Recent content by vitdoc

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    2nd AVR on my horizon : (

    I had my first aortic valve repair in 1977 with an early tissue valve and annulus enlargement. No one knew the life expectancy of the valve at that time. 5 1/2 years later it started to fail and in 83 I got a St.Jude and warfarin. On warfarin now for 36 years no significant issues. 2006...
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    5 and half years On my on-x valve

    Not to disparage medical treatment in Kuwait were I assume you are being seen but since you are not getting better maybe getting another opinion about your medical situation elsewhere would be the best option. Europe or the US might be the way to go.
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    Failure of Onx valve and problems with lowering INR

    I just want to clarify a small but important issue. When companies apply for drug or device clearance from the FDA they submit their studies to the FDA for review. The FDA does not do the studies. So the companies try to put the data in the most favorable light. As I mentioned previously the...
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    Need an MRI

    Pacemakers are certified by the manufacturers as being MRI compatible or not. To be fully compatible you need to have the leads certified also. If they are fully certified you can get an MRI in most places without an issue. It turns out that essentially all pacemakers can be used with MRIs...
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    Pacemaker Poll

    I developed complete (3rd degree) heart block after my third open heart in 2006. The surgery was for a aortic aneurysm with the aortic valve redone also. Basically the sinus rhythm generated in the right atrium could not reach the ventricles. Some people have an intrinsic ventricular rhythm...
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    Getting Ready For 2nd AVR - 29 Years Old

    Dear John, I have gone through somewhat similar experiences also. Born with bicuspid valve, replaced with tissue valve age 29 in 1977. Early on with tissue experience. Failed replaced 1983 St. Jude. Good until 2006. 6.5 cm aneurysm found and aortic repair with another St. Jude. 3rd degree...
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    I agree that blood cultures should be done. But while you are using antibiotics the yield for blood cultures may be reduced and you might get a false negative. So cultures could be obtained while on antibiotics and they might be positive but they might need to be repeated when off antibiotics.
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    It is time... and hello again.

    When I have a patient who has an obvious problem that I know everyone would agree upon I feel slightly annoyed when a patient doesn't go along with my suggestion. But as long as waiting doesn't cause harm I have no problem with them getting another opinion. If the problem is not as well...
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    What's in a name?

    When I ask patients if they are taking some sort of anticoagulant they look at me with this blank stare. If I say blood thinner they immediately get what I am talking about. So yes the term blood thinner might be cringeworthy to the cognoscenti but it is what most average people understand.
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    It is time... and hello again.

    Most if not all patients having this procedure appear to have had Marfans syndrome. This has a high rate of aortic dissection or rupture. I am not sure if there is much track record in non Marfans patients. 46 to 47 mm essentially is no change. The testing is not that precise. So there...
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    I’m just tired of taking warfarin

    Rob, I recently saw a pediatrician who had atrial fibrillation and knew she had it. For reasons only known to herself she did not take appropriate anticoagulation and she had a preventable stroke. In her case it wasn't as bad as it could have been since her primary loss was in an area of...
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    Low INR question

    In the real world the drug or equipment rep comes to the doctor's office provides a free lunch to the staff and then the doctor feels obligated to give the rep a few minutes to listen to their pitch. In the case of the On-X valve the pitch would be to take out a copy of the study suggesting that...
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    Never ending INR issues- warning LONG post

    Freddie, I didn’t say that test stip problems couldn’t cause inaccurate readings. Say going from a 3.5 to a 5. But she went up to over 7 And down again. So yes bad strips could be the cause but given the huge fluctuations less likely. Clearly she needs to be tested properly.
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    St Jude Valves

    I have written about what I have seen with the On-x valve and the lower INR requirements. The data was not compelling. I am sure the valve is fine but the lower INR requirements may not be truly accurate. If I were getting a valve today I might consider the On-x but it clearly doesn't have...
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    New (?) CoaguChek meter

    Usually the reason that the medical device is not available in the US is that the manufacturing company has not gotten the device through the FDA. Even if there are relatively small changes often the FDA still requires a lot of input from the company which may not make business sense given the...