BionicOldGuy Staying active- Despite Life’s Curveballs

Bicuspid Valve

 

First was a congenital condition where the valve has only two leaflets, known as a bicuspid valve. This does not open properly your entire life, but maybe opens enough so you get by.

 

Second, as you get older and it calcifies it goes bad more quickly than a normal valve.  My cardiologist suspected it was a bicuspid valve, because I had significant stenosis already at the relatively young age of 63.

A normal aortic valve opens to about 2.5 to 4 cm², while with moderate stenosis it is about 1 to 1.5 cm², and it is considered severe when it goes below 1. Here’s what that amount of opening looks like: Accidental Cyclist by John Lewis  

 

Mine was already like the middle picture, where the blood flow to my entire body had to squeeze through one of the fat straws for a Starbucks frappuccino instead of a garden hose. Later it would progress to the right picture, as small as a regular drinking straw.

 

That happened within a couple of years. The first symptom was a repeat of the badly out of breath symptom, so my cardiologist had me wear a monitor for a couple of weeks looking for arrhythmias.

 

Sure enough it detected atrial fibrillation (afib) that came on with exercise, probably a side effect of the bum heart valve. Afib is dangerous because it increases your risk of stroke. In addition, my next echocardiogram showed I’d progressed to severe stenosis. It was now time to get the valve replaced.

 

The best surgeon in my area turned out to be Dr. Vincent Gaudiani, who operates at El Camino hospital in Mountain View, Ca, a little over 30 miles from our house.

 

 

Median Sternotomy

 

 

Valve replacement usually requires a “median sternotomy” which requires cutting your sternum completely in half. More minimally invasive procedures are available, but unfortunately because I also had afib, we needed to do the “Maze” procedure while he had me open, and this requires the full sternum cut.

 

We decided to go with a tissue valve instead of a mechanical one because the tissue valves don’t require blood thinners.

 

Dr. Gaudiani made it clear we had to do this asap. Once it starts progressing, stenosis gets worse quickly. I’d probably be out of breath just walking around slowly within a few months, and could be dead in a year. So we scheduled the surgery as soon as we could.

 

I must admit I was nervous going into this surgery, it was a biggy and not without risk. Here is my number one tip: put yourself in a good surgeon’s hands and trust that it will go well.

 

Positive Mental Attitude

 

Do not focus on anything negative like the slight possibility of things going wrong in the surgery. Instead, focus on how great the outcome will be, and how much better you’ll feel in a couple of months after some rehab.  Why i love Cycling in the Winter.

With good attitude in place, Karen and I showed up bright and early on August 11, 2017 at El Camino hospital.

During my surgery. the new valve was sutured in place . The Maze procedure was then performed: The heart is pulled forward out of the pericardium.

Talk about having your life in somebodies hands! Small nicks are made on the surface in strategic places and then sewn shut.  Read Steven Robinsons story.

 

This will leave scar tissue that disrupts the propagation of abnormal electrical signals that can cause afib. Dr. Gaudiani performed this complex procedure superbly in just over 90 minutes. Read Eileens chester wheelers passion for cycling.

 

Major Side Effect

 

The hospital stay was a bit tougher than for the hips. The major side effect, from the surgery, which was not diagnosed till later, was that I had pericarditis, or inflammation of the lining around the heart.

This caused weeping of fluid which ended up accumulating around my lunges (pleural effusion). So I had discomfort in my upper back.

 

Next morning I woke with no pain. I was receiving intravenous diuretic to get rid of excess fluid. At this point I found from the pathology report that the removed heart valve had indeed been bicuspid, as well as calcified.

Right away they started me doing PT, mostly short walks around the hallway that gradually get longer and longer.

Under the circumstances, I was feeling pretty good about my progress. But then the physical therapist took me to a set of stairs.

After going slowly up one flight, I was on the landing gasping for breath. She said“don’t worry, that’s normal”, but this was knocked any cockiness I may have had about rehab out of me.

Stairs remained my nemesis for several months, although I got slowly better at them. It turned out the severity was worse in the early days because of continued fluid around the lungs. After a couple of nights I was well enough to go home.

 

Recovery

 

My at-home instructions were to start walking ramp it each day, And no lifting over 5 pounds (one of my precautions until the sternum healed).

And I had to be really careful about not falling for the first couple of months while my sternum was vulnerable.  It was great when I started walking outside (carefully, on nice flat sidewalks and paths).

The pleural effusion issue get coming back during this time until eventually my cardiologist just kept me on the strong diuretic (Lasix) for several months till it finally cleared up.

My other remaining symptom was that my resting heart rate was still abnormally high. It was less than 60 before my surgery because I’m in decent shape, normal for my age is low to mid 70’s. But mine was now in the 90s.

This is common after my type of surgery, and I was assured it would eventually clear up but could take up to a year (which turned out to be true).

 

Cardiac Rehab

 

My instructions recommended starting cardiac rehab after six weeks. There is a nice rehab facility at El Camino, where I ended up going for 30 sessions.

The staff was very nice and competent, nurses and PTs specializing in cardiac rehab. The facility was like a gym, but they had you wear a monitoring device that was constantly checking your heart rate and for arrhythmias, plus they would come by to get your blood pressure and see how you were doing.

I also could start using my arms on the elliptical. I routinely ran my heart rate up to as much as 140 and we never saw arrhythmia in any of the sessions.

And it helped I could go hard with my arms on the machines without bothering my sternum. By the end of my 30 sessions, I was able to go quite strenuously without exceeding my heart rate limit, and it was a great confidence booster knowing that no heart abnormalities were detected.

Around this time, after about 4 months post-op, my sternum was healed up enough to ride and hike (carefully!) outdoors, which I did on non-rehab days.

It was really nice to be able to get back to working out outdoors again. Things have progressed nicely in the four years since the surgery.

I’m probably a bit slower since I’m 68, but it doesn’t feel like it because the replacement valve makes me feel good as new. And my sternum has completely healed so I can do strength training as hard as ever.

In my old age adventures so far, I got two new hips for my 60^th birthday, and a new heart valve for my 65^th. Karen says she’d really rather I didn’t get any replacement parts for my 70^th. I’m inclined to agree with her.   Virginia is for lovers of cycling by Larry Lipman  .