Point of No Return........

[Jkm7]

When my cardio told me I needed a second OHS (four years after my first) and we discussed whether I'd go back to Mass General and my same (wonderful) surgeon, there must have been some expression on my face that troubled him that I might be considering refusing.

He ended our discussion by saying there is 'point of no return' when it is too late.

What would that be? What point?

Is it because the heart could be so overworked or weakened, it couldn't survive the surgery? How close to death would the patient be at that point when it was too late to opt for the surgery?

Thanks if you can answer. It's been something I've wondered about but have never asked my cardio.

 

[dick0236]

It's been something I've wondered about but have never asked my cardio.

That's a HEAVY QUESTION. My thought is that many heart issues, if left unattended, will reach a point where little, or nothing, can be done.

Prior to my surgery, the cardios were telling me that my heart was straining to do its job and was beginning to "enlarge".......and that I had a "one in four chance of sudden death" and "would not live 10 years without corrective surgery". I think they were telling me that I was rapidly approaching my point of no return.....and "sticking my head in the sand"....and, for a short while, I tried to.... was not a solution. Obviously they were right.

 

[Nancy]

Let me tell you what my husband's experience was. He had three valve surgeries, one aortic mechanical, one mitral mechanical and a repair on the cuff around the mitral. Along the way, he also developed several co-morbidities including some lung fibrosis, pulmonary hypertension, cardiomyopathy, atrial enlargement, kidney failure, and intermittent liver problems. And he also had to have 2 lung surgeries. He had rampant CHF. His tricuspid valve was failing and his root was enlarging. He probably needed a fourth surgery, but none of the surgeons would operate. His condition became too fragile and he was told that he wouldn't make it off the table by every one of his doctors. Still, he continued to press for this surgery. Finally, his very excellent cardiologist closed the door and had a very frank discussion with him. He said that he had spent hours and hours pouring over Joe's labs and test results, and had followed his case very closely and that he really liked Joe. He said that he had to have this frank discussion to tell him that there was nothing more that could be done surgically for his condition, probably ever, and that his symptoms could be handled as best they could medically and palliatively.

So, I would say that for Joe, this was the point of no return.

We never know along the way what else might crop up and compromise our health even further. Sounds like that is what your doctor was trying to say.

I am not saying that your health is as bad as Joe's, but another heart or other issue cropping up unexpectadly, could change the ratio that they use to recommend surgery or not, or to wait until things got very dicey, because then it would be done to save your life on an emergency basis.

If you are told you need surgery, then it is probably the prudent thing to do.

Joe died at age 75, basically from multiple organ failure.

 

[njean]

Now that's a thought I don't like entertaining at all Jim.

A year after my 3rd OHS in 2006, I was sent to Houston again by my cardio here because tests revealed that my 34-year old mechanical mitral valve had begun to show extreme signs of stress & I needed to have that valve replaced too. You can only imagine what my feelings could have been at that moment when I wasn't even fully recovered from the surgery I'd just had a year before!

And, to top it all off, when they repeated the tests in Houston, they revealed the same thing plus pulmonary hypertension! And then, the cardio there proceeded to tell me that my surgery would be such a huge challenge for any surgeon because there is massive amount of scar tissue in and around the valve that they would have to cut through in an ATTEMPT to get to the damaged valve to replace it!

And if that wasn't enough, I point blank asked him, the cardio, "if I was his mother or his wife, would he recommend the surgery" and his answer to me was 'NO'! But yet, he continued to tell me that if I waited too long before making up my mind, I would be reaching that point of no return you are talking about! He said that eventually my heart would give out --- or I'd be facing a heart/lung transplant which would probably be more than I could resist anyway! So with all this said, I whimped out!!!! I told them I wanted to go home & take my chances.

The only ray of sunshine came when the surgeon (Dr. Cooley), who had performed the first 2 OHS in 1975, said that they were going to try changing & upping some of my medications to see how I did & that he was somewhat relieved that I had chosen NOT to have the surgery.

And now, 2 years later, I'm still here & feeling okay for the most part. I went for a checkup in Houston just last year, & although my Echo was still NOT the greatest, some of the gradients had come down some as had the PH so the medications are holding.

I'm NOT gonna be volunteering anytime soon to have that 4th OHS & what could very well be my demise but I know too that if I start going into CHF & the medications don't appear to control it anymore, I WILL have to make that choice.

For now, I just pray for more time!

 

[Jkm7]

Thank you for the frank and informative messages. I greatly appreciate your sharing and explaining.

Just to clarify..........
I had the second OHS going on two years ago but this question has lingered in my head since.

 

[Bina]

It's a very good question which I was on the road to testing for myself.
In 2004 my cardio was urging me to have surgery, and I was freaking out too much to even discuss it. By 2005 my symptoms were bad and my cardio really didn't know what to do with me anymore. During a visit with my GP we had a very casual discussion about AS and AVR without the pressure of my cardiologist being around. My GP pulled out a reference book and started to read a paragraph from it which ended in "death can occur after approx. 2 years". He then said, "Ooops, you need to go home and think about this some more." We actually giggled a bit and I finally felt that the pressure was off of me and I went to see the surgeon. I just needed it to be my decision.

 

[Lynlw]

I think it can also mean, if you wait too long your heart will have perm damage even after you have the surgery

 

[Ross]

And like with so many other things, it's individual for all of us. It could become the point of no return at different stages for any of us.

I'm walking around today with a heart nearly twice the normal size and yes, I'm at risk for sudden death whenever the sickle man shows up, but that is only one of many things that can end the ball game for me. I know what you mean about weighing on your mind. It does mine daily.

 

[Nancy]

"Just to clarify..........
I had the second OHS going on two years ago but this question has lingered in my head since."

That's good, Now you can put this on the back burner. I guess I gave the long answer just in case there was anyone reading it who was considering not having surgery.

 

[Jkm7]

Nancy,
As always, your answer was so informative and helpful for all of us to read.
You are so generous about providing all the wisdom, experience and help you give us.

I am very appreciative for that.

 

[Lionheart]

Hi J---

I think its been mostly covered by the others and somewhere I have a link about what happens if we postpone surgery, but can't find it. From what I understand, if a person like us does not have valve replacement surgery, AND our valves continue to deteriorate then our hearts start working so hard that we eventually develop Congestive Heart Failure (CHF). For more on CHF see this site:
http://www.medicinenet.com/congestive_heart_failure/article.htm#1whatis
It describes causes, including heart valve disorders, and the long-term outlook for patients with CHF.

I think that at some point as CHF progresses (point of no return?) then even surgery will not reverse the symptoms and progression of CHF.

The positive side is that for many, valve repair or replacement stops and may reverse CHF. For those in CHF with no surgery options, there are many new treatments and drugs to help slow or reverse the negative trend. We have many great people here who are excellent examples of each.

John

 

[drivetopless]

awww , Ross. We always knew you had a big heart.
JKM-GOod questions. I intend to ask my cardiologist exactly those questions when I see him on Monday for my 6 mo check up.