Days 6-7: Wednesday-Thursday, 8th-9th October 2025
Days 2 and 3 on the normal ward were remarkably similar, establishing a new routine whilst the medical team continued to fine-tune my treatment.
Daily Routine
The normal ward routine is more relaxed than intensive or intermediate care. Nothing happens until 7:30 when breakfast arrives along with the standard observations - blood pressure, heart rate, temperature, and oxygen saturation. The doctor's team then comes round with updates. On Day 5, I woke earlier with a headache and buzzed for paracetamol before going back to sleep until breakfast time.
The food has been pretty good since moving off the terrible no-residual diet - there's even a menu with a couple of choices and a vegetarian option, though breakfast remained uninspiring.
Physiotherapy Progress
Day 5 brought a significant milestone. After getting ready, I headed for a short stroll and ran into the physio. Before we could start, I was called for an X-ray. The physio took over as my chaperone, and we walked to the X-ray department at quite a clip whilst I explained my elevated heart rate situation.
The X-ray was super quick, and the physio guided me back via a flight of stairs. Made it all the way up today! Back in my room, I discovered I'd even scored one Google Fit heart point - my first one post-surgery!
Later that afternoon, after breathing exercises and lunch, the physio returned for another stairs session. Three of us from the ward congregated at the top for a rest. I won first place for highest heart rate, but my only prize was more loud heart noises in my head.
Day 6 followed a similar pattern - the main difference being no X-ray scheduled. The routine of physiotherapy sessions, walking exercises throughout the ward, and regular breathing exercises with the respiratory exerciser continued.
Ongoing Tachycardia Management
The surgeon reassured me on Day 5 that I was experiencing common phenomena amongst younger aortic valve replacement patients. While the exact mechanics might not be clearly understood, the heart just got a significant upgrade and occasionally it will skip a beat. In his experience, this is a fairly simple fix: keep drinking plenty of water and doing plenty of walking. I am back on the mobile pacemaker just to be sure.
By Day 6, the team were still deciding on the correct medication to address my tachycardia. The situation is complicated by a one-off momentary pause that was caught on my continual monitoring. Whilst apparently not super uncommon in post-operative valve replacement patients, it does deserve additional monitoring. This is causing the decision-making process to take a bit longer than initially expected.
The combination of elevated heart rate along with the single brief pause means the medical team need to balance the medication carefully - they want to control the rapid heart rate without potentially causing more pauses. The mobile pacemaker continues to provide reassurance and detailed monitoring data to help guide treatment decisions.
Anticoagulation Education
On Day 5, I had an important discussion with the nurse about Sintrom (acenocoumarol), the anticoagulation medication I'll be taking long-term. This education session was crucial for understanding my post-discharge care.
Why Sintrom is Essential
With a mechanical aortic valve, anticoagulation is vital to prevent blood clots from forming on the valve. The mechanical valve surfaces, whilst durable, can promote clot formation if the blood isn't properly thinned. Sintrom works by interfering with vitamin K-dependent clotting factors, reducing the blood's ability to clot.
INR Monitoring
The International Normalised Ratio (INR) is the key metric for monitoring anticoagulation levels. I'll be able to monitor my INR at home using a portable testing device, similar to how diabetics monitor blood glucose. The target INR range for mechanical valve patients is typically 2.5-3.5, balancing clot prevention against bleeding risk.
Consistency is Critical
The nurse emphasised two crucial timing considerations:
- Medication timing: Take Sintrom in the evening, at the same time each day
- Testing timing: Perform INR tests in the morning, consistently
This consistency ensures accurate monitoring and stable anticoagulation levels. Irregular timing can lead to fluctuating INR values that don't truly reflect the medication's effects.
Dietary Considerations
Sintrom works by antagonising vitamin K, which means dietary vitamin K intake needs to be consistent. The key isn't to avoid vitamin K entirely, but to maintain steady consumption levels. Foods particularly high in vitamin K include:
- Leafy greens: Cabbage, spinach, kale, lettuce, Brussels sprouts
- Cruciferous vegetables: Broccoli, cauliflower
- Herbs: Parsley, coriander, basil
- Other vegetables: Asparagus, spring onions
- Some oils: Soybean oil, canola oil
The nurse stressed that I don't need to eliminate these healthy foods - just maintain consistency. If I eat spinach regularly, I should continue to do so. The problem arises when someone dramatically changes their vitamin K intake, which can either reduce the medication's effectiveness (if intake increases) or increase bleeding risk (if intake decreases).
Progress Summary
Key developments over these two days:
- ✅ Established routine on normal ward
- ✅ Managing post-operative headaches
- ✅ Consistent physiotherapy and mobility work
- ✅ Achieved first post-surgery fitness milestone (stair climbing and Google Fit heart point)
- ✅ Improved dietary options
- ✅ Comprehensive anticoagulation education session with nurse
- ⏳ Medical team carefully evaluating medication options for tachycardia
- ⏳ Additional monitoring due to single momentary pause event
- ⏳ Continued mobile pacemaker monitoring
The elevated heart rate episodes are concerning but apparently normal for younger patients after valve replacement. Whilst the medication decision is taking longer than expected, this careful approach demonstrates the thoroughness of the cardiac team in managing the nuances of post-operative recovery, particularly in younger valve replacement patients where heart rhythm variations can occur.
Reflections on Progress
Over these two days, there's been steady progress in mobility and establishing a ward routine, even though the heart rhythm management is proving more complex than anticipated. The ability to climb a full flight of stairs and earn that first fitness point felt like a real achievement, even if it came with some uncomfortable sensations.
The physiotherapy team's consistent attention and the medical team's thorough approach to medication selection help maintain confidence that these temporary challenges are part of the normal healing process for someone my age going through this procedure.
The next updates may come after a few days, once there are significant developments - particularly regarding the move to Kirchberg and any new treatment decisions.