Garry Stewart

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Ketchup

The AI assistant thinks the tile of this post should be “My Ongoing Health Journey: Updates and Challenges”. Not bad but I like “Ketchup” better. 🤣

For some reason I’ve been procrastinating about keeping the Journey blog up to date so this post is to catch up. While the Journey blog has been quiet, my Journey has been quite busy, too busy.

Well, where did I leave off? By the Numbers was a bit boring with just a recount of blood work numbers. Cardio Chron was a simple list of dates around the heart surgery.

While the heart surgery went well it didn’t accomplish all the goals. There was a plan for bypassing three arteries but only two were possible. As they had expected the radiation from the cancer treatment had damaged the area needed for the third bypass. The left ventricular ejection fraction (LVEF) is a measurement of how much blood the left ventricle pumps out of the heart with each beat. My Left Ventricular Ejection Fraction (LVEF) prior to any treatment was 59-60, a decent normal range. After chemotherapy my LVEF dropped to about 55 and then with some bike work recovered up to 57. After the heart surgery my LVEF is estimated to be 35-45. There are various opinions if this function can recover. While waiting on the recovery, my heart is running at sub-capacity which limits my cardiac abilities.

Shortly after getting home I fell in the kitchen. I passed out briefly due to postural hypotension. This triggered a 911 call and next thing know I’m back in the hospital. Shortly after this I develop a chest infection in the area of the heart surgery incision. This requires a lot of antibiotics both in hospital and at home over 5 months to get under control.

Next is yet another side-effect of the bypass surgery, fluid collection in a pocket at the bottom of my left lung. They call it pleural effusion. I get referred to a lung specialists and have several litres of fluid drained off in his office over a couple of visits. This fluid is compressing my left lung and shows no sign of stopping so I get referred to a thoracic surgeon.

The thoracic surgeon proposes a pleurodesis surgery. The surgery goes well and appears to work. At his point I’m hopeful this is the last “thing” and I’ll recover and stop seeing doctors and hospitals. However, another “complication” arises and I’m frustrated that my heath issues just never seem to end. This is certainly testing my faith and it’s getting harder to trust in God’s goodness and healing powering my life.

I get a cough, shortness of breath, and difficulty breathing when laying flat. I consult with the thoracic surgeon and he’s not concerned. The impression is that this is typical and will resolve on its own. As it persists I consult with the lung specialist who basically says he can’t do anything and I should stick with the thoracic surgeon’s advice/help.

Things continue to get worse with cough, shortness of breath, and I’m easily exhausted by even minor activities. I’m getting worried and at one point I call everyone I can think of to try and get some help. Feels like I’m pushing the panic button. Finally I consult my GP. He is pretty sure it’s pneumonia and starts me on antibiotics and requests a chest X-ray. The X-ray shows it’s a pretty bad case of double pneumonia and congestive heart failure (CHF).

The antibiotics start helping within a couple of days and my coughing is subsiding and I can breath a bit easier. Still quite tired and breathless on exertion. I’m left wondering when and if this will correct itself. Feeling a bit helpless with not being able to do very much physical activity.

The rower is idle, no energy or breath to workout.
I’m just supposed to rest and recover.

I get a referral to my cardiologist regarding the CHF. He will likely request an echocardiogram of the heart and then prescribe some form of treatment. A May 6th appointment is lined up.

Stay tuned for more excitement on The Journey.

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By the Numbers

I didn’t forget about you and the numbers are good! There were some dips as a result of the surgery which were expected and are recovering nicely.

Hemoglobin and Platlets
Neutrophils
WBC and ANC
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Cardiac Chronology

Time has flown by and also dragged by all at the same time. A conundrum eh? Some dates to bring a little more order to what has been happening.

DateEventDays
2024-01-15Cardiac pre-op meeting in person-15
2024-01-22Dr. Fagan phone consult with OR date (Jan 25th)-8
2024-01-25Dr. Fagan call to cancel surgery (#1) but still check in-5
2024-01-27Fords visit at the Asper Center-3
2024-01-28Des & Eric visit at Asper Center-2
2024-01-29Dr. J Hong  cancel surgery (#2)-1
2024-01-30Dr. Michael Raabe surgery0
2024-01-30Fords Visit0
2024-01-31ICU – Des visits1
2024-02-01Moved to Cardiac Ward from Cardiac ICU2
2024-02-01Eric visits, Mandy & Boys Facetime2
2024-02-01Blood Products – ICU2
2024-02-02Blood Products – Ward3
2024-02-02David, Merrill, Scott & Boys visit3
2024-02-04Discharged home at about 5pm5
2024-03-20Cardiac Clinic w/ Dr. Raabe50
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Day One

It’s January 31, 2024, the first full day after the cardiac surgery. I’m still in the Cardiac ICU.

Hooked up to a couple of things

Today’s goal is to be monitoring me and disconnecting most of the leads and tubes. Once I have a met a minimum mobility goal of walking to the elevator, about 30-40 feet, a majority of wires and tubes will be removed.

I’ll qualify for the move down from the 5th floor to the 4th floor, the dedicated cardiac recovery unit where I’ll stay until discharge.

As I’m doing this blog entry on the evening of Friday February 12nd I’ll likely have forgotten some of the details. It’s been quite a journey this time. More painful and challenging in many ways than everything that has come my way so far.

Thanks to all our family friends, and church friends for their ongoing support and prayers. We feel the love and God is still good, still on the throne.

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Day Zero

It’s on! I’m up at 6am for one last shower with the special cardiac soap to lighten the germ load then a “special” shave and under a nice warm blanket for a zip down to the 2nd floor surgical suites.

We’re into the pre-op holding area where I meet several members of my surgical team. Lots of questions and discussion confirming why we’re all here. Before I know it, I’m being wheeled into the OR!

This is where time and events start to blur. It’s a long 5-6 hour surgery during much of it I’m unconscious.

Once I’m in the OR I get introduced to the team, about 12 people. They are all wonderful and very reassuring. The head nurse seems to be running the overall show until the surgeon Dr Raabe arrived and takes over. His first job, among many things, is to run the checklist, BTW the Manifesto book is a good read and the manifesto is a Doctor invention that has saved a lot of lives in the OR.

Next up is the anesthesiologist, there are two of them. The Senior Dude is guiding the apprentice to put a central line on my right wrist. Just a little freezing, and ouch! It’s in and he’s fastening it down. Then the head guy puts the gas mask on me. “It’s just oxygen” and then it’s not and I’m in la-la-land for the duration. Next he puts in another line in my neck and again it is sutured into place to keep it from moving.

Speaking of the OR, one of the first thing that goes on to me is two thin pieces of very cold plastic about the size of my palm, one in the small of my back and the other is on the side of my rib cage. These are defibrillator paddles, just in case. Shocking!

Serious stuff happens here and I‘m unconscious for about 5 hours. 100-120 minutes of that time my heart is stopped and I’m on the bypass machine.

I find out later that they only did a two bypass rather than the three they had planned on due to the fact that there was too much scar tissue from previous radiation treatments for the lymphoma.

I wake up in the ICU recovery room and I open my eyes to see Shirley 😍

There are a few tears of relief and thankfulness for both of us and I try to say something but can’t as I still have the breathing tube in.

Reader warning! My editor has not reviewed the next couple of blog posts as I work to catchup on my journey. There are likely to be typos, spelling mistakes etc. which will get fixed but if you’re reading this for the first time in an email, reader beware 🙂.

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Another Date

Well, at around 1pm today my surgery was cancelled. The new date is January 30th with a 6:30am start and the actual surgery at about 8am.

This is the first slot of the day and while cancellation is still possible it’s a bit less likely.

A new date means a new anesthesiologist and a new surgeon. I met the anesthesiologist this afternoon and he informed me that the new surgeon is Dr. Michael Raabe.

The delay was initially a little disappointing after getting prepped to go ahead today but being first of the day when everyone is fresh feels better. Both Shirley and I are taking this as a positive change.

A good friend brought this to our attention “delays are often God’s way of working everything out for our good” or “delays are often divine detours”. God is good.

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The Date

Current surgery date is January 29, 2024 and I’m the “second case” which means starting the process at 11:30am and actual surgery likely to start at about 1pm.

We’ve been advised all along that any scheduled date is subject to change based on priorities of the moment. This morning when learned I was second case the nurse mentioned that if the first case goes long then it’s likely the second case would get bumped to another date. Praying that things go ahead as currently planned.

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Cardiac Catch Up

Cardiac Unit in here
View from my Room 4-56

This morning, Thursday January 25, 2023 I’m in the Cardiac Unit of St. Boniface Hospital in the Asper Building. There have been several emails and texts as Shirley has been keeping people informed on this part of the Journey and this post is to gather that all together to catch everyone up on what’s been happening.

On January 12th we had the pre-op meeting which went well and then we were waiting for the phone call with a surgery date. We got that call on Friday January 19 and the date was set for 6:15am today, January 25. On Monday January 22nd we got another call from the scheduling folks and the time was changed to 11:30am. No problem, and this was actually a better time as we could have a normal start to the day and not get up at 4am!

This morning we get another 8am phone call with another change of plans. It’s the surgeon, Dr. Fagan, and he talks to us about a couple of concerns that arose yesterday during the full team meeting about my bypass surgery. He expressed two major concerns, the first being my low platelet count thanks to cancer treatments and my bout with febrile neutropenia in June/July. Low platelets increase the risk of bleeding as they are a key component in blood clotting. The second concern is the possibility of tissue scarring in the area where they are going to be operating. The tissue scarring is caused by cancer radiation treatments. They know there is scarring but it’s unclear how much and what impact it will have. They won’t know until they open me up and have a look.

So while I look pretty healthy, and various health professionals say I’m a good candidate for the surgery, on paper the numbers have a different story to tell. And, in medical jargon I have some interesting “co-morbidities” ,cancer (in remission) and Crohns, (perhaps) which the surgical team are taking into account.

Another reason for the delay was that the surgeon didn’t want to do it late in the day but preferred a first thing in the morning surgery. I think this is to be cautious with having a full day and possibly more resources available if there are difficulties.

As a result of all this there will be no surgery today (25th) and the Hematology group is being called in on a consult to get their thoughts on the issues. To make this consult happen faster I’m admitted to the hospital so I’m readily available. Plus, I’m now wired into the cardiac system and my heart activity is monitored and recorded via a wireless telemetry system. I certainly feel that I’m in a safe place given my current condition.

Through all of this Shirley and I have had amazing support from our family, friends, and church friends both near and far. We’ve received so many encouraging emails, texts and phone calls. You all have helped lift us up.

This delay is certainly challenging for me emotionally. Waiting and getting psyched up for the surgery and then having things change brings its own anxiety. A friend summed it up bluntly this morning.

Well that sucks!

Both Shirley & I had a great laugh when we read that, which was a welcome relief.

So, what to do about the anxiety? God’s Word to the rescue in today’s Verse of the Day.

Certainly, anxiety is not good and very unpleasant. My challenge now is to take these thoughts captive and pray about everything.

Thanks for reading

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Journey: The Cardiac Edition

In the beginning, the Journey was about the Lymphoma cancer diagnosis. In the last year it has expanded to cover some other health issues. Today, we really move into the “Cardiac Edition” with the kickoff to heart surgery.

We’re up at 6am and off to St. Boniface Hospital for a 7:30 am meeting with the Cardiac Pre-Operative Assessment Clinic team. For those of you interested skipping to the outcome, click here, otherwise read on.

The team is a nurse, ECG tech, a nurse practitioner and the cardiac anesthesiologist.

The nurse confirms all my basic info, records height & weight, temperature, blood pressure (sitting & standing). All my medications and vitamins are reviewed and recorded. The contents of the pre-op package of printed material is reviewed. Special attention is given to what I need to do the night before and the morning of the surgery. Blood is collected for testing and an ECG is performed. The last test is to get a chest x-ray on the way out of the hospital.

The nurse practitioner confirms my medical history and confirms in more detail all my medications. She reviews all my symptoms related to the heart issue. She performs a physical examination. In addition to discussing the surgery she reviews what to expect post-surgery and highlights of the recovery process. The recovery is quite lengthy with the sternum that they cut open healing in about three months. There is a lot of detail on exercises you need to do both in hospital and after discharge to give me the best outcome. Lots of things you can’t do for quite a while, like basically don’t use your arms because it, stresses the sternum which is trying to heal. No pushing, pulling, lifting, no driving for 4 to 6 weeks, etc. etc. I’ll need to get used to asking for help and letting others do quite a bit of stuff. Deep breathing and walking seem to be key exercises.

The cardiac anesthesiologist shares his understanding of my situation gleaned from my hospital history files and his consultation with the nurse practitioner. He explains more about the nitty gritty of the surgery, the risks and benefits and answers all our questions.
He feels that I’m an excellent candidate and will do well in my recovery.

Summary:

  • I’m on the cardiac surgery wait list and flagged as “urgent”.
  • I will get a phone call with the date of the surgery. The date is likely to be “within days to a couple of weeks”.
  • The phone call is likely to be on a Friday morning with a date in the following week.
  • I’ve completed all the pre-op testing.
  • Surgery is typically 3-5 hours.
  • Hospital stay is typically 5-7 days
  • Full recovery is over the following 3+ months

Just waiting for the phone call with the surgery date.

At this point we are both feeling quite overwhelmed with the enormity of the journey ahead but we are also relieved and encouraged that things are moving ahead quickly. Our God is good.

Ps 91:2 I will say of the Lord, “He is my refuge and my fortress, my God, in whom I trust.”

More details

Cardiac Sciences Program website for additional information and videos including:

Your Heart, Your Health A Patients Guide To Heart Surgery – YouTube –

Patient guide to heart surgery book: https://cardiacsciencesmb.ca/wp-content/uploads/2021/04/PatientGuidetoHeartSurgeryEnglish.pdf

Heart and stroke “Living well with heart disease” book

Moving safely after heart surgery pdf/book

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Strength of my Heart

I use the YouVersion Bible app to guide my bible reading and every day it presents a Verse of the Day. 

Today’s Verse of the Day, on the day I’m having my angiogram, is Psalm 73:26.

Then the YouVersion Bible app “randomly” brings up a prayer request from my list entitled “Chest Pain” that started back in February.

Today the testing has arrived.

That prayer was followed by this one…

The MIBI testing on Nov 27 & 28, 2023 shows there are blockages that lead to today’s angiogram. 

More than ever I’ll need to rely on God to be the “strength of my heart” as today’s angiogram revealed several significant blockages that they were unable to open with stents today. 

The recommendation is for bypass surgery to address three blockage areas. While I knew that this was a possibility it still comes as a bit of a shock and something I’m struggling coming to terms with.