DAYS 220-239 RECOVERY

My last visit to the orthopedic surgeon showed no bone growth in my broken ankle so we've done some research and concluded that the blood thinner warfarin/Coumadin I have to take increases the risk of bone fracture. I avoided taking this medicine for two years, but after developing clots in my lungs after the open heart surgery, the surgeon and hematologist said I had no choice.  This puts me in a dilemma and I feel I'm playing Russian roulette.

A study done six years ago at Washington University School of Medicine, a very respected research institution ranked #3 in the nation, found that elderly (that word makes me cringe) patients taking warfarin have an increased risk for bone fractures.  Another study showed that taking warfarin for longer than one year led to a 25% increase in bone fracture. It's not clear if this affects women as well as men. 

Warfarin was initially introduced in 1948 as a poison for rats and mice and is still used for this purpose today.  In the early 1950s it was found to be effective and relatively safe for preventing abnormal formation and migration of blood clots.  It was approved for use as a medication in 1954 and is the most widely prescribed oral anticoagulant drug in North America.

This drug interferes with vitamin K's role in blood clotting.  Vitamin K interacts with a protein vital for bone formation and affects bone strength as well.  Fractures occur when the bones become so weakened that minor trauma causes breakage.

I had bone density tests done last year and five years prior.  The first showed I had great bones which I attribute to all the milk I drank as a teen.  I hated milk, but when others were drinking Cokes I stuck to my milk because I thought it would help me get boobs.  Well, it didn't do much in the boob department, but certainly my bones benefited.  The results of the test done a year ago showed I was still in the normal range, but closer to the low end of normal.

I'm required to take warfarin, not only as an anticoagulant to prevent blood clots and strokes, but mainly because I have two genetic blood disorders that cause my blood to hyper coagulate. This can cause clots which can lead to strokes.  So far I've met with the psychiatrist, the hematologist and next week will see the orthopedic surgeon and the cardiologist in an effort to come up with some alternatives. Some newer drugs are available, but since they aren't approved specifically for my condition no one wants to prescribe them as "off label" because of the fear of lawsuits. No doctor is going to give me "permission" to stop taking warfarin, once again because of the lawsuit thing.  So I took myself off this drug two weeks ago, thus I feel I'm playing Russian roulette.  Right now I'm going the natural route with vitamins, supplements and diet. 

There is no definitive answer because with the blood thinner my heart will be protected, but at the risk of broken bones and without the blood thinner I'll have strong bones, but at risk of blood clots that can cause strokes. 

Meds:   Amiodarone, Cardizem,  Vayacog, L-Carnitine, Vitamin D, I-Caps, Flax seed oil, Multivitamin, B-12, L-Arginine, DHEA, Glucosoamine, Calcium, Garlic, Aspirin, Omega-3 Fish Oil, Vitamin C

       

Days 204 - 219 Recovery

I almost feel human after getting two full nights sleep in a row.  The throbbing pain from my broken ankle went up into my leg.  Because it's been more pronounced at night, getting beyond three hours sleep has been hard to come by the past four weeks.  Two rounds of antibiotics finally wiped out the skin infection and most of the swelling is gone, so I feel I've gotten over the hump. The only pain I feel now is centered in the ankle area caused by the break and the surrounding torn ligaments. 

I received discouraging news yesterday, though, when the orthopedic doc said x-rays showed that so far the bone shows no evidence of fusing.  Age is a factor in bone growth.  Fifteen year olds can have bone fusion in just a couple of weeks. Since I'm a very long way from fifteen, I'll need lots more time and patience.   He wants me to return after another four weeks for more x-rays.  In the meantime I need to keep my ankle iced several times during the day until the swelling is completely gone.  I also need to do some ankle flexing exercises a couple times a day to help restore full range of motion.  Looks like there won't be any tutus and tights in my future.  This will probably kill my dream of becoming a ballerina. 

I won't be kicking my big black superhero boot anytime soon.  The doc wants me to continue wearing it all the time except in bed.  I'm becoming more proficient in walking in it and only use crutches when going up and down stairs.  Right now slopes are out of the question as they scare me too much. Since most of our property is slopped, I can't get up to the barn or down to the duck's pen.  I'm confined to the flat area where the cabin, the flower beds, and the greenhouse are located.  This will have to do for now.  

Meds:   Coumadin, Amiodarone, Cardizem,  Vayacog, L-Carnitine, Vitamin D, I-Caps, Flax seed oil, Multivitamin, B-12, L-Arginine, DHEA, Calcium, Glucosamine

DAYS 196-203 RECOVERY

Thinking I was turning into a pain weenie and because the pain and swelling was increasing day by day, I went back to the orthopedic doc last Friday.  The real source of my pain is not so much from the broken bone, but from a skin infection that goes from my toes to my knee, the area covered by the orthopedic boot.  It is very much like the continuous searing pain one endures with shingles.  On a 1-10 pain chart I'd have to give it an 8.  It could easily claim the 9  or 10 spot, however I reserve 10 for the birth of a child or the death of one's child.  I save number 9 out of respect for the intensity of pain that a man feels when getting kicked in the balls.  Of course not having this equipment, I have no first hand experience, but what I witnessed when being the kicker appeared intense, although short-lived.   Now that I think about it, maybe ball kickees shouldn't get the 9 spot after all since the pain is so ephemeral.  Sorry guys, this means I have to trump your 9 and give you the 8.     

I'm supposed to keep my damaged leg elevated at night and from time to time during the day.  The doctor tripled the dose of the pain med but it sill doesn’t do much to numb anything during those times when I lower my foot from an elevated position.  I'm taking an anti nausea med along with the pain med. So far it's doing a good job of curtailing this side effect, however the two meds are causing me to spend more hours sleeping than awake each day.  I'm looking forward to the antibiotic kicking this infection, so my body can focus solely on healing my  broken ankle bone. 

Meds:   Coumadin, Amiodarone, Cardizem, Promethazine, Percocet, Kelex, Vayacog, L-Carnitine, Vitamin D, I-Caps, Flax seed oil, Multivitamin, B-12, L-Arginine, DHEA, Calcium, Glucosamine

DAYS 192-195 RECOVERY

It hasn't been a full 4 days since my ankle injury and already cabin fever has set in.  Being such an outdoors person, it's killing me that I can't get outside to take advantage of this prime time in autumn to work in the gardens, tend my animals, maintain our property, paint some buildings, and party in and around Asheville. I don't have to sit here all day staring at the same four walls because I do have plenty of indoor projects to do, but I was saving those for the winter season when working outdoors isn't an option.  Things don't always go as planned, and sometimes I feel they NEVER go as planned, so I'll put a smile on my face and carry on.  If I can bring on the inspiration, I can use this valuable time to focus on writing and who knows, maybe finish the two books I was working on at the time of our son's death.

 

Fortunately the bone in my ankle was only broken and not displaced, so surgery wasn't required.  I'm wearing a big black Transformer super hero looking boot, but I'm not feeling very super nor very heroish since  I'm still in quite a bit of pain. The pain meds are either ineffective or they cause nausea leading to vomiting.  I can't afford to lose any of the eight pounds I've gained since heart surgery.  I've been hobbling around on crutches the past three days.  Crutches get me around and maybe once I master them I'll be able to do more, but for right now stairs and maneuvering around our mountain side is a big no-no.  The biggest drawback to crutches is not having a free hand so I can't carry much of anything from place to place.  Using them aids me in maintaining my upper body strength and is a practice in balance.  After bashing my arm and head into the countertop yesterday, I'd say I have to do a lot more work on perfecting the balance thing. 

Once my ankle heals, the docs tell me it will be a full two months, I'm going to be more wary of those slippery slopes. 

DAYS 185-191 RECOVERY

That one mile road up the mountain just got longer and farther away.  I fractured a bone in my ankle today while walking along a slope on our property.   We just returned from the emergency room.  Those slippery slopes can be hazardous to one's mobility.  l have to see an orthopedic surgeon at Southeastern Sports Medicine first thing tomorrow morning.  How pathetic since I wasn't doing anything but walking.  I wasn't even wearing my stilettos! Fortunately I still have one good leg since the broken ankle is on the same leg as my bummed knee.  I took the ER nurse's crash course, Crutches 101.  

Meds:   Coumadin, Amiodarone, Cardizem, Vayacog, L-Carnitine, Vitamin D, I-Caps, Flax seed oil, Multivitamin, Hawthorne, Garlic, B-12, L-Arginine, DHEA

DAYS 170-184 RECOVERY

I haven't abandoned my goal of a one-mile run up the mountain road to claim my "Rocky Moment," but working toward it has been delayed somewhat due to pain and soreness in my left knee.  I've been fortunate that I've never had joint or knee problems before.  I'm right handed, but I must be left kneed as it's my left knee that does most of the work when I'm climbing and supporting myself on our rock wall.  I've been working hard to remove the out-of-control weeds from under and between the rocks and then planting English Ivy. The project is about 3/4 complete, but it too is being delayed while I give my knee a rest.  

Meds:   Coumadin, Amiodarone, Cardizem, Vayacog, L-Carnitine, Vitamin D, I-Caps, Flax seed oil, Multivitamin, Lutein, Hawthorne, Garlic, B-12, L-Arginine, DHEA,

DAYS 167-169 Recovery

It's been six months since my open heart surgery and I'm feeling wonderful this week, better than I have in almost 1 1/2 years.  My blood pressure is still high, but everything else is going great.  Even my energy is coming back and so far no side effects from the new meds.  

Yesterday I met with the trainer and yoga instructor at Pardee Hospital's Wellness Center, which is adjacent to their Cardio/Pulmonary Rehab Center.  She worked with me on the exercise machines, in addition to teaching me some floor and bench exercises with the free weights.  She was amazed that I could do 140 lbs on the leg press machine.  I'm sure scaling the rock wall along our driveway while pulling the weeds that grow between and behind the rocks, then planting English ivy there is helping to strengthen and build muscle in these skinny legs of mine.  I must have strong legs in order to ride horses again. 

Here's a photo of the some of the wonderful staff at Pardee's Cardio Rehab Center.  They did a fantastic job of taking care of me from mid April until the begging of this month.  I saw them three days a week and they were an important part of my recovery.  I miss them. 

Meds:   Coumadin, Amiodarone, Cardizem, Vayacog, L-Carnitine, Vitamin D, I-Caps, Flax seed oil, Multivitamin, Lutein, Hawthorne, Garlic, B-12, L-Arginine, DHEA, Resveratrol  

DAYS 160 - 166 Recovery

These are the reasons I never ever wanted to take Amiodarone, however, I've been taking it for 13 days and so far have experienced none of the following:                                     

Check with your doctor if any of these most common side effects persist or become bothersome when using Amiodarone:

Abnormal taste or smell; constipation; decreased sexual interest; dizziness; dry eves; flushing of the face; general body discomfort; headache; loss of appetite; nausea; tiredness; trouble sleeping; vomiting.

Seek medical attention right away if any of these severe side effects occur when using Amiodarone:

Severe allergic reactions (rash; hives; itching; difficulty breathing or swallowing; tightness in the chest; swelling of the mouth, face, lips, throat, or tongue; unusual hoarseness); blue-gray discoloring of the skin (especially of the hands or feet); burning, numbness, or tingling; chest, jaw, or arm pain; confusion; cough; coughing up blood; decreased coordination; decreased urination; eye discomfort; fainting; fast or slow heartbeat; fever, chills, or persistent sore throat; involuntary muscle movements; joint pain; muscle pain, tenderness, or weakness (especially with fever or unusual tiredness); nervousness; new or worsening irregular heartbeat; red, swollen, blistered, or peeling skin; severe or persistent dizziness; shortness of breath; skin reaction similar to serious sunburn; sluggishness; sudden, severe nausea or vomiting; swelling of the hands, ankles, legs, or feet; symptoms of liver problems (eg, dark urine, loss of appetite, pale stools, persistent loss of appetite, stomach pain, yellowing of the eyes or skin); symptoms of thyroid problems (eg, feeling of being unusually hot or cold, increased sweating, mental or mood changes, numbness or tingling of the hands or feet, menstrual changes, swelling of your neck); trouble walking; uncontrolled shaking or tremor; unusual bruising or bleeding; unusual tiredness or weakness; unusual weight changes; vision changes (eg, seeing halos, blurred vision, loss of vision); wheezing.

This is not a complete list of all side effects that may occur.

Meds:   Coumadin, Amiodarone, Cardizem, Vayacog, L-Carnitine, Vitamin D, I-Caps, Flax seed oil, Multivitamin, Lutein, Hawthorne, Garlic, B-12, L-Arginine, DHEA, Resveratrol  

DAY 159 - Recovery

Fourth day on Cardizem and so far no side effects and IT'S WORKING!!!  My heart rate has been below 100 all day (quite an achievement with my always racing heart) and the best news of all, the beat is in rhythm - no fibrillation!  Now the next thing to conquer is the high blood pressure. 

Meds:   Coumadin, Amiodarone, Cardizem, Vayacog, L-Carnitine, Vitamin D, I-Caps, Flax seed oil, Multivitamin, Lutein, Hawthorne, Garlic, B-12, L-Arginine, DHEA, Resveratrol  

DAYS 148-158 Recovery

First the good news.  Last Friday after working my butt off since mid April, I became a graduate of the Pardee Cardiac Rehabilitation Wellness Program.  Just as on my first day of the program, I had to walk laps around the gym.  How easy it was this time with my body working with me instead of against me.  Just to prove I could do it, I ran the last lap.  There were high-fives all around, afterward one of the nurses and I boogied to "Hit the Road Jack" blasting on the sound system.  I felt jubilant.  The average improvement for program participants is 20%.  My improvement was 69.3%.   Although there were participants with ages in the 50's and 60's, and one young woman in her early 30's, most were oldsters like myself with some well into their 80's.  Yes, it sort of blows your image of the typical gym with buff young bodies populating the place.  I saw no six-packs, but some were sporting beer bellies likely due to too many six-packs.  Many have much more to overcome than just heart problems, such as diabetes, obesity, inactive lifestyles, worn out and painful joints, arthritis, and lung problems from a lifetime of smoking.  I felt fortunate that my challenges were simpler.  I can't say enough good about the Pardee rehab program.  The medical staff couldn't have been better.  Knowledgeable, caring, funny, and enthusiastic, they made each session feel like a party.  While operated by the hospital, being in a separate location in town, I felt like I was going to a cool gym rather than a medical facility, thus eliminating the medical-patient victim attitude. 

Well, now for the not so good news.  The very next day, last Saturday, my heart rate, which is usually on the higher than normal side anyway (called tachycardia), averaging about 105 to 110 when at rest, soared to the upper 140's and low 150's and remained that way all this week.  In addition to my heart beating so rapidly, literally pounding, it's very irregular.  I thought all this was behind me since I had surgery over five months ago.  I took some leftover beta blocker that causes me to have such shortness of breath I can barely walk across a room without gasping.  It did bring the numbers down a bit, but only for a few hours after each dose.  Obviously that wasn't the answer.  I did vagal maneuvers such as holding my breath and bearing down like childbirth, face planting into a pan of ice water, forced coughing and gagging and putting pressure on my eyelids.  Of course I didn't do all these at the same time and of course I couldn't do them without laughing.  Some worked, but only briefly.  I saw my local cardiologist on Monday.  He confirmed that my heart was back in artrial fibrillation and my heart rate was out of control.  He tried carotid sinus massage, another vagal maneuver that requires being hooked up to an EKG machine while pressing with his fingers deeply into my neck.  This didn't work.  He put me on a different drug that takes about three weeks to become effective.  My husband's brother, a cardiologist in Nashville, felt I needed to get my heart rate and blood pressure down ASAP.  I went to Spartanburg SC on Thursday to see the cardiologist I worked with pre-op and he put me on an additional drug that works faster while also keeping me on the slower acting one.  It must be working because today my heart rate has stayed below 140, but it's still irregular.  Although I hate taking medications, I was relieved that he had a game plan that didn't include rushing me to the hospital as happened several times last year.  If this med doesn't do the trick then I'll have to go for cardio conversion shock treatments.  This was done unsuccessfully last October.  At that time my heart stayed in rhythm for only 15 hours and I was left with some nasty burns on my back and chest from the electric paddles.  The Cox Maze III ablation I had in February is considered the "gold standard" treatment for A-fib (atrial fibrillation).  It is done only if there is another serious problem with the heart, in my case a dis-functioning mitral valve, because it requires open heart surgery.  Claiming a success rate of at least 96%, leave it to me to fall into that other 4%.  It may be necessary to have another ablation done, but it will be through a catheter in the groin or through incisions in the sidewalls of the chest.

I had big plans for this week in the work toward my "Rocky moment," but the docs curtailed that.  They don't want me to do any strenuous exercise until my heart stabilizes.  I did take my little duck and my goat for a walk up the road to the top of our property this afternoon.  Once again Olive, the goat, is learning to walk on a leash and she did much better this time.  When we stopped so she could graze on crab grass and weeds along the road, I enjoyed inhaling the sweet scent of the honeysuckle growing wild around us.

Meds:   Coumadin, Amiodarone, Cardizem, Vayacog, L-Carnitine, Vitamin D, I-Caps, Flax seed oil, Multivitamin, Lutein, Hawthorne, Garlic, B-12, L-Arginine, DHEA, Resveratrol