Will I need another valve replacement?

[pellicle]

Hi

Pellicle, you know very well that nobody on this board has the deep pockets or the required degrees "to conduct research and submit this as evidence challenging their findings."

shakey assumptions. I have a research masters in Environmental Science, how do you know what others have?

I object to your dismissive approach and further I object to your doggedly attempting to tag me with something. You asked a question let me remind you of it since you seem unable to recall it:

I agree Superman, I have not heard of these long term risks to which Pellicle refers.

so I gave you what I thought may been percieved as the risks.

Prodromos
...but why does it seem uncommon to get a mechanical valve at 22?

Please note my reply

It could be related to people attempting to avoid long term effects of warfarin.

However, I believe you are mistaken with your statement of "agree with it or not it is an effect."

the journal article makes clear that a correlation exists in the sample he took, this implies that warfarin has an effect on the bone density. This effect is actually made clear in another study I linked to ... did you read it

Just because your one article says that there is a statistical correlation, does not make it an effect.

What?? that it was the only significant difference in the cohort means that there is some effect of warfarin on the bone structure as observed by that researcher. There are more articles if you care to search ... Look, personally I don't give a stuff about it and was trying to answer another persons question. You said you had no idea what possible long term effects I could be referring to and I answered it. I'm sorry that you are personally upset by facts. Sometimes facts get in the way of our beliefs.

I did not say I agreed with it and if you read my answers again its quite obvious I was implying I don't think its a risk.

You seem to have no idea what a peer reviewed journal article is or what it means or how to differentiate that from any other "news". It remains an observable effect even if the mechanism is not clear. You have not begun to venture any analysis of the methods of the journal article and probably you didn't read it.

If you don't agree with the findings then tell me why? This is not church this is science.

 

[Mom2izzy]

Will I need another valve replacement?

My degree is in Chemistry and I have some training in statistics.

When debates like this one occur, I find myself thinking back to a class I had in college called "Issues and Misconceptions in Science". In this class, we researched topics in order to be able to argue either side of the debate. The surprising part was how easy it was to find contradictory research. It was a very long time ago, but one I recall pretty vividly was regarding second hand smoke (This was way back when you could still smoke everywhere.). Although it was widely accepted that second hand smoke was bad, there were multiple journal articles providing "statistical" evidence that it wasn't a big deal.

In my statistics background, what I have observed is that there are so many ways to test a hypothesis that if you don't like the results of one you move on to the next. If your data doesn't fit the model perfectly, you can apply a different confidence interval. When your sample is not large enough (which is relative to the data not any magical number), it can lead a researcher to inaccurate assumptions.

Additionally, whenever I read or listen to the side effects of a drug, it makes me wonder why anyone would ever take them, even though I work in the pharmaceutical industry and KNOW how much goes into safety testing of any drug to be marketed.

Sorry to hijack this thread, but it is at least the 2nd or 3rd I read this morning with a somewhat confrontational debate going on.

My whole point was there are going to be different sides to each discussion and even published research on both sides. I see nothing wrong with presenting both sides (although I'm a bigger fan of actual anecdotal evidence from members here), but it would be nice if those involved in the debate could take it down a notch. If somebody disagrees with research you present, it does not need to be taken as a personal attack...

 

[ramjet]

I had thought the long term effects of warfarin were well known among this forum, especially given the aversion to warfarin expressed by many here.

Primarily it revolves around increases risk of bone density in aging. This would appear to be exacerbated by people following conventional medical "wisdom" and avoiding a proper diet in the falsely based premise of making ones INR more stable.

A quick start in learning about this can be had at Wikipedia

http://en.wikipedia.org/wiki/Warfarin#Adverse_effects


Other reading

One for the positive case
http://m.stroke.ahajournals.org/content/28/12/2390.long
One for the negative case
http://www.ncbi.nlm.nih.gov/pubmed/21456505

http://www.valvereplacement.org/forums/showthread.php?34798-Long-term-effects-of-Coumadin-warfarin

Personally I am not worried about it and only raised it as a possibility as to why someone would not recommend a young male to have a mechanical valve.

PS the abstract at least is worth reading in this one:
http://joe.endocrinology-journals.org/content/194/1/213.full.pdf

Please be very very careful about quoting Sugiyama's (2007) rat study on warfarin's effects , and Stenova's 1 year long prospective bone density study that can't prove anything regarding long term effects... and abe very carful about reading wikipedia, it can be interesting, but honestly, if you believe everything there you will be afraid to even drink water....I'm not being rude, or mean, but out of all the articles quoted have little to no relevance to this particualr arguement even the article in the American Heart Asssociation's Journal is a study taht enrolled only 60 elderly patients in the intervention arm, and about 60 elderly patients in the non intervention arm ,and about half that number in the control arm, and it didn't even look at young, otherwise healthy, active heart valve recipients....so it relevance to this argument is negligable, honestly, the, patients were very sick with many of them bed bound, patially paralysed from a stroke so clearly their bone density and the effects warfarin would be very very different, as they are relatively inactive group, with many other issues impacting on bone density ....just being immobile will impact on bone density ...so,
...the decision about type of valve and hence the need for warfarin (or not) is often far more complex for some individuals, and rest assured that the cardiologists don't just ignore all the potential issues and side effects, honestly, I have seen them debate and talk about the long term benefits and side effects in great detail, and they almost all universally participate in some sort of data gathering and research on their patients so that they can all continue to do the very best by us, their patients....its about weighing the risks and the benefits associated with any decision, nd it can't be done very easily in this forum, but rather face to face with your expert, specialist who has an intimate knowledge of your specific condition, and everything else involved with your circumstances.... and I'll hapily post some relevant data when I have some more time...but remember, we are all different, with different ages, valves, aortas, allergies, medical conditions, lifestyles, and employment, all of which needs to be considered when making some decisions about valves, medciations etc...and sometimes there simply is no choice in what valve we need ...for whatever reason, but please be acreful about mentioning irrelevant, small, single centre, non randomised animal or small scale human studies involving very different disease processes, no matter how well intentioned, becase it can cause some people unnecessary concern....but anyway, I may have misread the whole debate I think, it's late, but play nicely while I'm asleep boys and girls .

 

[hannahsmom]

Prodromos,

I see things have gotten quite off topic from your original question. If you do by chance speak to your dr and get more information on the situation, would you mind providing an update? Having such a young valve patient at home I would be very interested to hear what the dr has to say.

Thank you,

Kelly

 

[tom in MO]

Pellicle, Ramjet articulated my thoughts much better than I could.

I don't know what a "research masters" is. I only have a lowly BA. I am fortunate to work in a job that is "scientific". This has taught me to be skeptical. It takes a lot for me to accept causality.

Yes, I did read your references and agree with you that there is no reason to fear osteoporosis due to warfarin.

 

[pellicle]

I don't know what a "research masters" is. I only have a lowly BA.

well as the name implies, it is a Masters degree obtained by doing research. Think of it as a PhD without establishing a contribution to the pedagogy. Unlike a Bachelors or Masters by Coursework you are not spoon fed data and examined on what you can regurgitate. The purpose is to train people to be researchers.

I am fortunate to work in a job that is "scientific". This has taught me to be skeptical. It takes a lot for me to accept causality.

which is fine, however if your reading was better you should have seen I was suggesting that
1) I don't think its a problem
2) this is the only medical reasons I can think of for avoiding warfarin (and having established he was male pregnancy was unlikely)
3) I wanted to present that there wasa not a homogeneous view in the professional literature so there WAS some reason to be cautious. (assuming you are by nature critical in your analysis you would of course EXPECT to see some presentation of both sides in any review of literature however brief).

I am disappointed by this discourse and will likely not be participating in this forum in the future. You Tom claim to have a degree (albeit at BA) and science working yet did not make inquiry, suggest any problems with the research which supports the claims of long term effects (and there are plenty), but you simply challenged me in a manner that was harassing.

Further you provided not a single shred of evidence, not one quote at all, to back up your assertions. You did not enter into a discussion only into denial and refusal. That does not imply to me you are skeptical it implies you are opinionated.

If I wanted to get hassled for helping someone I would have posted on usenet.

Yes, I did read your references and agree with you that there is no reason to fear osteoporosis due to warfarin.

so why didn't you observe that earlier? Do you prefer to foster conflict?

good bye

 

[pellicle]

Good Morning Roger

Please be very very careful about quoting Sugiyama's (2007) rat study on warfarin's effects

agreed, I only put it in as a PS because I thought it was interesting, I did not intend it as an sort of supporting argument.

I think critical to understanding this thread is to read the OP's question then my first responces.

Being in hospital at the time and only having access to a tablet typing is difficult and my answers terse by that (some people are brief in answering no matter what).

I got home yesterday and now have access to a PC with a proper keyboard

and abe very carful about reading wikipedia, it can be interesting, but

that is sage advice with any source. I was (as it happens) just having this conversation pre-op with the surgeon and the anesthetist (both educated and intelligent men). Both agreed that Wikipedia is an excellent source of a beginning on a topic. It is a great introduction and often supports with citations which can be great for then going and reading. Even peer reviewed journal articles should be viewed and read. The Abstract is one thing, the methods and the data presented are another. Just because the reviewers agree that the arguments presented are supported does not mean that the reviewers do not see other methods and other views which do not support the assertions of the authors.

So I agree, all things need to be questioned. But that questioning should be more than "this is wrong in my opinion".

... the article in the American Heart Asssociation's Journal is a study taht enrolled only 60 elderly patients in the intervention arm, and about 60 elderly patients in the non intervention arm ,and about half that number in the control arm, and it didn't even look at young, otherwise healthy, active heart valve recipients.

yes, that was one of the issues I took with it. Further it ignored lifestyle and sedentary nature. I feel it also failed to properly address co-dependencies on the effects of bone density.

As yet I have not seen anything actually follow a group of people with a broad cross section of activities and following them for some decades. I think that it is quite unlikely that we'll see such research now as the days of the priests doing research are seemingly gone.

(thank you again Fr Gregor Mendel for your fine contrbutions)

....just being immobile will impact on bone density ...so,

exactly, however in its support I thought it took into account groups of sedentary patients.

...the decision about type of valve and hence the need for warfarin (or not) is often far more complex for some individuals, and rest assured that the cardiologists don't just ignore all the potential issues and side effects

agreed, although this is perhaps addressed to the OP ... more so than me.

My views on warfarin have been stated many times here (for example here http://www.valvereplacement.org/for...y-find-images-disturbing)&p=533760#post533760)

As a mechanical valve recipient and as a person undergoing difficulty associated with reoperation I can only say that if the surgeon suggests mechanical or tissue is OK, then get the valve which minimises your potential requirements for reoperation.

 

[pellicle]

To recap:
answering the initial quection of the OP I ventured:

Probably the answer is yes but less certainly yes if you got a mechanical valve (which I thought uncommon at 22)

the OP asked:

but why does it seem uncommon to get a mechanical valve at 22?

to which I replied:

I have no statistics on it but its just my impression. It could be related to people attempting to avoid long term effects of warfarin.

somehow this was twisted into me having the premise that I am against warfarin and supposedly then supporting this stance against warfarin.

I am unable to comprehend how this happened, but then there are lots of things beyond my comprehension.

 

[Duffey]

Hello, I am 35 years old and I had my aortic valve replaced at the age of 22. Recently I’ve heard that sometime in the future I might need a new replacement, because at the age I had the operation my aorta had not yet reached its full growth. Is this really true?

It would help to know the source of your information. I have never heard that the aorta is not fully grown at 22 years of age; however, I wonder if there's some confusion concerning future aorta growth due to having a BAV and the possibility of connective tissue disorder.

 

[tom in MO]

Per "I am disappointed by this discourse and will likely not be participating in this forum in the future. You Tom claim to have a degree (albeit at BA) and science working yet did not make inquiry, suggest any problems with the research which supports the claims of long term effects (and there are plenty), but you simply challenged me in a manner that was harassing."

Sorry about that Pellicle. I am mortified that you would leave this place due to me. With your current difficulties, you need this place more. Please accept my apology. If you stay, I promise I won't comment on your threads or responses. OK?

 

[pellicle]

Sorry about that Pellicle. I am mortified that you would leave this place due to me. With your current difficulties, you need this place more. Please accept my apology.

Tom
I thought your response deserved a reply. I accept your apology and thank you for it. Please accept mine for getting agitated.

I do not feel that this forum has much to offer me from my participation although it will likely remain a source of research for me should I have any specific question. I am not sure that anyone has found any value in my inputs either. This is not the only thread in which I have identified problems with what I suggested.

I don't need to cry or commiserate here, I certainly don't want anyones prayers. so I am unsure that I need this place at all. Life is challenging and difficult for me at the moment and clearly I am unable to deal with conflicts with any strength.