Kathy's Heart Valve Journal

Well... I have learned something. When your INR is the same reading 3 months in a row (both on my machine and having the lab do it), something bad will happen. My cardiologist said that they firmly believe that a blood clot formed on my valve, then broke off and lodged into my coronary arteries, hence the heart attack.
So, after having both a TEE and a heart cath/angiongram yesterday, I got released from the hospital. Now I have a new, higher dose of Coumadin, and some lovely (NOT) lovenox injections. Those injections should be BANNED! The shot itself is not bad, it's the fact that the medicine BURNS as it's being injected! Richard is proving to be quite the nurse - he gave me my shot while I screamed. And he has been at the hospital every day while I recuperated. I will take the shots until Friday morning, then go in & have my INR tested. If my INR is in range, no more shots. INR not right, more shots & retest Monday. I found out that the Lovenox protects my valve from getting blood clots until my Coumadin level returns to acceptable levels.
New game plan... higher dose of Coumadin and aggressive monitoring until we find the right dose. Now that this little escapade has more than likely met my deductible and out-of-pocket, I should stock up on strips for my INR monitor. I will NOT let this happen again!
Once again, I have been blessed with an awesome husband, a great mom, and some truly wonderful friends. Sorry I left you hanging, Fran!
And yes, should there ever be a next time, I will have the ambulance take me.

Well... Just when I thought everything was going great, this past Thursday night I had an experience I hope never gets repeated. I had just gotten home from work and was getting settled in front of the TV. All of a sudden I feel a very intense, crushing pain in my chest. It continued for quite some time, accompanied by a feeling that my heart was going to explode from my chest. I sat down in hopes that the pain would subside, and then laid down trying to get the pain to quit. It didn't, and in fact it was gaining in intensity and had radiated down my left arm. So I decided that this was something that needed attention ASAP. I wasn't feeling dizzy or lightheaded so I thought I would be OK to drive myself to the ER. I got to the ER and of course when you state you're having chest pains they get you back so fast it's unreal. Before I knew it I had an EKG slapped on me and was chewing 4 baby aspirin. I had called Richard & was talking to him all the way to the ER. He was on his way to Tennessee to deliver a load and turned right around and made his way back to Tulsa. He had also called my mom & stepdad and they were en route. After my EKG, blood draw (to test cardiac enzymes) and chest x-ray, i got wheeled into a hallway to wait for at least 3 hours to see a doctor. Finally saw the ER doc around 9:30pm. I don't think he knew what a mechanical aortic valve is supposed to sound like as he said I had a murmur! Anyway, they admitted me to the hospital for overnight observation. Saw my primary care doc Friday morning & he said that it appeared that I had had a very mild heart attack. He then consulted with my cardiologist. Cardiologist then said he wanted me to have an echo & CT scan of my lungs (to rule out any blood clots). He also said that I will more than likely have a heart cath on Monday if the CT scan & echo were inconclusive. Meanwhile my blood pressure had been spiking, and when the ER people took my INR it was 1.8.
It's now Saturday. Saw cardiologist covering for my cardiologist who said the CT scan did NOT show any blood clots (Praise God). He thinks it might have been a piece of "debris" ( he would not elaborate on that) from my valve may have gotten lodged in a coronary artery. So, now I am to have a TEE on Monday, and if the valve is fine then I get a heart cath on Tuesday.
Has anyone had a similar experience? I'm wondering how "debris" from my valve could happen. I think it may be some scar tissue.
They are keeping me in the hospital over the weekend. I have been attached to a heparin drip (oh joy!) so I have my IV pole as a companion everywhere I go. They have encouraged me to walk a lot.
Stay tuned for further developments as events warrant.

Well... After about 6 months (since June) of trying to get an answer from the insurance company as to the real reason my cardiac rehab was denied, I FINALLY get a response - the hospital used the wrong diagnosis code! So, I have called the hospital & told them to rebill the claims using the correct diagnosis code. I am a certified medical coder so I am familiar with coding rules, which the hospital did not follow. So, we shall see if they submit the corrected claim.
In other news... I was approved for an at-home INR monitor! I had my training on it this morning. Very easy to use! Now for the interesting part. I had been on monthly monitoring and went to the lab on Wednesday (12/8) for my last one (since I have the home monitor now). My INR was 3.2. TOday, when I tested on my new monitor, both times my INR was 4.6! EEEEKKKK!! I called my primary doc & spoke to the nurse on call (my doc's office is closed on weekends, of course). She had the doc on call (my primary doc is in a group practice) look over my info. I am to not take my warfarin (generic of Coumadin) today or tomorrow & call my doc on Monday. I am wondering about 2 things here: 1) is the monitor calibrated correctly? and 2) what would cause such a dramatic jump in 3 days (with NO changes in routine or diet)? Actually, make that 3 things I am wondering about - 3) how much does my INR fluctuate between monthly testings? All those months I was on monthly testing it could have fluctuated and I would not have any clue whether I was in target range or not. This Coumadin business is SCARY! Anyone else having this issue?
And finally --- I marched in a Christmas parade last night. 2 miles and I wasn't winded! I am so amazed at how much better I feel now than I did this time last year!
Hope everyone has a safe & enjoyable holiday season!

The fight has begun. My insurance is denying all of my cardiac rehab because according to my EOB (explanation of benefits) "the service is not a covered benefit under your plan". If I had known that I would have a fight on my hands, I would have never done rehab as it is much cheaper to go to a gym as what rehab will cost me. Rehab will cost me $116 per session, and I had 36 sessions. If my math is correct (and I question myself because I have a horrible tendency to transpose numbers) that's about $4000, roughly.
I got my first EOB from my insurance stating that my sessions in June were not covered because they were beyond the 12 week period I was supposed to have them in. Then I got another EOB stating that my sessions in May (which were within the 12 weeks allotted) were denied because of the reason stated in the above paragraph. I have a feeling April & March will be denied as well -- watching the mailbox daily for yet another denial EOB.
I verify insurance benefits for an outpatient surgery facility here in Tulsa, so I know what to ask the insurance regarding coverage. I contacted the person who verified benefits for cardiac rehab & she told me that my particular insurance tells patients their rehab is covered and then comes back and makes the PATIENT prove that cardiac rehab is medically necessary! So... now I have to contact my cardio's office and get my clinical records and notes stating that I needed all 36 sessions of rehab! I am surprised they even approved my surgery! By the way I have a PPO as opposed to an HMO. I want to be able to go to any doctor at any time & not have to wait for my PCP to say it's OK.
I have a feeling that is also why my insurance is fighting me getting my own PT/INR machine - they don't think it's medically necessary.
I want to know the logic of making patients themselves prove that the treatments & procedures they need are medically necessary. 99% of patients are not savvy enough to know the medical field. I realize doctors are under so much pressure for ridiculous lawsuits so they order way too many unnecessary stuff, but come on! I feel for many of the elderly patients I deal with. They don't understand all the insurance and medical stuff - they just put their trust in the doctors to know what's best for them. And then they can't understand why they have such high bills.
Geez!!!!!
OK... enough ranting for now. Anyone else encountering flack from their insurance over your procedure & follow-up?