Cyborg in training

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johnmarkos

Cyborg in training
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It's been a week and a day since surgery, and mostly, I'm feeling pretty good, knock on wood! I'm taking lots of short walks, but since I live on the top of a hill, I haven't ventured off it yet. Sternal pain is not too bad, and I've been handling it with Acetaminophen/Paracetamol/Tylenol. Occasionally, I get some unpleasant tightness in the scapulae, which hurts a lot more than my chest does. I've got a low-grade temperature, just as I did in the hospital: 99F/37.2C just now, first thing in the morning. I've been getting frequent, short-lived migraine auras for the past few days, so I called my surgeon's office, and the PA told me that's a common symptom. I have an appointment at Dr. Egrie's office tomorrow (Wednesday).

Sleeping is slowly getting better. I wake up at 2 or 3 in the morning every night now, and I take an acetaminophen, and eventually go back to bed. Last night and the night before I got about 4.5 hours in two shifts each night, so that's not too bad. My normal, pre-surgery time asleep is about 5.5 hours. In the hospital, I was getting less than 3 hours/night, and one of the nurses told me that was more than most cardiac patients.

Our friends have put together a food train, so we're getting home cooked meals every night! It's wonderful. I've been trying to eat a healthy diet with plenty of vegetables ("dose the diet"), and my once and future running buddy came over for a walk and made us a delicious salad for lunch yesterday.

My parents are in town from New York State till the end of the month: it's so nice for us to spend some time with them. They've been truly helpful, and I can hardly imagine getting through this process without their help.
 
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PAN

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Oct 17, 2019
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UK
Thanks for the update. Really appreciate the detail in your posts.

Sounds like it is all going pretty well. Small steps and every day should get better. The cyborg will tackle the hill in no time at all.

All the best,

P
 

Protimenow

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Food trains can be great. It's good to have a caring community that will do that for you.

One suggestion -- if you eat a lot of greens, continue to do so -- then you can (eventually) adjust your warfarin dosage to match your diet. If you have found an appropriate dose, then stop eating greens, your INR will climb. (The greens interfere with the action of warfarin, so you need a higher dose to compensate).
 

johnmarkos

Cyborg in training
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Thanks, all! I had an episode of atrial fibrillation yesterday afternoon/evening. When I called the surgeon's office, the PA suggested some more tests tomorrow at my post-op visit, but was reassuring. Apparently, the main risk of Afib is increased risk of stroke, and since I'm already on Warfarin, I'm already mitigating that risk. The Afib resolved on its own before midnight.

Speaking of Warfarin, my father told me that WARFarin contains the abbreviation for Wisconsin Alumni Research Foundation. As my whole family comes from Wisconsin -- converged on Wisconsin in the 19th century, then diverged from it in the 20th -- that pleases me quite a bit.
 

Protimenow

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Close -- WARF is actually Wisconsin Agricultural Research Foundation. I've written about this before.

The story is that when male goats were being castrated, some came out just fine, while others bled to death. It was determined that the goats that bled out ate clover (I think it was red clover). Researchers at WARF isolated the material that caused the anticoagulation, patented it, and sold the patent to a pharmaceutical manufacturer - and we got Coumadin. Once the patent expired, it was marketed in generic form, using its original name - WARFarin.

It's a shame that they used WARF in such an unimaginative way. Imagine something called Warfwarf (people may think that it's an anticoagulant for dogs), Warfpier (would be attractie to sailors), Warffraw (for people who play games with letters), maybe just WARF, Warfare (something that only the military may like), and others yet to be suggested. Of course, we'll just have to stick with the original name. (Although it's a simple name, I see a lot of people who still can't spell it).
 

tom in MO

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Johnmarkos is correct according to Wiki "The name "warfarin" stems from the acronym WARF, for Wisconsin Alumni Research Foundation + the ending -arin indicating its link with coumarin."
 

Protimenow

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Yes, it apparently WAS Alumni, not agricultural.

The original story was that it was cows that died of internal bleeding - not castrated goats or cattle.

At least I got the Wisconsin part of it right (but it was already there, wasn't it). I'll have to do more research in the future before quoting from memory.
 
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johnmarkos

Cyborg in training
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I had my post-op appointment at my surgeon's office yesterday, and things seem to be going pretty well. I'm getting basically constant migraine auras with no headache -- normal-ish, I guess. Transient AFib not a big deal. Sternum is not fully healed yet, but looking good. Resting heart rate is elevated (80s-90s, was high 50s), although exercising heart rate seems to be the same as before -- RHR should go down. I'm a little anemic post-surgery, but I don't need to take any specific measures to address it. It should go away on its own. Small pleural effusion -- should go away on its own. I think I'm tensing my shoulders to keep pressure off my sternum, because occasionally, my shoulders hurt quite a bit. INR is currently 2, with a guideline of 1.7-2.5 for my St. Jude Regent mechanical valve. That guideline surprised me because it's so low, and I want to get more documentation about it.

I'm transitioning my care to my cardiologist -- I have an appointment in a week. I need to find out when my next INR test is, and transition to self-testing. I also want to get on the schedule for cardiac rehab, although the physical therapist in the hospital told me I'd be the youngest one there and max it out pretty quickly. Still seems worthwhile.
 

leadville

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Your RHR will drop after time, i'm a fitness geek and wanted a normal (low ) RHR straight away.

My surgeon explained that the body is in trauma and stress, you know you have had elective surgery however your body may think it's been in a car wreck.

My post Opp Afib lasted months and was aggravated by exercise.

If i had my time over, i would be more gentle on myself.

Take it steady John (y)
 

johnmarkos

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I have to make myself eat more. I was 141 lbs/~64kg just before surgery; now I'm 133 lbs/~60kg and still dropping slowly. Even though I'm relatively short in stature, (66.5"/169cm), that's a little below my target. Maybe I'll adopt a hobbit meal schedule.
 

pellicle

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I have to make myself eat more. I
In my last surgey I recall that I was much slower at eating. But I knew portion sizes and just say there till it was done. Slow and steady wins the race.

I'm concerned about your health being vegan. My supervisor is vegan and anemic, in discussion of this topic I hear from her that she resists all the advice from doctors because she wants to keep to her views.

I'm a pragmatic person and adopt views or reject them based on them being good or bad for me.

I hope you start gaining weight soon, as to me 68kg is where you want to be (I'm about your height)

Best Wishes
 

pellicle

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with a guideline of 1.7-2.5 for my St. Jude Regent mechanical valve. That guideline surprised me because it's so low, and I want to get more documentation about it.
Surprises me too a little. I guess its coming from the research showing we may be (in the past) over anticoagulant managing people (GELIA study) however I'm not sure jow I feel about under 2. I've never seen a research to validate that.

Do they have something to base that range on? Tom here had a similar experience with range, but he also didn't have any literature references to support it.

Without any studies supporting it I'd want to be 2 ~ 3
 

johnmarkos

Cyborg in training
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Jul 21, 2015
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111
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San Francisco, California, U.S.A.
I'm concerned about your health being vegan. My supervisor is vegan and anemic, in discussion of this topic I hear from her that she resists all the advice from doctors because she wants to keep to her views.
Thank you for your concern! I'm not strict, and I'm eating some eggs and dairy during my recovery. I asked the PA if there were specific foods I should eat to deal with the anemia, and she said no, it would resolve on its own. I'm looking into non-meat sources of iron, but if I really have to, I'll eat a steak.

I hope you start gaining weight soon, as to me 68kg is where you want to be (I'm about your height)
I have a small frame, so 63kg/139 lbs would be fine for me. It's about where I was most of the year before surgery.
 
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johnmarkos

Cyborg in training
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Messages
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Quality B12 can be problematic ( at the risk of being shot down ) :oops:
I won't shoot you down, but when I started going mostly vegan, I mentioned B12 to my primary care physician, and he said not to worry about it. He said he had patients who had been vegan for decades who didn't have a problem with B12. I do have a B12 supplement that I can take, but I seem to be getting enough from fortified foods, according to the docs I've read.
 

Protimenow

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John - being below 2 worries me. An INR of 1.7 worries me even more. If you consider that the accepted accuracy of testing is +/- 20%, a 1.7 INR could put your INR at 1.36. Some meters may report INR that's lower than blood draws by a RELIABLE lab.

There's really nothing to be gained by having an INR that low. Most of us (with at least one exception) are doing fine with INRs between 2 and 3 - and INRs between 3 and 4 don't make much difference in our activities or lifestyles.

I really don't see any benefits of having an INR below 2 -- and I see much higher risk.
 
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