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.