Cardiac Surgery Recovery Update

I’m on POD 47 so a little over 6 weeks. Immediately post op in the ICU My BP crashed and the Curly shuffle ensued. The surgeon walked in at 5 AM and asked me “how ya doing” I told him I need blood, and a few minutes later it hit the fan. They worked on me for 5 hours and finally the guy gave me blood and I stabilized. When he saw me later he said “I wish I had listened to you in the first place”. I find that hilarious. It’s a subtle anesthesiologist/surgeon kind of thing. And after standing toe to toe with these guys for 35 years it’s rare I’m wrong. I’m not knocking this guys skills, I consider him a minor god, but I was already doing anesthesia the same year he was going to his Prom

The ensuing Curly shuffle bought me an extra 35 lbs of edema. If you don’t think it’s a bitch getting out of bed or a chair post sternotomy with an extra 35 lbs strapped to you think again. My albumin dropped to 2 indicating I was under significant metabolic stress. The food was horrible mostly carbs, and healing is made out of protein so like Lynard Skynard: “I did what I could do” and 6 weeks out my albumin is over 4 with resolution of the metabolic component. at 16 days I was actually catabolic and loosing weight beyond the edema but at home I was finally able to get complete control of my diet and level off. I felt like a dive bomber diving into the ground and pulling up at the last minute, but the plane held together and pull up I did.

I managed to get an infection in the saphaneous canal where they harvest the vein. The C&S was unknown at that point. but likely staph so I started on Augmentin . It blew up over night literally. I was measuring the circumference of my leg and it grew an inch in a day. I DID NOT want to go back in the hospital. It would have been a week admission, so I called up my surgeon buddy who brought me to his office on a Sunday and Incised and Drained the saphenous canal. Got about 40 cc out, got a culture. I proceeded to drain more over the next 2 weeks. The bug was Proteus Mirabilis a gram neg rod so it had potential for very bad juju. I got on the right antibiotic and things have deffervesced nicely, but the infection made me quite ill. I’m also on a anti arrhythmic amiodarone for afib and I swear that stuff is rat poison. A-fib is common post op and the amio converted me but I’ve been in perfect sinus for a month so the pathway swelling has likely subsided so I’m starting a taper on the amio. Tapering is proof God loves me, I would hate to be on that stuff permanently. I’d probably opt for a pace maker instead.

6 weeks is the magic number for driving. The sternum can take 24 months to completely heal, and I can tell my manubrium is not well healed especially on the right (common) so I still have to watch my P’s and Q’s about things like lifting heavy weights, but “I’ll do what I can do”. My surgery included a LIMA to the LAD, so the right internal mammary is still in situ and should aid in healing.

I went to see my surgeon today and he discharged me 2 weeks early because of the progress I’ve made. I’ve been reviewing recovery times and this is going to be a 6 month deal at least. I’ve been doing twice a day workouts to total 40 minutes various activity prescribed by PT and have seen good progress. Yesterday I did 30 min. continuous aerobic exercise at a HR of 150 and had normalized my post workout BP in 3 minutes. Long way to go till I’m back in shape, this incident knocked it out of me, but it will come, totally worth it since I have a 55% EF and a normal echo. On the way home I took my wife out for lunch at a rib joint. We had a great time. The market is up and life goes on!

6 Replies to “Cardiac Surgery Recovery Update”

  1. Wow. Thanks for sharing the ordeal. I knew you had some issues but didn’t realize it was this extensive.

    Glad your plane held together pulling out of the dive.

    1. I ran an ICU when I was in the service, so I had more than average exposure to ICU medicine. The key for me was staying OUT of the hospital. Hospitals give you one standard format industrial strength “recovery” and if that recover happens to fit good deal, if not you’re hosed. Nobody treats metabolic disease they treat the sequella of metabolic disease, CAD, HTN, T2DM, NDD and probably some cancer and each specialty has its own little window on the elephant, but no-one quite understands the elephant. Much treatment is hammer / nail stuff. If you have a nail use a hammer. If you have a screw use a hammer because that is what you know to do. America is awash in the above diseases. They accumulate over decades until things finally break down, so it’s insidious, few extra pounds, little bit of HTN, A1C goes up past 6, inflammatory markers rise but it takes a decade or two and nobody tracks that longitudinally out to decades. Theories of disease are formulated around specific symptoms and recommendations made. HTN is now 130/80. Even measuring HTN with that level of granularity is near impossible. You would need multiple BP’s across the days that turn into weeks with no white coats present during measurement to make that diagnosis and if not done in this way you WILL end up on some medicine.

      It’s likely HTN is the result of inflammation which is the result of increasing insulin resistance largely due to diet. The proof is if you reverse the insulin resistance the HTN goes away. There are dietary changes that can make this happen. Diabetologist rather than changing diet make things worse by forcing MORE insulin further exacerbating insulin resistance and things spiral out of control. It’s like trying to fight a fire by throwing gas on it. I’ve spent several years studying this and there is some good science supporting the metabolic syndrome theory and proper treatment. There is also a lot of quackery since in the diet biz everybody is an expert and it’s pretty easy to write a book with a hook and retire young, not unlike the FI industry where everybody is an expert on retirement but NOBODY is actually retired. Insulin resistance is solved by cycling insulin with glucagon in the diet. Insulin is the master anabolic hormone and will win. One thing it does is forces unrelenting fat uptake (anabolism) by fat cells. Another problem is the change to so called “healthy fat” in the diet mostly the seed oils. Seed oils high in Omega 6 get over stored in the fat cell by hundreds of extra calories compared to animal fat. Animal fat forces the the fat cell to send out a signal for satiety where as Omega 6 seed oils do not signal satiety and you just keep eating and storing more fat. Glucagon is the master catabolic hormone it will force fat consumption not fat storage in the presence of low insulin levels, and the ability to cycle fat anabolism/catabolism is key to regaining health. Like I said all of this is well documented by renowned researchers. Long answer, but by understanding the science it puts you in shape to make choices that can change the course of a diseases progression. It comes down to Bayesian statistics and changing serial probabilities in disease expression and it is genetic and it is phenotypic but at least it addresses the problem and not the consequence of the problem.

    1. There was a study where they fed kids McD fries half got fries cooked in animal fat like the old days, and half got fries cooked in seed oil like they are today. The half that ate animal fat fries at an average of 700 cal till they were satiated, the seed oil group ate about 1100 cals worth of food. They switched groups and the veg oil group now consumed 700 cal and the animal fat group now consumed 1100 cal. Everything is now made with seed oil, all the processed food you eat, 2+2=4 eat seed oil = over eat = obesity crisis = insulin resistance and you wind up with a Walmart full of overweight people with CAD HTN etc.

  2. Helluva war story. Grateful you pulled the nose up at the right moment, more grateful still to hopefully enjoy the war stories for many years to come.

    Happy to have you on the mend and in control of your faculties,

    CD

  3. Tnx CD the only credit I take is not letting them do the wrong thing. There was more, but these were the key touch points. M sweet wife and her gentle care also saved me from a decubitus. Then there were the Nurse administrators who thought they would bully me into submission. I am the wrong Doctor to play those games with. Many actors played starring roles, even my FIRE friends, and I’m grateful for it all.

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