Tag Archives: robovalve

Echocardiogram Images 

I thought it would be cool to share my final echocardiogram results from my recent hospital stay. I took some video of the echo screen. My cardiologist points out the clot, which is small enough here to allow me to be discharged.

Also, notice my mechanical aortic valve shape. My doctor points to it in the 2nd video. It is near the middle of the screen. It is a circle, with a straight line that goes from its 12 o’clock to its 6 o’clock. That line will appear and disappear, which are the bi-leaflets closing. Use the picture of a St. Jude’s mechanical valve below to help identify it in the echo. regent-2

 

 

In screen shot below, I have circled the clot.  It appears as a little white smudge. It was larger when it was first detected last Friday. Try to look for that little smudge in the videos above.

img_5962

 

New Doctor, New Recovery

My new job is going well. With my new job came new insurance. So I no longer go to kaiser Permanante. My new insurance allows me to go to Loma Linda Medical Center’s Heart Institute, which has come highly recommended to me. Last week, I met my new cardiologist, Dr. Bansal, who is very experienced and has seen many heart surgery patients in his years. He is also in charge of echocardiograms at Loma Linda. Meeting with him for the first time went well. He looked at my surgical reports, and asked me about my history. Thoroughly. He wrote down almost three pages of notes. I never felt rushed. He instructed me to go in for some blood work and an echo so that he can establish a baseline of heart health for me.

The other day I went in for my echo. The tech did a thorough job. What happened next blew me away. My doctor came in and read the echo right in front of me, and discussed the results! He pointed out features of my prosthetic valve and graft. He showed me the sutures, which looked fine. I’ve never experienced this type of immediate response regarding echos. Normally, the tech does the echo, and you go home and wait over a week to hear from your doctor.  Though I found my way to Loma Linda due to circumstance, I am so happy with he level of care I have received already.

Another piece of good news. A few weeks ago, I talked with Cardiac Surgeon Dr. Larry Creswell of the Athlete’s Heart Blog. He seemed to disagree with my previous cardiologist’s conservative approach to recovery. My previous cardiologist had me on a year of strict physical restrictions. She didn’t even want me to do yoga. I understood the reason to be cautious due to my circumstance, however it turns out that these restrictions were not based on any sort of evidence. Larry did not tell me what to do, since he is not my doctor, however he gave me insight to the variety of professional opinions on the matter. When I asked my new doctor about restrictions (without mentioning my previous doctor), he gave me the normal routine, which is slowly resuming activity after 3 months after surgery. I then mentioned my previous doctor’s cautious restrictions and stressed the fact that I had 2 surgeries, and he said, “Nope, it is the same.”

This does not mean I am going to go hard right away. I will ease into exercise very slowly. Just because I feel that I can do it, doesn’t mean I will this time. I’m thinking that I can slowly work up to (close to) normal strength by 6-8 months post surgery. Also, I plan on doing a more broad exercise plan, involving more yoga and less weight training.

a nice day for a ride.

a nice day for a ride.

How am I’m Feeling? I feel pretty good! I’m less down in the dumps these days. I have to admit that my last surgery took some of the wind out of my sails, but I’m recovering. I took my bike out for a spin yesterday. You can see my workout here. I was able to easily keep my heart rate in an acceptable range. FYI the huge spikes in heart rate that immediately go down are errors due to wind or vibrations effecting the chest strap.

I’ll just keep on goin.

Happy Mother’s Day!

“I brought you into this world, and I could take me out.”

“You’ll miss me when I’m gone!”

“Make good choices.”

“Be careful” -Helen DiLemme

Mom <3

Mom <3

I always knew that my mother cared for me so incredibly much, but this experience of needing two open heart surgeries has really allowed Helen’s motherly instincts kick into high gear. Maybe she missed doing these duties because my brothers are adults now. I moved to California in 2006, leaving behind all of my family and friends. I know this made her sad to a certain degree, but she knew that living here and making my own life for myself is what would make me happy, so she embraced it and always told me how proud she was of me. Of course she occasionally says, “You should get a teaching job in New Jersey.”

She flew out here to care for me for the first 3 weeks of each surgery recovery (my dad did too, thanks Dad). She researches valve issues, she goes onto valvereplacement.org (valve forum), and she really knows her medical jargon. She knows how to talk me down when I’m freaking out about having a fast heart rate, PVC’s (a type of palpitation), or being worried about a million other things that come along with valve surgeries.

She fed me, she bought me anything that could maybe make me a little more comfortable (back massager, shoulder heater, pill boxes, medical supplies) during my recovery. She cleaned my entire house practically every day she was here.

She has done more for me in those two 3-week periods of surgery recoveries than anyone has in my entire life. Whenever I’m really feeling down, she figures it out and writes me an email to tell me how proud she is of me to go through this experience. She just knows.

Thank you so much Mom. I know I went through the motions for previous Mother’s Days, and always told you I love you, and sent you flowers or something, but this year it’s different.

This year I truly appreciate you more than I ever have imagined. I know you worry about me being so far away, but I’m doing fine, and it really is thanks to you. I love you.

Your son, Anthony

How to Fight Cardiac Depression

There are many forms of depression, and a whole range of degrees of severity of this mental condition. Cardiac depression is some form of depression that occurs after a heart event, such as a heart attack or heart surgery. There are many resources out there on this topic, but I found one to be very useful, and that is an interview on the Patient Power website with Dr. Kim Lebowitz of Northwestern Memorial Hospital. I highly recommend listening to the interview or reading the transcript

“When you look at the cardiac population as many as 20 to 40 percent of cardiac patients are going to be presenting with symptoms of clinical depression, and that might be compared to about 4 percent of the general population at any one given time having symptoms of depression.” -Lebowitz

Dr. Lebowitz explains that the presence of depressive symptoms after that cardiac event can actually predict a poorer outcome for a patient, which means that depression is an independent risk factor for both the development of heart disease and cardiac outcomes following a heart attack or cardiac surgery. Basically, depression can cause (increase) heart disease, and heart disease can cause depression. 

That sure does sound like a vicious cycle. Why am I discussing this? Because I have experienced first hand (on the lower end of the spectrum) some symptoms of cardiac depression. For me, it is easy to be positive in writing, like on this blog, on Facebook, or on posts at supportnetwork.heart.org/heartvalvedisease. I think these outlets have definitely aided in my overall outlook, which I will mention again later. That does not mean though, that I am not struggling with some symptoms of cardiac related depression. I would not say that I am depressed, but I have tasted the bitterness of some of the symptoms. I feel that I am taking positive steps (described below), but the effect of only a few symptoms have been very difficult for me. Imagine what someone who has full blown cardiac depression is going through.

So what does Dr. Lebowitz say & recommend?

  • Having a range of emotions or strong emotions does not mean you are depressed. It is healthy to express all sorts of emotions.
  • An individual with clinical depression will display a number of symptoms that cluster together that may cause the individual with distress or impairment to their daily life. These symptoms are:
      1. Sadness or a loss of interest or pleasure in most activities.
      2. Difficulty sleeping or an increase/ decrease of sleep.
      3. An increase or decrease of appetite. 
      4. Irritability.
      5. Cognitive changes: Feeling hopeless, worthless, guilt, trouble concentrating or focusing, feeling sad or down, and most importantly, feelings of suicide.
      6. Decrease in motivation in things, such as a decrease in sexual functioning. 
  • Depression is treatable and the treatment for depression is safe for cardiac patients and that effective treatment can improve their quality of life.
  • Not all pharmacological treatments are necessarily safe for heart patients. Antidepressants called SSRIs (selective serotonin reuptake inhibitors) have been found to be safe for most heart patients. 
  • Therapy, predominantly cognitive behavioral therapy is another form of treatment. 

Friends and family actually have a powerful role in reducing cardiac depression. The following steps can be taken by friends and family.

  • The first step is to recognize the symptoms listed above.
  • To decrease depressive symptoms, increase recreational activities. Initiating activities is the hardest part for patients. Friends & family members should encourage activities and participate with the patient.
  • Friends and family play the role of cheerleaders. It’s helpful to have someone point out how far they’ve come and everything they’ve accomplished. 
  • Friends and family may need to sometimes abandon their cheerleader mode, and simply acknowledge the patient’s frustrations and varying emotions. e.g. ‘Yeah, I know that this is hard and this is difficult and I understand.’ 

It appears that Dr. Lebowitz is from only a handful of healthcare professionals actually dealing with this issue with real patients at a cardiac hospital. What that means to me is that it is up to us (the patients) and their families to identify this condition, take active steps to alleviate the symptoms, and to report it to our cardiologists, primary care physicians, and mental health professionals.

While I recover from my 2nd open heart surgery, what am I doing to eliminate these symptoms and to stay positive?

  • Bonsai & gardening.
  • Blogging
  • Frequently walking around town with my dog Moon.
  • Finding new music.
  • Watching a new show (Dexter).
  • Meeting friends for coffee.
  • Being creative by doing art projects
  • Reading books & comic books.
  • Going on trips with friends.
  • Talking to mom on the phone.

See proof below.

Bonsai creation

Bonsai creation

Herb Garden +Cat

Herb Garden +Cat

Pale Blue Dot

I’d like to write right now, but I think I need a catalyst. I’d like to talk about a clip from Carl Sagan’s original Cosmos series. The Pale Blue Dot, an observation that also inspired a book by Mr. Sagan, is a photograph of the Earth taken by the Voyager 1 spaceprobe at an incredible distance of 3.7 billion miles away. The picture sparked some philosophical ideas that Carl Sagan thought worthy of discussing. The video below takes his famous speech and adds some pop culture clips and music for entertainment value. Watch the video and if you like, read below what this means to me. The script is here btw.

The point of his speech is summed up at the end:

“To me, it underscores our responsibility to deal more kindly with one another, and to preserve and cherish the pale blue dot, the only home we’ve ever known.” 

The idea that I am a tiny speck on a tiny speck does indeed make me feel small, as it should, but it does not make me feel insignificant. What i take away from The Pale Blue Dot, is:

1. I am small and cosmically unimportant. However, I am important to my loved ones, and there are people who are important to me. What a gift it is for all of us to have lucked out in having the opportunity to experience life! Whether it was given to us, or we simply happened to be the lucky sperm, we have a special opportunity to be alive.

2. Why not spend this amazing opportunity to “deal more kindly with one another.” Carl Sagan was famously anti-nuclear arms and used this photograph of an insignificantly small Earth to demonstrate the insignificance of our disputes responsible for war and violence.  This insignificance does not diminish our love, however. Our love for one another is a useful way to spend our short time here on this spec.

My recent days have been full of thoughts of life and death. When mortality is so blatantly obvious as it has been for me lately, it can be hard to stay focused. I have always loved The Pale Blue Dot because of its positive message. As I sit here attempting not to wallow, this Carl reminds me of the simple truth that I am alive, and I have the capacity to love. There is absolutely nothing insignificant about that.

3 Months Post Surgery: BIG Milestone

Recovery is more than getting back to physical health. I am psyched that I have been able to get back to where I am now, however there are some challenges that linger.

  • Emotions: I have noticed significant emotional changes since my surgery. I am not suffering from (cardiac) depression, which happens to many heart surgery patients, but my emotions are extreme. I feel greater joy, and greater sadness in my daily life. The extremes are more present than they used to be.
  • Pride: I feel like I have something to prove. I feel the need to be stronger than I ever have been before. I’m afraid that I am sometimes overdoing it.
  • Physical strength and endurance. Some stronger, some weaker.
  • Occasional PVC’s (premature ventricular contractions): though these have decreased dramatically.

Cycling

Cycling on Feb 22, 2014 ‘Greenspot rd route’: http://my.digifit.com/site/share/workout/c5906ac59bf911e395a409b929907b9a.html My restrictions have been dropped, so I do not need to keep my heart rate under 140 BPM any longer! The cool thing is, due to my beta blocker medication, my heart doesn’t really go above that anyway. We will see once I’m taken off the, hopefully this week. If you are looking at my heart rate chart, don’t worry about the extreme spikes above 200 BPM, I am pretty sure that those reading are errors due to the wind when I go very fast downhill. I think the wind vibrates my jersey against the heart monitor. Those spikes only occur when I go downhill, which is when I am exerting myself the least.

Climbing

I feel that I am back to my normal climbing strength. Now I am training to climb harder and better than I ever have in my life. I have begun a 3 month training regiment that will put me in the best shape of my life. I’ll be sure to post my progress on this. There are various climbing competitions in southern california that I will be competing in. It is time to get strong. I wish I had a recent picture of me climbing something cool to show you, but I don’t.

Personal Life

This one is tough. Refer to my first bullet at the top of this post.

SO anywayz here’s a picture of me with my shirt off!

Scar Shot!

Scar Shot!

Waiting Room Rules

“Some people see the glass half full. Others see it half empty. I see a glass that’s twice as big as it needs to be.”― George Carlin

I have learned from my peers over at valvereplacement.org that the time (days, weeks, months, even years) leading up to one’s heart surgery is appropriately nicknamed ‘The Waiting Room’. I still have a month and a half to go, but I have learned quite a bit about coping during this difficult period. I decided to make a Waiting Room rule list. Perhaps this list can help some future valve recipient.

‘Waiting Room’ Rules

  1. It is okay to be nervous, but do not let it consume you. Stay busy.
  2. Stay busy.
  3. Bring your loved ones, and trust that they will stay with you.
  4. Trust that your loved ones will be there (and still love you) when you get out of surgery.
  5. Exercise while waiting. Define restrictions and limitations and stay as active as possible.
  6. Daily responsibilities may be forgotten due to stress. Create daily checklists.
  7. Reduce stress with any or all of the following strategies: Exercise, Yoga, meditation, reading, attending social gatherings, traveling, blogging, talking, hugging, starting new hobbies, laughing, breathing.
  8. No yelling.
  9. Crying is okay.
  10. Do your research. Become as knowledgeable about your condition/ surgery/ recovery as your doctor.
  11. Stay positive by following this procedure: If life seems bad, adjust perspective. Repeat if necessary.

*ADDITION: I polled the audience over at valvereplacement.org to get feedback about this list. Other ‘Valvers’ chimed in with additions and constructive criticisms to my list. See that thread here: http://www.valvereplacement.org/forums/showthread.php?42161-Waiting-Room-Rule-List

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/