After your surgery, what are some of the things that you found out that surprised you

[DDT77]

That less than 12 hours after leaving the OR, nursing staff was trying to get me to walk. They were successful with an additional unit of blood and further 6 hours of time... first OHS: first walking attempt ~ 4 days after...

How many IVs and arterial access lines were used and present in ICU (1 central line, 2 arterial lines (both radial arteries), 5 IVs).

How little appetite one may have after not eating for a few days.

How little pain and discomfort are present when the sternum is plated and screwed (instead of wired) - painless coughing and sneezing? Wow!

How quickly edema can go away: many quick and clumsy trips to bathroom with chest tube containers...

How i cannot sneak up on my kids anymore (they can hear valve from ~ ten feet away)

 

[uncanni]

Things that surprised me:

Some nurses really know what they're doing, and some really don't. I was pretty surprised by the worst of them.

All the different meds I've had to be on; I just got taken off the Coumadin by my cardiologist, and will start the Xarelto tomorrow. Why would anyone put a patient on Coumadin instead of using Xarelto?????

How different I have felt in the sense of knowing that the heart, which I believe is the seat of the mind and spirit (not the brain!!) heals on many different levels, or different aspects. Not just a physical healing.

 

[pellicle]

Why would anyone put a patient on Coumadin instead of using Xarelto?????

If you have a mechanical heart valve Xarelto is not an approved drug.

I'd rather be on warfarin any day... Manageable and easily reversible.

 

[uncanni]

If you have a mechanical heart valve Xarelto is not an approved drug.

I'd rather be on warfarin any day... Manageable and easily reversible.

Thanks for clearing that up; it's obvious that I'm pretty ignorant about all these drugs, except for reading the descriptions, side effects, etc. I'm just so glad not to have to worry about the INR anymore...

 

[pellicle]

Thanks for clearing that up; it's obvious that I'm pretty ignorant about all these drugs, except for reading the descriptions, side effects, etc. I'm just so glad not to have to worry about the INR anymore...

we all start ignorant. That's what this place is here for, to remedy that ;-)

I'd worry more about that drug, managing my INR is a peach, the trick is to do it yourself and then its actually Simple.

Here is my long blog post (very detailed) on that:
http://cjeastwd.blogspot.com/2014/09/managing-my-inr.html

unless you have some specific medical condition which I don't know about managing INR is simple and there are myriad myths out there which are simply wrong. (again perpetuated in the USA to make money ... price warfarin vs Xarelto just for a starter ... follow the money trail and apply Occams razor)

 

[pellicle]

read this with a critical eye and tell me you're still happy with the expensive drug

https://clinicaltrials.gov/ct2/show/results/NCT00494871

good points to ask questions about:
why were there more withdrawls from the test by the warfarin group?
why were there more deaths under Xarelto
why did so few reach an end point under Xarelto (like did they quit it?)
why are there actually more adverse effects of Xarelto (and I'm willing to bet that proper managment could half that of the Warfarin group)

I wouldn't touch the stuff myself (oh, and for your background I did my first degree in Biochemistry, moved onto being a data analyist)

 

[uncanni]

I'd like to see research that's later than 2014, so I've been doing a little searching. My cardiologist switched my med for short term use--not long term. I trust his judgement completely.

If you are on long-term or permanent blood thinning med, I agree that warf. is the better choice.

 

[Keithl]

Biggest thing was waking up with breathing tube after every person at the hospital it would come out quick, I don't
call upwards of 45 min quick. Also I was hoping to be knocked out before Rolling into OR, but I was wide awake. Very well stressfully to roll in see the heart lung machine and listen to the surgical team huddle. I had to lay there as they were sorting out dozens of surgical instruments and waited as they go IVs started. The profusion texhncam over to explain he runs the heart lung machine to keep me alive.


The good news is I am 48 hours post surgery and walking without assistance. They pulled all my drainage tubes, arterial line and central line. Other than IVs in my 2 wrists, just in case, today was a great day. Surgeon was awesome, came by late evening of surgery night of surgery and again today Saturday around 2pm. They need CT done Sunday and then either Monday or Tuesdaythey will discharge me.

The issue the have is my INR is on,y at 1.1, they increased my Coumadin, but May put me on a Heparin Drip and discharge me with some injections of Heparin. Since he did an On-X valve they are targeting 1.7 INR and then a final of 2.0 give other take.

 

[Keithl]

Looks like after 3 days days on 5mg of Coumadin my INR is still 1.0 and they just started a heparin drip to keep clots from forming. Anyone else have a slo take up of Coumadin.

 

[DRG.]

Yes.
My first dose of Coumadin was April 13 / 2015 and it wasn't until May 26 2015 that my INR was above 2.5. In the middle of that I had a mild stroke ( probably AFib related but the actual reasons remain unclear ) --- when I got to emerg and they checked my INR it was 2.3. The disturbing aspect of this was the therapeutic range I was given when I left hospital was 2.0-3.0 which is a Thrombo range not the range for a Mech valve so I was in the range I was given but not the range I should have been given.

 

[Keithl]

Well that is scary.

 

[DRG.]

If they are keeping you on a steady 5mg you should see your INR raise up after a week .... BUT... as I have found from personal experience and been told by more than one doctor...everyone is different. In my case they started me on the 5mg the first day then I was told to only take 2.5mg for 2 days then take 5mg then 2.5 mg then 5mg then 2 days of 2.5mg and all of that brought me from 1.9 down to 1.7,

After that the dose was 2 days of 5mg per day then one day at 2.5 then two at 5mg and after a week that brought me to INR 2.0 and that 2 days at 5 and then one day at 2.5 then repeat was what I was on when I had the stroke. I didn't get on to 5mg for more than 2 days in a row until I had the stroke and as they also have you on a heparin drip you should hopefully not have a problem and your INR's should start to raise.

Had I been put on 5mg per day from the beginning there is a chance I may not have had the stroke but nobody can say for sure

 

[Keithl]

If they are keeping you on a steady 5mg you should see your INR raise up after a week .... BUT... as I have found from personal experience and been told by more than one doctor...everyone is different. In my case they started me on the 5mg the first day then I was told to only take 2.5mg for 2 days then take 5mg then 2.5 mg then 5mg then 2 days of 2.5mg and all of that brought me from 1.9 down to 1.7,

After that the dose was 2 days of 5mg per day then one day at 2.5 then two at 5mg and after a week that brought me to INR 2.0 and that 2 days at 5 and then one day at 2.5 then repeat was what I was on when I had the stroke. I didn't get on to 5mg for more than 2 days in a row until I had the stroke and as they also have you on a heparin drip you should hopefully not have a problem and your INR's should start to raise.

Had I been put on 5mg per day from the beginning there is a chance I may not have had the stroke but nobody can say for sure

Thanks. They are talking about giving me some variation of a hepari that has long life in the body until I can get my Coumadin and INR under control

 

[pellicle]

Looks like after 3 days days on 5mg of Coumadin my INR is still 1.0 and they just started a heparin drip to keep clots from forming. Anyone else have a slo take up of Coumadin.

Slow take up is normal, heparin drip is not, heparin injection is. They are naturally cautious on starting, and there is nothing wrong with being on heparin for a few days. Also expect that over the coming months your warfarin dose will slowly increase, that's normal too.

Best Wishes

 

[pellicle]

They are talking about giving me some variation of a hepari that has long life in the body until I can get my Coumadin and INR under control

that's normal protocol and wise.

If they are keeping you on a steady 5mg you should see your INR raise up after a week .

The dose you need is the dose you need. It is solely (properly) determined by INR. Some need 4mg, some, 20. The amount is irrelevant (and determined by your genetics) . Just hang in there and be patient, you've got decades to get the hang of it

 

[Sheila S.]

I'm just 7 weeks post-op right now and I'm delighted to have found this group!

I was surprised about the diabetic thing too. I'd been pre-diabetic but I lost 24 pounds (over 3 years) and wasn't pre-diabetic anymore. I was a bit miffed to find that I was getting insulin! (Since nobody had told me that happens post-surgery.)

I was surprised that my throat felt so rough due to the breathing tube. My appetite was affected too - it was several weeks before I was truly hungry.

I was surprised at them removing the dressing over the incision a few days later. It's healing really well though!

 

[Keithl]

I'm just 7 weeks post-op right now and I'm delighted to have found this group!

I was surprised about the diabetic thing too. I'd been pre-diabetic but I lost 24 pounds (over 3 years) and wasn't pre-diabetic anymore. I was a bit miffed to find that I was getting insulin! (Since nobody had told me that happens post-surgery.)

I was surprised that my throat felt so rough due to the breathing tube. My appetite was affected too - it was several weeks before I was truly hungry.

I was surprised at them removing the dressing over the incision a few days later. It's healing really well though!

Actually I just sounded like I had lost my voice, throat was never sore. Voice starting to sound normal at 5 days

 

[Keithl]

Latest update is my INR is still 1.1 after 3 doses of 5mg and one 7.5, tonight they did 10mg. Even the heparin at 18ml/hr is not hitting its target yet. This is stressful, they are talking giving me Lovenox shots to discharge me until Coumadin kicks in. With way for 5 days i have not had enough anti-coagulation in my blood.

 

[Keithl]

Well I am finally out 8 days after surgery. Took 3 days of 5mg, 1 x 7.5mg, 1 x 10mg then another 7.5mg and finally 2.1 INR. Follow up this morning shows 2.2 so seems to be leveling off. Feels great to be out. While there were some minor communication issues with Cleveland Clinic, overall my healthcare was exceptionally. I tried to collect a list of those deserving the most credit and will fire off a letter in a week or two. They already called today checking on me and said they will check back periodically.

 

[Asystole]

My biggest surprise was the lack of post-op pain following my second surgery. I had ascending aortic aneurysm repair in 2003 and the surgeon closed the sternotomy with the traditional sternal wires. I had the typical post-op pain and needed some opioid pain meds for a couple of weeks.

My second sternotomy in 2017 was for AVR and aortic root aneurysm. The same surgeon did this surgery as well and he closed my sternotomy with the SternaLock fixation system that utilizes titanium plates and screws that rigidly fixates the sternum. I had very little post-op pain and required zero opioid pain meds.

I was one of the first patients in the hospital to use the SternaLock system and the nurses were amazed when asking my pain levels and I would reply 1/2 to maybe a 1. I didn't even need a Tylenol. I was sleeping on my side a couple of weeks post-op, something that took a couple of months using the sternal wires.