Post-op Day 7

Hey there friends and family!

Thank you all so much for your prayers, comments, and support of my family and me throughout this experience.

First off, everything went really well. The surgery went off without a hitch and recovery without complications. For those who are interested, I will walk through the days briefly so that you can appreciate the effect that your prayers had on last week. The asterisks (*) are for "on the early side of their predictions." For those who are not, please skip to "Here's the Kicker"

Day 0- Surgery started at 8am. They closed up around 12pm*. I was taken to CV-ICU to recover with my breathing tube still in. I started to wake up around 2pm*. The breathing tube came out around 4pm* and then they sat me up*. (I don't actually remember much of anything about Monday except that my brother Wade played worship music for me as I woke up.) Just before my breathing tube came out, they gave me an alphabet board to communicate with. Unfortunately for the first few attempts, the letters walked all over the page and I couldn't manage to trap them effectively with my fingers. But after a bit, I managed to spell out "A FIB" trying to ask if my heart was in normal rhythm. It was and has been the whole time. Praise the Lord! I was also apparently very concerned with asking everyone in the room if they had eaten lunch yet...

Husband brag - My pain that evening was out of control despite the medication they had me on. Garrett, in his almost MD wisdom, asked the nurse practitioner if they could give me toradol (like really strong advil) to help with the inflammation. They did and it became my miracle drug for the next three days. He also spent the night in the ICU with me and was woken up every two hours for glucose draws and vital sign checks. He said he will think twice before ordering anything q2 hr (every two hours) for patients in the future because he realizes just how little rest they get.

Day 1- Sat up all morning*. Got all of my tubes out* except for my pericardial drain, chest tube, and peripheral IV lines. Walked around the ICU unit* and then walked to my step-down room down the hall*.  Sat up most of the afternoon and got to visit with some of Garrett's good friends, my parents, Wade, and my grandparents.

Day 2 - Sat up all day and walked 4-5 times. Got my chest tube and pericardial drain out. That was 100% the oddest feeling I have ever felt. It was kind of like a snake slithering out from behind my ribs and then biting me as it came out. The nurse practioner thought I tolerated it well. Honestly, I thought they would pull them out separately so I closed my eyes and stayed quiet through the first one and was preparing myself for the second one when she said, "All done," so I basically only endured half the pain I was expecting.

Day 3 - Had a great surprise from Dr. Petracek! He came in during the morning and told me I was going home. This was after the nurse practioner had said that I would be inpatient until day 4 because he "never let anyone go before day 4." But we went home around lunch time to my amazing in-laws house in Thompson Station about 45 minutes from Vanderbilt. That night we had a family dinner with Garrett, the Rampons, and my parents at their house. It was such a blessing to have both of our amazing parents together for a time of thanksgiving and relaxation for everyone.

Day 4 - I hung out at the Rampon's all morning while Garrett went out with his dad for some father-son time and his Memphis! My parents surprised me with an early birthday present of a recliner to aid in my recovery and I am so grateful. I am writing from it right now.
mom went to work. Then we went to lunch at Nashville's best pizza place, De Sano's with Garrett's brother and sister-in-law, Kenneth and Kristen. Finally, I took a big dose of pain meds and woke up three hours later in

Since getting home, I have been watching a lot of Today show, movies, reading and walking on the treadmill every day to try to not be too sedentary. Don't worry, this is all approved by the real doc and my in-house staff (Garrett).

I have been so blessed. There are no words for the provision and healing I have felt in this process. All credit and glory go to our great God for his work in my life. If you don't believe in Divine timing, let me tell you one more thing.

Here's the Kicker: During the surgery, Dr. Petracek came upon a blood clot in my heart which was just waiting to give me a pulmonary embolus or a stroke. We didn't know about this clot but a lot of people who present in adulthood with an ASD present with a stroke.

Going into the surgery, I thought we were protecting my heart down the road not protecting my life and my brain from imminent danger. I can't tell you in words, especially on blog, how deeply this impacts me. God has a plan for me and spared my life and my mind for His purpose. That's overwhelming. I'll spend the rest of my life trying to find out why.

Thanks again for your thoughts and prayers!

Preparing for Surgery

Hi friends and family!

I wanted to give you all an update on everything as we are now just two weeks out from surgery. First off, I am still feeling fine. The only thing that I have really changed about my routine is I have not been exercising as intensely as I was. I have found that though I feel fine, it makes me really anxious to get my heart rate up above 160 or so. Being anxious complicates getting your heart rate back down, so I figure that for the next two weeks 45 min on the treadmill walking 4-5 days a week will be fine.

Other adjustment made are taking iron supplements to keep my blood counts as perfect as possible and detoxing from caffeine. I figure the surgeons probably won't care if I get a caffeine headache but I will, so I am all the way down to one cup of decaf (not completely caffeine free).

I am nervous, of course I am. But I have really felt the strength and peace of all of your prayers throughout this. My family and I are confident in the ways that God has blessed us throughout this so far and will continue to carry us though. I am blessed to have been equipped with lots of stress and anxiety reducing practices from my experience in medical school. I already know things that work for me and things that don't. Journalling, yoga, and (don't laugh) deep breathing really help me focus on the here and now versus that hypotheticals that can drive me in circles. If you have never tried taking a 5 second inhale, pause, 5 second exhale, pause... for one minute, you might be amazed how much that can refocus your thoughts towards more productive things.  [If interested in my personal technique, I'll attach it to the end of my post.]

Now for some details about the surgery. It will be August 25 at 8:00am at Vanderbilt in Nashville. Dr. Michael Petracek (Pet-race-ick) will be the surgeon. He has done over 2500 of these surgeries and does 4-5 of these approaches per week. By "approach" I mean right chest incisions described below.  He and Vanderbilt itself, are widely regarded as being excellent at what they do. Dr. Petracek is the chair of department of cardiac surgery. I asked him how long I would be out of work for and he said, "one week at least." I thought I had misheard him, but he clarified, "I've had a doc go back to clinic a week after surgery. You will be really sore and I don't recommend it, but you could go back after a week if you needed to." We agreed that four weeks (the increment my school makes the easiest) should be good but we will obviously take more time if I need it.

As far as the actual surgery, there will be about three incisions. They will hook me up to the heart and lung bypass machine through my femoral artery. This will keep my blood pumping and oxygenated while they work on my heart. There will be a catheter in my neck called a Swan-Ganz that will snake down to my heart and help them drain part of the heart for the surgery. Finally the main incision will be on my right chest through my ribs around where the bottom of a bra sits (image on the right versus zipper on the left). That will be where they push everything aside to work on my heart. They will get everything working, cool my body down to decrease metabolic demands, and then paralyze my heart. They will enter the heart through the right atrium and sew a bovine pericardium (covering of a cow's heart) patch into where my septum should have been. When that is in place they will start everything back up again (Whew!) and check with ultrasound to make sure that there aren't any leaks. Then they will back-track and sew everything up. The surgery will take between 3-4 hours all together.

The main risk that I will be facing after surgery is an arrhythmia. The heart conducts electricity to make it beat but you can't see the wires with the naked eye. They know about where everything plugs in, but there is always a risk that they could nick a wire and upset how my heart is beating. Most likely this would put me into a rhythm called atrial fibrillation (which some older people go into because they are old). The main risk of this is blood clots because the blood gets jiggled around and get sticky. So if this happens, I will probably be asked to take an aspirin to thin my blood until my heart heals and flips back into it's normal rhythm.

We anticipate that I will spend 24-48 hours in ICU and then 4-5 days in the hospital. We are going to wait and see on coming back to Memphis. But that is the plan. If you have any other questions, just let me know. Thank you all so much for the prayers and support!




Praying and Breathing:

I actually learned breathing practices by a different name from my training to go to American Samoa in 2008. During that session, we were praying an abbreviated "Jesus prayer" and encouraged to match it with our breathing. Breathing in, we pray "Lord Jesus Christ"; breathing out "have mercy on me, a sinner." Actually, according to a Ph.D. psychologist at Vanderbilt that I met this week, taking a longer exhale than inhale helps to relax the body. So naturally, the extra syllables of "on me, a sinner" prolong the exhale to provide additional benefit. The benefits of praying are obvious, but I would add that this provides a cadence so that you don't need an app with swirling lights or a clock to time your breaths to.

My Big Heart

Hey friends and family,

I just wanted to give you guys a central place to get updates on my current little hiccup health-wise. As most of you will have noticed, I waited a while to talk about this on Facebook so that my family and I would have more information when the questions came. So here is the story from the beginning.

March 2014: I went to my PCP before I started studying for USMLE Step 1 for a check up. He heard a heart murmur which he described as a "pan-systolic flow murmur". I had been told I might have a little heart murmur when I was in seventh grade but we were assured it was nothing to worry about. I went back two weeks later and he heard the murmur again. We decided to pursue an echocardiogram (ultrasound of the heart) to make 100% sure that there wasn't anything to the murmur. I have never had chest pain or symptoms so we just "knew" it would be nothing to worry about.

April 2014: I finally got around to having my echo two days after taking Step 1. The ultrasound tech mentioned on her first view of my heart that she could tell that the right side of my heart was too big to fit on the screen like it should. She took all of the pictures she could and kept "hmph-ing" to herself perplexed at why the right side of my heart was so big. She walked outside to see if there was a cardiologist who could make sure she was doing everything she needed to and brought Dr. Garg in. He knew within the first minute or so of flipping through my scans that I had a hole in my heart. That was a shock. He told me he would get back in contact with me later in the day after he had done calculations.

He called me back a few hours later to tell me that I had an atrial septal defect. That's a hole between the right and left atria (septum = wall). At that point he said that my right heart was twice the size it was supposed to be because of this defect and that it would need to be corrected. He said we had to do a cardiac MRI to figure out how big it was and what approach we could use to fix it.

MEDICAL INFO TIME: 
I am not a cardiologist, but if you are confused on what I mean by ASD or atrial septal defect...
You have four heart chambers. Up top we have atria (singular atrium) and down low we have ventricles. The blood is supposed to flow as follows: Body --> Right atrium --> Right ventricle --> Lungs --> Left atrium --> Left ventricle --> Body. It obviously gets oxygen from the lungs to feed the rest of the body. The heart is obviously just a pump attached to a lot of flexible pipes. The size of the pipes depends on the thickness of the pipes and the pressure (which depends on the volume) of the flow through the pipes.

My heart flows as follows: Body --> Right atrium --> Right ventricle --> Lungs --> Left atrium...some goes through the hole back to the right atrium and some goes --> Left ventricle --> Body. Because there is more volume in my right atrium and ventricle, there is more pressure and that pressure has made the right side of my heart expand. Basically my right heart is doing twice the work yours is if you are normal.

Yes, this has been present my whole life. When you are in the womb, your heart starts off as a single tube. It then divides into your main vein (vena cava), one atrium, one ventricle, and then your main artery (aorta). As it grows and beats, it twists around itself and grows one septum to separate the atria and one septum to separate the ventricles. The wall between my atria only grew to about 25% of what was supposed to be there. Usually, they can figure out what went wrong based on how the hole looks. Turns out mine is too big for them to even figure that out.

Back to the story:
The next step was to find out if they could fix it with the catheter from my leg and a man-made patch or if they would have to do open-heart surgery to fix it with a piece of my own tissue that they could cut down to size.

May 2014: I got my cardiac MRI and Dr. Donovan (the radiologist) asked me to come to his office so he could explain the films to me because I am a student (very generous of him). He explained that because my right heart was actually pumping three times as much as it should have been (not two like the echo said), I would definitely have to have it repaired sooner rather than later. Also, the MRI revealed that my heart didn't have enough of the wall to attach the man-made patch to. Unfortunately, that is where we are now...scheduling open heart surgery.

Yep, that's right. As an asymptomatic, healthy 24-year-old, I have earned myself a ticket to open heart surgery. Pretty crazy. And yes, we are talking crack my chest, put me on heart and lung machines, stop my heart, operate, restart my heart kind of heart surgery.

We are investigating different options of possibly not having to have the massive zipper-looking scar down the middle of my chest called minimally invasive approaches. We are hopeful that we can find a surgeon that will spare me the horrible scar. The bottom line is we have to get this fixed before my heart gets any bigger and decides it's tired and can't handle the load. That is called heart failure. We are also preventing something called pulmonary hypertension which would eventually head me towards transplant. I am quite attached to my own heart, so we will be doing this soon. How soon, you ask?

Because of my school schedule, I am hoping for either July or September. However, cardiothoracic surgeons care relatively little about my school schedule, so we will see.

I would like to end with my list of things to be thankful for in this season. This is just a beginning of the huge list as God has revealed such faithfulness every step of this journey.

1. My awesome level-headed husband and super-supportive family
2. Not having symptoms or pulmonary hypertension
3. A cardiologist who really cares and gets me information fast
4. A radiologist who still texts me to check for updates
5. An awesome team at "work" who let's me go to appointments when I have to
6. A super understanding medical school who has encouraged me to take care of myself
7. The prayers of all who already know
8. My friends who are already planning a "Get well party"
9. Everyone who has been supporting my family as this is immeasurably hard on them
10. Friends in the medical field helping me get recommendations
11. Dr. Garg's nurse Lisa who is setting up appointments with surgeons right now so I don't have to and calling my insurance and all that jazz.
12. Access to medical care and diagnostic tests I need and medical knowledge to help me answer my own questions.
13. My normal EKG last Monday showing me that my heart is still being awesome at what it does and working perfectly with what it has got

I guess that is coolest thing about this...my heart has been doing triple the work it is supposed to and keeping up well-enough for me not to have ANY symptoms or problems. If nothing else, that assures me that God has put a fighter heart in me that will take this surgery in stride and appreciate the relief it will bring.

I appreciate all of your prayers and support. Feel free to contact me with any questions.

FAQs:

Yes, my heart should shrink back down to normal after the surgery. It will start to feel the relief and start to remodel within one hour of the surgery (WOW) and take about 6 months to a year to get back down to normal.

Yes, I will have to go to the CV-ICU for a day (hopefully only a day) and then be in the hospital for a few days.

Yes, I have contacted people in Memphis and Vanderbilt. No, I have not contacted Mayo.

No, this isn't super rare. Actually some people have tiny ones that never cause problems.

No, the murmur shouldn't have been louder earlier in life. This murmur comes from blood rushing through a pipe or hole. My hole is so big it's not making that much noise because there's not really anything stopping it from flowing there.

Yes, every surgery has risks. However, this is not a complicated procedure for CT surgeons to perform. Most heart surgeons have done lots of these.

Yes, it will be safe for me to have kiddos later. They said give it about a year post-op and my heart should look like normal.
No, that doesn't mean we will have a kid in a year. Sorry, Mom.