Monthly Archives: October 2014

My Meds: Warfarin & Metoprolol

ARC_Talk_About_Meds_Banner_Anthony

Hey cool banner huh?! The folks over at The Recall Center asked me to post about the medications that I’m on and how they effect my life. This is an important topic and I actually haven’t taken the time to write about it yet. I will review my diagnosis, surgical history, and the medications that I’ve been on within the past year.

My original diagnosis is that I was born with a congenital heart defect called bicuspid aortic valve. A normal aortic valve has three leaflets that open and close to let blood out of the heart, while I was born with a valve with only two leaflets. This condition is also associated with a compromised ascending aorta, which forms an aneurysm.

My valve was originally replaced on November 25th, 2013 with an On-X mechanical valve. I had a major complication only three months after that; infective endocarditis of the prosthetic valve, which led to a prompt, emergency re-do of the same operation. They implanted a St. Jude’s mechanical valve the second time.

The long term medications after each surgery were similar. I was placed on Metoprolol (50 mg), a beta blocker to keep the heart rate and blood pressure low. It controls the heart rate by binding to beta receptor nerve cells in the heart muscle, which blocks these cells from binding to adrenaline, epinephrine, and other stress hormones that can increase the heart rate. Basically, it keeps you chill all the time.  Usually the heart rate goes up for a while after heart surgery. Previous to surgery, I had a resting heart rate of 65 BPM. After surgery, even while on Metoprolol, My resting rate was 85-100 BPM for about six weeks. As my heart healed, my heart rate went down, which was a good sign. After that six week period, I started to get tired of this drug. It caused dizziness when I stood up too fast. It did not allow my heart rate to get above 130 BPM once I started riding my bike again. I felt that it was holding me back. I felt sluggish. I stayed on Metoprolol until four months after my second heart surgery. Cardiologists often disagree about whether prosthetic heart valve patients can discontinue Metoprolol. My current cardiologist explained that this drug is often prescribed after heart surgery, but in his opinion after the heart heals and there are no arrhythmia problems, then the beta blocker COULD be discontinued. My doctor gave me permission to slowly phase myself off of this med as discontinuing it cold turkey can cause  tachycardia or other uncomfortable/ dangerous issues. I decided to go off of this drug when my resting heart rate settled to 55-59 BPM, which technically speaking is brachycardia, or a slow heart rate. Since then, I’ve been feeling great with a resting rate of 65-75 BPM.

NEVER discontinue your medication without first consulting your doctor!

I was also placed on Warfarin (generic of Coumadin) with a target INR range of 2.0-3.0. Warfarin is commonly referred to as an blood thinner, though it is actually an anticoagulant. Patients with a mechanical valve must take an anticoagulant to prevent blood clotting on the valve. This clotting is called thrombosis, and is deadly as it can dislodge and cause a stroke elsewhere in the body. Once a month I go to the lab at my cardiologist’s office to get my blood tested. If I am not hitting my target range, then they adjust my dose. With a mechanical valve, there is no way around this med. I must take it or else I am seriously at risk. Taking anticoagulants, however often come with their own risks associated with bleeding. I have to be careful with my diet. Foods that are high in vitamin K, like leafy greens such as spinach or kale, can lower my clotting levels (INR). Other factors such as activity level and alcohol can effect a patient’s INR. To be honest, I live my life similarly to pre-surgery levels. I eat a well balanced diet with plenty of leafy greens, I am very active (cycling, rock climbing, lifting), and I have a few drinks each week. My Warfarin dose has been adjusted so that I hit my target INR without changing my lifestyle. People have problems with staying in their range when they make drastic changes all of a sudden to their diet, binge drinking, forget doses, etc. Often when a patient comes back from a vacation, their levels are off. Being a rock climber, cyclist, adventurer, I am at a legitimate risk of having a dangerous bleeding even while on this medication. A head trauma can be deadly. I have chosen to accept these risks in a pragmatic, responsible way by continuing my sports, but always wearing my helmet not participating in reckless behavior. Be sure you make these decisions along with your family and doctor.

I also take one baby Aspirin daily. This is taken for anticoagulant reasons as well. Studies have shown that mechanical valve patients are less likely to have thrombosis when they take aspirin in addition to Warfarin.

There are various anticoagulants each tailored to different types of conditions. There are some new drugs that have come out to treat people with different heart conditions, like atrial fibrillation , and who do not have artificial heart valves. Some of these drugs are appealing because they may not require monitoring of anticoagulant levels. The Recall Center recently posted about a series of lawsuits against one such drug called Xarelto. It appears that this drug may have some increased bleeding risks that may not outweigh the benefits of forgoing monthly monitoring testing that goes along with drugs like Warfarin. Also, Warfarin can be counteracted with high doses of vitamin K in case a patient needs emergency surgery (this happened to me), while Xarelto does not have an ‘antidote’. Do your own research before taking any new drug. You can learn more about Xarelto by clicking here.

How do I remember to take my medications?

Pill_BoxAfter my first surgery, I set a medication alarm on my iPhone. Studies have shown that patients who have some sort of reminder increases medication adherence, thus increasing their chances of a healthy recovery. I also always use my weekly pill reminder box. This pill case has morning spot and an afternoon spot for each day. I’ve gotten into the habit of every sunday, I refill the entire box with a week’s worth of meds, so all I have to do is take my dose when I wake up and go to bed each day.

Remember:

  • Ask your doctor why you are taking a medication.
  • Ask your doctor how the med works, and its side effects.
  • Ask your doctor if there are lifestyle changes that you can make instead of taking the medication. For example, you might be able to lower your blood pressure by changing you activity levels and diet.
  • Set up a reminder system that might involve alarms, calenders, and pill boxes. Consistency is important with any med.
  • Inform your family about your medications in case of an emergency.
  • Ask your doctor questions, and write down your doctor’s responses! I record every conversation that I have with my doctor on my iPhone’s audio recorder.

Post Surgical Wounds: Patient Perspective

I was contacted by  Dr. Mark Rippon, Visiting Clinical Research Fellow at the University of Huddersfield:

“…specializing in wound care. I have recently undergone aortic valve replacement and was surprised at some aspects of the wound care related to pain and psychological stress. As part of a small research project with the University of Huddersfield I have decided to investigate this further with a small questionnaire aimed at patients that have recently undergone major surgery through an online survey form. I was wondering if you could help me drive patients to the questionnaire by allowing the link to the survey on your website. The project is non-profit making and not commercially funded, but should help with a greater understanding of the needs of post-surgical patients with regards to their wound care treatment.

So there ya go. If you have had any sort of major surgery, especially cardiac, please take the time to complete this survey. It can help us understand how to address surgical wound care issues.

Take the survey here: https://www.surveymonkey.com/s/6V6P3XQ

Follow Dr. Rippon at: @markrippon100

Return to Sport Climbing

constant reminders...

constant reminders…

I’m going to brag and show off a bit in this post, so please excuse the narcissism! I was extremely pleased to return to sport climbing this past weekend with a trip to Holcomb Valley in Big Bear, CA. This was my first time sport climbing outdoors since my first surgery (November 2013).

Sport Climbing, in a nutshell, is type of climbing that involves climbing up a rock face with a rope attached to your harness for protection. As you climb, you attach your rope to bolt hangers that have been pre-bolted into the wall. You attach your rope to these bolt hangers using quick-draws (two carabiners attached together with a sling). This is called lead climbing, because you clip your protection in as you go. When someone has lead the route before you, and your protection is already at the top of the route, that is called top-roping.

I spent the early part of the day top-roping. I did not yet feel confident to lead. I felt nervous on the wall. I felt exposed. I could feel my heart pounding and clicking away. I thought about my surgeries. I thought about how difficult my recovery has been. I thought about all the challenges, and how I deserve to be on this rock, right now.

After top roping several climbs, we moved to a new crag to a climb that I was familiar with called ‘Powder Keg” (oh yeah, every route is named by the first person to ascend it). I’ve climbed it before. It isn’t too hard (difficulty: 10a), but it has an impressive move out of a big roof. I remember climbing this when I was a beginner climber, so it felt appropriate to lead it now.

roping up...

roping up…

I climbed Powder Keg flawlessly. My training in the gym, my patience after each surgery, my frustrations, anger, sadness, optimism, everything; summed up in one action. I felt emotional as ascended the top portion. I enjoyed it like a delicious beer, savoring every moment. Sorry, I had to get those scar shots in 🙂

What a kick off to this year’s climbing season! Next week we will be bouldering in Bishop. I can’t wait to crush. This weekend I’ll be cycling in the Levi’s Granfondo ride. I orginally signed up for the 100 miler, but I downgraded to the 65 mile ‘medio’ ride. Between work, school, coaching, and climbing, I haven’t had time to train for it. No worries, we’ll still have fun (and suffer a bit). Thanks for reading!

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i'm on bloodthinners... helmet: check

i’m on bloodthinners… helmet: check

The roof move.

The roof move.

:-D

😀

finish easy

finish easy