For Crabcakes, please: Aortic Valve Replacement

Posted January 8th, 2009 by
Categories: straightguysca.com

Hi 2CC A friend of mine who's nearly 80 had surgery last Monday (Jan 9) and it seems likely that he will be released from hospital on Sunday (Jan 15). He lives by himself although he's got friends and family nearby. I am concerned that he should take very great care of himself until he is fully recovered. Can you list any of the less obvious things that he should do over the coming weeks? (He won't be driving, running or lifting heavy weights, I hope.) Would it, for example, be useful if I got him a BP Monitor? All the Best Bryan

Some further thoughts: His bedroom, bathroom and toilet are upstairs. Maybe I should encourage him to sleep downstairs but he would still have to climb the stairs for his daily needs. I had thought of giving him a mobile phone but he's not at all techy and I doubt if he would be able to use it, especially in an emergency. B

I've just visited him, briefly. He was very tired today. I met one of his daughters as I was going out. She told me that he is going to move in with his partner initially which is better than nothing (just). The crazy thing is that there were two layabouts in the ward, walking about fully dressed. They were obviously in better shape than he is. BUT the hospital cannot discharge them until they find a Social Security placement for them. That's the UK for you.

Hi Steph Many thanks for your kind thoughts. He's sure got plenty to read already and I took a new book in for him yesterday. My worry is that he will do something stupid. It's ever so easy to take a tumble. All the Best Bryan (Oh yes I took some 'Superman' pyjamas in for him today.)

Hello Bryan! I?ve been worried about you!! You?ve been away for a long time! It is WONDERFUL of you to be concerned for your friend. Too often the elderly in this country (US) get neglected. I myself care for two elderly women ? taking them to the doctor, helping with meds, etc. You've received some good tips from the commenters already! Here are some more, some elaborate on the comments, and others are ?fresh? --Medicine boxes: Something like this, with a different color for morning, noon and evening. Label them with marker ? Morning, Noon, Night, for example. There are all kinds- look for one that is simple for arthritic or feeble hands to open. It?s actually easier for the elderly with a memory problem to have a separate box, of different colors, than one large box.: http://www.forgettingthepill.com/organizers.html http://www.elderdepot.com/customer/home.php?cat=398 --Slipper Socks with gripper bottoms (no skid) http://www.landsend.com/is/image/LandsEnd/81450_AE04_M1_RAG009999_M.jpg http://www.seniorsinc.com/non_skid_slipper_socks.htm --Seat for the shower: http://www.allegromedical.com/bathroom_assists/shower_chairs/invacare/careguard_shower_chair_with_back.P214503 --Soap on a rope (If he prefers soap versus liquid shower gel). Get a bit longer ribbon and tie it to a grab bar (if he has one) or someplace where he will be able to easily retrieve the soap should he drop it. (Grab bars are an excellent fall preventer) http://www.amazon.com/exec/obidos/tg/detail/-/B00021WMUI/sr=1-2/qid=1137206749/ref=pd_bbs_2/002-1719235-3304824?%5Fencoding=UTF8&v=glance --Grab bars http://www.ameraproducts.com/store/product.aspx?ItemID=527 http://www.bedbathstore.com/safetyitems.html --Good gripper bathmat (One that won?t lift up from the tub floor when wet) http://www.bedbathstore.com/tubmatsafinb.html --Raised toilet seat http://www.elderdepot.com/customer/home.php?cat=271 More bathroom tips: =================== TUBS/SHOWER equipment can be adapted to improve both safety and independence. Use hand-held shower heads, long handled sponges, simple tub benches and skid-proof rubber mats. Shower curtains are safer than shower doors. TOILETS can be installed with a wide variety of enhancements to improve safety such as simple grab bars or specially-designed commode chairs. PIPES that are exposed should be insulated to prevent burns and scrapes. This is important if you have toddlers who can squeeze into small places. FAUCETS can be converted to a single lever handle. Some even operate with a sensor eye so you don't need to use your hands at all. SKID-PROOF RUGS or rubber mats are recommended for the floor in front of the sink to avoid slipping on wet spots. In general ========== Falls in the home are a leading cause of serious injury, especially among the elderly. Have a doctor check hearing, vision or foot problems. Many of these problems increase your danger of falling. STAIRS AND HALLS must be well-lit at all times. Illuminated light switch plates make it easier to find light switches; they are inexpensive and easy to install. Use sturdy handrails when walking down steps; consider installing handrails for hallways. Tack down loose carpeting everywhere in your home, especially on steps. Consider removing lose throw rugs from your home because they can easily cause you to fall. FURNITURE should be carefully arranged to provide plenty of walking room. Use chairs with strong backs and sturdy armrests and tables with four legs (not tripod or pedestal tables). There is more on this site: http://www.mageerehab.org/education/article5953.html and here http://www.pamf.org/patients/falls.html Make sure your friend has a thermometer he can easily read, as he will want to check his temperature for signs of infection. Avoidance of infection is critical in valve replacement patients. Should he need any dental procedures, he should be put on antibiotics before the procedure. (His dentist and doctor will advise him of this). If he is put on Coumadin/Warfarin , a so-called blood thinner, he will need to adjust his diet, be sure other medications don?t interfere, use an electric razor and try to avoid getting scratched or scraped. Coumadin patients are advised not to use tools or put themselves in a position where they may suffer a wound. (More on this further down). ?After successful aortic valve replacement, patients can expect to return to their preoperative condition or better. Anticoagulation ("blood thinners") with a drug like Coumadin may be prescribed for 6 weeks to 3 months after surgery for those with biological valves, and for life for those with mechanical valves. Once the wounds have healed, most patients should experience few if any restrictions to activity. A patient will require preventative or prophylactic antibiotics whenever having dental work, and should always tell a doctor about their valve surgery before any surgical procedure.? http://www.sts.org/doc/3620#10 ?It will be very important for you to be up and around as soon as possible. Most patients may be able to sit on the side of the bed the evening after surgery and sit in a chair the following morning. Your nurse will assist you with your first walk the same day. Taking deep breaths and coughing are also important for recovery and prevention of pneumonia. Coughing and deep breathing help your lungs to remove fluid that collects as a result of remaining in bed for an extended period of time. You will be instructed on how to use a breathing device called an incentive spirometer, which should be used every hour while you are awake.? ?Please note that prevention of bacterial endocarditis is a key to the success of the valve repair or replacement. Inform any dentist or physician who treats you about your history of valve replacement or repair. They may prescribe antibiotics to prevent an infection from settling in your heart.? ******* Very Important***** ?In addition, be aware of the signs and symptoms of bleeding (therapeutic levels of Coumadin would be too high, thus causing bleeding tendencies): ******pink urine, black stools, excessive nosebleeds, unusual vaginal or anal bleeding, purple or red skin discoloration or bleeding gums.***** Report these symptoms to your cardiologist or the physician covering your anticoagulation therapy. Moreover, take Coumadin at the same time every day and never make up for a missed dose. Do not take aspirin or aspirin products, avoid excessive alcohol intake (it may cause bleeding) and carry an identification card indicating that you take a blood thinner and have had a heart valve repair or replacement. Patients with prosthetic heart valves should also be alert to signs of prosthesis failure. Often the signs of value failure resemble the symptoms that occurred prior to the valve surgery and may include ******fatigue, weakness, lightheadedness, shortness of breath while lying down or during exertion, as well as chest pain (angina).? ******* http://www.inova.org/inovapublic.srt/heart/treatment_options/cardiac_valve_repair.html ?What should I watch out for? ============================= Be sure to call your doctor if any of the following symptoms appear: ? Fever ? Warmth, redness, or swelling around the incision ? Drainage from the incision Will there be scar(s)? A scar will remain along the chest bone. When can I expect to return to work and/or normal activities? Your doctor will advise you to walk or to do other physical activities, increasing gradually in order to regain your strength and return to a normal, active lifestyle. Most individuals who have sedentary jobs can return to work in four to six weeks. Those who have physically demanding jobs will have to wait longer. Additionally, your doctor will not want you to drive a car for six weeks.? http://www.debakeydepartmentofsurgery.org/home/content.cfm?proc_name=aortic+valve+replacement&content_id=274 ?Generally, most patients can leave the hospital 5-6 days following surgery. It is important to have family members or friends available to assist you in your first week home. The nursing staff will contact a home care agency near your home to arrange a home nursing assessment the day after your discharge. Additional services available through the home care agencies for patients who meet criteria include physical therapy, occupational therapy, and the services of a home health aide or social worker. Cardiologist It is important to make an appointment with your cardiologist within two weeks of discharge. Your cardiologist will monitor your progress over time and adjust your medications.? http://www.brighamandwomens.org/patient/cardiac_valve.asp#discharge ?Difficulty sleeping and weakness are both fairly common post surgery, especially in someone so ill prior to the surgical repair, again this is more true in older patients (>65 yo). The lack of sleep surely needs to be addressed by your father's physicians as this could potentially hinder the progress of his rehabilitation. There are other sources of protein for protein for your father and yes this very, very important in his recovery, and I would try these (milk, soy protein, etc.)first before asking the patient to eat something he is against.? http://www.medhelp.org/forums/cardio/archive/1895.html ?Recovery after valve surgery may take a long time, depending on how healthy you were before the operation. You will have to rest and limit your activities. Your doctor may want you to begin an exercise program or to join a cardiac rehabilitation program. If you have an office job, you can usually go back to work in 4 to 6 weeks. Those who have more physically demanding jobs may need to wait longer. Life After Valve Replacement ---------------------------- Patients with a mechanical valve will need to take a blood-thinning medicine for the rest of their lives. Because these medicines increase the risk of bleeding within the body, you should always wear a medical alert bracelet and tell your doctor or dentist that you are taking a blood-thinning medicine. Even if you are not taking a blood-thinning medicine, you must always tell your doctor and dentist that you have had valve surgery. If you are having a surgical or dental procedure, you should take an antibiotic before the procedure. Bacteria can enter the bloodstream during these procedures. If bacteria get into a repaired or artificial valve, it can lead to a serious condition called bacterial endocarditis. Antibiotics can prevent bacterial endocarditis. Patients with mechanical valves say they sometimes hear a quiet clicking sound in their chest. This is just the sound of the new valve opening and closing, and it is nothing to be worried about. In fact, it is a sign that the new valve is working the way it should.? http://www.tmc.edu/thi/vsurg.html ?Another common problem occurs when calcium deposits build-up on a worn-out valve. This build-up can restrict the valve?s movement, leaving the valve either unable to open or to close properly. People experiencing problems with their aortic valve may experience shortness of breath, dizziness, chest pain, loss of consciousness, or a combination of these symptoms. Aortic valves generally cannot be repaired, especially if calcified, and are almost always replaced, either with an artificial valve or a biological valve. Many doctors prefer using artificial valves for their durability, but most use biological valves because of no need for warfarin anticoagulation. ?After this surgery, patients usually can expect to return to healthy, and more active lifestyles,? said Cohn. ?Now that the procedure can be done with minimally invasive techniques, their quality of life immediately after surgery also improves significantly.? http://www.or-live.com/BrighamandWomens/1127/ ?Life expectancy (LE) and event-free life expectancy (EFLE) for a 65 year old man after implantation with a mechanical valve or a bioprosthesis were 10.4 and 10.7 years and 7.7 and 8.4 years, respectively. The lifetime risk of at least one valve related event for a mechanical valve was 48%, and for a bioprosthesis, 44%. For LE and EFLE, the age crossover point between the two valve types was 59 and 60 years, respectively.? http://heart.bmjjournals.com/cgi/content/full/90/10/1172 Coumadin ======== ? Never take a double dose of this medication. ? Do not take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil, Nuprin, others), ketoprofen (Orudis, Orudis KT, Oruvail), naproxen (Naprosyn, Aleve, Anaprox), and others while taking Coumadin, except under the direction of your doctor. These medicines increase the risk of bleeding. ? Avoid sudden changes in your diet. Vitamin K decreases the effects of Coumadin. Large amounts of vitamin K are found in foods such as liver, broccoli, brussels sprouts, and green leafy vegetables (e.g., spinach, Swiss chard, coriander, collards, cabbage). Do not change the amount of these foods in your diet without first talking to your doctor. ? It will be necessary to regularly monitor your therapy with a blood test called a "PT" or an "INR." These tests help to determine the amount of Coumadin that you need to take. ? Contact your doctor if you experience any unusual bruises or heavily bleeding wounds, diarrhea, infection, or fever during treatment with Coumadin. Understand that your friend does not have to avoid foods that contain Vitamin K while on Coumadin, just maintain the amount of such foods. If he eats green leafy vegetables usually, then he should maintain that diet. Don?t start or stop eating the food listed above. http://www.drugs.com/coumadin.html This page has a chart with Vitamin K content of foods: http://www.dietitian.com/vitamink.html ?Rationale: Why do I need to pay attention to my diet while I am on Coumadin ? A. Coumadin works to keep your blood from clotting by decreasing the availability of vitamin K. Vitamin K helps your blood to clot. These are opposing actions. B. Excessive vitamin K intake can interfere with the Coumadin and allow your blood to remain susceptible to clots. Likewise, if you eat too little vitamin K, the excess medication may cause your blood to become too thin. C. Your medication will be adjusted to the amount of vitamin K typically in your diet. If you suddenly increase or decrease the amount of vitamin K in your diet, your medication will not work properly.? Your friend?s doctor will advise him about diet, but now that you know about it, you can keep a close eye on him! http://www.whmc.af.mil/coumadin/coumdiet.htm ?Q2:"Is life on coumadin really that bad?" Depends on who you talk to. Being on coumadin requires that you have regular INR checks -- Blood draw from arm or finger stick. Most people need to have once per month checks, but some need more frequent. You also may need to curtail some of your activities, depending on what you like to do with your spare time.? http://www.medhelp.org/forums/cardio/messages/34386.html ?It is important that you carry identification stating that you are using this medicine. If you have any questions about what kind of identification to carry, check with your health care professional. While you are taking this medicine, it is very important that you avoid sports and activities that may cause you to be injured. Report to your doctor any falls, blows to the body or head, or other injuries, since serious internal bleeding may occur without your knowing about it. Be careful to avoid cutting yourself. This includes taking special care in brushing your teeth and in shaving. Use a soft toothbrush and floss gently. Also, it is best to use an electric shaver rather than a blade. Drinking too much alcohol may change the way this anticoagulant affects your body. You should not drink regularly on a daily basis or take more than 1 or 2 drinks at any time. If you have any questions about this, check with your doctor.? Unusual bleeding may mean that your body is getting more medicine than it needs. Check with your doctor immediately if any of the following signs of bleeding or overdose occur: ? Bleeding from gums when brushing teeth ? blood in urine ? nosebleeds ? pinpoint red spots on skin ? unusual bleeding or bruising ? unusually heavy bleeding or oozing from cuts or wounds ? unusually heavy or unexpected menstrual bleeding. ? Signs and symptoms of bleeding inside the body dose-related Abdominal or stomach pain or swelling ? back pain or backaches ? black, tarry stools ? bleeding in eye ? blood in stools ? blood in vomit or vomit that looks like coffee grounds ? blood in urine ? blurred vision ? chest pain ? confusion ? constipation ? coughing up blood ? diarrhea (sudden and severe) ? dizziness or fainting ? headache (continuing or severe) ? joint pain, stiffness, or swelling ? loss of appetite ? nausea and vomiting (severe) ? nervousness ? numbness or tingling of hands, feet, or face ? paralysis ? shortness of breath, weakness (sudden) Also, check with your doctor as soon as possible if any of the following side effects occur: Less common ? Cough or hoarseness ? fever or chills ? lower back or side pain ? painful or difficult urination ? skin rash, hives, or itching ? Rare Blisters or itching on skin ? blue or purple toes ? dark urine ? pain in toes ? painful red sores on skin especially on thighs, breasts, penis, or buttocks ? sores, ulcers, or white spots in mouth or throat ? sudden increase or decrease in amount of urine ? swelling of face, feet, and/or lower legs ? trouble in breathing ? yellow eyes or skin http://www.fvleiden.org/publications/coumadin.htm An emergency alert system is a fabulous idea, if your friend can afford it. Perhaps some senior organizations can help with the cost. If not, you could schedule different friends/family members to call him twice a day, to be sure he is alright. Many communities in the US have a Meals on Wheels service that delivers meals to senior citizens- you may find the same thing available in your area. Remember, your friend will need to eat a healthy diet and drink plenty of healthy liquids to make a speedy recovery. The blood pressure monitor is thoughtful, but only useful if he suffers from elevated blood pressure! Aortic valve replacement and high blood pressure do not necessarily go hand in hand. Instead of a cell phone, how about a portable phone (cordless), that has a base that plugs into the regular phone jack, but the phone is wireless and can be placed near your friend at all times. (Ride in a robe pocket, perhaps) during the day. Cheaper too. Program his phone to emergency services if it is not already programmed. http://www.amazon.com/gp/browse.html/002-1719235-3304824?node=172614 If you are into cooking, you could prepare meals and freeze them for him to reheat in a microwave. I do this with my ladies. I cook a pot roast for example, with carrots and potatoes. When cool, I divvy it up into plastic containers. The ladies take one out in the morning to thaw enough to place into a glass bowl to heat in the microwave. They are very appreciative of this, and they get a nutritious homemade meal. If he was able to go upstairs prior to surgery, his doctor will give him the go ahead to climb stairs again and return to normal activity. The surgery is supposed to make life easier, not turn one into an invalid, even an 80 year old man, unless he has other ailments. Encourage him to quit smoking, if he is a smoker. I?ll bet what your friend will enjoy most, will be visits from you! Take a short walk outdoors with him. Don?t forget to hug him, tough his arm, and pat him on the back (gently). The healing power of touch is often overlooked. I hope this has helped you out! I?m so glad to see your return! Sincerely, Crabcakes Search Terms ============= socks + grippers + men's Medicine organizers Raised toilet seats Grab bars gripper sole socks + men's infection + post aortic valve replacement diet + Coumadin post + aortic valve + replacement recovering + aortic valve + surgery

Hi Bryan :) What a nice fellow you are for being concerned about your friend!!! As a person who lives alone myself, and after recently taking a bad tumble in my home while alone, I would say that perhaps he have someone around when he bathes, just in case he falls..... He should also not be reaching up for things. Mabe have someone put the dishes or cups on a lower shelf. The same goes for items that he may need in his medicine cabinet. While he recuperates, it would be thoughtful if someone brought over some good books ( I know a great author who I can recommend! ) or magazines that are of his interests or hobbies. Steph53

Bryan, Crabcakes's excellent answer reminded me of something else. Many old folks need a new armchair with higher, firmer seat, even one that helps them stand up. My mother-in-law - much to my surprise - accepted with delight one such to replace one of the pair of armchairs she has had for over 60 (!) years. And yes, better light switches, in case he has ones with just a little toggle; not everywhere, but for the front hall light, stairs, ... Take care, and hope to see you around here with less serious subjects. :) Myo

Hi Bryan, Good to see you back, but less so with this question. Another suggestion would be an emergency call device that he has with him at all times. Push the button, and it alerts an emergency service. I don't know what these are called in England, but a posting to another question indicated that they exist in the UK. I had the impression that that one was a county service. Maybe the poster was Geof-ga or Answerfinder-ga. Something to remember is that folks that age can be entirely mentally "intact", but still do "crazy" things when alone, either physically - Steph's consideration - or otherwise: forgetting to turn off the stove or water or where their keys/glasses/pills are. Pills: very important! Since it is not obviously apparent what they are for - not like cough tablets - oldsters often are forgetful about taking them or remembering when - which ones when, e.g., the green one morning, noon and night; but the pink one only after breakfast; and so on. There are pill boxes that help with this, but someone should check that your friend is taking his properly - and know the regimen, not just ask him. My parents had rubber bands around their pill boxes - top, middle, bottom - to remind them when and how often to take theirs, but there may be better solutions. Tell your friend that he has people around the world wishing him the best. Myoarin

As always, SUPERB! My friend actually had a biological valve fitted with a pig being the unsuspecting donor. My friend lives an hour's drive from me so I won't be visiting him every day that's for sure. I will therefore try to advise his family and friends on the care requirements. Very many thanks. Bryan

Thank you Bryan, for the stars and generous tip! Glad to see you around. My best to your friend. Sincerely, Crabcakes

Hi Myo Many thanks for your good advice and good wishes. Warmest regards Bryan

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For Crabcakes, please: Aortic Valve Replacement