Heading for a new aortic valve.

[LoveMyBraveHeart]

How long have you had your on X? I’m not a real big wine guy but I love my bourbon . How much can I drink? I may on the weekend drink 4 to 6 oz mixed or straight. Will this be a problem ? Thanks

Mathias has had his On-X for only 5 months. As far as alcohol goes, on his birthday earlier this month, he had 2, 22oz beers (one IPA, one light draft), 1 shot of tequila, and a double of Maker's on the rocks. He is a pretty sturdy guy and has been drinking since maybe 16 or 17 (no problem drinking, just social). Since being on Warfarin, his tolerance has decreased pretty drastically so after his birthday shenanigan he felt really great! The next morning he didn't feel so great, but by the afternoon he was fine. I would say, drink as you like to drink and follow the advice that anyone else would follow. Don't drink until you puke, and drink water at the end of the night (even better between drinks, but I know I'm not focusing on rehydrating when I'm having a good time). The alcohol had no affect on his INR.

 

[tom in MO]

Thanks , my cardiologist says he would not bridge me for my yearly colonoscopy. He stated that bridging is sometimes worse and could cause more bleeding problems than just getting off warfarin for the procedure then back on afterwards. It’s still a scary thing for me. I’m having a very hard time deciding which way to go, mechanical or tissue. I don’t want to have to have 2 or three more avr proceedures, but the inr and warfarin is scaring me.

I was 55, about your age, when I had to decide 7 years ago. I chose mechanical primarily because I didn't want a second operation. TAVR was on the horizon but only available to high risk patients. I work for a non-profit, and at 55, my job and thus health insurance is never secure. I've had 5 operations and not one has been "perfect" for me. There are always residual effects.

There are two things I don't like about a mechanical valve. First I cannot take NSAIDs for my arthritis. Second the cost of warfarin monitoring. There is the cost of supplies and recently, my cardio has started charging $30/month to "monitor" my home monitoring. If you don't comply they will not have you as a patient. I can afford it now but in the future...

One thing not always mentioned about tissue valves, is for someone younger, you will have the same gradual valve deterioration and associated symptoms that you did with your BAV. The same risk of death if the valve deterioration is not caught in time. You will still need routine echos and cardio appointments. Mechanical valves usually only need an echo every 5 years and your warfarin can be managed by a GP.

 

[Protimenow]

Tom: If the arthritis flares up, you should be able to take NSAIDS, but only for a day or two at a time. Personally, I take 81mg aspirin at night, and avoid larger doses of NSAIDS until I am REALLY in pain. True, you can't pop them like candy for any little ache and pain.

The NSAID thing is an issue for people on Warfarin.

I've said this before - there's another NSAID - Ketoprofen - that reportedly doesn't affect the platelets as much as other NSAIDs do. It should be considered a safer alternative to the other NSAIDs, but doesn't appear on drug formularies (which rate the drugs in tiers), so a needed dose can be very expensive. It would be great if the bean counters who formulate the pricing and tiering for medications make an exception for people on warfarin. It would be nice if the patent for ketoprofen expires, so we may be able to get it for pennies a pill - instead of dollars a pill.

The cost of self-testing isn't especially high. You'll need a meter, of course (if you're on Medicare, you should be able to have Medicare pay for one), and strips (about $5 per strip), and some kind of lancing devices (mine cost about a quarter each - single use, and automatic).

There are good resources on self management here -- check out Pellicle's links.

The only hitch in your self-management scenario is the Cardio. Charging you $30 a month is excessive -- your warfarin prescriptions can be written by your PCP or any physician or physician's assistant. Keep a spreadsheet of your testing and dosing to prove to your doctor that you know what you're doing and are able to self-manage; get blood draws to compare to your meter -- and this should prove to your doctor that you're on top of things. Once you can prove this to your doctor (not necessarily cardio), you should be able to get your warfarin prescribed.

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LoveMyBraveheart -- I drink very rarely. I'm wondering of Matthias is also taking medications that amplify the effects of alcohol. I haven't heard of warfarin - on its own - affecting the tolerance to alcohol.

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Buckeye -- I'm not sure how old the post that Tom quoted is, but I'm pretty sure that, by now, your fears of warfarin and INR management should be reduced considerably.

There are a lot of us here, and (although I can't speak for them) few have any problems with warfarin. It's not the problem that many myths paint it to be.

 

[LoveMyBraveHeart]

LoveMyBraveheart -- I drink very rarely. I'm wondering of Matthias is also taking medications that amplify the effects of alcohol. I haven't heard of warfarin - on its own - affecting the tolerance to alcohol.

This is true! I should have been more clear. He is not only on warfarin, but a beta blocker and another medication for BP. He was on these medications prior to any of his surgeries, and his alcohol tolerance was still pretty normal for him then. It wasn't until this last surgery that the tolerance has waned...it's unclear to me if it's because of the warfarin, or because he didn't consume alcohol after his first OHS for months.

 

[Protimenow]

Some people might welcome the lowered tolerance to alcohol. It saves time and money. As long as there's a designated driver, maybe this is a good thing. (Of course, some people like the taste of wine, beer and liquor, and don't want the enjoyment to be cut short because of a lowered tolerance to alcohol.)