At age 49 (two months from turning 50) I was presented with the option of tissue or mechanical and told that if I went with tissue I would most assuredly need a second AVR ... Ticking away ... case closed....
Which Valve do you Have?
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Very thoughtful post from Ross. From the heart and thought-provoking, no matter your perspective on the Great Valve Choice (and sometimes debate).
My own thought is how bittersweet it is that it was Valerie who started this thread. It says something about her becoming such a vibrant presence here in a short time. Her spirit will live on here, I am sure.
My own thought is how bittersweet it is that it was Valerie who started this thread. It says something about her becoming such a vibrant presence here in a short time. Her spirit will live on here, I am sure.
C
Cem
Started Out with Hancock II (Porcine)
Started Out with Hancock II (Porcine)
.... and compulsory switch to the mechanical St. Jude HP in ...less than a 1 year.
Started Out with Hancock II (Porcine)
.... and compulsory switch to the mechanical St. Jude HP in ...less than a 1 year.
Ross
Well-known member
I just don't want people thinking I'm against tissue valves. That is not my point. There are times where a tissue valve makes perfect sense. All I'm trying to do is provoke people into thinking a bit harder about what they're getting into and hopefully, save a few lives.
All too often, daily actually, I hear a younger person 20-55, male or older female who can't get pregnant, but may lead an active lifestyle, that some would lead this person to believe that he/she couldn't do it on Coumadin, using that as an excuse to go tissue without the slightest thoughts of the Pandora's box that is being opened.
I want people to realize that those nice 5% or less mortality stats are only good if they happen to be one of them. In my opinion, it's 50/50 whether it's your first or fifth. People are telling others to listen to their surgeons, but what if this particular surgeon has a financial stake in the valve company? I'm simply asking people to do their own homework, think this over very hard, then make their choice.
We've lost 5 people this year. That is a record number for one single year here. I'm now questioning is that just fate or is it an indicator that things are becoming even more unsafe in surgery world?
All too often, daily actually, I hear a younger person 20-55, male or older female who can't get pregnant, but may lead an active lifestyle, that some would lead this person to believe that he/she couldn't do it on Coumadin, using that as an excuse to go tissue without the slightest thoughts of the Pandora's box that is being opened.
I want people to realize that those nice 5% or less mortality stats are only good if they happen to be one of them. In my opinion, it's 50/50 whether it's your first or fifth. People are telling others to listen to their surgeons, but what if this particular surgeon has a financial stake in the valve company? I'm simply asking people to do their own homework, think this over very hard, then make their choice.
We've lost 5 people this year. That is a record number for one single year here. I'm now questioning is that just fate or is it an indicator that things are becoming even more unsafe in surgery world?
Well, I am a porcine tissue person (got one at age 63) and I know there are a good many others on this board, including some Freestylers. But under the circumstances, I don't know how many will be checking in to this particular poll. Just thought I would make this point for the record, because I know I am not in a 1 out of 77 minority.
I agree, Bob, I don't think many are checking this thread.
kfay
Well-known member
Bob, I also got a porcine valve (St. Jude Biocor) at the age of 45. Originally, I don't think there was a catagory for porcine so I voted in the tissue/bovine catagory. I bet I'm not the only one.
Kim
Okay! All together now, "With an oink, oink here, and an oink, oink there, here an oink, there an oink, everywhere an oink, oink....":p
JohnCalderwood
Well-known member
Excuse my ignorance Ross but is taking Coumadin or warfarin just a matter of taking a pill a day? It may be for you. Doesn't the fact (I don't know if it is a fact) that it has too be so carefully monitored an indication that the blood has to be just right. Does this not offer other complications. Do I have to worry about nose bleeds that I used to routinely get? Will it have possible interactions with other meds I may be taking? It may just be a matter of taking a pill a day but from my limited use of prescribed meds. they come with a whole baggage of other issues. Am I wrong? Please don't hesitate to tell me I am wrong. Is it simply a pill a day? Are the rejection rates the same? What did the five people that died this year have? You have been around this stuff a lot longer than I have so I value your opinion. Is it always just simply taking a pill a day?
BlindFaith
Well-known member
Mooo... at age 56. for me, I felt I was borderline for either valve. Chose tissue because, well, frankly... my dad suggested it - strongly and I agreed. He has had Porcine, St Jude mechanical and last year got human (aortic valve and aorta). The mechanical lasted 18 years or so and then an infection nearly did him in. He had no issues with taking the drugs. But the point was made - nothing is guaranteed. I agree that with mechanical, the daily dosing does not appear to be a big issue at all and therefore nechanical would seem to be to majority choice... it is still a very personal choice. Peace.
dsouter
Well-known member
It isn't just a pill and people need to weigh the risk of 40+ years on it. At that duration , you are almost guaranteed to have some significant issues, whether external bleeds , internal bleeds or stroke. A close friend almost died from a nosebleed last spring. His INR was 2.8 , so not high, but he lost almost 2 pints by the time he made it to the hospital. He lives in the country, an hour and a bit from the hospital and lives alone.
Some people are more prone to these events.
I , personally have nosebleeds all the time and also have a family history of Collitis and Crohns and suffer occasional irritable bowel.
For me, the risk of re-operations is better until the 3rd one when I plan on going Mechanical.
Hopefully this is the correct choice and I will likely find out in the new year when I go in for my second valve. No date set yet.
It is about balancing the risks and finding what is acceptable for you given your body.
Ross
Well-known member
All drugs, including ordinary aspirin, are going to have some "baggage" with them. For the most part, those of us with mechanical valves pretty much consider it to be this way, but yes, there can be complications. You have to respect the drug. The whole point is, I'm for anything that will keep one from further surgeries, if it's at all possible. In the heart game, nothing is guaranteed, but mechanical is the best choice for the possibility of never having another OHS again.
See this thread to answer more of your questions:
http://www.valvereplacement.com/forums/showthread.php?t=33570
What did the 5 die of? 4 of them, complications from open heart surgery and 1 because he refused to have surgery.
For 46 years I was pill-free except for an occasional week of antibs or anti-inflammatories. Life was decent.
Since my OHS four years ago, daily meds have become a routine....Aspirin gave me nosebleeds (luckily I could drop it),
my Beta Blocker is just nasty, and I have to say that my daily Coumadin gives me the least trouble.
So, yes, for me (at this time) Coumadin is just a daily pill to take.
Of course, if I had ulcers or colitis etc, that would be another story....
Since my OHS four years ago, daily meds have become a routine....Aspirin gave me nosebleeds (luckily I could drop it),
my Beta Blocker is just nasty, and I have to say that my daily Coumadin gives me the least trouble.
So, yes, for me (at this time) Coumadin is just a daily pill to take.
Of course, if I had ulcers or colitis etc, that would be another story....
dsouter
Well-known member
I agree with Ross and just wanted to say that while most a people can live quite easily with Coumadin, some can and do have issues.
I would rather have avoided the upcoming surgery. What happened to Valerie has shaken me up a lot.
Having said that, I am still leaning towards Tissue for the reasons stated above.
Need my next tests and some serious discussions with surgeon after I get the results before I am 100% though.
dsouter, you live in Ottawa.....no problem, great hospitals.
Out here on the Ottawa area farms they will air lift for emergencies.
(haven't tried it yet)
Out here on the Ottawa area farms they will air lift for emergencies.
(haven't tried it yet)
Ross
Well-known member
It has most all of us. Thing is, I've been around here since 2001 and I've seen this happen more then most of the members here have. The other part is, twice I nearly bought the farm, so a lot of it is survivors guilt. I'm sorry if I come off wrong to people, that is not my intention. I just don't like the feeling I get when I lose one of you.
JohnCalderwood
Well-known member
Well I have switched in my head from mechanical to povine and now back to maybe mechanical again. Maybe I will just tell the surgeon to friggin surprise me. The Valerie passing has messed me up pretty good too. For the most part I think I am okay with the worst case scenario most of the time. I can't stop thinking about how Valerie made it through the operation was starting to recover and then went back under. I wonder if she was aware of anything after the operation. Maybe I will find out for myself. I was begging for this extra time in my head a few weeks ago. Now I just want it friggin over with. I agree with you Ross that operations, surgeries just friggin suck. Maybe mechanical is the way to go but then I have to think about this: What other drugs could interact with Coumadin?
There may be an interaction between warfarin and any of the following:
* acetaminophen
* alcohol
* allopurinol
* aminosalicylic acid
* amiodarone
* aminoglutethimide
* anti-cancer medications (e.g., carboplatin, cyclophosphamide, fluorouracil)
* ASA
* azithromycin
* "azole" antifungals (e.g., fluconazole, ketoconazole, miconazole)
* barbiturates (e.g., primidone, phenobarbital)
* carbamazepine
* cephalosporins (e.g., cefazolin, defoperazone, cefotetan, cefoxitin)
* celecoxib
* chloral hydrate
* chloramphenicol
* chlorpropamide
* cholestyramine
* cimetidine
* cisapride
* clarithromycin
* clofibrate
* danazol
* dextran
* dicumarol
* diflusinal
* disulfiram
* erythromycin
* ethacrynic acid
* estrogen-containing medications
* fenofibrate
* fenoprofen
* fluoxetine
* fluoxymesterone
* flutamide
* fluvoxamine
* gemfibrozil
* glucagon
* griseofulvin
* halothane
* heparin
* levamisole
* methimazole
* methyl salicylate
* methyldopa
* methylphenidate
* metronidazole
* nalidixic acid
* neomycin
* nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., diclofenac, ibuprofen, naproxen)
* omeprazole
* paroxetine
* penicillins (e.g., ampicillin, penicillin G, piperacillin, ticarcillin)
* pentoxifylline
* phenylbutazone
* phenytoin
* prednisone
* propafenone
* propoxyphene
* propranolol
* propylthiouracil
* quinidine
* quinine
* quinolone antibiotics (e.g., ciprofloxacin, norfloxacin, ofloxacin)
* ranitidine
* rifabutin
* rifampin
* rofecoxib
* sertraline
* St. John's wort
* "statins" (e.g., fluvastatin, lovastatin, simvastatin)
* streptokinase
* sulfinpyrazone
* sulfonamide antibiotics (e.g., sulfamethoxazole)
* tamoxifen
* tetracyclines (e.g., doxycycline, minocycline, tetracycline)
* thyroid hormones (e.g., levothyroxine, liothyronine, thyroid)
* ticlopidine
* tissue plasminogen activator (t-PA)
* tolbutamide
* trimethoprim - sulfamethoxazole
* urokinase
* vitamin E
* vitamin K
* zafirkulast
There may be an interaction between warfarin and any of the following:
* acetaminophen
* alcohol
* allopurinol
* aminosalicylic acid
* amiodarone
* aminoglutethimide
* anti-cancer medications (e.g., carboplatin, cyclophosphamide, fluorouracil)
* ASA
* azithromycin
* "azole" antifungals (e.g., fluconazole, ketoconazole, miconazole)
* barbiturates (e.g., primidone, phenobarbital)
* carbamazepine
* cephalosporins (e.g., cefazolin, defoperazone, cefotetan, cefoxitin)
* celecoxib
* chloral hydrate
* chloramphenicol
* chlorpropamide
* cholestyramine
* cimetidine
* cisapride
* clarithromycin
* clofibrate
* danazol
* dextran
* dicumarol
* diflusinal
* disulfiram
* erythromycin
* ethacrynic acid
* estrogen-containing medications
* fenofibrate
* fenoprofen
* fluoxetine
* fluoxymesterone
* flutamide
* fluvoxamine
* gemfibrozil
* glucagon
* griseofulvin
* halothane
* heparin
* levamisole
* methimazole
* methyl salicylate
* methyldopa
* methylphenidate
* metronidazole
* nalidixic acid
* neomycin
* nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., diclofenac, ibuprofen, naproxen)
* omeprazole
* paroxetine
* penicillins (e.g., ampicillin, penicillin G, piperacillin, ticarcillin)
* pentoxifylline
* phenylbutazone
* phenytoin
* prednisone
* propafenone
* propoxyphene
* propranolol
* propylthiouracil
* quinidine
* quinine
* quinolone antibiotics (e.g., ciprofloxacin, norfloxacin, ofloxacin)
* ranitidine
* rifabutin
* rifampin
* rofecoxib
* sertraline
* St. John's wort
* "statins" (e.g., fluvastatin, lovastatin, simvastatin)
* streptokinase
* sulfinpyrazone
* sulfonamide antibiotics (e.g., sulfamethoxazole)
* tamoxifen
* tetracyclines (e.g., doxycycline, minocycline, tetracycline)
* thyroid hormones (e.g., levothyroxine, liothyronine, thyroid)
* ticlopidine
* tissue plasminogen activator (t-PA)
* tolbutamide
* trimethoprim - sulfamethoxazole
* urokinase
* vitamin E
* vitamin K
* zafirkulast
John, probably at least 90% of the meds on your list I will never need or want to take, and for the few that I may need, I will just continue to take my Coumadin and use my trusty home monitor to keep an eye on my INR level.
(monitors are $499 where you live)
Otherwise, I would have loved to have a pig/cow valve, but I was only 46.
(monitors are $499 where you live)
Otherwise, I would have loved to have a pig/cow valve, but I was only 46.
JohnCalderwood
Well-known member
Bina and others,
How often do you need to use your machine to monitor your blood? How much of a supply of coumadin or warfarin are you prescribed? More importantly how long does it last? Is it costly?
How often do you need to use your machine to monitor your blood? How much of a supply of coumadin or warfarin are you prescribed? More importantly how long does it last? Is it costly?
I have been on the drug 40+ years, actually 42+ years. If I had to make the decision to have my valve replaced at age 31 again, I would definitely go with the mechanical again. Had I gone with a tissue valve, I almost certainly would have gone thru at least two tissues, maybe three and getting prepared for another operation as an old man. The risks associated with multiple surgeries, in my opinion, far out way any of the problems I have experienced with warfarin.
I had a "significant issue" after only seven years on the drug that was due to my own ignorance and mismanagement. I wonder how many "significant issues" I would have faced with multiple open heart surgeries over these years.
Mechanical or tissue valves have their own set of risks and both involves many important decisions.....do your homework and go with the set of risks you are most comfortable with.
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