St Jude Trifecta failure

[pellicle]

Tom

Seems to me you are just fear-mongering and that's cruel.

I genuinely believe that he's not smart enough and/or disingenuous enough to be fear mongering, its my view that he's one who has not understood himself properly and is expressing his own choice as the best one ... "pick my team to barrak for, its the best".

Like many who do this they are usually unaware that (at least) some of the following is likely happening

• have an underlying anxiety about their choice, probably unconscious
• want to be in the same boat as others (all on the same team)
• do not want to learn after the fact things which they see may have changed their decision (leading to a regret or remorse situation)
• just simplistically trust the first opinion of authority they heard of and cast everything else in bad light because "they have the Word"

dunno, but I don't think he's consciously being malicious, I think he genuinely believes this rubbish.

In the past he has continuously discarded any knowledge which he's been presented with that provides an alternative view. This is commonly understood as portrayed here:

 

[Hyp2r]

Pellicle
I’m new to this so please don’t be too hard on me!
Why is it that a lot of Surgeons are recommending tissue over mechanical if as you say the choice is so easy? Is there more money for the Sugeon to use specific valves, or is the surgery easier perhaps?

I went into surgery thinking mech valves would be my choice but all the surgeons I spoke to went hard on recommending tissue.
I do wish now that I had questioned more, although probably quite happy ow that at least the warfarin isn’t an issue for me.

 

[pellicle]

Pellicle
I’m new to this so please don’t be too hard on me!

omg ... do I have that sort of rep ... I believe its undeserved simply because I'm frank.

I went into surgery thinking mech valves would be my choice but all the surgeons I spoke to went hard on recommending tissue.

this is indeed common (although not in NZ as I understood it), there is some good basic views that surgeons have which I believe that the stats are in support of, these are:

If you have a mechanical and thus need to be taking warfarin if you fail to do that you'll come to harm. Failure rates in the general community are quite high, staggeringly high actually. This is a good read and I recommend pondering it
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846139/
search for "compliance" for getting to the nub of the matter quickly

The next on the list of reasons is that many surgeons prefer to look at 10 year survival rates. To them 10 years is a long time out and at this point you're out of their interest sphere (not least) because in the "statistical age groups" that the data is about by 10 years you may be in for another reason (like aneurysm). Doing follow ups over greater periods is difficult because "people move or change contact details: and are lost to follow-up (particularly in the lower socio-economic group mentioned above).

Surgeons frequently don't assess you as an individual because they are already fixed in their ideas (and they themselves have good reasons to think they are right, but ignore the psychology including their own)

Then there is the management of warfarin and while European views are 10 years down the road of INR self management the USA is not and so without doing more than browsing the abstracts (and who really has time to read about INR management when they have a gruelling surgical timetable) it seems that the rate of strokes or bleeds is not good (in principle due to the so called "usual care" applied to its management.

See here:



The point I usually make when discussing this is that if you are one who will be dilligent and take the bit between your teeth, if you want to yourself make sure that you can do something about maximising your survival and health outcomes then unless you are contra-indicated you should pick a mechanical valve. This is indeed the actual surgical guidelines (that NZ even follows)

the top four points are pretty clear.

Lastly in private health systems (not public ones) there is an imperative for repeat business ... people make money out of having you in hospital, far more so than having you in an INR "usual care" (please read that as usual disregard) situation.

However I don't know enough about YOUR specific situation (age, issues, blah blah) to know any more. Knowing that (meaning not much) I don't think that you should have any anxiety about what valve you chose.

Lastly I'll tap @Warrick on the shoulder and say "fellow Kiwi mate" and see if he has anything more pertinate to say. You should be aware his dad just passed away (see here https://www.valvereplacement.org/threads/my-fathers-passing.888046/) and so may be a bit pre-occupied.

Hes a good bloke and talks no-bullshlt stuff as we Ozzies are known to do too.

If you have anything specific then hit me up here or via PM (the little envelope icon up the top) and we can yak there or via phone.

Best Wishes

PS: I checked your bio and it doesn't contain the data you mentioned in a follow up to your first post (which I hadn't spotted, I confine myself here to reading threads I'm mentioned in and replied to)

I should have added that I’m a 70 year old in pretty good shape for my age,

I suggest you whack that in your BIO

So my view is that at 70 you're in a position to get the longest life out of a valve but also in the position to have the worst outcomes if reoperation is needed in 15 or so years (instead of 20) .... its a coin flip and neither decision (mech or bio) is a clear winner IMO.

 

[MdaPA]

I went into surgery thinking mech valves would be my choice but all the surgeons I spoke to went hard on recommending tissue.

Hyp2r,
From another post you made, I see that you are 70 years old (see table 17 in pellicle's post) and that you mentioned "I had a very difficult time with warfarin when I was first diagnosed with a fib. My INR was all over the place for a year or so.". These, along with other factors, may be why "all the surgeons I spoke to went hard on recommending tissue.".

My Story. Aortic and mitral valve replacement

 

[pellicle]

Hey

My INR was all over the place for a year or so

thanks for digging that out ... I would understand @Hyp2r 's hesitations to go
"knowingly" into what his experience told him was fraught.

Knowing what I do today, I do wish I could help more, but getting my knowledge out into the public domain and used would take more than my lifetime. It meets resistance even here and labs in Australia are still saying "Coagucheks aren't as good as a blood draw".

https://www.valvereplacement.org/th...ened-to-me-today-at-the-phlebotomists.888017/
Heh

 

[MdaPA]

thanks for digging that out ...

It was easy, Hyp2r only had 4 posts!

It meets resistance even here and labs in Australia are still saying "Coagucheks aren't as good as a blood draw".

Sure, the labs see Coaguchecks as the competition.

 

[Hyp2r]

Thanks for the replies guys, much appreciated. Naturally it’s too late now but I wish I knew of this site before surgery.
Unfortunately, I’m the sort of person who just goes with the flow thinking the experts know best. I’m pretty knowledgeable in my field of expertise and without doubt always gave clients their best option. I guess I expect that when dealing with others.

 

[pellicle]

Naturally it’s too late now but I wish I knew of this site before surgery.

and to be honest (as I mentioned) I don't think you've made a bad call ... its all good.

if I'd fished out your age first I wouldn't have written as much detail as I did ... oh well.

Best Wishes

 

[Hyp2r]

So, your calling me an old *******! Thanks Pellicle

 

[user 15848]

I truly believe you're arguing with the wrong guy ... I gave up expecting logic from this fellow years back. He's been gone a while, his recent posts suggest he hasn't changed. People often don't

Agree, Is NOT possible to change people's minds

Because everybody wants to be right, and
ALL we can do is provide a DIFFERENT point of Reference

BUT

The solution to complex issues are always simple things;

" Me ", i was born with a defective, bicuspid aortic valve, and took many years
for doctors to find out why i was always tired; years...., Thas was my FACT of life;

Then, 8 years ago Eureka!, a Dr by Chance discovered i had that BAV thing that 3% of humans have, and then "Hamlet" came about, Tissue/Mech ? , that was the question...

Tissue, no matter how or what, WILL brake, fail , degrade, 100% it will happen
and, once a year or twice, go again and see the old good cardiologist to check on your tissue valve; and Big Pharma as Good all Big Brother, is always waiting to sale a new Tissue Valve, Recurrent Revenue....

Mech... , they are supposed to out live you by design and record, 80% of the time,

Yes, there are things that happen to all foreign objects inside your body, panus growth, calcification, fatigue, etc;

Is my Mechanical Valve Perfect ?, well no, not even my birth Valve was it,
BUT, i have not seen a cardiologist in past 4 years, and not planning to; even
though is free here

Sorry, i walked around the cloud here; but the point is, the only thing that
is ok , is educate yourself

Chek your variables, AGE, Life expectation, and Desire to PLAN or NOT to go back to the Hospital for a week,

Last but not least who knows for how long CCP will be playing with Viruses,
Communist Totalitarian Regimes can not be trusted.

 

[pellicle]

Morning

Agree, Is NOT possible to change people's minds

You are not the first to express that. A famous physicist once quipped

what this actually means is that even in the realm of Physics new ideas are not accepted by the most conservative thinkers, and so "science" has to wait till those impediments are dead ... thank Gawd we don't live forever or humanity would be mired in the middle ages if not worse.


Back to changing minds, its an interesting subject. Triggered by your words I looked at it and considered my own situation. I can say that on a number of smaller topics and a few larger ones my mind has been changed on some things on occasion to the polar opposite.

I have come to find this graph helpful

Because everybody wants to be right, and
ALL we can do is provide a DIFFERENT point of Reference

curiously I'd felt that most people want to conform to a group ...

The solution to complex issues are always simple things;

agreed, but sometimes the simplicity of the answer is really just a label representing complexity. Replacing a valve in a living mammals heart is pretty complex in method even though the idea of what is happening is simple.

" Me ", i was born with a defective, bicuspid aortic valve, and took many years
for doctors to find out why i was always tired; years...., Thas was my FACT of life;

so you are saying that diagnosis of your BAV took years?

Interesting

Is my Mechanical Valve Perfect ?

I read it put best in a surgical guideline where it was phrased "we exchange valvular heart disease for prosthetic valve disease"

To me that put it into a clear perspective. The reason we exchange is that one disease is managable with existing medicine (surgery or medication).

BUT, i have not seen a cardiologist in past 4 years, and not planning to; even
though is free here

Interesting, why?

Sorry, i walked around the cloud here; but the point is, the only thing that
is ok , is educate yourself

not at all ... that's what discourse is all about ...

Last but not least who knows for how long CCP will be playing with Viruses,
Communist Totalitarian Regimes can not be trusted.

I'd put it that any Totalitarian Regime can not be trusted. Quite a number of people in Australia (even from the 1980's) had the view that there was not as much difference as was supposed between the way that the US Government acted and the Russian Government.

I remember sitting in the library and reading Time magazine during the time of the proxy war between the US and Russia in Afghanistan and thought that the USA was insane for getting involved in Afghanistan.

In subsequent trade "agreements" with Australia the USA did not like what we were doing (with our health care system) and subsequently screwed us over in punishing agreements. Australians learnd on that occasion that the US is only a "Friend" to Australia when it suits the US.

Anyway ... nice chatting

 

[hevishot]

It is a known fact that when someone's position is so weak they usually resort to name calling. Pellicle inferred that I was stupid and made a crude reference to my religious beliefs and then called you an old *******. Only a coward calls someone a name and then hides behind the anonymity of the internet. This is usually a tactic of the liberal left. Really low life stuff. I never call anyone a name unless I am face to face and look them strait in the eye. Only cowards do otherwise.

 

[pellicle]

Pellicle inferred that I was stupid and made a crude reference to my religious beliefs and then called you an old *******. Only a coward calls someone a name and then hides behind the anonymity of the internet

what's even funnier about this is that you are apparently unaware that was humor and even taken that way by the recipient.

If you think I hide and am one who avoids taking responsibility for what I write that's even funnier.

then you call me a low life.

Really low life stuff. I never call anyone a name unless I am face to face and look them strait in the eye. Only cowards do otherwise.

lastly my reference to your religious beliefs was said as "potential" and not an accusation. However thanks for clarifying that

Source:
https://www.valvereplacement.org/threads/st-jude-trifecta-failure.888041/post-906130
QED