Robotic Mitral Valve Surgery | A runner's recovery program


3/27/2010 shortly after being released from ICU	7/23/2010 finishing the Blessing of the Fleet 10 mile road race in 8:01 pace. I had sub-80 in my grasp but I exceeded my allowed heart rate and had to back off.

In the winter of 2003/2004 I was training for the San Diego Marathon, which is now called the Carlsbad Marathon, and 5 miles into a 10-mile run, I had to stop and walk the remaining 5 miles back to my truck in 18 degrees because I couldn't breathe.

When I got home I had to curl up into a ball while my skin turned an ashen color and then had to wait 24 hours to recover. I put it off as simply having, as all runners will understand, a bad day. In January of 2004, we flew to San Diego, I was feeling good and was looking to run 3:10 to 3:15. I to’ed the line and 4 miles into the race I started coughing, couldn’t breathe and all of a sudden my race was over.

Upon my return from San Diego, I saw my primary Physician and I started an extremely frustrating and worrysome 6-year journey via an eclectic collection of specialists. In these 6 years I was under the care of…

One Ear, Nose and Throat specialist
2 different Pulmonologists
2 different Gastroenterologists
One Asthma/ Allergy specialist
My primary Physician consulted with a Heart Specialist via the telephone

...none of whom could diagnose my problem. I always answered ‘yes’ to the ‘do you have a heart problem question which in retrospect was a huge clue that they did not pick up on.

I was diagnosed with Mitral Valve Prolapse in 2000 but it was deemed so minor that I was never referred, or followed, by a Cardiologist. I experienced these breathing ‘events’ 2 to 3 times per month throughout this 6 year period irrespective whose care I was under or what medication I was on.

It only ever occured while running.

Not only did I invest a fortune in healthcare and unnecessary medications but I also underwent unnecessary medical procedures.

Nasal surgery
Installation of a bravo probe into my esophagus (twice with two different gastroenterologists)
Hiatial hernia repair.

I think a big part of the problem with these ‘specialists’ is that when you say “ Doctor I am struggling to run 10 miles in 80 minutes, they simply cannot register what that means” because if I can run 10 miles then how ill can I be?

After the failure in San Diego, I also failed with flying colors at the Philadelphia marathon ( stopping at 5 miles) and my most spectacular failure was at the Winnipeg Marathon, when I had to call it a day at one mile. I began to feel like a complete idiot as running buddies ridiculed me – why not, I was blowing up in races with great abandon, if the shoe was on the other foot I would have been making fun of me!

The medical establishment really didn't’t care because the problem with specialists is that when the have exhausted their ‘specialist check list’ they say “there is nothing I can do for you”. This could not have been more evident when the asthma specialist said you do not have asthma, you have no allergies and I cannot help you any more. That night I had one of my worst breathing episodes ever. The medical establishment effectively kept turning their back on me.

After 6 years, I still had no idea what was wrong with me, I tried another gastroenterologist, as we still thought that the problem was exercise-induced, acid-reflux induced asthma. It was a stretch but everyone was clutching at straws.

To reiterate, I informed every specialist that I had Mitral-Valve Prolapse. After more tests and another bravo probe, he suggested that all that was left to do would be to correct a hiatial hernia – it was a long shot, but if that was fixed it would eliminate any gastric component to my problem. The operation was scheduled for mid-January 2010. During my physical in late December 2009, the EKG indicated a problem (I had an EKG in July without any issues). My primary physician sent me for an Echocardiogram. While we waited on the results of the Echo, I underwent the Hiatial Hernia surgery. A few days into my recovery my primary physician called me to inform me of the results of the echo and indicated that I will most likely need heart surgery because I had:

Severe mitral valve regurgitation (leak)
Pulmonary Hypertension
Enlarged Atrium.

I saw a cardiologist a couple of days later and began my journey towards a robotic surgical valve repair at the Cleveland Clinic.

The most disturbing words that I heard through these 6 years was when a cardiologist at Cleveland informed me that my breathing episodes were ‘pulmonary edemas’ and the causal was heart failure. He was surprised that I had survived so long and he asked “ didn’t any one do an Echo?”

What can you say, really!

On March 26th 2010, just over a month past my 50th birthday, I underwent Robotic Mitral Valve Repair by Dr Mihaljevic and his crack team. Robotic Mitral Valve repair is minimally invasive and instead of undergoing open heart surgery a small incision is made in your rib cage and when it gets to the nitty griity Dr Mihaljevic, while looking at a video screen, used a series of joy sticks to operate the surgical robotic arms.

There are many advantages to this type of surgery but the reason I chose to travel to Cleveland for this procedure was the short recovery time.

I can honestly say that as I lay in the intensive care unit after the surgery, it did not feel like my recovery was going to be quick but I was released from hospital 3 days after surgery.

In addition to the technology and the brilliant surgeon, I truly believe that the Cleveland Clinic offers as close to 5-star health care that is possible. A truly inspirational experience.

The entry in each cell below is the distance (miles) followed by pace ( minutes per mile). The grean cells are races! Surgery date : 3/26/2010

Wk #	Mon	Tues	Wed	Thurs	Fri	Sat	Sun	Tot
1(3/29)				Rtn from Cleveland		2.4/18:45	2.7/16:44	5.1
2	3.6/16:46	0	3.5/17:06	3.7/16:24	***	4/15:00	5.4/14:56	20.2
3	0	6.3/15:10	0	4/14.26	1/15.10	0	6/14.27	17.3
4*	3.8/15:32	6.3/14:48	3/15:04	4/15:00	0	0	6/15.12	23.1
5	4/15:00	6.3/14:49	0	4.2/14:17	2.1/15:12	0	6/14:58	22.4
6	4.2/13:03	6.3/13:08	0	4.3/12:47	2.2/13:38	0	7/11:01	23.7
7**	5.2/9:48	6.3/11.10	0	5.5/9.31	3/9:13	0	8/9:28	28
8	5.1/9:16	3.1/9:41	3.5/9:21	4/9:46	3.5/9:35	0	8/8:40	26.2
9	5/8:58	4.1/9.54	4/10.1	0	3/9:12	0	10/9:03	26.1
10	0	6/9:16	6.3/8:33	0	8/8:37	2.8/9:36	7/9:36	29.9
11	0	6.3/8:44	0	8/8:59	3/10:12	0	10/9:26	27.3
12(6/21)	0	6.3/10:19	0	7/8:18	3/10:13	0	6/8:34	22.3
13	0	6.3/8:11	2.4/10:22	8/8:18	0	0	10/8:18	26.7
14	0	6.3/9:35	0	8/8:46	3/10:34	0	10/9:35	27.7
15	0	6.3/8:30	4/10:29	0	4/10:19	0	8/8:39	22
16(7/19)	0	6.3/9:35	0	0	10/8:01	0	6/8:47	22
17	0	6.3/7:53	0	8/8:12	3.4/8:56	0	10/8:45	27.4
18	0	6.3/8;56	0	0	0	3.1/7:05
27	0	6	0	0	0	13.1/7:57

Weeks 1 thro' 5 walking only
Weeks 6 and 7 jog/walk/jog
Weeks 8 plus jogging and running
Week 27Hartford 1/2 M2ndarathon
* start Cardiac rehab
** end Cardiac rehab - it was a 13 week course but I had exceeded the courses goals at 4 weeks
*** stress test

Although my Mitral Valve Prolapse deterioated to the point that it required surgical repair my heart was generally in good shape. There was no plaque in my system but during the cathertization process it was revealed that there was mild one vessel coronary artery disease of my left anterior descending (LAD) artery and I was asked to reduce my cholesterol. Athough minor, this artery carries the nickname the 'widow maker', so I will treat this this minor chink as if it was major!

My chloesterol levels were within the optimal range:

LDL (bad) cholesterol: 122 (range 60 to 129mg/dl)
HDL (good) cholesterol: 66 (An HDL of 60 mg/dL and above is considered protective against heart disease.)

Although, in range, I was asked to bring my LDL levels down.

I immediately excluded eggs ( i did eat 6 to 8 eggs per week) and cheese (cheese and wine was an evening regular in the Ross household).

Although this was the major change in my diet because being a life-long distance runner my diet was pretty healthy, I now focus on the saturated fat content of my food and while I am pretty picky, I allow myself to eat out one night per week where I am much less restrictive.

I have found a heart-healthy lo-fat diet to be a very easy adjustment but like most l others I like ice cream and often on a Tuesday night run with my club I would treat myself to an ice-cream bar, now instead of ice-cream I have a zero fat smoothie. There are alternatives, have fun, explore!

The day after surgery, while lying in ICU, I committed to myself to 'walk' the Blessing of the Fleet Road race on 7/23. I figured that walking 10 miles would be a good goal after cardiac surgery, I had no idea that my recovery would go so well and that I would be able to run the race. The following are my race times all completed within the first 18 weeks after surgery.

June 24th (12 weeks after surgery): Hazard Castle 7 mile road race. Pace 8:18 with a maximum allowed heart rate of 130 BPM
July 23rd (16 weeks after surgery): Blessing of the Fleet road race, Pace 8:01 with a maximum allowed heart rate of 140 BPM
Aug 7th (18 weeks after surgery): Handicap 5K, Pace 7:05 with a maximum allowed heart rate of 140BPM
Sep 18th, 5K for Parkinson's Disease, I broke 7' minutepace at 6:54
Oct 2nd, Hartford 1/2 Marathon, Pace 7:57 with an avearge heart rtae of 122BPM (It's tough to run a half with a base of only 25 to 27 miles per week...but job done!)
Nov 22nd. Mews tavern 5K - hilly course, felt a bit under the weather but happy with my 21:32
Dec 19th - Beat Santa 5K 21:06
Dec 26th - Nooseneck 18K - in the winter Blizzard with a few inches of snow of the ground running in white out conditions, the official race was canceled because of the condition but my running buddies and I ran the course anyways!! 1:37:12

At this point I am still keeping my heart rate to a maximum of 140BPM while I train but in 6 weeks (6-months after surgery) all limits are being taken of my heart rate.

I will see my cardiologist shortly and there is a strong indication that I will, at some point, stop taking beta blockers. Now, that would be nice.

My diet is forever and , I hope, will be my road racing addiction.

On October 9th I will run the Hartford 1/2 Marathon, 6 months after surgery and my goal is simply to run sub-8 pace...nothing too adventuous ( my PR is 6:11 pace) then I will take on a Marathon in the Spring as I have a bone to pick with that distance due my heart failure causing some spectacular marathon failures - I am considering with Sugarloaf or Vermont City Marathon.

I simply cannot thank all at the Cleveland Clinic enough. I was told that I would probably not live through 2010 by my cardiologist had the problem not been found. I was on track to be the infamous headline " Fitness fanatic drops dead while out running" and here I am planning a marathon in 2011. Pretty cool, huh?

Words are sometimes inadequate of truly conveying how thankful one is and this is one of those circumstances.

From Cardiac Surgery to 7-minute mile pace in 18 weeks...