David's Journal

Sorry if it's a redundant question. Has anybody got through the post-surgical recovery without friends family or neighbors and relied on only themselves or professional help? If so what kind of help is needed at home and for how long? Thank you.

Hey I know I'm probably a broken record but tell me I'm not the only one in all these valve groups who is single unmarried no children no living family not working? I'm always concerned about what's going to happen to me after surgery. All of these groups and all of the books related to heart valve replacement surgery always talk about family but what if there isn't any living family? I also live overseas and am 100% cash patient..The hospitals don't offer any post op support...Mental health support is really bad here in Thailand

My surgery was cancelled 3 days before I was to enter the hospital; 4 days before surgery. They said the surgeon had sent an email 2 days before but I never saw it. They showed me a hard copy but none of it made sense. No reason was given. The cardiology dept did not say anything about a rescheduled date or refer me to another surgeon. I am looking at other hospitals. I gave up on them. Shocking but it's Asia--wild west/wild east.

My surgeon cancelled the surgery today, March 17th, 4 days before surgery. No reason was given. They are trying to find another doctor for me. I think I overwhelmed him with my questions and anxiety.

Aortic Valve Replacement, Resilia, schedulued for March 21st, Vejthani Hospital Bangkok...UPDATE: My surgeon cancelled the surgery today, March 17th, 4 days before surgery. No reason was given. They are trying to find another doctor for me. I think I overwhelmed him with my questions and anxiety.

I am still thinking of skipping surgery at the last second and dying of natural causes. I am depressed, don't want to live anymore and don't see any reason to do the surgery. I've told friends and family I may still pull out the surgery soon. I have no interest in doing the surgery. My only concern is that dying of heart valve failure or heart failure could be painful. 

It looks like I'm gonna have surgery on the 21st of next month here in Bangkok Thailand Do the pre-surgical testing Like the echo and all that stuff on the 17th through the angiogram on the 20th I'm still freaked out because I'm paying for everything I don't have living family anywhere in the world and I'm depending on my girlfriend who I think I'm going to be breaking up with soon I'm freaked out about losing her less than a month before the surgery Um I feel like everybody else has it so easy they're in their home country they've probably got insurance I don't even use word family anymore I stopped using that word a long time ago I got one crazy sick brother My parents are long dead my younger brothers long dead there's no nieces nephews cousins aunt's uncles any of that I never got married never had kids So I kind of freak out when people use the word family because it brings up loss for me

Still shopping for a valve, surgeon, hospital. I live overseas, this is a pre existing condition so I am 100% responsible for the entire bill before I leave the hospital. No way I will do this in the USA. I have no living family to take care of me and I may be breaking up with my partner here in Thailand soon. So I am dreading being alone and going through major grief and readjustment at the same time as the surgery.

I am seriously thinking of skipping surgery due to having to pay for it, no family, alone etc etc. I've had a miserable life and always wanted to be dead so having aortic stenosis is a dream come true. I am 60 never married no kids no living family no career no job a wasted life

I don't have any living family or anybody living with me to take care of me after surgery how do I get the help I need if I have no friends or family to take care of me post surgery?

Hello Beautiful Cardiac Friends from Thailand my home since 2017,I have some updates and questions after doing a follow up with a surgeon1) My AVA is .87 cm 2 He recommends surgery in the next 0-3 months.My LVEF is 73%. He said I have a 1% higher risk of stroke than the averageperson due to my reduced AVA and has recommended I reduce intense exercise.He said heart is still working/pumping normal.2) He said my annulus in 20 mm and ideal annulus is 21 for a tissue valve.He said I need to be at 23 for a TAVI though he thinks in the future they might lower the annulus size requirement to 21 for TAVI.
what this means in regards to valve selection is that if I get a tissue valve, whenit fails I will NOT be a candidate for TAVI and will need a 2nd surgical reopeningat a time when I may be too fragile-at which point I would expire.I didn't know anything about annulus size until last week--do these facts and figuresand me not being a candidate for TAVI sound right ?I have serious concerns around mechanical as well--ticking, managing INR (vegan, arthritis take a lot of herbs and supplements, high K diet, diet can change due to lots of travel).Also concerned if I have an INR issue in a more remote area of Thailand/Asia/the World--not easy to reach doctorseasily here in Thailand between office visits.So I am working on 3 things here:1) Valve type2) Where to do surgery--I am self pay so price is a consideration3) Timing of surgery--I know sooner rather than later.Thanks!

Hello Beautiful Cardiac Friends from Thailand my home since 2017,
I have some updates and questions after doing a follow up with a surgeon
1) My AVA is .87 cm 2 He recommends surgery in the next 0-3 months.My LVEF is 73%.  He said I have a 1% higher risk of stroke than the averageperson due to my reduced AVA and has recommended I reduce intense exercise.He said heart is still working/pumping normal.
2) He said my annulus in 20 mm and ideal annulus is 21 for a tissue valve.He said I need to be at 23 for a TAVI though he thinks in the future they might lower theannulus size to 21 for TAVI.
what this means in regards to valve selection is that if I get a tissue valve, whenit fails I will NOT be a candidate for TAVI and will need a 2nd surgical reopeningat a time when I may be too fragile-at which point I would expire.
I didn't know anything about annulus size until last week--do these facts and figuresand me not being a candidate for TAVI sound right ?
I have serious concerns around mechanical as well--ticking, managing INR (vegan, arthritistake a lot of herbs and supplements, high K diet, diet can change due to lots of travel).
Also concerned if I have an INR issue in a more remote area of Thailand/Asia/the World--not easy to reach doctorseasily here in Thailand between office visits.
So I am working on 3 things here:
1) Valve type2) Where to do surgery--I am self pay so price is a consideration(I am in Thailand where this is cheap).3) Timing of surgery--I know sooner rather than later.

I just moved into severe.. Seeing my main cardiologist in 2 weeks then hope to see a surgeon soon. Hello from Thailand where I am a self pay. No date for surgery yet. Torn between valve types. Dreading the ticking and blood thinners of a mechanical valve but worried about a 2nd and 3rd surgery if I go with tissue. I have high levels of lipoprotein (a) so worried about burning through a tissue valve.

I am looking for work right now and working hard to rebrand myself, looking for a job, decide what kind of work I want to do and where, doing interviews, etc etc....I am moderate/severe-severe and am also in the midst of searching for where in Thailand to do the surgery.
I am afraid I get a job and then I probably do surgery and I am down from working for who knows how long--probably won't go over too well with an employer.
Kind of work I am looking at:1) Teaching remote or in person2) White collar work--office or remote
Variables:1) Work could be in Bangkok where I live, another part of Thailand, another part of Asia or back in USA2) Even a white collar office job could entail a bunch of travel or non office work3) Could get a job that would require me to be on my feet more or slight physical work
Obviously the work I would be able to get back to soonest is remote workOffice work next soonest/easiestWhite collar work with more activity/travelThen something more physical on my feet
Any rough time frames post aortic valve with bioi valve to get back to work ?
I am currently unemployed BTW, almost 60 and out of the workforce for 3 years so it's critical that I get back to work ASAP--been semi retired last 3 years just doing acting and voice work here in Thailand as well as adding to my education base.
Anyone else faced these issues and how did they handle them especially communicating with future/new employers ?
Thank you !

Hello Everyone from Bangkok/Thailand,
For the 1st time ever I have a time estimate of when I'll need surgery to replace my calcified aortic tricuspid valve.
I am currently 59--estimate is 2 years for the surgery. So new valve at 61.
I am pretty freaked out as the diagnosis says severe AS yet he thinks I have two more years until I need surgery (?)
I am getting echos every 6 months althought the next one is in 8 months.
He is thinking that I can go for a biological valve becuase he doesn't want to have me on blood thinners. I never discussed my concerns of blood thinners or ticking BTW.
Estimate is 10,870 USD to 27.180 USD here at a top University hospital---more if I do it at private hospital.
I am 100% on the hook for the bill as insurance will not cover pre existing.
Other option is go back to the states, do it for free in LA/Califorinia where I think can get reinsured for free..I can do an Air Bnb and then bounce back to Thailand in a month or so (reasonable?)
I've included my echo test results.
Is two years a realistic window given the recent echo ?
Further thoughts ?
Thank you) David Pearl

Dear All,
I live in Bangkok Thailand an am planning on having my tricuspid (caused by high lipoprotein) valve replacement at a university. I am in excellent health but do have a high level of calcification in my heart and aortic valve as well as mild mitral valve regurgitation..I am also about 8 lbs over the BMI...I am 59, no hypertension, low LDL, exercise daily, no drink, no smoke, low fat vegan diet, no caffeine, see doctors regularly, meditate every day, take statins, monitor health at home etc etc.
Will probably go with mechanical valve but dreading the ticking and blood thinners
Any 80 something year old American friend of mine her AVR at a low cost government hospital here in Bangkok and had amazing results, no complications..He advantage: Had a son to take care of her and son's insurance paid for her surgery.
Not sure when I will need surgery..Guess is sometime in my 60's
No reason to go back to USA to do it..no insurance, no family, no one to stay with, no job, no one to take care of me, no home, nowhere to stay.
Concerns are two fold:1) Cost of any complications as I have to fund the surgery ( surgery itself probably around 15,000 USD)2) Post surgical recovery--same concerns as anyone...Given my outstanding level of fitness. exercise and diet I expect a rapid recovery (I exercise every day--at least 6000-8000 steps a day plus daily gym workouts + some swimming + my low fat plant based diet).
Also: My LDL's have been as low as 55, blood pressure controlled without meds, tryglicerides good..HDL's low due to bad genetics and because my LDL's are so low..No diabetes--all related diabetes tests are good.. Treadmill tests are great.
Given what I know what if any complications should I expect ? Any way to know in advance what complications may occur during or post surgery ?

Thank you and to your health !
David

Dear All, Hello from Bangkok, Thailand ! I am planning to do aortic valve replacement in 6-24 months and will fund the surgery 100% as insurance does not cover pre existing conditions. There is little to no chance I will ever set foot in the US again so please don't recommend that..thanks ! A bunch of questions..Thanks! What are some of the most common complications op, post op and after surgery and how much as a percentage can this add to the cost ? How to prep home after discharge ? I live in a tiny studio condo in Bangkok. What are some of the limitations at home post discharge, for how long and how to get around them ? What are your experiences with blood thinners ? Bruising ? If you have a mechanical valve does the ticking drive you nuts ? Your partner or others hear it ? If you are single has having had surgery, the scar, etc etc crushed your self esteem in the dating world ? For those who are 100% reliant on themselves after discharge what kind of outside assistance, if any, do you need, for how long and how do you get it ? Would I need a 1+ bedroom condo to accomodate others living with me ? Does the scar disappear, after how long and has anyone gotten plastic or laser surgery to remove the scar ? How long does it take for the sternum and bones to heal and what is this process like ? How has your body/mind adapted to losing a body part/valve and how have you adapted to having a non native valve ? How does one reduce trauma related to being on a breating tube ? Describe how pre op testing allows discovery of potential op or pre op complications. How bad is the depression after surgery? How to allay fears of being put on the the heart and lung machine? How to allay fears regarding death ? How to allay pre op anxiety ? How to allay anxiety in regards to leaving the safety of the hospital and being released to home ? Is necessary to know your heart rate pre op ? Is male impotency a post complication ? Do you never feel the same after surgery ? Feel better ? Worse ? Were you more or less able to return to your pre op life ? Thanks !

Hello from Thailand Everyone ! I saw a new heart doctor today regarding my damaged aortic valve--the prognosis is not good : Recovery should be short He thinks Tissue valve should last 15 to 20 years He said a sudden decline in my valve is possible The hospital has a 4.8 rating on Google reviews He says over time the body rejects all valves--TAVR rejection rate unknown; mechanical the slowest rate of rejection. I am not sure how much risk there is of a Stroke Arrythmia* Aneurysm or sudden death ? He said I am at risk of a sudden heart attack in my sleep from an arrythmia. He called my valve disease progeression is bad in a grey zone..he said the Velocity and gradient are increase... He said I have a valve diameter opening 1.2 or 1.1 opening which is not good He caught Ectopic beat--check ? Should I do a Holter ? Will ask my doctor I am not insured for pre existing conditions so I am looking for ways to pay cash for the surgery--the bill needs to be 100% settled and paid for before you leave the hospital

Loneliness, depression, other health issues, being alone, cardiac issues go hand and hand and feed off eachother. I don't even have a person to drive me home post op I have lived alone since 2000 In three years I will need open heart surgery to replace my aortic valve I've never had a wife, kids, partner or even live with anyone other than the family I grew up with My family is all dead except brother Depression and being lonely cause inflammation and damage the heart. I'll ask again: Anyone here lonely ? Alone ? Live alone ? Unable to count on a single person to assist in regards to operations or health ? Anyone else here going into or in old age alone ? I left the USA cause I was so lonely

Anybody got through post-operative aortic stenosis completely solo? I can't be the only one that's utterly alone please tell me you've gotten do surgery without family or friends thank you

1) How would you have got through post and pre op 100% solo ? Grocery shoppiing, bathing, get meds, social support, was the lonelyness killing you, was it scary, run errands, lifting things, emergency support, showering, transportation, exercising, going to the bathroom, mobility going to the doctor, driving, going to the pharmacy, food prep, cooking, lifting things, etc etc ? 2) What did you do pre op to prepare your home ? 3) How bad is the ticking of the valve and anything you can do to mitigate it ? 4) Are you an actor or do you have work or other activities that require you to be publicly miked up ? Does the mic pick up the sound of your valve ? 5) Describe your diet and how your have kept your INR in line if you have got a mechanical valve? 6) Are you single how has dating been post op ? Socializing ? 7) Do you have other health issues or mental health issues that have been aggravted by having cardiac issues ? 8) Has having cardiac issues/surgery impacted your self esteem ? 9) Do you feel more alone and disconnected from the average person who is not afflicted by cardiac challenges ? 10) Describe your recovery as far as getting back to exercise, work, sex, dating, socializing, running errands, self care, activities of daily living ? 11) How long did take for your sternum to heal ? To get used to a new valve ? 12) Did you have depression and anxiety before surgery? How is it now ? 13) Describe some of your post op complications? PTSD ? 14) If you were single, not working, had other disabilities that limited you what were your motivations recover and go through the surgery ? 15) If one 100% lived alone and had zero support post op what/how would you get help to mitigate this ? 16) Was anyone uninsured or had to pay for substantial part of the surgery ? 17) What do you take for pain if cannot take ibruprofin or aspirin ?

Has having cardiac issues/surgery made: 1) Dating harder ? 2) Affected your confidence ? 3) PTSD ? 4) Depression ? 5) Self esteem ? 6) Anxiety ? 7) Insomnia ? 8) Finances or work ? What are your experiences with warfarin/INR? Did you do surgery overseas without insurance ? Thank !

Dear All,, I'm in Bangkok; I like living here in Thailand/Asia and have no interest in moving back to the USA. I am looking at doing a mechanical valve due to my age though I am concerned about Warfarin and managing my diet/lots of Vitamin and how to get pain relief if I/we can't take aspirin or ibrupofen how do to get pain relief when in pain ? However private health insurance in Thailand will NOT cover pre existing i.e. for me cardiac. There may be a few plans that will cover pre existing conditions but the cost may not be worth it. SWOT type analysis to follow: Strengths: 1) Lifelong exerciser. 2) Diet. 3) Financial. I am well off, live cheap, am frugal and have a low cost of living. Zero commitments i.e no pet, family, partner, roomates, house, car (don't need one in Asia) . I live off the grid and have few of the complications of a typical middle aged man my age (except bad health !!!). 4) Good at following through: Meds, screenings, diet, research, seeing doctors, exercise, etc etc. 5) Low weight low BMI most risk factors eliminated via exercise, meds, diet, no drinking etc etc Weaknesses 1) Aortic Valve stenosis probably caused by high Lipoprotein (a) and low HDL which also probably caused my high calcium score (over 600). Also genetic risk (family dies early of heart attacks). Diagnosed with CAVS 2019; was at mild moderate now at moderate. Via statins, exercise and a vegan diet I have driven down most of my cardiac risk factors to sub clinical low levels and am looking a few things that may lower Lipoprotein. I've also been a lifelong exerciser, former triathlete, hiker, backpacker etc., etc. Silicon Valley/California native that's how we roll). 2) Mitral valve prolapse mild 3) Aformentioned family risk, Lipoprotein(a) and high calcium score low HDL 4) Mild left ventricle hypertrophy related to exercise, past hypertension and AVS 5) Hypertension. Gone. I am almost off losartan due to the vegan diet. Kicking it !) Threats: 1) Health issues 2) Lack of cardiac Insurance 3) Lack of anyone to take care of me--regardless of where I live. Family dead, would not count on friends, single, live alone 4) Lack of career not working (but don't need to work in Asia-cheap) 5) Other health issues--none fatal 6) Family history of heart disease I have 4 options: 1) Stay in Asia with insurance that excludes anything cardiac (where I am at now) and pay for anything that comes up myself. A good government hospital here quoted me at $11, 500 to $13,000 for a mechanical valve, ICU, 8 days or so in the hospital and the surgery. Pre op not included. At a top private hospital 25,000 USD. Again pre op ni. Cardiac rehab included in one of the quotes I can't remember. Those prices aren't bad but if I had complications, further surgeries costs could add up. I can absorb these costs if I stay in Thailand; however they could eat into my ability to restart in the USA/ 2) Stay in Thailand but buy a pre loaded expensive plan-that may not cover surgeries or some of the costs 3) Go back to USA when AVR is more imminent: Hop on a plane, get seen by USA drs, get an Air Bnb for a few months, get the surgery, recover and head back to Asia in a few months. 4) Cut bait and move back to the USA--the safest plan but something I don't want to do. Which doesn't totally eliminate coming back to Asia but given my age, health, Covid 19 etc etc may feel like a final exit from Asia and the end of a 10 year dream. Post op home care would be cheap in Asia--plenty of nurses and others would could care for me. Already have a Filipina lady who cleans my place. I am trying to determine future risks via tests and consults with doctors. My fears would be heart attack, repeat AVS, mitral surgeries and arrythmia related issues or a stroke Thoughts ? Anyone else been in a similar situation ? Thanks and have a great day !