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Chuck C

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Definitely the most challenging situation I've faced before! The surgery went well!

Welcome to the other side! I'm very glad that it went well!

My blood pressure has always been normal, but after the surgery they put me on Metropolol and it lowered it even more. If it weren't for me saying do I need that if it's already low

This was my exact situation. Before surgery my BP was usually 115/75. It is standard of care to be put on blood pressure lowering medication to reduce the risk BP spikes that could cause damage as the healing is going on. But, I found myself nearly fainting several times- always about 20-40 minutes after taking the Metroprolol. Tracked my own BP and was getting readings of 100/60. So, I called and they agreed to cut my dose in half. I was still getting lows right after taking it, so they put me on slow release Metroprolol, which I found much better. So, if you experience BP lows like I did, that might be an option. I had to be proactive in asking for reductions and also eventually had to ask to be taken off completely, so you might need to do the same. It helps if you take your own BP often, so that you can make the case to reduce your dose if you want to.

One thing I didn't expect was the 27lb weight gain from all the fluids they pumped in me during the procedure.

This is common. I think some surgeons pump their patients up more than others. I recall one member sharing that they felt like the Stay Puffed Marshmallow Man after surgery. It should normalize in a few days.

You've made it through the hardest part! Well done!

Now the fun part- recovery!
 

Redone

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I got a 21" St. Jude placed. My surgery was at Brigham and Women's Hospital in Boston, MA. Yes, it was a full Sternotomy with breast implants that are problematic due to size. Metropolol is awful! They kept lowering my already low blood pressure. You definitely need to be your own advocate in the hospital because I finally said, to the nurse why are you still giving me this when my blood pressure is already low and she took me off it. I don't know about you, but I prayed to get out today. I've had little sleep in the last 6 days, not something that will help with healing. It often didn't seem like the nurses had the right schedule because I'd have vitals taken at 5am (even though they promised 6am) and then again at 7am. I finally asked the PCA what their schedule was and she said every 4 hours. Well she wasn't checking the schedule clearly. So glad to finally be going home!! 🙌🏻
 

Redone

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Messages
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Welcome to the other side! I'm very glad that it went well!



This was my exact situation. Before surgery my BP was usually 115/75. It is standard of care to be put on blood pressure lowering medication to reduce the risk BP spikes that could cause damage as the healing is going on. But, I found myself nearly fainting several times- always about 20-40 minutes after taking the Metroprolol. Tracked my own BP and was getting readings of 100/60. So, I called and they agreed to cut my dose in half. I was still getting lows right after taking it, so they put me on slow release Metroprolol, which I found much better. So, if you experience BP lows like I did, that might be an option. I had to be proactive in asking for reductions and also eventually had to ask to be taken off completely, so you might need to do the same. It helps if you take your own BP often, so that you can make the case to reduce your dose if you want to.



This is common. I think some surgeons pump their patients up more than others. I recall one member sharing that they felt like the Stay Puffed Marshmallow Man after surgery. It should normalize in a few days.

You've made it through the hardest part! Well done!

Now the fun part- recovery!
Yes, it was so uncomfortable for someone with lower body fat to wake up from surgery literally 27lbs over what I went in at. There were a lot of frustrating issues at the hospital, but not worth complaining because I can go home. An answer to prayer because my INR # is 1.7 and they have me checking with my PCP, Cardiologist and Coumadin clinic first thing tomorrow! The PA said they never release people with a perfect number. Either way I'm so grateful to have it in the rear view mirror!
 

Chuck C

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Dec 5, 2020
Messages
1,688
Yes, it was so uncomfortable for someone with lower body fat to wake up from surgery literally 27lbs over what I went in at.

I did not gain as much weight as many report. I was approximately 8 pounds heavier the morning after surgery. I have a little story about that, and it dovetails with your advice to be your own advocate, which I totally agree with.

In the ICU, it is their standard practice to put all OHS patients on IV diuretic so that you start eliminating the excess fluid from surgery. A couple of hours after being put on diuretic, I went into afib. The labs showed that my potassium dropped below the safe threshold after the diuretic, as reducing electrolytes is how the diuretic works to reduce body fluid. It turns out that afib is a well-known potential side effect from diuretics.

So they took me off the IV diuretic and got me back into sinus rhythm. I get on my PC in the ICU doing my homework about diuretics after OHS. It turns out that while diuretics after OHS has a benefit for high-risk patients with heart failure and patients with kidney problems, that there is no evidence of any benefit for better outcomes for low-risk patients without kidney issues. In fact, a two-armed trial concluded no outcome benefit at all for such low-risk patients from diuretic.

So, the next morning the nurse came in to give me my meds, including an oral diuretic. Given what I had learned and given that afib is a known potential side effect from the diuretic and given that I already went into afib once from the diuretic, I decided that I wanted to follow the evidence and not use a diuretic. It was a simple risk vs reward analysis. I was very nice about it, but firm. The ICU doctor then came to talk to me about it- you know the non-compliant patient who would not take his medication.

We had a good discussion about it. I explained my risk vs reward thinking and had him read the only published trial on low risk patients for diuretics. I told him that if he could give a good reason as to why I should take the diuretic that I would be happy to, but could see no reason to risk afib again without a good reason. He actually agreed with me and said that in his view, given that I went into afib from it before, it was the right decision to not take the diuretic. At the same time, they would be watching for hypertension and signs of abnormally high fluid retention. I fully agreed that if I showed signs of either I would go back on the diuretic.

I was doing great peeing off the excess fluid. They keep close track of how much you drink vs how much you pee out, and I was peeing off about 1.5 pounds per day. It is cute how they treat you when they come and see the full urine bottle. “Wow, you filled up the bottle all the way! Good job!” Kind of like when you are first training a toddler to use the toilet. It got to the point where I looked forward to the positive affirming remarks on how good a job I did filling the bottle. :ROFLMAO:

However, with every 12-hour shift comes a new nurse and a new nurse practitioner for the floor and each new shift the new nurse practitioner would prescribe the diuretic again. I was well on my way to normal weight with normal blood pressure, so I always refused. Still they would tell me that their goal was to release me from the hospital at the same weight that I came in at, despite the lack of evidence that this is necessary. Sometimes there will be policies that they have in place that might not apply to every patient from an evidence based standpoint. It's kind of like- well, a lot of OHS patients have heart failure, so lets give them all diuretics to play it safe. But, afib is nothing to take lightly and I was determined not to go into it again for a blanket policy not backed by evidence.

Anyway, I held my ground and by the time I was released I was only about 2 pounds above where I was when I checked in. I do believe that often you have to be your own advocate and sometimes that can mean digging in your heels.
 

drleng

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Joined
Oct 21, 2021
Messages
32
Wish I could have come here Tuesday! Definitely the most challenging situation I've faced before! The surgery went well! It took the surgeon 4.5 hours, which is amazing because I had a lot going on. Bicuspid Aortic Valve Replacement, Aortic Aneurysm, and both left and right Coronary Arteries required repositioning. I'm still in the hospital while they provide me with INR #'s. I praying to go home today. I've been at the hospital 6 days. My blood pressure has always been normal, but after the surgery they put me on Metropolol and it lowered it even more. If it weren't for me saying do I need that if it's already low I would likely be taking it much longer although I do think my care was top notch. I was in the ICU Monday, Tuesday and moved on Wednesday. I had/have absolutely no pain in my sternum (I am so grateful). One thing I didn't expect was the 27lb weight gain from all the fluids they pumped in me during the procedure. It might not be a big deal to most, but it's made me so uncomfortable (although honestly no big deal on the grand scale of things) after all I'm alive. Everything looks good for discharge today that's if my INR #'s come back good! I'm praying to go home because even though my care was incredible the hospital is a place to be repaired and home a place to heal. Every time I tried to sleep another tech or nurse was in the room taking vitals so I'm definitely sleep deprived right now. I'm also really looking forward to NOT being a human pin cushion. I have bruising everywhere from a harvested Artery that wasn't used to bruises on my arms from IT'S etc. None of which is a big deal because I am alive and so incredibly grateful for this life 🙏🏻

Great to hear you are recovering as expected! I echo the same sentiments about the beta blocker -the rationale is to reduce demand on the heart but the trade off is lowering blood pressure. I had bad postural hypotension on the beta blocker & I stopped it myself but I had a problem with rebound tachycardia :) which was uncomfortable! Yeah, have to wean off gradually :) You gotta keep questioning your healthcare providers when treatment doesn't make sense. Assuming you have a healthy heart and kidneys, the fluid overload will right itself.
Rest well!
 

Redone

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Sep 1, 2021
Messages
107
Location
Boston, Massachusetts
Excellent news. Congrats. So, what valve (size & mft) was implanted? Where was your surgery? Looks like full sternotomy.
Yeah that water weight gain was surprising for me too. Took about a week to get rid of it. And Metropolol, oh boy. Must be an incentive to put every patient on it. Did not like it and stopped it. Much better without. At least for me. Others may be different.
Good luck and get better! It goes quickly.
Can I ask I am an athlete and had a healthy body going into surgery, but my surgery pumped 7 liters of fluid into my body. When I woke my thighs rubbed, stomach was enormous and I had trouble putting socks on. Is this normal? I read 8 - 10lbs was average, but my gain has been 27lbs! I am so uncomfortable moving around. I've dropped close to 10lbs, but this seems very excessive. I'm taking Lasiks now and was sweating all night long my first night home. What was your weight gain and experience? I've read all this excessive fluid is not good for your organs.
 

Redone

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Joined
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Messages
107
Location
Boston, Massachusetts
I did not gain as much weight as many report. I was approximately 8 pounds heavier the morning after surgery. I have a little story about that, and it dovetails with your advice to be your own advocate, which I totally agree with.

In the ICU, it is their standard practice to put all OHS patients on IV diuretic so that you start eliminating the excess fluid from surgery. A couple of hours after being put on diuretic, I went into afib. The labs showed that my potassium dropped below the safe threshold after the diuretic, as reducing electrolytes is how the diuretic works to reduce body fluid. It turns out that afib is a well-known potential side effect from diuretics.

So they took me off the IV diuretic and got me back into sinus rhythm. I get on my PC in the ICU doing my homework about diuretics after OHS. It turns out that while diuretics after OHS has a benefit for high-risk patients with heart failure and patients with kidney problems, that there is no evidence of any benefit for better outcomes for low-risk patients without kidney issues. In fact, a two-armed trial concluded no outcome benefit at all for such low-risk patients from diuretic.

So, the next morning the nurse came in to give me my meds, including an oral diuretic. Given what I had learned and given that afib is a known potential side effect from the diuretic and given that I already went into afib once from the diuretic, I decided that I wanted to follow the evidence and not use a diuretic. It was a simple risk vs reward analysis. I was very nice about it, but firm. The ICU doctor then came to talk to me about it- you know the non-compliant patient who would not take his medication.

We had a good discussion about it. I explained my risk vs reward thinking and had him read the only published trial on low risk patients for diuretics. I told him that if he could give a good reason as to why I should take the diuretic that I would be happy to, but could see no reason to risk afib again without a good reason. He actually agreed with me and said that in his view, given that I went into afib from it before, it was the right decision to not take the diuretic. At the same time, they would be watching for hypertension and signs of abnormally high fluid retention. I fully agreed that if I showed signs of either I would go back on the diuretic.

I was doing great peeing off the excess fluid. They keep close track of how much you drink vs how much you pee out, and I was peeing off about 1.5 pounds per day. It is cute how they treat you when they come and see the full urine bottle. “Wow, you filled up the bottle all the way! Good job!” Kind of like when you are first training a toddler to use the toilet. It got to the point where I looked forward to the positive affirming remarks on how good a job I did filling the bottle. :ROFLMAO:

However, with every 12-hour shift comes a new nurse and a new nurse practitioner for the floor and each new shift the new nurse practitioner would prescribe the diuretic again. I was well on my way to normal weight with normal blood pressure, so I always refused. Still they would tell me that their goal was to release me from the hospital at the same weight that I came in at, despite the lack of evidence that this is necessary. Sometimes there will be policies that they have in place that might not apply to every patient from an evidence based standpoint. It's kind of like- well, a lot of OHS patients have heart failure, so lets give them all diuretics to play it safe. But, afib is nothing to take lightly and I was determined not to go into it again for a blanket policy not backed by evidence.

Anyway, I held my ground and by the time I was released I was only about 2 pounds above where I was when I checked in. I do believe that often you have to be your own advocate and sometimes that can mean digging in your heels.
If I had known how much weight gain would occur with this surgery it would have completely deterred me from doing it! Remember I could have waited awhile as my valve and aneurysm was in a wait and watch condition. Now I am so upset with my surgeon for pumping 7 liters of fluid in my body. I am taking Lasix and have dropped close to 10lbs, but I gained 27lbs!!! I just don't understand where the disconnect took place or how much the average, healthy heart patient receives, but I'm completely heart broken about how difficult it now is to move my very large body from point A to B. I've also read this is really bad for your other organs. Today, I'm going to call my cardiologist and primary care, but I'm completely devastated.
 

Redone

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Messages
107
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Great to hear you are recovering as expected! I echo the same sentiments about the beta blocker -the rationale is to reduce demand on the heart but the trade off is lowering blood pressure. I had bad postural hypotension on the beta blocker & I stopped it myself but I had a problem with rebound tachycardia :) which was uncomfortable! Yeah, have to wean off gradually :) You gotta keep questioning your healthcare providers when treatment doesn't make sense. Assuming you have a healthy heart and kidneys, the fluid overload will right itself.
Rest well!
I suppose I'm recovering as expected, but the water retention is beyond excessive. As an athlete I'm hypersensitive to changes in diet, etc, but this is the one factor that would have either swayed my decision or I would have discussed it with my surgeon prior to surgery. I tried to look up the average amount of fluid a heart patient receives during open heart surgery without much information on it as it appears it's different for all. I could punch my surgeon right now for the way I felt after surgery and still do. 27lbs of fluid? I can't reach my feet easily because my gut is that of a extremely overweight person! As a personal trainer this is purely painful and believe me I'm letting go of all vanity regarding this and just upset at my inability to move around as I did prior to surgery. I researched this surgery so much (apparently missing this hugely important factor) so you could say I'm disappointed in myself for not discussing this with him prior to the surgery. If anyone has any knowledge of how much fluid is typically standard during the surgery I would love to know. For now I'm praying my body continues to shed this ridiculously excessive amount of fluid.
 

Redone

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Joined
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Messages
107
Location
Boston, Massachusetts
I did not gain as much weight as many report. I was approximately 8 pounds heavier the morning after surgery. I have a little story about that, and it dovetails with your advice to be your own advocate, which I totally agree with.

In the ICU, it is their standard practice to put all OHS patients on IV diuretic so that you start eliminating the excess fluid from surgery. A couple of hours after being put on diuretic, I went into afib. The labs showed that my potassium dropped below the safe threshold after the diuretic, as reducing electrolytes is how the diuretic works to reduce body fluid. It turns out that afib is a well-known potential side effect from diuretics.

So they took me off the IV diuretic and got me back into sinus rhythm. I get on my PC in the ICU doing my homework about diuretics after OHS. It turns out that while diuretics after OHS has a benefit for high-risk patients with heart failure and patients with kidney problems, that there is no evidence of any benefit for better outcomes for low-risk patients without kidney issues. In fact, a two-armed trial concluded no outcome benefit at all for such low-risk patients from diuretic.

So, the next morning the nurse came in to give me my meds, including an oral diuretic. Given what I had learned and given that afib is a known potential side effect from the diuretic and given that I already went into afib once from the diuretic, I decided that I wanted to follow the evidence and not use a diuretic. It was a simple risk vs reward analysis. I was very nice about it, but firm. The ICU doctor then came to talk to me about it- you know the non-compliant patient who would not take his medication.

We had a good discussion about it. I explained my risk vs reward thinking and had him read the only published trial on low risk patients for diuretics. I told him that if he could give a good reason as to why I should take the diuretic that I would be happy to, but could see no reason to risk afib again without a good reason. He actually agreed with me and said that in his view, given that I went into afib from it before, it was the right decision to not take the diuretic. At the same time, they would be watching for hypertension and signs of abnormally high fluid retention. I fully agreed that if I showed signs of either I would go back on the diuretic.

I was doing great peeing off the excess fluid. They keep close track of how much you drink vs how much you pee out, and I was peeing off about 1.5 pounds per day. It is cute how they treat you when they come and see the full urine bottle. “Wow, you filled up the bottle all the way! Good job!” Kind of like when you are first training a toddler to use the toilet. It got to the point where I looked forward to the positive affirming remarks on how good a job I did filling the bottle. :ROFLMAO:

However, with every 12-hour shift comes a new nurse and a new nurse practitioner for the floor and each new shift the new nurse practitioner would prescribe the diuretic again. I was well on my way to normal weight with normal blood pressure, so I always refused. Still they would tell me that their goal was to release me from the hospital at the same weight that I came in at, despite the lack of evidence that this is necessary. Sometimes there will be policies that they have in place that might not apply to every patient from an evidence based standpoint. It's kind of like- well, a lot of OHS patients have heart failure, so lets give them all diuretics to play it safe. But, afib is nothing to take lightly and I was determined not to go into it again for a blanket policy not backed by evidence.

Anyway, I held my ground and by the time I was released I was only about 2 pounds above where I was when I checked in. I do believe that often you have to be your own advocate and sometimes that can mean digging in your heels.
I delt with so much incompetence in the hospital it was a bit crazy! As you've said the shift changes were interesting because more often than not I was getting my vitals taken every 2 hours after being moved from ICU. They kept loading me with drug after drug (seems physicians love drugs) and when I finally was well enough to speak for myself I did. In the ICU I was given Metropolol and my blood pressure had always been perfect and now after surgery it was low. So they kept giving me this junk and I said to the ICU nurse, why are you giving me this med when my blood pressure is already low. It was like light dawned so she took me off it. Gosh the things I wish I'd known regarding the hospital stay that I didn't. Do you remember how much fluid you were given during the surgery? I would absolutely love to know is there an average? I realize it must vary by Wright, etc. I went into surgery at 143 at home, to be realistic let's call it 152 on a balance scale with all my clothes on. After the surgery I was 177.7lbs, which seems absolutely ridiculous to me. I'm so upset I didn't realize this could happen.
 

Christyleedh

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Oct 22, 2021
Messages
26
Congrats on the successful surgery! I ended up with complications and in the hospital for two weeks! I’m very petite and went from 105 at time of surgery, to 120 when I left the hospital. My husband said I looked like the pilsbury dough boy. Then a week after being home, I ended up looking like a skeleton and was only 91 pounds after being on a diuretic. It was crazy having nearly a 30% swing in weight over the course of a month.
 

Redone

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Messages
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Congrats on the successful surgery! I ended up with complications and in the hospital for two weeks! I’m very petite and went from 105 at time of surgery, to 120 when I left the hospital. My husband said I looked like the pilsbury dough boy. Then a week after being home, I ended up looking like a skeleton and was only 91 pounds after being on a diuretic. It was crazy having nearly a 30% swing in weight over the course of a month.
Thank you so much for sharing your experience!! This has been so devastating! Believe me I am very grateful to be alive, but wish I'd known about this one important factor. So glad you lost it all plus some. My Dr told me that would happen. He said, I'd lose it all plus about 7, which is good, but also sad because I realize all those years of hard earned muscle mass will also be lost. I'll get it back though! Hope you're doing well and enjoying life! ❤
 

Chuck C

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Messages
1,688
Do you remember how much fluid you were given during the surgery?

I don't remember this number ever being discussed. I suppose they keep track and it is in my medical record somewhere. It is not an area that I have knowledge about, but in the past other posters have shared that surgeons vary in terms of how much fluid they like fill their patients with for/during surgery. I'm not clear about the benefit of doing so.
 

drleng

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Joined
Oct 21, 2021
Messages
32
I suppose I'm recovering as expected, but the water retention is beyond excessive. As an athlete I'm hypersensitive to changes in diet, etc, but this is the one factor that would have either swayed my decision or I would have discussed it with my surgeon prior to surgery. I tried to look up the average amount of fluid a heart patient receives during open heart surgery without much information on it as it appears it's different for all. I could punch my surgeon right now for the way I felt after surgery and still do. 27lbs of fluid? I can't reach my feet easily because my gut is that of a extremely overweight person! As a personal trainer this is purely painful and believe me I'm letting go of all vanity regarding this and just upset at my inability to move around as I did prior to surgery. I researched this surgery so much (apparently missing this hugely important factor) so you could say I'm disappointed in myself for not discussing this with him prior to the surgery. If anyone has any knowledge of how much fluid is typically standard during the surgery I would love to know. For now I'm praying my body continues to shed this ridiculously excessive amount of fluid.

Capillary leak syndrome explains the excessive extracellular fluid perioperatively. Around 20 litres is average. Always question when things don't seem right!
 

Chuck C

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Messages
1,688
So they kept giving me this junk and I said to the ICU nurse, why are you giving me this med when my blood pressure is already low.

It really is important to ask questions and do our best to pay attention. That was similar to my situation with the diuretic. Even when my weight was almost back to baseline and things were flowing great they kept trying to give me diuretics. A good medical team should always be happy to answer questions and explain the purpose of any medication or procedure.
 

Christyleedh

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Joined
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Messages
26
Thank you so much for sharing your experience!! This has been so devastating! Believe me I am very grateful to be alive, but wish I'd known about this one important factor. So glad you lost it all plus some. My Dr told me that would happen. He said, I'd lose it all plus about 7, which is good, but also sad because I realize all those years of hard earned muscle mass will also be lost. I'll get it back though! Hope you're doing well and enjoying life! ❤
Thank you! Back to my normal weight! I lost a lot of muscle mass, especially upper body strength because of the broken sternum, and found that cardiac rehab was helpful in getting it back.it took about six months for me to feel completely normal after my first surgery, and less time after my second- but I didn’t have complications the second time.
 

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