Part III-Long-term rehab and recovery.
I saw my surgeon for a follow-up at one month post-op. He showed me my ekg that indicated sinus rhythm (normal heart beat- no afib) and said “this means you aced the test”. Karen said “no, you aced the test”! He said my body didn’t know it had undergone surgery, it thought I’d been attacked by a mountain lion, so I had to give it time to heal and my resting heart rate would clear up. He said it would start to get better as I got my fitness back, and I was now cleared to go as hard as I wanted with cardio. I asked why I’d had such amazingly little sternal pain, was it he’d done such a good job on the sternal wiring? He laughed and said no, everybody is different. Other people might have lots of pain but not have the pleural effusion issue you had. It was wonderful talking to this great man who had saved my life.
Dr Gaudiani didn’t have to tell me twice about doing harder cardio, I was chomping at the bit at this point. I still couldn’t ride my bike or do my power walking with hand weights outside, so I joined the centennial rec center, a nice gym we have in Morgan Hill that’s a collaboration between the city rec center and the Y. I’m not normally a fan of indoor exercise machines, but this was an exception- it felt great to be able to go hard again on machines like exercise bikes, the elliptical, and walking up a steep incline on the treadmill.
I followed up with my cardiologist a couple of weeks later. She thought my lungs didn’t sound quite right and sent me for another x-ray. The effusion was back, perhaps not as bad as the previous episode but still serious. The black shows my lungs, expanded much smaller than they should be because of the fluid. If you look really close in the vicinity of the sternum you can see several of the wires that were put there to hold it together after surgery. They haven’t caused any problem so there has been no need to take them out.
She put me back on the Lasix but said I’d stay on it until we were sure the fluid wasn’t coming back. The effusion cleared up again in a few days. She also sent me for an echocardiogram, which showed the new valve functioning perfectly with a valve area back in the normal range. Because my original heart valve had been bicuspid, this valve area is probably higher than it had been in my entire life, so I was excited to see how it would perform when I recovered 100%. I was eventually able to get weaned off the Lasix, and thank goodness this time the pleural effusion hasn’t come back (as of the time I’m writing, now over 18 months post-op).
I felt good enough to start slowly going back to my freelance work at this time. Fortunately I work from home now and can set my own hours. When people tell me how lucky I am to be in this position, I remind them I paid my dues for decades commuting on US 101, which at one time had the honor of being named USA Today’s worst commute in the country.
My at-home instructions recommended starting cardiac rehab after 6 weeks. There is a nice rehab facility at El Camino so I gave them a call. I was concerned the level might be a little low for me, since my conditioning was already starting to improve. Julee, one of the directors, answered my questions and assured me they could make it as vigorous as I was ready for. The fact that she is an avid triathlete herself gave me even more confidence, so I signed up. My classes were to be Monday, Wednesday, Friday at 11 AM, which worked out fine because that is after rush hour trying to get from Morgan Hill to Mountain View. But first I had to come in for an orientation session at 9:00 AM. I decided to go up early before the brunt of rush hour and sneak in a hike at a nearby open-space preserve beforehand.
Apparently that is not commonplace, when I arrived they wanted me to do a six minute assessment walk to make sure I was ready for rehab. But when I mentioned I’d come early and done the hike they said “you went hiking? I think we can skip the assessment”. I started rehab the next week and ended up going for 30 sessions. It was great. The staff was very nice and competent, nurses and PTs specializing in cardiac rehab. The facility was like a gym, but they had you wear a monitoring device that was constantly checking your heart rate and for arrhythmias, plus they would come by to get your blood pressure and see how you were doing. I also could start using my arms on the elliptical. I routinely ran my heart rate up to as much as 140 and we never saw arrhythmia in any of the sessions. And it helped I could go hard with my arms on the machines without bothering my sternum. Even though I couldn’t do real strength training yet I think the combination of this, and my “heart hugger” strength routine described above, kept my upper body from atrophying too badly.
By the end of my 30 sessions, I was able to go quite strenuously without exceeding my heart rate limit, and it was a great confidence booster knowing that no heart abnormalities were detected. I actually should have gone for 36 sessions except for a Medicare quirk. I hit 30 sessions at the end of December, and would be turning 65 in Jan, 2018, and be switching to Medicare. I could have had Medicare pay for the last 6 sessions, but they will only pay for one cardiac rehab stint per lifetime and I didn’t want to waste it. I certainly hope to have no cardiac incidents to rehab from in the future, but one never knows. I thought that was a funny policy. “Didn’t we pay for cardiac rehab for you a few years back? Shouldn’t you be either better or dead by now?”
Around this time, after about 4 months post-op, my sternum was healed up enough to ride and hike (carefully!) outdoors, which I did on non-rehab days. It was really nice to be able to get back to working out outdoors again. I also was cleared to start strength training which I did in my garage gym, where I have dumbbells and exercise bands. You can get a good strength workout with bands as long as you use enough of them. They’re not as nicely calibrated as weights, you can’t say “I’ve added 5 pounds of weight since last week”. Instead you get a qualitative sign of progress like “I replaced one of the red bands from last week with a stiffer blue band”. The most important thing is you know you are progressing. I had to start with somewhat less resistance than before surgery, but over the next few months continued to get my strength back. I was also able to use hand weights while walking again without bothering my sternum, which felt great. My neighbors seemed relieved to see me getting back to normal, or at least as close to normal as I get. I was also able stand up to pedal for long periods again, prior to this I’d quickly get out of breath. It was nice to have that activity back as I find in relaxing.
I also started participating in group hikes again. At first I’d be lagging at the back of the group whenever the trail would get steep. My immediate goal was to be the second slowest so I could say “they’re not having to wait up for me, it’s that other guy”. But over a few weeks my stamina came back and I was up at the front again. It felt like I was really getting somewhere when we climbed one of the biggest local peaks in the Santa Cruz Mountains, Mt. Umunhum, and I was able to keep up fine. That hike had over a thousand feet of vertical. But at the top of the trail there is a series of flights of stairs that I still lagged behind on. Stairs were still my nemesis!
My 65th birthday came in January 2018, about 5 ½ months post-op. By this time I was feeling great, able to all the activities I enjoy. I’m sure my performance was still a bit subpar but under the circumstances I didn’t care. All in all, considering the seriousness of my condition and the major surgery I had undergone, I considered my recovery to date to be a nice birthday present and looked forward to continued improvement. The only thing that persisted was the abnormally high resting heart rate. As Dr. Gaudiani had predicted, this improved a bit when I got fitter. But it was still in the 80s. It probably bugged me more than it should because I had always taken pride in a low resting heart rate being a sign that I was in good shape. I decided to get a second opinion on this so went to a different cardiologist. He did do an ekg on me and it was normal. He said he was not concerned about the resting heart rate but we could drive it down by bumping up my dose of a beta-blocker, metoprolol, that I was already on, since I had no side effects from it. This lowered my resting heart rate into the low 70s and sometimes even the high 60s. The best fix for my resting heart rate was when I stopped wearing my fitbit, which I had gotten before the surgery. I was getting kind of obsessive about it. Sitting at lunch, I’d peek and go “damn it, what’s it doing back up in the 90s again?” Karen kept saying why don’t you just take that thing off, but didn’t get through to me. Then I mentioned to my brother that the high heart rate was my last symptom. He said, “so what, you said the doc isn’t worried about it. Can you feel it thumping, does it keep you awake?” “No…” “How do you even know about it?” “I keep looking at my fitbit”. “Why don’t you just take the damn thing off?” “Oh…” Needless to say Karen rolled her eyes when I told her “Bill gave me a great idea”, but she was still happy I took it off. No offense to fitbit, activity trackers can be great as long as you don’t obsess over them.
In March I redid my goal workout, the Arrowhead loop, in 2 hours and 7 minutes. I blitzed right up the section of trail where I had gotten badly out of breath when my aortic stenosis was bad. So it was great to be able to say “I’m Baaack”! This was at seven months postop. Update at about a year and a quarter post-op: I repeated the Mt. Umunhum hike the other day, and was delighted to be able to briskly motor right up the stairs at the end, and I also recently broke 2 hours on the Arrowhead loop, a new PR. And my resting heart rate is back down to 60. Considering the severity of the condition that had gotten fixed and how much tougher this rehab turned out to be than I anticipated, that’s not bad at all. It’s really nice to be fit and healthy again instead of the sorry state I’d probably be in by now if I hadn’t gotten this fixed.
In my old age adventures so far, I got two new hips for my 60th birthday, and a new heart valve for my 65th. Karen says she’d really rather I didn’t get any replacement parts for my 70th. I’m inclined to agree with her.