This is my first post...in need of support

[mn2mx]

I recently went in to my primary care physician for a pre op physical for partial/total right knee replacement. During the course of my physical she heard a pronounced murmur where there had only been a slight one in the past. For 30 years I've been told that I had a mitral valve prolapse...and, as a fact, tried to give blood the summer after my high school graduation and was told I couldn't because of a murmur...I dismissed that at the time. It certainly wasn't found during my induction physical in 1968.

So, I'm at the VA, my primary care physician sends me up to get an echo...I returned after the tech was through with me and my doctor got me an appointment the next week with a cardiologist.

The doctor was East Indian and in his 70s...a great sense of humor, but he was what the VA calls a Locum...a temporary contract. I'm 63 years old, btw. He told me that my aortic valve was stenosed and had a 1.2 cm opening...and that when it got to 0.8 I would need surgery...he also said the rate of degeneration was 0.1/year...but then said I would need surgery in 6 or 7 years. He wasn't good at math. This was three months ago. I was given a scrip for pravastatin and losartin. (I've been on atenolol since it first came out in 1979 or so). My cholesterol wasn't really high, my bp tends to run high around white coats...except for my primary physician whom I've known since 1990.

Last week I had an appointment with the staff cardiologist at the Fargo VA. The East Indian locum was no longer there. The staff cardio said they found he had some cognitive problems. Great.

This cardiologist was pretty laid back, went over my blood work. Said my cholesterol and BP are fine and that I should have a follow up echo in a year. He also told me he recommends a mechanical valve transplant eventually and a regular sternum cutting procedure. The Fargo VA farms the surgeries out to the Minneapolis VA which is a teaching hospital for the University of Minnesota and (he said) has top notch surgeons. He said he doesn't recommend a bio valve at my age, and less invasive procedures have a higher mortality rate because it takes more skill and concentration on the part of the surgeon. Also my knee surgery should be put on a back burner.

Well, I can live without the knee surgery...but I know I can't live long without heart surgery. I'm concerned about a lot of different things, of course. What will the nature of the VA system be politically in 3 or 4 years? Will Medicare exist? Will our health care system exist? Will the country exist? I know those sound alarmist, perhaps, but I tend to be that way.

I'd love to think that great strides will continue to be made in procedures, with less invasive surgeries becoming the norm...with <1% mortality rates...

I'm in the beginning throes of my contemplation. I'm asymptomatic as far as shortness of breath, etc. I'm prone to panic attacks and have been diagnosed with PTSD in the past. I am a combat veteran of Vietnam with 23 months in the field. I live in the midst of a state forest in northern minnesota to be away from the hustle and bustle of the world. We have 50 acres and built our own home here out of native materials, earth sheltered and powered by photovoltaics. I'm not a very trusting person. My wife is a saint. She was an Army nurse. I'm her penance and she's my reward, I often say.

I'm not sure what I'm asking here...I don't even know what to think about all of this.

Thanks for this forum.

 

[Duffey]

Hi, glad you found us. If you read through the different topic forums on the site, I think you'll see that your experience is similar to what many members experience when they first learn, they will at some point, need replacement.
Generally it takes some time for the valve opening to narrow to the point of surgery, but I don't think you can be absolutely confident that the figure (0.1 per year that the cardiologist stated) will result in a 6-7 year wait time. I believe you will have a better idea of the rate of progression after your next echo.
If you are 63 now, and he expects you will be approaching 70 when you need replacement, I wonder why he recommends a mechanical valve. Advancements are rapidly occuring in the field of valve replacement, so hopefully you'll have more options by the time you undergo replacement:smile2:.

 

[mn2mx]

I'm sorry I wasn't clear. It was the first cardiologist, the locum from East India, who couldn't add/subtract and said I'd be close to 70 when I needed replacement. The staff cardiologist (on 3 month follow up) said I'd need to have my valve replaced in 3 to 4 years probably. I'm very active and "young looking", not over or under weight and in good shape...which is why the staff cardio recommends the mechanical valve replacement.

 

[Lynlw]

I'm sorry I wasn't clear. It was the first cardiologist, the locum from East India, who couldn't add/subtract and said I'd be close to 70 when I needed replacement. The staff cardiologist (on 3 month follow up) said I'd need to have my valve replaced in 3 to 4 years probably. I'm very active and "young looking", not over or under weight and in good shape...which is why the staff cardio recommends the mechanical valve replacement.

Hi Like mary im glad you found us. The good thing is it looks like you will have plenty of time before surgery to learn as much as you can/want etc. Also agree with mary, it is hard to even guess how quickly your valve is getting smaller from a first echo, for all you know you MAY have been pretty stable with yur valve opening around the same size for a couple years or on the other hand might be stenosing quickly, hopefully your echo next year should give you a better picture of how you are progressing toward surgery.

I probably wouldnt put alot into what valve a cardiologist would reccomend considerring your age and not knowing when/if you will need surgery,who knows what the reccomendations would be when you need one. As mary said things are really moving quickly in vlves and even anticoagulationFWIW right now, many/or most surgeons and cardiologist would reccomend a tissue valve for someone in their 60s or older, for a few reasons. Even then you dont ncesarrily have to go with your docotrs reccomendation, since you are lucky enough to have a "warning' Id probably spend this time learning as much as you can about various valves and anticoagulation and keep an eye on advancement and even rresearch trials going on. Having a nurse for a wife certainly should help.

BTW Thank you for your service.

 

[mn2mx]

I'm thankful for any and all responses. It's good to learn from people with experience on the subject.

 

[Bina]

My story was similar, but i was younger.
In my early 20s an alert doc noticed the murmur and it was named "mitral valve prolapse". It wasn't much of a nuisance until many
years later when I had some palpitations and tachy episodes. Then another doc thought she heard some AS in my chest and sent
me off to a cardio and echo test. Yup, Aortic Stenosis. No sign of BAV then and no sign of MVP either.
I think it was about 4 years later that my valve had closed down to .8 and I was in very very bad shape. Mostly my own fault
because I refused to have the surgery earlier due to caring for a very dear senior horse on my farm.
My choice was a mech valve since I was 46.

Anyway, it is a good idea to do it as soon as you can, or as soon as you feel comfortable with it, things don't get better.
Welcome to the group, TONS of experiences here, but all are very individual as well.

 

[Herb M]

I had a murmurof my aortic valve since I was a young child. It didn't bother me and I did join the Air force and was in flight status. Most physicians did not detect the murmur until I was in my mid- thirties. I had no symptoms until my mid- 50s. A few years later the phsician recommended to have a valve replacement while I was still in good health, except for some shortness of breath . I agreed and had a mechanical valve installed.

It is a good idea to delay the heart valve operation until you start getting some symptoms. There is always significant improvement in heart operations and valves. At your age you should be thinking about a mechanical valve. I wouldn't worry about the VA or Medicare dissapearing.

 

[dick0236]

I'm not sure what I'm asking here...I don't even know what to think about all of this.
.

I think you have summed up how most of us have felt after being given the news that open heat sugery was in our future.

A lot may happen in the next few years regarding health care AND heart surgical procedures.....and those are things that you an I can't do a lot about. Stay in touch with your docs and educated yourself about your problem and available solutions so that, when the time comes, you can make an educated decision. OHS, in an otherwise healthy, active 70 year old, shouldn't be a big problem, although your current lifestyle may, OR MAY NOT, need some adjusting.

 

[tprice54]

Welcome, and before anything else, thank you for your service in 'Nam. Now....please do not think your valve will deteriorate in a linear fashion...they tend to go bad faster the worse they get, if that makes sense. Also, best to get it done before your heart start changing, as sometime it may not remodel after surgery. Last, research all valves and you pick the one that you feel most comfortable with. Good luck!

 

[Mentu]

My experience is somewhat similar to your's. I'm 62 now and my valve was replaced 3 years ago. Although I was never in combat, my time in the Navy probably overlapped your own. That said, it is a shock at any age to learn that there is a degenerative problem in one's heart. You should be reassured, however, that this is a problem that can be fixed with an extremely high rate of success. As you read through our experiences, you will find that commonly cardiologists are poor predictors of when valve replacement may be necessary. I would encourage you to become familiar with the array of symptoms and monitor yourself between echo cardiograms. At the time of my valve replacement, the area of my aortic valve was 1.25 cm2 measured during a heart Cath; 10 months later at the time of my valve replacement, the valve area had declined to less than 0.75 cm2. It is possible for things to change rapidly during the last few months.

Many of us at first ascribe our symptoms to other things. I was sure that I just wasn't working out enough or walking far enough. In truth, I just didn't have the energy for the types of sustained exercise I engaged in before. Shortness of breath is certainly one symptom, but there are others. I developed a sharp pain in my side. As well, heart palpitations became a real problem and, although I never passed out, I felt "woozy" every once in awhile. Finally, driving home from work one evening and only a block from my house, I experienced radiating pain that shot across my chest rather like some of my Father's experiences when he had a heart attack. My valve replacement took place 8 weeks later.

As for the knee replacement, I can certainly sympathize since I am currently preparing for one in a few weeks. In likelihoodhood, your doctors will want you to wait to the knee surgery until several months after heart surgery but it is only a delay. In the mean time, you might consider swimming orecumbentbant bike trainer where you Cardiordio exercise without stressing the knees. It is important that you stay as healthy as possible before your valve replacement. This will help insure your recovery goes well. As I said, it is a shock to learn that you have joined our "Club" but this community can be very supportive when you have questions or just want to share your experiences or, for that matter, need to rant. A little ranting is good for the soul.

Larry