HOW TO PREPARE FOR AND WHAT TO EXPECT WITH WATCHMAN

Boomer’s: The WATCHMAN From a Patient’s Perspective, 

I’m Calling This Blog WATCHMAN Phase I.

“There’s an alternative to blood thinners for people who need one.  It’s called the WATCHMAN Implant.  The most implanted, FDA-approved device proven to reduce stroke risk in people with atrial fibrillation not caused by a heart valve problem (also referred to as non-valvular AFib).”

Boston Scientific

As mentioned previously, my BoomerGuy went through the first phase of WATCHMEN over 10 days ago.  It is a minimally invasive surgery that does require anesthesia and most commonly, an overnight stay in the hospital. 

We are so fortunate he came through this procedure perfectly.  His cardiologist called it “text-book.”  Trust me when I say there are more steps to take than we initially thought.  Here are a few helpful tips before, during and after Phase I you might wish to consider should you and your cardiologist choose that WATCHMAN is right for you.  

ARE YOU A CANDIDATE?

• You simply cannot sign up for this procedure on your own.  It comes with a great deal of due diligence with your cardiologist as to whether you are indeed a candidate.  Once you have the green light it is important to understand all the ramifications of this procedure, before and after surgery.
• The WATCHMAN is an FDA approved device and procedure designed to eliminate the need for blood thinning medications by closing off the left atrial appendage which happens to be the location of most blood clot formations. A great deal depends on your particular cardiac symptoms and condition, such as non-valvular AFib.  Most likely your cardiologist has prescribed blood thinners to eliminate the formation of blood clots and thereby reduce the risk of stroke.  The side effects of blood thinners are numerous, but the risk of internal bleeding is most prevalent.
• Above and beyond the consult with your cardiologist so that you thoroughly understand all of the risks and benefits associated with the implantation of the device, then definitely go to www.watchman.com and get acquainted with Boston Scientific, the manufacturer of the medical device and the procedure itself.  Do your home work!  It is a comprehensive tutorial with excellent videos on the entire process, along with a complete risk assessment.  It will walk you through step by step of what to expect.  
• And this is very important.  Carefully monitor with the help of your cardiologist and healthcare liaison to ensure there is not a dangerous rise in COVID cases within your chosen hospital.  In our case, we were scheduled for last October 2021 and had to cancel due to a COVID spike here in southern California which pretty much eliminated available rooms for post-elective surgery.  It was truly out of our hands at that point, and we had to regroup and reschedule.

JUST BEFORE SURGERY

Once you are scheduled, there are a number of things which we found helpful to prepare in advance.

• My BoomerGuy recorded his blood pressure each day for two weeks prior.  He then presented this to the anesthesiologist to help them better understand his median range.  Why is this important, because when you arrive in pre-op it can be stressful, and your BP might rise artificially just due to your surroundings—they are intimidating. You do not want that artificial rise to be considered your baseline.  
• Sometime within a week of your scheduled procedure, you will most likely meet with admitting to provide all your pertinent personal information including insurance.  Come prepared with all your documents.
• Then you will meet with a nurse to go over your medical history and have blood work done along with a COVID and MRSA test.  It is helpful to bring along a list of your current medications and dosage.
• Some cardiologists will choose to perform a TEE (Trans Esophageal Echocardiogram) a week or two prior to the actual procedure.  This is done to measure your left atrial appendage so that during the procedure itself the correct sized device is implanted.  A TEE requires the patient to be anesthetized, usually with a “twilight” medication which allows him/her to return home the same day.  My husband’s cardiologist prefers to perform the TEE the same time as the procedure thus reducing the number of times the patient has to be anesthetized.  Further, he has real time imaging, performs all the same measurements and has at his disposal a selection of implant sizes so the procedure can proceed without any delay and to a successful conclusion. 
• Be prepared to spend the night in the hospital, so bring essential loose-fitting clothing and toiletries.  Your particular weather and climate will dictate the type of clothing you will wear.
• My BoomerGuy made arrangements for me to spend the night because of the longer distance we had to travel.  We had a ‘pull-out’ sofa in the room which we made up with pillows and throws from home and blankets from the nursing staff.  Oh, and get ready for little to no sleep.  I brought high energy food bars and plenty of water to stay hydrated.  Check so you know the hours of the coffee shop and cafeteria in case you didn’t bring enough food/drinks with you.  The one thing you do not want is to be intrusive on the nurses and staff.  They are there for the patient and not you.

THE DAY OF SURGERY AND POST SURGERY

Your hospital and doctor will set their standards, but here is what we experienced.  

• No food or drink from midnight before.  Medications can be taken with a sip, only a sip, of water that morning. 
• Arrived two hours prior at 10:00 am for a noon appointment.
• My husband was already preadmitted from the week prior, and I had to show my ID and vaccination card in order to get my Guest Pass. 
• We were then shown into the cath lab waiting room where we were introduced to several of the nurses assisting in addition to the anesthesiologist and cardiologist for any last-minute questions.
• Everywhere in the hospital I was required to wear a mask.
• Approximately two hours later I was able to visit my BoomerGuy in the recovery room.  Groggy is an understatement, but he rallied and then was taken to his room.  

• You should note the patient is required to lay on their back for between 4-6 hours post-surgery.  This is done to minimize any disruption to the positioning of the implant and to give the body time to rest after surgery.
• From there, it is a simple evening at the hospital where they monitor the patient every hour, perform several blood draws, and deliver the absolutely best tasting hospital food imaginable.   Check out for us was around noon the next day.  You will leave with a pack of papers outlining the dos’s and don’ts for the next 10 days in addition to a schedule of follow on appointments.
• You or a friend or family member must be in attendance at check out to drive the patient home.  

Aside from appointments with your cardiologist, the next schedule is the all-important follow up TEE sometime around 45 days later.  

I call this the Second Phase, and it requires another in-hospital admittance for the TEE.  This is usually scheduled 45 days following the WATCHMAN and is done to ensure the healing process is complete.  I will be submitting another blog called Phase II with what to expect on the follow up TEE and the prospect of getting off blood thinners.

Keep in mind the purpose and end goal of going through WATCHMAN is to get the patient off blood thinners and resume a normal life without the overhang of that dreaded medication.  My BoomerGuy has been on blood thinners for over 6 ½ years since his heart attack.  He wanted to put behind him the risk of severe bleeding, fatigue, and the high cost of renewing the supply of meds.

We are truly blessed to have such a competent and caring cardiologist.  He saved my husband’s life 6 ½ years ago and then performed a text-book WATCHMAN on him two weeks ago.  The talent and dedication to excellence of our physician is truly unparalleled.  

TAKE AWAY FOR THE PATIENT

• Do everything to get in the best shape possible prior to surgery.  Remember to work closely with your cardiologist post-surgery to stay on top of your health and follow their instructions and guidelines to a successful recovery.  Oh, and don’t expect everything to run on time.  My husband experienced a two-hour delay due to complications with two procedures prior to him.  
• In our case, the worst side effect following surgery was purging the anesthetic.  In fact, it may take up to a week or more to dispel it from your lungs.  It will be different for each person, some will have lingering pain in the groin at the insertion site, while others may experience fatigue and weakness.  As the spouse, friend or other family member be proactive in caring for your loved one.  
• No lifting for 10 days following surgery, short walks are OK, no bike riding, drink plenty of fluids and maintain a healthy diet. We found green tea to be very helpful in soothing the throat following the TEE.  Adhere to any and all directions from your healthcare provider.  The worst thing would be for the patient to lay around and do nothing, sit up, get up and take short walks.  

It is now 14 days following the WATCHMAN and we are back on our bikes living life like we did prior to surgery.  Woohoo!!!

Of course, everyone will be nervous about the Watchman, after all it is an intracardiac procedure where a medical device is implanted into the heart.  There are never any guarantees, so you put your trust into the hands of your cardiologist and the cath lab team.   My BoomerGuy tells me frequently how surreal it is to know that he is now walking around with a medical device implanted inside his heart, but he cannot feel it.  

We could not have gone through this without the support of so many friends and family and their many prayers, along with the highly trained and excellent staff at Loma Linda University Medical Center and of course, our ‘rock-star’ cardiologist and his staff.  Also, it is worth mentioning that Boston Scientific has been there every step of the way answering questions and introducing us to one of their ‘ambassadors,’ a living, breathing person who has gone through the procedure.  

Now there are two grateful hearts.  Your BoomerGal and BoomerGuy.  Stay tuned in 45 days for the next installment.

DISCLAIMER—I am not a physician nor trained healthcare professional.  Should you wish to proceed with the WATCHMAN, it is a decision you and your cardiologist must make together after careful deliberation as to your particular circumstances and needs.  This blog is not an endorsement to the efficacy of the WATCHMAN, but rather a way of relating the experience from the perspective of a patient who has undergone the WATCHMAN procedure.