Mike Kalahar's Surgery Log

Today, Dad has had a great deal of progress. He’s had a catheter in again for several days, and today he had that removed for good. Removing this, the last of his encircling tentacles, he was finally free. Combining that with increased strength and well-being, dad went for a walk without a walker this afternoon. His healthcare providers have decided that he’s ready to move to the general hospital floor, but they don’t have a bed for him there yet. He seems to be on track to head home in a few days or so.

We got an iPad yesterday at the apple store, and he’s been enjoying playing some games on it. Despite my best efforts to introduce him to awesome games like angry birds, and world of goo, his favorite seems to be solitaire.

He’s still got some serious wounds that need time to heal, but things are looking good. He’s cheerful, walking on his own, and generally being the smartass we all know and love.

Dad’s  all settled in with his new pacemaker.  He’s started to talk about being tired of being in the hospital, and wanting to go home.  It’s a good sign, but of course we’ll need to stick around for a few more days to make sure everything is okay before we can go home.  Tomorrow, he’ll likely move from the ICU to the general hospital floor, provided nothing goes wrong in the night, and the general floor has room for him.  We’re making plans to ensure he gets some tasty food, and entertainment.

To that end, if anyone in the Seattle area would like to drop by tomorrow, that’d probably go over quite well.  Bruce and Rudy visited today, and that was great.  If you’d like to visit, give us a call, and we’ll make it happen.

We had some good talks with the physical therapy folks about what sort of schedule to follow with exercise when we’re home.  It’s disappointingly slow for quite some time, but there are good reasons for all of it.  The two primary concerns are the healing of the sternum (which they had to break to do the surgery), and the security of the pacemaker wires.  Because of that, he’s not to lift heavy loads, or raise his arms above his shoulders for several months.  We’ll be going for walks every day, working up to a 45-minute walk each day.  These walks are to include mostly flat terrain, which will probably entail some driving, since 45 minutes of walking circles around the house would get pretty boring.

I apologize for the lack of a photo, but I’ve got nothing right now. I’ll make up for it tomorrow. :-)

Dad now has his pacemaker installed, and it is working great. He says he actually feels quite a bit better now that he has control of his own heart rate. With all the surgery behind him, he’s really ready to get out of here. His heart rate is up to 105, which is fairly high, but it’s normal for the heart to do that as it becomes more accustomed to the pacemaker.

Tonight he even ordered his own dinner! In general, all of his bodily systems are improving.

Dad is about to go into the operating theater again, and have his pacemaker installed. This will be done with some newfangled cameras and fancy dyes to be minimally invasive. The result will be a device that lets him function on his own, but takes over if his heart rate drops too low. It’ll be safe to dive to 130 feet, and other sports should be unaffected entirely. It’s a pretty exciting milestone.

Once the pacemaker is in, he just needs to heal up a bit, and we can all go home.  In 3 months, he’ll be back on his bike.

Earlier he went walking again, which went well. The only thing keeping him from walking longer is getting cold in the hospital robe.

This afternoon, Dad was freed from a number of other attending tubes and devices.  The biggest deal is the chest drain.  The drain was a rubber hose the diameter of my pinky that has been in his chest since the surgery.  This afternoon it was removed.  While it was a painful process, it’s an important step toward healing and recovery.

Also, he no longer needs constant connection to IV drips. This means he can go for a walk around the floor without dragging an IV tower with him.  The IV connections (two of them) are still in, as standard practice in the ICU, in case they need to administer drugs or fluids quickly, but they aren’t currently in use.  The only major connections he has left are the pacemaker wires and a telemetry connection to electrodes on his chest.  Both of these are related to monitoring and/or controlling the heart’s current condition.

They turned the pacemaker down, so it will only kick in if his heart rate drops below 54 beats per minute.  This speed decrease means his normal rhythm can take charge and control his heart.  Unfortunately, the “bundle of his”, which carries the signal from the sinoatrial node to the ventricles, isn’t carrying the signal to beat.  The ventricles have developed their own rhythm, but this means that the atrium and ventricles are not beating cooperatively as they should.  The electrocardiology folks suggest letting his natural rhythm run overnight, to see if they sync up.  If they don’t, a pacemaker will be installed to keep the two in sync.

Assuming all goes according to plan, and Dad still needs a pacemaker by tomorrow afternoon, they will install it then.  He’ll need a couple more days in the ICU to recover, and then he should be ready to go to the general hospital floor.  When that milestone is reached, he’ll just be a few more days away from going home.  Here’s hoping that comes soon. :-)

Today, Mom and aunt Sharron got dad soup from the metropolitan market. Earlier we got him a smoothie from jamba juice. The real food made a big difference for Dad, who has been suffering in silence on hospital food.

We had a visit from the doctor who does pacemakers, and she checked his intrinsic rhythms. She said that while his heart is beating on its own, it is what’s called an “escape rhythm”. While it is good to have an escape rhythm, it means he still needs a pacemaker. That said, he needs only the simplest of pacemakers, which means long battery life. He’ll be able to bike just fine, and potentially still dive to 120-140 ft. As far as I am concerned, this is still good news.

Right now he’s going for a walk. Excellent steps!

This morning, when we first arrived, the nurse told us that Dad had a streak of 7 of his own heartbeats last night. This is great news, and means he may not need to have a permanent  pacemaker. He’s currently being assisted by a temporary pacemaker, which they pause occasionally to see what his heart can on its own. This is the first time he has had any heartbeats on his own. Progress of this sort is often followed by more progress, so we are very hopeful.

The bad news, in comparison, seems minor. While he had the catheter out yesterday, he needed to have a new one put in today. This development is unfortunate, but not terribly surprising.

Today dad passed a number of great milestones:

1. His catheter was removed
2. One of the monitoring catheters which monitored his pulmonary artery was removed
3. He had a bath
4. He had a number of family members and friends visit

Other good news is on the pacemaker front:  Because Dad’s sinoatrial node is working correctly, a pacemaker could trigger the ventricles based on what the sinoatrial node is doing.  Plainly: his heart rate would be governed in exactly the same way it always has been, the pacemaker would just make sure the heart muscle keeps pumping blood correctly.  This means that working hard on a mountain bike is still feasible.  We still have unanswered questions about whether the pacemaker would be compatible with both mountain biking and diving, but the docs are doing research and will get back to us.

Dad’s pain meds were pretty strong this morning as a result of last night’s pain, and he was a little bit looped.  As the day wore on, he became more alert and conversational.  By the end of the day, he was able to carry on a conversation with us, and rated his pain all the way down at 2 on a scale of 10.

It was great to see lots of folks visit today.  It’d be great to have more people visit, but we don’t want to overwhelm him at this point.  If you’re interested in coming by for a visit, please let us know, and we’ll try to organize things.  Mom and I think that having lots of friendly faces is helpful as long as he’s getting enough rest.

Sorry for the long delay, I’ve been sleeping for the last 16 hours or so. Mom and I were both running on empty yesterday.

Last night, Dad had a pretty rough night.  He was in a lot of pain, and as a result is now on both morphine and hydrocodone.  This cocktail makes him very sleepy, and he was having trouble staying awake long enough to get the spoon from his breakfast to his mouth.

The doctors doing their rounds this morning suggested he talk to the folks who put in permanent pacemakers.  This indicates to us that the docs think there’s a pretty decent chance he’ll have to live with a pacemaker.  We’re concerned about the impact this will have on his ability to work out, especially his ability to ride trails on his mountain bike.  The docs assure us that there are pacemakers that know how to increase your heart rate as you work harder, but it’s still disheartening.  The doc told us that there’s a chance he won’t need the pacemaker, but that it’s better to get started talking about them now than to wait, and then have to stay in the hospital longer just for the pacemaker installation.

Mom is going to be sure to be there when the pacemaker folks arrive to chat with Dad about it, and I hope to be there as well.  I’m hopeful that the news will be good, but there’s nothing fun about being surprised by the need for a pacemaker.

We were present for rounds this morning.  We learned that a-fib is a common problem with the type of surgery he had but AV block, which is what he now has,  is less so.  With out the pacer, the ventricles are not contracting.  There is still a possibility the heart will get over the shock of what happened yesterday and get back to work properly.  We were told they may need to place a pace maker but that decision may be delayed days or weeks.

Michael is now off of O2 and has high O2 sats on room air.  He did get up to a chair for about 25 minutes, needed his pain Rx and then had a hard time staying awake.  When we are there, he tries not to sleep so we have decided we have to make the visits short.  When he is awake, he reminds me of  Grandfather Glion Benson and Papa Gordy making jokes (or attempting to) with the nurses. He said to tell Bob his funny bone is still in place.   He is highly motivated to get out of bed and is doing everything to move in that direction.  He is taking his job of healing very seriously.  As Benson noted, his pain is immense and he is amazing in his strength in dealing with it.  It hurts to watch him take a breath let alone move to a chair.  So far his appetite has been very poor; he has had 2 bites of jello (red) what flavor is that? and 2 bites of apple sauce.

We are passing messages to him that have been added to the blog; the more the better.  He needs something else to think about so if you have a thought or story, write it and we will be sure he gets it.  Our thanks to everyone for all the help and support. C.