Running worse after surgery

[Philip B]

Hopeless?

Hopeless?

Nope, it's never hopeless and you should never give up. The solution may involve working harder and smarter. It may be as simple as tweaking your training program to find something that works better.

-Philip

 

[Superbob]

When I talked with the doctor the day before my surgery, he asked why I decided to have it done, I told him ?To improve the quality of my life?. So far the surgery has had a significant adverse affect on my quality of life.
QUOTE]


You are obviously a very dedicated runner. Good for you. I am not offering my perspective any more since I am no longer a runner and so my view is not relevant.

But I am just curious: Has the quality of your life been adversely affected in any ways other than your running times?

 

[Tom Walski]

Thanks again folks. This discussion has gotten me to dig up some reports and test results.

The cardiologist at the hospital where surgery was performed said, "...I am actually quite ecstatic with the results and the continued success of surgery."

He used the word "normal" a lot in his report. I dont' want to be "normal". I want to be a good runner.

Here are some quotes from my tests (stress echocardiogram in Nov 04) for those of you who understand this stuff:

"Mitral valve appeared sclerotic. Leaflet motion was restricted more so the anterior leaflet than the posterior leaflet. There is a mild degree of mitral stenosis with a peak gradient of 8 and a mean of 3 with a calculated mitral valve area of 2.0 cm^2 and a pressure at half time of 109 mm/sec." ("Sklerotic" means harden.)

 

[mntbiker]

These remarks were just people expressing their feeling and out look on life after OHS and AVR, their gratitude?..They were not directed at you so I don?t see any reason for you to take offence?.They were trying to be helpful to Tom. They evidently struck a nerve with you?..When you are older and taking solace in, ?well I?m getting older? please remember this.

He was referencing when he received those comments from people not that Tom receiving these comments offended him, or at least that's how it appeared to me.

I agree as well (crap twice in one visit ) I found it offensive when doctors or others would tell me I was lucky to be riding and just enjoy it. What's important is the reason for finding those comments offensive. I understand their point of view, supposedly we survived a difficult surgery and potentially serious condition. But having been active people and used to pushing ourselves to the limit it is frustrating to have something out of our control that limits us and when we make a serious effort to work with the medical community and discover a definitive cause for this limitation and simply be told "your lucky to even do it" doesn't address the issue and is in fact insulting. We want solutions, we want answers, work with us, trust us to understand our bodies, support us in what we want to do, don't demean us.

Hi Tom, welcome to the site. There are several mitral valve runners here that have some very good information, Mike above is one of them also another Tom (Tommy) who is one of the people responsible for helping me understand that I could return to the activities that I enjoy.

I had stopped running a couple of years prior to my AVR so don't have enough numbers to compare to where I am now, but my running is improving on a regular basis, I just cut two minutes off my 4.5 mile run the other day (trail runner). My post about my most recent endurance race I got into some of how my improvement has gone as well:
http://valvereplacement.com/forums/showthread.php?t=25118

 

[perrypiratesdad]

Tom, have you considered going for an exercise stress test? It would be interesting for you to see for a number of reasons, but if done annually, you would be able to see how your body is changing and if things are changing for the better, worse or staying the same. As I am sure you are aware, you will get to see what your exercise capacity is, your METS, VO2 Max, RQ, AT, see if you are at maximal exercise capacity, breath by breath analysis of a number of things, etc.

When I had mine done two years ago it was a real eye opening experience for me and I was able to use it with a physical conditioning coach to help get me back into the game. At the time though, I was on bet blockers and my doctor was unwilling to take me off of them and this really limited my exercise capacity.

On another note. I didn't mean to offend anyone with the "be thankful you are alive" comment, but I just think we all need to think about that at times. I know if I had been born when my father was, I would not be alive today to be writing this, so I often times have to take pause and just be thankful that God gave me the life that I have, and as imperfect as it may be at times. Sometimes I get so caught up in "why can't I be normal" or " why can't I do that" and I forget that God has given me a gift that I may not have had 50 years ago.

We all need to face the reality that our lives are vastly different. Yes, maybe I was able to compete with the best of them x years ago, and now I can't. Am I really happy about that... NO, but should I be happy that I can at least try and compete... deep down in my heart, I know the answer is yes.

Anyhow, those are just my thoughts, take them or leave them for whatever they are worth. My intentions were not to insult anyone as we are all in the same boat here.

 

[Soilman]

Tom,

I too, am a long time runner since high school. Never fast enough to lead the pack, but definitely a strong, competitive "middle of the packer". I had surgery last year at 43. I knew going in, from reading this forum, my running times were going to decline. Indeed they have. Few, if any, "valvers" that i've heard of have re-established their previous times. However, there are a few things that keep me plugging away. First off, at 44 y/o, I know i've already seen my P.R. regardless of the valve. Secondly, at 44 y/o, I am still faster and can go longer than most men 10 years younger. Am I "the man I was" a year ago? No, not quite and that does admittedly bother me some, but not enough to complain about. I figure time will eventually even things out. At least with the valve replacement behind me, now I can live my life the way I want to and do all the thing I want to without worrying about my heart. That's a big load off my chest that DOES make running easier...and better.

 

[Cooker]

Tom,

I too, am a long time runner since high school. Never fast enough to lead the pack, but definitely a strong, competitive "middle of the packer". I had surgery last year at 43. I knew going in, from reading this forum, my running times were going to decline. Indeed they have. Few, if any, "valvers" that i've heard of have re-established their previous times. However, there are a few things that keep me plugging away. First off, at 44 y/o, I know i've already seen my P.R. regardless of the valve. Secondly, at 44 y/o, I am still faster and can go longer than most men 10 years younger. Am I "the man I was" a year ago? No, not quite and that does admittedly bother me some, but not enough to complain about. I figure time will eventually even things out. At least with the valve replacement behind me, now I can live my life the way I want to and do all the thing I want to without worrying about my heart. That's a big load off my chest that DOES make running easier...and better.

Great post.

 

[Superbob]

Great post.

Amen. Thank you, Soilman. You have made the point I was trying to make as a former runner turned walker/hiker in my senior years. Only you said it much more clearly than I did, and with the advantage of youth (well, at least compared to me. ) Very thoughtful post.

 

[ponygirlmom]

My Personal Fact Sheet
Date Of Birth 6 Dec 1950
Suffered from Mitral Valve prolapse
Underwent Mitral Valve repair surgery 27 Dec 2002.
Athletic performance (running/biking) became significantly worse after surgery

Here are my running times from a 5 mile (8K) race I?ve competed in numerous times.

Year Time Age
2001 32:51 50
Surgery
2003 37:02 52
2004 36:24 53
2005 38:10 54
2006 38:34 55
2008 39:05 57

It would help to know the months of these times. I am assuming that your 2002 time was almost identical to your 2001 time. If not, were you starting to lose speed during the year of 2002?

Your surgery was in December of 2002. When were you timed in 2003?

You show an improvement in 2004, which would be expected, and then a two-minute decline in 2005. How did you feel in 2004 compared to 2005?

 

[BillCobit]

Hi Tom

What you describe seems to be characteristic of MV'ers. After 6 years, I've resigned myself to a permanent position at the BOP, but I have never found a satisfactory explanation that reconciles the "medical success" with the cr@ppy performance. I had an enlarged heart and was deteriorating toward heart failure. Dimensions are now normal and I am stable, but I have gotten no faster since having my engine rebuilt. It's very cool not to be dead or dying, send my kids to college, etc., but like you I have been frustrated. I'm mostly at peace with it now, and BOP and occasional DFL is OK, but I really would like some training buddies I could keep up with. It seems that nobody who is as slow as I am does any significant mileage...else they start getting a lot faster. I would love to run at the pace you are currently capable of, but I totally get your dissatisfaction given your prior performance. I hope you get the breakthrough you are looking for. If you achieve that or get some insight to the post-op performance phenom, please let us know.

Good luck.

 

[Tom Walski]

Thanks folks for all the suggestions, sympathy and empathy. It's reassuring to hear that there are others out there with similar problems.

However, I have to agree with Bill, in that I didn't submit my original posting for sympathy. I am looking for a solution. "Just be happy you can run" doesn't cut it.

Just think if Lance Armstrong said "I'm just happy to ride" after his cancer was in remission. What if Wilma Rudolf was just happy to walk? Overcoming obstacles is what life is about. I'm going to try to improve my condition and not give up hope until I'm pushing up daisies.

Having said that, I've also tried to sign up for the cardiac athletes web forum. I thought I had registered but it won't let me log on. When I try to register, it says I'm already registered. I've sent a note to their help but got no response. Any suggestions?

Here's something I found on Wikipedia.

"The normal area of the mitral valve orifice is about 4 to 6 cm2...When the mitral valve area goes below 2 cm2, the valve causes an impediment to the flow of blood..." My valve opening after surgery was estimated as 2 cm^2. There is a valvuloplasty procedure to correct this. Has anyone looked into this procedure?

Just when I think that is the solution, I read in another place that during the state before surgery, when the left ventricle is overstretched, you can have "circumferential fiber shortening" which is essentially damage to the heart muscle itself. This also can explain the loss of fpumping unction.

It would be nice to know which of those two explanations best describes my condition.

 

[BillCobit]

Hi Tom

The reg process at CA takes a bit of time. The site administrator is a great guy, but extremely busy with his day job, etc., so it can take him a few days to reply.

I have wondered about valve area as the root of my problem. I don't know what my valve area is, but I know both leaflets were in pretty bad shape, and one had a perforation in it. That required a lot of leaflet trimming and a reduction in the size of the annulus to provide a functional valve, so I've theorized I have substantially reduced flow, but don't actually know if that's the case.

Regarding balloon valvuloplasty (I think that's what you're talking about), that is a procedure used to provide relief from a stenotic valve. If your valve area is reduced as a consequence of surgical restructuring, it wouldn't be appropriate or effective to try to widen it with a brute force technique. I'm guessing that BV would either have no effect (at best) or would damage or destroy the repair.

 

[Tom Walski]

I still haven't heard back about registration for the Cardiac Athletes site.

I'm going in for my annual cardiologist visit Thursday. Is there any question I should ask the doctor to get him thinking about anything that can be done to help me? Usually he just gives me an EKG and listens to my heart and tells me to come back in a year.

I've attached a graph (I think) which shows the different effect of aging and my hert surgery on my running performance.

 

[Tom Walski]

Oaktree, those are very valid questions.

I knew I had a heart murmur ever since I was a teen. My local cardiologist pointed out that my heart was enlarging and I would have problems if I didn't have the mitral valve repaired. I was completely asymptomatic but he said I should get it while I was young (52) before my heart deteriorated too far and repair rather than replacement was still an option.

It was the cardiologist at the surgical hospital who explained to me the risks of surgery such as infection, complications due to anethesia, the chance that they may not be able to repair the valve and once they cut me open they may need to use a mechanical valve. No one ever did mention that my heart might not work as well.

 

[SumoRunner]

I've attached a graph (I think) which shows the different effect of aging and my hert surgery on my running performance.

What strikes me aside from the jump up is your remarkable consistency. I've never been able to sustain the same performance level for such long periods. Here's a graph of my times in one particular 15K over the years. One step was due to the AVR, the others were from gaining weight. But even in the ten years prior to AVR the time varied quite a lot.

 

[Tom Walski]

Sumo, that's a pretty consistent long term trend. You've been at it for a while. I have times going back to the mid-60s. In the 70s and 80s, I could do 5 miles in the 28-29 minute range but not on that same course.

I saw my caridologist for my annual visit yesterday. After the EKG, he came in and asked me how I was doing. I started on my usual litany of "why have I slowed down?". He said that when you have mitral valve repair the opening of the valve is smaller and you can pass less blood. So you slow down. (No one told me that before the surgery.)

When I probed about options, his response was "Don't fret. Move on." When I pressed more about any hope for imporvement, he said "No" in a way that meant "stop bothering me". He quickly wrote a prescription for an echo and got out of the room as quickly as he could without actually running.

I'm not happy but I can see his position. He'd like to help me but he can't so he's frustrated with me.

I don't see a lot of options.

 

[Soilman]

I'm not sure I buy the "reduced opening" line altogether. My valve before surgery was 2.0cm. My new mechanical valve opening is 2.5cm. By that reasoning, I should be faster...but I just ain't. I tend to think it has more to do with the valve efficiency, the way it opens/shuts and the hemo-dynamics. Also, I'm on a beta-blocker which also slows things down some too. For now, like Bill, I'm ok with being a BOPer. I figure if I just keep on running, I'll eventually be able to win one in my age division ...when I'm 80.

 

[SumoRunner]

I figure if I just keep on running, I'll eventually be able to win one in my age division ...when I'm 80.

Taking the long view, there's a great deal to be said about outliving the competition.

 

[Tom Walski]

Thanks, Sumo. That's exactly what a friend of mine said when I got second place in my age group at a race recently (there were only 4 in my age group).

Waiting for people to die doesn't exactly sound like a postive apporach to racing.

 

[SumoRunner]

I used that age grading calculator for a long term comparison. I checked the best mile times I had over a couple decades.

age 41 6:15 = 5:53 equiv.
age 51 7:43 = 6:44 equiv.
age 60 8:25 = 6:47 equiv.

So I'm currently in almost as good condition as 9 years ago but not quite as fast as 19 years ago, which was before the heart surgery.