First Cardiology Visit

[Bryan B]

Nothing much newsworthy. They did not do an echo which surprised me. I saw my surgeon 3 weeks after the surgery and I was told I was going to have an MRI but I didn't. Yesterday I asked if I was going to have an echo and they said no. I said do you realize I haven't had any detailed imaging of my heart since surgery (I had echo 2 weeks after 1st surgery) and they said everything sounded great and they would be able to hear if there was a paravalvular leak or if something else was wrong. I go back in 3 months and they said they would do an echo at that appointment. I'm thinking...I am on Medicaid and those tests are expensive so that is why they are not doing them (probably just paranoia on my part).

My only three issues is that my BP has gone from perfect (110/70ish) to borderline high (135/90ish). He thinks as my heart remodels it will correct itself but to take my BP several times a day at home and call if it gets any higher or doesn't improve within a month and he will add another BP med (probably calcium channel blocker).

My other issue(s) is a pounding heart and insomnia mostly due to the pounding heart, although I probably suffer from insomnia more than the average person anyway. They prescribed a two month supply of the weakest dose of Ambien to help with that. Of course when I went to get it filled Medicaid requires a doctor's authorization that it is medically necessary for a patient to take this. I would assume the doctor would not write the prescription if they didn't think it was medically necessary. Lots of red tape with Medicaid but without it I still may not have had my surgery yet.

So overall no big surprises. I was taking my BP because of the pounding heart and saw that it had gone up so I was not surprised by that news. It's weird because I usually only feel the pounding heart when sitting or laying down. I have been walking 2-3 miles a day most days and it does not pound during or after the walks. If I am up and moving around I very rarely feel it. But sitting in front of the computer, watching TV, trying to get to sleep at night...it is just pounding away. It seems the less active I am at the time the more it pounds. If anyone has experienced this or has any theories about this please let me know. I have 2 theories. The first one is the most obvious...by BP is up. The second one I just thought of. When I am more active my heart has to work harder which it is used to doing so no pounding. Before surgery my heart had to work harder because of the leaky valve. When I am inactive my heart still wants to work hard when it doesn't need to thus the pounding. Hmmm.

 

[DebbyA]

Hi Bryan,

I don't know if this helps, but I'm fortunate enough through my husband's job to have the kind of insurance that makes medical providers happy, and the only reason I had an echo 3 months after my Jan avr was pericardial effusion. Otherwise, my cardiologist was going to wait until my annual appt in Oct because she thought it would be too uncomfortable. I have read many times about a 'baseline' echo right after surgery, but I never had one.

Also, even with that insurance, I couldn't get a refill on my Ambien prescription because it was a controlled substance and I didn't have a diagnosis that fit the approval guidelines.

About the pounding, sometimes it is because of the way sound travels through our physical structure. I'm a side/stomach sleeper, and when I have episodes of insomnia, I find my pounding heart still so disturbing I have to consciously sleep on my back.

If you have the time and energy to up your walking amount it may help your blood pressure and your insomnia.

Best wishes,
Debby

 

[Jkm7]

I also have excellent insurance and received no bill at all for two OHS in four years. I did not have an echo until 6 months post op after my valve replacement. My cardio knew my chest was sore and he saw no need for me to endure a 'sore' echo when he heard no leak. He was right. The echo was all good news.

Hope this gives you more faith in your doctors, Bryan.

I agree about the suggestion to do as much walking as you are able. I think it makes a tremendous difference and is one of the best things you can do to aid your healing. It's good for anxiety and stress in addition to all the physical issues.

 

[Bryan B]

I appreciate the thoughts on the echo, that does make me feel better. I guess my first surgeon happened to use the baseline echo method (and yes my chest was sore when she did the echo but she was cute so it was not all that bad ).

As far as walking how much should one be expected to walk at 6 weeks? I thought I was doing pretty good at 2-3 miles a day. I am trying to find a place close to me to do cardiac rehab that accepts medicaid. I know I can go to Duke but that is a 35-45 minute drive depending on the traffic. Add the cost of gas for 3 round trips 3 times a week and that adds up for someone with very limited funds. There are 2 places within 15 minutes of me (one 5 minutes the other 10-15 minutes) that do cardiac rehab but so far I have not gotten an answer to whether or not they accept medicaid. I will try to up my walking to a minimum of one 3mi walk or two 2mi walks but I think anything more than that is overkill. I feel great overall and this being my 2nd surgery I feel like my recovery has progressed faster than my first one. I am an avid golfer (used to be a professional) and always walk except in the extreme heat. I will get plenty of walking in once I can get back to playing. In addition to walking 5-6 miles you have a bag of clubs strapped to your back.

 

[Bina]

My cardio had me do a 3 month post op echo, which I was fine with.
The pounding heart beat while quiet or laying down is still with me unfortunately, but I have learned to accept it.
It sounds like you are doing really well, Bryan, good for you !

 

[Jkm7]

You're walking plenty, Bryan. Good job.
Hope you continue a good recovery.

 

[DebbyA]

Bryan,

Sorry, I was thinking '3 months' for some reason. You are right, 2-3 miles is great for 6 weeks after surgery. I hope you can get into a convenient rehab program, and continue to do well.

Debby

 

[Duffey]

I had the same thing-- a pounding heart while at rest. I think your second theory is correct, and that's what I attributed mine to.

My BP also took an unexpected rise. Almost six years out, it's still higher than it was pre-surgery, but I also have more problems with fluid retention. I've had to cut my salt intake down to almost nothing.

For what it's worth, I didn't have an echo until 10 weeks out, and I didn't do cardiac rehab. My insurance wouldn't pay for it.

 

[drivetopless]

HI, Bryan-
Sounds like you are doing great and on track--maybe a little ahead of the curve, even.
I have the pounding heartbeat and irratic bp, too. I started cardiac rehab 3 weeks ago. I have been suprised at how gentle they are with adding exercise to the program--much slower pace than I expected. I'm doing 20 mins on a treadmill. 20 mins on a recumbent and 10 minutes on an "arms-only-bicycle". Some stretches. and that's it. Seems like I could do that on my own at a gym. They don't give me a target heart rate. THey just say go by how you feel (slightly breathless but still able to talk).
I will say I've noted my bp is usually higher before the exercise than after the exercise session.

Re/ Echo - I got one at 3 weeks postop, but only because I was in back in the hospital for afib/CHF. It wasn't that painful and it was interesting to see even with the mild CHF (it's better now) my numbers were better than presurgery.

 

[Bryan B]

I'm going to do something I haven't thought to do since the pounding heart issue arose. I am going to start taking my BP after my walks after a cool down period and also take it when I have just been moving around the house doing chores, going up to the store/pharmacy, etc. I think I have only been taking when sitting like a bump on a log (is that the right saying lol???) so I am getting readings while my heart is pounding. I need to get some readings when it is not pounding to compare the two.

 

[Bryan B]

Bryan,

Sorry, I was thinking '3 months' for some reason. You are right, 2-3 miles is great for 6 weeks after surgery. I hope you can get into a convenient rehab program, and continue to do well.

Debby

Debby,

No problems...after thinking about it I figured you thought I was more like 3 months because that is generally when patients go for their first cardio visit. I have actually been slightly below my personal target for walking. I have been trying to add 1/2 mile a week to my walks because I want to have the stamina to walk the golf course when I get back to playing. I am hoping that will be late May which would be 3 months after my surgery. I will have to play that by ear as only my sternum knows if that is a realistic time frame. But it is torture seeing the courses green up and the dogwoods and azaleas in full bloom. Most days we have been having temps in the 70's which is a perfect temp to walk the golf course. I will watch the Masters this week (DVR'ing) it right now and watching bits and pieces on my computer (streaming video). Take care,

Bryan

 

[ejc61]

Hey Bryan,

I had my 1st echo 3 months post-op only when I had some pleural effusion issues. Otherwise, my echo would have been at 9 months.

 

[Bryan B]

Thanks ejc...I guess I just thought it was the norm to have one early when in fact it is the exception.

I took my BP after my walk but I took it sitting down and could still feel my heart pounding. Both numbers were about the same as before. I immediately took it standing up (cuff still at heart level) and both numbers were at least 10 lower (I think it was 125/82 with a pulse of 82). I could live with those numbers but would still like them 5-10 lower. My normal pulse is around 80 so 82 does not concern me although I would like that in the 70's. I think I am going to start taking my BP standing up. I remember at my first surgeon's office if the nurse got a high number she would have me stand up and take it again holding my arm for support (I didn't do that today) and she would always get a lower number.

 

[Bill B]

All this sounds perfectly OK. Some surgeons like to "check their work" with an echo and even a CT a couple of days post-op. Others don't. Follow-up echos at 6 months or so are common. I experienced the same high BP, insomnia, etc. My BP is still not resolved. The insomnia cleared up in a matter of a couple of weeks. I couldn't ignore my post-op HR in the 90s, especially when my resting HR had been 60 before surgery. That really interfered with sleep. I was started on Metoprolol for BP and HR control. Worked like a charm. It took a week or so to get down into the low 80s where I could ignore it. Eventually it got down into the 50s. I'm quite comfortable with that and I still have a good HR response to exercise.