Put this on your bucket list: open heart surgery

“I can hardly wait to see your nine-incher, Glenn!” Those were the words of a dear hiking buddy with whom I’ve had a long platonic friendship.

But I’m getting ahead of myself.

Beginning last summer, I felt less than my usual acerbic, aerobic self, especially when hiking at altitude with my group around Aspen. I finally awoke one morning feeling downright crappy, and a little light-headed. I’m not prone to illness. I haven’t vomited for at least 30 years, and my last cold was over ten years ago. I figured something was wrong.

I drove myself to the local emergency room. Cleverly, or so I thought, I skipped breakfast because I figured they’d want to draw blood for tests.

They did draw blood, and did lots of imaging. They found nothing wrong.

Except I passed out. That alarmed me and everyone else until we figured out it was due to plummeting glucose levels. That’s what happens in early afternoon if you haven’t eaten a thing for 20 hours. So much for my cleverness in skipping breakfast.

Over the next two months, I became a regular in the ER and in the medical offices. Each time was with the same symptoms: Intense fatigue, light-headedness, and now some cognitive and memory issues. Each time, they found nothing wrong.

They did notice my bicuspid aortic valve – a defect that I was born with and have been aware of for many years. The aortic valve is the exit from the heart to the aortic artery. All the blood pumped to your body goes through it. It’s supposed to be three-leafed, but about one percent of the population gets short-changed in the aortic valve line at birth and gets only a two-leafed version.

A bicuspid aortic valve is usually not fatal. Many people never realize they have it. But it’s not as efficient, and it can deteriorate over time.

They saw my bicuspid aortic valve through a routine echocardiogram. They apply an echo transducer to the chest, something like the transducers applied to a woman’s belly to generate an image of a baby in the womb.

The echocardiogram showed that I had “mild regurgitation” through my bicuspid aortic valve, and would need to have it replaced sometime in the next few years. But it was not an emergency and did not account for my symptoms.

I was starting to think my symptoms were imagined, and the docs probably were too.

Almost on a lark, I saw yet another cardiologist. This one was suspicious about the echocardiogram images showing only mild regurgitation at my defective aortic valve. He ordered up a different sort of echocardiogram. For this one, they put me under an anesthetic and put the transducer down my esophagus to get a view of the valve from a different angle.

That angle showed the regurgitation at the bicuspid aortic valve was not mild, but “severe.” The valve had deteriorated to the point that blood was backflowing from the aorta back into the heart. They checked me into the hospital that very day and performed open heart surgery to replace the valve as soon as they could round up a surgical team.

The lead surgeon happened to be a petite blond woman. Her blondness was of no consequence, medically speaking, but I noticed her small, strong fingers that would soon be fishing around in my chest. I thought, “That makes sense – all surgeons should be petite women.”

For the replacement valve, they can use a mechanical prosthesis or a biological one. We chose the biological one. It’s fabricated from natural bovine heart tissue. So, I have a bit of Bessy in me. At least it wasn’t porcine tissue.

Surgery entails a nine-inch incision lengthwise over the sternum (hence the remark by my friend which I quoted above). Then they cut through the sternum, still lengthwise, and pry open the split sternum and chest cavity with a steel prying cage that looks like something from a tire store.

That exposes the beating heart. A vein and an artery are accessed with catheters connected to a heart-lung bypass machine to maintain the oxygenation of the blood. The heart is then stopped with drugs, and remains stopped for an hour or two during the next steps.

The surgeon cuts into the heart to expose the aortic valve, carves it out, takes measurements, and sews in the prosthetic valve of the right size. Then the heart is closed with stiches, the bypass machine is disconnected from its arterial and venous access points, the heart is restarted, the prying cage is closed and removed, the sternum is stapled or wired together, and the skin incision is stitched up. The whole operation usually takes 4-6 hours.

I once had simple knee surgery where they used an epidural to numb me from the hip down. I elected to stay conscious the whole time and observed the surgery on a video monitor.

That was not an option for the heart surgery.

I awoke that evening with a tube down my throat. My first assigned task was to convince them that I was well enough for them to remove it. I succeeded, and they did.

I spent another four nights in the hospital. With encouragement, I was able to walk to the bathroom right away, and each day I walked a bit farther down the hallway. By the last day, I was walking a single flight of the stairwell. It wasn’t exactly the Matterhorn, but you have to start somewhere.

At home, it was tricky to get around without feeling pain in the sternum and thereabouts. After about three months, the direct pain was pretty much gone, except there would be odd bouts of intense pain or cramps in the intercostals between the ribs.

Heart arrhythmias are common after open heart surgery because the surgical incisions cut through established electrical pathways. The body finds alternative pathways that are incorrect and mistimed.

I got the full measure of arrhythmias. Atrial fibrillation was first, where the heart races and flutters. My heart rate would be 64, then 42, then 163, then 81, all in the span of a few seconds.

For that, I underwent the usual treatment of “cardioversion” where the patient is anaesthetized and the heart is shocked with a high-voltage current to reset the proper electrical synchronization. The burn marks left on the chest are usually small and heal quickly.

Then there were the premature ventricular contractions, or PVCs, where the sensation is that the heart is skipping a beat. All people get a few PVCs now and then, and they tend not to be dangerous, but mine would go on for hours or days. They were typically loud enough to keep me awake all night. Eventually, they subsided (I think).

The whole experience is disruptive to one’s metabolism, one’s head, and one’s emotions. I sincerely believe I’m a different person now.

That person is not yet as mentally acute. There’s a name for the symptom of brain fog after heart surgery involving a heart-lung bypass pump. They call it “pump head.” I confess to having a bit of pump head. It often improves over time.

I’m also not as aerobically strong. That, too, may improve – especially now that I have a proper and efficient aortic valve for the first time in my life. I’m not ready to hang up my hiking boots quite yet, or my spurs.

And I’m different in my personality. I’m relearning things, relearning people, and relearning myself. I choose to see it as a blessing. How many people get the chance to reinvent themselves, free of the baggage of who they were?

Meanwhile, I’ve got this nine-incher. Got that going for me.