I had my two-month follow-up appointments this last week with both my cardiologist and my surgeon, and they were both very happy. Here's a run-down of each appointment.
My cardiologist sees me way down at the South Health Campus, where the bicuspid valve clinic is. I had an echocardiogram, a process I'm very familiar with by now, which was followed shortly after by seeing the doctor. She was excited to hear how well my whole recovery had been going since the very start, and gave my heart and lungs a good listen. I laid on my back and she put her hands on and around my incision several different ways while I breathed deeply and she was happy with how the bone was healing. Not 100% yet of course, but solid and healing well.
Knowing about the pleural effusion that I had, she listened to my lungs and commented that it was much much better, almost negligible at this point. It will finish clearing up by itself, hooray! I was not relishing the thought of needing to have it drained.
I mentioned my lack of pain from start to present, and she was glad to hear it. She said that some people have experiences like mine and some folks do have pain and, but they can't predict where any given patient will fall on that spectrum. Slight advantage if you're otherwise healthy and fit, she said.
We talked about my prescriptions and what the plan was for the beta blocker, bisoprolol. It's prescribed for atrial fibrillation prophylaxis, and I've never had a-fib, not even right after surgery. I had a junctional rhythm for a day or two (very common), but that resolved without any intervention (also very common). I'm being sent for a holter monitor test (tracks your heart's electrical activity for 24 hours), which is mercifully set for pickup and dropoff at Foothills hospital very close to me, rather than needing to make the long drive down south two days in a row, like I had to for my 24-hour blood pressure last year. If it looks good then we'll probably cut the beta blocker, which would be great for me as I look forward to riding my bicycle to the limits of my (now meagre) ability. Once I get back in good shape I'm not sure how my cycling performance would be affected by a drug that slows down your heart rate. I was warned though: sometimes the surgeon has reasons to keep you on a beta blocker, depending on the specific layout of the aortic graft and other technical considerations. More on that below.
The doctor confirmed my intention to return to work in January, and decided to schedule my next appointment in December to make sure that everything is still on track. Going forward from then, appointments should be once a year for a while, and if things continue to look good they might spread out even further than that. Excellent!
I saw my surgeon at Foothills. He too was pleased with my recovery (and with his work), saying that my murmur was fixed and the coaptation of the valve (the coming together of the cusps of the valve) was excellent. He poked around at my bones and was happy too. He said that at this point my bone was pretty strong, that I wasn't going to make a wrong movement and have it come apart. Time for me to be exploring towards full range of motion. He advised me to rebuild strength slowly, which is very sensible (more on that when I post about the rehabilitation programme later).
We talked about the beta blocker situation, and he said that if the holter monitor test was good then he would have no problem with me coming off the beta blocker! Great news! He also thought that I'd probably be off my ramipril in a year, which would get me down to just my daily asthma inhaler and a baby aspirin, which I'd be on for the long haul. I'm all for taking drugs as prescribed, but if we can shrink that list I'm happy.
The one part of my chest that is still a bit sore is the very top of my sternum, the area between my clavicle and the top of my incision. I had been thinking it was a symptom of the bone not being healed yet, which makes sense since the manubrium is a thick, marrow-filled bone that takes a while to heal. But the surgeon had a different idea: that flesh was put through the ringer during surgery. The top and bottom of the incision have called the most attention to themselves during my recovery, and it makes total sense considering that that part of my body was stretched way open. Up top, the bone underneath moved aside as well, so I shouldn't be surprised that it's sore. Chest wall pain, not bone pain. That reasoning hadn't occurred to me, and I feel much more comfortable with that than what I was thinking before.
I was reminded that there are no long-term restrictions on me in terms of physical activity, so the sky is the limit. I just have to get off the ground in these first months. I won't be saying goodbye to my surgeon for good though. Annual appointments for now, hopefully moving to longer spaces in between, assuming all is well with my heart.
All in all, pretty much a perfect pair of appointments. I'm making lots of exercise progress too, more to come on that.