Pills, Pills, Pills, Rest, Rest, Rest

This segment of the Open Heart Series aims to cover my first days back home after five days in the hospital, my first days back at work, and what daily life was like up to my first check-up in late December, two months after surgery. In the next chapter, I'll recount my physical recovery from Thanksgiving 2014 to present, and my return to rock climbing.

A Triumphant Return Home

The house was ready when my fiancée, Mandi, and I came home from the hospital. I was so grateful for our preparation. The kitchen was clean and everything was in its place. Before we left for my operation in Denver, we'd also borrowed a plastic folding chair for me to use in the shower, and a comfortable recliner.

Obtaining a good reclining chair was absolutely worth it. In light of the fact that I ended up spending most of my time in the recliner with blankets and TV remotes, it was nice having a chair that gave me good back support in any position.

It was tedious to be stuck on my back or my butt for 20 hours a day during the first week home. Sometimes my muscles would cramp if I tried to sit cross-legged on the sofa for too long. I also wanted to lie on my side very badly but could not because of the discomfort. (Lying on my left side – the side where the heart is – still tends to be more uncomfortable than lying on my right side. It seems related to the fact that I have more weight pressing on my heart when I lie to the left.) Basically, if you're wondering if it's worth investing in a chair that is comfortable in a variety of positions, it is. Or if you're like me and can't afford one, you might be able to borrow one like I did.

Get as much of these things in order before you go to the hospital. You have enough to deal with afterward.

One thing I did not think of until later was how useful a pill box would be. A pill box eventually helped me keep my doses of medication organized by grouping the pills into little plastic pods labeled AM/PM for each day of the week. I'd never had to keep up with so many doses before.

Each morning I took an 81 milligram Aspirin tablet, a stool softener and a half-tablet (12.5 mg) of Metoprolol, which is a beta blocker. A beta blocker is a drug that helps control blood pressure and keeps the heart from pumping too fast, such as suppressing bursts of adrenaline that would otherwise spike the heart rate in a racing flutter (I'll go into this a little more at the end of the chapter). In the evenings, I took another half-tablet of Metoprolol and a stool softener to counteract the constipating effects of the Oxycontin. That may not sound like many pills compared to, say, a cancer patient, but the days start to blur together and it gets hard to remember what you took when. I lasted a week before I started losing track and realized how tiring it would be to keep up with that routine for three months. A pill box took that stress away.

For the first few days back home, I was also taking 10 or 15 mg of Oxycontin every six hours for pain, along with 800 mg of Tylenol (Oxy provides fast and powerful pain relief, and the Tylenol sustains it). All these drugs can be very hard on the liver, so I tried to stay hydrated as much as possible. After the first several days, I found I didn't need the Oxy during the day. I used it in 5 to 10 mg doses before bed and in the mornings to help me get to sleep, and then to deal with the stiff pain of getting out of bed.

Another part of our daily routine was thinking ahead when we came downstairs every morning. The goal was to save me unnecessary trips up and down the stairs. We brought any extra clothes or whatever I might need later on down with us at the start of the day. For the first two or three weeks, just going up the stairs often left me feeling dizzy and out of breath. Maybe it wouldn't have been as bad if I wasn't in such a habit of running up the stairs. I'm still not sure why I feel the need to go up stairs as quickly as possible. Maybe it's engrained from all my years of hiking steep mountain trails. Whatever the case, it was better to save the energy from the stairs and go for a short walk or two outside. It also saved energy for showering, which could take a significant amount of effort and is why I was glad to have the chair in the shower.

On Mandi's end of things, she'd arranged to have friends bring us dinner three or four times a week. That was a sanity-saver, and pretty fun. We rarely knew what we were going to get and we were introduced to some new recipes that we liked. One of our favorites was Korean beef (tofu for Mandi) with rice and spicy barbecue sauce wrapped in seaweed. (Thanks again to everyone who helped us with those dinners!)

Working Stiff

The surgeon said I would probably be OK to return to work one week after open heart surgery. It sounded far-fetched. To be on the safe side, I scheduled a return to my job at a used gear store 10 days after the operation.

My boss made special accommodations so that I wouldn't be expected to do anything beyond answering the phone and checking customers at the register. I lasted two hours. I took three more days off to rest and tried working again. I only lasted a few hours on each of those two days before my back pain had me writhing on the floor, dropping pills into my mouth. Not only that, but my coworkers were making special trips to pick me up and drop me off at home, even though I lived a mere five minutes away. I couldn't drive for a month (because my sternum was too fragile) and I certainly didn't have the energy to walk to work and be worth a damn when I got there. Besides, the icy sidewalks weren't the safest bet for a guy who could really hurt himself if he slipped. After my first attempts to return to work, my boss and I agreed I should take another full week off before I tried again.

Someone told me a second-hand story of a 19-year-old guy who returned home from open heart surgery the very next day. He was said to be spry and chipper, as if he'd had no more than his wisdom teeth removed.

All along, I felt like that guy was supposed to be me; that it should have been me. Just hearing the story made me feel weak and wimpy. Maybe I was just a wuss after all. Or maybe I was more in tune with what my body needed to recover, which was time and patience.

Everyone is different. The most important thing is to recognize your needs, whatever they may be. Otherwise you run the risk of undoing a lot of hard work, which many people beyond yourself – doctors, nurses, and especially the care-giving family members – have invested in you. Be patient with yourself, if not for you then for them.

Allowing myself to heal at a slower pace than what I had imagined was very hard. My self esteem got very low at some points. Mandi worked her ass off to take care of me, in addition to her full-time job and grad school program. One thought that helped me was remembering that if I pushed too hard too soon, and regressed in my recovery, I would be dead weight on Mandi's hands for that much longer. I owed it to her to take good care of myself.

When I went back to work again, about two full weeks after surgery, it was only for half-days at first. Then I started working a full day here and there, making sure I wasn't scheduled to work on any day after a full day. For example, I would work two half-days in a row, a full day on the third, and then take at least one full rest day. A couple weeks of doing that built up my endurance quite nicely, and soon I was working full days three or four days per week, or about 24 to 32 hours total.

It's important to note that during the first month I was especially careful to observe the doctor's restrictions on my activity. I was not supposed to drive, and I had to be careful not to lift more than 10 pounds with BOTH hands. Ten pounds isn't very much. That's about two pounds heavier than a one-gallon jug of milk. Limiting myself to that is tricky for a person who is used to doing fingertip pull-ups in door frames, or lifting a desk from here to there by himself because it's easier than coordinating his efforts with someone else. In short, I've been used to lifting heavy things without a second thought.

There were times at work when a customer would set a pair of skis and boots in front of me, expecting me to lift them – and why shouldn't she, when I look the part of a healthy, muscular young man? It was awkward to leave the skis and boots for one of my coworkers to carry. I mean, I wasn't doing anything else, right? My coworkers helped me stay the course more than not, but there were some moments when I would lift the skis anyway, because the store was busy. Technically I could lift those skis – I did lift those skis. But then I would pay for it later in the form of back and sternum pain that laid me out on the couch for hours, especially if I allowed myself to lift heavy-ish things too often throughout the day.

Home Game 

"Sternal precautions" pretty well sums up the main consideration for everything you do after open-heart surgery. You basically have a broken bone in your chest. Unlike a broken leg that can be protected and held in place by a cast, however, the only way to make sure a broken sternum heals properly is to be careful how you move, what you lift, and give it about twice as long to heal.

As far as how it impacts your day-to-day living, think of it this way: along with the bone, half of your core muscles have been separated from their anchor point. This affects your arms, your abdominals and even your head. For a long time I couldn't sit up out of bed; I had to roll off the edge of the mattress onto my feet. Doing a sit-up just wasn't happening.

Shoot, just rolling onto my side had to be done carefully. Sometimes I moved onto my side a bit too hastily and my breast bone felt like a couple batwing doors grinding against each other at the center point. And when I finally started driving, the motion of turning the wheel was disconcerting. With one arm pulling down and the other pushing across my body, one half of my chest was moving down while the other was going up, and I could feel the line down the middle where it seemed I might come undone with any errant movement – and that was after waiting a month to drive, just as the doctor told me to do!

It's been four months and a couple weeks since the operation and I still don't feel completely normal and maybe never will again.

"You'll feel things differently in that area for the rest of your life," my cardiologist said when I met with him in mid-December.

By then I'd been walking the dog regularly and hiking up to 2 miles. I was also lifting things that were perhaps 20 pounds or so, as opposed to the prescribed 10 pounds. Turned out I managed to slowly build some strength back by lifting those skis in the shop every so often. You don't want to do nothing toward getting back in shape, after all, but it's wise to test your limits with extreme caution. 

I'm happy to report that my physical recovery has been exponential. Patience is, and continues to be, the challenge. I've come so far at this point, I'm ready to blast off and reclaim my former fitness. However, it's still the same old story – I have to be careful not to get excited and push too hard too soon. It will come. I know it will. Back in December it was harder to imagine, but now I can feel it in my bones and muscles.

A note on the beta blocker and Aspirin

My original dose of Metoprolol was 25 mg twice a day. After a few days home, we realized that was too high a dose for me, judging by my dizziness and lethargy. 

I was glad I saved the discharge papers from the hospital, because I put the information and phone numbers to use. I had to contact my surgeon's physician assistant several times during the first month with questions about symptoms and medications. The PA recognized the side-effects of the beta blocker and lowered the dose over the phone. 

On Feb. 11, 2015, my cardiologist had me wean myself off the beta blocker by skipping the medication every other day for a week before coming off the drug completely. Since I was on a very small dose to begin with, coming off wasn't a problem. 

The doctor told me that potential withdrawal symptoms include surges of adrenaline. This is because the body produces more adrenaline while on the drug, because the receptors for adrenaline are "blocked." When you come off the blocker, you now have more receptors as well as more adrenaline coursing through your body.

As for the 81 mg "baby Aspirin" tablet, I'll be taking one a day for the rest of my life, or at least until I have to get a mechanical valve and go on heavy-duty blood thinners (after the bovine valve wears out). The baby Aspirin acts as a mild blood thinner as a precaution against clotting on my new aortic valve. However, I met one woman as old as I am who had heart surgery as an infant and refuses to take the Aspirin because she thinks the pills are bad for her. So, evidently, it's unlikely I would have something bad happen to me if I stopped taking this minimal daily dose. I plan to stick with it, though. (My parents also vaccinated me as a child, and I'm grateful for that. Clap if you believe in science!)