Adam's Journal

Has anyone experienced or no anyone who saw a drop in their INR levels due to Covid-19? I have an On-X aortic valve and my INR is in the range of 2.0-2.5 I had my regular monthly INR test on July 23 which was 2.1 I then had symptoms on Friday night/Saturday for Covid and tested positive for Covid on July 24. I decided to check my INR again on July 25 and it had dropped to 1.6 My daily Warfarin is 7.5mg. I took 10mg on July 25. I checked with my Cardiologist on Monday and my INR dropped to 1.5 So they told me to take 7.5mg on Monday. I checked my INR again on Tuesday and it was still 1.5. So my Cardiologist told me to take 10mg last night. I tested again today and it was 1.6 Has anyone else who has had Covid experienced and on Blood thinners had a drop in their INR levels? I've done a lot of research and I can't find any information on Covid impacting anyone on Blood Thinners.

I wanted to provide a quick update after my 6 month check up with my Cardiologist on Friday. She said I'm doing fantastic and I've graduated to annual check ups now. My echo cardiogram looked great and my valve sounded good. I'm very used to taking Warfin and getting tested regularly. Being on blood thinners is just normal part of life now. It did take over 18 months plus for my chest pain to fully go away. I sill have some minor pain, but I also found out I have arthritis in my sternum, which is the root cause.

It has been a long time since I've updated my journal. I wanted to give everyone a quick status on my recovery now that it has been over 10 months. At this point, I’m basically back to fully normal prior to surgery. My regular workout is over 3 miles of interval running in under 45 minutes. After completing, cardiac rehab early, my nurse recommended that I should only do interval running going forward and limit my peak heart rate to 150 bpm. I try to run about 3 to 4 times a week. In November I ran over 17 times doing just over 50 miles. Unfortunately, I was working too much in December, so I was only able to get about 5 runs in. I’m starting 2018 out strong though with the goal to at least 15 runs in this month. I’m also back to skiing and trying to make up for missing the ski season last year. I’m doing normal chores and work around the house. I had a follow up appointment with my Cardiologist before Christmas. She said that everything looks great. My BPM, Blood Pressure and INR are all great. I’m scheduled to see her again in June and have another Echocardiogram at that time. She still has me on Metoprolol Succinate and Warfarin. I’m taking 7.5 g of Warfarin a day and my INR is staying between 1.8 and 2.2. Before my surgery, I was concerned about being on blood thinners, but they have just become a part of my daily life. I do watch what I’m eating, so I do not eat too many greens. I have had a couple of cuts where it did take a lot longer to stop bleeding but overall my concerns with bleeding have been put to rest. I can say that I’m not 100%. I still have chest pain at times with my surgery. My Cardiologist said because of my age, it may take over 1 year for my chest to fully heal. Usually it’s more of an annoyance, than anything else. Plus it always gets better with rest. For those making a decision between a mechanical valve and a bovine valve, I would strongly go with the mechanical valve. To know that I won’t have to have another surgery is priceless. I have gotten the nickname “Tick Tock” because it does tick and I can hear it at night. It is something that I’m completely used to now and it comforting to hear it doing it’s job. This is my final entry on my journal, but I’m more than happy to discuss my experience with anyone. Please just reach out to me and I’m more than happy to talk.

Each day continues to get slowly better. I am now able to sleep more on my side, but still struggling to get a full night’s sleep like I did prior to surgery. I am trying to limit my Tylenol intake, but I definitely still need to take 1 pill a couple of times a day to help manage the pain. My daily walks have now increased to 60 minutes and walking for over 2.5 miles. I also had an appointment with the nurse practitioner at my surgeons office last week. She said that I am recovering and healing great. She took out the 2 stiches I still had left from the drain tubes in my chest. She said that my heart sounds great and the best part was that she cleared me to drive again!!! She also gave me the ok to go back to work in a couple of weeks, so I’m planning on going back to work on April 3rd. That will be just 5 ½ weeks after my surgery. Thankfully I have a desk job and I will be able to work from home the first couple of weeks back too. My cardiac rehab will also begin this current week and I’m looking forward to starting the rehab process.

Thank the Lord that every day gets a little better. I’m still not back to my normal sleeping routine, but I am getting more sleep. I have been sleeping on my side a bit, but I do wake up sore and have to go back to my back. I did have a couple of nights which were rougher, but overall improvement this last week. I’m still only taking Tylenol when I need it, but I am trying to cut back on it as I can. I’ve increased my walking now from 2 30 minutes walks a day to a longer 45 minute walk. Yesterday my wife and I walked for over 45 minutes and completed over 2 miles. I’m getting close to my normal walking pace again. I saw my Cardiologist last week. She said that my heart sounds great and that my murmur is completely gone. The On-x mechanical valve is working well and my INR has settled nicely at 2.2. I’m now on track for only having my INR checked once a month. My blood pressure is still higher than it was prior to surgery, so I will need to continue to monitor it for the next month. She stated that I may need to add a blood pressure medicine if it does not come back down to pre surgery levels. I’m now scheduled to have a follow up appointment with her in June and a Echo Cardiogram prior to my appointment to see how my valve is functioning. For those considering a mechanical valve. I am 100% comfortable with my decision. Given my age of 44 and still a very healthy and soon to be very active adult, I am very happy with the decision. The #1 concern I had was being on blood thinners the rest of my life. So far, at least when I’ve been poked for blood work, I haven’t bled any worse than I did prior to surgery. Granted I haven’t had a skin cut yet, but I don’t expect it to be bad when I do in the future. Prior to my surgery, I was not on regular medicine, so that is a life style change for me. However, for those technology savvy, I purchased an Apple Watch and have an app to track my medicines. I also use Apple Health app for my vitals to track my average heart beat and record my blood pressure numbers. I also have it set up as my Medical ID bracelet, informing anyone if I was unconscious that I had an Aortic Valve replacement and my current medications. The other thing with my mechanical valve is that I can hear it at night. This does vary per individual, but I can now here my valve at night when it is very quiet. I’m getting used to it and it’s not very loud. My wife can occasionally hear it at night too. The other thing to consider is that I can feel the valve working as well. It’s not constantly, but there are times through the day, even at rest, when I can feel the valve working in my body. I think part of it is still around the sensitivity of my chest and that’s why I can feel it. This is just something else to be aware of. As for my migraines, they have continued to improve. Thankfully I have not had anything near as painful as that first week. I still had a couple of minor ones this week. I’m also experiencing just a couple vision auras with no headaches. My Cardiologist confirmed with the change in my blood flow from the new valve, she is not surprised I was experiencing migraines as the blood flow has changed and my body is trying to recover and adjust to the changes. I’ve also noticed that I’m colder now than prior to surgery. Prior to surgery, I would get hot and sweat in places where everyone else seemed normal. After surgery, I did go through some hot and cold swings. Now that it’s been 3 weeks after my discharge from the hospital, I’ve noticed my body temperature is now stable. I’m now colder during those times in the past which I would be warm or sweating. I have noticed that my feet and hands get colder now. I also attended church again for the first time yesterday since the surgery and I was really cold in church. Our church tends to be colder and some people wear jackets, but I was usually just fine in the past. Now I need to start bringing a jacket with my Bible to church. This week I meet with my Surgeon for my 1st follow up. I’m excited because I’m hoping he will clear me for driving and restarting some of my normal activities. I’m also following up with my primary doctor. Then next week I start my Cardiac Rehab program.

I’ve been consistently sleeping in my bed now. My challenge is that I’m still not sleeping like I was prior to surgery. I’m getting a consistent about 7 hours of sleep, but I’m a side sleeper, so it’s been difficult for me to sleep like I used too. I’ve also been working my way off of the pain medications. I worked my way down at the end of week 1 to just taking Oxycodone at night. I’ve now cut out Oxycodone completely. My last Oxycodone was on the night of March 6th. I’m now just down to taking Tylenol to help control my pain. My migraines have also gotten better. I was still having visual auras and some minor headaches but still nothing in comparison to the first week at home.

MOST CRITICAL. Have someone with you at least the first week after surgery. Thankfully my wife is huge blessing and she has been able to help take care of me. She was a huge help for me in the hospital to help me get in and out of bed. Once I got home, she was more critical to help me that first week, because I just could not do a lot of normal activities. Your surgeon and staff will ensure that you have a post hospital support plan, but this is critical for your continued recovery. MUST/NICE TO HAVE – If you can afford, I would highly recommend an electric recliner. My friend from work, Stephen Phayre, also had the same surgery in December, highly recommended that to me. Fortunately Costco was carrying them at the beginning of the year. I was able to pick one up and it was a life save my first week at home. I slept in it the first week and it made my life so much easier to be more independent the first week at home. One thing I failed to mention when I left the hospital, I had actually lost 10 pounds from when I went in for surgery. Monday, Feb 27th was a very slow and easy day at home. I spent most of the day in my electric recliner. I did not need any medical assistant devices when I go home. I was able to slowly move from my recliner to the bathroom with no issues. I did go upstairs on the first day. We have a total of 16 stairs and I was able to make it up and down them successfully. I took it very slow and 1 stair at a time. Tuesday, Feb 28th was a set back for me. I ended up having one of the worst migraines in my life. I started having migraines back in 2014, but on that day it was one of the worst I had ever had. To me it was worse than the surgery. I happened to have an appointment that day with my Cardiologist to test my blood for INR. The nurse checked me out and followed up with the surgeon’s office. They said that I was ok and the migraine had nothing to do with the surgery. Fortunately it did not last more than a day. I did have some minor follow up migraine and vision issues later in the week, but they were all minor. As the week progressed I continued to walk more and become more mobile. By the end of the weekend I was walking about 2 times a day for 20 minutes each. I also was able to move better around the house. Also by the 6th night home, I started sleeping back in my bed. I am able to get in and out of bed by myself, but I still have to be careful and it is still painful.

After getting settled in my new room on Friday, I was much more mobile. I realized how painful and sensitive my chest and incision area. It is critical to listen to your Doctor and medical staff to follow all of the sternum precautions. My heart pillow was becoming my best friend with any movement. Getting in and out of the hospital bed was the most difficult and I wasn’t able to do this by myself. I had to have my wife or the nurse be able to help me get in and out of bed. Fortunately I do have strong legs so getting in and out of the chair was much easier and I could do that by myself. I was able to take my first walk on the floor that day. I was also eating normally again had a great lunch and dinner. At this point on day 3 I was able to go to the bathroom, but not all function had completely returned. I was able to take my first shower post surgery which felt great. The nurse and occupational therapist were able to cover what movements I could and could not make after surgery. Saturday – I still was not sleeping well in the hospital, but each night I was able to get more rest. That Saturday, I was able to eat breakfast, lunch and dinner. I also able to go to the bathroom, which was finally returning to normal. I saw the physician assistant and she said that my heart and everything else looked great at that point. The only thing holding me in the hospital was my INR level. On Saturday morning I was only at 1.1 and I needed to be greater than 2.0 before I left the hospital. The rest of Saturday, I took a nap and did a couple more walks in the hallway. Sunday after surgery, I woke up and they did my morning blood draw for my INR test. I was only 1.5 at that point, so unless I had a huge jump during the day, I would probably have to spend one more night. On Sunday, I was feeling better. I ate breakfast, lunch and dinner. I had my daily shower, and I was able to sit in the chair most of the day. I also was able to take multiple walks and continued to work further each time. Monday after surgery they took my morning blood draw and let me know my blood levels finally reached 2.8 for my INR. I was ready to go home. The Physician Assistant that morning came in and reviewed with my all of my post hospital routine. Swedish also has a great program, with a homecare daily checklist for things to complete. I go my discharge papers and list of my new prescriptions I would be taking for at least the short term period. My wife arrived at the hospital and I was finally able to leave the hospital on Monday Feb 27th.

According to my wife the surgery lasted about 4 hours. They brought me up to my ICU room and I really don’t remember much after I woke up. I definitely don’t remember waking up with the breathing tube, even though the nurses were pretty concerned I would struggle to take it out. My wife told me after I woke up initially, the nurses asked me a series of questions. They also asked if I could lift my head, which I did and they then immediately stated it was ok to get the breathing tube out. I didn’t remember much from that first afternoon in ICU. I was still on a lot of drugs and it was a matter of starting the recovery process after surgery. I did sleep a little bit the first night in ICU, but it was difficult because the nurses kept checking on my getting vitals and giving me medicine. I was up early on Thursday morning. At this point I still had my catheter in as well as my 3 drain tubes. I had 2 drain tubes in my chest and 1 drain tube in my groin. I also had the IV in my neck. Dr. Barnhart came in on Thursday morning to check on me. I asked him how bad it was when they opened me up. He said that my heart was definitely enlarged and he found I did have a bicuspid valve. He also mentioned that one of the leafs positioned below the other leaf which was causing the Aortic Stenosis. He did confirm he replaced it with the On-X mechanical valve. He said they completed the echo cardiogram after it was put in place and my heart was restarted. He said the echo cardiogram looked great and blood was flowing as expected. The rest of my second day in ICU was slowly recovering. I was able to get up and move to the chair in the room. By the afternoon, they started removing different things in preparation for me to move out of ICU. They removed by catheter and then the IV in my neck for just my heart. That surprised me because it was about 8 inches long. Then late afternoon they removed the 3 drain tubes. That was the most pain/strange feeling to have the drain tubes removed from my groin and chest. Once those were removed I then had dinner and they were prepping me to move to the cardiac rehab floor. However, I ended up getting worse on Thursday evening. The pain in my chest was becoming intolerable and it was becoming difficult to breathe. The nurses kept reviewing all of my vitals and everything looked great. They brought in the “charge” nurse to help evaluate my pain. They decided because I was in my 40’s they could give me an anti inflammatory drug. Once they I started feeling relief in 15 minutes. I finally started feeling a lot better and was able to get to sleep around 10 PM. I woke early again Friday morning in ICU. My chest did feel a lot better after they gave me the anti inflammatory drug. My ICU day nurse came in and was happy to see I was feeling a lot better. They finally had a room open on the cardiac rehab floor to get me moved to. My nurse then wheeled me up to new room on the cardiac rehab floor.

I woke up around 4:30 AM on the day of my surgery. I took my last shower with the surgical soap. I then applied my ointment for my nose and rinsed with the prescribed mouthwash. I took my small bag of things for the hospital and my wife and got an Uber to the hospital. We checked in at 5:30 AM at the registration desk and then we headed back to the waiting area for pre operation. The pre operation nurse came to get my wife and I to start the preparation for surgery. The pre operation nurse was fantastic. I was able to change into the hospital gown, put on my nifty hospital socks. Then we started all of the pre operation readiness. She got all of my vitals, and prepped me with one of my IV’s. Then the assistant came in to shave me. I was expecting my chest to be shaved, but I wasn’t expecting the rest of my body. She shaved my body from head to toe. After she was done shaving my body, Dr Barnhart came in and checked to see how I was doing and asked if I had any last minute questions. I was ready to go and get the surgery done. Finally the anesthesiologist and his assistant came in to explain the next steps. My anesthesiologist told me that he would also be putting an IV in my neck which would allow him better control for stopping my heart during the surgery. He reviewed all of the risks with anesthesia and then we were ready to go in to the operating room. I kissed my good bye and they wheeled me out to the elevator. They then wheeled me into the operating room which had at least 5 nurses and staff waiting for me. They got me moved over to the operating table and then my anesthesiologist put the mask over my nose and asked me to take deep breaths. I think I remember taking 5 breaths before going out .

Starting the Sunday prior to my surgery, I had to begin pre-surgery daily activities. That Sunday was the last day I was able to shave and also do any nail care. I also needed to take a shower using the “Surgical Soap” over all of my body. The other activities, is that I needed to ensure my PJ’s were clean every day and I also had to have clean sheets on my bed every night. On Monday, I just showered with the surgical soap and also ensured I had clean PJ’s and bed sheets. Tuesday, the day before surgery, we were able to enjoy one last night out. Since my surgery was a Swedish – Cherry Hill location in downtown Seattle, my wife and I stayed at the Sorrento Hotel only a few blocks away from Swedish. We also booked the hotel for Wednesday and Thursday night so my wife could stay downtown and not have to drive to and from the hospital each day. (This ended up being one of the best decisions with the surgery) It made it simple to just catch an Uber the morning of the surgery, since we needed to check-in by 5:30 AM. The night before the surgery, I had to take another shower with the surgical soap. I also had to apply prescribed ointment for my nose and rinse with prescribed mouthwash.