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johnmarkos

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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.
I agree with you, and I called my surgeon's office asking for more documentation of the INR target. The PA is supposed to call me back -- my surgeon is always in surgery or seeing patients, which is a good thing. I'll get this worked out.

As of my last check, yesterday, my INR was 2.0, measured at the CPMC Van Ness medical office building.

In the future, my cardiologist will be my primary contact for anticoagulation management, and he always shares detailed information with me about the decisions he makes.
 
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tom in MO

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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.
My St. Jude range is 2-2.5, recommended by a host of doctors for the last 7 years. Looks like they dropped it to 1.7, I'll ask my cardio if there's been a change. It explains why they don't get nervous the few times I dropped to 1.8. I'll ask when I have my next cardio appointment.

Cardio rehab is good. You can ask questions of the nurses and they know more than some doctors. I still do many of the exercises I learned 7 years ago in rehab.
 

johnmarkos

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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.
Thanks, @leadville -- while I'm experiencing AFib, it's really reassuring to hear that you got through it. I'm a fitness geek, too, and I was hoping my training would help me recover more quickly and easily. It almost feels as though my heart is trying unsuccessfully to get back to its old pre-surgery RHR.
 

DachsieMom

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My surgeon put my range at 1.9-2.3 for st Jude aortic valve conduit. My cardio prefers me at 2.3 to 2.8. I also take aspirin. You might not be able to home test until 3 months post op for insurance. Definitely do cardiac rehab. I was 41 and a runner - rehab was amazing. I think they wouldn’t let me start until 5 or 6 weeks post op.
I also live on a large hill. Be careful at first. I was shocked at how much it hurt to walk up the hill. Not at the time, but once I arrived at the top. I think my heart enlarged a bit due to heavy exertion and pressed on something. I was skipping beats like crazy that night.
 

DachsieMom

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Take it easy it rehab initially. I started out walking like a turtle at first, but was running 7.5 mph by the end. Just don’t push it at first.
 
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johnmarkos

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My heart rate got down to 82 while I was sleeping tonight, but it's still irregular. I'll call the surgeon's office, and my cardiologist's office, on Tuesday. Monday is a holiday in the USA, the birthday of Martin Luther King, Jr.

I'm not sure it's technically AFib -- my heart rate isn't particularly fast, at least for my post-op state. In my mind I have this image of my pre-surgery RHR (high 50s/low 60s) and my post-op RHR (80-90) battling it out, and currently, neither is dominant. That's what it feels like.
 
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LondonAndy

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I'm concerned about your health being vegan. My supervisor is vegan and anemic,
I don't know if this is specific to some makes of valve, but for some of us mechanical valves can damage red blood cells, resulting in a form of anaemia irrespective of diet. It is the physical action of the valve closing that can do it. I am now on daily iron tablets and even with those I am only just into the normal range.
 

Freebird

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Johnmarkos, thank you for sharing your journey. It's been really helpful and you sound like you're doing quite well in general. Hopefully your afib has now passed.

As someone who has yet to go through surgery I have a question about post-op afib as it seems to be common. How do you know when to 'let it ride' and when to go to the ER? Are there parameters they give you post-op as far are things to look out for?

Fortunately I live very near the hospital, but based on probably reading too many post-op stories, it sounds like the months following surgery entail many ER visits. Hopefully it's an unfair assessment as it would seem the folks who aren't having troubles aren't posting about it.

I guess my current general assessment is that the surgery is quite common and very successful, but the post-op part is the tricky part. Would love to hear everyone's take.
 

LondonAndy

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Johnmarkos, thank you for sharing your journey. It's been really helpful and you sound like you're doing quite well in general. Hopefully your afib has now passed.

Fortunately I live very near the hospital, but based on probably reading too many post-op stories, it sounds like the months following surgery entail many ER visits. Hopefully it's an unfair assessment as it would seem the folks who aren't having troubles aren't posting about it.

I guess my current general assessment is that the surgery is quite common and very successful, but the post-op part is the tricky part. Would love to hear everyone's take.
My recovery experience was only one visit to the ER - for what turned out to be dehydration. I am on a water tablet (Furosemide) and on a particularly busy day at work about 6 months after surgery I went home and felt intensely sweaty and dizzy, symptoms that I was concerned could be a heart attack. I wasn't disabled in any way, so I went by taxi to my local hospital who diagnosed the dehydration after a number of tests. It was a surprise, and I am much more aware of my liquid intake now, and I realise that when I am busy I must not lose sight of drinking some water!

I have ended up with permanent AFib, but I am not sure what causes it or whether it is related to getting a pacemaker - I didn't have AFib prior to surgery, but when I was trying to persuade my Cardiologist to stop the Beta Blocker tablet that I found was making me very tired, he did say that AFib is common and the Beta Blocker was protective for that. I only realised this is a permanent thing in the last few months, at a Pacemaker checkup, and will be asking my Cardiologist more on Thursday. I will post any interesting comments he makes.
 

Freebird

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My recovery experience was only one visit to the ER - for what turned out to be dehydration. I am on a water tablet (Furosemide) and on a particularly busy day at work about 6 months after surgery I went home and felt intensely sweaty and dizzy, symptoms that I was concerned could be a heart attack. I wasn't disabled in any way, so I went by taxi to my local hospital who diagnosed the dehydration after a number of tests. It was a surprise, and I am much more aware of my liquid intake now, and I realise that when I am busy I must not lose sight of drinking some water!

I have ended up with permanent AFib, but I am not sure what causes it or whether it is related to getting a pacemaker - I didn't have AFib prior to surgery, but when I was trying to persuade my Cardiologist to stop the Beta Blocker tablet that I found was making me very tired, he did say that AFib is common and the Beta Blocker was protective for that. I only realised this is a permanent thing in the last few months, at a Pacemaker checkup, and will be asking my Cardiologist more on Thursday. I will post any interesting comments he makes.
So being in AFib doesn't mean a visit to the ER?
 

johnmarkos

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Johnmarkos, thank you for sharing your journey. It's been really helpful and you sound like you're doing quite well in general. Hopefully your afib has now passed.
Not quite yet, unfortunately.

As someone who has yet to go through surgery I have a question about post-op afib as it seems to be common. How do you know when to 'let it ride' and when to go to the ER? Are there parameters they give you post-op as far are things to look out for?
The PA at my surgeon's office said if my heart rate was between 60 and 110, I shouldn't go to the ER -- I'd just spend the day/night there waiting, and in the end, they wouldn't do anything about it. If my heart was racing, i.e. 120 even after 15 minutes of rest, I should go to the ER, I guess. I'd be tempted to ride it out if it was 112. In my case, my breathing is at a normal pace, and it doesn't feel like my heart is racing. Because of the AFib, it's hard to tell exactly what my heart rate is right now, but the best read I can get is under 90 at rest. I hope that when you have surgery, you don't have to worry about AFib.
 

Freebird

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Not quite yet, unfortunately.


The PA at my surgeon's office said if my heart rate was between 60 and 110, I shouldn't go to the ER -- I'd just spend the day/nigh there waiting, and in the end, they wouldn't do anything about it. If my heart was racing, i.e. 120 even after 15 minutes of rest, I should go to the ER, I guess. I'd be tempted to ride it out if it was 112. In my case, my breathing is at a normal pace, and it doesn't feel like my heart is racing. Because of the AFib, it's hard to tell exactly what my heart rate is right now, but the best read I can get is under 90 at rest. I hope that when you have surgery, you don't have to worry about AFib.
Interesting information. What are you using to test your heart rate? I have a Fitbit and wonder if they'd consider that to be legit.
 

johnmarkos

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So being in AFib doesn't mean a visit to the ER?
I don't know how it is where you live, but in San Francisco, California, where I have lived most of my adult life, going to the ER means hours of waiting, and it'll ruin your whole day. This experience is a powerful incentive to avoid the ER, unless it's absolutely necessary.

Presumably, if your condition really is life-threatening, they'll get to you right away. I've only been to the ER for things that turned out not to require immediate attention.

But if I call the surgeon's office or my cardiologist's office on Tuesday, and they tell me to go to the ER, I'll go to the ER. But not Zuckerberg San Francisco General (link: vox.com), the closest ER to my home. I guess I'll go to the ER at CPMC Van Ness, where I had my valve replaced.
 
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johnmarkos

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We have a BP cuff, a really nice one, and I just used it -- BP 128/73, pulse 70. I'm still noticing some irregular beats, especially when I'm not at rest, but it seems less irregular than yesterday or early this morning.
 
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