Thought I had my Mind Made up

[RealtorRick]

I am 52 yrs old. I have been 6 years in the waiting room for BAV. Now, scheduled to meet surgeon of 12/29, and finding out yesterday that I likely need shoulder surgery after healing from AVR, I am waffling. How will the coumadin affect rotator cuff or similar surgery? My fear is not the OHS but of having a stroke when getting off Coumadin for surgery? Also, I am fairly active and clutsy. My cardio said the bleeding issue is nothing to worry about unless it is internal like a bleeding ulcer, blunt force trama, etc. I will certainly ask for advice from surgeon and still think the odds are with me on the mechanical. But I hate taking my pills now and miss a dose about 1x per week. Would love to hear from anyone who had surgeries after AVR. And yes I know it ultimately comes down to personal choice. I guess I just want some one to blame other than myself I have regrets, lol.

 

[yotphix]

Hi Rick,
I guess that if you are either unable, or unwilling to become the sort of person who remembers to take their pills, or if you are inconsistent about exercise, diet, alcohol etc., or are prone to bashing your head, Warfarin may not be for you.
The thing is, none of that is particularly difficult to achieve if you want to achieve it. If it is important enough to you, you can take simple steps to make your life consistent (without making it boring - I live and work on a luxury motor yacht, travel to Europe annually, ride motorcycles and bicycles, inline skate, camp, am off to Asia in March and enjoy a rich and varied diet). What works for me is to simply keep track. I keep a daily diary of my diet and activity. The book is in the same bag as my meds, which I place on my pillow every morning so that I can't forget to take them before bed. Once I've taken them, I always record that I've done so, then put the bag where I know I'll be eating in the morning (or, if I'm in a hotel, I put it on top of my laptop) so I'll remember to put it back on the pillow at night. Airplanes and actual travel days are a little trickier but those are relatively few in number.
As I said though, you may be either unable (some people are just forgetful - I have a friend who bought a diary like mine to keep track of his heart meds, and could never remember where he put it!) or unwilling to make those sorts of changes in your life. That's ok too, because there is another option for people in those shoes. Barring catastrophic accidents or other illness which take you while you're still young, you must realize that for you a tissue valve likely means a re-op or even two. Your position is really the same as anyone deciding between types. You know yourself, and you need to ask yourself which is right given what you know.
For me, a small change in lifestyle was preferable to the certainty of another year of serious disruption of my life. In order to have surgery I had to come home from my position on the boat and establish my life there again, have the surgery, wait a month, then do six months of rehab before I could come back to work and even then it was some time before I was back to normal. The knowledge of that disruption now, makes me more sure that I made the right choice for me. It wasn't the hardest thing I've ever had to do, but I'd really rather not do it again. You may feel that a disruption like that is a fair price to pay for the convenience of being able to forget your meds and bump your head when you please!

 

[Lynlw]

Hi Rick, As Yoyphix said either option is good, whatever you think you would prefer to live with, Coumadin or needing the valve replaced in the future both should give you a long happy life. Altho I think If you are 52 now, chances of needing 2 more OHS are probably slim even If you do live a long happy life. Chaces are pretty good IF you did choose a tissue valve at your age when it needs replaced in probably 10-15 years (conservativly) IF that valve couldnt be replaced by cath IF you needed a 3rd one id be pretty surpirsed if that one would need surgery, which is one of the reasons many of the leading centers and surgeons are reccomendng tissue valves for people in their 50s (and even 40s)
sorry i have to cut this short, w got a new puppy Tuesday night and he figured out stairs now lol
good luck whatever choice you make should be fine

ps yes coumadin does make other surgeries a little more complicated but most do fine with bridging etc.

 

[dick0236]

Hi Rick, and welcome. Going off warfarin for shoulder surgery probably presents little problem because of the "bridging" drugs available. The fear of stroke is often "blown outa proportation" and is largely unfounded IF a simple protocol is followed......take the pill as prescribed and test routinely. I am also a cluts and have had my share of bumps, cuts and stitches over the years with little or no problem. Missing a dose of warfarin "every now and then" will not cause a stroke although it may screw up the next INR test....I found a seven day pillbox solved my problem of missing doses.

Having surgery on 12/29 is a helluva way to ring in the new year and I wish you an easy surgery and quick recovery :biggrin2:

 

[scott.eitman]

as for remembering to take your pill. You will, because you HAVE to. I used to forget my pills too, but now on Coumadin and I do not allow myself to. I bought a daily pill box to help keep track of whether I took the pill. I keep a set of pills in the office, just in case. I call home if I do not remember if I took it and have someone check the daily box. I know I am not supposed to, but if I forget, I take it later in the day. In a 17 months I have only missed one day.

best of luck and stay well.
Scott

 

[neil]

hi rick what ever you pick it has swings and roundabouts, anti coags the rest of your life or another reop, you would be unlucky to need another 2,your doing the right thing in having another word with your surgeon, remember both choices are good choices and are gonna save your life,

 

[Jkm7]

There is no wrong choice and the choice is hard.
Tissue valve for a 52 year old is a reasonable choice as long as you accept you well may need one more surgery. There's every chance the valve you receive at the first surgery could well last 15+ years at your age and a second should see you through a long, full life.

Certainly there are no guarantees anymore than there is with mechanical valves. It is always possible a mechanical could need replacing but the chances are far less.

I chose bovine and am so happy I did.
Each has to make that hard choice for themselves in consultation with their doctors.
Best wishes.

 

[Bill B]

Even though I was a pharmacist, I was a notoriously bad pill taker. Before I developed stenosis and had my AVR I rarely had to take anything, not even aspirin, so I was pretty bad if I ever did. But I knew with warfarin you have to be methodical. For me, the pill bottle is at the bathroom sink, and I take it right before I go to sleep every night, whatever hour that might be. I don't think I have missed a single dose in the 26 months I've been on it. It's something I questioned as to whether I would be a good candidate, like you, but it has been a complete non-issue. Also, bleeding issues are over emphasized. I don't know about shoulder surgery, but the use of bridging and other maneuvers around surgery with people on warfarin has been questioned recently. I would expect the orthopedic surgeon to know. My ENT seemed completely in the dark about how to handle a deviated septum repair in the presence of warfarin.

 

[bradvo]

I have shoulder issues as well that will need surgery to repair, I'm going to try and live with it as long as possible. My doc said I do need to heal more before we deal with it.
My shoulder is a constant ache with a very annoying pain. I might see about a prednisone shot in the shoulder to help with the uncomfortable pain.
I knew I had an issue before OHS, but my OHS took priority. I chose the mechanical because I want to avoid a second heart surgery. In my opinion after experiencing OHS I made the right choice for myself, I just turned 56 last month.

 

[RealtorRick]

Great advice. Guess I was feeling sorr yfor myself. I can do anything I set my mind to do. Taking a pill a day and testing is no big deal. Sounds like having my shoulder fixed will not be that serious. Just started reading about bridging.

 

[RealtorRick]

Am I reading that right, you had AVR in 1967 with a mechanical and nothing since? That is a pretty good testimonial for a mech valve!

 

[RealtorRick]

Thanks bradvo. Hope you get your shoulder thing worked out. I am waiting for an MRI to see the exact diagnosis, but I had a partial tear of the rotator cuff, (rotary cup as some locals call it), and am betting I tore it more. Not to mention the torn bicep that was never fixed. I got a cortisone and Novacain shot last Wednesday and as long as I do not lift over my head or pick up heavy items, I am ok. I am still leaning toward mechanical as I do not want a 2nd surgery, or third. Not that I am afraid but insurance and down time issues are biggest concerns.

 

[JeffM]

Hi Rick - Fellow Realtor here down in the DC area. Had my AVR at age 52 (3 years ago) as well and decided to go with a tissue valve for a lot of the reasons mentioned within this thread. I'm a very active guy and an avid cyclist, not a good pill taker, very concerned about the increasing risks of coumadin that come with aging and knew I'd be getting other surgeries. In fact, I had lumbar surgery 6 months after heart surgery and then prostate surgery last year. I'll probably have shoulder surgery in 2012 (we'll arm wrestle after yours). I expect there will be others too numerous to mention down the road and I don't want additional risks of stroke while I go off coumadin. Additionally, I hate regulating what I eat to manage my INR levels so that I'm not at risk for a bleed or a stroke from a clot. OK, now that I've shared my fears and reasons, I'll tell you that my mom is about to turn 74. She has had a mechanical aortic valve since '84 and been on coumadin since then. She's had at least a 1/2 dozen surgeries since then and she's doing great. She stays very active, works out all the time and maintains a healthy weight (about 11% body fat). One thing I should add about her though is she's very disciplined about her diet. Bottom line I guess is nothing is a walk in the park. Everything requires a little sacrifice and carries some risk. And both a mechanical and tissue valve will give you many wonderful quality years of life. Two absolute miracle options if you think about it. I've often considered that if only one of them were an option, we'd still be incredibly fortunate. I made my choice for tissue expecting I'd be undergoing at least one more full fledged AVR. Perhaps this one will last long enough so that its replacement will be implanted minimally invasivally (i.e., via transcatheter) but I'm not counting on it. That was a chance I was willing to take and I don't regret it for a minute. On the other hand, I wouldn't for minute say it's the right choiuce for you or anyone else.

 

[RealtorRick]

Thanks Jeff. Nice point about having a choice. Either way I win and continue to live with a better quality of life that what I have now. Talk about win-win situations!

Hi Rick - Fellow Realtor here down in the DC area. Had my AVR at age 52 (3 years ago) as well and decided to go with a tissue valve for a lot of the reasons mentioned within this thread. I'm a very active guy and an avid cyclist, not a good pill taker, very concerned about the increasing risks of coumadin that come with aging and knew I'd be getting other surgeries. In fact, I had lumbar surgery 6 months after heart surgery and then prostate surgery last year. I'll probably have shoulder surgery in 2012 (we'll arm wrestle after yours). I expect there will be others too numerous to mention down the road and I don't want additional risks of stroke while I go off coumadin. Additionally, I hate regulating what I eat to manage my INR levels so that I'm not at risk for a bleed or a stroke from a clot. OK, now that I've shared my fears and reasons, I'll tell you that my mom is about to turn 74. She has had a mechanical aortic valve since '84 and been on coumadin since then. She's had at least a 1/2 dozen surgeries since then and she's doing great. She stays very active, works out all the time and maintains a healthy weight (about 11% body fat). One thing I should add about her though is she's very disciplined about her diet. Bottom line I guess is nothing is a walk in the park. Everything requires a little sacrifice and carries some risk. And both a mechanical and tissue valve will give you many wonderful quality years of life. Two absolute miracle options if you think about it. I've often considered that if only one of them were an option, we'd still be incredibly fortunate. I made my choice for tissue expecting I'd be undergoing at least one more full fledged AVR. Perhaps this one will last long enough so that its replacement will be implanted minimally invasivally (i.e., via transcatheter) but I'm not counting on it. That was a chance I was willing to take and I don't regret it for a minute. On the other hand, I wouldn't for minute say it's the right choiuce for you or anyone else.

 

[Luana]

Additionally, I hate regulating what I eat to manage my INR levels so that I'm not at risk for a bleed or a stroke from a clot.

There is no need to regulate intake of greens and veggies when taking Coumadin.

 

[Lily]

Rick, you're right, valve selection is a personal decision. We each of us need to talk with our doctors and decide what we can live with. Neither choice is perfect. But hopefully you're going to feel much better with your new valve. Best wishes.

There is no need to regulate intake of greens and veggies when taking Coumadin.

I'm not on Coumadin or Warfarin. But my Doctors told me differently from this comment and my relatives' Doctors have told them differently. Also I have read differently. But don't take my word for it. Look for official prescription warnings. Here are some excerpts of warnings:

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From drugs.com regarding Warfarin:

Botanical (Herbal) Products and Foods

Exercise caution when botanical (herbal) products are taken concomitantly with Warfarin sodium. Few adequate, well-controlled studies evaluating the potential for metabolic and/or pharmacologic interactions between botanicals and Warfarin sodium exist. Due to a lack of manufacturing standardization with botanical medicinal preparations, the amount of active ingredients may vary. This could further confound the ability to assess potential interactions and effects on anticoagulation.

Some botanicals may cause bleeding events when taken alone (e.g., garlic and Ginkgo biloba) and may have anticoagulant, antiplatelet, and/or fibrinolytic properties. These effects would be expected to be additive to the anticoagulant effects of Warfarin sodium. Conversely, some botanicals may decrease the effects of Warfarin sodium (e.g., co-enzyme Q10, St. John's wort ginseng). Some botanicals and foods can interact with Warfarin sodium through CYP450 interactions (e.g., echinacea, grapefruit juice, ginkgo, goldenseal, St. John's wort).

Monitor the patient's response with additional INR determinations when initiating or discontinuing any botanicals.

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From rxlist.com regarding Coumadin:

HOW TO USE:

Read the Medication Guide provided by your pharmacist before you start taking warfarin and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication by mouth with or without food as directed by your doctor or other health care professional, usually once a day. It is very important to take it exactly as directed. Do not increase the dose, take it more frequently, or stop using it unless directed by your doctor.

Dosage is based on your medical condition, laboratory tests (such as INR), and response to treatment. Your doctor or other health care provider will monitor you closely while you are taking this medication to determine the right dose for you.

Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day.

It is important to eat a balanced, consistent diet while taking warfarin. Some foods can affect how warfarin works in your body and may affect your treatment and dose. Avoid sudden large increases or decreases in your intake of foods high in vitamin K (such as broccoli, cauliflower, cabbage, brussels sprouts, kale, spinach, and other green leafy vegetables, liver, green tea, certain vitamin supplements). If you are trying to lose weight, check with your doctor before you try to go on a diet.

Cranberry products may also affect how your warfarin works. Limit the amount of cranberry juice (16 ounces/480 milliliters a day) or other cranberry products you may drink or eat.

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And a link to Wiki info: http://en.wikipedia.org/wiki/Warfarin

 

[yotphix]

Originally Posted by Luana
There is no need to regulate intake of greens and veggies when taking Coumadin.

Regulate might not be the right word for it, but for me it is certainly easy to have a consistent INR when I eat a consistent diet, get consistent exercise etc. I don't weigh my foods, or break out a calculator, but, like many people taking warfarin, I consider when deciding on a meal what I've already eaten that day, the previous day, and what I might expect to be eating the following day. I also keep track of it in a daily diary, which I only refer back to if I can't remember what I've been eating, or if I have an anomalous INR. It has been helpful on a couple of occasions to solve the mystery of why I shot up or down. (I once realized, looking at an INR of 1.9, that I had been eating large spinach salads twice a day for three days, and broccoli and brussel sprouts. No great mystery if you have record of it. I had just been too busy to notice what I was doing. As Rick Perry says, 'OOOPS')
So perhaps not 'regulate' but certainly keep aware of, and consider. It really isn't that onerous. You have do decide what to eat, at every meal (or someone needs to decide on your behalf) whether you take warfarin or not. Why is it harder to decide to eat a consistent quantity of greens?

 

[bradvo]

Thanks bradvo. Hope you get your shoulder thing worked out. I am waiting for an MRI to see the exact diagnosis, but I had a partial tear of the rotator cuff, (rotary cup as some locals call it), and am betting I tore it more. Not to mention the torn bicep that was never fixed. I got a cortisone and Novacain shot last Wednesday and as long as I do not lift over my head or pick up heavy items, I am ok. I am still leaning toward mechanical as I do not want a 2nd surgery, or third. Not that I am afraid but insurance and down time issues are biggest concerns.

Guess you figured out what I meant when I said prednisone, yes cortisone is what I am going to ask for .

I learned how dangerous that shot can be tho, I had 2 in my right shoulder 5 years or so ago over a years time, I did not baby the arm at all since I felt no pain, one day while working in garage the ligament tore, took me to my knees it hurt so bad and left me with a popeye arm. That is the term I hear most anyway, the muscle fell lower and when I flex I get a bigger pointy muscle.

I need to call the coumadin clinic today and find out if I can get one or not ( not sure of the side effects with the thinner), I have a appointment this Friday with my GP.
Good luck
Brad

 

[RealtorRick]

Guess you figured out what I meant when I said prednisone, yes cortisone is what I am going to ask for .

I learned how dangerous that shot can be tho, I had 2 in my right shoulder 5 years or so ago over a years time, I did not baby the arm at all since I felt no pain, one day while working in garage the ligament tore, took me to my knees it hurt so bad and left me with a popeye arm. That is the term I hear most anyway, the muscle fell lower and when I flex I get a bigger pointy muscle.

I need to call the coumadin clinic today and find out if I can get one or not ( not sure of the side effects with the thinner), I have a appointment this Friday with my GP.
Good luck
Brad

Let me know what you find out regarding surgery. I am still waiting for MRI results but going ahead with AVR on 1/11.

 

[bradvo]

Let me know what you find out regarding surgery. I am still waiting for MRI results but going ahead with AVR on 1/11.

My Doctor said no cordisone shot at this time, coumadin clinic confirms this.
Currently I am favoring this limb in hopes it will calm on it's own...I can tell ya I have been using a dose of tiger balm or ligament rub , it helps quite a bit.