Yet another speed bump?

[epstns]

As if an INR of 4.5 yesterday isn't bad enough, the past couple of nights I've noticed that the only way I can comfortably sleep is now in my recliner with the backrest fully upright. As soon as I begin to relcine the backrest, it starts to feel as if I am working hard for every breath, almost like breathing through a wet blanket.

I called the surgeon's office to discuss it, as I only have enough lasix to last today and tomorrow. At the moment, the plan is to watch it through the day today and call back tomorrow AM to consider extending the length of time I'll be taking lasix (and those ^&%*&^ potassium tablets). I just hope it remains stable and improves -- I really don't want to have to go back to the hospital, but if I can't breathe, that's a problem.


Any other ideas?

 

[Jeff Edmonton]

Are you using your spirometer, and if so, are you able to cough up from your lungs? Sure sounds like you have fluid in your lungs. Really sorry to hear you are having issues like this Steve, hopefully you will have it worked out soon.
I am having trouble sleeping still too, I get 4 hours sleep in 24 hours now. If I take a sleeping pill I can get 5 to 8 hours but I only take a sleeping pill every 3 night.

 

[ottagal]

Sorry that you are having another speed bump, Steve. If you are having breathing difficulties, then I would feel better getting that looked at. Nobody wants to go back in the hospital (including me :-0), but better to be safe.
Do you have a temperature?
You know the drill: When in doubt, check it out.

Hope that this is a very small speedbump for you.
Take care,

 

[drivetopless]

sorry for the breathing troub les

sorry for the breathing troub les

I had a lot of that sort of thing the first month, too. The afib made the fluid in the lungs worse. I slept upright the first month.

If you lungs are congested (mine were-I was coughing up junk), you might try these things (check with your doctor).

1. Mucinex or Coricidin HBP -- I took it at night and it did help get the junk out of my lungs
2. Switch to a super low sodium diet
3. Put a little Vics on your chest, neck, and nose.

Not sure if any of these would help if you don't have lung congestion, though.

Good luck. I know you are uncomfortable right now.

 

[Lynlw]

Personally to me, it sounds like you MAY have fluid around, outside, your Lungs, (Plueral) or heart (pericardial fluid).
Has it been like this since you got home or is it getting worse? When was your last echo? I'm surprised they aren't having you get an Echo just to rule that out, since IF it is fluid the sooner they diagnose it, the easier it is to treat with meds, but they know your body much more than I do.
IF it is plueral or pericardial fluid, usually lasix doesn't help that much (at least in our experience) If it was caught early, Justin always needed something like Motrin for inflammation Sometimes he needed steroids but he was able to stay home.

Hopefully this is just a small bump

 

[nngbwh]

Sorry to hear you are having another speed bump. I also can only sleep in a recliner after my surgery. Call your doctor right away or go to the emergency room if your breathing is getting worse. Play it safe. The road to recovery is never an easy one. Take care and let us know what is going on.

 

[epstns]

Well, here's the "inventory" of answers thus far:

I have been using the spirometer, can cough but little needs to come up.
Lungs are clear (nurse just left. . .)
No temp
Some edema - swollen ankles, not usual for me
This is all new to me since coming home from the hospital. Had some similar "sleep fear" issues at the hospital, but wrote those off to abdominal swelling due to GERD. Maybe I need to use a few more Tums to control that. . .

As I noted, so far the instructions I've received are to call back my surgeon's NP tomorrow AM to give her an update and receive instructions.

Crossing my fingers, sleeping in my recliner.

 

[Duffey]

Are you weighing yourself everyday, Steve? I agree with Lyn, it sounds like you've got excess fluid around either your heart or in your lung cavity. It might take a higher dose of Lasix than what you're taking now; that's why I suggest your keep track of your weight from here on out.

 

[LUVMyBirman]

This sounds all to familiar. Keep on top of this. With your symptoms...they should do an echo as well as and check your lungs.

I had the same symptoms including an elevated INR. Which is not a huge deal when you are not fresh out of the gate. Keep an eye on that. I was sent home from a simple follow up at 2 weeks with a 4.0. Was told to stay on the same dose. Over the next week I could not sleep lying down. It's a long story that you will appreciate once you are recovered.

I ended up having pericardial tamponade. 2 liters of fluid removed and a widow. I am sure...you could not be lucky enough to have this happen to you. I am just concerned that your symptoms are related to some sort of fluid. Lungs, or otherwise. Make the call and keep us posted.

Hang in there!

 

[Jeri]

HI Steve,

Sorry for all the problems.....I'm sure they are temporary. What did nurse say your pulse0x was??? DO you have 02 at home?? Do you think it could help? Maybe you need it temporarily. It's good to hear that lungs are clear. Any temp elevation? If it keeps up, I hope you go in for further testing just to rule out other possibilities. You shouldn't have to suffer with this. Please keep us informed if you can. As always, you are in my prayers with lots and lots of positive energy coming your way.

Jeri

 

[jhusker2]

Steve,

I had my surgery on Jan-10th 2011 and can remember feeling like I had a 25 pound weight was on my chest (couldn't breath) when I would lie on my back or left side at night. I had to prop my pillows up and sit upright just to fall asleep, but it started getting better after the 6th week though. I'm not on warfin, but do take a beta blocker and my surgeon said it can be one of the side effects from the surgery and meds. I do recall it feeling a little better after taking tylenol or ibuprofen some nights.

Like others have suggested, it could be fluid build up around the lungs and/or the heart, so I hope you see your doc soon if things don't improve. Wish you all the best and hope things start looking up for you.

Jason

 

[Allisoninoz]

Hi Steve,
Sorry you're having these probs. I am able to sleep in bed but not for more than two or three hours. I then wake up and have to reposition myself. I know it's more breathing difficulties than pain, but have you tried a hot shower before sleep and/or heat packs behind you or around your neck/shoulders? I find that heat helps me get more comfortable at night.
How much are you moving around (i.e. walking and doing exercise) during the day?
Alli

 

[normofthenorth]

Nothing to contribute but good wishes, Steve, sorry.

 

[Natina13]

Keeping you in my prayers, Steve. I am so sorry your having these issues. Hopefully your MD has already gotten this resolved. ( Breathing issues, with edema ....I would go to the ER, better to be safe, than sorry.)
Sending positive vibes your way.....
Renee
Go Team 2011 !!!!

 

[skeptic49]

Sorry to read about the bumps, Steve. Sheesh...this is what I have in store for me in the future??? I am impressed, though, with all of the good advice you are getting. Hang in there.

Jim

 

[RobThatsMe]

Hi Steve,

Just to echo what many of the others haves said. It could be fluid build-up. This also happened to me. I got home from the hospital and within 24 hrs had extreme difficulty breathing. I had to go back into the hospital for a week while they dealt with it.
Don't hesitate to seek out your doctors during this recovery time - No matter how minor you think the issue is, peace of mind is what counts!

Rob

 

[epstns]

Hi eveyone!
Made it through another night without a new incident. I'm in daily contact with my surgeon's assistant, and she is not overly worried yet. Also have visiting nurse twice a week, and she agrees.

Rob - My O2 sat is fine - 96 to 98%, so I have no supplementary oxygen at home. (Nearest hospital is 2 blocks away, so ER is near if I need it.)
jhusker - It sounds like I'm on a similar path to yours. If I have to sleep upright for a couple of weeks, so be it -- as long as nothing else starts to go south.
Allison - I haven't tried heat at bedtime. Used a heating pad for a couple of days when I first got home - for back pain.

So the plan for now is that we will contiinue lasix for another week, with nurse visits and check-in's with the surgeon's assistant. If nothing slipe, maybe I'm back on track.

 

[Duffey]

Steve,
Are you keeping track of your weight? That's often the first sign something's not right.
I was almost 6 weeks out of surgery when I ran into the fluid issue and the surgeon didn't catch it even with a post-surgery office visit.
I wouldn't put too much stock in what the surgeon's assistant advises unless you're showing no fluid gain.

 

[Bryan B]

Hang in there Steve...it seems the first few weeks it's hard to avoid a bump or three. I saw my surgeon today and I have the opposite problem. He thinks my cough is coming from being "too dry" and has taken me off the Lasix (which is fine by me...means I get to stop the potassium horse pills too). I have lost 12lbs since the surgery. He set me up with a PCP at one of the Duke Clinics close to where I live to keep an eye on my cough and a couple of other issues I have unrelated to my heart condition.

Like the others said...stay on top of this and do what you have to do to get rid of this bump for good.

 

[Lynlw]

Steve,
Are you keeping track of your weight? That's often the first sign something's not right.
I was almost 6 weeks out of surgery when I ran into the fluid issue and the surgeon didn't catch it even with a post-surgery office visit.
I wouldn't put too much stock in what the surgeon's assistant advises unless you're showing no fluid gain.

Steve I am NOT saying you have this, just posting this info here because IMO it is good to know. Hopefully you feel better each day

I agree with Mary it is a really good idea to weigh yourself every day when you're recoverry from surgery. Usually it is best to weigh your self the same time day to day. The one problem with weighing yourself and seeing IF you have pericardial or plueral fluid is something that only looks like a very small amount of increased weight, like a pound or two increase for your whole body, doesn't really help tell if you have fluid building around your heart or lungs.
If you don't have extra fluid anywhere else,(ankles hands etc) a pound or even 1/2 a pound gain could be a large amount of fluid in your pericardial sac or plueral sac and could cause problems, and If you do have fluid other places the weight gain or loss could mask the fluid also around your heart or lungs.

Also when you are recovering from surgery often if you gained weight from all the IVs etc, (and even not having good BMs) you can actually be losing over-all weight, as that body fluid goes away, especially if you're taking lasix, but could be building fluid around your heart or lungs. So it could be very possible not to see any weight gain or even day to day weight loss, but you could have increasing amounts of pericardial or plueral fluid. That's why many doctors will do echos and/or Xrays, if you have any of the symptons of plueral or pericardial effusions even if there is no weight gain. Especially since it can be so much easier to take care of the sooner it is diagnosed before the amounts get too large.

Here's some links to pericardial and plueral effusions There is alot of good info but i'm just copying the symptons.

http://my.clevelandclinic.org/disorders/pericardial_effusion/hic_pericardial_effusion.aspx

Symptoms of pericardial effusion include:

Chest pressure or pain
Shortness of breath
Nausea
Abdominal fullness
Difficulty in swallowing

http://my.clevelandclinic.org/disorders/pleural_effusion/ts_overview.aspx

Some patients with pleural effusion have no symptoms, with the condition discovered on a chest x-ray that is performed for another reason. The patient may have unrelated symptoms due to the disease or condition that has caused the effusion.

Symptoms of pleural effusion include:

Chest pain
Dry, nonproductive cough
Dyspnea (shortness of breath, or difficult, labored breathing)
Orthopnea (the inability to breathe easily unless the person is sitting up straight or standing erect)