Returning to exercise after valve surgery

[Redone]

I had similar intercostal pain. It is not surprising that the intercostals would experience some strain, given how the ribs are pried open after the sternal cut. For me, the intercostal pain was not severe enough to warrant pain medication, but it was annoying. If memory serves, I started feeling some of this pain about 6 weeks after surgery. It lasted about 2 weeks, but then another intercostal would start to bother me. I'd say by about 4 months out this was no longer an issue for me.

Exactly!! The surgeon told me separating the sternum and essentially disrupting the ribcage can cause this pain. It's muscle pain, but boy it feels worse. No, I didn't take medication either just dealt with it for a few weeks until I got stronger and now at 4 months no issues.

 

[d333gs]

Well, this week, week 9, I started my biking and did the 28k two times with one hitch; both times near the 14k mark, I got flat tires ; first day was the front tire, the second day the back . ...... the return home with flat tires was considerably more of a challenge than with inflated tires and added an hour to my usual time. Both days included carrying the bike upstairs , taking the wheel off and changing the tires. All in all, a pretty good workout and I felt great. In fact, I forgot all about the heart, and that felt great too. Today we have a wild wind here, so no biking but I will be riding tomorrow and hopefully free of problems.

 

[d333gs]

Finally got the full 28K done with out a flat. 3 minutes longer than my pre op time. Also saw the cardiologist who assisted my surgeon during my op; The surprise was I did not have a bicuspid but rather a really mangled tricuspid. The first cardio that I went to 10 years ago thought I had a torn valve. The next two cardios at the hospital said it was a bicuspid valve at which point my regular cardio agreed, not torn but rather a double flapper. In the end, it was a deformed tricuspid.

 

[pellicle]

Finally got the full 28K done with out a flat.

And the crowd cheers...

Glad your making progress (not meaning the bike, but the biking)

In the end, it was a deformed tricuspid.

Truth is always stranger than fiction

 

[elMIguel]

In the end, it was a deformed tricuspid.
That's what I had also. Very heavily calcified with no awareness of it for 56 years. Does anyone know what causes calcification of a tricuspid valve or is it just one of those things one is born with a predisposition for?

 

[elMIguel]

In the end, it was a deformed tricuspid.

That's what I had also. Very heavily calcified with no awareness of it for 56 years. Does anyone know what causes calcification of a tricuspid valve or is it just one of those things one is born with a predisposition for

 

[Chuck C]

That's what I had also. Very heavily calcified with no awareness of it for 56 years. Does anyone know what causes calcification of a tricuspid valve or is it just one of those things one is born with a predisposition for

Have you had your Lp(a) checked? Having high levels of Lp(a) is highly correlated with calcified aortic valve and aortic stenosis. I would definitely recommend getting it checked. It is a simple test that can be ordered along with your blood lipid panel. At your next doctor appointment, try to have your doc order the Quest Diagnostic Advanced Panel, called CardioIQ, which will include Lp(a). The test can also be ordered separately, in the event your insurance won't cover the advanced panel. But, the advanced panel includes lots of good lipid informaiton beyond a standard panel.

https://www.acc.org/latest-in-cardi...ssociation of elevated Lp,components of Lp(a).

 

[elMIguel]

I have not heard of the Lp(a). I've had the standard lipid panel but not this one. This is good timing because it just so happens that I have my one year follow up with my cardiologist tomorrow so I will asking her about this. Thanks for the information Chuck.

 

[pellicle]

I have not heard of the Lp(a). I've had the standard lipid panel but not this one. This is good timing because it just so happens that I have my one year follow up with my cardiologist tomorrow so I will asking her about this. Thanks for the information Chuck.

in Australia it costs extra to have that test done as its currently not covered by our health system. You may also like to enquire about the cost it will add to your tests. I think it was about $100 here but they were evasive ... naturally YMMV.

 

[Chuck C]

I have not heard of the Lp(a). I've had the standard lipid panel but not this one. This is good timing because it just so happens that I have my one year follow up with my cardiologist tomorrow so I will asking her about this. Thanks for the information Chuck.

Good timing!
Your cardiologist would have good reason to order the test, so hopefully insurance will cover it.

If insurance won’t cover, the test can be ordered through Walk in Labs for $55, at either Quest or Labcorp

Lipoprotein (a) Blood Test | Walk-In Lab

Or for $135 one can order the advanced lipid panel at Quest called CardioIQ, which includes Lp(a), apoB and a great deal of lipid particle data

Cardio IQ Advanced Lipid Profile Blood Test | Walk-In Lab

 

[elMIguel]

Good timing!
Your cardiologist would have good reason to order the test, so hopefully insurance will cover it.

If insurance won’t cover, the test can be ordered through Walk in Labs for $55, at either Quest or Labcorp

Lipoprotein (a) Blood Test | Walk-In Lab

Thanks for the great info. Even if my insurance won’t cover it, I’d happily pay if it will give me some actionable information.

 

[d333gs]

Of interest, general info on calcification;
https://www.heart-valve-surgery.com... on,blood stream which promotes calcification.

 

[d333gs]

I got a calcification-resistant Edwards Inspiris , size 23mm . My surgeon said it should last 20 years or until I am 98, then he will install a TVAR ...........
https://www.edwards.com/devices/heart-valves/inspiris-resilia

 

[elMIguel]

Have you had your Lp(a) checked? Having high levels of Lp(a) is highly correlated with calcified aortic valve and aortic stenosis. I would definitely recommend getting it checked. It is a simple test that can be ordered along with your blood lipid panel. At your next doctor appointment, try to have your doc order the Quest Diagnostic Advanced Panel, called CardioIQ, which will include Lp(a). The test can also be ordered separately, in the event your insurance won't cover the advanced panel. But, the advanced panel includes lots of good lipid informaiton beyond a standard panel.

https://www.acc.org/latest-in-cardi...ssociation of elevated Lp,components of Lp(a).

Update: The results of my Lp(a) test came in a day after my consult with my cardiologist. VERY discouraging. I'm at 124 with a reference range of 29 mg/dL. Following my cardio appt. I was placed on atorvastatin and lisinopril for cholesterol and blood pressure. This was before my LP(a) results came in.

 

[d333gs]

"First of all, it’s important to know that Lp(a) levels are inherited – they’re unrelated to diet, exercise, obesity, and lifestyle."
https://thefhfoundation.org/high-li...ll, it's important,of heart attack and stroke.

 

[d333gs]

Of interest;
https://www.health.harvard.edu/hear...owers-lipoproteina-a-suspect-in-heart-attacks

 

[Chuck C]

Update: The results of my Lp(a) test came in a day after my consult with my cardiologist. VERY discouraging. I'm at 124 with a reference range of 29 mg/dL. Following my cardio appt. I was placed on atorvastatin and lisinopril for cholesterol and blood pressure. This was before my LP(a) results came in.

Thank you for sharing your results for the benefit of others.

This was my concern when you indicated that you were tricuspid but had aortic stenosis. That is a very high level of lp(a) and high lp(a) is strongly correlated with aortic stenosis. Most here who have AS are bicuspid, but when a tricuspid person shows AS, lp(a) should be a prime suspect.

For what it's worth, my Lp(a) is also very high, about the same as yours. Lp(a) is genetic and diet and exercise have virtually no effect on it. Also, statins, used to lower LDL cholesterol, actually raise Lp(a), something which few cardiologists are aware of.

I have two cardiologists. One I see for follow up on my valve and one that I see once a year for my lp(a). My Lp(a) cardiologist is the top Lp(a) researcher in the country.

A little background on me. My grandfather, mom's side, died at 52 of heart disease. His father died at 54 of heart disease and his cousin died of heart disease at 44. Hign Lp(a) is inherited and my brother has been tested and has the same high level as I do. We had our mom and dad tested and my mom also has sky high levels. Lp(a) is now the prime suspect in the men on my mom's side of the family dying at very young ages from heart disease.

My cardiologist wants to lower my LDL and also my Lp(a). Statins alone raise my lp(a) as they do for most people. So, I am currently on a PCSK9-I called Repatha. This has lowered my LDL, but also has reduced my lp(a) significanlty. I'm also on high EPA fish oil, which there is some evidence lowers Lp(a) a little for many people. The fist oil lowered my Lp(a) about 5%, but I got a real good result when I went on Repatha. That lowered it another 42%. It is now 47% lower than my original baseline. It is still too high. My labs measure in nmol/L and the reference range is <75nmol/L. I'm usually at about 130nmol/L. That is still high, but much better than my baseline of 243nmol/L.

Also, there is good news for us on the horizon. There are two lp(a) lowering drugs in phase III trial stage and both are expected to be approved. One of them is expected to be approved in 2025 which lowers lp(a) 80%, which would put both you and I in the safe range. So, keep living as heart healthy as you can, get your exercise and eat a healthy diet and hang in there until 2025.

 

[Chuck C]

Update: The results of my Lp(a) test came in a day after my consult with my cardiologist. VERY discouraging. I'm at 124 with a reference range of 29 mg/dL. Following my cardio appt. I was placed on atorvastatin and lisinopril for cholesterol and blood pressure. This was before my LP(a) results came in.

Hi again Miguel.

Here is a link with information about the antisense theraputic which is in Phase III and expected to be approved about 2025.

https://consultqd.clevelandclinic.o...s-a-long-sought-treatment-finally-on-the-way/

 

[Chuck C]

Of interest;
https://www.health.harvard.edu/hear...owers-lipoproteina-a-suspect-in-heart-attacks

This is the antisense trial. My cardiologist is the lead researcher on this team running the trial. These are the phase II results. The phase III is well underway. If all goes well, approval is expected in 2025 approximately.

https://pubmed.ncbi.nlm.nih.gov/31893580/

 

[elMIguel]

This is the antisense trial. My cardiologist is the lead researcher on this team running the trial. These are the phase II results. The phase III is well underway. If all goes well, approval is expected in 2025 approximately.

https://pubmed.ncbi.nlm.nih.gov/31893580/

Chuck, thank you so much for taking the time to share this information regarding LPA levels, causes, and potential treatments. I'm working hard to try to stay positive. I will be speaking with my doctor soon to map out a plan forward and the information you posted is a great help to me. I don't have a family history of early deaths (other than a grandfather who died in his 40's of lung cancer) so I hope this is a positive in a sea of negatives. My father is 81 and my mother passed last week after a battle with Alzheimer's. Over the past year it just seems like it's been one thing after the other.