Being tired ... when does it end?

[AdrockTN]

Hi all ... newbie here with my first post ...

My name is Adam & I had an AVR (St. Jude's) on 12/20/13 after a bout of endocarditis. I was 38 (now 39) and in the best shape of my & BAM, this smacked me right in the face. Not to bombard with questions, but my main ones are:

--How long did it take before you didn't feel so tired? I started back to work last week (a desk job) & was completely wiped out.

--I still notice the heart palpitations, but they seem to be more prevalent at night ... anyone have any tips on this?

--How long before you actually put stress on the sternum? I've been told it takes it about 3 months to heal, but am still nervous about doing anything once I reach that point. My workout routine is DDP Yoga, which requires a lot of holding push-ups for 10 to 20 seconds, as well as various other yoga poses that can put pressure on the chest & elevate the heart rate.

Thanks very much ... I look forward to getting to know everyone on here.

 

[Guyswell]

Has your doctor ordered blood tests to make sure you're not anemic? Are you now taking metoprolol to slow down your heart rate. Either one of these things can make you feel tired.

 

[ski girl]

Hi Adam-

If you have a mechanical valve, there's a good chance you're anemic as the valve smashes your blood cells every time it closes, until it has grown a 'slime ayer' (doctor's term!). You can ask for a blood test, or just treat yourself with iron supplements.

I developed anemia about two weeks after my OHS with mech valve - a week before the operation I had run a 12km race so I wasn't exactly sedentary - but I gradually got to where walking more than 50m was really really difficult and almost had to have a blood transfusion as my hemoglobin was dangerously low.

Iron supplementation won't hurt you so it may be worth a go!

Oh and I also still get heart palpitations, also at night, and I don't worry about them, my cardiologist wasn't concerned.

As for exercise involving the sternum, my surgeon told me that at 6 weeks post-op the sternum is 80% healed and by 12 weeks 100% healed and I was free to do whatever I wanted then. Obviously if something hurts, don't do it!

 

[The Thief]

Adam,

I also received my AVR during the best shape of my life. I'm 30. I got my surgery on 11/25/13. I started getting palpitations (PVC's) at the 3 week mark, and they were very strong, also very prevalent at night. They happened pretty much whenever I laid down. They occurred for about 3-4 weeks and have since decreased to almost nonexistent. I get less than 5 a day, sometimes none a day, which is less than pre-surgery conditions for me, so i'll take it.

I'm a rock climber. I started climbing (gently) by week 8, which is too soon by everyone's standards (especially my doctor). I understood but i couldnt help it. I know this is bad advice, but I listened to my body, and never pushed it. Now, at week 12.5, I am climbing at my full strength from pre-surgery. Do not overdo it and do not injure yourself, BUT ALSO do not be afraid when the time comes to get back at it.

I did yoga too and lowering down from plank pose was very hard. I pretty much held plank while everyone else lowered slowly. I eventually put my knees down to lower, then move through the rest of sun salutation. Again, listen to your body. Childs pose when you need it.

If you are consistent about your light weight workouts, and you dont overdo it, by the 3 month mark you will feel practically normal (at least I do... I know everyone is different).

Check out Gym Guy's posts, he is pretty detailed in his recovery scheme.

 

[AdrockTN]

thanks for the responses everyone ... I'm on 12.5mg of metoprolol daily (down from the 25mg I was on just a couple of weeks ago). The bloodwork that I had done a couple of weeks ago came back fine (i.e. the cardiologist didn't seem concerned over anything from the report).

I seem to feel better over the past couple of days ... It may have taken just getting back into a routine ... adding in a protein shake may have helped too ...

I'll readily admit that I'm a little timid when it comes to returning to a normal exercise routine. Not only because of the sternum, but getting the heart rate too high.

 

[Sten Osis]

I was restricted to a HR of 145 max for almost 4 months. The doc wanted my heart to bulk down before he cut me loose because he was aware of my usual high activity level. Just follow your doctor's instructions and when you are allowed to work out again, go for it.

 

[clay_from_nj]

A commonly-used general rule is not to let the patient drive for six weeks after surgery. This is because they are worried about possible sternum damage in an accident. After that, it's pretty much "go for it." If your surgery was in December, I wouldn't worry about it at all now. A couple of months after my surgery, one of my favorite exercises was dumbbell pullovers.

And as to heart rate, I don't even pay any attention to it. If I'm working (like running, for example) and I can keep going, I'm not overdoing it. If I feel like I REALLY need to stop before I fall over, I'll consider it. I think it's best to exercise a lot and to vary your routine (intervals?) to get an idea of what you can really do. I've been slowly running faster for longer periods and it seems that I'm not increasing my endurance so much as finding out just how much I really have, finding the line between "really really uncomfortable" and "really cannot go on." Running is especially educational in that respect because you learn how you can feel like you're going to run out of gas at any time and yet keep going and going.

Go as far as you think you can, then go a little further. You'll be surprised at what you really can do.

 

[yotphix]

Hey Adam,

Sounds like you're feeling a little better now, but I'll offer my own experience. I was mostly past the extreme fatigue by about the end of two months, though exceptional efforts would really wipe me out still. I also had ups and downs re: fatigue, for most of a year. Most of the time I felt great, but there were days when I was just wiped.
I started doing chest work at about 3 months, but waited 6 months before going back to really hard stuff, on the advice of the doc. My sternum area was regularly achey for about 18 months, and still is sometimes.
Even while I was still on Bisoprolol, I took my heart rate past the doc's stated max while cycling about three times a week. I told the rehab people about it, and while they didn't like it, they agreed that if it felt good, it probably was. By 6 months, I was taking my heart rate well past my age predicted max on a regular basis for short spells when inline skating uphill or upwind, with no trouble at all.
It's good to take it easy to the extent that you need to, but it really does seem to be ok to let your own body dictate your pace. Just make sure you listen to what it's telling you!

paul

 

[Mentu]

Hi, Adam, it sounds as though your recovery is going well. You mentioned that your dosage of metoprolol was reduced. That by itself is enough to help one feel more energetic because loss of energy is a problem that many of us had with that durg. Our experiences do follow similar paths, usually, but we do heal at different rates. I think the others here have the right idea. We start out following the guidelines but at the same time, we "listen" to our bodies. In Cardiac Rehab, they didn't want me to push my upper body as hard as I wanted to do so outside of CR I began walking much more. The exercise really helped. Still, its important not to stress your chest to the point of damage because that can set you back for months. That said, I found that by the end of three months in CR, I was beginning to use my upper body more normally but it was a couple of months after that before I began feeling completely normal. One of the issues we must all deal with is coming to trust our bodies again to do what we want them to do. Be thoughtful about it but don't be afraid to carefully test your limits as your recovery continues.

Larry

 

[big_L]

At 9 weeks, I went back to work. The first week or so, it was all I could do to walk to the car at the end of the day. Your strength will come back. As others have suggested, rule out any other causes like anemia.

I started pushups on the stairs - feet on floor, hands on fourth step around 12 weeks. Then after a week or so, I moved the third step, etc. My the time I got to the floor with my hands, I was at maybe 20 weeks and I felt confident that a full pushup was OK.

 

[AdrockTN]

I think just getting back into a normal routine is half the battle ... not getting that afternoon nap I'd become accustomed to, ya know?

I'm gonna push myself a little harder at the Y tomorrow. I'd already been using a heart monitor with my DDP Yoga, as that's an important piece of that workout. It's really been handy for the self-rehabbing at the gym.

I know that I'm way better than I was 10 weeks ago today, as I was lying on an operating table with my chest split open ... anything past that is progress. Now the next hurdle (thing I'm looking forward to doing) will be sleeping on my chest again ... almost there.

 

[tom in MO]

My surgeon said it takes 6 months for the sternum to heal completely. He did not want me putting any significant stress on it until 6 months had gone by. I could drive as soon as I was off the prescription pain killers.

Per your tiredness, some people have trouble with metaprolol. The second "side effect" listed on the NIH site is tiredness. It was fine for me in the beginning, but made me lightheaded at about week 6 and I was taken off it. You may want to talk to your cardiologist about it.

 

[epstns]

I'm not sure if I mentioned this here before (getting older, you know. . . ), but immediately after surgery I was taking metoprolol at a fairly high dosage - 100 mg/day. This was prescribed to keep my heart rate down, as I experienced afib after surgery and had a pacemaker implanted as well (pacer was for looong pauses). The immediate effect of the metoprolol was feeling like I was dragging a sled full of rocks everywhere I went. I put up with it for months, until some significant healing had taken place, then had a talk with my cardio. Over about a six-month period (probably months 12-18 of recovery) we reduced my metoprolol dosage twice, first to 50 mg/day, and then to 25 mg/day. Each time, I felt even better than before. My cardio really doesn't want me to stop the beta blocker, but at 25 mg/day I feel better than I have in a long time.

The reason for the long story -- it may be a good idea to stay with the metoprolol for a while, then discuss reduction in your dosage until you feel good but still get the therapeutic effect your doc wants you to have.

 

[AdrockTN]

I decided to push myself at the Y on Saturday ... 10 weeks post-open heart surgery, I ran a mile (albeit in 1/2 mile intervals; walked 1/2 mile, run 1/2 mile X 2) ... I felt like I'd climbed Mt. Everest!

 

[epstns]

When does the tiredness go away? You really won't notice a point in time, but at some point you will look back and say "Wow! I used to be wiped out by now." At that time, you will realize the magic of valve replacement.

 

[clay_from_nj]

Smarta** reply: You'll cease being tired when you go to your eternal rest. Seriously though, you should gradually start to notice the difference between the bad tired, eg "wiped out" or "dying on my feet" and the good tired, eg "Whew! That was a good workout! I need to sit down for a few minutes with a tall glass of iced tea and admire the backyard before I get back to it." It's like the difference between actual pain from an injury or overdoing it, and the normal, healthy muscle soreness you get after a good workout.

 

[AdrockTN]

so after feeling pretty good for a few weeks, I feel like I've regressed ... it's been 13 weeks since my surgery & I'm starting to feel more tired than I did just a month ago ... also, my chest has been a lot more sore lately & I haven't been doing anything out of the norm to make it that way (as opposed to just a few weeks ago).

I'm still on the metoprolol (12.5 mg once per day) ... had my INR checked yesterday & it was low (1.8) ... can a low INR cause tiredness & some slight shortness of breath?

 

[epstns]

Others may chime in, but I don't think INR has much, if any, effect on energy level or SOB. You may actually be doing more than you think you are, physically, because you now feel so good compared to just a couple of weeks ago. Maybe "dial it back down" a notch or two for a day or so, and then see how you feel. Some of us, when we start to feel really good, just do too much and find ourselves doubting our recovery. Take it easy for a couple of days and see. If you still have issues, call your doc. 13 weeks is not too far from surgery to still be asking doc for advice.

 

[cjransom]

Goodness this is so comforting to read. I had Valve replacement surgery in October. Mine was preventative but by the time they caught it I had an aneurysm and sever stenosis. I went back to work in 5 weeks. I think it was too soon but it was part time for 2 weeks. I went back full time on the 1st day of December. I recovered fast in the hospital, got out quickly was doing all sorts of things early on that I think may have made it seem like I was better than I was.

I take martial arts and I went to the gym and did a lot of cardio. Now I'm put on 20 something pounds and trying to get the energy to lose it is bad. I have good and bad days for sure.

I make it through work most days okay. One hour to one and half hours of Martial arts class about does me in.

I've been told it can be a year before you are really normal. All I know is I feel really no better than I did prior and physically I'm weaker.

I am waiting for that moment when I'll notice that things are easier with my mechanical valve. I'm 43.

I'm also so glad I found this board. Thank you all.

Chris

 

[epstns]

Hang in there, Chris. The older we get, the longer it seems to take to get back into shape. Also, as we get older it seems that if we miss our workouts for a while it is more difficult to get back to where we were.

Maybe I haven't gotten back to where I was 3 or 4 years before surgery, but that would have been 6 or 7 years ago, and I'm 66 now - so I'm not surprised. I'm not trying to be TheGymGuy (look him up. . .WOW), but I am trying to stay in shape enough so that I can lie about my age and not get caught.