Imminent AVR - 40 y.o. female - advice please

[Amy]

Thank you, @Chuck C . Gosh, your poor wife! I hope she’s feeling better. We have to take care of our caregivers, don’t we? My husband has had to do so much more than I thought he would these last weeks - showing up early and staying late at the hospital, bringing food and drinks and blankets and meds, going grocery shopping, carrying everything, doing all the driving, coming along to see mean doctors... I’m really surprised and grateful at how good he’s been through it.

I don’t have power steering or even power windows, lol, so I may need to rethink whether I’m strong enough. I know I should just be glad I can open house windows, and the fridge, and dryer, at this point... but I’m so restless at home all day, and I don’t want to put my husband through any more of these awful Arkansan doctor appointments. (He stormed out of the last one)

 

[Amy]

Oh, I also want to ask about bruises - I still have these big green marks under my skin all over the place, from all the IVs and three heparin shots they did in the hospital post-AVR. It’s been two weeks but they haven’t gone away at all, which is very very unlike me, so I assume it’s either the aspirin or warfarin keeping them there. Should I worry about them?....

 

[Chuck C]

coming along to see mean doctors.

It sounds like your husband has been a saint. I feel the same about my wife.

I'm puzzled at the mean doctors you encounter in Arkansas. Almost every time I have seen a doctor in the past 5 years I have received a follow up survey as to how I was treated. This applies to UCLA, my local doctors and even urgent care clinics. Any physician with the bedside manner you describe would be canned.
It is almost as if there is a prerequisite in Arkansas that physicians be mean jerks. I wonder what such surveys would look like:
On a scale of 1 to 5, with 5 being the worst, which means the best as far as we are concerned, rank your physician:
How long did you physician keep you waiting?
How rude was your physician to you? Did he make sure to treat you as a person of inferior intelligence and belittle your comments and questions?
Was your physician arrogant and arbitrary with prescription requests, regardless of how reasonable and logical they may have been? Did he make sure to put you down for trying to be involved in any aspect of your own medical care?
Thank you for your participation in our survey. If we never see you again, frankly, we really don't give a f*ck.

 

[Chuck C]

Oh, I also want to ask about bruises - I still have these big green marks under my skin all over the place, from all the IVs and three heparin shots they did in the hospital post-AVR. It’s been two weeks but they haven’t gone away at all, which is very very unlike me, so I assume it’s either the aspirin or warfarin keeping them there. Should I worry about them?....

I had significant bruises on my arms from the IVs and all the blood draws, both inside the hospital and also for about 8 days after release. Some went away quickly and a few took significantly longer. They are all gone now, and I think it was about the 21st day after surgery that they were gone for me. For what it's worth I do not bruise easily at all and some of them took a surprisingly long time to go away.

 

[Amy]

I think it was about the 21st day after surgery that they were gone

Thank you, Chuck. I’m still at day 17, so I’ll try and be more patient. : ) Just thought I wouldn’t have to deal with bruises that never go away till I was about 90 or so.

And I don’t mean to gripe about doctors here but I swear, I swear, I swear it’s true. There are no surveys afterwards, either. Ha.

Take good care, & thank you for telling all about your experience. Really strange how despite the many people who do go through this, how easy it is to feel alone in it.

 

[johnmarkos]

I think I heard four weeks to driving, but I can’t remember because I don’t drive much. My surgeon was pretty chill about the restrictions, although they did exist — I immediately asked for a 10 pound max lift instead of 5, because that’s ridiculous. He told me that every patient he’s ever operated on has been fine in that regard, except for one rancher who tried to rope cattle too soon after surgery.

My recollection is that I had no lifting restrictions after six weeks. The sternum is 80% healed by then, IIRC.

 

[Amy]

A question:

I have a recurring, brief flutter in my abdomen, about five inches above my bellybutton, and an inch to my left. Almost as if a tiny baby were trying to stick his foot out of the aorta. Brand new sensation, never felt it prior to AVR 3 weeks ago.

When was everyone’s first post-op echo? I’m wondering if this is something that would show up, if indeed I’m supposed to have a post-op echo, say, 6-8 weeks after AVR. Wish I could just ask the surgeon’s office, but they’re directing me to my local cardiologist, and, well, he’s an ignorant ***, so - yeah. Any thoughts??

 

[Unicusp]

A question:

I have a recurring, brief flutter in my abdomen, about five inches above my bellybutton, and an inch to my left. Almost as if a tiny baby were trying to stick his foot out of the aorta. Brand new sensation, never felt it prior to AVR 3 weeks ago.

When was everyone’s first post-op echo? I’m wondering if this is something that would show up, if indeed I’m supposed to have a post-op echo, say, 6-8 weeks after AVR. Wish I could just ask the surgeon’s office, but they’re directing me to my local cardiologist, and, well, he’s an ignorant ***, so - yeah. Any thoughts??

Hello Amy. The location sounds like its right at the end of your rib cage? Is it near where the drain tubes were? It could be nerves still healing. Any pain, swelling, redness, tenderness, etc.? How is your BP and HR?
You really should find a new cardiologist and make a appointment for this and your follow-up tests (echo, ekg, blood work). I think that Cleveland recommended the tests at the 4 - 6 week mark. I went at 8 weeks due to a rescheduling.

 

[tezza]

How long till you guys could drive?

I had a minimally invasive AVR 2 1/2 weeks ago. I stopped pain meds a week ago. I can turn to look over my shoulders. Incision site looks pretty good:View attachment 887764

My cardiologist was supposed to clear me to drive, but as one of you fellow posters put it best, he was an ‘arrogant, ignorant *******’ who didn’t even look at the incision site.

Thank you in advance for sharing your experience.

I've been told to wait for 6 weeks, but I had a full sternotomy. I am 5 weeks post surgery today, and I'm not sure I would feel confident yet in driving. I still have a good deal of discomfort from the sternum when I move, but also have bad shoulder pain, that would seriously limit me driving, as I can't even lift the arm to help with dressing, do my hair, etc. But boy, am I looking forward to being independent again! Hopefully another week will make the world of difference. BTW, your scar looks great.

 

[Amy]

The location sounds like its right at the end of your rib cage? Is it near where the drain tubes were? It could be nerves still healing.

Hello. Thank you for your thoughts. It’s on the opposite side to where the drain tubes were. Nerves.... I didn’t consider that. No pain, tenderness etc. and HR and BP are fine. I know, I know, it could be wayyyy worse... I just feel weird ignoring such weird, persistent symptoms.

The cardiologist I saw said I didn’t need a follow-up echo for another year. I can’t remember what CC recommended, and Lars’ secretary no longer responds to my questions, saying I should follow whatever my cardiologist says. All that inconsistency / lack of guidance pushes me toward trying to ignore any issues that come up, just to avoid any burnt out medical ‘professionals’. But then .... Hence this post.

Thank you again for your kindly responding with a message. I forget, with all the advice you give, that you’re also still in recovery! Take care.

 

[Amy]

shoulder pain

Dear Tezza,

Have you gotten yourself a fishbellies corn bag? I’m cozied up with mine right now. : )

It is unexpected how my shoulder and back and pectoral muscle pain comes and goes, and doesn’t just get better as time goes by. Something must be healing that wasn’t ready to heal before.

I hope you feel better soon. Sometimes we have to look very closely for it, but signs of getting better are there.... I noticed my bruises are finally going away - woo hoo! Wish I could give you my leftover Baclofen, god knows it was too expensive to just leave unused. It may interfere with Warfarin a bit though, I think. In lieu of that, I’ve been doing shoulder rolls and stretching constantly. Have you found the right spot on your door frame to push against the knots? : ) Have you tried with a tennis ball?

 

[caro]

Hi Amy! CC had me get post op echo 4-6 weeks after surgery. I had my echo at four weeks because when I would lay down at night, my pulse slowed down SO much. Told my cardiologist I had concerns, and he saw me pretty quickly for echo. Turns out it was the metoprolol. Would def do that post op echo. Did CC give you a binder? If they didn't or if you don't have it anymore, your account through the Cleveland Clinic app on MyChart has that information.

 

[Amy]

Turns out it was the metoprolol.

Hi, @caro

Thanks for the advice. I’ll relook at MyChart.

Did you switch to a different beta blocker after that, or just stop taking it or what?

 

[caro]

It’s in my “inbox and sent messages” part of the app from “HVI Resource Nurse.” It was sent to me almost two weeks after surgery. My cardio halved my dose and then I think I took that for a week or two before going off of it completely. He also told me to eat a banana every day. He thought the high dose of metoprolol as well as lack of potassium was probably causing some irregular heartbeats after surgery. Turns out he was right. It helped a lot. Rhythm became normal. I still try to eat a few bananas every week.

 

[Unicusp]

It’s in my “inbox and sent messages” part of the app from “HVI Resource Nurse.” It was sent to me almost two weeks after surgery. My cardio halved my dose and then I think I took that for a week or two before going off of it completely. He also told me to eat a banana every day. He thought the high dose of metoprolol as well as lack of potassium was probably causing some irregular heartbeats after surgery. Turns out he was right. It helped a lot. Rhythm became normal. I still try to eat a few bananas every week.

It also helps to take Potassium supplements to boost the level back to normal quicker. That's what I've been doing since surgery.
Metoprolol, I agree is just bad all around. Causes more problems than it solves, at least for me.

 

[tezza]

Dear Tezza,

Have you gotten yourself a fishbellies corn bag? I’m cozied up with mine right now. : )

It is unexpected how my shoulder and back and pectoral muscle pain comes and goes, and doesn’t just get better as time goes by. Something must be healing that wasn’t ready to heal before.

I hope you feel better soon. Sometimes we have to look very closely for it, but signs of getting better are there.... I noticed my bruises are finally going away - woo hoo! Wish I could give you my leftover Baclofen, god knows it was too expensive to just leave unused. It may interfere with Warfarin a bit though, I think. In lieu of that, I’ve been doing shoulder rolls and stretching constantly. Have you found the right spot on your door frame to push against the knots? : ) Have you tried with a tennis ball?

Hi Amy,
I have a heat pack that I love, and I'm being very consistent with my shoulder rolls and stretches and have started some exercise with a very light stretchy band to help strengthen the rotator cuff muscles. Have to go pretty easy with that but I think it's helping. Yep, the tennis ball works a treat to help ease the knots and I am about to try with the spiky ball! I am feeling a lot better this week than last week, so I think I have to compare on a weekly basis not a daily basis and just be a little more patient!

 

[johnmarkos]

When was everyone’s first post-op echo?

Mine was four weeks after surgery, arranged by my cardiologist, when I was back in the hospital recovering from AFlutter and tachycardia. My left ventricle was back to a normal-ish size already, and my ejection fraction had already gone back up to normal, so it was some nice to hear.

 

[Amy]

5 weeks post-op and how concerned should I be about what I believe is a sinus infection / staph infection in the nose? I’m keeping an eye on my temperature, and have been swabbing my nose with diluted iodine since I can’t use mupirocin on warfarin. I’m not on any antibiotics but I’m guessing that’s what they’ll send me home with if I go to urgent care.

I’m afraid not showering for a week may have set it off - but I was so scared of getting my chest tube hole wet - and I wasn’t careful about washing inside my nose, though of course I washed my face and body every day.....

If anyone has any experience to share with nose infections, please do! How likely is it the bacteria would spread to the valve?... I’ve been a nervous wreck about this.

thank you very much in advance.

 

[MdaPA]

how concerned should I be about what I believe is a sinus infection / staph infection in the nose?

How do you know/believe it's an infection? Could it be dryness (maybe from nasal cannula post surgery) or allergies? If not, get it checked out.

but I was so scared of getting my chest tube hole wet

Your discharge instructions say not to get your chest tube holes wet? 5 weeks post opt I think they would be healed/scabbed up and you should be at least gently washing/dabbing with soap/water to keep the area clean.

 

[Amy]

Just an update - it WAS staph in my nose, but I was wrong - you CAN use mupirocin on Warfarin. Was 6 days on it and hopefully I’m all set now.

My hemisternotomy incision is still a bit open on the very bottom, but has healed a bit, possibly from the high protein diet I’ve been on - and vitamin d. I’ve also gained three pounds in a week! Maybe I should’ve stuck with plant-based protein like chickpeas and lentils, and not added things like yogurt and cheese... it’s eight weeks post-op.

All kinds of pains and arrhythmias still coming and (thankfully) going, but less than before.

Wishing everyone here a good recovery.