Yay?

Went back in for my semi-regular protime blood test at the doctor's office (my PCP, or GP for you Commonwealth peeps) and was happy to say I am actually pretty stable at this point (2.5 INR). At this stage I've been pretty good over my last couple of tests, so no more blood work till 6 weeks from now. Not sure how comfortable I am with that, seeing as how I am only 4 and 1/2 months out, and things are still changing as I continue to rehab: 6 weeks seems like a long time. However, insurance only pays for so many tests based on how stable I am, and they don't want to contribute towards any home monitoring, as I don't meet the criteria for needed weekly INR testing. I guess that is a good thing, will just have to wait and see. I've been pretty good about keeping things in my diet pretty stable,  and exercise levels are also pretty consistent, so here's hoping INR-wise things stay stable without too much drama till my follow-up....

Overall though, it's nice to finally be in a pretty consistent range that also meets with where my surgeon wants me to be. Honestly, for all the bad rap that coumadin gets, it really hasn't had that much of an effect on my lifestyle: I can eat and drink what I like, and my doctors just adjust the dose to match my lifestyle. The trick is is to be pretty consistent; have a consistent amount to drink (alcohol-wise), if you like greens, eat 'em, just keep the amount you eat over several days pretty stable, without wild swings back and forth. You need or like to take supplements/multivitamins? Take them too, just take the same thing every day. Not rocket science by any means, but it does require some discipline. Nice thing about all this is 1) I still get to drink, I just drink less. This means I can afford to get the good stuff :) 2) As part of getting in Prison Quality Shape/PQF (minus the jailhouse tats or actual criminal record) I have to watch what and how much I eat, which segueways nicely into monitoring what I eat as far as coumadin/wafarin goes. Not too bad.

Working out

As far as rehab goes, most if not all of my rehab has been in the pool, although all the walking I did in the first 2 and a 1/2 months is technically rehab as well (although not as sexy as swimming....) Am up to 30 min swimming 4-5 times a week, and have been getting more vigorous each time, so given now I'm 4 and a 1/2 months out post-op, it seemed a good time to add some other exercises to the mix. Being a mechanical valve patient with an aorta wrapped in Dacron, heavy, heavy weights are out of the question. However, given how important maintaining muscle mass is as we age, as well as the well-documented cardiovascular benefits of moderate weight lifting, I decided to add very low weight training to the mix. Benched 55 lbs total on incline bench-press, and did about 65 lbs on squats. Pretty low-level stuff for any fitness level, but damn....I'm weak. Little-girl weak. Did about 30 bench presses in sets of 10 and about 25 squats, and wow. Wow as in, I really had more trouble than I was expecting. Of course I was trying to keep things light to minimize effects on the heart from lifting heavy, but it still felt way heavier than I would have thought. Even weirder was the DOMS (delayed onset muscle soreness) I had starting when I woke up today. At least I know it had an effect on my muscles and wasn't just in my mind.

The plan now is to keep up the swimming and repeat the low weights in a day or two, only adding low increments as the soreness and heaviness go away. Getting Prison Quality Fit, one day at a time.....

Happy Halloween!

Anti-Coagulation Therapy (ACT) and mechanical valves

Have been struggling a bit with getting my INR completely stable. Going in for blood testing week after week, and the numbers tend to fluctuate. My PCP currently has me on 7.5mg of wafarin; if I go up in dose my INR seems to skyrocket, and if I go down, I tend to have my INR plummet, so we're hoping the INR stays stable. Luckily, having the On-X may reduce my risk of any thrombolytic/clotting events, so I'm not too worried at this time. Last reading was a 2.0, so I am at the low end of where my docs want me to be, which is 2.0-2.5 for my INR reading.

One interesting thing about managing INR levels is how different docs approach in in different ways.

"The ideal target INR is still controversial for mechanical heart valve patients. Many surgeons believe that current guidelines mandate excessive anticoagulation and that patients could safely be managed with lower-intensity INRs"

--2006 Editorial in the journal "Circulation"

So, when you get onto forums, or talk with different M.D.'s, you'll get all sorts of ranges for what the doc believes is the ideal target range for their patients. Mine, as mentioned is 2.0-2.5 per my surgeon, although some guidelines would have me in the 2.5-3.0, or even higher. Additionally, my M.D. wants to try me on 325mg of aspirin as well, which is different from some of the common guidelines that are in rotation. 

So, based on surgeon/cardiologist past experience, whether the valve is in the mitral or aortic position and whether you have additional risk factors or other health history issues, you may have a different INR target range than someone else with the exact same valve.  

Here is another excellent paper on that has some discussion on target INR levels and valve types.

Things *not* to have near your pacemaker

Here's an interesting link to a PDF by Medtronic of  interference guidelines and pacemakers.  I have a Boston Insignia model pacer, but the guidelines are essentially the same. Most things are pretty common sense, and modern pacemakers are so well shielded that even things like microwaves aren't the issue that they used to be.

But chainsaws? Really? Definitely didn't know those were a no-no.

Food of the Living Dead

Now I'm all about everything in moderation, and a few Macca's burgers and fries aren't going to kill you in the long or short term, but living here in the States, as well as having spent multiple times in cardiac recovery wards in hospitals, I can safely say that more than a few people make fast food such as McDonald's more of a staple in their diets rather than an occasional indulgence. Here's an article about a Happy Meal that hasn't decomposed in over six months(!?!) that is yet another reason why Mickey D's , not to mention other fast food, should be more of an occasional treat rather than a regular part of the weekly food budget.

I'm not even getting into the issues around sodium and fat content that can be an issue for healthy people, let alone heart patients with varying meds, procedures, and dietary restrictions...

Anyway, for all the doubters, this isn't the first time something like this has been done.

Rehab Update

Been very busy with work and travel, hence the lack of updates. Good news is, besides being busy, my overall health has been great! With a trip to Paris and Stockholm that was fun, but involved a ton of walking, as well as long days at work, plus trying to be consistent with exercise for rehabbing, I was pretty concerned I was going to either overdo it, or in other extreme, not be rehabbing effectively. Seems like things are on track for the middle path, where strength and energy levels are returning, even faster than I was expecting.

Besides the Bataan Tourist March I felt like I was on overseas (which was good, since I got to see a ton of great stuff) swimming has been about 4 times a week, at least 20-25 laps each time. HR has been at 120-130 peak during the swims, and it hasn't been the repaired heart slowing me down as much as the muscles in my arms and chest and especially my shoulders. I'd like to add more laps, but have been finding the muscles don't really want to cooperate at about lap 26 or so.

Honestly, the biggest part of my rehab so far has been my back and shoulders, rather than the chest and heart. So energy-wise I feel about 80 plus percent most days. Strength and muscle-wise I'm still pushing about 60 percent. But that's why they call it rehab, isn't it?

Breakfast smoothie!

Anyone who knows me well enough, knows I'm a junkie for smoothies; Jamba Juice, Surf City, you name it, I'm down with the smoothies. Problem is, the ones you get at those places are high in calories, and the fruit they use is sometimes more "fruit" than fruit. Add to that the base for the smoothies isn't always low fat milk or anything like that (or if it is, it's hormone/antibiotic/rGBH laden crap). Not sure what it is, but I suspect there's got to be some MSG in it since it's so damn delicious.

So, I decided it was time to start making my own. Weight has been stable at 193 lbs/ 87.5 kilo the breakfast smoothie was a success: some ice (for that smoothie consistency), a scoop of non rGBH vanilla ice-cream (for delicious), a banana, and some protein powder with omega-3's and some whey and whatnot. Came out pretty tasty and kept me fuller for longer than I thought.

Just thought I'd try to get a healthier, cheaper version of something you don't *have* to get at the store.

It's green from the protein powder. Has some greens in the mix.

Crash Cart Glossary

ACT: Anti Coagulation Therapy

Why stay in shape?

There are a lot of good reasons to stay healthy and stay in shape, but the ultimate decision to follow that kind of a lifestyle is a personal one. We all have to have a personal reason or reasons to follow a course of action. It's very much the old adage about getting therapy, joining AA, getting help for hoarding and the like: before you can get help you have to want to be helped.

For me there are a number of reasons that I want to stay in good shape as well as get in even better shape. The main one being, after going through a second operation, and as many complications and issues as I had post-op, being in pretty decent shape helped a lot. At the same time, I definitely could see the limits placed on my body by the shape I was already in; more flexibility, less body fat, and more lean muscle would have helped recovery even more. Waking up one day about a month and a half after surgery, and realizing I had lost about 18 or so lbs (about 8 kilo), and not that much of it was really muscle to begin with....it was enlightening, to say the least.

Another thing that stood out in my hospital stay, were all the heart patients on my floor who were obese or there for lifestyle related heart issues: blocked arteries, heart attacks, bypasses, stents, the list goes on. Having been through 2 separate OHS and going through rehab again now, just reinforced the fact that I do not want to go through that type of surgery ever again. Sure, technology is improving and they're getting less invasive every year, but having had a "minimally invasive" heart catheterization a week or so pre-op, I don't even want that again. Ever. Trust me, if you've never had to have one, be glad. All of these procedures suck on some level. If you can avoid them by choosing a lifestyle that gives you the best chance of staying out of hospital, then why not? I'd rather take my chances on staying out rather than having to rely again on my chances once I'm inside an OR.

Rehab update....

Well, so far, so good. Have been rehabbing per doctors orders, with swimming every second day, with an increase of 5 laps each time. Had a break of a week and a half, which was due to travel, but even then I was walking pretty much every day, all day, as I was playing the tourist (Paris and Stockholm are very pedestrian friendly cities) so, while not the same as swimming, I was pretty happy with how I held up, given the number of miles that were walked as well as suffering the cramped economy class (6'3" or approx 190cm doesn't make for the most comfortable of trips in those seats, at this stage of post-op) at various portions of the trip.

Happy with my weight too; when we travel, a lot of us, myself included, may tend to eat more, and eat more of the wrong foods. Luckily a) there was tons of walking, and b) the portion sizes in Europe are far smaller than in the US, so an entree/main course + dessert + glass of wine, doesn't destroy your calorie/kcal count for the day. Still I put on almost 1.5-2 lbs (almost 1 kg) which was a little disappointing, although not unexpected. Body fat is still around 19-20% so that hasn't changed much, and hopefully once the rehab gets into full swing, I'll start to put some muscle back on. 

Anyway, off to the gym.

Prison Quality Fitness: Learning to swim...again.

 

Well, today was the first day back in the gym. Limited to only 10 laps of non-vigorous swimming, but, hey, a start is a start. Swimming felt pretty good, although my left arm is still gimped up, and could barely manage the overarm stroke in freestyle. Breaststroke was easier, but the chest felt a little sore and tight muscle-wise. 10 laps went by fast, and even doing most of them via freestyle, still didn't feel the heart rate raise too much. Actually was surprised at how good the heart felt- it was  the rest of the body that seemed to give out on me.

Have to take a break of at least one day between swimming per my cardiologist, with an addition of up to 5 laps at each session, so lets see how this goes.

Just Sayings

"It's not how hard you can hit; it's how hard you can get hit and keep moving forward."

-Rocky

Week 10 post-op update

Well, went in to see my cardiologist today, and the news is pretty good: I'm finally cleared to easing back into the gym. Nothing too dramatic, mostly swimming to begin with, and he wants me to avoid consecutive days of exercise at this point. Basically, the typical post-op credo: don't overdo it. Pleased to say I've stuck with that 99% of the time, although it's been borderline stir-crazy here, sitting around, slowly getting better. On the flip-side though, I've seen and read about too many people who have gone overboard in doing too much way too soon, and the problems that have been the result. Of course you have the inspirational stories about people like the US soldier who ran/swam/biked a triathlon around 5 months post-op from aortic valve replacement. Impressive, but atypical. Most of us, even the fitter, younger ones, and especially the ones who have had re-operations, are more likely to have a longer recovery curve. Frustrating, but beats popping wires, clicking sternums, and going into a-fib. 

That being said, tomorrow is the first step on my plan to get build some prison quality fitness into this body. 

Slowly and responsibly of course......

On-X Valve update

Well, almost at the end of week 10 with the new valve, and things are going pretty well. Had a few setbacks early on, which all resolved pretty well (I'm still alive, aren't I? :) and the valve seems to work as advertised. One of the "benefits" of the On-X was it's reported lack of noise on beats relative to other valves. Initially, it was fairly quiet, but there were several situations where I could hear the 'clicking' fairly clearly; in bed before sleep, in a quiet room, after climbing the stairs etc. Even then it was fairly quiet, to where I wouldn't have minded if it made that level of noise perpetually, it's been a pleasant surprise to hear the valve get even more silent: within the last week, I've rarely heard it at all. I'm not expecting silence, but I can't complain with how little noise it's making these days. Pretty impressive compared to how much noise a lot of the older valves made. As one of my nurses put it "I used to be able to hear patient's valves standing outside their rooms in the hallway." Now, not so much.

Crash Cart Glossary: CHF

CHF: Congestive Heart Failure

See also: What is CHF?

The PQP program: Prison Quality Performance Program!

It's time to get into some prison quality shape!

Well, it's almost 10 weeks post-op now. The valve seems to be working well, getting quieter all the time, BP and HR look good, and all the recent doctor's appointments have been going well. With some luck, I should be cleared for an increased level of rehab at my follow-up with the cardiologist this week. The docs have been holding me back because of the issues post-op with inflammation, but I have still pretty much passed the point where conventional cardiac rehab would be useful ("You can go up 3 flights of stairs? The nurses in rehab won't know what to do with you!") given that the rehab in my hospital is geared more to patients who are having problems returning to normal activities, rather than getting back to the fitness levels that a lot of younger, more active patients might have been used to pre-op.  So, fingers crossed, I can get back into the gym pretty soon. So, lets look at some baseline numbers:

Crash Cart Glossary: BAV

BAV: Bicuspid Aortic Valve


See also: What is a BAV?

Crash Cart Glossary: AVR

AVR: Aortic Valve Replacement

My valve is the best valve in the world, all the other valves are for little girls!

Actually, I do think my valve is the best one for me, but that isn't quite the point of this post, although it does play a big role. If you have done any type of lurking/research/joined a forum, you tend to run into a couple of issues. Well, I call them problems, but lets be all PC and call them "issues". One of the major ones would be the fact that most valve performance information, graphs, comparisons, etc, showing how good each individual valve is, is found on the website for the manufacturer of the valve that you are researching. Not to say the information isn't good, but it would be shocking if the information presented isn't done in such a way as to make that particular valve look the best. Take my valve, the ON-X valve. Tons of great information, very impressive features, however, none of it is presented independently. Probably a little bias there, but who would blame them really; it is their valve after all. Same goes for ATS, St. Jude, and whoever else makes the little buggers. Then you have all the tissue valves, and their sites with impressive patient testimonials, so you can see where the confusion in picking a valve would lie. You want a cow valve? Right-mouse-click-link-cow is the awesomest! Uh-oh. So let's head to the forums! Surely we can get unbiased information there.

Crash Cart Glossary: OHS

So you've found out you/someone you know has a heart problem. Next, you hit the internets and log on to a forum with fellow heart patients/seekers of information on heart problems. And what's the first thing you're hit with? No, not a sense of relief at having found kindred spirits; it's the 'effing frustration at trying to decipher posts filled with countless, I mean countless, abbreviations. Think GenY is bad with the sexting, OMG's, LOL's, and ROFLcopters? You haven't experienced anything till you log onto a heart patient forum. Someone had an OHS for a BAV with an AVR and MVR with a St.Jude and a Ross Procedure? Twice? You have no f*cking clue what that means? Too bad friend, because no-one is going to explain it to you, so take your WTF and move along. 

You see, we heart surgery patients can't fit pictures of our surgical scars into those tiny avatars, plus we'd rather show picture of our cats and/or a margarita, so all these abbreviations are just a sign that we're a member of the club/forum. You get some degree of admission once you understand them, but we aren't going to make it THAT easy. So, having been though a couple of ops, as well as  finally working out what all those damn abbreviations actually mean, I'm going to share them with you.

Here's the first:

OHS: Open Heart Surgery

Yes Veronica, it is like learning a second language.

Clear!

Welcome to Crash Cart, a blog 'bout cardiac rehab, as well as a bunch of other heart related nonsense. None of this should be considered medical advice in any way, shape or form. What works for me, works for me; it may kill you, might end up killing me, and your doctor knows way more than I do anyway. If they don't a) run, b) when you calm down, get a different doctor.
I wanted a way to keep track of my own progress, and maybe someone else out there is going through someone similar and can benefit from the camaraderie. Plus, I'm generally too irreverent for the regular forums anyway....