Ultra runner with questions.

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E

echoguy

Hey Everybody:

I am new to the forum and have appreciated reading several of the threads on this page.

I am a 49 year old runner who has completed over fifty marathons and ultras over the past ten years. Aortic stenosis was discovered five years ago when I had problems with the heat in a 10K race. I did fine for years but my numbers have slowly worsened and I passed out during a tempo run two months ago. I am now planning aortic valve replacement surgery at the end of June.

I would love to hear folks opinions in three areas.

The "knee jerk" reaction seems to point me to a porcine valve to avoid coumadin. Should I seriously consider an artificial valve if I plan to run ultras? And maybe bike and mountain climb on the side?

Can I expect to return to my previous level of activity?

Does ultra running put the new valve at any risk or shorten the time before the need for a second replacement procedure (assuming I go with a porcine valve)?
 
Running

Running

Hi Echo,

Hopefully, you'll get a reply to your post by Sumorunner. He's got a pretty good handle on the running thing following valve replacement surgery.

Many of us here engage in pretty serious, rigorous activities even though we've got artificial valves. I gave up running and climbing after a climbing accident many years ago broke both of my knees. I am a serious cyclist and do both mtn and road stuff. I also do a lot of hiking and skiing.

My AVR surgery was almost two years ago. I take comadin and it hasn't slowed me down at all. Yeah, I bruise when I fail to keep my mtn bike wheels under me where they belong, but I'd buise when I crash even if I wasn't on coumadin.

Opinions will vary regarding valve choice for people who want to pursue rigorous activities. Most members seem to have strong opinions regarding this issue and that's not a bad thing.

If you're really into serious running, you might wish to check out cardiacathletes.com. This fourm has a lot of marathon, triathletes, and cyclists who have had valve replacement surgeries.

-Philip
 
Welcome. I'm not sure how much this will help in your decision but here is my story...and I'm sticking to it. :D
I had my AVR about 2 1/2 years ago. I'm a distance runner having completed 53 marathons (3 since surgery) and several triathlons, including one IRONMAN. I just turned 71 in Feb. I have a bovine valve (see my signature line) and my only wish is it was 29mm like Tom Price's not the 21mm, but I know there are reasons for it. The only meds I'm on is one aspirin daily. My first marathon post surgery was one year, one day with a time of 4:57:xx, my worst ever, but my most gratifying. Since then I've continued to train but I have never been able to get back to pre-surgery fitness. I think part of the reason is age and another part is the spark is gone for the long distances. I've also be plaqued with some downtime injuries or other medical crap that has slowed me down the last two years. Right now after 3 months off for a fracture of my left heel I am on the comeback. I think for the most part, you have a good chance to get back to where you. Like Philip mentioned check out cardioathletes, there is a lot more feedback there that might be more helpful.
Good luck in your decision. Like everyone here, when all is said and done regardless of our decisions, we're happy we are here to even talk about things like this.
 
Welcome! I will echo check out cardiacathletes.org (not com). Also, to answer some of your questions:
-research the valves and chose one you are most comfortable with. I had my AVR at age 52, so like me, your options are wide open. Know this, the only bad choice is doing nothing...this will not cure itself. Thanks to this site, I was happy to have either type valve, although I had to pick one, the surgeon knew I was ok with either.
-will you get back in shape....yes, you can, if you recover properly and get back in training at the right time. Over at CA.org, we have ironmen and marathoners who beat their old times, even qualify for Boston after AVR! It has taken me 2 years to get back to my times from 4 years ago.
 
My AVR was almost 18 years ago now. I'm what some would call a pioneer. It was a pretty rare thing to return to running after VR back when I did it. I was 43 at the time and now I've run more years, more miles, more races after VR than before. Never done marathons though. My biggest one every year is about 15K.

Mine is mechanical. I was told back in the day that the porcine valves would only last about 10 years before they needed to be replaced. I might be looking toward my third valve job by now. No-FRIGGIN-thank you! Once was enough. Some have been known to complain, in their best Quasimodo voice, "Oh the ticking, the ticking..." Forget about it, after a while you won't hear the ticking any more.

You can return to run as much as you please, but you may be a bit slower due to several factors, replacement valve max opening, self-doubt and desire, but age primarily. You ain't getting any younger, so don't blame the valve for what's going to happen naturally anyway. I slowed down a lot because of taking a beta blocker. That does effect max heart rate. Coumadin is only rat poison after all. It does not effect your HR or endurance, but you may from time to time get red cheeks from burst capillaries.

They keep your INR (clotting factor) in a reasonable range so that you are not really a "bleeder". You don't become a hemophiliac. But you have to track it constantly by drawing blood because it can change quite a bit due to what you eat or drink. I can tell if mine is high merely by flossing my teeth. And it does change by the season, the old wives tale about blood thinning in the winter. There's something to that.
 
Welcome to the forum. It seems as if everyone has already offered everything I could say. Let me just suggest, though, that you be very clear with your docs about what you want your life to be like post-surgery.

The differing responses can vary widely. Some physicians will insist you stop everything. Others will ask for pictures of your successes. Valve replacement has changed so much over the years that old biases still pop up, though. I can't believe what some surgeons said to me when I was shopping around. Find someone you're comfortable with and have an honest conversation. That way, at least you'll know going in if your goals are realistic/safe.

In the meantime, we're looking forward to your first post-surgery race.
 
Welcome aboard!

If you are avoiding mechanical valve to avoid coumadin, I tell you that once your INR is stabilized, Coumadin is not a big deal! As for your other questions, I am glad you got good answers above.

Whatever you choose, good luck.
 
Return to form post-op

Return to form post-op

Echoguy - I'm a cyclist (former 10k runner and swimmer). At 6 mths post op I was within a couple months of being where I was before surgery. I had been off for my surgery as well as for some acute back problems. Even with leg weakness from the back stuff and the extra layoff, the rate at which I was progressing convinced me I'd be able to well exceed where I was before. I didn't have any exercise shortcomings, just some recently acquired Afib in response to my enlarged left ventricle. I had back surgery last week and need to take some more time off, but if I can get some leg strength back, time will tell, I fully expect to improve on my pre op performance. Maybe my timeframe is too limited to provide meaningful information for you but I'm very encouraged about the future. I went the tissue route.
 
JeffM said:
Maybe my timeframe is too limited to provide meaningful information for you but I'm very encouraged about the future. I went the tissue route.
Click to expand...


Right, tissue valves seem to have fewer repercussions in the short term. I just didn't like the idea of facing OHS ever again.

Speaking of encouragement for the future, what about the new methods for growing your own new valve in a lab from your marrow cells? How far might it be before that's the norm? I can only imagine how much better that would be.
 
Thanks for the encouragement everyone. I will keep you all posted as I get closer to surgery time. Looking forward to reporting my recovery events.

Happy trails.
 
Welcome to the board, as you are seeing there is a wide amount of experience to draw from.

I am 8 months out from having an On-X Aortic valve installed. I started exercising in earnest the
first part of December. What I was told by my cardiologist was that I could do any amount of
cardio as long as I paid attention to my HR as Sumorunner has mentioned.

He also advised that when it came to strength training lift no more then 40 pounds during any
exercise, using a lower weight higher reps approach. He told me not to do anything that made me
red in the face. To do so on a continual basis could prematurely wear out the valve I have.

I'm not sure that if I had this information prior to my surgery that I would have changed my mind
on having a mechanical valve installed. Although, depending upon your future expectations of
exercise you may consider having that discussion with your cardiologist prior to your surgery.

What guide lines have others here been advised to follow?

Rob
 
R&N Brown said:
He told me not to do anything that made me
red in the face. To do so on a continual basis could prematurely wear out the valve I have.
Click to expand...

that can't be right, can it? is he just making this up as he goes along?

i was thinking weightlifting is anaerobic, doesn't really get your heart
pumping all that fast. should only be the high-intensity aerobic workouts
that elevate your hr to 200+ that could affect your valve. even then,
a mech valve shouldn't be negatively affected. they're like, um, designed
to accommodate that.

no, i don't know any of this as definite facts, just my impression from what
i've read. wouldn't the pressure increase from weightlifting only affect
your aorta, and only be a problem for someone with aneurism?
 
Just passing on what I was advised. It sounded a little funky to me too.

I had been doing reps on 6 machines where I had been doing 10 reps with 80 Lbs, wait a minute, 10 reps with 100 Lbs, wait a minute, then 10 reps with 120 Lbs. my doc told me that was not a good idea.

One thing that may come into play with me is that I also had my ascending aorta replaced too. But he did not mention that, he only mentioned the valve.

I wear a monitor and at the conclusion of each set my HR would be up in my 90% area. I felt OK.

I know some of the guys at the gym will push their HR much higher when working with higher weights.

SumoRunner, I enjoy your posts and you mention HR levels on occasion, any experience here?

Rob
 
R&N Brown said:
One thing that may come into play with me is that I also had my ascending aorta replaced too. But he did not mention that, he only mentioned the valve.
Click to expand...

i'd guess then that he was talking in 'shorthand.' just left out a few details.
given what some of the guys with mech valves on cardioathletes are able
to do, there should be no way of wearing out a valve like that.
 
ChouDoufu, Are you sure of you opinion? Is it founded on the advise of your cardiologist or a medical journal?

My Doc's advise did not sound all that off the wall to me. When I would get deep into reps I could feel the valve really working. Pretty much the reason I asked if I could do damage to it.

I am a technician by trade and I have yet to come across a mechanical part that does not have a cycle life expectancy, so I was not all that surprised to hear that a heart valve also has a cycle life expectancy. The harder and more often you push it to a perimeter it would make sense that it could reduce its longevity. The advice sounds logical to me.

I am curious as to whether anyone else has received this same advise from their doctor.

Rob
 
R&N Brown said:
ChouDoufu, Are you sure of you opinion? Is it founded on the advise of your cardiologist or a medical journal? Rob
Click to expand...

nonononono! i'm not a doctor, not a health professional, not a valve
mechanic!! (but i did do all my motorcycle valve work, and once slept in a
holiday inn express.....) i'm just a dude with a meat valve, and interested
in all this stuff. like everyone, i have my own opinion , but they're just
opinions and may be wrong. i follow some of the threads on cardioathletes,
amazing what some of them can do. multiple ultramarathons, ironmans, etc., many of them with mechanical valves. i don't recall ever reading of
someone wearing out a valve, or being worried about same.

these things are designed for a lifetime. you're talking about cycle life
expectancy, right? non-aerobic sports should not greatly increase the
number of cycles, and anyway, they're designed for more cycles than you'd
manage in several lifetimes (my opinion again). i better shut up for now,
as i don't have any research to back anything up. best to ask your cardio
for clarification, and contact some of the supermen with mech valves
for their inputl.

http://www.carbomedics.com/patients_faq.asp?faq=PFMech#2
Based on accelerated wear testing in the lab and on measurements made on explanted valves, the valve will last between 100 and 400 years.
 
Chou,

When I had my valve replaced in 89, the cardiologist said that he really didn't know what limitations I would have but said that he'd rather me not run marathons. Since I didn't know any better, I starting lifting instead. I power lifted for years and then later backed off of the really heavy weights and added aerobics back to the routine. At the 20 year mark I had to have surgery to repair an aneurysm above the valve, but the valve itself was still working just fine. I know one person doesn't make for definitive info, but I will say that I put mine through the ringer and didn't seem to hurt it. The aneurysm, however may not have been helped with the heavy weights. Oops.

Joe
 
Hello DoChou,

I'll take my chances with my Cardiologists advise and not your Opinion. I'm not buying the suggestion that a valve can't be worn out.

I'm pretty fit although I'm never going to, nor do I have any desire to compete in an ironman event so why take an unnecessary chances. I do think it's a good thing though that we have fools out there doing the in-field testing on just what the tolerances of a valve are.
Dead is for a long time.

You dong any testing or just talking?

Rob
 
R&N Brown said:
You dong any testing or just talking? Rob
Click to expand...

testing, testing....but starting slowly. just hit the 10 week mark yesterday.
ran 2.5 miles on the uni track, today a 50-mile bike ride.
planning on a half marathon by xmas, and a full marathon by next summer.
would love to bicycle across mongolia.
no ironmen in my future. ironwomen if i can find them.

from all my reading, at least for meat valves, high intensity workouts do
not affect valve longevity. problem with the meat valves, especially for
the younger folk (under 65) is they tend to calcify. that process proceeds
at the same speed regardless of exercise.

mech valves would not calcigy, would have a different set of problems.
 
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