Five weeks ago last Thursday I had open-heart surgery to repair the mitral valve in my heart. The surgery was a success and I was up walking around—in excruciating pain, but up walking around—two days after the four hour procedure.
I experienced some things of a spiritual nature after discharge from the hospital that I’m not quite ready to write about yet. Maybe later.
Last Thursday I had a post-surgery follow-up appointment with the heart surgeon. Everything is healing nicely, but it’s a much longer process than I was anticipating. I was initially told to expect a six- to eight-week recovery period—and I’m sure my kidney failure will make it take longer. The surgeon told me on Thursday that it would be a full nine months before “I had forgotten I ever met him.” But he cancelled the coumadin and gave me the okay to start driving again. The only real restriction is that I can’t lift, push, or pull anything over 10 pounds for another month or so.
Coumadin is a particularly nasty drug—one of the nastiest I’ve ever had to take. It’s billed as a drug to prevent blood clots, but it’s really just common rat poison. Except more expensive. Mix it with something rats like to eat and they bleed to death internally. I’m ever grateful that the surgeon was able to repair my atrial heart valve. Valve replacement would have meant having to take coumadin for the rest of my life.
I’m officially calling the valve job a total and unequivocal success; something that’s been sadly lacking as much as I’ve rubbed up against the US healthcare system. The surgeon told me that’s exactly why he became a heart surgeon. This is one of the few medical procedures, he says, where he can tell a patient that if the procedure is successful he or she will enjoy the same life expectancy as someone in the same shape who never had the procedure. Fifteen or twenty years ago, that wasn’t the case. So I’ll likely live as long as I would if I hadn’t had the valve repair. Except for the end-stage renal disease and dialysis wild cards that likely reduce that considerably. Dialysis patients still have a roughly 25 percent annual mortality rate in the US (it’s significantly lower elsewhere).
I’ve been told to expect bad days and days in which I make progress. I know all of this intellectually, but emotionally it’s just not sinking in. I feel significantly better five weeks after the surgery than I did immediately after the procedure but not as well as I think I should.
It seems as though I have a choice to take tramadol for pain and be a barely walking, non-functioning zombie or retain my clarity and endure considerable pain.
Tramadol is an opiate agonist and works by physically changing how I sense pain. My body thinks its a narcotic but not enough to paralyze peristalsis in my colon.
Last Thursday at 4AM was the last time I took tramadol and I’ve been in withdrawal since—nervous, sweating, unable to sleep, runny nose (although I’m pretty sure that’s anemia related), sneezing and coughing (makes my chest incision hurt like blazes), and nausea (although that’s a regular occurrence with my kidney failure as well). Reading the National Institutes of Health information about the drug, I realize that I probably should have weaned myself off the tramadol with successively lower doses, but I guess that’s just not my style. Or something.
When I first came home, I thought I could manage without the tramadol, but that was a big mistake and the pain got the best of me and was quite difficult to get in front of. I may have to start taking it again (and subsequently go through the withdrawal again). Here’s hoping not.
Meanwhile the venous pressure in my dialysis access fistula has started to go up. It’s usually around 200-220 at a 500 ml/min blood roller pump flow rate but for the last few weeks it’s been up around 270. I’m hoping it’s just that the needle is up against the wall of the blood vessel and not a stenosis (narrowing) of the vessel. It could also be related to the coumadin which was making me take more than twice as long as usual to stop bleeding after dialysis.
Finally, my anemia is starting to recover, but just barely and really, really slowly. All in all, I’m on the mend and should be in fine shape in time for Sue McLean’s Music in the Zoo series (Bela Fleck & The Flecktones, Los Lobos with Los Lonely Boys, and Railroad Earth; single tickets go on sale tomorrow at the Electric Fetus, bypasing the Ticketmaster beast). I’ll be there in line for tickets, but probably not so bright and early.
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