My random newby question thread

[Duff Man]

Interesting web site.

I don't mean to hijack this thread, but yesterday I read that garlic is a anticoagulant, and this web site says otherwise. And you wonder why people get confused

Sorry for the hijack Aaron.

um, that was a google search I'm not sure what you're looking at actually.

 

[Susan BAV]

Yes we had a poll, but lets not forget membership here hardly represents the full picture. There are many people who are not here that did not respond to the poll. I'm sure it's a much larger number then 1. This is why I wish people that come in here, have bad outcomes would come back and post to that effect. There too worried about scaring new people, well hey, the truth is just that, the truth. New folks need to see the down sides as well as the text book perfect ones.

This is interesting and possibly true in many ways and on many levels.

And Aaron, I and other members here have posted news reports about a genetic test for compatability with ACT which you could probably do an advanced search for here or on the Web. I think I understand your concern. I have a friend who is so allergic to aspirin (and also asthmatic) that if she so much as licked an aspirin, it could mean her demise. So obviously, aspirin therapy would never work for her. People can have a wide range of reactions to various medications.

 

[geebee]

I actually think a coumadin trial makes a lot of sense. Unlike many other types of meds like BP or cholesterol, coumadin is the only kid on the block. If you turn out to be in that 1% (or whatever) that cannot tolerate it, you are in deep doodoo if you already have a mechanical valve implanted.

I would not think it would be much more than taking a few pills to make sure you do not have a reaction. It would not be necessary to find out how fast you get in range or anything like that. A few pills would tell if there is an allergy. If you are not, you can decide from there.

Although I have never met or heard of someone that is allergic to coumadin, I am allergic to a few things that the doctors never heard of as causing allergic reactions so I would be the first to say anything is possible.

 

[deogloria]

I'm a newbie, but I don't think coumadin is the only choice after valve replacement. Everything I've read about pregnancy after AVR, and also what was told to me by a perinatologist a while back, says that pregnant women shouldn't have coumadin. They should be given heparin or some other drug that I think starts with an L, I think.

However, I think a coumadin trial is a good idea. Who wants to suffer through a bad coumadin reaction while recovering from OHS? Find out ahead of time.

 

[geebee]

I'm a newbie, but I don't think coumadin is the only choice after valve replacement. Everything I've read about pregnancy after AVR, and also what was told to me by a perinatologist a while back, says that pregnant women shouldn't have coumadin. They should be given heparin or some other drug that I think starts with an L, I think.

However, I think a coumadin trial is a good idea. Who wants to suffer through a bad coumadin reaction while recovering from OHS? Find out ahead of time.

Right now, coumadin (warfarin) is the only choice for an oral anticoagulant that is used for mechanical valves. Heparin (IV) and Lovenox (injectable) are really meant for short term use. I do believe that Lovenox shots have been used by pregnant women but not without risks.

There have been women who have successfully gone through pregnancy on a regimen of coumadin and heparin but, again, very risky.

It is usually considered best that a female valve patient either have her family prior to valve replacement or, should she be planning on a family after VR, go with a tissue valve.

 

[Duff Man]

Does coumadin make men less able to procreate?

 

[ctyguy]

Well I don't plan on having any more babies but I can say that within 3 weeks of surgery everything was working as expected

 

[ctyguy]

I've always gone with the "use it or lose it" mentality

 

[Duff Man]

3 WEEKS? All bets are off. I can't go through with this.

 

[ctyguy]

it was the wife, not me ! I was startin to bug her at two weeks but the whole chest ooze thing really wasn't much help in setting the mood.

 

[ctyguy]

constant whining and pestering ultimately won out. It might have been pity sex but.....

 

[ctyguy]

if my memory is right she was doing the whining, I was doing the pestering...

 

[Ross]

3 WEEKS? All bets are off. I can't go through with this.

It's the nurses Aaron, it's the nurses!

 

[ctyguy]

I gotta say that I almost felt like I was on Grey's Anatomy when I was in the hospital. My ER nurse was all of 24 and just....wow ! Then they move me upstairs and it seems every one of the female attending docs was a 30-something size 4. When I got home I tried to convince the wifey to buy a lab coat and stethescope, playing doctor never sounded so good !

 

[mrwjd]

I had a cardiac cath almost immediately I was discovered to have a problem and transported to hospital. I got a good report on my arteries, also the left ventricle, and a bunch of numbers that weren't too bad.

Before surgery, at another hospital, I had a very thorough echo, and was Dx with BAV. I was surprised the cath didn't turn this up, but my cardiologist (not sure if he was being charitable to the ER cardio, or this is true) said it's very hard to see a BAV on the cath, it's easier to detect with the echo.

Anyway, the echo turned out to be right, for what it's worth.

 

[Duff Man]

I have a new random newby question that just occured to me: Does a higher ejection fraction also spell trouble?

I've been under the impression for years that the EF would get lower if my valve was going bad. Can't remember exactly, but I think I'm at 65 or 70%, and it's been creeping up from 60%. What's it mean when an ejection fraction gets in to the 70's or 80's?

 

[Lionheart]

Aron,
Good question. I would like to know too. My ejection fraction (EF) was lower after surgery. I am hoping it will be higher when I get my follow-up echo next month. Maybe I'm wishing for the wrong thing. I always thought the higher the EF the better because I thought that EF was the percent of blood that is ejected from the Left ventricle. If that's the case, then you would think 100% would be perfect. Maybe there's a magic middle range thats "just right".

John

 

[Adrienne]

Unless you are a super athlete, going too high means the heart is overcompensating, and usually what happens is that at a certain point it will no longer stay high but will drop significantly because it can no longer compensate at all.

There are people out there who can explain this better than myself, but that's the gist of it.

 

[Leah]

Here's some of what the Cleveland Clinic website says. I'm including a link if you want to read the rest of their discussion. It's consistent with what I've been told consistently, over the last four years - that my 65-70% EF was perfectly normal.

http://my.clevelandclinic.org/heart/disorders/heartfailure/ejectionfraction.aspx

What is ejection fraction?
Ejection fraction is a test that determines how well your heart pumps with each beat.

Left ventricular ejection fraction (LVEF) is the measurement of how much blood is being pumped out of the left ventricle of the heart (the main pumping chamber) with each contraction.

Right ventricular ejection fraction (RVEF) is the measurement of how much blood is being pumped out of the right side of the heart to the lungs for oxygen.

In most cases, the term ?ejection fraction? refers to left ventricular ejection fraction.

What do the numbers mean?
Ejection fraction is usually expressed as a percentage. A normal heart pumps a little more than half the heart?s blood volume with each beat.

A normal LVEF ranges from 50-70%. A LVEF of 65, for example, means that 65% of the total amount of blood in the left ventricle is pumped out with each heartbeat.

The LVEF may be lower when the heart muscle has become damaged due to a heart attack, heart muscle disease (cardiomyopathy), or other causes

 

[Duff Man]

I'm definitely picking up what you're laying down Oaktree.

Although I should say that the last echo I had was when I was working a very physical job. It was so physical that the attrition rate was maybe 25% a month because people couldn't handle it. Not to toot my own horn, but there's not many people that can work that hard for 12 hours a day, 7 days a week. I had a job that would make any average athlete sweat. Looking back, I feel very fortunate my aorta didn't rupture.

I've got to believe that the persistent hard work made the ejection fraction higher than "normal" for me. Although I will say that when I had a surgery and did absolutely nothing for a month, I could literally feel my heart losing it's compensation to the stenotic valve. At the end of that month or two of bed rest, walking to the mailbox was a workout. But now I believe my heart is compensating again because I'm active.

What's a little bit worrisome though is that I've been on beta blockers the whole time, and these stats have still been degrading.

But basically, I'm not too worried about it. An average gradient of 13mmhg is no big thing if I'm not mistaken. I think the newer mechanical valves out there have similar average gradients... I did have a TEE done at UofM but I have no idea what the EF was. I'm going to get a copy of the report. I have a feeling it's back to "normal" for me.

Thank you for your thoughtful replies. I think you very well could be right, but I have a certain apathy about it right now. I'll keep an eye on it, but right now I feel like there's no way in hell I'm having the surgery for several reasons that are beyond the scope of the thread. I've been on the fence for this entire time but I just feel like there's some things I have to leave up to God, or fate.