Facing Surgery for 2nd time

[RCB]

I think you've gotten a keen analysis of the statistical picture from Dennis, RCB, Ross, and Mark.

I am no expert in statistics myself but I'm wondering if medical schools require future physicians to take a course in statistics. If not, they should.

All medical schools require a course in statistics in what is called the basic science classes, usually to MS1. The problem arises with biostatistics nuances such as we have discussed here. The older crowd can remember
SNL's Father Guido Sarduchi's famous joke about awarding a college degree
that would entail everything somebody remembered, five years after graduation(if this is not clear, I'm sorry- ask someone who has seen the show. I can't do it any better)- it is a classic and so true!. Well, the same is true of doctor.

By the way, Rob, most of them employ ghost writers to write their research!

 

[Mary]

He also right on the age group problem. Fully 2/3 of the people who have valve surgery are over 65 years old. They have an inherent greater risk for stoke even with out replacement valve surgery. There is also some evidence to show that warfarin reduces the expected rate of having a stroke due to a clot below that of someone not on ACT above the age of 65-which if you think about it, is common sense.

To the good doctor’s point about AF and to Mary reposting of Tobagotwo’s post which I had not seen before, I offer this study and let you decide:

http://content.onlinejacc.org/cgi/content/full/44/3/667

I'm interested in where the 2/3 of the people having valve surgery are 65 and over figure comes from. Is it recent?

Actually, the site displayed isn't a study. It's a Letter to the Editor and apt to be subjective.
There is a reply, by Dr. David Bach, printed below Bloomfield's letter that is also apt to be subjective and offers a different viewpoint.

http://content.onlinejacc.org/cgi/reprint/44/3/667 Hit the download and both letters will come up.

 

[RCB]

Sorry, my mistake

Sorry, my mistake

I'm interested in where the 2/3 of the people having valve surgery are 65 and over figure comes from. Is it recent?

Actually, the site displayed isn't a study. It's a Letter to the Editor and apt to be subjective.
There is a reply, by Dr. David Bach, printed below Bloomfield's letter that is also apt to be subjective and offers a different viewpoint.

http://content.onlinejacc.org/cgi/reprint/44/3/667 Hit the download and both letters will come up.

I should have said "I offer this discussion about a study". Sorry, if this caused
any confusion. The discussion use statistics from the study and like all
peer reviewed journals, welcomes comments from the readers. This is healthy
debate like we have here, which is also subjective, wouldn't you agree Mary?


Do you have a different figure for heart valve surgery ages, Mary? If so print it, while I double check to see how recent my sources are.

 

[Mary]

No,
I don't have different figures, RCB. Actually, I was just interested in knowing the source because I have never heard a figure given. As far as I know, it could be higher than what you quoted rather than lower.
Either way I'm interested in knowing so I can file it away in my brain for future reference.
But I would appreciate knowing the reference in case somebody asks me the source.

And yes, our heart felt debate on the site is subjective.

 

[RCB]

No,
I don't have different figures, RCB. Actually, I was just interested in knowing the source because I have never heard a figure given. As far as I know, it could be higher than what you quoted rather than lower.
Either way I'm interested in knowing so I can file it away in my brain for future reference.
But I would appreciate knowing the reference in case somebody asks me the source.

And yes, our heart felt debate on the site is subjective.

It may well be as Tobagotwo alluded to in his piece. These tend to be "ballpark" figures, as reporting can vary. I know I saw a table with it on, but I can't remember the URL title. The table didn't say 2/3- rather it gave a figure for each age group and then I had to add the groups and do the math in my head. I know the over 65 group was by far the largest group- it wasn't even close. What surprized me at the data, was that it showed so few for the young. I will work on it.

 

[DeWayne]

After much research, much talking and discussing with my wife, the surgeon and a little input from my Neice (Niece works at Mayo Clinic in the cardiac care area) Neice asked one of her doctors which he would chose and his answer was interesting. His comment was if it was the valve only he would go with a mechanical valve, but with part of aorta being replaced as well he would chose the tissue valve. It was comforting news for me since before she emailed me that I had made up my mind to go with the Medtronics Freestyle tissue valve.
I know it means a risk of another surgery, but I feel that technology will make it easier for this to happen by the time that occurs. Surgeon's assement of risk for a 3rd with valve only was not as bad as I thought it might be.
For me the idea of no coumadin, no noise, and a valve most like the human valve it is replacing just seems to fit right in my mind with my expecations of life after the surgery.

I am happy with the decision, I am at ease with the approaching surgery, which will happen July 27th as it is scheduled now. Now I am concentrating on concocting a easy way to operate my recliner so that when I get home I have a comfortable place to sleep for the first week or 2!

Thanks to all those who have given me thought and things to research. Unless something happens to really change my mind I am sticking to the freestyle.

 

[Kate]

Congratulations on reaching a decision you feel comfortable with! Kate

 

[Karlynn]

You have to go with what you feel most comfortable with and not look back. I wish you the best! Let us know when you have a date set.

 

[DeWayne]

You have to go with what you feel most comfortable with and not look back. I wish you the best! Let us know when you have a date set.

date is set....... July 27th

 

[Mary]

date is set....... July 27th

And I just took the liberty of adding your surgery date to our calendar!

 

[KMS]

Aren't you glad that's behind you?

Aren't you glad that's behind you?

DeWayne -

I think you'll find that these next three weeks will be more peaceful and productive now that you've made your decision. Not that there won't be some anxiety or questions -- that's completely normal -- but you'll be able to focus on pre-op preparation and the eventual re-entry to your home.

Just know that the waiting is the hardest part of this whole experience. Enjoy these lazy, hazy days of summer...and know that we're here for any questions that come up over the next few weeks.

Warm regards,

Kristine

 

[DeWayne]

It was a load off the shoulders deciding on a valve. At least the cardiolgist has told me I can play a round of golf, if I would like, to prior to surgery. All I have to do is get someone to put my clubs in the trunk and take them out lol.

I will do it if I have to, one club at a time She said as long as I had a cart, didn't push myself in the heat I could play. So I will do that at least once, if the weather cooperates with cooler day.

I don't remember much about my first surgery, I spent my 5th birthday in the hospital for that one, 47 years seems a long long time ago. I have not spent a day in the hospital since, so I am hoping my overall health will be an asset to me in my recovery. The waiting will probably get harder the closer the date comes. Told my wife the morning I had to go in I was going to drive, said it would be the last time I got to for a while. I will have to get her to take the other car out for a spin (she has not driven it) and I really don't want it to not be driven for 6-8 weeks. Ita a old classic from the muscle cars days. Of course I will miss most of the summer car shows for this year, but I will get back into it next.

Wills are made, I have tried to think of as much as I can, and keep coming up with more things to do in preparation, which I guess is a good thing. Being in business for myself this will hurt a bit moneywise, good thing wife has a job, and good insurance.

I am ready for what ever comes, I am as prepared as I will ever be. I have been aware this day was coming for 30 years, I got all I could out of my natural body and now its time to fix it and get on with the rest of life.

 

[Superbob]

DeWayne,

You've got a great perspective on all this. You've done your research and made the decision that feels best for you. You've made preparations (you will be grateful for that recliner!) And now you're going to have some r&r.

Sounds like a good plan. We'll be sending good thoughts and prayers as your date arrives. Please keep us posted. You should do well.

Cheers...

 

[Marguerite53]

Hello! I stumbled out of bed way too early this morning and thought I'd troll around in here for awhile. Your thread caught my eye...mostly due to the number of hits and responses!

It was like reading a story. I think it will make a very good read for others down the road who are looking to make an educated choice.

So you were 5 and that was 47 years ago. 52 now? We are the same age. I knew for almost 3 years that I'd need surgery and had known of my BAV for more than 25 years. I just had the AV replaced due to AS with moderate calcification. The root is fine. My scar is barely 5 inches long (you might ask the surgeon how long yours will be).

My gut from the first was to go tissue, so my personal journey was to have someone prove me otherwise. It never happened. My surgeon turned out to be my age and while experienced in both types, said that he personally would go with the valve he put in me. He asked me to not choose a stentless valve as he did not enjoy working with them. My reason for mentioning that, is that after having read this thread, and thought about all the personal experiences of those who contributed I just want to emphasize the need to be well connected with one's own surgeon. It seems to me that they are as different as car mechanics!! Not equally qualified/experienced in every domain of car (heart) repair! (I would not take my Saab to a Chevy mechanic). A person really needs to find one whose expertise lies in the realm of the individual's needs. We are all so different!!

I wish you well!! You will do fine! Having kept a medically "ancient" repair working for 47 years, you are obviously pretty well put together!!

Please start some new threads with new questions. And with those questions, I invite you to peruse Der Biermeister's early threads. He asked all the questions that were on my mind; sometimes just moments before I asked them!!! And while you may not hear from him pre-surgery.....he will definitely pester you about walking post-surgery. His unfaltering optimism will be a good friend, as well!

You've gotten a good introduction to our group......now branch out and get some more feedback!

Marguerite

 

[cam4est]

Response to DeWayne

Response to DeWayne

Well, DeWayne, if you can stand another letter from a someone who had to choose between a mech. valve and a tissue valve, I think mine is unique. I had a pulmonary valve and artery replaced in March of '04. I was told by my surgeon that mech. valves did not do well in the pulm. position and in fact, I did my own research on that and found it substantiated. 16 months later it degenerated adn I had another replacement. But this time , they kept the artery intact and only replaced the valve, The surgeon at the Mayo said I could have either. When I said that I had read many studies about the pulm. valve not doing well with the mech. he said "that isn't true". But I had read several long term studies. Also I travel a lot and as a nurse see the long term effects of coumadin therapy with patients in the hospital. I wish I had had this forum to talk to about it then because I only had one day to decide and was alone in MN. So I decided to take the risk and get the porcine valve hoping that by the time I have to have another one, we can go for the percu. which Dr. Puga said would only be possible if I kept my tissue PA. So, we shall see how this all plays out but frankly I am glad it is a tissue one as I am not terribly compliant(as nurses are so often apt to be) and didnt want to worry about testing. So here we are. Also, I went 40 years after my 2nd surgery as a child until another one. Now I have had 4 and keep on ticking. I know you will too!! Good luck. Karen

 

[Sherry]

Congratulations on your well-informed choice, DeWayne. We will all be behind you every step of the way.

 

[Phyllis]

Just found this thread also and want to chime in with my best wishes. You are well prepared and I know you will do well. Have a good round of golf and look forward to many years of hauling your own clubs!

 

[DeWaynesWife]

update on surgery in post surgery forurm

update on surgery in post surgery forurm

FYI, for those who want to know, I've posted an update on DeWaynes surgery today in the "post surgery" forum (sucessful!). Thanks a million to all of you for being so helpful in the past several weeks

 

[HarleyM]

Thanks for the update.