First full night of sleep

OK, week 4 and I now can roll over to my right side without prepping first by holding body pillow up against the front of my body and rolling like a log! Also, 1/2 vicodan last night needed before sleep. Aleve this morning and hope to stay on that.
Slept 7.5 hours last night without waking up. First time in a month! Hallelujah

28 days with ICD

Used no vicodan today, only Aleve, can't say it took a lot of pain away tho. Still prefer the stronger stuff for really allowing me to move and behave as if it wasn't in me. Worst time is moving into sitting from lying flat. Can hold baby against my chest without pain, thats very nice! Still no bra wear on a regular basis. Maybe next weekend we will try to accomplish that.

Day 25 with my new subcutaneous ICD

Got out and about again today. Stopped and walked/shopped at the Goodwill store (great finds BTW with $5 suitcase!) and then into my hospital to surprise my Neonatal Clinic Girls...how I love them. They were all interested in how the device looked, how big, where it is, etc. Since they are all medical folks this was of high importance LOL. Of course, I also had to brag on the grandkids.
Pain meds used every 12 hours and I am wondering/worrying if the doc will refill. The vicodan takes away the presence/my perception of the device and I tend to be more active, otherwise I want to remain supine and gravity free. Certainly makes a difference when getting comfortable in bed at night. I still have to use my body pillow when sleeping on my right side. Someone at work told me its like the pillow they give you after heart surgery.
Finished off my day with visit to furniture consignment (found a great cherry twin bed for Mike) and then off to produce store.
Working around  the house tomorrow to get things straighened and decluttered. Things I never get to do on work days. I have two pantry closets that really need to be reorganized so that may be on the agenda.
I also have my one month post op study visit with my surgeon. I have to have a chest xray beforehand. Note that this is not part of a traditional defibrillator followup so study will pay for this in full. The chest xrays are repeated thru the first year and again not part of the traditional followup. With digital xray technology I might be able to see it!
Renee

ah, wonderful sleep

Went 14 hours without pain med and had 9 hours sleep!!! Feels amazing for sure. Moving much easier and hope to get out for more walking/exercise today

3 weeks tomorrow

Out yesterday for about 5 hours of retail walking, about 3 hours today indoors and outdoors. Tolerating 9-10 hours between pain meds. Feels like a really bad charley horse, or muscle cramp, on my left side when it begins to ache. Have to continue to remember to stretch that left arm over my head and out to the side as well as take deeper breaths.

Post Op Day 19

70 degree weather here in NJ found me out and about for about 4 hours, tho not walking all of that time. Tolerance of Ahhbra lasts about 3 hours especially at end of pain med range. Clearly the wearing of the bra is a weaning process and I may be pushing it way too fast.
Renee

A Great Day

The weather here was delightful at over 60 degrees and sunny. A dear friend took me to a local park along the Rancocas Creek and we went birding!! She is an avid birder and has a high power camera and great binoculars. I saw a hawk as well as a beaver dam and mud house! Great conversation, great exercise in walking and a 34 year friendship celebrated. Doesn't get much better than that. Thanks Marge for a lovely afternoon.
2 1/2 hours outside and I feel great. Going 9-12 hours without meds for pain.
Oh, and I wore the AhhBra for 3.5 hours without issue. I highly recommend it for post chest surgeries in women.

Post op day 18

Body pillow was too big for me to use ( I am 5 ft tall). I exchanged it for a king sized down pillow and used it last night with some success in sleeping on my right side. My new program is to fall asleep naturally (after taking melatonin 3mg) but no pain pill, falling asleep on my back. I usually awake at 3-4 am, take a pain pill and then roll to my right side with my new pillow. I slept until 6 am two days in a row this way. I do wake with some chest pain. I think it is the "crush" of the shoulders together when you sleep on your side. It bothers the lead over the sternum. The pain resolves quickly but you should stretch out on your back to help it along.
Sinus headache this morning.....tylenol for sinus headache doing nothing.......will have to resort to Imitrex I think.......
Planned walk in the park on this lovely day with one of my oldest friends, Marge. Should be lovely.
And there is a nap in my future......soon

post op day 16

Now using pain med every 8 hours. I try to get out every day to walk inside stores or outside. Due for warmer weather end of the week so a park visit will be in order. I think bra wear may actually occur over the weekend so stay tuned for reviews and pix of choices. So far the seamless camisole works best. I picked this one from Kohls. It is Daisy Fuentes and is seamless.

Continue to exercise arms, especially left over my head and out to the side.

Slept on my right side with help of body pillow for about 2 hours last night. Body pillow helps with support of left arm and leg and cushions the chest wall. I actually was hugging it to me. Slept well that way.

Subcutaenous ICD education video

Since we celebrate love and its association with the heart in this the National Heart Month please check out this video to see the different kinds of electrical devices used to keep the heart beating so we get to stay with our loved ones even longer!
The subcuteneous ICD is what I have and continue to hope to never use.

Day 15 Happy Valentine's Day!

Ironic that I had my surgery on the cusp of National Heart Month. There is a big push in the media regarding women's heart issues and that more women die of heart disease than from any cancer. Heart attack symptoms are different in women and often symptoms are ignored by us and by physicians. Now my problem is genetic and not necessarily related to heart attacks, though heart attacks run in my family and I have a female first cousin who had her first heart attack before the age of 50. Please be aware of your numbers: blood pressure 120/80 or below, cholesterol 200 or below and genetic makeup. Obesity, diabetes and smoking are risk factors that you can control and you must!

Those three little people are my reasons..........

What are yours?

Renee

Post Op day 14

We are 2 weeks out from surgery and I am needing pain meds less and less. Can go maybe 12 hours over night without and every 7-9 during the day ( I guess because I am more active). The pain seems now to be mainly in the area where the device actually sits and I think that once those steristrips come off it will feel even better. The other two incisions over the sternum are now without steristrips and look really good.
Ahhbra arrived yesterday and will try those out shortly. And the best news is that I can hold my 2 week old granddaughter without pain

re: Bra

Yes, indeed. Order a size larger. Still not ready to wear it for any length of time. I suspect that you have to work on weaning yourself into it. I propose starting with 1 hour and adding 1/2-1 hour each day until you work up to the 8-12 of usual wearing time. There is a lace version that I ordered as an exchange for the one that is too small.
Will add pictures sometime over the weekend.
Also order my new medical alert ID. More on that later.

Wound Check/Bra Review

I had my 10 day wound check today. All is well. Steri strips should be coming off, or coaxed off, by day 14. No sutures to come out. Dr was pleased with the lack of bruising and minimal amount of swelling. Next visit is a study visit at 1 month with chest xray required. Study pays for xray as it is out of the scope of standard post op care for the traditional device.

My Dream Products bras arrived today. I probably should have ordered one size larger and may do that. I tried it on and it fits well and is not uncomforable. Not gorgeous and you might not wear it under a shear blouse, but certainly ok for T-shirts and sweaters. Still not ready to wear a bra at the moment but will let you know how it works out when I do.

Walked 2 miles today and now I can drive, if I am not taking the pain meds (which I am not able to get rid of yet).

10 days post op

Took a 3/4 mile walk today in the brisk cold air. Careful to cover mouth and nose as to not set off the asthma cough. I was less short of breath today which is encouraging. I am probably walking at a 2.0-2.5 speed.
Still managing pain with hydrocodone every 6-7 hours. Pain remains primarily at the lower left rib area under left breast.
I am also trying to be diligent with the range of motion exercises for my upper extremities and plan to post an instructional video for those who might be undergoing this procedure in the future.

Lateral view straight on to device. Bruise inferior to incision, down by my waist, is over my floating rib and most likely occurred in the course of this surgery.

Promised Pictures 2/8/11

Far left: closeup of device site left chest wall under arm

Immediate right:chest view of the two incisions over the sternum. I believe that these were necessary to allow tunneling of the lead over the sternum and under left breast.

One Week Post Op

PAIN: well under control with half of the meds used prior. The "pain" or discomfort is no longer white, hot and searing, but very local, intermittent, unexpected. Pain is usually occurring with small movement or increment in movement even if one minute ago you were perfectly comfortable. Location of pain has and continues to be localized at device sight on left chest wall and under left breast on rib cage. Occasionally, the incision at the top of the sternum (breastbone) will pain me. Pain usually, when it strikes quickly,is a 7 out of 10 and really not mitigated well with pain meds after 4 hours. That is why I have used prescription strength motrin for breathru pain. By tomorrow afternoon I hope to have transitioned to Aleve as suggested by my doctor.
MOVEMENT: much easier. Got myself settled in bed last night with much less issue with the pillow placement. Pillow under left arm continues to be a godsend even when I am sitting here eating or typing. Even last night at a Super Bowl Party I felt more comfortable sitting and leaning forward on the arm of the sofa than to have my arms in my lap. Left arm range of motion is within normal limits above my head and out to side tho the sensation of pulling at device and wire occurs at ends of ranges.
SLEEP: elusive again last night. I do believe this is a function of the fact that I do not sleep on my back at all. I am exclusively a left side sleeper. I have not retried the failed sleep on the right side position ( and had been practicing this preop) and might consider buying one of those bed/body pillows for tonight. If not, I may just try again to lie flatter like normal, with one pillow.
ELIMINATION: back to normal
CANDIDIASIS (yeast infection from antibiotics): under control but not gone. May need prescription med.
APPETITE: wish it were less. I am trying to watch the caffeine and salt intake and drink more water. I bought Mrs Dash last night to use in cooking.

I have my wound check on Thursday morning though again my understanding is that my sutures will "dissolve" or are internal only. I do have steristrips and maybe they will come off by then. I do believe I will have adhesive marks for quite some time. Will post before and one week after pictures this afternoon when my friend comes over to help me take the after pictures. Hope to show the lateral view as well as the front view so you can get an idea of the dimension of the device bulge. This is the question I had preop that no one seemed to be able to satisfy with pictures.
Renee

Bad Night= Good Day???

Had a great deal of trouble getting comfortable last night. 2 vicodan didn't even cut it. Had about 4 hours sleep. If contemplating this surgery, have lots of pillows at your disposal, all densities required from soft and squishy to stiff and thick. Its weird that the same setup doesn't work night to night, or day to day. One little movement can just set you on a downward spiral (to quote my dear friend Cyd).
Since it was a rainy day and exercise was on the "to do" list we went to some local stores to walk around. Got to try out the Daisy Fuentes seamless camisole that I purchased at Kohls. You can see it herehttp://www.kohls.com/upgrade/webstore/home.jsp;jsessionid=fGgnNN6TvG06pSLplsTKwMms75z0ll2ycJH4SfyQnGdMG1Blp4Ry!-1305738932!1999540316. Gave me some extra warmth under my oversized fleece. Also found some soft undies at Nordstroms. Shimera is the brand. Seamless and easy on/off. Especially comfortable for lying around. No time for Spanx I am afraid.
The other thing to be prepared for is the nearly inevitable candidiasis from antibiotic use. Prepare for that with some over the counter medication. Better to have it handy me thinks.
Hoping for a good night's sleep tonight. I really need it.
Oh, BTW, I set off the security alarm at Tuesday Morning!!! The saleslady said it might be my keys, but then it dawned on me......YIKES!

One More Dressing Tip

Left arm in first
Left arm out first

Trust me, you will only it the "wrong" way, once. LOL

Got Up and Got Out!

Post Op day 4: today I get to take a shower. Had a great night's sleep=9 hours! Feel really rested and was able to get up from my semireclined sleeping position in the bed all by myself. Had to roll right and push up with right arm ( I sleep on the left side of a queen bed). No pain in that activity and in general today much less discomfort. No hot, searing pain.
Shower went well. Used antibacterial liquid soap from hospital, disposable washcloth and clean towel for drying. That will be my habit until all wounds are healed. Husband had to wash my back, but I could wash my hair ok. No shower chair needed, tho it would have been nice to have.
Since surgery I have been wearing soft flannel button down jammies.
Preop prep: I went thru my closet and found all the button down tops, or easy on tops ( large holes for head/neck vs turtlenecks) and placed them all together on the ironing board. I did not want to have to figure this out on the fly and while in pain. I also purchased several jogging sets, soft, thinner sweatshirt material for lounging around and receiving guests or taking walks. Included in this preparation was the necessity of bra wear. I have purchased several seamless bras with wider chest bands in hopes that they will not reproduce pain when I am finally able to wear one. Also, seamless camisoles for those times when I have to be public and possibly not able to wear a bra. Note that some left side seams may need to be covered with a softer material like moleskin over the area where the incision is on the left chest wall. This can be accomplished with iron on interfacing so no sewing required. I will continue to endeavor to attach pictures of these items and suggestions, but that ability continues to escape me here.
When a brand or item of clothing works you will be the first to know. These have not been issues with the traditional defibrillator or pacemakers that we are all used to.
Clearly the thinner you are, or the less need for a bra, the easier this transition will be. Of course, many of us are already looking for these items given the hassles at the airports with underwires LOL.
Ah, also spending some time stretching arms overhead, resting hands on my head and I took a 1/4 mile walk today. No real shortness of breath. I am short of breath with stair climbing and I think that is more related to not being able to take a deep breath on a consistent basis. Shallow breathing doesn't cut it when exertion is called for.

Take a Deep Breath

This surgery does tend to encourage shallow breathing. In the first 24 hours after surgery I was requesting the max dose of morphine as without it my breathing was very shallow and diaphragmatic only. There was no rib excursion and I was (and am) concerned about developing pneumonia. Today, chest is very tight like there is a band around the lower rib cage and it is difficult to get comfortable.
I was surprised that they did not give me spirometer ( clear plastic apparatus with blue balls that you attempt to float in a tube by exhaling into straw) to encourage deep breathing. I am sitting semireclined with arms resting on my head to effect mechanical rib raising and excursion to assist deep breaths.
And speaking of diaphragmatic..........like in some surgeries where you experience severe gas pain, I have hiccups on occasion that rock my world.

Words for the day

Ok, the words for the day
"stool softener"
Maybe TMI however a necessity to be taken daily from time in hospital to offset the constipation issues that occur with the use of narcotics and the result of lack of movement. I also have been cognizant of the fiber in my diet, and it just so happens that I love prunes!
I also forgot to mention that I was hypokalemic on my preadmission testing. That means not enough potassium which is imperative for heart muscle function. The lab norm is 3.5 on the low end but my cardiologist prefers a number closer to 4.0. I did take 20 mg supplemental potassium for 2 days before surgery as well as a banana a day for the week before. Level was 3.8 when I checked into the hospital but I am to eat a banana a day.
Slept well last night after several attempts at pillow placement. Actually took a picture this morning so we know how to set it up for tonight. Also called in to office for prescription strength motrin to help with the breakthru pain.
I hope to be able to post a picture on this blog to identify where most of *my* discomfort is. Don't know if it will be the same for everyone.

day 3 postop

I might have to have a clearer head to report on my hospital stay. Operation went well, lasted about 3 hours. They used propofol, versed and fentanyl ( with a zofran chaser for nausea) as my anesthesia. I don't think that I was intubated and came out of surgery a little loopey but awake, able to talk, no nausea and ready for a meal.
My surgery took place at Cooper University Hospital in Camden, NJ one of the locations of this multicenter study to seek FDA approval for this new device. I believe that it is meant to replace the traditonal device that requires its location under the left clavicle and has a lead that actually enters heart muscle.
So far there have been 175 cases completed, 320 are required for the study here to be complete. 65% are men, 35% are women so far. The regional biomedical engineer attends the surgery and met with me the next day for a portable EKG lying flat and seated to be used, I think, for my future followup visits, like as a baseline. I also had 2 chest xrays and will require more thru the next year.
Sutures will "dissolve" as they are internal. I have 3 incisions, top of breastbone, bottom of breastbone and on the left chest wall where the device is implanted. Pain is managed with morphine in the hospital with tylenol with codeine for breakthru pain. At home I am using hydrocodone ( as I don't take well to percocet) and motrin for breakthru pain. My biggest issue is sleeping well at night as I usually sleep on my left side and getting up from a totally lying down position.
If you are considering this surgery, please know that you will need assistance for at least the first week after your surgery. You will need someone to help you position yourself and move from sit to lying down and back again. Strong abdominals help, but your chest still "crunches" as you move and that causes the pain to escalate, albeit momentarily. The pain is a hot, searing type that occurs sharply and lasts if you are in the wrong position. For instance, on the night of surgery I attempted to reposition myself on my right side and nearly screamed out in pain. There is also the issue of the weight of the device and its lead that you experience the sensation of as you adjust yourself to gravity when you do sit. I know that the awareness of this sensation will decrease over time and suspect that this is one of the reasons that they tell you that you will be out of work, or temporarily disabled, for 8 weeks.
NURSING SUGGESTIONS: offer patient pillow for left arm to rest on while in bed or seated in chair; patient might be most comfortable in an elevated position with pillow longitudinally along the back (vertical) for support. Encourage patient to perform passive range of motion of left arm at some point in time. I started the next day. I also try to stretch the chest wall open while lying down. Still cannot lie flat today. And I have to remember to stand up straight.

There is no showering for 2 days after discharge, spongebathe and keep incisions dry.
Well, off for motrin administration and some sleep. Post more tomorrow. Expect reviews and suggestions for preop planning tomorrow or the next day.