MRSA

So this is week nine, but it should have been week 13. Just as I was leaving for the hospital for the surgery a few months ago I got a frantic message to say that it had all been cancelled because I had MRSA. I was unclean. I knew this was a contamination – but little else – I just assumed that I would be put on a course of antibiotics to clear it up. Which, when you consider, was pretty stupid?
MRSA is a bacteria that is resistant to the commonly used antibiotics, and whilst it should stand for Microbes Resistant to Standard Antibiotics, it actually stands for Methicillin Resistant Staphylococcus Aureus. The Staphylococcus Aureus is a common form of bacteria which lives on the skin of about 30% of the population. The most common sites where it can be found are in the armpits, the groin or the nose. The test is of the content of swabs which have been rubbed in each of those locations.
MRSA is a problem if you are going to have an intrusive procedure because there is the two fold risk, firstly of spreading it within the hospital and secondly of the skin surface bacteria being transferred into the wound during an operation.
Before I could have the operation I had to have had three negative (no contamination by MRSA) results from tests. So the MRSA had to be dealt with. And how am I to be rendered clean – why with soap and water and clean bed linen, for a week. First I had to wash using a Hibiscrub. This is an antimicrobial preparation. So you take some mediwipes or a new Jay cloth and make sure you have rubbed every surface and orifice (including under the nails) in the liquid before rinsing off. This includes washing your hair with it at least twice in the week, and then throwing away the mediwipes or Jay cloth you have used.
The second part of the treatment was to apply a powder to the groin and under arms. I am not used to applying any powder – so this involved a learning experience. The powder comes in a small plastic bottle about the size of an eye drop container. Putting the powder into the groin was relatively easy, gravity was on your side, but getting it up under my arms was less straight forward. Pressing the flexible sides of the container produced an asthmatic wheeze. Shaking it produced anything from a dust storm to a winsome puff. In the end I shook the powder onto my hand and then rubbed it onto the areas required for treatment.
The third part was the application of the nasal ointment. This came in a small tube with a chemical carried in paraffin wax. This had to be applied high up into each nostril three times a day, the size of each application being ‘of the size of a match head’. My early attempts were a failure. A lump was pushed into the nostril, and then massaged, in the process of which it all seemed to come out of the nose. I evolved a system that worked. Firstly, I placed the tube in the sink in warm or hot water. This made the wax soft and it was easier to eject a bead of the material – and easier to push the soft wax high up into each nostril. By pinching the base of the two nostrils before massaging, the inside of each nostril was coated.
Then came the final part of this week of treatment – changing towels and bed linen every day. This is an onerous task, remaking the bed every day with clean sheets. It does not endear one to one’s partner, especially as helping is hindered by the very heart problems that required the operation in the first place.
And after the week of treatment it is off to hospital to be checked. The taking of the swabs is not a problem, although the wait for the results is about three days. If it is a fail, and you still have MRSA, then it is a case of redoing the treatment again. I had tests done twice before I went back for the operation and both were negative. I had a further check when I went in the day before the operation and when the results came through that evening they still showed that I was clear.
So the need to eliminate MRSA delayed the operation by 4 weeks – and the most onerous part of that treatment was changing towels and bed linen every day for a week. So this is week 9 and not week 13.
I have never had an empty diary before (cleared because of the anticipated operation and recovery period), so the four weeks was put to good use so that when I eventually went into hospital I was in better shape than I had been in years

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Houston – we have a problem

It started a week ago (week six) when I became aware that my breathing was not quite as good as I thought it should be.  The slight drag became more pronounced until by Wednesday I knew that there was a problem. But what?   I have allergies, dogs, cats, pollen, mother in law’s – the usual list, and had had supper with friends and their three dogs. Could they be the culprits?  My wife had been suffering with a cold – had I caught the virus and had that affected my breathing?  I was using inhalers to gain respite, but the relief was very short lived.(When I went down with pneumonia, the collapse of my breathing was one of the first indications I had that all was not well and in bed that last night before I went into hospital I recall trying all my inhalers, but their giving no repite.) Oh, and my weight, it has started ballooning. My weight rarely changes – but suddenly each morning it was another kilogram; that made an additional 4 kilos in a week.  And my pulse – that was racing at 122 beats per minute.

I had had a blood test at the beginning of the week as a follow up from the chest infection and antibiotics taken after the operation, and there was a routine GP appointment the following Monday to sort out the aftermath.  The weekend was difficult, and I had no appetite.

Came the GP appointment on the Monday and he checked my pulse and decided it was normal and prescribed anti-histamine.  My measurement of my blood pressure and pulse rate was very different and still had it racing. By the next day my breathing was laboured and sleep was very difficult as a result. On the Wednesday I had a consultation with the surgeon that had been arranged post-op, (usually 6 weeks after, but because of holidays it ended up 7 weeks over.) The ECG undertaken before the consultations showed, amongst other things,  a pulse rate of 122 and a slightly irregular heart beat. His opinion was that the heart was fluttering, that the weight gain was associated with the heart as was the breathing problem and recommended amongst other changes, taking Digoxin.  It took another 24 hours to get a prescription before I could start taking.

The first tablet taken, I read the leaflet in the packet and noted that the Manufacturer’s recommendations for the Initial dose was nearly 10 times the amount I had just taken. Phone calls and emails and by the next morning that anomaly was corrected. Almost immediately the breathing improved.

The surgeon had recommended that I saw a cardiologist – and by good fortune he agreed to see me on Christmas Eve.  The ECG he required showed slight variations in the heart beat and a pulse rate of 113.  He carried out an ultrasound of the heart, and it confirmed atrial flutter which he recommended be dealt with by cardioversion – something I gather that is rather like being given an electric shock.

The next month will require me to take warfarin prior to the procedure and for a further two or three months after, together with other medication to control the weight gain, the blood pressure and all the remaining inaccuracies of my body.

And, apparently, these problems are very common post operation, occurring in about 30% of cases. I didn’t know that. None of the warnings, guides or instructions mention this as a possible down side – possible, probable more likely. This occurs in 37 to 50% of patients after mitral valve surgery, and around 70% of those occur in the first week post-surgery, but it is common for the problems to occur six or so weeks later.

In a 1971 paper following the monitoring of 50 patients 74% experienced arrhythmia in the first 7 days after the operation.  The paper concluded that ‘whereas arrhythmias are a very common complication of cardiac valve replacement, early detection and treatment has lessened their significance as a cause of postoperative mortality and morbidity’. My concern is that early detection did not happen, and it has taken two weeks to get to a stage where the problem is being treated.

So my hope of seeing the end of these medical issues in 2012 has been dashed, and it looks as if at least the first month or so of 2013 will continue the theme. The end of next February will be the first anniversary of that train ride to A&E.

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Blood

If you are squeamish you don’t have to look away now – because there was precious little of the red stuff that I saw. When I came round after the operation I had expected my chest to be swathed in bandages but there was only the slit with a couple of Elastoplast’s (Band-Aids) towards the top. The rest was laid open with an ingénue scab forming. Nothing oozed from this cut and there was no blood on my clothes or the bedding. And no stitches – I do not know how they joined together the opening of that is over 30 cms long that the surgeon had needed – superglue? There were three stitches – but they were in a horizontal line at the bottom of the scar and did not seem to be holding together any part of an opening through the skin. Perhaps that had to tack back in place some of the bits that went back lower down – what is that goes there?
Yes there is a scar. For the more manly and hirsute man the bared chest (it will have been shaved for the operation) will soon afforest and conceal the surgeons’ tracks– but for the naturally bare chested like me (I could always count the hairs on my chest on the fingers of one hand) there is no hope but to display the surgeon’s handiwork with aplomb whenever stripped. For the ladies the bikini may not be advisable – but fortunately for them precious few seems to have problems with their heart and need this type of invasion. Having spoken (but not checked) with friends whom I know have had the same operation most said the scar was hardly visible after seven or eight years. Next time I am on a beach (and its warm enough for bare chested display) I might go looking to see how prominent the scars are – although as it is a nudist beach close by, that might not be a good idea.
To say the whole thing was bloodless would be an exaggeration. My first wet cough when I came round after the operation was very alarming. It was black, being blood of a wholly different appearance than I had seen before. That was to remain the case the next three to four weeks as coughing became less and less painful – although even now I will ‘swear allegiance’ each time I feel a cough coming. Over these early weeks the colour of the emissions changed, and became more diluted and eventually grey, and then white. I examined each deposit with care to ensure that it did not suggest an on-going problem.
The sight of blood to me was a matter of panic when first it happened – but was dealt with in a very matter of fact way by the nurses. Everything that frightened me they took in their stride, but those inconsequential things that I did not regard as serious seemed to result in a need for urgent action from them. At the beginning the blood that was coughed up was sent for analysis – but later deposits did not seem to attract the same interest. However, after I left hospital at the end of week one (my life is dominated by week numbers – with week six being the much sought after ‘I can drive again’ target) the results of one analysis of these bloody samples did show that I had caught a chest infection.
So don’t fear blood, in the main it stays where it should be, and only the redundant deposits are ejected from the lungs.

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How am I now?

I am remarkably well, thank you for asking.
Do I notice any difference? Well, funny you ask I suppose I can ‘feel’ a change. I have been an asthmatic since I was two years old (so I am told) so being out of breath is something that I have become used to. In the period that followed my recovery from pneumonia, exercise left me breathless – but with the feeling of empty air. There seemed to be no benefit from the breathing that I did to recover from exertion. Emptiness was the best way of describing it. Now, four weeks after the operation I am tired, and I get out of breath if I walk up a lot of stairs or walk quickly, but I sense that I get some benefit from breathing deeply – even if it is perishing cold air that comes in. So perhaps I do feel a change.
At the moment I have not found the limits of what I can do. A long walk is dealt with in relative ease, but I am tired afterwards – and sometimes the weariness extends to the next day. Reading the guidance given to me when I was in hospital, I notice that being tired the next day is supposed to be an indication of having over done it.
I have now managed two days this week in which I did not stop for a rest. One of those days was doing an inspection of a Grade 2 listed property in North London. The strangeness of that was packing a minimal bag so that I did not exceed my weight limit. (I tried to shut a part-jammed sash window today and probably exceeded the amount I am supposed to carry – one does this type of thing without thinking.) My usual equipment includes cameras that themselves are heavier than the guidance suggests for the first 12 weeks. In the end I relied on the lightest camera that I had, a few simple pieces of kit and put the lot in a rucksack to avoid the weight being carried and exerting pressure on my chest.
Occasionally I am aware of discomfort high up in my chest – I suppose one could call it a sharp pain – but only at 1 of a ten scale. It is at this stage that I realise I do not know where my heart is. OK, I know it is on my left side of the chest, but at what height – I assume below the left lung. Now, having checked, I see that it is close to dead centre and much higher than I thought, mid-way between one’s nipples. This doesn’t change the location of the ‘pain’, which was not in the location of the heart, now that I do know where it is. Heavens to murgatroyd, I gave permission for the thing to be carved up, you would have thought I would have known where it was.
So what has changed now that I have completed week four. I now know where my heart is.

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Weak Four

My main achievement this week was eating a meal and leaving a clean table. Last week’s panic over my loss of dexterity and spatial awareness resulted in my spreading food from a plate onto the table. How that happened escaped me, I would concentrate on placing food onto a fork to lift up to my mouth, and at the end when I picked the plate up to wash it there was food on the table around the line of the back of the plate.
Last week’s mental gymnastics resulted in a number of tests and medical appointments – the outcome of which would seem to be that I am improving. But then I knew that because I can dress myself and no longer urinate onto the closed lid of the toilet. The suggestion seems to be that an interaction between a pill and low blood pressure affected the brain. And as I was assured would happen, my mental awareness has come back.
I was warned I might have to advise the DVLA of the operation. Having read their website, and understood some of it, I came to the conclusion that they had to be notified only if I had a heavy goods vehicle licence (which my mother had – she had picked up her licence in the times before driving tests and had been given one to drive any road vehicle of any weight.) I was also supposed to notify my car insurers. So I have at last summoned up the courage, or bottle, to tell my car insurers that I have been told not to drive for six weeks. They were not interested and eventually summed up the call with the helpful advice not to drive the car for six weeks, which is what I rang to advise them was the advice the surgeon had given. Making the call seemed so final – to confine oneself to the availability of other should I need to go anywhere. (I am not supposed to use public transport lest I catch one of the cold bugs doing the rounds, so being chauffeured around it has to be.) I am not the best of passengers, occasionally letting out an audible wince at a speed bump struck at a tad over 20mph, or commenting on an interesting route that is being taken. My helpful comments resulted in the chauffeuse becoming even more tight-lipped.
We did go out to Sunday lunch, a first social event post operation, which involved a cross London journey of a couple of hours. Sunday lunch time is not a good time to drive and all of the usual bottle necks were corked (or screw capped). Every light was red, tourist spots were hot, shopping centres peopled, and roads full of slow moving traffic. After a delightful meal we watched the film ‘In Bruges’ on a home cinema. It was a brave choice, for whilst it is a very good film, with a great performance from Brendon Gleeson, there is a tiny bit of swearing. To entertain your elderly aunt (and slightly less aged uncle, part of whom is almost 4 weeks old) and have the confidence that they are sufficiently broadminded for the language not to faze them is almost a vote of confidence. Having the film projected onto a wall – giving an image about 80 inches (as the television companies measure their screens) – does put the imagery very full in your face. Home cinema is mighty impressive. The book said that I would find social engagements tiring – well this is the first day that I have stayed up all afternoon and evening, with no lie down or surreptitious closing of one’s eyes in the dark.
So four weeks on, there are signs of improvement although tiredness remains a constant, but there are signs that the sense-of-humour bypass may not have been successful. Oh,
and my self-wind watch doesn’t. Presumably I am not sufficiently active to keep the thing ticking  – which reminds me, time for my exercise – I don’t have the additional facility of rewinding my heart if that stops ticking and they removed the wires for rebooting the thing before I left hospital.

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Week Three- not so good

[This post was written painstakingly whilst I was having problems. It therefore contains errors and mistakes – which I have not corrected. The purpose of this blog is to record honestly how I have felt or reacted to the heart treatment I have received].

So this the start of week three.
Now it is all a lot more difficult. I seem to have lost my spatial awareness and I cannot see properly. The spatial thing does not sound much but the effect is that when I come to those familiar tasks, for example typing or entering an alarm code there is no memory as to the location of the letters or the numbers on the keyboard. This means that each stroke is a new journey. Each letter that I type has to be found out the sea of I cannot recall where letters are located on the keyboard amongst a sea of similar dots of similar black dots. The journey does not always arrive at the right station or it goes on a loop and comes back through the same station again sometimes in a different direction.
Even mundane things like combing my hair were beyond me, as I could not work out how to hold the comb so that it was parallel with my head, and using a towel defeated me when trying to dry myself after a shower (I could not get it to lie flat against my skin).
Dialling a phone number was very difficult, the sequences of similar numbers seem to overlap so that I might start with the first numbers and transpose to the second group without being aware of making the change. The number sequences 330 3311 (British Heart Foundation) took seven attempts to get right.
At the worst I could not apply shapes – for example a shirt was a meaningless jumble that I could not see how to wear. And even a bath robe defeated all attempts to put it on. I described it as having lost my spatial awareness.

When trying to read, words are drawn out, stretched, as if pulled through a pasta-making-machine, each stretched and distorted and then joined up in the middle. I cannot read because what I see is the line which I seem to read from the middle out. Reading is tough because as I look at the text the beginning and the end of the line overlap, and the distinguishment of line ends is impossible – so I find that I am restarting the line I have just read.
At the worst I could not enter the 4 numbers into the burglar alarm keypad because I saw no relationship between each, and I had to search for each number whilst my eyes were reading images from the middle out.

The loss of ones faculties is scary, even though I am being reassured that this is temporary, caused by the fluctuation of blood pressure but a side of me fears that it might be worse.
Fortunately my neighbour has had the same operation, and there is someone to go to for his experiences – even if they do not include loss of spatial awareness. My panic, and it did get close to this in when it was at its worst, was that no one said that this was unusual, or reacted with any urgency.
After a week I am making progress and am much improved from last week. I can now dress myself, and am able to type but at a much reduced pace. The problems of last week were scary. Fortunately, things are now much better and everyone has been telling me that it is only temporary.
Oddly, this was not one of the things that they warned me about. Of those, they said I would take two months to build up to walking a mile, but this I was doing after two weeks.

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Painful?

Painful?

I would be lying if I were to say that there had been no pain but there was precious little and what there was I cannot recall, save for one thing.

When I arrived at the hospital a tightly folded hand towel taped up into a shape approximately 20cms by 15cms by about 7cms was lying on my bed – this made it the size of a squashed rugby ball. I was to see grown men caressing this bundle and gazing down upon it with rapt affection, or be close to tears because they had been separated from it by more than a few feet. It was our constant companion, sharing our bed, meal times, our exercise and our thoughts. All of us, from time-to-time, would quietly withdraw in mid conversation and go for a cuddle with it.

It was, quite literally, our comfort blanket in case we were to cough. That was where the wave of pain would sweep over us and bring tears to our eyes. When you think about it, someone had broken through the rib cage and after repairing the heart and stuffing everything back where it came from, had wired up the rib cage. A cough would result in the rapid swelling and deflating of the chest-cavity and all that bone that was trying to re-bond with itself would get a shake-up. A cough was needed but human nature meant we all tried to supress the extent of the activity. A cough was a very quiet moment, a personal moment when one withdrew to allow a slight speeding up of the exhaled air, it was something that one allowed only to slip through, in the manner of clearing your throat. Grown men could be seen creeping round, cuddling their bundle, trying to do the gentlest of coughs. And when the doctor, listening to your chest asked for a cough, he go the weakest apology for one. A hearty – let’s get it all out- was never on the cards.

And make no mistake, it was men. Allowing for the token woman, most of the occupants of the ward were men, and the majority of those were in their 40s. Their presence was due to a variety of restricted veins, heart attacks, tumors or similar, some of which were the result of life style choices.

One of the downsides of living is realising the consequences of one’s life.

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The days fly by

Tuesday
It has all rather flown by – I read the paper, did the crossword (easy) was tested and am now nil by mouth. I now recall the pleasure of hospital beds – sweaty plastic sheets and narrow. And I have a week more to enjoy?
So here I am, suited, booted and soon to be anointed – with iodine. (I recall the pain of iodine being applied by my grandmother to a soap box car race induced knee scrape in my childhood – I have always been a wimp). The iodine is to ensure minimum risk of infection from my skin. I shaved my chest on Monday morning – removing both hairs in the process. Suited is not quite the right word – gowned would have been more accurate. Breakfast before the fast and now ready to roll.

My main worry is no news from New York. Emails overnight have not gone through – which might suggest there is no signal there. It would have been nice know they are all safe before …

Last I heard Richard was composing a list of the best music of 2012 and Gavin and Erin were stocked up for the duration of Sandy. How can a storm that will have caused so much loss of life, money and time, and be said to have lost Romney the election, have such a sweet Olivia Newton John name?

A nurse comes into the room with a vacuum cleaner – and points the nozzle in my direction. I am puzzled, whether this is to enable the room the be cleared of any detritus that I might have dropped – having started the tranquilisation process I am relaxed and chatty. A man comes in with the gurney, and the nurse connects the vacuum to the mattress and blows air in – the mattress expands and begins to entomb me. The sides come in and envelope me and they slide me from my bed onto the gurney, rather in the manner of a hovercraft. It is a relatively short journey to the anaesthetists’ corner where I am to be turned off.

On the Wednesday those on the New Jersey Coast and in Lower Manhattan were waking up to the damage to their homes and the loss of power caused by Tropical Storm Sandy. I remained in an induced sleep throughout the day blissfully unaware of the tribulations of other – with my two guardian angels monitoring my every lack of movement. Somewhere in a lucid period I have put glasses on, taken them off, and dropped them on the floor breaking a lens. It would appear that I did wake, but I have no recollection. I must have had them on in the recovery room or Intensive Care and taken them off and there being no side table they slipped off the bed onto the hard floor. I remember them falling, the sound of the impact – but did not move to see the consequence. All those years ago I bought them in Hong Kong. A pair of bifocals for £200 – I was never entirely happy with them and although I had been told they met the requirements of the DVLA and were fine for reading I have never used them for driving. They had survived two months of ITU earlier in the year so maybe this means an end to my hospital experiences (at least for this year).
On the Thursday I was moved into the care of Marius, and he was responsible for my being moved out of the intensive care ward during the day. I was aware of things happening but struggled with many details, like my name and what I did. My fingers would not work when typing responses to messages on my Blackberry. Richard struggled to get to the theatre, still without power, because there was a boat on the railway tracks.

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My Heart

My Heart.

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My Heart

A few months ago I knew nothing about the heart – it was just something that chuntered away doing its thing and, provided I ate sensibly, didn’t smoke and was reasonably active I did not expect any problems. I kept my part of the bargain and rather assumed that it was an honourable fellow. I was not aware that it is a muscle with four chambers, that 80 to 100 times per minute squeezes (rather like ones hand on a damp sponge) and through a cunning set of chambers, and in so doing it squirts blood (not through ones fingers as would happen with the sponge), but around the body. The right side receives the return blood into the first chamber, squirts it into the next ventricle from where the blood is fired off to the lungs. The other side of the heart receives the blood from the lungs and fires it off around the body. The blood is moved from chamber to chamber by the squeeze of that part of the heart, and valves between each of the chambers act like lock gates on a canal (except the pressure created is enormous) and ensure the blood keeps going one way. Brilliant and simple. Each heart beat is each part of the heart squeezing the blood into the next chamber, and with me every fourth beat was weaker.
The symptoms of one of these valves going wrong include tiredness, breathlessness, palpitations, dizziness or feinting. I had none of those (I would have put breathlessness down to asthma).
So I lay there whilst a small gentleman of Indian abstraction, with small hands works inside my chest. They have sliced my rib cage from just below the neck straight down to the base of the ribs and then broken the ribs apart and lifted them sufficient for the surgeon to get his hands into my chest, and – the heart now being still – open it up to inspect the damaged valve. He had mentioned that he would repair it if he could – but obviously this was not possible as it was worse than expected. So a replacement valve was fitted – being taken from a specially bred pig. The new tissue valve sits on a support ring and is fixed into place within the heart and gradually everything is closed up and the heart restarted. After nearly five hours my body is wheeled off to a recovery room where two people watch me for signs of unusual activity. Me – I just enjoy the sleep. From slipping into unconsciousness to my wife being told by the surgeon that the operation was successful was a total of six and a half hours.

30 October 2012

Posted in Heart - how it works, Heart surgery, how it is done, Mitral valve, Uncategorized | Leave a comment