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Charlie

Active member
Joined
Jun 28, 2011
Messages
41
Location
Eureka Springs , Arkansas in the Ozark Mountains
Hi all,

I'm a 61 year old male living in the wilds of Arkansas near Eureka Springs. For most of my adult life I've been told by different physicians that I had a heart murmur. I am career military (retired) and it never stopped me from doing my job nor did it prevent my entry into the military some 40+ years ago.

In 2002 I had a career ending accident while "on the job" and had to have several surgeries on my back and neck. Since that time I have steadily gained weight because my once active lifestyle abruptly ended.

For the last three years I had several incidents of severe shortness of breath which I mostly blew off because I had gained so much weight since my "retirement". I voiced concerns with my primary care physician and she promptly dismissed it as adult onset asthma. On subsequent visits I assured her that the inhalers she had prescribed were not effective. It fell on deaf ears. Turns out I should have been more proactive in finding out what was wrong.

A month ago I was taking our garbage to the curb. Our driveway is extremely steep and long. All I remember is breathing hard then waking up looking at the sky wondering how I got there.

I of course saw my PCP who finally sent me for an EKG and a stress test. As they were preparing me for the treadmill the PA that was in charge listened to my heart and heard my murmur only he was more astute and said he would like an echo of my heart before the test. The echo revealed aortic stenosis and then the real tests began.

So, at this time I am to get a heart cath at the VA in Little Rock, Ar. on the 8th. From there I will be advised as to my surgical options. This process has been daunting to this point from the standpoint of nobody believing that someone with my background and physical training could have anything wrong with their heart. But I learned a valuable lesson from all of this, advocate for yourself. Make yourself heard and stick to your guns.

This site has allowed me to learn what to expect both pre and post op. It also allowed me to make an intelligent decision as to which valve I will have installed. I will go with the bovine replacement.

I've been waiting a week or so for the mods to activate my account so this is my first post. However, it is gratifying to read the stories, understand the process and know that there is a greater outcome from all of this. I look forward to your comments and insight as to what I should expect as this progresses.
 
Love the attitude, Charlie! You might want to invest $30 on a copy of my fave new article comparing your cow valve to my pig valve, assuming you can find a good surgeon who uses the Hancock II. (It's still not used as much in the US as it is in Canada and the rest of the world, I think, and I don't see a good reason for it.)
It's entitled "Hancock II Bioprosthesis for Aortic Valve Replacement: The Gold Standard of Bioprosthetic Valves Durability?" by Tirone E. David, MD, Susan Armstrong, MS, Manjula Maganti, MS, in Ann Thorac Surg 2010;90:775-781, abstract at ats.ctsnetjournals.org/cgi/content/abstract/90/3/775? .
The authors compare the durability of the 1100-odd Hancock IIs that they've implanted over the previous 25-plus years with all the other published studies of longevity of tissue valves, including the CEP cow valve that seems the most popular in the States. None of the other studies show durability that's even within a year or two of their Hancock II results. And if you correct for a systematic bias that overstates the durability of most other valves (equating "freedom from re-op" with "freedom from Structural Valve Deterioration" -- which puts the patients who are too infirm for a re-op in the "win" column!!), the Hancock II outlasts the others by MORE than "just" a year or two. I find the article impressive and persuasive.

The main factor that seems to favor the CEP/cow over the Hancock II/pig is hemodynamics, where one recent (2007?) study comparing results between Toronto (pig) and Germany (cow) gives the edge to the cow. But I think there are many reasons to downplay hemodynamics as a factor in valve choice, unless you have an unusually small Aorta and AV compared to your body size (aka "valve-donor mismatch"):
  • The heart is a complex system, with multiple possible "bottlenecks" that might limit maximum flow volumes. In most cases, any reasonably good AV shouldn't be the "bottleneck", i.e., its hemodynamics won't matter.
  • Many of us have personal experience demonstrating this fact, because we were aggressively athletic with no symptoms while our AVs were moderately or even severely stenotic. I was doing great on the treadmill (stress EKGs) while my effective AV area was being measured at way below 1.0 cm sq -- 0.9 and 0.8, and even 0.6, unless I'm hallucinating that one. No new valve will have measurements from that PLANET, much less actually that low -- and those tiny areas didn't have any effect on my measured athletic performance!
  • My fancy and experienced cardiac surgeon told me that he's seen quite a few patients with experiences like mine -- good CV performance with valves that were basically toast -- including one woman who delayed her surgery until the day after a marathon she was determined to run. She ran, and did fine. When Dr. F saw her valve, he was puzzled that she'd made it to the OR, forget the marathon!
  • Again, all of this info suggests that adding a few 0.x square cms of effective AV area to a new valve is like having tires on your car that can go 300mph instead of just 150 -- a "distinction without difference". (The tires might make you a bit safer, while a bigger AV won't even do that, as far as we know.)

OTOH, if you happen to have an unusually small AV for your body size, then you should go for an AV with the best hemodynamics, and the CEP/cow seems to beat the HancockII/pig, based on that one study. But otherwise, I'd go for the extra years of durability.
 
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Hi Charlie and Welcome.
You've made a well known point "advocate for yourself. Make yourself heard and stick to your guns." which has to be done in many cases.
Another well known saying is: 'when in doubt, get it checked out'.
 
Charlie, a heart felt WELCOME to our OHS family glad you found the site most of the community are OHS brothers and sisters, there are some minimally invasive so ask away, there is a wealth of knowledge here for the future .....


Bob/tobagotwo has up dated a list of acronyms and short forms http://www.valvereplacement.org/forums/attachment.php?attachmentid=8494&d=1276042314

what to ask pre surgery http://www.valvereplacement.org/for...68-Pre-surgery-consultation-list-of-questions

what to take with you to the hospital http://www.valvereplacement.org/forums/showthread.php?13283-what-to-take-to-the-hospital-a-checklist

Preparing the house for post surgical patients http://www.valvereplacement.org/for...Getting-Comfortable-Around-the-House&p=218802

These are from various forum stickies and there is plenty more to read as well


And Lynw recently added this PDF on what to expect post op
http://www.sts.org/documents/pdf/whattoexpect.pdf

Add to that Freddies sage advice (she is ALWAYS right) LOL


Hi Charlie and Welcome.
You've made a well known point "advocate for yourself. Make yourself heard and stick to your guns." which has to be done in many cases.
Another well known saying is: 'when in doubt, get it checked out'.
 
Welcome, All I can say is I do not know how many AVR they do in little rock , But you are not that far from St. Lukes in Houston, they are in the top 4 world wide for heart surgery, I would be looking for a major hospital for my surgery one that does hundreds every year. There is a big diffrence in hospitals in my humble openion most surgeons can talk the talk but not all can walk the walk! DO YOUR HOME WORK
 
Thanks everyone for the warm welcome here and the sage advice. In regard to picking a hospital and Cardiothoracic Surgeon I am somewhat limited as to where I can go for the surgery since the VA Medical System is footing the bill.

Much to my advantage, the VA Little Rock and UAMC (University of Arkansas Medical Center) are in a contractual dispute right now. My Cardiologist here in Fayetteville told me that I can have the pick of hospital in Arkansas where I want the surgery done. I am choosing to go to Washington Regional Medical Center in Fayetteville with Dr. Counce if he will have me as a patient. This much I have determined.

Still up in the air is the cath and subsequent findings and then determining the surgery schedule.

One thing I know for sure is that I want this done and behind me so I can get on with life. I have too many fish left to fry.
 
Charlie
Welcome to the family !!! So sorry ...you are having to go through this, but so happy, you are on the journey to fixing the problem, so you can get on with your life and return to frying your fish ! May I suggest ,baking it though, as it may be better for your heart health :)
Renee
Go Team 2011 !!!!!
Dx BAV and 3 proximal arteries 75% occluded 11/2010 AVR 4/14/2011 with a Edwards "Magna" Bovine Tissue Valve and a Triple Bypass Dr.Richard Gregory St.Agnes, Fresno, Ca.
 
Charlie - Welcome to valvereplacement.com and welcome to The Waiting Room, the virtual room where many folks await their own turns at valve surgery.

My case has smoe definite similarities to yours. I am now 63, and had aortic stenosis for at least 9+ years that we know of. Mine was discovered in a physical exam being performed to try to find out why my energy levels were declining so badly. It was discovered by my endocrinologist who, after blood tests showed all within normal ranges, did another physical. He then asked me "How long have you had the heart murmur?" That started the years of watching and waiting until this past February when I decided it was time to move ahead. While we were watching my valve, I did all the things a guy my age (and even a dozen years younger) would have done -- family outings, travel, work, even ran (recreationally, not competitively) for all those years. My point is that the body can compensate for the heart's shortcomings for quite a while. When it cannot compensate any more, we get symptoms. Then it is almost late for surgery.

I had my valve replaced with the Edwards Lifesciences bovine pericardial valve, and it is too new to know much about its performance - but so far, I'm quite pleased with it.

Anyway, welcome again to The Waiting Room. Make yourself comfortable and visit often. Ask all the questions you want - the folks here are the most caring, sharing people I've met, and they have a world worth of first hand knowledge to share.
 
I have a dilemma this morning. I have a really severe tooth ache. My cath is coming Friday, surgery schedule will be shortly after. So now what? Get the tooth worked on and risk delayed surgery? I have some some cipro (I have left over from an infection) and get the tooth fixed and keep taking it until Friday. If I tell the Docs they may delay the cath and or the surgery. Advice anyone?
 
Charlie,
As crappy as this sounds cause I knowy you want to get this surgery over and done with, you better call your cardio and tell them about the tooth. You need to have all dental work done and clear before you progress. The very last thing you need is to encounter endocarditis. You sure don't need any infections to mess up your new valve. Best thing to do is to fess up and see what the doc has to say.
 
I agree with Chris, tell your doctors about your tooth and go to the dentist. chances are you will need dental clearance before they will operate on your heart anyway, so taking care of this ASAP will probably help things move quicker not slow them down.
 
Alright then, I just got back from the Dentist. Told him of the upcoming surgery he said I did the right thing by getting it pulled now. I was not infected or abscessed so that is a good thing. He prescribed amoxicillin for a week. I will call my cardiologist tomorrow and let them know. Wow, when it rains here it pours....haha.
 
Wow, when it rains here it pours....haha.

I know what you mean, last month I got fillings on one side of my mouth, this month got fillings on the other side and they pulled a wisdom tooth. One last filling in a week and then surgery very soon after that. I've never been to the dentist before in my life at 28 years old. WOW!
 
Well, I've returned from the Little Rock VA Hospital. They did all sorts of tests but the most notable of course were my Cardiac Cath and my Cardiac EP. It seems the plumbing is all ok without plaque anywhere except on my Aortic Valve. There were no other notable deformities! I do have a bicuspid valve and they confirmed that my Aortic Valve is very tired and in fact has appendages on the flaps like streamers. Because of the stenosis and the streamer things it is barely opening and closing at all. The Doctor that did the CC recommended that to the Chief of Thoracic Surgery and the Chief of Staff at Little Rock that I am a candidate for immediate for Aortic Valve Replacement.

So, after a couple of years of wondering what is wrong with me, and getting repeatedly stonewalled by a well meaning but otherwise clueless unexperienced PC I have definitive confirmation of what is wrong and have finally embarked on a course that should provide resolution to my health issues.

On our way back to NW Arkansas I called my Cardiologist at the VA in Fayetteville (he wanted me to call after the Cath). After hearing about my results he set my surgery into motion. I am very lucky because the VA Little Rock (a regional facility for the VA) is currently in a contractual dispute with the University of Arkansas Medical Center. As a result I was able to choose the Cardiothoracic Surgeon that I wanted and in addition I got to choose the facility that I wanted the surgery to be performed in.

Before the four hour trip home was over I had a call from my Cardiologists Office Manager who verified my choice of surgeons and then she made the appropriate calls. Before I got out of the car I had an appointment set up with Dr. James Counce of Washington Regional Medical Center which will be tomorrow, Monday the 11th. Dang that was fast.

All that remains is my consultation, a choice of valves and my surgery scheduling. So, now I look forward to my surgery, my rehab and claiming my life back!

Happy Days!
 
All that would leave my head spinning
Spinning_Mario_head_by_thweatted.gif
BUT WAY TO TAKE CONTROL
 
Hey Charlie,
It's all good going forward. You will in fact be able to claim your life back and live many many years. Best wishes to you on your upcoming surgery. Keep us updated when you have the date. God Bless You
 

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