Incision on chest not healed completely.

[ATHENS1964]

The cardiologist and the surgeon told me 2-3 and they both agreed that round 2.5 would be ideal and safer in the changes especially downwards, while it is not a small case to go and 3.2 while if I go below 2 for some time this could create a clot.
Because I do self-management with inrange and there is a difference in the measurements with the lab usually 10-15% the inrange shows 2.8 and the lab 2.5 so I am in inrange 2.5-3.2 I will always be in the preferred.

 

[Chuck C]

if it helps my surgeon (its the surgeon who does the call in Oz, not the Cardio) wanted me to be min 2.2 so my range was effectively 2.2 ~ 3

I assume that he prefers 2.2 because if we account for margins of error he feels being above 2 is better than being below it. I happen to agree. Indeed if you take one of my yearly plots you'll find very few below 2 and the majority above 2.2

View attachment 887796

seems better than skating on the edge of the ice thickness

I totally agree with the idea of having margin. And, as the data you have previously presented shows, there is much more margin on the high end than on the low end, in terms of avoiding events. So, even if they eventually move me to a target of 2.0-3.0, I plan to still try to stay 2.5-3.0, as I don't like the low margin of safety as one approaches 2.0, and I'd rather keep at least .5-1.0 distance, as a target, from the danger zone.

 

[Amy]

My assigned target range is 2.5-3.5, but I personally try to stay between 2.5 and 3.0

Before the surgery, I’d found a bunch of papers that convinced me 2.5-3.5 was the way to go.

Then the NP the day of discharge said 2.0-3.0.

Then I read 2.5-3.5 is better for just the first three months....

then I tried telling my Coumadin clinic I wanted my range to be 2.5-3.0 and got told off...

Theeeen I read that having a range actually makes you less consistent and you should pick a target number ...

and now I’m wondering if there’s anyone who knows wtf they’re talking about when it comes to INR range.

...which makes it difficult when, like last night, my INR was 2.3... do I wait to see if it’s on the low side again before adjusting dose a bit up? Do I skip a salad for a day? And my different dose pills are a different brand, so I’d be mixing brands, which depending on who you ask, matters....

I ended up taking 5.5 mg instead of the usual 5, and plan to continue that, a 10% increase; now to figure out if I should wait a whole week to test again, or do it in a couple days, since it’s only been a month on Warfarin..

Easy to overthink this stuff a bit, in the beginning, isn’t it? (Did I have more avocado toast than usual this week? Was it that new super strong jasmine tea? lol)

 

[Chuck C]

Hi Amy.
Just wanted to give an update on my INR while on Cipro. Today is day 6 on Cipro and my INR this morning was 2.9. I have been staying consistently at 4mg of warfarin per day.
At this point, my data seems to suggest that Cipro has very little impact on my INR at day 6. I would estimate that it has raised my INR somewhere in the range of 0 to .2.

 

[Amy]

Hey @Chuck C -

I decided to hold off on the Cipro for a couple days - just to watch and see. (In part thanks to you and Pellicle’s kindly offering your opinion that my incision was not infected - thank you.) But interestingly, (disturbingly??) a second NP called (after the first one who called in the script said Cipro doesn’t affect INR) to tell me to halve that night’s dose of Warfarin. If like you, my INR was not affected by the Cipro, I’d likely be in ‘the danger zone’ now...

 

[tom in MO]

I have taken Cipro many times on warfarin and it has no effect on my INR. However, I have been warned Cipro can change the INR. You should never stop taking an antibiotic "just to watch and see." If your antibiotic is needed, generally you need a full course of it to assure the infection won't come back.

My sternum healing included some spots that took awhile to go away and some weird oozing. I even got a few pimples, the cardiac rehab nurse had never seen that before. For me, going to cardiac rehab was helpful beyond the exercise because I could ask the staff and RN all sorts of questions and get good answers right away.

 

[Amy]

My sternum healing included some spots that took awhile to go away

Hi @tom in MO - -

how long about would you say? For your sternum incision to completely heal?

(Just to be clear, I never started the Cipro, so I didn’t stop taking antibiotics in the middle of a course.)

I’m just now thinking about whether to try cardiac rehab or not... I very much doubt the people there will be able to competently answer questions. If even the cardiologist didn’t,....! Would I lived one state north....

May I ask how long you did cardiac rehab for? Did you see a big difference in how you felt, your mobility, decrease in aches and pains, etc.?

 

[tom in MO]

Hi @tom in MO - -

how long about would you say? For your sternum incision to completely heal?

(Just to be clear, I never started the Cipro, so I didn’t stop taking antibiotics in the middle of a course.)

I’m just now thinking about whether to try cardiac rehab or not... I very much doubt the people there will be able to competently answer questions. If even the cardiologist didn’t,....! Would I lived one state north....

May I ask how long you did cardiac rehab for? Did you see a big difference in how you felt, your mobility, decrease in aches and pains, etc.?

how long about would you say? For your sternum incision to completely heal? I don't remember, but would guess a month or more. In two weeks it was looking OK but I had two areas that took longer.


May I ask how long you did cardiac rehab for? Did you see a big difference in how you felt, your mobility, decrease in aches and pains, etc.? I did cardiac rehab 2-3 times a week for about 3 months. The max allowed by insurance. I still do the exercises today ~8 years later. I am not an exercise person by nature, but cardiac rehab showed me how much good it can do. My main motivation now is my arthritis. I do the exercises in the morning and it loosens me up for the day. Stretching exercises will decrease aches and pains and increase mobility. The camaraderie with the other patients was good motivation too. Also good for bouncing my complaints off their experience. The rehab had a team of 3 physical therapists and an RN. The RN helped out with my wound healing, removing errant strips, BP, heart rate and she convinced me to get my sleep apnea fixed. She also gave a little talk about heart health for each session. The cardiac rehab was run by the local heart hospital where I had my surgery so all my records were integrated with theirs. If I went to the doctor, the rehab RN would talk to me about it.

Is your picture a Red bud tree? It's that time of year. IIRC you live in Arkansas, one of my favorite states...even more so now that Crystal Bridges is open. I even like Little Rock and Hot Springs Arkansas has such diversity from the northwest corner's forests down to the southeast corner's rice fields.

 

[Amy]

Just an update - the very bottom of my hemisternotomy incision is still not healed up and closed... at 7 weeks post-op. I wonder if this could be helped by eating more protein? (I’m a vegan) I’m trying not getting it wet at all - daily showers were making the scab keep coming off; and trying not to exercise too much - walking at my usual pace was making it weep a bit - and I’ve stopped the arm exercises - the cardiologist thinks that was pulling on the skin.

Any tips or experience to share regarding protein’s effectiveness at healing, or words from people who also had an open incision at 7 weeks post-op, would be great.

I even tried positive rumination, I’m so desperate!!!!

 

[MdaPA]

the very bottom of my hemisternotomy incision is still not healed up and closed.

Usually it's that last bit at the bottom that is the last to heal/close, especially just around the bottom of the sternum where the skin folds when you sit down (may not be the case with you if you had a hemi and not a full sternotomy).

I’m trying not getting it wet at all - daily showers were making the scab keep coming off

Are you following your wound care guidelines?
Heart Surgery: Incision Care

walking at my usual pace was making it weep a bit

I would think with weeping/drainage after 7 weeks post-op it should be looked at again.

 

[Chuck C]

I wonder if this could be helped by eating more protein? (I’m a vegan)

I found this article that may be of interest regarding the importance of vitamin D. Most vegans are well aware of the importance of taking a B-12 supplement, when on a vegan diet. But, many do not know the importance of taking a vitamin D supplement as well. I know from experience in my own family that when people eat vegan that they are most often deficient in vitamin D. Vitamin D is very important to wound healing:

https://advancedtissue.com/2014/11/...d healing process.,wound healing is vitamin D.

So, if you are taking a vitamin D supplement, great. If not, I would strongly consider it. I am not vegan but I personally take 4,000iu per day of vitamin D. You can also get a blood test that can test your level of vitamin D to make sure your levels are good.

 

[Amy]

Mdapa,
Yes, I’m following those guidelines but it still hasn’t healed, which is why I’m trying not getting it wet now, which seemed to help my chest tube holes close.

Chuck,
Thank you. I take d3 every day generally, but have skipped the last weeks, focusing on other things... Thank you for the great reminder - I’ll start again right away.

 

[newarrior]

I found this article that may be of interest regarding the importance of vitamin D. Most vegans are well aware of the importance of taking a B-12 supplement, when on a vegan diet. But, many do not know the importance of taking a vitamin D supplement as well. I know from experience in my own family that when people eat vegan that they are most often deficient in vitamin D. Vitamin D is very important to wound healing:

https://advancedtissue.com/2014/11/...d healing process.,wound healing is vitamin D.

So, if you are taking a vitamin D supplement, great. If not, I would strongly consider it. I am not vegan but I personally take 4,000iu per day of vitamin D. You can also get a blood test that can test your level of vitamin D to make sure your levels are good.

I am vegan and I take B12-my D is high from living in SE Asia. B 12 also relates to nerve damage and repair and functioning of nerves...Chuck C do you also recommend patients take calcium supplements or anything else to heal bone ? I think magnesium and glucosamine might also speed up bone healing

 

[Amy]

Hey newarrior,

Thanks for the reminder not to skip my b12 or magnesium either. : ) I needed that.

 

[newarrior]

Hey newarrior,

Thanks for the reminder not to skip my b12 or magnesium either. : ) I needed that.

Are you vegan ? B12 is great for nerves..Mag helps with so much--bones muscle tinnitus ..stress..hearing depresson affib and heartbeat/rate and digestion.I take 400 mg a day in powder/water...Great insurance policy..I mix with orange glucosamine powder (which helps my joints).. I think meditation and visualization help all body parts as well..To your health !

 

[Amy]

I used to be vegan until yesterday I think. I so want my chest incision to heal, I bought canned salmon and eggs and cheese and yogurt (and lentils, chickpeas and two types of trail mix). And I’m going to use my marathon runner husband’s protein powder to make a smoothie with all of that. That, plus b12 & d3 oughta do the trick. I hope.

 

[Chuck C]

do you also recommend patients take calcium supplements or anything else to heal bone ? I think magnesium and glucosamine might also speed up bone healing

I took magnesium for heart heath before surgery and take it now post surgery. As you have noted, it is recognized as being good for heart health, as well as helping with heart rhythm. I believe it is also important for bone healing, as well as calcium, but I've not done research on this. I know that many believe that glucosamine helps with joints, but again, I have no special knowledge there.

 

[Unicusp]

Hey Amy. Have any of your Doctors suggested a couple of sutures or dermabond glue to hold that small section together to heal? Seems logical to me.
Or just do it yourself with Krazy Glue!
Assuming no infection of course.

 

[newarrior]

I am vegan to save my heart--not just vegan--no oil no fat: FAQ | Dr. Esselstyn's Prevent & Reverse Heart Disease Program

 

[user 16827]

I so want my chest incision to heal, I bought canned salmon and eggs and cheese and yogurt (and lentils, chickpeas and two types of trail mix). And I’m going to use my marathon runner husband’s protein powder to make a smoothie with all of that.

it will be interesting to see if your strategy make a difference over a few weeks.

please keep us updated & best of luck with the healing