Mike Kalahar's Surgery Log

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.

We came to visit Dad at about 7:30 this morning. The night shift nurse says he did great all night with everything she asked him to do. They extubated him in the night, and are now asking him to use a couple of pieces of equipment to help prevent pneumonia. One encourages deep breathing, and the other loosens mucus in the lungs to help cough it up.

The site of the surgery is under a bandage, and very neat and tidy. He has a number of ivs currently, providing all kinds of fluids.

He has been eating ice chips, and trying to get his intestinal tract moving again. They brought him some jello, but he hasn’t eaten it yet.

They are managing the pain, which is significant (i.e. 8/10), with a combination of morphine and oxycodone. The majority of the pain is at the surgical site, but some is also due to his arthritis.

We still haven’t talked to the surgeons, but that should happen shortly.

His heart is still not ready to beat on its own, so he is still dependant on the pacemaker. I’m hoping the surgeon will give us more info when we talk.

If anyone has any questions, please don’t hesitate to ask.

Mom and I saw dad briefly in the ICU this evening.  He was still very much in surgery recovery mode.  For the surgery, they cooled his body temperature and put his heart on ice (probably in the literal sense).  They put him on a heart and lung machine to keep his blood moving while they removed the heart and worked on it.  As a part of recovering from that, he’s been equipped with a breathing tube.  To help the heart recover from the stress of stopping it, they use a temporary external pacemaker.  When we saw him, he still had a breathing tube and a pacemaker.  His heart was running at a steady 80 bpm on the pacemaker.  His body was still cooler than normal, but they had him under an insulating / heating blanket of air with a special machine to keep it at just the right temperature.  This will help him to recover his normal body temperature.

Unfortunately, we were unable to speak to the surgeons directly today.  We did speak with the on-call resident, who had spoken with the surgeons and the anesthesiologist.  He reported that everything had gone as well as could possibly be expected, and that Dad is doing great.  We were a little shocked by the presence of the pacemaker, as we hadn’t been warned about it, but the doctors assure us this is a very normal part of the recovery process.  When Dad’s heart is once again beating happily on its own, they will remove the pacemaker wires, and it should all heal up nicely.  Also, Dad will have a wicked-awesome scar.

Mom has had a really hard time seeing Dad sedated heavily and hooked up to all kinds of machines.  We’re all wiped out from an extremely long day on mediocre-at-best sleep, but things are, all in all, going very well.  By morning, it’s likely they will remove his breathing tube, and it’s even possible his heart will be ready to beat on its own by then.  We’ll be able to see him, wake him up, and talk to him.  When we reach that point, I expect everyone will feel better.

Right now, Mom, Ashleigh and I are all at Meagan’s house.  Mom and I have been up since 4:30 or so, and fairly stressed all day.  The high point of Mom’s day was seeing the Ballard locks for the first time.  We didn’t hang around in the ICU, since Dad wasn’t conscious anyway.  Mom’s about to go to bed; Ashleigh and I will find some food and then try to sleep. Even with as little sleep as I have had recently, I’ll probably need some sort of distraction before I can sleep, but I expect mom to be out like a light any minute.

Dad’s in good hands, and being taken care of.  We’re all a bit worried still, but the most dangerous part is over.  Hooray for modern medicine!

Dad’s still in surgery. Mom, Jane-o, Harold, Ashleigh and I all went for a bike ride.  We rode about 20 miles from Meagan’s house where we are staying to my Aunt Sharron’s house (she wasn’t home, but we didn’t really have time to visit anyway), and back to Meagan’s house.

As we got back to the house, we got a phone call from the folks at UW Medical Center. They said the surgery is going well, and they’re reconnecting his heart and warming him (and his heart) back up. Apparently, the surgery is done with low body temperatures and with the heart itself on ice to slow its use of nutrients and preserve the heart muscle as much as possible. The warming of the heart indicates that much of the work is done, and he’s being reassembled (for lack of a better term).

In a few hours, we’ll head back to the hospital and stay in the waiting room until they call for us.  When they call for us, they’ll either give us more info or let us see him. When that happens, I’ll write more.