A week after surgery, my story

[Trinalovescats]

Dreamy885-

Welcome to the club.I had Mitral Valve Replacement and Triscupid Repair on May 3,2016.I was 31 and misdiagnosed with asthma
back in 2015,when it fact it was my heart failing.

How long were you in the hospital?

in my case,I was sedated for 6 days and was in the hospital for a total of two weeks!

glad your doing better!
remember,pace yourself ok?

 

[dreamy885]

Hi

glad to read (even if I don't reply much) that you're doing well ...



firstly I'll observe that you have a low dose ... its not of particular meaning one way or the other but just is. I'm willing to bet that a blood test would turn up a genotype known for this.

its not good nor bad, just is. The only "issue" is that it makes managing your dose that bit trickier as the standard pill sizes are made to make management of accurate dose easier for folks between 7 and 14mg daily dose.



astute observation and supported by our existing knowledge

http://www.medicine.ox.ac.uk/bandolier/booth/AF/paraod.html




all seems prudent and appropriate. More broadly I generally feel uncomfortable with tow things:

• thinking in weekly doses
• the alternation of doses by significant margins

However in your case the alternations are within relatively fine practical limits and I don't think its any issue.

If you are interested PM me and I'll set up a Google sheet for you and you can then input the data and monitor it yourself. I believe that even if you accept the management of another party that knowing how to "take the wheel" is important for your own long term comfort and self confidence. It can (for instance should you travel) take one more worry out of things knowing that you know how.

At the very least it increases your own awareness of yourself and takes it that extra step past being a "managed patient" into a feeling that you understand and know what's happening and can anticipate well what may happen. If you need to take control for some reason, you'll then know you can.

Best Wishes

Thank you I can't get the link you sent to work, it say's "Object not found." Anyway, I'm completely off Tylenol (and any other pain meds) now, I'm also off the beta blocker and water pill so I'm only taking my warfarin and a baby aspirin. I guess I'm thinking in weekly doses since they are testing me weekly and they always mention how many mg I've taken the prior week. I think that's a great idea for me to set up a spreadsheet. I don't know when I'll start self-testing as my insurance doesn't cover the machine, but will cover INR testing in the doctor's office. Eventually I'll spend the money when I feel comfortable enough to do it on my own. I'll be starting cardiac rehab next week, it's in the same building that I get my INR tested, so it's not too much of a hassle.

 

[pellicle]

Thank you I I think that's a great idea for me to set up a spreadsheet. I ..., so it's not too much of a hassle.

Send me a PM and we'll work it out

 

[Protimenow]

There's on thing that may not have been absolutely clear. Thinking in weekly doses is the way that dosing management is done -- but if you're taking different doses, be sure to alternate days when you take the doses. For example, 2 mg for four days, and 3 mg for 3 days -- just be sure that you alternate between the 2 mg and 3 mg doses - otherwise, your INR test results may vary, depending on the day you're fested. (If you're tested after four days at 2 mg, your INR would probably be lower than it is if you're tested after three days of 3 mg - alternating doses will give you a more usable result).

Home testing is also somethihng you should consider -- it gives you more control (or at least information). I've been self testing for 8 years and don't intend to ever rely on clinics for testing (although I have an occasional blood draw to compare the lab results to my meter's results).

 

[pellicle]

Hi

There's on thing that may not have been absolutely clear. Thinking in weekly doses is the way that dosing management is done

actually, I'd phrase it more as "Thinking in weekly dosing is the old fashioned way that dosing was done (and may still be done in historical thinking places)"

there is no sound argument that can be made for weekly dosing, and indeed there are reasons why you should abandon it as a relic.

As you yourself argue:

-- but if you're taking different doses, be sure to alternate days when you take the doses. For example, 2 mg for four days, and 3 mg for 3 days -- just be sure that you alternate between the 2 mg and 3 mg doses - otherwise, your INR test results may vary, depending on the day you're fested. (If you're tested after four days at 2 mg, your INR would probably be lower than it is if you're tested after three days of 3 mg - alternating doses will give you a more usable result).

so you immediately need to think about more.

Thinking in "weekly dosing" would have you think that:

Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday	Weekly dose
3	7	9	9	9	2	2	35

was the same as taking 5mg as your daily dose. Yet a test on Saturday would give you an entirely biased result.

Why not just think in daily dose? After all every other medication you take is dosed that way.

The weekly dose paradigm is only logical to those who grew into it and also factor in the idea that one needs to be even. So why not just "be even" and think of the target. I've never even heard of that "weekly dose" stuff till I came here. My Sister-In-Law (who is a sales rep for a pharma company) is now training clinic staff here in Finland and the methods they teach are daily dose.

Same goes for INR management around "a range" or a target INR. If you think in quality management terms it makes sense to aim for a target than "anywhere on the paper is fine".

Lastly I'm not sure that self testing suits everyone (it sure suits me), and there is a good argument to be made for using your clinic and still learning about your own INR and still learning what happens to it by recording and observing. For starters you may then make observations and feed into the clinics decision making process. They will appreciate it (or not if they're jerks) and you may get just as good outcomes that way.

Myself I find the liberty of not needing to make the journey and sit on my arse waiting for a clinician, finding parking and taking time out of my day worth while. Some folks however look forward to the trip out to the Drs office....

Each has their own priorities.

 

[dreamy885]

Just figured out how to make a little chart like you did So this was my dosing from last Wed to yesterday:

MON	TUES	WED	THURS	FRI	SAT	SUN	TOTAL
3	2	3	2	3	2	2	17MG

My INR was 2.0 yesterday (last wed it was 2.1)

They added 2mg to my next week by changing Thurs and Sun to 3mg. I don't understand why they wouldn't raise my dosage by a little more than just 2mg for the week. The whole thing confuses me and I'm trying not to worry about it going down.

Anyway, I started back at work, doing hair, it's going well. I've been doing some driving, a little shy of 4 weeks. I actually can't believe tomorrow is 4 weeks post op!! I start cardiac rehab tomorrow too. Technically I have my "interview" and then they introduce me to the treadmill and all that, kinda nervous because I've never been a person who works out. What was everyone else's experience with cardiac rehab? They said it's 3 days a week for 6 weeks, I had no idea it would be that much!

Has anyone else had an internal suture poking out through their incision? I figured it would go away on it's own but everything is healed except right where that is. I tried pulling on it with tweezers but it doesn't want to budge.

 

[pellicle]

Hi

Just figured out how to make a little chart like you did

So this was my dosing from last Wed to yesterday:
...
They added 2mg to my next week by changing Thurs and Sun to 3mg. I don't understand why they wouldn't raise my dosage by a little more than just 2mg for the week. The whole thing confuses me and I'm trying not to worry about it going down.
.

It can be vexing when dealing with others controlling your INR and doing things you disagree with.

I don't recall if you have the On-X valve, but even if you have a St Jude or another bileaflet valve an INR of 2 for a short time shouldn't be threatening. Myself I'd have probably upped a few more of those 2's to 3's

It's also true thst as you heal you are likely to experience a need to raise your dose bu a few % to keep your INR in range.

 

[FredW]

Hi Heather, From what you say you are doing, it sounds like your recovery is going well. I suspect your doc may have an issue with you driving so early. It's the concern of having an accident and the safety belt and air bag doing damage to your sternum, which may not be healed enough to handle an accident. But, saying that, I also drove before they officially allowed me. Just be careful.

My cardiac physical therapy also stared on the treadmill. Being monitored with a heart monitor, they didn't allow me to even work up a sweat. I pushed the envelope and tried to work harder, but they would look at me with an evil eye and tell me to slow down. Of course, you being younger, they may allow earlier and more strenuous activity. It is nothing to worry about, but it may give you some good tips about getting your heart conditioned and restored from the surgery.

Being patience with yourself both mentally, emotionally and physically may be in order.

Best to you and your recovery.

Fred

 

[MartinF]

Hi Heather,

You shouldn't be concerned about Cardiac Rehab. They will monitor your heart during easy exercise. Mine was 20 minutes on an exercise bike, some light weights, 20 minutes on a treadmill and then some stretching. They also measured blood pressure during the exercise. This is more for your recovery from surgery. But you will need to do regular cardio exercising even after rehab. I've been post-surgery almost 5 years and still walk 4-5 days a week. Would do more but work gets in the way. My cardiologist also want me to do this.

Glad to hear your recovery is finally going well.

Martin

 

[Paleowoman]

What was everyone else's experience with cardiac rehab? They said it's 3 days a week for 6 weeks, I had no idea it would be that much!.

Hi Heather - for cardiac rehab I started out with a lot of fast walking and light weight lifting exercises, but then one of the exercises screwed an old ankle injury and I could hardly walk so the cardiac nurse devised a weight lifting program for me which I loved as I had been doing weight lifting prior to surgery. This gave me confidence in being able to weight lift again, something I have continued to do (except the last few weeks cardiologist has told me to stop weight lifting - another story). I also walk several miles a day. I love to exercise. I hope you are enjoying your rehab classes !

 

[epstns]

Heather - I did the "standard" cardiac rehab, and I'm very glad I did. Like Anne, I was a 5 days a week gym rat for many years prior to surgery. I was 63 at the time, and worried that I would never get back to any significant level of fitness after recovery. I discussed rehab with my cardiologist and we agreed that it made sense for me.

The "class" was 36 one-hour sessions, Monday - Wednesday - Friday for 12 weeks. I scheduled it so that I could go to work as usual in the morning but leave a couple of hours early to get to class. On Tuesday and Thursday after work, I went to my usual fitness center and did exactly the same routine I had done the day before at rehab.

In my rehab class, we usually did 20 minutes on an Airdyne stationary bicycle (the kind where the faster you pedal, the harder it gets), followed by 20 minutes on a treadmill, and finally some light free weights. This was all tailored to the current abilities of each patient, and our heart rates were monitored in real-time, wirelessly. At the start of the 12-week class, I could walk, but not fast and not on an incline. By the end of the 12 weeks I could jog comfortably on a treadmill inclined about 5%, and not be breathless. I started out with 4-pound hand weights and ended at 12-pound weights. Remember - I was in good shape before surgery, so your progress may differ, but you will progress I'm sure.

I was sort of the class clown in rehab, too. Whenever the tech would ask me "Do you think you can. . . . ?" I would just say "Bring it on, 110%!" I pushed hard, knowing that they would never let me hurt myself. (I know for sure that I was the only one in a class of 12 who broke a sweat.) This in itself gave me the confidence to just go back to my life, in spite of my new valve, bypass and pacemaker, and now I'm over 6 years out and haven't looked back.

 

[dreamy885]

Heather - I did the "standard" cardiac rehab, and I'm very glad I did. Like Anne, I was a 5 days a week gym rat for many years prior to surgery. I was 63 at the time, and worried that I would never get back to any significant level of fitness after recovery. I discussed rehab with my cardiologist and we agreed that it made sense for me.

The "class" was 36 one-hour sessions, Monday - Wednesday - Friday for 12 weeks. I scheduled it so that I could go to work as usual in the morning but leave a couple of hours early to get to class. On Tuesday and Thursday after work, I went to my usual fitness center and did exactly the same routine I had done the day before at rehab.

In my rehab class, we usually did 20 minutes on an Airdyne stationary bicycle (the kind where the faster you pedal, the harder it gets), followed by 20 minutes on a treadmill, and finally some light free weights. This was all tailored to the current abilities of each patient, and our heart rates were monitored in real-time, wirelessly. At the start of the 12-week class, I could walk, but not fast and not on an incline. By the end of the 12 weeks I could jog comfortably on a treadmill inclined about 5%, and not be breathless. I started out with 4-pound hand weights and ended at 12-pound weights. Remember - I was in good shape before surgery, so your progress may differ, but you will progress I'm sure.

I was sort of the class clown in rehab, too. Whenever the tech would ask me "Do you think you can. . . . ?" I would just say "Bring it on, 110%!" I pushed hard, knowing that they would never let me hurt myself. (I know for sure that I was the only one in a class of 12 who broke a sweat.) This in itself gave me the confidence to just go back to my life, in spite of my new valve, bypass and pacemaker, and now I'm over 6 years out and haven't looked back.

They say I'll go 3 days a week for 6 weeks, my insurance will cover 12 weeks though. I got a bit of a late start it sounds like, I didn't start till 4 weeks out. All we do is stretch/warm up and then I walk on a treadmill for 40 minutes. It's mostly just boring, yesterday I brought my phone and some headphones to watch Netflix on It's been so hot and humid here lately (Iowa), it's hard to walk on my days off from rehab but I managed to do it on Tuesday, found a little trail behind the school where my son takes speech classes on Tuesdays.

With it being so hot, I've been wanting to take my boys swimming but I can't find a clear answer on when it's okay to start soaking your incision. Everything just says until it's healed. To me it looks healed, but I'm not a professional. I still have a darn stitch sticking through my incision...I've got an appointment on the 22nd with my surgeon's PA, so I'll ask her about that then.

 

[epstns]

Don't worry about your "late start" at rehab, Heather. I was not cleared to start rehab until I was 12 weeks out from surgery, due to the several complications I had in recovery (primarily nasty digestive issues, pleural effusion and fluid retention). I was actually back at work full-time before I started rehab.

If they have you walking on a treadmill, are they monitoring and increasing your pace? My rehab tech's kept increasing my speed, and when it got so fast that I was almost jogging (which I would have liked), they slowed it down and started increasing the incline percentage to add effort. The treadmill can be good exercise, but they have to continue to challenge you so that you improve your cardio efficiency over time.

Can't help about swimming. We took out our backyard pool about 15 years ago, and I don't swim in the lake (you know - fish poop in there. . . ).

 

[dreamy885]

Don't worry about your "late start" at rehab, Heather. I was not cleared to start rehab until I was 12 weeks out from surgery, due to the several complications I had in recovery (primarily nasty digestive issues, pleural effusion and fluid retention). I was actually back at work full-time before I started rehab.

If they have you walking on a treadmill, are they monitoring and increasing your pace? My rehab tech's kept increasing my speed, and when it got so fast that I was almost jogging (which I would have liked), they slowed it down and started increasing the incline percentage to add effort. The treadmill can be good exercise, but they have to continue to challenge you so that you improve your cardio efficiency over time.

Can't help about swimming. We took out our backyard pool about 15 years ago, and I don't swim in the lake (you know - fish poop in there. . . ).

They do monitor my incline and speed but they never tell me to increase it, that's all up to me I guess. Today I did push myself a little harder, but I'm not jogging yet. The room gets so hot with everyone exercising, I was mostly just uncomfortable from the heat today! I take the stairs to and from rehab where everyone else takes the elevator, I also don't worry about getting a close parking spot. Little things like that to challenge myself are helping. I'm wondering if I can start doing some exercises at home, like squats, planks, wall sits, etc.

 

[MartinF]

Heather, do workouts at home, just don't overdo it. I walked an hour on the days I didn't have rehab and kept it up after rehab. I also picked up some free weights at Goodwill for home workouts (can't seem to get that into a regular routine). Regular exercise will make a difference.

 

[Paleowoman]

I'm wondering if I can start doing some exercises at home, like squats, planks, wall sits, etc.

The cardiac rehab nurse I had told me to do rehab at home inbetween sessions and gave me a print out of an exercise programme to do. I would guess, Heather, though I might be wrong, but many of the people in your rehab class were not fit before surgery/heart attack. How many are in your age group ? How many had surgery for a genetic problem like bicuspid aortic valve ? Ask the rehab nurse running the course what you can do at home. Do you have a heart rate monitor and have you been told what to take your heart rate up to so that you can monitor yourself when exercising ?

 

[dreamy885]

The cardiac rehab nurse I had told me to do rehab at home inbetween sessions and gave me a print out of an exercise programme to do. I would guess, Heather, though I might be wrong, but many of the people in your rehab class were not fit before surgery/heart attack. How many are in your age group ? How many had surgery for a genetic problem like bicuspid aortic valve ? Ask the rehab nurse running the course what you can do at home. Do you have a heart rate monitor and have you been told what to take your heart rate up to so that you can monitor yourself when exercising ?

Nobody in my class is in my age group, closest one is probably late 50's and she has an arrhythmia. I do have a HR monitor, I'll have to ask what they want me to keep it below. I can already tell that this shiny new valve is functioning much better than my old one, just by how low my HR is staying during exercise. I'm just anxious to lose weight and I can't seem to do it with diet right now, or at least I have to be careful because my INR has been below range and dropping for 3 straight weeks. Once they get it in range I'm going to ask them if I can start eating greens and if we can just increase my doseage or something. I'm 20lbs heavier than what I'm used to, and I'm thinking the birth control (IUD) could be a culprit. Either way, exercise is always good

 

[epstns]

It sounds like you're on the right track, Heather. Whatever they ask of you in rehab. . . do that and a bit more. Don't push hard enough to cause yourself pain or shortness of breath, but do realize that your heart has been "fixed" and that it will not break if you stress it a bit. You will know when you've pushed too far.

When it comes to exercises at home, just be aware of your body's state of healing. Don't do things that cause pain, as some soft tissue (e.g. pectorals) as well as your sternum, will take some time to hear properly.

Did I also mention push-ups? I've always done them (well, since army training in 1970), but after my OHS I could not stand to do them for a whole year. I finally got back to it, but even now 6 years later, I can't do as many as I used to. Oh, well, I just admit to getting older. . .

 

[ClickityClack]

I missed the last half of this thread so I'm just catching up.

Heather, I can't believe you were cutting hair 4 weeks post op. I'm just getting past the tightness and soreness in my chest when I reach above my shoulders (5 weeks post op). It's still pretty tender and my strength is terrible - just steering the dang mower for an hour whooped me pretty good.

The incision is looking really good too. Mine is very pink, is fairly wide in spots and still has some glue on it. Oh, and I still have a bit of a lump at the top where the connective tissue bunched up.

I think I'll start cardiac rehab in a couple weeks. The only VA facility that offers it is an hour and a half drive each way so they offered me some kind of remotely monitored cardiac rehab program. I think I'll be one of the first in the area to do it. I'll let everyone know how it goes.

 

[dreamy885]

I missed the last half of this thread so I'm just catching up.

Heather, I can't believe you were cutting hair 4 weeks post op. I'm just getting past the tightness and soreness in my chest when I reach above my shoulders (5 weeks post op). It's still pretty tender and my strength is terrible - just steering the dang mower for an hour whooped me pretty good.

The incision is looking really good too. Mine is very pink, is fairly wide in spots and still has some glue on it. Oh, and I still have a bit of a lump at the top where the connective tissue bunched up.

I think I'll start cardiac rehab in a couple weeks. The only VA facility that offers it is an hour and a half drive each way so they offered me some kind of remotely monitored cardiac rehab program. I think I'll be one of the first in the area to do it. I'll let everyone know how it goes.

I actually started back doing hair at 3 weeks post op (and did a couple people here and there even before that!) My pain after surgery was horrible. I hear from a lot of people who are much older than I am, that they weren't in a lot of pain after surgery. I would say 2 and a a half weeks was my turning point but there's no way I would have steered the lawn mower around, I still haven't done that! I am pretty amazed at my incision, I mean most of what is seen is my old scar, the fine pink line next to it is my incision from this time around. I'm enjoying cardiac rehab other than how warm that room gets. I go to work after it so I feel all gross afterwards and all I'm doing is walking.