Precautions

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kevinsworth

New member
Joined
Nov 14, 2013
Messages
4
Location
NJ, USA
It's been a year and a half since my AVR and I'm wondering if I still have to observe the same precautions I did initially. I am 62 and I live in NJ, where Winters are cold. I remember one of the hospital rehab nurses telling me I should avoid the cold, because it constricts the blood vessels, and makes the heart work harder. My cardiologist told me not to shovel snow (is it the shoveling, or the lifting, or the cold, or the combination?) Prior to my surgery, I was active and did all my own yard work. Winter and summer. I know I'm not a kid anymore, and I take things a lot slower. But are there things I absolutely should not do?
 
I'm almost 3 weeks out from my valve repair and aneurysm replacement and the one visiting nurse told me I should never drink coffee ever again-even though my BP is fine and arteries are clear- then 2 days later my cardiologist said I can have a cup now as long as it doesn't kick my BP way up. My surgeon says after 3 month's I'll have no restrictions. I live right across the river from you in Pa and I'm 45. I can't give you medical advice, obviously, but think the professionals opinions are all over the place.
 
Hi

I think who ever told you about rehab and vasoconstriction due to cold is either a complete idiot or you have some other serious condition which is not being discussed or included here. I'm inclined to think its the former.

One of the wonders of the human body is that just beneath the skin we keep our core temperature very well regulated and we do this by allowing blood to flow. I have been just recently living back in Finland (back in Australia again now) and was out skiing and hunting in -20C (which is -4 in that funny depricated nearly abandoned German scale Farenheit).and I can assure you that with exersize (like skiing and walking is) as long as you are properly dressed you will have good blood flow even to your fingertips.

To hear that absolute non-sense about making work harder is mind boggling.

Unless you have some acute vascular or circulatory disease which you are not mentioning or are morbidly obese then if you feel inclined to get out and shovel snow then do it! I suggest take it in small stages and quit as you feel tired (perhaps before you feel tired).

It took me a few months of mowing the lawn at home here to be able to do it with the same gusto as I did when pre-surgery, but I am now.

Remember you are not a china doll and your body needs exersize (not cotton wool padding and stored in a box) to be healthy and to recover.

Lastly it is the contractions of the biggest muscles (like the Quadracepts) in the body which causes blood pressures to rise and restircts the blood flow (thus putting pressure on the heart and the aorta).

Like you say, you're not a young buck anymore , but take it easy, listen to your body and get into it gradually. Go out and do those things, take care of your back and when the snow's wet (like late winter tends to be) take smaller chunks.

Best Wishes
 
pellicle;n853444 said:
Hi
Remember you are not a china doll and your body needs exersize (not cotton wool padding and stored in a box) to be healthy and to recover

Pelicle puts it very well. It's been a year+ since your surgery and, unless you are a special case, you need to resume a normal life and do what your body will let you do.
 
I was told not to lift or drink coffee during the recovery period. Now my cardiologist says no restrictions. I do what I feel like doing and right now I feel like another cup of coffee.
 
I believe that the Canadian Red Cross also says the same thing about shovelling snow and it's more about breathing in the cold air while doing this type of exertion that constricts the blood vessels, although I still do it but I take my time. (it also helps to have battery operated gloves to keep your hands toasty warm, best investment I ever made lol)
At six weeks into recovery I started our gas lawn mower, now that was a bit of a challenge but I did get it running.

My best suggestion is to do some searching now that you have conflicting reports from this forum and question your doctors again.

Good luck
 
I'm probably NOT the best to advise on this, as I'm now 67, just about 4 years out from aortic valve, bypass and pacemaker surgery, and I still shovel snow, run a snow blower, and do all that "kid" stuff. I do dress appropriately. I also listen to my body and try to pace myself and do ensure that I do not try to lift too much at one time. If you are otherwise healthy, you should be able to do these things. Just pace yourself so that you do not become short of breath, and be sure not to hold your breath when you push or lift.

I'm with pellicle on this one. Yes, there are dangers in the cold if we are not otherwise healthy. If you have been cleared for all other exercise and activity, you should be able to shovel snow and do yard work, too. Just start out slow to be sure you can tolerate it well.

If you are not otherwise at risk of a heart attack or other injury, you aren't likely to "break" when you work a bit.

P.S. I live near Chicago. It doesn't merely get cold here, it gets really cold.
 
Hi Guys

this website was sent to me by email and I thought it was interesting

http://www.bbc.com/news/blogs-magazine-monitor-30119410

I thought I'd quote what I saw as the salient points and what I see as the reasons for it

His team found that when healthy young men shovelled snow, their heart rate and blood pressure increased more than when they exercised on a treadmill. "Combine this with cold air, which causes arteries to constrict and decrease blood supply, you have a perfect storm for a heart attack," he says.

(my underline)
I have problems with that point because to the best of my knowledge arteries do NOT constrict but some surface skin capilaries do.


Snow shovelling is particularly strenuous because it uses arm work, which is more taxing than leg work.

anyone knows that doing squats with weights in the gym will show that higher BP comes from the legs, but I guess he's simplifing things as there is also back and even legs involved in shovelling (and yes I've done my inlaw granparents driveway in Finland which is 200 yards long....)


Straining to move wet and heavy snow is particularly likely to cause a surge in heart rate and blood pressure, Franklin says.

which ties in with what I said above about late winter snow ...

Many people hold their breath during the hard work, which also puts a strain on the body.

this is an interesting point and ties in with what Freddie said above. Anyone who has done any gym or exersize training knows that the most important point is breathing. Holding your breath is bad and especially when lifting weights is likely to create enormous pressure on your CV system. The lungs are like a great pair of blood vessel permeated sponges and fed into by the heart
Illu_pulmonary_circuit.jpg


holding your breath while lifting a weight pressurises that system with all those muscles squeezing in on the rib cage (normaly driving exhalation) and in combination with greater resistance from the muscles doing the work is to my understanding what makes the "perfect storm"

In Finland where its gets quite cold too its common that people don't do outside work thats strenuous when its at its coldest. The reason is that you are likely to cause damage to your lungs by deeply rapidly breathing cold air. I've never heard of this in itself increasing blood pressure, but it can cause other problems (something similar to a cold burn which promotes a fluid response and would then set up conditions which could favor pneumonia).

The article goes on to say:

"People at greatest risk are those who are habitually sedentary with known or suspected coronary disease, who go out once a year to clear snow," he says, adding that smoking and being overweight drastically increase the risk.

so the unift, the obese and the sedentary are "most at risk" from exersize. To me this is the main issue - unfit inactive obese people suddenly doing work that they are not accustomed to ...

The article makes points similar to those I made on "dress properly" but makes them more clear:
... push rather than lift the snow, dress in layers, take regular breaks indoors and don't eat or smoke before shovelling, he advises.

In Finland this means long johns to keep your skin warm (and importantly wick away any sweat). The new technical synthetics are excellent but merino wool is good too. Then a micro flece and lastly something like a Gore-tex or other shell jacket (does not need to be padded) to keep the snow from getting onto the microfleece. Naturally a "beanie" (as we call them, Canadians use the word tuque) for your head and some gloves.

so Kevin, given that you said you do your own yardwork, go at it thoughtfully , listen to your body (give it a break if you're puffing) and you'll be fine.

best wishes clearing the stuff.

PS: like almost everything I've ever come across in the medical world I think this (cold effects on your work) is a Myth which comes from simplifications made for ease of communicating a complex topic to simple people. If you tell them lots they'll get it wrong. Best to tell them something (which may be wrong) simple that results in them misunderstanding, but avoiding the risky task. The problems come from the compounding of this simplification and the failure in teaching people (that deliver the message) that it is a simplification.
 
My mother in law warns me about snow shoveling every year when it comes on the news. I don't think she gets that shoveling is like taking a nap compared to the running or weight lifting I do every day (for her, walking to the kitchen is a workout). Yes it does cause a lot of heart attacks, but like Pellicle said, I think it is people way overexerting their normal routine (so that they can escape their homes) more than the cold or anything unique about shoveling.

Of course I have now exposed myself to Death by Irony. . . .

But I think if you feel good, and pace it so you are not out of breath or sore, that getting back to yard work (if you like it) would be good for your spirits.

If you don't like it, TOTALLY unsafe and you should hire it out. For your health, man. : )
 
LOL

dornole;n853509 said:
My mother in law warns me about snow shoveling every year when it comes on the news
....
Of course I have now exposed myself to Death by Irony. . . .

I can see it now, you find yourself floating up, detached from all the sensations of the world. You look down and see your body holding that snow shovel in your hand. You feel the warm glow and see a welcoming light ... as you drift towards that you feel only happiness ...

then you hear your mother-in-laws voice in the distance saying "See, I told her ... didn't I tell her ..."

you smile and give her the bird (even though she can't see you)

sorry if this was inappropriate, but I couldn't resist ...

(*this has been a variant of Agatha Kristies little known novel "Death On The Snow" ... that's of cours Agatha Kristie - the unknown Dutch Author)
 
Thanks everyone, for your comments. I have scheduled a consultation with my cardiologist (in 2 weeks.) I'll be bringing a list of activities and hope to get some definitive answers. I'll let you know!
 
Kevin, I had my AVR in 07-08 (almost 7 years now) and I am a working police officer. There is LOTS of misinformation out there. (Especially about Warfarin) I can do ANYTHING. I have no issues at all and no Warfarin issues. I had heard a major Atlanta hospital patient info station (on the room TV) say to give up bike riding for playing cards! (For patients on blood thinners) WHAT THE HECK?
I missed Doctor day at the academy so I may not know everything but I bet, if you go in well read and thus well armed (against wrong information) you will not be disappointed and your activities should not be reduced very much if at all.
Good Luck.
Greg
 
Hi
Agian;n853912 said:
No restrictions? That rocks!!

I think that's more or less what most of us mech valvers have been repeating like a stuck record since I've been on this site. Aside from normal cautions considering age , people like me , ski girl, gymguy, dick ... usually say there are no specific restrictions being on warfarin. Assuming you go into valve surgery healthy and not sporting a bunch of other problems.

A recent study inGermanyy identified that younger mechanical valve recipients who self managed had no greater problems than the general population of their age group.

I have posted my travels here where I ski, hike, travel, motorcycle , home reno .. with no restrictions since I started warfarin in 2011.
 
I get that Pel. I meant imposed occupational restrictions. Like a cop being told he can't do X and Y because they're on Warfarin.
Btw, could you upload the link to that study? I think you've put it up before.
 
Ya that is probably a different story and dependent on different jurisdictions. I could see the solicitor saying that the higher risk of bleeding if you get shot, God forbid, being used as an excuse to limit your assignments or say you can't do the job depending on how shitty your management is.
 
I haven't any restrictions, apart from one. I can lift as much weight as I want, do as much exercise as I want etc BUT I'm not allowed to donate blood anymore - some stupid EU regulation. Even though my heart is supposed to be in better shape than ever, the blood transfusion service here in the UK won't allow me to donate. I even took this to appeal and wasn't allowed. So annoying since I was donating when I had severe stenosis ok !
 
Hi Agian
Agian;n853927 said:
I get that Pel. I meant imposed occupational restrictions. Like a cop being told he can't do X and Y because they're on Warfarin.
Btw, could you upload the link to that study? I think you've put it up before.

sometimes I swear I have a kind of autism or OCD or (perhaps) alternative interpretation blindness ... sorry about that.

The study results are buried within a journal article, which requires you to read it carefully rather than just accept the spoon feeding in the abstract. The article is: Survival Comparison of the Ross Procedure and Mechanical Valve Replacement With Optimal Self-Management Anticoagulation Therapy



http://circ.ahajournals.org/content/123/1/31.short

as I always say (about these things) its always about "late survival" and for these guys that means 10 years. Which (as I always say) is bull5hit because nobody here expects to only get 10 years ... espeically not the 30 year olds.

Conclusions—In comparable patients, there is no late survival difference in the first postoperative decade between the Ross procedure and mechanical aortic valve implantation with optimal anticoagulation self-management. Survival in these selected young adult patients closely resembles that of the general population, possibly as a result of highly specialized anticoagulation self-management, better timing of surgery, and improved patient selection in recent years.

essentially this article supports what any home tester has attested to for ages ... if you are capable of doing things then doing it for yourself will not only cost the community less but give better outcomes to you.

I hate the ongoing decapactisation pressure of this society. Increasingly we have less capacity to maintain our own stuff, cook for ourselves, perhaps soon even tie our own shoe laces. The whole "service" industry is based on taking your capacity away from you and exchange it for ... well for being shafted often enough if you ask me.
 
pellicle;n853948 said:
Hi Agian

sometimes I swear I have a kind of autism or OCD or (perhaps) alternative interpretation blindness ... sorry about that.
You've got nothing to apologise for.
Thanks for the link.

BTW Didn't you also upload a link showing that self-management demonstrated similar bleeding events to the general public?
Hmm, could be the same paper. I'll read it carefully.
 
Agian;n853952 said:
BTW Didn't you also upload a link showing that self-management demonstrated similar bleeding events to the general public?
Hmm, could be the same paper. I'll read it carefully.

it is the same paper ... hmm ... I wonder if I've misread it (then I would have something to apologize for).

will read it again later
 
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