I just received a great email from Janice about directions for the incentive spirometer after heart valve surgery in which the heart-lung machine was used.

She writes, “Hi Adam – I just read your blog about the incentive spirometer, fluid in the lungs and pneumonia. I’m 64 and going in for mitral valve repair next week. I’m curious to know how patients actually use the spirometer. Can you help me prepare? Thanks, Janice”.

In the past, I would immediately direct Janice to a blog titled, “How To Use An Incentive Spirometer?”. Today, however, I decided to see if there were any online videos that could help Janice out. It took about five minutes, but I was lucky to find a pretty good video that addresses Janice’s question. Although the production of this video is relatively amateur-ish, the quality of instruction is very good. That said, I hope you enjoy it.

FYI, if you have never heard of an incentive spirometer before, patients use this breathing tool after cardiac bypass surgery to (i) prevent pneumona, (ii) reduce fluid in the lungs and (iii) protect the alveoli.

Alveoli Shown In Respiratory Tract

I hope this helps!

Keep on tickin!

My brother, Doug, just sent me these visual illusions. I thought the pictures were pretty amazing. Plus, I liked learning the science behind the illusion (see below).

Do you see what I see?

Flowing leaves – The brown leaf shapes against a green background make this look as if the entire group is flowing—making waves if you focus on the picture as a whole. Photo courtesy of Flickr.

Waves – The blue almond-shaped objects look as if they’re all passing over three separate columns. Photo courtesy of Flickr.

Starbursts -  These bright purple and green star-like shapes appear to be moving, which can be a little nauseating if you stare at it for too long. Photo courtesy of Angie Armstrong.

According to Olivia Putnal, from Yahoo!Health, what your eyes perceive when looking at one of these images is actually a visual illusion. You see the image as something different than what it is because the different cells and receptors in your eyes distinguish images and colors at dissimilar speeds.

The eye can only receive a limited amount of visual stimuli, but as your brain constantly processes the visual information, it gives you the illusion of continuous sight. Whether it’s an optical, physiological or cognitive illusion, the design plays a trick on your eyes (and mind).

Keep on tickin!

As patients and caregivers… We need to research our heart valve disease. We need to research our surgical options. We need to research surgeons. And, we need to research hospitals.

Why do we do this? Ultimately, I believe this research empowers us to make smart and confident choices that minimize our surgical risk.

On that note, I just read a fascinating report that suggests there is (i) a significant gap in quality among America’s hospitals, and (ii) a corresponding large difference in the rate of patient deaths.

Healthgrades said patients have a 52% percent lower risk of dying in a top-rated hospital than in United States hospitals in general. The study is based on an evaluation of hospital mortality related to 17 procedures and diagnoses at 5,000 non-federal U.S. hospitals. The study’s conclusions came after researchers examined 40 million Medicare hospitalization records from the years 2006, 2007 and 2008.

“The fact is, patients are twice as likely to die at low-rated hospitals than at highly rated hospitals for the same diagnoses and procedures,” Dr. Rick May, an author of the HealthGrades study, said in a statement. “With Washington focused on rewarding high-quality hospitals and empowering patients to make more informed healthcare choices, this information comes at a turning point in the healthcare debate.”

Other findings in the 12th annual “HealthGrades Hospital Quality in America Study” include:

• If all hospitals performed at the level of a five-star rated hospital across 17 procedures and diagnoses studied for mortality rates, 224,537 lives of Medicare patients could potentially have been saved from 2006 through 2008.
• About 57 percent (127,488) of the potentially preventable hospital deaths were associated with four diagnoses: sepsis (44,622); pneumonia (29,251); heart failure (26,374) and respiratory failure (27,241).
• Across all procedures studied, there was a 62% percent lower chance of experiencing one or more inhospital complications in a five-star rated hospital compared to the U.S. hospital average.

So you know…

When I conducted research, prior to my own aortic heart valve replacement, it was studies similar to this one that forced me to consider the best medical centers for cardiac care. For me, it was simple. I wanted a top surgeon. Often, as this study alludes, it is the top hospitals that attract the top surgeons.

Please, please, please conduct the proper diligence before you, or anybody you know, is rolled into an operating room for heart valve surgery.

Keep on tickin!

I just received a very appropriate email from Phil about age groups and heart valve surgery.

Phil writes, “Hi Adam – On Friday, I was diagnosed with severe aortic stenosis due to a bicuspid aortic valve. I’m 48 years old with three great kids and a loving wife. This was a complete shock to me and I’ve spent the weekend digesting the uncomfortable news that open heart surgery awaits me. It’s odd. Although I knew about the murmur, I was told this wouldn’t impact my heart for 10 or 20 years. Now, the doc says the valve is calcified and surgery is a must. Is heart valve surgery common for my age group? Thanks, Phil”

Phil raises some excellent points in his question. In fact, Phil’s story brings back several memories specific to my own diagnosis and surgery. Like Phil, my valve disease rapidly progressed from moderate to severe aortic stenosis. Like Phil, I had a bicuspid aortic valve. Like Phil, I was told surgery would not occur until I was in my 50′s. (FYI, at the time of my surgery… I was thirty-three.)

Picture Of Calcified Heart Valve Leaflets

Still, as we have discussed before… Every patient case is unique. As shown in the chart below, heart valve disease can impact all age categories – from newborns, to teens, to seniors, to elderly patients.

For this reason, it is critical that all patients diagnosed with valvular disorders – aortic stenosis, mitral valve prolapse – get regular examinations to monitor the progress of their heart valve disease.

However, specific to Phil’s original question, it should be noted that the most common congenital abnormality of the heart is the bicuspid aortic valve. According to Absolute Anatomy, the condition can be undiagnosed until the person develops calcified heart valve leaflets. Aortic stenosis due to a bicuspid valve usually occurs in patients during their 40s or 50s, an average of over 10 years earlier than people with normal aortic valves.

In light of that reference, it appears that Phil is, unfortunately, in the age category for developing severe aortic stenosis which, if left untreated, could:

• damage his heart – via dilation (heart enlargement, thickening of the heart muscle)
• lead to congestive heart failure over time.

As we now better understand the timing of Phil’s diagnosis, I would strongly encourage Phil to get a second opinion to confirm the diagnosis prior to any surgical treatment or invasive, diagnostic testing (e.g. angiogram).

I hope this helps Phil (and perhaps you) learn a little more about heart valve surgery.

Keep on tickin!

Hi everybody,

Thanks for all of your emails about Ethan, our six-month old son.

So you know, Ethan is doing ab-soooooooo-luuuuutely wonderful. He’s been very, very, very busy adjusting to his new life and his new parents, Robyn (my wife) and me. Here’s the latest Ethan update:

• Ethan watched his first Michigan Wolverines football game. As I went to Michigan for college, I was very happy to see him cheering for the right team.

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