Dave's Guestbook

Dave Van Buren (DVB)  Hi Suzanne! I dropped a note on your guestbook page. Smart to take care of it right away before it gets out of hand. I'll be checking your journal - best to you.

Dave Van Buren (DVB)  Hi Deb. That's a great question and probably deserves more thought than just this quick note. But here you go anyway!

In your routine checkups you'll generally get some combination of various exams & tests: stethoscope, EKG, ultrasound, treadmill, blood analysis. So the simplest kinds of questions revolve around the tests and what they are showing. I ask to listen to my heartbeat with the stethoscope and ask "what am I hearing?" When they do the EKG, what am I seeing on the traces? With the echo: show me my annuloplasty ring and the leaflets coming together. Show me the (lack of) backflow when the valve closes. These kinds of questions lead to others and exploring them gives you a good picture of how your heart is working.

Questions about your repair: how is it holding up? Is there anything to be on the watch for? Just in general, how durable are repairs? Most last by the way.

There are questions about good health practices: What can I do to keep my blood pressure low? What can I do to keep my arteries clean? What can I do to reduce my chances of other bad things happening to my heart, for example from diabetes?

If you are on medications you can ask about what they do, how they work, how they interact with other medications. If there are safer or less costly alternatives. Are there other medicines that do the same thing with different/fewer side effects? What are the studies showing their effectiveness and where do you stand with respect to the corresponding study groups. Some drugs require discipline and monitoring so discuss what discipline is needed and how to monitor, especially when away from home base. And what safety nets are appropriate.

Then there are the questions about your potential. How vigorously can I exercise? Is it reasonable for me to do X? Do I have any medical limitations?

Successful mitral valve repairs fully restore patient life spans. Of course the surgery is key, but contributing is that patients learn a lot about heart health and are motivated to apply what they learn. So asking questions during checkups is important.

And congrats to you on your upcoming 2 year anniversary. You seem to have your head fully wrapped around it and are doing a great job helping the "newcomers" in their journeys. Bravo!

-- DVB

Dave Van Buren (DVB)  Thanks for the kind words. I left a note in your guestbook. Holding you close in my thoughts tomorrow, 26 June.

Dave Van Buren (DVB)  Hi Deb. Great question. Inspired me to do a full-fledged blog post on the topic so check on my main journal page. I would hope your cardiologist keeps in touch with your surgical team regarding your progress. Mine does. But my surgeon doesn't check up on me personally so I send him a short note every six months to a year. Congrats on 17 months, you rock -- DVB

Dave Van Buren (DVB)  Thanks for your kind words. It makes my day to know these blog posts are helpful.

Many people struggle with depression. For some people exercise and other self-help is not enough and it works better if they seek treatment.

I hope your surgery goes well, and your recovery uneventful. Explore ways to reduce risk and improve your already excellent odds.

Safe journey! -- DVB

Dave Van Buren (DVB)  Half marathons! Dude, you are busy proving it just gets better and better after getting wonky valves fixed.

I'm doing pretty good. Finished teaching an evening class last quarter (do it every few years) so back to playing lots of ultimate frisbee. League started last week and its looking like a good season.

Great to hear from you, be monstrous in 2013! -- DVB

Dave Van Buren (DVB)  Hi Steve. I posted my reply in your guestbook so you can have all your stuff in one place. Best to you -- DVB

Dave Van Buren (DVB)  Hi Janis. Thanks for the note. I will always remember your laundry remark. It belongs in the "best of" collection. All the best to you and yours -- DVB

Dave Van Buren (DVB)  Thanks Nancy. Yeah, things only happen to other people. Ain't that the truth. Until it happens to you. The thing is there's lots of stuff that happens to other people because there are so many of them. But remember too that we are the other people's other people! Happy New Year to you and may your beat be strong! -- DVB

Dave Van Buren (DVB)  Thanks Lee. Your info about diabetes and the heart is key. They already tinkered around in my heart once and I'm not so keen on it happening again! Good luck with your plan. Happily there are still lots of yummy things to eat. -- DVB

Dave Van Buren (DVB)  Hi Deb. Yeah, it takes thought more than anything else. And a decision each time faced with something sweet. Cutting out all sugar sounds hard - I just cut out the "added sugar". And now I relaxed that some, maybe by a third back to my prior levels since it had such an effect. No need for torture! -- DVB

Dave Van Buren (DVB)  Hi Connie. Hope all goes well with your honey. What we eat is as much a habit as anything else. Hard to change... until it's a new habit. A lot of what we eat is social, so I'm sure you will be a huge help to him if he wants to give it a go. All the best to you guys -- DVB

Dave Van Buren (DVB)  HI Deb.

Beta blockers also are used to reduce hypertension aka high blood pressure. They weren't part of the report, but it's a plausible thought that they would have similar effect because they reduce the work load on the heart. Beta blockers are also used by millions, so their side effects and risks are relatively well known.

By the way, heavy lifting raises your blood pressure significantly and puts a higher load on your heart. It's kind of like an anti-drug because you really want to lower the load.

These drugs all operate on different parts of the blood pressure regulatory system. Beta-blockers bind to receptors in the cell membranes of your arteries and smooth muscle, preventing the entry of adrenaline.
If adrenaline were to enter those cells it would cause them to contract, which in turn would increase blood pressure.

Beta blockers are also used post heart surgery to limit heart rate and blood pressure, and I guess from your note, palpitations too. I had a six week prescription of metropolol (which targets cardiac muscle beta receptors) after my surgery. In other settings beta blockers are used to reduce anxiety, and to lessen the severity and frequency of chronic headaches among other things.

And thanks Deb for the encouragement. I can't articulate well enough what it means to me when I hear that my posts have been useful. And I have to give thanks to everyone who posts here, giving information, spreading encouragement, being examples to the rest of us and even asking for help. This is a magical place and thank you for being a part of it.

Take care -- DVB

Dave Van Buren (DVB)  Hi Wes!

Thanks for the kind words. They picked me up on a blah day.

I'm a big believer in rehab. It gives structure and discipline to the post-surgery physical conditioning necessary for rapid recovery. Also gives confidence to push your body some that most folks wouldn't have without the monitoring.

5K trail run? Monstrous! I love trail running. I'm not so big on races but I do one at work each year because it is on a trail. Trail running though... It's such a free feeling running through the wild with nothing but your shirt, shorts, and shoes. Kinda primal. Keep it up my man.

-- DVB

Dave Van Buren (DVB)  Thanks Lee.

I think you hit the nail on the head with "the sheer satisfaction of taking control". Taking control directly confronts the negative feelings we can have. Then we are doing things instead of things are being done to us. Much better for our heads.

Your rehab routine is an inspiration. Monstrous! -- DVB

Dave Van Buren (DVB)  So here's how I read the chart in my case. I was diagnosed with severe mitral regurgitation following a bad heart murmur and an echocardiogram, so I entered the chart at the top. Since I did not have any symptoms, I went to the left, where it says "No" and dropped down to the circle "LV Function". That's left ventrical function. My "EF" (Ejection Fraction) was 0.6 (60%, normal) and my "ESD" (End Diastolic Dimension) was less than 40 mm (heart not significantly enlarged), so I dropped down again to the left. Then, since I did not have atrial fibrillation or pulmunory hypertension I continued to drop down to the "mitral valve repair likely" circle. The answer was yes (90% or better of the time it is repairable for non-rheumatic valve disease). That resulted in a recommendation to undergo surgery for repair. So I scheduled it at the earliest time possible to avoid further deterioration of my heart.

If the chart is obscured by stuff from the web site, you can click on it and drag it to your desktop where it will just be an image file on your computer.

-- DVB