I've crossed the line into severe and need to make a decision

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Chuck C

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I went off Metoprolol for just a day, and my nice low 50s heart rate jumped up to 115 at rest this morning.
It sounds like it is probably still needed in your situation. All seem to indicate that pulse comes down over time, following OHS/valve surgery. Some have indicated that it takes a year or so to normalize. So, give it time and hopefully it will come down.

I did the mountain again yesterday, third time in 6 days. Resting pulse this morning was 61. I'm not sure what to make of it, except that it seems that the morning after I do the mountain, my morning pulse is low, and getting lower each climb. Yet, when I don't climb the mountain, the next morning my pulse is back to 78-84 in the morning. Also, once I have started moving about for the day, it goes up and seems to mostly stay up. It's 84 right now.
 

Unicusp

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Interesting....

I went off Metoprolol for just a day, and my nice low 50s heart rate jumped up to 115 at rest this morning. The out-of-breath feeling I hadn’t really felt since before surgery was back! Only without exertion! It scared me into taking a pill... Maybe I’ll try again next month.....
Hello. Are you on any other BP meds? If not, that's understandable. There are other options with less side effects. Worth exploring. Some people have no issues with Metoprolol, whereas others it can be pretty bad. Feel better!
 

Chuck C

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Whoa, climbing a mountain? Did I tell you that given your shape this recovery would be mind-blowingly crazy? FWIW, I'm on 25mg of Metoprolol and probably will be forever - just to help keep my BP in check. I seem to tolerate it well. Then again, I've been on bp meds, including beta blockers, for so many years that I have no idea what normal is. 🤪 But in general I have energy and feel great. Not climbing any mountains, however! I'm also about 20+ years older than you are! 😱 Congrats on the progress.
Thanks Herb!
Mt. Monserate is close to you- North County San Diego- Fallbrook. You should check it out some time. It is actually a World Trade Center memorial, as the elevation gain in climbing the mountain is about the same as the gain if you climbed to the top floor of the WTC- The WTC had 110 floors and Mt Monserate would be about 120. Every time you climb the equivalent of 10 floors they have a pole marker indicating your current level. 10th floor, 20th..ect. When you get to the 110th floor marker, you just have one more climb to go, but the mountain saves the best for last, at the final climb is the steepest, lol. So, the nice thing is it gives you an incremental measure of progress and also allows you to set goals short of the top- and the views are great all allow the way up.

"I'm also about 20+ years older than you are! "
Age is no excuse! lol! One of my best buddies is 67 and I bumped into him yesterday as I was on my way down and he was on his way up. Like me, he is hooked on climbing it often. He is getting double knee replacement surgery in July and his goal is to push as hard as he can before then to go into surgery in top physical shape. The downhill takes its toll on his knees, but he's sacrificing them now and just trying to deal with the pain, as they are getting replaced anyway.
 

bizinsider

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Thanks Herb!
Mt. Monserate is close to you- North County San Diego- Fallbrook. You should check it out some time. It is actually a World Trade Center memorial, as the elevation gain in climbing the mountain is about the same as the gain if you climbed to the top floor of the WTC- The WTC had 110 floors and Mt Monserate would be about 120. Every time you climb the equivalent of 10 floors they have a pole marker indicating your current level. 10th floor, 20th..ect. When you get to the 110th floor marker, you just have one more climb to go, but the mountain saves the best for last, at the final climb is the steepest, lol. So, the nice thing is it gives you an incremental measure of progress and also allows you to set goals short of the top- and the views are great all allow the way up.

"I'm also about 20+ years older than you are! "
Age is no excuse! lol! One of my best buddies is 67 and I bumped into him yesterday as I was on my way down and he was on his way up. Like me, he is hooked on climbing it often. He is getting double knee replacement surgery in July and his goal is to push as hard as he can before then to go into surgery in top physical shape. The downhill takes its toll on his knees, but he's sacrificing them now and just trying to deal with the pain, as they are getting replaced anyway.
So tempting, Chuck. But... there's the issue of my wife, who I do believe would say, "Over my dead body." 🤣
 

Dodger Fan

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For comparison, here's where I was 9 weeks out. I was not in great shape. This was supposed to be a run. Ignore the BPM data. This was around the time that I learned my Garmin chest strap and my pacemaker were not friends.
 

Chuck C

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View attachment 887836

For comparison, here's where I was 9 weeks out. I was not in great shape. This was supposed to be a run. Ignore the BPM data. This was around the time that I learned my Garmin chest strap and my pacemaker were not friends.
That's not bad for being 9 weeks out. Brisk walking is 18 minutes/mile and you were clearly moving quicker than that.
I have not timed myself on a run in ages. Perhaps I will do so soon.
 
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Michael O

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Only about 3 pages through this thread, but wanted to express my appreciation for the issues discussed here. My situation is nearly identical to Chuck's - decent shape, 56, severe stenosis but mostly non-symptomatic, even down to concerns about having to give up Muay Thai. Came here to ask about the decision to put the surgery off or pull the trigger and have found an incredibly worthwhile discussion. Many thanks, and congrats on what's sounding like a good recovery. Now back to the thread.
 

bizinsider

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Only about 3 pages through this thread, but wanted to express my appreciation for the issues discussed here. My situation is nearly identical to Chuck's - decent shape, 56, severe stenosis but mostly non-symptomatic, even down to concerns about having to give up Muay Thai. Came here to ask about the decision to put the surgery off or pull the trigger and have found an incredibly worthwhile discussion. Many thanks, and congrats on what's sounding like a good recovery. Now back to the thread.
Bottom line is this: Catch it before your heart is damaged. There is a fine line there. Get several opinions. Etc Etc.
 

Chuck C

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Only about 3 pages through this thread, but wanted to express my appreciation for the issues discussed here. My situation is nearly identical to Chuck's - decent shape, 56, severe stenosis but mostly non-symptomatic, even down to concerns about having to give up Muay Thai. Came here to ask about the decision to put the surgery off or pull the trigger and have found an incredibly worthwhile discussion. Many thanks, and congrats on what's sounding like a good recovery. Now back to the thread.
Welcome to the forum Michael.

You face the two big decisions that I faced, now that you have the severe diagnosis:
1. Get AVR surgery now or wait for symptoms.
2. Mechanical or tissue valve

Like most of us here, I thought a lot about these decisions and studied a lot of published scientific literature. I also found a wealth of information and support on this forum- it is truly amazing.

At the end of the day, these decisions are an individual choice.

For me, as to wait for symptoms or get surgery, I was heavily influenced by the following:
1) The published studies which show significantly better long term outcomes if surgery is done before symptoms.
2) Feedback from this forum, suggesting that I get the surgery now while I am in good physical health.

While my cardiologist emphasized that either course was reasonable my surgeon felt strongly that I should get the surgery now and not wait. He had two very good points 1) My severity has progressed quickly in the past 6 months and 2) Sometimes the first symptom is sudden death. That one is hard to argue with.

Here is one of the studies that influenced me. It found that mortality after two years was more than twice as high for those with severe aortic stenosis who took the wait and watch approach, compared to those who had surgery before symptoms.

" The researchers found that two years after the recommended approach, survival in the AVR group was 92.5 percent compared to 83.9 percent in the WW group. "


It should be pointed out that there is likely a difference between individuals who get surgery immediately after symptoms and those who wait a long time after they have symptoms. If one gets the surgery soon after symptoms, there is a greater chance than any structural damage can be reversed- the longer one waits after the onset of symptoms, the greater the chance of irreversible structural damage.

Here is another study that had an influence on my decision, better surgical outcome and lower mortality during the follow up period:

" In conclusion, in this randomized trial, early surgical aortic-valve replacement resulted in a significantly lower risk of operative mortality or death from cardiovascular causes during the follow-up period than conservative care among asymptomatic patients with very severe aortic stenosis. "


even down to concerns about having to give up Muay Thai
This was what really made it hard for me as well. At the time of surgery, I was on the MMA team at Dan Henderson's. Since you are into Muay Thai I'm guessing you may have heard of us. I spared on a weekly basis with guys like Sam Alvey and other MMA pros and amateur fighters. At the time, the Muay Thai boxing was the sport which I enjoyed the most. Going with mechanical would mean giving up sparring, with the exception of very light sparring. This was not easy for me, but ultimately I did not want to face multiple future surgeries, just so that I could keep boxing. And, the literature was pretty convincing that there is a longer life expectancy for those in our age range who choose mechanical. I really do understand why someone in their 50s would choose tissue valve. After I was diagnosed with aortic stenosis, for the next 18 months, my plan was to go tissue valve when the time came. But the more I delved into the literature and researched the subject, the more convinced I became that for someone at my age 53, mechanical would give me the best chance at a normal life expectancy.

But, these choices are yours and yours alone. There are some individuals who are in their 50s, whom I believe should choose tissue. Many variables come into play and there is no absolute right or wrong choice.

Please feel free to reach out with any questions that you may have, either here on this thread or you can private message me if you are more comfortable with that.
 
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Michael O

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Yup - I pretty quickly got to "Sooner rather than later" on the grounds that it's better to do it before the heart deteriorates even more. Also, the non-zero chance that the first big symptom = sudden death makes me wonder why anyone with a severe stenosis is told to wait and monitor. Also got to mechanical pretty quickly.

re: MT - The BAV diagnosis pushed the "stop sparring" decision into a (forgive me) no-brainer. Active sparring was getting harder to justify given the cumulative CTE risks, and the post-surgery/medication setting made it an easy decision. Not a bad life, to say that I have to fall back on coaching as my main activity.

He won't remember me, but if Tarec Saffiedine is still at Hendo's gym, he once put me downrange during a MT seminar we were in together. The instructor kept pairing us up b/c we had similar stance approaches and was like "you guys fight the same, you can learn from eachother". Pretty much just target practice for him....

Greatly appreciate all your work on this site.
 

Chuck C

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He won't remember me, but if Tarec Saffiedine is still at Hendo's gym, he once put me downrange during a MT seminar we were in together.
Tarec is a good friend of mine and a great coach! He has not had a pro MMA fight in awhile, although I think he is technically still under contract with the UFC. He now is the head Muay Thai coach at Hendo's. He's very good and fun to spar with. He's also just an all around very nice guy.
 
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Chuck C

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Yup - I pretty quickly got to "Sooner rather than later" on the grounds that it's better to do it before the heart deteriorates even more. Also, the non-zero chance that the first big symptom = sudden death makes me wonder why anyone with a severe stenosis is told to wait and monitor. Also got to mechanical pretty quickly.
In my view, you made the right call on both decisions.

At 56, it is hard to justify going with tissue valve. I would suggest that most under 60 go mechanical, with one big caveat- being honest with yourself about whether you will be diligent in taking warfarin for the rest of your life. I think most of the individuals who are diligent enough to find this site are going to be the type that will be diligent with taking their medication. But, a significant percentage of the general population discontinue taking medications after a couple years, and this is true even for medications that are of critical importance, such as warfarin.
 

Chuck C

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Not a bad life, to say that I have to fall back on coaching as my main activity.
Tom Gallicchio was the head BJJ coach at Hendo's after Pantcho left and would sometimes tap me to teach if he could not make it. I have also been teaching friends on my mats at home for about 3 years now. I really like teaching and plan to do more BJJ teaching. As for the boxing, like you, I'm aware of the risk of CTE and perhaps it was for the best at this point in my life that I stop an activity which had this possibility and now the risk of a head bleed forces my hand in this. Possibly a blessing in disguise.

Since it is not a striking martial art, I can still train in BJJ as well, although tournaments are now out. I'll probably just roll with guys who I know have good control and not likely to hit me in the head with their elbow or knee by accident.
 

Michael O

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Sorry to go slightly OT on this, but it is sort of in the realm of general interest for post-OHS patients. There's a significant amount of research indicating that brain bleeds/CTE is more likely/more severe if the person is dehydrated. As I'm sure you know, this is VERY difficult to manage in any martial art. (Honestly, I instantly lose 4 lbs of water weight within 10 mins of putting on my gi.) I figured you knew this, but its always worth mentioning for the public at large, because the whole field of research is pretty new. Coupled with the blood thinner regimen post-OHS patients are typically on, it's worth paying attention to.
 

Michael O

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Possibly a blessing in disguise.
Yup - doing my best to re-cast as much of this situation as great fortune. My GP caught the barest trace of a murmur. I didn't die. I should probably stop getting in fistfights with 25 year olds as my form of exercise. I can justify getting a guy to do the heavy yardwork for a few weeks. I have the perfect excuse to dodge a summer get-together with the in-laws.
 

Chuck C

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Sorry to go slightly OT on this, but it is sort of in the realm of general interest for post-OHS patients. There's a significant amount of research indicating that brain bleeds/CTE is more likely/more severe if the person is dehydrated. As I'm sure you know, this is VERY difficult to manage in any martial art. (Honestly, I instantly lose 4 lbs of water weight within 10 mins of putting on my gi.) I figured you knew this, but its always worth mentioning for the public at large, because the whole field of research is pretty new. Coupled with the blood thinner regimen post-OHS patients are typically on, it's worth paying attention to.
I was not aware of that. Thanks for sharing.
And, yes, I totally experience what you are talking about with sweating. I sweat a lot. I usually go in maximally hydrated, but lose so much water in training- especially in the gi from the extra heat created when one trains hard while wearing thick fabric. I actually bought an ice vest to see if that would help- that was a fail, lol. The million dollar invention will be the gi that is light enough to breath, but strong enough not to tear when the 280 pound training partner grabs hold of it and tosses you across the mat.
 

cldlhd

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Yup - I pretty quickly got to "Sooner rather than later" on the grounds that it's better to do it before the heart deteriorates even more. Also, the non-zero chance that the first big symptom = sudden death makes me wonder why anyone with a severe stenosis is told to wait and monitor. Also got to mechanical pretty quickly.

re: MT - The BAV diagnosis pushed the "stop sparring" decision into a (forgive me) no-brainer. Active sparring was getting harder to justify given the cumulative CTE risks, and the post-surgery/medication setting made it an easy decision. Not a bad life, to say that I have to fall back on coaching as my main activity.

He won't remember me, but if Tarec Saffiedine is still at Hendo's gym, he once put me downrange during a MT seminar we were in together. The instructor kept pairing us up b/c we had similar stance approaches and was like "you guys fight the same, you can learn from eachother". Pretty much just target practice for him....

Greatly appreciate all your work on this site.
Curious as to why the BAV diagnosis, in and of itself, made sparring a "no-brainer"?
 

Michael O

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Brain bleeds are at elevated risk on post-OHS medical regimes even without the additional head trauma from getting bopped on a regular basis. That moved it from "I could keep sparring for another couple years" to "ok, it's time to stop".
 

MdaPA

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That moved it from "I could keep sparring for another couple years" to "ok, it's time to stop".
How about switching to a more "gentle" form of martial art like Aikido which resembles some of the fighting methods found in Jujitsu, Judo and Krav Maga? There is no punching or sparing so you should be able to fully participate.
 

Chuck C

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How about switching to a more "gentle" form of martial art like Aikido which resembles some of the fighting methods found in Jujitsu, Judo and Krav Maga? There is no punching or sparing so you should be able to fully participate.
I think it's hard to go from a combat sport to a discipline that is more of a martial art, with the heavy emphasis on the art. Although, I think arts like Aikido and Tai Chi are great exercise and great for the mind as well.
 
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