Valve Selection / Pre-Surgery / Post Surgery forums in one thread

[IronmaninTraining]

First I'd like to say this is a great community. Since finding out a change in my bicuspid aortic valve its been a roller coaster and this site has helped with some of my fears.

I am 28 years old and when I was younger they noticed a heart murmur and later found out I had a bicuspid aortic valve.

I am really into running (since I found out about my valve I stayed away from lifting...used it as a way to get out of things sometimes lol) and recently have wanted to do a Ironman (note my name). I took a couple years off from my yearly doctors visit and with my goal of completing an ironman I went back to see my pediatric cardiologist in Oct 2013 (my wife was concerned after someone died at the Pittsburgh Marathon last year with a heart issue). It was a tough moment for me to hear from the doctor that there was a change (more of a leak resulting in larger ventricle) and that she would like me to see a adult congenital cardiologist at the Children s hospital of Pittsburgh.

Since my appointment in October I had a MRI (since I hate needles having a catheter for over 2 hours was not the greatest experience) and my latest office visit in April where we found my ventricle enlarged by 4mm.

With that said I am now meeting with the surgeon in the next two weeks and have a surgery date of July 1st.

My pre-surgery has been a roller coaster ride like I mentioned earlier. I go from days ready to tackle this problem to days where I just feel down and out worrying about the horrible experience that is coming. Alot of this deals with my valve selection that I'll hit next.

Valve selection
Ross..
At first the Ross procedure seemed like the only one for me. Being 28 and having no blood thinners for life seemed great. Being the engineer I started looking at all the stats regarding the Ross procedure and reop concerns I became very worried. Is going with the ross procedure really worth messing with more than necessary? It makes me hesitant when I think about it. However, I still look at the ross since I do like socially drinking and sometimes from time to time I have more than is necessary. I know this shouldn't be an issue, but I don't do anything else bad and drinking some beers on a weekend is a way to relax. In a way I look at blood thinners as a end to one of my guilty pleasures.

Mechanical...
I am very impressed with the On-x valve and the prospect of low anti coagulation (PROACT) and if I did go this route I would hope I could participate as I feel I would be in the lowrisk arm of the trial. Again I don't fully know how a baby aspirin and plavix a day would have a impact on my life (I would think very little). Also, I worry a little bit about the sound of a mechanical valve...I think I can move past it as it will mean mine hearts ticking after a while.

Tissue...
I don't really look at this as an option (never presented by the cardiologist) given my age and concern that my training or day to day life may impact the life of a tissue valve. Plus after having a OHS I wouldn't want a reop in the current span of tissue valves.

My final point is post surgery from my MRI comment you can probably surmise that I have a low pain tolerance (sometimes I think I do whine just to milk it for the wife). I'm very concerned about the level of pain and the several days in the hospital being hooked up with multiple things such as the chest tubes (probably my biggest concern). Is it really that bad? Can you relate the level of pain to anything? Do the meds really cover up all the pain?

Overall I know this is something in my life that I need to hit head on and be positive. Everything happens for a reason and after this I will be able to tackle all my goals. Writing this helped me vent some of my concerns and I hope that some of you can shed light on my thread.

Also if anyone has any experience with Children s Hospital of Pittsburgh I would be interested in their story.

 

[R1Phrankey]

Still some big choices to make. However, I must say that you already did a lot of homework.
I agree with you about the Ross procedure. Why mess with a good valve and end up with 2 valves changed.
I cannot make the choice for you but with my 47 years I have chosen a mechanical valve. Each day medication is no issue for me. I must add to this that I do not drink alcohol, and I do not know how this might influence the INR value.

About the pain after surgery: I had my surgery 2 weeks ago and in the hospital the nurses asked me about the pain level on a scale from 0 - 10 (0 = no pain) and I gave it a 2. In hospital I was on paracetamol. Also the first week at home I took some daily dosis of paracetamol, but I also stopped with this 5 days ago. During the day, I sometimes feel a very low pain, but most of the time I feel totally no pain. The pain is located at the sternum.
About the drains: I did not feel any pain when the drains were removed in hospital.
I must say that I did not sneeze for the last couple of weeks and hopefully that will stay away for another 4 weeks.

Good luck with the choice to make about the valve type.

 

[Patsman07]

Im in the exact same situation as you Ironman. I turn 30 tomorrow and I'm going for surgery in the next few weeks. I'm edging towards the Ross so that I can continue playing gaelic football (a contact sport) and i'd also like to live without worrying about INR levels etc. Although most people on this site find next to no trouble with anti-coagulants. My surgeon seemed quite positive about the Ross, modern techniques seem to be reducing the re-op rate and he said even if a re-op is needed the risks (which are already low) don't increase that much.

I also enjoy a few beers with my mates around once a month. A great way to blow out the stress I find. Alcohol will affect INR levels but from what I gather, people who are experienced with measuring their own levels can adjust their medication to maintain a safe INR despite a night out. I'm sure those people will be along shortly. Although this is not something that will be recommended by your doctor.

The pain is something I'm not looking forward to either, but temporary pain is better than the alternative we would be facing without surgery!

 

[Heart Of The Sunrise]

"I worry a little bit about the sound of a mechanical valve...I think I can move past it as it will mean mine hearts ticking after a while."

IRONMAN: I am 15 months post-op with one of the largest ON-X valves- I rarely hear it anymore. Initially, I felt it more than heard it.
I only hear it occasionally very late at night if I awake from sleep. I see you are in PA. If you go with the ON-X I highly recommend Dr. Bavaria at U of P Hospital (HUP).
It is worth the trip to Philadelphia.

My INR target range is 2.0 to 2.5. My insurance has approved home-testing, the paperwork is being processed.
I have had no issues with Coumadin.

 

[clay_from_nj]

Valve selection
Ross..

I think that it would be predicated upon whether you are even a candidate for it. Not everyone is. I think it's frequently chose for children because they would outgrow a mechanical valve and would probably wear out several tissues.

Mechanical...
I am very impressed with the On-x valve and the prospect of low anti coagulation (PROACT) and if I did go this route I would hope I could participate as I feel I would be in the lowrisk arm of the trial. Again I don't fully know how a baby aspirin and plavix a day would have a impact on my life (I would think very little). Also, I worry a little bit about the sound of a mechanical valve...I think I can move past it as it will mean mine hearts ticking after a while.

The way things are going, I wouldn't count on Plavix or PROACT. It's not the first time a valve has been suggested for low anticoagulation and the standards are still the same. Ticking varies - I only hear mine at all under very limited circumstances, which do not include while I'm trying to sleep.

My final point is post surgery from my MRI comment you can probably surmise that I have a low pain tolerance (sometimes I think I do whine just to milk it for the wife). I'm very concerned about the level of pain and the several days in the hospital being hooked up with multiple things such as the chest tubes (probably my biggest concern). Is it really that bad? Can you relate the level of pain to anything? Do the meds really cover up all the pain?

Pain after surgery was absolutely no issue for me. I had none at all except while sneezing, and that wasn't so bad if I clutched a pillow to my chest when I felt it coming on. Tubes and wires were annoying but not painful, even when being pulled out. I know I'm not the norm, but from talking to other people I've decided that I would much rather go through heart surgery than hip replacement or most other surgeries.

 

[dick0236]

I can't help with pros/cons of Ross procedure or Tissue valves as they where not around when I had the surgery, but I never regretted having a mechanical valve implanted at age 31. Before the surgery, my life expectancy was 40(maybe) and now I am pushing 80.....on one valve. The "blood-thinner" thing really is no big deal...but it does require a simple discipline of taking the pill as prescribed and testing routinely. With all of the new products now available I doubt it will be long before major changes are made in ACT(anti coagulation therapy). Alcohol is not a problem so long as you drink responsibility, and as a matter of fact, I was prescribed a beer each evening in the hospital to help get fluids out of my body. You seem to have done a lot of good research, so go with the one that you feel will impact your life the least, now, and in the future.

BTW, I still remember some of my post-op pains, but thankfully, most of the new folks seem to poo-poo serious post-op pain.....and that is a true blessing LOL.

 

[river-wear]

Ironman, I believe Clay is the one who only hears his ticking when he's "cuddling" with the missus. :tongue2: My apologies if I'm incorrect. Less than 7 days 'til surgery and my filters are malfunctioning.

Depending on the specifics of your case, repair could potentially be an option. If your valve is stenotic, then it's not. Just tossing that out there since you seem to be checking every angle. I'm an engineer too and was initially excited about the potential of a Ross. I like the On-X too. Ultimately it's your choice and I'm sure you will be satisfied with it. Without a time machine or a clone to experiment on, there is no "perfect" solution.

Best wishes for smooth recovery - and good luck with that triathlon once you're better!

 

[knotguilty]

I cannot comment on a Ross or a mechanical valve but I can tell you for me, the only pain I experienced was what felt like a pulled muscle in my back. It was from the chest tubes because once they took them out, the pain immediately went away. Otherwise, with the pain meds, I felt no pain. It was more an uncomfortable feeling with everything sticking out of you. Even when they took everything out, it did not hurt, not even the breathing tube. Good luck to you in what ever you decide. Try not to be afraid, you will be good to go once you get yourself fixed.

 

[MrsBray]

My pre-surgery has been a roller coaster ride like I mentioned earlier. I go from days ready to tackle this problem to days where I just feel down and out worrying about the horrible experience that is coming. Alot of this deals with my valve selection that I'll hit next.

I experienced that as well. There was no rhyme or reason to my emotions in the month before surgery. I did what you're doing - research, reading anything I could get my hands on about the post-op experience. You don't like pain, I don't like surprises!

Mechanical...
I am very impressed with the On-x valve and the prospect of low anti coagulation (PROACT) and if I did go this route I would hope I could participate as I feel I would be in the lowrisk arm of the trial. Again I don't fully know how a baby aspirin and plavix a day would have a impact on my life (I would think very little). Also, I worry a little bit about the sound of a mechanical valve...I think I can move past it as it will mean mine hearts ticking after a while.

I have an On-X valve. I did the survey at the top of the page. I take 81 mg aspirin, and warfarin to keep my INR between 2.5 -3.5. I'm still learning about Vitamin K and how much I can tolerate without changing my warfarin dose. The possibility of no anti-coagulant did NOT play into my decision. Daily medicine has no effect on my life.

I was OBSESSING about the sound of the valve. Once i hear something, i can't un-hear it. Yes, i hear my valve. Sometimes it's a quiet watch-like ticking. Sometimes I can feel it in the back of my neck, like when you're swimming in a lake and some JERK picks up two rocks and starts banging them together underwater. And sometimes I just don't hear it. I've found that when i can't hear it, someone standing near me in a quiet room CAN hear it.

Yes, it can be aggravating, but consider the alternative...

My final point is post surgery from my MRI comment you can probably surmise that I have a low pain tolerance (sometimes I think I do whine just to milk it for the wife). I'm very concerned about the level of pain and the several days in the hospital being hooked up with multiple things such as the chest tubes (probably my biggest concern). Is it really that bad? Can you relate the level of pain to anything? Do the meds really cover up all the pain?.

Oh the pain! It's simply AWFUL! Not really! My worst pain was one of the pre-op nurses trying to get in to my radial artery. It brought tears to my eyes! At the same time, another nurse was on my other side starting the "YOU'RE NOT GOING TO REMEMBER ANYTHING PAST THIS POINT" meds that I am so thankful for.

The first time I woke up a few hours later, I was vaguely aware of the ventilator tube being in, but I was so relieved that I was alive that nothing else mattered. I went right back to sleep. The next time I woke up, the vent tube was out, someone had put my glasses on my face, and I felt like I had been in a rock tumbler with a lot of boulders. Everything ached, and I was afraid to move because I didn't want to dislodge anything. My pain level never went higher than 5 out of 10.

My last narcotic painkiller was 2 days after surgery, and only in preparation for tube & wire removal (which weren't bad for me - it felt like when I was younger and we would partially swallow spaghetti and then pull it back out to the disgust of our parents. I took naproxin for the next two weeks. I really didn't have a lot of PAIN, it was mostly strong discomfort. The most discomfort was in my back, as a result of my arm position during surgery and having the tubes in. Once the tubes came out, I started feeling better exponentially faster.

Don't get me wrong, it wasn't easy, not by a long shot. But it also wasn't nearly as bad as I thought it would be. I'm 3 months post-op today, and most of my hospitalization is a blur. I simply did what needed to be done, chest drain tubes, catheters, IVs, it's over. I'm glad I did it, I feel better today than i've felt in 5-7 years. More energy, more grateful, more "in the moment," more zest for life.

It's a second chance, one I will be forever thankful for. If I can do it, so can you!

 

[pellicle]

Hi
and welcome.

First I'd like to say this is a great community. Since finding out a change in my bicuspid aortic valve its been a roller coaster and this site has helped with some of my fears.

I am 28 years old and when I was younger they noticed a heart murmur and later found out I had a bicuspid aortic valve.

thats a very well thought through question and as there are already a number of people saying more or less what I think in their answers I will keep my reply a little more brief than I sometimes tend to do.

I think that modern mechanical valves in combination with modern anticoagulation monitoring (you know Point of Care stuff) allows you to be safer on AC therapy than the stats would suggest and safer than ever before. As you probably already spotted (from a stats perspective) mechanical valve is the only option where reoperation is not a certainty. All other types have a reoperation certainty.

When I was 28 (22 years ago) I got a homograft AVR. At that time mechanicals were less well developed and certainly warfarin care was primitive. For those reasons (and I think also because he had a preference to explore homograft) my surgeon went away from mechanical. I think he also suspected that it may be a permanent replacement (although it turned out not to be so).

Actually for my age group (at that surgery date) homograft proved not to last as well.

Anyway I was reoperated in 2011 and had a mechanical fitted. The valve was failing bit an aneurysm was found too and that made the operation perhaps a year sooner than it would have been.

I am prety much a poster boy for the sorts of stuff that can go wrong in reop surgeries but which are (as yet) not fatal and (as yet) do not require a major surgery. The invection I got at my last surgery has taken over a year to treat and been quite a hassle. So if you were to consider that as a potential side effect of a reop then the warfarin stuff is so trivial as to be like complaining about getting skim milk instead of full cream with your latte.

There has been written much recently about warfarin and drinking, and findings of both literature and members here is that its a non ossue unless you are a career alcoholic. I have a blog post (more on the way) on my blog about some aspects of managing ones INR and perhaps you'll find that interesting / helpful.

http://cjeastwd.blogspot.com/2014/05/inr-management-goldilocks-dose.html
Best wishes with your decision process. Keep in mind its an A class solution set : all choices are really not bad.

 

[ski girl]

You have a low tolerance for pain, yet you're training for an Ironman? Well, as they say: toughen up princess! Post-op pain for most of us is nowhere near as painful as running the second half of a marathon with a blister, after 112 miles on a bike seat.

And to continue on the tough love that I'm dishing out to you (hee hee) - watching you go through this is tougher for your wife than it is for you, so don't make it worse for her by whining unnecessarily! You'll be either unconscious or drugged to the gills for days, she won't.

Lastly - you don't have a whole lot of choice about having surgery, unless dying of something that is 100% curable is preferable to you . . . . Hit it head-on and with a positive attitude about how much faster your Ironman time will be once your heart works correctly! Best of luck from down under.

 

[IronmaninTraining]

Thank you all for your responses. Its great to know others around the world are willing to share their experiences and in some cases individuals like Patsman07 are close to your age.

The valve selection is a big obstacle for me right now (despite what should be a really easy decision when looking at the stats), but I am staying away from that issue until I talk to my surgeon. Also I made the mistake of watching a video of chest tube removal on youtube and that was mistake as well so I will be staying away from the videos.

Hopefully I don't sound to whiny about the pain. I guess I rather go out and tire out my body voluntarily whereas being poked and prodded seems like something I can't handle (which I know I can and will). In a way your responses help me toughen and hit this surgery head on with a positive attitude.

This surgery is a big deal in my life just like graduating college and getting married. I know when I get through it I will be able to accomplish bigger and better things and be there for my wife and future kids (trying to put that off for as long as I can...although the wife is getting antsy).

Earlier when I mentioned the alcohol I was just looking for limits. I want to be safe and healthy for the rest of my life and I was surprised when I asked my cardiologist about limits on blood thinners and he made the statement "I know people who ride ATVs without helmets and are always drunk". This to me is not a right way to handle your life after a major surgery, but I know he was just trying to show extremes.

Lastly, I know this is not the right forum...however I thought I would throw it out there. I like the option of Plavix as it doesn't require monthly blood testing. I know clay mentioned earlier to not count on it (even though it was approved in europe)...Are there any other options out there other than plavix that don't require monthly blood testing and are just a pill a day require no monitoring.

I know several others on the site documented their entire stay and I plan to do that as it was very helpful me in getting an idea of the experience.

Thanks again,

Eric

 

[Duffey]

Eric, you asked about CHOP (Children's Hospital of Pittsburg) and member lynlw's son has had all his heart surgeries done there (I think). If you do a search for her posts, I think you'll see that she has always had high praise for the work they do.
Best wishes going forward.
Mary

 

[tom in MO]

Ironman-Testing is not really a bother, although it is an expense. You can do it at home in <5min. The good thing about warfarin, especially if you like to do extreme things, is that it can be quickly be reversed in case of emergency. This is not true of some other anticoagulants.

THe only risk with warfarin and alcohol is you may fall, hurt yourself, and bleed. The warfarin will insure you bleed about twice as much as a "normal" person. There is not an "interaction" between the two chemicals.

When it comes the pain, OHS is not bad at all. It's easier than a colonectomy, passing a kidney stone or a ~20 puncture hernia repair. For me my most annoying pain was in my shoulder from the physical manipulation of my rips, sternum with my arm tied down to a board. This pain was like any other muscular skelatal disruption from sports. It was best treated with muscle relaxants, physical therapy and mild prescription and OTC pain killers. The pain from the incisions were mostly a bother since I sleep on my stomach, but couldn't for the first couple of weeks.

 

[scott.eitman]

So much to discuss. it is really tough at a young age to deal with all of this. I am glad you are open minded about your choices. At 34, I was not. It was repair or Homograft (human tissue) for me. I figured every 15 years ish a new valve would be dropped in. Well, going into the 2nd OHS at 12 years, I want nothing to do with a 3rd so I opted for Mechanical. I also latter learned that redos are not all that easy as the body develops a lot of internal scar tissue.

The 12 years after the 1st were great! I wrestled and did a ton of bicycling. The homograft did me good.

Mechanical: I would have it removed if they are ever in my chest again. I think it is mainly just me. My valve doors seem to slam shut. I do not feel it all the time, but I do at bed time. I have a belief that my heart is working differently than many others in this regard. I am also very happy to have it and hope to never have that 3rd operation. The coumadin has not been an issue, however my clinic is about one mile away and I only go every 6 weeks on my way to work. Love the CCF for this.

Ross procedure, I know there are many happy Ross people out there, but I only considered it long enough for Dr. Cosgrove's nurse to tell me that due to lack of success the CCF no longer was doing them and that was back in 1998. I believe they may do them again, but in all of my patent visits, I have not talked to one who got it.

 

[clay_from_nj]

Re ski girl's advice: I think I'm in love... :biggrin2:

 

[Aggie85]

I just received a OnX valve from Cleveland Clinic. They originally had me planned for a Bio valve but we realized it wouldn't work for my situation. But, one thing that is relevant to this discussion is their reasoning behind originally planning the bio valve. At least in the US, no idea if it's already approved elsewhere, there is a new valve being studied called a Melody Valve. It can be placed via catheter, through femoral vein access, into a failing bio valve to replace it. This saves the need for OHS to replace failing Bio valves. The technique can't be used with mechanical valves but offers much less invasive means of replacing bio valves when the time comes.

It wouldn't work for me because I have an interrupted FV pathway so they can't do groin venous caths on me and the valve I needed replaced was my Pulmonary valve. Currently, the only means of placing the Melody valve is via the femoral route. I didn't want to take the chance on technology being ready for alternate means of delivery by whatever point I may have needed a Melody Valve replacement for a failing Bio one. But anyone debating which valve, should look into the possibility of Melody Valves as future replacement possibility.

As stated elsewhere on this thread, the good thing is there really are no BAD alternatives now a days. Each has issues, but valve technology is advancing constantly.

Best wishes to all looking at future valve surgery!
Linda C

 

[slipkid]

My 2 cents...

You have the luxury of doing some research before you make your decision and that's great! Keep reading on-line and discussing pros/cons with your doctors. I wish I had had that luxury.

Normally before I buy something, I research it out the wazoo for weeks before making a decision, and for a heart valve you're talking about something that is a pretty major "purchase". But this was all just dropped on me while I lay on the table in the cath lab/ER after having a heart attack. My heart had stopped during the cath stuff, I woke up and there was a man I had never met before (the surgeon) looking down on me saying that I needed a new heart valve in addition to a bypass and asking if I wanted a mechanical or animal one. It was surreal to say the least, and I had no idea of ANY issues/differences/things to consider, nor time to make an informed decision. I asked what the difference between the valve types was and the answer was that "with a mechanical valve you will have to be on a blood thinner for the rest of your life."

Since I do not like taking any medication period, my answer was a quick "well then I don't want a mechanical one"! To which the surgeon seemed shocked/surprised and told me that for someone my age (in my 50's) that they don't use animal valves, that they only last about 10 years and after that I would probably need surgery again. What went through my mind was "well then why are you asking me???". Not going through all that happened next, in the end I was given a mechanical valve. But I was not fully informed of all the issues of one vs. the other and had no time to really consider all the pros & cons.

Anyways...

I don't hear it clicking so that doesn't bother me (one of the Dr's told me he can hear it but I guess he has better ears than I have).

However I HATE the fact that I am now stuck taking coumadin for the rest of my life and having to deal with the risks of that, and the issue of dealing with PT-INRs which so far have been a hassle. But that is just me. I certainly would not want to go through the surgery again but....if I had time to really research and think about it I may have gone for an animal valve and rolled the dice that I would not need another surgery in my lifetime (for all I know I could get run over by a bus tomorrow, or medical science could develop a new surgery for replacing/fixing animal valves, who knows?). Again that is just me though since I do not like being on meds, not just the hassle of having to take them, balance the INR testing etc but also because of the havoc meds wreak on your body, some of which are not understood and come back to bite you later in other "don't mess with mother nature" ways.

As far as the pain of OHS, and everything that went with it, I have had quite bit of that. I was not able to lie down at all for at least 3-4 weeks it was so painful (I had to sleep sitting up or in various crazy piles of pillows). Just walking around hurt like hell. Riding in the car was agony, every bump. I've gotten a lot of miles out of clutching my heart pillow to my chest during that time (keeping pressure on there helps). I couldn't deal with taking the pain meds that often though, especially during the day, they made me feel too lousy in other ways, so most of my pain has been straight up once I left the hospital. Even in the hospital I made them cut down my painmeds dose in half, percocet had me hallucinating every time I shut my eyes if taking two of those pills.

I'm now about 6 weeks out and finally the pain intensity has started to subside but it is still pretty uncomfortable, and certain things make my chest hurt worse than others (sneezing is the worst). I've done a lot of grunting and groaning, muttering f-words under my breath, and repeating "ouch ouch ouch" over and over every time I move the last 6 weeks.

Regarding the chest tubes that you mention - oh man - I had three btw. Two of them were pulled at the same time. The Dr. told me it wouldn't hurt but he admitted later that he was lying. Thank God I did get a full dose of painkillers before he pulled those; that was the worst pain I felt through this whole ordeal even with the painkillers. That double pull was still hurting when he pulled the last one and I didn't even feel that one in comparison. I even remember afterwards that I was so wiped out that I couldn't get out of bed that afternoon like my usual routine and instead I just lay there the rest of the afternoon and asked my visitors to go and leave me alone to sleep/recover. 6-7 weeks later one of those "bullet holes" still has the scab on it (the others have already fallen off).

Prior to this I have never had an operation and the worst pain I've ever felt was breaking a collarbone and recovering from that. That paled in comparison to this though.

Not to scare you though about any of this - all of us posting our experiences up here have survived this stuff and so will you! Pain is just a state of mind and it goes away....

 

[dick0236]

My 2 cents...

Regarding the chest tubes that you mention - oh man - I had three btw. Two of them were pulled at the same time. The Dr. told me it wouldn't hurt but he admitted later that he was lying. Thank God I did get a full dose of painkillers before he pulled those; that was the worst pain I felt through this whole ordeal even with the painkillers. ..

Hi slipkid and welcome. I think you will find this forum very helpful as you recover from the surgery. There are only about two things I really remember about my surgery....and one of them is the pulling of my chest tubes. Your description is exactly as I remember it....so I guess somethings never really change. The warfarin/INR thing you will get used to quickly.....and if you are like most of us, you will find ACT(anti-coagulant therapy) easy to deal with and it will have little impact on your life or lifestyle.

 

[slipkid]

Hi slipkid and welcome. I think you will find this forum very helpful as you recover from the surgery. There are only about two things I really remember about my surgery....and one of them is the pulling of my chest tubes. Your description is exactly as I remember it....so I guess somethings never really change. The warfarin/INR thing you will get used to quickly.....and if you are like most of us, you will find ACT(anti-coagulant therapy) easy to deal with and it will have little impact on your life or lifestyle.

Thanks. Yes, this forum has been a Godsend. You have no idea (or maybe you do). I've been searching for something like this for weeks now and so glad I've found it. A whole community of people who either already went through, or are going through, a lot of what I've been dealing with, asking the same questions, sharing experiences & answers etc. Whew. Hope I don't ramble too much but I've had nobody to really talk to about this stuff!