When Does Pain Ease Up

[Kim54]

Hi Everyone,

I had AVR on Oct 16, 2012. the surgery was performed under the right breast between the ribs. My pain had been getting better. I stopped taking Tramadol 5 days ago and just take Tylenol. Today I woke up with alot of pain and burning in the area of the incision and mid chest all day. I have been walking and moving around and have been able to do laundry until today , I had to take a Tramadol.

I see my surgeon tomorrow for the 3 week follow-up. Is the return of more pain normal? When will the pain start getting better? I thought it was getting better.

Thanks to you all that are on the other side of this mountain, for your great wisdom and for responding !!!

Kim

 

[Fundy]

Its probably hard to say when it stops getting worse and just keeps getting better. Myself, felt great for 5 weeks really then one day just started getting sore, a few hours later my entire torso was in a lot of pain and it hurt so bad I couldn't open or close car door on way to ER. Stayed that way for about ten days then got better bit by bit. Still a bit of discomfort I remember 8 or 9 months later sometime.

Doing the laundry so soon maybe caused the pain to flare up. Most seem to say that they notice big improvements after 2 or 3 months.

 

[Luana]

Kim, I had the same type of incision you have, only mine was higher up, a few inches down from my collar bone, as it was my aortic valve that was replaced.

I did not experience much pain at all; however, I've been told I a high tolerance for pain (I thought I was kind of wussy, but what do I know?), but please know that cutting through muscle is more painful than an incision in the stermum, as there's not much muscle covering the sternum, at least that's what I was told.

I had more pain when I got home than in the hospital, as I was doing things, so that's pretty normal. I think your pain is probably pretty normal for where you are now, too. Do take a look at your incision to check for any redness or inflammation that could be a sign of infection.

You may want to call your doctor's office in the morning about your pain. Tramadol really doesn't do that much and it sounds like a more potent pain killer might be better for you for the next couple weeks or so.

It will get better!

 

[Kim54]

I had to go to the ER this morning because of the pain and I was profusely sweating with nausea and feeling faint. The ER Doctor did a EKG and Chest x-ray both were normal. He gave me an injection of Toradol, which has helped. The ER Doctor told me that it may have been a reaction to the Tramadol. He called my Surgeon and told me to go straight to his office. The Surgeon took off all my bandages and said I was healing beautifully. I showed him where my pain was and he said that is where he sawed two ribs off the sternum and reconnected them with screws and titanium plates. I did not know this so I was surprised to hear it.

Since I am on Coumadin and my INR runs a little high, I asked both doctors if this would affect the Coumadin and the both said it would be alright to take it. I called the nurse for my Cardiologist and he said to take it short term and then repeat INR Friday. I hope the Toradol does not affect my INR because it works for my pain.

Thank you all for your help. My friends, you are all priceless !!

Kim

 

[ramjet]

It sounds like you may have overdone it by doing the laundry so soon after surgery. I am a little surprised that that you didn't know that they would cut some ribs and then rejoin them, so now that you know this perhaps you can understand why it takes a little while to heal. The ribs and sternum need to heal, and this does take a bit of time...between 3 and 6 months, and the older you are the longer that can take. There was one patient who sneezed so hard that he factured the site where the rib/sternum was screwed together and he needed to have another operation to repair this. I was certainly told lifting nothing heaver than a 2 lire bottle of mild for 6 weeks, and then no lifting above my head....I guess you need to ask lots of questions. In Australia it seems that they try and get all heart patients into a "cardiac rehabilitation" program, which involves weekly visits to specialised nursing and exercise physiology staff, but this doesn't happen until about 3 montsh post surgery,and the weekly visits they gradually supervise you each time lifting gentle weights and doing special exercises etc, and overabout 12 weeks they build you up and now I'm back to where I was (even better actually) presurgery. Anyway, take care, seek advice, don't overdo it, keep walking daily, and the moment something strange happens, such as worsening pain or the like...see your doctor.

 

[Kim54]

It sounds like you may have overdone it by doing the laundry so soon after surgery. I am a little surprised that that you didn't know that they would cut some ribs and then rejoin them, so now that you know this perhaps you can understand why it takes a little while to heal. The ribs and sternum need to heal, and this does take a bit of time...between 3 and 6 months, and the older you are the longer that can take. There was one patient who sneezed so hard that he factured the site where the rib/sternum was screwed together and he needed to have another operation to repair this. I was certainly told lifting nothing heaver than a 2 lire bottle of mild for 6 weeks, and then no lifting above my head....I guess you need to ask lots of questions. In Australia it seems that they try and get all heart patients into a "cardiac rehabilitation" program, which involves weekly visits to specialised nursing and exercise physiology staff, but this doesn't happen until about 3 montsh post surgery,and the weekly visits they gradually supervise you each time lifting gentle weights and doing special exercises etc, and overabout 12 weeks they build you up and now I'm back to where I was (even better actually) presurgery. Anyway, take care, seek advice, don't overdo it, keep walking daily, and the moment something strange happens, such as worsening pain or the like...see your doctor.

Thanks ramjet!! I will take it more easy and yes maybe I did overdo it. I have chosen not to do cadiac rehab because I would have to travel. I have a treadmill and stationary bike at home so I plan on doing it at home.

Thanks !!!

 

[Luana]

Kim, don't worry about your INR, if it's out of range, the dose can be adjusted. It's important for you to be somewhat pain free, as that will help overall with healing.

I'm surprised your surgeon did not tell you about your ribs, or someone should have told you before you were discharged. Glad your incision is healing well.

 

[Kim54]

Kim, don't worry about your INR, if it's out of range, the dose can be adjusted. It's important for you to be somewhat pain free, as that will help overall with healing.

I'm surprised your surgeon did not tell you about your ribs, or someone should have told you before you were discharged. Glad your incision is healing well.

Thanks Luana, I am so glad I found this site !!! I am also surprised no one told me or my family. I am feeling better as long as I am on the Toradol. With monitoring the INR every Friday it should be alright.

Thanks again !!
Kim

 

[pellicle]

Small steps every day

Personnaly I found that from ICU to home the improvement could be seen every day. Soon it slowed to I could identify an improvement every week. Then it seemed to slow with noticing improvement per month.

By 6 months I realised that I was about 60% normal.

Now after a year I am stronger in cardiovascular fitness but still have a few issues with the scar and scar tissue

Take small steps forward, don't take too big a step and slip back further than a small step

 

[ramjet]

Thanks Luana, I am so glad I found this site !!! I am also surprised no one told me or my family. I am feeling better as long as I am on the Toradol. With monitoring the INR every Friday it should be alright.

Thanks again !!
Kim

Kim,
Please check that you should be taking torodol. Here in Australia I have been told that Torodol (ketorolac) is not prescribed for postoperative pain, particularly postoperative cardiac pain, and if it is used its use should be limitd to five days maximum, and NOT if you are on warfarin or anticoagulants....I don't know yuor specific circumstance, or your dose, or in fact if I am referring to the same drug, but wen you said you are taking torodol it rang alam bells for me and I confirmed this with some others. If your cardiac surgeon and doctor are aware that you are taking it, and have specifially prescribed torodol then they may have a very good reason....but if you have decided to take this medication without a specific medication order for your specific condition, then you might just be doing the wrong thing Kim....I guess I'm saying please double check...anyone else have any comments that may help Kim with regards to Torodol?

I took paracetamol after I was discharged from hospital (I am not sure what country you are but some countries call it acetamenophen I think) as prescribed for about a week and then nothing after that, and I had a full sternotomy.

 

[Kim54]

Kim,
Please check that you should be taking torodol. Here in Australia I have been told that Torodol (ketorolac) is not prescribed for postoperative pain, particularly postoperative cardiac pain, and if it is used its use should be limitd to five days maximum, and NOT if you are on warfarin or anticoagulants....I don't know yuor specific circumstance, or your dose, or in fact if I am referring to the same drug, but wen you said you are taking torodol it rang alam bells for me and I confirmed this with some others. If your cardiac surgeon and doctor are aware that you are taking it, and have specifially prescribed torodol then they may have a very good reason....but if you have decided to take this medication without a specific medication order for your specific condition, then you might just be doing the wrong thing Kim....I guess I'm saying please double check...anyone else have any comments that may help Kim with regards to Torodol?

I took paracetamol after I was discharged from hospital (I am not sure what country you are but some countries call it acetamenophen I think) as prescribed for about a week and then nothing after that, and I had a full sternotomy.

ramjet,

I was given Toradol in the hospital and then when the acetaminophen was not working. I questioned the ER doctor, my Surgeon, the nurse at my cardiologist on whether I should be taking this 1) affect on bleeding issues and arrhythmia . They all said it would be ok. It was ordered 4x a day, I only took it 2x a day. Today I did my INR and it is 5.9 ( normal range is 2.5-3.5 for a mechanical valve). I am very upset !! I called the Coumadin therapy nurse and am waiting for her to call me back. I have skipped my coumadin today and will eat a spinach, broccoli salad. I stopped the Toradol yesterday. I will try acetaminophen again.

Again thank You all so much !!!
Kim

 

[AgilityDog]

Well, it sounds like the pain med interacted with you coumadin. But your nurse should adjust your coumadin dosage if you need to keep taking the toradol another week or two. It will be ok. Controlling your pain is important to the healing process.
Your nurse probably would have told you to skip today's dose, and will likely decrease your coumadin slightly for the next week, but if you are not going to be taking the toradol anymore, then she may NOT have to adjust your dose - just skipping may bring you down enough to get back into range. You may need to have your INR checked 2x per week for a week or two if you are going on and off the toradol.
Don't worry about the 5.9, you'll be fine. Been there, done that.
Just don't jump off of bridges or hit your head.

 

[Kim54]

I heard back from the coumadin therapy nurse. She said to stop the coumadin 3 days then on Monday, Wednesday, Friday and Sunday take 5 mg, then 25m on the other days. She also said I could take the Ibuprofen thru this weekend.

Thanks for all your help and responses!! I appreciate you all and all the advice !!

 

[carolinemc]

Well, hopefully the pain has eased somewhat by now. It takes the incision to actuallytake 6 months to a year to fully heal and recover from the trauma of being cut open. Just take it easy, do not rush to get somethings done. You will get better at time passes, just let the body tell you when it is fully recovered. Take it one day at a time. Good to wean off the meds as you see fit for the pain. Hugs for today.

 

[carolinemc]

And saw your other note about skipping coumadin, never do without advice from the medical profession. You take a risk when do skip a dose. Just adjust when you do blood work. When eating green, leafy vegs., just make note of when you had them and when you get the blood work done and the protime number is low, remember when you had the green leafy veg and adjust along with the coumadin. You must be consistant with the foods with the coumadin. If you ever post again about skipping a dose without doctor persmission, I will haunt you. LOL. Just don't skip, adjust the dosage when blood work come back. Hugs for today.

 

[Kim54]

I took the Ibuprofen and feel so much better. The nurse told me not to take the coumadin for 3 days. I am so glad I was able to take the ibuprofen, it has reduced the swelling and inflammation. I feel Great !

Thank you all !!
Kim