3-4 Weeks After Surgery

After my emergency room visit on Easter day, I was able to concentrate on recovery the rest of post op week three. I had a visiting nurse come out on Monday morning and check up on me. The cannulated stitch in my upper thigh from the bypass incision site was removed, and all my vitals were checked. I ran through a list of medications with her to update her on any changes. Nothing had been changed yet, as I had not started reducing the Prednisone yet. I was anxious to start getting off of it, though, because I struggled with the side effects. One minute I was doing okay, and the next I was angry or bawling my eyes out. It also made me feel like I could eat the entire sink and still be hungry, a typical steroid side effect. I started becoming concerned with the fact that I was not losing any more weight from the fluid retention, and instead the weight was staying on. I tried not to concentrate on that. Being a young female who had worked so hard on my physique before surgery, I was disappointed in the aftermath. I needed to remember that none of these factors were permanent and I would soon be able to tone my muscles back to where they were. I struggled with the first stages of atrophy and my joint pain increased throughout the week. I practiced the exercises I was assigned by the Occupational Therapist to begin the process of strengthening my upper body through a series of controlled stretches. These were inspiring as I felt myself getting a little more controlled and having increased endurance each day. I also continued a long walk each day with lots of movement in between. Beginning the process of strengthening myself and getting moving again kept me going.

Toward the end of the week the glue was working its way apart from the sternal scar. It peeled back slowly, mainly on it's own accord. I had to consciously not help it along, and wait for it to fall off naturally so that the scar could heal correctly. Once all the glue had fallen off, the scar was just a light wrinkle about four and a half inches long, barely noticeable under a necklace. This was inspiring to me, and I watched for the bruising to reduce on the rest of my body. I still have the fading hematoma on my thigh, it has not reduced yet. Also there are bruises on each elbow from IVs, and a yellowing bruise on the right side of the sternal incision. There was some bruising where the port was removed but it went away pretty fast. My body continued to heal, getting better by the day and able to do more without becoming short of breath. People who saw me could no longer tell that I had open heart surgery just three weeks before. My efforts could begin to concentrate on aligning my future plans, and finding some help with the burdens I was encountering financially (see 'Partners In Health'). By week four, I was well enough to begin my final exam essays for American History (my last high school class needed to graduate). The essays took the entire week, but by the time they were done I was so relieved I could have cried. I also did a lot of paperwork for state programs and tried to concentrate on deciding which issues in my life were more pressing than others. When there is so much going on at one time, that is when I begin to list. I had this pointed out to me by my incredibly intellectual boyfriend. He noticed that with my anxiety, I list all the possible negatives, the what ifs, and the oh-nos of anything currently overwhelming my life. Worrying about things does not get you anywhere, so when he notices me doing this he cuts me off and makes me recenter on the current situation. I do the same thing to help me stay organized as well though. I write out long lists and make notes as I accomplish things, and when enough of the list has been accomplished I make another list. It's cool to feel accomplished when you check items off of the list.

On week four I was taken off of the Cardiocom system that checked my vitals daily because I was doing so well and feeling stabilized. My Occupational Therapist came to my house and went on a walk with me for the final time, discharging me for good. I ventured out and about more often, for some short shopping trips and visiting friends, and did not feel as worn out by the movement. I began to feel more comfortable lifting a gallon of milk and pulling my car door closed as my muscles healed. I even picked up a cheap oximeter at Wal-Mart to measure my pulse through exercise and my oxygen levels if I need to. I improved my upper body exercises, and felt inspired to improve my walks with some uphill slopes. All these things fell into place, and I knew by the time I saw the surgeon for a check-up in another week I would be improved enough to be released to do more activity.

Home Sweet Home, This Time To Stay

I took in a deep breathe of felines and family as daycare children circled my living room the day I returned home. I had my 'therapy cat', Pippin, at my feet and my parents and some kids carrying on around me and I decided it was not that bad to be home. I spent six days in the hospital the second visit, and most of them were sunny and beautiful as a New Hampshire spring blossomed in mid April, stealing the last of the snow from the leaf littered forest floor. This day however, was a rainy, cold, unpleasant Tuesday. It reminded me that paradise is what you make of it. I wished I had enjoyed the great weather on the first days of true spring throughout the previous weekend, but there would be more to come. In fact, more than sunlight I couldn't wait to just feel my soft sheets around me. I missed the ability to lay in my own bed each night, uninterrupted and sleeping peacefully on my side. The side part would not be happening for awhile, as laying on my side felt as if my breastbone would crush at any given moment. I relearned sleeping on my back with pillows encasing me and blankets tucked under my chin. It was not the most ideal but it beat being awakened every morning at four for blood work, six for vitals, seven for rounds, eight for tests, and so on and so forth. I could sleep as late as I wanted, and roll out of my waist high mattress to help myself to pain medicine and snacks. 

Two of my cats taking over my bed the first night I was home.

The program set up for my arrival home was perfect for keeping a close eye on my improvement. The day after discharge I was visited by a visiting nurse who would see me weekly for at least three weeks. She checks my vitals, listens to my heart and lungs, oversees my Prednisone taper and other medications, answers questions, checks scars for signs of infections, and can run blood tests if needed. She also set me up with a Cardiocom system that alarms each morning at nine to check my entire condition, and then sends the results by phone line to the office for review. It starts with a series of questions answered yes or no, like 'Have you been taking your medicines?' and 'Have you eaten a salty meal today?' which keeps me in check. It then measures oxidation, blood pressure, pulse, and weight. I can recheck any of these things at any time of day without completing the full health check and sending the results in to the office. If I feel worse symptoms at any time I can pull up a chair and make sure my vitals are in a safe place before worrying over the possibility of pericardial effusion recurring. 

Along with the VNA, I have a visit weekly from an occupational therapist who is making sure I am not pushing myself too much before I am ready, and that I am doing exercises to stretch my upper body and building up my walking at a safe pace to improve my cardiac conditioning. I did not previously think I would be eligible for Cardiac Rehabilitation so she decided to be a short term stand in, and help guide me at home. We decided on a target heart rate zone, a comfortable 14 exercises to perform for warm ups before a walk, and I was released after week one to start a half mile walk twice daily. The day after I was released to start building my cardiac endurance with walks, I received a call from Concord Hospital Cardiac Rehabilitation to set up an appointment with a therapist for a consultation. Apparently Medicaid would end up covering my unique diagnosis for the rehab program, and hopefully I could find a way to continue the program after the consultation that was booked a month out. The rehab would not only teach classes about diet and exercise and heart function, but also attach heart monitors to watch while exercise is started and make sure a healthy level of conditioning is reached and slowly increased. It gives a great guide to ease a post op patient back into an independent workout regime without pushing the heart to unhealthy levels. I have a way of overdoing things and not taking things slowly, so a guideline to follow and someone to encourage me will help me have accountability as I begin to return to the gym and work my way up to where I was before. 

Settling back into my own medication schedule was another challenge I faced upon my return. I now take Prednisone 40 mg daily (every morning), Metoprolol 50 mg twice daily, Aspirin 81 mg daily, Ibuprofen 800 mg every 6 hours, Tylenol 1000 mg every 6 hours, Axid (antacid) daily, allergy medicine daily, and any additional as needed medications for nausea and sleep. I have, over the course of the week, tried to reduce my Ibuprofen to 600 mg (better on the stomach) and Tylenol to evenings only. I haven't needed to take Zofran for nausea, or Ativan for anxiety at all. I've also been religious about my heart related medications, on a 9 am and 9 pm schedule, which has helped. It's been a huge relief not worrying about antibiotic treatments, and being able to stop the antifungals because of that. My body is still adjusting to all the changes and I haven't decided through the side effects of the steroids how I'm doing yet with the tick born infections. 

The Friday after I came home I was quickly swept in for the Port removal procedure (see 'Port Removal'). Aside from that day, I spent the days adjusting to home life concentrating on appointments, logistics of arranging appointments and paperwork for state financial assistance, trying to appreciate good showers (the hospital revoked that right for a week when the chest tube was in), trying to get myself mobile and reconnected to family and friends by route of social networking, napping and eating myself into a sugar coma, and waiting for a miraculous recovery to occur. The miraculous recovery did start coming in slow doses, as each day I woke up feeling a little bit stronger, a little more awake, a little more at ease with movement, and a lot more inspired. I started getting out and about more, which was a relief from being home every day in a daycare listening to screaming babies that aren't even related to me. I had visits from a few friends, and even was able to dress up for Easter Sunday and spend time with my family. To an untrained eye that had never previously met me, I appeared completely healthy. I could wear more typical clothing, walk around in public for short bits, carry on conversations until they left me winded, and the scar was barely noticeable. Overall my improvements were in leaps and bounds, and by week three after surgery I was energetic and carrying a purse, even going out for dinner dates, ready to take on the world. 

Easter Sunday with my man