Robert Talbert

Math professor, Dad, Catholic, cat herder.

Springing forward

Today (the spring equinox, hence the title) marks exactly six weeks since my heart surgery, and it's been a busy last week in the recovery process.

Last week I had an echocardiogram to see how the new aortic valve is doing, along with a chest x-ray to see how my sternum is healing and look for anything out of the ordinary. Then I had the big 5-week followup with my surgeon. It was all good: The valve has zero leakage, the pressure coming out of the heart was perfectly normal, and all the muscle/nerves/bone in my chest are healing nicely. The surgeon lifted some of the sternal restrictions, for example I can now lift 20 pounds instead of 10; and very importantly, he cleared me to start driving again.

A word on driving: That's huge. The worst part of this whole recovery process --- which has been largely trouble-free, so I'm not complaining --- hasn't been the physical discomfort or anything, but the physical and social isolation of being stuck at home all day. Want to go to the grocery store? Get a ride. Tired of walking inside the house and want to go to GVSU to walk? Get a ride. Being able, if I chose, to pile into the van and drive up to the coffee shop for an hour is a privilege I didn't realize I had until I didn't have it.

Back to this week: Today I had my last follow-up appointment with the doctors until probably January 2020. Again, it was generally an all-clear, and all systems are normal at this point. My blood pressure read a little on the high side, so I'll need to watch this and some of my meds may get adjusted if it stays high. But otherwise, this meeting was merely a formal closure to the main part of the recovery process. And for that, I am very grateful.

From here on out, I will see a cardiologist once a year --- maybe once every 18 months if things continue to go well. My new heart valve has a lifespan of about 20 years. Every year, I'll be checked over to make sure that the valve is performing properly --- no leaks or clots or anything like that. At some point when I'm nearly 70 years old, I'll have to have it replaced again, but the next time I can have it done using the much-less-invasive TAVR procedure.

Back to this week again, I've started the next part of the recovery process: cardiac rehab. Starting in April, I'll be going into a Spectrum facility every MWF to exercise --- specifically to push myself in exercise to find out what my limits are, and start building back up to the level of activity I want. I'll be working with a trainer doing treadmill activity, rowing machines, weight training, and more while hooked up to monitors. The place is basically a gym with nurses.

The goal I have set for myself is to run a sub-30-minute 5K --- something which I could do fairly regularly back before the arterial stenosis began to make me pass out when I got above 160 beats per minute in my heart rate. I also have a longer-term goal of losing weight, from my current 194 pounds down to 180 pounds. That will definitely take longer than 6 weeks to accomplish, but I think now's the time to start. I think the staff at the rehab center will be super valuable in helping me get there.

Meanwhile, I have a little over two weeks left on my FMLA leave, and then I'll be back at work. I've been ramping up my work while at home, since I have three speaking engagements coming up in April and May to prepare for. It will be weird going back since I was gone for the entire middle 2/3 of the semester. But I'm also looking forward to resuming a more normal work life. Not that it's been disagreeable; working from home (or right now, from a coffee shop) suits me pretty well.

Personally, I feel better every day for the most part. I continue to take beta blockers and aspirin to help with the workload on the heart, but I mostly haven't needed pain medication. My chest area is still pretty sore and will be for a few more months as the sternum grows back together. (As the doctor told me today, "You do not want to see what they did to your chest.") But I can move around a lot more easily than I could just 10 days ago, and I'm now walking 2+ miles a day at a good pace with no issues. (In fact this is the first time in my entire life that I've stuck with a daily regimen of exercise, without taking days off or letting life get in the way, and I can feel it.)

The only real issue is with sleep. I'm a side sleeper, but it hurts my chest to roll over onto my side, while on the other hand it's hard for me to sleep while on my back. So getting to sleep is a issue. And when I do get to sleep, I will roll onto my side unconsciously and wake up with a lot of soreness in my chest and shoulder area. One Tylenol will take care of the soreness for most of the day, but I'm hoping my body will figure out how to drift off when I'm not in my normal position.

And honestly if that's the worst thing I am experiencing right now, I would call that a near miracle. My sister Carolyn and I were texting recently about my Mom, who had this kind of open heart surgery near the end of her life when she was not in good health and I just find it hard to imagine how tough she must have been to deal with that level of discomfort on top of everything else. I count myself fortunate that I had this done when I did.

Thanks again for reading and for all your support.

Recovery Marches on

Here's a quick update on my health and surgery recovery now that we've passed into March.

Shortly after the last post on February 20, I had an issue with irregular heartbeat. It wasn't a full-blown atrial fibrillation like I experienced in the hospital because my heart rate never really got elevated like it did then. But my heart would skip a beat, then add 2-3 extra beats, etc. etc. at random intervals. It felt like a muscle tic you sometimes get in different parts of your body --- a nervous twitch that you can actually see from the outside as the muscle contracts randomly. This went on most of one afternoon.

We called it into the nurses' office and because I wasn't experiencing shortness of breath or anxiety, they just said to keep an eye on it over the weekend, and the in-home nurse who's been coming in twice a week would run an EEG at my Monday visit. They suggested it was just an ectopic heartbeat where the upper and lower chambers of the heart start beating independently of each other. This is actually very common, in fact everybody has this happen to them regularly, we just usually don't notice it, like random muscle tics.

At the nurse's visit the EEG showed the irregularity, but still since I had no other symptoms, there was nothing really to do. As the nurse put it, when people poke around on your heart, the heart reacts and it just takes time for it to settle down. (I feel like there's a life lesson in there.) They drew blood to make sure certain mineral levels were OK, and everything came back perfectly normal. I feel fairly confident now that the irregular heartbeat thing was transitory, just another milestone toward recovery as my body acclimates to the new heart valve.

In fact it feels like the week that just ended held the most progress toward recovery I've had yet:

  • The irregular heartbeat has only come back a handful of times, and only in short episodes that last for a few minutes. Again probably everybody experiences this, we just don't notice because most people haven't just had major heart surgery.
  • The soreness and pain in my chest and back are still there, but less so every day it seems, and I can manage it with just a couple of doses of Tylenol each day. Getting into and out of bed has been a lot easier.
  • I'm able to do a 30-minute walk at a fairly brisk pace without my heart rate spiking. 10 days ago I was capable of two laps around Rivertown Mall; my heart rate would be in the 130-140 bpm range and I was exhausted afterwards. Yesterday I did 8+ laps and my heart rate never left the 110's, and it was the first day since before surgery that I rang up 10,000 steps on my FitBit. In fact there were moments on that mall walk where I really felt like I could have taken off at a jog and been OK --- which I did not do, because my doctors would kill me.
  • I've also starting doing more things in public, like going to a restaurant to eat (thanks to my friend Shelly Smith who came and kidnapped me this week and took me out for brunch) and going to Mass for the first time since before surgery.

Last week, too, I was officially discharged from in-home nurse visits. My bloodwork is completely normal, my EEG is normal, vitals (especially blood pressure) are normal --- there's no more need for close observation.

I can't stress enough the importance of physical activity in all this. I've discovered that a lot of the pain in my back that I've experienced isn't from the muscle and bone healing but from sitting down in a recliner for hours at a time. Just getting up and moving around both loosens up the muscles and builds strength in my legs and core, which helps with the actual soreness from my sternum healing up.

And while I've been avoiding public places because I am frankly terrified of getting a cold (the pain from coughing or sneezing is still quite intense), I think to really start recovering from something like this you need the presence of other human beings in your life.

I am still off from GVSU until April 8. Even when I return, there won't be much to do other than get my summer course ready and handle some personnel review matters.

In the meanwhile, I keep my day structured:

  • Prayer and writing in the mornings, followed by doing work on my summer course (a new prep for me so I want to get a strong headstart)
  • More writing (an upcoming article for Flipped Learning Today and new content for my blog at rtalbert.org)
  • Prepping for a webinar I am doing for Magna Publications in April, and some reading
  • Then my daily exercise (walking for 25-30 minutes while listening to audiobooks) followed by lunch; this week I may shift this to later in the day so I can go to GVSU to walk on the track, because pacing up and down my hallway for half an hour is super boring;
  • Then working through some DataCamp Python courses and reading books and research articles piled up in my reading queue
  • Toward the end of the afternoon I like to transition into language practice --- I am traveling to Brazil to give a workshop at the end of May and am trying to learn some Portuguese --- and more reading.

I put these into one-hour blocks and end each hour by getting up and walking 100-200 steps up and down the hall way or up and down the stairs. By the end of all this, it's 3:00pm and the kids are getting home from school, so I like to be done with all this by then and give them my attention (homework help, etc.).

I do make exceptions to this structure. Last Thursday (when Shelly kidnapped me) I just decided to blow off everything for the whole day. That was nice but I felt a little bit adrift. I'm just a person that needs a schedule to feel normal.

The next three weeks are going to be pretty eventful:

  • This Thursday (March 7) I go in for an echocardiogram and hopefully this will come back with no issues.
  • The following week (March 14) I go in for a chest x-ray followed by my big follow-up appointment with Dr. Leung, my heart surgeon, where probably a number of important things will be decided such as whether I am fit to drive and whether I can ramp up my physical activity.
  • The week after that, I start cardiac rehab (March 19) and have my final follow-up with a nurse practitioner (March 20), which might signify the official end of the main recovery period from the doctors' POV.

So we're sort of entering the home stretch.

This week is the start of Lent, and I am taking 40 days to completely unplug from all social media. I'll probably post some quick updates around the above dates and those will show up on my Twitter and Facebook feeds, but otherwise I plan to go dark. I'm hopeful that no other updates will be necessary. As I was told by all my nurse friends at the outset of this adventure, the recovery process is slow and arduous and there's not much you can do to speed it up (although a lot of things can be done to slow it down). I'm mainly focusing on being as active as I can be, both mentally and physically, while still meticulously doing exactly what the nurses tell me to do, no more and no less. That's been a winning combination so far, and I guess to sum all this up, it gets a little better every day.

Update at two weeks

Time for a little update since it's been two weeks since the heart surgery and a little over one week since coming home from the hospital.

Every day I am getting a little closer to being back to normal. I still have some way to go --- no 5K runs for me any time soon, and I can't even drive until some time in March. But I think I've come a long way in two weeks. Consider 10 days ago versus now:

  • 10 days ago, I was doing three walks a day around "7 Heart" (seventh floor of the Meijer Heart Hospital in Grand Rapids, where most cardiac patients go before being discharged). I couldn't do this unassisted. I was using either a walker or the IV pole, plus I had a nurse holding on to me with a strap in case I fell over. Now, I am walking around the house and even going up and down stairs no problem, and multiple times a day.
  • 10 days ago, every square inch of my upper body felt like it had been in a car accident and if I didn't get a dose of pain medication every three hours, life was pretty unenjoyable. Today I am well on the way toward being off those pain meds and in between doses, the worst that it gets is a very sore back. (Unless I cough; more on that below.)
  • 10 days ago, basically any movement I wanted to make beyond shifting around in my chair or bed, I needed to call a nurse and have them help me get up and move. This included getting into and out of bed, as I've described before. Today I can pretty much move freely; this morning I even got back into the kitchen and made some food for the rest of the week.

I continue to have an in-home nurse drop in twice a week to check in on me. The first visit this week, she said that the incision on my chest is healing very well, and all my vitals -- including my pulse rate and blood pressure which were a concern because of the atrial fibrillation episode I had in the hospital -- have been right where they should be. The only continuing blip on the radar is that one lobe of my right lung has still not re-inflated properly; I was on a heart-lung bypass machine while in surgery and my lungs had to be deflated, and this one area still hasn't quite gotten back to normal. But I am diligently inhaling on my sperometer once an hour as directed and eventually that will pop open like it should.

A bit more on pain management: I have been taking not just one but two different kinds of pain medication this entire time. These are not just pain meds but straight-up opioids, Tramadol and Hydrocodone. The other day I noticed I was down to the single-digits on each of these and realized I needed to start working on pain tolerance not just pain management. So I started two things: (1) Extending dosage from every three hours to every five hours and (2) going even longer between doses at night while I'm sleeping. What's resulted is that I feel the pain more acutely, but I think there less of it as my bone and muscle heal. It's not so much "pain" as it is a deep soreness, usually felt in my lower back and right at the incision on my chest. I've found it to be tolerable, and I get just as much relief from just lying flat on my back or legs-up in the recliner as I do from taking narcotics. Once the pain meds run out, I will be going to regular OTC Extra-Strength Tylenol, which works fine now but I am limited to just 3000mg of the stuff daily (and one dose of two capsules is 1000mg).

The exception is if I have to cough. When I cough, the muscle going across my chest contracts and pulls the two pieces of my sternum together and, well, that's more than just soreness. The muscle contracts and just stays contracted until I have a chance to just breathe for a few minutes. I count myself very fortunate that I haven't had to cough or sneeze much since I've been home. (Harry has had a deep chest cold since right around the time I went into the hospital and as much as I want to hang out with him, he's basically quarantined from my presence, and if he must get around me, he is under orders to slather himself in hand sanitizer first. I shudder to think what it will be like if I start getting a sinus infection.)

Cathy is home from work through the end of this week and should be returning to her job next Monday. This is a bit longer at home than we first expected and I know it has to get a bit on the boring side, sitting around doing nothing. We did leave the house once --- the first time I'd left the house since coming home from the hospital on February 12 -- to go to the mall so I could do my daily extended walk somewhere besides my hallway. It was a real treat (normally I can't stand shopping malls, but this is a special situation) and I did a lot more exercise than I was really ready for --- I was completely worn out the entire rest of the day.

My daily routine hasn't changed much, although I am starting to do more intellectually engaging stuff during the day. I'm sleeping 7-8 hours a night (I usually get 6!), waking up when the girls are getting ready for school, get my one daily cup of coffee and checking messages until the kids are off; then doing prayer and spiritual reading while Cathy's getting cleaned up. Then I do some combination of reading, math, or programming in the morning. I'm teaching a new class this summer and I'm working through the textbook, going through some Python courses at DataCamp, and nibbling at an article to submit to Flipped Learning Today at the end of the month. Still not exactly "work"; there's actually almost no "work" for me to do, since I finished almost all my GVSU responsibilities for the semester before going into the hospital. I usually break for lunch, do my daily extended exercises (pacing up and down the hallway for 20+ minutes unless I manage to get a ride to the mall), then settle in for the afternoon which is usually spent reading books or web articles. I take hourly breaks to do breathing exercises and take short walks (more pacing up and down the hallway).

I've been told all along that somewhere between the second and third week post-surgery, I'll notice that I'll be better able to do physical activity and handle more normal everyday activities. It's still slow going, and I still have to take precautions --- for example I do find myself getting light-headed and dizzy more easily than normal if I get up from a seated position too fast, and the chest pain makes it hard to breathe deeply --- but this three-week rule seems to be accurate. It's gratifying to feel like I am getting better and hopefully before long. the weather will get a bit nicer here (just gross snow and rain and winter weather advisories on an endless loop) and I can possibly get out and enjoy it.

Home life

This is my third day since arriving back home from the hospital. Keeping in mind that my primary responsibility right now is to take it easy and let my body heal, there's still a lot of things that I need to do during the day, along with some challenges to normal activities and an emerging routine to how the day is going.

A typical day so far looks a little like this:

  • Get up around 6:00am as the girls get ready for school. (It's noisy.)
  • Have a single cup of strong black coffee. Well before the surgery, even before we knew exactly what was wrong with my heart, my doctor ordered me to cut way back on caffeine. So ever since around September, rather than downing 5-6 cups a day as I used to, I've been having one very strong cup of coffee, black, in the morning and then tea or decaf the rest of the day. During the hospital I was basically able to purge myself of all caffeine. So now when I have my one cup in the morning, it's like rocket fuel! (Yes, the newly upgraded heart can handle it.)
  • Check email (not much of that these days thankfully) and see the kids off to school.
  • Cathy is home with me for the next few days thanks to her own FMLA leave. While she takes a shower, I will usually pray the Rosary. Praying the Rosary daily has been one of my goals for this recovery period.
  • Also during this time, and then once each hour while I am awake, I do deep breathing exercises using an incentive sperometer affectionately known as "my bong". While I was in surgery, I was on a heart-lung bypass machine and my lungs were completely deflated. I do these breathing exercises to continue to re-inflate the far corners of my lungs and clear out any gunk that might have accumulated there.
  • I'll usually then have some breakfast. (See below for more info on my diet.) Then at 9:00am I take a cocktail of meds for heart functioning, potassium, a diuretic to help me drain fluids, etc.

Throughout the day I have nothing planned, but I do have to keep track of a few important things: Doing my breathing exercises once an hour, making sure I am taking my painkillers on time, and doing physical exercise.

It turns out that having your chest cut open and then glued back together makes you incredibly sore afterwards. I've been dealing with that deep aching pain since February 7. It gets easier to deal with every day, but I couldn't do it without the major-league painkillers that were prescribed for me. One is Tramadol and the other is Hydrocodone with acetaminophen a.k.a. Norco. I am alternating these once every three hours. If I'm late on that schedule, I will absolutely feel it over the next three hours. When I first came home I wasn't clear on this schedule and was waiting 4-5 hours between doses, and I could barely move some of the time. Once I got the schedule corrected, the pain, while still pretty strong, has been very manageable. But for example when I sleep for longer than 3 hours and then wake up, it's like I have pulled every muscle between my groin and my head. Even with the right amount of pain meds in my system, right now my back is very sore and the incision site is sensitive.

The physical exercise is in the form of brisk walks around the house. In our house, that means up and down the main hallway. I started out with five 3-minute walks per day and am working up to fewer walks but of longer time periods. Today for example I'm on two 8-minute walks. Eventually this will become a single 10-minute, then a single 12-minute, etc. until I can walk for 30 minutes at a time without getting dizzy. Going up and down the hallway is boring but I do have audiobooks to help with that. Occasionally I will throw in a trip down to the basement and then back up. Doing stairs was hard earlier in the week --- I practiced at the hospital with a nurse, and it was very slow going. Now I can go up and down our stairs with little problem as long as I take it slow, because I can still definitely feel it. I can even tell a difference between a 5-minute walk and an 8-minute walk. At least for now, the former are easy but the latter get me to the limits of what I can do.

I'm also supposed to be eating, especially getting proteins in my system to help the healing process. This is tricky, though, because I'm restricted to fewer than 2000mg of sodium per day. That is not a lot of sodium and it makes getting enough protein difficult. (Forget about grabbing some sliced deli turkey for instance -- that's 490mg sodium per 2 ounces of turkey.) Add to this the fact that my appetite is diminished and I just don't really want to eat as much as normal. But, the doctors have said that whatever I normally conceive of eating, eat a little more, because I need calories to rebuild the bone and muscle that were cut apart during the surgery. So I'm in the weird position of being told to eat more than I really feel like.

When I'm not eating, walking, doing breathing exercises, or taking meds, here's what I've been doing during the day:

  • Reading books. I have way too many of these to catch up on. Also audiobooks for my walking spells.
  • Re-watching the entire MCU in chronological order. I finished Guardians of the Galaxy last night.
  • Visiting with friends. It's been great to have people over at the house who want to stop in and check up and I encourage this if you're in the area and have wondered if that would be helpful.
  • Writing, e.g. this post.
  • I am a productivity nerd and am taking this recovery time to think carefully about how I manage my time and tasks and projects. I just set up a completely reconfigured GTD system and have been tinkering around with it in all this spare time.
  • I'll be doing a few more DataCamp courses on Python soon.

So I'm trying to keep my mind active but I am not doing what I would call "work", nor am I trying to "keep busy". I just like to have 1-2 things that have been on the back burner for a while that I like to try to accomplish each day.

We'll spend family time together in the evenings and then crash around 9:00pm. The first two nights I was home, it was too hard to sleep in my bed, so I slept in the amazing new recliner that Cathy bought for me. Last night was the first time I was able to get into and out of bed unassisted and without too much pain, although I still don't think I'm following the directions properly and I was sore following getting up.

I feel like I've come a long way in in the last week and even in the last three days since getting home. This time last week, going for a 500-foot walk involved using a walker and having a nurse keep hold of me via a strap in case I should fall, and I would often get light-headed just trying it. Now doing the same thing is no problem and I am very steady on my feet. But I have a long way to go still.

Thankfully I've had no episodes of atrial fibrillation like I had in the hospital following surgery. By all accounts the upgraded heart is working beautifully, and I feel like I can tell a major difference in other functions too -- like I am thinking with more clarity thanks to having a more efficient heart. (Or it could be because I'm not grading anything!). For now, it's just a matter of resting, keeping my exercise ramping up, doing what the nurses tell me to do, and maintaining my diet. I feel like if I can do all that, my body will take care of itself and I'll be back to 80%+ in short order.

I want to especially thank Cathy, my wife, who has made all of our home life work while I've been out and who is here for a few more days to babysit me. There have been a couple of times when she's been called into action in that role (helping me get out of bed, picking up stuff that I dropped, etc.). We didn't get a real Valentine's Day date this year thanks to my recovery but I plan on making it up to her soon.

On the other side

The surgery is over and I am back home now. It was a bit longer of a stay than I thought it would be, and I was only making real updates on my Facebook page and my wife's page. So in this post I just want to recap all that went on during my stay.

The surgery was Wednesday (Feb 6) morning. My wife and I rolled into downtown Grand Rapids and the Fred Meijer Heart Hospital around 6am after a tricky commute on icy roads. Around 8:00am, I was fully prepped for surgery and the anesthetist gave me the juice that put me under. I didn't even make it out of the room before I was completely under. Then, simply, 5 hours passed and I was woken up.

This was an open-heart procedure and so during the surgery I was on a heart-lung bypass machine which deflated my lungs and stopped my heart. It also involves pumping 10 pounds of fluid into my chest cavity to make the surgery work. And, I was on a lot of drugs. The surgery itself went off without any hitches. The first thing I remember was being helped to stand up --- I'm having to learn some new ways to do this, say tuned --- and being told that I did it well, whereupon I vomited all over the place. Actually dry heaving because I had stopped eating the night before, but still some pretty impressive nausea.

I stayed in the recovery room all night and most of the next day. The anesthetist came in around 8:00pm and said, "Not gonna lie, this is gonna be a rough night." And he was right. Incredible soreness in my sternum area because they had, you know, split my sternum in two for the procedure. With this procedure you cannot do anything but lie on your back, and you cannot just move the way you want. You have to avoid any movement that puts separating pressure on the sternum or the incision area. Think about those kinds of movements when you go to bed tonight --- it turns out this is what we do constantly in bed. It was also painful to breathe deeply. So pretty much everything about going to bed that night was waking me up with throbbing pain, despite getting some major league painkillers.

The pain from my sternum was and still is an aching pain rather than a sharp pain. Those of you who have experienced broken bones before -- that's kind of what it is, because they did break a bone to accomplish the surgery, along with cutting through muscles and deep tissue.

So I counted the hours that night until around 9:00am on the 7th. Not much whatsoever happened on the 7th, just hanging around in the recovery room. My wife came in to sit with me and talk, and my 15-year old made it in as well. Doctors and nurses were checking in on me, and good progress was made. I should have been moved up to the 7th floor of the hospital where the individual patient rooms are located, but there were no beds available so I just had to wait until enough people were discharged.

That happened later on that night, and I was moved to a private room with a bed, chair, and TV. I managed to sleep 4-5 hours that night which isn't bad considering how painful it was to go into REM sleep and deep breathing.

Then exciting stuff started to happen.

On the morning of the 8th, as I was eating breakfast (the first food I'd had since the night before surgery) I suddenly felt my heart accelerate and stay there, and I started to sweat buckets. Within 30 seconds, nurses were through the door and attending to me. I was having atrial fibrillation or "a-fib". According to the nurses my pulse rate spiked to 180 beats per minute, which sounds like this. Additionally my blood pressure bottomed out which concerned the nurses more than the pulse rate. Thanks to quick action and some meds I was immediately put on, there was no damage of any kind and I was brought back to a normal heart rate within an hour.

But up until that point, everything had been going textbook and it was looking like my post-surgery hospital stay was going to be unusually short. I was hoping to come in, conquer the surgery, nail the recovery, and head home to sit in my new recliner and watch movies for two months. The a-fib changed all that, and it was scary. If that kind of thing happened once, it could happen twice, and what if it sets itself off when I'm out of the hospital? About 1/3 of patients who have my procedure end up having a-fib, some chronically. So this wasn't unusual, but it was a setback.

As a somewhat funny side note, during this whole a-fib scenario, a volunteer Eucharistic minister showed up to offer me Communion. It was just their normal rounds for the day and they were visiting every Catholic on the floor. But here I am, pulse rate through the roof, sweating buckets, nurses obviously concerned and this random person shows up telling me to say the Our Father and take Communion. I didn't think that's what they did when you're dying, I thought, but what do I know?

Things got better each day from there.

Later that day I got out into the hallway for a walk and this made a huge difference in my attitude and belief that I was going to be OK. Into and through the weekend, the day had a discernible routine:

  • Wake up usually around 6:00 and have a nurse come in and take my vitals, and accompany me to the bathroom to pee. Wash hands, brush teeth, then into the reclining chair in the room.
  • Take pain meds for the morning and settle in either to watch a movie on my phone, watch soccer on TV, or try to read (hard thanks to the mind-altering effects of the painkillers).
  • Interrupt for walks -- they had me doing 4 walks each day of 300 to 500 feet, just a loop around the floor.
  • Order lunch from room service at noon, and have my vitals checked again while waiting for it. I'd also usually talk with a nurse practitioner or doctor about bigger stuff, especially the a-fib. Smaller a-fib episodes kept happening both during the day and overnight as I slept and my blood pressure was still too low.
  • Move movies or books, punctuated by walks.
  • Visitors usually, often just my wife but I had a few wonderful visits from work colleagues and from my priest.
  • Move to the bed around 9:00 and try to get to sleep by 10:00.

On Sunday night we finally hit a breakthrough when I flipped back into a normal heart rhythm and stayed in rhythm. I had been taking IV drugs to help with this with the idea that we'd eventually switch to oral drugs that, if a-fib kept happening, I could take home with me along with blood thinner to prevent a clot and then hope for better later. But the heart rhythm I had switched into was so textbook the doctors decided to just take me off all those meds and see what would happen. Nothing happened and that's exactly what we'd hoped.

So this morning (after a truly terrible night of no sleep thanks to a deepening sternum/backache) the nurse practitioner declared she was going to send me home. And now, here I am.

It's wonderful to be home but also a little scary, since in the hospital I had 24/7 world-class care literally steps from my room, whereas now I have to figure things out on my own should something go bad. I have to keep track of my meds and exercise and be careful not to put strain on the incision, as opposed to having nurses do that for me. But it's the start of long recovery period and I am glad to be on that road.

Twas the night before

If all goes according to plan, this time tomorrow I will be on the operating table. This will probably be the last post I make here before the surgery happens, and (assuming all goes well) for several days following, since I'll just be too mentally out-of-it to write anything coherent. (Although coherence never stood in my way before.)

Yesterday I was at GVSU for some final closing-out tasks and a couple of meetings. More than one of my colleagues was surprised to see me there -- and a few more were surprised to hear that the surgery is Wednesday. I'm gratified that my January sprint was successful and all my "stuff" is now handed off to a colleague or else on auto-pilot until April. It was kind of a bittersweet day. I'm ready to have the surgery done; but the kindness of my GVSU Math colleagues was so meaningful, it's hard to walk away knowing I'll miss sharing work with them for basically the whole semester.

When I was still at Franklin College, I worked with a sociology professor named Virginia Seubert. She liked to be called "Ginger". Although I was never very close with Ginger personally, I came to really value her mind, her humor, and the work she did. Then one day, the word came down that Ginger had been diagnosed with a terminal disease -- I believe it was cancer -- and she would be leaving the college mid-semester for medical care which eventually became hospice care. One day after the news was announced, I was coming back to my office --- which was on the first floor of "Old Main", the primary classroom/office building on campus --- and stumbled across a scene I will never forget: Ginger and a friend, with Ginger's office belongings on a hand cart, exiting the building and the campus for the last time before she entered hospice care and eventually passed. It was her final moment leaving a career, a professional life, she'd spent decades building and would never see again.

That was over a decade ago and I have thought about that scene often, wondering what it would be like to be in Ginger's shoes, leaving my work and my colleagues for good. Although my condition and my surgery are the same kind of health issue that Ginger had, I have to admit that yesterday, closing up the office and making my way back to the car, I got a bit of a sense of being in that scene.

Don't get me wrong. Although I struggled when the diagnosis first came down, I have been and remain positive and optimistic that tomorrow's procedure will be a success, and after a time of healing up, I may end up feeling 10 years younger thanks to a properly-functioning heart. At the same time, this is a serious procedure, and I'm fully aware of that seriousness despite being positive and making jokes about things.

I have a monthly newsletter for my blog readers, and today I sent out the January 2019 issue. I wanted to end here by sharing something that I put into it about how I've dealt with "What Might Happen" when it comes to the procedure.

People have asked me if I'm anxious about [the surgery]. The surgeon said there is a 1/100 chance that "something really bad" could happen during the operation -- stroke, heart attack, or just plain old death. It's not every day that you come face to face with that high of a probability of dying. Am I anxious about it? I have to say --- not really. My personality is such that if something is obviously completely out of my control, I have a hard time getting emotionally invested in it. And also, maybe we come into contact with 1/100 chances of dying more often than we think. (I'm particularly thinking about the weather overnight --- a quarter inch of ice predicted --- and thinking the drive to the hospital might be more life threatening than my procedure.) Additionally, I see the outcome of the surgery as only partly a scientific or medical issue, and from my vantage point more of a spiritual issue. I've spent this week thinking a lot about life --- what it means to have one, and what it means to live the one you have --- and after thinking, praying, talking with my priest, and engaging with the Sacraments of the Church, I'm honestly ready to go get this surgery done, and 1/100 probabilities don't scare me.

So as we come, finally, to the time to get all this done, I'm well aware of the possibilities both positive and negative, and my family and I are heading into this with our eyes open and confident of a good result.

I appreciate your continued prayers, well wishes, and good vibes. If you're local, do check in on Cathy's Facebook feed as she will probably have the best updates over the next week.

See you on the other side.

Updates and FAQs from 6 days out

Yesterday I had my final pre-operation meeting at the heart hospital, with Cathy and one of the cardiac nurses. The purpose this time was to get our FMLA leave paperwork filled out (finally!) and to go over the game plan for the next few days and into my recovery period.

We learned at the meeting that the results from the x-ray procedure I mentioned last time indicated that I was indeed eligible for the "minimally invasive" form of the valve replacement surgery, which means that my surgeon will be OK to make a much smaller incision when he goes in -- something like 3-4" long instead of 6-8" or more. This means a faster healing time and, I suppose, less pain as the bone heals. This could change if he gets into the surgical process and decides he needs more real estate. But for now that's good news.

Otherwise what we discussed is information that I'd already learned from the literature they gave me. Here's kind of what the next few days are going to look like.

  • As of yesterday I am not allowed aspirin, ibuprofen, or vitamins. And today I start in with an antibacterial ointment I use in my nose because that's where some of the breathing apparatus will be located.
  • I'll go into the hospital on Wednesday at 6:30am. The surgery itself will take 3-6 hours to complete. I'll be on a heart-lung bypass machine during this time (it turns out operating on your heart while it's still beating is a bad idea). Cathy will be there and they'll come out and give updates every so often. Once the surgery is done, I'll be in a cardiac recovery room for the rest of the day, completely knocked out and connected to a breathing machine, pacemaker, and other apparatuses.
  • Once I wake up, they'll take out the breathing tubes and have me start breathing on my own. I'll be doing deep breathing exercises once an hour, because there will be fluid in my lungs and I'll need to breathe to inflate my lungs and cough this stuff out.

Question: But they're cutting open your chest and cutting your breastbone in half, then patching it the bone back together with stainless steel wires and you'll have a big incision on your chest. Isn't coughing going to hurt like a [insert expletive here]?

Answer: Yep. But it has to be done. They'll be giving me a "heart pillow" that I am supposed to clutch up against the incision when I cough (or move, or...) that should support the incision and moderate the pain. That, and the drugs. (And I suppose I can cry into the pillow if the drugs aren't strong enough.)

  • The usual stay in the hospital is 3-5 days. They said 3 days is really unusual, so we are planning for me to be there basically through the weekend. While I'm there, I'll be doing breathing actitivites, going on walks with the nurses up and down the hallways, and learning how to avoid using my arms for things. About the arms, try getting up from your chair right now the usual way, by pushing off from the chair or a desk with both arms. Feel that pressure it puts in your chest area? Exactly.
  • At some point over the weekend I'll go home and continue this process. I'll be basically in my room for a while, then as I get stronger I'll be able to go downstairs and maybe even get driven out to the mall for a longer walk. No outside walking for now since it's still winter here until usually around the middle of March.
  • I'll have a home nurse come in twice a week to check in on me and make adjustments as needed, for the first month. I'll go back to see the cardiologist in March for a checkup and then we'll see what the trajectory looks like.

Q: What will you be doing once you're home?

A: The plan is to take it slow and easy. No GVSU work will enter my consciousness during February. I want eventually to get back to being active in both work and play. The fastest path to that goal is to do nothing whatsoever that is remotely active or stressful for the first 3 weeks at least, apart from taking walks. This is totally against my nature but I've accepted it, even kind of looked forward to it, since I have 100% permission to just sit around. My main plan for the short term is twofold: (1) re-watch the entire Marvel Cinematic Universe in chronological order in the run-up to Captain Marvel and Avengers 4 (both of which I fully intend to see on opening night) , and (2) do the Zepathon.

Q: Are you going to be writing stuff and giving updates during this time?

A: Sort of. I have two new blog posts for rtalbert.org already written that I have set to auto-post during February, and on Twitter I have scheduled some posts that link back to older blog posts, like a "greatest hits" that people may not know about. But otherwise I'm not planning on blogging until March. Here at this mini-blog I'll post updates as I have them. If you want more frequent updates, check out Cathy's Facebook feed.

Q: What are Cathy and the kids going to be doing?

A: Cathy will be home with me the entire first week that I'm home, thanks to FMLA. Then I'll be hanging here by myself during the day, except for visits from the in-home care person. The kids will be in school until... well, possibly July at this point, but certainly through this entire process so they're taken care of. Everybody is going to have to pitch in to cover what I usually do, including cooking the meals, which should be interesting.

Q: Speaking of meals -- do you need people to bring you stuff to eat?

A: We appreciate that offer, but we'll let people know if that's something we need. Our kids are so picky with what they eat that we're afraid that most of what people might bring us will end up going bad before we can consume it. So again, maybe watch Cathy's Facebook page and this blog for any needs.

Q: When do you go back to work?

A: My FMLA plan has me returning to GVSU on Monday, April 8. I've spent the whole month of January doing a focused sprint on several Assistant Chair projects to get them either done, or ready to be handed off to someone else or put on ice for 8 weeks, and I'm mostly done with that. A few of those projects are what I'll be spending the last 3 weeks of the semester doing --- that, and preparing for my summer online class that starts May 7. Otherwise: No GVSU work will enter my consciousness in February and only little stuff in March.

Q: Are you nervous?

A: A little. You can't not be nervous when you're looking at a life-changing event for which you have no prior experience for comparison, not to mention it's not exactly a risk-free procedure. It's all becoming very real this week, and I wouldn't be fully human if it were just no big deal for me. However:

  • I just so happen to live near a city with some of the best aortic valve replacement surgeons and cardiologists in the country. I may look back at all this and see that the series of events that led me to leave my job in Indiana in 2011, then find work here in GVSU and west Michigan were all designed to get me to the point where I could have this surgery done here, in this city at this hospital.
  • I'm relatively young and in good health, except for my heart.
  • I also have faith in God --- for real, as in what you find in the Nicene Creed, as the "maker of all things visible and invisible". He made me and sustains me now, and always has, so I really don't fear anything going into Wednesday.

Thanks as always for your support, prayer, good vibes, and anything else you have been sending. I'll check in at least once more before the big day.

Thoughts at T-16 days

It's 16 days until my aortic valve replacement surgery. It's been fairly quiet on the health front, but now the February 6 date shows up in the "two-week" view on Google Calendar which drives home the reality of what's going to happen.

Yesterday I went into Butterworth Hospital in Grand Rapids to get a CT scan done, so my surgeon can determine just how invasive the surgery needs to be. The choices basically are "incredibly invasive" (the incision in my chest will be about 3-4 inches long) or "extremely invasive" (6-10 inches long). I don't pretend to know heart surgeons make this decision, but apparently it involves injecting dye into my bloodstream and then running me through a CAT scan machine.

I'm obviously hoping for the "incredibly invasive" option because this will cut down on my recovery time by at least a week or two. But whatever happens, happens. It's not something in my control so I am studiously avoiding worrying about it.

A note on my heart surgeon: His name is Stephane Leung, and Cathy and I met him and had a 30-minute consult back on January 7. It turns out Dr. Leung was a math minor in university and so we had a nice discussion about discrete mathematics in between talking about the inner workings of my vital organs.

On the work front, I am continuing with what I am calling "the January sprint", to get basically a semester's worth of work done in four weeks. I wrote about this here on my main website. People who know me find this completely unsurprising. (I was describing my January spring to a former student last week, and he replied, "Professor Talbert, you are always sprinting.") The FMLA paperwork is currently making the rounds; it has to be signed by my department chair, my dean, a "Work-Life Consultant" in HR, and finally by the provost. It reminds me all too much of when, after I'd defended my dissertation, I had to get five physical signatures on a cover page, and it took me six weeks thanks to a continuous stream of errors and vacations. Let's not do that again this time, OK?

At home, we're starting to think concretely about what it's going to be like during the recovery period, when my energy is going to be very limited and my physical movements restricted. The hospital gave me a binder full of information about physical activity during recovery, which includes tidbits like this:

To get out of bed:

  1. Lie on your back and slowly scoot to the edge of the bed.
  2. Bend your knees slightly and roll slowly onto your side.
  3. Carefully push your body up, using the elbow beneath you and the arm on the other side of your body. At the same time, gently swig both legs to the floor.
  4. Sit for a moment. This will help you from getting dizzy.
  5. Put your hands on your thighs. Bend forward from the hips, and push your body up with your legs.

To get into bed, do the reverse.

I tried this and promptly fell out of bed after step #2. I think the takeaway here is "Stay in bed" which is pretty solid advice no matter who you are.

Seriously though --- a lot of how I go through daily life will be seriously altered for the first 3-4 weeks after surgery, and there will be a lot of trial and error on figuring out what I can do and how to do it. My main plan is to camp out in my room most of the day and listen to music and audiobooks.

And how am I feeling? Physically, most of the time I feel very good. As a vanguard action for post-recovery life I have cut way back on caffeine and sodium, and these two things alone have improved how I feel generally speaking. But there are still moments where I just know that something's not right inside. Walking up an incline, my heart starts hammering away and I get a little woozy. Sometimes I'll just be sitting around and my heart will start palpitating crazily and then settle down, for no apparent reason.

So mentally, because of moments like that, and because I know that if I don't get this surgery done then these moments will only get more frequent and severe, I'm also feeling good --- glad that I only have 16 more days to wait.

We have a date!

Greetings. This morning Cathy and I met with the surgeon who will be performing my open-heart surgery to discuss a few remaining options and some of the details surrounding the procedure. Here are some new bit of info from this meeting.

First and perhaps most importantly, we finally have a date for the surgery: Wednesday, February 6. This is a bit later than I originally thought it would be, but in fact I think this date is just right. It gives me a full month to get my head down at GVSU and complete a number of important Assistant Chair-related tasks that need to get done. The biggest of these is merit review for departmental faculty -- it's a lot of work, and I'm happy that I can do it now instead of find someone to pawn it off onto. Then, when February rolls around, I'll check out of work and go on FMLA for eight weeks. Eight weeks from February 6 happens to coincide with GVSU's Spring Break, so I'll come back after that break and spend the last month of the semester finishing off anything that needs finishing off.

Second, we made the decision this morning to have a bio-prosthetic heart valve put in, instead of a mechanical valve. While the mechanical valve would last longer (20-30 years) and while I thought the idea of being a cyborg was kind of cool, having the mechanical valve would require me to go on blood thinners for the rest of my life. The whole point of having the valve replaced is to get me back to the place where I can fully enjoy the kinds of outdoor physical activities I love to do. Being in a position where, for instance, if I fell off my bike I could die from internal bleeding because of the blood thinner, doesn't really mesh with that goal.

What's next:

  • I'm back in the office for the month of January, like I said, to do a heads-down sprint of Assistant Chair activities before FMLA. I am not teaching this semester --- I only had one class, and this has been taken over by a colleague --- so my entire focus will be on administrative projects and finishing up research projects from my sabbatical that I had already intended to finish this semester.
  • I go in on January 31 for a pre-operation meeting to get educated on what exactly is going to happen during and after the procedure. Also there is a chance that the surgeon can do the procedure with a much smaller incision on my chest than normal --- like, 4 inches instead of 10 inches --- and a shorter recovery time. Some time during the week of 1/31 I will go in for a CT scan to determine if this can be done.

One more thing --- The tweets and emails of support that I have gotten from you all, sometimes from people I don't even know, have been overwhelming. Although this is a serious event, there's a lot of good that comes from something like this because you can see all the good connections you can make with other people. It means a lot, and thank you for it.

Update on my health and upcoming surgery

Hi again. First of all, I want to thank all of you who sent well-wishes and prayers following my previous post. It means the world to me, to know that I have so many keeping me in their prayers and thoughts throughout this journey toward getting my heart fixed. (Or as I've started calling it, "getting upgraded".)

As I mentioned in the last post, today was the day I went into Meijer Heart Hopsital in Grand Rapids for two more procedures prior to the surgery itself. I just got back from this visit and it went very well. Here's a rundown:

  • I had a transesophageal echocardiogram (TEE) done, which as the name suggests is an echocardiogram done by sticking a probe down my esophagus so that the probe can get right up next to the heart to take pictures. That's about as fun as it sounds and fortunately I was completely knocked out the whole time. Through the TEE, the doctors confirmed something I speculated on in the last post, namely that I have a bicuspid aortic valve -- the valve has two flaps instead of three. This is just something I was born with, not the result of any poor health choices or whatnot, and it's the cause of my aortic stenosis that I wrote about last time.
  • I also had a heart catheterization done to get a look at my arteries. Good news here, my arteries are totally clean without any kind of clogging or buildup. (Despite the massive amounts of bacon, etc. I eat.)

So what's next?

Because of the bicuspid valve situation, there's no other treatment for my condition besides open-heart valve replacement surgery. On January 7 I will have a pre-op meeting with the heart surgeon who will be handling the case. Unfortunately I still don't have a firm date for the surgery itself, although I suspect it will be something like one week following the meeting. I am just going ahead and telling my work and every one else that I will be out from January 14 through March 8. The surgery will definitely be close to the beginning of this 8-week period, and this puts me on a schedule to get the surgery done, recover, and then get back into work -- slowly! -- after our Spring Break is over.

On that note, the GVSU Math Department has been amazing in supporting me and lining people up to fill in for me while I'm out. My colleagues Filiz Dogru and Akalu Tefera will be taking over my Linear Algebra class and some of my Assistant Chair duties, respectively. The rest of my duties --- most of which are from my Assistant Chair position --- can be done remotely or can wait until I return.

Meanwhile, life goes on. We're getting ready for Christmas here, and the kids will be out of school next week. I'm feeling actually really good for the most part, and the prayers, thoughts, and well wishes from all of you have played a large part in that. Especially helpful has been my priest, Fr. Bill VanderWerff, who's given me good advice and reading to do during this time, along with my entire faith community at St. Luke University Parish in Allendale.

I'll continue to give more updates here as they happen.

A note about my health and what's ahead

I'm writing this post to update friends, family, and others who are interested about some recent issues with my health and what those issues mean for me in the coming months. I'll continue to use this website (https://listed.standardnotes.org/@rtalbert) to post updates in case you want to keep up.

Many of you know that I used to be a runner, doing 5K and 10K races pretty regularly. About a year and a half ago, I was doing a run indoors on our treadmill when I suddenly felt very short of breath, my vision started closing in on me, and I start to pass out. I stopped the treadmill and got off in time, and I thought: Whoa, that was weird. I must have been pushing too hard. A couple of months passed, and I was outside doing a run around the neighborhood when the same thing happened -- shortness of breath, vision getting blurry, and I started to pass out. Then it happened a couple more times on runs outside over the next couple of months. I also started having some episodes where I would get dizzy while driving, and over the summer I found myself getting fatigued and short of breath while doing fairy light exertion.

Whatever was going on was getting worse, so I mentioned it to my doctor when I had my annual physical in August. He checked me out and detected a heart murmur. Because of that, he ordered an echocardiogram and a cardio stress test, which I had three weeks ago. The techs did the echocardiogram and consulted with the doctors, and based on what they saw, they told me I shouldn't be on a treadmill, and sent me home. They couldn't say what the issue was. But when I got home, I got a call from my doctor with the results.

Based on the echocardiogram, I was diagnosed with aortic stenosis, an abnormal narrowing of the aortic valve. The aorta, of course, is the main pathway for blood to enter your circulatory system. The aortic valve has three little flaps that pop open when blood is coming out and close up to keep blood from coming back into the heart. In aortic stenosis, the flaps become inflamed and stick together, even starting to fuse together, causing the flow of blood to be obstructed. The heart then has to work overtime to get enough oxygenated blood out to the body and eventually the heart just fails because it's working too hard. Or, it could result in a stroke because there's not enough oxygen getting out.

After the first test, where I got the diagnosis, I wasn't sure how severe my case was. This morning I met with a cardiologist to go over all the details. The results basically confirm what I suspected: My case is severe, and although there is a small chance that I might be eligible for a less invasive treatment, it's pretty much certain that I will need to have open-heart surgery in January to replace the aortic valve.

So here's what's next.

  • I'll be going in on December 21 for two more tests to rule out some fringe conditions, things that would make me a high risk for open heart surgery. The doctor thinks being high-risk is very unlikely given that, other than this condition, I am in very good health and still relatively young.
  • Assuming that I am not high-risk, I will have the valve replacement surgery some time in January. That is the full deal: Cracking my chest open and the whole nine yards.
  • Then I will be in recovery for 4-8 weeks after that.

This means that most likely, I will be on medical leave from GVSU for the entire Winter 2019 semester. The first couple of weeks of recovery, the doctor said that basically I'll be so sore I won't feel like doing anything. But then I should be able to do the kinds of stuff I normally do other than teaching -- stuff that involves just reading and working on the computer. I have no end of that kind of work thanks to being Assistant Chair. But I will definitely not be in the classroom during Winter, which sucks because I was looking forward to teaching Linear Algebra again. At least that was the only class I had/have. I will also have to cancel on four speaking engagements that I was really looking forward to doing, because travel is not on the menu.

This is heavy news, but it's not bad news. I'm not afraid of what's down the road here because the surgery and the recovery are going to get me back to the place where I can once again enjoy some of the physical activities that I cannot do right now because of my condition. It also gives me an excellent starting point for doing a complete overhaul of my diet, exercise, and lifestyle which had become pretty unhealthy lately even without the heart condition. The thing that I'm not looking forward to is the hospitalization and the fact that I won't be able to be 100% present with Cathy and the kids.

I take a lot of comfort in my faith, family, and those of you out there who are reading this. We all appreciate your prayers as we get this thing done.