Valve Choice - Papers From the Medical Literature

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Hey I have a quick side question: I have minor peptic ulcers with some esophogeal erosion from reflux. Obviously there's some incrased risk of bleeding there... but does this make warfarin out of the question?
Aaron,

This history would certainly warrant a lot of discussion with your doctors. In my opinion, I would think warfarin is not impossible but only your doctors would have the answers or suggestions.
 
I would agree with Gina. It doesn't make warfarin out of the question. It just means that you should incorporate it into your discussions with your doctor in terms of possible later impact. If the doctors feel the conditions are temporary, they wouldn't have any effect on your health on ACT, and thus no effect on your decision.

Otherwise, it's intelligent to consider these issues in the larger scheme of anticoagulation, to determine if they are liabilities and how they should be handled.

As far as personality patterns... Personal experience and observation over time are valid tools. Trending is part of what I do for a living. The personality traits mentioned are from observations over the years, and are plainly generalized (see: "In general" at the start of each sentence). Insofar as they go, I think they indicate the trend. Remember, a lot of people don't get to pick their own valves, so valve recipients will fall out of those general patterns not just by the nature of variance, but also because their doctors were the choicemakers.

It's important for people to consider their general natures for valve choices. If your friends and doctors are all urging you to get a mechanical valve as the sensible choice, and you hate doctors and are already bad about taking medications because you instinctively resent them due to your personality, maybe you shouldn't listen to your friends. And vice-versa, of course, if a tissue valve will leave you feeling that you have surgery hanging over your head all the time.

And if you disagree with my interpretations, bringing it up in posts at least encourages people to explore the concept. Hopefully it will help people realize that they shouldn't suspend their personalities during the decision-making process due to pressure from the many well-meaning entities that surround all of us. We are the ones who live with the choices in the end.

Best wishes,
 
Hey I have a quick side question: I have minor peptic ulcers with some esophogeal erosion from reflux. Obviously there's some incrased risk of bleeding there... but does this make warfarin out of the question?

You need to have a Serious Discussion with your Cardiologist, Surgeon, AND Gastroenterologist (you do have a Gastroenterologist, don't you?)

What is being done to *treat* (and heal) your esophageal erosion?

The usual treatments include avoidance of 'triggers' for reflux such as Caffeine (including Chocolate, Coffee, Cokes, Tea, etc.), Peppermint, eating Large Meals, wearing your pants / belt 'too tight'.

Have you raised the Head of your Bed by 6 inches or so?

Are you taking any acid-pump inhibitors such as Nexium ("the healing medicine"), or Prilosec?

Pepcid is also prescribed just before bedtime to help control reflux while you sleep.

I'm not familiar with the treatment for Peptic Ulcers.
That would be a good question for your Gastroenterologist.

'AL Capshaw'
 
Well, I've been appreciating so much of the information from this thread and now I'll drop a couple of petty little opinions in:

Aaron, I was wondering if aspirin therapy might also be a problem for your gastro issues. And not related to valve selection, I'll suggest you really try hard to get on top of the erosion issue. Barrett's is eventually a precursor to full blown cancer and you don't want to go there. Cancer of the esophagus is, as it was seven years ago when my dad died from it, "the fastest rising incidence of cancer in the U.S." 50% of those cancers develop from chronic acid reflux issues. My husband found that less sugar and avoiding certain spices and losing a little weight got rid of his heartburn. Other people have other triggers. Find yours. Try to get rid of that hearburn.

Next, I usually thoroughly enjoy Tobagotwo's posts and also Bicuspidboys's posts. I think some of the grumpily-worded opinionated criticism could be one finger pointing at Bicuspidboy and three fingers pointing back? Are you doing what you complained he was doing? Or maybe I'm seeing it all wrong. I have been occasionally known to be grumpy and opinionated ;) ...

But, I did think this explanation from Bob slightly contradicted itself though: "...In general, people who like to be more in control of their surroundings or people who are petrified of the surgery tend to favor mechanical valves and warfarin. In general, people who are antithetic to authority figues, who don't want to be bothered, or who are fearful of outside dependencies will drift toward the tissue valves..." To me they contradict because I like to be relatively in control of my surroundings and I'm somewhat anxious of outside dependencies--the two fall together in my mind.

But I also enjoyed considering Bob's well-worded opinion. [edit - my post crossed another.]

Carry on. I've learned a lot from this thread. Hopefully I can remember it :) .
 
I'm not (and wasn't) offended by Bicuspidboy's comments. I didn't feel that I was out of line in offering those tidbits, but then again, I knew what I meant when I wrote them, so I may not be the best judge of how they're most often interpreted. So, for clarity, I'm altering that part of the post to make it more plain where those thoughts came from. Done and done: we're all friends in this scary place.

I don't use the acronym IMHO, because I'm but a poor substitute for Underdog's Shoe-Shine Boy alter ego - only somewhat lovable, and even less humble... :rolleyes:

Be well and happy,
 
valve replacement statistics

valve replacement statistics

An above post requested data regarding mechanical vs tissue trends. It is true that in the United States, about 80 percent of valve replacements are tissue now.

This trend toward tissue has been attributed to excellent long term reults of newer generation valves. The ACC/AHA guidelines even changed this year to say that tissue valves are acceptable to younger patients that are properly counseled (not an exact quote.)

This data can be validated by listening to EW and STJ quarterly investor updates as they do tons of research into implant statistics.

You can also see implant trends form the STS database if you don't like to use industry numbers.
 
I am meeting with a surgeon for the first time on Tuesday. There are only a few surgeons in my area that do this and they all work for the same practice. You say "they need to learn what questions to ask and how to find surgeons who offer those alternatives."" What ARE the questions I need to know to ask and how DO I find the right surgeon?
 
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