Life is positively "ate up" with choices. Some of them are pretty low input. (Do I really have to take a shower today?) Others are somewhat more serious. (Do I really have to wash my hair if I do shower?) Periodically throughout our lives, we are all faced with much more difficult choices and right now mine is whether my new heart valve should be mechanical or made of tissue.
Like all hard choices, it is a messy one with no really clear answer. Each choice has its upside and downside. Mechanical valves last a lifetime, so I won’t have to worry about my valve failing and the need to replace it. That is pretty appealing. I kind of like fixing something and not having to worry about it anymore. They make some mighty fine mechanical valves these days—carbon, titanium. The problem is that blood clots tend to form around mechanical valves. Apparently the mechanical valves damage some red blood cells, increasing the potential for clotting. So, mechanical valves come with them the need to take anticoagulant medication for the rest of your life. They are called blood thinners but they don’t really thin the blood, they just slow its clotting. Clots are bad because they can break free and travel to the lungs or brain, causing strokes and deadness.
Among the many unpleasant things about anticoagulants is that when you slow your blood’s natural clotting, you do it for all clots. If you cut yourself shaving, you bleed longer…if you sustain a serious injury with internal bleeding, you increase the chances that you will bleed to death. Also, sometimes anticoagulants can cause spontaneous internal bleeding. Cool, huh? I want to take something that might cause me to start bleeding somewhere on the inside for no good reason! (Did you know an anticoagulant (heparin) is the main ingredient in rat poison? Now you know how those rats die.) The reality is most people take anticoagulants without any serious problems.
But if you do things that already increase your chances of sustaining serious injury, then anticoagulants make those kinds of things much more dangerous. I may not have mentioned it before, but I like to ride my bike. Given the chance, I would ride my bike a long ways as many days a week as I could, and I would travel to exotic places like Virginia and ride my bike there. Biking riding is not inherently dangerous. Still, the longer you spend on the road, the greater the chances that you will encounter someone who: a. hates cyclists and wants to run them down; b. is talking on the cell phone; c. is more interested in their Baconator from Hardees than the road; or d. is a modern-day shaman driving in a chemically altered state of consciousness. You also increase the chances that you will do something stupid like hit a ‘possum carcass or an empty OE 40oz on the road and take a detour into the woods or down an embankment. Under normal circumstances those kinds of things can be a problem, but if you’ve hindered your blood’s ability to clot they can be really bad—like “Good night Irene, the party’s over” bad.
Plus other things can affect how much you are slowing the clotting—other meds, eating leafy green vegetables, boozing it up. So, you have to test your blood regularly…weekly or monthly. If I need surgery down the road—you know a nip here, a tuck there…or say to fix my ptosis (non-functional eyelid muscles)—then you have to stop taking the meds, increasing the chances of a blood clot forming. Yadda, yadda, ya.
OK, so what about the tissue valve? Well, those gems only last so long. In a spry youngster like me, maybe only 5 years but more like 7-10 years. No need for the anticoagulants and they work great, but they have a built-in self-destruct element. Failure of a valve isn’t usually life threatening and I’d know it was happening. The problem is I’d have to get a new one. No biggie, I have insurance. Well, I do now but really I might not in a decade (let’s hope not). Still, the thought of signing up for open-heart surgery AGAIN in 5 or 7 or even 10 years sounds…well, kind of stupid. Shouldn’t I try to avoid major surgeries like that? The mortality rate on heart surgery is very low. It increases on repeat surgeries but not by much. Still I am not excited about multiple surgeries.
Generally, for someone who is over 65 a tissue valve is the way to go. They last longer in older folk and so it is assumed that most tissue valves will outlast their hosts. For someone my age, mechanical valves are the recommended choice because otherwise I’d be back by age 55 for another valve. If I chose another tissue valve, I’d be back for surgery #3 by 65 at which time they’d give me another tissue valve and hope it outlasted me.
Now you could say that medical science will improve over the next decade and surgeries will be less invasive, valves will last longer, etc. So just go get that tissue valve because things will be a lot better in the bright future. Now, I’m not going to advocate ruining the earth because we can move to the moon in future…so that logic doesn’t necessarily play with me. As humans, we’ve gotten ourselves into the messes we have because we’ve continued to kick the can down the road and depend on technological advances to bail us out.
You could say get the mechanical and a life-time supply of blood thinners because civilization as we know it is going to implode in the next decade so you are better off with the permanent fix. I am all for the permanent fix idea, but not because I believe I will be Mad Max (a shell of a man) trading gasoline for food in a decade. Even if that did happen, I’d be OK. I know enough people with guns and they would become rulers of their neighborhoods. I am sure my friend Kyle would take me in once he became King of Murraywood. Plus, I’d have skills that would be valuable in a post-societal collapse world. Archaeologists will be in demand in that world…for digging taters and burying those who displeased the leaders with guns. My cycling would come in handy, too. I could become indispensible as the rickshaw driver for the King of Murraywood—in a world where gas was scarce. I am sure the King of Murraywood would make sure his valued rickshaw driver could get is anticoagulants from the syndicate controlling medication in a post-societal collapse world. Right, Kyle?
Then there is the stem or root of my aorta. It is stretching and if that is allowed to continue it eventually will bust. Blood thinners or not, if that happens I am pretty much toast. That is how John Ritter went. The doctors can’t tell if mine is dilated enough to warrant replacing it and they can’t know if it will continue to stretch or not. They’ll have a better idea after my next echocardiogram (sonogram of my heart), but may not know if it needs to be replaced until I am opened and on the table. According to one surgeon I have spoken with, if that needs to be replaced, my best bet is to go all artificial—aortal root and valve. And that means anticoagulants. Of course, I could get an aorta and valve package from a cadaver and have that installed…but that still will only last 5-7-10 years. Plus then you’ve got someone else’s stuff in you…I’ve seen enough of those horror movies to be just a little worried about that. Then again, if I get pig tissue in me what will I start doing?
It is possible to have my aortal stem and valve repaired, thus saving my own parts. The repaired bits won’t last forever, but will last longer than pig parts or stuff from someone who has crossed over. That is only possible if the stem and valve aren’t too badly messed up…so it’s another game time decision. My surgeon here in Columbia won’t do that procedure, so off to Charleston I go on Tuesday to talk to another surgeon (in my insurance network, of course). He works at the Medical University of South Carolina—I wonder if I get an employee discount?
So, either choice has its problems. I am, by nature, conservative—not politically, but in terms of not taking unnecessary chances. However, I am not thrilled with the whole bleeding to death thing, either. The problem with this choice is that there are few external factors pushing me one way or another. This one is purely about what I want to do…the hardest of all choices. So, I’ll do what any rational person would do. I’ll do my research, discuss my options with family and friends, reflect, kill a chicken and look for tell-tale patterns in its spattered guts, seek advice from the homeless man who used to cut my grass, and then flip my lucky penny.
