Recovery from surgery

Discussion in 'Trumpet Discussion' started by amzi, Aug 12, 2014.

  1. amzi

    amzi Forte User

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    barliman--I resigned from the big band since it will be quite a while before I'm playing lead. My replacement has talked to me about coming back and eventually playing "ride". I'm thinking about it but it will be a while. I play in a non-paying band also and that's the one to which I was referring--going to keep everything in the staff for a while. Sorry to learn of your grandmother's misfortune--fortunately (for me) techniques have improved and I'm not predisposed to do anything that might hurt me.
    I think this will actually be an interesting experiment that I'm looking forward to completing.
     
  2. joe1joey

    joe1joey Piano User

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    Get a second opinion...and a second doctor.....or since I didnt read all the forum entries getting to this point, ...never mind and keep up the spirit.
     
  3. Ed Lee

    Ed Lee Utimate User

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    Am I wrong or isn't there quite a bit of bouncing the stomach around as we play? I'm in contact with a 16 yo who was so severely overweight (350#+) that no band uniform would fit him. He underwent bariatric stomach surgery 3 months ago and then had to have it reversed. He's now recovering and playing with the high school concert band. His main problem is that he still waddles when he walks and is in braces to attempt alleviation of this. He blew me away with his comment about the braces: "If injured Vets can, so can I." He's now staying in a rehab center and is bussed to and from high school. Normally, he lives with his Mom at his Grandmother's house a block from our home.
     
  4. amzi

    amzi Forte User

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    Ed, you had mentioned him before--I wondered how he had done. I don't march when I play so there isn't much (if any) bouncing for me. The greatest concern in my case was giving my diaphragm enough time to heal from the hiatal hernia repair. I'll be taking it easy for a while but figure I'll be up to playing a little lead by the end of the year.
     
  5. Ed Lee

    Ed Lee Utimate User

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    Considering all the factors he's been coping with in his life, IMO he is doing remarkably well. He's now adapted to a specially prepared diet for him at the rehab center. What presently enlightens him most is to wear off the rack 48" waist blue jeans instead of 60" W. his Granma made for him ... albeit she is an excellent seamstress (and a terrific pastry chef). While his parents are divorced, his Father is paying his bill at the rehab center I've been told, and we all know such isn't cheap. Too, his Father keeps him on his Medical Insurance and had been paying me for tutoring him.

    I wasn't referring to marching, but only to the flex of the diaphragm creating stomach and other thoracic organ movement, not only when playing or other exercising, but also when asleep.
     
  6. amzi

    amzi Forte User

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    It's been a long time since I updated my progress, but here goes. It's been a rocky road toward recovery. First it was a trip to the ER for shortness of breath--ended up being atrial fibrillation, multaq and warfarin prescribed; the next week I was hospitalized for pneumonia. I also developed congestive heart failure and am now on 80mg of lasix a day (and a whole bunch of potassium). I have a consult for possible ablation (creation of scar tissue inside the heart that interferes with the unwanted electrical impulses that result in the fibrillation). And to top everything off, I had c diff. (an infection of the colon). So, here's what's happening with me. I am playing "ride" in a jazz big band, section leader in a community band, 3rd in another community band as well as doing solo work when possible. My range has suffered a bit, and my endurance (at the top of my range) has suffered a lot; but I still suspect that everything will be back to normal (trumpet wise) by the time the new year rolls around. By the way, in the midst of all this I have lost 95 pounds--typical weight loss would have been about 35 pounds (according to my surgeon)--my hypertension is non-existent and my diabetes is being easily controlled (if you remember that was my purpose for having the surgery), unfortunately not eliminated but down to one oral medication (glyburide) instead of 3 oral and insulin. My primary care physician has "ordered" me to quit working so I can eliminate stress in my life, so I've turned in my resignation pending the church finding a replacement. And that's about it, should (according to my doctors) take me about a year to fully recover from everything that's happened to me; but I'm generally feeling better day by day.
     
  7. TrumpetMD

    TrumpetMD Fortissimo User

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    Thanks for the update, my friend.

    Mike
     
  8. Tomaso

    Tomaso Pianissimo User

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    Amzi, I want to tell you something you may not understand, but if you tell your cardiologist, he will. Atrial fib is real serious stuff. I had it, and did the extensive research to find and eliminate the cause, which cured my AF permanently.
    Here goes: Your esophagus lies right next to a section of pulmonary vein (big vessels that carry oxygenated blood to the heart from the lungs). This apposition is important in people like you who also have GERD (gastro-esophageal reflux disease).
    Why? because we know that the atrial "hot spots" arise in the pulmonary vein - the pulmonary vein is the source of the super-sensitive spots in the atrial walls that cause atrial fib by firing off rapidly and randomly over-riding the heart's sinus node which ordinarily regulates the heart beat steadily and regularly.

    You said that your surgeon discovered a large hiatal hernia. A hiatal hernia occurs when the opening between the stomach and the esophagus (food tube) is enlarged and allows a small part of the stomach and the food in it to regurgitate up into the esophagus. Symptoms when they occur, are heartburn and indigestion.
    Why is this important to you?
    Because the lower part of the esophagus is in direct contact with the pulm. vein, the irritation and inflammation of the esophagus from regurgitated stomach acid also irritates and inflames the wall of the pulm. vein, which in turn sends excitatory signals to the atrium causing the heart to fibrillate.

    Confusing? I know it is, but what I just described is one of the newly-discovered causes of AF, and your symptoms and signs, Mr. Amzi, fit the picture perfectly. If you're smart you will copy/print this out and show it to your cardiologist. It couldn't hurt, and very well could help in the management of your case.
    In addition, read up on the side-effects of every med you are taking. Some cardiac and hypertension meds can cause AF. Calcium channel blockers are one example.
    In the meantime start taking a "proton pump inhibitor" med (Protonix is one example). It will reduce stomach acid, reduce inflammation in your irritated esophagus, which will in turn reduce the irritation of the pulmonary vein, which in turn will reduce and/or hopefully eliminate the source of the excitatory impulses from the pulmonary vein to the atrial wall.

    Finally, I will say that although we know that the source of the electrical impulses that cause atrial fibrillation is the pulmonary vein, we don't understand the exact mechanism of how they get carried down into the heart to there cause AF. I've given you one possibility for the etiology of AF. There are others that don't involve esophageal acid reflux. But if I were your doctor, I'd go for the obvious, on the support of the old medical dictum: "Common things occur most commonly."

    TDC MD, ret. New York Presbyterian Hospital prof.

    And by the way, if I were you I wouldn't use any of the examples given here in this thread, no matter how well-meant, as a guide for when you can again play the trumpet. No two cases are alike.
     
  9. amzi

    amzi Forte User

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    Thanks Tomaso--but, the hernia was completely asymptomatic, I did not have GERD and still do not. When they scoped me prior to surgery no esophageal erosion was noted. Also, since I no longer have hypertension I do not take any anti-hypertensive medication. My AF has been fairly well controlled by the multaq, but not completely eliminated--thus the consult for the ablation. I will, however talk to my cardiologist regarding the connection between esophageal irritation, pulmonary veins and AF. Since the primary part of the surgery involved removing the majority of my stomach it is certainly possible that some esophageal and/or pulmonary vein irritation could have been the result.
    By the way--my surgeon initially told me to not play for 6 months following surgery. He feared air would be forced through my esophagus into what remains of my stomach and cause problem. Anyway, I settled on a 6 week hiatus that has seemed to be appropriate. The surgery has apparently healed nicely--it's the "complications" that have complicated things.
     
  10. Ed Lee

    Ed Lee Utimate User

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    AMZI, my error, Billy's parents were not divorced, but the update is they are getting back together and moving back to Durham NC the first of 2015. Due to his former weight and size, he never marched (they didn't have a uniform to fit him) and it took some wrangling by me to get him a seat in the high school concert band. I really enjoyed playing duets with him.

    Otherwise, a check back of my posts you'll read I'm triple bypass member of the "zipper club", but post heart surgery I went into Atrial Fibrillation and with that spent a month in the hospital, Too, before I came to NC I had a triple aortic aneurism surgically addressed, thus my "zipper" is now all the way. Also, I've COPD (from cigarette smoking). Thus, as needed, I've oxygen service and my own de-fibrillators (yes 2, one at home and one in my car). Yep, as Tomaso stated A-Fib is very serious! Life threatening indeed? Since, I've periodically undergone nuclear stress tests inclusive of a recent one and now have an 11:00 AM appointment with my cardiologist and another with my pulmonologist in the afternoon (assuming I'm cleared by cardiologist) this coming Tuesday, November 25, 2014 in Raleigh NC, 112 miles from our home.

    I've just two questions to ask: Do you snore heavily when sleeping? Have you been checked for sleep apnea?
     

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