Topic: Getting a second opinion for heart valve repair, heart valve replacement or any form of cardiac surgery.

Recently, I was asked about the need for getting second opinions. Specifically, I was asked, “Do I really need to get a second opinion?”

My response was an emphatic, “ARE YOU NUTS? OF COURSE!!!!”

Okay, maybe I wasn’t that dramatic but I was very open about the NEED for getting second opinions from both your cardiologist and your cardiac surgeon.

Why should someone potentially needing heart valve surgery get a second opinion?

There are two key reasons.

First, heart surgery is probably one of the most invasive surgeries that exists. The only surgery, in my opinion, that is even close in severity is brain surgery. That said, you must be sure that your symptoms constitute a true need for the operation.

This may sound odd to some of you… But, when my second cardiologist confirmed that I needed an aortic valve replacement following my second echocardiogram, I WAS RELIEVED.

That’s right. I was relieved because there was consensus from two separate and completely distinct doctors that the regurgitation and stenosis in my valve was impacting my health and well-being.

Next, I went to two separate cardiothoracic surgeons to discuss my surgical options – Dr. Alfredo Trento (Cedars Sinai) and Dr. Vaughn Starnes (USC) in Los Angeles. Again, I was relieved that both surgeons felt that I was a qualified candidate for a special aortic valve replacement surgery known as the Ross Procedure.

Following my second opinions, I slept better knowing there was consensus regarding the best surgical approach to fix my valve defect. (I had a bicuspid aortic valve that was very calcified.)

The second reason I suggest you get a second opinion if you are considering heart valve surgery has to do with an awful story revealed in a book called Coronary. Have you heard of it yet? Well, here’s the overview:

CORONARY BOOK OVERVIEW: In 2002, a Catholic priest named John Corapi had his heart checked out by Dr. Chae Hyun Moon. The celebrated cardiologist, who practiced at a Redding (Calif.) hospital owned by giant for-profit Tenet Healthcare Corp. (THC ), responded to Corapi’s symptoms of exhaustion and shortness of breath with five of the scariest words in the English language: “You need a triple bypass.”

Thus begins the tale of the priest, the doctor, and the multibillion-dollar hospital chain, recounted in penetrating detail in Coronary: A True Story of Medicine Gone Awry. Fortunately, as author Stephen Klaidman reports, Corapi then got opinions from three other doctors, all of whom said no surgery was needed since his arteries were completely healthy. The priest went to the FBI. An ensuing investigation and a raft of civil lawsuits turned up more than 600 patients who were allegedly subjected to unnecessary heart procedures by Moon and a colleague, Dr. Fidel Realyvasquez. The scandal, along with simultaneous revelations that Tenet may have improperly billed Medicare by as much as $760 million a year, brought what was the nation’s second-largest hospital chain to its knees. And it provided forceful evidence that the drive for profits can put patients in mortal danger.

Klaidman, an ex-reporter at The New York Times and The Washington Post and a former health-policy researcher, deftly intertwines elements of a medical mystery story with disturbing details about corporate greed. So profit-focused was Tenet, Klaidman discovered, that it required each hospital CFO to submit monthly reports on individual doctors’ contributions to the bottom line. Redding Medical Center (RMC), home base to Moon and Realyvasquez, was a cash cow, generating $3,181 in revenue per patient per day, or twice Tenet’s average. What’s more, in 2002 its pretax income soared 31%, to $93.6 million. Drawing on medical records, depositions, FBI files, and interviews, Klaidman brings this culture to life, offering vivid dialogue and scene-setting.

With all of the above said, “Ready for that Second Opinion?”

Keep on tickin,

Adam

Adam Pick is the author of The Patient’s Guide To Heart Valve Surgery, a unique book which integrates the clinical facts of heart valve surgery with the personal experiences of an actual heart valve surgery patient. This special book divides the valve surgery process into four sections which address the challenges and opportunities faced by both patients and caregivers. To learn more about Adam’s heart valve surgery book, click here.

After open heart valve surgery, it is very common for the patient to be incredibly aware of all the potential problems that occur during the recovery. For me, my awareness to anything and everything problematic was sennnnnn-sational.

To some extent the patient is entitled to a little bit of neurosis.

I mean, open heart surgery is pretty invasive and pretty serious.

For me, I had aortic and pulmonary valve replacements (via the Ross Procedure) due to a bicuspid aortic valve. Thus, my chestbone was split, my heart was cut open and my heart valves were replaced.

Accordingly, I was incredibly cautious to do anything that might infringe on my sternum healing. In my head, I replayed the same thought, over and over and over again… “Don’t break. Please don’t break.” As I would later learn… I would not break.

However, that did not stop my fascination with potential issues and roadblocks to healing.

In particular, I noticed a distinct ‘clicking’ sound when I got in and out of bed. I’ll never forget the first night I heard it. I was getting into bed when I heard… “CLICK!”

I immediately looked at Robyn (my fiancee).

“Did you hear that?” I said with concern.

“No,” she said, “What is it baby?”

“My chest… It just clicked,” I said with more concern.

She assured me that I was fine and we went to sleep.

A few days later the same thing happened when I got out of bed… “CLICK!”

“Could something be wrong with my chestbone? Did something go wrong during the median sternotomy? Are my wires not tight enough?”

It started to drive my crazy. I ‘clicked’ here. I ‘clicked’ there.

I really thought something was wrong going into my seventh week post-operation.

I was so concerned that I went to see my surgeon, Dr. Vaughn Starnes at USC. I explained my neurosis and Dr. Starnes assured me that it was normal.

With that, I was completely comforted knowing that I was not going to break.

Guess what?

Now, fifteen months after my valve replacement… I’m still ‘clicking’.

It doesn’t hurt.

It actually feels good.

Almost like a good knuckle crack!!!

Keep on tickin!

As you research heart valve surgery, an endless number of questions arise. I’ll never forget when I first interviewed Dr. Trento at Cedar Sinai. He told me that my aortic valve was in bad shape – fully calcified, both stenotic and regurgitation was going on. Then, Dr. Trento looked at my chest, noticed I had some chest hair and said, “Ehh. No one will ever know you even had the Ross Procedure.”

While I did not end up selecting Dr. Trento as my cardiac surgeon, Dr. Trento was incredibly accurate in his prediction about my scar healing. It’s fourteen months following my surgery, and my incision scar is barely noticeable.

However, I was lucky to hear about, read about and use Mederma scar treatment after open heart surgery.

Does Mederma Work?

To see pictures of my before and after use of Mederma scar cream, click here.

Cheers,

Adam

Ahh yes… The good ole’ sternum cracking question. I’ve received this question a number of times from friends and family following my surgery. As you can read in my story, I had aortic and pulmonary valve replacements (using the Ross Procedure).

Unfortunately, my cardiothoracic surgeon, Dr. Vaughn Starnes (USC), could not use a minimally invasive procedure considering he needed direct access to my defective aortic valve which was suffering from aortic stenosis and regurgitation. My congenital bicuspid valve had become very calcified during my 34 years of life prior to the surgery.

In any case, Dr. Starnes needed to perform a median sternomoy to perform the valve replacement. So you know, median sternotomy is a type of surgical procedure in which a vertical inline incision is made along the sternum, after which the sternum itself is divided, or “cracked”. This procedure provides access to the heart and lungs for surgical procedures such as heart transplants, corrective surgery for congenital heart defects including heart valve replacements.

FYI, median sternotomy is often mistakenly referred to as open-heart surgery; however, open heart involves incision of the pericadium, and many median sternotomy procedures do not require this. Open heart usually involves the use of a cardiac pump, also known as a heart-lung machine. In the case of valve surgery, however, the pericardium is pierced is the procedure is “open-heart”.

That said, back to the pain… “HOW PAINFUL WAS IT?”

Well, let me just say that it wasn’t fun. Similar to the entire heart valve surgery experience, it was like a rollercoaster – a number of ups and downs. Sometimes I didn’t notice it. Other times the incision throbbed.

For example, following my aortic replacement, I was given a prescription of Vicodin as I left USC Medical Center in Los Angeles. Upon departure from the hospital, I was taking eight to twelve Vicodin per day. As you might imagine, I didn’t feel much pain on those days.

However, as the Vicodin levels were brought down and the dosage reduced, the pain started to be much more noticeable and quite uncomfortable. As you can read in my book, The Patient’s Guide To Heart Valve Surgery, the pain brought about a number of issues for me which led to a little bit of a “problem”, or dependence, on Vicodin.

Ultimately, I think the heavy use of pain medication and sleeping pills triggered cardiac depression during my recovery. This was a very trying time for me and my family. Had I known a little bit more about the realities of the recovery, I could have avoided these issues. Again, for a patient’s perspective on the heart valve surgery experience, I highly encourage you to read my book. I wrote it for both patients and caregivers.
THE GOOD NEWS: It’s been 14 months since my surgery… The pain has pretty much subsided. I’m working on my big physical goal right now — TO SURF AGAIN!!! That said, sternum cracking pain in the incision is simply, an uncomfortable, but temporary part of the valve repair and valve replacement experience. Besides, what is the alternative to a little bit of pain – A dialated heart and eventual death? I’ll take the pain!

Keep on tickin,

Adam

Recently, I received an email from Taylor Browning. Taylor is going to be having an aortic valve replacement in March, 2007. He has selected an artificial valve and the surgery will be conducted by Dr. Craig Miller at Stanford.

Taylor’s questions was, “I’m having problems concentrating at work knowing that my surgery is in a few weeks. Should I take some time off work before the procedure?”

My opinion and response to this question is yes.

So you know, I took six days off before my Ross Procedure (aortic valve replacement).

Why?

Well, for one thing, I wanted to get mentally prepared for the operation. Specifically, I wanted to take care of any and all loose ends that existed in my life so that my recovery would not be impacted. I paid bills in advance. I purchased birthday presents in advance. And, so on…
The other reason I took time off is that I wanted to spend some extra time with my family and friends prior to the operation. As you can read in my book, I felt it was very important to connect with my support group and inform them of the upcoming surgery and the recovery. This was very critical. Going into the heart valve surgery, my family and friends were all on the same page.

While this is my opinion, I have spoke with many patients about their time prior to surgery. The majority of them that still worked for a living did take some time off before their surgery. And, for the few who did not take time off, in retrospect, most felt they should have.

If you have any questions, please send them to adam@heart-valve-surgery.com.

Keep on tickin!

Adam