Frustrated!

[Thriell]

I went to Little Rock today to talk with the heart surgeon. It was, for the most part, in my opinion, a wasted trip! Except for the blood draw (which could have been done locally and faxed to him), the whole thing could have been done over the phone instead of my wife and me driving for two and a half hours each way!

What he said boiled down to this:

"There are three different hospitals where we could do the surgery. I'll have to talk to your cardiologist and rheumatologist before deciding which one to use. There are two different kinds of replacement valves I could put in. One will have you on blood thinners for the rest of your life, the other will need to be replaced in about 10 years. I'll have to talk to your cardiologist and rheumatologist before deciding which one to use. I'll want you off of your arthritis medication for a week or so before doing the surgery, so I'll have to talk with your rheumatologist about that. By the way, I notice you've got a couple of teeth broken off. You'll need to see a dentist and have him fax me a statement verifying that there's no infection there before I schedule the surgery. Can't afford a dentist? Well, you don't want to have this surgery without seeing a dentist first and, if you choose not to have the surgery at all then this condition will eventually kill you. Have a nice day."

The surgeon's staff tells us that everyone who's going in for surgery must be seen by a dentist because an infection in the mouth can travel to the heart in nothing flat and cause all sorts of ugly problems after heart surgery.

My feeling is that the man is a doctor and he has a sample of my blood. If I was fighting an infection, he should know it.

 

[ALCapshaw2]

Welcome Thriell,

He's right about having your dental problems taken care of before surgery. The best solution for broken teeth is to have crowns put in but without insurance that can be expensive. You should at least have a good cleaning before surgery because dental procedures are not recommended for 6 months afterward. You will also need to 'pre-medicate' with 2000 mg of Amoxicillin or other appropriate anti-biotic one hour before ANY dental procedure for the rest of your life. This is to prevent Bacterial Endocarditis from infecting your heart which can ruin your valve(s).

There are different types of Mechanical Valves (all require Coumadin anti-coagulation for life) made by St. Jude, On-X, etc. and several different types of tissue valves, porcine, stentless porcine, Bovine Pericardial, cadaver, etc. Each type of valve has certain advantages and disadvantages. You can find a LOT of discussion on this subject in the Valve Selection Forum. Some of the newer tissue valves can last up to 15 or 20 years depending on your age and other factors. (The older you are, the longer they last).

You may want to look for a surgeon who is familiar with more different valves, or at least the ones you are most comfortable with.

'AL Capshaw'

 

[Thriell]

Welcome Thriell,

He's right about having your dental problems taken care of before surgery. The best solution for broken teeth is to have crowns put in but without insurance that can be expensive. You should at least have a good cleaning before surgery because dental procedures are not recommended for 6 months afterward.

The teeth I have broken off are broken right at the gumline. It's not gonna be crowns for them... we're talking bridgework here. Other dental problems I have are 4 wisdom teeth that, by rights, should have come out 15 years ago and a few teeth that have been shattered because of the pressure applied by the wisdom teeth combined with the weakening caused by almost 10 years of prednisone. I'll go so far as to get a good cleaning, but, frankly, the rest of those problems have waited 15 years or so already, and I don't think a few more months will kill me.

There are different types of Mechanical Valves (all require Coumadin anti-coagulation for life) made by St. Jude, On-X, etc. and several different types of tissue valves, porcine, stentless porcine, Bovine Pericardial, cadaver, etc. Each type of valve has certain advantages and disadvantages. You can find a LOT of discussion on this subject in the Valve Selection Forum. Some of the newer tissue valves can last up to 15 or 20 years depending on your age and other factors. (The older you are, the longer they last).

You may want to look for a surgeon who is familiar with more different valves, or at least the ones you are most comfortable with.

'AL Capshaw'

This surgeon's not sounding like I'm going to have much choice about what valves I end up with. He's already ruled out mechanical valves because of my rheumatiod arthritis and the medication associated with it . . . doesn't want me on blood thinners 'cause he's affraid of infection. He didn't go into a whole lot about the various kinds of tissue valves . . . just that tissue valves were the alternative to mechanical valves.

 

[DebbiN]

got any other opinions?

got any other opinions?

Sounds like you might want to get another opinion somewhere. He doesnt sound like he has much of a bedside manner!

 

[ALCapshaw2]

The oldest and simplest tissue valves are pig valves. Unfortunately they also have the shortest longevity.

The latest Bovine Pericardial Valves (made from the pericardium of a cow's heart) are hoping to achieve 20 years in older patients. I would start looking for a surgeon who is familiar with these types of tissue valves. It would probably be a good idea to get at least a second opinion as well. Can your cardiologist recommend other surgeon(s)?

We have some other members from Arkansas. Some of them went to the big Heart Hospital(s) in Texas because they had more complex cases.

'AL Capshaw'

 

[Nancy]

It's pretty much a standard to have people get dental problems taken care of prior to valve surgery. Dental infections are like a highway to your heart and new valve which will be very vulnerable. Many here can attest to the fact that they had to have dental clearance first.

Your surgeon sounds like a terse man, however, not being a good communicator doesn't mean that he's not a good surgeon. Some of the best ones have not much in the line of bedside manner. You won't be spending much time with him anyway while you're awake. If he's an excellent surgeon, that's primary. However, getting a second opinion is important if you have any doubts.

 

[Karlynn]

It's pretty much a standard to have people get dental problems taken care of prior to valve surgery. Dental infections are like a highway to your heart and new valve which will be very vulnerable. Many here can attest to the fact that they had to have dental clearance first.

Your surgeon sounds like a terse man, however, not being a good communicator doesn't mean that he's not a good surgeon. Some of the best ones have not much in the line of bedside manner. You won't be spending much time with him anyway while you're awake. If he's an excellent surgeon, that's primary. However, getting a second opinion is important if you have any doubts.

I was required to have a thorough dental exam prior to my surgery too. Since infections in the mouth can spread easily througout the body, the doctor wants to make sure you don't have anything that can lead to a post-surgical complication.

My cardiologist of many years was a very solemn man. It was rare to see him smile (although I managed to pull some out of him over the years). It took me a while to learn that he was a very sensitive, caring man that just didn't wear it on his sleeve. As Nancy said, the lack of personality doesn't tell you about his surgical skills.

 

[Cris N]

I don't have dental problems anymore...

I don't have dental problems anymore...

I met with my surgeon on a Friday morning, his office scheduled me for a 1:15 visit to oral surgeon to discuss my periodontal disease. It was a very short discussion! I was to come back at 3:00 to have all my teeth removed. Had the MVR surgery on Monday. Truth of the matter is that my teeth had been in such bad condition that they probably contributed to some of my valve problems.

 

[Michaelena]

I went to 3 different heart surgeons for consult in the last two months and none of them said anything about my teeth. Maybe in the East teeth don't count! Honestly, the medical community has me befuddled

Michaelena

 

[Phyllis]

Having your teeth checked before AVR surgery is routine. They may not mention it in surgical consults, but I am sure once a surgeon and a date is set, they will require a letter from your dentist saying all is A-okay before admittance for surgery.

 

[Michaelena]

Having your teeth checked before AVR surgery is routine. They may not mention it in surgical consults, but I am sure once a surgeon and a date is set, they will require a letter from your dentist saying all is A-okay before admittance for surgery.

Phyllis and Dick,

Well, I did choose a surgeon and the date is set, July 26, 2005, I am still waiting for a request that a letter from my dentist will be needed to proceed. The cardio's office called with pre-admission stuff, but no word about my teeth. This should be very interesting. I tell you here on the East Coast we just do things differently, not wrong, not right, just different!!

Thanks again for your insight on this subject.

Michaelena

 

[Michaelena]

Phyllis and Dick,

In reference to my last post, I noticed you are from Connecticut (East Coast), maybe I should have qualified that and just said Pennsylvania.

Michaelena

 

[Thriell]

Been a while since I've checked on this thread. The dentist explained the same thing to me tha several people here have . . . Where infection is concerned, the mouth is an expressway to the heart. Got it. Thanks. I'm scheduled to go in and have six broken teeth removed on Tuesday, then I've got a week on antibiotics, then the heart surgeon will schedule me "in a couple of days" after that.

Someone suggested I get a second opinion if I don't like the surgeon. It's not that I don't like him. I've heard nothing but good things about his work. He's just not, from what I've seen, a "people person" and I have no right to complain about that - I'm not either! The problem with a second opinion is this: I live in middle-of-nowhere, USA. There is exactly ONE cardiologist within a reasonable driving distance. That cardiologist uses exactly ONE surgeon. I'm unemployed and uninsured, and, with gas well over $2/gallon, the idea of driving to, say, Iowa or some place is out of the question. So, since I've already said I don't have a real problem with this surgeon, I'll stick with him.

I've also found out that yes, the surgeon has ruled out mechanical valves in my case and he only uses two kinds of tissue valves: Bovine and Pig. Bovine, he reserves for children. Therefore, my valves will be Pig Tissue. According to the nurse who talked to my wife yesterday, the Pig Tissue valves are lasting 15 - 20 years now days. Anyone heard anything about thaet?

One more question, then I'll shut up. I've been more symptomatic than usual for the last couple of days - as in, walking from the living room to the bathroom and back takes the wind out of me. How far can this be allowed to go before the surgeon is going to say, "Forget the teeth, you need this done now"?

 

[Nancy]

You WILL be quite symptomatic prior to surgery. My husband could barely manage to walk to the bathroom, and going out to the mailbox to retrieve the mail was out of the question. Just take it really easy right now.

It is VERY important to get your teeth fixed and get rid of any possible source of infection.

Several can attest to the fact that they developed valve problems directly from bacteria from their teeth. You do not want to risk that either just before surgery or just after, and you will probably have to have regular dental care throughout your life to keep things infection free, and you will probably have to premedicate before every dental appointment.

It's an intrusion into your life that is necessary.