Tissue Valve

[pellicle]

Hi

firstly that's a great post.

As a medical professional having done surgery for many years I sort of find it interesting that lay people think that what surgeons suggest is always optimal.

and this is exactly what shlts me the most about presumptuous arrogant posts like the one which (yet again) triggered this sort of lengthy response: none of us are doctors apparently. These dismissive people are seldom well meaning and indeed have no idea as to what reliance doctors have on being informed by people who aren't doctors.

Take for instance this excellent paper on managing warfarin. It is NOT a journal article, it is itself NOT research, Jeff is not a doctor or a surgeon, but Jeff is a Senior Lecturer in Clinical Pharmacy at The University of Auckland and a clinical pharmacist at Waitemata DHB. Before moving to NZ he managed a pharmacist-led, open access outpatient anticoagulation service in the UK serving a catchment of half a million people. The service ran eight clinics a week looking after only newly initiated and the most problematic patients.

If Jeff was posting here twats like the house flipper (sorry **** I accept your very understanding evaluation and I have my own) would dismiss Jeff if he was a poster here. Much as they would dismiss Al Lodwick were he posting.

Why is this line of argument even given (the line that "we are all just bloggers"), my view is (formed on many years here) that it is because "they were told" things by their doctor and they feel very uncomfortable in the emerging evidence that maybe what they were told was wrong. So they double down on it.

Let me furnish an example from my blog:
https://cjeastwd.blogspot.com/2011/08/why-discussion-gets-nowhere.html

A Professor from Georgia State University, Jason Reifler conducted a series of experiments that looked at whether people changed their views when they were presented with the correct facts. He found that not only did they not, but it reinforced their will to keep a grip on their existing views.​

...​

ELEANOR HALL: So not only did they not believe the facts that you were putting before them; they actually reinforced the incorrect views they originally had.​

​

JASON REIFLER: Exactly.​

​

ELEANOR HALL: What hope is there then for truth in politics?​

​

JASON REIFLER: The downside of the research that my co-author and I have done to date is that it's very depressing. We don't have a terribly good understanding yet of ways to try and improve public debate, to try and improve political dialogue.​

People like our house flipper will not be convinced and will indeed just double down on their beliefs like a martyr.

Further I think they also enjoy stirring up trouble.

Much of society has this idea that "belief" is what matters, indeed it is the core of what happens in religion. Faith in the "word". This is of course NOT what science is built upon, but we know from history that even physicists have trouble letting go of cherished ideas, thus Max Plank (Nobel prize winner) famously wrote:

“A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.”​

Best Wishes

 

[Superman]

One of my favorite parts of the movie, “Idiocracy”, and I paraphrase: “Joe finally gave up on reason and science and told them he could talk to the plants and the plants told him they wanted water.”

Fantastic movie. Coming true far quicker than the writer prognosticated.

 

[pellicle]

Fantastic movie. Coming true far quicker than the writer prognosticated.

it is, and sadly it is ...

 

[pellicle]

an interesting slant

Post-modernists believe that knowledge itself needs to be understood in a different way to modernists sociologists such as Functionalists and Marxists. It follows that not all theorists of post-modernity are post-modernists.​

sadly I think in "post modernity' we are going to regress not progress, because even this is in dispute

I see less and less "understanding of knowledge" even being on the plate at university now.

Society seems to be following this path now

 

[Superman]

an interesting slant

Post-modernists believe that knowledge itself needs to be understood in a different way to modernists sociologists such as Functionalists and Marxists. It follows that not all theorists of post-modernity are post-modernists.​

sadly I think in "post modernity' we are going to regress not progress, because even this is in dispute
View attachment 888342

If that’s space, then where are the stars!?! Plus, if that’s the moon and there’s no atmosphere, what’s blowing the flag!?!

 

[Chuck C]

If that’s space, then where are the stars!?! Plus, if that’s the moon and there’s no atmosphere, what’s blowing the flag!?!

Indeed! Have you seen my tin hat? I left it around here somewhere.

True story, friend in CO. Refuses a smart phone- only flip phone. We have to schedule our calls, because he always leaves the phone off otherwise. You know, so that they can't track him. And, no he's not a narco dealer. He flips homes for a living.

 

[dick0236]

True story, friend in CO. Refuses a smart phone- only flip phone.

Me too!.........and I don't give out my cell number.

 

[Chuck C]

Me too!.........and I don't give out my cell number.

And I thought my CO friend was the last hold out. Eventually you'll be talking about your flip phone that is 55 years old and still working

 

[dick0236]

And I thought my CO friend was the last hold out. Eventually you'll be talking about your flip phone that is 55 years old and still working

Ya never know. I still use my "corded" land line in my office/study and it has to be thirty years old......at least My Grandpappy told me to never thro out anything that still worked......and I never have to worry about putting it on charge

 

[carolinemc]

As a medical professional having done surgery for many years I sort of find it interesting that lay people think that what surgeons suggest is always optimal. First we are governed by our own experience, where we trained and hopefully continued review of the medical literature. We attend meetings and conventions and read journals. First it is sort of assumed that most medical questions are answered by studies. Unfortunately there are many questions that good studies are not available for. Studies can be influenced by where and who did them by bias based on patient population in the study and innumerable other factors. Studies provide guidance but they often are not definitive. There are studies on various valves but are there studies over many years of sequential treatment? For example what happens in patients who have a bio prosthetic valve and then go on to TAVR? There might be a few small studies but not yet a large well done definite study.

Equipment manufacturers bombard us with "detail" people who try to influence our choices. For example the idea of low INR levels as touted by the ON-X company is pounded into everyone's thinking. Each institution has it's own culture and ways of approaching how to do things. The Mayo clinic may do things a bit differently then the Cleveland clinic. And each surgeon in an institution may do things differently than their colleagues.

I think that a good physician should be aware of these influences and try to paint an accurate picture as possible to the patient what the limitation of our knowledge is and what we feel is well established and clearly defined.

As I have said previously if there was an obvious approach to a medical issue than everyone would be doing it. The fact that there are multiple approaches just means that they all have their pros and cons and each doctor and patient needs to make the best decision AT THE TIME.

When I had my third open heart due to an aortic aneurysm at age 58 I had a choice of a bioprosthetic valve or another St. Jude. The surgeon said you don't want someone in your chest a forth time. So I had a St. Jude placed. I heartily agreed with that since I am not a fan of heart surgery. This was before TAVR was available. As I have also said EVERY PROCEDURE HAS RISK so as a general rule fewer is better. Warfarin has risk. So pick your poison.

Also in regard to **** he probably had an Occipital stoke if he lost inferior field in both eyes simultaneously. This most likely was from an embolus from the valve most likely due to inadequate anticoagulation. Today with self testing this would be much less likely. So things do change with time. Maybe the Foldax valve will work out and solve many of these issues but we won't know for many years.

We here value our doctors and surgeons. And no need to bash lay man, for we layman know how to do our homework and get knowledge from reliable sources. You cannot come here diagnosing people without their permission, nor without knowledge of their medical history. Please just concentrate on yourself and give advice, no diagnosing, which make people think in it fine to get diagnosed online, which is a dangerous thing to do with all health issued. And Warafarin is not a risk, it is a must for many of us here, no matter the heart issue. Have a nice day at stop diagnosing people on this board.

 

[carolinemc]

We all are experienced, not doctors and value all medica resources and experiences here.

 

[carolinemc]

Some of this reminds me of a buddy of mine. He’s a big fan of the movie, “Fast Times at Ridgemont High”. Knows all the famous quotes and a lot of the less well known funny bits. For whatever reason, that’s his thing. Can’t quote many other movies. He always says his knowledge is deep, but not broad.

Sean Penn was in the movie. I would not be surprised if my friend could quote more of the movie than Sean Penn. My friend can’t act. Wouldn’t get a part in any other production. But he knows a lot about that movie. Penn has long since moved on and has had an extensive career in acting. That was just one movie he did when he was young.

Even though many of us aren’t doctors, we can read and know a lot about our specific situation. Until recently it was difficult to even find a cardiologist that specialized in adults with congenital heart defects. I’d bring up studies or issues I’d read about that my cardio would have to look into and get back to me.

I’m not saying anyone here is a doctor (although some are). But to dismiss the experiences and knowledge of board participants as just a bunch of internet knuckleheads that don’t know what we’re talking about is a bit extreme as well.

People here are just sharing their experiences and answering questions about how we dealt with decisions and situations that new folks are facing. What they do with our experiences and how they apply to them, that’s ultimately their decision.

I agree due to the fact I have been a heart patient since birth, congenital heart defect with heart murmur of the aortic valve, which was replaced with St. Jude's valve and had a great heart surgeon and great Cardio-Vascular specialists. I would never bash anyone here as a layman not knowing anything, for many here have helped me over the past 20 years, to guide me, held my hand and when I had to leave for a few years. was here when I got back. I have certain experiences that I have shared for others to learn from. I even had a quack Cardio once, took my blood pressure and put me on blood pressure med, after saying I was 500 over ? Never said over what. But I was not scared off from Cardio's, for most of them would never do BP. But I love it here and the shared experiences and knowledge for they are laypersons and know more that some GP. Have a great day, Superman.

 

[Daniel758]

sadly it is not a straw man argument it is what is implied by you saying don't ask here. You failed to address my point about "what if there are conflicting advices" from medical professionals ...

It is the very definition of a straw man argument. A straw man argument deflects away from the actual argument which you know you can't defend and sets up another false argument, the "straw man", that you can.

In this case, you deflected my actual argument that you are not an expert, you do not have the education, expertise, etc., and that you should not pretend to be an expert and present yourself as such to vulnerable people coming here to this forum because it's dangerous and could cause them harm into a false argument that you could defend, ex. me claiming people here should have no opinions, this forum has no value, etc., etc., which is the "straw man" and false since that is not what I said at all.

The straw man does appear to have served its purpose, though, as it has riled up a number of people and successfully deflected away from you having to admit that you really shouldn't be giving out medical advice.

Also, my apologies for not going through your straw man rants and addressing you point by point but your rants are quite extensive, chaotic and irrelevant to the actual argument.

I have to look again but I think your rants have also now devolved into name calling ("****"?), etc. and now seem to be mostly ego driven and written to prove to others here that you are not "full of baloney" (to put it nicely ).

I did find one interesting passage included in one rant that was quite telling and may explain a lot of things you do and say here on this forum, and why you may feel that you are, indeed, qualified to give medical advice.

I believe it was where you said that you discuss medical issues with your doctors as "equals".

That's a pretty bold claim that I'm not sure your doctors would agree with but... okay... if you say so.

I do know, however, that it certainly brought a chuckle to my morning and I want to say thank you for that.

Now I have to get on to the rest of my day so you have a good yourself and stay safe.

 

[Daniel758]

...when I discuss things with medical specialists they don't eye roll , they engage and we discuss it. I do not pretend I can be a cardiologist, but I do know that on specific topics I can engage as an equal.

Here's the part I like...

And I know I should not ask this... but...

Pellicle, when your medical specialists or your cardiologists are presented with an unusual or especially difficult case, do they have your number on their speed dial to consult with you or do they just automatically send a Bat Signal out into the skies throughout Australia (in case you're on your scooter and out of cell range)?

I'm curious.

 

[pellicle]

I'm curious.

well yes, you are quite a curious specimen, although not unusual on the internet: you're a troll and one unable to assess why they don't know enough to comment.

 

[Superman]

It is the very definition of a straw man argument. A straw man argument deflects away from the actual argument which you know you can't defend and sets up another false argument, the "straw man", that you can.

In this case, you deflected my actual argument that you are not an expert, you do not have the education, expertise, etc., and that you should not pretend to be an expert and present yourself as such to vulnerable people coming here to this forum because it's dangerous and could cause them harm into a false argument that you could defend, ex. me claiming people here should have no opinions, this forum has no value, etc., etc., which is the "straw man" and false since that is not what I said at all.

The straw man does appear to have served its purpose, though, as it has riled up a number of people and successfully deflected away from you having to admit that you really shouldn't be giving out medical advice.

Also, my apologies for not going through your straw man rants and addressing you point by point but your rants are quite extensive, chaotic and irrelevant to the actual argument.

I have to look again but I think your rants have also now devolved into name calling ("****"?), etc. and now seem to be mostly ego driven and written to prove to others here that you are not "full of baloney" (to put it nicely ).

I did find one interesting passage included in one rant that was quite telling and may explain a lot of things you do and say here on this forum, and why you may feel that you are, indeed, qualified to give medical advice.

I believe it was where you said that you discuss medical issues with your doctors as "equals".

That's a pretty bold claim that I'm not sure your doctors would agree with but... okay... if you say so.

I do know, however, that it certainly brought a chuckle to my morning and I want to say thank you for that.

Now I have to get on to the rest of my day so you have a good yourself and stay safe.

Frankly, your actual argument isn’t worth arguing because it’s akin to, “Have you stopped beating your wife?” You start with a conclusion and demand that pellicle defend himself.

Personally I don’t see saying what we would do or have done as telling someone else what to do. It’s providing the personal experience that people come here asking for. I don’t see pointing out peer reviewed articles and linking them and encouraging folks to read them as telling them what to. It’s giving them information that actual doctors have learned by studying similar data. Are those doctors somehow unqualified? Nor is pointing to research that discusses standard of care a disservice just because it might disagree with their current provider.

I see it as providing information that allows someone to make a well informed decision. You keep putting doctors on a pedestal. A surgeons decision could be as simple as:

1.). The Edwards folks call my office a lot.
2.). I know I can get a response when I need one.
3.). I’ve never been sued using this valve.


All of which are perfectly valid from a medical professionals point of view. But the notion that they take your individual circumstances and want to do what’s best for you as an individual is silly.

It’s like buying a car. There’s no one absolute best car for your situation that only the salesperson can help you identify. You need a car, almost any will work. You get the one that you’re most comfortable with.

How many times have they not even looked at your chart when they come into the appointment? “We talked about this last time and I just repeated it all to your nurse. Again.”

 

[Superman]

Ya never know. I still use my "corded" land line in my office/study and it has to be thirty years old......at least My Grandpappy told me to never thro out anything that still worked......and I never have to worry about putting it on charge

My landlines stopped working in 2004 when I stopped paying a phone bill. Hardware is paid for. My phone service is basically free with my ISP now. There are enough wifi hotspots where I only pay the minimum $12 a month for a little data if we’re in the middle of nowhere and I need Google maps. And that’s for six lines.

 

[vitdoc]

We here value our doctors and surgeons. And no need to bash lay man, for we layman know how to do our homework and get knowledge from reliable sources. You cannot come here diagnosing people without their permission, nor without knowledge of their medical history. Please just concentrate on yourself and give advice, no diagnosing, which make people think in it fine to get diagnosed online, which is a dangerous thing to do with all health issued. And Warafarin is not a risk, it is a must for many of us here, no matter the heart issue. Have a nice day at stop diagnosing people on this board.

First of all I just commented on what **** already told everyone. He had a stoke. And it turns out my "guess" was correct and **** was not upset. And yes warfarin is a must but it also has risk, these are not mutually exclusive. And nowhere in my post did I "bash lay man". All I said is that no one including cardiac surgeons have the definitive answers to what exactly to do in valve repair.

 

[pellicle]

And that’s for six lines.

I'm guessing this is VoIP right?

I used to use that but fortunately Australia modernised and now cell (we call it mobile) plans are pretty competitive and have good coverage. To my mind Finland was the benchmark on this (in all aspects ranging from coverage, services provided and costs) but Australia caught up.

Some older blog posts:
https://cjeastwd.blogspot.com/2010/05/phone-bills.html
https://cjeastwd.blogspot.com/2010/12/my-pennytel-experience-cont.html
now I pay something like this:

which is of course more than your $12 but that's for my entire phone and internet system and additional sims are about $5 a month and pool off the data.

There are no "minutes" deducted for incoming calls and I also get unlimited calls to a host of other countries like Canada, USA, UK .... (32 in all) which helps me to keep in touch with friends and relations in other places too.

I'm not sure of the value of this information to you though...

 

[pellicle]

All I said is that ...

try my advice:
https://www.valvereplacement.org/threads/making-vr-that-bit-nicer.888377/post-913422