ramjet
Well-known member
Go steady fundy, remember FC didn't have much time for valve choice, and in fact may not have had any choice at all given the valve op was shortly after an emergency aortioc repair procedure, and in fact in some instances, where there is aortic dissection and aortic root involvement, the patient may indeed be better off with a mechanical valve, because a redo operation to replace a tissue valve can indeed be more challenging in this paarticular instance....thats what my very experienced surgeon told me anyway. Given the emergency nature of the aorta reapir operation mechanical may have absolutely been the best way to go....unfortunately there is now the ongoing warfarin issue with someone who plays a sometimes violent contact sport, but it was a life and death situation as oppposed to many valve repalcements, which are a planned procedure with time to make informed decisions.
JC, the other issue is that if you are on warfarin, and you take a significant blow to the head, and they take you to the emergency department, you are much more likely to get a CT image of the head to look for a bleed due to the increased risk of bleeding. However, not all emergency departments have a CT, so you may have to be transferred to another hospital , and CT images are not without risks in themselves due to radiation exposure, and depending on your insurance cover there may be quite a cost involved. I was on warfarin until my tissue valve had settled in (so to speak), and a couple of months after I was taken off warfarin I was involved in a car accident where my head hit the side window and I saw stars for a while. A couple of very senior doctors said I was very lucky that I didn't have the accident while I was still on warfarin, because they have had patients die due to intracranial bleeding, one had fallen from a ladder while on warfarin, and another had fallen down the steps at a train station.
I guess it all really depends on how you play the game, and at what level, you simply can't have a CT of the head every few weeks every time you get clobbered about the head, so there just comes a point where you will either have to stop because of either bleeding on the brain or because of too many CT images of the brain. I guess it will really come down to how hard you play the game, how likely you are to get a serious knock to the head, what sort of protection you are wearing, what sort of insurance cover you have and what sort of risk you are prepared to take. Personally I wouldn't be worried too much about cutting yourself or bruising elsewhre, its all about bleeding in such important places that you can't access to stop any bleeding, like in your brain from a blow to the head. Personally I would be loath to play around with altering the target INR levels. Maybe you could look at getting a super dupa, top of the line, custom fitted protective hockey helmet (if you don't already have one.)
But anyway, best of luck with it all, and remember you did indeed survive an event that many many people simply do not survive ( a major aortic dissection), and the mechanical valve and aortic root was almost certainly the best option in your particular instance (having already had an emergency aortic dissection repair which might hae made a valve reoperation much more risky and difficult) ...take care....I like the idea of continuing to play hockey ...but not a the top"MAD" level....its hard to get the image of ice hockey palyers out of your mind that we used to see in the "MAD" comic series, where the hockey player had all these stitches in the head, teeth missing, eyes gouged out, ears bitten off, hockey sticks jambed into their throat etc....if its a bit softer than that it might well be worth considering continuing with the sport. You might have to check insurance cover etc,a nd the hockey club may in fact have a rule that you need a medical clearance to play
