Why does it take so long to recover?

[johnp]

Things are going about as well as one can expect now, 6 mos out from MV repair.
I can run, I can ride a bike, I can swim, I can surf, I can play a little soccer with my kids.

My bike and my swim stamina is a lot closer to my pre-op days than my run. As an example, before op, I would average about 20mph on a 25 mile training ride, Sunday I averaged about 19 mph.

Just for kicks, yesterday I set the treadmill for an 8 minute mile with a slight incline, and I tried to see how I would hold up. I could only go a quarter of a mile at that pace, whereas I could do 6 miles on the treadmill at that pace during my better days. I can't say its cardiovascular deconditioning entirely. My HR was only in the 130s. But in addition to being tired, I felt a little fragile, I just didn't have the will to push myself like I did a year or two ago. That may be a good thing, but it is an observation nonetheless.

Which brings me to my question. Maybe someone has asked a doctor with experience in this area.

Why does it take so long to recover? Is it lower EF? Heart remodeling? Scar tissue? Loss of blood flow after trauma to the heart? Is your body chemistry somehow altered? Or is it psychological and are you less willing to push yourself?

What do yuo think?

 

[DeuxofUs]

John,

I think it's all of the above. While I haven't had my valve surgery yet I can imagine the toll it takes physically and mentally. OTH, I am amazed at how fast people DO recover considering they just had their hearts tinkered with....

My brother had a heart transplant last year and my mother has been his sole caretaker and has seen it all... she wasn't "impressed" when I told her about my valve issue since what she saw that with my brother, it was nothing short of a miracle. What she did tell me was.... "the body WANTS to live, the heart WANTS to keep beating"... just remember that when you aren't feeling well.

Keep going but don't push yourself beyond what you think you can do.

 

[scott.eitman]

I feel for you see my thread which may shed a little light:
http://www.valvereplacement.org/forums/showthread.php?37880-Low-stamina&referrerid=7522

 

[neil]

my cardio told me 6 to 9 months full recovery........you sound to be doin just fine

 

[epstns]

I'm waiting for the definitive answer, John. I am currently about 15 weeks post-op and although I could still slowly jog during the months prior to my surgery, I cannot manage more than 1/4 mile intervals yet. I have to walk 1/4 mile, then I can jog 1/4 mile, then I have to slow down and repeat the walk/jog cycle. I'm still wondering how long it will be before I can jog any distance.

My complications and limitations now include a beta blocker and a pacemaker, but I still want to at least jog, if I can no longer run.

 

[neil]

you have been through a lot steve.........bet your body is still looking out for that darn truck.........but you are doing ok...........bye the way whats jog? lol

 

[johnp]

I guess its all relative.

I try not to push myself. I am exercising, but I'll stop if I feel tired. I never stopped during a run before, ever. Sometimes I stop and I swear I'm not that tired.

I am on a beta blocker, but I was on a beta blocker before. But just before I had some serious arrhythmia issues pre op they put me on something called flecainide. I am still on the drug now, but the cardio insists its the BB that limits the HR.

Could be a lot worse. I know that.

 

[epstns]

Neil - Here in The States, jogging is what old runners do when they are too stubborn to quit the sport. Old runners never quit - they just run a lot slower. (I guess I'll have to quit, though, when the walkers start to pass me, and I think I'm jogging. . .)

 

[ski girl]

John I felt the same - six months post-AVR when I still couldn't see any improvements in how I could perform with my crappy old valve vs my shiny new one, I raked my poor cardiologist over the coals about my lack of ability to run. He gave me a stress echo and I managed 14:25. Two years ago with an AVA of 0.8 and things starting to look bad, I did 14:10. No difference!

What he told me was that he has very few (when pressed, I was it) patients who expect to be able to perform better athletically after their surgery, so he didn't know why I wasn't better. His patients are happy just to be able to walk to the shops. He sent me to my surgeon who told me to be a bit more patient, the heart had 40 years of 'pushing blood through a straw' and now had some remodelling to do.

Amazingly at eight months post-op I'm finally coming good and can run for the first time in my life. Frequently I feel I must stop or I'll die - any my heart rate is only 155. I think our brains are just so used to us NOT being able to do much, that they are maybe over-riding the messages coming from our hearts that we actually are ok.

Just a theory - but hang in another couple of months and you may be as pleasantly surprised as I am about what I can do now!!!

 

[SumoRunner]

It's the beta blocker. It trims the max HR, so 130 bpm is much closer to your max than it was before. If you could have gone to 180 pre-op, you may only be able to go to 160 now. In time you'll be able to push it higher despite the BB but never again to your true max unless you go off the BB. Also you need a bit more patience, 6 mos is very quick to reach even the point you are at now.

 

[LeakyUK]

Sorry, I think all runners are completely mad, and I have never seen one with a smile. Nevertheless I was up today at 6am, the sun was shining and I was ready for a challenge - so managed my first mile walk to buy the morning paper. I had a real feeling of achievement, so celebrated by returning to bed for another hours sleep. Really I am very impressed by all this fitness, but I think I will stick with the walking program.

 

[Bean Counter]

Patience is the key.

I am coming up on my 1 year mark and am still not in pre-op shape yet. My general aerobic pace (the pace the most of my runs are at) is about 45-60 seconds slower than pre-surgery when I hold the same HR. The good news is that I am slowly improving, but it is coming back much slower than what I would have hoped. I also have about 10-15 lbs to loose as well, so that is part of the slowdown.

 

[johnp]

Well, for my case, I think I have part of the answer. The beta blocker, plus the drug called felcainide, is doing its job in regulating my heart rate.

Despite a good history with endurance events, things deteriorated in the year leading to my valve operation, and I had very very serious heart rhythm issues. These drugs got the situation under control. And for the time being, things are going so well so there is not desire to reduce thse dosages just yet.

I had a quick Q&A with my electrophysiologist recently on all of this.

He quickly put it into perspective, given my medical history.

"I do not think the objective here should be to optimize athletic performance."

:eek2::eek2::eek2::thumbup:

 

[Natina13]

You all can run, jog or walk...I'm driving Btw....... I had to look up the word " sexagenarian ".........I thought perhaps it was a new sexual technique, taught to only senior OHS patients....wow, all it means is "between the ages of 60-69"...what a let down Smile.........it is all good, walking, jogging, running or driving.........at least our hearts are still beating and the sun is shining some where on planet earth, at any given moment of the day! Guess I am just easily pleased..... and sometimes, pleasantly surprised.
Renee

 

[epstns]

I'll agree with Jack - I think my culprit is the beta blocker. I've been monitoring my heart rate in rehab class and find that I seem to top out at about 120-125 BPM. Knowing that my pacer is set to a max of 130 BPM, I can see that I am not bumping up against the pacer limit, thus it must be the BB (and, of course, general state of healing). It is encouraging that even with these limitations, I can see progress. I now have greater stamina "under load" than I did just a couple of weeks ago. This must be a good sign, and I'll see where it takes me.

 

[tprice54]

John, it took me a year plus to get into any real shape, and longer to get even close to my pre op pace. And all that was without beta blockers, which I got to stop at 6 months post op. My only suggestion is to keep at it, and stop comparing your pace to pre op....it's a whole new world now!

 

[hensylee]

you had MAJOR surgery. that's the BIG operation, we are told. My dr said a whole year and that's maybe about right for all your stuff to fall back into place, not to even mention meds you take that might make you tired. I also think we are left with a memory that sticks in our minds all the time - and forever. Blessins......

 

[Eva]

John, it took me a year plus to get into any real shape, and longer ............ My only suggestion is to keep at it, and stop comparing your pace to pre op....it's a whole new world now!

John,

In my humble opinion, anyone's energy and sense of well being fluctuate from one day to another, depending on the incidents that take place in our lives, the quality of people we meet, the food we eat, and our interactions with others. Top all of these with the trauma of the surgery and its psychological effect.

I personally started getting into real shape only three months ago. Do not be discouraged! The psychological effect of the anxiety and the fears I went through since I was told I needed surgery traumatized me more than the surgery traumatized my body and my heart and thus, it subcontiously caused my energy and moods' fluctuation which delayed me from feeling fully recovered.

I would/could/might have reached my full recovery earlier if I had learnt earlier how to handle my anxiety better by accepting my new me, relaxing and resting instead of pushing myself and continuing to sleep early as I did right after my surgery.

Here is an exerpt from Mid-Atlantic Surgical Associates website:

"...There will be days of high energy and of fatigue, accomplishments, moments of temptation, feelings of exuberance and even days of feeling blue or angry, all of which are a part of the physical and emotional healing process that takes place." [

You may read the whole article here: http://www.heartsurgeons.com/ed5.html

Hang in there...better days are on the way:smile2:

 

[JEANIE1957]

Things are going about as well as one can expect now, 6 mos out from MV repair.
I can run, I can ride a bike, I can swim, I can surf, I can play a little soccer with my kids.

My bike and my swim stamina is a lot closer to my pre-op days than my run. As an example, before op, I would average about 20mph on a 25 mile training ride, Sunday I averaged about 19 mph.

Just for kicks, yesterday I set the treadmill for an 8 minute mile with a slight incline, and I tried to see how I would hold up. I could only go a quarter of a mile at that pace, whereas I could do 6 miles on the treadmill at that pace during my better days. I can't say its cardiovascular deconditioning entirely. My HR was only in the 130s. But in addition to being tired, I felt a little fragile, I just didn't have the will to push myself like I did a year or two ago. That may be a good thing, but it is an observation nonetheless.

Which brings me to my question. Maybe someone has asked a doctor with experience in this area.

Why does it take so long to recover? Is it lower EF? Heart remodeling? Scar tissue? Loss of blood flow after trauma to the heart? Is your body chemistry somehow altered? Or is it psychological and are you less willing to push yourself?

What do yuo think?

I'm 8 mos post op avr (bioprosthetic) and I feel wonderful. Still a bit fatigued at the end of the day , but I can BREATHE!!!!
I've also never been in better shape, gotta take care of this wonderful gift.

 

[sensei Ade]

Hey johnp, absolutely it is all the factors you mention but I would say the heart remodelling is the one thing that really takes time as your heart has to adjust to the new valve so the whole heart has to rebalance itself and grow strong again. You're doing great, keep going man, slowly but surely you get there. I'm now 7.5 months after surgery and I'm still not totally there yet, but there's always that bit of progress that you keep seeing as long as you persevere. It's a long up-hill stretch this whole thing but you will get there. All the best.