Raj's Journal

1 year surgery anniversary today. I can’t believe it’s been a year since my mitral valve repair - and it’s been a long time since I posted. But I wanted to share with everyone in this community my good thoughts and wishes for your own journey! For me, I am back to doing pretty much everything I was doing before - but with a greater sense of perspective and “seize the day”. I guess heart surgery does that for you. To celebrate this heart-a-versary I hit the road bike hard - 75+ miles/7000 feet of climbing - on this beautiful fall day in the MidAtlantic. I did something similar 6 months out, and am ever grateful. So yes, surgery is scary, and the recovery is never linear nor lock-step - but it is amazing what the docs can do when they find this thing and fix it.

When I went under the knife six months ago, my cardiologist said “within six months you should be able to resume your prior level of activities at the same - if not better - level of intensity”. As a lifetime endurance athlete, I was skeptical - and curious. Also very focused - and hopeful - that the mitral valve surgery would take care of something that was posing a material risk to my health and longevity. My near term aspiration was to be able to get back on the bike and knock out long, hard rides without feeling poorly. So here we are, six months out, and I am coming off a weekend that included a fantastic early season century with over 100+ miles/10K+ feet of climbing - all at a vigorous and challenging pace - I think 6.5+ hours of riding with an average HR ~ 145 or so (with some peaks on the climbs well above that). And as it relates to my heart - I didn’t notice it one way or the other. It did what it had to do and then some (although my legs were feeling it as we entered the seventh hour of riding). All of this is a long winded way of saying: “trust the process, trust the recovery” and believe it or not, you can get back to what you were doing, and perhaps “and then some”.

Hi - I’m 3 months post mitral valve surgery - recovery (exercise, eating, sleeping etc.) has gone well - but wondering from others if the frequency of odd-ball “sternum pain” (not by the heart, and not necessarily by the incision) has been something that folks have either gotten used to, or something that has receded. My cardiologist mentioned that patients who had the mini-mitral (through the right side) tended to have a lot of nerve pain that came and went - but my context and experience is only 3 months - so wondering if others can chime in.

Today is one month post surgery…had my “final” check in with the surgery team last week and they saw the incision, reviewed the chest x-rays, and in general, gave me the thumbs up (“looks great - we hope we never have to see you again!”). I have my cardiologist follow-up in one week’s time. Question for those who have had this surgery - and in particular the mini (through the side)…while the incision itself is healing, have others experienced what feels like an intense/painful “pulling” during certain motions (for me, it is reaching down with my right arm to pick something up) - it’s something that has sprouted up recently. Wondering if this is a function of becoming more active as the overall OHS recovery progresses? Other than Tylenol and stretching/heat etc., anything to do here?

Hi all - 3 weeks post surgery and day by day, feeling better. I am able to go for walks, ride my bike, do PT etc. One thing I have noticed though is that my resting HR is decidedly higher than it used to be (and this is with me cutting back to 1 cup of coffee a day - only in the AM). I am probably +15-20bp or so vs. levels pre-surgery (which was quite low - mid 40s). My cardiologist has taken me off beta blockers (which feels great) and otherwise I feel pretty good, but wondering from others: post surgery, is it normal to have a higher base rate for resting pulse? Or is this something that settles back down to pre-surgery levels over time. FWIW, there is no adverse fluid retention etc. (weight has been very consistent). Seeing the surgical team later this week for my official post-op visit so will hopefully learn more than but this forum has been a wealth of information so wanted to try here as well!

My cardiologist has given me the green light to stop using Metoprolol based on results of my post op echocardiogram, and review of my vitals (daily weight, HR stability, BP etc.) since discharge. Anyone with real-life experience on what discontinuing this type of medicine does? Beta blockers are new to me (have typically run with low resting pulse and low blood pressure) so any insight would be helpful.

I’m a bit over 2 weeks post-op and per PT (and cardio team) recommendations from last week, was given the green light to “increase exercise intensity within pain tolerance”….so I decided to eschew the indoor bike and went outside for a bike ride as it was such a beautiful (Sun)day.

Impressions:

- surgery takes a lot out of you! Between the overall physical trauma, there is some serious musculoskeletal tweaking that occurred while I was prone on the operating table. The minimally invasive approach has afforded me good range of motion post-surgery, and the incision is healing very well, but the upper body connecting parts (shoulders, ribs etc.) will take a while to get back to normal I think - nightly stretching helps a ton
- beta blockers are weird! I was put on Metoprolol post-surgery to prevent against arrhythmias (which I have not experienced yet). As such, my upper HR band is quite limited (~130s vs. easily 160s pre-surgery) so adapting to this new medicine is an interesting process (never rode my bike up a hill with a HR “governor” before … different types of muscle fatigue with this new wrinkle). I am hopeful that the docs can modify this dose or the actual drug
- being outside is great, and I am ever grateful! My severe mitral valve regurgitation was caught by my excellent cardiologist as part of my yearly work-up. I am curious to see where I’ll settle in physically as the recovery progresses

Good luck to all those facing surgery soon…this is my week 3 and it’s startling how much better I feel vs. the first day+ in the ICU and step down unit. The body is an amazing machine….

2 weeks post surgery now (mini for mitral valve repair)…I saw the medical staff for my first post-op check-up and all seems to be working…incision is healing, no material water retention (weight stabilizing to pre-op levels), heart rate stabilizing (maybe +10-15bp from what it was before - which was way low) and blood pressure in an ok range (ok, a little low but they think from the new daily dose Metropolol - which is a new med for me).

Per the guidance from my PT, I’ve also been encouraged to ride my indoor bike daily, ~30min with a cap at zone 2 (today I was in the 115-120bpm range as a frame of reference), in addition to outdoor walks when/where possible.

In today’s meeting with the medical and cardiac surgery staff, they also gave me the “ok to exercise at increased HR and use ‘pain as guide’ for intensity”. When I pressed for details, they indicated that this means I can go outside (Vs. indoor bike) and let the HR drift above zone 2 (for me that’s into the 140s/150s).

I finish the pain meds tonight and will likely return to the indoor bike again tomorrow for a longer (but still zone 2) session - no use pushing it as I am still building up my strength/getting lots of sleep in!

However, I am curious to hear from other valve patients on their return to “more rigorous” exercise given the guidance I’ve gotten above (“pain as guide”). I figure that means that if my HR drifts into zone 3 (say going up a hill on the route, or increasing resistance on the trainer) that’s ok? Any real life insight….I’m all ears (and in no rush, BTW to ramp up anything given that the seasons are turning here anyway and it’s time for base miles…)

How long does it take for resting pulse to settle back down to pre OHS levels? My RP has been low (40s) forever - given many decades of endurance sports. It’s a little weird to see my baseline RP now in the 60s+. From what I understand, a higher RP post-surgery is par for the course given the trauma etc. associated with OHS (even if minimally invasive - as mine was), but I’m wondering what others have observed post-surgery. Thanks

Milestones…Post minimally invasive procedure for mitral valve repair…what are the typical milestones that folks crossed on their return to “normal”? And are there yardsticks of how one “ought” to be feeling/able to do 1 week out, 2 weeks out etc. in the general recovery process?

Ups + downs on recovery path…Hi, back home from hospital (8 days now since heart surgery) after minimally invasive mitral valve repair…they released me on the early side (<72 hours) after repair (not replace) and going in from the side (vs. down the middle). My question is for those further down the recovery path as me and your insight on the progress of recovery. Specifically, I feel that 80% of me feels like 100%…and there’s 20% that sometimes feels like 0% or less than zero (say -20%). Specifically, I heard some anecdotes that procedures through the side have the potential to cause more lingering nerve pain etc. especially for the narrower/smaller statured, given the path (through muscle, fat etc. right-to-left) of the surgical tools and drainage tube? Today was also the second day of an in-home visit from the PT nurse who worked my upper body/arms (lightly) with rubber bands and about 1/2 hour after he was done the static localized pain (top of chest etc.) was quite different/higher than days before, and not at all localized to the incision. Sound similar to anyone? I also made the mistake in hindsight in waiting until after the session to take my regular pain meds vs. managing the “break-through” earlier on. Any insight folks have - all ears.