Adam's Heart Valve Surgery Blog – Page 70

Thanks to the wonderful patients, caregivers, nurses, cardiologists and surgeons who write me, I continue to learn many interesting and helpful details about heart valve surgery. That said, I often take those emails and post them in this blog for you to review as well.

Recently, Jennifer wrote me about the health challenges of her husband. In her note, Jennifer shared her thoughts about the harmful impacts of radiation pills on heart valve function due to infection.

Dear Adam,

Good morning! I received your heart valve surgery book I ordered from you on Saturday afternoon. Needless to say by Saturday night, I had finished reading it.

A quick brief rundown of our situation… Back in March, 2008, my husband took radiation pills to kill an overactive thyroid. A week after he took the pills, he became extremely sick with a high fever, chills, etc.

It seemed to get better. But, over time, the symptoms never went away. It was like clockwork. Every evening, my husband would get chills, sweats, low grade fever, aches, pains, just plain misery. This went on for 2 months.

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Depending on who you talk to, general anesthesia is either one of the GREATEST or WORST parts of heart valve surgery.

I can see both sides. On one hand, general anesthesia is great because your pain receptors are numb. On the other hand, general anesthesia can be scary for patients because your brain and body are, quite frankly, paralyzed. Plus, there are many patients, nurses and doctors which suggest that general anesthesia may have some lingering effects on the brain and body that are not all positive.

As for me, I opted to value the benefits of general anesthesia during my aortic valve replacement. I am aware that some patients are now having open heart surgery while awake but, for me, I didn’t want that experience.

Recently, I was asked the question, “How many patients receive general anesthesia each year during any type of surgery?”

It’s an interesting question.

After doing some research, which included watching the movie “Awake” starring Jessica Alba, I learned that approximately 21 million patients will be under general anesthesia each year. FYI, that number is for all surgery types, not just cardiac-related operations.

Keep on tickin!
Adam

This is very interesting!!! (Especially, for those of you wanting to learn more about human heart valve anatomy.)

I just came across a three dimensional, reconstructive image of the human heart valves. While this animation also shows echocardiogram images (on the left), I was more fascinated with the colorful, 3D presentation of the heart valves opening-and-closing (on the right).

If you look close at this 3D image of the heart, you can see the leaflets of the mitral valve, the aortic valve and the tricuspid valve. Unfortunately, the pulmonary valve is not visible.

So you know…

When I learned that I needed aortic and pulmonary valve replacement operation, I wanted to learn as much as possible about the human heart and its heart valves. My hope is that these types of pictures will help future patients and their caregivers better understand the anatomy of their own hearts before heart valve repair or heart valve replacement operations.

Keep on tickin!
Adam

Robyn (my wife) will tell that I don’t really like to use cliches.

But, if there is one thing I have learned since my heart valve replacement surgery, it is that “there are no guarantees in life”.

Yes. I did just use a cliche. But, it is sooooooo appropriate to heart valve surgery. As you may already know, there are risks, there are uncertainties and there are surgical complications that are undeniably associated with cardiac surgery.

As we have already seen (in patient stories from Leslie Lafayette or Brad Mueller), “there are no guarantees in heart surgery”.

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When I receive a patient or caregiver question that is unique and interesting, trust me… you are the first to read about it.

For example: This morning, I woke up, gave Robyn (my wife) a kiss as she left for work, made a cup of coffee and then turned on my computer. Among all the spam emails that I quickly deleted, there was a question from Bhupinder about kissing heart valve patients.

Bhupinder’s question was, “Hi Adam, Is there any risk to kiss or to smooch a heart valve patient? Please advise. Thanks! Bhupinder”

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As a follow-up to my recent blog about cardiac rehabilitation exercises, Tony just asked me, “Is it okay to swim after open heart surgery? Do you swim? If so, how long did you wait to go swimming after your aortic valve replacement?”

Thanks Tony! These questions just brought back a flood of wonderful memories specific to my recovery from valve surgery.

So you know, I am a fish out-of-water. I’ve been lucky to live near a pool and/or a beach my entire life. As a kid, I was a swim-a-holic. At the age of three, I was racing in meets against six year-olds. In fact, here is a picture that my mom recently found.

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Amongst patients, the costs of heart surgery can be a delicate discussion. As you can read, the costs of heart valve surgery vary from patient-to-patient.

To some extent, the initial billings associated with fees from the hospital, the surgeon, the anesthesiologist and the cardiologist can make your jaw drop to the floor.

Regardless of what your heart surgery cost will be, I was just reading a fascinating report by the American Heart Association. According to a 2006 study, the AHA believes that the total annual cost of heart disease is…

Go ahead…

Take a guess….

Really… Venture a guess…

$258 BILLION DOLLARS PER YEAR!!! (Yes. That was with a ‘B’ for billlllllllion.) You should know that estimate includes medical services, medications and lost productivity from people affected with heart disease.

My jaw just dropped to the floor again.

Keep on tickin!
Adam

Yesterday, Sean made some interesting comments to Nancy about the risks of Coumadin use. In his response, Sean referenced an online video for patients and caregivers to learn more about the use of blood thinners (anticoagulants) to prevent clotting for those patients that select a mechanical heart valve replacement.

I just spent some time reviewing the video on anticoagulation (Coumadin / Warfarin). Sean was right on. Dr. Gaudiani does a great job with this one. While the video can be a little technical, it is rich with information for people looking to learn more about the advantages and disadvantages, risks and opportunities of Coumadin use.

Thanks Sean!

Keep on tickin!
Adam

For most patients, the process of selecting a replacement heart valve can be tricky. These days, there are several options to consider. Plus, we can be influenced and (quite frankly) confused by friends, family members, nurses, cardiologists and surgeons who maintain their own opinions about tissue valves and mechanical valves.

One of the big considerations specific to mechanical heart valve replacements is the use of blood thinners (e.g. Coumadin) to prevent clotting. Patients have different thoughts on Coumadin therapy and its impact on their lives. Some patients feel that using Coumadin is simply “no big deal.” Others find the ongoing use of Coumadin to be burdensome and, at times, problematic.

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Cardiac rehabilitation programs are a critical, and sometimes overlooked, part of heart surgery recovery. As my 2007 survey showed, only 51% of patients attended structured classes with cardiac rehab exercises during their recovery. In my opinion, that is a shame. I could go on-and-on about the physical and mental benefits of good cardiac rehabilitation programs.

However, I just received a quick question that reads, “What types of exercises do you do at cardiac rehab centers?”

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I recently received a unique question from Samantha, a caregiver. She writes, “My husband recently had a cardiac catheterization and appears to be depressed. Is it common for patients to become depressed following a catheter procedure?”

This is a phenomenal question. Unfortunately, I do not have a phenomenal answer.

However, I can share with you that your husband may be feeling common emotions of patients newly diagnosed with heart valve disease. Specifically, the biggest emotional challenges patients experience leading up to surgery, in my opinion, is fear, confusion, doubt and, most of all, loneliness.

Those emotions may or may not trigger your thoughts about a “depression” related to cardiac catheterization. It could be isolated to that one event. But, my gut tells me there is more to the story.

One thought for you… Patient cardiac depression following heart surgery can be a monster. In some studies, between 30% – 75% of patients experience some form of depression. Dr. Scott Mitchell recently stated, “I think there is a significant incidence of acute post-operative depression.” That said, if you feel your husband is having behavioral challenges pre-surgery, you may want to consider some form of counseling (therapy) for him to assist and support his recovery.

I hope that helps share a little bit about depression and cardiac catheterization / heart surgery.

Keep on tickin!
Adam

Below you will find a neat animation of blood flowing through the human heart.

As you can see, blood is pumped through the atria into the ventricles and back out to the body and lungs.

Here is your cardiac question of the day, “Can you identify each of the four heart valves shown within this animation?”

Don’t struggle. If you need a refresher on heart anatomy, watch this video about the four heart valves and their main function (opening and closing).

Keep on tickin!
Adam

I know I typically write about all things related to heart valve replacement and heart valve repair.

However, I can’t get over what’s happening to my wallet… It’s shrinking right before my very eyes.

There’s obviously no need for me to rant-and-rave about the first G of inflation… GAS! We hear about it. We read about it. It’s all over the news. And, every time we fill up our cars, SUVs and trucks, that little voice in the back of our brain screams aloud, “OH MY GAWD!”, as the price goes up-and-up-and up. In fact, with gas prices up 20% since last June, my local gas station cuts me off when I reach $75 at the pump. A trip to Costco doesn’t make it any easier. Lines for cheaper gas are always nine-to-ten cars deep.

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If there is one thing I see in heart surgery patients, it is their renewed vigor for life.

Personally, I consider the time after heart valve replacement surgery (in 2005) as my own “Second Chance”. As I have shared with you in prior blogs, I am much more appreciative of all the wonderful things that this amazing life has to offer. I get set off by the smallest things (the wonderful smell of a rose) or and the largest commitments (my marriage to Robyn).

That said, any time I see something which resonates with this mindset, I share it with you.

Sooooooo…. Here is in a fascinating story about a heart surgery patient that is chasing his dream. Mike McGill, left his insurance job of 17 years to open his very own sportsbar called “The Plate”.

I thought you might enjoy this story published in The Times earlier today. Click this link to read about, Mike McGill Opens Sportsbar After Open-Heart Surgery Story.

Keep on tickin!
Adam

Yesterday, I spoke with a patient who asked me, “Are cysts in the mitral valve common? Do they require surgery to be removed?”

I have to admit… I was intrigued. I had never heard this question before. That said, I did some Google’ing about medical conditions involving the mitral valve and cysts.

After reviewing several websites about cysts and heart valves, I learned that mitral valve cysts are rare. I found several write-ups that emphasized this point. Interestingly enough, I found two patient cases which identified blood cysts in the mitral valve and the surgical treatment used to remove them (mitral valve repair surgery).

CASE I (from Asian Cardiovascular And Thoracic Annals): A 68-year-old man underwent coronary angiography for postinfarction angina, which revealed right coronary artery stenosis and a mass in the left ventricle. Transesophageal echocardiography showed a large blood cyst originating from the anterior papillary muscle of the mitral valve. Coronary artery bypass grafting was performed and the cyst was successfully excised.

Case II (from American Heart Association): A 25-year-old, apparently healthy woman was referred to us with suspicion of left atrial myxoma found incidentally by echocardiography. Physical examination was unremarkable except for a diastolic plop sound on cardiac auscultation. Transthoracic echocardiography showed a large, very mobile cystic mass (23×25 mm) attached to the mitral valve and mild mitral regurgitation with normal ventricular size and function. At operation, a bluish cystic mass was seen attached to the anterior mitral valve leaflet with a broad base (pictured above). Resection of mitral cyst and mitral valve repair was performed successfully. Histological examination showed a blood-filled cystic cavity surrounded by a fibromyxoid wall with an internal lining of endothelial cells. The postoperative course was uneventful. Although small blood-filled cysts of the heart valves are sometimes found at postmortem examination of infants, a large cyst found in an adult is very rare. To learn more about mitral regurgitation, click here.

I hope that helps explain more about cysts in mitral heart valves.

Keep on tickin!
Adam

After two heart surgeries in six days (yes, you read that right), David Barnes has quite the tale to tell. That said, I thought you might like to hear more about this inspirational and educational patient success story.

Dear Adam,

I had my heart surgery on March 25, 2008 at Methodist Hospital in Indianapolis, Indiana. My surgeon, Dr. Fehrenbacher, replaced a dilated ascending aorta (5.3cm) and repaired an old descending aorta coarctation repair from 1972. I also had the David Procedure – aortic root replacement without replacement of the aortic valve.

On March 31st, just six days later, I required a second surgery (a Ross Procedure with a synergraft pulmonary valve from Cryolife), because the David Procedure failed.

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Earlier today, I was at Borders reading a fascinating book called “The Ultimate Question” by Fred Reichheld. The book claims that YOUR customer satisfaction is best measured by one simple question, “Would you recommend this product or service to a friend?”

When I stopped to think about it, I was amazed at all the different product and service recommendations I made during the last 24 hours. The list included everything from one-cup coffee machines (Keurig) to 7-inch digital photo frames (Philips) to attorneys (Valle Associates) to gardening centers (Lowes) to…. yes… you guessed it… HEART SURGEONS.

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There never seems to be a shortage of inspirational emails waiting for me in my inbox.

Recently, I exchanged emails with Robin, a fellow patient recently diagnosed with aortic stenosis. As you can read, this is the second major health issue for Robin. Several years ago Robin fought cancer (Hodgkin’s lymphoma).

In her note to me, Robin mentioned something that I had never heard before – the negative impact of radiation on heart valve function. Specifically, Robin noted that her medical team believes that her stenotic valve was caused by radiation treatments used to fight the cancer.

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It really is amazing to read and learn about all the new studies and research about heart surgery and heart valve disease.

You may have read my recent posts about minimally invasive aortic valve replacement, the use of statins to reduce complications post-operation, blood transfusion concerns or treating stenotic aortic valves with HDL-increasing drugs.

Well… Here’s another interesting study just released from the University of Michigan Health System.

According to Michigan researchers, nearly half of all heart surgery patients may experience blood sugar levels high enough to require temporary insulin treatment after their operation, even though they’ve never had diabetes. And a significant minority of those patients might need to take medicines for days or even weeks after they leave the hospital.

To read more about Michigan’s research, please click here.

Keep on tickin!
Adam

I don’t know about you…

But, as I went through the heart valve surgery process, I learned ALOT of interesting information about the heart – specifically, its anatomy and function.

I also learned there was a laundry list of Do’s and Dont’s specific to the recovery. In past posts, I’ve written about many of these recovery suggestions which include everything from not drinking coffee after surgery to using your incentive spirometer after heart surgery.

FYI, here is another little fact to remember during your recovery from heart valve repair or heart valve replacement surgery.

Do not spend time in a jacuzzi, wet sauna, dry sauna or extremely hot shower immediately after cardiac surgery. High temperatures force the heart to work harder to circulate blood throughout the body.

As The Practical Guide For Heart Health states, “Avoid working and exercising in extremely hot temperatures during your early recovery from heart surgery.”

Keep on tickin!
Adam