mech vs. bio statistics

[Mary]

Hi Randy,

My mother works in a pharmacy and she also flipped when I mentioned coumadin for the first time. Pharmacies never, ever hear from well-managed anticoagulators. Why would they? But they see disasters (both bleeding & clotting) from street people and habitual users and frankly, older, somewhat "hazy" patients who don't understand the principals of INR or the consistancy and faithfulness needed to make it work (and I blame their doctors for this.) My mother actually thought I could never eat spinach again, that I would constantly having to be looking and seeing what vitamin K foods were hidden in recipes so I could avoid them and that if I cut my leg shaving, I would have to go to the hospital. She's not an uneducated or uninformed person either, but working at a pharmacy really skewed her perspective. I would pay absolutely no attention to a pharmacist's horror of coumadin. I'm sure he's seen horrible things but they are the working with the very "fringe" of life.

Karen,
I think you have grossly generalized with the "pharmacies never, ever hear from well-managed anticoagulators."
My father in law is a pharmacist and was "well managed" on coumadin for 15+ years due to a variety of heart problems (none valve related).
He remained on coumadin while undergoing a routine colonoscopy, but a tiny nick during the procedure almost caused his death. He no longer is prescribed coumadin.

In addition, your generalization of "older, hazy patients" unfairly assigns blame to both patients and doctors while overlooking the health problems seniors accumlate with their advancing age. My mother (an RN ) was on coumadin, successfully, for many years. However after she developed cancer, her anticoagulation management was made much more difficult due to the chemotherapy regime she underwent. After the cancer invaded her stomach, her anticoagulation was stopped. She was older, but she not hazy. The medical profession recognizes the relationship between age, increased medical issues requiring more medications, and anticoagulation.
Tissue valves are generally recommended for senior citizens for this very reason.

To label all anticoagulation patients that a pharmacist deals with as people on "the very fringe of life" is irresponsible.

 

[Randy & Robyn]

Well Randy I'm going to go eat a can of spinach in your honor and I'll even be sure to nick my face with my razor a couple times too!

Actually the razor nicks sound like more fun than the spinach.

 

[Ross]

I take it you ain't a Popeye man?

 

[Randy & Robyn]

I take it you ain't a Popeye man?

Love broccoli, love brussel sprouts even. HATE SPINACH!!!

 

[Ross]

Oh well, two out of three ain't bad.

 

[Karen7]

Wait Wait Wait Mary! I'm sorry you're having a bad day. I didn't say your father-in-law who is a pharmacist doesn't know anything about coumadin! I'm sorry if it sounded personal. People do not call their pharmacist to say they've been taking coumadin with no problems. The same could be said for any medicine. The pharmacist hears about the reactions & interractions and the extreme cases. They have to hear about those. This can skew the overall picture of taking that -- which is what Randy and I have both experienced personally. Glad you did not.

I also didn't say your mother is hazy because of her advanced years. ?!

Al Lodwick has cites an article on the number of older patients receiving mechanical valves against the ACC & AHA guidelines. But I think that's probably for another thread.

God bless you, Mary. Very sorry about the misunderstanding.

 

[Mary]

Wait Wait Wait Mary! I'm sorry you're having a bad day. I didn't say your father-in-law who is a pharmacist doesn't know anything about coumadin! I'm sorry if it sounded personal. People do not call their pharmacist to say they've been taking coumadin with no problems. The same could be said for any medicine. The pharmacist hears about the reactions & interractions and the extreme cases. They have to hear about those. This can skew the overall picture of taking that -- which is what Randy and I have both experienced personally. Glad you did not.

I also didn't say your mother is hazy because of her advanced years. ?!

Al Lodwick has cites an article on the number of older patients receiving mechanical valves against the ACC & AHA guidelines. But I think that's probably for another thread.

God bless you, Mary. Very sorry about the misunderstanding.

Karen,
And I assumed it was you that was having the bad day!

Of course you didn't mention my father in law or my mother. You generalized and lumped all pharmacies ( in your experience) with patients having difficulties as street people, habitual users, and older, hazy people. That's why generalizations, especially on a website Forum where you don't know the particulars of member's experiences, should be avoided.
Thanks for clarifying your point of view, and let's move on to bigger and better things--namely the holidays!
Mary Sunshine

 

[KristiinSD]

I need hugs, statistics, and for this #*^%

I need hugs, statistics, and for this #*^%

surgery to over with...Interestingly my new cardiologist has had two mitral valve repairs, which suprised me. I thought once a repair failed they would automatically give you a new valve...but I guess not.

Kristi
mr
surgery 11/30

 

[PapaHappyStar]

aortic valve repair -- review on ctsnet

aortic valve repair -- review on ctsnet

http://www.ctsnet.org/sections/innovation/valvetechnology/articles/article-3.html

 

[Roberdowski]

mechanical valves

mechanical valves

Im reading about the possibility of a mechanical valve "failing in 30 years???" Unlike a human valve that starts to show signs of failing doesn't the mechanical valve fail all at once???? Im still in the process of checking out all of my possibilities. Bob A.

 

[Randy & Robyn]

Im reading about the possibility of a mechanical valve "failing in 30 years???" Unlike a human valve that starts to show signs of failing doesn't the mechanical valve fail all at once???? Im still in the process of checking out all of my possibilities. Bob A.

Hi Bob,

It's my understanding that all of today's mechanical valves are tested to last for far far longer than any of our human bodies ever will. The chance of an actual mechanical failure is extremely low.

The problems usually lie with your own tissue. It can sometimes develop leaks around the valve periphery. Another problem with valves that have been placed for a long time is called pannus overgrowth. That is when your tissue grows around the valve and begins to impede its function. Either of these problems would typically happen over an extended course of time and would be found on your routine echo.

I'm not sure but I should think that a tissue valve could develop the same types of problems if it lasted long enough.

Randy

 

[Sherrylynn41]

My first valve was bovine and began to fail less than 1 year after surgery, I realize this is not the norm. I was against mechanical valves, the only reason, being on coumadin. If I had it all to do over again, I would not have chosen the bovine valve, coumadin is not that big of a deal, I have even messed up with taking it and the results were not disaterous. I do know that most bio valves wear out in half the time as mechanical but I don't know whether one day a mechanical valve would just give out, unless of course you were to get a blood clot. I guess it all depends on the person and how you feel after all the research, when it comes right down to it, you have to live with your valve, you have to be happy with your choice.

 

[PapaHappyStar]

Im reading about the possibility of a mechanical valve "failing in 30 years???" Unlike a human valve that starts to show signs of failing doesn't the mechanical valve fail all at once???? Im still in the process of checking out all of my possibilities. Bob A.

Newer mechanical valves claim to cause less turbulence in the blood flow to minimize damage to blood cells and valve surfaces from the constant ebb and flow of blood across them. This is the type of progressive damage that can cause structural failure in mechanical valves, it has not been demonstrated in newer mechanical heart valves. The FDA monitors the "cavitation potential" of mechanical heart valves and structural failure rates in tests are very low, so the average mechanical valve should last for a very long time with stable hemodynamics.

Biological valves are "treated" by the body with calcium deposits and become stiff and calcified with age, but ( probably due to a combination of flexible leaflets, central flow + a lack of sharp edges projecting into it and bio-compatible material ) dont cause as much blood damage and thrombo-embolism. So anti-caogulation is not required and the new generation of tissue valves is the recommendation in the surgical community for patients > 65 yrs -- biological valves last longer in older people.

http://circ.ahajournals.org/cgi/con...lookupType=volpage&vol=111&fp=2178&view=short

For people in the 40-65 range the mechanical valve is probably the recommended choice.

Biological valves in the mitral position wear out faster than in the aortic position. Mechanical valves require higher levels of anti-coagulation in the mitral position but may not cause more cavitation or turbulence ( rather the clot formation may be due to larger contact times between blood cells and the valve surface ).

This is what I have understood from looking around so far, go to a large teaching hospital with high volume of heart valve procedures and ask them what they recommend in your case. Doesnt hurt to go armed with plenty of information though.

Burair

 

[William]

This has been some good reading! I was/still troubled with my decision to put in a mechanical valve should the repair not be possible. Well, I ended up with a St Jude and the Coumadin is a hassle but liveable. My idea of a perfect drug would be one with all the benefits of Coumadin, but without the food and bleeding issues, checked every year or 6 months for dosage. This would make me forget about my mech valve very quickly. Will

 

[Karlynn]

This has been some good reading! I was/still troubled with my decision to put in a mechanical valve should the repair not be possible. Well, I ended up with a St Jude and the Coumadin is a hassle but liveable. My idea of a perfect drug would be one with all the benefits of Coumadin, but without the food and bleeding issues, checked every year or 6 months for dosage. This would make me forget about my mech valve very quickly. Will

William, hopefully this will take some of the burden off of your Coumadin use. Diet doesn't really need to be watched as closely as most doctors and other medical professionals would have you believe. Most people already have a diet routine without realizing it. We don't vary our intake of food so drastically that one dinner is going to greatly impact our INR. We always say that consistancy is the key. But I think most people really are consistant. It took me several years to stop being scared of eating anything green, let alone leafy. Now I enjoy what I want. My sister-in-law (the Salad Queen) makes a killer spinach salad. When she brings it to family gatherings I have some - I don't have the whole bowl, but I have a regular serving. The stress from denying myself such a tasty treat would probably have almost the same impact on my INR as the spinach.

It's the hidden K in things like breakfast shakes and nutritional bars that need to be watched.