My name is Jim Jacobson and
I am a retired 58 year old
white male living in Incline
Village, Nevada on the North
Shore of Lake Tahoe. On
October 22, 2001 I had a AVR
at the Balboa Navy Regional
Medical Center in San Diego,
CA.
A "problem" with
my Aortic Valve (bicuspid) was
uncovered during a routine
Navy physical in the spring of
1976 so I've known a
replacement valve was in my
future for a long time. Just
didn't know when. There was
talk of medically discharging
me and I was asked if that is
what I wanted...I said no. I
stayed in the Navy for 26
years, retiring in July of
1996. My wife, also a Navy
Intelligence Officer, retired
in 1999. During an annual
physical and just prior to
retirement it was determined
my Aortic Valve had degraded,
and my heart enlarged to the
point closer observation was
required. This increased
observation involved
semi-annual Echoes and a once
a year Mugga. There was no
further degradation until this
past October when I was
informed of a
"significant
dilation," and that
"it was time" for
the valve to be replaced. I
said "okay" and a
week later I had a new valve;
a tissue valve from a-moo-cow.
The advantage I've had is
that I've known this was
coming for 25 years and that
time afforded me the
opportunity to mentally
prepare myself and research
the available options afforded
me. The Navy was willing to
install whatever type of valve
I desired; pig, cow,
mechanical, or human. My
personality is such I tend to
take things matter of factly.
I think that helped my
objectivity. I've also
maintained myself in good
physical shape, and had no
other indicators detracting
from the surgery or the
healing process; i.e. kidney,
blood, or liver issues. I've
also never smoked, nor am I
overweight. Well, perhaps
that's a bit of a stretch as
most of us could stand to lose
at least a few pounds.
Prior to surgery I was, as
near as I could tell, asymptomatic.
The difficulty we all face as
we get older is, what is part
of the normal aging process,
and what things should we be
concerned about. No one can
answer those questions for us
and since we only grow old
once...well, there are no
manuals. I was still able to
run and could do six to eight
miles, but my recovery time
was now three to four days
vice the previous 24 hours.
And I must admit moving from
sea level in San Diego to
Incline Village at 6,350 feet
has it's own set of
challenges, particularly when
the heart function is
degraded. If that was a
symptom, it was the only one I
had. No chest pain, no
significant shortness of
breath, and my recovery when
hiking in the mountains was
rapid.
My surgeon was Dr. Jim
Hemp, a Navy Captain whose
name kept coming up as I
inquired around. Additionally,
about a year ago our son and
Dr Hemp's son were together on
a father-son camping trip in
the Cub Scouts. He remembered
me because I brought a six
pack to the event for the
adults while the kids did the smores
thing. There was a connection
and I liked him right away. He
retires from the Navy in a
couple of years and will
probably stay in San Diego in
case any of you reading this
reside there and may have need
of his services.
Why did I decide upon the
cow tissue valve. It boiled
down to my lifestyle. I'm very
active; golfing, bike riding,
walking, jogging, lifting
weights and so on. For
example, last summer my son
was driving a 4-wheeler with
me on the back south of
Yellowstone at a friend's
ranch and went around a corner
too fast - about 15 MPH. I was
thrown off and incurred a
large and very nasty bruise
above my left hip, but no
other injuries. Had I been on
a blood thinner the fall could
have been a very significant
health issue. Each January my
family, along with friends, go
snowmobiling from the
community of West Yellowstone
for a weekend. I asked Dr.
Hemp if I could wait to have
the surgery after January and
was told that given the
degradation since my last echo
in June I shouldn't wait. The
trip remains the focus of my
recovery. Originally, and
after consultation with Dr.
Hemp, I decided upon a
stentless tissue valve, but a
CT scan determined my aortic
artery was very big and Dr.
Hemp did not have enough
historical information to
determine if the largeness was
a result of dilation or just
because of the fact I'm a big
guy (6'2", 215 lbs). The
artery was inspected during
surgery and no weaknesses were
found, but as a result of it's
possible dilation it was
decided to use a stinted
tissue valve and do a post-op
annual CT scan.
I talked at length with Dr.
Hemp concerning the type of
valve I should have,
originally wanting a
homograph. The doctor
indicated a homograph was
technically easy for him to
install, however, he also
indicated when it was time to
replace this new valve I now
have, a stinted tissue valve
would be much easier on me
physically than if a homograph
was the valve needing to be
replaced. The reason for this
is the Homograph is like a
tube with a valve midway. When
that is replaced, the entire
tube must be dissected out.
With other tissue valves, the
valve can be removed without
breaking the integrity of the
Aortic artery. Hopefully it
will be 10-15 years before
this new valve needs
replacement. But one thing for
sure, when replaced, I'll be
older and less able to
tolerate the surgery. I want
that next valve replacement to
go as smoothly as possible,
and without complications.
Anything I can do now to
affect the outcome of that
next surgery I want to do.
Standard to this surgery is
to cath your heart prior,
since, if you have a blocked
artery, well, while your chest
is open... I had this done on
the Friday preceding the
Monday AM surgery.
Fortunately, the team doing
the cath found nothing
indicating any blockage to the
arteries of my heart. They did
say something they probably
shouldn't have though, and
that was my arteries were
"as clear as a 20 year
old." I used that as a
license to steal, eating
Mexican and downing a couple
of shooters the night prior to
surgery.
Recovery. Surgery was first
thing on Monday morning, I was
out of ICU the following
morning and walking that
afternoon. Dr. Hemp said I
could leave the hospital the
following afternoon,
Wednesday, if I wanted because
he felt I could go then and my
wife was arriving also. I told
him I think I should wait one
more day and was released on
Thursday about noon. We stayed
in the area and a week later I
received my final release. I
tell you I milked my wife's
good graces as she really took
care of me, waiting on me hand
and foot. The emotional
support from loved ones is a
factor equally important as
exercise or meds. I don't know
if it's a good thing or a bad
thing, but I have a very high
tolerance to pain and have
needed no pain meds since
leaving the hospital. The
hospital staff was concerned I
wasn't getting enough pain
meds since I had not taken
anything for pain since
leaving the ICU. I finally
took a nightly dose of
Percocet, more to keep them
from asking me to take it than
really feeling like I needed
it.
By the way. As a reader of
this, should you find yourself
needing open heart surgery ask
for a "Cosmetic
Closure." Its the buzz
phrase I heard when I
suggested they have someone
from plastics come down to
close me up. I was informed
that "Dr. Hemp only does
cosmetic closer." Works
for me.
I don't know if it's
because my body was cooled way
down for the surgery, or the
shock of the surgery itself,
but for 2-3 weeks post-op, I
would break out into sweats
and chills at random, similar
to a low grade fever and like
my body was trying to
"find itself,"
temperature wise. It was most
discerning, but Dr. Hemp
assured me not to worry and
this problem slowly abated and
was gone after about three
weeks.
I was able to sleep on
either side in the hospital,
but I now understand when
older folks say they have
"good days" and
"bad days." For the
first several weeks I would
engage in a physical activity
and feel great the next day. A
couple of days later I'd do
the same physical activity and
feel lousy the day following.
I don't understand it and no
one can explain it. Slow and
steady is the method of
recovery that seems to work
best.
In retrospect I had higher
blood pressure than normal for
several years even though I
was taking an ACE inhibitor
pre-op for to save wear and
tear on the valve. Getting
used to having my BP normal as
controlled by an ACE inhibitor
(Monopril 10 Mg 1 x day) and a
Beta blocker (Atenolol 25 Mg x
1 x day) was the most
difficult thing about the
surgery. Getting used to those
meds and living at 6300 feet
is quite an adjustment. At
eight weeks all seems to be
well and my body is pretty
much back to normal. I would
say I'm at about 90%, the
remaining 10% being just in
getting back in aerobic shape.
Three times per week I now
lift the same weight I did
pre-op and also do 30 minutes
on the treadmill, two and a
half miles, alternating 1/4
laps between a fast walk and
medium jog at a nine minute
pace. The treadmill will
increase as time goes on. I
want to be able to do a hour
at a time, all at a jog, three
times per week. I am totally
unaware of the surgery except
for an occasional
"awareness" centered
below the sternum.
I had some initial food
issues that should be shared
with you. I lost 15 pounds in
the hospital on what could be
described as a very expensive
weight loss program. The only
food items that appealed to me
were fruit and tomatoes. Don't
know why, but I really craved
tomatoes. About two weeks
post-op I had a glass of red
wine...yuk! At about four
weeks I had a Margarita and
told my wife it was the worst
Margarita I've ever had...she
said it tasted all right to
her. At eight weeks the food
issues are gone and everything
that was good before, is good
now.
A couple of weeks ago I
went back to San Diego for a
baseline Echo which was
normal. I will continue that
Rx each year. I'll also have
the aforementioned CT scan of
the Aortic Artery to insure it
does not dilate or form a weak
spot that will need attention.
To all those reading these
personal accounts because they
are soon to undergo valve
replacement, I will tell you
that Open Heart Surgery is
certainly not like a having a
hang nail, but if you are in
reasonably good health without
other significant risks,
you'll do just fine. Remember
the valve you choose is the
right one for you...there are
no wrong choices. Remember
also medicine moves on-and
rapidly. I'd be willing to bet
in the near term there will be
a mechanical valve that will
not need blood thinners.
Decisions will get a lot
easier.
Update...
January 2005.
I will be 62 in April. Last
October was the three year
anniversary of my AVR. To
tell the truth I don't even
think about my new valve
much any more.
My annual exam is in October
and so far all is well. I
take a daily aspirin and two
low-dose BP meds. I've even
become accustomed to the
seven inch scar down the
middle of my chest. There
was a small keloid at the
base of the scar but it has
disappeared after two
steroid injections.
As previously noted I have a
large Aortic Artery which is
being watched and may
(will?) have to be replaced
at some point.
During these past three
years my weight had crept up
to 225, but now stands at
215 (New Year's resolution
thing), with a goal of 190
by next year. I'm running 6
miles, 3xweek and feel
excellent. The loss of that
first ten pounds has
resulted in reducing my
Atentanol dose by 1/2 and is
a good motivator for
continued weight loss and
exercise. I am hopeful if I
can reach my weight goal, I
will be off both BP meds.
In initial remarks I
commented on having good
days and bad days, and an
off and on low grade fever
for 2-3 weeks post op. It
turns out these symptoms
were the result of a
sensitivity (allergy) to the
iodine injected during MRI
tests. A pre med of 50mg of
over the counter Benadryl
works fine to eliminate
these symptoms.
Dr Hemp has now retired from
the Navy and continues his
practice in San Diego. I
wish each of you well. We
can consider ourselves lucky
to have been born at a time
when valve replacement is an
option. We all have much to
be thankful for.
Drop me a line if you have
specific questions:
jhjacobson@san.rr.com