my body now are pieces of plastic, pieces made from a cow (for real) and a whole lot of metal. 

These kinds of open-heart surgeries occur frequently, so I am not the only one.  However, that knowledge doesn't really do much for me.   The survival rate is high, but so is the complications rate.  And although the survival rate is high, it really only is if a certain perspective is omitted.

That perspective is that 1.5% die from the operation.  This means that most people survive.  But emotionally it means that if you considered that every day you had a 1.5% chance of dying, then it isn't so hot.  Without the operation, I had a virtual 100% chance of making it to the next day.  With the surgery 1 in 65 people have the last thing on earth they see is an operating room.

One of my favorite actors, Bill Paxton, died from this type of surgery.  He was 61, and I am 70, a whopping difference.   How ironic it is that his most famous movie line was "Game over, man, Game over."  (Aliens).   I paid close attention to his heart surgery, although I also realized that his heart was, overall, not as strong as mine.  He had rheumatic fever as a child.  All of my tests showed my heart and arteries were in terrific shape--a testament to good genes, good food (thanks Vicky), a fairly stable history of exercising, and a consistent and substantial amount of exercise especially over the past 7 years (thanks Vicky).

In other words, my heart is strong because of good luck and because of Vicky.

The operation also carries with it, in addition to a risk of dying, a fair risk of complications.  The most important is a stroke.  I am taking Coumadin for that, which I hate because it means I bleed easily and have to get my blood tested every week.  I am also experiencing something called Atrial Fibrillation, which is an abnormal heart rhythm.   I am taking medication for this, but am still experiencing it.  Most likely it is a result of the surgery, although it is possible I had episodes prior to surgery and just didn't realize it.  I'll never know.  But it is a problem that must be solved for the long-run.

But, we will deal with it.  I wish I didn't have any of this, but I am, after all, 70.  I am no longer a young man. Heck, I am getting Social Security, Medicare, just bought a home in a retirement community with a bunch of old people, still put two spaces after a period, love 1950s western movies, and complain about the "younger generation."  What more do I need in order to know that I am old?

It has been, at times, a brutal 2 weeks.  I have said that it is like being dragged under a truck.

But I wanted to live another 20 years, and this operation was my only shot at that.

I have read that there can be depression after this operation.  I understand that now, but wonder if it is something other than depression.  I tire easily, am not motivated to do much, am bored, and am in constant discomfort/pain.  That could be seen as depression.  But the mind set I have isn't a depressive one--instead it is a hopeful one, a chomping at the bit for Vicky and me to get back into our life together.

These past two weeks have also given me a powerful, mind-boggling sense of how important having someone like Vicky is at a time like this.  She makes it so that I can make best use of my limited strength and energy.  The number one thing I need to do each day is walk.  It is the prescription I left the hospital with, so we do that.  We have a park close-by that we visited a few times before the operation so we could scope out the best trails (graveled, not slick, no roots).  Now we go there every day and do just under a mile and a half walk.  We take smaller ones also.

And other than that my job is to rest and heal.  She does all of the rest.  Unbelievable.  And she manages my medications.

When I met her, I saw this in her.  She was the same way with her family and with her work.  It comes naturally, but that doesn't mean it doesn't require great courage and energy on her part.  She does it all cheerfully.

I can't imagine how much more difficult this would be without her.

I am a long way from "well."  And I have this pesky side-effect of an irregular and rapid heart beat that needs to be brought under control.

But my heart is all healed, according to the surgeon.  It heals quickly (probably because there is a good oxygen supply to it).  The sternum takes forever to heal.  And monitoring the side effects to see what kinds of interventions are going to be needed on an on-going basis will require months.

But I am alive and I no longer have a time-bomb in my chest.  I am so fortunate and so grateful.  I will get past this, and then we can return to our lives with an increased likelihood of being able to have more of a future together.  We want to see a bunch of grandchildren graduate from high school.

Managing the pain of open heart surgery

I expected pain after my open heart surgery.  I knew the surgery would involve cutting a lot of tissue and bone.  I wasn't too worried about it, just knew it was something I had in my future.  Aren't I the brave one, huh?

Well, the future has not disappointed in that regard.  There has been pain, a lot of it, constant.  "Knowing" something intellectually like I did before the surgery is quite a bit different from 'knowing" it as a current experience.

All I can say, is "wow."

When one thinks about managing pain the first thought of course is medicines.  Mine too.  But I also knew that there were other strategies.  One strategy is to re-frame the pain.  Instead of viewing it as bad, for example, to view it as reflecting the fact that I am alive.  So, the pain I have experienced in the past week is the trade-off for being able to stay alive longer. Which would I choose?  To be dead now and feel no pain or to feel this (temporary) pain?  Keeping that in mind helps.

Another strategy I knew would help was to have everything else, to the extent possible, be under control.  Have my life organized.  Don't leave a bunch of unfinished stressors.  So, Vicky gave me a haircut two days before surgery.  That may seem like a small thing, and ordinarily it is, but feeling like my personal hygiene was under control helped.  Our Nuestra Casa home in Mesa had a leaky roof.  We contracted with someone who completed the repair two days before the surgery.  Now I don't have to worry about that.  It's under control.

I didn't want to get sick before my surgery, so for the two weeks prior to it Vicky and I wore masks whenever we went out into public, and we limited out public trips by buying groceries, etc. before that.  We wore latex gloves whenever we went outside, and used lots of Purel.  Who knows whether I might have been OK without doing that, but I went into the surgery knowing, to the extent possible, that I had not been exposed to any viruses.

Us at the airport flying back here from Mesa:

"Keeping the rest of my life under control" means "Vicky going the extra mile for me."  We work as a team on this.  We try to use the old phrase about work, "only handle a piece of paper once," as our motto.  Keep up with things, get things done right away, that kind of thing.  For this current ordeal the principle has served us well.

Medications:

While in the hospital I used three pain relievers which, when I reflected on it, were a strange combination.

It's odd to think about the fact that one of my most important medicines is an over-the-counter one:  Tylenol.  In fact, it is the base pain reliever.  It is actually a highly potent drug.  One of the staff at the hospital said that if the FDA knew then what it knew now about Tylenol (in terms of strength and side effects) that it would not get clearance to be an over the counter medicine.

The second was Oxycontin.  More on that later.

The third was shots of Dilaudid.   Dilaudid is an opiod derivative.  I was told it was many times stronger than morphine.  I got a few, not many, of those shots while in the hospital.  When the nurse came to administer it I violated one of my cardinal rules for being in the hospital----That rule was that I was NOT going to make captive nurses deal with old man humor.

But I couldn't help myself, I was in pain, under the control of drugs, just had open heart surgery, and am a special person. Anyway, my old man humor was to start singing the Cole Porter song:  "It's delightful, it's delicious, it's Delaudid!!!!

I'm sure the staff was sorry to see me discharged.

So, now, at home, I am using Tylenol and Oxycontin, doing a lot of reading about both kinds of medications.  One an over the counter drug that a child could walk into a gas station and purchase, and the other a controlled substance that is so dangerous that to get it you have to physically walk into a pharmacy carrying a paper prescription.  Doctors can't just phone the prescription in for you as they can for all other kinds of medicines.  These two medicines couldn't be more different.

Our strategy is to deal with the pain by taking close to the advised dose of Tylenol (but staying shy of the upper daily limit) and taking Oxycontin only at night so I will get a good night's sleep.

It seems to be working. 

(If by "working" one means "making things barely tolerable until my body heals.")

I had, of course, like most others, been following the problems associated with Oxycontin, in particular the almost unbelievable numbers of people who are using it as a recreational drug.  From what I have read, though, the problem is not Oxycontin or the maker (Perdue Pharmaceuticals) but, instead, the problem is that it is just this era's drug-to-abuse of choice.  Before that it was Meth, before that it was crack cocaine. Before that it was Heroin, and goes on and on. 

To abuse Oxycontin one has to take active steps to make it addictive,  That is, it is a time-release pill.  To get a high from it, one must pulverize it and then either snort it, or swallow it, or put it into a liquid form to inject it.

When taking it in an unauthorized manner makes it addictive, people take more and more of it, and experience withdrawal when they stop.

One thing I am pleased about regarding my care at Virginia Mason is that the physicians there are not going to make me pay for other peoples' abuse of this medicine.  It is highly effective.  I am allergic to codeine, so don't have that as an option.  And I have no history of illegal drug use.  I have taken Oxycontin in the past, after other operations, and had two reactions to it:  (1)  it worked, but I only needed it for a short time, and (2) I did not feel any type of "high" or "euphoria"  from it.  Same this time.  It gives me about as much of high as do the laxative pills I need to take.

Pain is not a growth experience.  I don't believe it should be thought of as something to just "tough out."  My lungs are an example of this principle.  During the operation my lungs were deflated.  Then several hours later they were inflated.  Imagine your lungs as a deflated balloon.  When they are reinflated there are still tiny sacs that need more inflation.  I have a breathing tool (Voldyne 2500) to help me reinflate those sacs.

The problem is that to use this breathing tool means drawing in a big, deep breath.  When I was feeling the most pain I could only draw in a medium sized breath until the pain would become intolerable.  When the pain is managed, I can inflate my lung sacs more.  So, having my pain reduced leads to better healing of my lungs.

I also need to walk as much as I can tolerate.  This is easier to do when my pain is somewhat managed.  The medicines give me more space to move my body, which is important for healing.

Upon discharge from the hospital, my instructions were to walk as much as I could tolerate.  For this, I am using another tool:  My Fitbit!  I am adding 400 steps/day and no more.  I want to build up slowly.  When the weather is nice I can walk around our driveway.  When it is rainy (most days) I do laps inside the house. 

Not only are there pain medicines, but there is a large collection of other types of medications that need to be taken in the morning and others in the evening.

Boy, do I ever depend upon Vicky for all of this.  We  have a process for the medicines, for example,  that keeps everything on track.  I am so grateful for her.  I'll be saying that and saying that for many years.  Taking these medicines is a time when it is good to engage the obsessive-compulsive side of you.  Do everything precisely as prescribed.

Maybe not for other people, but for me the experience of being under anesthesia affects my short-term memory for quite awhile after the surgery.  That is something I noticed with short, orthopedic surgeries on my foot.  In addition, I am taking Oxycontin.  And I am in pain.  Add all of those factors up and I am not in a good position to be able to accurately monitor my medicines.  I don't know how someone would do it if they lived alone.  Or if you didn't have not only a capable care-giver but a willing one, like I do. 

Vicky had a funny experience when she picked up the Oxycontin at the hospital pharmacy in preparation for my discharge. 

When she got to the pharmacy she found that she needed to provide a street address.

Well, this was awkward with all of the focus on illegal use of Oxycontin as a "recreational" drug:  The reason it was awkward is the street name where we live:  Zig Zag Lane.

Now, something I didn't know until after I bought this home in 2006 was that Zig-Zag is a type of paper used to roll marijuana cigarettes.  I wasn't even all that aware of what street the house was on because there was no street sign.  Apparently people living on the lane just gave up erecting a street sign because it was always getting stolen.  I wonder by who.

So, imagine the discomfort of picking up a prescription for Oxycontin and having to write down that you live on Zig-Zag lane. "Oh no.......we aren't getting the Oxy for recreational use.  I know we live on Zig-Zag lane but it wasn't named for the paper but instead because it zigs and zags.......honest!"  Nobody gave her any grief about this, of course---they were very professional---but we thought it was funny and could only happen in Washington State.

I will be so glad when I am beyond this experience of pain and discomfort.  But I can tolerate it, with her help, while my body heals itself.  Without her running interference for me and taking care of day-to-day details, I would need more pain medicine I am sure. She is what is keeping everything under control so I can use my resources to get better. 

My first night in the hospital after open heart surgery

I spent the first night after surgery in the ICU.  I was alert enough to stand about 10:30 p.m. and then went "right to bed."

In a hospital bed, on my back.

I didn't have any sleep medicine, because I hadn't anticipated that I would need any.

After being zonked out on medicines for most of the previous day one would think it would be quite easy to sleep.  But then I learned that being zonked out on medicine is not, physiologically, "sleeping."  Your body still needs the same amount of sleep.

Good luck with that, Dan!!!!

I had wires and tubes sticking out of me,  One tube in the wrist, one tube in the neck, and one tube in the you-know-what.  I had what seemed like dozens of little stickies going to this monitor or that monitor.  I had a monitor on one finger.

But the worst was that our dead cat, Jack, was back, haunting me, kneading my legs, every few seconds.

"Jack" was actually a device that applied pressure to my calves.  He wasn't really my dead cat (an animal I adored by the way) or Jack the Ripper.  I was only kidding.  This is the best photo we have of one:

It would inflate and deflate, and basically feel like Jack, who liked to knead my legs too, even though I always hated it when he did that.  I liked Jack.  But my artificial "Jack" was a nuisance I couldn't get rid of.  It was necessary because it prevented blood clots.  When Jack used to knead me I could just wiggle my leg and say "go away, Jack." (True confession time:  Sometimes I said other things).  But ghost Jack wouldn't go away.  I "kneaded" him (har har)

With my ghost Jack, it would inflate about every minute, on alternating legs, then deflate.  When ghost Jack deflated he made a small whooshing sound.  So not only was ghost Jack kneading me all night long, but he was whooshing when he did it.  Every....minute....all.....night.....long.

My throat hurt.  From the breathing tube that had only recently been removed.  Ordinarily I sleep on my stomach and sides, but the only position I had for sleeping in the ICU was on my back.  To turn over would have been impossible and wouldn't have been smart---I would have had to use my arms which would have put a strain on my incision.

And there were all those tubes and wires.

In order to move even a little bit onto my right or left side I had to call for help.  Two people would come, grab a sheet that was under me, count to three and then at the same time hoist me in the right direction, and put a pillow behind me to support me.  That was better than nothing and was appreciated.  Even in my drug-addled state I also could see how much physical strength it required from the nursing staff to do this.  They were each lifting about 80 pounds.  I wonder whether doing push-ups is a part of nursing training.   My admiration for hospital nursing grew during this whole experience, and it started off high to begin with.

The first time two of them were leaning over me one said to the other:  "on the count of three.  So I said "is it one, two, three and go or one, two, go on three, assuming the two young people doing it had even heard of Lethal Weapon.  They looked at me like I was in some kind of drug addled state.  

It was obvious that attempts were made to minimize the disruptions to my sleep.  And, in fact, the whole set-up was noticeably better than a hospital (different hospital) stay I had about 8 years ago, where I was for only one night.  That is even the more remarkable when I compare the two operations I had for the hospital stays.  The previous one was elective, and didn't involve anywhere near as much surgery in terms of time, "systems" affected, etc.  This one was an assault. 

But, as I have mentioned in other blog entries, only people who are alive get to have a crappy night's sleep.  I'll take my crappy night's sleep.

I was hooked up to several machines.  I was told that there is a person who sits somewhere doing nothing but looking at screens.  This person's attention to the monitors isn't erratic in the slightest because she/he does nothing else.  Looks at a monitor, looks at another monitor, looks another monitor, etc. etc.

That doesn't even include my night-time nursing staff who were also monitoring me.

And if that wasn't sufficient, the hospital also allowed Vicky to sleep in the same room as me.  Her accuracy rate of "problem" or "no problem" is not going to be as high as will be the accuracy rate of the professional staff there, but it is greater than zero.  One of the principles of psychological measurement is that if you have a psychological test where each item has only, say, 80% accuracy, if you have 4 items on this test you are not going to be as valid in detecting a problem as you would be with, say, 10 items.  In other words, even though Vicky's intuitions about whether I was experiencing something serious would not be as accurate as the judgments (based upon training and expertise) of the professional staff, her input would increase the overall validity of "Dan's in trouble."

Not only that, but her "inaccuracies" would likely be false positives.  In other words, she sees something on the monitors that she believes could be a problem when there really isn't one.

She would alert the nursing staff when she was worried about something.  They would respond immediately and check things out.  And each time told her that everything was OK.

In other words, and this is a crucial point for me, the hospital staff could have regarded her as a nuisance, or could have written her off as being just an "anxious spouse," etc., because her ability to add to the overall prediction of me being in serious distress wouldn't be as high as theirs is.  However, to see the big picture, that even with her inaccuracies she is adding to the overall validity of monitoring me requires a big picture understanding on the part of the people in charge.

The other thing that it does to have allowed her to be there through all of the nursing process is that got informal "training."  In a few days I would be released to come home.  There would be no nursing staff.  How do they make her into a more accurate observer and monitor of me?

A couple of times it appeared to Vicky that my oxygen levels were low and that my blood pressure had dropped, and she called the nursing staff who validated her observations.  They had already received an alert by that person who was monitoring patients, but machines can malfunction, even with all of the fail-safe mechanisms the hospital had.  Rare, I'm sure, but all machines can malfunction. 

So, how do they make her into a more accurate observer when I come home?  Answer:   By "training" her.  She received several "trials" comparing her thoughts to the thoughts of the professionals.   She is a more accurate monitor now than she was before the surgery.  She learned.

So, that first night I got a really, really crappy night's sleep.  And Vicky got virtually none--instead sitting by me and watching monitors.  I had no idea this was happening.  But the fact that when she saw that this is something she was allowed to do she did it.

I don't think a Target gift card is going to be enough to express my gratitude for her.  Buying her the entire Amazon river might get me closer.


Me the next morning, 24 hours after surgery, and after my awesome night's sleep: