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

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ottagal

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Hello fellow VR members,
I hope you are all coping during these 'interesting' times.
I have a question for anyone who have dealt with cancer and then was faced AVR (in particular second time around) .

Did having cancer (and treatments) impact your valve choice? ie bioprosthetic versus mechanical? Any stories and reasons would be helpful.
I know this is somewhat of a generic question and each circumstance is unique; however, I welcome feedback from all members.
Thanks everyone.
Take care,
 

vitdoc

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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.
 

ottagal

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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.
Thank you vitdoc. Those are good questions. I am 58. The prognosis is apparently 'good', but Covid has impacted alot of treatment decisions and a particulat surgery was delayed etc. The one question is: do anticoagulants have an impact on treatments (certain chemotherapy regimes) or potential surgeries if needed down the road? I understand no one has a crystal ball.
Separate from that is at 58, (and second time around), does one go bioprosthetic again with the chance of needing another surgery in my lifetime ? Apparently , I am an unlikely candidate for TAVR due to the size of the valve unless things change.
So, feeling a little caught between a rock and a hard place.
I understand anticoagulants can be managed as many have on this forum. I'm just trying to keep my eyes wide open with the other health issue. It is fairly new and I wasn't expecting the double whammy news on the 2 C's front.
 

pellicle

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Separate from that is at 58, (and second time around), does one go bioprosthetic again with the chance of needing another surgery in my lifetime ? Apparently , I am an unlikely candidate for TAVR due to the size of the valve unless things change.
ok, I'll have a go at grappling with this.

On the subject of needing another surgery, I would also ask the perhaps unthinkable question of the word used in cancer treatments which is remission. I have a few friends who have had serial remissions with as much as several years in remission. Each has had the view that every day free is a good one. But its not the word "cure". So each is clear that one day they may find its returned. They are not concerned by this (we've had long discussions) although their partners aren't in the same situation (mostly).

So this is to say "if you can, consider to encompass that in your planning"

I come back to the view that mechanical prosthetic valves are managed by managing ACTherapy while bioprosthetic valves are managed surgically by replacement. We are used to replacing things which wear out, but we seem to no longer be able to grasp the idea that something will last my life time if I tend to it, like the Lavender that my cousin gave me (and I planted in my garden) when I moved into this house. This house was built in the 1920's and many have lived here before. Some have tended it, as do I. Barring a fire I am of the view it will be in "my estate" (when I pass).

My personal definition of a realist is one who reacts to issues of reality and deals with them using reality. Indeed my personal definition of sanity is "minimal distortion of reality", meaning that concocting fictions that ease the mind to allow comfortable living is a sign of insanity or at least mental infirmity. To do otherwise is not "coming to terms with something" it is (to me) "attempting to change the terms by pretending they are something else".

Not everyone will like my view (or even follow it) but it has stead me in good stead in my life and in the effective evaluation of others.

A person here once remarked that "what makes a good valve is a valve that gets you 20 years" .. I anticipate that like Dick my valve will not require replacement again. All I have to do in the meantime is to manage it (and myself). At my surgical meeting it was clarified to me that a mech valve would last my life, but that a tissue would require a reoperation at some point in my future. I didn't want to put my wife through that and I didn't want to have a 4th surgery which may save me from death (or as I view it, re-negotiate the inevitable date) but at the cost of a very high likelihood of a drastic reduction in my health (because 4th surgeries and longer surgery at a time when one can least recover from such things ).

At that time I knew nothing about ACT but as always I believed that I can manage reality or adapt to it. As it happens I've learned a lot about ACT and managed ACT very well (for myself and for others).

From the day that you chose your valve you must have been clear that it would not last you out. So now you have reached that day. I say "look carefully at the options" and set aside emotional views. Look carefully and decide from the position of knowledge and experience.

This is not to say that ACTherapy is without issue (cite: Harriet) but as long as you know you are not "intolerant" then in all cases I am aware of it can be managed.

I would not think it wise to add more issues to your life such as a known cardiac surgery in your autumn years, for that to me would (having watched a few) not lead to a "live long and prosper" outcome. Life is different in ones 70's and I've seen quite a few fit old ladies suddenly wither and die from a good hard surgical shove (like a hip replacement gone awry or an accident on the ride on lawnmower).

Live for now, but don't forget to plan for tomorrow.

Best Wishes
 
Last edited:

vitdoc

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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 problematic. But if the cancer is likely one and done then you can approach the issue like anyone else.
Also ask your physicians what they think.
 

ottagal

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ok, I'll have a go at grappling with this.

On the subject of needing another surgery, I would also ask the perhaps unthinkable question of the word used in cancer treatments which is remission. I have a few friends who have had serial remissions with as much as several years in remission. Each has had the view that every day free is a good one. But its not the word "cure". So each is clear that one day they may find its returned. They are not concerned by this (we've had long discussions) although their partners aren't in the same situation (mostly).

So this is to say "if you can, consider to encompass that in your planning"

I come back to the view that mechanical prosthetic valves are managed by managing ACTherapy while bioprosthetic valves are managed surgically by replacement. We are used to replacing things which wear out, but we seem to no longer be able to grasp the idea that something will last my life time if I tend to it, like the Lavender that my cousin gave me (and I planted in my garden) when I moved into this house. This house was built in the 1920's and many have lived here before. Some have tended it, as do I. Barring a fire I am of the view it will be in "my estate" (when I pass).

My personal definition of a realist is one who reacts to issues of reality and deals with them using reality. Indeed my personal definition of sanity is "minimal distortion of reality", meaning that concocting fictions that ease the mind to allow comfortable living is a sign of insanity or at least mental infirmity. To do otherwise is not "coming to terms with something" it is (to me) "attempting to change the terms by pretending they are something else".

Not everyone will like my view (or even follow it) but it has stead me in good stead in my life and in the effective evaluation of others.

A person here once remarked that "what makes a good valve is a valve that gets you 20 years" .. I anticipate that like Dick my valve will not require replacement again. All I have to do in the meantime is to manage it (and myself). At my surgical meeting it was clarified to me that a mech valve would last my life, but that a tissue would require a reoperation at some point in my future. I didn't want to put my wife through that and I didn't want to have a 4th surgery which may save me from death (or as I view it, re-negotiate the inevitable date) but at the cost of a very high likelihood of a drastic reduction in my health (because 4th surgeries and longer surgery at a time when one can least recover from such things ).

At that time I knew nothing about ACT but as always I believed that I can manage reality or adapt to it. As it happens I've learned a lot about ACT and managed ACT very well (for myself and for others).

From the day that you chose your valve you must have been clear that it would not last you out. So now you have reached that day. I say "look carefully at the options" and set aside emotional views. Look carefully and decide from the position of knowledge and experience.

This is not to say that ACTherapy is without issue (cite: Harriet) but as long as you know you are not "intolerant" then in all cases I am aware of it can be managed.

I would not think it wise to add more issues to your life such as a known cardiac surgery in your autumn years, for that to me would (having watched a few) not lead to a "live long and prosper" outcome. Life is different in ones 70's and I've seen quite a few fit old ladies suddenly wither and die from a good hard surgical shove (like a hip replacement gone awry or an accident on the ride on lawnmower).

Live for now, but don't forget to plan for tomorrow.

Best Wishes
Thank you Pellicle. Appreciate the thoughts and response.
 

ottagal

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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 problematic. But if the cancer is likely one and done then you can approach the issue like anyone else.
Also ask your physicians what they think.
Thank you for the reply, vitdoc. I hope to get some input from oncology and cardiology.
 

Superman

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Hello fellow VR members,
I hope you are all coping during these 'interesting' times.
I have a question for anyone who have dealt with cancer and then was faced AVR (in particular second time around) .

Did having cancer (and treatments) impact your valve choice? ie bioprosthetic versus mechanical? Any stories and reasons would be helpful.
I know this is somewhat of a generic question and each circumstance is unique; however, I welcome feedback from all members.
Thanks everyone.
Take care,
Sorry to read this challenge you’re facing. I wouldn’t say it’s a generic question at all. Really, only those with actual experiences could provide any meaningful help. For me and others, all is conjecture. I don’t know what I’d do, but I do know what I’d ask:

Does cancer treatment impact INR to the point that it would be difficult or dangerous to manage appropriately?

Does cancer treatment impact the life of a bioprosthetic valve to the point that any reoperation would be accelerated?

Unfortunately I don’t know the answer to either of those. Honestly, if both are non-issues, meaning cancer treatment has no affect on warfarin or on valve wear - the cancer would be a separate issue to me and I’d choose whatever I would if the cancer didn’t exist. That would be my best case scenario.

I hope you can get some good, meaningful information. Keep us posted!
 
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Critter

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All great responses. A question to ask is what type of cancer? Will it involve radiation treatment to your chest area? Might be a concern with a biological valve if treated with radiation. Tough questions.
 

ottagal

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All great responses. A question to ask is what type of cancer? Will it involve radiation treatment to your chest area? Might be a concern with a biological valve if treated with radiation. Tough questions.
Thanks, Critter. You made an excellent point about radiation treatment. Wish I had a crystal ball....
 

Duffey

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So sorry to hear of this latest health challenge. The only information I can offer is in regards to Tobagotwo’s experience. He fought his own battle with cancer and did need his aortic valve replaced about nine months before his death. He underwent TAVR, and of course that was due to his weakened condition, but he did tell me that due to the radiation and chemo treatments, he was happy to have another tissue valve implanted.
 

ottagal

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So sorry to hear of this latest health challenge. The only information I can offer is in regards to Tobagotwo’s experience. He fought his own battle with cancer and did need his aortic valve replaced about nine months before his death. He underwent TAVR, and of course that was due to his weakened condition, but he did tell me that due to the radiation and chemo treatments, he was happy to have another tissue valve implanted.
Thanks for sharing, Duffey. Tobago is still missed here. Always looked forward to his expertise, well-researched information and sage advice.
 
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Luckyguy17

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Sorry to hear of your dual health challenge Ottagal.
if Montreal for your 2nd OHS, the facilities are much improved, cardiac team remains top notch.
Hoping your health professionals can help you with the best valve options. Best wishes
 

ottagal

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Sorry to hear of your dual health challenge Ottagal.
if Montreal for your 2nd OHS, the facilities are much improved, cardiac team remains top notch.
Hoping your health professionals can help you with the best valve options. Best wishes
Thanks LuckyGuy. Appreciate it.
 
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