I'm Strong to the Finish, when I Eats Me Spinach

Is it just me or are all GPs useless? Cue my rant:

Every time I visit my GP I wonder how the hell he’s managed to keep his job for so long. Instead of looking at you while you speak, he stares at the computer. This is no exaggeration. Recalling my last visit to him, I think the only time he looked at me was to give me my prescription. It’s quite worrying to be honest because he doesn’t exactly inspire confidence in patients so if I had personal problems I would be reluctant to discuss them with him. But saying all that, he’s the perfect doctor compared to his colleague.

I had an appointment with her today about my INR. My blood is clotting too quickly (the level is 1.6) and that’s very dangerous for someone in my position because I’m at a big risk of a stroke as the blood can clot on my mechanical heart valve; and that clot can travel to the brain. Now the usual way doctors and nurses calculate how much medicine I need to take is with a computer. Simple? Not for this specific doctor I saw today. She seemed to think calculating it by a chart would be better than the computer. That made me cautious but I thought, hey, she’s the doctor after all. She then said I should come back tomorrow. TOMORROW?! It’s an emergency considering how low my blood is and she wants me to wait a day? I then told her exactly how to open the program on the computer to calculate the dosage, but she didn’t trust me. In the end I asked for my original doctor to calculate it and ring me back. Which he did. Thank god. He might not look at me but at least he knows what he’s doing! It’s quite scary to think these people are in control of my anti-coagulation levels...

In terms of why my INR is so low...I'm not sure. It's been stable for the last month or so, and the only thing I can think of is that I had spinach two days ago. Apparantly it's high in Vitamin K, which interacts with my medicine and causes the blood to clot quicker...Damn...I better be more careful from now on. I also learnt that if your heart beats very rapidly then there is a risk of a clot forming. This little piece of information has torn apart my plans for sky diving next year. God damn it...what a rubbish day.

Healin' Tape

As you’ve probably noticed I haven’t been updating my blog as regularly as I used to. One of the main reasons for that was because, heart-related, there wasn’t much to say. The aim of the blog had always been to provide a site where future patients could come and see what the experience would be like before their own surgery. And I felt if I deviated off that track and wrote about other things...well that wouldn’t be good! But I am aware that a blog that gets updated rarely would not get read...so give me some feed back people! Is it just heart related stuff that you’re after or other topics too?

Getting back on track, I consider myself pretty healthy now. In fact, fully recovered. It’s strange because my family and friends always ask how I am and it’s getting quite irritating now. Although I shouldn’t be annoyed because they mean well! I think it’s always harder on them because they had to witness what I went through and it always looks worse to them. That’s not to say it was a walk in the park! So now I’m doing a lot of running, weights, and even bought an exercise bike. I know, I’m turning in to a fitness freak.

The only sign of my surgery is the scar. It’s still quite unsightly because it’s raised a rather large (keloid scar). My GP offered my the option of injecting the scar with a steroid which can help...but the stories I’ve heard of how painful that is made me refuse. So instead he offered me something called Haelan Tape. Keep that in mind if you have a keloid scar yourself! I’m sure you don’t need me to tell you how annoying those things are and Haelan Tape actually works. It’s like Sellotape that you place on the scar and throughout the day it will release some form of steroid on to the scar to reduce the size. I’ve been using it for about 2-3 weeks and the size of the scar has reduced dramatically. I would post a picture but I don’t think you’d like to see that! Hopefully it will go away eventually.

I’m still taking Warfarin (obviously, otherwise I’d be dead!)and my anticoagulation level is pretty much stable (if you don’t know what I’m talking about shame on you! Have a read of some of my older posts to do with INR/anticoagulation/Warfarin). I know have to see the nurse every two months or so, which is great compared to the 3 times a week when my INR was unstable after the operation.

Drugs, Cheese, and Puss

So apparently I have yet another infection. Fun times! This time it’s on my scar. Puss = bad. No matter how much you have of it, it pretty much means there is an infection. So if any of you ever get into that situation after surgery, go straight to your GP. They’ve given me antibiotics and I don’t seem to see any more puss but I still won’t be happy until I’ve seen my cardiologist in 2 weeks time. GPs just seem to be...rubbish.

Now, for life with a mechanical valve. For one thing there is a constant ticking every time the heart beats. Before my operation I was pretty worried about this because if I came to hate the sound...I would be pretty much stuck with it. And there’s no way of listening to it before you have the surgery! The sound comes from the two mechanical valve leaflets opening and closing. Having lived with it for a month now I can safely say that no-one has anything to worry about this. A lot of the time I just don’t hear it – whether I’ve blocked it out or not I don’t know. IN fact, I’m pretty sure my family hear it more than I do. Even when I do hear it, it’s so soft that it just doesn’t get annoying. It’s become part of me, like the sensation of my heartbeat.

Of course having a mechanical valve means taking Warfarin (aka Coumadin in America) for the rest of my life. Not to go in to the details again as I’ve covered this at the beginning of my blog when it started, but Warfarin is an anti-coagulant which slows down how quickly blood will clot. This is important because normal blood will clot on the valve and cause a stroke. The other side is that if the blood is too anti-coagulated (i.e. takes too long to clot), it can cause a fatal bleed (e.g. in the brain).

This sounded terrifying to me before the operation but I will say that living on Warfarin really is a breeze. Yes you have to go for regular blood checks, but if you’re confident enough you can do these independently. I recently bought a machine which checks how anti-coagulated my blood is. This means I can test at home in my own time, then email the results to my nurse/GP. They will then calculate how much dose of Warfarin I need. I will say that if you’re not willing to purchase one of these machines then you will have to go to your GP/clinic every week or so, which can be a hassle for working people.

There are a lot of myths regarding Warfarin but if you do some reading around it should help calm your nerves. Yes Warfarin interacts with a huge amount of things – Aspirin, Ibuprofen, Broccoli (no loss there), Cheese (gasp!). The list is endless. And it’s not just limited to food and drugs. Even the amount you exercise can impact on your anti-coagulation level. But for people considering having a mechanical valve, the key thing to remember is you don’t have to change your life greatly. I still eat just how I used to. You don’t alter your diet, but the dosage of Warfarin you take. As for drugs...well I was never one for them and you can still take paracetamol for aches and pains. The fact that you bleed more easily shouldn’t be an issue – the only time it will be a problem is in a trauma situation (e.g. a car crash).