Somehow I managed to miss this thread until now. It appears that you have already made your decision, but I'll go ahead and add my voice and give my answers for the benefit of others who might come across this thread in the future.
1. At what age did you get your mechanical valve?
2. How long did you have / have you had your mechanical valve for?
Just shy of 2 years.
3. If your valve failed, what was the reason?
My St Jude mechanical valve has not failed. If you mean my native valve, I had a bicuspid aortic valve, BAV, which became severely stenotic when I was 53.
4. Do you self manage your Warfarin, or go to a lab?
I've been self managing since about 2 weeks after surgery.
5. On a scale of 1-10, with 1 being annoying and 10 being no big deal, how would you rate the effect Warfarin has had on your day-to-day life?
9. The only thing that really changed for me was that I did boxing and kick boxing as a hobby before surgery. I decided it would be best to stop that activity. I still do all my other activities and am very physically active.
6. Have you ever had a stroke or a significant bleed? If yes, why do you think this happened?
7. Has Warfarin caused any limitations with regards to supplements, antibiotics, or medicines?
I stopped taking one supplement, once I was on warfarin. Prior to warfarin, I was taking tumeric. Tumeric may act like aspirin, with some anti-platelet effects, which are not picked up as an increase in INR. Tumeric has anti-inflammatory properties, but I have very low inflammation markers, so I figure it is best to just avoid it for me. I have had some dishes with tumeric with no apparent adverse effects.
8. Is it easy or risky to ‘bridge’ when you needed other medical procedures like a colonoscopy or other surgery? Have you ever had issues?
I have not had to bridge. I had a thyroid procedure and just reduced my INR below 1.5 for a short period, the day of surgery. Pellice has documented my experience doing this and has linked it above. There have been studies published which support lowering INR as superior to bridging, with fewer events, for many surgeries. For major surgeries, bridging is still the standard, but for less severe procedures, there seem to be a number of surgeons moving towards lowering INR vs bridging.
I have not had a colonscopy, instead opting to get Cologuard. If I do need a colonoscopy at some point, I will work with a doctor who subscribes to lowering of INR for this procedure vs bridging.
9. What are the ‘best practices’ with regards to alcohol and cannabis? Is it the same ‘dose what you ingest’ mentality as food? (I don’t drink or use cannabis daily, but once every week or 2 I enjoy a having most of a bottle of wine - or consuming an edible)
I can't speak to cannabis, but I drink regularly. Some days I don't drink at all. Some days I have 1 or 2 and on a festive day I might drink 5 or 6. I have tested extensively before and after drinking. One or two do not appear to move my INR. If I drink 5 or 6, it will move my INR a little, but never enough to be concerning. For example, I might be at 2.4 one morning, then drink 6 beers that day, and be at 2.8 the next morning. By the next day after that I will be back to 2.4, and sometimes I seem to get a little rebound to the downside, maybe down to 2.2 or so, if I was at 2.4 at baseline.
So, it would go something like this.
Morning day 1: INR= 2.4
Relive heavy drinking due to celebration of some sort- 6 beers.
Morning of day 2: INR= 2.8
Morning of day 3: INR= 2.2
Morning of day 4: INR= 2.4 or 2.5, basically about what it was on day 1.
I've seen this pattern a few times and yes, it took me some strips to figure it out, but I don't worry anymore about testing every time I have a drink and I don't worry that I need to drink exactly the same every day.
10. How often, if ever, is it necessary to go to the hospital for a fall or accident? Would you go if you fell skating or skiing? If you got hit in the head with a ball? What if you were in a car accident?
It really depends on the severity of the injury for me. I participate in a grappling martial art and will catch an accidental knee or elbow to the head from time to time. I also bumped my head on the garage door pretty hard once. I paid close attention and watched for symptoms of hemorrhaging, but never felt the need to go to ER. But, I would err on the side of caution. If you hit your head, if you are nervous about it or in doubt, go to ER and get it checked out. If there is a serious bump to the head, whether on warfarin or not, one should get checked out in ER. For those of us on warfarin, I would suggest erring on the side of caution here and be more quick to get things checked out.
11. Do you feel you have any limits with regards to your heart beat? (I play squash and would want the freedom to get my heart rate to 180)
I'll try not to get carried away here, as I am an athlete and like to monitor my HR a lot. Basically no, I don't feel I have any limitations. My max HR was about 170 when I did a treadmill before surgery- about 3.5 years ago. I recently pushed myself on an uphill and got it up to 166. I'm not sure if that was my absolute top- I may be still at 170 or it may be 166/167 now. In that 3.5 years have passed since that treadmill, it would be normal if my max HR has gone down a few points, as it generaly dropps about 1 point per year, in terms of our max.
Today at Brazilian Jiu Jitsu our instructor was encouraging us to go hard during a take down drill. My partner was a 42 year old ex marine, wo is in good shape and I was tossing him around the mat a bit. The instructor jokingly told me to start acting my age, and then said I was training like a 25 year old or something. Well, before being on warfarin, I guess I did not always act my age in this regard, and I guess now post surgery and on warfarin I still don't act my age at times. My point is that I don't feel like the valve or warfarin have slowed me down much.
12. Did you ever lose sleep due to the clicking sound? How long before you got used to it?
I don't believe it has ever caused me to lose sleep. It has never bothered me at all.
13. On a scale of 1-10, with 1 being miserable and 10 being happy, how happy are you with your choice for mechanical valve?
10. I hesitate to put 10, because the choice is not a perfect one, regardless of which valve is chosen, but if I had the choice to make again, I would choose mechanical. The past 2 years have flown by. People often start to see the intitial signs of SVD in their echos after 5-6 years in their echos. 5 years will be here before I know it. The thought that, if I had chosen tissue, that in just a few years I might stard getting reports of SVD on my echos is something which did not appeal to me. I don't think it is a good idea to plan for repeat surgeries, when it can be avoided. At 53, choosing a tissue valve would have meant I would be planning for repeat surgeries. So, I don't second guess my choice.
14. Would you recommend someone in my shoes get a mechanical valve? (39 years old, severe regurgitation, bentall needed, dilated annulus and LV, can probably self manage INR responsibly, otherwise healthy, likes to travel, hike, eat everything, drink and consume a bit of cannabis occasionally, likes silence and might be irritated by the clicking).
The first question I would ask is whether you plan to be consistent with taking warfarin and to fully appreciate how important this is. You are here on this forum, and that might seem like a silly question, but studies have shown that there are some individuals in the general population who are not good at compliance and don't take it seriously as they should.
If you appreciate the importance of being diligent with warfarin and if you don't have any medical contraindications to warfarin, then every guideline in the world would call for a 39 year old to get a mechanical valve. At 39 you would face many future surgeries with a tissue valve and studies have shown that young patients have a shorter life expectancy with tissue valves, due to the repeat surgeries, which is why the guidelines call for mechanical for young patients.