Hi! New member... just getting acquainted!

[AnnieShannon]

The technician who did my echo at the last appointment said that Dr. Skeif (the new doc) was going to be taking over "a few" of Dr. Evans (the old doc... and I mean old, literally. LOL) patients. She also said that the "old school" way of looking at valve replacement surgery was to wait until the LV started to enlarge, but that the younger doctor's would prefer to get the surgery done BEFORE the heart is compromised. That way you don't have a replaced valve, AND a damaged heart. Sounds like a good philosophy to me, but what do I know.

I still don't understand how/when "they" know when you need the surgery or if you are still in the "wait it out" category. I guess that's something I'll talk to Dr. Skeif on Monday about, but it really just seems totally subjective? I would much rather the doctors have some kind of hard and fast rule about when the surgery needs to be done, but that doesn't seem to be the case?

 

[AgilityDog]

Annie, my symptoms before my mitral valve replacement were HORRID! But my internist poo-pooed me. I nearly died before and after surgery because of her sloughing me off and delaying my proper diagnois and treatment. DON'T put up with that.

My symptoms before my recent aortic valve replacement were much milder, but similar to yours: fatigue after the simplest things, and chest discomfort (which lasted only 2 weeks before my cardio visit, when he said "it's time for that second replacement.") Anyway, I'm so much better after this second surgery, it's amazing! I'm not yet 5 months out, but have so little fatigue these days, and very few symptoms.

The TEE will tell them more, but from your symptoms, I'd be asking for a referral to a top aortic valve surgeon.

 

[ALCapshaw2]

Annie -

As you have discovered, there is a Huge Difference between Old School Cardiologists and more 'up to date' Cardiologists.

Surgeons like to operate BEFORE there is any permanent damage to the heart walls and muscles.
My personal view is that Surgeons probably have a better feel for timing than (many) Cardiologists.

Many Surgeons (and Cardiologists) use an effective Aortic Valve Area of 0.8 sq cm as their 'trigger' for recommending surgery. To my mind, Symptoms are a sign that Damage is being done to the heart but NOT all patients exhibit (or recognize) symptoms before surgery is advised. Some who have thought they were not having symptoms later reported that their valves literally disintegrated in the surgeon's hands. Bottom Line: Good Surgeons (and Cardios) will look at BOTH the 'Numbers' and 'Symptoms' in deciding when to recommend proceeding with surgery.

'AL Capshaw'

 

[AnnieShannon]

What is the "normal" measurement of the effective aortic valve area? The tech who did my last echo said something about the leak being about 50% of the valve opening? Not sure what that means, and I'm sure I should just wait and see what they say on Monday, but I can't help but wonder! LOL

 

[ALCapshaw2]

What is the "normal" measurement of the effective aortic valve area? The tech who did my last echo said something about the leak being about 50% of the valve opening? Not sure what that means, and I'm sure I should just wait and see what they say on Monday, but I can't help but wonder! LOL

It sounds like you are confusing two (or three) different parameters.
'Usually' the only measurement that is expressed as a percentage is Ejection Fraction.
Normal is somewhere between 50 and 70% (different hospitals use slightly different ranges).
I've never heard of a leak being compared with the valve opening.
Leakage has a different type of rating system.

Do you have a copy of your Echocardiogram Report?
If not, I highly recommend that you obtain one.
You will have to sign a release of information form (to yourself) at the facility that performed the test.

Effective Valve Area (for both Aortic and Mitral Valves) are 'usually' part of the Echo Report and measured in Square Centimeters (sq cm or cm sq or cm^2). Anything over 1.0 cm sq would probably NOT be recommended for surgery. Less than 1.0 cm sq with symptoms or 0.8 cm sq with or without symptoms would likely be recommended for surgery.

'AL Capshaw'

 

[AnnieShannon]

Yeah - I'm obviously confused... and I need to learn what to listen for when I'm talking to my doctor, and what all the terms / parameters mean.

We'll start with asking questions on Monday, hopefully.

Thanks again!

 

[Duff Man]

Hi Annie, I wish I had a TEE on Monday. I'm overdue for a nice relaxing nap. As long as they're giving a good push of the versed, you won't remember anything and you'll be in paradise. Think of it as a mini vacation from the worries the valve has presented you... that's how i'd look at it.

The only complication I've ever heard of is when some kid ate before his TEE and puked, and then aspirated his puke. Because of his naivety, he spent a few extra weeks in the hospital... So don't eat before it!

 

[AnnieShannon]

LOL okay I like that visual Duff Man! Is it out of line to ask them what they're going to give me, before they get going?

And no more stupid questions, I promise. I will try to understand what I'm asking, before I go to blabbing.

 

[Kathy McCain]

Annie,

I don't believe you'd be out of line at all!

Good luck! You'll be fine

 

[Jkm7]

You should always feel free to ask any of your doctors, nurses, techs etc any questions about any medication or treatment you are receiving. You should always expect a courteous informed response.

 

[Duff Man]

LOL okay I like that visual Duff Man! Is it out of line to ask them what they're going to give me, before they get going?

And no more stupid questions, I promise. I will try to understand what I'm asking, before I go to blabbing.

No, it would not be out of line to ask them any question related to the procedure whenever. In fact, they should tell you what they're giving you before they give it to you and what it's effects will be, in my opinion... but that's not usually the case. Usually they'll just warn you that they're administering the sedative and you're going to feel sleepy soon, or something like that.

Your questions are not stupid at all. This is serious stuff, especially when it's your first time. I remember being very scared before my first TEE.

 

[AnnieShannon]

I don't know if I'm more afraid of the TEE, or what they will (or won't) find when they're in there.

Everyone around me keeps telling me not to think about it, and to burn that bridge when you get there, but sometimes that's easier said than done.

Then I read about people on here who have had multiple surgeries, and I feel like a big baby. LOL

 

[ALCapshaw2]

The usual IV meds administered during a TEE are something for pain (typically Demerol) and some form of "Conscious Sedation" (typically Versed), which can take you from Not Caring to Not knowing or remembering anything about the procedure. If you don't wnat to be aware of what's going on, just tell them before they start and they will adjust your dose appropriately. For my last one, there was a Nurse Anesthesist present who administered some kind of fast acting anesthetic that wore off with no lingering effects. Pretty amazing stuff.

They will spray your throat with some really YUCKY stuff and then ask you to Swallow it.
Just Do It. Hopefully that will prevent an undesired Gag Reflex.

 

[Marcia58]

Welcome, Annie!

Don't worry about not knowing all the terms, etc. None of us did, starting out.

About the TEE, my meds were so good, I still think of them fondly on especially stressful days!

It's NEVER out of line to ask about meds, procedures, test results! You should be included as much as you want to be. After all, none of THEM has to take your body home and live in it! And you can get copies of your records. What a lot of people don't know is that in the US, the HIPAA law includes a section that stipulates your right to be informed!

Let us know how things go on Monday....

Marcia

 

[AnnieShannon]

Ah, the joys of modern technology! I'm in the waiting room now, posting this from my smart phone. LOL

Should be going in soon, will let you all know how it goes! Thanks again for all the kind words and support! You guys are awesome!

 

[AnnieShannon]

Wow. Talk about an exercise in futility.

Once we finally got things going, looks like my AI is not considered "severe" after all. Cardio says it's still in the "moderate" category. According to what the Doctor told my husband, it's the medication that's causing all my symptoms. I would not disagree that the Metoporol may be making my fatigue worse, but how about all my other symptoms? I was having symptoms before they put me ON the metoporol, it's why they put me on it to begin with. It's not like a was totally asymptopmatic, and then developed symptoms AFTER I started taking medication.

I feel like I am right back to square one, and it's back to all in my head.

 

[ALCapshaw2]

Wow. Talk about an exercise in futility.

Once we finally got things going, looks like my AI is not considered "severe" after all. Cardio says it's still in the "moderate" category. According to what the Doctor told my husband, it's the medication that's causing all my symptoms. I would not disagree that the Metoporol may be making my fatigue worse, but how about all my other symptoms? I was having symptoms before they put me ON the metoporol, it's why they put me on it to begin with. It's not like a was totally asymptopmatic, and then developed symptoms AFTER I started taking medication.

I feel like I am right back to square one, and it's back to all in my head.

SO, did this Cardio tell you to just STOP taking the Metoporol?

If so, call your Pharmacist and ask about the preferred way to withdraw from Metoporol.
As I recall, going Cold Turkey can cause other arrhythmias to occur.


It is my understanding that the usual protocol for withdrawing from Beta Blockers is to 'taper down', say 1/2 dose for 2 weeks, then cut that dose in half for another two weeks and finally stop.
The size of your dose and length of time you have been on it 'may' factor into the withdrawal protocol.
I'm not totally sure about this which I why I suggest asking your Pharmacist (who should KNOW and NOT charge for providing his knowledge).

'AL'

 

[AnnieShannon]

Yes, he told me to quit taking the Metoporol, and he gave me Diltiazem CD to take instead.

 

[Duff Man]

I bet it's not all in your head. Not ALL of it. If you don't think it's right, then get a second opinion... perhaps from a surgeon. IF you get one from a surgeon you'd probably want to get more than one opinion from a surgeon too.. at least I would.

The new medicine is a calcium channel blocker which doesn't have some of the side effects a beta blocker does.

 

[AnnieShannon]

I took the new medication last night, we'll see how it goes.

I have a follow up with my doctor on the 13th, I'll get some more information about the test etc from him then. LOL I was kind of groggy and grouchy last night.