Isis
Well-known member
new_onx_34 was scheduled to have AVR on Sept. 10th; one day before me. Have not seen posts yet on his status. Anybody have any news?
Isis
Isis
Any Word From "new_onx_34"
- Thread starter Isis
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P
Phyllis
No word, Isis.
Hope all is alright and someone hears soon!
Hope all is alright and someone hears soon!
N
new_onx_34
On the path to recovery
On the path to recovery
Thanks for checking on me. Sorry for not posting earlier but every time I thought I'm ready, something came up (more below).
Thanks everyone for their best wishes and kind words of encouragement. I?m feeling much better now and here is how I spent my last month.
Once the decision to go through the surgery was made, it was just a matter of waiting for September 10th. Surgery was scheduled for 7:30 AM and we were to reach there by 6:00.
Reached Beth Israel before 6:00 and waited for the check-in clerk to arrive at 6:00. They take all surgery patients to one area for preparation. Looks like there was some screw-up and waited till 11:00 for the surgery. I don?t have any memory for next 8-12 hours but my wife remembers every minute of it.
Woke up in the ICU with breathing tube down my throat but took a big sigh of relief knowing that the surgery is DONE. Nurses in the ICU took wonderful care of me all night. Next morning bunch of doctors and nurses came and announced that there is some air trapped inside and they have to put a tube from the side of my chest to get the air out.
They promised me that I?ll get local anesthesia and I?ll not feel more than some pressure, but in reality, getting the tube inserted was the most painful thing in my life so far.
Rest of the stay was more or less uneventful and I got discharged on 15th. I was happy to be home but I started having some dizziness and lightheadedness next day but at the time I thought it was the reaction to the medication I was taking. Visiting nurse came on Monday September 17th and was puzzled by my heart rate and pulse. Called doctor office and they asked to go to nearest ER. Given that I was still convinced that it is the reaction to the medication, we called Taxi and went to Metrowest Hospital in Framingham.
Within half an hour I was surrounded by doctors and I was told that I?ve a complete heart block and I?ll need a pacemaker right away. After hours of argument with the doctors I accepted the fact that I do have a problem and got the pacemaker that day.
Spent next 3 uneventful days at the hospital and came home again on September 20th. Echo report before the discharged looked great. EF is still low but my LV is back to normal in size.
Next few days were spent in following up with doctors/hospital about both the surgeries. As I started to feel better, I developed acute pain in my left shoulder and arm. Initial I thought that the pain is due to the pacemaker and tried to control it using ice pack but as the pain started to spread to other joints in the arms and leg, it was clear that it is more serious.
After few fanatic calls to the doctors, I was told that I can thank Lipitor for this acute muscle and joint pain. Apparently it is a known side effect and only solution is to just bear it for few days. Now the pain is gone and I?m back to the uneventful recovery and hope there are no more surprises.
I would like to note that the issues I faced are rare and most people having AVR recover without a hitch.
On the path to recovery
Thanks for checking on me. Sorry for not posting earlier but every time I thought I'm ready, something came up (more below).
Thanks everyone for their best wishes and kind words of encouragement. I?m feeling much better now and here is how I spent my last month.
Once the decision to go through the surgery was made, it was just a matter of waiting for September 10th. Surgery was scheduled for 7:30 AM and we were to reach there by 6:00.
Reached Beth Israel before 6:00 and waited for the check-in clerk to arrive at 6:00. They take all surgery patients to one area for preparation. Looks like there was some screw-up and waited till 11:00 for the surgery. I don?t have any memory for next 8-12 hours but my wife remembers every minute of it.
Woke up in the ICU with breathing tube down my throat but took a big sigh of relief knowing that the surgery is DONE. Nurses in the ICU took wonderful care of me all night. Next morning bunch of doctors and nurses came and announced that there is some air trapped inside and they have to put a tube from the side of my chest to get the air out.
They promised me that I?ll get local anesthesia and I?ll not feel more than some pressure, but in reality, getting the tube inserted was the most painful thing in my life so far.
Rest of the stay was more or less uneventful and I got discharged on 15th. I was happy to be home but I started having some dizziness and lightheadedness next day but at the time I thought it was the reaction to the medication I was taking. Visiting nurse came on Monday September 17th and was puzzled by my heart rate and pulse. Called doctor office and they asked to go to nearest ER. Given that I was still convinced that it is the reaction to the medication, we called Taxi and went to Metrowest Hospital in Framingham.
Within half an hour I was surrounded by doctors and I was told that I?ve a complete heart block and I?ll need a pacemaker right away. After hours of argument with the doctors I accepted the fact that I do have a problem and got the pacemaker that day.
Spent next 3 uneventful days at the hospital and came home again on September 20th. Echo report before the discharged looked great. EF is still low but my LV is back to normal in size.
Next few days were spent in following up with doctors/hospital about both the surgeries. As I started to feel better, I developed acute pain in my left shoulder and arm. Initial I thought that the pain is due to the pacemaker and tried to control it using ice pack but as the pain started to spread to other joints in the arms and leg, it was clear that it is more serious.
After few fanatic calls to the doctors, I was told that I can thank Lipitor for this acute muscle and joint pain. Apparently it is a known side effect and only solution is to just bear it for few days. Now the pain is gone and I?m back to the uneventful recovery and hope there are no more surprises.
I would like to note that the issues I faced are rare and most people having AVR recover without a hitch.
P
Phyllis
Wow, you have had your share of "bumps in the road", but so glad that you reported in and glad things are finally going well for you. Keep us informed and best wishes to you.
K
Karlynn
So much for doing things the easy way. I hope you are on the smooth road now. Wishing you the very best.
N
new_onx_34
List of questions
List of questions
Here are some of the questions lingering in my mind.
1. Loud heartbeats
Since the surgery I hear my heart beating most of the time. It could be due to ON-X valve but I was wondering if other people have similar experience. May be I'm now more sensitive to my heart
2. Medication
I'm off the most medication except low-pressure (Metoprolol). I was wondering how long this medication will continue.
3. INR
My INR is still not stable. How long it takes to get to stable INR? Also what is the INR goal for ON-X in aortic position? Surgeon says 2-2.5, Cardiologist who is not very familiar with ON-X says 2-3 while coumadin clinic people say 2.5-3.5.
4. Pacemaker
So far doctors think that my heart block was due to some inflammation and I'll not need pacemaker in the long run. Anyone has experience getting pacemaker removed? My surgeon said that he has not seen anyone develop heart block after going home and he is very confident that it is temporary. He mentioned that I had right bundle block after the surgery but it seems it is common after AVR.
List of questions
Here are some of the questions lingering in my mind.
1. Loud heartbeats
Since the surgery I hear my heart beating most of the time. It could be due to ON-X valve but I was wondering if other people have similar experience. May be I'm now more sensitive to my heart
2. Medication
I'm off the most medication except low-pressure (Metoprolol). I was wondering how long this medication will continue.
3. INR
My INR is still not stable. How long it takes to get to stable INR? Also what is the INR goal for ON-X in aortic position? Surgeon says 2-2.5, Cardiologist who is not very familiar with ON-X says 2-3 while coumadin clinic people say 2.5-3.5.
4. Pacemaker
So far doctors think that my heart block was due to some inflammation and I'll not need pacemaker in the long run. Anyone has experience getting pacemaker removed? My surgeon said that he has not seen anyone develop heart block after going home and he is very confident that it is temporary. He mentioned that I had right bundle block after the surgery but it seems it is common after AVR.
new_onx_34 said:Here are some of the questions lingering in my mind.
1. Loud heartbeats
Since the surgery I hear my heart beating most of the time. It could be due to ON-X valve but I was wondering if other people have similar experience. May be I'm now more sensitive to my heart
2. Medication
I'm off the most medication except low-pressure (Metoprolol). I was wondering how long this medication will continue.
3. INR
My INR is still not stable. How long it takes to get to stable INR? Also what is the INR goal for ON-X in aortic position? Surgeon says 2-2.5, Cardiologist who is not very familiar with ON-X says 2-3 while coumadin clinic people say 2.5-3.5.
4. Pacemaker
So far doctors think that my heart block was due to some inflammation and I'll not need pacemaker in the long run. Anyone has experience getting pacemaker removed? My surgeon said that he has not seen anyone develop heart block after going home and he is very confident that it is temporary. He mentioned that I had right bundle block after the surgery but it seems it is common after AVR.
Justin tends to go into complete heart block after caths and some surgeries, he had a cath when he was 10 and had ER surgery the next day for his conduit and ended up getting a pacemaker at the same time because he was in complete heart block. In a couple months his heart got back to his nomal rythm (he always has RBBB since his 1st or 2nd surgery and usually 1st degree heart block)) and it didn't fire again until he had his next cath 2 years later. and then only for a couple months. When he was 16 it was malfunctioning and had to be removed, since he wasn't in heart block at the time they didn't replace it, since it was in his abdomen and they want his next one in his shoulder area, so that would have been 2 surgeries. So they decided to leave it out until he needs one again. He has had 2 more caths and 3 more surgeries since the pacer was removed and so far he hasn't needed it replaced.(knock on wood)
I'm glad you posted. I have no comments since I am pre surgery but wanted to wish you luck.
WayneGM
Well-known member
Welcome back. Thanks for your update. It sure sounds like you had a bit of a bumpy road, but hope you are on smooth pavement now. Unfortunately, I can't help you with your questions as I didn't have any of these experiences. Best wishes for a smooth, uneventful, recovery from now on.
ALCapshaw2
Well-known member
The USUAL recommendation for INR following AVR with a Mechanical Valve is 2.0 to 3.0. Your Surgeon's recommendation of 2.0 to 2.5 'might' be appropriate for the On-X valve, but best to wait until the Low INR studies are completed. Besides, it is Very Difficult to maintain a window of only 0.5 given that is mostly taken up by 'test to test variation' so my recommendation would be to just stick with the 2.0 to 3.0 range.
Note that the 2.5 to 3.5 Range is the usual recommendation for MITRAL Valve Replacement or AVR patients with other risk factors (typically stroke related risks). Some MVR patients are even advised to go up to 3.0 to 4.0 if there are other risk factors.
MOST of us never have a Bleeding Problem even up to 5.0
Until proven otherwise, it is best NOT go Below 2.0 because of increased risk of stroke.
Bottom Line: An INR of 2.0 to 3.0 is SAFE and Managable for your AVR.
'AL Capshaw'
Note that the 2.5 to 3.5 Range is the usual recommendation for MITRAL Valve Replacement or AVR patients with other risk factors (typically stroke related risks). Some MVR patients are even advised to go up to 3.0 to 4.0 if there are other risk factors.
MOST of us never have a Bleeding Problem even up to 5.0
Until proven otherwise, it is best NOT go Below 2.0 because of increased risk of stroke.
Bottom Line: An INR of 2.0 to 3.0 is SAFE and Managable for your AVR.
'AL Capshaw'
P
PeggyM
new_onx_34,
I've been putting up with my loud mechanical AR since the first one 15 years ago. You get use to it. You can have fun with it too, confusing people in quiet rooms and such. I use to tell some people it was my watch. Or I'd tell them, "Wow your watch is loud." LOL.
I've been putting up with my loud mechanical AR since the first one 15 years ago. You get use to it. You can have fun with it too, confusing people in quiet rooms and such.
I use to tell some people it was my watch. Or I'd tell them, "Wow your watch is loud." LOL.
Soilman
Well-known member
I had an On-X installed on Aug. 21. For the first week or two, my heartbeat was "strong" as well. It seems to be gradually decreasing.
I'm also on Metaprolol. Doc. say's I'll eventually get off it unless I experience irregular beats or something.
Be patient with the INR. I was over 6 weeks out before I got mine over 2.0
I was also getting concerned about the length of time with a low INR.
Like you, I figured my INR would end up between 2.5 and 3.0. Since I cracked the 2.0 two weeks ago (2.3 last week, 2.2 this week) my cardiologist has been satisfied and kept my coumadin at the same level.
I have an appointment in mid Nov. I'll try to remember to ask about it then.
As long as it's safe, being on the lower end of the INR is fine with me. I get cut, scratched and bruised a lot. So far, it's been no big deal and I've not noticed a big difference in bleeding.
I'm also on Metaprolol. Doc. say's I'll eventually get off it unless I experience irregular beats or something.
Be patient with the INR. I was over 6 weeks out before I got mine over 2.0
I was also getting concerned about the length of time with a low INR.
Like you, I figured my INR would end up between 2.5 and 3.0. Since I cracked the 2.0 two weeks ago (2.3 last week, 2.2 this week) my cardiologist has been satisfied and kept my coumadin at the same level.
I have an appointment in mid Nov. I'll try to remember to ask about it then.
As long as it's safe, being on the lower end of the INR is fine with me. I get cut, scratched and bruised a lot. So far, it's been no big deal and I've not noticed a big difference in bleeding.
nickm3
Well-known member
new onx 34,
Really good to hear from you, had noticed your lack of a post surgery report but was afraid to ask.
If I remember correctly you had your AVR replaced along with a dacron grapht of your aorta? Am having similar surgery in about 2 weeks so you have put me a little more at ease.
Thanks and hope all continues to go well for you.
Nick
Really good to hear from you, had noticed your lack of a post surgery report but was afraid to ask.
If I remember correctly you had your AVR replaced along with a dacron grapht of your aorta? Am having similar surgery in about 2 weeks so you have put me a little more at ease.
Thanks and hope all continues to go well for you.
Nick
N
new_onx_34
Goodluck Nick
Goodluck Nick
Nick,
I'm sure you would do well. As I said in my post, the the complications I had are vary rare.
With so many other interesting things going on, I forgot to mention that my surgeon left my Ascending aorta alone. He said that he did not feel the need to replace it. I'm hoping that it will not dilate given that the valve is fixed.
Goodluck Nick
Nick,
I'm sure you would do well. As I said in my post, the the complications I had are vary rare.
With so many other interesting things going on, I forgot to mention that my surgeon left my Ascending aorta alone. He said that he did not feel the need to replace it. I'm hoping that it will not dilate given that the valve is fixed.
What a scary story.....looks like it will be smooth sailing ahead.
sue943
Well-known member
I had complete heart block two weeks after my surgery, they said it was due to digoxin toxicity. They couldn't give me a pacemaker straight away as my INR was 8.9, after a few days it settled down and I didn't need to have a pacemaker.
N
new_onx_34
more on my Heart block
more on my Heart block
Hi Sue943,
I'm so glade you mentioned about your heart block as I'm still wonder once in a while about what could have caused it.
I has surgery on Sept 10th and was discharged on 15th evening. I came home and I was tired but feeling ok. Took my medication and slept ok. Next morning I felt fatigued but nothing alarming. Took medication in the morning. While taking afternoon nap I felt dizziness but since I was sleeping, I didn't worry about it. Got up in the evening and I was still feeling tired but ok. Started having more frequent spells of dizziness. I was almost fainting for few seconds. I was drinking milk and cup fell on my lap which made my wife very worried. I was convinced that I'm having these symptoms because of the medication specially Metoprolol and Hydromorphone. I read the paper I got from the pharmacy and it clearly said that these medication could cause the symptoms I was having. My wife called few doctors and they agreed that if the symptoms are coming and going then it could be caused by medication.
It was very late in the night so we decided to go to the doc next morning. The dizziness became less frequent and it gave me reassurance that it will get better as the medication wears out. Next morning again I had few spells of dizziness and fainting. Later in the morning, visiting nurse came and she got worried when she could not get reliable pulse and blood pressure. She called my surgeon office and they asked me to go to ER.
At ER, I was told that I need a pacemaker due to complete heart block. I argued with the doctors that it is temporary and will go away soon but doctors said that this kind of heart block can not be caused by medication alone. Doc said that heart block is due to some inflammation caused by the surgery and medication is just making it worse. I wanted to wait it out but doctors and my wife was not at all comfortable leaving me in this condition so finally I gave up and got the pace maker.
Now I feel stupid about not taking my symptoms seriously and taking such a risk of staying at home for almost 24 hr with the heart block but I still think it was the medication while all the doctors still say that it was some inflammation from the surgery. Would I ever know?
Now I just hope that my next pacemaker check will tell me that I'm not using the pacer.
more on my Heart block
sue943 said:
Hi Sue943,
I'm so glade you mentioned about your heart block as I'm still wonder once in a while about what could have caused it.
I has surgery on Sept 10th and was discharged on 15th evening. I came home and I was tired but feeling ok. Took my medication and slept ok. Next morning I felt fatigued but nothing alarming. Took medication in the morning. While taking afternoon nap I felt dizziness but since I was sleeping, I didn't worry about it. Got up in the evening and I was still feeling tired but ok. Started having more frequent spells of dizziness. I was almost fainting for few seconds. I was drinking milk and cup fell on my lap which made my wife very worried. I was convinced that I'm having these symptoms because of the medication specially Metoprolol and Hydromorphone. I read the paper I got from the pharmacy and it clearly said that these medication could cause the symptoms I was having. My wife called few doctors and they agreed that if the symptoms are coming and going then it could be caused by medication.
It was very late in the night so we decided to go to the doc next morning. The dizziness became less frequent and it gave me reassurance that it will get better as the medication wears out. Next morning again I had few spells of dizziness and fainting. Later in the morning, visiting nurse came and she got worried when she could not get reliable pulse and blood pressure. She called my surgeon office and they asked me to go to ER.
At ER, I was told that I need a pacemaker due to complete heart block. I argued with the doctors that it is temporary and will go away soon but doctors said that this kind of heart block can not be caused by medication alone. Doc said that heart block is due to some inflammation caused by the surgery and medication is just making it worse. I wanted to wait it out but doctors and my wife was not at all comfortable leaving me in this condition so finally I gave up and got the pace maker.
Now I feel stupid about not taking my symptoms seriously and taking such a risk of staying at home for almost 24 hr with the heart block but I still think it was the medication while all the doctors still say that it was some inflammation from the surgery. Would I ever know?
Now I just hope that my next pacemaker check will tell me that I'm not using the pacer.
Jim P
Well-known member
New_Onx_34,
I'm sorry you had such a bad experience post-op and am hoping that you are starting to feel better at the 6-week point.
You had some questions. I can not help you on INR or the pacemaker, but for the others:
1. Loud heartbeats -- I also have heard the loud heartbeat ever since my AVR (8 1/2 months ago). There have been several threads on this site from people who have had the same experience. Do a keyword search on "Loud Heartbeat" "Strong Heartbeat" or other topics similar to that, and you will find these threads. It is apparently a common consequence of valve replacement surgery.
2. Medications -- You asked how long you would be taking a beta-blocker. I asked the same question in a thread several months ago and got many varied responses from other "OHS veterans" on this site. My conclusion was that "everybody is different" and "every cardiologist has their own plan of attack." Many completely stopped the meds -- some earlier and some later. Others are still taking them. I talked to my cardiologist last week, and he told me to expect to be on the beta-blocker for a long time -- maybe for the rest of my life.
I'm sorry you had such a bad experience post-op and am hoping that you are starting to feel better at the 6-week point.
You had some questions. I can not help you on INR or the pacemaker, but for the others:
1. Loud heartbeats -- I also have heard the loud heartbeat ever since my AVR (8 1/2 months ago). There have been several threads on this site from people who have had the same experience. Do a keyword search on "Loud Heartbeat" "Strong Heartbeat" or other topics similar to that, and you will find these threads. It is apparently a common consequence of valve replacement surgery.
2. Medications -- You asked how long you would be taking a beta-blocker. I asked the same question in a thread several months ago and got many varied responses from other "OHS veterans" on this site. My conclusion was that "everybody is different" and "every cardiologist has their own plan of attack." Many completely stopped the meds -- some earlier and some later. Others are still taking them. I talked to my cardiologist last week, and he told me to expect to be on the beta-blocker for a long time -- maybe for the rest of my life.
Ross
Well-known member
new_onx_34 said:Here are some of the questions lingering in my mind.
1. Loud heartbeats
Since the surgery I hear my heart beating most of the time. It could be due to ON-X valve but I was wondering if other people have similar experience. May be I'm now more sensitive to my heart
2. Medication
I'm off the most medication except low-pressure (Metoprolol). I was wondering how long this medication will continue.
3. INR
My INR is still not stable. How long it takes to get to stable INR? Also what is the INR goal for ON-X in aortic position? Surgeon says 2-2.5, Cardiologist who is not very familiar with ON-X says 2-3 while coumadin clinic people say 2.5-3.5.
4. Pacemaker
So far doctors think that my heart block was due to some inflammation and I'll not need pacemaker in the long run. Anyone has experience getting pacemaker removed? My surgeon said that he has not seen anyone develop heart block after going home and he is very confident that it is temporary. He mentioned that I had right bundle block after the surgery but it seems it is common after AVR.
1. Beleive it or not, it's because normal pressures have been restored and your inner ears are once again working properly. Soon it will be unnoticable again.
2. The medication will continue so long as you need it.
3.When it comes to INR, we need to know your exact dose for the day/week, how often your being tested and how often the dose is being changed. Don't expect to be stable for at least a month. As your activity increases, your INR will go down. If the people managing you know what their doing, well know by what you tell us and if they can't get you stable, give us a try. We aren't doctors, but we know how this stuff works.
4. Hopefully you won't need the pacemaker for long. Some do, some don't.
