DerekMy name is Derek and on December 2, 2004, at the age of 32, I had an aortic valve replaced by Dr. Steve Jones at Providence Medical Center in Anchorage, Alaska. I first learned I had a heart murmur in 1990 during a routine athletic physical exam. Subsequent tests revealed that a leaking congenital bi-leaflet valve was causing the murmur. The attending physician determined that I was not symptomatic, but that I should monitor my condition annually, and take antibiotics prior to having dental work done as a precautionary measure against cardio infection. In the years following the diagnosis I remained physically active and had a relatively uneventful medical history, with only routine physicals with no indication of problems. In the spring of 2004 while fighting a bout of bronchitis, a general practitioner detected the murmur and ordered further examination. After a regimen of tests it was determined that the valve was “leaking severely” and I would need to speak to a cardiologist and a surgeon for further diagnosis. Huh? Heart surgery? At my age? This was overwhelming news that surely humbled me. My hometown of Fairbanks, Alaska has no cardiologist at its medical facility, so I had to travel to Anchorage for a trans-esophageal echocardiogram at the Alaska Heart Institute. The test revealed that the valve was indeed leaking severely, and if left untreated would continue to increase the size of my heart. My cardiologist introduced me to a surgeon and we discussed valve replacement. The prognosis was that within six months to a year my condition would worsen to the point that the team could medically recommend surgery. I returned to Fairbanks to continue my normal routine but over the next few months I became increasingly aware of my body and valve related symptoms. I work as a case manager for a mental health program which at times can be stressful. My exercise comes from regular visits to the gym complemented by officiating basketball in the evenings. I became more easily fatigued and noticed a decrease in my stamina. The more visible signs were shortness of breath, an occasional racing heartbeat and significant pulsation in my lower neck. After a follow up appointment in August with my cardiologist I was given the green light to schedule surgery. That was actually a relief, as the progressively noticeable symptoms and the idea of impending major heart surgery had become its own ordeal. Prior to surgery I did a lot of reading and research on the procedure, which I found both informational and disturbing as I visualized some of the things that would happen to my body during and after surgery. I donated four units of my own blood to hold in reserve in case it was needed during the operation. Surgery was scheduled for November 28 and I returned to Anchorage. Both of my parents were with me and I greatly appreciated their presence and support. The day prior was spent going through pre-op tests and receiving a lot of information. The most invasive pre-op procedure was the heart catheterization, which indicated that my coronaries were clear. Making the decision between an artificial valve versus a pig valve seemed easy to me. The artificial valve would probably outlast me, whereas the pig valve would eventually wear out and necessitate more surgery. My choice meant that I would take Coumadin for an extended period of time, but at my age the idea of one or more future surgeries to replace worn out pig valves was not an option. I reported to the pre-op area bright and early on the 30th of November. They shaved my torso and began to prepare me for surgery. They took my temperature and discovered I had a low-grade fever. No go. They prescribed antibiotics and I was told to report back the following day so they could check my temperature. All dressed up in my gown with no where to go. I still to this day feel like things happen for a reason. By the following day my temperature had stabilized and surgery was rescheduled for December 2nd. That morning the prep routine took little time and before I knew it they were giving my parents time to wish me the best before surgery. As they rolled me into the operating room it was noticeably cooler and they laid me on the table and said, “You’re going to feel sleepy now.” The last thing I remember was nervously attempting humor and muttering, “OK, team, git ‘er dun.....” My leaky valve was explanted and replaced with a 27/29 On-X artificial valve. One unit of my own blood was transfused during the procedure. ICU was a blur as they kept me well medicated for comfort. The Intensive Care team did a phenomenal job in mitigating my pain and frustration. I do recall feeling extremely dehydrated and wanting those @#$#%^$# tubes out of me. It wasn’t long before I was out-breathing the respirator so they removed the tube. My post-op recovery progressed fairly rapidly and tubes and catheters and lines were removed one by one. I moved to the step down unit the second day after surgery. I became one with my “heart pillow” because coughing, sneezing and just moving made me feel as if I had been hit by a semi truck. My appetite was extremely diminished and the anesthesia caused constipation as well. Another aspect that was truly frustrating for me was the necessity of sleeping on my back, as I am normally a side sleeper. The nursing staff kept me motivated to get up, walk and continue deep-breathing exercises even though at times I just wanted to lay there like a chunk of Jello. While it was clear to me that it was important to actively participate in my recovery, I learned very quickly that my body was the major player. When I tried to speed up the healing process it would get cranky and throw a tantrum to let me know it had enough. If I can offer any advice it is this: no matter how strong you are—physically, physiologically, psychologically—if your body has a heart-to-heart discussion with you, heed every word. I quickly learned who was really in control. Patience is indeed a virtue. I was discharged on the 7th of December and was prescribed Toprol, Coumadin, Prevacid and Cardizem, as well as pain medication to take PRN. I rested a lot but also did some walking around malls for cardiac therapy. I was restricted from flying for 15 days and checked into a hotel to wait it out until I could leave. A couple of nights later I woke up and could feel and hear my heart racing and beating irregularly. I phoned my doctor’s on-call service in the middle of the night and he directed me to come in to his office first thing the next morning. According to my surgeon a certain percentage of heart valve patients experience atrial fibrillation and atrial flutter due to the trauma the heart experiences during the procedure. My INR or anti-coagulation of my blood was also not up to a therapeutic level. He ordered me to be hospitalized immediately to thin my blood using a Heparin I/V. This was actually comforting as the a-fib and a-flutter were very unsettling. Through continued medication adjustments my anti-coagulation leveled out to a therapeutic range. But my heart was continuing to have intermittent episodes of a-fib and a-flutter. My doctor ordered a cardio-version, which involved general anesthetic and shocking my heart back into sinus rhythm. The procedure was performed without incident and I was discharged the following day. It is well known that Alaska winters are cold and dark, and it’s not the best environment for recuperation. I was fortunate to have a grandmother living in California and I spent the next few weeks visiting. A couple of daily walks and lots of rest helped in my recovery. I have since had a follow-up consultation with my cardiologist in Anchorage and I returned to work in Fairbanks on January 10th. Very soon, I hope to be back on the basketball court officiating games. My sternum is slowly healing and I will be restricted in my upper body activities for awhile. Meanwhile, my co-workers and friends are impressed by my battle scar and sound effects. I’m still not quite accustomed to the click-click-click of my new valve as it opens and closes. But at least I know it’s working!
Derek Fyten |