Two weeks after surgery

[Traveler]

Hi all,

This is the second installment in the what my experience is like following aneurysm replacement and aortic valve repair. Week two was easier, primarily because I began to find out how much energy I had and how much rest I needed. The answer to how much rest I need is a lot, about 15 hours a day. I spent most of the week of the week going to bed between 8:30 and 9:30 pm and getting up about 8:30 to 9:30 am. I then napped about an hour in the late morning and 1 -2 hours from 4:00 to 6:00 pm. The day that I cut corners on naps left me exhausted, sick, and shaking in the evening - so getting enough sleep seems to be pretty important for me.

Everything has been going well during recovery - so that's left me time to worry about things that haven't happened and probably won't. So I've been worrying about irregular heart beats and a-fib. My cardiologist said that I had some number of premature ventricular beats and so kept the dose of Toprol higher than I would have liked. This is the same dose as before (50 mg/day) but I was hoping to have it be lower. My blood pressure (96/58) and pulse (48) are low enough I get dizzy when I stand, but dizziness is better than a-fib. I'm not sure I understand the connection between the Toprol and irregular heart beats and a-fib. I should understand this better.

On the doing things front, I can touch the floor and comfortably pick things up, and reach over my head finally, I can also tie my shoes. I can't pull my socks on yet, maybe next week.

Day-by-day
Sunday - up at 9:30 am, felt great, breakfast, church (I sat rather than stood - I think standing is very exhausting). Back home slept for an hour, lunch, slept another hour, went walking for 2.5 miles at the gym, showered, another 1 hour nap, in bed at 8:30 pm.

Monday - up at 8:30 am, walking for 3 miles at the gym, breakfast, shower, nap, lunch, walked into work (1.5 miles), worked 1:00 - 4:00, walked home (1.5 miles), slept for 1.5 hours, dinner, in bed at 9 pm.

Tuesday - woke up at 8:30 am with a sore throat, called the Dr., Dr. appt - virus not a bacterial infection, so no big deal, Drs. advice: get more sleep. Napped 3 hours, worked 4 hours, walked 4 miles outdoors, in bed at 8:30 pm

Wednesday - 12 hours of sleep, 3 hours of naps, walked 5 miles, worked 3.5 hours.

Thursday - cardiac rehab intake meeting, set goals, nothing exciting. walked 3.5 miles, 12 hours of sleep, 3 hours of naps, worked 5 hours.

Friday - mtg with cardiologist (he noted how well recovery was going - gave me another lecture about listening to my body and talked about a-fib); no naps; up early - only 11 hours of sleep; walked 1.5 miles at cardiac rehab; worked 6 hours; too tired to eat dinner; sick, miserable, shaking, and in pain in the evening; went to bed at 8 pm. I need to be more careful about sleep.

 

[EVELYN]

Hi Traveler

WOW I just read your post!!! Walking 3, 4, 5, 7 miles a day at the second week.....no wonder you're freakin' exhausted!!! Take it easy, my man and let that body heal....that would be my advice. Pushing yourself is NOT good and it sure sounds to me like that's what you're doing.....let yourself regenerate, my man.....JMHO.

Evelyn

 

[WayneGM]

You're certainly walking more than I did in week two. You're sleep more than I did, too. You're doing well. You've heard it before...pace yourself and listen to your body (nag..nag...nag...)

Wishing you the best.

 

[NH_Male]

Wow! You are having an amazing recovery. I go in on Monday for my aneurysm repair next week and your posts have been inspirational to say the least.

Keep up the great work!

 

[Phyllis]

The way you felt Friday night should be your big clue!- you're doing an amazing amount of walking for 2 weeks out and working too! Don't push it, listen to your body and take it slower- it's the recovery in the long term that you want to be good- no relapses!

 

[Ross]

Your pushing too hard!!! Slow down a bit. Your about 4 weeks ahead of yourself.

 

[Superbob]

I've harped at you before, so I hesitated to again, but will just say you won't get any wiser advice than from Ross. Along with the others, I am delighted you are doing well, and I am all for cardiac rehab and walking. You just give the impression of being compulsive about the distances. When you are fully recovered, heck yes, walk the Appalachian Trail, run a marathon, whatever. But just 2 weeks out, you are courting a severe setback with distances of those magnitudes. Just my two cents. I do wish you well.

One thing I worry about (nanny-like, no doubt) is someone reading the mileage you are posting one and two weeks out of open-heart surgery, and concluding that is a reasonable goal for them, too. Maybe you can handle that level of exertion, but it might have a devastating impact on others who tried it.

 

[Adrienne]

Ditto to what all the others have said. If you are trembling at the end of the day, that is courting disaster!!!!!!

 

[marky]

wow.. that is a lot in a short amount of time..
Make sure you take care of yourself!.. slow and easy..

 

[ruth]

Traveler -

Sounds like you watched the same video I did, designed for folks who had ballon angioplasty or a CABG surgery, not a valve job. My video implied an early walking program but yours just seems excessive, no offense, please.

Slow it down, you only need to recover once and nobody is timing you.

All my best,
Ruth

 

[MarkG]

Traveler, Take this word of advice from a fellow type A, this is a time to slow down and let our bodies heal. I do like how much sleep you are getting, but that maybe a result of the mileage you are getting in. I could not sleep for 12 hours if I had to.

I also can’t tell you about how you should not be working since I got back from the hospital on Wednesday, I have gone through most of the 1000+ e-mails I had outstanding for the last two weeks and called a few of my folks to get some things on track. But it is not work, it is for entertainment purposes only. At least that is what I am telling myself.

One thing I just did yesterday I got a back and neck message. It was wonderful. Not something I would normally do, but my wife convinced me to do this. I will have to go back next week and this time for 1 hour.

Good luck with your recovery.

Mark

 

[marciemarine]

I think this weekly tracing of your recovery will be very insightful to everyone who will follow. Keep up the good posts and I'm happy to learn that your recovery has been so swift...just don't overdo! Marcie

 

[StretchL]

Traveller. Amigo. Mah homie.

CHILL.

I can't begin to imagine having done what you're doing only two weeks post. No way no how.

Those bouts of shaking, utter exhaustion, etc. Just MHO, but your body's telling you that you're overdoing it.

Enjoy a little vacation while you can. No one is ever going to let you slack off like they'll let you now, so at least consider taking advantage of it. I'm back to taking out the garbage, making the bed, working all the time, yada yada yada, and I somewhat miss those days when Noni was peeling grapes for me.

ps- You're also making the rest of us look bad.

.

 

[tobagotwo]

Worked five hours, have a virus, but worked six hours, walked this, did that, shaking, too tired to eat, sore throat...

Things are not going fine. PVCs are irregular heartbeats. In fact, you are having so many PVCs (Premature Ventricular Contractions) that your cardiologist has upped your medication to the point where you're dizzy (48bpm and minimal BP) and may actually faint one day, just trying to stand up.

"...too tired to eat dinner; sick, miserable, shaking, and in pain..." This is your description of you. You have a virus and a sore throat, which can invite bacterial infection (endocarditis) or can even do its own work on your still-healing heart. You may work your heart back into AFib, despite the near-syncope Toprol dosage you're receiving.

I find myself in the awkward position of agreeing with your cardiologist, who lectured you to listen to your body. All these things are messages from your body. And you're not listening.

Why do you insist that you must work while your heart is trying to recuperate? The cheapest short-term disability packages are obliged to give a minimum of four, but normally six to eight weeks before return to work. There's a reason for that. Consider that it takes a full year for your heart to be mostly back to normal.

Maybe you feel that you have no personal value if you aren't working? Or maybe you feel that if you just keep moving fast enough, you won't have to think about the Open Heart Surgery you've just undergone, and what might have happened to you during it?

Between your manic activity schedule and ignoring your body's messages, you're setting yourself up to sabotage your own recovery. Forcing yourself into an unrealistic schedule that is obviously potentially harmful is not an accomplishment: in fact, it's a warning signal.

A good number of people have depression or other adjustment issues after OHS. I strongly suggest you speak to a professional about why you seem to be bent on self-destruction at a time when you should be celebrating the renewal of your heart and life.

It sounds very much like you can't help yourself: you seem very much your own victim. I hope it doesn't end up expressing itself negatively in your recovery.

If I sound as if I'm criticizing you, I assure you it is only concern. I urge you to please consider seeing someone about your feelings about your OHS as soon as you can.

Very best wishes,

 

[michellep]

Hi Mark,
As you may or may not know, I just hit the 6 week mark after AVR with a quad. aorta valve. At 2 weeks, yy hospital and surgeon suggested walking 1/2 mile over a 30 minute period. Like you, I am also in bettery shape and definately pushed the limit. At 2 weeks, I was proud that I did 1 mile in 30 minutes.
I totally understand your desire to get your life back. Your brain functions are strong, and most times your body feels good. It tricks you because it operates in waves. You feel great, you push yourself, then you get the dip.
You need to take care of yourself so that you can have a healthy life for the next 40+ years.
We have been right so far about your recovery, please listen to us. We care.

 

[Traveler]

[snip]
Things are not going fine. PVCs are irregular heartbeats. In fact, you are having so many PVCs (Premature Ventricular Contractions) that your cardiologist has upped your medication to the point where you're dizzy (48bpm and minimal BP) and may actually faint one day, just trying to stand up.

Thank you for your note - appreciate the time and concern you put into it. I should clarify the Toprol-XL situation a bit. Before surgery I was on 25 mg of Toprol-XL once a day for about 3 months, from the time they found and understood the aneurysm to the time of surgery. My cardioogist wanted to increase the Toprol dosage but my blood pressure and pulse would not support it. I questioned the need for Toprol since my blood pressure has always been low and doubted it needed to be lower. My cardiologist and my surgeon both explained that Toprol was primarily to change the viscosity of my blood to minimize the shear stress on the aneurysm. This makes sense if you consider that from a simplified view point (shear stress) = (viscosity) x (the partial of the normal velocity at the wall of artery). This reflects my understanding of why I was taking Toprol and my understanding may or may not be correct. I've been a little blurry on whether that is really the function of Toprol, however my wife assured me that the literature supported the idea of Toprol for aneurysms.

Following surgery my Toprol dosage was increased to 50 mg. I understand this to be a relatively small dose as 200 mg is the max. When I questioned this I was told that my blood pressure was higher after surgery than before surgery (as expected) and that I could therefore support a higher dosage of Toprol. Also I was told that many people would be taking 50-100 mg 2x a day rather than 50 mg/day total. I understand the current function of Toprol is to reduce my pulse and help minimize the risk of irregular heart beats and a-fib.

Since my blood pressure and pulse had dropped since surgery and I have been dizzy when standing from sitting (I understand this to be a dangerous situation that requires care) I was hoping that the Toprol dosage could be reduced. I was also worrying about the alleged sexual side effects (I tend to worry about a lot of things). My cardiologist thought that based on his experience and the occasional premature beats that we should continue the Toprol at 50 mg for the next 6 weeks and review it at that point. My own preference is that I would be medication free in 3-6 months but that may not be reasonable.

As far as passing out (syncope), I have passed out when I'm cut, have blood draws, in crowds, and in enclosed spaces since I was in grade school. I passed out a sufficient number of times at Mayo that they noted the tendency on my discharge papers. I was amazed recently to find that only about 1 in 4 people has ever passed out and less than 10% have passed out more than once, since I have passed out probably a dozen times in the past year.

Mark

 

[tobagotwo]

Mark,

Like other beta blockers (which are very frequently given after OHS), Toprol should slow your heart rate, make your heart beat more softly, and lower the number of PVCs and other quirky arrhythmic misadventures your heart is going to share with you over the next six to twelve months. The size of the dose isn't really relevant to what other people can take. That argument by your physician was both unfair and absurd. People's reactions to beta blockers (and most all prescriptions) are extremely personalized, based on their individual chemistries.

There are a number of possible side effects of beta blockers, including the two that you spoke about most concerning you: syncope and sexual dysfunction.

If you're taking one, 50mg dose per day, ask your cardiologist about splitting it into two, 25mg doses each day (25mg morning and 25mg night). That may ease the dizziness.

If you're already on split doses, ask if you can change one dose to a 12.5mg dose (use a pill splitter), and split the dosage difference with him (to 37.5mg/day), rather than remaining in this dubious condition for six weeks.

Sexual dysfunction is not considered important by the medical commuity (shame on them). If you don't believe me, look up the side effect in any medical site and see which column it's in. Again, it's not a function of or relative to what other people can take, it's a matter of your own sensitivity to the compound.

I'll wager that over time it will be "discovered" that most male impotence is not caused by age, overweight, or even diabetes, but rather by overzealoous application of blood pressure medications that almost all of those people take. Cruelly, Viagra, Cialis and Levitra all cause smooth-wall muscle relaxation, and pose risks of dangerously (even fatally) lowering blood pressure, so they're not good to use if your blood pressure medication is the culprit.

Be well,

 

[Bradley White]

Hi Bob,

My understanding was that toprol XL was a slow release medication. If you take 50mg once it takes approximately 24 hours for all of that 50mg to be released into the body. As such, I don't see how splitting into two doses would make any difference in terms of dizzyness since the same amount would still be "active" in your body at any particular point in time. You seem to suggest that one has an "acute" reaction to the 50mg dose. I don't know if this is accurate.

Brad

 

[geebee]

Traveler,

Your recovery is indeed very impressive. I hope things continue to go well for you and the speed of your activities does not come back to bite you.

Keep up the good work but, for heaven's sake, be careful. We care about you.

 

[lynn]

Mark,

Like other beta blockers (which are very frequently given after OHS), Toprol should slow your heart rate, make your heart beat more softly, and lower the number of PVCs and other quirky arrhythmic misadventures your heart is going to share with you over the next six to twelve months.

I don't want to hi-jack this thread, as far as the make your heart beat more softly, is this true?? If so, then I've got some complaining to do as mine is like a bass drum in my chest, especially around my collar bone. Hubby can hear it....GRRRRR!

On another note, I take 25 mg at bedtime and 25 mg at breakfast. I have a few woo-woo (I wouldn't call them full blown dizzy) spells a day. When I was on 25 mg at nite and 12.5 in the a.m. I was fine.

Guess I'll be chatting it up with the cardio about this!