Recovering

Greetings my Stars and Angels:
Thanks to all for the wonderful thoughts, prayers, boosts of energy, and blessings sent our way this week!

I am now about 2 days out from surgery and doing well.

As I expected, I did not even get rolled down to the OR Monday afternoon until after 4 pm. The procedure itself lasted about 45 min. and I was back in recovery by about 5:30 or 6pm or so.

As I (finally) understand it, the surgeon, Dr. Craig Selzman, made an incision beginning in the bottom inch of my heart transplant scar and continued down the mid-section of the chest about another inch or two (thankfully, the incision does not connect with my more recent abdominal surgery scar, which begins just above the belly-button, so I do not quite have a "full zipper"!!) Anyway, the surgeon removed some of my xiphoid bone/cartilage (the pointy bone that is at the bottom of the sternum and apparently is somewhat analagous to the appendix, i.e., does not serve a useful role in the human body as it has evolved today) so as to improve access to the pericardium to the left. He then essentially cut out the bottom of the pericardium (the sac surrounding the heart), thereby removing about 5" x 2" of tissue. The fluid between the pericardium and the heart itself will now hopefully be draining into the space between the bottom of the pericardium and lung cavities and the top of the abdominal cavity (the peritoneum). This space is called the pre-peritoneum. Apparently, even in skinny me, the surgeon found enough fat and tissue in the pre-peritoneum space that he was comfortable allowing the fluid to drain and hopefully be reabsorbed there (thus avoiding the slightly riskier procedure of cutting a second hole into/through the peritoneum and the diagphragm to allow the fluid to drain into the abdominal cavity). As I recover in the hospital I have a temporary "drain" or small chest tube coming out the bottom of the incision. This tube/drain first drained the post-surgical fluid but, now, appears to be draining some of the fluid from around the heart (difference is the color - no blood in fluid now). The surgeon hopes to remove that tube and drain in the next couple of days and then monitor me for a bit, then will send me home, hopefully by Hallowe'en night.

A piece of great news was discovered during the surgery: The docs used the transesphogeal echocardigram (or TEE -- an ultrasound of the heart from inside the esphogus, in which the echo probe is inserted alongside or through the breathing tube) to look at and assess my heart during the surgery. The assessment showed that my LV is back to 100% function!!! Yippeee, really great news.

I also learned today that the docs (transplant team) do not believe that the fluid around the heart actually caused the LV function downturn in Sept. - they still believe I had a case of rejection, which was treated. Rather, I think their theory is that the complete recovery of the LV function was inhibited by the effusion fluid, as evidenced by no improvement in function from Sept. 24-Oct. 8, and then by improvement in function between Oct. 9 (day 2.5 liters of fluid was removed by pericardiocentesis) and Oct. 13 (day of follow-up echo after discharge, which showed improvement to low end of normal function), to Oct. 26 (day of surgery and TEE results). So, I and the docs are thrilled with that excellent news.

I spent about 4 hrs. post-surgery Mon. night in the SICU (surgical ICU), then they moved me to the Intermediate Care Unit b.c. needed a bed in the SICU. Spent rest of night in IMCU, then moved to the 4th floor, Cardiovascular Med. Unit, where I have been many times before! I moved again this morning from a room with a view of a brick wall to a room with a view West of the Valley and the new snow in SLC! I expect to be here through the end of the week, hopefully home early weekend, but we'll see.

My boys and Maggie the wonder-dog are faring pretty well at home. Thankfully, my mom came in Sun. night and is here until Fri. morning to help. Pete is hanging in there, though he is definitely a bit tired and stressed by my continued health issues and handling all on the home front.

Hope you are all well, and thanks again for all your love, support, prayers, energy, meals, visits, emails, phone calls, etc.

Love, peace, & good night,
Em