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bicuspidrek

Member
Joined
Feb 20, 2023
Messages
14
Location
Singapore
Today is exactly two weeks since I've had my valve replacement procedure. Spent quite a bit of time mentally processing this entire thing and I figured sharing it here will be of greater value versus simply existing within my own mental chamber.

35 year old Singaporean, asymptomatic, bicuspid aortic valve.

Discovery & Diagnosis - MAY-AUGUST 2022
As a Singaporean male, I have to fulfill national duty by serving 2 years of full-time military service. Following this, I will need to serve about 10 years of service (about 1-2weeks/year). If you turn 35 and are still serving your national service, you have to attend a check up. It was during this check up that I got picked up for my bicuspid heart valve.

I recall playing football the night before the check up and not getting very great sleep. I also recall overcaffeinating and squeezing in a cigarette before the check up. All of these did not make for a grand BP reading and I was flagged. They gave me an EKG and the Medical Officer picked up on an anomaly.

I was referred to National Heart Centre Singapore and by July 2022, it was clear that I had an issue with my heart.

In August 2022, I found a cardiologist from National University Heart Centre, Singapore and an echocardiogram later, it was confirmed that I had a bicuspid aortic valve. I was completely asymptomatic, thankfully. The regurgitation was moderate-severe and there was "left ventricular hypertrophy; eccentric".

My cardiologist's advice was for me to stop high-impact sports (soccer) at the time, and we were to take a wait-and-see approach. I stopped soccer, and picked up some leisurely cycling, quit cigarettes (more than a decade long habit, at a pack over 2-3 days) and was generally healthy, active.

We agreed to monitor this, and he set the next appointment for January 2023.

My wife and I had taken the period from August till January to sort of process (and perhaps compartmentalize/rationalize) the diagnosis and our next steps. We spoke about it on and off and had a general consensus as to where we were going with this.

Do this with someone who means something to you, it really helps take the edge off things.

Pre-Surgery - JAN 2023
My cardiologist squeezed me in before the Lunar New Year period. I recall him looking at my scan and still being pretty optimistic about it.

Wife and myself had mentally set aside a Apr/May 2023 procedure date "cos we wanted to do a short trip together first".

My cardiologist was very supportive, but he mentioned that "there's this surgeon who's in town right now" and maybe you could meet him first and see. He set the meeting up for the day after.

As I waited to meet my surgeon, I remember being pissed off having spent such an amount of time in hospital so early in the year. Stepping through the doors, there was a very different aura to my surgeon. Prof Theodoros Kofidis is a very confident man, and having a confident surgeon really helps you make the tough decisions.

He asked when I had initally wanted to do the surgery, and I mentioned April/May and he counter proposed, "What if I told you we could get it done in February, and by April/May, you and your wife can be on that trip?"

Had a discussion with the wife and we decided to go with it. One of the biggest factors was that Prof Kofidis had mentioned that there was a good chance my heart could shrink down to normal size. He is also a leading expert in the minimally invasive procedure.

The date of surgery was 3 weeks from that day of the meeting, with almost a week-long worth of public holidays (CNY). I did not think it would happen, but crazily it did.
I was obviously visiting the hospital a great deal in the 3 weeks leading to surgery. MRI, meeting with hospital finance team, dental, meeting with anaesthetists etc.

They gave me a hibiscrub body wash with instructions to start using it couple of days before I was admitted.

Surgery - FEB 2023
Was asked to come in the evening before the surgery. Checked in, and it was relatively fuss-free. Wife made sure I was settled in, bought a couple of snacks for me and left. We already had been advised by the nurses that she didn't have to be around during the procedure - they'd called her to inform her once it was over.

I took my shower, and was asked to fast from midnight onwards. I clarified if water was fine, and they replied, "sips are fine". Slept rather peacefully all things considered and before I knew it, it was time for my final shower before they pushed me into the OT.

I recall being pushed into a prep area where they stuck lots of monitors on me. I was given a central line on my left arm at a waiting area. I had a lot of worries - do they put in the catheter while I was conscious (answer: no), will the neck injection hurt (answer: no) etc.
I was pushed into the OR and in fact my last memory of the entire thing was just a neck injection. I don't even recall being asked to count backwards or to hold my breath. The time was approximately 0700hrs in the morning.

Post Surgery - FEB 2023
Day 0

If not for this forum, I'd have freaked out by the amount of tubes in me. I recall waking up around 1400-1500hrs and had fitful sleep at ICU. They removed the breathing tube at 1800hrs. My wife was there. Nurses were talking to me. My wife left at 2000hrs after visiting hours.

2200hrs they removed another tube and allowed me to sip on water. It was unpleasant but I expected worse. I had painkillers at 0000hrs and they wore off at 0200hrs. I stared at the clock and listened to every sound (there's plenty) in the ICU. I felt my pressure in my heart and lungs. I felt miserable.

It was 0500hrs when the nurse hurriedly gave me some painkillers. It made me burp and gasp, but she was rushing off. She hurriedly gave me a spitoon. I survived. I recall dozing off finally and waking up at 0640hrs, listening to a resuscitation process. I dozed back to sleep.

DAY 01
The catheter was next to come off. I thought it would hurt (it didn't). Learnt how to use amazing urinals in bed. By then I was already on the fast track to recovery. They allowed me with soft foods so very bland porridge and small cut food. I had to stay another night at HDU as I was draining quite a bit of blood through the 2 tubes.

DAY 02
Big day. Therapist came in and kicked me out of bed. Showed me how I had to stretch to minimize potential formation of scar tissue and gave me everyone's favorite Incentive Spriometer (2500 Voldyne). Wife thankfully prepared porridge- hospital food was really bad! Took a walk around the ward and had a dizzy spell. Had a couple friends visit today as they had a check-up. Got transferred me to a general ward later in the day. Pressure/pounding was still present, but definitely improved. Slept more compared to when in ICU, but fitfully. Thanks pump alarms.

DAYS 03, 04, 05, 06
Day 3 - Spent some time walking around, not much. Wife accompanied me, working from the hospital. Spent quite a bit of time in bed and just recovering, napping.

Day 4 - Saw a number of visitors, owing it to being a Saturday. Parents visited, ate very well. Was running a slight fever by evening time. They took out my pacer and one drainage tube this day. The expectation of it to hurt helped.

Day 5 - Walked a lot. Also had 700ml of drainage fluid discharged. Tube had to be kept another day as a result.

Day 6 - They got sick of my drainage tube and removed it. Again, the expectation of it to hurt helped. I was very concerned about pleural effusion and being short of breath and raised it up. They seemed unparticularly concerned. "Do deep breathing, use your spirgometer". Yep.

DISCHARGE
I was so ready to get out of hospital and was a bit annoyed I had to wait longer for some doctor's memos. Took a taxi back and disliked the experience very much - we had a very aggressive rider (braking, accelerating, weaving through traffic). The first thing that struck me upon returning home was... how warm it was. I had grown accustomed to air conditioning. This took a while to recalibrate.

CLOSING THOUGHTS
Recovery is tough but having a positive mentality most certainly helps. I remember the first night I was in ICU, I had a couple of miserable thoughts - why did I do this when I was asymptomatic, now I feel every heartbeat/intake of breath. Accept this. It happens. Let the thoughts come, gently cast them out because it gets better.

Coughing, sneezing, burping was scary but it gets better. Showering is an inconvenience, but it gets better. It gets better. I motivate myself by knowing that today is better than yesterday.

I will update this thread as I go along and learn new things about my new valve. I have had some issues with INR and with the ACC. Will update here once I get a handle on things.

Fire away if you have questions!
 
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Thanks for the story. Had you considered any options other than the mechanical valve? Is your ascending aorta normal, or enlarged?
 
Thanks for the story. Had you considered any options other than the mechanical valve? Is your ascending aorta normal, or enlarged?
Hi Lucker,

Looking at my Echo report from August, it seemed like my ascending aorta was normal.

I had been actually considering an organic valve but my cardiologists mentioned the downsides of that. I'm 35 and I'd possibly be facing more surgeries down the road should I have gone with that. The thought of a lifetime of Warfarin seemed daunting at the start, but pellicle and this forum really helped me come to terms with it - I'm still learning how.

You've got the right attitude! Please keep us posted on your recovery journey.
Thanks Chuck, I appreciate this. Learning to appreciate the little things too! It's an active work in progress I suppose, like most things.

.
Also as an update, coming home from the hospital was great - I started getting quality sleep. Not uninterrupted, just better (I had already managed to get an almost flat sleeping posture in my final nights at the hospital). My wife had gotten an attachment that you could install on the existing bed so I could sleep at an angle but it turns out that I didn't require it.

Wound Healing
My wounds (minimally invasive ones) are on the mend. We'd been a bit obsessive with counting my protein exchange since the dietician spoke to me at the hospital. She mentioned that protein is crucial for wound healing first 6 weeks. So quite a bit of protein exchanges each day. The hospital I stayed at counted half a drumstick as "1 protein exchange" and a "matchbox sized" serving of meat as 1 protein exchange. It's all quite confusing and arbitrary. I just try to get enough protein, and so far, so good, I suppose.

Showers required the wife's assistance for a good 4-5 days before I was confident enough. We had to use a scentless detergent and be mindful not to rub the wounds when lathering/drying.

Button-ed down shirts/pyjamas really helped out. I was however already able to shimmy into a t-shirt by the third/fourth day of discharge.

Shortness of Breath, Heart Palpitations
These things still exist here and there but once the body got used to it, I got bothered less and I can feel these things slowly going away. I still feel the occasional pressure in the chest/lung area and this is a reminder to get on my Spirometer.

I took some walks around the neighborhood over the weekend with the wife. I immediately noticed how sensitive I'd become to second-hand smoke (I had been 6-month clean coming into the surgery). I guess my lungs are still recovering from surgery. This is really one of the remaining grouses of the surgery.

INR things
On the second day of my discharge, I had to return to the hospital for an INR check with the ACC. Got pricked and had a reading of 2.5, which I was happy with. Pharmacist mentioned he was aiming for 1.8-2.5. I told him I wasn't comfortable at 1.8. He didn't say anything. He maintained the Warfarin dosage.

Strange thing - over the weekend, I had rather regular food. Perhaps 2 square sheets of seaweed, a small half-cup of boiled spinach and some greens over 2 meals seemed enough to skew my INR to 1.5.

At my 2nd ACC appointment start of this week, I got put on Clexane (I hate, hate, hate self-administering these) and my dosage of Warfarin was upped (only by 0.5mg). I was pretty pissed and let my pharmacist know. It didn't seem like she could do anything about it. I called up my cardiologist and we had a long-ish chat to understand where we were on the issue. He agreed to write a memo to my file to be maintained 2.0-3.0 but highlighted the potential bleeding/bruising issues. He also arranged me to be put on a self-test INR programme after hearing that I almost bit off the heads of two pharmacists during the two previous ACC appointments (I was very passionate).

I spoke to my insurance agent about putting a claim in for the machine, and insisted that it'd be cheaper for the insurance company to pay for my machine rather than the twice-weekly sessions at ACC. He agreed to attempt to put it in for me.

I'm scheduled for my next ACC tomorrow, and am hoping I'd be taken off Clexane by then. Right now, I'm already starting a Google Sheet to log my INR, Warfarin Dosage, Clexane intake, as well as meal intakes so as to better track my INR. I know this will put me at a better place once things are more settled.

Again, everybody, one day at a time!
 
Hi and Welcome


CLOSING THOUGHTS
Recovery is tough but having a positive mentality most certainly helps
welcome to this side. Excellent views.

I hop for you to have a continuing smooth recovery

quick question, what is the ACC you speak of with respect to your INR.

PS:
Do this with someone who means something to you, it really helps take the edge off things.

it sure does ...

Best Wishes
 
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Oh, and in the mean time (if you haven't already) I will suggest this as a good reference

https://cjeastwd.blogspot.com/2014/09/managing-my-inr.html
its nearly ten years ago that I wrote that, and now getting around to a book.

In a discussion I had with one of your fellow Singaporeans here here he offered the interesting observation that "Asians tend to be bleeders and Caucasians tend to be clotters". So what I'd like to add to that is (seeing in your bio that you have an On-X) don't be beguiled to steer below INR=2 in your AntiCoagulation Therapy (ACT).
 
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quick question, what is the ACC you speak of with respect to your INR.
I apologize for the usage of local abbreviation/acronym. ACC in my country (for my hospital) refers to Anti-Coaguation Clinic.
Oh, and in the mean time (if you haven't already) I will suggest this as a good reference
This has been the main reason why I became okay with the concept of managing INR. Thanks for relinking it here.
In a discussion I had with one of your fellow Singaporeans here here he offered the interesting observation that "Asians tend to be bleeders and Caucasians tend to be clotters". So what I'd like to add to that is (seeing in your bio that you have an On-X) don't be beguiled to steer below INR=2 in your AntiCoagulation Therapy (ACT).
I'll be keeping a look-out for this discussion!
.

Will update more after my visit to the Anti Coagulation Clinic tomorrow. Should be interesting to see how the Clexane jabs (I wonder how successfully I have been administering them) and slight Warfarin dosage adjustment pans out. Also looking forward to receiving a tutorial on my INR device for self testing. More tomorrow!
 
Hi

I apologize for the usage of local abbreviation/acronym. ACC in my country (for my hospital) refers to Anti-Coaguation Clinic.

no apology needed, I was just wondering if it was related to Anti Coagulation Care or something ... but I hope you'll soon be free to branch out on your own.

This has been the main reason why I became okay with the concept of managing INR. Thanks for relinking it here.

I'm glad that its helped.


Will update more after my visit to the Anti Coagulation Clinic tomorrow. Should be interesting to see how the Clexane jabs (I wonder how successfully I have been administering them) and slight Warfarin dosage adjustment pans out. Also looking forward to receiving a tutorial on my INR device for self testing. More tomorrow!

sounds good ... be keen to hear what they say, they've certainly landed you in range much faster than most of what I read here.

FWIW this article from the 1980's shows the Brits were able to get people dialled in by day 6. All this before INR

I only found that recently and was surprised by how closely it resembles my own system. Apparently basic pharmacokinetics works ... if only ACC's knew about it.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7967860/
Best Wishes
 

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Welcome to the forum. I had my first OHS at 37 and I was asymptomatic also. They found a large clump of calcification on my biscuspid valve and were afraid it could break off and cause a stroke. So, I dealt with the same questions as to timing. Being young and in good health should help you with your recovery. All the best to you!
 
Today is exactly two weeks since I've had my valve replacement procedure. Spent quite a bit of time mentally processing this entire thing and I figured sharing it here will be of greater value versus simply existing within my own mental chamber.

35 year old Singaporean, asymptomatic, bicuspid aortic valve.

Discovery & Diagnosis - MAY-AUGUST 2022
As a Singaporean male, I have to fulfill national duty by serving 2 years of full-time military service. Following this, I will need to serve about 10 years of service (about 1-2weeks/year). If you turn 35 and are still serving your national service, you have to attend a check up. It was during this check up that I got picked up for my bicuspid heart valve.

I recall playing football the night before the check up and not getting very great sleep. I also recall overcaffeinating and squeezing in a cigarette before the check up. All of these did not make for a grand BP reading and I was flagged. They gave me an EKG and the Medical Officer picked up on an anomaly.

I was referred to National Heart Centre Singapore and by July 2022, it was clear that I had an issue with my heart.

In August 2022, I found a cardiologist from National University Heart Centre, Singapore and an echocardiogram later, it was confirmed that I had a bicuspid aortic valve. I was completely asymptomatic, thankfully. The regurgitation was moderate-severe and there was "left ventricular hypertrophy; eccentric".

My cardiologist's advice was for me to stop high-impact sports (soccer) at the time, and we were to take a wait-and-see approach. I stopped soccer, and picked up some leisurely cycling, quit cigarettes (more than a decade long habit, at a pack over 2-3 days) and was generally healthy, active.

We agreed to monitor this, and he set the next appointment for January 2023.

My wife and I had taken the period from August till January to sort of process (and perhaps compartmentalize/rationalize) the diagnosis and our next steps. We spoke about it on and off and had a general consensus as to where we were going with this.

Do this with someone who means something to you, it really helps take the edge off things.

Pre-Surgery - JAN 2023
My cardiologist squeezed me in before the Lunar New Year period. I recall him looking at my scan and still being pretty optimistic about it.

Wife and myself had mentally set aside a Apr/May 2023 procedure date "cos we wanted to do a short trip together first".

My cardiologist was very supportive, but he mentioned that "there's this surgeon who's in town right now" and maybe you could meet him first and see. He set the meeting up for the day after.

As I waited to meet my surgeon, I remember being pissed off having spent such an amount of time in hospital so early in the year. Stepping through the doors, there was a very different aura to my surgeon. Prof Theodoros Kofidis is a very confident man, and having a confident surgeon really helps you make the tough decisions.

He asked when I had initally wanted to do the surgery, and I mentioned April/May and he counter proposed, "What if I told you we could get it done in February, and by April/May, you and your wife can be on that trip?"

Had a discussion with the wife and we decided to go with it. One of the biggest factors was that Prof Kofidis had mentioned that there was a good chance my heart could shrink down to normal size. He is also a leading expert in the minimally invasive procedure.

The date of surgery was 3 weeks from that day of the meeting, with almost a week-long worth of public holidays (CNY). I did not think it would happen, but crazily it did.
I was obviously visiting the hospital a great deal in the 3 weeks leading to surgery. MRI, meeting with hospital finance team, dental, meeting with anaesthetists etc.

They gave me a hibiscrub body wash with instructions to start using it couple of days before I was admitted.

Surgery - FEB 2023
Was asked to come in the evening before the surgery. Checked in, and it was relatively fuss-free. Wife made sure I was settled in, bought a couple of snacks for me and left. We already had been advised by the nurses that she didn't have to be around during the procedure - they'd called her to inform her once it was over.

I took my shower, and was asked to fast from midnight onwards. I clarified if water was fine, and they replied, "sips are fine". Slept rather peacefully all things considered and before I knew it, it was time for my final shower before they pushed me into the OT.

I recall being pushed into a prep area where they stuck lots of monitors on me. I was given a central line on my left arm at a waiting area. I had a lot of worries - do they put in the catheter while I was conscious (answer: no), will the neck injection hurt (answer: no) etc.
I was pushed into the OR and in fact my last memory of the entire thing was just a neck injection. I don't even recall being asked to count backwards or to hold my breath. The time was approximately 0700hrs in the morning.

Post Surgery - FEB 2023
Day 0

If not for this forum, I'd have freaked out by the amount of tubes in me. I recall waking up around 1400-1500hrs and had fitful sleep at ICU. They removed the breathing tube at 1800hrs. My wife was there. Nurses were talking to me. My wife left at 2000hrs after visiting hours.

2200hrs they removed another tube and allowed me to sip on water. It was unpleasant but I expected worse. I had painkillers at 0000hrs and they wore off at 0200hrs. I stared at the clock and listened to every sound (there's plenty) in the ICU. I felt my pressure in my heart and lungs. I felt miserable.

It was 0500hrs when the nurse hurriedly gave me some painkillers. It made me burp and gasp, but she was rushing off. She hurriedly gave me a spitoon. I survived. I recall dozing off finally and waking up at 0640hrs, listening to a resuscitation process. I dozed back to sleep.

DAY 01
The catheter was next to come off. I thought it would hurt (it didn't). Learnt how to use amazing urinals in bed. By then I was already on the fast track to recovery. They allowed me with soft foods so very bland porridge and small cut food. I had to stay another night at HDU as I was draining quite a bit of blood through the 2 tubes.

DAY 02
Big day. Therapist came in and kicked me out of bed. Showed me how I had to stretch to minimize potential formation of scar tissue and gave me everyone's favorite Incentive Spriometer (2500 Voldyne). Wife thankfully prepared porridge- hospital food was really bad! Took a walk around the ward and had a dizzy spell. Had a couple friends visit today as they had a check-up. Got transferred me to a general ward later in the day. Pressure/pounding was still present, but definitely improved. Slept more compared to when in ICU, but fitfully. Thanks pump alarms.

DAYS 03, 04, 05, 06
Day 3 - Spent some time walking around, not much. Wife accompanied me, working from the hospital. Spent quite a bit of time in bed and just recovering, napping.

Day 4 - Saw a number of visitors, owing it to being a Saturday. Parents visited, ate very well. Was running a slight fever by evening time. They took out my pacer and one drainage tube this day. The expectation of it to hurt helped.

Day 5 - Walked a lot. Also had 700ml of drainage fluid discharged. Tube had to be kept another day as a result.

Day 6 - They got sick of my drainage tube and removed it. Again, the expectation of it to hurt helped. I was very concerned about pleural effusion and being short of breath and raised it up. They seemed unparticularly concerned. "Do deep breathing, use your spirgometer". Yep.

DISCHARGE
I was so ready to get out of hospital and was a bit annoyed I had to wait longer for some doctor's memos. Took a taxi back and disliked the experience very much - we had a very aggressive rider (braking, accelerating, weaving through traffic). The first thing that struck me upon returning home was... how warm it was. I had grown accustomed to air conditioning. This took a while to recalibrate.

CLOSING THOUGHTS
Recovery is tough but having a positive mentality most certainly helps. I remember the first night I was in ICU, I had a couple of miserable thoughts - why did I do this when I was asymptomatic, now I feel every heartbeat/intake of breath. Accept this. It happens. Let the thoughts come, gently cast them out because it gets better.

Coughing, sneezing, burping was scary but it gets better. Showering is an inconvenience, but it gets better. It gets better. I motivate myself by knowing that today is better than yesterday.

I will update this thread as I go along and learn new things about my new valve. I have had some issues with INR and with the ACC. Will update here once I get a handle on things.

Fire away if you have questions!
They generally wait till almost fatal before surgery is done. Being positive helps the recovery. Did they tell you to be on stool softener for a few days, for they did tell me and was glad they did. Just take it one day at a time, doing as the doctors instruct you for the next 12 months. The chest muscles have been through trauma from surgery and takes a year to heal completely.
Good luck in recovery and keep us updated.
 
Good news, I have been granted the device. Paid for it and scored some free strips that they had (still well within expiry). So what my cardiologist did was to tell the AntiCoagulation Clinic that I wished to take matters into my own hands and self test. They have teams going around, teaching patients to use the devices and making sure they are familiar with the strips - you had to pass a test yourself in front of them (I ended up wasting 1 strip).

So my hospital still charges a yearly administrative fee so that someone from the clinic/pharmacy team is on your case to ensure you don't bounce too much. I don't think there's anything I can do right now to be completely independent from this - will explore this again in a year and see what my cardiologist says.

So apart from this, my INR got within range (2.0) and hence no more Clexane thank goodness! I was already reasonably cheered up by this. The team they assigned me today had very progressive views on INR dosing (finally!) and most of what they told me echoed a lot of the thought process here, rationally. It was so different from the two different pharmacists I encountered at my 2 earlier INR meetings so I am also very cheered by this.

I'm told to keep with my daily 3.0mg Warfarin dosage for now and submit my self-test INR next week. Looking forward to this 'new freedom'.

Post Surgery
I have a post surgery appointment scheduled next week. They will do the works - blood tests and scans and removal of some stitches and then a consultation with the surgeon before he hands me back to my cardiologist. Looking forward to this one.

Cardio Rehab
I'm quite surprised nobody from the hospital contacted me regarding this - I had been keeping an eye out for it. Might have gotten overlooked, will wait till next week before I raise anything. Are there tips regarding cardio rehab for those wanting to regain stamina in a jiffy? The therapist did mention some exercises but didn't go too in depth.

oh and @bicuspidrek , was there any sign of aneurysm in your studies?
I privately responded, but for the benefit of this thread, nope!

I was really a different case and my surgeon seemed very enthused in getting me to get the surgery anyway. He mentioned about the chance that my ventricular wall could shrink down to normal size, which sounded attractive.
Did they tell you to be on stool softener for a few days, for they did tell me and was glad they did.
They issued me stool softener but I did not need to take it. I was prescribed it during my stay at the ward, twice. And both times it helped. But by the time I was discharged, I no longer required it. I had been eating reasonably well, and bowel movements were keeping up, thankfully.

Welcome to the forum. I had my first OHS at 37 and I was asymptomatic also. They found a large clump of calcification on my biscuspid valve and were afraid it could break off and cause a stroke. So, I dealt with the same questions as to timing. Being young and in good health should help you with your recovery. All the best to you!
Thanks Dano! How long did it take you to get back your general fitness?
 
Good news, I have been granted the device. Paid for it and scored some free strips that they had (still well within expiry). So what my cardiologist did was to tell the AntiCoagulation Clinic that I wished to take matters into my own hands and self test. They have teams going around, teaching patients to use the devices and making sure they are familiar with the strips - you had to pass a test yourself in front of them (I ended up wasting 1 strip).

So my hospital still charges a yearly administrative fee so that someone from the clinic/pharmacy team is on your case to ensure you don't bounce too much. I don't think there's anything I can do right now to be completely independent from this - will explore this again in a year and see what my cardiologist says.

So apart from this, my INR got within range (2.0) and hence no more Clexane thank goodness! I was already reasonably cheered up by this. The team they assigned me today had very progressive views on INR dosing (finally!) and most of what they told me echoed a lot of the thought process here, rationally. It was so different from the two different pharmacists I encountered at my 2 earlier INR meetings so I am also very cheered by this.

I'm told to keep with my daily 3.0mg Warfarin dosage for now and submit my self-test INR next week. Looking forward to this 'new freedom'.

Post Surgery
I have a post surgery appointment scheduled next week. They will do the works - blood tests and scans and removal of some stitches and then a consultation with the surgeon before he hands me back to my cardiologist. Looking forward to this one.

Cardio Rehab
I'm quite surprised nobody from the hospital contacted me regarding this - I had been keeping an eye out for it. Might have gotten overlooked, will wait till next week before I raise anything. Are there tips regarding cardio rehab for those wanting to regain stamina in a jiffy? The therapist did mention some exercises but didn't go too in depth.


I privately responded, but for the benefit of this thread, nope!

I was really a different case and my surgeon seemed very enthused in getting me to get the surgery anyway. He mentioned about the chance that my ventricular wall could shrink down to normal size, which sounded attractive.

They issued me stool softener but I did not need to take it. I was prescribed it during my stay at the ward, twice. And both times it helped. But by the time I was discharged, I no longer required it. I had been eating reasonably well, and bowel movements were keeping up, thankfully.


Thanks Dano! How long did it take you to get back your general fitness?
The stool softener was not to keep your regular, it is so you not need to push when needed in doing #2. So there is no pressure on the when you have a bowl movement.
 
Good news, I have been granted the device.
That is great to hear! Textbook example of a person doing a good job self advocating!

So my hospital still charges a yearly administrative fee so that someone from the clinic/pharmacy team is on your case to ensure you don't bounce too much.
This is not a bad thing. Once a person learns the ropes a little, the vast majority stay in range way more often than those managed by clinics. Studies have shown that the clinics generally keep people in range 50% to 70% of the time. I manage to stay in range with home testing well over 90% of the time and my cardiologist is thrilled with my numbers. Staying in range this often seems to be the norm for those who self test. My expectation is that this will be the case for you, provided that you are mindful about your own management, testing weekly and having a good system to remind yourself to take your pill.

I'm told to keep with my daily 3.0mg Warfarin dosage for now and submit my self-test INR next week. Looking forward to this 'new freedom'.

I'd suggest having some various sized doses on hand. If you normally take 3mg, then have 3mg, but also have plenty of 1mg. You can always break the 1mg in half to hone in your dosage. Personally, I was at about 3mg to stay in range when I was released from the hospital, and by about 12 months it took 6.5mg per day. It has stayed about at that level in the past 11 months. Sometimes I need to go to 6.75/day, which I achieve by taking 6.5 one day and 7mg the next day. Something to be aware of, is that it is well documented that during the first few months, you will usually need to gradually increase your dosage to stay in range. A number of reasons for this, but by testing weekly you will see if this is the case with you. Just don't be surprised if you find that as the months go by you need a little more warfarin to stay in your range.


Are there tips regarding cardio rehab for those wanting to regain stamina in a jiffy?
My suggestion would be to walk as often as they will let you, including doing some brisk walking, if your cardiologist approves you for that, and I expect that he would. I can totally understand that you are in a hurry to get your full stamina back, but you have to let the wounds heal properly. Your new valve will be vulnerable for the first few months as it heals and the last thing that you want to do is to push too hard too soon and cause some damage. Arnold Schwarzenegger pushed too hard after his first surgery and had to get a reoperation within one week, presumably to repair the damage that he caused. So, relax and walk a lot, push a little on the walks as you get the ok from your medical team. As the months pass, they will give you the green light to push harder in your cardio workouts, and this is what will help you return to top fitness. Personally, I was given the green light to do hard cardio, without limitation, at 12 weeks. I still took it easy for at least another month. Within about 9 months I felt that my cardio was strong once again and was back in the gym doing intense martial arts against guys in their 20s and 30s. Be patient with you body as it heals and the time will pass before you know it.

Please keep us posted as your journey continues. So far, excellent news!
 
Last year, being 58, it took a little longer for me, but I was doing all of my regular fitness within 3 months of the surgery, with the exception of lifting or anything putting extra stress on my healing sternum. Similar but I improved a little quicker when I was 37.
 
Hello everyone, I had my first post-surgery appointment today with my surgeon. Bloodwork, ECG and X-ray had to be done. Had the stitches removed too, and wound is healing well.

Pleural Effusion
My surgeon does not like to go in-depth medically with me. He mentioned that the fluid in my chest is still present, but was not medically specific.

I have done my fair share of reading up, so I kinda am aware that this could be a case of pleural effusion. Sucks, but oh well. I already feel better that 2 weeks ago, so I know there is progress. Anyway, he gave me more furosemide and upped my dosage too. Was told to head back in a month for another X-ray and tests to confirm. I have asked my cardiologist separately what happens if the pleural effusion is still present. Again, I am not happy about this because I did mention my concern of pleural effusion before I was getting discharged and a doctor waved away my concerns and mentioned an impossibly low statistic that I am well aware isn't factual. They were trying to get me out of hospital cos I was 'young' and had 'minimally-invasive' and shouldn't have stayed that long.

To those here, how long did you have to deal with pleural effusion? Besides breathing exercises, are there other methods to improve the condition. Breathing for me now has become much less painful, I still definitely cannot get the full lung capacity but it is significantly better. I do get shortness of breath when I walk a little too quickly.

He also mentioned that in the many cases that had similar procedures as me, none of them required an operation for aneurysm. I don't know how to feel about this. But sure. I'll bring this up with my cardiologist, just in case.
I had been following the 'cyborg in training' thread (Cyborg in training) and had also seen how he was in a hurry to get back his fitness but had to deal with pleural effusion. He had to get it clinically removed after close to a month. I fear this, but if it comes, I'll be ready.

INR Management
pellicle has very kindly shared his INR self-management concept and it has been working well for me. As mentioned, I was granted the device last week, and yesterday, I just submitted my INR to the anti coagulation clinic via SMS - it was 2.1, so yay! The clinic did call and I informed them about updating the firmware to 1.09 (https://coaguchek.roche.com/content...irmware/update-v-01.09.00-YT-release-note.pdf). They had given me one that had the older 1.06 firmware and the issue of the incorrect battery level had come up when they installed the batteries and started the device up for the first time.

When I mentioned that I had on my own accord changed my dosage to alternate between 4.0mg and 3.0mg (effectively 3.5mg, from 3.0mg), I detected some resistance. I have taken this up with my cardiologist and am seeking an understanding as to how self this self-testing, self-management of INR is going. Will update when he gets back.

The Every Day
Routine helps. Meals, pills, naps, reading, light exercise.

I have not been very disciplined in taking my daily walks/exercises. It's a strange monsoon season here in Singapore and the past week has been pretty wet. Been spending way more time off the bed and sitting up/standing up and doing meal prep so definitely a slight ramp up in activity. Hope to be on my feet a lot more next week, weather-permitting.

Heart Clicking
You will definitely hear it. It will definitely gets better. Don't worry about it.

Queries
For those who had minimally-invasive surgeries, how long before you were sleeping on your side again?

And to the bunch who'd very kindly offered their perspective + advice + encouragement, thank you so much. It's been close to a month since I got my valve, and ya'll have made the recovery so much more assuring and comforting.

I can totally understand that you are in a hurry to get your full stamina back, but you have to let the wounds heal properly. Your new valve will be vulnerable for the first few months as it heals and the last thing that you want to do is to push too hard too soon and cause some damage.
Thanks Chuck for your insight! I appreciate it. I definitely have my work cut out for me since I am still fighting pleural effusion (presumably). My superficial wounds have healed decently enough, but of course I will have to be mindful of the valve site. Will slowly ramp up my walks and see how I feel along the way. :)
Within about 9 months I felt that my cardio was strong once again and was back in the gym doing intense martial arts against guys in their 20s and 30s. Be patient with you body as it heals and the time will pass before you know it.
This is great to know that it is fully possible. I look forward to getting back my pre-surgery fitness.

 
When I mentioned that I had on my own accord changed my dosage to alternate between 4.0mg and 3.0mg (effectively 3.5mg, from 3.0mg), I detected some resistance
Which I always find interesting because you are in range (just) and wouldn't be if you had simply followed their directions.

I had this argument in hospital once. It had to get blunt (explained that it was me who would actually suffer for their "taking responsibility" not them.

It was fortunate that I had my own supply with me (as a travel habit).
 
Don't remember exactly, but I think it took me about 6 weeks to be able to sleep on my side as I am a dedicated side sleeper. I do remember very well that laying in my side did trigger some pain for quite a while - maybe a few months - gradually diminishing. I am guessing that was stress on the healing from the surgery.

HTH YMMV
 
Hello everyone, I had my first post-surgery appointment today with my surgeon. Bloodwork, ECG and X-ray had to be done. Had the stitches removed too, and wound is healing well.

Pleural Effusion
My surgeon does not like to go in-depth medically with me. He mentioned that the fluid in my chest is still present, but was not medically specific.

I have done my fair share of reading up, so I kinda am aware that this could be a case of pleural effusion. Sucks, but oh well. I already feel better that 2 weeks ago, so I know there is progress. Anyway, he gave me more furosemide and upped my dosage too. Was told to head back in a month for another X-ray and tests to confirm. I have asked my cardiologist separately what happens if the pleural effusion is still present. Again, I am not happy about this because I did mention my concern of pleural effusion before I was getting discharged and a doctor waved away my concerns and mentioned an impossibly low statistic that I am well aware isn't factual. They were trying to get me out of hospital cos I was 'young' and had 'minimally-invasive' and shouldn't have stayed that long.

To those here, how long did you have to deal with pleural effusion? Besides breathing exercises, are there other methods to improve the condition. Breathing for me now has become much less painful, I still definitely cannot get the full lung capacity but it is significantly better. I do get shortness of breath when I walk a little too quickly.

He also mentioned that in the many cases that had similar procedures as me, none of them required an operation for aneurysm. I don't know how to feel about this. But sure. I'll bring this up with my cardiologist, just in case.
I had been following the 'cyborg in training' thread (Cyborg in training) and had also seen how he was in a hurry to get back his fitness but had to deal with pleural effusion. He had to get it clinically removed after close to a month. I fear this, but if it comes, I'll be ready.

INR Management
pellicle has very kindly shared his INR self-management concept and it has been working well for me. As mentioned, I was granted the device last week, and yesterday, I just submitted my INR to the anti coagulation clinic via SMS - it was 2.1, so yay! The clinic did call and I informed them about updating the firmware to 1.09 (https://coaguchek.roche.com/content...irmware/update-v-01.09.00-YT-release-note.pdf). They had given me one that had the older 1.06 firmware and the issue of the incorrect battery level had come up when they installed the batteries and started the device up for the first time.

When I mentioned that I had on my own accord changed my dosage to alternate between 4.0mg and 3.0mg (effectively 3.5mg, from 3.0mg), I detected some resistance. I have taken this up with my cardiologist and am seeking an understanding as to how self this self-testing, self-management of INR is going. Will update when he gets back.

The Every Day
Routine helps. Meals, pills, naps, reading, light exercise.

I have not been very disciplined in taking my daily walks/exercises. It's a strange monsoon season here in Singapore and the past week has been pretty wet. Been spending way more time off the bed and sitting up/standing up and doing meal prep so definitely a slight ramp up in activity. Hope to be on my feet a lot more next week, weather-permitting.

Heart Clicking
You will definitely hear it. It will definitely gets better. Don't worry about it.

Queries
For those who had minimally-invasive surgeries, how long before you were sleeping on your side again?

And to the bunch who'd very kindly offered their perspective + advice + encouragement, thank you so much. It's been close to a month since I got my valve, and ya'll have made the recovery so much more assuring and comforting.


Thanks Chuck for your insight! I appreciate it. I definitely have my work cut out for me since I am still fighting pleural effusion (presumably). My superficial wounds have healed decently enough, but of course I will have to be mindful of the valve site. Will slowly ramp up my walks and see how I feel along the way. :)

This is great to know that it is fully possible. I look forward to getting back my pre-surgery fitness.

Glad you finally got it done. And now you have a great future ahead of you. Be sure to not strain your sternum for a time, to let the muscles heal. Take your time and follow doctor orders. Be good to yourself.
 

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