Returning to exercise after valve surgery

[Chuck C]

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 sea of negatives. My father is 81 and my mother passes last week after a battle with Alzheimer's. Over the past year it just seems like it's been one thing after the other.

Sure thing Miguel. That is why we are here- to help each other and support each other.

Due to the highly genetic nature of Lp(a), I'd suggest having siblings and children tested for it as well, now that you know you have high levels. Once mine was discovered, I had all family members tested. My brother and my mother have very high levels as well. One of my daughters also has very high levels- the other daughter has completely normal levels.

If you have not had one done, you might consider having a coronary artery calcium scan done. (CAC scan) Despite having very high lp(a), my brother and I have only mild heart disease, with relatively normal levels of coronary plaque. At this point we have both outlived my grandfather, who we believe passed the lp(a) gene down to us. Also, my mother will turn 80 this year and has no indication of heart disease. She has dementia however, and there could be a link there.

One other thing, I would really try to live a lifestyle which controls insulin resistance and encourages insulin sensitivity. If you are even pre-diabetic, and most adults in the US are, especially after the age of 50, I would stay on top of that very closely. We are seeing more and more evidence that when significant insulin resistance and high lp(a) are combined it is especially harmful.

 

[pellicle]

Sure thing Miguel. That is why we are here- to help each other and support each other.

actually its just this sort of sharing that triggers my annoyance at a few members here who just continue to say slavishly "don't listen to some random person on the internet".

These people are fools and I have grown tired of saying "well why are you even here then" to them and have blocked these idiots.

It is true, you should not believe everything you read, but it should be examined and considered and then taken to your team.

 

[pellicle]

I see that a couple of people have clicked like on my above post, so I'll not amend it (in case they don't like what I have to say next), but instead add a PS here to it.

People who diss what other members say here are disingenuous. Its one thing to make a critique of it but it is altogether another to simply diss the poster and deny them any credit for education or experience as well as any knowledge they may have.

To make a blanket statement of "don't listen to some random person on the internet" (which logically includes the poster saying that 5hit) in an oblique adHominem attack, it is tantamount to admitting you don't have a clue and implies that other readers are unable to differentiate good advice from bad.

Some people, it seems, are unable to grasp the idea of medical opinions (and why they may diverge), or the importance of experience (other than their own).

If this place is not to ask questions and evaluate those answers then what is it for? To reinforce the mantra of "only listen to your Cardiologist"?

dissing:

belittle	disparage
vilipend	trash
deride	undervalue
knock	scorn
defame	ridicule

 

[user 16827]

@Chuck C

Do you only use EPA ? Not DHA ? just curious

Early data suggest a link between Lp(a) level and both ASCVD and valvular aortic stenosis (VAS), but the exact pathophysiologic mechanism is not entirely clear. One current theory includes a two-pronged contribution by the Lp(a) molecule. Apo(a) has homology with plasminogen and has been shown in vitro to inhibit fibrinolysis. Therefore, it could hypothetically promote thrombosis at vulnerable arterial plaques or turbulent flow within stenosis causing obstruction or promoting emboli formation in VAS. The LDL-like portion may promote intimal cholesterol deposition but the cholesterol content in even very high levels of Lp(a) are below traditional LDL cutoffs and likely contribute less. Newer evidence suggests that oxidized phospholipids co-localize with Lp(a) molecules and together may promote endothelial dysfunction, inflammation and calcification in vasculature.


This is a study extract , High Lp(a) are thought to be protective in wound healing and offer an evolutionary advantage , i think you are on the right track with insulin sensitivity and oxidisation , High LPa issues i believe are driven by Phenotypic expression (environmental factors) .

 

[d333gs]

Yup, good stuff Chuck. Considering the tricuspid link I will get the LPa test too

 

[Chuck C]

Do you only use EPA ? Not DHA ? just curious

Hi Leadville.

There was a study called he Reduce It Trial
link here:

https://www.acc.org/latest-in-cardi...apentaenoic-acid-levels-in-reduce-it-acc-2020
In the trial, a theraputic with 4g of EPA was used and found very significant reduction in CVE. They now have a prescription pill with 4g of EPA per dose. However, it’s very expensive.
Consistent with the dosage of the trial I take 4 g of EPA per day but I just use over the counter fish oil to achieve that. I buy a product from Carlson’s called EPA Gems which has 1,000 mg of EPA per capsule. It also has a little DHA and in any case I get plenty of DHA from eating wild caught sardines and salmon a few times per week.

EPA Gems is available on Amazon. It’s more expensive than other brands of fish oil but the company has a good reputation and I’m seeking to get the highest concentration of EPA available. With other brands it would amount to taking eight or 12 capsules per day to get the 4000 mg of EPA.

 

[user 16827]

Thanks chuck

 

[Daniel758]

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

Be careful posting that your surgeon told you the Inspiris Resilia should last 20 years, several posters will take offense to this...

they may tell you you misunderstood...

the surgeon doesn't know what they are talking about...

or you are simply lying.

And don't forget that these posters have antiquated charts and grafts, 40 year old educations in fields other than medicine and, of course, Dunning-Kruger delusions that they know more than they actually do to back them up.

Your surgeon just has years of actual medical and surgical experience, education and training as well as medical institutions that treat thousands upon thousands of patients just like us each year to back them up.

It's definitely a tough decision who's opinion to trust when your life is at stake.

 

[Brokenhip]

Be careful posting that your surgeon told you the Inspiris Resilia should last 20 years, several posters will take offense to this...

they may tell you you misunderstood...

the surgeon doesn't know what they are talking about...

or you are simply lying.

And don't forget that these posters have antiquated charts and grafts, 40 year old educations in fields other than medicine and, of course, Dunning-Kruger delusions that they know more than they actually do to back them up.

Your surgeon just has years of actual medical and surgical experience, education and training as well as medical institutions that treat thousands upon thousands of patients just like us each year to back them up.

It's definitely a tough decision who's opinion to trust when your life is at stake.

His surgeon may well be right & lets hope he is, but a look at the IR documentation from Edwards, the data currently only goes for 5 years.

 

[carolinemc]

His surgeon may well be right & lets hope he is, but a look at the IR documentation from Edwards, the data currently only goes for 5 years.

It is up to the patient, to go with the information he feels good and safe about. That is what matters most. Feeling safe with the medical surgeon's advice and the cardio.

 

[d333gs]

"several posters will take offense to this..." I hope not! I asked him if it would be good for 10 to 15 years , 20 was his response. I would be happy if it lasts till I am 80 and if I am still alive in 12 years a tarv would be fine. Fingers crossed! ...............Anyway , we already know cardiology opinions vary to extremes

 

[d333gs]

Back to biking update;
I am riding a vintage downhill GT LTS mountain bike.......It is a slow on flats and hills but great exercise and I love all the suspension:Now THAT Was a Bike: 1995 GT LTS - Pinkbike
My first outing on my regular 28k dirt road circuit I had a time of 1hr 53.......which I thought was ok , mistakenly thinking my pre op time was 1hr 48 ...... until I went over my old data and saw my last pre op was in fact 1hr 38. The next outing I hit 1hr 40......then 1hr 38 and then..... Last Saturday I did it in 1hr 27 with out issue........so I guess the valve is working. With improvements like this, I can't imagine what my times will be at 80.

 

[Chuck C]

until I went over my old data and saw my last pre op was in fact 1hr 38. The next outing I hit 1hr 40......then 1hr 38 and then..... Last Saturday I did it in 1hr 27 with out issue...

Well done! A new PR!

With improvements like this, I can't imagine what my times will be at 80.

That's the spirit!

You have a great positive attitude. This will serve you well all during your recovery.

 

[d333gs]

Thanks Chuck, this board has been invaluable!

 

[d333gs]

I will blow my horn one more time for all newcomers wondering what to expect post op:
My 28k bike time is now down to 1H25min and at this point it is the limitation of the bike , I have run out of gears. I also spent a couple of days cutting a tree up and splitting the wood...........no sweat.
I am amazed because I didn't really recognize anything pre op that I would call "symptoms".
But now I really recognize a significant improvement.
My AVR was three months ago Feb 5.

 

[Chuck C]

I am amazed because I didn't really recognize anything pre op that I would call "symptoms".
But now I really recognize a significant improvement.
My AVR was three months ago Feb 5.

Thanks for the update! That is great news! Keep up the great work on the bike and keep chopping up trees!

 

[pellicle]

My 28k bike time is now down to 1H25min and at this point it is the limitation of the bike

of course it is ... speed is just a matter of money, how fast can you afford to go?

;-)

I am amazed because I didn't really recognize anything pre op that I would call "symptoms".
But now I really recognize a significant improvement.

the body is an amazing coping mechanism, its a benefit but a hazzard when we think we feel fine (but have no objective measurements).

In 2009 I as regularly skiing my local cross country track (in Finland) and noticed that my technique was improving but my garmin said I wasn't in terms of times. My HR was about the same up hills. I suspected my valve was failing as I was improving.

I might not have noticed this if it was my first rodeo and thought I was asymptomatic.

2011, back in Australia again I thought I'd have a test ... turns out it was the valve and an undetected (and would soon have been fatal) aneurysm.

6 months later I was back jogging on the beach with my wife.

 

[d333gs]

of course it is ... speed is just a matter of money, how fast can you afford to go?

;-)


the body is an amazing coping mechanism, its a benefit but a hazzard when we think we feel fine (but have no objective measurements).

In 2009 I as regularly skiing my local cross country track (in Finland) and noticed that my technique was improving but my garmin said I wasn't in terms of times. My HR was about the same up hills. I suspected my valve was failing as I was improving.

View attachment 888538
I might not have noticed this if it was my first rodeo and thought I was asymptomatic.

2011, back in Australia again I thought I'd have a test ... turns out it was the valve and an undetected (and would soon have been fatal) aneurysm.

6 months later I was back jogging on the beach with my wife.

"turns out it was the valve and an undetected (and would soon have been fatal) aneurysm." Sun of a gun, we have to be vigil!

 

[pellicle]

Sun of a gun, we have to be vigil!

yep ... had I not come back to Australia because my wifes job contract (in Finland) ended and I wanted to keep an eye on my ageing father, I'd have likely died on a XC ski trip we were planning (Abisco to Kebnekaise and back) for the following March. It may have also caused significant difficulty for my wife if I'd dropped dead mid trip in that area. We'd scoped it a previous summer and were keen to get back to it.

In that time I was unaware of the relationship between BAV and Aneurysm.

We'd done similar distances in Finland previously

For clarity this was after my second OHS ... I was about 46 and reasonably fit (my wife fitter).

One of our previous explorations and gear tests
http://cjeastwd.blogspot.com/2010/02/bad-skiing.html
but yes, once you know there is no reason to not keep up the regime of getting medical imaging done. Anything less is ... well ... foolhardy.

 

[d333gs]

yep ... had I not come back to Australia because my wifes job contract (in Finland) ended and I wanted to keep an eye on my ageing father, I'd have likely died on a XC ski trip we were planning (Abisco to Kebnekaise and back) for the following March. It may have also caused significant difficulty for my wife if I'd dropped dead mid trip in that area. We'd scoped it a previous summer and were keen to get back to it.

In that time I was unaware of the relationship between BAV and Aneurysm.

We'd done similar distances in Finland previously

For clarity this was after my second OHS ... I was about 46 and reasonably fit (my wife fitter).

One of our previous explorations and gear tests
http://cjeastwd.blogspot.com/2010/02/bad-skiing.html
but yes, once you know there is no reason to not keep up the regime of getting medical imaging done. Anything less is ... well ... foolhardy.

Is that you in the photo?