Harris's Journal

Larry Beck  I had a MRI in January. I have mechanical valves and a pacemaker. . Now I'm scheduled for rotator cuff surgery in August. Very impressed that it's possible now to have a MRI with a Pacemaker. Not so happy about more surgery.

Rita Savelis  Sorin Biomedica bicarbon (made in Italy). Any commercially available mechanical valve poses no problem for an MRI.  No worries. 

Harris Chrysanthou  Thanks Rita for the reassuring information. Can we connect either on WhatsApp or somewhere else to share info on INR testing, surgeries etc?

Carlos Banuelos  Have not yet needed one but was told an MRI is fine with an On-X valve. I would confirm though to be certain.

Marie Myers  I think the main side effect (if you can call it a side effect) is simply the risk of bleeding from the anticoagulant. That is why monitoring of INR is so important. I am not sure there are many common side effects of life-long anti coagulation. Good question for your cardiologist or internal medicine doctor.

Chris Hall  I have a rare clotting disease and have been on blood thinners for most if my adult life. I have been on Xeralto for about 5 years but prior to that I was on Coumadin ( Warfarin) for about 25 years. It takes a while to get used to monitoring and understanding that everything you eat and every medicine you take may have an affect on that balance. As Marie pointed out, bleeding can be an issue. I have become a wound expert because I live a normal life and have never let blood thinners slow me down. Monitoring will be frequent in the beginning but once to level it will be less. I eventually used a home monitor. I hated everything about Warfarin but I'm here to tell you I wouldn't be here without it. Bottom line follow doctors orders, be prepared(car first aid kit) and live life and have fun. It will only be a pain if you let it.

Adam Pick  Hi Harris, Hmmm... Thinking back. I don't remember having that type of numbness. Let's see if anyone else experienced something similar. Have a great weekend!

Lynn Loudermilk  Hi Harris, I have numbess in my right hand and just a little in my left, they told me it was positioning during surgery. LOL I was hoping it would all be gone by now. I had this also before my neck fusion and it went away now it is back.

Harris Chrysanthou  Hi George! I asked my doctor the same thing and he prefers I do not undergo MRI's. He said CT scans are fine. What should I do?

Chris Hall  There's several good articles online that suggest that the magnet field is not strong enough to damage heart valves. But as always give your cardiologist a ring.

Rita Savelis  I have 2 mechanical valve. There's no problem having an MRI at all. I've had many. I do have to have a rhythmologist check my pacemaker though afterwards.

  Hello Harris, I had AVR one year ago and yes I have experienced some mild dizziness on and off after surgery. I think is normal but call your doctor and ask if it is normal for you. I hope you are doing well in recovery besides the dizziness. Keep us posted and be well. God bless you

Rose Madura  I don't know if it was related to the surgery or not but about 2-1/2 years after my surgery, I suffered terrible vertigo. I was diagnosed with BPPV and had a procedure done called the Epley Maneuver. It worked and I have not had the problem since. It is a good idea to discuss with your doctor.

Harris Chrysanthou  Hi Adam, thank you for the informative video. So basically, according to the website mentioned in the video a mechanical ON-X Aortic valve is not entirely safe in MRI procedures.

Marie Myers  Has this happened before, or is it new? The fact that you felt like fainting is a little concerning. I would say if it happened again, maybe the doc would want you to wear a heart monitor so they could see what exactly your fast rhythm is. Some rhythms are harmless, and some are a little more dangerous. Any changes in your medications since the heart rhythm issue?

Robert Osmachenko  I had an occurrence similar to yours about 2 months post op. I felt fine but the scope said otherwise. Anyways, the Emerg doctor monitored based on phone coaching from the cardiologist and I went home the next day. Since that time, I cut back on coffee to once a day, supplement with multi minerals, reduce calcium and supplement with Mg (before bed). Hopefully this helps you on your journey.

Alex Sigalov  Hi Harris, i have OnX valve 4 months post-op, i have been having palpitations issues alot since surgery, but feel like ig has gotten better over past couple of weeks, but more of skipping beats not pulse going over 100(i had this issue pre surgery), maybe u want to get this device it takes instant ekg and u can send to ur Dr. I do that when i feel funny https://store.alivecor.com/products/kardiamobile6l?variant=28007532101697¤cy=USD&gclsrc=aw.ds&&gclid=Cj0KCQjw4dr0BRCxARIsAKUNjWSJVsZCh-tp5tPFimQPO9QVpnCp9k918-Hy5DUcDGEcGS6KzEsIrmwaAryREALw_wcB

I also take 400mg of Magnesium Taurate, that helps with palpitations

Alex Sigalov  Harris can u takl out any of the chess and left arm discomfort if u had any general thoughts or concerns u have experienced at about 4 months. I sometimes too feel funny was supposed to get echo done but got canceled because of caronnavirus, and noone is doing appointments now.

Marie Myers  Your blood will be more likely to form clots with an INR below 2-3 in a patient with a mechanical valve. Warfarin increases your INR by interfering with a Vitamin K dependent clotting factor. So that is why eating a meal with a larger amount of Vitamin K (like a big kale salad) can decrease your INR. The Vitamin K in the kale actually counters the effect of the warfarin. If you regularly eat foods high in Vit K (which are healthy foods) you will figure out what your warfarin dose should be by regular testing of your INR. A normal INR is 1.1 or below. Having a mechanical valve increases the chance of a clot forming, so that is why warfarin is used on patients with mechanical valves. Newer research shows that the target INR might be safely lowered a bit in patients with the Ony-X valve since it may have less tendency to encourage clot formation than other mechanical valves. Obviously, when you are on warfarin, you will bleed longer when cut than a person not on warfarin. Not sure if I answered your question, but I hope that helps.

Harris Chrysanthou  Thank you Marie for your answer!
So when you say blood clots form, are these formed on the mechanical valve and might interfere with the functioning ability of the valve or are these clots formed anywhere in the body that might have the risk of let's say a stroke?

Marie Myers  The risk is clots forming around the mechanical valve, and interfering with its function. The clot that could form around the valve might then be circulated to cause a stroke or pulmonary embolus. One interesting thing I heard from a doctor was that if you suddenly don’t notice the “clicking” or “ticking “ noise that your mechanical valve makes, it could be that a clot is dampening the sound and should be investigated. I don’t know how true that is, but I thought it was an interesting idea. I guess the noise that the valve makes is, in a way, reassuring that it is functioning well.

Harris Chrysanthou  Is there any research on how long a patient can stay with a low INR and avoid clots being formed? I assume it depends on the age and physical state of the patient.

Rita Savelis  I have 2 (Italian made) mechanical valves and my INR range is 3 to 4.5 . I test about once a month (my surgery was 5 yrs ago). I prefer my INR to be in my lower range. My cardiologist prefers it in the high range (even over 4.5 is good for him). High means less risk of stroke.
My INR goes up and down and up and down as most peoples do.
I'd try to stay in range. The 2 times I've been in hospital (since OHS) my anticoagulants had to be lowered so I that I could have other surgery. It took weeks to get my INR back to at least 3. But they wouldn't let me out of hospital until I hit range again... My advice is to stay in range if you can, (even as you wish to be in lower range). I do hear you, though. And it's taken me years to be more relaxed with all this....

Marie Myers  One article I read from March 2019 indicates that an INR of 1.5-2.5 with an aortic Ony-X valve is safe if the patient has no other risk factors for clots. I know other studies are on ongoing . But I have no info on time frames for clot formation with low INR. Like you said, it may vary with many different patient factors and conditions, including hydration, activity status, and even smoking status.

Harris Chrysanthou  Thank you all for the useful information! I am taking 12mg of warfarin daily and it looks like my body filters the med really well.

CHALAH DiCESARE  Hi - the way I understood it - they just have to get the dosage right. When you change your eating habits then the INR will chg. They had told me - just try to be consistent w/ the veggies b/c some cause it to chg. So, if you're eating them pretty regularly, then it will stay around the same. I also had a bicuspid aortic valve replacement (11/2019) I chose a bovine valve mainly b/c I didn't want to deal w/ coumadin forever - probably will again at some point - but, I stopped a few wks ago. :) yay It's a pain - but, I imagine that you get in the groove and learn what you can and cannot eat or how much you can eat and still get away with it not affecting it too much. Anyway, good luck & take care!!

Alex Sigalov  Hi Harris if u have on-x in aortic position u should be able to go to 1.5-2 after 3 months postop, i discussed with my cardiologist and once I hit 3 months mark i will be reducing my warfrin intake to takget 1.5-2 range

Chris Calhoun  I eat 2 salads a week - take a 5 - on Mon , Wed and FRI and 7.5 the other days and slide right in a a 2.0 INR - Its not that hard just be consistent

Harris Chrysanthou  I am currently 4.5 months post operation and my doctors still recommend being between 2-3. I am currently taking 10mg of Warfarin per day except Wednesday (11mg). Looks like my body is filtering really well the med.

Alex Sigalov  Harris yeah i am only on 3mg going down to 2.5(or 2) next week. This out of On-x valve brosure brin it up to ur doctors sometimes they don't know all details
INDIVIDUALIZATION OF TREATMENT Anticoagulation – Adequate anticoagulant or anticoagulant/antiplatelet therapy should be administered. Selection of an anticoagulant or anticoagulant/antiplatelet regimen is based on the particular needs of the patient and the clinical situation. Patients with an On-X valve in the aortic valve position should be maintained on long-term warfarin anticoagulation which should achieve an International Normalized Ratio (INR) of 2.0 – 3.0 for the first 3 months after valve replacement surgery, after which the INR should be reduced to 1.5 – 2.0. Patients with an On-X valve in the mitral valve position or in multiple valve positions should be maintained at an INR of 2.5 – 3.5 continuously after valve replacement surgery. The addition of a daily aspirin at a dose from 75 to 100 mg is also recommended for patients with an On-X valve in any valve position, unless there is a contraindication to the use of aspirin. Studies show that stable control of INR provides better clinical results and that patients should be regularly monitored. The use of home monitoring to accomplish stable INR control is recommended.

Mike Henning  Eating and exercise affects your INR. When I started a low carb diet and daily bike riding I had to increase my warfarin. I have a home test unit and test every 2 weeks. All things need to be consistent. High hopes for the new On-x trial to stop using warfarin and use one of the new blood thinners.

  Hello Harris, keep watching your numbness and if you feel you need to see a doctor even if it’s just for your own peace of mind, go. I’m 2 months post op and have a mild pain on my left breast. Thinking about going to urgent or emergency care next week if it persists. God bless you

Chris Calhoun  I have numbness and tingling in different areas a lot - I have been ignoring it and just keep going - I have a tightness that will pop up near my left nipple quite a bit - If I went to the doctor every time - I would always be there it seems - I will say I felt like this before the procedure so not much has changed in that dept

  I still think you should tell your doctor you are experiencing these symptoms and get his or her opinion.

Chris Calhoun  Harris- Ana certainly is not wrong but only you know what you are willing to let slide and what warrants a trip to the ER - any updates?

Harris Chrysanthou  Hi guys, sorry for not replying but I am not getting any notifications of comments or updates. I have not experienced any numbness since then but I have started light weight training again - I hope it solves my circulation issue.

  Hi Chris, you are right. My issue went away and didn’t need to go anywhere. Took a couple of Tylenol and kept massaging with Eucerine Calming cream. Thank you for your post

Chris Calhoun  not sure how old you are but personally I think you should definitely be doing cardio - your legs are probably sore because you have been idle - I am on warfarin and do not think that is the cause - I am 4 months out and have been jogging for more than 2 months now - yes I have the clicking too - sometimes can be louder than others - all sounds like what I am doing - what is your ejection fraction? did you have the aortic valve done? I did went On X

Harris Chrysanthou  Hey Chris, I have been jogging for the past month and I usually walk around 5-6km per day. I don't know what my ejection fraction is and yes i also went with the aortic On X replacement.

Alex Sigalov  Hi Harris, i am only 6 weeks post-op also got aortic On-x valve, have not started running yet waiting for my first day of rehab tommorow so cant comment on that portion; Depending on my body position i hear clicking, especially when lie down or sit in certain positions(cant imagine what its gona be like when they make me run) what dose of warfrin are you on? Is that you thats on 10mg, i am only on 3mg, if you are on high dose maybe there is an effect.

Mike Roskowinski  Hey Harris congrats on 3 months! Things start moving fast. You will get used to the clicking sound over time. I am 9 months post surgery and hear the clicking and also can feel my stronger heart beat. Since I was monocuspid with my valve and the new On-X one is the biggest they could fit in I am sure my blood flow is a lot better. I wonder if your pain has anything to do with the bypass machine that was hooked up when you went through your surgery. I can still feel a little numbness in my leg where I was connected.

Harris Chrysanthou  Hey Alex so at 3 months post operation i am taking 10mg of Warfarin as my body filters the med pretty well. I am stable aroun 2.4-2.7

Chris Calhoun  Keep up the cardio - do what you know you can do but listen to your body if it says take a break - then take one

Susan Lynn  Harris - You may want to consult a dermatologist or plastic surgeon. I'm not sure how effective over-the-counter products are for keloid scars.

  You are doing great and congratulations. I know since I started walking again I have been feeling much stronger. Keep it up!

Harris Chrysanthou  Thanks Bradley and Ana! Walking or jogging or even stretching helps me allot, takes my mind off my heart operation. Highly recommended

Rita Savelis  Try to stay out of the sun for a year, and your scar color should evolve to match the rest of your skin.

Deepak Khanka  Harris,This is still happening to me after 5 months. When I asked
the same question Marie Meyers , one of our colleague in this
group stated that she feels after 2 years. You just get used to it . I guess with time mine’s gone a bit milder but still there. Did you go for a ONX?

Harris Chrysanthou  Yes, I went for the on x aortic valve. Does this limit you in any way when exercising? Or any activity involving deep breathing?

Deepak Khanka 

Hey Harris , I have had a David’s procedure. So won’t be able to comment much on ONX yet. However I will have a second surgery to replace my native valve some point. It will be a ONX. In due course I will be asking you questions about your new valve. I am sure there are other bloggers who might answer your questions

Mike Roskowinski  Hey Harris I am 7 months post surgery and I feel the same thing. I talked to my cardiologist and he said that it is normal after surgery cause you lose some of your insulation. It bothered me at the beginning but now I am used to it. I workout at the gym 5 days a week and play volleyball and other sports. You will get used to it.

Marie Myers  ever since my surgery in 2017, I have felt stronger, louder heartbeats than before surgery. I understand that this feeling is due to the loss of insulation and muffling provided by the pericardium and fluid in the pericardium. I understand that many cardiac surgeons do not close the pericardium at the conclusion of surgery to prevent an overload of fluid during healing . This overload of fluid is known as cardiac tamponade, which can impede the hearts pumping ability. It requires emergency intervention to fix with a pericardial window procedure. Also, the new valve is probably doing a more efficient job at pumping fluid, so you really do have a stronger, more efficient heartbeat. I really notice the stronger beat when I take a deep breath, or when I hold my breath. If I breath slow and shallow, I don’t feel it so much. After almost 3 years, I don’t notice the strong beats so much as I did in my early recovery. Hope that explanation helps!

Jeffrey Dyer  It does...one thing I noticed after my surgery is that the beat of my heart was more crisp. I can hear my heartbeat in my ears and when I'm exercising it gets louder and that's when I notice the crispness of the heartbeat more. I think it's the new valve actually closing and opening like it should. My old one didn't have that definitive open and close.

Meredith Bray  Good morning! My pre-op heartrate was about 50, and post-op was about 85-95 for about 3 months. 6 years later, I'm resting comfortably at about 65. So my experience shows yes, I did have an elevated heartrate after surgery.

Meredith
Clearwater, FL

Mike Roskowinski  Hello Harris. Yes I has elevated heart rate all the time when I got out. I talked to my cardiologist and he put me on metoprolo which helped control my heart rate.

Meredith Bray  Hi Harris, I had my bicuspid aortic valve replaced with an On-X mechanical in 2014 when I was 42 years old. I love my tick-tocker!

Carlos Banuelos  I have an on-x and my post-op resting heart rate was 10-15bpm more than before surgery. I’m almost 5 months post-op now and my resting heart rate is back to normal in the high 50’s. I think it just takes time for the heart to heal and adjust. Good luck.

Harris Chrysanthou  Thanks everyone! So it's normal for higher beats per minute in the first few months after the operation. Everything will get back to normal

Marie Myers  It is a slow process of recovery, but every day will be a little better. Best wishes for a full recovery!