"I'll See You on Tour"

Gary surgery

I first want to extend my thoughts and prayers to the people of Texas who have experienced an incredible shock to their lives with the loss of electricity and water during the polar vortex. I know we have employees and residents affected by this and virtually every property we own in the state has some form of damage. This is going to be a Herculean task for property owners, managers, investors, employees, insurance company employees, vendors, etc. to coordinate their efforts and resources to clean up water-damaged units resulting from pipes breaking, as well as many other related issues. We gained a lot of experience during Hurricane Harvey that we intend to apply here as well.

I have made a concerted effort to not miss publishing a weekly blog of new material. Some weeks may be thinner and chart heavy than others but, still, the task has gotten done for almost six years uninterrupted. Occasionally it has also required pre-writing some of them when I’m going to be on vacation or, in the case of last week, medically indisposed due to my mitral valve repair surgery. This one will be another very Gary-focused entry since my post-surgical recovery has been front and center for me and it’s something I want to log to keep a record of this monumental part of my life.

As I write this, it has been 13 days since my surgery and it has been four days since I have been home. Being back at home is something for which I’m extremely grateful. It definitely takes a village to care for those who have had the surgery that I had. The care that I got at Cedars-Sinai was wonderful and the different teams that were involved in my care were large in number and terrific in competence and quality. I came through a very complicated 6+ hour surgery quite well. This is in spite of the surgeon saying it was one of the worst mitral valves that he’d seen. He was pleased with the outcome and thought it would put me back on the life trajectory I would have been on had I not had this problem.

Before heading to surgery I was told that after I reawakened I would still have the breathing tube in me and that it may be many hours before it was removed. Fortunately, I was the exception and it was removed in under two hours and I was in very little discomfort having it in or out from what I can remember. That was a very good early sign. I was in the intensive care unit for a little under 24 hours. I ran a small fever that they wanted to see break before they released me to regular care on the sixth floor of the cardiac unit. And while I would like to convey how strong and manly I was by telling you that it was smooth sailing from there and that I was released as fast as their healthiest patients are, I would be lying. There were definitely some bumps in the road. 

The challenges I faced as my time in the hospital unfolded were really twofold. One was anemia, which is when you have a low amount of red blood cells in your body and can result in oxygen deficiency and labored breathing. My hemoglobin counts were consistently low as well as some other associated tests. This can be due to iron deficiency, but more commonly in my post-surgical situation, the loss of blood. The other issue related to high liver enzymes. What’s great about being in such a sophisticated, well-equipped hospital is that most of the testing is done in your room so if you need chest x-rays or ultrasounds, and, of course, bloodwork, then those can almost all be done through mobile equipment or drawing blood from your I.V. or from your vein if necessary. To rule out internal bleeding the medical staff did a number of ultrasounds and chest x-rays and constant blood draws. One time I had to leave the room for a medical procedure during my nearly seven days there and that was so they could get a more expansive view of my lungs and chest which required that I stand up while the pictures were being taken. 

Fortunately, everything seemed to be working fine such that there was no indication of any internal bleeding. I went through a very intensive open-heart type of surgery, which often results in a lot of blood loss, and so it’s not surprising that my hemoglobin numbers would be low. Once my hemoglobin numbers leveled off, even at a lower ranger (above 8.0), they felt comfortable letting me go because they ruled out internal bleeding. And while they talked about giving me a transfusion, this was something they wanted to avoid because they wanted me to improve naturally on my own. After doing additional testing related to my liver to rule out hepatitis and other liver issues, they also concluded that my elevated enzyme levels were most likely due to medication and/or the surgery and the body’s response to it. I have a follow-up appointment this week and hopefully, I will have a much clearer picture of how I’m doing with regard to these two situations.

The pain management was better than I thought in terms of not having to take very strong pain medication. This greatly surprised many of the nurses given their experience with other patients who have had similar very invasive operations. They kept checking on my pain levels and always offering me something if I needed help with pain management. I had started reading a couple of books prior to my surgery to help me prepare psychologically for experiencing pain, which is something for which I have fortunately had very little experience. One was Living Beyond Pain and the other was Embrace The Suck. The former is written by a Ph.D. and DO while the latter a Navy Seal.

Both talked about the powerful feedback loop between negative psychological anticipation of pain and the physical sensation of it and how they can both elevate the other and make it a less bearable outcome. The converse is true as well, however, in which a positive reframing of the pain can result in less experience of pain.

In spite of the surgery being robotic, they still had to go through the right ribs and spread them out to insert the Da Vinci robotic equipment. They also had to do insertions under the right nipple, insert tubes and wires in my right upper chest, and hook me up to a heart-lung bypass machine via an artery in my groin. Probably a little TMI but the point is that there were many parts of my right side invaded that could trigger a lot of pain. Early on it felt like I had lifted a ton of weights 100% focused on my chest area and during the next morning when I woke-up there was tremendous soreness from the muscle overuse. I could also feel it skeletally. I was also surprised to find that my right shoulder was in tremendous pain as well, even though there were no incisions there. I was told that was due to two things. The first was how I was positioned during surgery while the second was related to the tubes and wires and once they were removed I should feel almost instantaneous relief. They turned out to be spot-on as that pain dissipated almost completely after the tubes and wires were removed.  And when I told the surgeon that I was surprised that I developed left shoulder pain days after the operation, he basically dismissed me with a wave of the hand and said “You’re going to have pain come and go in many different places for no rhyme or reason.” He was essentially saying to “embrace the suck”.

I’ve been diligent about taking three walks per day. Early on in the hospital, there was a lot of pain in my left collar bone/chest area when walking which made it hard to breathe and quite draining from an energy perspective. It’s hard to explain but I felt like my energy and stamina and will be pretty healthy but I was stymied by the pain and labored breathing. After I got home I continued to focus on taking at least three walks a day and these have been about 10 to 12 minutes each or so, generally on a flat surface outside of my house or inside. What was extremely surprising was the pain and tightness I felt in my calves from walking, particularly when waking up the next morning. It’s as if all of the walking that I had been doing on hills in my neighborhood or playing tennis had no value whatsoever because the calves were just so tight and extremely sore such that it’s a challenge to put my heel down first and then my toes, which I came to learn is really the proper way to walk and something that I had been doing the opposite for my life. 

The books I had leaned on were very helpful for situational, almost one-time pain such as when tubes and wires are being removed and stitches being applied. I often thought about really competitive and challenging tennis matches I had been in and that I only got through those by “embracing the suck.”  There is no growth without pain. It’s that simple. Embrace the pain and growth will materialize. This worked wonderfully for these types of situations. When it came to chronic pain, however, for which I, fortunately, had only one experience, this was much more challenging and my heart goes out to those who suffer from it.

The first night home I had one spot of pain behind my left shoulder and it was so incredibly debilitating that I can’t really put into words how one seemingly small area could result in me getting no more than one hour of sleep the entire night. I don’t think I have felt such piercing, breath gasping pain at any point in my life. I also discovered that there was nothing that could be done to alleviate it and it was just fascinating how it all emanated from one point. That was one lesson learned, stay curious and fascinated if at all possible to create a detachment from the situation. I had taken some pain medication before I went to bed, but they didn’t help. I also told myself to focus on bringing love and compassion to the pain and not anger and hatred. I stuck with this and I think in some way it helped, or at least is something I can apply the next time I’m faced with a similar situation.

When I finally got to the morning, I took some more medication but there was just no way I could lie or sit back down. I had to start walking in my master bedroom and just keep moving. The thought of laying my shoulder back against something was unbearable. And, what’s worse, the pain started spreading across to the other shoulder. By the time I had stopped walking back and forth for about 25 minutes the pain medication seemed to be kicking and the relief started to flow through. I have this chair with a straight back in my bedroom that I have been sitting in for most of the day.

The next night I had a lot of psychological issues about sleeping in my bed with the prospect of that pain reemerging so I decided to go to bed, put my back straight up, and see if I felt any of it reemerge. Unfortunately, I could feel it coming on almost immediately so I decided to get out of bed and sleep in the chair and that worked like a charm because since then I’ve not had that pain reemerge and I’m so thankful that there is a solution for it, especially one that didn’t require medication. After a few nights of doing that I finally went back into my bed and there was no pain still so it looks like I might be able to remain there. 

The pain is now primarily where the incisions took place and, what was labored breathing in conjunction with shooting pains in the chest area as I was going for walks, seems to have dissipated and now it’s just focusing more on building up my stamina, muscles, and my breathing ability. I’ve been using this lung expanding contraption which requires you to inhale to see if you can elevate one, two, or three balls. It was a struggle to get one of the balls up in the early days. By the time I left the hospital, I could do two fairly consistently and now three is more of the norm thankfully.  Someone has to always be on the lookout for the incisions and making sure that they are not changing in ways they could foreshadow an infection. I also have to be on the lookout for blood clots and swelling in my feet and ankles. So far so good based on the visit from a nurse last week. 

Heather Mrs. Carmell Jacob Ariella

I couldn’t be more thankful for the support from my kids, my girlfriend Heather who has been amazing, my mother who has cooked some amazing meals and come to stay with me, as well as my siblings and my family at CWS. My partners, friends, all of the caregivers, and the countless numbers of people sending their good wishes and positivity have been wonderful for me and helping me in my recovery.

I’ll leave you with this one last story. I never turned on the television for even a second during my time in the hospital. I was much more focused on music and following current events and doing some occasional reading. These helped get me through the days and nights. One of the nurses was intrigued by what I was listening to since my earbuds weren’t working so the music could be heard in the room. I told her a lot of it was the jam band Phish. I said I was fairly new to the Phish scene but I really enjoy their music. She said it was too bad her friend Heather, a fellow nurse, wasn’t working that day so she could introduce us since she was a huge fan. It turned out that a day or two later Heather made an unannounced visit to my room for the sole purpose of talking about Phish. She had seen 89 shows since graduating high school in 2009 in upstate New York and she just loved everything about the scene. She gave me some show recommendations to listen to and then she got back to work. I was so jazzed she stopped by to introduce herself and spread the gospel. It turns out that as I was being wheeled out to leave the hospital a few days later she was in the hall and saw me. She gave me an elbow pump and said “I’ll see you on tour.” What a way to end this part of my journey and start my next one.


6 comments on “"I'll See You on Tour"
  1. Bill Hoban says:

    Best wishes for a successful recovery Gary! Hang in there! Bill Hoban

  2. Donnie Crevier says:

    Gary, So glad you are getting through this a very serious surgery so much better than the initial complications!! Couldn’t have been fun! You will be back on the tennis court before you know it!! Good recovery!!! Donnie

  3. David A Helman says:

    Great news. Enjoyed the upbeat nature of today’s blog.

  4. Heather says:

    Embraced! Wheels Up my friend … it is certain will be “on tour” in no time!

  5. Debra Torres Buck says:

    Remarkable journey thus far, Gary. I’m so glad you’re getting stronger every day.

  6. Dovie Edwards Cherry Valley, California says:

    Gary,
    I just read your story of your Mitra Valve Surgery.
    I also have Mitra Valve prolapse. I’m 82 years old.
    Sometimes I experience sharp pain,but I just take
    Asperin and pray.pain easies up.
    God Bless You.

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