Surgery this Friday

[pellicle]

. Particularly when to test after having alcohol

I always test in the morning, seldom drink then.

Having alcohol in your blood makes no difference to the test accuracy but the effect of the body clearing the alcohol does choke down the disposal system (cytochrome p450) and results in a short term elevation of INR after drinking (a day or two). Its either minimal (meaning sub clinical significance) for a few drinks or notable (after a lot of drinks). Either way once you get the hang of it you may be the type to reduce your subsequent dose by (say) 10% to account for that and its all smoothed out.

 

[pellicle]

Hi @Adamlee

I would suggest taking your HR manually to compare the rate over a minute.

I would double vote agreement on leadvilles suggestion because the simple machines don't know when they are counting an irregularity (an arrhythmia) as they make the assumption in sampling (fancy word for counting) that your heart is a metronome. It may not be after surgery.

If you count for 15 or even 30 seconds you'll get a better sample. Supermans post is a demonstration of this sampling error too.

I’ve had my smart watch show 120 when I can hear my ticks at 60. Best guess is sometimes it’s picking up two locations and double dipping,

Think of how a simple machine will have to operate (mathematically) to make an assessment of your HR in seconds. Its "peak to peak timing"

PS: this is a classic example of the wisdom contained in the novel Dune: "Never send a machine to do a humans job"

 

[Adamlee]

Definitely about 130 bpm. Checked on a blood pressure machine. GP doesn't seem too concerned as I have no other symptoms (fever, chest pain) but GP's are pretty clueless. I phoned the ward that I was on and a nurse answered and told me to talk to my GP.... So...yeah not sure what to do now.

 

[pellicle]

So...yeah not sure what to do now.

Are you on a beta blocker of any type? Such as metoprolol?

 

[Adamlee]

Off to the GP later for an ECG. Head nurse at the ward where I had the surgery said it might just be a change in my medication needed.

I'm on Ramipril 2.5mg but that's classed as an ACE inhibitor.

 

[Chuck C]

Definitely about 130 bpm. Checked on a blood pressure machine. GP doesn't seem too concerned as I have no other symptoms (fever, chest pain) but GP's are pretty clueless. I phoned the ward that I was on and a nurse answered and told me to talk to my GP.... So...yeah not sure what to do now.

130 bpm at rest is not normal. It is probably ok for short periods, such as during exercise, but if this is the at rest number, that means your heart is under stress. It sounds like you are on beta blocker. They may increase your dosage, which might be all it takes. Keep pushing until someone pays attention to your situation and takes it seriously.

I'm not sure if you are allowed to switch GPs in the UK. Can you go to a private GP for a specific issue?

 

[pellicle]

Definitely about 130 bpm. Checked on a blood pressure machine

Count and time, something with a second hand.. Notice the word machine in the above?
It uses the same magic I (be others) mentioned above

 

[Adamlee]

So I'm now in hospital again (different one to surgery) hooked up to an ECG machine/heart monitor. They've given me 5mg of betablocker but it hasn't worked so I think they'll give me more once it's been 6 hours since the other one.

 

[Superman]

So I'm now in hospital again (different one to surgery) hooked up to an ECG machine/heart monitor. They've given me 5mg of betablocker but it hasn't worked so I think they'll give me more once it's been 6 hours since the other one.

Hope they figure things out for you soon. Sorry to read about the challenges. Keep us posted.

 

[Adamlee]

Thanks guys.

They say it is a Atrial Flutter not Afib.

Searched the forum and saw this person's post.

So there I am, minding my own business 10 days post discharge, when I try out my new BP cuff, one that highlights pulse anomalies. Resting HR is sustained 130+. Whoa! Didn’t really feel like my heart was pounding it’s way out, no shortness of breath beyond “expected“ 10 days out, maybe a little more tired. Called my PCP and told him, who then called me in for an ECG. He consulted with my cardiologist, and they decided to get me to the ER since I had had OHS so recently. Dang!
Got admitted and learned a new term: Atrial flutter. I was told it can happen to around 30% of post-operative OHS patients. Over the course of several days they tried medicinally getting it back to proper rhythm, with no sustainable effect. They finally, in combination with TEE scope monitoring, sent me down for cardioversion which zapped me back into sustained proper sinus rythm at around 75-80 BPM. Home again a couple of days later, with surprisingly way more energy. Just a bump in the road.

Early bit is very similar to me. 130 resting, just over a week out. They've given me amiodarone and will be in for 4-6 weeks if it works. Only had one dose so far.

Feel a bit calmer seeing how common it is and fairly easy it is to correct. Just in for a few more days than I wanted I guess.

Still feel pretty good though. Thanks to everyone for listening to me worry the last 24 hours.

Adam

 

[ValveAdmin]

Hey Adam, wishing you all the best!

 

[pellicle]

Still feel pretty good though. Thanks to everyone for listening to me worry the last 24 hours.

its not just listening to you worry, its often the case that we worry with you. Sometimes there are events which can occur to you with these situations which you *really* don't want to occur ... such things as stroke can and do leave permanent disabilities.

Your INR should not be below 2 for any significant amount of time, especially so soon after surgery. I would make sure you remind them of that. For that is how strokes happen.

I also suggested you count the beats manually (I'm quite sure you can hear them anyway) because that will key you in to the fact that you are not in rhythm. They should be metronome like. Very similar timing between beats if they are not that is serious too (and is the cause of errant readings on all types of machines).

Nothing I wrote was trivial or flippant.

Are you in hospital now or are you released?

Please note >> amiodarone is a powerful drug and has a powerful interference with warfarin and therefore INR<<

Make sure that your INR monitoring team know about this. It has a long half life and will continue to interfere with INR for a while after you cease it.

This is all serious stuff and needs to be attended to and nothing you're writing so far is giving me the sense that your team is competent or that you are taking in the points made to raise them with your team.

We are not doctors but many of use are quite experienced enough and (probably) we all know that you must advocate for yourself of fall through the cracks.

You seem to be having a bit of a post surgical bumpy road landing (which is possible) but you must steer around the bumps not just slam into them while watching them. These bumps can take a wheel off if you don't avoid them.

lastly, you said you were a teacher, what do you teach?

Best Wishes

 

[Adamlee]

Thank you for your concerns.

The Cardiologist I spoke to this morning was aware that it can have an affect on my warfrain/INR levels. My INR today was 2.8 and will be monitored daily. I've also had those lovely injections again today which should help the warfrain too.

My heart rate is now 124-125 consistently so has come down slightly and slowly.

I can hear my valve much better and clearer today. I can hear a rhythm and tap my foot to it which I couldn't do yesterday (felt like I couldn't really hear a rhythm). It was difficult to get a pulse manually yesterday as it was just all over the place.

All these things are encouraging I feel. Just hope it starts to bring it down a bit more now.

I will let my INR team know about the amiodarone.

 

[pellicle]

Hi @Adamlee

My heart rate is now 124-125 consistently so has come down slightly and slowly.

good sign

I can hear my valve much better and clearer today.

excellent, now keep a track of how you hear it ... people say that its annoying hearing your heart beat with a mechanical valve but I say it can save your life because you become intimately familiar with it and (especially with your heart) change is not a good thing.

I can hear a rhythm and tap my foot to it which I couldn't do yesterday (felt like I couldn't really hear a rhythm). It was difficult to get a pulse manually yesterday as it was just all over the place.

especially this is a very significant fact and you should make a point of mentioning this when reporting about this. None the less you should count every beat (and if they're fast then use a 15second window, start counting at zero) and then multiply by 4. Report that number (which will be an average) and report that there were ectopic (see link) or "irrregular beats" ... even if its irregular the actual number of beats in a minute means something important. This is why we (at least three of us) asked you to report the manual count).

All these things are encouraging I feel. Just hope it starts to bring it down a bit more now.

mine was high for the duration of my stay in hospital, but was about 110 on release ... I didn't get anything less than 80 for some weeks.

I will let my INR team know about the amiodarone.

good idea!

Best Wishes

 

[Adamlee]

especially this is a very significant fact and you should make a point of mentioning this when reporting about this. None the less you should count every beat (and if they're fast then use a 15second window, start counting at zero) and then multiply by 4. Report that number (which will be an average) and report that there were ectopic (see link) or "irrregular beats" ... even if its irregular the actual number of beats in a minute means something important. This is why we (at least three of us) asked you to report the manual count).

I really tried to yesterday but really couldn't get a decent read. Even my Dad tried and said it was hard to track the rhythm. Today is much better. Just did a manual read of 124 (31 beats 15 secs). I agree, I love hearing my mechanical valve and the fact I can hear it clearly today has put me at ease. To me, it says that the drugs are working.

Thanks again! I cannot thank you guys enough. This forum has been so helpful.

 

[pellicle]

Even my Dad tried and said it was hard to track the rhythm

glad that today is better ... anyway, don't try to track the rhythm ... just do your best to count ... if you miss one it won't matter, but if you're counting more than 25 in a 15 second sample its fast.

noting if there are a lot of one or two irregular beats is about as good as it gets without an ECG

sorry, just recalled I forgot to add the link last time

Ectopic beat - Wikipedia

en.wikipedia.org

BTW, what do you teach?

Best Wishes

 

[Adamlee]

I teach Primary School (Year 5 10-11year olds) so I teach everything really. Maths, English, Science, PE, French, RE etc.

 

[Chuck C]

We are not doctors but many of use are quite experienced enough and (probably) we all know that you must advocate for yourself of fall through the cracks.

Well said. No one here claims to be a doctor. Well, except that a few are actually doctors, but they don't boast about it. It is not about playing doctor, but many here have a lot of experience that can help inform, that they may learn from our experiences, and help them ask good questions of their medical teams. It has never been about "listen to the forum and not to your doctor" It has always been along the lines of helping patients to be informed to help them advocate for themselves as they interface with their medical teams.

 

[pellicle]

Well said.

Except that I just noticed a spelling error

 

[Chuck C]

The Cardiologist I spoke to this morning was aware that it can have an affect on my warfrain/INR levels. My INR today was 2.8 and will be monitored daily.

That is good news. Like you, I was on amiodarone upon release from the hospital. It caused my INR to go from 3.1 to 9.7 in three days. Those who were should have been paying attention to this contraindication were not, including the clueless Coumadin Clinic. So, very good that your cardiologist is on top of this and will be taking your INR daily.