Joanne's Journal

christine blackway  I got my surgical opinions (3) with only the TEE. If the echo results are questionable and they can't clearly tell what would be needed then they might request the TTE before determining you are a candidate. I got my TTE once my surgery date was scheduled. 

J Alexander Lassally  Hey there Joanne - just logged on and saw this.  A TEE is definitely needed and advised, but you can still have a consult with a surgeon based on Echo alone. If you are a clean cut case, you can meet and discuss with surgeon.  But, a TEE is the gold standard pre-op. 

Yumiko Ishida  I think you can get opinions with just the regular echo. You probably want to wait on a TEE unless a doctor specifically requests it. You have to be sedated, so the doctor will likely want to combine it with other procedures, like a diagnostic cath. There are certain information you can only get from a regular echo, and vice versa. I never got a CT or CMR for my heart, so those for sure are only needed if a doctor thinks are needed for your particular case.

Allen Carkner  Depends on how good of echo “windows” they have. I did have a second echo just a month after my first “severe” echo with a second opinion cardiologist just so they could get another confirmation.

Robert Miller  I had a similar experience as Christine. I got a regular echo and that pretty much determined that I needed surgery. From an echo they can see your leakage, your ejection rate, size of chamber, etc. I then got a TTE but that was mostly to determine the exact status before the surgery. So to answer your question, yes, an echo is enough. You might want to get a second echo, though. The echo (and TTE) can show very different results depending on the current state of your heart. 

Grace Mason   Joanne,
I recently met with a surgeon at CC and specifically requested rigid fixation. I was told they normally do not do for people under 100kg. Then he said sometimes we do for 90kg, and I guess we could do for you.(I am 80kg) We don't do it for the "little old lady". It didn't leave me feeling very confident about receiving it. However, if you want it, anywhere, ask for it.

Most hospitals use wire because of cost. I believe you will have to advocate for it, if it is important to you. One hospital exception I know uses it every time is Franciscan Heart Health and Dr Gerdisch.

Grace Mason   https://www.heart-valve-surgery.com/heart-surgery-blog/2019/11/13/sternalock/?utm_campaign=shareaholic&utm_medium=email_this&utm_source=email

Grace Mason   You are welcome Valerie. It is important to me. I feel like it is one thing I want to know will happen before going into surgery, since I won't know if a repair or replacement will be done beforehand. Gives me a little sense of control in a situation where you feel you have very little control over what happens to your body. Plus the benefits of rigid fixation too!

Valerie Allen  Grace, did you get the sense that CC would take this approach if requested? I am probably closer to what you named as instances where they would use it. But I don’t know about the little old lady part 😉

Grace Mason   Well, I would like to think they would, but if you don't specifically tell your surgeon, I will have my surgery here, if I can have rigid fixation, I don't think they would automatically do it, even if you are 90 or 100kg.
I don't know why this surgeon even found it necessary to add the little old lady comment.

Brady Busch  When first talking to my surgeon,I said sternum plates were my preference,after hearing about them on this site.The doctor said,they use a combination of wire and plates,because plates are not always secure and can move around.

Marie Myers  I bet the “ little old lady” comment has to do with your ability to not try to do any crazy strenuous activities before the sternum is healed.  I had the traditional wires, and really followed the dont “ lift anything over 10 pound “ rule. It was hard since I am an active little old lady, but I managed to avoid too much activity, lifting, ect, and healed my sternal wound without complication. I am sure the younger patients, especially the younger guys, have a tougher time holding themselves back from doing too much too soon.

Rita Savelis  I had a traditional surgical sternum cut with no pain afterwards. I was told by my anasthesiologist beforehand that the sternum doesn't hurt (like ribs) when cut and that proved to be true. No special sternal plate, just wires. I trusted my surgeon to make the right surgical choices for me. Occasionally some patients do not do well with wires, but that seems to be a minority. But many procedures are now being marketed directly to patients... Take care. 

Grace Mason  
I think it is good, especially as you can lift 30lbs(15 in each arm) immediately after surgery and lift arms above your head. I believe it will help mentally, to see yourself as "normal" and less restricted immediately after surgery, and it is beneficial for those who don't have someone to help them at home after surgery. 

Another info article found here at HVS:
https://www.heart-valve-surgery.com/heart-surgery.../rigid-sternal-fixation/

Joanne Heckmann  Grace, thank you and I agree with you.  Patients deserve better.  Dr Gerdisch explained in a YT video about this that cardiac surgery is the ONLY specialty that hasn't caught on to rigid fixation.  It's SO MUCH better for the patient.  IMO if a surgeon poo-poos it he's not well informed.  I had a feeling even though CC is a member of ERAS, they might not be fully committed.  And that "little old lady" comment... shameful.  We've lost so much ground that was gained in the 70's.  https://www.erascardiac.org/about/eras-cardiac-society

Valerie Allen  Marie, yes it is listed as a “Moderate” recommendation under During Surgery/ERAS Recommendations. The critical ones are deemed “Strong.”

Miriam St.Clair  I had rigid fixation devices plus cotton ties (I'm allergic to the nickel in wires) placed at the Cleveland Clinic. I was a re-do sternotomy and I've had radiation treatments so I had a "hostile" chest. My sternum was damaged from the previous surgery and radiation plus it adhered to the underlying blood vessels and tissues. I required 16 units of blood products during the surgery because of trying to get through and lift off the sternum plus several units of cryoprecipitate. I think they didn't want to take ANY chances that my sternum would come apart post-operatively so the sternalock blu fixation devices were used and the ties.  I've done well and had very little pain after the first day of surgery and no pain now at all. I do know they have no intention of ever trying to open my sternum again so another reason for the strong closures. I'm definitely a little old lady who weighs 105 pounds (48 kg).  I was driving and easily lifting heavy objects after 6 weeks. No pain or discomfort or creaking in the night since the surgery. Good luck!

Anna Ma  It shows 404 for both links. I have been wondering too what data and criteria USNews have been using for their ranking. For example, when I drill down from the general cardio/vascular ranking further to aortic valve surgery, the rankings are totally different. All the top 10 well known hospitals fall to after 20, actually only cedar sinai and cleveland made to before top 50... Nevermind, I just realized that they don't actually have a rating for valve surgery, it is in alphabetical order, no wonder it doesn't make sense. LOL

George Gardopee  Joanne - I had repairs to my mitral and tricuspid valves done at the Cleveland Clinic in November of 2021. We are on Medicare and a United Healthcare Advantage policy. My total share for the surgery and hospitalization was $200. It was all seamless and easy except for a little trouble getting confirmation for pre-approvals for pre-admission testing.  BUT - the UHC plan we are on is not available to the public - it is for retired CT teachers, so I can’t claim you would have the same experience with a different UHC Advantage plan. Good luck!

Joanne Heckmann  George, thank you, nice to hear from you.  I read through your journal, well done, very detailed and very helpful.  Like you (not an engineer but retired IT, private pilot and experimental aircraft builder) I have been analyzing my echo data.  Yes I will consider AARP UHC, that's what my ex has and he just had a carotid "roto rooter" surgery;  he's doing ok and I will ask about his insurance experience.

George Gardopee  Nice to meet you Joanne. I am also a private pilot - I should say “was” as I am severely not current.  Just curious and perhaps too nosy - but has your heart condition influenced your ability to pass the 3rd class physical? I don’t expect to be returning to flying, but I did wonder if I would have been able to pass either with a severe leak (prior to surgery) or now that it has been repaired.

Herb Greenberg  I had regular Medicare with a supplement and my $180k bill cost me zero. Only cost was plane travel and the cost of lodging which can be a tax deduction, if you qualify.

Joanne Heckmann  George, I sold my Avid Flyer years ago, it's currently flying in Ohio.  I had a C5-7 cervical spine fusion and the risks of flying (or really, landing) became too great.  Amy Laboda wrote a nice 7 page article in EAA Magazine here:  https://tinyurl.com/EAAAvidFlyer .

Joanne Heckmann  Herb and Ana, thank you... I was wondering how many here were using original Medicare with a Medigap plan for this.  I just found today that CC has partnered with an independent Medicare broker to help answer the coverage question.   I was able to find the MA plans in my area which include CC in their network (basically all UHC and Humana PPO plans).   Not sure what that will mean in terms of total costs.  Still researching.

Joanne Heckmann  According to a very useful Medicare Advantage plan comparison chart created by a local nonprofit agency, one of our local hospital systems (the one my cardiologist is in) is not in network for Humana.  So that narrows it down to UHC.

Louise Moore  Hi Joanne, I had my surgery at CC and I have Medicare and Plan G with UHC.  CC accepted Medicare and my Florida Plan G covered the 20% or more excess.  It's great that you chose CC for such an important surgery!

Joanne Heckmann  Thanks Louise, glad you are doing well and are pleased with Dr Gillinov.   My thoughts are that Medigap is 10x the cost of the PPO here, being single that's an important consideration, plus going to Medigap is a one-time, one-way decision.  I don't have anything else pushing me in that direction.

Joanne Heckmann  New info thanks to more research and a kind soul on Reddit.  NY is one of the few  states where underwriting is not a concern for Medigap, so you can switch back and forth between Advantage and Medigap from year to year.  And in NY, if you qualify for EPIC, you get a "get out of jail free card" in the form of a SEP that allows you to switch any time during the year, every year.  So I can switch to a UHC PPO by 3/31, on 4/1 submit my application for EPIC, and plan for either plan F or G when the time comes.  Whew.  Going to double check this with a local Medicare insurance broker, but I feel a lot better now.

George Gardopee  Joanne -that sounds like an excellent outcome for you. I bet you will be pleased with the CC.

 I read the Avid article -I am extremely impressed. I restored a ‘59 Alfa myself some years ago (a 2000 Spider). It took me 10 years. By my calculation, that would mean it would have taken me about 80 years to build an Avid. 

Joanne Heckmann  I subscribe to a couple of medical industry email newsletters.  This article was in today's Healthcare Dive newsletter.  It's about how MA plans (including UHC) use AI to deny benefits.  Don't read it to get angry, read it to be informed.  https://www.statnews.com/2023/03/13/medicare-advantage-plans-denial-artificial-intelligence/?utm_source=Sailthru&utm_medium=email&utm_campaign=Issue:%202023-03-13%20Healthcare%20Dive%20%5Bissue:48740%5D&utm_term=Healthcare%20Dive

Joanne Heckmann  George, that's amazing.  It's such a beautiful little Swiss watch of a sports car.  Did you autocross it or show it?  Mine had a chrome air cleaner that everyone lusted for.  

George Gardopee  Just showed it, mostly. I suspect it would have been too large and heavy for anything like auto cross - the model was not nearly as nimble as the Guilietta.   I sold it about 8 years ago when I lost my appetite for another round of rust repair.  Here is a link to a page that has several photos of it at the Pittsburgh Vintage Grand Prix. All the ones of a car with a tan interior are of mine.

https://www.conceptcarz.com/view/photo/295356,10543/1959-alfa-romeo-2000-spider_photo.aspx

Joanne Heckmann  Wow, what a beautiful restoration.  Nice memories.  Yes, rust was the problem with mine as well, you could watch the road go by through the floor.  Autocross is just so much fun regardless, you never get out of second gear... My current 2006 NC Miata GT (just turned 25k miles last summer) isn't competitive without an RX7 rear swaybar at the very least.  The local SCCA club incorrectly put me in the same class as the NBs, which made it look a half second faster in stats.  I took an instructor with me on a few runs and he said my approach was "aggressive"; well, he was telling me to go faster!   My father grew up racing dirt track so I guess it's in the genes.  I was navigator on a few road rallies as well - nothing like hanging on in a 90-degree turn in an original Mini on a state forestry road at night in the middle of nowhere in snow.  I learned to read tulip maps :-) .