OK! These medical people are driving me crazy!!

[Marguerite53]

Time to vent!! Tomorrow I go in for a breast biopsy (not too worried, about the results....early, early, early if at all). They'll do a wire localization then the biopsy. The anasthesiologist calls the night before, standard procedure. He "notices" that I have severe stenosis. Yes. Then asks if I might know the measure of the valve (almost like, am I sure it's severe ) so I say .5. He says no way, that's critical. Why haven't you had your surgery yet? Uh, it's the dance we do with the cardiologist. She says I'm not ready. Well, he procedes to tell me that he has worked cardiac for years and I am definitely critical. Nice. Am I sure? Well, I have the echo report right in front of me! It says .5. Well, .5 is critical.

Okay. so we have that established now. Funny how when I asked the cardio she said I was at .7 . When I finally got the report faxed to me it clearly says .53. The.7 is in the box above and is the LVOT velocity -- quite a different thing, yes?

Anyway, it didn't matter, since the visit with the surgeon last monday was obviously leaning toward surgery sooner than later. It's just that I keep running into well intended people with differing opinions and it is absolutely driving me crazy.

The anasthesiologist is not going to put me under for this procedure tomorrow. I'll have a local while she carves away. I'm fine with that (I hope!). It can't be any worse than the colonoscopy, sedation wise and that went fine. So why am I so rattled????? It's that damn term "critical". It's scary!! And I won't be at the right hospital if anything goes awry. Trying to calm down and I'm really just all rattled.

Well. I'm going to make my second opinion surgeon appointment for ASAP. Then I'm going to just make up some stronger symptoms and get my a** on someone's AVR schedule soon! This is driving me nuts!!

errrrrrgggghhhhhhhhh !!

Thanks. All better now.

Marguerite

 

[Jims]

Hi Marguerite,

Boy when it rains, it pours. Good luck on the biopsy.

I also had severe stenosis. My valve area was 0.9 sq cm. My cardio said that at 0.8 they consider it critical and recommend surgery very soon. One other parameter that is important is something called "pressure gradient". This is the amount of pressure that develops behind the valve, because it does not open sufficiently. This back pressure is what they usually worry about. Under some circumstances this back pressure can send the heart into bad rythm. If you really do have a 0.7 valve, then you should also have a high gradient.

Are you having symtoms like severe shortness of breath walking up a flight of stairs? Or chest pain. At 0.7 you should be seeing lots of problems. How long have you known about your 0.7?

If I were in your situation, I would get a second echo cardiogram from a different cardiologist. Valve area is a measurement prone to error. If the second one also says 0.7 sq cm. Then I would be concerned and ask for their recommendation. It would be good to follow it. Once the valve closes down to below 0.8 all kinds of bad things could happen. On the plus side if you do have a valve serious valve problem then after surgery you should feel a lot better.

Please let us know how things turn out tomorrow and with the valve.

Jim

 

[PapaHappyStar]

Marguerite,

I was at about the same valve area at surgery, the classification based on valve area depends somewhat on body size ( and consequently age and gender ) -- at 0.5 cm^2 though you should be due for surgery.

However the old (1998) ACC guidelines do not assert the necessity of the surgery even at 0.6cm^2 or less:

where class II means:

Class II
Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment.
Class IIa:
Weight of evidence/opinion is in favor of usefulness/efficacy.
Class IIb:
Usefulness/efficacy is less well established by evidence/opinion.

http://www.acc.org/clinical/guidelines/valvular/PValvulr.pdf

So your cardiologist needs to believe your symptoms are heart related if they are going by these guidelines. Also you need someone you trust believes what you say on your side at the hospital after surgery ...

Best,
Burair

 

[OldManEmu]

Marguerite I am concerned, I clearly remember my cardio saying that at 0.7CM and below the patient is at risk of sudden death. At 0.5CM I would be getting very concerned. It is always best if surgery can be delayed but at 0.5CM things have moved into the critical realm. I am glad you have seen the surgeon and things are moving in the right direction if you know what I mean.

 

[hensylee]

like you say, get it in gear........

 

[Phyllis]

Marguerite,
Get through this procedure this morning with all good results and then get hopping on the surgeons! Wishing you the best.

 

[Marguerite53]

Thank you so much for your responses.

One other parameter that is important is something called "pressure gradient".
Are you having symtoms like severe shortness of breath walking up a flight of stairs? Or chest pain. At 0.7 you should be seeing lots of problems. How long have you known about your 0.7?
Jim

I looked on my echo and the peak gradient was 86 mmHg with the mean at 56. Those numbers were up by about 20 from 8 months ago. No aortic regurgitation. In her comments on the echo she says Concentric left ventricular hypertrophy is seen. Overall systolic function is preserved with ejection fraction estimated at 50-55%.

I am a little out of breath (definitely increasing, but not greatly) at the top of stairs, a little woozy, maybe. Cannot lift things anymore as I feel a pressure in my chest that is annoying (maximum is a full, large laundry basket).

It's so weird, since I was at first exhalted by the news that I could slowly start looking toward a surgery date and began to relax. Now, I really do feel a stronger sense of urgency and I appreciate all your encouragement. I won't be dilly dallying!

I just wish I hadn't let this man upset me so. I wanted to be so calm today and I'm just not. Got really revved up -- not really like me to. Ah well. The sedatives should do the trick!!

I'll be back later (they said I'd be going home around 6pm, Pacific) to report .....if I'm not too loopy!!

Thanks again. Marguerite

 

[Karlynn]

Praying for good results for you on your biopsy.

 

[PapaHappyStar]

I looked on my echo and the peak gradient was 86 mmHg with the mean at 56. Those numbers were up by about 20 from 8 months ago. No aortic regurgitation. In her comments on the echo she says Concentric left ventricular hypertrophy is seen. Overall systolic function is preserved with ejection fraction estimated at 50-55%.

I am a little out of breath (definitely increasing, but not greatly) at the top of stairs, a little woozy, maybe. Cannot lift things anymore as I feel a pressure in my chest that is annoying (maximum is a full, large laundry basket).

Chest pain and dizziness are clearly symptoms of ( physiological stress due to ) the AS, if your cardiologist has not either asked you about this or is not listening and had further not informed ( or misinformed ) you about the number from your echo, you need a different cardiologist for your hospital care and after the surgery.

I am glad you are actively pursuing this -- I think you are doing the right things.

Regards,
Burair

 

[Nan]

Marguerite,

Looking forward to your post tonight! You are in my thoughts this morning.

To echo everyone else, glad you are pursuing another opinion. It seems fairly clear that it is time to have that valve taken care of...between the gradients, the size and your SYMPTOMS! It is definitely time. Your cardio should be asking you about symptoms....that is one of the keys here. But even without, the size and gradient are a concern.

Hope all is well,

Take care,

 

[JCDavis81]

Marguerite,

Good luck with the biopsy today (or at least I hope it went well since you'll probably be reading this message after you get home!)

It seems like .7 is something to worry about so maybe you should contact your cardio/surgeon again -- but don't let it freak you out too much. If the surgeno says you can wait, just make sure to ask her why. There probably is a good reason, right?

Bottom line, these docs are now watching you closely and I doubt they would let anything catastrophic happen to you.

Best,
Joe

 

[Georgia]

Marguerite, good luck. I had a lumpectomy with a local and thought it was the only way to go. I wish I'd had a cd player or something, however, because I didn't like what I was hearing - suggest you take one with you. But I sure felt better afterwards than the gals who'd had a general anesthetic; no pain, was able to get a couple painkillers in me before the novocaine wore off, etc.

Best of luck with your biopsy.

btw - I had mine in '90. Then had to go back for lymph nodes; and the anesthesiologist required a new echo (I'd been diagnosed with mvp in '79); and then, altho there wasn't any problem particularly (at least as far as I know) he wanted the surgery done with a local - just because of the mvp and I'd never had a general before!!! The surgeon said no, and I had a general.

Anyway, I think anesthesiologists are very conservative about using generals. So altho his concern is certainly valid, and I agree with everyone that you need to assert yourself before you have permanent heart damage, I think you might take his words with a grain of salt.

Again, best of luck, hope all goes well and you have an excellent outcome.

 

[tobagotwo]

Some of us have been pushy about this all along. I'm glad you're finally on the move with this. In the phrase "sooner or later," .5cm² is definitely later.

It seems like there are some doctors who will wait until there's a symptom they can hang their hat on, no matter what common sense seems to dictate. That approach always works best when the patient doesn't expire before the symptoms show up. Shortness of breath is absolutely a symptom, as are wooziness and chest pressure. These should be pushed strongly with your cardiologist as things which are rapidly escalating for you. Light a torch under the cardio's behind.

86mmHg peak, and 56 mean are in the top of the severe range, and higher than mine were before they opened me up.

As far as the wire implantation, my wife underwent that without being offered any sedation. In fact, in many cases sonography can be used to locate the spot more accurately and cheaply than through mammography, and with no radiation.

I hope that part goes quickly and smoothly for you. As you know, the vast majority are benign. Go with the crowd, this time...

Best wishes,

 

[Mary]

Some of us have been pushy about this all along. I'm glad you're finally on the move with this. In the phrase "sooner or later," .5cm² is definitely later.
86mmHg peak, and 56 mean are in the top of the severe range, and higher than mine were before they opened me up.
Best wishes,

Marguerite,

Your numbers are higher than mine were at surgery. When you have that small of valve area with correspondingly high pressure gradients, it is time to have the surgery. You should not be feeling woozy; that is a symptom!

Get through the biopsy and then schedule the surgery for as soon as possible.
Mary

 

[geebee]

I had a biopsy with a local but I did have some valium to calm me down. It wasn't too big a deal except the anesthetic needle was a little uncomfortable. I wish you luck and will be praying that all is well.

Now, on to the valve. I agree with the others. Get through the biopsy and then go hound the heart folks.

 

[George]

I'll be thinking of you. I trust the biopsy will yield good results. It sounds like you are at the point where waiting on the valve surgery will just cause you more mental anguish...not a good thing. I remember how that was. Once the decision is made, & a date is set, you will feel a big sense of relief....and anticipation!

Talk to you soon,
George

 

[Marguerite53]

Hello all. Growths were benign. NO WORRIES! Excellent news.

The two procedures were nothing. The localization table was abit uncomfortable, but they treat you like a queen with warm blankets and soft, kind words. My surgical site is still under gauze til tomorrow, but is barely sore at all. As predicted I was way more worried about the sedation than the procedure.

They were saying they were only going to give me mild sedation. I don't remember anything beyond the anasthesiologist saying he was putting a small bit of it into my drip and then my memory goes blank. I must've been conversant, though.....after the surgery the surgeon claims to have asked me if anyone was waiting for me..... well, I said no!! Yet, my husband and daughter had been waiting for 2 hours and were starting to get concerned! They finally asked about me and I guess the surgeon had to be called back in to talk to them!!Apparently I had some trouble in recovery. uncontrollable shakes. They gave me some Demerol and that made me nauseous. Finally, they gave me a half dose of phenergran and I got to go home. I'm going to ask for the particulars about that when I have my post-op next week, so I can have the information to give the next anasthesiologist.

This anasthesiologist was still curious, and I brought my echo report for him to look at. He went over a few things with me that he noticed about it. He really shook his head at the numbers, as we all are. I asked him about his experience with valvereplacements and frankly, he didn't seem to know as much as I thought he should to be making such emphatic remarks to me. But he seemed very young and I definitely appreciated his honesty. Anyway, I'm still considering it a red flag warning for myself and am glad he got me rolling. I've upped my cardio visit to feb 3rd and I've made an appointment with my second opinion surgeon for feb 10th.

And many thanks to all of you who have pushed me along also. So many of us find a new strength from this group. I am so lucky to have you all.

I"m off, splitting headache, time for another nap!!

Marguerite

 

[Cris N]

Well that's a relief. One more hurdle conquered! Hope your next appts go well for you and you get the information you seek.

Cris

 

[Georgia]

Hallelujah! So glad to hear the biopsy was negative. Talk about a weight off you!

 

[aussigal]

Gentle hugs...dont want to hurt your boo-boo....

Well that is a relief off all our minds here ...


you sure do have a big fan-club Marguerite... ...

Now we can concentrate on sending out prayers for your carers to get their numbers straight !...

Early Februaury , you reckon...thats not too far away at all.