Another not totally random question, @WendyBG …do you know what type of valve might be used in the event of a replacement? Thinking ahead to my husband’s appointment on Monday, I actually asked him if any new valve (hopefully not necessary) would be another bio/pig valve or mechanical or other random type I know nothing about …and it turns out he’d chosen not to wonder (his strategy for stuff like this).
FWIW, I think I mentioned in the other thread that my daughter was being taken to see the Stones at the Mile High Stadium concert a couple of weeks ago? Turned out this new bloke in her life had snagged seats near the stage and she could attest that Mick really was strutting about like a Little Red Rooster in steroids…and showed no evidence of a lack of function even at altitude.
Also, I learned something new last week. That us Medicare beneficiaries don’t actually get annual physicals as such…but rather “wellness checks”. Essentially, filling out forms with questions about falling, feeling depressed, etc.etc. None of the Usual Suspects…like slapping a stethoscope on yer chest…required.
This came up because dh.was telling the story to the new scribe about the fortuitous finding of his about-to-dissect aortic aneurysm…and our doctor pointed out how little sense it made to not be at least screening for the stuff that commonly occurs in the elderly. I hadn’t been aware of that from personal experience. I think you mentioned that your own PCP hadn’t listened to your chest for a while??? That’s the reason, if so. Bet he/she’ll change their ways from now on
If there is a specific reason to do a physical test then Medicare will cover it as part of the wellness visit (i.e. free without a copay or deductible). An example is a low-dose CT scan for long-time smokers (like DH if he would only make an appointment).
Any mention of a specific malady will boost the appointment from a wellness visit into a diagnostic visit! Ding! Ding! Ding! Can you say $?
As for heart valves, here are the key parameters.
Mechanical – lasts forever BUT need daily blood thinner. Nix for me because that increases the risk of bleeding stroke. Recommended for younger patients who may need a valve to last for decades.
Bioprosthetic (pig or cow). No blood thinner needed. BUT may wear out in 10 years or less. Studies show that patients with bioprostheic valves live as long as people with mechanical valves since they can get a second bioprosthetic stuffed into the first one. My cardiologist doesn’t like this because he thinks I will live until age 85 (another 15 years) and he’s afraid that the second valve will cut off too much blood flow. The manufacturers are actively working on this problem so he wants me to wait. I think this may be overthinking since 10 years is a long time and I may die from cancer before then.
Had my transesophageal ultrasound today. Still somewhat discombobulated from the anesthetic and stress. No feedback from the doc yet. I’ll let you know.
Well, the doc I see asks those questions, an aide takes my vitals, the doc whips out the stethoscope and listens to my heart, and whatever else interests him, then orders up a flock of bloodwork. He does not check my prostate, feel around in my abdomen, or do an EKG, like my old doc, when I was on employer provided Blue Cross. I asked him about the difference in outcomes, Medicare “wellness” vs traditional physical. He said he was in med school at the tail end of when they were training docs to do the really invasive physicals. He said the data shows there really isn’t a significant difference in outcomes between the invasive, traditional physical, and a “wellness check”.
I think it is up to me to tell the doctor what health concerns I have and it is the doctors duty to pay attention and reply with expert answers. Years ago I had a Kaiser Primary Care doctor who did not correctly diagnose my compliants about pain in my esphogus when swallowing something though like apple skins, bread, or raw vegtables. I treated me for heart burn. It was not heart burn. I finally demanded that a specialist look at the problem. The specialist did the following procedure:
An esophagogastroduodenoscopy (EGD), also known as an upper GI endoscopy, is a procedure that uses a long, flexible tube called an endoscope to examine the upper gastrointestinal (GI) tract. The upper GI tract includes the esophagus, stomach, and duodenum. The endoscope has a small video camera and light on one end, and may also have small tools inserted into it.
The specialist found that I has a dialted esphogus and the two sphincters that regulate the flow of food between the esophagus and stomach were not letting certain foods pass into my stomach. This rare condition is called achalasia.
Under general anaesthetic, the muscle fibres in the ring of muscle that lets food into your stomach are cut. This is done using keyhole surgery (laparoscopy) and is called Heller’s myotomy.
It can permanently make swallowing easier.
Often a second procedure will be done at the same time to stop you getting acid reflux and heartburn, which can be a side effect of the Heller’s myotomy operation. Your surgeon will talk to you about this and any other surgical options which may be the best option for you.
That operation was done over 10 years ago. It made swallowing much better, but I still cut off apple skins and avoid bread and tough to chew foods.
My Primary Care doctor (who misdiagnosed me), suddenly decided to retire form Kaiser.
Wendy,
I think there is a 3rd option. When I was training at the Cleveland Clinic, one of our heart surgeons Delos Cosgrove, MD was doing every valve surgery as a repair if it could be done. He published papers on this because the outcomes were so good. Best of all you didn’t need a blood thinner if he was able to save the original valve. That would be a good thing to try to find is an institution where they will try to fix the valve first IMHO. Hope your throat isn’t very sore from that TEE…doc
One of my favorite columns in the N.Y. Times is “Diagnosis,” where Dr. Lisa Sanders presents a case which baffled a series of physicians. Dr. Sanders also wrote a book, “Every Patient Tells a Story” and starred in the Netflix documentary, “Diagnosis.”
Occasionally, the malady is caused by an unexpectedly common problem, such as cannabis hyperemesis or overdosing on the barium in Pepto-Bismol. But usually the problem has a rare cause like yours.
After following Dr. Sanders’ cases for many years I have come to the conclusion that most doctors practice medicine with blinkers on. Outside of a narrow range of common problems the average general practitioner doesn’t have the knowledge.
Do not pass GO, do not collect $200. Go directly to a specialist. That’s what I did after my GP sent me for the first echocardiogram.
Per my husband’s ultrasound yesterday, the HALT has not only been halted but reversed. Valve leaflet back to normal appearance and function…no regurgitation…so no TAVR for him. For now.
Now back to the regular trials and tribulations…as in my daughter’s increasingly acrimonious divorce. If these divorce lawyers ever have sleeplessness night, it certainly won’t be due to fretting over finances. From what I can see, it’s one big gravy boat to dip their bread in. And they do!
