Routine Physical at 51, and I end up needing a new Aortic Valve

[Ras1151]

Hi, this is my first time posting.

When I went in for a physical at age 40, my doctor told me about my bicuspid aortic valve and sent me to get a echocardiogram. Everything was fine at that time, but the doctors said to have it checked every year.
I was only 40 and in good health, so I paid no attention to them (in one ear and out the other).
This last year I have been out of breath and I would feel my chest tighten up with the smallest amount of exercise. I just figured I was getting old.
It has been 11 years since my last visit to the doctor, so I went in for a routine physical at age 51. The doctor ordered an echocardiogram for me and a week later, I received a letter explaining that I had moderately severe, narrowing of my bicuspid aortic valve.
My doctor referred me to a cardiologist in Corvallis, Oregon. The first thing was a TEE, the TEE showed it to be not quite as bad as the first echo. He said that my Aortic had an area of 1.1 cm2. He did not want to do a stress test because of my symptoms, so the next day he did chest x-rays, and a Coronary angiography. I have good cholesterol levels and the results of the angiogram showed clear arteries. At the end of the tests he said it was time to discuss valve replacement. I had my consultation with the surgeon on December 7th, 2010, and we mainly talked about tissue vs mechanical valves. His recommendation was the
on-x mechanical. He then said that white water rafting and downhill skiing amoung other things was OUT.(due to coumadin) and I said bummer. I still plan to go skiing ( I have been skiing for about 40 years).
I have a scheduled pre-op appointment for Jan 5th,2011 and surgery appointment for Jan 6th,2011 at 5:30 AM. Surgery starts at 7:30.
The plan is to go with the ON-X mechanical.
I have vacation untill my surgery to try to get a few things done, get the house cleaned up, Christmas holidays etc.
My brother is taking our two Labador Retrievers for a few weeks( they jump on me and rough-house all the time.
Any other tips would be greatly appreciated.

Thank-you Ron S.

 

[normofthenorth]

I think we have a lot of downhill skiers here with mechanical valves and Coumadin, though I'm occasionally wrong. I just booked my flight to Vancouver so I can (I hope) ski a week in Whistler 2 months after my recent valve replacement, while I'm still in my 3-month round of Coumadin.

Please chime in and pile on if I'm wrong, folks.

 

[Superbob]

It's like a kick in the gut when you get the news, isn't it? Nevertheless, sounds like you've got everything lined up to "get'er done" and get on with your life. I've never skiied in my life so I'm not one to advise you on that, except to suggest, follow the doctor's advice on when your sternum has healed sufficiently. Welcome to the forum; looking forward to your further posts.

 

[Mileena46]

I don't know anything about skiing but I wanted to welcome you! I am on coumadin and while it might not be as bad as you've heard, I do believe it is something you have to work your life around. You bruise a lot easier, and you will bleed more if cut...I have never had a major issue of any bleeding. I also know that a head injury would be something to be much more concerned about on coumadin than normal.

There are people on here that will give you more accurate information, I am just telling you how I feel. I don't have a life change because of coumadin, but I didn't have an active life before coumadin. All I do different is remember to take a pill every night, and try not to be so clumsy that I walk around all bruised up. The winter is not so bad, but I do tend to have a lot of it in the summer when I am wearing less clothes to pad me.

I wish you a quick recovery from your surgery. I know how bad it can be to just wait. Good Luck to you,

Mileena

 

[bigsidster]

Welcome RAS1151.Yes getting this news at 51 would be a shocker.Hope all goes well for you on Jan 6-2011.We will be looking for you to post again with the results.

 

[Ras1151]

This Forum is very Cool place, all the knowledge everyone has.

A couple of questions. The only thing I know about my Aortic valve is it has narrowed to 1.1cm. When I first found this out I wanted to make sure the symtons were real and not my imagination. I tried to run to the mail box, but could not make it much past the end of the driveway (about 150 ft.) and was forced to stop. I was out of breath, and the chest was getting very tight. I have done this a couple of times and my Wife gets mad at me for doing that, I know it's real, so I have stopped home testing.
I noticed some people with aortic area of 1.1cm2 have no symtoms.

1. Why symtoms in some but not others with same valve area?

I work in maintanance (Instrument Technician) in a Titanium manufacturing plant. There are lots of ladders on furnaces that I have to climb on regular basis, crawling around on pipes and equipment etc...

2. What is the average recovery times to get back to work after different types of surgeries?

3. How long before climbing stairs? and How Long before I should get our Labs back?

Thanks

Ron

 

[bdryer]

Hey Ras 1151

We are very similar as I ski and work as an aircraft tech and drive a desk. I will be transplanted with a MHV and ascending aorta in later Jan/11.

I ski a lot and have so since the 1970's. From what I have read, you can ski after 2 months. Once your INR is balanced you are not going to bleed to death or throw a clot. After 2 mths though, cruise the greeny blues and protect your healing chest. As for me I will not ski this season regardless of La Nino. I also do a lot of water skiing but this season might also be out. I'll concentrate on the Tri sports.

As for you returning to work, think about this, you can't swim for 3 mths while the sternum heals. Climbing ladders will be similar to swimming, so I am using this as a reference for you. I can't imagine laying on pipes, ducting and structure prior to a 3 mth recovery! Light duties should be what you are relegated to after 2 mths off.

I have taken the time to interview and research athletes on warfarin. From my understanding I will be able to carry on, but with a little caution. Then again I'm 55 coming on 20. I'm treating this as a 3-12 mth set back in my life and then full steam ahead.

Your lucky to get it done so promptly. I was diagnosed with a .6cm opening of the AV on Oct 14, but because we have a public system in Canada, I am required to wait about 5 mths for surgery. It sucks as I am developing more symptoms and getting weaker. Now I have been placed on Beta blockers to stem the tide.

Carry on

 

[Mentu]

Ron, welcome to the VR community. Preparing for surgery sort of depends upon your circumstances. I live alone so I went through the house and moved the things I use most often to lower shelves so I would not need to stretch my arms above my head during that first three weeks after surgery. I did some cooking and put some of my favorite meals in the freezer and made sure the cupboard was stocked with things easy to fix. My brother gave me a recliner in case I needed it for sleeping. I actually never had a problem sleeping in my own bed but the recliner was very nice for naps or just resting after walks. It will take about three weeks for the chest incision to heal over so shipping off the dogs is a good idea. You will also find more experiences and suggestions about preparing the house in the "Reference Sources" page of the site and in the "Pre-surgery Forum".

I was 59 at the time of my AVR, Ron, so a few years older than you. My experience, however, was somewhat similar in that during the run up to surgery, my doctors found that I had excellent lung function and no arterial disease to complicate the valve replacement. My surgeon indicated that in such cases that the risk of surgery was actually less than 1.0%. Still it seemed prudent to me to update my will and to make a Medical Directive (Living Will).

As for your other questions, Ron, it sounds trite but everyone is at least a little different. I began experiencing symptoms when my valve area reached 1.25 cm2. I have since wondered if many people just don't recognize that they are experiencing symptons. I know that at first I wrote them off to being out of shape or not exercising enough. It didn't occur to me that they were symptoms of my deteriorating valve.

Your recovery is something you have a lot of control over, Ron. If you want to do it once and get the best results then you need to start thinking in terms of a graduated exercise program that will protect your healing heart, bones and muscles while getting you back into condition so you can carry on with your life. As for climbing stairs, you can probably do that the day you return home after surgery. You just may not be able to do it very fast. The chest incision should heal in about 3 weeks but your sternum will take about 2 months to heal. During that time, you are probably not going to want large creatures thumping you in the chest. Cardiac Rehab programs generally begin 6 weeks after surgery and run for 36 weeks. If you have read any of my other posts, you will know that I am an advocate of Rehab. It gets you back into an exercise routine that is going to help you get through early recovery and back to a normal life and leave you able to exercise vigorously without danger of reinjury. So Cardiac Rehab at 6 weeks but no upper body exercise until 12 weeks after surgery. As you will discover for yourself, your chest will make you very unhappy if you over do things or push things too soon.

I went back to work at 7 weeks and you probably can do so around that time. If you want to avoid reinjury and slowing down your recovery, you will need to avoid some strenuous activities at first. There again, If you are participating in Cardiac Rehab, it can serve as a guage for how much activity you can safely participate in. It seems to me, Ron, that it is better to take things in a steady, graduated fashion than to suffery reinjury and have to start all over again. With the gradual increase in upper body exercise after 12 weeks, you will be well on your way to establishing your new "normal" activity level.

Larry

 

[drivetopless]

Welcome!

I'm getting an On-X on Jan 13. I personally think it is an excellent choice. There is some hope (see online research) that the On-X valve will eventually require less anticoagulation therapy (lower dose coumadin) or alternative therapy such as Plavix+aspirin.

I think you should be able to get back to your normal routine eventually, provided you make sure your INRs are in control once on coumadin. RE/ skiing-- I think the possible head injury is more of an issue, so maybe wear a helmet.

Re/ work. I've been told 8-12 weeks. The difficult part will be you can't really use your arms for a while. Plan on taking it easy for first 6 months at least. Better to take extra time upfront to heal properly than to have a setback.

Good luck with your surgery! Keep us posted. See you on the other side.

 

[Lionheart]

Ron,
I would question your doctor's advice about the hazards of white-water rafting and skiing while on coumadin. I would think the worse thing is that you might flip the raft and lose your Rx. So maybe plan for that possibility and have several stashes of coumadin in different rafts. Skiing?- wear a helmet and maybe slow down and do less aggressive stuff, but why stop completely? Maybe take up cross country skiing. There was a news article a few years ago about a lady that climbed Mt Everest, I think, and she had a mechanical valve and took coumadin. Gee is that safer than rafting?

Tell your doctor that "You can do dangerous things safely, and you can do safe things dangerously" and tell him that you plan to do somewhat dangerous things (rafting, skiing, skydiving) carefully.
John

 

[ALCapshaw2]

For desk jobs, many surgeons release their patients after 6 to 8 weeks when the sternum will be 80% healed. It takes 12 weeks to reach 100% healed. It can take many months for you to recondition your body / muscles to reach your full 'surgical benefit'. Full recovery always seems to take longer than we like. Your body will tell you when it needs to rest. LISTEN to those messages! Slow and easy wins the day.

'AL Capshaw'

 

[Jkm7]

At your age, it is not unreasonable to consider a tissue valve. Before you make a final decision whether to go mechanical vs tissue valve, please discuss at length with your doctors about the advancement of percutaneous valve replacement. Large strides have been accomplished and it is expected more advancements are coming soon.

Should you get a tissue valve now and in 12 or 15 years might need another, there is a good possibility that might be accomplished without opening your chest again.

By discussing it with your surgeon and cardio etc, you will at least know you investigated all possibilities.

Best wishes.
Let us know how you are doing and what you decide on.
The decision is never easy and the only bad choice is to not make one.

 

[AgilityDog]

Ron, I too, had a pair of Labs when I had both my surgeries. One has since passed. Jet, the present Lab, is a handful. She tends to hysteria. Seriously. At 5 1/2, with lots of training classes and lots of exercise, and even though she has earned multiple performance titles in agility, obedience, and field, she's still a problem.

My first surgery, I was in really bad shape (long story), and hospitalized for 3 weeks. Jet was then only 18 months old and a real hellion, despite 4 training classes per week. My dog training friends kept the dogs until I came home from the hospital, so my husband could be with me full-time. The dogs came home the same day, or the next day, I don't remember which. I did have my friend keep Jet on a leash until she settled down, and I had a couple large pillows in front of my chair, to keep her from jumping on me. After the initial greeting, she was just fine.

You may need to have someone available the first few weeks to help you control the dogs, especially the jumping part. Sits and downs help, but if your dogs have no training at all, you're not going to fix this problem in 2 weeks. Keep them on a short leash aroung the house so someone always has a handle. And if they are pullers, do NOT walk them yourself until at least 8 weeks out, or your sternum will be VERY sore. You can PM me if you have doggy questions, and I'll give you whatever advice I have.

 

[neil]

good luck ron you will be just fine

 

[swim mom]

I was just going to say hello and good luck. It is nice to see still another Oregon person! I grew up in The Dalles, went to Oregon State and my mom used to live by Costco in Albany. My grandparents also lived by Sweet Home.

 

[normofthenorth]

Hey Ras 1151

Your lucky to get it done so promptly. I was diagnosed with a .6cm opening of the AV on Oct 14, but because we have a public system in Canada, I am required to wait over 3 mths for surgery. It sucks as I am developing more symptoms and getting weaker. Now I have been placed on Beta blockers to stem the tide.

Carry on

Bdryer, what you're describing seems to be a Calgary problem, or an Alberta problem, rather than a Canadian one. When I decided I was ready for surgery, I think I could have scheduled the OR for maybe 2 weeks away here in Toronto, at any one of a number of fancy cardiac centers. I didn't even choose the quickest available date, because they were surprisingly soon!

We've seen other problems with your local health system -- like patients in the ER having to phone 911 to get some attention(!) -- that seem pretty foreign here.

 

[normofthenorth]

Re:
"1. Why symptoms in some but not others with same valve area?

3. How long before climbing stairs?"

#1: GOOD QUESTION!! Some of it may be patients in denial, but a lot of it is real. My fancy heart surgeon told me that he'd had patients who'd scheduled their AVR "around" a competitive Marathon they didn't want to miss. They ran the marathon, then checked in for OHS. When Dr. Feindel examined the patient's AV "up close and personal", he had trouble believing that the patient was fit enough to make it to the OR in a wheelchair, never mind running a marathon!

After my surgery, he told me that my AV was "right up there" in that category -- remarkably bad-looking. Yet I'd only had symptoms -- and quite mild ones -- for maybe 4-6 weeks before my surgery! (I would have bicycled to my surgery, except that I couldn't figure out how to get the bike home.) I think my area was 0.8 or 0.9 cm2, and I had significant regurg, too.

#3: My hospital told me that they'd check me out on stairs before sending me home. I had to remind them, but they did. The "going home" booklet says that it's OK to walk stairs as soon as you get home, but don't make a habit of it, at first. DON'T use it for exercise, keep that to walking on the level. And it says to try to keep it to one flight of stairs in each direction per day, at least for the first couple of weeks. I've gone a bit farther than that, like getting around by subway (without taking the elevators), and hitting the basement a few times, and making multiple trips upstairs.

A few of my hospital "classmates" got "prescriptions" to a rehab hospital on the basis of the number of stairs they had at home (about the same as mine). It might have been a prescription of convenience -- the patient was happy to be cared for for another week, and the hospital was happy to facilitate it -- but it happened. Me, I was so happy to get home, I was giddy!!

 

[Protimenow]

Unlike you, I was warned in my 20s that I would be needing a new valve 'in about 20 years.' I didn't pay much attention to symptoms for 17 or 18 years -- when I finally had good medical insurance, I did the annual check-up thing. It wasn't until my cardiac rhythm went a bit funny (extra beats), and my endurance slipped fairly dramatically that I started thinking about the inevitable surgery. My question to my doctors (and I've written this on the forum before) was 'how sick to I have to be' before I have the surgery? For me, in my early 40s, mechanical was the obvious choice. I don't recall many details about the area of my aorta.

For me, they had me walking the hallways a day or so after surgery, and taking fairly long walks just weeks out. There was no cardiac rehab or PT - perhaps because my work was mostly sedentary.

If I were you, I wouldn't be scared of warfarin -- it's pretty easily managed, once you get the INR pretty stable.

The big risks of skiiing, parachute jumping, falling down stairs - or whatever - is usually bruising (although a head injury may put you at more risk of bleeds that don't close as quickly.) I haven't found that I bleed much more on Warfarin than I did pre-op.

Good luck on your surgery. It sounds like you're going in strong and healthy (other than cardiac issues), and these are always helpful for recovery.

 

[CATDOG]

Re: "My question to my doctors (and I've written this on the forum before) was 'how sick do I have to be' before I have the surgery? "

Protimenow, So what was the doc's answer? How sick do you have to be?

Ron, It IS a shock when they mention HVR! I first heard 3 yrs ago. I was only scheduled for an echo (no HMO referral to the cardio doc) by my pcp, but was called back in the door to hear that I would need an AVR sometime in the next 10 yrs, and that I should see a cardiologist. Since then the wording has changed from moderate to severe AS. My other docs keep saying "don't wait too long", so last year I asked to be referred to a cardiologist. As of this year I'm still in the "come back in a year" category with a regular cardio doc. So, in a way, I'm glad for you that everything seems to be getting sorted out and planned, albeit quickly. On-X sounds great. I hope it goes by fast and isn't too difficult. Best wishes.

 

[ALCapshaw2]

Re: "My question to my doctors (and I've written this on the forum before) was 'how sick do I have to be' before I have the surgery? "

Protimenow, So what was the doc's answer? How sick do you have to be?

Ron, It IS a shock when they mention HVR! I first heard 3 yrs ago. I was only scheduled for an echo (no HMO referral to the cardio doc) by my pcp, but was called back in the door to hear that I would need an AVR sometime in the next 10 yrs, and that I should see a cardiologist. Since then the wording has changed from moderate to severe AS. My other docs keep saying "don't wait too long", so last year I asked to be referred to a cardiologist. As of this year I'm still in the "come back in a year" category with a regular cardio doc. So, in a way, I'm glad for you that everything seems to be getting sorted out and planned, albeit quickly. On-X sounds great. I hope it goes by fast and isn't too difficult. Best wishes.

CATDOG -

With an Effective Aortic Valve Area of 0.8 to 0.9 cm sq, I'm surprised no one has suggested that "it's time"... Well, maybe not, since all you've seen is a Cardiologist. At that level, I would ask for a referal to a Surgeon. Surgeons like to operate before there is permanent damage to the Heart Muscles and Walls. Is anyone looking for signs of chamber enlargement? That is another trigger.

BTW, do you have copies of ALL of your EchoCardiogram Reports? If not, I strongly urge you to obtain them. I chart my Echo reports on a Spread Sheet for easy comparison. Even my Cardio refers to my sheet to look for signs of progression.

'AL'