Tag Archives: recovery

December 26th @ 366

A life milestone at 366 days

Today marks a year since my heart attack.

I reached a major milestone today. This is Day #366 since I suffered a heart attack a year ago last December 26. Early that morning at Ala Moana Beach Park I had just started my short walk when I felt the slight pain, definite congestion and hobbling pace. Something was wrong as I turned around and headed back for my car and eventually to the hospital that led up to major bypass surgery. Those events are recounted in earlier entries to this blog.

December 26, 2016: This morning I returned to Ala Moana Beach Park / Magic Island to take the walk that I did not complete a year ago. It was my way to quietly celebrate the milestone of life which would have probably ended if I did not make the right decisions last year. Today I reflect and count my blessings that I am still here on Earth, doing what I like to do and trying my best to cope with my improved but still challenging situation.

My health is good. I can walk, talk, eat, drink (water mostly), drive and do all of the other things that I can or love to do. I have changed my eating habits and try to walk at least 2 miles every day. I lost more than 30 pounds since last year and have had to down size my clothes and the clutter of my living condition.

I could not have gotten to where I am by myself.

First of all I’d like to thank my doctors and nurses who helped me live and overcome much of the trauma associated with major heart surgery and the long road to recovery. Special thanks to Dr. Steven M. Kramer at Kaiser Permanente who has been the patient and understanding physician in my life for the past 4 years. He recently left his general practice to move on to specialized care for senior citizens.

Lisa Davidson is my close friend who has championed not only the changes I made for my health but also encouraging me to try new things in life. Early on I was not very kind to her as we had a falling out shortly after my surgery. But time healed and I am happy to have her back in my life again as a lifelong friend. Today we are both there for each other to help us overcome many of life’s challenges and struggles. Lisa is a very talented writer and creative type that is looking for a new professional opportunity in which she can once again spread her wings to “change the world”.

Then there is Jerry Stanfield, my good friend who I met many years ago through an association we had while working for the non-profit, but now defunct Small Business Hawaii organization and the Hawaii State Legislature. Over the years Jerry and I have become good friends due to our sharing of many common interests such as photography, computers, music, history and aviation.

Jerry who moved to Costa Rica about 2 years ago went out of his way to come back to Hawaii and help care for me the 2nd month that I was out of the hospital. He encouraged me to keep to the walking regimen and helped build my independence. In return I always help him with his computer and other tech questions. Today Jerry is back in Costa Rica enjoying his retired life there after spending more than 50 years in Hawaii.

Last but not least is my sister Sandra Ah Ching. She has had to put up with me a lot over the past year. Sandra arrived in Honolulu on January 5, 2016, the day that I was discharged from the hospital.

There is a lot that I could and should write about the care that Sandra gave to me for that first month and later on 2 return trips to Honolulu. She is sometimes misunderstood, but definitely has nothing but good intentions for other people in her life.

During my month-long period of early recovery, Sandra did a ton of stuff for me. The first few weeks after my release from the hospital, I could barely do the routine stuff. Sandra was there to do it all for me — grocery shopping, some cooking, driving the car, assisting me in getting dressed, tending to my surgical wounds, helping me with my medications, the bathroom and propping me up in bed. She encouraged me to walk the first feeble, painful steps after surgery. She encouraged me to “cough through the pain” because that was good for me. Fact is to this very day, she encourages me often to go the extra mile, to push it to the next step even though I can be the stubborn, reluctant person to some of those changes.

At the same time during the month of January, Sandra also managed to help me get my cluttered home life into gear. You see, after surgery I had to stay for more than a month at the Pagoda Hotel in Honolulu which I live nearby. My condo was a huge mess and had to be cleaned up. — too much clutter. I was forbidden to go there in my weak, vulnerable, post-surgical state.

She took charge of the clutter extraction at the apartment with the help of an organizational company we hired and later with contractors to fix the place up. What she helped me with is beyond words and the story for a possible, separate blog entry.

So in addition to helping me recover with my health, she also had to be “clutter buster” and then later “organizational manager”; the latter task of which she loves to do.

In time I was able to move back into my apartment, regain my health and reach a point to where I could once again live independently and alone as I have been for most of my life. She and later Jerry were instrumental in getting me there.

Today I am grateful to have a very supportive sister like Sandra and close friends like Lisa and Jerry who have gone out of their way to help me. I also want to thank my other friends who helped me in their own way — Daniel and Emma, Moses and Lesley, my Big Island O’hana and those on Facebook who offered words of support and encouragement through this process.

The bottom line is this: Recovery from major surgery is not something you can do by yourself. It takes the help of very dedicated people from within your pool of family or friends to aid in your recovery. People with large families will have no problem with this. For single people like myself, it is important to have a family member or a pool of close friends who can offer help in time of need. Their assistance is invaluable.

Today with God’s blessing, I hope to be around for many years to come as I start another new year of my new life. It will be an interesting one with even more challenges ahead.

Hopefully with this entry, I will be inspired once more to kick start this blog and offer a posting at more regular intervals.

Aloha and God Bless You All.

 

What to Expect After Heart Bypass Surgery — Part 1

Heart and function monitors after surgery in intensive care. Photo by Mel.

Heart and function monitors after surgery in intensive care. Photo by Mel.

So you are going to have heart bypass surgery. This post will be about what to expect after your surgery as you spend the next several months in recovery.

AT THE HOSPITAL

First day you’ll be in intensive care, legs up with a number of tubes and other sensors plugged into your body. These are all hooked up to monitors that track your health condition for the time you are there. The stay in intensive care is 24 to 48 hours. It was 36 hours for me.

The stuff plugged into you are gradually removed before you move to the recovery ward.

More than likely after your brief stay in intensive care you will be moved to a telemetry ward. There the hospital staff will monitor your progress. Doctors will occasionally visit you, encourage you to start eating and walking. Nurses are there all the time and help you with just about every aspect of early recovery. Nurses are the lifeblood of most hospitals. Without them the system would probably collapse.

While confined mainly to a bed you will be encouraged to eat, and especially walk. Nurses and other personnel may / will come and visit you to work on your basic motor skills such as standing and walking. You will need help to go to the bathroom or use the bedpan. I chose the bathroom all of the time…

Before that happened though you are hooked up to a catheter which takes care of the urinary functions for the short term. Later the thing is removed and you are free to use the bathroom. I don’t like catheters, especially when it goes in and even comes out. One word: pain.

Speaking of which.

PAIN will be your constant companion for quite some time. Pain will be apparent every time you cough. The intensity of the pain shortly after surgery is high. Your pain level for every cough will be in the area of 8 to 9 on the 10 point pain scale. The pain from coughing will gradually wane. Sneezing also brings about the same chest pain.

The cause of the pain is fluid buildup in the lungs and the fact that your chest pounds against the healing wounds of your ribcage which is located just above your heart (see Wounds below). I tried to suppress my coughing but that was futile. It could have made things worse. As my doctors told me, “cough it out”. Be sure to use the “heart pillow” every time you cough.

WALKING: From early on you are encouraged to walk. You will find walking to be difficult, especially in the beginning. Your walking range after surgery will be short. A walk around the hospital ward will be considered “good”. Walking helps build your strength and gives your newly repaired heart a workout. While in the hospital you are hooked up to a heart monitor that is tracked on computers in the telemetry area. That is kind of cool I think. I used to always like to walk around the telemetry area to check my vitals like pulse and respiration that was displayed on a large flatscreen monitor.

Walking in those first days after surgery will be slow, short and maybe labored. My heart rate was between 100 to 120 beats per minute (bpm) while I walked. While idle I think my heart rate was at around 92 bpm. It gets better as time goes on.

Daily walking will be a recommended activity after your discharge.

EATING: You probably won’t have much of an appetite shortly after surgery. But that improves in time. One thing about eating is that if you were a junk food junkie like me (which more than likely brought about my heart condition) you definitely will have to change your daily menu. Divorce yourself from sugary carbonated drinks, beef, pork, sweets, candies, hamburgers, etc. Think more fruits, vegetables, water and fish. I will write more about meals later.

MEDICATIONS: You will be given a lot of medications shortly after surgery. Nurses are good at being timely in administering your medications. Some will be given through tubes while others will be given in pill form. Before you are discharged from the hospital a long list of medications will be prescribed to you for home use during your recovery and beyond. Be sure to dutifully take your medications. They are vital to sustaining your heart and life.

TUBES AND STUFF: More than likely there will be several tubes stuck into your body. All of these were inserted while you were in surgery. Thankfully you were spared the pain of the insertion since you were under anesthetic at that time. However, the tubes will have to be removed during hospitalization. Some like the catheter and the one going into your chest will be briefly painful when they are removed. The chest tube looks kind of gross upon removal… yellow/brown slime coats it. Yeah, you needed to know that.

There will be at least 1 or 2 intravenous tubes inserted into your arms for blood testing and medication purposes. These will be removed shortly before discharge. From the times you are poked with needles, you will find that your arms will become bruised.

Since you may also be on blood thinning medications, the chances of being bruised increases even after your discharge.

WOUNDS: Everyone who goes through heart bypass surgery will have two major wounds on their body. The first and most obvious wound is the large cut that go from the top of your chest to the bottom just above your tummy. Surgeons cut this area of your chest to gain access to your heart. They also had to break the bones on your rib cage to get to your heart. After the bypass veins are placed around your heart the bones have to be mended with a wire mesh that will stay inside of you for the rest of your life. Then the wound is stitched. It looks pretty gross when you first see it after the big bandage is removed a few days after surgery. Think Frankenstein’s monster… heh.  The chest wound will heal but will be a permanent scar on your body. The resulting scar is called “The Zipper” by many bypass survivors.

The Zipper.

“The Zipper” and tube wound just below that. Photos by Jerry Stanfield.

The other major wound will be on your leg at the lower end of your thigh just above the knee (at least it was in my case). Basically it is a big hole where the surgeons extracted your own veins for insertion around your heart (hence the word “bypass”). There will be a small tube coming out of that for drainage after surgery which will be removed before discharge.

Taking care of your wounds and being mindful of the condition of your healing heart and ribcage will be an important part of your recovery. The ribcage takes a while to heal. Patients have to be mindful in following instructions to prevent the ribcage mesh from accidentally dislodging itself which would probably result in a medical emergency that will probably require surgery and hospitalization to repair.

The reason for much of the chest pain associated with coughing is attributed to that healing ribcage area.

Below the chest incision wound will likely be a hole from which the gross tube was removed. It will be bandaged and will take time to heal. You have to keep it cleaned and medicated until it heals. The healing time for this wound is about 2 to 3 months.

I think I covered most of the things that happen after surgery. This post ended up being about care during hospitalization. The next post will be about home care. Fun stuff.

 

 

 

Home is Where It Was Not

Pagoda Hotel

The Pagoda Hotel on Rycroft or Kanunu streets in Honolulu.

One of the unexpected events that happened because of my surgery and hospitalization was the fact that I could not go home. What you ask? Yes, my sister Sandra and friend Daniel before her were the only 2 people who went to my apartment and found that was a total mess. I was told by both of them that I could not go back until the mess, which consisted mostly of electronic equipment, cameras, CDs, tapes, records, DVDs and paper was cleaned up.

So on January 5 I started my long stay at the “affordable” Aqua Pagoda Hotel on Rycroft Street. On discharge day (January 5) Sandra flew in from Hilo on the Big Island of Hawaii to begin her stay with me. Her mission was to help me in my recovery after the operation. She knew about my heart attack early on, but we decided there was no reason for her to come during the time I was in the hospital. She saved her trip to help me with my recovery.

For the next several weeks Sandra and I were almost permanent residents of the Pagoda Hotel. That was not cheap.

The hotel is nice. Not a “five-star property” but genuinely hospitable, convenient (very near my place of residence), and “affordable”.

So there I was learning how to recover some of my most basic skills. Doing stuff like walking, cooking, bending, eating and even sleeping had its challenges. I was also still in pain.

After you have a bypass surgery one of the major annoyances is the constant, painful coughing. The doctors all encouraged me to cough so that liquid junk does not build up in the lungs. Every cough was greeted with stinging pain and at the beginning the words I used to describe each cough were not the type you use in pleasant company.

Surely at the outset I took pain medication along with all of the other pills that were and still are required of me to this day. By the way, medications are also not cheap.

Eating was a hassle because I had to make a major change to my eating habits, which from that time going forward consists mostly of fruits, vegetables, fish, some grains (like cereal) and water. Occasionally I do eat other foods like chicken or turkey. Beef and pork have been off limits and so are foods that you get at places like Burger King, McDonald’s and Pizza Hut.

The other fact regarding food is that I had to learn and am still learning how to cook my limiting types of meals (mostly lately, steaming, microwaving or “saute” (what does tht mean; seems like frying to me)….. More on food again, in a later post.

After discharge from the hospital I could not walk very far without running out of breath. For every few feet that I walked, I would have to stop, rest and catch my breath. At first I only hung around the hotel and occasionally walked down the hall or to the downstairs lobby. Later Sandra took me shopping to WalMart, where walking to and from the car was a chore. I ended up usually sitting at the front bench at the entrance while I waited for her to shop.

Other things that I had to get used to with was taking a shower on my own (I needed assistance at first), using the toilet, brushing my teeth, putting on my clothes, getting to bed and trying to lie down in a specific way. Because of my pain and my weakened condition, all of these tasks that we all take for granted are not easy after you get out of surgery. I also did not feel like updating my blogs, websites or even visiting Facebook.

In time though, I did get better and slowly improved, though another major bump was looming.

 

Stress, Fribillation, Pain, and Release

Heart Pillow

Heart shaped pillow given to Kaiser heart surgery patients during the holidays.

At only 3 entries in, I found that this one is one of the hardest to write. The main reason is that shortly after my surgery was done, I was extremely stressed and worried about a lot of things, some not even with my health condition. Not being overly detailed in describing this part, I have to say that I was so stressed that I did get angry at some people for doing things that was out of my control (intense questions “I wish you were dead” and pre-mature release of my health status to a group of people that I best did not want to let know regarding anything in my life). These just made my recovery much more stressful at the time. As a result, I think these stresses only a couple days after surgery contributed to my “heart fibrillation” that I suffered through the next 5 days in the hospital.

Now that I have made my condition known through this blog on my own time, I am OK about people knowing. I just did not want it to happen so early.

Anyways, I’d like to say “sorry” to everyone that I have offended.

That all said, briefly going into the next few days of my January 2016 hospitalization before I hopefully zoom into the present day….

January 1, 2016 started with an early rise (for medications, etc. How can anyone actually sleep in the hospital when nurses are coming in and out at hourly intervals to give you medication and check your status?) to catch the first sunrise of 2016.

I told the nurses that one of the things I always did in past years was to take a photograph of the first sunrise for the new year. In recent years that usually occurred at Diamond Head Lookout or somewhere at Ala Moana Beach Park or Kaka’ako. This year, given the state that I was in that Friday morning, all I simply wanted to do was take my tiny camera and get an image of the sunrise from the Kaiser Moanalua hospital balcony just outside the 3rd floor.

The nurses in charge of my care obliged with my request to be taken out to the balcony and see the sunrise and get my shot. I was not strong enough to walk very far, so I was wheeled out by an assistant nurse. I lingered on the balcony for more than 45 minutes and was just so thankful to be there and live to see the first sunrise of the new year. I got my shot, not the best in the series, but it was a shot. I was happy.

I think it was later that afternoon after I met two visitors, that things started to go south. By the end of the day I had the heart fibrillations. I think I was put quickly put on new medications and my heart was probably monitored more intensely.

January 2 to January 5: Subsequent days in the hospital I was highly encouraged by the medical staff to “exercise” and start walking around. I was weak, but I did take short, painful, feeble walks around the 3rd floor facility. I had to push or pull the IV rack around with me as I was on a constant flow of medications….. even while I walked around. Plus I had the heart sensor device (about the size of a large iPod) with wires hooked up to my chest 24-7 monitoring my heart rate and all that stuff.

I remember walking past the heart monitoring station where a bank of computer screens kept track of each patient in cardio care. My heart rate while walking around was high at around 120 beats per minute. I am sure this was due in some part to my fribillations and that I was still feeling stressed.

Over the next several days the tubes that were initially stuck into me during surgery were removed one by one. The two that I remember the most was the long suction tube or whatever it was that they had inserted just below my chest. I think I had to hold my breath while they pulled that foot long tube out of me. It was a weird sensation and that thing had a wet iodine color coated on the outside when removed.

Later the catheter was removed from the private place where the flow should be one way out only. It was briefly painful when the nurse pulled that sucker out. Ouch! I hate those things.

Let me tell you about pain. You would think that after going through such an intense surgery that I would recover quickly, be free of pain, and just walk out of there in a couple of days. Nope… not happening!

Pain was my constant companion and to this day still is. However pain a day and a few more after surgery was intense. The most intense pain happens during the process of coughing. It seems like coughing is part of the process in recovering from heart bypass surgery.

From what I understand, since my breastplate bones were cut and then put together again with a fragile wire mesh (which allows new bones to grow in place), whenever I coughed, the motion (I think) forces my heart and other organs back there to hit up against the breast, causing intense pain per cough! Ouch.. Ouch… OUCH!!!!!

The reason for coughing I had been told was to get the liquid build up out of my lungs. Apparently after surgery your body produces a lot of liquid that ends up in the lungs and a couple of other places like your legs. The lung ones are a problem because you don’t want a large build-up of liquid mucus in there. Best way to get rid of it is to cough it out.

Let me tell you about the hospital’s pain scale that they use. The one that Kaiser Permanente uses is the Nurmeric Rating Scale (NRS 11) which “is an 11–point scale for patient self-reporting of pain. It is for adults and children 10 years old or older.” The breakdown of each pain threshold is as follows:

Rating Pain Level
0 No Pain
1–3 Mild Pain (nagging, annoying, interfering little with ADLs)
4–6 Moderate Pain (interferes significantly with ADLs)
7–10 Severe Pain (disabling; unable to perform ADLs)

The pain that I experienced while coughing was in the neighborhood of 7, 8 and 9. Extremely painful per cough. Imagine 10 being equal to the pain of having a shark bite a limb off you… well 9 is just short of that hugely intense pain factor.

Fortunately they give you two tools to help ease the pain.

The first tool I got was a “heart pillow” that the people at intensive care gave me. You can see a photo of it at the top of this blog post. Fact is I got two of them from IC. The red and green one was a holiday design since I had my surgery shortly after Christmas. Nice.

What you do with the heart pillow is hold it tightly against your chest whenever you cough. While it doesn’t totally alleviate the pain, it lessens the blow. Use of the pillow is to also lessen the impact of support the chest while coughing, assuring the wire seems holding the cavity together do not come apart. I still use pillows.

The second remedy I got were strong pain killers (pills, drugs, what have you). This medication is given to help patients reduce the amount of pain they are experiencing. Unfortunately the medications do not totally alleviate the pain in totality when I cough.

For comparison’s sake let me tell you that the pain I felt during my December 26 heart attack was about a level 4 or 5. Not as intense as one would think.

The result was I learned very quickly to hold back on the coughing. That would prove to be the wrong move in a few days.

Eating: Before I had my surgery, I was eating OK. After surgery I lost my appetite and only ate a little every day. While we had a choice of “healthy” food from the hospital menu on a daily basis, most of it I found either bland or tasteless. Bland would be in the future of my eating habits…. more on eating in another post.

Discharge: January 5, 2016 came around fairly quickly. The doctors seemed to want to get me out of the hospital as soon as possible, even suggesting an earlier date. However I had several issues (like not being able to go home and no one to care for me) before I could leave. Lucky for me, my sister Sandra showed up from the Big Island of Hawaii on January 5. She came in the morning and I was discharged later that afternoon.

The first major changes to my life had happened with more to come.