Need to make a choice by December 28th???

[zlever]

Hello All, my name is Zack. I am 35 years old. In 1999 I was diagnosed with AV Insufficiency-Bicuspid Valve. I am in the Army (17 years now). I have recently relocated back to Fort Lewis, WA were I was initially diagnosed with the valve issue back in 1999.

Bottom line is I need to have Aortic Valve replacement soon and most likely will have it done in early Jan of the coming year.

I met for the first time with my surgeon-DR. Meyer last week. He has told me he has done hundreds of valve replacement surgeries-both tissue and Mechanical. I had gone to the appointment with the foregone conclusion that I would be getting a mechanical valve, but after the usual exchange of pleasantries, he made a statement about the choice of valves that kind of surprised me. After explaining each valve he stated that, "he personally would be hard pressed to get a mechanical valve".
This kind of shocked my wife and me as I was constantly under the assumption that I would get a Mech valve because of my age? Now I’m kind of stumped and unsure of what to do? Thank God for this great site and the ton of info I have already read on here.
He stated Coumadin as one of the reasons why he wouldn’t choose a Mech Valve. I am wondering since he does so much of these surgeries if OHS is viewed by him as being routine so much to the point that for himself a OPH every 15-20 years wouldn’t be a big deal for him.--But it is for me--I’m really scared to death--with my wife + 3 young kids and all.

He also mentioned the ON-X valve; however he hasn’t ever personally done a surgery with that valve. He stated that a surgeon from Tacoma General would come down and assist him. I am definitely leaning a little bit toward the ON-X but the fact he hasn’t done one has put up red flags for me.
The surgery would be done here at Fort Lewis Madigan Army Medical Center.
Dr. Meyer did seem very intelligent and I did feel very confident with his background with OHS's in the past.

My next appointment is Dec 28th of which we will choose a date for surgery in early Jan. and the type of valve we will use.
I really, really like the idea of the pig valve in regards to NO Coumadin but I really don’t want another OHS in 10-25 years. (I do understand mech valves need to be replaced sometimes in the window of 10-25 years too but the percentages are much lower).

Last question that maybe someone can help me with. My anxiety for this surgery is extremely high. After serving tours in the "Sunni Triangle" of Iraq conducting hundreds of combat missions and surviving that whole ordeal, I now find my days in Iraq as something I feared much less than this coming surgery.
I 100% know it’s the right choice and I will do it for my beautiful and very supportive wife Traci and three terrific young children, I’m just nervous as hell!
Back to the question. Is there any medication for anxiety I can be prescribed as the date gets closer? The last week or two leading up to the surgery I will be a mess.
Thanks for any input--You are All Terrific!!

 

[Cooker]

Hi Zack and welcome to VR.com. As far as medication for your nerves, ask your doctor. I personally think your anxiety level will subside as you get closer, it did with many of us.

I can not help with the valve question. That is something that you and your doctor will decide. I have a couple of question for you. Will this surgery end your army career? Will a tissue and no Coumadin allow you to stay in where a mechanical and Coumadin would cause you to leave the army? Just curious.

Again, welcome!!

Tom

 

[Superbob]

Hi Zack, and welcome.

Anxiety is normal before having this surgery but I think someday you will look back and chuckle at yourself for thinking it more fearsome than the Sunni Triangle. I think most people will tell you that the waiting was the worst part of it. Pain management is quite advanced in modern medicine -- as long as the pretty nurses kept giving me my percocet I was a happy camper during my 5 days in the hospital. In answer to your question, though, there are anxiety meds that can be prescribed beforehand. I didn't go that route but you could talk to your doc about it. I think others on here may have some thoughts on pre-surgery meds.

Thanks very much for your service to our nation.

Valve choice is one of the hottest topics on here, as you probably know, since I gather you have already been reading and researching. I preferred the tissue but I was in my mid-60s so the dynamics were different for me. Still, young people sometimes prefer tissues for a variety of reasons. Cooker asks a good question about the possible impact on your military career (if you are making a career of it).

Ultimately, it's a very personal decision. If, after all your research, you prefer, say, an On-X, I would find another surgeon who has done those and is comfortable with it. I wish you the best as you make this decision, which is a tough one (but far, far better than having no choice at all!)....

 

[zlever]

Thanks for your reponse's Tom and Robhol. To answer your question, Will this surgery end your army career? Will a tissue and no Coumadin allow you to stay in where a mechanical and Coumadin would cause you to leave the army?
Thes answer to both of those questions is "NO". The type of valve has no issue on whether I am allowed stay in or not. I will be allowed to stay in regardless with the assumption that the surgery is successful. I have 17 years in now-with just three left for retirement. They have assured me that they will not medically retire me but allow me to stay for at least 20. I am thankful for that as a 20 year retirement is greater than a "100% disability medical retirement". I will also have disability in connection with the 20 year retirement. So for my family and I it is much better to get the surgery done while I am in the Army and also to stay in until the 20 year mark hits. Thanks Again -Zack

 

[Karlynn]

Welcome! And first let me say "THANK YOU" for your service to our country and for the sacrifice that both you and your family have made for our nation. My son's best friend is now in Iraq on his 2nd tour there.

Yes, some mechanical valves end up having to be replaced. This is not due to them wearing out. It is most often due to scar tissue encroachment on the valve. It is not the majority of them by far. I have had mine 16 years, there are members here who have had them much longer than myself. My echo last year showed my valve to be sitting pretty, free of scar tissue and lookin' good. I had mine installed at the age of 32. My children were 5 and 7. I am very pleased to have made it through all their growing up years without having to interrupt their life again with Mommy's heart problem. They are now both college graduates. I'm a grandma of a beautiful girl (thanks to my son) and I will be traveling to France in February to visit my daughter who is teaching in Provence. (It's a tough life, but someone has to do it. ) Should my valve need replacing tomorrow, I will not regret my choice for one second. It got me through the busiest most hectic years of my family's life without having to deal with my heart issues.

I have found Coumadin to not be an issue in my life. I home test and manage my own dosing, with the total agreement of my cardio. The worst problem with Coumadin is having someone manage it who is still operating off of old standards and myths. It's not hard to learn the ins and outs, and we're here to help you with that. If you take a look at our Active Lifestyles forum, you'll see that we have some very active members on Coumadin.

I agree with Robhol, if you're going with an On-X, I'd find a surgeon who has done them. Your surgeon may be great, but I don't think I'd want to be his first On-X install. St. Jude is still a terrific mechanical valve as well. I don't know much about the other mechs. Today, I think I'd lean to selecting the On-X.

Getting a tissue valve at 35 means you're probably looking at at least 2 more valve replacements in the future. Unless you go tissue now, and mech later. But then this is probably reversed of that which concerns you about replacement and your children's ages. They are working on technologies that may make tissue valve replacement easier in the future. But I'm personally of the mind set that the decision should be made on current technology and not based on hopes for future technology. Some may come to fruition, some may not. Kind of like people hoping for a "better" drug than Coumadin. It will probably happen some day, but that shouldn't be your primary reason to go with a mech.

As far as anxiety, if it gets too bad, your doctor should be able to give you something. Although, if you weren't worried - we would worry! It's a very successful procedure - but it's also a serious procedure.

Best wishes!

 

[Ross]

In my opinion, because of your age, mechanical would be appropriate to avoid future surgery. There is no guarantee that you won't have another, but chances are greatly reduced. Coumadin will always have a bad reputation so long as our Doctors keep perpetuating myth about the drug. If everyone were up to speed on how to use it and dose it, there would be far less hullaballue about it. It's not nearly the picture painted by some. I would advise going to www.warfarinfo.com and begin an education on Coumadin by reading while your choosing your valve.

Fear not the On-X! Many here have had them and some were done for the first time by the surgeon with outstanding results. Look at the physicians overall record for replacements etc.

Everyones anxiety is up when it comes to this, so if you feel the need for it, ask for some meds to help you through. They shouldn't give you any problems giving them to you since you've had additional stresses.

 

[Phyllis]

Welcome, Zack and thank you for your service to our country. Can't add to all the good advice you have already gotten here, but want to be sure that you let us know the date when you make your decision so we can put you on our calendar. You have a good start as you are becoming a well-informed patient and that will reap rewards. Best wishes,
Phyllis

 

[Isis]

As far a deciding on tissue or mechanical, I went back and forth constantly for about a week or so. Every different study I read would lean me toward that type. Then I decide to stop dwelling on it for a while and just let the decision come about on it's own over a few weeks. Which it did.

Eventually I realized it would be best for "me" to go mechanical.
1) Did not want to have another surgery hanging over my head. Was diagnosed with insufficiency in 2000. Those 7 years went by fast .
2) I just felt a (hopefully) permanent fix was a more sensable way to go.
3) Had good family support to get through recovery now. In 15-20 years, who knows.
4) Was not too concerned with the coumidin. And so far it has not been any problem. Was stable in the mid 2's about two weeks post op and have stayed there. I eat the exact same diet as before surgery.

None of my reasons may apply to you, but just some thoughts.


Good luck on your journey.

 

[WayneGM]

Welcome to the VR community. Glad you found us.

Anixiety is perfectly normal. I'm not sure about medicine for anxiety but obtaining information and knowledge will help you cope with the situation. We're here to help.

My own personal experience was that OHS was not nearly as bad as I envisioned. This the first significant medical procedure I had ever had as I was never seriously sick or injured ever before...so OHS was quite the initiation. When I woke up after the surgery, my first thought was "is it over already?". Recovery requires patience as it's kind of slow, but the pain etc was not bad at all thanks to pain meds.

Best wishes and good luck.

 

[Tom F.]

I agree with Wayne's comments about the surgery. As for what your surgeon told you I had TWO heart surgeons say the same thing, they would prefer tissue over mechanical.

 

[marie]

I can not add anything to what's already been said as I am trying to make that same decision and my surgeon recommended tissue as well but left the decision to me. I am 66 years old however.

I do want to say "Thanks" for serving our country and keep us posted.
Earline

 

[jiniani]

Warfarin is not a big issue

Warfarin is not a big issue

I'm 36/male. I had my AVR and root replaced at Stanford on 20th,July,2006. I opted to go with St.Judes mech valve. I don't see any issue with coumodin. I also do in home testing like some of the members here. I totally avoid greens, instead I'm taking vitamin supplimants. I'm taking 36gms of warfarin per week.
If you are careful, warfarin is not a big issue. I opted for mechanical, because I don't want to go under the knife again for this issue.

 

[Marguerite53]

That's quite a twist of fate to serve your country so bravely and then return home to face a scary surgery! I think we can all reassure you that when you have both events to look back on, the surgery will have been a picnic. Thank you so very much for your service to us.

Please ask for some anti-anxiety meds if your anxiety continues to escalate. Start with a very low dose....it might just ease that bit of tension you are feeling and help you feel more normal. You are normal, by the way. This is a daunting prospect, having someone cut you open and touch your heart. Since you feel good about the surgeon, that is a wonderful thing. Trust is very important.

Your valve choice is very personal. So many of us have had wonderful results with many different kinds of valves!! It is something that you have to decide with your surgeon. Keep reading and digesting information for awhile. Give yourself a personal deadline (say, Dec. 23rd so you don't have to think about it over the actual Christmas Day if you celebrate) for your choice. And then don't look back. You are choosing life. So many of us have said that to pre-surgery people. But it is true. You will be alive and well regardless of which valve you choose. Who knows what is around the corner in life anymore? You've survived combat for heaven's sake!! Your body will accept your choice, and so will your family. You will be there for them!!!! It's all good.....really!!!

Best wishes. Please don't hesitate to keep the conversation going to whatever length you need it. That's why we're here!!

Marguerite

 

[Guest]

Thank you for your service.

Thank you for your service.

I chose mechanical because I did not want to have a second OHS, though I know it can happen, I chose ON X because of the less turbulence for blood cells and hopefully lower INRs after the clinical trials are completed, I don't think anti-coagulation will cease entirely with this valve. I can hear the valve sometimes. I'm looking forward to messing with my coworkers when I go back to work, I laugh thinking of them wondering where the ticking is coming from. I'm sure it will freak some of them out.

When my cardio was discharging me from the hospital he said he was glad that I chose mechanical rather than face another OHS in 10 yrs or so, it's more risky the second time around.

My husband is career military, he is now in what is called 'sanctuary', 2 years to retirement. He cannot be discharged unless he really messes up which will not happen. He has a steller record, current rank LTC, DA selected for COL but the slots are few. He will gather all of his medical records for review also because any existing medical conditions will add disability payment to his retirement. Make sure you keep accurate records for your retirement and disability is added to retirement in percentages, every little bit will help you. I'm wondering if you will get a medical profile due to your valve replacement?

Whatever you decide, you will be fine. The anxiety leading up to surgery is the most difficult part, the calm will come to you. Good Luck.

 

[Karlynn]

I'm 36/male. I had my AVR and root replaced at Stanford on 20th,July,2006. I opted to go with St.Judes mech valve. I don't see any issue with coumodin. I also do in home testing like some of the members here. I totally avoid greens, instead I'm taking vitamin supplimants. I'm taking 36gms of warfarin per week.
If you are careful, warfarin is not a big issue. I opted for mechanical, because I don't want to go under the knife again for this issue.

There's no need to avoid greens because you take Coumadin. Avoid greens if you hate greens, but not because you take Coumadin. If you're going to have a large spinach salad every day for a week, you'd probably need to increase your dose. I just had a large Spring Greens salad with my dinner. I can't remember the last time I turned down a food because of being on Coumadin. (Now I wish sugar was expressly prohibited for people on Coumadin - that would make my weight battle a little easier!) What we eat has little effect on our INR. The only thing to be aware of is hidden K in many sports bars, nutritional drinks (Boost) and prepackaged diet food. Their popular protein source is soy. So if you're starting to incorporate a food product with soy protein in it, you'd probably have to run a test and adjust your dose upwards to accommodate the extra daily Vit. K. We have a member who lives in Japan and eats a lot of soy. His dose is just adjusted accordingly.

http://valvereplacement.com/forums/showthread.php?t=17116

Home testing is the best isn't it?!

 

[geebee]

Welcome Zack,

You have come to the right place for help so ask away.

Being anxious is very common and medication is available - talk to your doctor. As others have said, you might find you are less anxious once all your decisions are made.

Many people have different reasons for valve choice. The only thing I would say is make your choice based on facts and not the horror stories out there about coumadin. Both valve choices are good ones in that the object is to keep you alive. It really depends on whether the thought of a repeat surgery is less scary than what you view a life on coumadin to be. I will say I have had no problems with coumadin (27 years now) but some have. In addition, some folks (myself included) have had multiple surgeries with a mechanical but that was not because of the valve failing but rather because I develop a lot of scar tissue - very rare but it does happen.

Read the stories, talk to your surgeon and family and I am sure you will come to a decision that will make you comfortable. Everything else will fall into place.

 

[ALCapshaw2]

Welcome Zack,

You wouldn't be human if you weren't a bit afraid of having your chest cut open and heart stopped while someone cuts on it! So YES, ask your Doc about prescribing an anti-anxiety medication to help calm your nerves.

OTOH, you need to know that First Time Surgeries in patients under age 60 are 98% SUCCESSFUL with a 1% risk of mortality and 1% risk of stroke. Choosing a surgeon with LOTS of experience replacing valves is the KEY to Success.

At least 4 of our members were "First Time On-X Valve Recipients" for their surgeons. ALL are doing just fine. Most likely, ON-X would be happy to send a representative to be IN the O.R. to advise / consult with the surgeon on implanting their valve (they have a recommend method of 'tacking' 4 points around the valve to stabilize it before sewing around the cuff). Contact Catheran Burnett at [email protected] or 888-339-8000 ext. 265 for any questions you may have about On-X or surgeons who use their valves. You may also want to check out their websites at www.onxvalves.com and www.heartvalvechoice.com

To learn more about living with / on Coumadin, see AL Lodwick's website www.warfarinfo.com He is a Registered Pharmacist and Certified AntiCoagulation Care Provider in Pueblo, CO. and is a well known consultant and author on AntiCoagulation issues.

'AL Capshaw'

 

[Bina]

Zack, welcome aboard!
When I first started researching OHS I was freaking out because of the 98% survival rate....I don't gamble.....period. What I learned was that some surgeons can have a near perfect 100% success rate, others may have 95%, so I just went with my cardio's recommendations for a major teaching hospital and interviewed the chief of surgery. We "clicked".
I had only 2 weeks notice before the OHS, so I asked for some Ativan (.5mg) it's like valium, in case I started to freak.....just my luck, they called me in 2 days early so I never needed the ATivan.
Post op I had 2 days of IV morphine, 1 day of oxycodone (crap), 1 night of morphine tablet (crap), by day 4 those pills were making me worse, so I switched to regular Tylenol for a couple more days, that was it.
Men in your age group do well and recover fast with this surgery.
Tissue valves are great, but don't let Coumadin deter you either. It is really a non issue for me. I chose mechanical because I have a real problem with anesthetics, so I am hoping for a lesser chance of a re-op.
My friend has 2 St.Judes and he just had a re-op after 17 yrs, because of some stitching coming loose.
We never know what the future holds for us, we just do the best that we can.

 

[briansmom]

Welcome to this site and thanks for all that you and your family have given this country. There is a wealth of information and experience here. I know that I would not have made it through my son's last surgery without these wonderful people and a nightly dose of xanax. Whatever valve you choose will be the right one for you. I think that you will find the surgery much easier than what you anticipate. As you can see from below, we went with the On-x for my son. I think his doc had only done 1 before. We are only 9 months post op, but so far so good. My son was an off-road motorcycle racer, but has had to give it up because of his heart issues; however he still drives/races an off-road car and the docs are comfortable keeping his INR on the lower end of the scale with the On-X.

 

[temp69]

On-X a great choice

On-X a great choice

I got one put in 1.5 yrs. ago and feel fantastic.
coumadin is no big deal at all
and with the on-x you don't have to worry too much because, as my surgeon told me, i probably won't need it after a few years anyway.

check out my surgeon, dr. laks at ucla -- one of the best in the country.

i feel better now than the year before surgery.
and you won't want to go back in for a second or third one.
but...some people do, and they seem okay with it.

contact me if you have any q's

t