Tag: cardiac surgery

My husband’s heart Part 4: TAVI

~ Jennifer Barraclough ~ 8 Comments

In 2015 my husband Brian had major cardiac surgery. I wrote some posts describing his operation and gradual recovery on this blog – here are the links to Part 1, Part 2 and Part 3. Now it’s time for another episode. Writing about these experiences is my way of processing them, and maybe reading about them will be helpful for other patients and their partners who are going through something similar.

The operation was successful, and Brian remained fit and active both physically and mentally for the next eight years. Then he became slightly less well, with a more irregular heartbeat, and more shortness of breath when climbing up the 68 steps on the hill behind our house. These changes happened slowly and neither of us took too much notice – after all, it would seem normal to be slowing down at the age of 90. But after seeing the results of Brian’s routine followup echocardiogram, his cardiologist was concerned and arranged a series of further investigations.

These included a Transoesophageal Echocardiogram, CT Coronary Angiography, and Coronary Angiogram. Performed at weekly or fortnightly intervals, with blood tests in between to check Brian’s renal function, each of these tests involved spending a long morning at our local North Shore Hospital. They were not without risk, because they required sedation and/or arterial injection of contrast media, but Brian tolerated them well. He was understandably anxious during this period and I gave him a course of Bach flower remedies, Mimulus and White Chestnut, which seemed to help. When all the tests were complete we saw the cardiologist again. He said that the porcine aortic valve inserted in 2015 was broken and that Brian needed another operation “soon” – otherwise his prognosis would be very poor.

Brian said that he didn’t feel ill, so was rather reluctant to have another operation at his age, even though it would be a far less invasive procedure than the open heart surgery he had before. But he did agree, and on the following Monday I got a call from Auckland City Hospital asking us to come straight in that afternoon. Brian was given a single room, and hooked up to an ECG monitor. I tried to concentrate on reading while he had various tests, was visited by the anaesthetist and cardiologist, and was shaved all over in preparation for his TAVI at 7.30 a.m. next day. I went home in the evening and fed the cats.

TAVI stands for Transcatheter Aortic Valve Implantation. The procedure, which takes about two hours, is carried out under light anaesthesia. It involves making an incision in the groin to access the femoral artery, through which the new valve (formed from either porcine or bovine tissue) is delivered to the heart on the end of a catheter. Another incision is made in the radial artery, near the wrist, for the injection of contrast media to allow the procedure to be monitored by x-ray. There is a large team of clinicians involved: two interventional cardiologists, a specialist nurse, other nurses, cardiac physiologists, and radiographers.

It seemed pointless for me to go back to the hospital until Brian was out of the operating theatre, so I stayed at home and occupied myself by changing the bedlinen. In the middle of the morning a doctor rang to tell me that the operation had been completed successfully. I had not realised quite how stressed I was feeling until, on hearing this news, I burst into tears. When I returned to his room about noon I found Brian conscious and lucid though looking rather strange, with most of his body covered in a red dye, and wound dressings on his arms and legs.

Having had another echocardiogram to check that his new valve was working well, Brian was discharged the evening after his operation. A few days later he was feeling reasonably well, still needing to rest much of the time but able to go out for short walks. Full recovery is likely to take a month or two. It is wonderful to see what modern medical technology can achieve, and hopefully Brian’s TAVI will be followed by another long period of good health.

Update: I was going to publish this post last week but then Brian had a serious setback due to bleeding from the bowel. Apparently this can happen after a TAVI for various reasons. He required emergency admission to hospital and was very unwell for several days, but improved after a series of blood transfusions, and is now happy to be back home. He needs to rebuild his strength, and will be having further outpatient investigations to see whether there is a correctable cause for the bleeding.

Writing a medical memoir

~ Jennifer Barraclough ~ Leave a comment

Regular readers of this blog will know that in 2015 my husband Brian had a near-fatal heart attack, and that this was followed by a whole series of medical and surgical emergencies affecting our family. I had spent many years working on the medical staff of hospitals and hospices, but experiencing serious illness from the perspective of patients and relatives was very different.

After recovering from the traumas I decided to write a short memoir about them, and this is now available on Smashwords, Amazon US and Amazon UK under the title Across a Sea of Troubles. The first part tells the story of what happened, and the second part is a review of various topics including life event stress, the mind-body connection, post-traumatic syndromes and the role of  the carer.

I wrote this partly for myself as a way of coming to terms with things. Whether it has actually been therapeutic I am not sure – revising the manuscript involved rather too much focus on painful memories. So even if it still not a perfectly finished book, I have decided to publish it and move on. I hope it will hold some value for people who are coping with illness, whether as patients or relatives or health care professionals. But as always when publishing something new, I feel apprehensive about its reception: have I revealed too much personal information about myself or others? does it come across as morbid and self-pitying? is the medical information accurate?

A memoir can be defined as “a record of events written by a person having intimate knowledge of them and based on personal observation”. In contrast to an autobiography, it describes one particular aspect of experience rather than a whole life. Naively perhaps, I have always tended to assume that both memoirs and autobiographies are historically accurate. So I was a little shocked to be advised on one on-line site that it is acceptable, even desirable, to alter the facts to make them more interesting or inspirational for the reader. Although I did wish there were more positive aspects to my own story I resisted any temptation to embroider the truth, and wrote it exactly as I remember, checking all the dates from my diaries. So, rather than one of those books about “illness as a precious gift that transformed my life” it is an honest account of a rather gruelling sequence of events. Here again are the links for Smashwords, Amazon US and Amazon UK. I will share a short extract in my next post.

ast-smashwords-cover

My husband’s heart Part 2: Auckland City Hospital

~ Jennifer Barraclough ~ 3 Comments

Following on from my previous post: Brian spent 18 days in the cardiology unit of North Shore Hospital. On 23 September came the long-awaited news that a place for him was available at Auckland City Hospital. Accompanied by a nurse carrying a defibrillator, he was transferred by ambulance across the Harbour Bridge, and admitted to the cardiothoracic surgery ward in preparation for a five hour procedure to bypass his left coronary artery, replace his aortic valve, and repair the aneurysm of his ascending aorta.

We kissed farewell as he was wheeled through the doors of the operating theatre next day, and then for the first time since it all began I broke down in tears. Fortunately a close friend was available to take me out for coffee and listen to the story of our recent woes.

When the surgeon phoned me that afternoon to say that the procedure had gone well my relief was enormous. But when I arrived to visit Brian in the intensive care unit later on, I was told that he had had a stormy few hours. A group of doctors and nurses were gathered round his bedside. He was deeply unconscious and blood was flowing out through the drains in his chest.

Despite repeated transfusions of blood and blood products, his condition did not improve and shortly before midnight the decision was made to recall the surgical team and take him back to theatre. I was trembling with fear and distress, and very thankful that family members had come in to sit with me and then drive me home.

After the second operation, which involved the removal of blood clots and fluids, Brian began to get better. By next morning his vital signs were stable, and I was present to watch him being awakened from his drug-induced coma.

Two days later he was moved out of the intensive care unit into a four-bedded ward, where he stayed for over a week. On some days he made rapid progress, and on some days his condition caused concern. On two occasions he went back into rapid atrial fibrillation and required intravenous amiodarone to restore sinus rhythm. At other times his heart rate became too slow, and a week after the first surgery he had a pacemaker fitted. He had some brief spells of anger and despair, but overall remained remarkably positive.

Brian in Wd 42 after heart op.jpg

 

For myself, the physical and emotional demands have felt almost overwhelming, and I developed several apparently unrelated medical problems during the month that Brian was in hospital. These included an episode of hypertension and tachycardia beginning on the same night that, unknown to me, Brian’s recurrent arrhythmia was causing great concern. Anxiety and exhaustion were the obvious triggers for my own symptoms and, despite having done so much clinical and research work in the field of mind-body medicine, this was my first significant personal experience of stress-related illness. If I had had such an experience before my retirement I think I would have been a better doctor.

Brian has now been discharged from hospital, and although life may not be easy during the projected recovery period of three months, we are both happy and relieved that he is home again. Through this whole saga I have been tremendously grateful for the skill and kindness of the hospital staff; the marvels of modern medicine and surgery; the practical support, good wishes and prayers of family and friends; and the comforting presence of our three cats.