A failure of the heart

Decline is winning.

I base that statement on the fact I’m currently recovering from major heart surgery.

Didn’t see this coming!

As i write this i should have been taking part in the Holkham half-ironman triathlon in Norfolk (aplogies Ade-Rose Belcher). Instead i’m nursing wounds, taking painkillers and my exercise consists of nothing more than some deep breathing and some very lightweight stretching.

The year started with the obligatory colds and chest infections. The day after New Year’s Day I was at my local surgery as a paramedic placed a stethoscope on my chest and back, turned to me and said: “Your entire chest cavity is infected - we need to get antibiotics into you as soon as possible!”

Most of my winters are like this. No great drama. And nothing to stop me carrying out my usual 2am internet searches for the year of challenges.  With my credit card ready, and in no particular order I signed up and paid for:

 - Holkham half ironman

 - London to Brighton off-road cycle challenge

 - The Serpentine swim

 - A three-day swim challenge in the lake District

 - 3 Peaks Challenge

Just to be sure everything was working as it should be in my declining body I signed up for one of those full body health check MOTs too.

I duly reported to the Nuffield in Bury St Edmunds and spent the next two hours being prodded, poked, tested and and scanned, before releasing urine and blood and finally - and something i’ve dreaded for a long time - having a rubber-gloved finger popped up my bottom to check on my prostrate. Not nearly as bad as i anticipated and by all accounts I have a healthy one. So why it takes me about ten minutes to have a wee must be down to something else.

And everything else seemed pretty good too, until it came to my heart. And then things started going downhill.

“You definitely have a murmur,” said the kindly and attentive female doctor. 

A murmur sounds pretty innocuous. “How bad could it be?” I asked.

“Well we need to get it checked soon,” she said.

“How soon?”

“Tomorrow,” she responded.

Great.

Here’s the time to let you know that I have private health cover - which, in the current climate, whatever your views on our national health service is probably a very good thing. With a wife who works for, and cares passionately about the NHS, I have some good evidence to back this.

Testing testing 1,2,3,4,5….

For the next few weeks I had a series of tests by a wonderful cardiac surgeon in Ipswich. Echo Cardiograms, CT scans, x-rays…before I sat down with said surgeon for a review of my heart and my options.

“You have,” he explained, “severe mitral valve regurgitation.”

I asked if that was bad. He said it wasn’t good.

He asked me if I’m struggling to walk and to climb a flight of stairs. I told him that the day before I’d run 10 miles before swimming 1,500 metres and then cycling home.

He was somewhat surprised by this.

But I did confess that there were times when I felt extremely out of breath during exercise - far more than seems normal and that I’d put it down to simply getting older.

I assumed some pills or potions would sort ‘severe mitral valve regurgitation’, but he informed me that I would need surgery, open heart surgery no less, and then demonstrated with his hand how this would mean sawing open my chest cavity to fix my faulty valve.

“You are young and fit to be having this level of failure,” he said. At this point, even those compliments didn’t seem to make me feel any better.

“Because of this I’d like you to see a colleague of mine that carries out this procedure using keyhole surgery, rather than sawing open your sternum,” he added.

I’ll take that.

A week later I’m in the plush surroundings of London Bridge Hospital, overlooking the River Thames, HMS Belfast in full resplendent view, and across the water to old Billingsgate Fish Market, speaking to an immaculate, handsome and debonair looking chap called Dincer Aktuerk. Dincer, it turns out, has pioneered a procedure called ‘minimally invasive mitral valve surgery’ as opposed to taking a circular saw to the sternum.

Before he can confirm that I’m a candidate for this - more tests, inducing a rather unpleasant one that involved having a camera placed down my throat to get a clear picture of my heart. Wouldn’t recommend that one.

Finally, all the scans and tests were analysed and for those familiar with medical terms, I had:

• Severe mitral valve regurgitation

• Significant posterior mitral valve prolapse Eccentric anteriorly directed jet

• Mild prolapse of all segments

• Prolapse of posterior leaflet, extending across all three segments, with severe holo-systolic mitral regurgitation

• Preserved biventricular function

• Dilated left ventricle

• Diliated MV annulus

• Incidental tiny PFO

And to round it all off:

• Sinus bradycardia and 1st degree arterial ventricular block with Wenckebach, mainly nocturnal secondary to athletic adaption

Now, without sounding too dramatic, that reads like a fucking big list of bad news.

To put it simply, for those of us without medical training, I have a very flappy valve; an incompetent valve; an insufficient valve. Funny how a heart can reflect the person. Not the first time I’ve had the words, incompetent, insufficient and even flappy associated with me. But I digress.

For a better explanation see:

Mitral regurgitation is a valvular disease in which the mitral leaflets, which are comprised of two tissue flaps, do not seal properly. As a result, blood leaks backwards in your heart forcing a constant strain on your cardiac muscle. Over time, this disorder can result in many complications including atrial fibrillation, an enlarged heart and congestive heart failure.

This type of disease is also known as mitral incompetence and mitral insufficiency, although most patients refer to it as a leaking heart valve. A mitral valve prolapse is the most common anatomical defect that causes mitral valve regurgitation.

So there it is.

And on a Monday in June, that happened to be the first day of a week of actual summer weather, my long-suffering wife, my son, joined me on the journey to London Bridge Hospital for the day of my surgery under the skilled care of Mr Aktuerk.

What big veins you have

My wife and my son watched with both amusement and surprise as a robust and forthright nurse got out what looked like sheep clippers and began ploughing through the crop of hair across my stomach and chest and all around my groin. Not sure this is something you want your teenage son to see but in the open and honest way we choose to lead family life - this is how it is.

It was 7am when I said goodbye to them both and that I’d see them later when it was all done.

Felt remarkably calm. The same way I do when I’m on an aeroplane. I’m in the hands of other, far more competent people than I could ever be, so in the great words of John Candy (Planes, Trains and Automobiles) make ‘like a branch on the shoulders of a mighty river…’

Dead on 8am I’m wheeled into a room with a team of people and Bonnie - the anaesthetist. - who will send me off into pain-free oblivion which I was oddly looking forward to.

“What big veins you have,” said Bonnie, as she began inserting needles into may arm. Unfortunately my big veins turned out to be very wiggly and despite trying both arms they could not get the needle in. Instead they had to plump for a smaller, more compliant vein, in the back of my hand. I heard something about needing a new bag of emergency blood delivered from Barts, and that was it. Gone.

It seems I was in surgery for about six hours. For just over 4hrs and 30 mins my hearts was stopped.

Incisions were made into my chest just above my right nipple and another through my right nipple area and a further incision made below this to place a tube that would syphon all the blood and fluid out of my chest cavity while two robotic arms and a camera controlled by Mr Aktuerk were driven through my chest cavity to my heart to carry out the job of fixing the long list of heart failures - but essentially that naughty, flappy, incompetent mitral valve.

While he was in there he found a hole in my heart. A hole in my heart! Fixed that too. As someone said I might have been better with a heart transplant.

Morphine

Thanks to the general anaesthetic administered by Bonnie I clearly didn’t feel a thing during the operation despite holes in my body and surgical procedures that opened up my heart. If that isn’t amazing - I don’t know what is. For the record, general anaesthetic works by interrupting nerve signals in your brain and body. It prevents your brain from processing pain and from remembering what happened during your surgery. How brilliant is that!?

I woke with tubes down my throat, pipes and electrodes seemingly all over me and coming out of every part of my body. As soon as the tubes from my throat were removed, I said, so I’m told: “Can you grab my trainers so I can go for a run please.”

My wife and son were beside my bed in the intensive care unit while I swirled in and out of consciousness and some delirium. But I vividly recall touching my son’s face and telling him how proud I was of him and lots of tears as I breathed through the oxygen mask clamped to my face.

Can’t deny that I’m now a massive fan of morphine. There’s no debate, no question, that morphine is and has been for a long time, one of the greatest substances on earth. That and butterscotch Angel Delight.

In my hand I had a little console with a button. When I pressed it a burst of morphine would pour into my body. And let me tell you: that’s a very good thing.

Quick fact: morphine is a natural alkaloid derived from the resin extracts from the seeds of the opium poppy, otherwise known as Palaver somniferum in Latin. I got a little trigger happy with that one. Pumped myself full of that one to the extent I wasn’t sure what all the fuss was about and was ready to go home. A critical care cardiac nurse advised me against that.

The next week was spent in London Bridge Hospital. A continual round of tests and scans and bed baths - I just could not stop sweating - and the worst constipation of my life. Incredible 24 hour care by nurses from all over the world - from the Philippines and India to Spain and SE Asia which made for some fascinating conversations and stories.

My recovery room had an uninterrupted view of the Thames and the city of London. I left the curtains open at night to see the lights of the towering office blocks and the boats as they ploughed up and down the brown swirling waters of the Thames. But I was desperate to get out and start moving.

Six days later I left with a sack of pills - from blood thinners to pills that would, hopefully, sort out the slight issue of atrial fibrillation. Some fine looking bruises and a few holes down the right side of my chest and ribcage and an assurance that my right nipple would reappear once the swelling from one of the scars dies down.

“As far as I’m concerned you have a triathlon proof heart now,” said Mr Akteurk as I left. “But don’t rush it.”

So where does that leave me? Yet more canceled events - although this time for a pretty decent excuse - and a new triathlon club, the West Suffolk Wheelers, who must be wondering quite what happened to me after I paid my joining fee. I think I’m going to need a club and some structured training to get through this winter.

Life goes on with this deteriorating middle-aged body. I’ve lost yet more weeks and months, which as I try to explain to my teenage son, seem precious and brief in ways I could never have imagined at his age. And yet I feel somewhat reassured that I could, maybe, feel far better and fitter than I have in a long time. Relieved that I did go for a health test to see what was going on in this failing body. And perhaps a growing awareness that I was in fact very lucky and should - all being well - live far longer than I would have done if I hadn’t gone for that test.

Until the next thing comes along of course.

It's 2am. Credit card to hand. Back on the search for events to justify my existence - there's an ultra run in the Dolomites, that looks fun, a race across Scotland.

New heart with flaps that work - ever optimistic.