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Thread: COPD and Surgery?

  1. #1
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    Default COPD and Surgery?

    I have a friend who has COPD. She needs both aortic and mitral valve replacement fairly soon, as both have "moderate" issues, and she has severe angina, because of the valves in combination with the lung issues.

    Her doctor has told her that she can't have surgery because of the COPD. He now has her coming in for echoes every three months. What for, if he's not going to do anything for her? All these echoes do is to rub her nose in it. The COPD and the heart get worse over time. Eventually, the COPD will be bad enough that no one will be able to operate on her.

    She is still in good enough condition to come to work each day. I've never heard her coughing, so it must be one of the other types of COPD. You wouldn't know she has any of this, if you saw her working. I want to believe she can get her heart fixed.

    She's a very nice lady, and we've had a nodding acquaintance for a number of years. I've mentioned CCF to her, but I'd like to know if anyone here is aware of or has had valve surgery with COPD. Any information I could give to her would be a blessing. Who to talk to, how to contact them, which surgeons, where, whatever news.

    Thank you,
    Bob H

    "No Eternal Reward will forgive us now for wasting the dawn..." Jim Morrison

    Click here to View the Glossary of VR Terms and Acronyms

    I am not a Medical Professional. Aortic Valve Replacement (Medtronic Mosaic) on 4/6/04, at Robert Wood Johnson UH in New Brunswick, NJ. AVR again (St. Jude Biocor) on 08/25/09 at St. Michael's MC in Newark, NJ. Both performed by Dr. Tyrone Krause, a true Zen Master Mechanic in the world of valve replacement surgery.

  2. #2
    Susan BAV Guest

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    Hey Bob -

    Remind (some of) us what COPD is?

    It appeared that both my (bicuspid) aortic valve and also my mitral valve "might" have needed replaced, presurgery, and I had a cough (on exertion) and fairly significant angina (although I didn't recognize it as such until the cardiologist diagnosed it). But the aortic valve replacement was enough for me and I didn't need the mitral replaced too, afterall.

    Hoping things go well for your friend; wish her the best from your "buddies" here at VR.COM...

    P.S. Have you written your "story" yet? I have really enjoyed your humor.

  3. #3
    KimC Guest

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    Susan,

    COPD = Chronic Obstructive Pulmonary Disease, a progressively worsening group of lung diseases such as emphysema or chronic bronchitis that can lead to cor pulmonale:

    "Cor pulmonale is enlargement of the right side of the heart, which pumps blood to the lungs. This enlargement occurs when the heart has to work harder to pump blood through damaged lungs, such as when a person's lungs are damaged because of chronic obstructive pulmonary disease (COPD). With time, cor pulmonale leads to heart failure."

    Tom,

    I would like to hear from others, (especially Ross) but my "somewhat educated" guess is that, if her heart condition is secondary to COPD, then only drugs can treat her symptoms, valve replacement wouldn't "fix" her problem.

    I hope that you're encouraging her to seek several opinions and that she's taking a long-acting nitro (and CoQ10).

    All the best,

  4. #4
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    What I have is identical to COPD and in many ways is exactly that. She needs to find a new Doctor. I'm in pretty bad shape and it has never stopped them from helping me. I'd suggest she get another Doctor, second opinion, or be evaluated by a Pulmonologist.

    She'll likely have an extended date with a ventilator, which is not something I wish on anyone, but if that's what must be........

  5. #5
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    Remember how bad off Nicole was? She managed to get to another group; now she's getting better and better every day. We thought our dear Ross was not going to make it - but here he is, and still fighting to stay afloat. This lady needs second opinion, and thirds if necessary, til she finds someone who can help. It's probably out there somewhere. So tell her.
    Ann
    My philosophy:
    No matter where you are, who you are with, what you are doing, enjoy every moment, every day. Blessins.........

  6. #6
    Mary Guest

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    Does she smoke Bob? I just read this thread this morning, but I'll run it past my husband when he gets home.
    For 30+ years I've heard stories brought home from the hospital about
    "chronic COPDers." As Kim says, they have ongoing lung disease processes that will not resolve. Many, many of the patients have smoked all their lives and will continue to do so until the bitter end. It is progressive, but the pace of the disease varies from patient to patient.
    Around here, where coal mining was King for so many years, exposure to occupational agents is/was a significant cause of COPD. If I understand it correctly, the air sacs in the lung become so damaged that there is no way to repair them, and they become basically dead tissue. A percentage basis
    is given to the lung capacity (similar to the heart's EF number).

    The fact that your friend is still working leads me to suspect the COPD is not yet severe. I'm assuming she has seen a pulmonologist by now for the diagnosis. There is no cure for it, but patients can impact the progression by proactive measures. Find out if she smokes. If she does, that might be why they're saying they won't do the heart work.
    Mary

  7. #7
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    Even if she does smoke, that is not a basis for which to deny her treatment.

  8. #8
    Mary Guest

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    No, of course not Ross.
    You and I know that. However, we also know that the people practicing medicine don't always think like we do. (That's their loss!)
    And, it's very possible that she doesn't smoke.
    Love your pig.
    Mary

  9. #9
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    My DLCO for lung capacity and gas exchange is really low, around 4.15, where for someone of my height and weight, it should be around 15. It may not mean much to some, but that's very bad and they still work on me.

    I'm not saying it's not going to be a rough time, because it is. A lot rougher.

    I've been told that should I be put on the vent now, I may never come off of it again.

  10. #10
    Birky Guest

    Default copd

    I was diaganosed as having COPD when I had the surgery for the valve. I was a smoker at the time. Nothing was ever said to me by the cardiologist or the surgeon regarding this. I asked the nurse and she said it is something that people get when they are long time smokers. This was on my diagonosis from the surgeon. I had not trouble going off the vent.afterwards. I quit smoking when I had the surgery. I don't have a cough but do have a lot of mucus in the morning which needs to come up. I was really upset that no one told me about. Evidently they didn't think it was bad enough to address. When I see my Cardio I will talk to him about it. I have since had a surgery to take out the wires with no problems.

  11. #11
    Mary Guest

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    Ross,
    I'm going to go back and look at your old threads if you don't mind. I saw an early one where you have a bleeding lung disease besides the heart and aortic repairs.
    I understand the comment about the ventilator completely. But sometimes some of the very worse scenarios are resolved to everyone's surprise. Many times my husband will come in and say, "So and So (chronic COPDer) is back in the hospital on the vent." Few weeks later, they're better, have stabilized, and been discharged. They will probably be admitted again, but for the time being, they've made it through.
    Back to the original thread. . .
    I know that they will turn heart transplants down for patients who smoke. It happened to my girlfriend's mother.
    Mary

  12. #12
    KimC Guest

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    I have to say that from my own painful experience, if someone has been denied care or continues to experience inexplicable symptoms then he or she must become their own health care advocate, and seek the best care that he or she can afford.

    Shit, I was told that my asthma symptoms during pregnancy were anxiety. After PFT's and a very surprised look from the pulmonologist, (my numbers were low) I was diagnosed with asthma at age 37. Neither my PCP, cardio or OB could figure it out. They all thought being newly diagnosed with aortic insufficiency during the pregnancy caused anxiety with SOB. I've never hyperventillated in my life, and a brief course of anti-anxiety meds sent me to the ER with pre-term contractions.

    Meanwhile, my former cardio is making front page news with his substance abuse problems, and my OB has left the island. (I live at Melrose Place!) Rumor has it that the cardio will lose his license in another week. As much as I don't like the part of me that enjoys vengeance, my family and I suffered a great deal last year because of their incompetence in properly diagnosing me, and who knows what kind of long-term damage was done.

    One year and six months later, I'm taking Nasocort, Advair and occasionally Prednisone and hopefully will recover fully. I'll find out later this month when I have a right/left cath if my asthma is related to the aortic and tricuspid leaks.

    Ross is our living proof of the best that medicine can offer those with chronic lung disease. He's here today because of the care he received at the Cleveland Clinic. I am probably still here today because of their diagnostic skill. I'm not sure I would've survived Orlando without the Imdur.

    Ross, I'm prayin' for you, bro. I'm so sorry you're suffering. You mean so much to so many.

  13. #13
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    I'm not really suffering. I do have to say that if I had to placed on the vent for life, I'd rather take death. I know there are folks here that will disagree with this statement, but I've been on the thing for extended periods of time plenty of times. There is no way in hell I want to be on it for life.

  14. #14
    Birky Guest

    Default vent

    I agree with you Ross. To me this would not be living but existing. It would be too hard on my family to have to go through this but this is not carved in stone so I really shouldn't be making this statement. My Dad was 87 when his kidneys failed and was put on a respirator by his choice and then was airlifted to a trauma center and stayed on dialysis until he could no longer do it. They had told us 5 to 10 days but he lasted 6 weeks. Very long weeks for all of us. Mind was great but the rest was shot. I hope that we never have to go through this again. I can still replay all our conversations from that week.

  15. #15
    Yaps Guest

    Default could the person

    in question be misdiagnosised? I had chest pain and sob for a long time then heart attack, they had dx me as emphysema, inhalers , prednisone all of this no help at all.
    Only a quadruple by-pass and new mitral valve brought relief.
    Could she have been misdx? Just my 3 cents worth.. Love Yaps

  16. #16
    Mary Guest

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    Bob,
    In regards to your friend with COPD, I ran it past my husband and he said if she is able to work, is up and walking while at work, and not on oxygen, he can't imagine why they're saying no possibility of surgery.
    Much like you, he sees no reason to be doing an ECHO every three months if there is no possibility of vr.
    He says she has probably had a pulmonary function test to determine DLCO, FVC, TLC, and FEF 25-75. None of it makes much sense to me, but he said that's what they would look for on the test results. I had a pulmonary function test last month to rule out the possibility of lung problems causing my SOB, but in my case, it's all valve causing the problem.
    Unless the numbers are really bad,she probably is a candidate for the surgery.
    Mary

  17. #17
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    Sounds like possible good news, if a few assumptions pan out. Is there someplace or someone special I should point her at (along with CCF)?
    Bob H

    "No Eternal Reward will forgive us now for wasting the dawn..." Jim Morrison

    Click here to View the Glossary of VR Terms and Acronyms

    I am not a Medical Professional. Aortic Valve Replacement (Medtronic Mosaic) on 4/6/04, at Robert Wood Johnson UH in New Brunswick, NJ. AVR again (St. Jude Biocor) on 08/25/09 at St. Michael's MC in Newark, NJ. Both performed by Dr. Tyrone Krause, a true Zen Master Mechanic in the world of valve replacement surgery.

  18. #18
    Mary Guest

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    Bob,
    Is this lady seeing a cardiologist now? She should see a pulmonologist first so he/she can assess the severity of the COPD, look for possible changes that might be made in medications, and see if she would benefit from pulmonary rehab. Pulmonary rehab might help enough to make her a better candidate for the surgery.
    If she's not seeing a cardiologist, that needs to be done. Finally, she needs to see a cardiothorastic surgeon since he will have the final say on risk factors. Some surgeons will take higher risk patients than others; she might have to see more than one.
    Start with the university hospital where you had your vr done. If that doesn't seem to be a good option, John Hopkins and CCF would be able to address both the heart and lung issue.
    If she is still working, she probably has insurance coverage. It seems that she would want to try and find the answers now rather than waiting until she is no longer able to work.
    Bottom line is, the surgery should be performed before the COPD progresses even more.
    Mary

  19. #19
    Nan Guest

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    Ross, I read your messages with concern! I fully understand what you mean about not wanting to be on a vent.....when I was conscious on it it was not a happy time, for sure. My husband went to tremendous lengths to get me off of
    it even though the docs said I still had fluid (CHF). He knew I would recover faster, and he was right.

    But I was just wondering if there aren't any other options for you? Not that you would want another surgery, but it seems to be there are such things as lung transplants.....would that be a viable option?

    Don't mean to pry, just concerned.

  20. #20
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    I've already been told it's not an option, as this darn disease would just eat up another set of lungs. I've already outlived all the medical fields expectations on longevity.

  21. #21
    KimC Guest

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    Ross,

    Judging from your photo, you'll continue to outlive all our expectations of longevity.


  22. #22
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    Quote Originally Posted by KimC
    Ross,

    Judging from your photo, you'll continue to outlive all our expectations of longevity.

    I darn well better, I'm not in the least ready to give up just yet. Besides, I haven't learned everything about xp yet and haven't done any graphics work yet. Oh yeah, and I haven't corrupted you as of yet!

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