Navigating Aortic Valve Replacement (AVR) Surgery with mPEAK and Mindfulness

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Read this very personal story from a recent mPEAK participant and Join Pete Kirchmer for the next mPEAK 3-Day Intensive March 11-13, 2017, UC San Diego Center for Mindfulness, San Diego, CA.

By William R. Matthews, MA, LPC

Medical literature contains numerous references proclaiming the benefits of meditation and mindfulness on cardiovascular health and pain management. But to me, these were merely academic case studies, as I had not personally known anyone who had successfully used mindfulness to manage through a major medical procedure. That is, until August 17, 2016, when I had aortic valve replacement surgery.

I need to back up a moment. In March of 2016 I participated in the three-day mPEAK intensive that included six weekly one-hour conference call follow-ups. For me the follow-up sessions were critical for integrating the didactic and practice sessions taught in the three-day into a consistent meditative practice. mPEAK was my first hands-on experience with mindfulness. At that point in time, I had been aware for several years that I had a bicuspid aortic valve that would “eventually” need replacement (in fact it kept me from fully participating in the five-mile mindful walk that is part of the program), but there had been no discussion of surgery with my primary physician or cardiologist. Two months after returning from mPEAK, my new primary care physician sent me for an ultrasound of my heart. The results indicated significant blockage of the aortic valve, and that started the ball rolling for surgery “as soon as possible.”

When a date for surgery was set, I emailed mPEAK ccf9e-headshot2program director, Peter Kirchmer, asking if he could provide me with additional mindfulness resources on pain management, since that seemed to be a big concern connected to surgeries. In response, Pete wrote “Forget about additional resources. You have everything you need already. Just continue developing the skills you already have.” Wise counsel indeed. So I loaded up my iPod with all the meditation files mPEAK had made available to us on its website, added John Kabat-Zinn’s Mindfulness Meditation for Pain Relief, and a few other meditations. I played these every evening before bed, in the waiting lounges of airports, and in my office sharing them with my clients. Ultimately, my iPod was headed with me to the hospital.

The night before surgery I slept soundly without the benefit of any sleep aid other than my meditation-filled iPod. I arrived at the hospital at 5:40 AM surgery day and was taken back to pre-op shortly thereafter. The nurse remarked that my blood pressure showed no signs of anticipatory anxiety.  I too was surprised at how calm I was considering someone was about to cut my chest open and mess with my heart. I told the nurse about my mindful preparation and she asked a lot of questions of interest to learn more. A brief chat with a family member, a friend and a short prayer from the rector of my church was all I remember before waking up almost six hours later.

I awoke in recovery to see the same three faces that I had left there that morning. After a few minutes I was taken to cardiac ICU. A nurse and a member of the physical therapy team armed with a pillow were waiting for me. The PT announced that she was there to help me get into bed by “leaning into my pain and clutching the pillow” as my incisions were on the right side along with two chest tubes. Even in my post-anesthesia fog, my mind went immediately to a body scan, noting that my left side was incision- and tube-free. I also made a mental note that at home my bedroom is set up so that I can only get into bed from my left side. I got up off the gurney without assistance walked around the end of the hospital bed, sat down and got into bed on the left side of the bed without assistance (with minimal pain) and said, “I think I’ll do it this way instead.” The PT could only respond, “I guess that way’s OK too.”

The nurse waiting her turn with me announced that she was there to help me with pain management. She advised, “The key to pain management is staying ahead of the pain.” I interpreted that to mean don’t wait until the pain gets bad, keep taking your medication. At that point my mind recalled an activity from mPEAK where we were asked to insert a hand up to mid-forearm into a bucket of ice water and keep it there until the pain started to hurt. Most people removed their hands from the buckets in under a minute. The teachers explained that a large part of managing pain is changing our relationship to the pain. After sharing techniques and mindsets for doing so, we were given the opportunity to try immersing our hands into the ice water again. Most everyone were able to keep their hands in the ice water for considerably longer the second time around. With this recollection I informed the nurse of my plan – to measure my pain on a scale from 0-5 every hour or so, and if the pain number was not any higher than the last “reading” I wouldn’t be asking for pain medication. I received medication for pain only twice: 1) shortly after arriving in the ICU and 2) later that day when they removed the chest tubes. By the next morning, the day after surgery, I had discontinued all pain medication for the remainder of my hospital stay.

Prior to my surgery, my cardiologist and cardiac surgeon both agreed that I would need to go to a rehab facility “for at least a week” after being discharged from the hospital because I live alone. However, I created a dilemma for them because my recovery was so quick and complete. The discharge social worker advised me that I didn’t meet any medical criteria for rehab placement. She even had PT and OT evaluate me one more time in hopes of coming up with some reason to get me admitted, but neither could come up with a medical need. So I was discharged after 4-1/2 days, with my doctors agreeing that I could stay with a friend who lived within a mile of the hospital. I had a return visit to the cardiac surgeon four days afterward. At that appointment my cardiac surgeon said I was free to go back home and decide for myself when I would go back to work. I was back to work half-time three weeks after surgery and returned to full-time work the following week.

While I wouldn’t necessarily put AVR surgery in the category of a high performance activity, I am convinced that the skills and tools I learned from mPEAK, played a central role in my recovery.

William R. Matthews, MA, LPC is in private practice with the Great Lakes Psychology Group. Bill works out of GLPG’s office in Clinton Township, Michigan, where he counsels with children, adolescents and adults using family systems, EMDR, Mindfulness and sports psychology approaches. Bill is also a volunteer trainer and curriculum consultant for the University of Notre Dame’s Play Like a Champion Today educational program. Bill can be reached at bill.matt.GLPG@gmail.com.

Join Pete Kirchmer for the next mPEAK 3-Day Intensive March 11-13, 2017, UC San Diego Center for Mindfulness, San Diego, CA.

ccf9e-headshot2Pete Kirchmer is  the Program Director for the UCSD Center For Mindfulness mPEAK (Mindful, Performance Enhancement, Awareness & Knowledge) Program. Pete specializes in coaching his clients in applying the practice of mindfulness to making healthy lifestyle changes as well as improving performance in life, work and sport. For more information about Pete Kirchmer please visit his Mindfulness Based Health Coaching website.

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