5 Week Post Maze Update, 3rd posting

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Posted by Troy Clement on May 01, 2002 at 14:27:37:

5-week update (35 days) since my Maze at the Cleveland Clinic by Patrick McCarthy. I am 34 years old. I must say, I was skeptical about receiving this procedure due to my pre-existing condition of Hypertrophic Obstructive Cardiomyopathy. This hereditary condition causes the septum muscle to become enlarged. This enlarged muscle is located in the area where blood exits the heart at the aorta valve. This enlargement creates an obstruction and reduction of blood flow as it exits the body and an increase in pressure in the left ventricle, which effects the pumping action of the chamber. Although I had an Alcohol Ablation that was experimental 4 years ago that relieved the obstruction, the 30 years living with Cardiomyopathy and being highly aerobic and active (not advised with this condition) has changed the dynamic pumping action of my left ventricle, making it somewhat compromised. This added condition was of a grave concern for me, and it would cause my a-fib episodes to be very, very symptomatic. I was also concerned the Maze could further impair my already compromised heart to go into congestive heart failure or reduction of my ejection fraction. I enjoy motorcycle racing and other aerobic sports, but when a-fib would strike, my life would come to a stand still as I would be forced to go straight to the ER for Cardioversion. I have been cardioverted 48 times in the past 7 years. The a-fib intervals started once a year but had shortened and were occurring every 3-7 days. After 2 years contemplating the Maze, my decision was made to go forward with the Maze as I felt I had no other option. This board and its “mazers” posting their stories helped me make the decision to have this procedure. I watched this board in silence with no input or postings for almost two years. In return to the board and those considering the maze, I will post my maze experience and recovery. I will not leave out any setbacks or complications that I may have. Here is my 5-week post maze story.

I had a Mini Cox III Maze procedure and the use of the atria-cure clamp / radio frequency scarring on the outside of my pulmonary viens on March 27, 2002. My heart was stopped for 52 minutes. Although I did run into some complications after surgery such as cardiac arrest (V.T.), fluid retention on one lung, and the start of liver failure, I survived and was released 12 days from surgery. The V.T., or cardiac arrest, was due from a combination of surgery stress, my cardiomyopathy, and a intern / fellow cardiologist that did not identify that I was in Atrial Tachycardia with a rate of 120 bpm for two full days during the Easter weekend when my surgeon and primary cardiologist were out of town. My heart couldn’t handle the rate, as a high rate and Cardiomyopathy are a dangerous combination, especially after surgery. After the V.T. event, my AICD detected the arrhythmia, and delivered therapy that cardioverted me into normal rhythm. The fluid was removed from my lung with a needle and catheter. I immediately recovered and started feeling great. Unfortunately, my Atrial Tach that I was in prior to my cardiac arrest looked like Sinus Tach on the 4 lead ECG on the cardiac monitoring floor, and I just had some bad luck not being properly diagnosed. Even I, somewhat experienced at reading ECG’s, also believed I was in just sinus tach. But I felt something was not right, and several times had called the cardiologist on call to request IV Lopressor to slow the rate. I predicted an arrhythmia if my rate didn’t’ fall…and nothing would lower the rate as I was truly in an arrhythmia, and the following morning I was begging for something to be done to lower my rate. I was told what I was experiencing was normal, and that I must start walking, that the high rate was normal. I dropped when I put foot out of bed. I went into Ventricular Fibrillation, twice, back to back. I’m just glad I survived, and for some reason, I have dismissed hard feelings as mistakes happen. These complications I had are extremely rare, extenuating circumstances, and I would not let this interfere with anyone’s decision to have the maze, especially at the Cleveland Clinic, as my care there was incredible. Dr. Hammer, Dr. Lever and Dr. McCarthy gave me a great deal of time, consideration, and let me input my questions and concerns without stepping on me.

I was discharged 12 days from surgery feeling wonderful and delighted. One week later at 19 days out, I went into Atrial Tacycardia at a rate of 115 bpm while house cleaning. It was not symptomatic, it felt like a high rate, but I knew it was the same rhythm I was in prior to my cardiac arrest while admitted, so I was quick to visit my local EP and he cardioverted me on the spot. NSR again…sweet. My meds I was discharged with were left alone. Those meds were and still are; Norpace 150 mg twice daily, Toprol XL 100mg twice daily, and Coumadin. Two nights later or 21 days out, Atrial Tach again, and my local EP suggested I try to sleep and see if I would convert before morning. I converted just 5 hours later in my sleep. NSR again. Two days later (23 days post maze), Atrial Tach again, non symptomatic, and again, I cardioverted just hours later in my sleep. That has been the last of any arrhythmias…. 3 episodes of A-Tach which were non-symptomatic, just felt like a fast rate of 115 bpm, and the last two I cardioverted on my own. Prior to this, I have never had Atrial-Tach. Through all this, I have had ZERO a-fib episodes.

It has been 14 days since my last a-tach episode, and 35 days since my last a-fib episode (coincidently the day of surgery). Although it’s been 5 weeks since surgery, I only consider it 4 since I had complications. I have been feeling exceptional well, since three weeks out; I have pretty much been active all day with light duties and errands. Besides my chest being sore and having difficulty rolling over and sitting up bed, I feel great. Muscle tension has also been a problem with me around my neck and shoulders, but I’ve also had this problem prior to surgery. A bi-weekly visit to my massage therapist has worked wonders. My local EP has been very supportive despite his original concern and reluctance for me to have the Maze. He now seems opened eyed to my progress and recovery, and his care for me has always been world class. He’s known me for over 20 years, and I’m sure he gets sick to see a 34 year old cardioverted so many times, and several times without sedation as I wanted to be released immediately after without going to recovery as necessary with sedation.

I work and relax much of my day at my desk, and run occasional errands. I feel little anxiety and no depression. Maybe concern or rare occasion, but for the most part I feel compelled to stay driven, as that is my natural tendency. Driving will make your chest sore, all the bouncing, tugging and pulling on the wheel. My local EP suggested I may be going at it too hard, and that I should take more time out during the day to rest or nap. I’m trying hard to do so, and it does seem to help my energy level that seems to fall in the late afternoon and evenings. When I overdue it, I do have a slight pounding sensation in my heart, especially when I lay down for sleep. It’s very annoying and kind of discomforting, but I’m accustomed to as it is a symptom of the Cardiomyopathy I have. I also become sore in the sternum / chest area with each increase in movement. Several steps forward, one-step back. Sneezing and coughing is painful! With rest and rehabilitation, I believe the pounding / squeezing sensation in the heart will go away soon. I do not believe it is from the Maze, just my pre-existing condition. I have bought a Mountain Bike to aid in exercise, and last week I rode it several miles with no problem, except becoming sore in the sternum. I have started lifting light 5lb weights for the bicep muscles only…just a straight lift that does not affect the chest or sternum area. I developed muscle atrophy and I lost 18 pounds in the hospital from not eating for about 6 days straight. I’m eating like a horse now and trying to gain back some weight and muscle tone. I was a medium large build at 188 pounds, now a medium small build at 170 pounds

My resting rate pre-maze was about 55 bpm. After surgery, my rate was in the low 90’s. Now, 5 weeks later, my resting rate is 74, and my sleeping rate is 68 bpm. It seems to be coming down slowly, week by week. I have also noticed my rate tends to respond slowly to any increase in activity, and it’s return to my resting rate is also slow. The first 4 weeks, my rate seemed to be “locked” around 75 to 80. But this 5th week, I have noticed an improvement with rate response, which I have pushed to 92 during an intimate moment, and the recovery rate took 20 minutes to recover to 75. The rate response seems to be improving. I have not made any attempt to push my rate over 90, and have not made any attempt to do anything other than light walking. The increase in heart rate after the maze seems consistent with all maze patients, but I especially look forward to a lower rate, as I feel more comfortable with a low rate due to my Cardiomyopathy condition. I will be pushing my rate further next Wednesday, May 8th during my first Cardiac Rehab, which falls on 6 weeks out. The great news is that since my Maze, I have had NO AFIB at all, just 3 small bouts with a-tach and two of those events I converted on my own, and it’s likely the first one may have also converted on it’s own had I had not rushed to get cardioverted.

If you are interested in a more detailed outline of my day-by-day recovery and complications I had immediately after surgery, or my current condition, you may view my “surgery status page” which I update regularly. The page contains almost daily updates from my wife when I was in surgery and through recovery, and I took started making my own updates when I was able. This site keeps a chronological log of all updates since the day of surgery. I archive the old postings, so be sure to click on view “Archives” to see all updates starting back from surgery. My current updates are ready to view. There are also pictures of me post surgery, and I rotate the site with new photos weekly. I am on my 3rd round of photo updates, and the photos are current photos that were taken during the same week of the updates. I find the day-by-day account of the updates and my recovery progress as well as my setbacks an invaluable source for personal memories of my maze experience. You may visit my status page by going to www.thestatus.com. Click on “patient log-in”; enter the patient’s name “clement”, and password “thinking-mail”. Should you visit my site, please sign my quest book, and enter any “guest messages” if you wish too. If I may be of any assistance to you, simply email me, I’ll be glad to answer or assist with any concerns or questions you may have.

I want to especially thank Jack Drum and all the others for putting in the time and effort to maintain this site, and all the “mazers” who supported me during and after my hospital stay. I received an incredible amount of encouragement and inspiration from people I had never spoken with before, which I never expected. What a family. My extreme gratitude goes to Dr. Donald Hammer, Dr. Lever and surgeon Dr. Patrick McCarthy and their entire team at the Cleveland Foundation. I have no regrets in the procedure, or in the decision to have this team perform my surgery (I interviewed 3 other maze surgeons prior to my selection of Patrick McCarthy). The quality of care at the Cleveland Foundation was incredible, and I now see why they are so highly regarded with heart procedures, particularly the maze.

Troy Clement, New Orleans
Information Systems Analyst
Competitive Motorcycle Racer

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