A few questions post surgery

[FredW]

My surgery was July 22 and I guess I'm recovering well since. I can sleep in my own bed now, walk about 2 miles daily, am weaning myself off Tylenol, the only pain meds I have been taking for over two weeks. I do have some questions that I wonder if others have input on:

1. Up until today, I have had headaches in the back of my head. This only occurs when the Tylenol wears off - about six hours after taking it. The pain feels like my head was in a vice or clamp during surgery. Is it possible they do that to keep me immobile? The Tylenol does help somewhat, but I never get headaches and wonder just what they did to my head during surgery that may have caused this. I also have pains in the upper chest across the breasts bone, but I think that is expected due to the extractor used to open me up.

2. I have a tooth bothering me, feels like a abscess starting. I'm trying to locate a new dentist for my old one retired. I also have calls to my docs to see if I should be on an antibiotic before any dental work is done. I think I read someplace that we artificial valve people should take an antibiotic before work is done. The nurse from my GP's office called and said they don't do that any more, but I am suspect of her answer.

3. Is is normal to be 'out of it' mentally and emotionally? I seam to have not energy or motivation to do anything. Is this the normal depression one gets after OHS? My wife tells me I'm distant, I can't remember music I use to be able to play on the piano. I've been reading a fair amount of novels that my neighbor gave me from her used bookstore, but ever that seams a choir to do. I take naps often, have to really fight the desire to not walk and fine even eating is no longer fun. I have this metallic taste in my mouth that I suspect is due to some of the drugs I'm taking ,but have yet to figure out which one it is.

4. I'm so bored that I'm tired of being bored. I tried to so some minor work like load and fire a gas kiln we have with pottery. I suspect I'm pushing my limits when I life the kiln shelves into the kiln, for after wards, I have to hit the Tylenol to kill the pain in my upper chest area. Yesterday, while my wife was out for the day, I decided to violate my doc's orders and drove to my old place of work to drop off a package to be picked up. I figured I lived and drove 20 years before safety belts were required, that I could drive 15 miles without one and survive. Nothing happened and maybe it was a stupid risk, but I felt so much better than being cooped up at home. I will see my docs next week and hopefully they will life some of these restrictions. Is this what recovery is like?

One think I have observed is that the doctors don't always know the answers. One specializes in surgery and may be very good at it, but has not experience in how to deal with an old man who has to get up 4 - 5 times a night to pee and can't get a good nights sleep. One may be a good cardiologist, but if the echo numbers do not all say 'serious' he argues against OHS until he sees a stress test EKG that tells him, I'm a time bomb ready to go anytime. They look at the numbers and compare that to the protocol book and give you orders never considering you, just may be unique human.

Sorry, if I sound like I'm ranting. Just wondering if my experiences are unique or normal.

Thanks in advance,
Fred

 

[Paleowoman]

Hi Fred, Not sure of all your issues, but here's some ideas based on what I know and experienced:

1) I don't think the head is put in a vice, but when I've seen photos of people being intubated it looks like the head is tilted very far back, so maybe the base of the skull/top of spine suffers somewhat ? Then afterwards the mouth is kept open forcefully - I have a photo of me in ICU when I was still on the ventilator and my face/head is held in position with my mouth open with a tight band which is tied around my mouth to the back of my head. I can try and post a picture - it doesn't look like it would be very comfortable !

2) I had a dentist tell me that antibiotics weren't prescribed prior to invasive dental treatment anymore, but then my cardiac surgeon said I should have them and wrote an appropriate letter for me to show dentist. In the event, my GP gave me a prescription for antibiotics in case of dental treatment. That is on my 'repeat' so I can order it anytime.

3) Yes, it's normal to be out of it mentally and emotionally. I couldn't read for several weeks post surgery, nor even watch my favourite films. I remember trying to watch Lord of the Rings on DVD to distract myself from pain (I had very bad pain for several weeks and no pain meds) and I just couldn't, when Frodo said to Sam "I just can't go on" I knew how he felt. The films are now almost spoiled for me as it reminds me of how badly I felt while trying to watch them.

The metallic taste can come from Zopiclone. It's a well known side effect of Zopiclone and maybe some other meds in that family.

Re the docs - you need a good generalist rather than specialist. Most doctors these days are specilists and that causes issues for patients as we're not just a heart or a head or a bone etc. My endocrinologist is a fantastic endocrinologist AND generalist. When things were going badly three weeks post surgery I saw him as an emergency. He was much better than any other doctor I know. But that was luck that he's my endo and I could get quick access to him.

I hope you start feeling better soon - it will come, give yourself time.

 

[scott.eitman]

1. This is a new one for me.
2. Pre-med for dentist i still done for valve patients...or at least I still do. Talk with your dentist as they will be the one to prescribe it.
3. Yes, being out of it is normal. all of it. Give it a some more time and it this does not get better talk with other. I really believe that as you get better and are able to load the kiln by yourself with out pain, you will start feeling better. You did not go through this to feel worse. I see you are on a beta blocker. I found that to have a negative effect for me as well, however I have talked with many that it does not have the same effect on.
3. Driving...that is fine as long as there is no steering wheel nor airbag to hit you in the chest. Really if you ht one of those while your sternum is healing, that might not be so good.

Doctors, they are not gods. Be willing to change doctors if they do not click with you.

 

[dick0236]

1. Can't help.....it's been too long since my surgery.
2. My dentist requires pre-med before ANY invasive dental work. Had a friend of mine with mechanical valve die recently from endocarditis that complicated other health issues. The endocarditis appeared shortly after he had some dental implants done. Anti-biotics are a small price to pay for peace of mind......plus Amoxicillin is dirt cheap.
3. I think the emotional aspect of "heart surgery" doesn't get near the attention it deserves. It was a big problem for me although I tried to deny it. Big boys do cry and that is OK.
4 Boredom, after you start feeling good, is natural.....and healthy. It shows you are feeling better. Just don't think you are Superman for a while. .

 

[Warrick]

Hi, yep antibiotics a must "any manipulation of the gingivitital tissue" (excuse the spelling) , which means if you have your teeth cleaned you need them, dentist seemed pretty on to it with this

" Is it normal to be 'out of it' mentally and emotionally?"

Yep I found this to be the hardest part, still not 100%

 

[pellicle]

...I do have some questions that I wonder if others have input on:

2. I have a tooth bothering me, feels like a abscess starting. I'm trying to locate a new dentist for my old one retired. I also have calls to my docs to see if I should be on an antibiotic before any dental work is done. I think I read someplace that we artificial valve people should take an antibiotic before work is done. The nurse from my GP's office called and said they don't do that any more, but I am suspect of her answer.

they do here ... and my dentist will send me home if he thinks I've not taken them...

3. Is is normal to be 'out of it' mentally and emotionally? I seam to have not energy or motivation to do anything. Is this the normal depression one gets after OHS? My wife tells me I'm distant, I can't remember music I use to be able to play on the piano. I've been reading a fair amount of novels that my neighbor gave me from her used bookstore, but ever that seams a choir to do. I take naps often, have to really fight the desire to not walk and fine even eating is no longer fun. I have this metallic taste in my mouth that I suspect is due to some of the drugs I'm taking ,but have yet to figure out which one it is.

happened to me ... and I've read of it here ... even had problems reliably adding simple numbers without writing them down

 

[honeybunny]

I can't speak to all your concerns other than wish you a speedy return to "normal" (whatever that is). Regarding pre-meds for dental work: When I told my new dentist about my OHS and new tissue valve, she agreed I should take antibiotics, even when I had my teeth cleaned. My late husband, who had OHS in the early 60s for his BAV (not a replacment; one cusp was cut into two), took pre-meds each time he went to the dentist, which was mostly for routine cleanings. He had a cleaning about a week before his sudden death and I've wondered if bacteria might have still reached his heart. He'd been having TIAs for six months but the autopsy showed only an enlarged left ventricule...no stroke or heart attack. So my opinion is to request antibiotics. Better to be safe than sorry.

 

[Mellyouttaphase]

I work as a dental assistant in Australia. Currently our guidelines are to provide antibiotic prophylaxis (basically a fancy word for prevention) for all heart valve patients. Providing our patient does not have any allergies to penicillin, we usually provide 4 x Amoxicillin capsules to take approximately one hour before the appointment where work will be done.

We had a dentist from the UK who was less conservative than the Australian-trained folk and left it up to the patient to consult their doctor/surgeon but the principle dentist put the kybosh on that behaviour. No hat, no play.

Also, you may not be able to have an extraction whilst on anti-coagulants. We like INR to be checked that day and wherever possible, temporary cessation of the "big ones" as we call them, namely Warfarin and Xarelto. This is more the case in the elderly but any self-respecting dental practice will have protocols in place to deal with a "bleeder" should there be an event and be prepared to do the extraction meds and all if necessary.

 

[Mellyouttaphase]

Fred, I definitely felt "out of it" mentally. Reading was a tiresome chore and I was really quite anti-social. I've always been a bit of a scatterbrain, but in the first weeks after my surgery I could not keep track of any train of thought for long at all adding to my distaste for social interaction - conversations became hard work!

Embarrassingly, I played games on my phone and this was pretty much all I was interested in. I have earned all the swords and dojos in Fruit Ninja, mastered minesweeper and solved the first 200 deals in Freecell. (Normally I would look down at others for such time-wasting ways, how things change!)

 

[LondonAndy]

Hi Fred

When I had my OHS (at the London Heart Hospital) they did a nurse-led briefing about what to expect both during surgery (not too much detail!) and after, and they described the body as amazing in how it diverts energy from other parts of the body to where repairs are needed, ie where the surgery was done. They said that the biggest user of energy in the body is the brain, and so a lot of that repair energy comes from the brain, therefore leaving the brain functioning less well. They said it would be difficult to focus on any particular task for longer than about 20 minutes, and advised against taking any big life decisions for several months afterwards.

Also depression is not unusual after this surgery. In the words of the hospital guide: "it is not unusual to have mood swings, or to feel tearful - you will have good days and bad days. Your memory and/or concentration will not be as good as usual. Do not become discouraged - this will improve."

Regarding dental work, firstly don't delay - get treatment. Again, from my hospital guide: "There are two reasons [for a dental checkup before surgery]: firstly dental infection can sometimes settle on the valves of your heart causing a serious condition known as Infective Endocarditis; secondly there is mounting evidence to suggest that chronic oral infection may be one of the causes of Ischaemic Heart Disease."

Again in the UK, re dental treatment antibiotics are not currently part of treatment guidelines, and my dentist does actually advise against, on the basis that too much use of antibiotics is bad. However, cardiologists have mixed views, and seem to lean more towards using them. I have a small supply of Amoxicillin that I use shortly before treatment as my own choice, and my doctor prescribes them when needed. I have been going to my dentist for cleaning every 3 months since surgery (about 2 years ago), though he has now reduced that to every six months now that I understand the importance of good oral maintenance and using those little inter-dental brushes between teeth! (I hate flossing so use those instead).

 

[honeybunny]

Update on the pre dental work meds. I saw an endodontist today for a root canal. He said that opinion has changed over the years and the thinking now is that pre meds are not needed, and if you ARE advised to take them it won't be necessary a year after your surgery. I didn't ask for his source of information and will likely take them when I get my permanent crown in a week or two and probably not worry about it after that.

 

[AZ Don]

2. FYI, here are the 2014 findings by the American College of Cardiology:
http://content.onlinejacc.org/article.aspx?articleid=1838843

1.Prophylaxis against IE is reasonable for the following patients at highest risk for adverse outcomes from IE before dental procedures that involve manipulation of gingival tissue, manipulation of the periapical region of teeth, or perforation of the oral mucosa(54–56)(Level of Evidence: B):

• •Patients with prosthetic cardiac valves;
• •Patients with previous IE;
• •Cardiac transplant recipients with valve regurgitation due to a structurally abnormal valve; or
• •Patients with congenital heart disease with:
  • ○Unrepaired cyanotic congenital heart disease, including palliative shunts and conduits;
  • ○Completely repaired congenital heart defect repaired with prosthetic material or device, whether placed by surgery or catheter intervention, during the first 6 months after the procedure; or
  • ○Repaired congenital heart disease with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device.

So assuming your surgery included a prosthetic heart valve, based on these guidelines you should always take antibiotics prior to dental work. I would just show your Dr. this information and ask for a prescription. I didn't see the dosage listed in here but it is generally 2g amoxicillin 1 hour prior (for those not allergic to penicillin)
3. To be physically tired more than before is normal, even at one month. To be out of it mentally or emotionally, may not be unusual. I would say that it is more important where you are going than where you are. If it is not getting better then it might be useful to bring it up with your Dr. The meds could be involved in this, as well as that metallic taste. I found metoprolol to cause insomnia when I took it at bedtime, though it took some time to make that connection.
4. It's different for everyone. I enjoyed the reprieve from some of my responsibilities as well as the opportunity to catch up on some reading and movies. Driving restrictions are usually lifted at about 6 weeks so that should help.

One think I have observed is that the doctors don't always know the answers.

Absolutely! I view my Dr's like a general contractor views the subcontractors they hire. I hire them for their experience and expertise, which I value, but I am in charge and ultimately make the decisions.