Prepping for the Big One

[Peter Easton]

Hi there friends --

I am now scheduled for surgery on September 4th -- either CE Perimount bovine or the new Cryolife SG valve -- after a longish decision process recounted in excessive detail on a thread over in the Heart Talk forum. So I have now graduated to pre-surgery!

I gather that I am among the lucky group that has time to prepare for the event, since a good number must undergo it on more of an emergency basis or at least have less choice and less lead time.

Is there a guide around to the most important things to do in preparation -- or a former thread on this forum that would be particularly informative? Seems to me one would want to be mentally, physically and spiritually prepared -- but just what that means in practice is another question. I wonder about things like diet, taking vitamins or herbal supplements, rest, exercise, deep breathing, you name it. Given that there's no avoiding this particular rendez-vous, I kind of look forward to gearing up (or down or sideways) for it -- making the most of it as a human experience, so to speak.

Any advice on what to do or where to turn?

Thanks!

Peter

[Nancy]

Hi Peter-

Congratulations on your upcoming surgery. You will feel so much better afterward.

My husband Joe, being an extremely organized person, has prepared for all of his surgeries by getting every bit of paperwork, bills, license renewals, car inspections and repairs, major home chores (getting the driveway sealed, plumbing repairs etc.) and other chores that he would ordinarily do or have someone do, out of the way. He knows that he won't be able to drive after surgery for a little while and that would make these above chores hard to do. He also makes a list for me of things to do. I appreciate that because I am his direct opposite, not as organized and a little more free-wheeling. Bear in mind that your significant other or those who will be caring for you will have their hands full for a while and will not be able to get to some of the above chores. Indeed, going to the market is even difficult. I didn't want to leave him home alone for about a week.

I wish you all the best.

[Peter Easton]

Thanks, Nancy. VERY pertinent. In fact, this morning I am working on long overdue garage clean out with my spouse. And she is going to have something of a circus juggling kids and job while I am convalescing. Thankfully, we've got an extended family heareabouts.

Peter

[hensylee]

Congratulations on your upcoming personal miracle!

The latest advice to come out is discontinue herbals 2 wks before any surgery as drs don't know affects of them yet. As you approach your date, you may become apprehensive (or your spouse might) so just keep coming in, asking your questions and you will get answers.

Get a small pillow or hosp may provide you with one. This is probably the most important single item you MUST have asap after surgery as it becomes your new best friend and constant companion, even in the bathroom. Continue your life otherwise, normally til surgery time - it's going to change for much better after surgery, once you get past the soreness and weakness. Others will add to what I have written, as they come in to visit.

One other thing, avoid the dreaded evil sneeze after surgery, if you can, and be sure to grab the pillow. God bless

[Nancy]

Hensylee's right about that sneeze! Here's a tip that might work, it worked for Joe and it works for me.

When you feel a sneeze coming on, press with your finger really hard right under your nose, till the feeling goes away.

Must be an acupuncture point.

[Kevin M]

Peter, I was fortunate enough to take time off work prior to my operation. I wanted to sort of celebrate this event.

I used this time much in the same manner as described by others, but in addition, I tried to prepare myself spiritually since I've recently gone through depression and felt like I was living in a bit of a "spiritual vaccum".

I looked at pre-surgery with a bit of a ritualistic approach. Meditation, walking, reading, etc..

It was all a bit of "Tuesdays With Morrie", but it helped me. It felt good to be centred, strong and prepared for the upcoming trauma. Your presentation on this forum leads me to believe you are long past this sort of finding yourself exercise, so perhaps my comments are not relevant.

To be more concise, I guess I would highly recommend to anyone that they relax and be gentle with themselves. Try to enjoy the moment, instead of worrying about lifes' little day-to-day catastrophe's. After all, they will still be there after you recover...
Kev

[hensylee]

Kevin, I read "Tuesdays With Morrie" and found it to be such an enlightening book that I want to recommend it to everybody. The lessons taught in it are the most important ones all of us need.

[ken]

Hi Peter:

Two Medical books I recommend:

(1) Healing from the Heart by Mehmet Oz. Published by the Penguin group. This book was originally recommended to me by Gerry from Aus. Dr. Oz is the director of Columbia Presbyterian Medical Center's mechanical heart-pump program & is the founder & medical director of the hospital's breakthrough Complementary Care Center. In the book Dr. Oz provides interesting, informative descriptions and definitions of the alternative healing systems.
http://www.amazon.com/exec/obidos/ASIN/0452279550/ref=ase_davidframbes/102-9241096-5591324

(2) Coping with Heart Surgery and Bypassing Depression: A Family's Guide to the Medical, Emotional and Practical Issues By Carol Cohan, M.A. June B. Pimm, Ph.D and James R. Jude, MD. - Published by Psychosocial Press.
http://www.amazon.com/exec/obidos/ISBN%3D1887841075/102-9241096-5591324
This book has also been recommended by Al Capshaw, another list member, (if my memory serves me correctly?) on a number of occasions.

There is also a third book that may be of interest to you titled The Cleveland Heart Book. I have only scanned this book in the store & thought after reading the above two that it's general nature didn't add much to ones knowledge together with the information gleaned from this forum.
http://www.amazon.com/exec/obidos/ASIN/0786864958/qid=996971856/sr=1-1/ref=sc_b_1/102-9241096-5591324

Two Natural Medicine Books I also recommend for a few specific areas are:

(1) Prescription for Nutritional Healing (Third Edition) - A Practical A-To-Z Reference to Drug-Free remedies using Vitamins, Minerals, Herbs & Food Supplements by Phyllis A. Balch, CNC & James F. Balcj, MD.
http://www.amazon.com/exec/obidos/ASIN/1583330771/qid=996972428/sr=1-1/ref=sc_b_1/102-9241096-5591324

There are 2 specific areas that I feel could be useful re: strengthening ones Immune System - Weakened Immune System (5 pages) & a section titled Preparing for and Recovering from Surgery (4 pages)

(2) Encyclopedia of Natural Medicine (revised 2nd Edition) - Your comprehensive, user-friendly A-to-Z guide to treating more than 70 medical conditions - from arthritis to varicose veins, from cancer to heart disease. By Michael Murray, ND & Joseph Pizzorno, ND
http://www.amazon.com/exec/obidos/ASIN/0761511571/qid=996972989/sr=2-1/102-9241096-5591324

This book has expansive sections on Heart & Cardiovascular Health & Immune Support.

Ken

[ken]

Hi Peter:

A fairly common complication from any open heart surgery is atrial fibrillation. It can occur in up to 60% of patients having heart valve surgery. Magnesium has been shown to lessen these occurrences. You should ask your surgeon for his views on the use of magnesium before, during & after surgery.
http://my.webmd.com/roundtable_printing/916442

New Magnesium Regimen Reduces Incidence of Atrial Fibrillation After CABG
NEW ORLEANS (Reuters Health) Jan 31 - The incidence of atrial fibrillation, a common and dreaded complication of coronary artery bypass grafting (CABG), is reduced when a novel magnesium regimen is administered, according to study findings presented Tuesday at the 37th annual meeting of The Society of Thoracic Surgeons.

Dr. Huseyin Cem Alhan and colleagues, from Acybadem Hospital, in Istanbul, Turkey, assessed the ability of magnesium to prevent postoperative atrial fibrillation by randomizing 200 patients undergoing CABG to receive 1.5 g of magnesium sulfate in 100 mL 0.9% saline or saline alone, 1 day before, during, and 4 days after surgery. Patient demographics were similar between the groups.

The researchers found that 2% of magnesium-treated patients experienced postoperative atrial fibrillation, significantly fewer than the 21% of untreated patients who manifested this arrhythmia.

"Many other studies have shown that magnesium has an effect on atrial fibrillation, but the appropriate dose and timing of infusion was not clear," Dr. Alhan told Reuters Health. "While many patients are hospitalized prior to their surgery, we found that even patients who do not receive the preoperative dose still have lower rates of atrial fibrillation."

"There are no contraindications to magnesium therapy, we give it to patients with normal as well as low magnesium levels," Dr. Alhan stated. "In the elderly it has been shown that patients may be total body magnesium deficient, but have normal serum levels," he explained. "We are not sure if the therapeutic mechanism is replenishment of a deficiency or a pharmacologic effect of the drug."

"Atrial fibrillation is not the most serious complication after cardiac surgery, but it is the most common," Dr. Alhan pointed out. "It has a strong impact on the hospital length of stay and therefore on the cost associated with cardiac surgery," he noted. "The patients who received magnesium in this study went home earlier," Dr. Alhan emphasized.

Other studies have also shown magnesium benefits heart patients"

http://www.yourhealthbase.com/magnesium.html

Summaries of the latest research concerning magnesium


Magnesium benefits heart patients
LOS ANGELES, CALIFORNIA. The health of the lining (endothelium) of the blood vessels is crucial to cardiovascular health. There is considerable evidence that a dysfunction of the endothelium can lead to atherosclerosis and subsequent coronary artery disease (CAD). Researchers at the Cedars-Sinai Medical Center now report that oral magnesium supplementation can substantially reduce endothelial dysfunction and improve exercise tolerance in CAD patients. The randomized, prospective, double blind, placebo- controlled trial involved 50 patients (41 men and 9 women with a mean age of 67 years) who had been diagnosed with CAD either by angiography or after having had a heart attack. Initial evaluation of the patients showed that 72 per cent of them had a lower than normal tissue magnesium level. The tissue magnesium level was measured in sublingual epithelial cells scraped from under the tongue or from between the gums and the upper or lower lips. Magnesium levels measured in sublingual cells have been found to correlate well with levels found in heart tissue.
The patients were randomized to receive either a placebo or 365 mg of elemental magnesium (in the form of oxide and carbonate) daily. After six months tissue magnesium concentration was measured again, a treadmill test was performed, and endothelial function was evaluated using ultrasound. Patients in the magnesium group increased their intracellular magnesium level by about 10 per cent to reach the lower limit of the normal range. Endothelial function (flow-mediated vasodilation measured at the brachial artery) improved by 25 per cent in the magnesium group as compared to a 4.5 per cent decline in the placebo group over the six-month period. The magnesium supplemented group also performed significantly better on the treadmill test than did the placebo group. Not only did they improve their exercise duration as compared to baseline and the placebo group, but it was also highly significant that none of them experienced an arrhythmia during the test whereas four patients in the placebo group did.
The researchers suggest that magnesium may protect the heart against the detrimental effects of a calcium overload and may improve intracellular ATP production and glucose use. They conclude that oral magnesium supplementation improves exercise tolerance and endothelial function in coronary artery disease patients. NOTE: This study was partially funded by Asta Medica Company, Inc. (Vienna, Austria) the manufacturer of the magnesium supplement.
Shechter, Michael, et al. Oral magnesium therapy improves endothelial function in patients with coronary artery disease. Circulation, Vol. 102, November 7, 2000, pp. 2353-58



Magnesium and heart surgery in children
CHARLESTON, SOUTH CAROLINA. Administration of magnesium has been shown to reduce the incidence of heart surgery related arrhythmias in adults. It has also been observed that the magnesium level in the right atrial tissue is lower in adult patients with postoperative cardiac arrhythmias compared to patients without arrhythmias after heart surgery. Researchers at the Department of Pediatric Cardiology at the Medical University of South Carolina now report that children undergoing surgery for congenital heart defects develop a severe magnesium deficiency immediately after surgery. This deficiency is associated with a greater incidence of a serious arrhythmia (junctional ectopic tachycardia) and can be prevented by an infusion of magnesium sulfate immediately after completion of the surgery.
The study involved 28 pediatric patients (average age of five years) who were scheduled to undergo heart surgery with cardiopulmonary bypass (CPB). The patients were randomly assigned to receive an infusion of magnesium (30 mg/kg body weight of a five per cent saline solution administered over a period of 10 minutes) or an infusion of saline solution immediately after cessation of CPB. Blood levels of magnesium were measured in all patients before surgery, before CPB, after CPB, upon arrival in the intensive care unit (ICU), and then every four hours for 24 hours. Each patient was also monitored for arrhythmias for 24 hours with a Holter monitor.
Comparison of the results for the two treatment groups revealed that the magnesium level was significantly below normal in patients who had received saline solution (placebo) when they arrived in the ICU and for the following 20 hours. Patients who had received the magnesium infusion, on the other hand, had magnesium levels that were well within the normal range (1.6 to 2.3 mg/dL) when tested in the ICU and for the following 20 hours. There were no incidences of junctional ectopic tachycardia in the magnesium group, but four (27 per cent) of the patients in the placebo group experienced this serious arrhythmia. It stopped after a magnesium infusion. The researchers "recommend routine measurement of magnesium levels after CPB in children undergoing heart surgery, with timely magnesium supplementation in the postoperative period." [49 references]
Dorman, B. Hugh, et al. Magnesium supplementation in the prevention of arrhythmias in pediatric patients undergoing surgery for congenital heart defects. American Heart Journal, Vol. 139, No. 3, 2000, pp. 522- 28

Lack of magnesium and heart disease
ATLANTA, GEORGIA. Researchers at the Centers for Disease Control and Prevention have just released the results of a study which shows a clear association between low blood serum levels of magnesium and the risk of dying from heart disease and other causes. The study involved 12,000 participants who were enrolled between 1971 and 1975 and followed for 19 years. At the end of the study 4282 of the participants had died, 1005 of them from ischemic heart disease. Compared with participants having a magnesium level of 0.80 mmol/L or less the risk of dying from heart disease was 21 per cent lower among participants with magnesium concentrations between 0.80 and 0.84 mmol/L and 31 to 34 per cent lower among participants with concentrations higher than 0.84 mmol/L. This correlation held true even after adjusting for other major variables such as age, sex, race, education, smoking status, systolic blood pressure, use of anti- hypertensive medications, body mass index, history of diabetes, alcohol use, and the level of physical activity. The researchers estimate that about 11 per cent of the almost 500,000 deaths from coronary heart disease which occurred in 1993 in the United States can be attributed to low magnesium levels. They also point out that a recent study (NHANES I) found that about 23 per cent of the people evaluated had magnesium levels below 0.80 mmol/L. Other studies have shown that a large proportion of the American population does not consume the recommended daily allowance of magnesium (350 mg/day for men and 280 mg/day for women).
Ford, Earl S. Serum magnesium and ischaemic heart disease: findings from a national sample of US adults. International Journal of Epidemiology, Vol. 28, August 1999, pp. 645-51

Got Magnesium? Those With Heart Disease Should
Blood Vessels Improve, Ability to Exercise Increases


By Janis Kelly
WebMD Medical News


Reviewed by Dr. Gary D. Vogin


Nov. 9, 2000 -- Every cell in the body needs magnesium. It helps keep muscles strong and nerves alert. And a new study in the journal Circulation suggests that daily magnesium supplements can even help an ailing heart.


Lead author C. Noel Bairey Merz, MD, tells WebMD that magnesium supplements enabled heart disease patients to exercise for longer periods and appeared to protect their hearts from the stress of exercise. Magnesium also restored some of the blood vessels' ability to open up when the body needs more blood. Merz is director of the preventive and rehabilitative cardiac center at Cedars-Sinai Medical Center in Los Angeles.


Half of the patients in the study took a supplement containing 365 mg of magnesium twice a day for six months. The other half took a placebo. Merz tells WebMD that at the end of the study, the patients who took magnesium had better blood vessel function and their hearts showed less stress during treadmill exercise compared to the placebo group. Nearly three-quarters of the patients were magnesium-deficient at the beginning of the study, but their levels rose to nearly normal by the end.


So what is it about magnesium that makes it such a friend to the body? It could be that magnesium helps the body's cells fend off stress. Magnesium-deficient cells also are more vulnerable to injury, and patients with heart disease may have greater need for magnesium, Merz says.


Carla A. Sueta, MD, PhD, who was not involved in the study, says, "we probably should move toward routine screening" for all patients with heart disease and offer supplements to all those found to be deficient. She cautions that the simple blood test available to doctors is not an accurate measure of magnesium levels. If the tests results are low, magnesium levels are probably very low in reality, so even someone with normal levels may still need supplements. Sueta is associate professor of medicine at the University of North Carolina at Chapel Hill, N.C.


Similar magnesium supplements are available over-the-counter in the U.S., but they might not provide similar benefits. "The product we used is from Germany, where supplements of this kind are regulated and quality is monitored," Merz says. "Because that is not the case in the U.S., it is impossible to know what you are getting in a supplement, or even whether it contains any magnesium at all. Patients who decide to try magnesium supplements available in the U.S. are probably fairly safe unless they have kidney problems," according to Merz.


However, he does suggest that people "follow the dietary recommendations to eat five to seven helpings of fruits or vegetables and two or three of nonfat dairy products every day. If everyone did that, we probably would not see the levels of magnesium deficiency we often find."


The most important food sources of magnesium are green vegetables like spinach, nuts, seeds, and some whole grains.


The research was funded in part by Asta Medica Co. Inc., manufacturer of the magnesium supplements used in the study.



© 2000 WebMD Corporation. All rights reserved.

[Peter Easton]

Wow -- what great stuff! A truly "hearty" thanks to everyone who responded. I have a bunch to digest here before my next question.

Kevin M. -- I can very much hear and appreciate what you said. Went through major depression some 18-20 years ago and was left very aware of what it can do and how important centering is to our lives.

On the book front, a friend on the RP listserve recommended one other or which I can only remember the title but have promised myself to look up: King of Hearts, being apparently the story or early heart surgery and its pioneers.

I feel enriched!

Peter

[ALCapshaw]

WOW, what a GREAT CONTRIBUTION Ken !

Thanks for taking the time to prepare it for us.
I have copied it to my files and heart friends.

Having had a couple of A-Fib events following my Bypass Surgery,
and another couple preceeding diagnosis of my Valve Disease, I can appreciate the benefit of preventive measures.

Each of my 'events' exhibited high heart rates (150-180 BPM) which lasted from 15 to 30 minutes. The cardiologists acted like it was 'no big deal' but it sure got MY attention! Following the post surgery events, they put me on a Holter Monitor for a month. No more events. Typically, as long as the A-fib resolves itself in a short period of time, it is not considered dangerous. When it continues for long periods of time (many hours? days?) then it can have undesirable consequences (I don't remember what they are).

Bottom line, if you can prevent Atrial Fibrilation events from occuring it would seem to be worthwhile.

'AL'

[ALCapshaw]

Hello again Peter,

In the spirit of the Boy Scout Motto, BE PREPARED, you may also want to consider seeing that your will is up to date and look into estate planning if you have not already done so.

Things to consider are:

Will
Living Will (defines your desires should you become incapacitated)
Power of Attorney
Medical Power of Attorney (designates person to act on your behalf)

The book, PLAN YOUR ESTATE, by Denis Clifford was recommended to me. Your library should have many books on this topic.

Best wishes,

'AL'

[Nancy]

I agree with you Al that these things should all be done. We did it. It's important to have all of those things done in any event. One never knows what tomorrow will bring. Very important points.

[Jeff H.]

Hi Peter;
Glad to meet you. My name is Jeff and I had my aortic valve replaced june 19th this year. This was my 1st operation ever and I was pretty worried. I too tried to take care of all the big things at home so my wife would not have to be faced with major problems. What I did not do was the little things, such as how to start the lawnmower, what gas can I used and where I kept things that I used on a weekly basis. The little things can make somone feel helpless also, and cause you to help. You will need all the rest you can get and she will need all the help now she can get. I had plenty of time to prepare for this event in my life, but when that last week comes I found out I was more prepared the previous week. If you can take little walks in the afternoon and look around, I really got a different perspective while I was on my pitty party, just looking at the sky and trees ect. was therapy, so to speek.
Good Luck, and your not alone.
Jeff H.

[ken]

Hi Peter:

Today's Los Angeles Times referenced a PreOp guide website, parts of which you may find useful:
http://www.preopguide.com/preop-guide/contents.html

The 'book' is free online at the above website and although much of it is of a general nature I thought there was enough useful information to post the link above & the extract of the LA Times segment below.

Ken


Background: Dr. Robert A. Catania, a surgeon in Brown University's medical school, wrote this guide while working as a resident, and he still uses it to prepare his patients for surgery.

What Works: Catania writes as if he's been under the knife himself: "Surgery is really nothing more than a controlled injury, and your body responds as it would to any other stress ... you may feel very frightened or anxious." You'll feel less so after reading the guide. The doctor explanations of the "workup" and tests done before surgery are readable and make sense: Much of the blood testing, for instance, tells doctors whether a patient's immune system is up to sustaining a controlled injury. His PreOp Preparation page spells out exactly what you need to know about how alcohol, vitamins, exercise, smoking, dieting, sleep and pain relievers may affect the operation--in effect, how surgery intersects with the rest of your life.

[Peter Easton]

Great reference, Ken. We really need some sort of readily-accessible anthology of these things appended to the website, verdad?

Peter

[darkoosh]

Hi,

I am new the this forum and am not sure that I've posted to the right section - so forgive me till I get this all figured out.

I am another one of the many people queing up for valve replacement surgery. Yippee. I've done a lot of research, though, and after some rocky visits with a local cardiologist, I am now pretty comfortable with my decision on the surgeon (Dr. James Oury) and hospital (St. Pat's in Missoula, MT). Still have some unresolved questions about the type of valve, but I think that is an issue everyone of us deals with right up until the last minute.

In response to some of the questions about donating ones own blood, I have gleaned some information that might be helpful. Many surgeons now require that you donate at least 3 pints of your own blood before surgery. This means a weekly trip to Red Cross, and, at least in my town, it is done by appointment only. No walk-ins.

Not only do you dontate each week, but you also get a saline infusion afterward. I think this is keep our blood volume and pressures stable. A possible reason why doctors frown on AR patients donating blood for general purposes. It's too hard on an already compromised system.

Red Cross requires a doctor's order to donate your own blood. Not only that, but in Boise, Idaho, (where doctors are conservative and insurance providers are cheap), they insist that you be able to guarantee pre-payment in the event that insurance will not cover costs.

The average cost per donation is +/- $200.00, so be prepared to pay each time you go in if you have poor insurance. $600.00 out of pocket for 3 pints of your own blood is pricey.

The good news is that insurance companies are getting better about picking up the costs. Just be sure to 1) get your doctor's orders in writing 2)pre-schedule an appointment 3)call Red Cross in advance to discuss arrangements 4)plan to spend extra time because of the infusion 5)save a lot of pennies if you must self pay.

Hello to the familiar faces here from the RP list serve and to all the new faces as well. This is a great site!

Deb Arkoosh

[Peter Easton]

Hi Deb --

Nice to "see" you over here on the Heart Forum after our exchanges a few weeks back on the RP listserve. I am glad to hear about all the progress made in your decision process -- and thanks for the further information on blood donation. I hope to start mine tomorrow and have time for the three pints before the operation -- or before the one-week-previous time limit everyone sets.

Hereabouts (Tallahassee, FL) Red Cross doesn't and won't draw the blood but refers inquiries to the local community blood bank. Talked to them today and they are awaiting a fax from the office of my surgeon down in Gainesville before inviting me to belly up to the bar.

Wishing you smooth sailing through to Missoula.

Peter

[Peter Easton]

I meant that Red Cross/Tallahassee won't draw blood to bank for the donor's own operation. They stick to the regular donation work.

[ticktock]

Peter
Great suggestions from all!! Each of my surgeries seemed to present a different priority. The last one, 10/99, I found I was
avoiding pain medication because I did not like the way my head felt. Finally a Nurse sat with me, and explained the benefits of pain meds, they are a necessity actually. The body needs relief
to rest, to reduce physical stress, and to sleep. So, dont be a hard head like me, and refuse the pain shots/pills.

You are going to great. You are preparing well.

[ALCapshaw]

As Mindy noted, the heavy duty pain medications can cause dizzyness and nausea. I requested pain medication with lesser side effects following my bypass surgery and did fine, with no adverse side effects. Just remember, there ARE solutions between the heavy duty pain killers and NO pain killers. Just ASK.

'AL'

[ALCapshaw]

Originally posted by Peter Easton
Great reference, Ken. We really need some sort of readily-accessible anthology of these things appended to the website, verdad?

Peter

I heartily (pun intended) agree Peter!

I've long thought we needed a REFERENCE forum listing to post
Articles, Books, and Web Sites.

What do you think Hank?

'AL'

[darkoosh]

I would like to see the Reference Forum happen and have my own collection of articles, books, and Web Sites that I'd be willing to contribute.

What a great service this would be to those people new to the quest of information on AVR. If there is anything I can to help put this together, let me know.

Deb

[hensylee]

Peter, as soon as I knew I was due for surgery, I got my affairs in order (had been putting it off). Just about all of us come out of our heart surgeries with flying colors, but better to be safe than sorry, besides you're kinda forced to do what you should've done long time ago. God bless

[Peter Easton]

The advice about getting one's affairs in order is good -- hope I follow through on it!

Regarding the collection of lessons and resources developed on these sites, several things seem to be underway that folks might want to relate to. First, in general, the "Support" forum covers issues like these and there is currently a thread there entitled "A Learning Site" with some initial ideas about building this dimension of the valvereplacement.com website. Second, I believe that Kevin M. is working as we speak, so to speak, on composing a guidebook for AVR candidates with all kinds of things on valve choice, surgeon and cardiologist relations and what not. I'm sure he would appreciate everyone's help at some point. I don't think too many cooks can spoil the broth on this one.

Peter

[srwieland]

Wow! This thread truly demonstrates how wonderful this group of heart buddies is. Peter reminds me of an astronaut and all these other people are working with/for him to prepare him for launch!

It's hard to add much to what everyone else has contributed here, but for me, the most important thing pre-surgery is taking time, freeing up time, for the preparation. I succeeded at that to some degree, but wish I would have had more.

Of course, extra time can also be a problem if one has trouble focusing and keeping busy with the preparations. So, I think for some people, it may be better to just continue to be absorbed with the regular affairs of life.

However, knowing you a little bit now, Peter, I think you are the type of person who will certainly take very good and positive advantage of any time you have for preparation, so my advice is to free as much time up for it as you can.

Also, just before surgery, I did begin to get cold feet. That is not normal for me, as I'm generally fearless and have done a lot of public speaking and have faced many other dangers, etc. in my life. I had no difficulty dealing with it, but deal with it I did have to do. So, that's something you might want to be ready to overcome, just in case you encounter it too.

Also, keep positive however you can, both before and after surgery. There are many causes for concern and worry, but don't let any of them get you down. Otherwise, that could become the biggest cause for concern.

Although not a psychiatrist, I am an administrator for psychiatrists and see a lot people with depression, etc. Although not prone to it myself, I must admit that, post-surgery, I did feel that I was vulnerable, especially when it seemed that the recovery was going really slow. And, in my case, my recovery was going really well so imagine the test someone must go through if their recovery is more problematic. So, even though you might not encounter depression or be overcome by fear, etc., these problems are not that uncommon and you should be prepared to recognize and deal with them effectively if they do occur.

Your surgery will be upon you before you know it and soon you will be over that mountain and on the other side to be welcomed by all your well-wishing heart buddies here. Prepare as best you can and then, blast-off!

[joy]

Hi Peter, I was actually wondering, did you get your aortic stenosis from rhuematic fever? I was just wondering. I got mitral stenosis from rhuematic fever. I never knew anything about the heart before all this happened, but now...I had to learn fast! Good luck Peter, I have my surgery on the 27th of this month! Keep me posted, and I will have either my husband(Who's name is Kevin) keep you guys posted every night as to how I do with my surgery. THere isn't anywhere for him to sleep in the ICU there, so he's going to sleep at home, and come in the morning. Well, good luck!
Joy

[Peter Easton]

Joy --

My surgeon did say in his (good and lengthy) first briefing with me that, worldwide, the majority (or in any case plurality, I guess) of people with aortic stenosis developed it as a consequence of childhood rheumatic fever, originating maybe just in untreated strep throat.

In my own case, I'm less sure, as both my eldest sister and my Mother had AS and valve replacement surgery, which seems to argue for something more hereditary.

Steve -- I really hear the words about potential post-op (post-partum!? -- we are losing a part of ourselves, it's true) depression. I personally went through a major depression about 18 years ago and know that it is nothing to trifle with. One consequence, though, of going through that particular version of hell is I guess that one is attuned to the signs of impending problems and somewhat practiced in forestalling them. Will be interested to see how that plays out post-op. Happily my spouse is a veteran in dealing with those issues as well.

Peter

[joy]

Actually my gramma had the same thing, mitral stenosis...I am begnning to think that there's something hereditary with strep throat or rhuematic fever??? I am definately going to ask my cardiologist if there is. Well, have a wonderful evening!

[Peter Easton]

We wll keep you in our thoughts and prayers for the 27th, Joy. I'll be about a week behind you (see me back there in line?)

Peter

[Peter Easton]

Well, it's countdown time. My operation -- either Cryolife SG or C-E Pericardium -- is set for next Tuesday and I go down to Shands Hospital in Gainesville tomorrow for pre-op, being that I can't do it on Labor Day.

I note a sort of strange and wonderful phenomenon. I have had very manageable symptoms, overall -- just things out on the edge of my "envelope" of daily activity that I have handled by gradually restricting that envelope. First it was just a case of avoiding sprints, then not walking uphill fast with loads, then not walking up hill with loads, period, then not walking up much of a hill at all...

But I really haven't felt effects in my daily living to any great extent -- this despite an aperture that appears to be at the borderline of the survivable (0.6 cm2). Not in any case until the last few days. Now I can feel the dizziness, breathlessness and other symptoms beginning to encroach on normal life... just in time, so to speak. As we are now only four or five days before the operation, the increasing symptoms don't bother me as much as they make me for the first time quite relieved to be undergoing surgery, in fact "motivated" and ready to go ahead and come out on the other side.

I don't imagine I could have handled this better if I had planned it. I had more than a month to prepare without much in the way of discomfort, then a few days with sensations that have sort of primed me for the event. Hope my luck holds!

Peter

[srwieland]

Yeah, it always helps to feel a little worse before so that the aftermath is clearly, and not just theoretically, better. We've got to feel the difference, not just understand it!

For myself, I had manageable symptoms for 25 years and then, boom, one night woke up and had to head for the hospital ER in an ambulance. The next 3 months before surgery were very uneasy and manageable only because of the meds. My surgeon said that I was leaking back through the valve half the blood it had just pumped through; just the opposite of your condition.

In any case, soon you will be on your way to recovery and a condition that will definitely be much less risky than your current condition.

Let us know how it goes tomorrow in pre-op.

[Nancy]

Hi Peter-

I want to wish you best of luck for you surgery. It will be such a relief to get it over and you'll feel so much better afterwards. We'll all be waiting to here about what happened and your thoughts about everything. Talk to you on the other side.

Here's to a healthier you!

[tnboomer1013]

The best of luck to you. With Gods help you will come through with flying colors. Look forward to the updates from the other side. Our thoughts and prayers will be with you.

BOOMER


P. S. Stay away from the green jell-o.

[Tammy]

Well Peter, the time is nearing and you are so prepared (at least as far as preparedness goes). I will keep you in my thoughts and prayers. I will also look forward to hearing how all goes. I know you will have a story to tell since you seem to be pretty thorough - I will be awaiting your tales of your great adventure.
Take Care.
Tammy
MVR 04/06/89
AS = 1.04 cm (and holding, and holding, and holding, etc. etc.)