12 week update: Work in process

[tjay]

UPDATE: To wrap-up the physical activity progress post-surgery, I've been now running 6 miles during my 1-hour sessions since my 3-month anniversary which was just over a week ago (Oct 23rd). With that, I've met my own expectations to this regard, and would hopefully settle down at this level here (no records to break ). I'll post any further activity update on the other appropriate forum, if any at all. And save this important Post Surgery space for many other urgencies or updates our fellow patients face during most critical times (days/weeks) after the surgery.

I've plenty of clinical follow-ups (and lagging attributes) of my own yet, and will prompt you all here (or on this forum) or somewhere, as necessary.

Thank you again for everything.

 

[BAV]

Thanks for sharing. Yes, for MVR, the EF is known to drop and is expected I hear. But mine was an AVR

As to your question about which hospital I had surgery at, I've no problem sharing that. But I want to make sure you are hearing my experience, or interpreting it correctly. I'm GLAD that I went to this hospital and that particular surgeon is the one who operated on me. The kink/pinch in my coronary was my sheer luck, not workmanship issues. Whatever they could do, they did more of. Like I mentioned in the Reply to another thread above:

"I'm so glad they did a CT scan before my discharge. I wonder if all hospitals or surgeons do this as a condition of discharge or only I was the lucky one... Because they could've easily discharged me without a CT scan, only to encounter this situation weeks or months later, like in your case. My surgeon was very conservative and wanted to ensure everything was perfect before discharging me, so he was ordering so many other tests too. If other hospitals or surgeons are not requiring CT scans before discharge for the aortic surgery, I guess they should."

My surgeon did so many other tests too before my discharge. Like Echo too. That's how I could find out that my EF was low right after the surgery. Then, he watched my RBC, Haemoglobin closely, and won't discharge me until it started coming back up, even though the drop was expected after the surgery. Same with my INR levels. He won't let me go until it was in the range. He did a whole suite of so many other tests I can list if necessary.

Having said that, my hospital was Stanford. One of the best in the country, and it lived up to its name. They solidly took care of me, and I felt at home with the nurses and staff there. My surgeon visited me EVERY day I was there and stayed with me as long as I wanted to ask him question. I highly recommend Stanford.

Do you mind me asking what your hemoglobin levels were when they released you?

Also, what kind of medications were you on post surgery and at this point? Any beta blockers?

I'm really impressed with your recovery on your cardio post surgery. You're killing it

 

[tjay]

My Hemoglobin/RBC/Hematocrit at the time of discharge were depressed, and actual numbers (and pertaining discussion) can be seen here:
https://www.valvereplacement.org/th...ocrit-rbc-remain-depressed.889702/post-935371

A few weeks later, they were all in normal range. I went for another exam just last week at 3 month anniversary, in which they were rechecked as normal: RBC = 4.95, Hemoglobin = 13.9, Hematocrit = 44.4

Now the Rx. During discharge, there's a whole boatload you are sent home with, but most/many of the bunch are temporary in nature which you stop after a while (days/weeks) e.g. Lasix, pain killers, etc... and others as applicable e.g. GI-track rx (pantoprazole), potassium, stool softner, etc etc which you also stop soon after..... Then there are keepers, one too many in my case which I hate and hope to trim down some eventually:

- Beta-blocker: My understanding is that it's a must after aortic surgery. I was on Metoprorol initially, then they replaced it with stronger Carvedilol perhaps because of some post-surgery issues I noted in my original email

- Losartan: Now this was a negotiation. As I noted in my original email, my EF post-surgery was lower than the one before. Surgeon didn't think that was an issue and something which would come up within 6 months after surgery. But as I was handed back over to the cardiologist a month after surgery, he scared me with the CHF conversation and contemplated stronger drugs like Entresto and Jardiance. I asked for some time and see if heart would come back-up on its own as surgeon had suggested. A couple more weeks later I had an echo and it showed some improvement (as I noted in my original email), so we settled down to adding Losartan only (for now). Time will tell if my cardiologist is happy with the return of my heart function, EF etc or not, and if those other stronger drugs will be needed or not.

- Coumadin: For obvious reasons (mechanical valve). I would've loved to only take this and nothing else (that's what I thought before the surgery).

- Plavix: As I noted in opening message, I also got a stent unexpectedly (issue encountered during/after surgery). I will need to take this for 1 year, and then stop.

- Statin: I've been offered statin but I've politely declined (for now). As I noted earlier, I never had any coronary artery issues and my lipid profile has always been text-book perfect. Then multiple CT angiograms before surgery demonstrated very good coronary arterial health. But now that I've stent, my cardiologist doesn't want to take any chances and think that I should take statin anyways. May be I will, have not started yet.

So I'm currently taking 4 Rx. Most people probably only take 1 or 2 (Coumadin and beta-blocker/BP).

I also take vitamins and supplements, always have - before the surgery too.

What's your current situation?

 

[3mm]

EF post-surgery was lower than the one before. ... so we settled down to adding Losartan

Please educate me: does your Cardiologist think your blood pressure is affecting your Ejection Fraction, so he prescribed the Losartan to lower your blood pressure? Otherwise, how does the Losartan help your EF?

 

[tjay]

Please educate me: does your Cardiologist think your blood pressure is affecting your Ejection Fraction, so he prescribed the Losartan to lower your blood pressure? Otherwise, how does the Losartan help your EF?

No, that's not the case. BP isn't a problem here. ARBs are known to also have some heart function/EF rebuilding properties, like Entresto and Jardiance, albeit latter ones are much-much stronger (and new drugs available/approved for this intended use in the last couple of years). Listen around 12:30 on this video, for example:

 

[SatoriFound]

My Hemoglobin/RBC/Hematocrit at the time of discharge were depressed, and actual numbers (and pertaining discussion) can be seen here:
https://www.valvereplacement.org/th...ocrit-rbc-remain-depressed.889702/post-935371

A few weeks later, they were all in normal range. I went for another exam just last week at 3 month anniversary, in which they were rechecked as normal: RBC = 4.95, Hemoglobin = 13.9, Hematocrit = 44.4

Now the Rx. During discharge, there's a whole boatload you are sent home with, but most/many of the bunch are temporary in nature which you stop after a while (days/weeks) e.g. Lasix, pain killers, etc... and others as applicable e.g. GI-track rx (pantoprazole), potassium, stool softner, etc etc which you also stop soon after..... Then there are keepers, one too many in my case which I hate and hope to trim down some eventually:

- Beta-blocker: My understanding is that it's a must after aortic surgery. I was on Metoprorol initially, then they replaced it with stronger Carvedilol perhaps because of some post-surgery issues I noted in my original email

- Losartan: Now this was a negotiation. As I noted in my original email, my EF post-surgery was lower than the one before. Surgeon didn't think that was an issue and something which would come up within 6 months after surgery. But as I was handed back over to the cardiologist a month after surgery, he scared me with the CHF conversation and contemplated stronger drugs like Entresto and Jardiance. I asked for some time and see if heart would come back-up on its own as surgeon had suggested. A couple more weeks later I had an echo and it showed some improvement (as I noted in my original email), so we settled down to adding Losartan only (for now). Time will tell if my cardiologist is happy with the return of my heart function, EF etc or not, and if those other stronger drugs will be needed or not.

- Coumadin: For obvious reasons (mechanical valve). I would've loved to only take this and nothing else (that's what I thought before the surgery).

- Plavix: As I noted in opening message, I also got a stent unexpectedly (issue encountered during/after surgery). I will need to take this for 1 year, and then stop.

- Statin: I've been offered statin but I've politely declined (for now). As I noted earlier, I never had any coronary artery issues and my lipid profile has always been text-book perfect. Then multiple CT angiograms before surgery demonstrated very good coronary arterial health. But now that I've stent, my cardiologist doesn't want to take any chances and think that I should take statin anyways. May be I will, have not started yet.

So I'm currently taking 4 Rx. Most people probably only take 1 or 2 (Coumadin and beta-blocker/BP).

I also take vitamins and supplements, always have - before the surgery too.

What's your current situation?

My hubby stopped taking the stool softeners as soon as the nurses made it sound optional in the hospital. He wasn't having a problem going to the bathroom. That is still one of the side effects of the whole thing that he hasn't gotten. We didn't even buy the Senokot at the pharmacy. I figured if he decided he needed it I would go back. At three weeks post-surgery he has 9 medications, most 1X per day, some 2X. Besides taking Amiodarone and Metoprolol and Warfarin, he is also taking Colchicine. Then he has the aspirin and iron plus Losartan, atorvastatin, and Flomax (those last two he took pre-surgery, along with one other that doesn't seem to be on the list). He has a muscle relaxant and pain killer on an as needed basis too, but I didn't count those in the nine since they are definitely temporary. Hopefully after his follow-up appointments they can adjust, but I would assume if his heart rate remains higher and afib remains constant he won't.

 

[Asghar]

You feeling a bit unwell (shortness of breath, lethargic/lack of energy etc) around the same time every evening may have to do with the timing when certain drug(s) (e.g. beta blocker) are taken, and/or its dosage. I'm sure talking to your cardiologist will help resolve that.

Feel free to post using a fresh thread on this forum for wider reach so that others may be able to provide their feedback on any specific questions you may have.

Yeh it feels like heavy headedness, and lack of energy, visiting my electrophysiologist next week to discuss this issue.

I posted an new thread on this which can be accessible at https://www.valvereplacement.org/threads/mitral-valve-repair.889804/#post-937537

 

[tjay]

UPDATE: My echo last week (3.5 months post-op) is all normal. EF is now 55-60%, no pericardial effusion etc. All concerns noted earlier are resolved.

Once again, thanks for everyone's help, concerns and attention