Complications post-surgery

[Zara0006]

Hi all,

I had my bicuspid valve replaced with an Edwards Resilia just over 5 weeks ago, and was recovering quite well until I was diagnosed with pericarditis during week 4 and hospitalised again- they were unable to find any other reasons for my shoulder and chest pain. I’ve had scans and the valve seems to be functioning well, however I’m unable to take anti-inflammatory meds due to being on warfarin for 3 months.

I’ve only been given colchicine for the pericarditis and it does not seem to have done anything yet (one week). The pain is excruciating and constant, aggravated by inhaling and honestly worse than that from the surgery, mostly in the left shoulder/neck region and some chest pain. Just wonder if anyone has experienced this and how long did it take to clear?

The other question I had was regarding something the surgeon mentioned about my right coronary artery/Ostia being quite low, although they tried to position the valve to keep the struts away from the Ostia. Is this quite common? Apparently this can cause major complications following the surgery, but I’ve been told to not worry about it for now and take warfarin which should reduce the chances of thrombosis. It’s difficult to not worry considering the complications and pain I’ve had recently!

Many thanks!

 

[SSJ4]

I had a similar experience several weeks after my open heart surgery in late October 2023. I went to the emergency room about two to three weeks after surgery with bad pain in my upper back. I could feel a sharp pain every time that I inhaled. My cardiologist wanted to rule out a clot so I went in on a Saturday for a series of tests. It was determined to be pericarditis. The doctor treated it with a steroid that alleviated the pain within a day. After the steroid I continued on the colchicine for a while. I never was hospitalized for it and it improved significantly after that day. I hope you can get some relief soon.

 

[pellicle]

Hi there

sorry about the rough ride.

...they were unable to find any other reasons for my shoulder and chest pain.

the surgery itself and the positions you're put in during surgery would (and in my case certainly did) lead not only to pain following the surgery but a marked decrease in movement of the shoulder. I suspect some ligaments were torn but I didn't go get any scans done. I've also read of a poster here who had troubles

a worthy thread to read

https://www.valvereplacement.org/th...and-redo-operations.888053/page-3#post-906437

I’ve had scans and the valve seems to be functioning well, however I’m unable to take anti-inflammatory meds due to being on warfarin for 3 months.

well let me just say "unable" is a different word to "may" and if you read the guidance it says "may" not "contraindicated"

I'd read this post I wrote of my own personal experience:
https://www.valvereplacement.org/threads/ibuprofen.887853/

and then go discuss that with your Surgeon (not necessarily your doctor because at this level of detail they don't have specific drug interaction experience

if the clinic puts up a fuss about being lazy arsed *******s and not wanting to manage your INR around your actual needs then I'd put it to them in exactly those terms that they are not the overseers and enforcers of you suffering.

... The pain is excruciating and constant, aggravated by inhaling and honestly worse than that from the surgery, mostly in the left shoulder/neck region and some chest pain.

this however does not seem like its something an anti-inflamatory would help and also doesn't seem right. Talk to your surgeon.

best wishes

 

[Zara0006]

Thank you both!

@pellicle : Frozen shoulder was ruled out, they said it was unlikely, as I didn’t have any problems after the surgery for 4 weeks and my neck /shoulder were checked in hospital last week. Currently there is no change in symptoms when I move my shoulder/arm, but it’s more painful when inhaling or on exertion.

The surgeon actually suggested I take NSAIDs but cardiology advised it was too risky, however I agree that it feels like it’s something more than just inflammation. I spoke to the surgical team who advised that pericarditis can be as painful as a myocardial infarction, and should hopefully resolve eventually, so I’m now just waiting and hoping that it does.

Last week I had two CT scans, several chest X-rays, ECGs, echo and blood tests. The only abnormalities noted were some pericardial effusion and very high CRP suggesting inflammation!

Thank you so much for your input, I’ll have a look at the links!

 

[pellicle]

The surgeon actually suggested I take NSAIDs but cardiology advised it was too risky

I know who I'd put credence in .. hint the person who knows the most.

I hope that you get it under control and the pain goes away soon.

Best Wishes

 

[Seaton]

Hi Zara

So sorry to hear about your debilitating pericarditis issue.

I had pericarditis about 6 months post Inspiris Resilia implant and hospitalised for 4 days. My diagnosis included a pericardial effusion. At first, they suspected endocarditis, but after extensive tests, pericarditis was the diagnosis. It was indeed painful and disabling. Was difficult to walk without severe breathlessness and excruciating pain.

I recall leaning forward would ease the pain.

I wasn't on warfarin post surgery (in fact only began warfarin this year because of various issues), but was taking aspirin. Paracetamol was allowed.

Discharged with a prescription of colchicine. The severe pain eased relatively quickly, but the breathlessness and fatigue took a few weeks to subside.

I imagine still being close to your recent surgery isn't helping your pericarditis symptoms. I was well healed at six months when I had my pericardial infection.

Give yourself plenty of rest for a while. Don't overdo it. Things should slowly improve. But if those symptoms you're describing persist or become worse, definitely seek further or immediate medical guidance.

Hoping things improve for you soon. All the best going forward.

 

[Zara0006]

I know who I'd put credence in .. hint the person who knows the most.

I hope that you get it under control and the pain goes away soon.

Best Wishes

Thank you so much Pellicle, wishing you all the best!

So sorry to hear about your debilitating pericarditis issue.

I had pericarditis about 6 months post Inspiris Resilia implant and hospitalised for 4 days. My diagnosis included a pericardial effusion. At first, they suspected endocarditis, but after extensive tests, pericarditis was the diagnosis. It was indeed painful and disabling. Was difficult to walk without severe breathlessness and excruciating pain.

I recall leaning forward would ease the pain.

I wasn't on warfarin post surgery (in fact only began warfarin this year because of various issues), but was taking aspirin. Paracetamol was allowed.

Discharged with a prescription of colchicine. The severe pain eased relatively quickly, but the breathlessness and fatigue took a few weeks to subside.

I imagine still being close to your recent surgery isn't helping your pericarditis symptoms. I was well healed at six months when I had my pericardial infection.

Give yourself plenty of rest for a while. Don't overdo it. Things should slowly improve. But if those symptoms you're describing persist or become worse, definitely seek further or immediate medical guidance.

Hoping things improve for you soon. All the best going forward.

Hi Seaton, many thanks for your reply! It is very helpful and reassuring to know that I’m not the only one this has happened to, but yes it was unfortunately quite soon after surgery. So sorry to hear about what you went through, although I do feel reassured that perhaps it is the inflammation causing pain and hopefully nothing more serious. In case my symptoms aren’t resolving quickly due to lack of aspirin/NSAIDs, I’ll discuss this with Cardiology as Pellicle suggested.
Many thanks and all the best!

 

[pellicle]

Paracetamol was allowed.

good point about paracetamol (some people only think in brands, so that would include Nurofen).

using it to the max daily allowance for days at a time will create an elevation but that can (well should be) easily managed around. Such maximum dosages are usually:

Take with water

• Adults and children from 12 years: 2 tablets, then 1 or 2 tablets every 4 to 6 hours as necessary (maximum 6 tablets in 24 hours).
• Children (7 to 12 years): 1 tablet every 6 to 8 hours as necessary (maximum 4 tablets in 24 hours).

best wishes

 

[Zara0006]

I was also advised that I could take the max dose of paracetamol, didn’t realise that could affect INR. When I was admitted in hospital it was checked every day, and kept jumping between 2 and 3 within a couple of days. I was also on colchicine though which makes me sick and my diet was very different in hospital!

 

[pellicle]

I was also advised that I could take the max dose of paracetamol, didn’t realise that could affect INR

yes, it is widely known in medical literature that it can effect the INR, however I always take the view that INR is important and dose is just the vehicle to attain that.

https://www.nhs.uk/medicines/warfarin/taking-warfarin-with-other-medicines-and-herbal-supplements/#:~:text=It's safe to take paracetamol,you at risk of bleeding.

which is a bit 'patient oriented'; this is a bit more appropriate for thinking people

https://www.bmj.com/content/350/bmj.h1186/rr-0#:~:text=We included 7 trials with,of paracetamol taken [3].

We included 7 trials with 225 patients, and the mean INR increase with paracetamol was 0.6 (95% Confidence Interval 0.46-0.78) [3]. Meta-regression showed a mean increase in the INR value of 0.17 for each daily gram of paracetamol taken​

which does require a bit of thinking (like each tablet is often 500mg or 0.5 of a gram) and will not really show on just a single administration of two tablets. So it looks more helpful than it really is in a "personal and quantitative way".


INR control is pretty simple and all you need is to keep in mind this simple rule

the slightly tricky issue is the amount to increase ... which is individual ... but for which I have a data model which gives good results.

Best Wishes

 

[vitdoc]

Hi all,

I had my bicuspid valve replaced with an Edwards Resilia just over 5 weeks ago, and was recovering quite well until I was diagnosed with pericarditis during week 4 and hospitalised again- they were unable to find any other reasons for my shoulder and chest pain. I’ve had scans and the valve seems to be functioning well, however I’m unable to take anti-inflammatory meds due to being on warfarin for 3 months.

I’ve only been given colchicine for the pericarditis and it does not seem to have done anything yet (one week). The pain is excruciating and constant, aggravated by inhaling and honestly worse than that from the surgery, mostly in the left shoulder/neck region and some chest pain. Just wonder if anyone has experienced this and how long did it take to clear?

The other question I had was regarding something the surgeon mentioned about my right coronary artery/Ostia being quite low, although they tried to position the valve to keep the struts away from the Ostia. Is this quite common? Apparently this can cause major complications following the surgery, but I’ve been told to not worry about it for now and take warfarin which should reduce the chances of thrombosis. It’s difficult to not worry considering the complications and pain I’ve had recently!

Many thanks!

I have been using warfarin for 41 years. I have used non steroidal anti inflammatory drugs many times but in short courses often with proton inhibitors with zero issues. The concern about NS anti inflammatory drugs is real due to inhibition of COX 1 which has to due with maintenance of the stomach lining.
But the duration of treatment if short usually doesn't cause immediate problems. Also using proton inhibitors reduces complications. So a short course of nonsteroidals plus warfarin plus proton inhibitors is usually not a big deal. Also as mentioned corticosteroids may be used for pericarditis.
Check out this review.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5478398/
Sometimes physicians may not be versed in the details but just read the headlines.

 

[pellicle]

Good Morning

due to inhibition of COX 1 which has to due with maintenance of the stomach lining.

interesting, so not unlike aspirin (which also inhibits cyclo-oxygenase? I'm not (on a quick search) seeing that (manifest in platelets) as a side effect of (say) ibuprofen. Interesting

Check out this review.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5478398/

thanks, a good read!

Given the mentions of peptic ulcers I would wonder if the authors know about the relationship with heliobacter?

Sometimes physicians may not be versed in the details but just read the headlines.

I love the way that some societies use the implied negative to suggest the almost certain positive. Myself I prefer the direct statements; I prefer to leave effusive courtesy and its associated ambiguity to the Japanese and the English.

Best Wishes

 

[Habana58]

Dose adjustment as per Australia guidelines , 2016; assumes INR range of 2 - 3, but applies in general

 

[pellicle]

Dose adjustment as per Australia guidelines , 2016; assumes INR range of 2 - 3, but applies in general

I've seen those (thanks), they aren't bad as an approximation.

 

[Zara0006]

I have been using warfarin for 41 years. I have used non steroidal anti inflammatory drugs many times but in short courses often with proton inhibitors with zero issues. The concern about NS anti inflammatory drugs is real due to inhibition of COX 1 which has to due with maintenance of the stomach lining.
But the duration of treatment if short usually doesn't cause immediate problems. Also using proton inhibitors reduces complications. So a short course of nonsteroidals plus warfarin plus proton inhibitors is usually not a big deal. Also as mentioned corticosteroids may be used for pericarditis.
Check out this review.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5478398/
Sometimes physicians may not be versed in the details but just read the headlines.

Hi, yes that’s what I was advised at the anticoagulation clinic regarding the effect on the stomach. Colchicine alone doesn’t seem to be working yet but I really hope I don’t need steroids.

On a more positive note, I spent the entire day sitting and leaning forwards. I’ll probably end up with endless back problems and sciatica but at least it has reduced this pain by about 50%!

 

[3mm]

the surgery itself and the positions you're put in during surgery would (and in my case certainly did) lead not only to pain following the surgery but a marked decrease in movement of the shoulder. I suspect some ligaments were torn

If a surgery candidate has a couple months to prepare, perhaps some shoulder, arm, and neck stretching over a couple months would minimize these issues by giving the shoulder better flexibility before surgery.

 

[pellicle]

If a surgery candidate has a couple months to prepare, perhaps some shoulder, arm, and neck stretching over a couple months would minimize these issues by giving the shoulder better flexibility before surgery.

entirely possible ... probably even beneficial ...

 

[Chuck C]

If a surgery candidate has a couple months to prepare, perhaps some shoulder, arm, and neck stretching over a couple months would minimize these issues by giving the shoulder better flexibility before surgery.

I totally agree. I believe that increasing neck and shoulder flexibility in the months leading up to surgery is a good idea and could very likely help mitigate pain in recovery. There would certainly be no harm in doing so, and possibly a lot to gain.

 

[Standardvelocity]

My shoulder has been bothering me and frozen shoulder exercises didn’t seem to help much. Last week I was invited to golf with the guys I wasn’t going to go because of my shoulder, my wife insisted I go so the first few baby swings were painful but by the end of the round the swing were almost pain free. The next day my shoulder felt not too bad , swinging a golf club is going to be included in my exercise