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.