Collateral damage?

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I was just about to post about the same kind of pain... I am just over 2 months post op and i still have sternal / incision pain that is constant but for the most part is tolerable. sometimes i will get a sharp blast of it from reaching for something or bending. I am scheduled to see my cardiologist on the 8th. I have been released from my surgeons care and have completed a month of rehab already. Other than this nagging pain I am doing great for the most part.
 
I'm not sure BUT he MAY have been told to use the ibuprofin now, because he had pluerisy or pericarditis, and the first treatment for that or pericardial effusions, are NSAIDS,(ibuprofin, motrim, Alieve ect) because they help with the imflamation and tylenol which works differently doesn't help. I think the reason people are told to use tylenol, and not take NSAIDs is because of the side effects, gi bleeds ect also he isn't on coumadin,
 
Another reason they may tell you to take Tylenol and not NSAIDS, is some of the NSAIDs can affect blood pressure and I think blood pressure meds
 
If you saw what they did to you, you'd have no doubts about what you feel. Your shoulder blades are actually contacting each other once they spread the ribs apart. You really are filleted like a fish. Muscles are stretched way beyond anything they were designed for, which leads to that tiny, nagging, bit of pain that goes on for so long afterwards.
In regard to Ross' gentle explanation, Michael, I have heard/read that muscular people have more pain than those of us (usually girls) with less muscles. So perhaps you can just blame it on your muscles :D .
 
My left arm was completely numb and swollen for about a week following my first surgery, and it was painful to use it off and on for weeks after. After my second surgery, the exact same thing happened, only it was my right leg this time?

Really weird, but it seems to be common occurrence for this type of thing to happen.
 
Ah, the sore shoulder! As you can see by the responses, you are not alone. A few weeks before my AVR, I dislocated my left clavicle at the shoulder. It was improving by my surgery date but has been a problem ever since along with my right shoulder. At 14 weeks both of my shoulders are still sore but there is light at the end of this particular tunnel. At Cardiac Rehab, the physiologist let me start a mild upper body workout last week. The shoulders are already improving. Their manta is chest first then the shoulders. Massage helps.

Larry
 
After my first OHS my shoulder hurt like hell, for a long time, and didn't completely go away for about 4-6 months.

My second, I did the therapy, and did more stretching. That seemed to make things much better and though my back get me, my shoulders have been fine after the first month. I think the stretching, massage, and heating pads helped in that area. I hope you feel better soon. Harry
 
I, too was told to not take Advil post-surgery and only Tylenol. Does anyone know the reason behind this (I am not on coumadin, only ASA). I would like to take some advil if this relieves the shoulder pain.

I am also on only ASA, but I also have a genetic clotting disorder, so I have not only a cardio and cardiac surgeon, but also a hematologist. Here's the explanation I got from him on the Advil/Tylenol issue, in laymen's terms:

There are "notches" in the clotting cells, that lock together to form a blood clot. Either aspirin (ASA) or ibuprofen (Advil/Motrin) fit into those notches and block the cells' ability to lock together. The difference between the two meds is that aspirin locks in permanently, while ibuprofen is a temporary block. In other words, when a cell is locked by an aspirin molecule, it's locked for the life of the cell, while the ibuprofen block "falls out" after a while. The problem with taking the two meds together is that the Advil may get to the notches before the ASA, giving you only short-term protection, rather than the long-term your doctor thinks you're getting. If that is the concern behind your doctor's "no Advil rule," it may be possible to take both, but they should be taken two hours apart, so they aren't competing for the same notches. But it's easier to just say, "Don't take both."

Might not hurt to discuss it further with your doctor.
 
Thanks for the great explanation, Marcia. I don't mean to highjack your thread, Wristshot, but thought this article from Biology Newsnet might be of interest regarding the possible interaction of advil and ASA (aspirin) as Marcia explained. I recognize it is only one study and couldn't find any more info at this point.

March 2008

Stroke patients who use ibuprofen for arthritis pain or other conditions while taking aspirin to reduce the risk of a second stroke undermine aspirin’s ability to act as an anti-platelet agent, researchers at the University at Buffalo have shown.

In a cohort of patients seen by physicians at two offices of the Dent Neurologic Institute, 28 patients were identified as taking both aspirin and ibuprofen (a nonsteroidal anti-inflammatory drug, or NSAID) daily and all were found to have no anti-platelet effect from their daily aspirin.

Thirteen of these patients were being seen because they had a second stroke/TIA while taking aspirin and a NSAID, and were platelet non-responsive to aspirin (aspirin resistant) at the time of that stroke.

The researchers found that when 18 of the 28 patients returned for a second neurological visit after discontinuing NSAID use and were tested again, all had regained their aspirin sensitivity and its ability to prevent blood platelets from aggregating and blocking arteries.

The study is the first to show the clinical consequences of the aspirin/NSAID interaction in patients being treated for prevention of a second stroke, and presents a possible explanation of the mechanism of action.

The Food and Drug Administration currently warns that ibuprofen might make aspirin less effective, but states that the clinical implications of the interaction have not been evaluated.

“This interaction between aspirin and ibuprofen or prescription NSAID’s is one of the best-known, but well-kept secrets in stroke medicine,” said Francis M. Gengo, Pharm.D., lead researcher on the study.

“It’s unfortunate that clinicians and patients often are unaware of this interaction. Whatever number of patients who have had strokes because of the interaction between aspirin and NSAIDs, those strokes were preventable.”

Gengo is professor of neurology in the UB School of Medicine and Biomedical Sciences and professor of pharmacy practice in the UB School of Pharmacy and Pharmaceutical Sciences. Results of the study were published in the January issue of the Journal of Clinical Pharmacology.

“We first looked at this issue way back in 1992 in a study conducted in normal volunteers, but it was published as an abstract only,” he said. “We never followed through with a manuscript, but another group published an elegant study in the New England Journal of Medicine showing this interaction at least seven years ago.

“When we began to assess this in our stroke patients, a surprisingly high percentage of a group of 653 patients, around 17 percent, were taking aspirin plus Motrin [a brand of ibuprofen].

“The prescription medication Aggrenox, which also is used for secondary stroke prevention and contains aspirin and extended release dipyridamole, is affected the same way as aspirin,” Gengo continued. “In preventing strokes, it is statistically a little better than aspirin but more expensive.

“However, one of the most common side effects when you first start taking Aggrenox is headache, so some physicians, pharmacists or physician assistants tell patients to take a Motrin so they don’t get a headache. This likely would negate the effects of the aspirin and extended release dipyridamole. Those patients might as well take this expensive drug and flush it down the toilet.”

Gengo and colleagues verified with urine testing that all 18 patients, six men and 12 women, were taking their aspirin or aspirin and extended release dipyridamole as directed. Information on the concomitant use of NSAIDS was obtained from patient interviews. Data from the earlier healthy volunteer study showed the magnitude and time course of each drug administered separately, as well as in combination.

The UB study provides important information, Gengo noted, because in most previous studies, measurements were taken only at one point in time, and that time point may have been during the 4-6 hour window when concentrations of NSAIDS were sufficiently high to inhibit aggregation.

“Our data report the entire time course of this interaction,” he said. “The results showed that platelets resumed aggregating within 4-6 hours when aspirin and ibuprofen were taken close together, leaving patients with no anti-platelet effect for 18-20 hours a day. Normally, a single dose of aspirin has an effect on platelet aggregation for 72-96 hours,” Gengo said.

“When I lecture to pharmacy students, I tell them ‘Please, you have a responsibility to the patients you care for. When you counsel a patient taking aspirin/extended release dipyrdamole to lower stroke risk, tell patients they may have some transient headaches, but to avoid ibuprofen. You may have prevented that patient from having another stroke.’”

Source : University at Buffalo
 
Collateral Damage

Collateral Damage

Everyone is different. I had my AVR in August of 08, and still sometimes when I reach a certain way, or pull I still get a twinge from time to time. I blame it somewhat on age too! (70) We should all be thankful we're over the mountain now and are feeling much better!! :)
 
Thanks for the great explanation, Marcia. I don't mean to highjack your thread, Wristshot, but thought this article from Biology Newsnet might be of interest regarding the possible intereaction of advil and ASA (aspirin use) as Marcia explained. I recognize it is only one study and couldn't find any more info at this point.

Thanks for providing this information -- Marcia, too.

I think this is the best explanation yet for the potential interaction between aspirin and ibuprofen (disclaimer: speaking as a biochemist NOT a physician!). And it's certainly very topical for all of us trying to manage various types of post-operative pain along with our basket of daily meds.

Truly appreciate all the help I've received here.
 
And it's certainly very topical for all of us trying to manage various types of post-operative pain along with our basket of daily meds.

Basket? Why wasn't I informed of this? I have an entire drugstore right here at home. :)
 
Me too. But both shoulders, back, and arms. Was terrible. Had it up to about 4 to 5 weeks after surgery. I am told also, how they stretch you out on the operating table. Try mild exercise and stretching, it should go away.
Neal
 
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