Paul's heart attack saga

Paul's son, Chris, wrote the first several info e-mails to friends and family while I was without internet at the hospial with Paul. After we got to a hotel I was able to e-mail the update titled 'Friday to Friday, Paul's progress'. all that is included here for any who missed the happenings.

Karen



Our Dad, brother, and/or friend has criss-crossed the north american continent for the last 5 years and through his travels discovered a little piece of paradise in south central Alaska, appropriately, named Homer. Where some may see humor...Dad saw "opportunity." Many might have enjoyed a day or two visit,taken in the sights and left it at that, but not Dad. It was all too good to be true, and the allure of putting Alaska license plates on his cars and drivers license was enough for him to first buy a parcel of land for the "Winnie" to rest, and then prove his mettle to himself and "winter" in Alaska. So back in October, he brought his Rig down to Costa Mesa, CA to sell, and turned tail to make the drive back Home to Homer. They arrived on Halloween, and have spent the last 2 1/2 months feathering their new little nest. If any of you remember how proud Dad was of the wood-burning stove in Las Vegas, it will be no surprise to you that one of his first projects was to replace his 'drafty' fireplace with a stove. That project was completed a few weeks ago and they have been enjoying the warmth it brings and the snow that's falling.Which brings us to the intensive care unit of the Alaska Regional Hospital...(nice transition, huh?)Apparently - Saturday morning he ran an errand or two and came back to the house to tell Karen that he probably needed to go to the hospital to get checked out. He was experiencing shooting pains down both arms and felt an elephant on his chest. So off they went. The crew in Homer ran some tests on him and didn't like what they saw...major obstructions in the blood vessels feeding his heart. So...they booked him a flight on the nearest bush plane and he and Karen flew up to Anchorage. (the drive from Homer to Anchorage would be about 6 hours with winter conditions, 225 miles) Once in Anchorage, the Eskimo doctors circled around him and started running all kind of tests on him. Tests in Homer played down any talk of a heart attack but anchorage verified that he had one and pinpointed the timing around 9 am Sat.Sunday morning the angiogram revealed that he had three coronary arteries that were >90% occluded, p.s...thats bad, and that there was some muscle damage to the anterior and septal walls of his heart. (we have since been told that once the grafts (bypasses) were in place the muscle wall did respond favorably and started working again...it's always good to see an immediate response following a graft, or so I've been told.They had to wait for the bypass surgeon to come take a look later that afternoon. His verdict was to wait until Monday morning since he was stable. Initial expectations were that he would need 6-7 grafts. They prepped him that night and got the party started Monday morning. He went into surgery at 8:30am and what was expected to be a 6 hour ordeal ended up taking about 5. Less is more...good sign. Immediate prognostication was positive...he responded well, was stable, and muscle activity resumed. They only had to make 4 grafts because the other concerning vessels were too small, hence the reason for the 4th graft. They were generally pleased, and expected Dad to have a 5 day stay in the hospital and that he would be on the ventilator overnight.Dad was back in his room in the ICU About 1:30 Monday afternoon. As time went on they became increasingly concerned that he was draining too much...so they started a battery of blood products to increase his blood's ability to coagulate. No luck...Dad wasn't responding to those prelim treatments so they wheeled him off for round 2. Last night about 7pm they took him back into surgery and opened him back up. We've come to find out that this only happens to about 5% of people who undergo heart surgery (per the anesthesiologist). They didn't find any active bleeding, but that's not clear at this point (we haven't spoken to the surgeon yet.)He was back in his room about 9pm last night and has been heavily sedated and remains on his ventilator as of 3pm this afternoon. They are weaning him off the ventilator which can be an extended process...(i get the sense, that it's possible they could keep it in overnight, but I hope not.) he is still under now, but the nurse is messing with him a bit...to make him gag and bring him out of the clouds, but that's the most animated I have seen him today.As it stands right now...we are sitting and waiting...until the surgeon returns and checks out the x-ray they took earlier and decides when he wants to remove the ventilator and make him breathe on his own.More to come...By the way...Alaska is cold and snowy...which is nice.



They just pulled out the tubes and he is miserable...but the good kind of miserable.He is talking...or trying too and has smiled and told the nurses muchos gracias...and yeah Alaska...Cheezy but good to see personality..



Well, some have expressed a subtle desire to be continually updated...Dad's brother, Jerry showed up late last night to lend a hand to Dad's cheerleading crew. I think he is staying around until Friday afternoon.I will be on a plane headed back to Orange County 1:00 am Thursday am.I'm a short-timer and this version of the Traveler Chronicles will come to an end...(poor Karen doesn't have Internet connection in the hospit also she won't be able to resume this until her and dad check out of thehospital and move the rehab unit over to a nearby hotel)Dad has made good progress today. The best way to describe today hasbeen to sit on the sidelines and watch a complicated dance where everything hinges on the proper oxygen levels, heart rate, and a variety of other key measurements to keep Dad's ship headed in the right direction.I had a chance to speak with the Surgeon earlier this afternoon and got some more details about the second trip to the OR. As I mentioned before, Dad was leaking too much so after trying all available means...they had to open him back up. Once inside...the doctor explained that he tightened him up a bit and took advantage of the opportunity to "flush" him out. (apparently, you want blood clots on sutures...not strewn about your pericardial sac. Be sure to remember that the next time it comes up in casual conversation)As you might imagine, opening up the chest and messing around with a guy's heart causes a fair amount of trauma to the surrounding area, but the doctor assured us that he is optimistic about the outcome here and noted that Dad is making good progress.One of the earlier episodes today involved a significant increase in his heart rate that made his nurses stand to attention. I guess they don't like to see a guy like Dad start to tach at 155 bpm. The had three different approaches to get it back in step...magic drug #1, magic drug#2, or use a pair of jumper cables and reboot.Dad didn't flinch when they gave him drug #1, so Jerry thought it would be a good idea to give him another blessing. He was right. We did so,and when they administered magic drug #2, he responded favorably and returned to normal.He didn't sleep last night...and was up to about 3:00 this afternoon when he drifted off for a nap. The nurse says he has made good progress today by getting off 3 different lines...They are talking about getting him up and moving tomorrow...the idea of it, makes him nervous...but that's an important step...we'll have to get Karen to tell us how it goes...Not much else to report...other than I've relayed all messages given tome...He's sad that he's scared everyone...but is quick to counter that he scared himself more! Signing off...Oh, and dad requested that I retract the reference to his Medivac airplane as a bush plane...it was a King air. (nice)Chris



Quick and simple update.First and foremost, it's Sara's birthday. Dad wanted to make sure everyone remembered that.Second...some have already received reports, others haven't, but i'l give you all a super quick synopsis.Dad has been recovering a bit slower than anticipated, but has been making progress... He is still very weak, but it seems like the onslaught of various medications, lack of quality sleep, and the trauma of having people get up close and personal with your major organs...is taking it's toll.Because of what we believe is a lack of sleep and a cocktail of heavy duty drugs...Dad has been a bit "detached" from reality. The doctor asked him what month it was. He answered May...er...June, July? Then the doctor said..."there's snow outside Paul...so Dad said...oh...It's December....(closer, but this was? lt supposed to be a multiple choice question)Needless to say...this has been weighing heavily on Karen for the past few days. Thankfully, he was able to get some quality sleep last night...so did Karen! They both need it... As of this morning...Karen is feeling better...and we'll see if Dad turns a Corner this week!That's all I got



Good news today.Dad was moved from the Cardiac Care Unit this afternoon to the Cardio Vascular Unit....which means he got unplugged from almost all the machines and drip lines that have formed a spider-web around him for the last week.He also completed his respiratory therapy today...another great sign.Looks like Arla did the trick. A day or two with Arla by his side...got Dad to snap to attention and get out of Intensive Care. I hear she plans to be there until Friday...so she still has two more days to work her magic. Who knows...we might even get an idea when he will check out of the hospital for good before she leaves?It's still a battle...though, and as you might expect, things are going to be very, very tender for the next few days.Keep the prayers coming...its making a difference and Dad still needs them all.That's all for now...





Last Saturday (Jan. 12, 2008), Paul had an "elephant" sitting on his chest and I took him to the hospital. He was life-flighted to Anchorage and had an angiogram on Sunday morning. The blockages were too severe to use stents so 4 bypasses were scheduled for Monday morning. There were several complications and set-backs along the way.

FRIDAY: Jan 18th

Paul has been on a few meds to keep the heart from fibrillating and he's improved much today. He has been helped up into a chair for all 3 meals and has done leg exercises 2 times today to make him stronger. By dinner time it was easier to get him out of bed and in to the chair.

He has had a visit with physical therapy and respiratory therapy. Both have given him exercises that are helping his breathing and strength. He continues to have lots of congestion in his lungs and sometimes he chokes on the crud he's coughing up into his mouth. Twice today it looked like he was choking on phlegm but he fainted or passed out for several seconds. The nurse thinks he was passing some plaque thru the brain but she is calling the doctor for further info. The doc doesn't want to make any changes yet, he thinks it's like the TIA he had in September and that the body is throwing some plaque. There is no damage, all his reactions are fine and all his vitals remained stable (no change in his monitor readings at all during the episode). We will all just keep a close watch as it seems to happen rarely, and only when he is coughing up crud. During the shift change, Paul thinks he had another episode but there was no one around. He is fine and they're going to watch him over night. The respiratory therapist is here at 9:30 pm to do a breathing treatment and give him some asthma medication to open the airway.

I'm starting to be concerned with Paul's confusion. He thinks there is condensation dripping from the ceiling, there are flies in the room, we are in Mexico, Seattle or the basement, he's in a garage etc. They have cut his Xanax to 1/4 of what they were giving him and cut his pain medicine (vicoden) in half but his delusions persist. I think he's dreaming and it must seem real to him.

Saturday:

Today, Paul is occasionally talking in the present. The doc came in and removed the chest drains and the sensor thru the carotid to the heart. He is cooperative to do his leg exercises and breathing treatments. They gave him a nurse sitter so that I could get a nap. I've been exhausted and falling apart because of Paul's set-backs. I called Arla and asked her to come help me watch Paul and help keep him oriented. She'll arrive Sunday afternoon and stay to Friday afternoon. I'm sure he's going to be okay but the recovery is going to be long and trying. I appreciate the prayers and love from everyone, T H A N K S ! ! ! ! !

Sunday:

Paul has been thinking he was taken to the basement or other places while he was asleep. The doc ordered a "sitter" to stay by his side all night. He finally got some much needed sleep. This morning his nurse let him sleep instead of bathing him early. I think we have finally turned the corner. The episodes that looked like passing out may have been small seizures. There is no damage with a seizure so all should be fine, especially since he hasn't had anymore episodes. I didn't go in to see him at 6:30 this morning because he was sleeping. I may have more update later today.

Yup, there's more to the story:
It turns out that he did sleep several hours last night and he slept 1 1/2 hours in the morning while I sat there and then another 2 hours from 3 to 5 in the afternoon. Sleep deprivation is probably the main culprit causing the psychosis and confusion along with the immense amount of drugs and anesthesia. At 5 pm he awoke and said "this is the first time I woke up in the same place I went to sleep". Pretty scary and sad that he's been frightened to sleep because he thinks he's being taken away from his room while he's sleeping.

Another problem is that he's had atrial fibrillations and medicines haven't controlled it completely. I didn't know that they called a specialist to ZAP his heart in to regular rhythm. WELL, as it turns out, when the doc arrived this morning he found that Paul's rhythm returned to normal during the night. Maybe sleeping helped the heart to get it's act together.

Well, some more good news, Arla arrived about 6 pm tonight and will split the sitting with Paul for the next 4 days. Hurrah!!!
Also, I've needed my big suitcase so I could get Paul and I home on a airplane without Paul carrying the luggage. Christine found that Ruben was heading to Anchorage Monday to take a dog up. WOW, I'm being provided for at every turn, Ruben will bring my suitcase and visit with Paul at the same time. Paul was excited to have Ruben visit. Paul has really enjoyed the time they have worked together the last few months.

Paul wants me to list all the good things that happened today, so, here goes:

He's finally sleeping more than 10 minutes at a time (he's had no REM sleep for the past week). He's talking more clearly and more loudly. He's standing and bearing his own weight when they get him up in to his chair. He is able to start feeding himself and his appetite is improving (his hands had been so swollen he couldn't grasp anything, even if he'd been coherent). With eating, comes the need to move your bowels and Paul is doing well in that department too. He's starting to get his sense of humor back and started joking with the nurses and therapists (you know, the old Paul is starting to show up). His lungs are improving and clearing. His heart returned to normal sinus rhythm. No seizures today. He's even holding my hand, I've missed him!!!

Monday:

Well, time will tell if Paul gets out of the CCU/ICU (cardiac care unit and intensive care unit) today. When his surgeon comes in he can assess if he's ready for less nursing care. While they do shift change I have to be out of the room so I'm doing my laundry. (I thought we'd be gone from home for 3 days, not 2+ weeks). I was in his room from 6:30 am to 7:00 am to check on his night (which I do every morning). He slept 4 1/2 hours without interruption, HOORAY!!! He has trusted the nurse-sitter to protect him while I'm sleeping at night.

It's been a good day and he's been getting stronger everyday. Hopefully the doc will have him transferred to the CVU (cardio-vascular unit) tomorrow. When the doctor came in today Paul asked him what it would take to get out of "here" and the doc said "show me you're strong enough to walk out of here and take care of yourself". So, Paul made sure he got up for meals and stayed up for an hour or more. He's determined to go home, I'm sure with him on that.

TUESDAY:

Hallelujah!!! Paul has improved enough to be moved off the CCU and on to the CVU. He got up and walked and has all the tubes, wires and catheters removed with only the pocket heart monitor wires taped to his chest. He looks good and is finally feeling well enough to complain.

Wednesday:

Wow, Paul has walked several times today and is feeling so much better. The doc will consider letting him out Friday, they want him to have 2 good days in a row. The way he's going he'll definitely be out.

THURSDAY;

Well the second day is good and it looks like a "GO" for escaping the hospital prison. Paul is walking 15 minutes and sitting in a chair to eat his meals. I'm making reservations at an Anchorage hotel for 4 days. Hooray.

FRIDAY:

Well, it takes 3 hours to get released from the hospital. The cardiac rehab guy talks to Paul about how to protect his ribs and sternum and what kind of schedule to maintain for the next month. The nurses have morning meds and the doctor and his nurse practitioner both see him and evaluate and give last minute instructions. The prescriptions written and the discharge orders written and signed by both nurse and Paul. HOLY COW, what a process. I put Paul in the car and we picked up his sister and headed to the hotel to get Paul settled in before taking Arla to the airport for her trip to Las Vegas. I finally got a nap from 4 to 6, whew. The last order of business is the doctors check up at 1pm on Monday. Tuesday we should be on a plane home(r).



Thanks for all the love and prayers that have supported us through this event,

Karen