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  1. vitdoc

    Increasing Dietary Vitamin K Intake Stabilizes Anticoagulation Therapy in Warfarin

    Basically eat what you want adjust the warfarin accordingly and forget about the cardiologist telling you not to. As long as you can self test you will be fine.
  2. vitdoc

    Increasing Dietary Vitamin K Intake Stabilizes Anticoagulation Therapy in Warfarin

    The underlying question is why are there significant fluctuations in the INR while taking warfarin. There are probably a few reasons assuming a constant warfarin dose. Probably predominately it is the amount of Vit K consumed and how the body deals with it. Other issues are other concomitant...
  3. vitdoc

    Tissue Valve Turns 14

    Go valve!
  4. vitdoc

    Difference between ohs and minimally invasive avr

    Sorry but incorrect. Your coverage may have paid but Medicare which covers most in the US over 65 covers usual and customary. If medical procedures are done outside of those conditions which Medicare defines the patient pays, not Medicare. Laser cataract surgery is not currently defined as...
  5. vitdoc

    Difference between ohs and minimally invasive avr

    You inadvertently proved my point. In the US cataract surgery for those over 65 is covered by Medicare. Medicare pays something like $600 to a cataract surgeon. This includes seeing the patient for the next 90 days. Not a stellar amount for the skill involved in my opinion. However, if the...
  6. vitdoc

    Can I take flu shot?

    The question should be “Why shouldn’t you get a flu shot?”. I can’t think of any reason. Also personally I generally do not mention I am on warfarin when I am getting a shot. Too much nonsense to deal with. If I was having a large needle driven into my liver being on warfarin might be very...
  7. vitdoc

    Difference between ohs and minimally invasive avr

    Sometimes there are real breakthroughs in technique or technology that make a big difference in medicine. Other times there are lesser differences that may on the surface look good but may be a bit over hyped. In my field of ophthalmology there have been over the years small changes in...
  8. vitdoc

    Getting confused - Questions re: Ross and other options - Severe AR

    The Germans were pioneers in the development of electrophysiology and deemed the test EKG which is based on the Greek kardia. So the test has been frequently called EKG. At some point the English equivalent of ECG was also used due to the English spelling for kardia being cardia. Not sure...
  9. vitdoc

    Variable/pounding heart rate following AVR/Aorta graft

    Your resting HR shouldn’t be that variable. Suggest discussing with cardiologist and probably getting it monitored. May be nothing but needs to be better understood.
  10. vitdoc

    Valve Choice with history of Cancer. Anyone deal with this?

    Personally I would tend toward a bio prosthetic valve. I suspect if you have a significant cancer issue you may need long term treatment and evaluation. You might need procedures, biopsies, placement of a port to allow for blood drawings and IV access. Being on anticoagulants might prove to be...
  11. vitdoc

    Valve Choice with history of Cancer. Anyone deal with this?

    It depends. First how old are you? Will the cancer affect your life expectancy? Will you be needing more surgery for the cancer? Will anti coagulation make treating the cancer more difficult? The cancer itself probably will have little affect on the valve of any type.
  12. vitdoc

    Post Surgery Timeline

    When I went to medical school we were taught a few things about post operative care. In GI surgery we always asked after surgery “have you passed gas?”. Then we knew the bowels appeared to be working OK. When drains are left in one watched to see when the drainage stopped - then they are...
  13. vitdoc

    Royal Paworth

    I am not intimately familiar with the NHS. Can you go to a different facility? If the records are available it might not put you too behind. Good luck.
  14. vitdoc

    Royal Paworth

    90%+ of hospitalized Covid patients are not vaccinated. So aside from prolonging everyone’s misery these patients are preventing care of those who need it for other issues. So I can understand why many people are frustrated and state things like “anti Vaxxers are the lowest of the low” Not...
  15. vitdoc

    Why both Warfarin AND aspirin?

    Like everything else there are trade offs. There might be a mildly reduced thromboembolism rate if antiplatelet agents are added to warfarin therapy. It is not however a huge improvement certainly not 40%. On the downside that possible modest effect comes at a cost of increased bleeding. The...
  16. vitdoc

    Foldax valve trials

    I am a big fan of the fewer things needed to be done the better. Yet I have this long list of procedures. Each procedure has it's own risk so when one adds procedure to procedure the risk adds up. For example when I had my last big surgery in 2006 which was an aortic aneurysm repair with...
  17. vitdoc

    Foldax valve trials

    I am one of I believe many that have been very active on warfarin. Started in 1983 till now. Skied at a pretty high level until a few years ago. Still road biking over 100 miles / wk. Had one bike fall around 15 years ago where I bleed significantly into my leg. Had trouble climbing...
  18. vitdoc

    CryoLife On-X INR Claims

    The problem with the On-X data was that it was not very robust. It was a small trial of less than 100 participants. If one looked at the data there was a higher risk of thromboembolic events and a lower risk of bleeding. The company concocted a combo statistic combining these two different...
  19. vitdoc

    25 years Post Op Ross Procedure

    Yes that is a plus. And now that I have continuous A fib warfarin is also necessary. But I don’t think that one is protected from stokes since some strokes are hemorrhagic stokes which would be exacerbated by anti coagulation. But every procedure has it’s own set of risks so to me fewer...
  20. vitdoc

    25 years Post Op Ross Procedure

    You will have two questions to think about. What kind of valves to put in the pulmonary and aortic positions? Tissue or mechanical. I would be surprised if the pulmonary is not redone since it has been in for 25 years which is usually past it's due date. With tissue valves no anticoagulation...
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