Recovering from major heart surgery, the difficult second month

Logic dictates that on the first month of recovering from major heart surgery the second month swiftly follows. I’ll try to write up a few more thoughts about my experiences, challenges, successes and more during the difficult second month of the recovery.

Slowdown of progress, or at least a perception of slowdown. This is why I call it the difficult second month. A lot of it is probably perception and expectations, but at least to me it felt as if the recovery slowed down in the second month, causing a certain amount of frustration. I had to remind myself frequently that I was only 5, 6 or 7 weeks after the operation, so still not a long time. One example was the walking, over the first few weeks it felt like I could increase the distances fairly quickly, from a mile to mile and a half and then to two miles. This probably raised my hopes how quickly I would be fit again and may be even able to start with some very slight jogging. But then I kind of hit a plateau. I still felt I made some progress (e.g. around walking speed), but it was significantly slower. I didn’t feel I could significantly increase the distances (despite doing the odd three mile walk, I don’t feel ready yet for a four or five mile walk in one go) and walking up inclines was still very tough and despite including it in my ‘training’ progress felt very slow. Accepting that things will take time (even though I knew it all along) was difficult at this time.

Mood swings. Same as in the first month they were still around, in particular related to the slowdown of progress. Again I tried to as much as possible see the positive and when I had a down phase remind myself how far I had come and that better days/times were just around the corner. That didn’t always work, but it was the only way I could think of dealing with it.

Weight control. An interesting area, as I wasn’t always sure how to handle this. While not massive I did gain some weight since returning home, what I wasn’t (and am still not entirely sure about) is the question/concern how much (if any) of it is related to water retention and how much is genuine weight gain. I tracked my weight daily (may be not the best idea?) and while I noticed daily fluctuations I also noticed a general upward trend. I also felt that my waist did grow, but again that’s difficult to track. I certainly felt that I ate more (and also ate more sugar, e.g. biscuits), partially due to the tiredness (when you’re tired you get hungry), partially for convenience/enjoyment (a few nice biscuits while relaxing after coming back from a walk, or as a reward for completing something). Either way, it’s something I feel I need to watch and since late November I’m trying to cut down my sugar intake. I can see first signs that the gain is halted, it looks like it’s even starting to go down again.

Painkiller reduction. Pain management is a key component of the recovery, if you’re in pain the recovery will be much slower. This generally worked fairly well for me. While I was in hospital I was on the maximum of 8 Paracetamol per day (2 each in the morning, lunchtime, afternoon and night). When I returned home I cut this to 6 per day by reducing the lunchtime and afternoon rations to 1 each. This seemed to work quite well, so I decided to stick with it for a while. I wasn’t entirely comfortable with it as I’m concerned about the long time impact of prolonged painkiller usage, but decided to stick with it until mid November, four weeks after leaving hospital. Then it was time to try a staged reduction with weekly changes and a goal to as much as possible get off them by early to mid December. I did this by gradually reducing doses mainly in the morning and during the day (including taking half doses, you can break the Paracetamol pills in half, they’re already prepared for that) while for the time being keeping the night dose to help with sleeping. By late November I had cut out the daytime doses and only took one in the morning and two and night. This generally went OK, I was never in real pain although I did notice that my chest was still sensitive in various (often changing) places. There were the odd very short term pains, but they went within a few minutes or even seconds. My goal is still to be off them by mid December.

Sleeping problems. I’m not sure how and why they developed, but about halfway through the second month I developed some sleeping problems. While I was tired I just couldn’t fall asleep. I also felt at times my body was tightening up for some reason, making me struggle to stay in bed, it was more comfortable to get up and walk around or sit on a chair. Quite often I was awake until two or three in the morning, then later in the morning hitting the snooze button when I originally had planned to get up at 7:30 or so in the morning. Not what I was looking for. I’m slowly feeling like I’m getting this under control again now, although I still have episodes.

Temperature struggles. After the mild autumn and winter 2015/2016 I was hoping for a repeat, but that didn’t happen, at least not for the period of my recovery. While the first few weeks in October  were still quite mild the end of October and certainly most of November turned out fairly cold, especially compared to last year. November was below the long term average, as was at least the start of December. This did cause me a few problems as I seemed to be more sensitive to the cold weather. I had to turn up the heating in my flat more than I would usually do, yet I still noticed the cold at times, in particular when there was a cold wind which for some reason I still seemed to notice. Having no permanent heating in my north facing bath room and heating up the top half (while the bottom remained at fridge temperatures) with an underpowered fan heater taking half an hour didn’t help either. More importantly the cold weather didn’t help during my walks, as I had to cope with the cold air. In some of the literature they recommend to walk indoors (e.g. in a mall) during cold weather, but that wasn’t really an option living where I live. So I just had to cope with it. I certainly did notice the cold air making it more difficult to breathe at times.

Regaining confidence. This I found an interesting and challenging balance to strike. Especially during the first 6 weeks you are physically unable to do certain things, you are in some cases also advised not to do them (e.g. twisting your upper body, lifting above a certain weight, directly showering your chest). As your recovery progresses you can slowly start or increase some of these activities again, however, this is where I found striking the right balance in increasing activity and having the confidence to do it in the first place can be tricky. While I was sure the scar on my chest had healed sufficiently I found it quite challenging to start showering ‘normally’ again instead of trying to only let the water run over my shoulders on to the chest. The confidence to just point the shower at my chest just wasn’t there. Similarly with lifting where I know I need to gradually build this up, I often worry I might do too much too early and cause damage, which in turn is probably stopping me doing some things I could actually do. Building up my general confidence I found my first trip into Reading for a haircut, lunch and some light shopping quite helpful, while I was quite tired afterwards it showed me I was able to do it, which helped to build confidence.

Rebuilding routines, getting rid of ‘bad habits’. During the first weeks of my recovery I was struggling with concentration, which led me to stop editing and posting daily pictures on my photoblog, I also wasn’t reading as much as I had hoped before the operation. Instead there was a lot of slacking and aimlessly surfing the internet, it was just easier to do. As I was able to concentrate more I started to set myself goals (e.g. edit and post at least three pictures this week) which I found quite helpful, by now I’m back to posting pictures daily. I’m still struggling to an extent with some of the slacking, it’s just so easy to do and a bad habit can be difficult to get rid of. For the time being I’m relying on willpower to overcome this, it’s not fully working just yet but I’ll get there.

Those are some of the key points from the second month, the third month is obviously just about to start now. Assuming everything goes to plan I’m aiming to start a phased return to work in a week’s time. That and whatever else I experience in the third month will be the topic for another entry.

A frosty November Rose

Time to revisit my November Rose, as it presented a new photo opportunity this morning. The last few days have been very cold and sunny, yesterday morning I used the opportunity for my longest walk yet: Over three miles in beautiful sunshine walking back from my GP appointment/review (taxi is ridiculously expensive as mentioned earlier). While I must admit some of the inclines were rather tough the flat parts and certainly the downhill sections were beautiful (especially as they were south facing in the sunshine). Quite motivating after some not so good days before (more about that some other time). When I arrived home at lunchtime the Rose was bathed in beautiful winter sunshine, so I took a few pictures. However, they didn’t turn out too different to the ones I already had, so I didn’t do anything with them. Good thing I didn’t, as this morning after a very cold night for here (-6°C, we don’t get that often in West Berkshire) ice crystals had settled on the Rose, giving me some nice views:

(click on the pictures for larger versions, including a bonus picture of a view over the canal)

A November Rose

A bit of an unexpected nice surprise during my recovery from heart surgery. I’m not entirely sure when I first noticed them, it was either just before I left for the hospital or the day I returned from the hospital with my sister. Anyway, back then the flowers were still closed and considering it was the start or even middle of October I didn’t really expect them to flower. Especially after a few night frosts in late October and early November I thought they would fade away. But they didn’t:

In mid November three of the five rose buds opened and started to flower, a nice view especially on the often grey and dull days. Cheered me up when I had a bad day during my recovery. Today is a nice and sunny day, so I thought I try to take a few pictures of them to share the joy.

Recovering from major heart surgery, the first month

Recovering from major heart surgery takes time, a long time. Related to this a little flashback to my first or second evening back on the ward in the hospital: The Martian with Matt Damon was shown on television. Early on he is hurt by a piece of antenna and operates on himself, pulling out the fairly large piece of antenna with some kind of forceps before stapling shut the deep wound. He then proceeds as if nothing had happened. Keeping in mind the state I was in I just thought, yeah right. Later on I mentioned this scene to one of the nurses and we both agreed that it wasn’t very realistic (the same applies probably to many action movies where the heroes operate on themselves).

But back to my own recovery after having been discharged from the hospital. As mentioned in the previous entry I had booked a private hire car for the journey home. This was definitely the right decision as completing that journey on a train would have probably completely exhausted me. One point to note is that the driver said he was going to drive extra carefully especially around corners and roundabouts when we told him about my operation, which I was very grateful for as it made the journey much more pleasant.

When we arrived home my sister took the luggage up to my flat while I waited downstairs. She then came back down again and we went on a short walk around a local pond close to my flat. While only short I think this was one of the most enjoyable walks I’ve done in my whole life. Walking outside in the sun (of course it helped that it was a nice sunny afternoon) after having been stuck indoors for over a week was just amazing.

Having my sister staying with me for the first few days at home (even though shorter than originally planned due to my longer than expected hospital stay) was certainly a huge help I was very grateful for. She provided companionship and helped me to figure out what I could and couldn’t do. It was also good to have someone helping to instill a bit of discipline during the first few days.

Now let me talk about a few of the areas I found interesting or challenging over the first few weeks of my recovery at home:

Sleep. You will need lots of it, yet still feel tired a lot of the time. I also found it difficult to get uninterrupted sleep, I frequently woke up during the night. At times I found it difficult to fall asleep again despite being tired, so I read something or surfed the Internet on my tablet for 10 to 15 minutes after which I was able to sleep again. I also noticed that I was sweating a lot especially during the middle of the night, this improved as my recovery progressed. I’ve been taking naps at lunchtime for many many years now, so I found it quite easy to do this during my recovery as well. If I can I sometimes even try to take several naps during the day.

Walking. One of the key activities you are told to do to aid your recovery is walking, something I was more than happy to do. I typically went walking twice a day, starting with a shorter walk in the morning. I kind of viewed this as a continuation of my daily morning run I used to do before my operation. During the first few weeks this was only a short 15 to 20 minutes walk around the estate, later on I expanded it to a 30 to 40 minutes walk along the canal (using part of the route I used to run). The second walk was at either lunchtime or in the afternoon, initially aiming for about a mile which I later expanded to 2 or even 3 miles. This walk I sometimes combined with a visit to the canal tearooms or lunch at a pub. One example was my first canal walk after returning home. One interesting area to be aware of is walking on flat ground versus walking up inclines. While I was able to walk fairly long distances on flat ground fairly quickly I did notice that I found walking up hills or even over a bridge challenging at times, especially if I started to tire after having walked for a while. To help me improving on this I included crossing a railway bridge at the end of my morning walk. I’m starting to see some improvement, but I think this will still take a while.

Housework. As mentioned in a previous post I had originally booked a domestic help to visit daily to help out with domestic chores. However, when the day arrived they were supposed to start (after my sister had left) they never showed up and my emails were never answered. I therefore needed another solution. While my sister was still with me we had figured out that I was able to do more than I had originally expected. Of course it took me longer, but I was able to prepare meals and with a few workarounds do my laundry (e.g. as I wasn’t able to carry the laundry basket I pushed it along the floor with my foot and I split hanging up the laundry into several manageable chunks interrupted by rest). My main concern therefore was cleaning the flat and changing my bed. Luckily I was able to find a local cleaning service (Merry Maids) who was able to send somebody around at quite short notice. We agreed that they would come around once a week for an hour and also change my bed. This worked out very well and I was very pleased with their services.

Shopping. This one luckily turned out to be one of my least worries so far. I had already decided to do pretty much all my shopping online at Sainsbury’s as I’m not allowed to drive and also can’t carry any heavy shopping. My only concern was that as I’m living on the second floor some of the delivery drivers might not be willing to carry everything up to the second floor (according to the Sainsbury’s terms and conditions they officially only deliver up to the first floor, anything further is at the discretion of the driver), but when I explained my situation so far they have all been extremely helpful and have even carried it into my kitchen. I’m very grateful for their help as otherwise it would have been a significant struggle. Still, I’m very much looking forward to be able to drive and carry my own shopping again in a few weeks time.

Time. Everything takes longer. I estimate that on average almost everything I did took me about one third longer than it would normally take. This is mainly for two reasons: either it takes longer because you are just slower in your movements and doing things or you need to break up activities into manageable chunks with rest breaks in between (like hanging up laundry as mentioned above).

Concentration and motivation. Something I found quite challenging in particular over the first few weeks was concentrating and finding the motivation to do certain things. I found it very difficult to concentrate on e.g. replying to emails or reading a book, so I fell behind quite a lot on what I had hoped to do over the first few weeks. Instead there was a lot of largely aimless surfing the Internet, visiting social media and watching YouTube videos. I even found it difficult to find the motivation to edit and post pictures on my Islay pictures photo blog, something I otherwise love to do. This started to improve after a few weeks but I found (and still find) it frustratingly slow.

GP and hospital visits when living out in the country. I live in a fairly small village several miles away from pretty much everything, which presents a challenge if you are not allowed to drive for several weeks. I still needed to visit my GP/pharmacy as well as having blood tests taken since I had been restarted on Warfarin. For my first visit to the surgery/pharmacy I took a taxi which turned out to cost £20 one-way, obviously something not sustainable. Luckily the West Berkshire community hospital also offered a blood test service and is serviced by a bus leaving only a few minutes walk from my flat. While the whole exercise takes me over two hours (instead of less than an hour when done at the surgery) the bus fare is only £6.40 return. I was also able to combine this journey with my daily walks by getting off the bus a bit earlier than I had to and walking the remaining distance back home along the canal. Similarly I found out that there was a twice-weekly bus service taking me close to the surgery/pharmacy, which I was able to use to pick up my prescriptions and combine it with a walk as well as lunch at a pub or cafe near the surgery.

Wound and pain management. While the wound and scar on my chest (23 cm/9 inch scar from the incision and openings from the chest drains) seem to have healed very well and cause me hardly any problems I found the pain and sensitivity in my chest and neck more difficult to handle. I don’t have any ongoing pain but the whole area is still quite sensitive and at times I have some very short-term pain in varying areas which luckily disappears again very quickly. It is nevertheless annoying and in a way frustrating as after some good improvements over the first few weeks progress seems to have slowed down. I’ve started to carefully reduce the amount of painkillers I take aiming to find the right balance between controlling the pain and weaning myself off the medication. As an interesting side note, during the first few weeks the sensitivity stretched into my chin area, something a mainly noticed while lying in bed when my duvet touched my chin. It wasn’t painful but a strange and unpleasant sensation and had to move the duvet away from my chin in order to sleep.

Mood swings, ups and downs. This I found (and still find) to be one of the most challenging aspects of the recovery. I have days where I feel great, positive and optimistic. On other days I feel horrible, tired, negative and pessimistic. The contrast between these days (it’s mostly days although it can also change during the day) is quite harsh and sometimes difficult to handle. On the bad days I try to be optimistic, thinking that the next day will be better, but that’s not always easy. On the good days I tried to preserve the mood as best as I can, hoping that the next day will be a good one as well.

Social interaction. This is an interesting area, especially as I’m single and therefore spend a large part of the day on my own at home since my sister had to leave. While I’m happy to entertain myself I must admit I do miss the social interaction of working in an office, the collaboration, the banter and generally interacting with people. I have to admit I got quite emotional when I received a get well card as well as a large dark chocolate (they know my tastes at the office…) selection from my colleagues at Verizon. As long as I am limited in my ability to get out (remember that I can’t drive at the moment and public transport is limited around here) I aim to utilise any other opportunity for social interactions including talking to my neighbours, the Sainsbury’s delivery drivers, people I might meet on my walks and anyone else really. I also use social media a bit more often, although I find it’s a limited substitute for real face-to-face interaction.

I think I’m going to stop here, there will probably be a follow-up post in early December about the second month of my recovery at home where I will cover areas I’ve missed here as well as updates to the topics above. My current goal is a phased return to work starting in mid-December, fingers crossed everything will go to plan. If you have any questions or feedback, well, that’s what the comments are there for.

PS: I wrote most of this entry using speech recognition software, a huge help as I sometimes still find it uncomfortable typing long texts on a keyboard.

Nothing but the truth…