Staples OUT!

[Raverlaw]

Well, I am no longer sporting those 25 shiny, pointy little devils. The staples and sutures on the drain holes came out today and I feel like I can expand my chest more and move around more freely.

My BP at the checkup was 100/70. Nurse comments it's a little low for big guy like me. I told her I've never been hypertensive and you've got me on Toprol XL 25 mg per day - why don't we skip the Toprol and see where my blood pressure lands?

She wouldn't go for it. Is it just me or do all doctors overmedicate? Never any problem with BP and they give me Toprol; never any problem with cholesterol and they've got me on Lipitor 10 mg daily. When I asked her when could I get off the meds, she said to talk with my cardiologist about it after the surgeon releases me back to him!!

Of course, this is the same nurse who's got me bouncing my warfarin dose all over the place and testing me like every other day!

Do I seem a little frustrated? I guess I'm just tired. I had a nice 1.25 mile walk today; kept up a good pace, didn't get out of breath, and kept my pulse under control. When I told the nurse what I was doing for exercise, she told me I was overdoing it and to limit myself to 15 min x 2, no hills, per day.

 

[Johnny Stephens]

Congratulations on the staples! Sounds like you're continuing a very rapid recovery in fine shape!

Keep in mind that the the Toprol XL may not be for blood pressure - for example, I take it purely to help control my heart rate. You say you never had any BP problems - so what's the Toprol for? Did the surgeon or the cardiologist put you on it?

Feel free to vent - the warfarin dosage will take a while to figure out.

 

[Ross]

Hey Bill I got your work around for her every other day testing! Just conveniently not be able to keep the appointment until 3 days later. Maybe the car broke down, nuclear war has broken out, whatever it takes.

 

[ALCapshaw2]

Hello Bill,

It sounds like your surgeon is just being cautious.

My surgeon stopped my previous meds and sent me home with 9 new prescriptions, some of which gave me 'fits' (mostly pain pills which all had the undesirable effect of making my dizzy and / or nauseous).

My guess the that the Toprol was prescribed to prevent Arrhythmia's ( you know, A-fib, PAC's, PVC's that have been giving Christina fits). 25 mg is a pretty small dose. Some cardiologists claim that 100 mg is the minimal 'theraputic' dose, whatever that means. 25mg works for me. Without it, physical and / or mental stress can create any and all of the above arrhythmia's.

Re: Lipitor, just another precaution. They don't want you developing Coronary Artery Blockages while you recover from Valve Surgery. Most people tolerate it well.

Once your Surgeon releases you, you can discuss your meds with your Cardiologist who hopefully knows you better than the Surgeon and may be more willing to 'customize' your meds to suit your situation better.

'AL'

 

[suz]

Great news, Bill! No more "friend of frankenstein" for you!

I hope you will take the nurse's advise to heart, so to speak, and not push yourself right now. It seems that it is very common to be tired for some weeks post surgery. I am glad that you brought your exercise routine up for discussion with her!

I just want to remind you of the great resource re what to expect post heart surgery that has been posted here before. I and my dad found it very helpful to reread the info post surgery.

http://www.ctsnet.org/doc/3563

best,
suz

 

[Luc]

An other step behind you William. There is a fine line between being an informed patient and second-guessing the medical professional, from reading your post you are doing a great job , but just remember that is better to be safe then sorry. We have a saying in French "le petit train va loin" (a small train just go as far) so it is OK to take it one step at a time. Hope you will feel fine enough to have a great celebration for you son birthday, he must be real happy to have a "new" dad. Take care.

 

[Raverlaw]

Thanks, everyone,

I suppose the Toprol is for heart rate, as I had some minor arrythmias in the hospital, and continue to have a few little "hiccups" once in a while.

As for exercise, I plan to do as much as I can tolerate, in short bursts, maybe 20 minutes three times a day.

Luc, thanks for the good wishes. We were able to go out last night after all to celebrate my son's 20th! Sandy and I are congratulating ourselves on not having any teenagers in the house

 

[Lisa]

That's great, Bill. You seem to be recovering nicely (and quickly).

 

[SteveK]

Bill, is your heart enlarged? My surgeon has me on Toprol XL for the next 6 months to help shrink it back normal size. He also told me to exercise every day, and that I should be out of breath when I am done. I thought this was a little strange, you would think working the heart would make it grow rather than shrink.

 

[MelissaM]

Bill,

I am with you - question everything! The plants ate several of my pills during my stay in the hospital. I think drug reps pushing pills account for some of the over-medication. The docs put me on Nexxium after surgery. Nexxium?!? I haven't had a day of heartburn in my life! Not everyone has this sense of insanity , but I felt free to start, stop and modify medications as my body dictated. The docs only have half the story, you know. The other half is provided by you and how your body is reacting.

*off soapbox*

Glad you are doing well!

Melissa

 

[Gemma]

enlarged heart

enlarged heart

Steve - what is Toprol?
My boyfriend Jim's on ramipril (an ACE-inhibitor). He was on this before his operation to stop his heart getting any bigger, and his cardio has kept him on it as he believes it has helped it reduce in size since the surgery. In fact it is now smaller than average (LV 4.3cm I think they said, was 7cm before the op - 5cm is average)!
Also his blood pressure is at the low end of normal, but in the cardio's words "if I was taking these meds you'd have to prise them out of my hand to get me to stop taking them". Hmmm. Seems they err on the side of caution this side of the pond too.
Hopefully if everything's still OK in November when Jim has his next cardio appointment we may be able to convince him Jim doesn't need the ramipril. (the cardio didn't seem to believe the new valve had any effect on the size of Jim's heart.....what can you say?!!). Also makes him feel dodgy when he takes it so he has to take it at bedtime. Again, the cardio didn't believe that ramipril has these side effects (should've told him my mum had the same problems with it!!!).
Gemma.

 

[SteveK]

GemmaJ, Toprol is a beta-blocker (whatever that means) and is used for high blood pressure heart failure and other conditions.
I was told my heart was 53 centimeters and normal was between 35 and 45.
It seems like your boyfriends Cardio would stop the meds if his heart is smaller than normal, unless he wants him to take it for some other reason.

 

[Gemma]

Steve,
Thanks for the quick reply
Think that doctors over here are just in love with ramipril!!! My mother also tried to convince her GP she no longer needed it and was told pretty much the same thing (hers is for high BP). Jim's BP was very high pre-op but is no longer a problem. His GP is reluctant to make any changes to his meds though, just says to ask the cardio at next appointment!
He's also on a beta-blocker, to prevent rapid heart rate (he was admitted to hospital a month post-op with SVT (supra-ventricular tachycardia, ie regular but very fast abnormal rhythm - finally discovered exactly what it was last week, 2 months after the event!) but it has been under control since. A side effect of beta-blockers is they also reduce BP, which is why it seems strange he's still on the ramipril. I really wish the cardio was someone who would explain himself more but he seems to be of the "trust me, I'm a doctor" school of medicine! Unfortunately me & Jim both need to know what's going on and to understand EVERYTHING so we have a bit of a personality clash on that score!!! I think he's more used to dealing with patients who have always just done what they're told and not wondered why...
By the way Bill, meant to say before - congratulations on doing so well, so soon. Are you finding Sandy lagging behind when you're walking? I'm sure getting fitter now Jim's doing all this walking and cycling!!!
Gemma.

 

[ALCapshaw2]

WOW, Steve K, you must have a REALLY BIG Heart (53 cm ? )

That's equivalent to about 21 INCHES. I'll bet you dinner at Metzger's that you were told 53 MILLIMETERS (mm)

'AL'

(Go Blue)

 

[SteveK]

Al, All this time I thought I had a beer gut! It must be my enormous heart!

 

[Marge]

I had to really fight to get off ACE inhibitors (in my case, something called captopril). They put me on it automatically at the hospital. I started getting this horrible cough. I thought I recognized the nature of the cough and when I found out I was on an ACE blocker I knew what it was, because at one time my PCP put me on lisinopril (another ACE blocker). I developed a bronchial cough that tore my chest up, until he finally took me off it and put me on an ARB (cozaar) instead. I sure did not want that happening while my chest was still sore after surgery. So I explained to everybody at the hospital that I CANNOT take ACE blockers. But my list of post-discharge meds, already faxed to the pharmacy, included captopril. Finally, on the last morning in the hospital, I was able to convince the attending doctor to take captopril off the list and put me back on cozaar instead. At that, it took several days at home without the ACE blocker before the cough dissipated.

I had a veritable laundry list of meds that I was supposed to take when I got out of the hospital! After consultation with the HBS at my surgeon's clinic they have been whittled down to three: cozaar (the ARB), lopressor (metoprol, a beta blocker), and warfarin.

I asked the doctor at the hospital for explanations on all these meds, and, in particular, why the meds had been changed from the ones I was on b4 the surgery. Why, for instance, was I now on lopressor, where b4 I was on a different beta blocker, coreg? (My cardio had been very insistant that coreg was THE single best beta blocker for people with my condition.) The best the hospital doctor could come up with was: "Well, you know, meds are frequently changed at the hospital." (Yes, I know, doctor, but why is it so hard to explain to me why I am on THESE particular ones?)

I think Gemma's comment is too true, of too many doctors! <<I think he's more used to dealing with patients who have always just done what they're told and not wondered why... >> My cardio is like that. He would stand in one corner of the examining room and speak in a really LOUD monotone AT (not TO) my husband and me. He's a CHF specialist, and I guess many of his patients are eitner deaf or senile or both. Finally I asked him to please slow down and just talk in a normal tone of voice. I pointed out that, although I am diagnosed as having CHF, I have excellent hearing, and my husband has very good hearing aids, and neither of us suffer from dementia (yet). i still don't like him very much, but he is now easier to deal with.

 

[bvdr]

I think sometimes we are over-medicated. Once at cardiac re-hab I had this incredible heaviness in my chest so I stopped pedaling and waiting a minute. It went away so I resumed my exercise. The same thing happened so I quit again and signaled one of the staff and they ran off a rhythm strip. The doctor came over and looked over my chart and as much said that no one could feel good taking that amount of medicine.

I am on a fraction of the medications I was once on. The ones I am on I think I need.

Melissa, you are right. You are the final word on what medications you take but then of course you can't complain if some condition doesn't improve or you get worse. I think we just need to be well educated and go from there.

Bill, you sound like you are doing very well indeed. I was told too that if I wasn't slightly winded then I wasn't pushing myself quite hard enough.

 

[George DiMundo]

My blood pressure has always been pretty low too and I have been on Lopressor (25 mg) since I returned from the hospital almost 7 weeks ago. I also had two other medications but my cardiologist and I decided that I did not need to take them soon after I returned home. I, too, wondered why I was prescribed medication that lowers BP given my BP history. When I asked I was told that the medication helps to control arrhythmias following surgery. The dosage is quite low and I will be off of it in two more weeks.

The first morning after I came home I began to feel very weak and faint after taking the prescribed medications. I called my local cardiologist and he agreed with me that I probably did not need two medications which could lower my BP. I suspected that I was prescribed the medications as part of my surgical team's normal discharge orders, with no consideration given to my already low BP. On the other hand, while I don't think the surgeons are incapable of error or over-medicating, they are the experts. They have a lot more experience with heart surgery and recovery than I. In any event, I will be glad to be done with the medication soon.