Adam's Heart Valve Surgery Blog – Page 64

What a week for those interested in the topic of heart valve surgery!!!

First, we learned that Barbara Bush was recovering from aortic valve replacement! Then, news reports started buzzing about Robin Williams’ need for heart valve surgery on his aortic valve.

As a result, my email inbox has been flooded with interesting questions about all types of heart valve surgery – especially aortic valve replacement.

Aortic Valve Replacement – Positioning A Prosthetic Valve

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Yesterday, Barbara Bush, at 83 years of age, joined a long list of public figures to have undergone successful heart valve surgery.

The former first lady, Barbara Bush, underwent open-heart surgery Wednesday to replace her aortic valve, a family spokesman said. Barbara Bush’s heart surgery took place at Methodist Hospital in Houston, Texas and lasted about two and a half hours.

Barbara Bush – Heart Valve Surgery Patient

Bush, like many patients, was suffering from shortness of breath due to aortic stenosis. This valvular disease results from a narrowing of the heart valve which may occur due to congenital factors, calcification or infection.

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Interest in minimally invasive procedures for heart valve surgery is increasing for both medical device manufacturers and patients. As we learned last week, Medtronic spent over $1 billion to acquire CoreValve and Ventor Technologies, two companies that specialize in non-invasive valve replacement technologies for diseased aortic valves.

From the patient perspective, the advantages of minimally invasive surgery are (i) less post-operative pain, (ii) faster recovery and (iii) lower mortality. As you have read in this blog, several of my readers have had such procedures including non-invasive robotic surgery for mitral valve repair.

Over the past few months, I’ve been receiving additional comments about minithoracotomy for aortic valve replacement and mitral valve replacement. In this type of cardiac surgery, the patient does not have a median sternotomy in which the sternum is broken (as discussed previously in “Vicki’s Thoracotomy Versus Sternotomy“).

Given this topic, I just received a very interesting patient story from Jim Engelmann. Jim, as pictured below, recently had aortic valve replacement via mini-thoracotomy.

Jim’s Mini-Thoracotomy Scar After Valve Replacement

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Managing anxiety before heart surgery can be quite challenging for patients and their caregivers. However, Rochelle just asked me an interesting question about dealing with anxiety after heart surgery. Here is what she writes:

“Adam – I had aortic valve surgery 4 months ago. Everything went well but I am suffering from anxiety. I have been taking Ativan… one milligram. I also go to cardiac rehab once a week. My question is, “How many patients suffer from anxiety after heart surgery? Does it ever stop? Thank you, Rochelle (P.S. Your book has helped me alot!)”

Here is my response to Rochelle:

Like you, I also suffer a bit from anxiety. However, I don’t think my anxiety increased after heart valve surgery. To counter the anxiety, I do my best to exercise, to write and to share any anxious thoughts with those around me.

After surgery, I also entered individual counseling. While some patients enjoy support groups, like Mended Hearts, I chose a more personal setting to enhance my mental well-being following the challenges of my recovery.

So you know, I’m not the only patient to seek therapy following heart surgery. In a 2007 study, 9% of patients acknowledged that they saw a therapist post-operation to help with the emotional and behavioral changes after cardiac surgery. From experience, I can tell you that therapy really helped with my anxiety and sleep issues.

Here’s the funny part… It was my brilliant therapist who suggested I write a book and blog about my heart valve surgery journey to help future patient and caregivers. Without her thought, you would not be reading this right now.

I hope this helps you better understand anxiety relative to heart surgery.

Keep on tickin!
Adam

On November 27, 2007, I posted a blog titled, “Will Heart Valve Manufacturers Consolidate And Gobble Up Each Other?”. In that post, I rambled-on about the possibility that the heart valve industry would consolidate to create advantages for both patients and manufacturers.

Guess what?

Earlier this week, Medtronic spent over $1 billion to acquire two heart valve manufacturers – CoreValve and Ventor Technologies.

In the first deal, Minneapolis-headquartered Medtronic acquired CoreValve, developer of a transcatheter, transfemoral aortic valve replacement product. The deal calls for an initial payment of $700 million plus additional payments contingent upon the achievement of agreed milestones.

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Barbara, a 57-year old patient from Georgia, just asked me a very honest question about heat valve surgery and hospitals.

She writes, “Hi Adam – I’ve been diagnosed with severe stenosis of the aortic valve. I got a second opinion to confirm the diagnosis. Now, I’m mentally preparing for what lays ahead of me. I’m overwhelmed. Just the thought of heart surgery keeps me up at night. Also, I have an aversion to hospitals. I’ve never had major surgery so I don’t know what to expect. Sometimes my brain focuses on the negative reality of spending several days-and-nights among sick people. This may sound like an odd question, but… What is the worst thing about staying in the hospital after surgery? Thanks, Barbara”

As most of you know, I consider heart valve surgery to be a medical miracle. With this belief, I started this blog and wrote my book with a single passion – to help transform patient fear into patient hope. However, this passion is not oblivious to the fundamental concerns that confront both patients and caregivers as they transition through each phase of cardiac surgery – diagnosis, pre-operation, the surgery and recovery.

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I could be wrong but I think the cliche goes something like, “A picture is worth a thousand words.” While I’m not a fan of cliches, I am a fan of this one – especially when it comes to understanding heart valve surgery.

Before my surgery, seeing pictures and diagrams helped me digest (i) my diagnosis and (ii) my need for aortic valve surgery.  I’ve always been a visual person but understanding the structural problems of aortic stenosis was very helpful.

That’s why I really appreciate the email I just received from Tanya. She writes, “Hi Adam – My dad is scheduled for mitral valve prolapse surgery on Tuesday. I think I understand what the problem is. He’s had valve regurgitation symptoms for years. But, I was curious to know if you had any diagrams that show the physical defect of a mitral valve prolapse?”

I guess Tanya and I are somewhat similar – seeing things helps. With that said, here are two pictures which illustrate the challenges when mitral leaflets do not open-and-close properly. The first diagram shows a side-view of the heart and mitral valve prolapse.

Here, in the second diagram, you can see a top-down view of a mitral valve prolapse:

Considering the two pictures above… I guess, according to the cliche, I just saved myself 2,000 words. Phew!

Keep on tickin!
Adam

I just received a very, very, very interesting question from Debbie about stroke and heart surgery.

Debbie writes, “Adam – My mom is having open heart surgery next week due to severe regurgitation from a mitral valve prolapse. I have heard that stroke is a risk for patients during cardiac surgery. Is that true?”

Diagram Explaining A Stroke

So you know… Debbie’s question brings back a distinct and touching memory for me as I prepared for my own heart valve surgery.

It was December 20, 2005, the day before my aortic and pulmonary valve replacement surgery. I was at USC Medical Center in Los Angeles, California. My pre-operative tests were almost complete when it came time to discuss the surgical consent form.

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Even though there continues to be some, ongoing debate as to the long-term efficacy of the Ross Procedure, many of my readers continue to select this unique form of aortic valve replacement. Here is the latest Ross Procedure success story from Bruce in Texas.

Hello Adam-

I am now almost 5 weeks post-surgery. I feel GREAT after the Ross Procedure! Doctor John Oswalt is such a caring, compassionate and wonderful surgeon.

For me, the days leading to my surgery, specifically the morning of, were very challenging. About one minute after being rolled into the operating room, the general anesthesia kicked in and… I was OUT! The next thing I remember is trying to open my eyes, some 4 hours later. INCREDIBLE.

Here’s a quick play-by-play of my first few days in the hospital:

• Day one – I was standing up.
• Day two – All tubes, wires, and other “stuff” were removed. I was actually walking stairs in front of the nurses station.
• Day three – I was on my way home, two days shorter than most other patients. Certainly, I was scared at the short time in the hospital, but I was ready to be home.

Here I am now, five weeks after surgery. I’m driving and already back to work full time. If not for the dreaded allergy season in Austin, Texas… I would be just perfect. I feel great, but for the nagging cough associated with the allergies. THAT HURTS THE INCISION!

Dr. John Oswalt – Heart Surgeon

Adam, I owe you a great deal of gratitude. It was your heart surgery book that led me to the Ross Procedure. You also referred me to Dr. Oswalt. Thank you so very much for helping me make the most important decision in my life. Now, I am 47 years old and ready to take on the world!!!

God Bless,

Bruce Hale
Austin, Texas

I start my days with a good, fifteen minute stretch that includes both breathing and yoga exercises. Some days, I watch The Today Show with Matt Laurer, Meredith Vieira, Ann Curry and Al Roker as I stretch.

This morning… There was a very interesting segment led by The Today Show’s chief medical editor, Dr. Nancy Snyderman, about heart disease. Doctor Synderman reviewed her six critical tests for men to monitor heart-health throughout their lives.

As heart disease is the #1 killer among men, I listened intently to Dr. Snyderman’s compelling discussion. In fact, I even stopped my stretch, grabbed a pen-and-paper and started taking notes. (I guess I’m a little sensitive to anything heart-related after my double heart valve surgery.)

Here are the six tests Dr. Snyderman believes are critical for monitoring heart health in men:

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On behalf of Robyn (my wife) and Baby Pick (my unborn son), I wanted to wish you a very, very, very Happy Valentines Day!

I hope you all take a few, if not many, special moments to appreciate the love within your heart and the hearts of those around you.

Keep on tickin!
Adam

Mike just had open heart surgery to correct an aneurysm and leaky heart valve. I thought you might enjoy reading about Mike’s positive outcome and his incredibly positive attitude. Here is what Mike wrote to me:

Hi Adam, I wanted to thank you for your book. It certainly helped me to understand what was going to happen to me and what to expect – before, during and after heart surgery.

My Story: I went in for a routine physical last July and although I’ve had a heart murmur all my life, my doctor noticed the murmur was significantly louder. He ordered an ultrasound and sure enough it showed my aortic valve was leaking over 50 percent of what it was pumping. I also had an aneurysm in the first six inches of my upper aorta measuring 5.3 cm. I was told I should get it fixed within the next 5-to-6 months.

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Hi everybody,

I just wanted to say thank you for all the kind emails, phone calls and letters regarding my birthday. As you may know, I turned 37 earlier today. (Actually, I will really turn 37 tonight. I was officially born at 10:35pm.)

After work, Robyn and I are going to celebrate at one of my favorite, local restaurants here in Los Angeles!

Speaking of birthdays…

Baby Pick is getting closer-and-closer to his birthday. As Robyn’s tummy gets bigger (and cuter), our little boy is really putting on weight. With eight weeks to go, he now weighs over 3 pounds, 8 ounces.

So you know, we had a four dimensional (4D) sonogram last week. We actually saw Baby Pick smile in the womb!!! And, truth be told, we also saw him wee-wee in the womb as well!!!

Is he cute or what? (I’m guessing all parents would say the same thing, right?)

Keep on tickin!
Adam

I just received this educational and inspirational note from Dr. Leo Hernandez, MD. I thought you might enjoy reading, seeing and learning about Leo’s heart valve surgery journey. He writes:

Good Morning Adam:

My name is Leo Hernandez and I had my aortic valve replaced on my 57th birthday on January 6, 2009 by Dr. Richard Shemin at Reagan UCLA Medical Center.

I have read your book – which I found very inspirational – and have been reading your blog for the past few months. I would like to share my story with you in the event you would like to include it in your blog.

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This is fun…

I’m noticing a fantastic, new trend as of late. Many of my readers are now sending me pictures of themselves with my book. Here are two examples of Peter (from California) and Emmanuel (from United Arab Emirates).

I can’t tell you how great it makes me feel to receive your pictures, your emails, your phone calls and your cards. To know that I am making a difference in your lives is more rewarding than anything else I have experienced thus far in life.

That said…  I’m smiling from ear-to-ear right now!

Thank you! Thank you! Thank you! 🙂

Keep on tickin!
Adam

As a follow-up to our ongoing discussion about insurance (health, life) for heart surgery patients, I just inquired about getting health insurance from a local agent here in Los Angeles. The agent asked me some questions, we discussed my heart valve replacement surgery, and then… he went off to look into an individual health insurance policy for me.

Within three hours, the agent called me back saying that an individual policy would (most likely) not be possible. He informed me that when he called Blue Cross, one of the Blue Cross underwriters told him, “If the valve has been touched, it’s an Auto Decline!”

My agent then told me that I would need to set up a group policy for coverage. For me, my wife and our baby (expected on 4/11/09), the cost would be around $925 a month.

That’s a lot of money! I now know why over 46 million people in the United States don’t have health insurance. Then again 99.8% of the uninsured don’t have heart valve surgeries in their medical record (which makes it even more expensive).

I’ll continue to update you as I learn more.

Keep on tickin!
Adam

I just received the most fantastic picture of 5-year old Garrison Griffith. His mother, Vanessa, sent me this picture along with a very reassuring note about her son’s heart valve surgery.

Vanessa writes, “Here’s Garrison about a month after his Ross Procedure. It is now six months after the double, heart valve replacement and Garrison is doing great!”

How great is that picture? Way to go Garrison and the Griffith family!

Keep on tickin!
Adam

I just received an anniversary note from Leslie Lafayette in California. I thought you might like to read how she is doing one year after robotic mitral valve repair surgery.

Hi All,

One year ago today at this time I was wired up, prepped and trussed like a big turkey, ready to be wheeled into UCLA Medical Center. I went into the operating room at 10am for my heart surgery.

Can you BELIEVE IT? As a blast from the past, consider that Heath Ledger died the day before I had my mitral valve repair and Britney Spears entered UCLA for her mental breakdown on fifth day in the hospital.

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I have to admit… I’m typically a little more relaxed when I make the annual pilgrimage to USC Medical Center to see my surgeon, Dr. Vaughn Starnes, for my check-up.

Since I’ve already seen my cardiologist, Dr. Rosin, I know that my heart is doing very well – after my last echocardiogram (a few weeks ago). Still, I want to make sure that Dr. Starnes is of the same opinion as Dr. Rosin. Plus, it’s always helpful to get consensus that my aortic and pulmonary valve replacements are performing as expected.

Adam with Dr. Vaughn Starnes (His Heart Surgeon)

Well… I have good news to report!!!

During my afternoon appointment with Doctor Starnes, the Chairman of Cardiothoracic Surgery, he stated, “Your heart sounds great!” As you would expect, I’m very happy right now. In fact, I may just have a large glass of red wine tonight to celebrate. I’m into Pinot Noir these days. I stocked up during the last 5 cent sale at BevMo. 🙂

Keep on tickin!
Adam

Every once and a while I receive a patient question that really, really, really stumps me. In those situations I simply post a blog about the topic to see if YOU have any ideas.

This just happened when I opened an email from Galina that focuses on sleep apnea, heart strain and heart valve function. Do you have any ideas for Galina? Here is what she writes, “Hello Adam… I love your blog and the information from everyone.  I’d like to ask you if you have ever discussed sleep apnea and it’s strain on the heart?”

That’s what we have discovered regarding my husband. We are trying a mouth device to help this condition. He has a narrowed aortic valve (stenosis) due to endocarditis and has to be checked regularly. We are here in Perth for the checkup at the moment.

There is also a possibility that a few seizures he has been suffering are related to the sleep apnea, as the brain gets starved for oxygen. Any thoughts or feedback would be very much appreciated. Best, Galina”

Do you have any ideas for Galina? If so, please leave a comment below!

In advance, thanks for your help!!!
Adam