Fluid Retention - Tom

[JudithD23]

Hi,

Tom is still retaining fluid and I don't know if it should be bothersome or if it's w/n the normal range of expectations. His echo on Thursday showed he was fine in and around the heart, no excess fluid or not more than is expected with ohs. His ankles are still real swollen though.

This past Wednesday he weighed 3 lbs more and has since lost that weight, but has stayed steady, not losing any. He has started eating more, the appetite is coming back, and he's doing his walking. Yesterday he felt and acted so much better and this morning he walked 8 min w/o stopping. And now he is so very tired and depressed. I've told him that's to be expected, some days aren't as good as others, and the changes can occur from morning to afternoon to evening.

Tom sees his GP on Monday and was going to be cardioverted by the cardiologist on Monday morning but that has been put off due to his not being in a therapeutic INR range, (thank you very much ensure, and thanks to all of you that alerted Tom to the vit K content). So Tom will get another protine count on Wed morning and then sees the cardiologist Wed afternoon, and hopefully we'll schedule a cardioversion at that time. Even more hopefully, maybe he'll convert to normal rhythm by then himself.

I guess I'm just going on and on here to get some reassurance myself. I'm not sure if Tom should drink more to get his kidneys working better (his GP said to up his fluid intake, his kidney count was a little high) or less as his cardiologist suggested for the water retention (he suggested somewhere between 48 and 60 oz. a day would be good). Tom is on 20mg of Lasix and Potassium, not a high dose of lasix, but the cardiologist didn't want to go higher since his blood pressure is low.

Anyway, it's good just to get all this down. Thanks and I hope everyone else is doing well.

Judith

 

[Ross]

What reason did they site for INR having anything to do with cardioversion? That shouldn't be a problem. Sounds like someone doesn't understand Coumadin. If he continues to have problems with INR, have him go to our anticoag forum and we'll fix him up. We arent' Doctors, but we are self dosing home testers that probably know more then those treating him.

Fluid retention takes a while to resolve. How longs it been since surgery?

 

[JudithD23]

Surgery was two weeks ago, almost exactly. He went in at around 1pm on Friday the 15th and came out on Saturday about 12am. A long surgery.

I think Tom's cardio wants his INR to be in the 2 to 3 point range for the a-fib for a week. That's also what Tom's cardio in Santa Cruz wanted the thinness of his blood to be.

I know that with a St. Jude mechanical valve, Tom will want to get the home testing regime going and so will definitely be online here researching that issue when the time comes. One reason he made the decision to go with a mechanical valve, was what he read online here about testing. And since he has had a-fib for two yrs now (but was in normal rhythm with tikosyn until the surgery) and was on coumadin for that and had no real issues, the coumadin wasn't a problem for him.

Okay, so the fluid retention takes time; that makes me feel better. And of course he'll have up days and others that aren't so up.

Thanks for responding.

Judith

 

[Ross]

Walking around more should help shrink him up. If that's not happening, then he may need to be put on a diuretic. I know my feet were huge for a long time after surgery.

 

[JudithD23]

Thanks. I'm not sure the 20mg of Lasix, which is a diuretic, is doing the job.

 

[njean]

Thanks. I'm not sure the 20mg of Lasix, which is a diuretic, is doing the job.

It may be that he may need to have more Lasix than the 20mg that he is on but his cardio should be the one making that determination. I for one, had to have my dosage increased because 20, or even 40 was not cutting it for me.

It takes a while before your body starts to recover from such a horrendous ordeal so give it some time. And the bouts of depression are to be expected so tell your hubby to hang in there! Best of luck to both of you!

 

[JudithD23]

Thanks Norma and Ross,

I appreciate the support at this time, so much.

Everyone must be on vacation; there are hardly any new posts or threads!

Judith

 

[Susan]

jist a suggestion

jist a suggestion

Judith, it may be an idea to keep records or his fluid intake and output. Hopefully he is producing at least as much urine as the fluid volume he drinks. Some foods, such as sherbet is considered a fluid too.

I vote with Ross about the cardioversion. What is the realtionship to the Coumadin?

Take care

susan

 

[Nancy]

It sounds like the doc wants to keep the diuretic at a low dose right now because he had an abnormal kidney test result. That's what happens, they back off the dose or keep it low until the kidneys recover, then it might be possible for the dosage to be increased.

It becomes a tricky balancing act between fluid gain and keeping the kidneys happy.

Trust me, if he had a ton of fluid and they wanted to get rid of it pronto--there are many, many ways to turn your husband's lower extremity into a fire hose.

So apparently slow and steady is what they are doing now.

 

[Granbonny]

Judith

Judith

Weekends are always slow on VR.Com...Many members work during the week.and want to spend time with their family/ect. on weekends.. ....I am sure you will have many replies after the weekend...Nancy is our #2 poster on VR.Com....She has lots of info on post op problems.. after surgery....Yes, Tom will have 1 good day and the next a bad day..on/on for several weeks..but in about 6 weeks..he should be back to normal. Bonnie

 

[JudithD23]

Regarding coumadin, which controls the clotting factor in the liver, I think, keeps the blood thin so that when they cardiovert and the rhythm changes, going into a normal rhythm, they don't want a clot thrown off of the valve, whether it's mechanical or tissue.

I may be wrong about this, I've been wrong before on many things.

 

[Bridgette]

Judith is right

If you have been in AF for less than 48 hours before the cardioversion then they will do it with covering shots of Heparin - otherwise you will be started on Warfarin and will not be cardioverted until your INR reaches the desired range - for exactly the reason that Judith states - the danger of a clot being thrown when the rhythm reverts to sinus.

This is the protocol at most hospitals in NZ anyway - I will post a link later on if I can find it again, which gives a really good explanation of this.

Just went back and read Judith's original post and I see that Tom was already on Warfarin - however the explanation still applies - Tom does NOT want a clot being thrown off his valve which is why the doctors want his INR in the correct range.

 

[South Sound Sailor]

Judith... I'm 25 days post-AVR surgery (prosthetic, On-X). Ditto to what Bridgette just posted. I was cardio-verted (electrical synchronous) 6 days ago. Docs told me same thing about clot worries. For what it's worth, the cardioversion has been effective and all I can do now is progressively appreciate each day that goes by without a-flutter or a-fib.

On the fluid retention, I too posted concerns about 2 weeks post-surgery. It was hard to gauge but I estimated a weight gain of almost 20 pounds (140 to 160), all fluid. Now at 25 days post-surgery, I'm back to normal weight range with very little signs of fluid retention. In fact, in just the past 48 hours I've noticed a marked difference in leg puffiness (and I've been urninating like crazy for the past 24 hours). I was only on Lasix/potassium for 10 days post-surgery and then I was off of it. Maybe had I stayed on it I would not have gone so long but from what I've read from others, loss of fluid post-surgery can take weeks. That's what I've experienced. And for the record, I'm keeping my fluid intake normal, about 6 to 8 full glasses of water daily.

It's been a great relief to see my body shedding all that fluid and puffiness!!!

Steve C.

 

[Bridgette]

Ok, I didn't find the exact link I was looking for yet, but here is another one if anyone is interested.
Ignore the term "blood thinning" though - this particular site is written for lay people and often, sites like that use that term (blood thinning) - I guess they think it is easier for the average person to understand??

http://www.hrspatients.org/patients/treatments/cardioversion.asp


Bridgette

 

[Ross]

Thanks Norma and Ross,

I appreciate the support at this time, so much.

Everyone must be on vacation; there are hardly any new posts or threads!

Judith

It's always like this on the weekends.

 

[EVELYN]

Hi Judith

I read your post and do have one question.....is Tom up and walking around. I know that walking will help that edema in his legs. As long as he's feeling ok, I would start to increase that exercise a bit. Just a thought.

Evelyn

 

[CHDDoug]

Good and bad days...

Good and bad days...

Judith,
Tell your husband to keep his chin up...there will certainly be good days and bad days! I remember 2-3 days after I got home...I over-did it (walked too much) and was wiped out for the next couple of days! Slow and steady is the best. Short, frequent walks are MUCH better for you than long ones. Once he gets some of his energy back again, have him start slow. He'll notice a big difference.

I wish your husband the best with the water retention 'issue'. I didn't have that problem, but I hear of alot that do. It will come off in time.

Take care,
DA

 

[JudithD23]

I can't tell you all the value of this site; it is so therapeutic. Tom stayed steady on weight for the past two days and then this morning he dropped 3 lbs. We made sure he did his four 5 min walks yesterday, and actually the first was 8 minutes long. In prior days we would go up to the home we're building, (it's almost done) but he wouldn't actually walk continuously, he would walk then stop and talk with someone and then walk a little more. So I'm thinking that walking continuously for the five minutes may be the key.

When do you start increasing the distance? Or maybe that's really up to the person and how they're feeling? I know his Dr., Craig Miller said to walk even though you may not feel like it.

Thanks again everyone, and Steve C., it looks like you're just 10 days ahead of Tom, so you may be our gauge, although from reading the posts I know how individual we all are.

Judith

 

[Adrienne]

Regarding coumadin, which controls the clotting factor in the liver, I think, keeps the blood thin so that when they cardiovert and the rhythm changes, going into a normal rhythm, they don't want a clot thrown off of the valve, whether it's mechanical or tissue.

I may be wrong about this, I've been wrong before on many things.

That's right (even though I don't like the word "thin" for blood"). Having A-fib can cause blood clots to form. When the heart goes back into normal rhythm, if there are blood clots, the fact that the atrium starts really pumping instead of fibrillating can pump those clots into the bloodstream.