Tag Archives: dilemme

Echocardiogram Images 

I thought it would be cool to share my final echocardiogram results from my recent hospital stay. I took some video of the echo screen. My cardiologist points out the clot, which is small enough here to allow me to be discharged.

Also, notice my mechanical aortic valve shape. My doctor points to it in the 2nd video. It is near the middle of the screen. It is a circle, with a straight line that goes from its 12 o’clock to its 6 o’clock. That line will appear and disappear, which are the bi-leaflets closing. Use the picture of a St. Jude’s mechanical valve below to help identify it in the echo. regent-2

 

 

In screen shot below, I have circled the clot.  It appears as a little white smudge. It was larger when it was first detected last Friday. Try to look for that little smudge in the videos above.

img_5962

 

10 week Post-op Update

Just a quick update & status report. I met with my cardiologist several weeks ago for the last time. With my new job come new insurance and no more Kaiser. I’ll be meeting my new cardiologist from Loma Linda University Hospital this friday. I spoke with Larry Creswell M.D. of the Athlete’s Heart Blog. He was kind enough to speak with me about my situation, which I really appreciated. He is a cardiac surgeon who spends a great deal of time thinking about athletes with heart problems. He gave me some good insight which will help steer my conversations with my new cardiologist.

I have been riding my bike indoors on my indoor trainer. I have been keeping my heart rate under 120BPM with no problem. The metoprolol helps with that. It’s not too bad, i just drag the rig into the living room and watch an episode of Dexter while I pedal away.

We hiked out into the desert to watch the meteor shower the other day. The shower turned up pretty dry, but it was nice to camp. I even carried a pack for a half mile with no problems. I even can lift my girlfriend again with no problems. The slow march continues.

indoor setup

indoor setup

How to Fight Cardiac Depression

There are many forms of depression, and a whole range of degrees of severity of this mental condition. Cardiac depression is some form of depression that occurs after a heart event, such as a heart attack or heart surgery. There are many resources out there on this topic, but I found one to be very useful, and that is an interview on the Patient Power website with Dr. Kim Lebowitz of Northwestern Memorial Hospital. I highly recommend listening to the interview or reading the transcript

“When you look at the cardiac population as many as 20 to 40 percent of cardiac patients are going to be presenting with symptoms of clinical depression, and that might be compared to about 4 percent of the general population at any one given time having symptoms of depression.” -Lebowitz

Dr. Lebowitz explains that the presence of depressive symptoms after that cardiac event can actually predict a poorer outcome for a patient, which means that depression is an independent risk factor for both the development of heart disease and cardiac outcomes following a heart attack or cardiac surgery. Basically, depression can cause (increase) heart disease, and heart disease can cause depression. 

That sure does sound like a vicious cycle. Why am I discussing this? Because I have experienced first hand (on the lower end of the spectrum) some symptoms of cardiac depression. For me, it is easy to be positive in writing, like on this blog, on Facebook, or on posts at supportnetwork.heart.org/heartvalvedisease. I think these outlets have definitely aided in my overall outlook, which I will mention again later. That does not mean though, that I am not struggling with some symptoms of cardiac related depression. I would not say that I am depressed, but I have tasted the bitterness of some of the symptoms. I feel that I am taking positive steps (described below), but the effect of only a few symptoms have been very difficult for me. Imagine what someone who has full blown cardiac depression is going through.

So what does Dr. Lebowitz say & recommend?

  • Having a range of emotions or strong emotions does not mean you are depressed. It is healthy to express all sorts of emotions.
  • An individual with clinical depression will display a number of symptoms that cluster together that may cause the individual with distress or impairment to their daily life. These symptoms are:
      1. Sadness or a loss of interest or pleasure in most activities.
      2. Difficulty sleeping or an increase/ decrease of sleep.
      3. An increase or decrease of appetite. 
      4. Irritability.
      5. Cognitive changes: Feeling hopeless, worthless, guilt, trouble concentrating or focusing, feeling sad or down, and most importantly, feelings of suicide.
      6. Decrease in motivation in things, such as a decrease in sexual functioning. 
  • Depression is treatable and the treatment for depression is safe for cardiac patients and that effective treatment can improve their quality of life.
  • Not all pharmacological treatments are necessarily safe for heart patients. Antidepressants called SSRIs (selective serotonin reuptake inhibitors) have been found to be safe for most heart patients. 
  • Therapy, predominantly cognitive behavioral therapy is another form of treatment. 

Friends and family actually have a powerful role in reducing cardiac depression. The following steps can be taken by friends and family.

  • The first step is to recognize the symptoms listed above.
  • To decrease depressive symptoms, increase recreational activities. Initiating activities is the hardest part for patients. Friends & family members should encourage activities and participate with the patient.
  • Friends and family play the role of cheerleaders. It’s helpful to have someone point out how far they’ve come and everything they’ve accomplished. 
  • Friends and family may need to sometimes abandon their cheerleader mode, and simply acknowledge the patient’s frustrations and varying emotions. e.g. ‘Yeah, I know that this is hard and this is difficult and I understand.’ 

It appears that Dr. Lebowitz is from only a handful of healthcare professionals actually dealing with this issue with real patients at a cardiac hospital. What that means to me is that it is up to us (the patients) and their families to identify this condition, take active steps to alleviate the symptoms, and to report it to our cardiologists, primary care physicians, and mental health professionals.

While I recover from my 2nd open heart surgery, what am I doing to eliminate these symptoms and to stay positive?

  • Bonsai & gardening.
  • Blogging
  • Frequently walking around town with my dog Moon.
  • Finding new music.
  • Watching a new show (Dexter).
  • Meeting friends for coffee.
  • Being creative by doing art projects
  • Reading books & comic books.
  • Going on trips with friends.
  • Talking to mom on the phone.

See proof below.

Bonsai creation

Bonsai creation

Herb Garden +Cat

Herb Garden +Cat

A Letter to my Students

Dear Students,

I have been missing all of you. No, really I have. As much as we all look forward to vacations, this ‘vacation’ I am currently on is not a welcome one! I would much rather be at Cedar. I’d like to explain what happened to me, in case you were wondering. As you all know, in November I had open-heart surgery to have my aortic valve replaced. That surgery went well, and I recovered well, as you all may remember. Fast-forward 3 months everything was honky dory. I woke up on Monday, March 10th and I felt kinda weird. I had shortness of breath. What that means is even though I was sitting still, it felt like I just got done running a mile. When this happens to people, it is often a sign of heart or lung trouble. I went to the ER on Wednesday but they did not find anything wrong. Finally, on Friday afternoon, my cardiologist called me and told me to come to the ER that she was at, so that she could check me out personally. I was very nervous. Mrs. Maxwell saw that I was distraught as I was leaving school for the hospital. She drove me down the hill because she didn’t want me driving while I was upset! She is a great principal and a good caring person.

When I got to the hospital, I got a special type of imaging procedure called and echocardiogram. It is just like what doctors use to see babies inside a mother’s belly, only they are looking at my heart instead. What they saw was not good. The heart valve that was installed in November was actually COMING OFF! It was wobbling around in a funny way. I could even tell that something was wrong when I looked at it. My cardiologist told me that it was bad and that I needed to go to the LA Kaiser hospital to most likely get surgery again.

The ambulance took me to LA, and my girlfriend met me there. I was very scared. My first surgery was planned. This one was an emergency. The surgery was going to be riskier than the first. The chances of something bad happening during the surgery were higher, but I had the best surgeon around, and I had no other choice but to put my life in his hands. Saturday morning, I went into surgery.

The surgeons found out that some sort of bacteria infected my valve. Bacteria enters the human body all the time. Bacteria live in our mouths, on our skin, everywhere! This is normally not a problem because our immune system fights them off if they enter our bloodstream. The problem is, people with artificial valves are more likely to get infected by everyday bacteria than normal people. This is because the bacteria can stick to the artificial valve or the stitches that hold it in place. Even though that is true, it is still rare. Lucky me.

I was in the hospital for a week. The first few days were very hard and painful, but things gradually got easier. Now, here I am, recovering from heart surgery again. It feels like I traveled through time back to December, recovering from my first surgery. The frustrating part is that I was just feeling back to my normal self before this happened. I was cycling and rock climbing and feeling strong. Another difficult part of this surgery is that I have to give myself lots of antibiotic medicine, everyday, for 6 weeks total! 4 times a day I have to connect the medicine to a special tube that runs into a vein in my arm. This is called a PICC line and it stays in my arm until my 6 week antibiotic treatment is over. Learn about PICC lines here.

Life sometimes has a way of knocking you down when you least expect it. Don’t worry though, I intend on getting back up. This is a challenging time in my life, but it is not impossible. The only choice as far as I’m concerned is to focus on my goals that will help me get better. Just like how many of you have goals that will help you get into college someday, I have goals that will help get me healthy and strong again. Exercise and eating healthy are super important. By the way, I think you all should stop eating so many hot Cheetos and eat more fruit. Bring an apple to school!

So, even though I wanted to come back to work (this week), my doctor said NO WAY! She refused to let me come back to work because I really do need to heal. She said that another surgery would be even riskier, and we don’t want that now. Coincidentally, before my emergency, I accepted a job offer in Rialto (closer to my home) that would have required me to leave Hesperia a few weeks early in May. Even though this is a great opportunity for me, I will be very sad to leave the Cedar family, and all of you of course. The combination of my medical emergency and new job means that I will not be returning to school this year. This is happy and sad for me. My life is full of changes right now; some are tragic, some are exciting.

I have a strict policy of not friending non-relatives under the age of 18 on Facebook, however my other forms of social networking are public. I have Instagram, Twitter, and of course email. You can get my contact info on this page: https://robovalve.wordpress.com/contact-follow/

Remember, you can also follow my journey by returning to this blog to see my future posts about my life after heart surgery. On the right hand column, at the top of this page, you can enter your email to follow this blog. You will get notification emails when I write a new post.

I hope to stay in touch with all of you. If you have any science questions, high school questions, career questions, or life questions, please feel free to email me. Also, feel free to leave me a comment at the bottom of this post! I wish you all success in your lives. You know what success means? To me, success means happiness.

I would like to leave you all with a list of advice of how to be successful. Here it is:

Love, Mr. D


Mr. D’s Advice for 12-14 year-olds

  1. Think for yourself. Always respectfully question authority.
  2. Things are not lame or uncool. This is only your perception. Force yourself to be open to new ideas.
  3. Be peaceful and non-violent. Any form of violence does damage. All forms of peace make the world better.
  4. Remember who your friends are. Even if you lose touch with them, they are still your friends.
  5. Have lots of friends and few enemies. Respect all.
  6. Become a pro at SOMETHING. Learn how to do something new. Learn how to program computer code or design clothing or rock climb or create comics or how to write a song or play an instrument.
  7. Do science AND art. Science is a way to understand the universe. Art is a way to express how the universe makes you feel. To me, these two disciplines are interconnected.
  8. If you want to be a good student, you have to want to learn. Open your mind to your education and it will reward you later in life. I’m going to tell you right now, you probably aren’t going to be in the NBA. There, I said it. Now after basketball practice, GO STUDY DAMNIT!
  9. Make a list of 10-20 goals for the next 10 years of your life. Hang that list on the wall in your room. Change the list as needed. Check off items when completed.
  10. Be positive and be strong. Life will sometimes bring you down. It is up to you to get back up. Nobody will do it for you.
  11. Love.
  12. Whatever drama you are having now, or tomorrow, or even a year from now, you will someday forget about! If you are having trouble in middle or high school, PLEASE BELIEVE ME… It gets better.

Pale Blue Dot

I’d like to write right now, but I think I need a catalyst. I’d like to talk about a clip from Carl Sagan’s original Cosmos series. The Pale Blue Dot, an observation that also inspired a book by Mr. Sagan, is a photograph of the Earth taken by the Voyager 1 spaceprobe at an incredible distance of 3.7 billion miles away. The picture sparked some philosophical ideas that Carl Sagan thought worthy of discussing. The video below takes his famous speech and adds some pop culture clips and music for entertainment value. Watch the video and if you like, read below what this means to me. The script is here btw.

The point of his speech is summed up at the end:

“To me, it underscores our responsibility to deal more kindly with one another, and to preserve and cherish the pale blue dot, the only home we’ve ever known.” 

The idea that I am a tiny speck on a tiny speck does indeed make me feel small, as it should, but it does not make me feel insignificant. What i take away from The Pale Blue Dot, is:

1. I am small and cosmically unimportant. However, I am important to my loved ones, and there are people who are important to me. What a gift it is for all of us to have lucked out in having the opportunity to experience life! Whether it was given to us, or we simply happened to be the lucky sperm, we have a special opportunity to be alive.

2. Why not spend this amazing opportunity to “deal more kindly with one another.” Carl Sagan was famously anti-nuclear arms and used this photograph of an insignificantly small Earth to demonstrate the insignificance of our disputes responsible for war and violence.  This insignificance does not diminish our love, however. Our love for one another is a useful way to spend our short time here on this spec.

My recent days have been full of thoughts of life and death. When mortality is so blatantly obvious as it has been for me lately, it can be hard to stay focused. I have always loved The Pale Blue Dot because of its positive message. As I sit here attempting not to wallow, this Carl reminds me of the simple truth that I am alive, and I have the capacity to love. There is absolutely nothing insignificant about that.

3 Months Post Surgery: BIG Milestone

Recovery is more than getting back to physical health. I am psyched that I have been able to get back to where I am now, however there are some challenges that linger.

  • Emotions: I have noticed significant emotional changes since my surgery. I am not suffering from (cardiac) depression, which happens to many heart surgery patients, but my emotions are extreme. I feel greater joy, and greater sadness in my daily life. The extremes are more present than they used to be.
  • Pride: I feel like I have something to prove. I feel the need to be stronger than I ever have been before. I’m afraid that I am sometimes overdoing it.
  • Physical strength and endurance. Some stronger, some weaker.
  • Occasional PVC’s (premature ventricular contractions): though these have decreased dramatically.

Cycling

Cycling on Feb 22, 2014 ‘Greenspot rd route’: http://my.digifit.com/site/share/workout/c5906ac59bf911e395a409b929907b9a.html My restrictions have been dropped, so I do not need to keep my heart rate under 140 BPM any longer! The cool thing is, due to my beta blocker medication, my heart doesn’t really go above that anyway. We will see once I’m taken off the, hopefully this week. If you are looking at my heart rate chart, don’t worry about the extreme spikes above 200 BPM, I am pretty sure that those reading are errors due to the wind when I go very fast downhill. I think the wind vibrates my jersey against the heart monitor. Those spikes only occur when I go downhill, which is when I am exerting myself the least.

Climbing

I feel that I am back to my normal climbing strength. Now I am training to climb harder and better than I ever have in my life. I have begun a 3 month training regiment that will put me in the best shape of my life. I’ll be sure to post my progress on this. There are various climbing competitions in southern california that I will be competing in. It is time to get strong. I wish I had a recent picture of me climbing something cool to show you, but I don’t.

Personal Life

This one is tough. Refer to my first bullet at the top of this post.

SO anywayz here’s a picture of me with my shirt off!

Scar Shot!

Scar Shot!

Just an Update

The Margarita Throwdown Winners!

The Margarita Throwdown Winners!

I haven’t posted in a while. Work started a few weeks ago, so I’ve been super busy starting the year off right with a new group of 8th grade science students. I’ve been continuing my workout plan, so cycling, climbing, and light weightlifting/ core workouts, all while keeping my heart rate under 140 BPM. In addition to keeping my heart rate under 140, I also make sure that I do not ever strain. With weightlifting, it is easy to be straining under too much weight and still have your BPM low, so I must manage both. BTW, when I say light weightlifting, I really mean light. I have always been more into light weight, high rep anyway.

Bike BBQ/ Inland Empire Bicycling Alliance Margarita Throw-down Victory! Redlands is graced with a pretty cool cycling scene. Behind Augie’s Coffee Shop (where I write most of my posts) is Bike BBQ, a place where people can use tools and seek expertise from volunteers on how to fix and maintain their bikes. They even sell bikes/ parts for a very good price. These two cycling organizations threw a contest where cyclist teamed up with bartenders and used stationary bike-powered blenders to make margaritas. I am proud to say that my bartender friend Bryan Bruce (From Caprice Cafe in Redlands) and I won with a very interesting jalapeño/black sea salt/pineapple foam Margarita concoction. Check out the video at the bottom of the post to see how it went down. The quality isn’t too good, but you’ll get the idea.

Inner Evolution Yoga: My friend Phil owns Inner Evolution Yoga in Redlands, CA. We used to climb a bit together. When he opened his studio a few years ago I helped him paint the ceiling. I even worked there for 2 weeks as the front desk guy while he was away on a retreat. When Phil read my blog and saw what was up with my life right now, he gave me 10 passes to his studio. Yoga is a fantastic form of exercise that will also aid me in breathing and relaxation techniques that will be very useful leading up to my surgery. Thanks Phil, and if any of my readers live near Redlands, check out his studio.

False Alarm: The other day I had a little false alarm. I had a sudden onset of a sore throat thursday afternoon, and being the researcher/ hypochondriac that I am, I googled it and found this article, and this one too. In my head I understood that the chances of an aortic dissection with only a sore throat as a symptom is possible, yet extremely rare. I also knew that if it was a dissection, and I ignored it, I would die. As I was freaking out, some people said, relax it’s nothing, others said that I should go to the ER just in case, and I just didn’t know what to do. I realized that If I didn’t go to the ER, I wouldn’t be able to sleep, so I just drove myself to the ER thinking that I’d be home by midnight if everything was okay, and that’s exactly what happened. It is a little embarrassing that I freaked out so much. I did learn about how Aortic Dissection can be diagnosed with a blood test called D-Dimer. Really interesting actually. This is what they did for me. The other option is a CT scan, which subjects the body to a large amount of radiation. I’m calling this experience ‘My Dry Run’.

Surgery Day Scheduled

thump thump

my heart

Whelp. It’s official. My Open Heart Surgery has been scheduled for MONDAY, NOVEMBER 25TH 2013. I chose the week of Thanksgiving break so that I can take off from work during the time in between Thanksgiving and winter break, then come back to work, ready to go after the New Year. This would minimize the number of days that I will be out.

When I was on the phone with my coordinator from the surgeon’s office, I asked about available days on the week of Thanksgiving. She replied with, “Yes, Monday the 25th, would you like me to schedule?….       sir?       hello?…” I couldn’t answer. I was thinking, is there maybe a better day? Would I rather it be after winter break? Is it better on a tuesday? My fear had my tongue. I realized that this surgery was going to happen and it didn’t matter when. Just get it over with.

“Yes, November 25th is fine, thanks.” I replied.

There. Done. Open heart surgery scheduled. Another stepping stone. Next step: My coordinator will ask my surgeon & cardiologist if they think I need an Angiogram. What’s that you say? An Angiogram is when they stick a tube into your heart from your groin to determine the size of bulges and blockages in arteries. So in case you were wondering the way to a man’s heart, in this case, it’s the groin. Cheers.

Anthony

OH NOOOOO!

Let’s start of with a little background on how this all began. When I was a child, my pediatrician heard a heart murmur in my chest. He referred me to a specialist, and after some imaging, I was diagnosed with Bicuspid Aortic Valve (BAV). I went back every 4 years for checkups and until recently I was always told that I would be over 50 years old when I would need surgery, if I needed it at all. I’ve been secretly hoping for advances in human organ teleportation technologies, but alas we are many years off on that one. I lived my life with little anxiety about it. I went to college and got a job. I moved to California from New Jersey and got different jobs. I became a teacher and finally got health insurance. I went back to the cardiologist, who told me that my heart condition got worse and that I would need surgery in 2-5 years.

That was 2011. I kept doing my thing. I continued to rock climb as hard as I could. I love bouldering and sport climbing. More to come on that soon. I bought a new road bike (Cannondale Supersix) and rode hard. I tend to push myself. I went back to my Doctor every 6 months and my stomach would be in a twist until I heard from her after each echocardiogram. Each time, everything remained stable. Until last month. I received a CT scan for the first time. CT scans are better at revealing Aortic Aneurysms than echocardiograms. The scan revealed that I have a 4.6 cm Ascending Aortic Aneurysm. This is commonly associated with BAV, or can exist by itself. When a person with BAV also has a Thoracic Aortic Aneurysm, it is usually time to operate. Too many risks at once. I met with a surgeon to see what he thought. He told me that it was up to me, but if it were him, he would get it ASAP.   This is a video of me when I found out that I needed Heart Surgery:                                                                 

So here I am. The wheels are in motion. Things are happening. This is actually going to happen. It is no longer a dark thundercloud in the distance. The surgery will happen soon. The thing that I have been wishing away will be coming, soon. SOON.

soon

My surgeon told me to keep my heart rate down in the meantime. I bought a heart rate monitor and intend to continue exercise to my heart’s content. It will be a challenge to rock climb and attack big hills on my bike while keeping my BPM under 150. I’ve been using a cool app called Digifit, which is highly customizable. I can do this. After the surgery, I will climb hard again.  I will not allow this to change my lifestyle. Soon I will post my goals and intentions.

What’s on the horizon? I have to get to the dentist to clear my mouth of any possible cavities (mouth bacteria can infect the heart valves under stress before & after surgery). I am continuing my exercise routine with some caution. A new school year is coming soon. I gotta start planning!

I hope you join me for this ride.