Tag Archives: beats per minute

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.

Small Victories: Hangboard

What is each day but a series of conflicts between the right way and the easy way?

Rock Climbing has taken a backseat these days. The spikes in heart rate and blood pressure during climbing are just too huge to feel comfortable with in my condition. This is a bummer because all I want to do is climb. I’ve realized though, that there is strength training that will maintain, if not improve certain elements in my climbing. I’ve been utilizing my hangboard!

Metolius SImulator

Metolius Simulator

I took a simple workout plan from Steph Davis’ climbing blog. I decided on this one because it does not involve any pull-ups, just hanging. In the workout below, a ‘grip’ refers to a ‘hold’ on the hangboard. I use a Metolius Fingerboard, and did a total of 4 grips. If you plan on doing a hangboard workout, don’t forget to warm up and stretch those digits. Read the entire workout descriptions on Steph’s blog and the Metolius fingerboard workout page, linked above.

(Steph’s) Typical workout:
3 sets for each grip
set one = 7 sec hang 3 sec rest x 7 reps
2 min rest
set two = 7 sec hang 3 sec rest x 6 reps
2min rest
set three = 7 sec hang 3 sec rest x 5 reps
2 min rest between grips

Doing this type of workout will do wonders for my grip strength while I take a sabbatical from actual climbing. The best news is that while doing this workout, I took my blood pressure in between sets, and found that only a mild increase in BP was involved. I can do this type of workout frequently without risk of dissection associated with dynamic strength training.

just keep hanging, just keep hanging…

The Athlete’s Heart

cycling red rocks

cycling red rocks

The different opinions coming from different patients and doctors about how much exercise is appropriate for someone with BAV can be a little frustrating. There are various camps out there on this matter, and I will attempt to break it down here. Keep in mind that recommendations can vary depending on severity of regurgitation & stenosis, and the presence/ size of an associated thoracic aortic aneurysm. My current status is Bicuspid Aortic Valve with mild-severe regurgitation and 4.6cm ascending aortic aneurysm. Here we go:

1. Doctors and patients who see the potential of dissection and rupture, even though it might be a small risk. If there is a possibility, then why risk a catastrophic event with the stress of exercise? These opinions stem from the recommendations made at the 36th Bethesda Conference in 2005. Walking, bowling and golf are ok.

2. Doctors and patients who take a cautious yet more liberal approach. This is where I’ve been hanging out for the past few months. I continue my normal forms of exercise, yet I do not push myself. Keep BPM under 140, avoid the Valsalva Maneuver while exercising, and listen to your body.

3. Patients who say, “Screw what anyone else says, I’m doing what I want!” I seriously considered this for a while. Not the smartest move, but potentially liberating. Potentially liberating from life as well.

I just recently had a cool email correspondence with Dr. Larry Creswell, from a blog that I’ve been following called athletesheart.blogspot.com. His blog is exactly the resource that I need. He is a Cardiologist who cares enough about people like me to make his knowledge available to the public. He also responded to an email of mine in full detail. I asked Dr. Creswell about what he thought I should be doing in regards to exercise right now, and he definitely falls under category #1. His response was, and I quote:

“…You ask about my thoughts about exercise between now and 11/25.  I’d be very cautious.  Guidelines developed by an expert panel can be found online in the Proceedings of the 36th Bethesda Conference.  Athletes with BAV and aortic diameter >4.5 cm should participate in only low-intensity sports (eg, golf, bowling).  I know that’s not what you’d like to hear.      On the brighter side, once you’ve recovered from operation you should be good to go.  I’m aware of a bunch of young athletes who’ve returned to their sports after operations like yours.  You might check out Ironheart Racing online; their founder, Dave Watkins, had your operation and is back at triathlon.  Climbing El Capitan would be awesome.”

Dr. Creswell is right. That IS NOT what I wanted to hear, though it is important for me to hear these second opinions. His thoughts will definitely help me shape the next couple of months. Maybe I should scale back a bit. More yoga. Less climbing. Less hills while cycling. More patience.

Ima still jump off cliffs though

Digifit Testimonial

About a month ago, I posted about how I was using Digifit to continue exercising while keeping my heart rate low. The editors over at Digifit contacted me about doing a little testimonial for their blog. Check it out!:                           http://blog.digifit.com/2013/08/digifit-helps-anthony/

It is just really incredible (and strange) that, so far, this has been one of the most positive experiences of my life. I know there is a hard road ahead of me, But I can also see some rewards up ahead as well. I have many ideas that I can’t wait to explore and share with you.

I really don’t know when I was happier than now.

happiness

happiness

cheers!

Anthony

Just an Update

The Margarita Throwdown Winners!

The Margarita Throwdown Winners!

I haven’t posted in a while. Work started a few weeks ago, so I’ve been super busy starting the year off right with a new group of 8th grade science students. I’ve been continuing my workout plan, so cycling, climbing, and light weightlifting/ core workouts, all while keeping my heart rate under 140 BPM. In addition to keeping my heart rate under 140, I also make sure that I do not ever strain. With weightlifting, it is easy to be straining under too much weight and still have your BPM low, so I must manage both. BTW, when I say light weightlifting, I really mean light. I have always been more into light weight, high rep anyway.

Bike BBQ/ Inland Empire Bicycling Alliance Margarita Throw-down Victory! Redlands is graced with a pretty cool cycling scene. Behind Augie’s Coffee Shop (where I write most of my posts) is Bike BBQ, a place where people can use tools and seek expertise from volunteers on how to fix and maintain their bikes. They even sell bikes/ parts for a very good price. These two cycling organizations threw a contest where cyclist teamed up with bartenders and used stationary bike-powered blenders to make margaritas. I am proud to say that my bartender friend Bryan Bruce (From Caprice Cafe in Redlands) and I won with a very interesting jalapeño/black sea salt/pineapple foam Margarita concoction. Check out the video at the bottom of the post to see how it went down. The quality isn’t too good, but you’ll get the idea.

Inner Evolution Yoga: My friend Phil owns Inner Evolution Yoga in Redlands, CA. We used to climb a bit together. When he opened his studio a few years ago I helped him paint the ceiling. I even worked there for 2 weeks as the front desk guy while he was away on a retreat. When Phil read my blog and saw what was up with my life right now, he gave me 10 passes to his studio. Yoga is a fantastic form of exercise that will also aid me in breathing and relaxation techniques that will be very useful leading up to my surgery. Thanks Phil, and if any of my readers live near Redlands, check out his studio.

False Alarm: The other day I had a little false alarm. I had a sudden onset of a sore throat thursday afternoon, and being the researcher/ hypochondriac that I am, I googled it and found this article, and this one too. In my head I understood that the chances of an aortic dissection with only a sore throat as a symptom is possible, yet extremely rare. I also knew that if it was a dissection, and I ignored it, I would die. As I was freaking out, some people said, relax it’s nothing, others said that I should go to the ER just in case, and I just didn’t know what to do. I realized that If I didn’t go to the ER, I wouldn’t be able to sleep, so I just drove myself to the ER thinking that I’d be home by midnight if everything was okay, and that’s exactly what happened. It is a little embarrassing that I freaked out so much. I did learn about how Aortic Dissection can be diagnosed with a blood test called D-Dimer. Really interesting actually. This is what they did for me. The other option is a CT scan, which subjects the body to a large amount of radiation. I’m calling this experience ‘My Dry Run’.

Monitoring BPM with Digifit

20130726-120509.jpg

Yesterday I rode my bike to the climbing gym (Threshhold Climbing & Fitness) and then climbed at the gym, all the while monitoring my heart’s beats per minute (BPM). My goal is to keep my BPM under 150, even under 140 if possible. As you can tell, my heart rate spiked pretty high, but I was able to bring it down immediately. I think that soon I will have greater control over my heart rate.

Digifit

I tried several apps with my bluetooth heart monitor, and ended up using Digifit on my IPhone. I like Digifit because it is highly customizable and has crisp graphs and graphics. Most importantly to me, I am able to create my own heart rate zones and enable the voice feedback feature to notify me when I enter these zones. For cycling, zone 1=130-140, zone 2=140-150, and so forth. For climbing, zone 1=140-150, zone 2=150-160, etc. I set my zones up in this way so that the voice feedback doesn’t bother me at lower heart rates, only when I am approaching or within my prescribed max zones.

Results

Cycling Test: It was pretty hot for my bike ride, which made controlling my heart rate difficult. I also had a full stomach. If you look at the line graph, the biggest spike in BPM correlates with a big increase in elevation, thus a decrease in speed. As i kicked the bike into an easier gear and slowed down, my BPM quickly dropped to an acceptable level.  CLICK HERE FOR BIKE RIDE RESULTS

Climbing Test 1 (Lead Climbing): Lead sport climbing is climbing up a rock face and clipping your protection into pre drilled bolts as you climb up. This is typically more difficult and straining than top roping, which I am yet to test with my heart rate monitor. Lead climbing proved to really jack up my heart rate. This particular climb was only rated 5.9, yet it still sent my heart rate above 180 BPM. I may have to steer clear from this form of climbing for the next few months.                                                                    CLICK HERE FOR LEAD CLIMB RESULTS

Climbing Test 2 (Bouldering): I like Bouldering better anyway. Bouldering is climbing literally boulders without rope protection. Typically a boulderer will carry a ‘crash pad’ out and a friend to spot their landing to avoid injury. I had a much easier time controlling my heart rate during this short bouldering session. Boulder problems are rated and I usually max out at V6. I’ve only sent V7 a handful of times in the climbing gym. During this workout, you can clearly tell by my heart rate that I climbed 4 boulder problems. They were V1, V2, V3, V4 in that order. One important indicator that I’m doing an okay job here is to view the pie chart that presents the percentage of time spent in each zone. I only spend 3% of my time in the 150-160BPM zone. I believe that just like with cycling, soon I will have better control over my heart rate as I practice my breathing methods and body control.              CLICK HERE FOR BOULDERING RESULTS

Why is this important? Do I really need to obsess over this? This is empowering me to stay at my current fitness level without putting myself at risk for aortic dissection or rupture. I want to go into this surgery as fit and strong as possible, so that my recovery can be swift.

In other news, I went to the dentist yesterday to get my mouth ‘cleared’ of infection, cavities etc. Mouth infections can easily infect a defective heart valve, which would be a big risk before, during, and after a surgery. The surgeon requires a dentist to take X-rays and inspect the mouth. Luckily, despite my 3 year dentist visit abstinence (yikes) my dentist did not see any cavities/ infection and cleared me for surgery. This means that soon I will have a surgery date.

Also, a HUGE shout out to all of my friends, especially in this case my climbing friends who poured over their support for me! I would especially like to thank young Kristen and her dad Jess. Kristen has a similar heart issue as me and said she was climbing in yesterday’s climbing competition for me! Cheers!

Anthony