Recovering from a body beating

Controlling painful sneezes, no heavy lifting and possible memory problems are among the challenges Sen. Bob Graham faces as he recuperates from heart surgery.

By SUSAN ASCHOFF, Times Staff Writer
© St. Petersburg Times
published February 4, 2003

When Sen. Bob Graham underwent surgery Friday for a faltering heart valve, he and more than 200 other Americans that day had a procedure that has become routine in its frequency yet remains brutal in its assault on the body.

The most difficult part for Graham, 66, may be taking time to recover.

Under pressure to publicly decide whether he will join the race for the 2004 Democratic presidential nomination and begin raising money, Graham is also under doctor's orders to rest and wait a month or two before returning to work.

Then, his stamina may be greater than before the surgery.

But initially he will be one sore patient.

"You don't want to sneeze, and you don't want to cough. That's the unbearable part," says Brooksville Fire Chief James Daugherty of the days immediately following his valve-replacement surgery.

Heart surgery patients are advised to limit activity for four to eight weeks. Healing takes six months to a year.

The speed of recovery depends on the individual, doctors say.

"I put very few limitations on my patients," says Dr. Cedric Sheffield, a cardiac surgeon who performs about a half-dozen valve procedures each month at Tampa General Hospital. "Many at one month are walking a mile at a time. Some are working at home two weeks (afterward).

"(Graham's) major limitation is he won't be able to lift anything because he just had his breastbone split open."

About 90,000 people in the United States undergo some type of valve repair or replacement every year, almost double the number a decade ago, according to the American Heart Association.

The heart has four valves that control blood flow through its four chambers. Graham's aortic valve, stiffened by calcium deposits likely due to aging, leaked blood between the left ventricle and aorta.

The valve was replaced at the National Naval Medical Center in Bethesda, Md. "Graham is fairly young. The surgery is harder on someone who's 70 or 80," says registered nurse Suzanne Baker, clinical coordinator for the cardiac surgical unit at Regional Medical Center Bayonet Point in Hudson. Bayonet Point has one of the largest open-heart surgery programs in Florida.

Although valve surgery has become common, it is still a major trauma to the body.

A surgeon saws the breastbone, or sternum, in half and stops the heart. The sedated patient breathes through a tube connected to a ventilator, and his blood is routed through a cardiopulmonary bypass machine for pumping back through his body.

Risks during and immediately after surgery include infection, irregular heart rhythm, stroke, heart attack and death (about a 2 percent risk).

"The sternum bone takes four to six weeks to heal," says Dr. Vibhuti Singh, director of cardiology at Bayfront Medical Center in St. Petersburg. Most postsurgery limitations are imposed to protect the incision site.

A patient spends one to three days in intensive care, then an additional week or two in the hospital before going home, where a home health care worker typically monitors the recovery for a week.

The patient is instructed how to prevent bacterial infections while bathing. A "chest hug" move is demonstrated so a cough or laugh is not excruciating. The patient is schooled in diet and exercise for heart health. Elastic stockings are worn to keep the legs from swelling and to improve circulation.

The recovering patient is encouraged to move.

Daugherty, 55, walked through the rooms of his house first, then from door to mailbox, after his surgery in September. Since returning to work in January, he averages two to three miles walking each day.

"It's according to how you feel," the fire chief says. "They don't want to see me out there fighting fires, but most of my work is at a desk anyway."

Patients are not allowed to drive for four to six weeks.

Avoiding heavy lifting is key: Do not heft anything more than 10 to 15 pounds, doctors agree.

Graham received a replacement valve made from cow tissue. Valves from a pig or human cadaver are also used. A tissue valve needs to be replaced every 10 to 15 years but does not require recipients to take the blood-thinning medication required for those with a valve made of plastic or metal. Clots can form on the metallic portion of the valve, interfering with its operation. It can prove fatal if a clot breaks free and travels to the lung or brain.

If the blood is too thin, a patient hemorrhages.

Blood thinning "has a very tight window of safety," Singh says.

Almost three-fourths of heart patients have some cognitive dysfunction -- called "brain fog" -- for as long as six months after surgery. In about 10 percent, the mental fuzziness is permanent, Singh says.

Temporary feelings of sadness are common, a result of the stress to the body and the emotions.

Daugherty says he feels stronger than ever, his energy level "double or triple" how he felt before surgery, when one lung was filling with fluid and he had to "pull for air."

"There were people here concerned: Was I going to be able to come back and do the job?

"I'm more productive," he says.

Graham, a three-term senator who became aware of his condition in the mid 1990s and only recently experienced fatigue and shortness of breath, is accustomed to dealing with stress.

But pressure to declare for president and begin intensive fund-raising carries the potential to rush the recuperation.

Amid the political jockeying, Graham would do well to not only follow his heart but, for a few weeks at least, cater to it.

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