Bob and Ann Marie found out today that Bob will be discharged from the rehab facility on Thursday, October 1st. They are excited. Mom is nervous. Bob will continue to get therapy through home health care. They appreciate every one's help and prayers.

During his visit to the cardiologist's office yesterday, Bob was found to be doing better than expected. He is off oxygen during the day, but still needs it at night. He will meet with his surgeon in a couple of weeks. The surgeon will determine when Bob will be able to leave rehab and go home.

Bob is doing well in rehab. He says they have to hold him back so he does not try to hard. Mom reports that he looks better. He does like his naps after therapy. The therapy sessions wear him out a little. He will see his regular cardiologist tomorrow. He is in a different room, so ask at the front desk when visiting him. He would also like people to call the cell number because he keeps the cell phone close to him.

Overnight Bob's heart rhythm returned to normal. He has been transferred to Stonehenge. His private number is 801-850-5421. Visitors are welcome anytime. He will be at this rehab center for up to 30 days. His duration of stay will depend on his improvement.

Bob is still at the Utah Valley Regional Medical Center. He saw his surgeon and two cardiologists today to review what to do about his ongoing atrial flutter. They tried to cardiovert him three times today but were not successful. During cardioversion paddles are used to send an impulse of electricity through his heart in order to hopefully reset the electrical activity so that the heart can resume its normal function. They feel that post-operative inflammation is either causing the flutter, preventing them from correcting the flutter or both. For now they will wait 4-6 weeks to see in the flutter goes away as his inflammation heals. If the flutter remains, they will likely try to cardiovert him again. If they are not successful, a pacemaker will be placed.

While Bob has flutter his atria or the small chambers of the heart do not empty as they should. This dramatically increases the risk that a blood clot will form in the atria. Such clots can dislodge and travel to other parts of the body. If a clot forms in his right atria and then dislodges, it will go to his lung and cause a pulmonary embolism which is a life threatening condition. If the clot forms in this left atrium and then dislodges, it can go to his brain and cause a stroke. In order to prevent these serious complications, Bob has been placed on a blood thinner called Coumadin. This is the same chemical that is found in some types of mouse and rat poison. Bob will have blood tests periodically to make sure his coumadin levels are therapeutic (at the right level).

Lastly, while Esther was visiting today, one of the cardiologists told them that Bob's risk of heart attack would be higher if he were to go home now and that his risk will be lower in the hospital or rehab center. This news helped mom and Bob feel better about their decision to have Bob go to a rehab center for a few weeks.

Bob had good weekend and plans had been made to transfer him today to a rehab facility near their home called Stonehenge of Orem. However, he is either having more flutter, a third degree heart block or both--I am getting mixed reports on this from Mom and Bob. Flutter is when the atria or small chambers of the heart beats very rapidly. A third degree heart block means there is a complete disconnection between the electrical activity of the atria or small chamber of the heart and the ventricles or large chambers of the heart. Bob's surgeon has consulted Bob's cardiologist to help decide what to do about these issues.

Bob had some more tubes removed today. He now had no chest tubes to the pericardial sac (the sac where the heart rests). He continues to have tubes in both pleural spaces (the space between the lungs and chest wall). His physicians are increasing his diuretics (water pills) in an effort to get rid of the excess fluid more quickly.

Bob cannot yet get himself in or out of bed by himself. He is using a walker when he walks. He also continues to fall asleep a lot during the day. Because of these and other challenges, he will likely be transitioned to a rehab facility before he is able to return home. He needs to be fairly "tuned up" before going home because mom cannot lift him due to the injuries she suffered in their car accident.

Bob is having one of his chest tubes removed today. He also ate a full breakfast and a full lunch. He walked 300 feet twice today. Lastly, they are beginning to plan how to transition him to rehab. All in all, he continues to show slow, gradual improvement.

Bob has improved enough to be moved out of the ICU to room 561. He is sitting up more and says he feels "a little better." He will have a new appreciation for the nursery rhyme "The Tortoise and the Hare" in that his recovery will be more like the tortoise. 3 IV's have been removed. However, he still has a central line (big IV in his neck) and all the chest tubes are still in place. Children can visit him in his new "tiny" room. Shift change for the nurses is between 6-7 am and pm so we cannot visit during these times.

I am now back in Boise. Mom tells me that Bob sat up in a chair this afternoon for the first time since his surgery. Here are some photos I took yesterday.

Bob feels better this morning. He walked further than he did yesterday. He ate without indigestion. His heart is back in sinus rhythm (normal rhythm). However, his chest tube drainage continues and his overall recovery is taking longer than is usual.

Mom and I met with the social worker today. After Bob is discharged from the hospital he will need to go to cardiac rehab 24 times for about an hour a day. I do not anticipate that he will be discharged for at least 10-14 days. The timing for the cardiac rehab is from 8:45 to 11:00 am daily Monday to Friday (possibly Saturday). He must arrive no later than 10:00 am on those days. If anyone is interested in helping them drive to these appointments let them know. Mom cannot drive and Bob will not be allowed to drive for about 8 weeks.

Bob was more awake and alert during our afternoon visit. He really enjoyed the call from his son Michael who is in Dallas to visit friends.

As a reminder, while Bob is in the ICU visitors are not welcome between 5-7 pm and 5-7 am while the nurses have shift change.

I arrived in Orem late last night and then visited Bob this morning. I will take a photograph and post it when I return to Boise tomorrow. Seeing Bob in the ICU reminded me of all the visits to the Eastern Idaho Regional Medical Center to visit mom in that ICU. Although he is not in a coma like mom was, Bob is still quite sick. His post operative recovery is progressing as expected. The third day is often the worst and that seems to be the case with Bob. He is quite sleepy today and had some syncope (passing out) this morning. He was not able to walk as much this morning but was able to get himself to the commode.

He continues to receive hydration through an IV. He has four chest tubes draining fluid from the chest cavity. He is receiving medication to help his heart contract more strongly and a medication to prevent atrial fibrillation--a common post operative heart arrhythmia that is different from flutter. He has not yet regained his appetite.

One thing that is common after these types of procedures is depression. Bob would enjoy visits from family and friends. While in the ICU he can receive visits from family, close personal friends and ecclesiastical leaders. He is in the Cardiac ICU on the second floor of the west tower at the Utah Valley Regional Medical Center.

Bob and mom appreciate every one's thoughts and prayers. We especially appreciate members of the Suncrest 10th Ward who have been very helpful with food and transportation (Mom has not been cleared to drive again).

Bob had a good day. He sat up and ate breakfast this morning. Later today he walked twice and planned to watch the BYU football game. Mom and Bob discovered today that instead of a porcine or pig valve, Bob actually received a bovine or cow valve. He says he is wearing a "moo-moo."

I just spoke to Ann Marie who is at Bob's bedside in the ICU. They have told her that Bob's surgery went well. He is not yet awake but is starting to act like he is waking. He has four chest tubes which drain his chest cavity. He is on several medications. Ann Marie has been told to expect him to be in the ICU for several days.

I am resurrecting this blog in order for people to have updates on Bob's condition. As I write this Bob is having open heart surgery to repair Aortic Stenosis, 4 blocked coronary arteries and his atrial flutter. Aortic Stenosis is a narrowing of the valve which lies between the heart and aorta. The aorta is the main vessel that supplies blood to the body. He has had this condition for years. People can be born with Aortic Stenois or it can occur as a result of acute rheumatic fever--I don't know which is the case with Bob. He will have a porcine (pig) valve placed to repair this defect.

During his evaluation he was also found to have 4 blocked coronary arteries. These are the arteries which supply blood to the heart itself. Bob will have 4 bypasses done. During this part of the procedure, the surgeon takes a section of veins from his leg. One end of this transplanted leg vein is attached to the coronary artery in an area before the blockage and then the other end of the leg vein is connected to the coronary artery in an area after the blockage. This reestablishes blood flow to the heart muscle. We have been told this has probably been present for awhile is unlikely to be related to their accident. These types of blockages are what cause myocardial infarctions or heart attacks.

Lastly, the electrical activity in the small chambers of Bob's heart is causing a condition called atrial flutter. This means that the contractions of this chamber are to rapid to be effective. He will also have this problem repaired today. Each of these three procedures is a significant surgery. His heart is stopped during the procedure while his circulation is supported by a bypass machine (like an artificial heart). He will likely come out of surgery around 3 pm and have his heart restarted at 4 pm today. I would anticipate that he will be in an ICU for several days and the hospital for several weeks.

Earlier this week he had about a liter of fluid removed the spaces between his each lung and chest wall (pleural effusions)--about 1.2 liters from one side and 0.9 liter from the other. This fluid accumulated due to the heart problems discussed above.

All these issues have postponed the care of his bulging discs. These back problems are long standing and are not due to the accident in February. In fact he had these disc problems when he wrecked the Corolla several years ago.

Lastly, Ann Marie is doing quite well. She no longer is receiving care in the home. She can walk short distances without her walker. She can also eat a full diet.