Lifestyle and Coumadin

[jcubby]

Hi folks,
I am facing the decision a lot of members have faced - mechanical or biological valve. This forum has been great in giving me opinions that I would not get from my cardiologist (as much as I trust him), and research hints. However, I can't get a good feel for how the anticoagulant therapy will affect my lifestyle. I understand watching the diet and all, but still have some questions. Specifically, does anyone have any experience with ability to do active speorts like downhill skiing while on this medication? I am in my mid fifties, so I am not a crazy jump off the cliff type, but I very much enjoy the black diamonds. I'm not so much worried about my other favorite sport, golf - it's hard to see how I could damage myself that way (except mentally). Finally, I am a social weekend drinker, and would like to know how others have found managing the medication while still occaisionally partaking of the grape.
Thanks in advance for any advice.
John

 

[MarkU]

Hi John,
I had a St. Jude mechanical installed 2-1/2 years ago and just turned 50 this past May.
It took me about 4 months to get my Coumadin stabilized and 9 months to get over the effects of the surgery.
Since then things have been great. I feel better than I have for years, work out at the gym 4-5 times per week, and basically do everything I have ever done, with the exception of heavy weightlifting.
The Coumadin has basically been a non-issue to me. No bleeding problems, no bruising, etc. Don't know it's due to my age, relative good physical condition, or just plain dumb luck.
Oh, and I have a glass or two (or three) of Merlot at least three nights a week: figure I'll at least die feeling good with a smile on my face...

Mark

 

[ALCapshaw2]

Hello John,

It's a tough call. I wanted a Bovine Pericardial Tissue Valve but my Surgeon elected to install a St. Jude Mechanical Valve after opening me up.

After a while, I got used to being on Coumadin, developed a chart and pill dispenser system to allow me to keep track of my medications and got on with life...until this month, 14 months post op, when my INR jumped up to 4 to 5 and I had blood in my urine. It's back in range but we never could come up with a good explanation for the spike.

Today, I cut my finger when I bumped it with a saw blade, after cutting over 2 tons of tree limbs by hand without incident. It finally stopped bleeding with a bandage and pressure, but took longer than my PCP's nurse liked.

Bottom Line: You've gotta be careful and if you get banged up badly, that could be the end of the line. I still haven't used the Electric Chain Saw I bought as my Cardiologists words, " If you cut an artery, it's all over", are permanently etched into my memory!

I suspect most people choose the valve whose undesirable aspects they can best live with. Best wishes making your choice!

'AL'

 

[Simon Gee]

just go for it!!

just go for it!!

Hi John,

and welcome from England. I had a St Jude mechanical valve fitted in 2000 and shared all the same concerns as you before surgery. The decision in my case was made eventually by my surgeon, who felt strongly that mechanical was more appropriate for me than biological, and I was willing to take his advice as I figured he knew a little bit more about it than I did.

So what has it meant, having to take anticoagulation therapy? In my case, the answer is not a lot. My diet has changed little and I still enjoy green vegetables and salad just as before. I have changed my drinking habits and now relish a couple of beers or glasses of red wine every day, merely in the interests of consistency you understand, and have given up the spirits. The only area it has affected is the physical one. I have given up all hope of ever playing full contact rugby again, which is the one aspect I find a real bore, and I have found that minor nicks and cuts can often be a nuisance - I now use elastoplast as a matter of course! However, I would have absolutely no qualms about downhill skiing, other than the fact that I would make a complete fool of myself as I haven't done any skiing for 25 years!!!

The other aspect that does impinge of my life is the regualr blood testing, done at the doctor's surgery in my village. Frequency varies depending on my stability, but I have got up to eight weeks with no problems and am very happy with this, despite the worries of some members here who feel that testing should be much more frequent.

The bottom line is that having a mechanical valve is not such a big deal. There are aspects of your life that will be affected, but the main one, your health, is paramount and the other issues are a very, very small price to pay for that!

Good luck with your decision - a lot of us have been there so we're rooting for you.

Simon

 

[Sherry]

Hello, John. Welcome to this wonderful forum. You're making a tough decision right now so there's a lot to think about. The mechanical valve is more durable than the tissue valve, but of course there's that darned Coumadin. To be honest with you, my lifestyle hasn't changed that much. I've had some wild INR numbers lately, but we can't trace it to anything dietary so I just go get tested when she tells me to. I've never been snow skiing but if the opportunity arises, I will. As for the alchohol, you mentioned the weekend parties: you'll have to be consistent with the alchohol (as Simon mentioned). My hubby and I sit on the porch and drink a glass of cabernet almost nightly in the summer. When I'm teaching, it may be more like every second or third night. Just be aware of that. Best of luck to you.

 

[Swill]

Drinking (in moderation, of course!)

Drinking (in moderation, of course!)

As everyone say, keep it consistent. Your Warfarin nurse may tell you not to have any Vitamin K, which is what mine did, but my understanding is that a consistent level is what is important. But you have brought up a good point. my drinking has not been consistent, and I guess i will have to use that as an excuse for why my INR is bouncing around. I'll need to be a little more consistent in my drinking from now on <grin>.

On the other hand, does alcohol cause the INR to go up, or down? I've heard both...

Cheers,

Will

 

[ccrawford]

Hi John, you got some good posts and i agree with them. I own a farm and do a lot of woodworking for fun and sometimes profit. I haven't skied since surgery, but wouldn't hesitate doing it. You may have some larger bruises if you have a hard fall. I use a full range of power tools in my workshop, and also use a chainsaw quite frequently. My arms get scratched frequently when the dogs jump on me or when I'm bush-hogging and the briars are thick, but its not a problem-just takes longer to quit bleeding. I've had one deep cut on a finger since surgery (in the kitchen), but applying pressure and ice finally stopped the flow. The point of all this is that you should be a little more careful than normal, but I certainly wouldn't stop doing those things you enjoy. Chris

 

[jcubby]

Folks,
I want to thank everyone for their replies and thoughts. I am still somewhat worried about the skiing, I would really miss it - even if I kept doing it I might lose some of the enjoyment through worry. I do like very much how you suggest coping with the alcohol issue - having a drink more often and consistently could be fun, even though it might be tough on the waistline.
Well, I will keep researching and thinking about it for a bit. My cardiologist has been after me to have the valve done for two decades now, but I cannot bring myself to submit until I start seeing the symptoms that it is affecting me. We have been watching my aortic valve area and gradient change slowly over that time, but while it is severe, the numbers are not yet critical. So I coast along waiting to feel a difference that would indicate that it is time.
Having bought that much time, I am very sure the valves and techniques are much better, so that is another inducement to wait.
Thanks again, John

 

[Ross]

Just bare in mind that there is such a thing as waiting too long and it's not always with symptoms that this plateau is reached. Once that's occured, nothing can be done. Don't want to see that happen to you.

 

[McCln]

John

John

I can never seen to get away from the name John. I have a brother and half-brother named John, an uncle named John and male friends named John. Just kidding aside, I have had a St Judes aortic valve since 2001 and I am younger, now at age 38, but would not trade the valve for anything. After a repair bypass 30 years ago and this past surgery, am not ready for another anytime soon. It is better for having a mechanical valve in years from having another replacement withing 5 to 10 years from now. Adjusting to the coumadin, it nothing to it. Just adjust your weekend drinking and diet. You will be all right. Just soak all th information in. There is an advantage to having the tissue valve, no coumadin. It is your decision. Take your time and you will make the right choice. Take care.

Caroline
09-13-01
Aortic valve replacement
St. Jude's valve

 

[Gail in Ca]

Now that I am on coumadin, I no longer snow or water ski.
I fell once snow skiing 6 yrs ago and my leg twisted with the ski still attached. It swelled up and bruised and now my knee has not been the same. I wouldn't want to have this happen while on coumadin, as I bruise really badly now. My cardiologist would rather I avoid sports that might involve contusions. So I do.
But I miss being out on the slopes with my family. I am now content to read a book while hubby and teenager do the black and dbl black diamond runs, and I get all the details of their adventures.
My first valve was tissue and I went back to doing anything I wanted. It was great for 11 years, too bad not longer!!
Gail

 

[Granbonny]

John

John

My hubby of 37 years is also a John. On your choice of valves..remember any type you choose..takes a full year to feel your old self again..So...if you are in your mid-fifties...plan to take a year off after your open-heart surgery..If you choose a tissue..in 10 years..when you are in your mid-sixties...plan to take another year off. I had my mechanical at age 61.. 17 months ago. Lucky, to have had a good family to help out. They have their own lives to live..and would hate to think about putting them thru it again. Coumadin has never been a problem for me. NO bleeding..No brusing. Stay on it when I have my teeth deep cleaned..every 6 months. No problem. About the skiing..if you are lucky..you may be able to find some snow or not.. but just how many times do you ski in the winter anyway? Think about how much golf compared to snow skiing you really do? Bonnie

 

[mharris]

I am 29 and had a mechanical valve put in after repair surgery did not last but 3 weeks. I would not wish for myself or anyone to have to go through a second open heart surgery. I am trying to get used to coumadin but I was told you just need to be more careful and if you fall or get hurt, you just need to go into your doctors office and be checked out. So if you only ski a few times a year and be extra careful you should be ok. You just need to do what feels right for you. To have a mechanical valve and not have to go through the surgery again far out ways the extra caution and pain in the rear of taking coumadin daily. Good luck!
Michelle

 

[Granbonny]

Hi Michelle

Hi Michelle

Wow..4 children, a newborn and a daycare provider( read your user profile)..and just 2 1/2 months post-op. I hope you really have a lot of help. Mother. mother-in-law..ect. and one heck of a good hubby. I agree..no you do not need rehab. all that lifting, washing and lack of sleep but..remember..it does get better. slowly. one day at a time. Agree with you about the mechanical valve. Now, you do not have to worry about another open-heart surgery when they are all teenagers. Coumadin is no big problem. Maybe you can get a home tester down the road. Lots of good wishes for you. Bonnie

 

[dano]

I had my first surgery in June of 2001 to repair an aneursym and aortic valve and I chose a homograft at that time. I was 45 and knew I'd probably be facing a second surgery 15 or 20 years down the road, if projections were good. I wasn't too keen on being on Coumadin and neither was my surgeon. So, that helped to confirm my decision. Every thing was going really well, or so I thought. A regular visit indicated a problem and it was determined that my new valve was leaking worse than my original. So, in January of 2003, I had a second surgery. At that time, my surgeon and cardiologist both thought I had better go with a mechanical and hopefully avoid a third surgery. So, that's what we did. In surgery, my surgeon almost opted to put in another tissue valve as everything was looking great. But, since we hadn't discussed, he went with the mechanical. In the long run, that is probably the right decision. There were two things that concerned me with the mechanical valve. Coumadin and clicking. I've not had a lot of reaction to the Coumadin - bleeding a little longer when cut, trying to get and stay stablized on INR, and trying to figure out how to be consistent with the Vitamin K stuff. Don't drink or ski, so I can't help you there. Do play golf and it hasn't helped my game any - oh well. However, I am still trying to get adjusted to the clicking. I think mine is extra loud. If I get close to somebody from behind - looking over their shoulder at work, etc - some people can hear it clicking. Of course, I hear it quite often. I've been told I will get used to it eventually. It's not an easy decision and I thought many hours about mine. I can say that it is still major surgery, even though we have come a long way and treat it almost routinely. So, if you want to opt for a really long time before another surgery, then you might lean toward mechanical. With the tissue, I think there is still a chance of rejection, if it is not homograft (at least that's what I think), but no Coumadin or clicking, however repeat surgery is probably a given.

 

[Susan BAV]

Hi John - From the research I've done on this subject, this all sounds like a broad range of excellent advice. I haven't had valve replacement surgery yet. But I agree with Ross; you don't want to put it off too long. Of course, what is "too long?" That's where hindsight will be 20/20. But it probably never hurts to get a second - and maybe a third - opinion. I'm very new to this site. But in my searches, I've read several serious questions from various people who seem to be having extremely serious health issues and then there are no more entries from them. It bothers me. ~Susan

 

[Nancy]

Hi Susan-

Don't get too worried about disappearing members. I have found over the years that people come and go. Most times, the people who don't post much anymore have had a big improvement in their lives and have either gone back to work, or otherwise moved on to focus on other things.

You should know, in looking over some of the more serious posts, that many of the things that seem dire at the time, eventually get worked out and have a positive outcome.

This surgery really is a miracle. The mortality is low and prolongs life and gives a much better quality of life.

If there weren't fixes for serious problems, my husband wouldn't be here.

So chin up, your life will improve, I promise!

Keep on reading.