Ashok's Journal

Alina FH  Hi, Ashok, I have had an IT/ software job now for about 12 years, and I have always disclosed my heart condition to my managers and co-workers. Over the years, I have had so many appointments and some of them are long (hours or days), so I wanted them to know I am not missing work for other reasons. I think it will depend on the manager and the employer, though. I never felt discriminated against for my condition, but I know that some people could be that way. Good luck.

Ashok Vaid  I sent an email to dr paul stelzer , he replied back :) ! The thing that confuses me is that on-x requires lower anticoagulation doses for INR 1.5 - 2.5.... So it means much more safety with lower warfarin....

Rita Savelis  I travel with 2 mechanical valves - there is a leeway of about 6 hours in which to take your meds, so you adjust to a new time zone by gently adjusting times when you take meds.
It's okay to eat different foods.
Travel in general will destablisise you somewhat, but it is okay to travel.
Essentially you have to get over / get through a first stabilisation time after OHS, which can take weeks/months.
After that your body gets used to it and you get used to how to manage your meds.
Different types of valves require different levels of INR - the on-x being one that requires a lower dose.
I have several mechanical valves so require a higher dose.

Ashok Vaid  thank you so much rita , how do you stabilize after travel ? suppose you had to stay long term outside US , how do you manage INR ?

Rita Savelis  Ashok, the nature of INR is that it goes up and down. That's just what it does. By "stabilise" I mean you eventually get to a point where you take the same amount of medication, with tiny adjustments. INR will still go up and down, but it usually won't be far from your range....
You will need a blood test every 3 or 4 weeks or so (initially more often for a few months). You can get this simple blood test in any country and the INR numbers are universally the same.
I travel (from France where I live) to the U.S. (9 hour time difference).

Getting used to anticiagulatns and INR testing takes awhile and can be frustrating/disheartening at the beginning because of how INR goes up and down. But at some point, one does get accustomed to it and more relaxed.

You should be open about your concerns, and the fact that you travel a lot, when you speak with your doctors. They have many patients like you, I'm sure, and so will know how to advise you and let you know what they think is the best valve for you because of your specific heart condition, your age, your lifestyle, etc. The choice will be up to you, but it is nice if you can trust your doctors.

What doctors are recommending in the India may be different from the U.S.
Every country has a different medical culture, and different financing/marketing of products.
I am sure that medical care and cardiac surgeons in India are of high caliber!
I wish you all the best.

Catie B  With an On-X, you would need to take warfarin/Coumadin daily. Foods with high amounts of Vitamin K (especially green vegetables) alter the anticoagulating effects of the medication, so it's best to be fairly consistent with diet and to have the dosage fitted to your eating habits.

Clare Auten  I have an On-X mechanical valve. I do have to be consistent with green vegetables but I eat anything else (in moderation). Next week is my 3 year valve anniversary.

Catie B  I'm not familiar with any decalcification process to be used for aortic stenosis. But here is a link to an article on this site that may be helpful.  https://www.heart-valve-surgery.com/heart-surgery-blog/2013/01/15/de-calcify-valve-repair-replace-junaid-khan-md/

Keith Heflin  I saw it in a video of an AVR on YouTube. They used an ultrasonic device to debride the calcification from the tissues surrounding where the leaflets are removed before the new valve is installed.

Catie B  Ashok, have you read Adam Pick's story? (The founder of this site and author of The Patient's Guide to Heart Valve Surgery) He has fared very well after having his Ross a few years ago.

Cathleen Weed  45-50 pre surgery
65-67 post surgery at 3 month check-up
(70 is the highest so don't think of it as a 0-100 scale)

Bob Fessler  Really? I thought any mean aortic gradient over 60 was considered VERY SEVERE and a valve velocity over 4 was considered SEVERE. So I'd think your readings would be considered severe than moderate. But I guess there are lots of ways to read the echo.

Ashok Vaid  I got a second opinion, seems to me gradient is 56
mmHg , and velocity 3.62m/s ..so its moderate for now ! It seems to be fluctuating

Cathleen Weed  I had severe stenosis and my only symptoms were occasional dizziness and palpitations. In fact, I was still working out up to the end. A routine echo caught it but even then it was confusing to my cardiologist because of my lack of symptoms. A surgeon (who sees this every day) can give you a much better idea of where you stand. He will also want additional testing done with more accurate results.
Severe AS is usually defined as mean gradient >40 mmHg, aortic valve area (AVA) <1 cm2 and peak aortic jet velocity >4.0 m/s (2).
Do you know your AVA (Aortic Valve Area)? Mine was 0.5 -very small (the surgeon described it as equivalent to the opening of a coffee stir straw when he saw it). I almost waited too long because I didn't know. I would ask about yours.

Bob Fessler  I agree Cathleen. >40 is what I was told for severe stenosis. >60 is considered very severe stenosis. Also the AVA below 1cm2 is severe. Less than 0.6cm2 is very severe. But I guess it is all subject to interpretation considering all the readings and symptoms.

Cathleen Weed  Hi Bob yes and that AVA is so important. My results were listed as very severe/critical after a CT with contrast and the heart catheterization. It was so weird because I had no shortness of breath this time. Echos only tell part of the story. Stenosis can be tricky that way versus aortic regurgitation (more obvious symptoms). Plus the left atrium becomes more of an issue than the left ventricle. With the absence of symptoms, I say get more tests and trust the numbers. 🌟

  Echo's are subjective to opinion. My echo's vary from moderate to severe. I've been told that cardiac MRI is the most accurate way .

Peggy Whitecotton  Mine did, even when my aortic stenosis was mild and eventually when my aortic got severe and enlargement did get worse. However, my doctor did not seem concern as long as my aortic was mild (not sure why). But he did say it was due to the heart being overworked and he was always trying to keep my blood pressure low because it puts extra strain on the heart. After my heart surgery surgery it took up to a whole year for my heart to return to normal size. My surgeon told me 9 months to a year it would take and he was right. I would talk to your doctor for your own peace of mine....

Ashok Vaid  thank you so much , I really wanted to see what people say . I want to put off surgery till atleast severe disease . The left ventricle size is actually unnerving .

Elaine Cutri  It did in my case. Caught early enough the heart can return to a normal size, but only if the muscle tissue is not over-stretched. I don't know the medical term for that. My childhood cardiologist kept a close eye on that due to my young age and permanent damage. He succeeded!

Adam Pick  Ashok, This happened to me as well. For those of you who are unfamiliar with all the details about aortic stenosis, I'll post some info here for you. Also, you can type "Aortic Stenosis" in the search bar at the top of the screen to learn more.

Ashok Vaid  Dear Adam . thank you for your response. When you finally decided to have surgery did you have severe aortic stenosis ? Did you also have any regurgitation