Day 18 of Recovery - Home Time! Managing Blood Thinning and Planning Discharge

Monday, 20th October 2025 - Day 18

Day 18 marks a rather pivotal week in my recovery journey - the final stretch at Kirchberg Hospital. For the past week, whilst I've had the benefit of an echocardiogram to triple-check the new valve and a pacemaker check with settings tweaked to bestow upon it a most agreeable 15-year battery life, the principal focus has been achieving what the medical profession terms the "therapeutic range" for blood thinning. Rather crucial, as it happens, when one has a mechanical valve ticking away in one's chest.

The Art and Science of Blood Thinning

Having a mechanical valve means I require thinner blood to ensure clots do not form on the valve - the body, in its infinite wisdom, tends to treat foreign objects with suspicion and attempts to form clots around them. This is where the fascinating world of anticoagulation comes into play.

The goal is to achieve an INR (International Normalised Ratio) of 2.5. For those unfamiliar with this particular metric, allow me to explain: INR is a standardised measurement of how long it takes your blood to clot. A normal person without anticoagulation therapy has an INR of 1.0 - their blood clots at what we might call the "factory standard" rate. My target of 2.5 means my blood should take 2.5 times longer to clot than normal - thick enough to still do its job, but thin enough to prevent clots forming on my shiny new mechanical aortic valve.

Think of it rather like Goldilocks and her porridge - not too thick, not too thin, but just right. The consequences of getting it wrong are decidedly less pleasant than merely eating the wrong temperature of breakfast, I dare say.

The Sintrom Dosage Dance

The medication in question is Sintrom (acenocoumarol), and achieving the right dose has been something of a delicate operation. The challenge lies in the fact that changes in dosage do not manifest in blood test results for approximately two days. This means the process is necessarily slow and methodical - one cannot simply adjust the dose and immediately see the results. Rather like steering an ocean liner, one must plan ahead and make adjustments well in advance of seeing their effect.

Throughout the week, my dose has been closely monitored and slowly increased until I entered the target range. Each morning brings a blood test, each result informs the next dosing decision, and patience is the order of the day. It's a testament to the precision required in modern cardiac care.

Self-Testing Independence with the Roche CoaguChek

Most splendidly, I have now been equipped with a Roche CoaguChek device, which allows me to test my own blood at home. This remarkable piece of technology means slightly fewer trips to the hospital for blood tests and, more importantly, provides me with immediate feedback on how my diet and daily activities affect my INR levels.

The device itself is rather straightforward to use - a small lancet pricks the finger (one quickly becomes accustomed to this particular indignity), a drop of blood goes on a test strip, and within moments, one has an INR reading. Knowledge is power, as they say, and in this case, that knowledge translates directly into better health management.

Dietary Considerations and Vitamin K

Here's where things become decidedly more complicated: vitamin K works against blood-thinning medication. Vitamin K is essential for blood clotting, which is precisely what we're trying to moderate. This means certain foods, particularly those rich in vitamin K, must be consumed with caution.

Two particular favourites from Polish cuisine will, I'm afraid, need to become rare treats rather than regular features of my dinner table:

• Bigos (hunter's stew) - that magnificent concoction of cabbage, sauerkraut, and various meats
• Gołąbki (stuffed cabbage rolls) - those delightful parcels of minced meat wrapped in cabbage leaves

Both feature cabbage prominently, and cabbage, along with other leafy green vegetables, contains high levels of vitamin K. It's not that I cannot eat them at all - consistency is key. If I were to consume large amounts of vitamin K-rich foods sporadically, my INR would fluctuate wildly, rather defeating the purpose of all this careful monitoring. The solution is to maintain a relatively consistent intake of vitamin K, allowing my Sintrom dose to be adjusted to a stable level that accounts for my dietary habits.

Other foods I'll need to be mindful of include:

• Leafy greens (spinach, kale, Brussels sprouts)
• Broccoli and asparagus
• Certain oils (particularly soybean and canola oil)
• Green tea

One learns to adapt, and there are, fortunately, plenty of delicious foods that don't pose such challenges.

Physical Limitations and Activities

I remain considerably limited in what I can physically accomplish. The restriction on lifting anything over 5 kilograms continues - this means no heavy shopping bags, no lifting the dog (much to his confusion), and no attempting to shift furniture around. The sternum, having been sawed through and wired back together, requires time to heal properly, and straining it prematurely could lead to decidedly unpleasant complications.

Walking presents an interesting paradox: I can walk around with no problems in terms of immediate discomfort, but the distance I can cover is quite limited before fatigue sets in. It's rather like having a battery that drains far more quickly than one expects - the first hundred metres are fine, but the next hundred require considerably more effort. This will improve with time and the rehabilitation programme, but for now, short walks are the order of the day.

The Journey Home

Given my limited walking capacity and the need to avoid physical strain, the doctor has provided me with a prescription for an ambulance transport home. This might seem rather dramatic for someone who can walk about the ward, but it's actually quite sensible. The alternative would involve walking to a car, potentially climbing stairs at home, and generally exerting myself more than advisable at this stage of recovery.

The Luxembourg healthcare system continues to impress with its thoroughness - they consider not just whether one can technically get home, but whether doing so in the usual manner might compromise recovery. Capital thinking, I must say.

Reflections on the Week

This past week at Kirchberg has been characterised by patience and learning. Patience whilst my body adjusts to the anticoagulation therapy, and learning about the lifestyle adjustments that will be part of my life going forward. The mechanical valve offers durability - it should last indefinitely without needing replacement - but it demands this careful management of blood thinning in return.

I've had time to become proficient with the CoaguChek device and come to terms with dietary modifications. The medical team has been thorough in their education, ensuring I understand not just what I need to do, but why I need to do it. Understanding the mechanisms at play makes the restrictions far easier to accept.

Looking Forward

Home beckons most enticingly. Whilst Kirchberg Hospital has provided excellent care, there's no place quite like one's own home for proper recuperation. The familiar surroundings, the comfort of one's own bed, the freedom to potter about at one's own pace - these are the things one misses most during a prolonged hospital stay.

The rehabilitation programme awaits, starting a week or two after my return home. Eight weeks of structured recovery with a consistent group - it will be good to work systematically on rebuilding strength and endurance under professional guidance.

Day 18 Summary

Key developments on Day 18:

• ✅ Final week of focused INR monitoring and management
• ✅ Successfully achieving therapeutic INR range with Sintrom
• ✅ Received and trained on Roche CoaguChek for home INR testing
• ✅ Understanding of vitamin K dietary restrictions (farewell, frequent bigos and gołąbki)
• ✅ Echocardiogram confirms new valve functioning properly
• ✅ Pacemaker check and optimisation for 15-year battery life
• ✅ Prescription for ambulance transport home arranged
• ✅ Continued physical limitations (no lifting >5kg, limited walking distance)
• ✅ Preparing mentally and practically for home discharge

Progress Summary

Day 18 represents the culmination of the acute recovery phase. From open-heart surgery to pacemaker implantation, from intensive care to cardiac ward, the journey has been eventful. Now, with blood thinning properly managed, mechanical valve and pacemaker functioning correctly, and a clear understanding of the limitations and requirements going forward, the focus shifts to home recovery and the longer rehabilitation journey ahead.

The next chapter begins at home, where the real work of rebuilding strength and adapting to life with a mechanical valve and pacemaker truly commences. Rather exciting, in its own way - the start of a new normal, as they say.