Thank you all.

[JohnCalderwood]

My surgery went incredibly well last Tuesday. I think God had just so much prayer thrown at him he could do nothing but oversee things go well. My AVR only took two hours no complications. Very smooth. It was pretty much what everybody had said it would be. Nothing was really thrown at me I could not handle. It was a tough few days but I expected that. The on-y is a little louder than I expected but what a small price to pay for life. When they released me today my INR was only at 1.3 and should be at 2.5-3.5. I am nervous about that. They have me taking 10mgs for the next 5 days. They don't want me to test until the 8th. Three days from now. Asked why not test until 8th. They said it will probably take that much time to increase? All in all I feel very well. The last 6 days of complete and utter rest was eeriely enjoyable. I have not had that much time to watch tv, read, do puzzles since about 12. Without feeling guilty or I should be doing something more productive. Kinda says something about my lifestyle. {gotten way too busy}. Only complaints were the food which I only picked at. Which is probably the amount I should be eating anyway instead of the platefulls I normally eat and the bed allowed me to only lie in it for about half an hour without killing my back. But that was probably a good thing too because it was probably better for me to sit upright. Met some deadly nurses. Tough being married. Unfortunatly that was the same pre and pro surgery. Looking forward to recovery and I will be following others on the plavix trial. Read about who was randomized to plavix. I will really want to know how you guys are doing on the Plavix. Anyway thank you all again for everything I really appreciated all your support and words of wisdom through probably the most difficult time of my life. Thank you . Take care. John.

 

[hensylee]

Good to hear from you, John. Wishing your continued good recovery is easy. Blessins.........

 

[Ross]

Welcome to your new lease on life! Coumadin takes 3 days to fully show in a blood test. I don't know what they had you on in the hospital nor what kind of diet you had, so I can't elaborate about your dose just yet. IF you have problems, come see us in the anticoag forum and we'll get you straightened out. Unless your very lucky and have a manager that actually understands Coumadin, which most DO NOT, you'll need our help and we are more then willing to help anyone needing it.

 

[nngbwh]

Nice to hear you are doing well.

 

[buncle]

sounds like you climbed the front of the mountain - slid down the back and landed squarely on your feet! good for you!

 

[Bina]

John, welcome home. Don't feel guilty for resting and doing puzzles, that is what I did too.
I am kind of surprised that they let you out with such a low INR.....are you having Lovenox shots at home?
My surgeon kept me in hospital for 16 days and on a Heparin IV while my INR was creeping up. We took it slow and it stayed rock steady.

 

[Glenda]

John, it sounds like you made it great to the other side of the mountain. It's great that you are doing so well. Hugs & prayers are coming your way.

 

[JohnCalderwood]

John, welcome home. Don't feel guilty for resting and doing puzzles, that is what I did too.
I am kind of surprised that they let you out with such a low INR.....are you having Lovenox shots at home?
My surgeon kept me in hospital for 16 days and on a Heparin IV while my INR was creeping up. We took it slow and it stayed rock steady.

Yes Bina I was a little surprise too. I think I presented quite well. Up often walking, showering needing little attention. When the doctor came in she said are you ready to go home. I said I would rather leave that up to you. I was torn. I wanted to get to a real bed and real food but I also wanted to be fully on my way. I do not want to go back. I think it is easier to stay in than get back in. I felt safe there. like I said earlier I was surprised I would not get my InR tested for three more days but apparently that is about how long it takes to start working or changing your inr. Are the lovenox shots the ones I had in the evening that cause the bruises? I have no self administered shots. I do take ranitidine at night. I think to control acid in the stomach.

 

[Ross]

Lovenox shots, yes, they can cause bruising. That is known as bridge therapy until your Coumadin level is high enough to consider you anticoagulated.

 

[Bill B]

Initiating warfain therapy is still a bit of witchcraft. There is a more or less universal method of starting warfarin that involves 5 mg dose daily for a couple of days, drawing an INR, and then making an adjustment based on this early test result. The problem is this is way too early and clearly does not represent the eventual equilibrium. Although you should see some effect in 2 days, the eventual steady state is not reached for a week to 2 weeks after any dosage change. Still, the early test must be done in order to catch those individuals who are very sensitive, like me, and if maintained on 5mg for the week or two it usually takes to reach equilibrium would be in deep trouble. My first INR after 2 days was 3.0, and with the expectation that it would go much higher over time, the next dose was held (and my INR still increased some more to 3.6) and my dose was then restarted at 2mg. Eventually I ended up on 1.5mg/day, which is crazy low but what I need. Now, how did they know that 2mg was the right dose for me based on an INR of 3 after 2 days? And how did they know that they should hold the dose for a day? For some drugs you can make very precise mathematical predictions from test results based on what is known about the way the drug is metabolized, but for warfarin that science is not there yet, as far as I am concerned. So, it becomes a judgement and the common dosing protocols don't cover a lot of situations, like yours or mine very well. With an INR of 1.3 after several days of warfarin you basically were having no effect. A conservative approach would have been to hold you until you got into the therapeutic range, or at least confirm that you had some decent early response to 10mg with a test after a few more days. But your doctor is making a judgement based on his experience for a situation that is not well covered in the protocols.

 

[skeptic49]

Congratulations on your successful surgery, John. Best wishes for a smooth recovery.

Jim

 

[Johan]

Wonderful John, welcome to this side of the mountain. So happy for you that it went so well. Here's to a totally smooth further recovery.

Can't help you with the warfarin, have a tissue valve.

 

[JohnCalderwood]

Initiating warfain therapy is still a bit of witchcraft. There is a more or less universal method of starting warfarin that involves 5 mg dose daily for a couple of days, drawing an INR, and then making an adjustment based on this early test result. The problem is this is way too early and clearly does not represent the eventual equilibrium. Although you should see some effect in 2 days, the eventual steady state is not reached for a week to 2 weeks after any dosage change. Still, the early test must be done in order to catch those individuals who are very sensitive, like me, and if maintained on 5mg for the week or two it usually takes to reach equilibrium would be in deep trouble. My first INR after 2 days was 3.0, and with the expectation that it would go much higher over time, the next dose was held (and my INR still increased some more to 3.6) and my dose was then restarted at 2mg. Eventually I ended up on 1.5mg/day, which is crazy low but what I need. Now, how did they know that 2mg was the right dose for me based on an INR of 3 after 2 days? And how did they know that they should hold the dose for a day? For some drugs you can make very precise mathematical predictions from test results based on what is known about the way the drug is metabolized, but for warfarin that science is not there yet, as far as I am concerned. So, it becomes a judgement and the common dosing protocols don't cover a lot of situations, like yours or mine very well. With an INR of 1.3 after several days of warfarin you basically were having no effect. A conservative approach would have been to hold you until you got into the therapeutic range, or at least confirm that you had some decent early response to 10mg with a test after a few more days. But your doctor is making a judgement based on his experience for a situation that is not well covered in the protocols.

Thank you Bill. That all makes a lot of sense. When they were initially trying to get your numbers stable were you in the hospital? Being in there would have allowed me to get that lovenox shot at night as a precaution. Oh well just have to hang tough and hope it gets in control. Thank you. John.

 

[hall]

Welcome home! I think being home makes you automatically feel better. Wishing you an uneventful recovery.

 

[Bina]

My surgeon would have liked to release me after 7 days, but they had started me on the typical 5 mg daily dose of Coumadin,
which ended up being way too much. My daily dose ended up being 2.5 mg.
There was another thing to consider and that was the fact that I didn't live near the hospital, so I never pushed to be released early.
You sound like you are doing really well, rest often.

 

[njean]

Glad to hear that you are home now & on your way to recovery. I too find it a bit unusual that they released you with your INR so low. I wasn't released until my INR was over 2.0 & they still wanted it a bit higher but I begged & whinned so much, they told me I could go home, PLEASE!!!!

Take care of yourself!

 

[gerrys]

John:
Welcome to the far side. Glad to hear you're doing well.
Gerry

 

[Superbob]

What wonderful news, John! So glad you are home and doing well. All best wishes for a continued smooth recovery!