Mechanical Valve and Intense Exercise

[conk]

Looking for others who have had similar desires and experience

I recently (8/26/03) had a redo of my AVR (first was on 12/20/02, with a Homograft) and now I have a St. Judes Regent valve (23mm).

I am one of those individuals that is just not happy unless I'm able to push myself physically. Before I had my first surgery I was just starting to get into road biking with a group of very good riders. After the first surgery I was back riding with the group at about 2 months after surgery and road with them for 1.5 months before I was told to back off by my Cardiologist since my Homorgraft valve was beginning to leak more and I had severe AR. I stopped riding at that point and limited my exercise to light weights and stationary bike. At the point I stopped, I was riding about 70 miles (about 4-5 hours) in a weekend at an average heart rate of 140.

I am now riding a stationary bike and kinetic trainer (my bike attached to a kinetic resistance device) about 4-6 hours a week at an average of about 130 HR.:) :D :)

My question is -
"Does anyone have experience cycling or exercising at an intense rate after recovery from a Mechanical AVR in the range of 3-4 hours at one time with a HR average of 80-90% (136-153 for me) of Max up to Max (170 for me)? I will be 52 this month.

My Cardiologist said that he does not want me to exercise at more than 140. When I asked him for how long, he said forever since he didn't want me to hurt myself. I clarified his concern and he was referring to physical injury, not injury to my heart since I'm now over 50. I kept my mouth shut, but I think he could tell I wasn't happy with what he had just told me.

Am I crazy to want to ride with this very fast group of riders again which will take me to fairly aggressive heart rates with the potential risk of a going down. I had been told my Surgeon and Cardiologist before the surgery that there really wouldn't be any restriction on my heart (once I recovered). Certainly injury is a consideration being on Coumadin. I am willing to take that risk, but is there a serious risk of overdoing a health heart (other than the Mech AVR)?

Sorry this is so long...this is such a Great group I'm sure you won't mind and I anxiously await the cojent advice.

Regards...Conk:) :D :) :D

[Karlynn]

Conk,
I know someone with an MVR that does bike riding long distance, but I don't know how hard he pushes.

I also know that your target heart rate should be lower than a "normal" person.

Personally, I wouldn't risk it. It sounds like this group is pretty aggressive in their riding. At the very least, I wouldn't jump back into anything too quickly. Take it in stages and let your body adjust.

Since this is a great group, maybe there are some that would be willing to step back a bit occasionally and ride with you.

Your surgery was very recently. Are you already starting to feel up to resuming that kind of activity yet? If so, WOW.


Karlynn

[rcatalano]

I'm not sure I understand. Conk, are you saying your cardiologist doesn't want you to get your HR over 140 because your over 50 and not because of the valve?

There are members here that run marathons with a mechanical valve. I'd be surprised if their heart rate never gets above 140.

I had my 2nd avr the same day as you. If what your doc is saying is true, its the first time I heard anything like that. It would be devastating to me also...

Karlynn, could you explain why our target heart rate should be lower? Is that just for mechanicals or any valve replacement. I'm asking because I've never heard of that before. My cardiologist and surgeon both said I could resume running and biking with a mechanical, but we never discussed effort level. They never mentioned to take it easy.

[conk]

Rob,

When I queried my Cardiologist about his comment, he didn't indicate it was the heart or valve that was of concern, but that he knew of many 50+ people that have sustained injuries in the knee, back, arms, etc. by exerting at a high level of intensity.

My reaction to this is that many injuries in this group are caused by not warming up properly or doing sports where those types of injuries occur (although I think he was specifically referring to bike riding, since he knew that's what I like to do). I think there is much less risk of those kind of injuries on a bike, not counting a fall that could occur. I have only sustained injuries playing sports such as softball, flag football, etc., but these were only pulls and strains, never needed any kind of surgery. I have never sustained an injury riding my rode bike???

What I would really like to do when I'm fully recovered is ride road bike competitively in my age group. I think my cardiologist is very fearful of this, although he is a very knowledgeable and competent doctor when it comes to the heart itself. Does this sound like undue risk on my part or concern on his part?

Regards…Conk

[Nancy]

Hi Conk-

I came across these articles on Dave Cullinan. It's probably not what you would like to read because he went from a mechanical valve to a tissue, so he could race competitively.

http://expn.go.com/xgames/sxg/2001/s/010731_cully_int.html

http://outside.away.com/magazine/0995/9di_excu.html

[conk]

Nancy --- Thanks for the links

I can understand why Dave needed to revert to a tissue valve. The mountain biking and X-Games type of competition has an intense risk of injury and some serious as Dave encountered with an injured heart from one of his accidents.

Road biking performed with a bit of caution is a much safer sport, in my opinion, although the risk of a fall type of injury is certainly there, I don't this is as routine compared to what Dave does.

My assumption is that even if you fall on a road bike, which I have, usually the injuries are mostly external, not internal and could be sustained by someone on coumadin, although you better be riding with someone and have some compression bandages fairly handy. I read my response and think...Am I being bull headed, I know I have this tendency.

Thanks again Nancy!

[Nancy]

I think all will agree that head injuries are very serious with Coumadin. You do wear gear, don't you?

[rcatalano]

I can't really speak for competitive cycling. I've done a few triathlons, but the biking isn't the same with the no drafting rules. I guess the scariest thing would be a head injury.

I'm not sure where you draw the line. Right now, I'll be happy just being able to work out and enter an occasional race for fun. Its a tough call for you.

There's another member here - chilihead - a competitive cyclist deciding on whether to have a Ross procedure or get a mechanical valve. He also mentioned his doctor told him he would have to give up biking if he got a mechanical valve (though he seemed to emphasize mountain biking). See the 'One valve for life?' thread in Heart Talk.

[Karlynn]

Rob, I have a mechanical mitral valve and my card told me to "stay around 140" when working out. I'm 44 and that's a little less than what is recommended for my age. But one of the symptoms that MVP people (mitral valve prolaspe, not most valuable player, unfortunately!) deal with is a heart rate that jumps up quickly upon exercise. So maybe that's the reason for the recommendation for me.

I also read it doing some web research a few years ago, but can't remember where. However, I think part of the equation is how fast your heart gets up to that target rate. It sure doesn't take long for me. But then, I've never been an athlete. My husband's resting heart rate is about 60. It takes him forever to get to 140 - let alone beyond. And then the other key element is recovery rate.

Conk - just out of curiousity - does the doctor look like someone who works out or participates in sports? It seems strange for a doctor to discourage people from participating in those activities you mentioned because of their age, particularly if it's something they've been doing. When first reading your post I assumed his concern was the heart/coumadin issue.

Just for safety sake - I'd assume the worst could happen - a fall with an injury that requires surgery, or a head trauma, and then decide what the likelyhood would be for an injury and if that's a risk you want to take. Bottom line is it's your life to live and you need to decide how to live it. It certainly doesn't sound like you are being careless about the decision. Educate yourself (which you are trying to do) then make an educated choice.
Maybe get a second opinion from a cardiologist who also works out. :D

Karlynn

[Susan BAV]

Hey, Conk - I don't remember reading posts from Bruizer lately; do you know how he's doing? Thanks, ~Susan

[KristyW]

Conk,

It does sound like your cardio is hedging on injury. I'm not sure why though. When I talked to my surgeon before my AVR, he told me that I could do anything I wanted after the mechanical replacement except extreme sports. He did mention downhill skiing and mountain biking as belonging to the "extreme" category.

However, at no time was I told that I should keep my heart rate down. As a matter of fact, when I was in cardio rehab, my target heart rate was 150-160! My rehab techs would give me the "evil eye" if I didn't get over 145!

My opinion (for what it's worth) is that your road biking shouldn't be a problem as long as you take the proper precautions, i.e. wear a helmet, have the proper first aid supplies along, and most important of all-- wear a medic alert bracelet that says you are on coumadin.

[conk]

Yes I do wear a helmet, one I bought just over a year ago to replace my old helmet, but I think I'll be looking to get an even better helmet if I don't think it will protect me. I've been meaning to get a medic alert bracelet, just haven’t looked into where to get one. Any suggestions would be appreciated.

I'm pretty good about looking at all the data I can get my hands on, but in the end, I will decide what I do and don't do. I'm sure my Cardiologist is just trying to instill a bit of fear since he knows I'm such a type "A" personality when it comes to exercise.


Kristy,
Thanks for HR information. I think he just wants me to be cautious and he likes me, so he doesn’t want to see anything bad happen. As far as that goes neither do I, but when you've seen the seen the back of a Carrier Deck on a dark night almost 100 times, this just seem to be quite as risky. I’ve still got some time to think about all of this since I’m still on the road to recovery, although I was riding with the group after only two months after the first surgery, I believe it will take me a little longer this time, since I’m taking a more conservative approach, at least in the early stages.

Susan,
I talked with Bruce last weekend and he is going well now. I don’t think he has gone back to work yet, but should soon. I will be talking with him within the next couple of days so I’ll update you after that.

[tommy]

I say do what motivates you. Everthing has its risks - and rewards. Doing nothing can have the greatest risk.

Just get a clear reading from the cardiologist about your heart function and any risks associated with your heart condition.

[Karlynn]

Conk,
You can order a bracelet at www.medicalert.com

They come in many different styles and prices from the very inexpensive, to solid gold ones ( in my dreams!)

Karlynn

[conk]

Karlynn,
I ordered the bracelet last night on the web and talked with them this morning to verify what would be placed on the bracelet. I got a sports bracelet. I forgot to ask if these can be washed, but I assume so. I'm prodigious at producing sweat when I exercise, so maybe I should order an extra. Can I get another bracelet at $5 or will I need to pay $30 for an extra bracelet?

[John S]

Conk,

I feel like a slacker after reading about your regimen. I have a mechanical mitral valve, and never got any flack about my exercising from my GP or my cardiologist. My sport of choice is swimming, though, coupled with weight lifting. I need the weights to get stronger for the water, and I can't hardly hurt myself in the water! My heart rate doesn't approach 140 in the pool. I'm 53, we just had our first grandchild, and life is wonderful. I feel as you do that it's all too short to not squeeze every drop of fun out of the time we have. After every setback, I'm always anxious to get back to my regular workout schedule. So my uninformed unscientific view is to do what feels right. Your body will let you know when you're pushing too hard.

John S.

[Marty]

Conk, soon after my surgery when I was starting rehab I called St.Jude and talked to one of their engineer -scientists that actually design and manufacture my mechanical valve. He was very reassuring and as I remember among other things he told me they had a valve in a stress test setup in ther lab that had been clicking away at 220 beats per minute for 15 years, now maybe 20. So I don't think you need to worry about the valve being the limiting factor in your future plans.

[sylviayasgur]

hi conk!
first of all, it's great to see that you are doing so well! so happy for you!
it seems like your doctor is more concerned about you injuring yourself during biking than he is about your heart rate, right?
i think it's a great idea to get in touch with jim/ chilihead. he is contemplating a mechanical vs. a ross procedure. you may want to pick his brain, i know he is thoroughly researching this.
also, if your concerns are h.r., maybe ask mark wagner our in house marathoner. he has a mechanical and certainly runs his body ragged!!!
hope these help.
glad that this is your difficult decision; it's a really positive one!!
stay well and happy biking!
-sylvia

[JimChicago]

Somehow my post didn't go thru correctly - 4th try -
Thanks for the info Marty - do you think the heart tissue the metal valve is bound to - the sutures or whatever will hold up as well as the mechanical valve itself? I just wonder since I tend to run a higher heart rate a lot of the time - (105-120) and it doesn't bother me - I just hope the heart valve holds up OK and I've seem some say it's the sutures or whatever that would fail before the valve itself.

[conk]

Jim,

I have the same questions about the sutures. Since there is no tissue to bond with, then I began to think that the tissue valves are not live, so I would think that they would have the same possibility of suture bonding problems. However, I haven't heard much discussion of problems myself.

I'm not really concerned about the valve itself. From what I know and have read in studies, they are very reliable.

I will try to get in touch with chilihead. He might want to talk with Bruizer about his Ross AVR redo operation he just had after only 3 years downstream from his Ross procedure.

[HFK]

Hi Conk, I have a homograft valve and I remember them telling me not to have HR up to 120-130 for about 4-5 to five months,due to the healing process and pressure changes. I guess I had alot post op complications and I was really strict about staying in that range . I was a competive racquetball player,so you know how hard that can be. I started with aerobics at 12 weeks for 1-2 months then progressed to racqetball at 6 months had HR up to 170 felt great , my doctor had me come in and do treadmill and I did great . So I have no Hr restrictions he always says "if you feel alright, continue if not slow down". I will say the first time I was back in the court playing , I truly had tears in my eyes because I felt now I was really back.If you know what I mean.HFK

[chilihead]

Conk,

I am definitely with you on the "A" type personality. I ride with a tough group on the road and occasionally race my mountain bike. I hate to leave a race without a trophy! This valve situation is driving me nuts!!!!! I'm really wanting to be onte of the Ross success stories. I'm about 6 weeks from surgery time and have about ruled out the pig valves. If I know I could keep kicking butt with a mechanical I'd go for it. I also engage in some heavy beer drinking sessions occasssionally as a competition chili cook. These things just don't seem to jive with coumadin intake.

I was thrilled to hear you were back on you rbike in two months the first time. Very inspiring.

The mechanical is the safest bet. I was told that I have a 31MM aortice orfice which would give ample hemodynamic flow with a St. Judes Regent HP. WHat size did you get?

[Karlynn]

Ah, Chilihead, the truth comes out. It's not so much the bike riding, it's the beer with the Chili Cookoffs that's the main motivator for the Ross!:cool:

Sorry, just giving you a hard time.:)

Karlynn

PS - beans or no beans?

[chilihead]

Please.......... I'm a native Texan. Beans in chili is something we just won't hear of. Yes, that is one of the considerations. My diet and excercise are at both ends of the spectrum. I eat and drink whatever I want and get in a lot of exercise, ususally competitive typeos of things. Our motto is "Every bike ride is a race".

The International Chili Championship is upcoming in Terlingua, out in Big Bend. I'm hoping to make that my last hurrah before surgery in mid November.

Thanks,

Jim
South Side Foggy Mountain Chili

"Those who ride,
Choose South Side!"

[tommy]

If its got beans in it, then ya gotta call it "stew". Chili with beans is an oxymoron.

[conk]

I know how tough this decision is. I've had to make twice in less than 1 year. I can't tell you how disappointed (maybe devastated is a better word) I was when I heard my replacement valve (Homograft) was leaking on my first Echo after only two weeks. Somehow you have to move on. I'm very hopeful that this St. Judes Regent valve (23mm) I have will be the ticket. As for valve size, I was told I was a 25mm based on my previous surgery, so don't be surprised if you go this way that it may go down or up a size (down is the most likely direction), but being a 31mm, 29mm would certainly still be very satisfactory.

I went back to look at some statistics from earlier this year as I was recovering from my first surgery. This is what I found:

Surgery Date 12/20/02
At 4 weeks doing life cycle at avg heart rate of about 135 with max of 145.
At 6 weeks first bike ride of about an hours with avg HR of 150 and max of 158
At 7 weeks bike ride of 1.5 hours with avg HR of 148 and max of 163
At 8 weeks bike ride of 2.5 hours with avg HR of 141 and max of 159
At 11 weeks bike rides on Sat/Sun of 4 hours total at avg HR of 139 with max of 156

On our (my wife Joanne and I) trip to Europe and stay at Alpe d'Huez between July 8-15th I could not resist riding the CSC race bikes for rent as we waited for the stage up the mountain that week. During a 5 day period I rode about 7 hours with an avg HR as high as 145 and a max of 166 (realize at this point it didn't take much to get my heart rate up not to mention most of the riding was on the 7.9% grade of Alpe d'Huez. Probably not the smartest thing I've done in my life, but fortunately I didn't keel over.

I'm really hopeful that this valve will give me the performance I desire, but way too early to tell at this point. Definitely won't start exploring much higher HRs than I'm doing now until I get to about the 3-month point. Just taking a bit more conservative approach this time compared to the first surgery. Definitely don't want to experience another one any time soon.

BTW...Gotta try some of that Texas chili

[chilihead]

Conk,

You're my kind of guy. I was in Germany this summer for two weeks on business and glued to the TV each afternoon watching the tour "live". Hey did you ever consider a Ross procedure?

Best of luck with your new valve. If a mechanical will work for you, I'm sure it would do me fine. I usually ride road bikes at @ 168 heart rate with highs up around 180-185 on the hills. A few years ago I hit 200 on the mountain bike, but I wasn't riding as much and that causes it to rise. I can ride all day long at 168, even with my severe leakage on the aortic valve. I'm still kicking butt on short rides, but I'm not pushing any harder than I have to. I'm going to taper off between now and surgery but still ride some 25-30 mile stints to keep the blood moving.

Keep me posted.

Regards,
Jim

[conk]

Jim,

The reason Vaughn Starnes ended up doing my surgery was I consulted him about the Ross Procedure. However with my previous Radiation treatement for Hodgkins Disease he told me I was not a good candidate for this procedure.

In terms of the Heart Rate, I remember the ride about one week before my first surgery I went on a 3 hr ride, but my average was about 145 and the max was 166. You're a bit younger than me, but I believe my max at that time was 175, but didn't really test it out. My resting HR before the surgery was in the 40s. I think I'm now back down to the high 60s range, but I'm sure it will continue to come down.

Currently my max has been 148, so trying to be good and not exceed that for another 4 weeks or so.

...Denis

[chilihead]

Denis,

If you can bike like you could before, I'd consider the mechanical . I can do without snow skiing, but I spend a lot of time on my bikes and don't plan to give that up, even if I end up not as fast as I currenly am. It will surely suck to see these guys passing me that I have grown accustomed to stomping whenver I felt like it!

Ride hard and keep in touch,

Jim

[Granbonny]

As the Mother Hen of the group:D I would like to ask you some questions. How do you really feel at 6 weeks post-op? Are you sleeping good..all night without pain? Are you driving? Do you not feel pain in your back and shoulders from riding that bike? Do you still nap during the day? Do you have one good day and one bad day? (common) Are you not foggy-headed? How is your INR? In range? How often do you go to lab to have it checked? It usually takes 3 months to get in range 2.5-3.5.......the reason i ask all these questions..It is more important to heal first..then think about what you want to do later. It takes 1 full year to feel yourself again. Have you had your flu shot? I took my first long trip at 6 weeks to see my Daddy. Just a 6 hour trip..a few days there and back home. Took a week to feel good again...Back to your INR..Get it stable.. If you run high ..you may bleed from gums..Urine, ect. When you are on coumadin..you could trip going down the steps and hit head. ect. Always be alert for the little things. Next spring..I plan to sit somewhere during Little League games. Almost got hit in head from fly balls. Those kids can really hit that ball:eek: You may can take pain..but I found it hurts. Driving and looking around, ect. washing windows and sharp pain..in shoulder. Scares me. thought I was having a heart attack. Takes at least 6 months to heal..and still had those bad days and good days for next 6 months. Now at 18 months...have sat in Jury stand for last 2 days and probably another week. Guess what the case is..Medicine Malpractice:eek: Putting in a 9 hour day..but feel GREAT.And looking forward to going and watching Grandson play football this weekend. I'll be his team's biggest cheerleader.:D Bonnie

[Granbonny]

I called Hubby when I was leaving courthouse tonight and told him..Have me a cold one ready.:D Miller Lite.. Beer does not effect my taking coumadin. Stay in the 3.0 range.:D Really relaxes me after hearing 6 Lawyers argue all day.:p :p :p Bonnie

[Karlynn]

Okay, now I'm thirsty. A nice cold Miller Lite sounds great. I don't find that alcohol messes with my INR much. I'll have around 4 drinks a week, either beer (Miller Lite's my choice!), some red wine, or a rum and diet Coke. (Bacardi makes a rum and tequila mix called Ciclone that's really good.) Even an occasional martini doesn't seem to hurt. I figure that the de-stressing effects of an occasion drink is probably good for my heart.:cool:

Karlynn

[fyrfytr]

Hey Bonnie,
I think you have found you a part time job. You need to print up some flyer's with all that info on it and give it out to everyone in the waiting room. That is very good information that everyone should have. I wish I would of had it.
Take Care

Dave
___________________________
Surgery: 4/21/03
Aortic Aneurysm Repair
AVR, with a St. Jude Mechanical

[conk]

Bonnie,

You are right, today is 6 weeks, so it's a good time to do an honest assessment of how I feel.

How do I really feel at 6 weeks post-op?
You know, I almost feel guilty at how well I feel at this point. I did something about a week ago that set me back a couple of weeks in terms of my sternum and I think it was sit ups that did it, but not 100% sure. However, aside from that, I'm just as active on the job (not to hard to do on a desk job), but still all the same stresses. I'm also working out other than the long weekend rides about the same amount of time before my first surgery.

Are you sleeping good..all night without pain?
I have absolutely no pain and I sleep as if nothing is different than before. The only difference I have is that I can hear my heart beating just a bit more than before.

Are you driving?
I have been driving since about day 10 (don't tell my doctor).

Do you not feel pain in your back and shoulders from riding that bike?
I feel no pain from riding the bike, however it's a bit different on a stationary bike or on your own bike in a stationary mode, so I'll let you know after my first real ride which I'm planning for this Friday. I did feel tremendous pain in my back and shoulders in the first two weeks after surgery. About 3 weeks after the pain had significantly subsided and then day by day, it just went away and I don't even think about it at this point.

Do you still nap during the day?
I haven’t taken a nap in quite some time, since about week 3 or 4 and at the end of the day I do feel like I've put in a good day, but maybe that's why I have no problem sleeping.

Do you have one good day and one bad day? (common)
All of my days now seem very even in terms of how I feel. If I've had a fairly hard workout, or didn't get to sleep as early the previous night, then I might be a bit tired at the end of the day. In the first 2-3 weeks I certainly did have some up and then down days.

Are you not foggy-headed?
I've had a few moments where I might have felt a bit this way, but it seems fairly short-lived.

How is your INR? In range? How often do you go to lab to have it checked? It usually takes 3 months to get in range 2.5-3.5.
This might be the most challenging area, but it seems to be coming together. Believe it or not, my first check after leaving the hospital was right at 3.0. My next check was 4.8 (I'm not so sure about this one), so we backed off the amount of coumadin to zero for three days. I believe that this was too aggressive. Now I've been coming up from 2.0 to 2.6 and we have been making very small adjustments (now taking 5mg every day except M/T/W when I take 4mg) and I've been trying to eat as I would normally, including drinking zero, one or two beers in the evening. These small adjustments are slowly bringing my level to the right range I hope. I'm currently checking once a week, but as soon as we get a couple at the about the target number (3.0), then will probably go to two weeks.

.......the reason i ask all these questions..It is more important to heal first..then think about what you want to do later. It takes 1 full year to feel yourself again. Have you had your flu shot? I took my first long trip at 6 weeks to see my Daddy. Just a 6 hour trip..a few days there and back home. Took a week to feel good again...
It's funny you mention a trip. I traveled to Tailhook in Reno, NV at about 3.5 weeks after surgery and drove the entire way (8 hours in the pickup) after work (left work about 2:30pm) on a Thursday and arrived in Reno about midnight. Stayed up the next two nights with my wife and hook buddies until about 11pm the first night and 1 am the next night. Drove home on Sunday (yes I did all the driving again) and I was actually surprised myself that I felt ok, although as you might expect, I was probably a bit tired that night.

It sounds like you are doing well and I certainly appreciate the sage advice. I expect that I'm not the normal individual when it comes to this and I hope that others take the message from thier body and not rush the process (I know, I should listen to that myself). I've always had an extremely positive attitude and I can't stress enough at how powerful that can be on the heeling process and recovery. Yes...I'm probably too optimistic and agressive at times, but it's certainly better than the alternative. I certainly look forward to being around when my Grandson is doing sports some day (he is only 2 months old at this point), but it's great that you can now be back to a normal long day and still have energy to watch that Grandson of yours play football.

Ok aftet this long post, time for a Negra Modelo.

Best...Conk

[sylviayasgur]

hi conk!
boy, are you one of the lucky ones!!! your recovery seems picture perfect!
i am soooo happy for you. i can't believe that you had the surgery just 6 weeks ago and you are close to being back to "normal"!!!
wishing you a continued easy recovery. i can see why you want to bike vigorously...
keep it up. sounds like you know how to listen to your body.
be well, sylvia

[chilihead]

Conk,

You're my hero! Are you really sticking to only two beers a day? Even at tailhook?

Regards,

Jim in Dallas
4 weeks from surgery time and can't decide between mechanical or Ross!

[Granbonny]

You do sound great at 6 weeks. But, the driving at 10 days..more for the safety of other people than your driving...You were lucky that you did not have a sudden double vision or the gray blind on one eye..that is very common and normal for people after open-heart surgery. Driving at night is bad enough but to Reno? on those twisting mountain roads..:eek: :eek: :eek: who is managing your Coumadin? 4.8 and asked to hold for 3 days. No way..you could have taken 10% of your weekly dose LESS..and been back to 3.0....We all have a positive way of thinking positive about wanting to feel good sooner than later. but when your shoulder blades were pulled back to meet one another on operating table so surgeon could get in there good.:eek: one is going to have back and shoulder pain for a long time. That is why I encourage my girl valvers not to pull wet clothes out of.washer wash windows, ect. for at least 3 months. Reaching out..down and up..with arms... Slow down and smell the roses..you will be back to normal after 1 year. :) Don't lift that Grandson yet.. You said you want to be around to watch him play Little League. My age 11 year old cannot stay up with his Granbonny now.:D And I am age 63.. I thank God every night that I had a Husband who watched me like a hawk..Still does.:) 37 years being married to me..don't think he wants to lose me now.:) Bonnie

[Granbonny]

You do sound great at 6 weeks. But, the driving at 10 days..more for the safety of other people than your driving...You were lucky that you did not have a sudden double vision or the gray blind on one eye..that is very common and normal for people after open-heart surgery. Driving at night is bad enough but to Reno? on those twisting mountain roads..:eek: :eek: :eek: who is managing your Coumadin? 4.8 and asked to hold for 3 days. No way..you could have taken 10% of your weekly dose LESS..and been back to 3.0....We all have a positive way of thinking positive about wanting to feel good sooner than later. but when your shoulder blades were pulled back to meet one another on operating table so surgeon could get in there good.:eek: one in going to have back and shoulder pain for a long time. That is why I encourage my girl valvers not to pull wet clothes out of.washer wash windows, ect. for at least 3 months. Reaching out..down and up..with arms... Slow down and smell the roses..you will be back to normal after 1 year. :) Don't lift that Grandson yet.. You said you want to be around to watch him play Little League. My age 11 year old cannot stay up with his Granbonny now.:D And I am age 63.. I thank God every night that I had a Husband who watched me like a hawk..Still does.:) 37 years being married to me..don't think he wants to lose me now.:) Bonnie

[conk]

Bonnie,

Yes you are right about the driving, but I was very cautious at first and would not have drivin if I had the slightest tinge of dizziness or balance uncertainty during any time during that period.

In addition, this was my second surgery of the same type and I did not have any of the symptoms you described on my first surgery or on this second one. Lucky I guess.

As for waiting 1 year, I'm sure this is good advice, but ya know...I'm not too good at taking it slow. Smelling the roses for me might be different than for others, but if I'm not in the game, might as well not be any roses. I feel the need for speed. Always have and I guess I always will.

I have no pain at all at this point (7 weeks post surgery), but I am going to wait a significant time before I go back to the weights, probably 3 months before I start and will gradually work myself back into it.

I am doing a 30-mile cycling ride this weekend (Saturday) in Santa Barbara for MS. I'm not going to set any speed records, but this will be my longest ride since surgery. Actually have only ridden on the bike one other time (21 miles) last weekend. I have been getting about 3-5 hours a week on the stationary and my kinetic trainer.

For Chilihead,,
I'm following the training in Chris Carmichael's (Lance Armstrong coach) book and it seems to be working very well. I can feel my ability to push more resistance and maintain the prescribed HR. Great book if you don't have it.

Regards...Denis

[chilihead]

Conk,

I have the book. Did your doctor say anything about biking? Not htat it would matter. I think you can probably do what you want if you understand the risks.

I'm less than 5 weeks form surgery and I'm still kicking butt on my bike. I mountain bike last night and whipped everyone I was riding with!

Keep up the progress.

Take Care and ride as much as you can.

Jim

[Granbonny]

You can still have problems with your eyes...up until many months after surgery. I have read many threads..from members asking about the gray blind like a curtain coming down. I, had 2, during first months of post-surgery. I think you can find these threads by typing in eyes..(somewhere)..maybe Nancy or Ross can post how to do it??? Be careful biking. even Lance Armstrong took a nasty fall in France.:eek: :eek: :eek: Glad he wasn't on coumadin:eek: Hate to be such a Mother-Hen..but after having posted..1,883 posts on this forum..Have read it all...Just hate to see you hurt yourself..If you take 1 foot forward..you may have to pay..3 feet back..Hope you get that Protime. I love mine..Stays in range all the time.(INR) BTW..those Roses smell so good..now..Taking Grandson on motorhome trip to Smokies tomorrow. Hiking, swimming (in heated pool at campground) fishing for trout..and hey, I'm age 63.:D :D Drive the motorhome (36 ft.).but, now, at 18 months...No problems.:D :D Good Luck this weekend. Make lots of money for MS..:) :) Let us know how you did....Bonnie

[conk]

The Santa Barbara MS ride is done every year in October. This year the options were 12, 30, 60 or 100 miles. I chose the 30 miles, which I believe is what I rode on the first year I did the ride.

12/18/03: I just cannot express how good I felt on this ride and the fact that when I finished, I felt better than I had in any of the other years I have done the ride. Of course I took it easier this year and tried to stay within my heart rate goals, but I did not have total success there. My average HR was 141 (not too bad) with a maximum of 166 (about 16 higher than planned), which I reached on Ortega Hill. It felt good to be able to maintain over 9 mph up and over this hill.

Now I know I'll get a lot of criticism for this decision, but I ended up getting Strep Throat a few days before the ride, but decided it wasn't really going to change the course of recovery from ST, so proceeded with the ride. Probably another day or two of dealing with a flaming throat, but the feeling I had from this ride makes it more than worth it.

:D :D :D

[tommy]

Martin,

Welcome to the Forum.

You will find lots of athletes in here. My inspirers are Les Barrett and Mark Wagner - marathoners. Mark just finished his second (count 'em ONE TWO) marathon last week. Check out their (and other's) stories in the "Stories" section of this site.

I suspect that you will need more than four weeks off work, but perhaps not much more with a sedentary job. Talk that over with the cardiologist and the surgeon. Can you use vacation time as well?

[conk]

I really think that being in good shape prior to surgery is a significant benefit toward a rapid recovery. It's probably not a 100% guarantee, but I sure think it helps.

In terms of the activities you do, running and swimming should be no problem at all, just don't rush the recovery process. You will be amazed that in a fairly short time (6 months to 1 year), you will be right in the competitive swing of things. That's not really too much to ask for a healthy heart.

I've had my mechanical for two months tomorrow and I know my condition prior to surgery definitely helped. However, I don't think I was in the shape I was prior to my first surgery in Dec 2002. While dealing with a leaking homograft valve, I could not progress with the recovery like I will now be able to do.

In terms of the coumadin...just want to make sure that you have someone who is very competent at monitoring and doesn't make big changes in dosage.

I took only 3 weeks off from work, but I think this varies widely on job, recovery etc. Just don't push it. If you feel good then go, if not take a little more time.

[Bob Bates]

To One and All:

I am going in for my AVR this Monday, 11/3/03. I've opted for a tissue valve, the Carpentier-Edwards Pericardial Bovine. I intyend to get back into prior active pursuits, like jogging, backpacking, and weight trainning.

I was told by my surgeon this valve would allow me to do all of the above. Does anyone have this valve (the CE bovine), or any other tissue valve that feels restricted in any way from being as active as they want to be?

Regards,

Bob

[Marty]

Bob, Even though I have a mechanical valve ,I now think for most people the C-E tissue valve is the way to go. I have a friend at my fitness center who has had one for seven years .Recently he was hospitalized for severe pancreatitis; he had three surgeries', was in a coma for weeks,etc. but they pulled him through and he's now 80 years old, back at the club on the treadmill every day looking great. I really wonder how he would have done with a mechanical valve on Coumadin. His C-E valve came through all this working fine. Good luck, Marty

[Bob Bates]

Marty;

As a physician, and a person who is on coumadin, for you to say the CE valve is the way to go is music to my ears. Thanks for being so forthright.

Regards,

Bob

[HFK]

Hi Bob and Marty,
As a RN this was a concern for me ,the effects of coumadin and surgery,in the ICU I saw secondary effects of coumadin. So opted for homograft valve 3 years ago ,had good surgeon but he got a bit aggressive my aortic valve he replaced perfectly,but than decided to take calcium off my perfectly functioning mitral valve and tore a leaflet and came out of surgery with pacemaker and 2+ regurg. I now need mitral valve replacement soon as it has progressed to mod-severe regurg. But last year I had to have my R ovary removed suppose to be 1 day surgery,the surgeon nicked something and I bleed,he let me sit there for 5 days thinking it would absorb itself,I was taken back to surgery ,not by him and they removed 1245cc ( over 1 liter)of blood and fliud needless to say and very long story I was in the hospital for 30 days. The reason I am bringing this up was my cardiologist said if you were on coumadin the situation would of been MUCH worse.Every person is so unique in their personalities and medical histories,and these also play a factor in which valve can and may be used.Don't get me wrong people on coumadin have surgery and procedures done all the time a things go ok. One never knows what can come next, I certainly never thought I would have to deal with this OTHER valve situation.I am glad I found this sight,everyone has different opinions but we all have the same common denominator. HFK

[mike anthony]

Bob, I have posted on other post and has you know I have the C/E Bovine. My activities have not been restricted at all. I'm 50 years old and play full court basketball and have had my HR will over 150. I had more problems with sore muscles,because I was so out of shape. As I have said on other post, if it wasn't for the nerves in my chest area and of courses my battle scar. I wouldn't know I've had open heart surgery. I believe your body will tell you when enough is enough. I believe in this so much. That's why I'm alive today. It was because I knew my body, that I kept going back to the doctors and they finally did a Cat Scan. And guess what they found an "Aortic Aneurysm", size 6.5 cm. Anyway, I have a very aggressive doctor and he told me to do whatever I want. Actually, the only thing he cautioned me on was weight lifting.(no heavy weights).

[conk]

I am feeling very fortunate and want to share the possible. My recovery is going well indeed.

On Friday 10/24 another guy at work (about 14 years younger) and myself went out for a morning bike ride of about 1.5 hours. In the first part of the ride we did a 3-mile field test, which means to ride 3 miles as quick as possible. Maximum and average heart rates over the time were also recorded. A cool down period of 10-15 minutes was followed by another 3-mile filed test. Bryan did the 3 miles in a time of 7:27 and 7:14 (almost 25 mph average). As you can surmise, he is an advanced rider. My times were 9:18 and 9:17 (average of 19.4 mph). My high heart rate and average for the runs was 169/175 and 164/172. I thought this was great for this point in my recover, still 4 days before my 2 month anniversary on my second AVR. I know that the maximum heart rate on the ride if not my maximum is very close, however, I felt no adverse sensations from this effort, other than being a bit spent from the effort, which I know is normal.

On Saturday I rode 37 miles and so far this week I have done almost 3 hours on a life cycle/kinetic trainer averaging about a 140 HR. Other than not lifting weights, I'm feeling as if I hadn't gone through surgery.

Jim and Bob,
I sure hope you have the same success with your surgeries and recovery.
Regards...Conk

[khan2]

Conk: As a cardiologist familiar with the St. Jude valve, I am nearly certain you won't hurt your heart valve by getting your exercise heart rate up to 150 (or higher). However, the issue with exercise may have to do with the state of your heart muscle. Some patients (not all) develop damage to their heart muscle from their valve disease which may put them at risk if they exercise too strenuously. For example, if you have severe hypertrophy (thickening) of the heart muscle or if you have developed other forms of damage to the muscle (cardiomyopathy) from your leaking valve, you may be at risk for arrhythmias (irregular heart beats) or even sudden death with strenuous exercise. However, the heart can remodel back to normal over a period of time (typically 3 months or more) after valve surgery. You may want to check with your cardiologist about some of these issues. He may want you to have an echo and/or an exercise study before OKing you for very high intensity exercise. After another form of open heart surgery (CABG) patients receive 12 weeks of cardiac rehabilitation (supervised exercise) at the end of which we usually do a full Bruce protocol treadmill test to see what each patients safe exercise tolerance is.

Another option used by many competitive athletes to evaluate their fitness level is a cardiopulmonary exercise (CPX) test. If you look in some of the triathalon magazines available here in SoCal (such as Competitor), you should see ads for these. A CPX test can give you a better idea of your true fitness level as judged by your VO2max. The heart rate is really just used as a surrogate for VO2max since heart rate tends to go up linearly with VO2max. If your Cardiologist OKs you for exercise, you might consider seeing an exercise physiologist (again check ads in Competitor) and getting a training regimine/exercise prescription. Best of luck.

[Nancy]

Hi Dr. Steven Khan-

Just wanted to welcome you to this terrific site. We'll look forward to your posts and hope to see you here often.

My husband is the patient here, he's been through a TON of stuff.

[HFK]

Hi Dr Khan, Welcome to this site, many good people here. I believe there are a few doctor's aboard here and a few RN's.HFK

[Marty]

Dr. Kahn, That was a terrific post. We really need a cardiologist to ring in regularly. I am a semi-retired radiologist working half time for Kaiser here in Northern Virginia. I've learned a lot of cardiology
since my own surgery but can get in too deep very quickly. Hope to hear from you frequently. Marty

[conk]

Thanks so much for your informative post. This is great information.

"...Some patients (not all) develop damage to their heart muscle from their valve disease which may put them at risk if they exercise too strenuously. For example, if you have severe hypertrophy (thickening) of the heart muscle or if you have developed other forms of damage to the muscle (cardiomyopathy) from your leaking valve, you may be at risk for arrhythmias (irregular heart beats) or even sudden death with strenuous exercise..."

I have had two echoes since my heart surgery on 8/26. The first was 8 days after surgery and all my readings were normal and my left ventricle diastolic measurement was 6.0, down from 7.0. I had a second echo on 9/28 and all my heart measurements were within normal limits and my LV measurement had gone down to 5.4. I've had no other damage to my heart muscle, at least that I've been told about. I have a Stress Echo scheduled for 12/27, which is about 4 months after surgery. Should get a good indication about progress at that point.

"...However, the heart can remodel back to normal over a period of time (typically 3 months or more) after valve surgery..."

My Cardiologist told me that the heart had remolded back to normal parameters on the 9/28 Echo. Seems a bit fast, since this was only 1 month after my surgery.

"...Another option used by many competitive athletes to evaluate their fitness level is a cardiopulmonary exercise (CPX) test..."

I will look into the CPX test. I've had one run in the past, about 6 years ago and still have the records, so will be very interested to see how I would compare now that I have a new (mechanical) valve. I understand the hemodynamics are not as good as a human valve, but the St. Jude's Regent seems to have the best of any mechanical from the information I've gathered. I will probably do this test after my echo in December.

Thanks again for all the good info.:) :) :)

Regards...Conk

[conk]

I wanted to ask about your comment in terms of intense exercise not being a problem if I didn't have the problems that you mentioned.

The only real concern that I have is that my heart muscle be fully healed such that I'm not subjecting the heart and/or valve area to pressures they are not ready to handle a little over 2 months after surgery.

How long in an optimum recovery does it take for the stitches around the valve to be able to hold up?

Do the stitches disintegrate over time or are they permanent?

Is there ever a problem where the valve could come loose from its location?

Two years after surgery, what holds the valve in position?

I appreciate your input on these questions.

Regards…Conk

[khan2]

Conk wrote:
"The only real concern that I have is that my heart muscle be fully healed such that I'm not subjecting the heart and/or valve area to pressures they are not ready to handle a little over 2 months after surgery."

"How long in an optimum recovery does it take for the stitches around the valve to be able to hold up?" For all practical purposes, the stitches will hold up right away, assuming the surgeon has tied it in properly. As tissue grows in over 2-3 weeks the bond gets stronger and the seal tighter. There may be very small leaks back through the valve in the first couple days after surgery but these usually seal within days. In 16 years and over 2,500 valve implants, (13,000 patient years*) , I don't think I've ever seen an aortic valve tear out without a serious infection. Rarely, a valve can come partially loose (dehisce) related to technical surgical issues (not enough sutures!). This usually results in a leak around the valve. Although this is usually seen with new or inexperienced valve surgeons, it does occasionally happen to very good surgeons. We recently operated on a patient who was 3 years out from his AVR at a very prominent LA academic institution who had a leak around his valve that had probably been there the entire time from his original surgery.

Do the stitches disintegrate over time or are they permanent?
They are permanent. Look at the photo of the explanted Starr-Edwards valve on this forum from a patient who had his valve about 20 years ago. You'll see the stitches completely intact on the valve ring after 20 years!

Is there ever a problem where the valve could come loose from its location?
Thankfully, most valve surgeons are good at tying knots these days! So pretty much the only reason a valve would come loose late after surgery is an infection (endocarditis). I do remember one case we had of a patient with a St. Jude aortic valve infection where the valve ring was completely encased in pus. When the surgeon opened the aorta, the valve could easliy be just lifted out with a forceps without cutting any sutures. Scary!

Two years after surgery, what holds the valve in position?
The sutures do and the fibrous tissue that has grown into the fabric of the sewing ring. This tissue ingrowth was an problem for the St. Jude Silzone valve** which had a sewing ring covered with a new silver based coating. The silver coating was designed to reduce infection by preventing bacteria from getting into the cloth ring. However, the coating also prevented the fibrous tissue from growing into the ring and they had some late valve leaks. The valve was taken off the market subsequently.

*Twenty-year comparison of tissue and mechanical valve replacement. Khan SS, Trento A, et al. J Thorac Cardiovasc Surg. 2001 Aug;122(2):257-69. Divisions of Cardiology and Cardiothoracic Surgery, The Cedars-Sinai Medical Center Burns & Allen Research Institute, University of California at Los Angeles School of Medicine

** Paravalvular leak and other events in silzone-coated mechanical heart valves: a report from AVERT. Ann Thorac Surg. 2002 Mar;73(3):785-92.

[khan2]

Just to clarify my last post, leaks around the Silzone valve were rare (<5% of patients) and they appeared early after the valve was put in. If you've had a Silzone valve, are doing fine, and have had an echo after surgery that showed no leak, you have nothing to worry about. :)

[conk]

Dr. Kahn,

Your thorough response is much appreciated. I believe in probably one month I will be in better condition than prior to my first surgery. I had no obvious symptoms before the first surgery, but I did not seem to have as much aerobic capacity as expected over an extended bike ride.

It's good to know I don't have to worry about the valve coming loose.

Thanks again....Denis

[conk]

300 mile Bike Ride - Carmel to Camarillo

Just an update on my progress and for those who are concerned about intense excercise post surgery. On Superbowl weekend, I joined 4 others for a 3-day back to back century.

This was not a sponsored ride, but some of the group have been doing this ride for the past 8 years as part of early year training. The other riders in the group have been riding far longer than I, but I had completed a 72 mile ride as part of a 145 mile week, just two weeks prior, so thought I might be up to the challenge. Even though I was suffering a bit (any one who has riden long distance on a bike know what I mean), it was a great time and I completed the entire ride.

Some statistics follow:
DAY 1: Carmel, CA to Cambria, CA on the Pacific Coast Hiway
Max HR-164, Avg HR-145, Distance-96.6 miles, Total Ascent-6,400 ft, Avg Speed-16.9 mph

DAY 2: Cabria, CA to Buellton, CA on PCH, 101 & Other roads
Max HR-160, Avg HR-137, Distance-106.2 miles, Total Ascent-4,000 ft, Avg Speed-18.4 mph

DAY 3: Buelton, CA to Camarillo, CA on 101 & Other roads
Max HR-167, Avg HR-138, Distance-94.9 miles, Total Ascent-2,400 feet, Avg Speed-17.8 mph

I have in the past 3 months riden to a probably near max HR of 175, but for such a long ride, one must conserve enough energy to complete the day.

Here is a picture of the group. Questions welcome.

[Rush20]

Nice Pics Conk! Glad to see another avid biker in the group. Prior to my AVR on 8/29/03, my exercise regime consisted of four basic activities (1) road cycling - about 100 miles per week in season, (2) 12-inch softball two nights per week, plus occassional tourney, (3) weight training twice per week summer and four times per week winter and (4) golf - mostly social and business.

After my surgery, I too was very skeptical as to how soon and to what intensity I could resume those activities. While lying in the hospital bed, the idea of performing a bench press seemed very remote.

Now, as I close in on my 6-month anniversary, I have resumed my weight and cardio training to almost 70% of my pre-surgery intensity.

As with any "life-changing" event, what I have gained is a better appreciation for what makes my body work and the delicate balance of moderation. My weight lifting is now focused on better form and less weight moved per exercise, however more weight moved per session. Although my indoor cardio routine centers around my treadmill, I'm starting to chomp at the bit for my cycling season to start in about 6 weeks. (I live in the Chicago area so my cycling season is mid-March through mid-November with an occassional winter ride). Due to my surgery in late August, last year was the first fall riding season (my favorite) that I missed in 20 years. That probably added to my post-surgery funk.

After completing my 12-week Phase II rehab the week of Christmas, I purchased a heart monitor to help with my workouts. It's amazing the difference between aorobic and anaorobic exercise and the effects on your heart. While performing arms curls or leg presses, my HR will go from 90 at rest to 145 at the peak of the excercise. While walking/running on the treadmill, its a more gradual effect.

Lastly, thanks for asking all the questions I have wanted answered since my surgery pertaining to the valve and the effects of the heart muscle, etc. Thanks to Dr. Kahn for his thorough responses.

BTW - What kind of bike do you ride? I have a three-year old Trek 2500. Love it! My only planned cycling change post-operation is that I plan to ride the trails more vs. the open road due to the coumadin.

[tommy]

Way to go Denis. Wow 300 miles in 3 days!!!

[RunMartin]

Good to hear that you are doing well (most impressed!!). I Was wondering only the other day that I had not seen a post from you.

All the best

Martin

[conk]

Sounds like you have been doing very well after surgery as well. I have also resumed weight training, but with the same kind of focus as you mentioned, form and moderation of weight. I have to admit I'm not getting in the gym as much as I would like, but I have been averaging about 80 - 100 miles/week on the bike. I plan to add a spin class and some kinetic or life cycle training during the week until we get to daylight savings time again.

I wanted to get back into some golf as well (still have 3 of 6 lessons that I paid for that I have not yet used), but have been focusing on the riding and the "BIG RIDE" that I just completed.

I believe that I'm in as good and most likely better cardiovascular shape than I was prior to my first surgery. The group that I ride with is very fast and often drops me, but it takes longer and I recover quicker than before, so know I'm still gaining on them, although I have no illusions of being as good (some of them race in 1/2 category). I just want to be able to hang on group rides.

I admire your spirit of riding in Chicago in March or November, must still be very cold. We don't have many trails for road bikes, but many bike lanes, so I do take my chances, especially being on Coumadin, but I try to minimize the risk as much as possible in descents and which roads I ride.

In terms of the questions, I believe Dr. Kahn has put my mind at ease, but my Cardiologist is very conservative and does not recommend exercise above 85% of max, i.e. 143. Good advise I'm sure, but I'm known for being a bit bull headed and in this case it probably applies.

"BTW - What kind of bike do you ride?" I ride a 2002 Specialized Comp that I purchased off of eBay. It had only been ridden about 100 miles so got a great deal. It sure beats the "OLD" but reliable Raleigh that I was riding.

Good luck with your upcoming riding season...KICK B%##

[Rush20]

Wow Conk. I think we're kindred spirits. I also had a Raleigh Tri-Light that I sold when I bought my Trek. That good ol' Raleigh gave me 10 years of thousands of miles of reliable service. In hindsight, I wish I would have kept it and turned it into an indoor trainer.

Good luck this season. I have about 4 more weeks before the weather hopefully breaks for good. As a present to myself for what I've gone through, I plan to buy a new pair of road shoes and helmet for the upcoming season. I'm already fingering through the magazines ;)