Valve choice and snow skiing

[inlaguna]

Now that your decision is made........don't look back.


Best of Luck

Dan

 

[gageyk]

Picking the valve is as much fun as waiting for the surgery. Glad to see you've made your choice. Now that's out of the way, may I ask as to the specifics of why they want to go tissue? I'm just curious as to the how these discussions went with these gentlemen. Trying to get their mindset as to what they're thinking is today.

Primarliy concerned with impacts to the head. I do wear a helmet when skiing and snowboarding. Remember, I've averaged 50 days a season on snow for the past 25 years and spend very little time on the groomed runs so the doc's feel I'm suceptible to injury more than the average skier. All four felt the same way. I did not let them what each other had said until they had made their recommendation.

Two other key issues brought up was time spent in the backcountry, winter or summer, and if a head trauma occured how long it could be before getting proper medical attention and travel to locales for 2-3 week periods that would make coumadin management more difficult. My family and I average an overseas trip every 2 years.

The last surgeon I talked to recreates the same as me at a similar level. I felt comfortable that he knew what the risks are for a person who enjoys the things we do.

I'm comfortable with the decision knowing that I can get a few more years of fun at the same level as the previous 25 years.

 

[Ross]

O.K., just curious as to how they were thinking, that's all. Good for you. Now, get fixed and get better.

 

[Gail in Ca]

I snow and water skiied while I had my pig valve.
No problems at all.
Now I have mechanical and I do not do those activities any more. Too risky for me.
Gail

 

[Rory]

Oh, how I wish that I had known about this website before my surgery, which was in November 2000. I am a 58 year old female, so I was 53 then; I was having heart failure due to congenital aortic stenosis and a bicuspid valve. I thought it was ridiculous that I had to make such a monumental decision about a valve that would affect the rest of my life when I was so weak. My surgeon refused to recommend anything -- just explained the pros and cons of different choices. I did online research and read a lot and chose the "homograft". It took me a long time to get my strength back, but I am doing great now. It is wonderful to be living in a time when things like this can be corrected. I live with the knowledge that I will have more surgery if I live long enough%, but there are no guarantees with the mechanical valves, either. It seems to me that neither choice is perfect and I agree with whoever said "don't look back." I hope your surgery went well.

 

[TomS]

Big time skier too- here is my two cents

Big time skier too- here is my two cents

I'm 48 and had my aortic valve replaced with a mechanical four weeks ago. Like you, I had been tracking a murmer it for years with no symptoms, then it went south in May. My first question all along was "can I ski with a mechanical valve", since we ski every weekend from November to April. The universal answer was "yes, but from now on wear a helmet". Frankly, we ski a lot on holiday weekends and I've had enough close calls to make me consider getting a helmet anyway. Some of my friends have already gotten one. So, my valve choice actually came down to "helmet versus another open heart surgery". Not a very difficult one in my mind.
My brother had a mechanical aortic valve put in about 11 years ago. He is totally active and behaves like he has no restrictions. So I have had a point of reference point going into this, and based on assessment wasn't concerned with the coumadin issues. I also asked my brother if he had chosen a bio valve would he be ready to go back for another surgery right now, and he said "no, no thanks". Plus, the surgeons told me that the risk goes up to about 5% for the second operation due to scar tissue, and that you want to avoid a third if possible. At our age, all of this would be in the cards. Furthermore, my research told me that it looks like the more active that you are with a bio valve, the faster it will wear out.
The operation is not horrible, but in my opinion it is something that you want to avoid.
A week after I came home from the hospital some of my friends stopped by - and brought me a new Boerl two tone helmet. Now my son wants one too.
Best of luck in your decision.
Tom

 

[Mary]

I wanted to mention that hopefully gageyk is no longer worrying about valve choice. He posted two weeks ago that the surgery has been postponed indefinitely.

 

[djexec]

Valve Options - on-x

Valve Options - on-x

Im curious to know what you decided or have you postponed your decision? I was reading today about the on-x valve www.onxvalves.com which I was initially intrigued about after reading a post from Bob H (tobagotwo). It seems that their valve may only require aspirin as ACT.

 

[Ross]

Im curious to know what you decided or have you postponed your decision? I was reading today about the on-x valve www.onxvalves.com which I was initially intrigued about after reading a post from Bob H (tobagotwo). It seems that their valve may only require aspirin as ACT.

At this point in time, even with On-X you must be anticoagulated. Their studying the aspirin thing, but don't count on it happening anytime soon. My surgeon wanted to use it in me, but they don't have any with a grafting sleeve attached and that's what I needed.

 

[djexec]

Ross Procedure

Ross Procedure

Jim
what is the expected functionality of the Ross Procedure versus other tissue options. I am 36 and will be having AVR in a month or so as well as an ascending aeortic aneurysm repaired and would like any additional info or resources that you could share to aid in my decision. thanks!
deane

 

[Mary]

Jim
what is the expected functionality of the Ross Procedure versus other tissue options. I am 36 and will be having AVR in a month or so as well as an ascending aeortic aneurysm repaired and would like any additional info or resources that you could share to aid in my decision. thanks!
deane

Deane,
You need to do a search on the site for Ross Procedure. There is a great deal of information concerning it. Shine_on_Syd provided much information when he was presurgery; particularly with resources online from Dr. Paul Stelzer. Pappahappystar also had the Ross and has given his rational for why he chose it over a tissue or mechanical valve. You can do a member search of posts and bring up the threads pertaining to it, or look back at the Valve selection forum and pull threads up from there.
I hoped to have the Ross Procedure but I started having TIA's from the valve calcification (amaurosis fugax suggestive of embolization) and chose not to wait and make the trip to New York.

 

[maryann1941]

Hello and welcome

I'll start by saying that most, not all, Doctors haven't the foggiest clue as to how Coumadin works. That is our experience here and I've had personally experienced myself. My surgeon couldn't get a handle on it, but my Cardiologist does. As long as you are taking necessary precautions against head injury or significant trauma, I don't see why you couldn't continue your winter recreation. If the medical community had it their way, they'd place us all in rocking chairs to finish our remaining days. None of us will give them that satisfaction. There is so much myth and misunderstanding about Coumadin, that most physicians are relying on knowledge of the stone age and have never gotten up to speed on recent events. Everyday, we wonder if we'll see them all on the same page in our lifetimes.

With that being said, the thyroid problem may be a deciding factor, but even then, if you were on Coumadin, the dose would be adjusted accordingly.

http://www.warfarinfo.com/levothyroxine.htm

It's really your call. No matter what valve you choose, there is no guarantee that you won't need another reop, but going tissue would pretty much guarantee at least one more in your life time. I'm for anything that keeps you out of the surgical scene. I truly believe you should only consider doing this one time and no more, even though others have done it many times. Each successive surgery presents it's own set of problems. Another thing, if you went tissue and develop afib afterwards, your going to be on Coumadin anyhow, so that is distinct possibility to consider.

I'll let others weigh in, but your kind of at that age where either choice is difficult. Tissue makes sense in lots of ways, but then again, it doesn't. What is your gut instinct telling you?

I just had Aortic valve replacement on Sept 26. a Tissue valve. i am 64 and still a snow skier and had no symptons. My condition was picked up during a routine physical in May. After a number opinions, I opted for Minimally invasive surgery and a tissue valve. My surgeon said that skiing was out if I was on Cumadin. After 3 weeks I feel really strong and can drive locally and can lift start lifting weights in my work out- up to 15 lbs. If you can have minimally invasive that is the way to go. I will be off cumadin on Nov. 15 and will be on 1 aspirin a day. right now i have to get blood tests twice a week to check that my cumadin level isn't too high. good luck

 

[tobagotwo]

I'm partial to tissue valves, but only for the right reasons.

I do not believe, from my time on this site, that snow skiing is rendered that much more dangerous by the use of Coumadin. It's your skill that matters, warfarin or not. One minute you're Jean-Claude Killy, the next, you're Sonny Bono. Not being on Coumadin didn't help Sonny Bono at all.

The more treacherous, fanatic mountain biking seems more of an obvious risk, but "regular," rugged mountain biking shouldn't be.

The key is mostly to avoid head injuries.

Interactions with other drugs can be very important, and you should ask if that's a driving factor in so many doctors recommending a tissue valve. That may be a reason on its own. Look to the suggested Al Lodwick site for good information.

There are many reasons to favor a mechanical or favor a tissue valve, or a Ross Procedure. I just don't feel that skiing (or most active pastimes) is one of the more defensible ones for eliminating mechanicals. That doesn't mean a tissue valve isn't right for you; just that you might want to review your options in another light. If you're fully decided on a tissue valve, then you should consider which type you want to have.

Here are some things from a thread for someone about your age. I suggest you read the whole thread, as there are a multiplicity of valuable opinions there, but I will point you to these two as some of my own thoughts about your time of life and mechanical, tissue, and Ross options:
http://www.valvereplacement.com/forums/showthread.php?p=146878#post146878 and http://www.valvereplacement.com/forums/showthread.php?p=146989#post146989

Best wishes,

 

[Ross]

I just had Aortic valve replacement on Sept 26. a Tissue valve. i am 64 and still a snow skier and had no symptons. My condition was picked up during a routine physical in May. After a number opinions, I opted for Minimally invasive surgery and a tissue valve. My surgeon said that skiing was out if I was on Cumadin. After 3 weeks I feel really strong and can drive locally and can lift start lifting weights in my work out- up to 15 lbs. If you can have minimally invasive that is the way to go. I will be off cumadin on Nov. 15 and will be on 1 aspirin a day. right now i have to get blood tests twice a week to check that my cumadin level isn't too high. good luck

Congratulations! There isn't any reason why you couldn't ski while on Coumadin. Doctors would put us all in rocking chairs on the porch because of very old beliefs and ways. Very few of them are up to speed on Coumadin and that's a concern.

If they are testing you twice a week, chances are they don't know how to manage Coumadin. It takes 3 days for a dose to appear in the blood test, so if they are testing too frequently and changing doses all the time, they have you chasing your tail. Thankfully for you, it won't be long till your off of it and no more testing, but it would be nice to know if this is what they are doing.

 

[bobcatrel]

valve choice

valve choice

I too am very active - running my first 5K since OHS 9 weeks ago. The decision is very difficult and very personel. There were 3 areas that concerned me and resulted in my decision to go with a tissue valve.

My activity level - I run, mountain bike or cross country ski 5 to 6 days per week. The majority of the times I am alone miles from the nearest house. I was concerned about an accident when being on blood thinner for a mechanical valve.

My surgeon told, after I asked, that every year of your life, you have a 1% chance of a major incident when on coumadin. A major incident he defined as uncontrolled bleeding or a clot.

Finally, my own personal view that if you can do anything to stay off a medication - do it.

These three reasons resulted in my decison for a tissue valve.

I was able to go into surgery very confident that I had made the right decision for me. You should feel very comfortable with whatever decision you make. It helps with your outlook on the OHS.

 

[Ross]

Not trying to pursuade anyone here nor start conflict, but before buying everything you hear about Coumadin, research the facts for yourselves. Doctors for the most part, are not giving accurate information, heck most of them can't even manage a Coumadin patients dosing. There are so many horror stories from the old days about Coumadin that have carried over into today that it's not funny at all.

I'll take my Coumadin anyday over another surgery!

 

[MarkU]

The mech v tissue thing is going to be a controversial/emotional issue until they either develop a mech that doesn't require anti-coagulation, or a tissue that doesn't wear out or calcify.

No wrong choice. Either one will keep you alive & kickin', which was the primary objective the last time I checked. The rest is all just details.

I do fully agree with Ross about Coumadin. Really not a big deal. It only affects your lifestyle if you let it. I'll leave it at that for now...

Mark

 

[sweetmarie]

I k now this is a really old thread but I wanted to add a personal comment pertaining to wearing a helmet while skiing. I had OHS with mech. valve in jan/2011. I haven't skied since, not because of the OHS/coumadin but of other factors. I started wearing a helmet in about 2004,, years prior to being on coumadin. I had taken a flip and banged my head, that's when I decided to go the helmet route although I was thinking about it.
I know I may get flamed for this comment but people, do not let your appearance stand in the way of you wearing a helmet. I would think that the other skiers are a little more interested in looking at your skill level and probably your skis/goggles more than your helmet. I know for a fact that a lot of skiers refuse to wear helmets because of the way it makes you look or messes up your hair, etc. The same goes for snowmobiling, hockey, etc. I always carry a ball cap in my skiing bag to wear for the "apres ski". I can tell you that I would never ski again without it, it cuts down on the wind and keeps you warm. Granted I don't do the spring skiing (snow too soft for me) so the warmer temps aren't a factor.

Safe skiing everyone.
SM

 

[Greg a]

I k now this is a really old thread but I wanted to add a personal comment pertaining to wearing a helmet while skiing. I had OHS with mech. valve in jan/2011. I haven's skied since, not because of the OHS/coumadin but of other factors. I started wearing a helmet in about 2004,, years prior to being on coumadin. I had taken a flip and banged my head, that's when I decided to go the helmet route although I was thinking about it.
I know I may get flamed for this comment but people, do not let your appearance stand in the way of you wearing a helmet. I would think that the other skiers are a little more interested in looking at your skill level and probably your skis/goggles more than your helmet. I know for a fact that a lot of skiers refuse to wear helmets because of the way it makes you look or messes up your hair, etc. The same goes for snowmobiling, hockey, etc. I always carry a ball cap in my skiing bag to wear for the "apres ski". I can tell you that I would never ski again without it, it cuts down on the wind and keeps you warm. Granted I don't do the spring skiing (snow too soft for me) so the warmer temps aren't a factor.

Safe skiing everyone.
SM

AND YOU DON'T HAVE TO SPEND A LOT

:biggrin2:​

 

[contactstevek]

Valve Choice and Coumadin =

Valve Choice and Coumadin =

Hello and welcome

I'll start by saying that most, not all, Doctors haven't the foggiest clue as to how Coumadin works. That is our experience here and I've had personally experienced myself. My surgeon couldn't get a handle on it, but my Cardiologist does. As long as you are taking necessary precautions against head injury or significant trauma, I don't see why you couldn't continue your winter recreation. If the medical community had it their way, they'd place us all in rocking chairs to finish our remaining days. None of us will give them that satisfaction. There is so much myth and misunderstanding about Coumadin, that most physicians are relying on knowledge of the stone age and have never gotten up to speed on recent events. Everyday, we wonder if we'll see them all on the same page in our lifetimes.

With that being said, the thyroid problem may be a deciding factor, but even then, if you were on Coumadin, the dose would be adjusted accordingly.

http://www.warfarinfo.com/levothyroxine.htm

It's really your call. No matter what valve you choose, there is no guarantee that you won't need another reop, but going tissue would pretty much guarantee at least one more in your life time. I'm for anything that keeps you out of the surgical scene. I truly believe you should only consider doing this one time and no more, even though others have done it many times. Each successive surgery presents it's own set of problems. Another thing, if you went tissue and develop afib afterwards, your going to be on Coumadin anyhow, so that is distinct possibility to consider.

I'll let others weigh in, but your kind of at that age where either choice is difficult. Tissue makes sense in lots of ways, but then again, it doesn't. What is your gut instinct telling you?

This is my first entry on this blog-
I appreciate your comments about Coumadin. You are correct in that I have had a few doctors scare me with thier coumadin commentary. However, if you read some of the objective research on the web you will see people are doing very well on coumadin. There are also some great advances in altermatives to coumadin and adjustments downward on INR levels for those needing aortic valve replacement only. It's always confusing and exciting to hear about the guy that just found out he needs to replace his tissue valve after 20 years. Amazing! But then there's the guy that needs it after 5 years. I still don't know what's the best way to go either but it seems progress is happening right now and we'll all benefit from this. That's a good thing.