Monthly Archives: September 2013

Slackline Confessional

A couple posts ago, I mentioned an email correspondence I had with Dr. Lawrence Creswell, a cardiac surgeon who blogs about athletes’ hearts, and athletes with heart problems. His recent post, More on Athletes and Bicuspid Aortic Valve (BAV), dives very deep into the various issues that someone like me thinks about and needs to make decisions about. It is a very thorough post. Dr. Creswell’s blogging helps heart patients everywhere, not just the ones that he gets paid to treat. He touches many hearts (beyond the hearts he touches). See what I did there? That was a heart surgeon joke. In all seriousness, this is what the internet is for. Dr. Creswell ends his post with some points that he also made in an email to me:

“Athletes will ask when they can return to their sports….

…Unanswered questions include:  Can a bioprosthetic valve wear out more quickly than expected?  Does the (unreplaced) aorta enlarge over time?  If so, how quickly?  Do medications like beta-blockers limit any potential harm?  We just don’t know.

Yet I’m personally aware of a good number of athletes who’ve returned to endurance sport after operations of various sorts for BAV, presumably after discussion with their doctors.  Athletes should have detailed discussion with their doctors about any prudent limitations to exercise after operation and settle on a mutually agreeable plan.”

I think Dr. Creswell is saying two things here. On one hand, he feels that heart valve replacement patients should not do certain sports, including endurance cycling and rock climbing, and on the other hand, many patients are going to do it any way, as long as their docs give them the proper low down. I think most athletes are willing to take that risk. I understand that there isn’t enough data out there for some doctors to completely release their heart valve patients into the world of extreme and endurance sports. The thing is, and as Dr. Creswell reluctantly acknowledged, some of us are completely willing to be the lab rats. Quality of life includes doing the things one loves to do, not necessarily living to be 105.

Inspired by Dr. Creswell’s post, and after some reflection, I decided to do my first video Blog (Vlog) while slacklining. Thanks for watching! I call it ‘Slackline Confessional’.

Fun little side note, moments after I posted this video, I hopped back on my bike and almost got clobbered, sending me over my handlebars to avoid a collision with a truck backing out of a driveway. Moments of clarity are often quickly replaced with the harsh reality that is life!

Ascending Aortic Dilatation Associated With Bicuspid Aortic Valve

aortic dissection

aortic dissection

If you are like me, then you have an ascending aortic aneurysm associated with bicuspid aortic valve and are potentially at risk for aortic dissection. This may sound fun and interesting, but it’s actually a health risk. Turns out you need to get the darn thing replaced. The tricky thing for cardiologists has been determining what size aneurysm should be an indicator for elective surgery. Apparently, based on this study (from Circulation), there is a neat little calculation that can be used to make that determination. What you do is compare your aneurysm size relative to body size, with the value of 10cm/m^2 being the indicator. But don’t take my word for it:

…adults with small body size should undergo earlier intervention because a higher ratio of aortic size to body size is a predictor of increased risk.85,118,119Calculating the ratio of aortic area in square centimeters to body height in meters, using a ratio of 10 as an indicator of increased risk, has been proposed.85,119 The value of 10 was derived from the mean ratio minus 1 SD at time of dissection in BAV patients; it is a conservative threshold that would theoretically precede 95% of dissections. Increasing “aortic size index,” a ratio of aortic diameter in centimeters to body surface area in square meters, was correlated with dissection, rupture, and death in 1 study; an index ≥4.25 cm/m2 indicated high risk (20% per year).118 The aortic size ratios and indexes should be used as rough guidelines until validated by further studies. Measurement of aortic elasticity by echocardiography may aid with risk stratification in the future; prospective studies are needed.66Genomewide association studies may identify high-risk genotypes that will aid with risk stratification as well.

Source: http://circ.ahajournals.org/content/119/6/880.full

I found this calculator on the Valley Health System’s website so that the layperson can simply enter their aneurysm size, height, and weight to obtain their suggestive results. Turns out I am still just under the recommended elective surgery point, which is great news because the point itself is already conservative. To see my results, just type in my data: height: 5’9″     weight: 158lb     aneurysm: 4.6cm

Calculate Your Relative Aortic Size Link: http://valleyheartandvascular.com/Thoracic-Aneurysm-Program/Calculate-Your-Relative-Aortic-Size.aspx

Hands to Heart Center

If you live in the Redlands, California area, please check out Inner Evolution Yoga.

Phil and I were originally climbing buddies  before he opened his own studio. His studio donates to local causes, and has weekly community donation yoga classes, where anyone can come and practice yoga for whatever they can afford. Inner Evolution is about community.

The Yogis call it your ‘yoga practice’, because that’s all it is. It’s like life, something that you must practice, and get better at. Some days are better than others. There are many physiological aspects that Yoga is assisting me with, such as breathing and core strength. Yoga also reminds me that it is okay to let some things go. If it is going to injure you, then let it go. Come back to it next time. Patience and persistence. There are many analogies.

And on that note, something completely different (not really). When I watched the following Nike commercial, I became overwhelmed with emotion. I usually don’t pay much attention to commercials, but I get this one. It’s like Dr. Seuss’ “Oh The Places You’ll Go” for extreme & endurance athletes.

“You’re in a fight against an opponent you cant see but oh, you can feel em’ on your heels cant you? Feel em’ breathing down your neck. Know what that is? THAT’S YOU.”

go get em.

Why I Chose Mechanical Over Tissue

It was recently suggested to me that I provide an explanation of why I decided to receive a mechanical valve, rather than a tissue valve to replace my diseased aortic valve. This post will  be dedicated to why I made this (very personal) choice.

ross procedure

ross procedure

There are generally two options for someone in my situation; Replace the Bicuspid Aortic Valve with either a mechanical valve, or a tissue valve. Tissue valves are usually from a cow or a pig. They can also be homograft, which comes from a human cadaver (check off organ donor on your driver’s license y’all!). There is also a crazy option called the Ross Procedure where the surgeon takes the patient’s pulmonary valve, puts it in the aortic position, and takes a pulmonary valve from a cadaver, and puts that in the pulmonary position. I mean, wow.

Mechanical Valve Pros & Cons

  • Mechanical valves typically last for life. Patients who expect to live for more than 15 more years are often encouraged to get mechanical valves. This means that one should expect only one open heart surgery.
  • The main drawback of mechanical valves has been their requirement for warfarin anticoagulation therapy, with its accompanying risk of bleeding. Bleeding events are rare but are potentially fatal. With properly managed anticoagulation therapy, rates are low for both bleeding and clotting. Without anticoagulation therapy, a blood clot may form on the new valve, inevitably causing a fatal stroke.

best-heart-valve-replacement-1

Tissue Valve Pros & Cons

  • The lifetime of a tissue valve is typically 10 to 15 years, (possibly) less in younger patients. Tissue valves may also last longer.
  • Additional valve replacements places additional chances of risk that inherently goes along with open heart surgery.
  • The primary advantage of tissue valves is their lower requirement for anticoagulation therapy, which reduces the incidence of bleeding. However, other heart issues may require patients with tissue valves to go on anticoagulation therapy.

My Choice: The On-X Mechanical Valve.

Perhaps it is the cyclist and rock climber in my that thought that ‘carbon fiber with titanium housing’ sounded cool. My surgeon did not specify whether or not he thought this brand was better than others.  The St. Jude’s Valve is the most commonly used. I chose mechanical for several reasons:

  • If I can help it, I only want one heart surgery in my lifetime. Getting tissue valves would mean getting 2 or 3 replacement surgeries in my lifetime, especially since I am young.
  • Though doctors recommend against competitive or extreme sports, the reason for this is for the potential of injury, thus causing major bleeding events due to the anticoagulation therapy. I feel that I can do my sports of choice, with an understanding of the risks, and taking necessary precautions.
  • After recovery, the mechanical valve will probably perform better than the current diseased valve.
  • An exciting study involving On-X Valves and lower anticoagulation drug doses may result in future recommendations of lower doses of the anticoagulant drug Coumadin or Warfarin. Lower doses would lower the excessive bleeding episode risks.
  • Because mechanical valves typically last for life, I can get the replacement surgery now, rather than waiting for the last possible moment, which is often done with tissue valves (to reduce the total number of heart surgeries in one’s lifetime). This is a benefit since I also need an ascending aortic aneurysm fixed. The aneurysm dissecting or rupturing actually poses my greatest current risk.
On-X Mechanical Valves

On-X Mechanical Valves

This choice is a personal one. Some athletes choose tissue valves because they do not want to worry about anticoagulant drugs affecting their sports of choice. It is is important to remember however, that sometimes tissue valves still require these drugs, depending on the circumstances. To some athletes, multiple surgeries are an acceptable consequence to avoiding drugs for 6-15 years. For me, I have learned from my doctors and other mechanical valve ownersWomen who plan on having children will also choose a tissue valve, because anticoagulation drugs cause damage to the fetus.

The best thing to do is to weigh the pros and cons, think about what you want out of your own life, make a decision, and then make a game plan that will lead you towards a healthy, active, productive life.

I’m kind of annoyed that I cannot embed this here. Welp, here is the link.

Tell me how it is, Doc.

“You’re heart is abnormally big,” Dr. Yun said,  “and it leaks allot.”

“Mmhm,” I say, waiting for the punchline.

Dr. Yun paused for five seconds, perhaps to highlight the importance of his next statement, “Ultimately, You’re heart is going to fail.”

“When it’s going to happen, we do not know.”

Until this moment, in my everyday life, my attitude toward this whole ordeal was that of desperate denial. Finally, upon meeting with my new surgeon was it clear to my thick skull that I would require open heart surgery on my 30th year. Even toward the end of the 45 minute long meeting, I still tried to buy myself some more time.

“Umm, I guess I’m still confused about what to do,” I lied.

The surgeon said, “Why are you still confused? You wanted options and I gave you options.”

We chuckled and I knew what he meant, but what I wanted was a direct command from him. I asked him if he were in my shoes, when would he opt for surgery.

“Soon,” He said, plain and simple.

So there it was. He explained that because I was leaning toward a mechanical valve, there was no reason to wait for the operation. Mechanical valves last your whole life, so re-operation at any point would be a minimal risk. This is why I chose a mechanical valve, because I did not like the idea of getting a re-operation on a tissue valve in 9-13 years.

We look up to doctors as authorities on the human body, however they do not control your body. You are the master of your own domain, and you must make these difficult decisions yourself. I knew what I had to do. I scheduled my operation.

Prompt: http://dailypost.wordpress.com/2013/09/16/writing-challenge-dialogue/

 

Warm-heartedness for Healthy Mind, Healthy Body

The internet is full of rants. Perhaps this will help tip the balance.

I’m thankful for my health. You heard me. Despite the fact that I need major surgery, everything else is working swimmingly. This will help my recovery, I hope.

His Holiness, the Dalai Lama discusses how fear and anger are connected, and how these feelings can affect the physical body. I have been aware of this for the past few years, and it has been an ongoing process to improve. One should not feel bad for being afraid, however the more we can let go of these fears, the more anger we can also release. ohmmmmmmm…

I’m also thankful for my Mother, and Natalie

Writing Prompt taken from: http://dailypost.wordpress.com/2013/09/11/daily-prompt-thanks/

Six of One, Half a Dozen of the Other

A six word story:

Anxiety now, chest cut next… LIVE.

How perfect that I fall victim to a writing prompt via wordpress. The irony is that I assign such work almost daily to my students.

More and more, I’ve been wishing that my surgery date was sooner. More irony. Previously I wished it away into the distant future. Now, i feel that the anxiety leading up to it must be worse than the surgery itself. The last part of the six word story is “LIVE“. I just want to put this behind me so I can get on with life. I am very excited about life ‘on the other side’. I plan on livin’.

Which leads me to a relevant lesson taught to me by a Bruce Lee JPG (click pic to read).

then die...

then die…

http://dailypost.wordpress.com/2013/09/10/daily-prompt-six/