Reaching New Heights with the On-X Valve
– Sir Edmund Hillary (mountain climber, first person to reach the summit of Mount Everest)
Imagine looking straight up a sheer mountain wall and then beginning the climb – one hand, one foot at a time, rock by rock, ascending to dizzying heights. Now imagine doing it after heart valve replacement surgery. Bob Smith has done both. He has a passion for rock climbing, and is meticulous about how he prepares for a climb, carefully choosing and using the best quality equipment. That’s the same way he went about preparing for heart valve replacement and choosing the valve that was right for him.
“When I choose the rock climbing gear that I use, I want to make sure that it’s durable and that it’s the best equipment that I can get, because I know it’s something that’s going to be saving my life and I want it to last a long time,” Bob said. “And that same decision [went] into me choosing a heart valve.”
When the time came for his heart valve surgery, Bob and his surgeon chose the On-X Ascending Aortic Prosthesis (AAP).
“When I chose the On-X Valve, I knew that it was one of the best options and that it would last me a long time and be really durable – and that was the best equipment that I could get.”
A 29-year-old English teacher from Denver, Colorado, Bob was born with aortic stenosis.
“My aortic valve was too narrow and that was creating some issues with the blood flow going into my body, and basically my left ventricle was working harder to pump blood out of my heart,” he said. “That condition was relatively stable until I turned 27.”
Despite his aortic stenosis, Bob was always active, participating in baseball, swimming and other sports. His only restrictions were anaerobic activities like lifting weights and playing football. Bob got into rock climbing while participating in a program at his university.
“I started off learning the systems, like learning how to use the ropes, learning how to climb a little bit and then didn’t really get into it for myself until after college. Up until then I started guiding and taking people rock climbing, and I didn’t enjoy that too much cause it was more like work at that point. And then once I got out of college and I started doing it for myself, then I really started to enjoy rock climbing and that was about 7 years ago.”
At a Crossroads: Deciding on a Heart Valve
Even while participating in all the strenuous activities he enjoyed, Bob had not experienced any issues because of his aortic stenosis. Then, in 2016, he was “running around with a backpack at around 9,000 feet and I felt kind of out of breath, and I couldn’t regain my breath as easily as I normally could.”
Later, he went to his cardiologist who performed an echocardiogram, and found that the pressure in his heart had doubled in a year’s time. The cardiologist said he would need aortic valve replacement surgery within six months. Bob always knew the time would come that he would need valve replacement. But he had gone for yearly checkups with no symptoms and no change in his condition, so it came as a shock when, at age 27, he was told he would actually need the surgery. Bob said the meeting with his cardiologist raised a number of questions he hadn’t considered. In particular, he wondered what life would be like after surgery, and if he’d be able to participate in those activities he enjoyed most, like rock climbing.
“After meeting with my primary cardiologist, I was a little bit nervous. He didn’t necessarily give me a lot of options,” Bob said. “He basically said I would meet with another cardiac surgeon. I didn’t have a lot of information when I left his office. He did try and get information for me about my questions to do with [anticoagulation] and life after surgery, but he didn’t seem like he had a lot of knowledge on what that would look like for somebody my age getting the surgery.”
A couple of weeks later, Bob met with his cardiac surgeon, Dr. Kevin Miller, to discuss the type of heart valve he would receive.
“That was a little bit scary because we were talking about heart valves kind of like you’re talking about what kind of car you’re going to buy,” Bob said. “It’s a big decision, but I didn’t think I was qualified to make that decision. So, it was interesting that he let me be part of that conversation, and basically was just a way to get good information before I made the decision.
“It felt good to know that I was ultimately in charge of what was going to happen,” he said.
Bob said he was also fortunate that Dr. Miller took plenty of time to meet with him to help make his decision.
“The thing I liked most about Dr. Miller was that he did sit down with me and [Bob’s girlfriend] Marissa for an hour and half. And he didn’t seem rushed, he didn’t seem like he had another patient coming in or anything like that. He wasn’t working on multiple patients at a time; it was just me and Dr. Miller sitting in his office talking.”
Bob said he and Dr. Miller spent a lot of time discussing the difference between tissue valves and mechanical valves.
“The one thing I didn’t like about the tissue valve is that… I would eventually need another surgery. And I didn’t want to have multiple surgeries so I kind of settled on the mechanical valve,” he said.
In addition to discussing his surgery, Dr. Miller gave Bob some resources for doing his own research, as well as some patient stories about heart valve recipients.
“So, I started doing my own research a little more and ultimately decided that the On-X Valve was the best option for having an active lifestyle and needing one surgery instead of two.”
In addition to talking with his cardiologist, cardiac surgeon and doing his own research on heart valve choices, Bob found it helpful to have a network of people supporting him. Bob’s girlfriend Marissa, who works in the medical field, was extremely supportive.
“Marissa gave me a lot of good information about what it would look like after surgery, and she was a good advocate during my cardiac appointments because she would ask all the questions that I didn’t think to ask,” Bob said.
Another important part of Bob’s support system was a friend named Jack, who had valve replacement surgery a few years earlier, and also chose an On-X Valve.
“It was also nice having a friend who had the surgery before me, so I could talk to him and see what his experience was like; and see why the On-X Valve was his choice, and use his research and his experience...”
“I sat down with [Jack] and talked with him about what his recovery was like, what his diet was like afterwards, any restrictions that he had. He was just a person who knew what it was like to go through the surgery, so it was nice to talk to him to get that aspect of things too.”
Finally, after all the consultations and research was done, it was time to make his decision. On June 1, 2016, Bob received the On-X Ascending Aortic Prosthesis (AAP).
“The biggest thing I was afraid of when I was deciding which valve to go with, was that my decision was pretty permanent,” he said. “If I went with a tissue valve, I would need to get a second surgery and there was really no way out of doing that. And if I went with a mechanical valve, then I would need to be on [anticoagulants]. So, there were positive and negatives to both, but it was a little bit nerve-wracking because I didn’t know – I mean, both options were pretty good; they both just ended with a different life experience. It was kind of a tough decision to make at first because you know that it’s going to be a big difference in your life.”
Anticoagulants: No Big Deal
In considering his options, one of Bob’s major concerns about mechanical heart valves was using anticoagulants, also known as blood thinners. He discovered there were many misconceptions or inaccuracies about anticoagulants. In particular, Bob said he was told that he would not be able to eat leafy greens or drink beer. This was another instance where his friendship with Jack proved to be helpful.
“The night I met Jack he was drinking a beer and I said, ‘Hey, you’re on blood thinners – you’re not supposed to be drinking beer!’ And he’s the one that told me about the idea that you just have to keep your diet consistent [with anticoagulants]. There is no real restriction as long as you’re being consistent with your diet,” Bob said. “So, I thought that I’d have to change my diet and I thought that I wouldn’t be able to be as active when I was on blood thinners. But meeting Jack really changed that idea. It made me more comfortable with it.”
Bob has found his life after receiving the On-X AAP is not much different.
“Now that I’m on [anticoagulants] my diet has not changed at all,” Bob said. “The thing I usually keep in mind, though, is I want to keep my diet consistent. So, if I’m eating a lot of leafy greens, then I can do that as long as I do it consistently. And if I have a beer or two a week, then I need to keep doing that consistently. And other than that, there is no real restriction or no issues with diet. I can eat the same foods as anyone else and don’t ever feel restricted when I go to a restaurant or anything like that.
“Before I started taking blood thinners I was really nervous about how they would impact my life,” Bob continued. “I thought that if I got a cut on my skin then I would have a bleeding issue and I wouldn’t be able to stop the bleeding. After I started taking the blood thinners, I realized that that’s not really an issue. When I go rock climbing, I’m constantly cutting my fingers, getting small nicks and scrapes and things like that on my arms and legs, and I usually keep a roll of tape on me and a first aid kit. I haven’t had to use the first aid kit yet, but sometimes when I’m bleeding a little bit I just tape it up and it seems to go away.”
When rock climbing, Bob said he is careful to take precautions, something he always did but now there are just a few more.
“The biggest issue I have is if a rock were to hit me on the head or if I were to fall off my bike and hit my head. Those types of bleeds are things that I wouldn’t be able to control so well, so to deal with that I just wear a helmet all the time when I’m doing those types of activities. Before taking [anticoagulants], there may have been some days when I didn’t wear a helmet, but now that I’m on [anticoagulants] I make sure I wear a helmet every time I go out.”
Keeping Up With Bob
Before heart valve surgery, Bob feared his life would be changed forever; that he would no longer have the ability to do the things he loved. But not long after surgery, he was increasingly hopeful and challenged himself to return to rock climbing.
“Before I got the [On-X] Valve, I thought that I wouldn’t be able to do as many aerobic or anaerobic exercises after I got the surgery, but that hasn’t been an issue at all,” Bob said.
“I’ve been able to resume all activities I was doing before, and I actually seem like I have more energy now,” he said. “I feel better going to altitude and doing rock climbs that were hard for me before. I can push myself a little bit further and try a little harder and not have to worry about any issues.”
“Since my heart surgery, one of the hardest things to do is find people who are willing to keep up with me all day and go rock climbing as much as I’d like to go.”