David and his new ICD, walking, and caffeine

My message board buddy David had his myectomy at CC with Dr. Smedira last Thursday. The procedure itself went fine, but his recovery has been considerably more rocky than mine. He's still in the hospital, having had an implantable cardioverter/defibrillator (ICD) placed today after some rhythm disturbances, including atrial fibrillation and possibly ventricular tachycardia (very serious). Please keep him in your thoughts. Fortunately, as we know, he's in the best place in the world if he's going to have post-op cardiac complications that need to be monitored and managed. Plus his positive attitude and sense of humor are fully intact.

As an aside, part of the evaluation of HCM at diagnosis is an assessment of the risk factors for sudden death and subsequent recommendation for/against ICD placement. An ICD is basically a battery installed surgically under the chest skin, with wires running into the heart, that activates a defibrillating shock when it detects a potentially lethal heart rhythm. It can be life-saving, but it's not benign. For example, an ICD can misfire, which is painful; the leads (wires) can break or permanently embed themselves into the blood vessels; and it needs to be "interrogated" regularly for evidence of abnormal rhythms and use. The risk factors for sudden death in HCM are prior cardiac arrest or sustained v-tach; family history of sudden cardiac death; syncope (fainting); extreme thickening of the septum (>30 mm); and a decreased BP response to exercise. Of these, I have only one, decreased BP on exercise. Therefore, although every HCM expert I've ever consulted has initiated an informed discussion of ICDs, it has never been definitively recommended to me, and neither I nor my doctors believe it's warranted. For obvious reasons, this is a highly controversial and delicate subject clinically, and there are no right answers (at least in my case).

I've been doing some walking every day, and it's obvious that I will be able to tolerate exercise much better. We went shopping in King of Prussia this afternoon, and wandered all around at a reasonable clip (read: I'm no longer being passed by 65-year-olds), with no fatigue or shortness of breath whatsoever. I've been looking for a similar coffeemaker to the one Jay recommended in an earlier comment, but it isn't stocked in Kitchen Kapers, Crate and Barrel, Bon-Ton, Williams-Sonoma, or anywhere else we checked. (Told you we'd been walking - thank you, Jay, for sending me on a wild goose chase and getting me off the couch). So I ordered it online. Caffeination is imminent. Meantime, the baristas at Starbucks now recognize our Toyota at the top of the drive-through lane.

My first follow-up internist appointment is Friday. I have a laundry list of things to ask him - pain and sleep meds at the top of the list - but all in all, I think everything is progressing incredibly fast and well. Thanks to everyone for all of their support. I've been reading the comments every post-op day since I could log on, and I believe that they are instrumental in helping me recover as fast as I am.

Take care,

Michael