BAV Club Membership, Feb 2023, Singapore

[bicuspidrek]

Hi all, Tuesday marked the first monthsary of my On-X. Yay!

I ranted a little to my cardiologist and he arranged for a call early this week with my case manager (surgical team) and himself, separately. The poor case manager was doing her job "protecting the surgical team". It was clear she wasn't listening to what I was not happy about - the doctor who said that "no lungs were collapsed" and that pleural effusion was "very unlikely". If anything, the phone call acted as catharsis.

AntiCoagulation Clinic and Management
Cardiologist called the following day and we discussed how much leeway I'd have adjusting my own dosage. He mentioned that because I'm still a 'newbie', the clinic will obviously be concerned if I were to vary from their instruction but seeing how I am methodological (thanks @pellicle) in the dosing, he is confident that I'd be given more leeway. This was confirmed later in the week when the anticoag clinic called and we discussed things, so all's good.

Exercise
I took a 'massive' walk on Wednesday. I mean it's just 6-ish km, but it's definitely the longest (continuous) one since my discharge and my calf is still aching. I'll need to make these walks more habitual. Short walks are a lot easier to handle this week. I no longer feel like I need to take more breaks to catch my breath. Stamina is also slowly coming back.

Heart Rates
Resting HR has dropped to 60s, sometimes falling below. Walking HR remain generally in the 90s. During the 6km walk, it peaked around 110s. Hoping more exposure to exertion will bring it down. But will definitely take it progressively.

Pleural Effusion
My right lung no longer feels in danger of imploding when I yawn or burp. It still does when there's a sneeze coming up but for sure the pleural effusion is slowly clearing up. More night time visits to the bathroom for now (to spit, and pee) from the furosemide but that's fine for now.

Side Sleeping
Case manager called back on Friday to retract her advise of waiting another month before I could sleep on my side. She said since it's not sternotomy, I could very well begin sleeping on my side. I tried it in little periods yesterday - not on the wound site yet tho, and it was nice. I think I'll wait a little before I go on a full night on the side.

INR Supplies
Landed nicely within range at 2.2 this week. I take this as a small victory seeing how they had initially tried to put my target as 1.8-2.5.

Need to start looking around for test strips, probably shop locally for immediacy and start looking into overseas (reliaston) options. The pain point of purchasing overseas is that our government has activated Goods & Services Tax (8% GST) on any product coming in from this year onwards. It used to only kick in if item value was >S$400.

Glad you finally got it done. And now you have a great future ahead of you. Be sure to not strain your sternum for a time, to let the muscles heal. Take your time and follow doctor orders. Be good to yourself.

Thanks Carol, I was fortunate to qualify for a minimally invasive procedure so my sternum was untouched. Nonetheless, I am taking my time and not overstraining. Hope all is good with you as well!

Don't remember exactly, but I think it took me about 6 weeks to be able to sleep on my side as I am a dedicated side sleeper. I do remember very well that laying in my side did trigger some pain for quite a while - maybe a few months - gradually diminishing. I am guessing that was stress on the healing from the surgery.

HTH YMMV

Yessss, tried sleeping on my side last night and I managed to in short periods, which I already am grateful for. Thanks for sharing your experience. I should be able to soon, since my procedure was minimally invasive.

 

[pellicle]

The pain point of purchasing overseas is that our government has activated Goods & Services Tax (8% GST) on any product coming in from this year onwards. It used to only kick in if item value was >S$400

our money grabbers are still at 10%, its been in since 1999, so far they have resisted raising it (after all the 'popularity' of it in 1999). However once they do I'm sure it'll go like it has in Finland where its called VAT and is 24%

Two certainties in life: one is taxes

 

[carolinemc]

Hi all, Tuesday marked the first monthsary of my On-X. Yay!

I ranted a little to my cardiologist and he arranged for a call early this week with my case manager (surgical team) and himself, separately. The poor case manager was doing her job "protecting the surgical team". It was clear she wasn't listening to what I was not happy about - the doctor who said that "no lungs were collapsed" and that pleural effusion was "very unlikely". If anything, the phone call acted as catharsis.

AntiCoagulation Clinic and Management
Cardiologist called the following day and we discussed how much leeway I'd have adjusting my own dosage. He mentioned that because I'm still a 'newbie', the clinic will obviously be concerned if I were to vary from their instruction but seeing how I am methodological (thanks @pellicle) in the dosing, he is confident that I'd be given more leeway. This was confirmed later in the week when the anticoag clinic called and we discussed things, so all's good.

Exercise
I took a 'massive' walk on Wednesday. I mean it's just 6-ish km, but it's definitely the longest (continuous) one since my discharge and my calf is still aching. I'll need to make these walks more habitual. Short walks are a lot easier to handle this week. I no longer feel like I need to take more breaks to catch my breath. Stamina is also slowly coming back.

Heart Rates
Resting HR has dropped to 60s, sometimes falling below. Walking HR remain generally in the 90s. During the 6km walk, it peaked around 110s. Hoping more exposure to exertion will bring it down. But will definitely take it progressively.

Pleural Effusion
My right lung no longer feels in danger of imploding when I yawn or burp. It still does when there's a sneeze coming up but for sure the pleural effusion is slowly clearing up. More night time visits to the bathroom for now (to spit, and pee) from the furosemide but that's fine for now.

Side Sleeping
Case manager called back on Friday to retract her advise of waiting another month before I could sleep on my side. She said since it's not sternotomy, I could very well begin sleeping on my side. I tried it in little periods yesterday - not on the wound site yet tho, and it was nice. I think I'll wait a little before I go on a full night on the side.

INR Supplies
Landed nicely within range at 2.2 this week. I take this as a small victory seeing how they had initially tried to put my target as 1.8-2.5.

Need to start looking around for test strips, probably shop locally for immediacy and start looking into overseas (reliaston) options. The pain point of purchasing overseas is that our government has activated Goods & Services Tax (8% GST) on any product coming in from this year onwards. It used to only kick in if item value was >S$400.


Thanks Carol, I was fortunate to qualify for a minimally invasive procedure so my sternum was untouched. Nonetheless, I am taking my time and not overstraining. Hope all is good with you as well!



Yessss, tried sleeping on my side last night and I managed to in short periods, which I already am grateful for. Thanks for sharing your experience. I should be able to soon, since my procedure was minimally invasive.

Thanks for the tap. And glad you are doing fine.

 

[bicuspidrek]

It's been slightly more than 6 months since I updated... Everything has been going very well. My last appointment with my cardiologist was in June, and he was happy enough to revert to half-yearly appointments.

Cholesterol
On my second last visit (sometime in May), my cardiologist turned his attention at my cholesterol and blood pressure levels, and mentioned I needed to be on medication, pronto. I tried to bargain an extra month, promising to watch my diet (had been eating a lot of protein prior for wound healing). He denied me that and put me on 5mg Rosuvastatin immediately. He mentioned how my arteries were in a bad condition. I went on the medication and on top of it, I maintained a strict diet (very little red meat) and within a month, my cholesterol levels dipped dramatically.

I'm still on the medication, on his advice, but it's okay. Am also feeling great and healtheir so can't really complain.

INR Supplies
Managed to find an overseas supplier for my strips, bringing my weekly cost down by half. Which adds up real quickly. Super stoked about this.

Exercise & Overall health/diet
I am commuting 2-3 times a week on my bicycle, about 10km both ways, so I'm pretty much back to pink of health. No more pain in the lungs (due to pleural effusion) and side sleeping is amazing too. Still get some blood in my spit when I wake up in the middle of the night but am attributing this to the dry-ness of the air conditioning in the bedroom.

Food wise, am also eating whatever I want to, and managing my dosage accordingly, big thanks again to Pellicle. I avoid cranberries, grapefruit and acai and take care not to consume chinese medicinal herbs. Nothing too drastic from previously. Still consuming my greens - spinach and avocado etc.

-
I know I was feeling pretty down in the weeks following the surgery mainly because I had been asymptomatic for the most part, and having to deal with the breathlessness, medication and recovery. 7 months on, I am so so super thankful that I went for the surgery to fix the valve. I feel a lot healthier and slightly more appreciative about things in life (this takes time and is a work in progress).

Hope everyone else here is doing great and keeping positive.

 

[pellicle]

Food wise, am also eating whatever I want to,

Durian?

 

[bicuspidrek]

Durian?

Yea that too! Although I impose an arbitrary 4-seed limit upon myself. Also only had it like once every three months or something to that extent.

 

[Chuck C]

Great update! Thank you for keeping us posted.

I am commuting 2-3 times a week on my bicycle, about 10km both ways, so I'm pretty much back to pink of health

Glad that you're getting regular exercise. Reports like yours also help dispel the myth that those on warfarin can't be physically active.

Still consuming my greens - spinach and avocado etc.

Again, your update here helps dispel the myths about life on warfarin and adds to the chorus of voices on the forum that you can still eat your greens and vegetables while on warfarin. Well done.

7 months on, I am so so super thankful that I went for the surgery to fix the valve

As well all are.

 

[bicuspidrek]

Passed the one-year mark of being discharged following valve replacement / On-X installation.

So far it's been great and I want to thank everyone here helping out and sharing opinions, and resources. There are a number of things I'd just speak about that really helps in this journey. I'd want to document it here in a single thread since there are a multitude of threads out there as well.

Exercise & Wellness
You can absolutely have an active lifestyle. I have gotten back on my bicycle and commute mainly on it.

I recommenced jogging much later following recovery, but have not managed to get back to where I was prior to surgery due to Covid, influenza and generally bad management of time. I still believe it can be done. It hasn't been easy, my heartrate still climbs pretty quickly and according to my Apple watch, my VO2 max has plummeted following surgery. I have not had an open conversation with my cardiologist regarding this but will make it a point to do so this year.

After my wound was sufficiently healed and my cardiologist was satisfied about how my heart was functioning, he turned his attention to my overall health and put me on 5mg statins. I watched my diet and my cholesterol are all within very ideal levels. Cardiologist told me to carry on statins to build/repair the arterial walls.

This year, I wish to get back to jogging again and try to get closer to pre-surgery levels of fitness.

INR Management
As we all know, pellicle has been steadfast in his advice and support - get in touch with him if you are a new mech valver and require help.

Equipped with this, INR management has been a cinch. Get your own device and your cardiologist's blessings and you'll be good to go.

My Anti-Coagulation Clinic (or the subscription service I was forced upon) used to ask me to submit monthly results to them. I missed submission once due to work and they got in touch about 3 months later. I told them I no longer required their services, and asked to be taken off the service. I was (pleasantly) surprised there weren't any protests from the lady-in-charge.

On a more personal level, my weekly testings have been very helpful in knowing what causes shifts in INR. Alongside the dosages and the INR readings, I keep a daily food diary and that helped immensely when I started shifting to a plant-based diet (vegan).

Bleeding
Following the surgery last year, I had noticed there had been pretty frequent blood in sputum (spit). Initially, I pegged it down to the pleural effusion following surgery.

Towards the later part of 2023, I noticed that the blood in spit happened more frequently and raised my concerns to my cardiologist. He was concerned and we mentioned that we should have it looked into. He ordered a chest X-ray and had me looked into at the ENT but they were all clear.

We managed to narrow it down to my wisdom tooth eruption. This was actually discovered during pre-surgery but because it was too close to the scheduled valve replacement, they had pushed it aside.

I will be going for the extraction tomorrow and my dentist + cardiologist were confident enough that so long my INR was 2.5 and below, they'd be happy to continue with the extraction.

Again, I was initially concerned about having to bridge but they said it wasn't necessary. I botched my last test strip last week and couldn't take my INR. When my new strips arrived, I was at 3.5, and had 3-4 days to bring it down to 2.5 so that the extraction could happen.

Thanks to the self-testing and documentation, I was able to titrate the Warfarin dosage and I am sitting comfortably at 2.6 today. So guys, self-test, self-test, self-test.

Will update about if extraction of the wisdom teeth (2 of them) will solve the mystery of the bleeder.

--

Thanks everyone once again!

 

[pellicle]

Great stuff and I'm so glad I could do something meaningful in helping your journey.

Best Wishes and I hope that extraction goes well.

 

[3mm]

Thank you for your status report. This information is useful to me and others who are on a parallel path through life.