Monthly Archives: March 2016

The Great INR Balancing Act

Living with a chronic disease/condition comes with up swings and down swings. Things are good, then not so good. It is a balancing act to stay healthy. Yesterday; great news, today; less great news. Below is an explain-y section, and a vent-y section.

Explain-y: Living with a mechanical valve means that I must be on the drug Warfarin (Coumadin) for life. Warfarin is an anticoagulant, which means it slows down the clotting factors in the bloodstream. This is prescribed to patients with mechanical valve because the platelets tend to stick or snag on the edges and surface of the synthetic valve. When the platelets snag, they begin to clot, forming a blood clot, which can then dislodge and cause deep vein thrombosis, heart attack, or a stroke.  Super bummer right?

Warfarin/ Coumadin are often dubbed as ‘bloodthinners’, though they DO NOT thin the blood. ‘Bloodthinning’ implies that the viscosity of the blood changes (Think ketchup vs. water). These drugs are anticoagulants. The term ‘bloodthinner’ is simply a nickname and not to be taken literally.

That being said, even doctors and nurses will use the term ‘bloodthinner’, though I will not for the remainder of this post. The anticoagulant factors in the blood can be measured using a simple blood test called the Prothrombin time (PT) test, which generates a number called the international normalized ratio (INR). A person that is not on Warfarin/ Coumadin will have an INR of 1.0. Someone who has a mechanical valve will usually be directed to maintain an INR between the range of 2.0-3.0. My cardiologist likes me to stay between 2.0-2.5, though it is difficult to stay within that small of a range. Basically, I am tested every other week, and if my INR is too low (under 2.0) they increase my daily dose), and if my INR is too high (above 3.0), they lower my daily dose.

There are lots of risks and factors to keep in mind when you are taking anticuagulation therapy medication like Coumadin. I’ll let you read about how Vitamin-K (found in leafy greens) affects INR, how having a high INR can be dangerous, and other factors by clicking this link.

IMG_2721

Please excuse my Bitmoji use.

Vent-y: For months and months my INR has been stable, but all of a sudden (last week) my  INR was measured at 4.3! That is certainly the highest it has ever been. They adjusted my dose, and ordered me to take my PT two days later. When I took it again, it was measured at 1.5! Too low! Two days after that (today), I measured again and…. 1.4! It is very frustrating, especially since this is a chronic condition, and this problem will spontaneously occur (hopefully rarely) for the rest of my life. As frequent readers of this blog my recall, last year I lost a fellow valver, cyclist, and friend due to deep vein thrombosis/ brain embolism due to clotting issues associated with his mechanical valve.

Two Year Anniversary

I would like to share my recent milestone and the emotions that went along with it.

March 15th 2016 marks my two year anniversary of my last open heart surgery (aortic valve replacement emergency re-do due to endocarditis). I had my yearly echocardiogram scheduled yesterday, one day before my anniversary.

Two years ago, I had a traumatic experience during an echocardiogram where the echo tech spilled the beans about the emergency that was occurring inside my chest (which was extremely unprofessional of him, and against code). He told me that my recently implanted prosthetic valve was literally falling off. This led me to a panic until my cardiologist came into the room 20 minutes later.

So you can understand why echo appointments freak me out. I’m feeling great now, in fact I think I’ve never felt better athletically speaking. Despite this, I was still very afraid that I would go in and hear bad news. I almost expect to hear bad news. I know that’s not the most positive thought, but it is the truth. It is fear that guides me to think that way.

And it was that same fear that caused me to keep this echo appointment and my anxiety about it a secret from my friends, girlfriend, and family. I spent most of the weekend with my buddy, and I didn’t bring it up once. But there I was, bottling it up inside, stewing on it, just being afraid; alone in my brain. One of the main reasons I started this blog was so I wouldn’t contain my anxieties, yet I failed to utilize this outlet, which would have been useful during the past 2 weeks.

Yesterday, I went to the echo appointment. The echo tech did my yearly echo last year as well, and we remembered each other enough to pick up where we left off in small talk from last year. The doctor checked the echo results remotely, and told the tech that everything was A-Okay, and that I can be sent on my way for another year.

The relief was astronomical. I didn’t realize how much of a weight this was on me. In the car, on the way home, I completely broke down for a solid 2 minutes. After I finally got a grip, I felt cleansed. Blue sky. Now, I feel energized and ready to make the best out of every day, at least for the next 50 weeks (until my next yearly echo approaches).

Cheers ❤

Anthony