I've crossed the line into severe and need to make a decision

[Chuck C]

There are two. One measures inhale volume in ml the other measures how fast you inhale, with slow being better. I can inhale a much larger volume than before. So, I am doing better with the one that you want to go as high as possible. I am also doing better with the one that you want to keep low, which will only stay low if you inhale slowly.

Do you recall getting a diuretic post surgery?

 

[bizinsider]

I was pumped with Lasix, but was also bloated with liquid.

 

[egar]

Do you recall getting a diuretic post surgery?

I was on diuretics in the hospital post surgery (probably Lasix) and also at home for a period of time. Not sure about the dosage at the hospital, but at home, it was a very low dose. The docs said it was just to take some load off of my healing body.

 

[Unicusp]

Do you recall getting a diuretic post surgery?

Yes, I believe it is pretty standard. They call it by the brand name Lasix, but it is usually the generic Furosemide. I was on it for 4 days after getting released. But, I was up like 14 lbs like Bizinsider was. Bloated inflamed tissues. Back to normal about a week later. Are they weighing you everyday? Do you still have one tube in? Still draining? You may still have liquids in there.

 

[Unicusp]

magnesium and potassium if I was on diuretic. Transfer out of ICU and into the ward and the electrolyte IVs stopped. Just low dose oral magnesium. A fib returns after stability for the night. I told them I suspected my potassium and magnesium where low again and they re-tested at my request. Well, it turns out they were low. So, now I am getting them by IV again. It seems to have helped. Glad that I spoke up.

Did you require any units of blood during surgery? You may be low on other things too like Iron. I'm surprised that they are not running a complete blood test to check all of your levels.
Keep up the breathing exercise! It hurts, but helps!

 

[Chuck C]

I was pumped with Lasix, but was also bloated with liquid.

I think it makes good medical sense for someone who is bloated from surgery. It also certainly has clinically improved outcomes for patients in heart failure, which many have when they get valve surgery. This is possibly why they do it routinely for all who get cardiac surgery.
I am probably up only 2-3 pounds. Weighed 186 just now. That is pretty close to my baseline. It is also about one pound less than yesterday and I am eating up a storm the last 2 days, so setting aside the surgery, if I ate like this and did not get to exercise much I would be putting on weight. So, I would guess that I am maybe 1-2 pounds of extra fluid right now. I've managed to have good discussions about my concerns at least once per day with the physician doing rounds or the head nurse. My understanding is that pre-covid it was routine for the head floor nurse and the floor physician to have a direct conversation with you. But, with covid, they started have them communicate only with your nurse and then she sort of follows their orders. But, if you ask, they will have a discussion with you. I have done so and have felt heard. They have listened to me and mostly agreed, but it has been kind of "we just want to see if we can get your weight down a little more" But, I believe the price of losing that final pound or two may be afib, probably temporary reversible, but then a few other meds added in to control the afib. Anyway, I suppose if the Lasix is causing the afib, my body will probably restore completely once I am off of it and, even if not, it just means getting a pacemaker, which is not that big of a deal. I am fortunate to be doing as well as I am.

 

[Chuck C]

Did you require any units of blood during surgery? You may be low on other things too like Iron. I'm surprised that they are not running a complete blood test to check all of your levels.
Keep up the breathing exercise! It hurts, but helps!

Good question. I don't believe I received any blood but will confirm. Yes, I have been doing the breathing and will up it even more today.

 

[Chuck C]

Morning update.
Feeling a little better, as I have each day. Staying in this Unit is so much better than ICU. It is kind of like staying in a hotel.
INR is 2.8 yes! The order just came in to stop heparin.
Warfarin dose was 5mg. INR 1.6
Warfarin dose 5mg again INR 1.9
warfarin dose 6mg yesterday- INR 2.8 an hour ago
They will test INR again in the afternoon and decide on today's dose depending on whether it is still rising. Their target for me is 2.5 to 3.5 so I am right where I need to be just don't want to overshoot.

Just had a really good meeting with the ICU head nurse, and the nurse practitioner of my current ward. It was good to have this, as I felt that there was a little communication gap in terms of goals, ect. They have agreed to hold off on the Lasix today, which I have been pushing for and I have a very good feeling that this will take care of the afib. We'll see.

I will not be released today. It will be tomorrow if my rhythm stabilizes.

 

[Unicusp]

Morning update.
The order just came in to stop heparin.

I will not be released today. It will be tomorrow if my rhythm stabilizes.

Sounds like you're doing well. The Heparin may have been causing some issues too. I did not like it.
You have no wires that need removed? Did they install any?
Keep up the good work!

 

[Chuck C]

Yes, I believe it is pretty standard. They call it by the brand name Lasix, but it is usually the generic Furosemide. I was on it for 4 days after getting released. But, I was up like 14 lbs like Bizinsider was. Bloated inflamed tissues. Back to normal about a week later. Are they weighing you everyday? Do you still have one tube in? Still draining? You may still have liquids in there.

The first tube came out Wednesday and the second tube came out yesterday. They hurt coming out, but I just kept focused on the reward of having them out. It is like a blessing having each tube, IV removed. I no longer have a pole that I need to walk around with, just a double port in my left arm in case they need to give me something by IV. They even took off the pulse ox dangly from my finger. It is so nice to have this freedom- to be able to get up and go to the bathroom without dragging this giant ICU pole behind me.
I think it is possible that I have as much as 4-5 pound of water, but I'd guess a little less than that. So far my hypothesis that the Lasix was causing me to go into afib is looking like it might be correct. Current pulse is 66 with normal rhythm all morning. Blood pressure is 119/75. Really hoping the rhythm stays normal, and if so I will likely be able to go home tomorrow.

 

[Chuck C]

Sounds like you're doing well. The Heparin may have been causing some issues too. I did not like it.
You have no wires that need removed? Did they install any?
Keep up the good work!

Yes, I had temporary pacemaker wires that are standard and were removed the day after surgery. I am down to only one double port in my left arm and EKG wires on my chest. But the EKG has a battery operated portable transmission device that fits in the pocket. It is so freeing to gradually have all of the wires, tubes and ports removed. The first couple days you feel like you can't even move without setting off an alarm because something loses connectivity.

 

[bizinsider]

At CC, the EKG device barely fit in the pocket. On my last day, just as I was about to get dressed to leave, I just pulled off all of the electrodes after nobody showed up to help. (OK, I can be like that!) That set off the alarms. A nurse came in VERY annoyed, admonishing me. I just smiled because contrary to what the alarms suggested, I was very much alive! So glad you are almost out. You have to admit - it's really quite the experience. Your body is about to amaze you.

 

[Unicusp]

At CC, the EKG device barely fit in the pocket. On my last day, just as I was about to get dressed to leave, I just pulled off all of the electrodes after nobody showed up to help. (OK, I can be like that!) That set off the alarms. A nurse came in VERY annoyed, admonishing me. I just smiled because contrary to what the alarms suggested, I was very much alive! So glad you are almost out. You have to admit - it's really quite the experience. Your body is about to amaze you.

Yep! That device was a little annoying. And just about every nurse made the comment that they really should make those pockets bigger. But, it's been that way for years.
I was still peeling off some of the electrode adhesive a week later in the shower. Was like 3M permanent adhesive. Oh well. Fun stuff.

 

[Chuck C]

At CC, the EKG device barely fit in the pocket. On my last day, just as I was about to get dressed to leave, I just pulled off all of the electrodes after nobody showed up to help. (OK, I can be like that!) That set off the alarms. A nurse came in VERY annoyed, admonishing me. I just smiled because contrary to what the alarms suggested, I was very much alive! So glad you are almost out. You have to admit - it's really quite the experience. Your body is about to amaze you.

Yes! The pocket size! It was just big enough to get the device into the pocket, but you really had to fight with it to get it in. For me, it was key when I started wearing my boxer shorts with big pockets under the gown. Problem solved, plus no longer flashed everyone

 

[Chuck C]

Today was a very good day.
The atrial fib stopped, and I believe this was probably due to stopping the Lasix. Very glad that I self advocated for this. My rhythm stayed good all day and pulse was 60 to 80.
I was cleared to go on walks around the ward by myself and did over 4,000 steps. I feel this has really helped my recovery and I would encourage all to do this as much as possible in recovery. I could feel the lungs opening up after each walk and felt stronger and stronger. Also, would really recommend using the spirometer as often as possible. They recommend using it 10 times an hour, which is a lot and I doubt anyone really uses it that much, but use it as often as you can. For me, I could literally feel the lungs opening up more after each use. At first it feels almost impossible to inhale very much at all. But, just keep at it and they eventually do open up.
INR is stable. Last two readings at 2.8. At UCLA, if you are not local, they work with your insurance company to find a home testing nursing provider to visit and test INR and vitals 3 times per week. Your doctor's office gets the results and adjusts your warfarin accordingly. I will eventually self test. The customer service at UCLA has been great in this regard.
I've had two visits from each of the surgeons who worked on me. They are very caring and incredibly competent. The other surgeon who worked on me with Dr. Shemin has been a surgeon all his life and has worked at many clinics with many other surgeons. He told me that I was worked on by the best surgeon in the country, referring not to himself, but Dr. Shemin. As far as I am concerned, he is correct.
The whole surgery team was top notch in every way.

 

[Meanjellybean]

Today was a very good day.
The atrial fib stopped.
He told me that I was worked on by the best surgeon in the country, referring not to himself, but Dr. Shemin. As far as I am concerned, he is correct.
The whole surgery team was top notch in every way.

Well done @Chuck C, by the sounds of it you will be home in no time!
Attended to by the best has got to be reassuring.
You are in a shared ward now?

 

[Chuck C]

Well done @Chuck C, by the sounds of it you will be home in no time!
Attended to by the best has got to be reassuring.
You are in a shared ward now?

I believe this ward is all cardiac. By shared ward do you mean sharing a room? I have my own room. Better than I expected. I have a couch, my own bathroom with shower and a recliner. I have found that I prefer to sleep in the recliner. It is much less painful when I need to get up for anything- sitting up and standing is easy and pretty much painless. The bed, however, is somewhat painful to get in and out of, even using the exact technique that they teach you and I always worry that I am disturbing the wound and delaying healing.
I've taken a shower each day in this ward- so nice to be able to shower. They will assist you showering if you need it, but my wife is here, so she helped me.
Have to comment about the bathroom situation. There is no privacy in ICU. You have 1 liter pee container and a commode and sometimes they are in the room when you need to use them. They generally give you some privacy usually when you go #2, but usually not when you go #1, just depends on the nurse. I accepted the offer of a sponge bath each time- again, you just have to swallow any issues you have with privacy. They use a special antibacterial and antifungal solution, which they let air dry on you. It has been proven effective at reducing infections, but personally I found it irritated my skin some- especially the boys. They hurt so bad I had to have the nurse apply some lotion and again, forget about privacy.

I am very sleep deprived, but have been catching up a little since they moved me to this ward. I got maybe 4 hours last night and another 2-3 during the day, after my shower. That was wonderful, getting all relaxed from the hot shower, then being able to take a nap. The three nights before that I had approx 2 hours sleep each 24 hour period, if you can even call it sleep. Not much sleeping happens in ICU, at least for me it didn't. On average I probably had 5-10 alarms going off per hour. It might be an elevated pulse, an irregular heart rhythm, an IV being empty or blocked and sometimes due to loss of connectivity of one of the electrodes. You kind of think that you must be dying because all of these alarms keep going off. Then, you'll get 15 minutes of quiet and start to doze off, just when the x-ray guy comes to take an x-ray of your chest. So, for me anyway, I can't get any real sleep in an environment like that.

Compared to ICU, the new ward is a piece of cake. The nurses are very kind and sweet. Different types are drawn to each unit. ICU, it is sort of like working in the emergency room and they are individuals who can multi-task under a lot of stress and not make mistakes. In the current ward, they are very sweet individuals, who make your life easier. In both wards they are very knowledgeable, although you can a wide spectrum there.

Here is a tip: once they move you to the next ward, have them adjust the room the way that works best for you. For me, that just meant putting the recliner right next to the bed, positioned so that I can see the computer screen with my vitals. And keeping the IV pole in the best spot to allow for easy movement from the recliner to the bathroom. You might be here for a few days, so find the arrangement that makes you happy.

At this point, it really is the easy life. I have freedom of mobility, I am staying ahead of the pain with the meds. I get to order 3 meals per day and it is very good. If I need anything, I just push a button and help usually arrives within minutes. I could get used to this.

That being said, it will be nice to be home and sleeping in my own bed and I can't wait to get released tomorrow. See, you asked a simple question and I gave a great big answer.

 

[Meanjellybean]

*the quote is way too long to keep attaching.. just know it flows from your last post haha
@Chuck C

sounds like a good experience. The ICU is pretty intense but that is more reassuring then anything. Yes sleeping in the recliner would be more comfortable but nothing beats the bed at home (especially if you get to share it ).

The fact you have your own room is so good. You can change things and have guests without it impacting on others (assuming that is possible due to COVID). I remember when i was 20 i was in the ward after 2 days in ICU (resection of subaortic membrane). The sleep was terriable because sharing a room with 3 other people who are all intense pain from their own surgeries is not fun at all. I was able to get out in a short period but i did rush it due to lack of sleep. I was near madness lol..

The privacy can be tricky for some, but if you cant wipe then you just need the help. No way around it.. I have been a disability support work for many years and i do have to admit that when its you recieving the care is can be awkward.

So you know that tomorrow will be the final day?

 

[Chuck C]

*the quote is way too long to keep attaching.. just know it flows from your last post haha
@Chuck C

sounds like a good experience. The ICU is pretty intense but that is more reassuring then anything. Yes sleeping in the recliner would be more comfortable but nothing beats the bed at home (especially if you get to share it ).

The fact you have your own room is so good. You can change things and have guests without it impacting on others (assuming that is possible due to COVID). I remember when i was 20 i was in the ward after 2 days in ICU (resection of subaortic membrane). The sleep was terriable because sharing a room with 3 other people who are all intense pain from their own surgeries is not fun at all. I was able to get out in a short period but i did rush it due to lack of sleep. I was near madness lol..

The privacy can be tricky for some, but if you cant wipe then you just need the help. No way around it.. I have been a disability support work for many years and i do have to admit that when its you recieving the care is can be awkward.

So you know that tomorrow will be the final day?

Yes, it is almost certain that tomorrow (today) is the final day. Of course, things could change. The atrial fib could come back, but I've had very stable rhythm and low pulse rate since I stopped the Lasix. I'm told that all other metrics were good enough for them to let me go yesterday.

 

[Chuck C]

*the quote is way too long to keep attaching.. just know it flows from your last post haha
@Chuck C

sounds like a good experience. The ICU is pretty intense but that is more reassuring then anything. Yes sleeping in the recliner would be more comfortable but nothing beats the bed at home (especially if you get to share it ).

The fact you have your own room is so good. You can change things and have guests without it impacting on others (assuming that is possible due to COVID). I remember when i was 20 i was in the ward after 2 days in ICU (resection of subaortic membrane). The sleep was terriable because sharing a room with 3 other people who are all intense pain from their own surgeries is not fun at all. I was able to get out in a short period but i did rush it due to lack of sleep. I was near madness lol..

The privacy can be tricky for some, but if you cant wipe then you just need the help. No way around it.. I have been a disability support work for many years and i do have to admit that when its you recieving the care is can be awkward.

So you know that tomorrow will be the final day?

My afib came back about 8am this morning. So, I will be here at least one more day while they try to get it under control. Disappointing, but like I said, it is like staying in a hotel. Just chill and take your meds, get to order from a pretty decent menu at mealtime. I don't mind staying an extra day or however long is needed.
If any have any experience they could share about having afib in recovery that would be great. My BP is normal and my pulse is staying around 125. I do not feel uncomfortable.