By BJ Reyes
Look who's back, both here and on the pages of the Star-Advertiser.
Finally returning to work after an eight-and-a-half month hiatus exclusively for health issues, some of which were detailed here from August through February, and new ones -- or, rather, one new BIG one -- that came up literally four days before my original scheduled return date.
First, I should say that the leg is OK. Can't say "fine" or "doing great," because truth is, it is still somewhat weaker than I expected it to be at this point, six months after the surgery. But there's a reason for that.
Treatment was open-heart surgery and roughly two more months of rehab. Because of a month of inactivity in and out of the ICU, rehab on the knee/hip/femur essentially started over.
So what happened? (Settle in, this is long.)
You know that scene in "Indiana Jones and the Temple of Doom," (spoiler alert: if you didn't grow up in the 80s, stop reading) where the cult priest reaches into some poor sap's chest and pulls his heart out so he can see it beating before he is lowered into the lava pit to his death? Well, it wasn't quite THAT, but it may as well have been.
A little background: Knowing when I was about to head back to Hawaii in March led to a "victory lap" of sorts, mostly involving copious amounts of eating really unhealthy food, capped off by a Cavaliers game where all the soda, popcorn, chips and hot dogs were all-you-can-eat.
So on midnight of that Friday (right after the game) I found myself at home, short of breath and unable to lie down flat, with a tightness in my chest that probably felt like that poor dude bare-handedly gutted in the name of KA-LI-MA! KA-LI-MA!
My home blood pressure meter showed a slightly elevated BP, but an extremely low heart rate of 50 beats per minute (resting rate for me is typically 75-85 bpm). Our best guess was some kind of indigestion or acid reflux from all the horribly unhealthy food. So to play it safe, we went to the emergency room at a local hospital affiliated with the Cleveland Clinic.
To help my breathing, they hooked me up to a BiPAP machine to help get air into my lungs, took a chest X-ray and ran an EKG. The quick diagnosis was CHF, but at the time they did not rule out a heart attack.
So I spent the night in the ICU, and the next morning, after a few more tests, the determination was CHF brought on by a heart block. Basically, the two chambers of my heart were beating at different rates, causing my chest cavity to fill up with fluid. The proposed treatment was to let the fluid be absorbed and install a pacemaker. There was even the possibility I might still make the flight!
But with something that sounded pretty serious, along with my medical history and the recommendation of my orthopedic surgeon, we instead asked to be transferred to the CCF main campus, which incidentally has been ranked the No. 1 cardiac care program in the country since 1995.†
The battery of tests continued there for four days, ruling out, at that time, a heart attack, heart disease, pneumonia or an infected heart valve (endocarditis). The initial diagnosis was confirmed: CHF brought on by a heart block. What was causing the heart block was still unknown. Such issues are more common with someone much older, or with a family history of heart disease. The best estimation was that through all of my surgical procedures and medical issues (16 surgeries, diabetes, kidney disease, staph infections, etc.) that my heart had needed to work harder than most 40-somethings, and had aged a little faster. A pacemaker was installed and I was on my way 10 days after the fateful ER trip.
Fast forward to two weeks later -- mid-March -- our flights to Hawaii had been rescheduled and the knee/hip/femur rehab, which had been set back a bit, resumed. We headed to the Clinic for one last follow-up, in which we expected the doctors to tell us all was OK and I could get back to Hawaii. Not quite. Because my white blood cell count was a little elevated (an indicator of a possible infection) they decided to do a routine echocardiogram.
This time the echo showed something.
There was a "vegetation" in one of my heart valves, a sign of an infection. Instead of going home to prepare for the trip home, I was instead admitted immediately for IV antibiotics and more tests to determine if, in fact, one of my heart valves had been infected. Given my history of battling the staph infection in my leg, it was probably a good bet.
After four more days, it was pretty much confirmed: endocarditis, most definitely in the aortic valve and possibly in the mitral valve as well. The gold standard for treating it? Open-heart surgery to replace the valves with new valves of some sort: pig, cow, cadaver, artificial or combination, depending on the severity of the infection.
But because this is me we're talking about, nothing is ever easy. After the surgery to explore and replace the valves (a procedure that took more than eight hours, I'm told), I had to go back the next day because of excess bleeding in my chest cavity. After that, there was still more bleeding, and so a third procedure was done to stanch the bleeding again.
I have very little recollection of what happened, just that I was in a haze for virtually all of it. The first semblance of a coherent memory was about four days later, when I could recognize some family but not others, and I had only a foggy notion of where I was and why I was there. The first surgery happened on a Tuesday, the earliest vivid memory I have was from around Sunday‡ -- when one of the games from the NCAA Basketball Tournament was on the TV.
A few more days of recovery in the ICU followed and I was then on my way to a "step-down unit," where I spent all of about four days -- mostly out of it, weak and needing blood transfusions, while chest tubes drained fluids from four different sites on my chest. By day four I was headed back to the ICU and another surgery for yet more internal bleeding. That was followed by another week in the ICU to make sure all was OK before sending me off to a step-down unit, where I spent another week waiting for the fluids to stop draining and my kidney function to return to normal.*
If you're still with me, that was four heart surgeries since that mid-March follow up where the extra echocardiogram was done "just to be safe." Thirty-three days after that echocardiogram, I finally was released from the hospital.
As for what caused everything, it's impossible to know with absolute certainty, but as one doctor put it: If it were a multiple choice test, the best answer would be that at some point the bug from my leg traveled via my bloodstream to my heart, lodged itself there and slowly went to work. It never showed symptoms because I was on a heavy antibiotic regimen for my leg, but finally when it got the chance, it spread seemingly quickly (as evidenced by the same test showing no signs of it in early March, but revealing the vegetation two weeks later).
Needless to say, just getting back in walking shape, let alone flying and working shape after all those operations, was a slow, arduous process. The knee/hip/femur rehab felt like it had regressed to Day One, but it came back more quickly than I expected. If you've had or know anyone who's ever had open-heart, you know that rebuilding the stamina is among the biggest challenges. So I basically spent the rest of April and much of May building up my endurance.
It's not quite back to normal -- the leg still requires outpatient physical therapy twice a week -- and I tire out much more quickly than before, but it's to the point where I can start getting back into the swing of things and returning to the business of reporting on the state Capitol and upcoming elections. Rehab on the leg should transition smoothly into cardiac rehabilitation and a regular regimen of diet and exercise.
In the meantime, I'll try to keep this blog fed during my spare time with details of the rehab and any news on the other stuff: cancer, diabetes, kidney disease and whatever other helth-related topics I can find.
Add heart health to the list, too.
† - This little nugget of information is heralded on plaques, banners and other media throughout the campus, but until this moment, we had never taken note of it.
‡ - By this time I had experienced enough conscious moments that I began asking what day it was and how things went, finally recalling that I was there for heart surgery.
* - At one point, there was talk of placing me on dialysis because the repeated surgeries had made them work especially hard, but it never came to that, as the kidney function slowly returned to stable.