One Person's Recovery Data

[nate_c]

I posted this over on cardiacathletes.org, but then thought maybe a few people here might also like to see this info or share their own. My point was to address two questions I had prior to surgery: what can I expect in recovery, and am I going to be faster at the end of my recovery. I can’t speak authoritatively to either question, but since I’m coming up on the 6 month anniversary of my own AVR surgery next week, I thought I’d share my personal experience in the form of my raw Garmin data collected over my recovery period.

Prior to my surgery (8/23/10) I was almost completely asymptomatic. Since recovery training paces will all be relative, here’s a baseline for where I was pre-op. I', mostly a runner, and I finished a half-marathon fairly easily with 1:37 time (only pushing a little in the last couple miles) in early August. When I got my surgery date, I’d been in the middle of training for the Portland marathon with a goal time of 3:10, which I felt was in reach with a couple more hard months of training. I usually did my general aerobic runs at about an 8 – 8:20 pace, with a average HR of 155 – 160. I was running between 45 – 55 miles per week, with long runs between 13 – 18 miles most weeks.

So, for comparison purposes, here’s one guy’s cardiac recovery from AVR for 16 weeks. This data doesn’t represent all my workouts or treadmill runs, but it does show my outdoors runs with my Garmin. I haven’t taken a ton of time to format this, but for what it’s worth:

• Weeks 2 – 6: Not allowed to run, but walk twice daily, sometimes cycle. HR capped at 120, then later at 130. Around the middle of September, started having afib episodes and strings of PVCs in the evening. This continued off and on until about week 10 or 11.

• Week 7: First run outside – More walking than running. Average pace: 14:31. Distance: 2.43 miles. Heart rate capped at 130. If I pushed into the 140s, I immediately starting having many PVC beats.

• Week 8: Ave pace: 13:11. Totals: 7.77 miles. HR: 134.

• Week 9: Ave pace: 14:00. Totals: 10.06. Most runs still between 3 – 4 miles. HR: 133

• Week 10: Ave pace: 12:06. Totals: 12.87. HR: 139.

• Week 11: Starting to work in runs up to 5 miles. PVCs stop! Ave pace: 11:36. Totals: 20.27. Now working up to HRs in the 140s.

• Week 12: Long run - 6 miles. Ave Pace: 11:36. Totals: 25.15. Permission to Start working in pull-up and push-up cross-training routines.

• Week 13: Long run of 7 miles. Ave pace: 10:44 Totals: 26.94 miles.

• Week 14: Long run of 9 miles. Pace: 9:57. Totals: 26 miles

• Week 15: Long run of 10 miles. Pace: 9.49. Totals: 31.6

• Week 16: No more HR restrictions!! Long run of 11.5 miles. Pace: 9:27. Totals: 33 miles.

From here on out, I kept it at about 30 – 35 miles per week, and worked in high-intensity upper-body cross-training routines. Pre-surgery I could do about 60 push-ups and about 23 pull-ups. My first work-outs after surgery were abysmal. I could only do about 6 pull-ups and about 20 push-ups. Very discouraging.

Since then, I’ve gotten better, but I’m not back to pre-surgery levels yet with upper body strength. For running, I’ve improved to the point where I can do 5-7 miles in the 8:45 pace range, but at the 6 month mark, I’ve still got a long ways to go to get back to pre-surgery speeds. Endurance-wise, I’m up to about 15 miles. Still, looking over this data, the moral of my personal story is consistent improvement week-over-week, but a longer overall recovery than I’d anticipated. Gains are coming harder now, and even though I’m not nearly as fast as I was yet, a 3:10 marathon is still my goal in the next year or two.

I hope this is useful to others in some way. I’ve had this data filed away here in my training logs for a while and thought I’d take some time and share it. And, one last thing that the data doesn’t show: the euphoria I’ve experienced at times while running since surgery, when it just felt so amazing to be moving again and feeling my legs working and my heart beating strongly.

 

[drivetopless]

Thanks for posting this here. It's very interesting and you are doing great 6 mos postop. I am 5 weeks postop and am starting to feel like I need some formal training to get my strength back. Also experiencing surprising upper body weakness, tho I know it is still early. I've been surprised by the little setbacks along the way (afib/pvc's) that have more impact than I expected.
Thanks again for sharing your experience.

 

[Greg a]

Hank I think this should be a sticky

 

[normofthenorth]

That's great, Nate, and helpful to a bunch of us, I bet. I'm behind you in the timing, an aging (aged?) athlete but a confirmed non-runner (except for the running I do while competing in sports and such). I'm treating one forum thread as a "blog", trying to update it periodically on my progress in recovering my former CV fitness and my former activities. It's at http://www.valvereplacement.org/for...52-Norm-s-Story-so-far-starting-with-recovery .

So far, I haven't done much besides walking, walking stairs incidentally at home, and one week of dowhnhill skiing. Cardio rehab doesn't start 'til March 7. Winter's been miserable for bicycling, so I haven't done any yet, but itching to. (I don't like walking much more than distance running -- too pedestrian! )

 

[johnp]

Thats good info. I think your pace was a little faster than me pre-op, but then again my cardiologist said my regurg was so bad he had no idea why I was not symtpomatic. Maybe I was.

I just did my first run last Saturday. About 7 weeks out. It was just a 3 miler, with some stops. My wind was fine but my legs felt weak. Today my quads are still a little sore as well as my hams.

I am happy to see your progression. Please post again and give us an update.

(I cannot register to cardiac athletes, not sure why, no biggie)

One other question, what types of meds are you on? Pre=op I was on a high dose of beta blocker and I was somewhat disappointed with my paces. The doctor kind of laughed and said I needed to re-set my expectations as a beta blocker will slow me down on the road.

 

[epstns]

Keep it up guys! I'm on my way into surgery on March 1, and eagerly look forward to getting back on the road (at the right point) later on. I've had to drastically slow my pace over the past couple of years, and am hoping to get back at least part of what I've lost. (Of course, I'm not gettng any younger, either.) Your example helps me to continue to believe that there is sport after VR.

 

[MarkU]

Congratulations on your recovery. Obviously you were an accomplished runner before your AVR and you are making great progress getting back to your pre-surgery levels.

Although I resumed most of my normal activities within about 10-12 weeks of my surgery, it took me much longer to get my stamina back. It was nine months before I felt completely 'normal' again.

Keep up the good work and good luck!

Mark

 

[johnp]

I appreciate it will take us quite some time to recover. It seems to make common sense. But (and this might sound dumb), but does anyone know why it can take upwards of year to fully recover?

Is it that muscles are not getting oxygen like they were before? Is it that inflammation in the lungs does not allow me to absorb the oxygen? Is the heart muscle weak from the surgery? Tissue damage from the meds? Just curious

 

[MarkU]

I appreciate it will take us quite some time to recover. It seems to make common sense. But (and this might sound dumb), but does anyone know why it can take upwards of year to fully recover?

Is it that muscles are not getting oxygen like they were before? Is it that inflammation in the lungs does not allow me to absorb the oxygen? Is the heart muscle weak from the surgery? Tissue damage from the meds? Just curious

I can't give you a very scientific answer, but it did take me close to a year. Although I was 'functional' after about 12 weeks, I was achy, had no stamina and tooks lots of naps, which I had never done prior to my AVR.

I attributed a most of it to the trauma of the surgery on my body.

I also had some other side effects like changes in my sense of taste. I couldn't stand the taste of Coca-Cola for a couple of years post-op.

On the other hand, I could sense a great improvement in my cardiac function immediately after my surgery - my symptoms completely disappeared.

The other issue that I'm still dealing with was the post-op depression that would occasionally overwhelm me in the first year after surgery. It eventually got better, but now ten years later I still 'get the blues' occasionally for no obvious reason.

Mark

 

[johnp]

well, one thing I see is an "issue" is general weakness. OK, it not really weakness, its just that I think my body can do X but it can really only go 75% of that.

Today I ran to catch my train, and I was running up the stairs. My mind said "go 2 steps at a time," but my legs didn't quite respond. So now I have a few stitches on my head. What a clutz. I can't believe my legs just didnt fully respond.

Quite humbling

 

[JeffM]

Hey Nate - Thanks for posting your data and progress. That is awesome news. Hey, I totally hear you on the frustration as I experienced something similar. I admire how you have taken it slowly because you no doubt have avoided injuring yourself trying to get it back to quickly. The upper body strength will come and, by the way, there aren't many people who can do 10 pull-ups. 23 puts you in a high percentile, but, I know, you're comparing yourself to yourself. With your running, have you been doing any speed work? Some shorter runs with intervals? Running uphill sprints? I know you know how to train, but just wondering if you've overlooked these critical pieces to gaining speed, improving your kick and increasing your lactate threshold?

 

[nate_c]

One other question, what types of meds are you on? Pre=op I was on a high dose of beta blocker and I was somewhat disappointed with my paces. The doctor kind of laughed and said I needed to re-set my expectations as a beta blocker will slow me down on the road.

No medications pre-op. Post-op, my doc put me on metoprolol after I started having afib episodes. That lasted about two months. I'm not sure whether it slowed down my recovery or not. The only symptom I was sure of is that it made me very light-headed when I stood up after sitting for a while. That was annoying. Currently, i take a baby aspirin daily and that's it.

I wonder why you weren't able to register over at CA. If you ever want to try again, I'm sure the community over there would love to have you join.

 

[nate_c]

Hey Nate - Thanks for posting your data and progress. That is awesome news. Hey, I totally hear you on the frustration as I experienced something similar. I admire how you have taken it slowly because you no doubt have avoided injuring yourself trying to get it back to quickly. The upper body strength will come and, by the way, there aren't many people who can do 10 pull-ups. 23 puts you in a high percentile, but, I know, you're comparing yourself to yourself. With your running, have you been doing any speed work? Some shorter runs with intervals? Running uphill sprints? I know you know how to train, but just wondering if you've overlooked these critical pieces to gaining speed, improving your kick and increasing your lactate threshold?

That's a good point. I have started been doing speedwork, and it's been a mixed bag. I think I'm getting better, but sometimes speedwork frustrates me because that's when I'm most aware of how much slower i still am than i was. I try to mix things up: I typically do strides 2-3 times per week at the end of my easier runs. I also do 800s intervals or hill training once a week, along with pace runs and tempo runs.

 

[KLAMDUP]

I am 7 weeks post-op mechanical valve replacement. Age 49yrs. I started cardiac rehab early at 13 days post-op. I will be done this comomg week and will continue to use my stationary bike at home. I am not and never have been a hard core athlet, but i exercise to keep fit. Recently past year pilates and stationary bike. But becuase of my shortness of breath prior to surgery and a chronic bad knee i did not push cardio much on my bike. Last week i was able to go faster then the past for a longer period then i was able to do long before surgery wit no shortness of breath. I cant wait to continue to improve. Strange yhing about my heart rate. My resting heart rate is around 90, and i cant get my heart rate to go up much during cardio exercise. I am still on metapropol, and will be for 3 more months. The cardiac nurses at rehab said that was normal with valves and will improve over time.
Klamdup

 

[johnp]

No medications pre-op. Post-op, my doc put me on metoprolol after I started having afib episodes. That lasted about two months. I'm not sure whether it slowed down my recovery or not. The only symptom I was sure of is that it made me very light-headed when I stood up after sitting for a while. That was annoying. Currently, i take a baby aspirin daily and that's it.

I wonder why you weren't able to register over at CA. If you ever want to try again, I'm sure the community over there would love to have you join.

Thanks, yes, I tried many times, this is what it says:

"The following errors occurred during your registration
The administrator has banned your email address. You will need to change your email address in order to continue. If you think this is done in error, please click here to contact the administrator." No clue what that is all about.

 

[LittleOwl]

Nate thank you so much for posting this. I am a total Garmin junkie and I live and breathe by what mine says with my training. It is truly inspiring to see the progress you are making. I live for riding my bike and running, and I think that the time off from hardcore training will probably be the hardest part of the surgery for me. I have no idea when my valve will require surgery, but it is very helpful to know that when that day comes there is still hope for marathons and century rides post surgery

 

[Bean Counter]

Nate thank you so much for posting this. I am a total Garmin junkie and I live and breathe by what mine says with my training. It is truly inspiring to see the progress you are making. I live for riding my bike and running, and I think that the time off from hardcore training will probably be the hardest part of the surgery for me. I have no idea when my valve will require surgery, but it is very helpful to know that when that day comes there is still hope for marathons and century rides post surgery

It sounds like you are in the same boat I was in. Mine was discovered in October 2009, but was allowed to keep training for marathons. Almost a year later it got to the point where he did not want me doing anymore hard running or anything over 10 miles long. At the same time, it was not bad enough for surgery. The ignorant person I am asked him if we could just go ahead and do the surgery sooner than later and he would not do it. My condition worsened with 7 months and I was on the table June 21, 2010.

Racing was always my reason for getting out the door every morning. When I had my restrictions put in place, it was hard to find that motivation. My new motivation became showing up the day of surgery in the best shape possible with the restrictions I had in place. Not as motivating as training for a race, but it did help me hit my goal of 50 miles a week. I also felt being fit really helped with recovery.