OHS in near future

[jtf2]

Hi All.Certainly going down the rabbit hole so to speak,in regards particularly valve replacement.
I came to be here as a link from reddit

Was diagnosed a while back with Aortic stenosis,and bicuspid aortic valve.
Had an angiogram yesterday,and met with a surgeon at that time.Waiting on a ct scan on heart to determine some other issue,about a graft??
After ct scan it could be 4-8 weeks before surgery

Now just been studying the options,benefits and risks etc of mechanical vs skin valve.
I am 60 years old male,relatively fit,no obesity diabetes etc.
I have been living with addison`s disease for about 30 years,and that means corticosterdoids every day.
Surgeon did say that could cause an issue with healing the bones as many years of those pills can weaken them.

I am curious as to those who did the mech valve and are on warfarin,who is using a coagucheck meter to check their levels.
I have no interest in going to clinic repeatedly for blood tests to check the inr levels.

Anyway that's some info i am happy to share and looking forward to spending some time hear reading and learning,
Thanks

 

[pellicle]

Hi and welcome

lots of good threads here, naturally feel free to ask any questions.

I am curious as to those who did the mech valve and are on warfarin,who is using a coagucheck meter to check their levels.
I have no interest in going to clinic repeatedly for blood tests to check the inr levels.

reddit ... uhgg

Given your age and parameters so far you pretty much can't make a bad choice in valve

 

[pellicle]

... oops, forgot to link these, I believe this is a good order to read them in

https://cjeastwd.blogspot.com/2014/09/managing-my-inr.html
https://cjeastwd.blogspot.com/2017/01/2016-inr-data.html
https://cjeastwd.blogspot.com/2017/12/perioperative-management-of-inr.html
and just plain everything in most recent post first:

https://cjeastwd.blogspot.com/search/label/INR

 

[jtf2]

... oops, forgot to link these, I believe this is a good order to read them in

https://cjeastwd.blogspot.com/2014/09/managing-my-inr.html
https://cjeastwd.blogspot.com/2017/01/2016-inr-data.html
https://cjeastwd.blogspot.com/2017/12/perioperative-management-of-inr.html
and just plain everything in most recent post first:

https://cjeastwd.blogspot.com/search/label/INR

Thanks for welcome and those links,really appreciate that!!

 

[dick0236]

There are a lot of folks on this forum that self-test successfully with the Coaguchec meter. I did until my monitoring company left the business and I decided to go back to my family doc for INRs. In my case, my doc is nearby and convenient. The issues we have in the USA involving insurance coverage for self-testing are unique to the US and should not be an issue in Canada. Home testing is easy, accurate and will help you to stay involved with your INR management. I have an old, old mechanical valve and have lived well into old age (87+) and on warfarin for 56 of those years.

 

[jtf2]

thanks as well for your feedback.A LOT OF INFO TO DIGEST
But i see already the surgeon did not touch on some issues i have seen here

 

[pellicle]

Hi

A LOT OF INFO TO DIGEST

it is, and I'm glad that I grew up with it all (first OHS at about 10yo) ... as Dick frequently says: "you eat an elephant one bite at a time"

I think the more you think about that the more its right from every angle. Ultimately all advice has to take into account your perspective. Different responders are of different capacity to think outside of their own choices. None of us know your situation as well as you do, and so there's that too

But i see already the surgeon did not touch on some issues i have seen here

its seldom that a surgeon takes into account issues on the patient side and issues which are not in their realm (meaning post surgical management). You can ask a mechanic all you like about driving and they may not even be good drivers; because that's not their role. Next there are very few good cardio vascular surgeons who have hours of a day in which to reflect on how a patient feels and what's the best way to communicate with them (perhaps even less patients who could have such a conversation.

So if I may open a per perspective I'd say this;

• there is no definitive cure for valvular heart disease, we exchange (what until the 1960's was) a terminal illness with "prosthetic valve disease". There are two fundamental types: one is managed by lifelong administration of anticoagulants, the other is managed by probable redo surgery (the younger you are the more probable).
• management of the anticoagulation therapy (ACT) shouldn't be difficult. Equally people shouldn't be stupid, shouldn't break laws and should respect their body. Looking around we see the basic reasons why ACT is not as successful as it could be. The statistics on drug compliance are terrible (with ACT perhaps the worst).
• reoperation isn't bad per say (god knows I've had my 2 subsequent reoperations) but much of this depends on the age you are on reoperation (as well as other factors). I had my 3rd OHS at 48, and my second at 28. I'd say my recovery in my late 40's was much harder than in my late 20's. I'd genuinely dread an OHS at 76
• many people assiduously avoid ACT and choose a tissue prosthetic, but statistically they'll frequently end up on ACT for (a variety of) other reasons but may also be because their valve in the later 5 years of its life starts throwing clots just like a mechanical does. To me that would always seem like a very bitter pill

As I see it, at your age the choice of a bioprosthetic valve with a good track history could well get you 20 years. What happens after that is what I call "a craps shoot".

Also this newspaper article is a good introduction to the reasons why surgeons may not be good communicators
https://www.dailymail.co.uk/news/ar...-psychopath-says-leading-cardiac-surgeon.html

Ruthlessness, emotional detachment and fearlessness are traits more usually associated with psychopaths.​

But the best doctors also need the same ‘attributes’, a leading cardiac surgeon has revealed. Professor Stephen Westaby, 71, said it helped him undertake a pioneering operation that saved a baby girl’s life.​

He developed an appetite for risk following a rugby accident as a medical student that left him with a fractured skull.​

This is a topic which has received a little bit more than casual research
https://hospitalhealthcare.com/latest-issue-2018/stress-immunity-in-surgeons-2/

James Pegrum MBBS BSc (Orthopaedics) MSc (Sports Medicine) Diploma Mtn Med FRCS (Trauma & Orthopaedics)09 October 2018​

​

Surgeons are subjected to a high level of psychiatric morbidity with various factors presented in the literature; long working hours,2,3 working night shifts, divorce,4 medical lawsuits5 or failing to meet continuing medical demands.6 It will therefore not be too surprising to find out that some of the traits associated with a psychopathic personality, such as preternatural calmness under pressure, and an apparent indifference to human suffering when making life or death decisions, are perhaps selected out in those who rise to the top of our profession. ​

​

a worthwhile read if you ask me.

HTH

 

[TGM]

Hello there. I’m the parent of a 20 year old with a mechanical valve. He’s had 4 OHS and uses the Coaguchek to monitor his INR. It is very convenient and he’s been on warfarin since aged 4. Sending you best wishes on your surgery and recovery