The good info continues to roll in. This in response to some hesitations I had expressed privately to normofthenorth about mech valve choice and long term implications of blood thinners for activities I hope to be involved in (cycling, skiing). Not trying to be secretive here - just a little uncertain about the protocol I guess re: public or private posting so am posting some previous content. I guess the intent IS to share so my apologies. I had indicated that I assumed that a determination of valve type would need to be made before going in but what Norm describes here sounds better. I have had some discussions with the surgeon to date, basically expressing my preference for a mechanical valve in order to avoid re-operation. This seemed to be their feeling too although I felt no pressure either way. Perhaps they seemed agreeable to help me feel comfortable with the decision. Now, after reading up and understanding that life expectancy of a bio valve may well exceed 10 years AND now recognizing the apparently real possibility that technological advances my allow future re-operations, if required, to be accomplished without OHS I would like to have another discussion with the surgeon I guess. Ultimately though, my thought would be that the most reasonable go-forward plan would be for me to discuss the relative trade-offs with the surgeon and to leave the 'best-fit" determination of what needs to be done to them. I don't see myself saying NO to anything since I cannot be as informed as the surgical team. I am OK regardless - just make the best call - that gives me the highest comfort level going in too.
Paul
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From: normofthenorth
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Re: your post
I think a top surgical team WILL make last minute, best fit decisions -- and I think you want to encourage them to do just that. "It's not like they're going to have an array of potential valves at the ready is it" is exactly wrong, AFAIK. They should have the whole resources of the Hospital and maybe the surrounding University and Community available to them during the op. I don't know if they bring in a cooler chest with every piece they might reasonably need, or if people run stuff in from outside, or what, but they don't -- and shouldn't -- restrict their choices because they lack the "piece" they want.
I'm a competitive volleyball player -- at least I was until a year ago when I tore an Achilles tendon (my second!). In both court and beach ball, high-level play includes "sacrificing your body" by diving flat out to retrieve a ball. In high-level COURT play, the best technique is actually to hit the floor with your sternum (the very THOUGHT!!!) and SKID in the direction of the ball, both before and after the actual play. If you bruise easily, it's literally a bruising game, so it's not a great spot for an elevated INR, IMHO.
Similarly, I race little 15' "Albacore" sailboats competitively all summer. (My best result was 12th at the 1999 Worlds in Delaware.) Every time human tissue comes in high-speed contact with the reinforced plastic (GRP = fiberglas) of an Albacore, the tissue loses, and often bruises. Serious female racers have been "approached" by "interventions" over suspicion that they'd been abused! AFAIK, NONE of them was on Coumadin, but that would make the bruising worse.
OTOH, I don't "get" your concern with bike trips. Once ACT folks get stabilized on Coumadin -- as maybe 90-95% do quite successfully -- they usually only get tested every couple of weeks, and their readings don't vary much. Having a diet that "spikes" in strange directions that involve Vit. K intake (from green leafy vegetables) can make it less reliable, and ACT folks are urged to stead that out.
Check the "active folks" section of VR.org for role models and such, and there's also a "Cardiac Athletes" site, (.org), that has a bunch of others. Perhaps because the average cardio jock is much younger than me (and maybe younger than you, too), it seemed to me as if the mech valves were over-represented. Lots of runners and cyclists and triathletes, I think. Lots of pure "heart" stuff, rather than what I call "sports". I didn't see any competitive v-ballers.
Cheers,
Norm
P.S. To the extent possible, I think any exchange like this that could interest another present blogger or a future one (e.g., through Search) should be held in the public forum. I don't think we discussed any secrets here.
BAV, extended ARoot, some MV damage.
65 y.o., keen active athlete until recently, only symptomatic since mid Oct (2010).
AVR (Medtronics Hancock II) Dec. 1 w/ Dr. Feindel at UHN aka Toronto General. Also a "tuck" on the Aortic root, and a Dacron "simplicity ring" patch on my MV. ACT for 3 months for the MV patch.
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Paul
Forwarded Message:
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From: normofthenorth
Member
Join Date
Nov 2010
Location
Toronto
Posts
69
Re: your post
I think a top surgical team WILL make last minute, best fit decisions -- and I think you want to encourage them to do just that. "It's not like they're going to have an array of potential valves at the ready is it" is exactly wrong, AFAIK. They should have the whole resources of the Hospital and maybe the surrounding University and Community available to them during the op. I don't know if they bring in a cooler chest with every piece they might reasonably need, or if people run stuff in from outside, or what, but they don't -- and shouldn't -- restrict their choices because they lack the "piece" they want.
I'm a competitive volleyball player -- at least I was until a year ago when I tore an Achilles tendon (my second!). In both court and beach ball, high-level play includes "sacrificing your body" by diving flat out to retrieve a ball. In high-level COURT play, the best technique is actually to hit the floor with your sternum (the very THOUGHT!!!) and SKID in the direction of the ball, both before and after the actual play. If you bruise easily, it's literally a bruising game, so it's not a great spot for an elevated INR, IMHO.
Similarly, I race little 15' "Albacore" sailboats competitively all summer. (My best result was 12th at the 1999 Worlds in Delaware.) Every time human tissue comes in high-speed contact with the reinforced plastic (GRP = fiberglas) of an Albacore, the tissue loses, and often bruises. Serious female racers have been "approached" by "interventions" over suspicion that they'd been abused! AFAIK, NONE of them was on Coumadin, but that would make the bruising worse.
OTOH, I don't "get" your concern with bike trips. Once ACT folks get stabilized on Coumadin -- as maybe 90-95% do quite successfully -- they usually only get tested every couple of weeks, and their readings don't vary much. Having a diet that "spikes" in strange directions that involve Vit. K intake (from green leafy vegetables) can make it less reliable, and ACT folks are urged to stead that out.
Check the "active folks" section of VR.org for role models and such, and there's also a "Cardiac Athletes" site, (.org), that has a bunch of others. Perhaps because the average cardio jock is much younger than me (and maybe younger than you, too), it seemed to me as if the mech valves were over-represented. Lots of runners and cyclists and triathletes, I think. Lots of pure "heart" stuff, rather than what I call "sports". I didn't see any competitive v-ballers.
Cheers,
Norm
P.S. To the extent possible, I think any exchange like this that could interest another present blogger or a future one (e.g., through Search) should be held in the public forum. I don't think we discussed any secrets here.
BAV, extended ARoot, some MV damage.
65 y.o., keen active athlete until recently, only symptomatic since mid Oct (2010).
AVR (Medtronics Hancock II) Dec. 1 w/ Dr. Feindel at UHN aka Toronto General. Also a "tuck" on the Aortic root, and a Dacron "simplicity ring" patch on my MV. ACT for 3 months for the MV patch.
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