Friday, May 12, 2017

SOMETHING PERSONAL




I share with you a little personal details why my blogging has been scantier than usual this week

In the first place my daughter and son in law from Virginia are here since Wednesday

But my story goes back to over a year ago when although I had no symptoms of heart failure my Cardiologist informed me that my aortic heart valve was showing its age and becoming so calcified that it was restricting the heart output. He suggested that in the past five years medicine had so progressed that no longer was the high mortality after age 75 open heart surgery which meant splitting the breastbone down the middle the only choice; one that no Cardiac Surgeon would willingly attempt the only option..

For the past five years a ‘noninvasive (?) technique in which catheters were inserted through the artery in the groin and threaded up the aorta into the heart carrying a collapsed valve which would be opened liked an umbrella and inserted over the expanded opening of the natural valve had been developed. Morristown Hospital had is one of the leading centers in the country for that procedure.

The negative factors besides that once the valve was opened it could not be readjusted. This was important since most often the fit was not perfect and there would be leakage back after each heartbeat. Other dangers included clots to the brain i.e. stroke during the operation.

It so happened that there was a trial program for FDA approval of a new valve that and been used in Europe for almost 2 years. It could be reposition before final placing and had minimal reflux (back leak). Morristown was one of the few hospitals in the country that was chosen to participate in the 100 patient 5 year study. It seemed to be a no brainer to be one of the individuals. Despite a minor hiccup during the surgery I was home in a week and fully active before the end of the next week. I still feel as good as I did before this happened.

I had had a good 6 months checkup and this Wednesday went back for my one year FU. I had recently learned that my warranty was no longer valid; since the manufacturer of this valve had gone out of business since the two established giants in the field had revised their valves
with similar properties  to be competitive  and had the advantaged of being reliable established vendors.

However Dr Kipperman is continuing the terms of the study and I will go back next June 2018 for my 2 year FU and then I believe there is a 5 year follow up. My son will no longer receive the $50 travel reimbursement from the study sponsor.


 One reason for this story is to show that American medicine can still be top notch and progressive. The problem has become with the 1970s advent of the HMOs and promises of low cost care for all. Up to today’s ACA and Trump’s ACHA the profit oriented insurance industry and bureaucrats have decided what is can be provided as cost effective care. 

Pre-authorization for procedures and studies are required which can result in denials due often to a non-doctor not a professional determining need Denials can be due to a limit on the number of such procedures or age of patient; in effect rationing. Fortunately I have great supplemental insurance no panels, no copays etc. No one to deny the operation ‘because there is a less expensive “medical option” that may help for a year or two. “After all you are 96 and how much longer do you expect to live?”

Hey boy I am going to have a big party in 2020 and this valve is good for 10 years before it has to be replaced.

5 comments:

  1. Will this new type valve put the pig valve business out of business??

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    1. The composition of the valve is still"organic"' (animal).I joke that min e is kosher (beef) but the pig valve still will be there, Pig tissue resists rejection an d deterioration better than other tissues and apparently man made doesn't work. The big difference in this one is that it is not spiked into place but once positioned there is an inflatable ring that c an b e deflated and then sealed inflated when it is right. I am happy with my choice but the older others would have been OK with a greater incidence of significant regurgitation when the valve closes.

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  2. I always knew you had a great heart for Plainfield, and now it is even better!

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  3. You definitely made some good points regarding insurance company approvals -- I had to wait a month for my health insurance company to approve a procedure that, while relatively new in the USA due to only getting FDA approval a few years ago, is much less intensive, easier on the patient and less expensive than the "older" procedures. By the way, I'm marking that party on my calendar!

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  4. You're as young as ever Doc!

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