Struggling with limits

[FredW]

I find the group here kind and supportive so I ask for their feedback on something that I’m struggling with.

I’m a 72 year old male with aortic stenosis and a possible bicuspid aortic valve. I have been in monitor mode for almost three years. The last four echo tests have shown my stenosis progressing from mild to currently moderate or moderate/serious. Other than high blood pressure, which I control with meds, I’m fairly healthy and active for my age.

One of my sons lives in Colorado near Boulder. He hikes 14,000 foot mountains as a hobby and has a goal of hiking all 54 of them in CO. One of the things we share is the love of the mountains. In 2013 and 2014, I flew from my home in Western PA hike with him. In June of 2014, I summited my first 14,000 ft mountain, Mt Sherman. At that time, my stenosis was in the moderate category and I will admit that it was not easy. The shortness of breath is aggregated by the altitude and my stenosis. But, I was able to make it.

I started seeing a cardiologist in June of 2015 when my stenosis approached the mild category. She told me that my 14,000 ft mountain hiking days are over until I get my valve replaced. Last September, my son visited me in Western PA and we did a two day hike of 23 miles in the wilds of PA. I didn’t ask my doc for permission, I just did it. It was a relative mild hike as far as elevation gain, only about 1500 feet. But the 95 degree weather, a 35 pound backpack and my stenosis did require me to take it slow and rested often.

In December of last year as my echo test indicated I may be approaching the serious category. Due to concerns about the doc and test results, I sought another opinion and my new cardiologist says I am 12 – 24 months away from needing surgery. However, he also tells me I need to limit my physical activity: no 14,000 ft mountains, no hiking, put my chain saw on the shelf, and so on.

This summer my son plans on hiking his last (54[SUP]th[/SUP]) 14,000 foot mountain. He and I have talked for years about us hiking his last one together.

I’m considering trying to do it.

I would like to have a serious conversation with my cardiologist about this to try to understand the real risks and ways I may reduce them. My fear is that he will just tell me I stupid and give me the standard “I could kill myself” line. I can of course, not tell him about this and do it without any advice he may have. But, I’m the kind of person who likes data and facts to help me make better decisions.

My questions to the forum are: Shall I talk to my cardiologist about this? Those of you who have lived in the waiting room for a while and are physically active, have you limited your life while in the waiting room? How do you handle the limits placed on you?

This inactivity drives me crazy. I question if I am compromising my quality of life now to get a roll of the dice to maybe get better life in few years. At my age, I question the wisdom of putting off what you love doing.

Have any of you gone through this? If I were 50 or even 60, I could argue that putting off hiking mountains for a few years is wise for you can hike later in life. But , I feel I have only have a few more years of hiking in me and I’m wasting them sitting the waiting room doing nothing.

Thanks in advance for reading and providing you thoughts.
Fred

 

[pellicle]

Hi

we all struggle with limits ...

You may know me here if you lurk much. So to couch my answer in terms of understanding me, I'm 52 years old and planning to try and complete a ski trip my wife and I planned back in 2009 (for 2010) pulling a sled with my gear and food up in the north of Sweden from Abisco to Mt Kebnekaise and back (google map). Probably in March 2017. I have been back in Australia for a few years now and have become unfit with office work. The location is 250Km north into the Arctic Circle so its both cold and prone to "unpredictable" storms / blizzards. I will determine my fitness for this after I get back to Finland and spend next winter back training again. I'm 52 and had a few OHS over the years.

so ...

I’m a 72 year old male with aortic stenosis .... Other than high blood pressure, which I control with meds, I’m fairly healthy and active for my age.

well probably you like me are the best judge of your limits. Perhaps you exceed them from time to time, but only you really know. The specialists can advise on what they see happening to tissue and muscle (cardiac muscle) but not what you do with that bag of protoplasm you call home.

Over the years I learned to walk alone (did a lot of rainforest hiking around Lamington National Park (google images) which is some of the toughest jungle sort of terrain around these parts.

During this time I was meeting regularly with my surgeon (yearly) between a valve repair (at 10yo) and an eventual replacement (at 28yo). He would just raise his eyebrow and would let me know the facts about myself.

One of my sons lives in Colorado near Boulder. He hikes 14,000 foot mountains as a hobby and has a goal of hiking all 54 of them in CO.... In 2013 and 2014, I flew from my home in Western PA hike with him. In June of 2014, I summited my first 14,000 ft mountain, Mt Sherman. At that time, my stenosis was in the moderate category and I will admit that it was not easy. The shortness of breath is aggregated by the altitude and my stenosis. But, I was able to make it.

ok ... well hike is different to "climb" (meaning ropes and harnesses) so its possible

why not do some tests and some training?

Pick an area, fill a pack with nothing much but weight (the weight you'll need to carry), and go for it. Take your time and see what happens.

I'll strongly recommend that you get a chest strap HR monitor and watch. Nothing fancy or expensive , just the basics. I totally recommend that you do some walks around your local area where there are hills with that on and see how you go.

It will tell you some important points.

• ​​you will see your actual heart rate on the move. This is very handy stuff and you can correlate it later with your feelings
• you will learn what your "feeling puffed" translates to. Typically its something like doing more than your 70% of Max HR for extended times. You can work around this by going slower but doing it on hills WITH a pack will let your know quantatively.
• you can see if over a few weeks you're getting better or worse.

I started seeing a cardiologist in June of 2015 when my stenosis approached the mild category. She told me that my 14,000 ft mountain hiking days are over until I get my valve replaced.

that could be wise or it could be "caution"

Last September, my son visited me in Western PA and we did a two day hike of 23 miles in the wilds of PA. I didn’t ask my doc for permission, I just did it. It was a relative mild hike as far as elevation gain, only about 1500 feet. But the 95 degree weather, a 35 pound backpack and my stenosis did require me to take it slow and rested often.

I don't recall asking anyones permission to do stuff like that in my entire life.

In December of last year as my echo test indicated I may be approaching the serious category. Due to concerns about the doc and test results, I sought another opinion and my new cardiologist says I am 12 – 24 months away from needing surgery. However, he also tells me I need to limit my physical activity: no 14,000 ft mountains, no hiking, put my chain saw on the shelf, and so on.

well unless you are somehow in total doubt of their appraisal and unless you can't feel any change yourself from "mild" to "seroius" then ... well you know ... they didn't just make that **** up right? It's based on measurements ... blood flow rates ... you can't get a 451 to pull 500 horsies with a bung fuel pump. Ya hear what I'm saying?

So grab that HR monitor and MEASURE it.

..This inactivity drives me crazy. I question if I am compromising my quality of life now to get a roll of the dice to maybe get better life in few years. At my age, I question the wisdom of putting off what you love doing.

me too so as you say "you like numbers" ... go grab your own and see. Don't be "inactive" go find out what your activity levels can be ... that HeartRate monitor will tell you that. Seriously you won't find a single runner out there not using one.

Write it in a journal methodically with a single line for every day. Date it, Give it information like "duration of walk" and "MAX HR attianed" and "time in training zone".

You'll probably get one that does "training zones" even for $50.

I use a Garmin VivoFit which syncs with my PC (or phone, or iPhone) and uploads the data to Garmin. I in particular like the little graphs it gives of my training events.

Equally I still like my older simpler watch that you set a MIN and a MAX and it would give you a "hey slacker" alarm when you went below a level and then a "whoa buddy" alarm when you went over a level.

It would at the end of a session (you stop and start like it was a stopwatch) it will report:

• time in zone
• time under zone
• time out of zone
• average HR
• Max HR

which was plenty for me, but you had to write that down after each session because you'd lose it on the next session.

The Garmin keeps it on a website and I can track it .. it nice

A VivoFit with an ANT+ strap runs at about $100, but you'll need a PC with Win7 or higher or a Mac with some cats name as the OS or an Android phone (test it before comitting) or an iPhone (if you can tolerate them)

When you've got the data you'll know. Then you will know if you'll be able to do it, or become a risk for your son to evac you and probably (if you're as proud inside as me) feel like a fuddy old fool for getting yourself into that fix.

So, as I always say ... data data and more data then plan then train (gathering more data) then execute.

 

[tsanjose]

if it were me, id get the surgery done asap. then you can tell your son to wait about a year for you to heal and THEN go do the trip. it'll be more meaningful to do this after you've recovered.

 

[dick0236]

if it were me, id get the surgery done asap. then you can tell your son to wait about a year for you to heal and THEN go do the trip. it'll be more meaningful to do this after you've recovered.

I would take this advice. Your son's 54 mountain accomplishment would be badly tarnished if he had to bring you down the mountain in a body bag. The mountain aint gonna go anywhere......so do it when you're fit and can enjoy the experience without looking over your shoulder.

 

[AZ Don]

This is a good question and I think it definitely merits a discussion with your Dr. Myself I had an aortic aneurysm and now aortic regurgitation so I am not as familiar with aortic stenosis but I understand that severe aortic stenosis carries the risk of sudden death. I googled it to confirm and found an article discussing it, here:
https://www.escardio.org/Guidelines...e-Is-Sudden-Death-a-Threat-in-Aortic-Stenosis

To conclude, asymptomatic patients with AS are at a low risk of sudden death. To avoid unnecessary risk however, strenuous exercise is contraindicated.
Symptomatic patients on the other hand are at a high risk for sudden death and should be promptly identified and referred to surgery.

From your description it sounds to me like you are not entirely asymptomatic. If that's the case then maybe you should try to get on with getting it fixed. If you are asymptomatic then perhaps you don't need to rush into surgery but then again, if it is inevitable and affecting your quality of life, again maybe better to get on with it.

Regarding your situation now. Risks are something we face every day of our lives. Many people at 72 would consider hiking to 14,000 feet too risky, even without a heart condition. I did it in my 20's and found it very challenging then. Still, some people accept the risks of such activities as hang gliding, parachuting, etc. that many would not accept. Ultimately you have to decide the risks you are willing to accept, but I would consider Dick's advise as well. An unfortunate incident may affect others much longer than you.

After having my aortic aneurysm repaired I don't push myself like I used to, but I still swim, bike, hike. I may be done with downhill skiing, more because of my knees than my heart, but I am far from sedentary. I would think there are some activities that you could do with your son that are less strenuous. Personally I always found hiking without a heavy pack much less strenuous and more fun.

 

[FredW]

Thank you all for taking the time to give me feedback. I have ordered a heart monitor and have plenty to think about.

 

[Heart2.0]

I use the lower priced polar monitor with a cloth strap. I don't care to chart what I am doing but I have been able to see improvements in recovery time
As I am working back to health after AVR. It also works in the pool. There are glitches. But over all it has helped me train in intervals and be knowledgable
About my activity and recovery. I am admittedly pretty sad about perhaps never being able to really go flat out, skip ( seriously I love skipping) or enjoy
Serious lengthy workouts Olympic style race walking. But I am not dead, survived an aneurism and I am still experiencing fitness gains.
Would you also consider talking to your son, who obviously loves your company? Maybe there is a mutually enjoyable compromise trip before a surgery?
I suspect sometimes we parents unrealistically want to spare our children any worry ( I did) but if he doesn't know your risks, maybe his hopefully positive response would surprise you?