Progress continues. . .

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epstns

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Dec 26, 2002
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I had my latest check-up with my favorite cardio yesterday afternoon. The schedule called for a baseline stress test to see if I'm ready to begin rehab, and a consultation. Apparently all the "studying" I've been doing at the gym was good enough. They had me on the treadmill for all of 7 minutes at an easy pace (but a heavy incline. . . ) and all was well. BP went up as expected, with no unplanned drops. Rhythm remained normal sinus. So, I am cleared to start rehab as soon as the orders are entered and they call about the schedule.

We discussed all of my questions and concerns, and agreed that although my BP is higher than we like it (now about 130/90), we will not aggressively treat it. We will add a potassium-sparing diuretic to my morning meds and watch it from there. His rationale is that my heart will be doing a lot of "remodeling" over the next few months, and my BP may actually decrease on its own, once the heart gets "accustomed" to pumping through a normal-sized valve. As long as my BP doesn't go up or become unstable, I'm willing to go along with him.

So, I'm pleased with my progress of late. I could wish for a bit more "oomph" at the gym, but we concluded that if rehab shows me to be hitting the upper limit my pacemaker allows during planned exercises, they will increase the limit. I suspect that the range of 60-130 BPM as it is now set will be too narrow a range, and I may need to upper limit raised quite a bit (used to run in the 150's before). I am willing to leave it as-is to start, and let the rehab folks discover my limitations and discuss adjustments with my cardio and me. Not rushing it -- just want to leave that door open.

My cardio and I closed our meeting with an agreement that the proverbial 3-month hurdle is the point at which I (and most patients) begin to really feel like ourselves once again. To the others in the Class of 2011. . . IT REALLY DOES GET BETTER!
 
Steve, you talked about a normal size valve in your post.My post surgery echo reported that my new valve area was 1.2 cm/ I guess I am hung up on these numbers. The cardio told me after surgery that artifical valves did not have as much area as our original equipment, but I didn't expect it to be that small. The mean gradiant pressure did drop to 9 from 34 pre surgery. The report said "Well seated bioprosthetic aortic valve with normal derived hemodynamic data". I guess I need to quit stressing over these numbers and go back to acting like a normal person.
Sounds like you are getting along very well after your rocky start! I have been in rehab since 4/22 and feeling better all the time.

John
 
It's good to read that at the three month mark, it's all starting to come together with your recovery. I had higher blood pressure readings for almost a year post-op but they eventually went back to the low, pre-valve replacement #'s I was use to.
 
Steve,

Good news on all fronts. My B/P was great at my 3 week checkup but was a bit high at my 6 week checkup. The doc said that this is common and didn't increase my meds, just keep an eye on it and if it didn't come down on it's own or got worse to contact him. It has come back down to ~ 125/75 (pulse was and has been fine ~75). It was running about 135/90 so me and my doc are satisfied with where I am at. Hopefully yours will come back down as your heart continues to heal.
 
John - Almost anything is a more normal sized valve compared to the 0.7 or so mine was prior to replacement, so there will still be a major difference. Don't forget that valves are measured in area rather than linear dimensions, so the difference between 0.7 and even 1.2 is a lot more than it seems.

Bryan - I'm hoping my BP comes down with just the mild diuretic, although prior to valve surgery I took Avalide (an angiotensin II receptor blocker, or ARB) for many years with great results, and would have no problem going back to it. I just would like to minimize the chemicals I have to ingest (and have to remember to restock), and now that the amiodarone is gone, would like to be able to drop the warfarin. Time will tell.
 
Steve,

I am so happy for you. Everything sounds so positive. Thank God. I had my 4 week check up with cardio today and she was pleased with my progress and wants me to start cardiac rehab once the surgeon sees me next week. I expect him to feel the same. My Bp has been up also...I am running a systolic of 156- 160 and a diastolic in the 80s but my HR is only in the 50s. And I am having frequent PVCs which are exhausting. But it's better than a-fib. That seems to gone so that is a good thing. Anyway I am looking forward to cardiac rehab also. I appreciate you keeping us updated on your progress. I know there is light at the end of this tunnel. I look forward to reading your progress in cardiac rehab.

Jeri
 
Onward & upward, Steve!

My BP has generally been comfy-low (like 115/70-ish) both before and after OHS/BAVR, EXCEPT for 3 days ago, when a student in my PCP/GP's office kept getting 150 over something! Everybody else is getting those comfy-low numbers (including my cheap Chinese monitor), so we're treating it as a weird outlier -- or maybe a student error!

My cardio rehab "boss" says I should treat 145 bpm as a "red line", which sounds pretty generous to me. I think 150 is around the standard limit for a 66-year-old anyway, and I doubt that I ever need to go higher to do the things I love to do -- which does NOT include road running!!
 
Steve
Very happy you had such a positive visit !!!!! You have come a long way, from the rocky start of your recovery.....keep up the great work and may God's blessings be upon you.

Renee
Go Team 2011 !!!!
 
Another good update to read, Steve. Things are really going well for you, and thanks again for the updates.
 
Glad to see the progress is continuing in the "better" direction for you! :)



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