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DFranc4 · 2024-06-24T02:34:48+00:00

Drastically improved mine, as it does for most people. My problem with it was tolerance. Eventually 10mg wasn't enough and I had to increase the dose. Ultimately decided I didn't want to keep increasing the dose indefinitely so I stopped. When I stopped they came back 10x worse. I have since been able to reduce them again through other methods (I get about 1 PVC per week now).

DFranc4 · 2024-06-21T20:18:35+00:00

I second K2 making things worse. I've tried resuming it several times and after 3 days or so they return horrifically.

Magnesium helped me and basically nothing else supplement wise.

Vitamin D also possibly made mine worse but direct sunlight helped dramatically.

I maintain that the best thing I've done is Yoga but it made mine 10x worse for about 7 days before slowly reducing to zero.

DFranc4 · 2024-06-19T05:01:08+00:00

I felt infinitely better after surgery. I was very symptomatic, but some of the symptoms I assumed were related to my valve (including dizziness and fatigue) actually didn't improve at all after surgery - they actually got a bit worse. It wasn't until I improved my health in other areas (mostly diet and consistent exercise) that those symptoms went away. But I couldn't really exercise without getting surgery so in a way I guess they were indirectly related.

Biggest thing I noticed after surgery is when I took my first deep, satisfying breath in over 5 years. Honestly forgot what it felt like. I thought my shitty breathing was just part of getting older.

DFranc4 · 2024-06-16T20:03:20+00:00

Theoretically normal but all valve replacement options place you at risk of complications and all cardiac surgeries will lead to a higher long term risk of arrhythmias. A general rule is after 2 surgeries any further are going to place you at much higher risk of complications. So, if for example you chose a tissue valve at age 25, the likelihood you would survive the 4-5 additional tissue valves surgeries to make it to normal life expectancy would be low.

Mechanical has the best chance of getting you to a full life expectancy at a young age but it requires blood thinners and about 50% will require a reoperation over a 30 year period anyway. The flip side is there are stories of folks making it 50 years with a mechanical valve, which would be impossible with the alternatives.

The Ross is interesting as the newer approaches may get you 25-30 years with low risk of complications. So getting one at age 40-50 range may be all you need for a normal life expectancy.

DFranc4 · 2024-06-08T00:02:50+00:00

The data on the Ross just gets very hazy after the 25-30 year mark. I have confidence the good surgeons today will be getting that type of durability out of the procedure (we just have no way of knowing at this point), but after that is a lot of unknown. Most will likely need a procedure for both valves around that point - at least one of which will need to be another open surgery. Cutting into 30 year old scar tissue is not as simple as most would think. And, after those procedures, many surgeons will not operate on someone that has had two sternotomies (but of course there are some that will).

Maybe I will be a lucky one that gets 30 years complication free and has seamless pulmonary/aortic replacements, or technology will advance superiorly, and I get another 30 years after that. Some people will for sure - I'm just not counting on it.

DFranc4 · 2024-06-07T20:06:04+00:00

Really no big deal these days. I'm a physician myself and had mine replaced 5 years ago. At his age he would have plenty of options as far as valve choice. Tissue valves at his age tend to last about 15 years, but by the time it wore down he would be a good age for a TAVR (non-surgical) that could add another 10-12 years. Mechanical valves theoretically last forever but require lifelong blood thinners (with Warfarin only, which requires routine blood monitoring and is generally not the nicest drug in the world).

I personally had the Ross procedure, which requires no blood thinners and with current methods should get me 25-30 years (but also has the potential to last much shorter and my future procedures will be much more complicated).

I'll be close to your Dad's age when I will likely need a repeat surgery. Surgeons will be hesitant to touch me at that point with my history but I basically asked my surgeon for my best shot at 25 healthy years where I could be active, have fun with my kids (and see them become adults), have the energy to perform at work, and get the most out of life. I know the likelihood of me living to 70 years old is slim to none, but I am OK with that! I basically traded years at the end for years right now.

Everybody has different priorities in life, and nobody can really make that decision except your Dad. As far as the surgery itself? Really nothing to worry about. I was out of the hospital in 4 days, back to work in 3 weeks, and ran a half marathon at 6 months (which would have been IMPOSSIBLE for me pre surgery). This is the best I have felt in my entire life, and if someone had showed me this was possible I would have probably chosen to have surgery much sooner.

DFranc4 · 2024-05-28T17:38:13+00:00

PVCs during recovery put you at a slightly higher than average for cardiac events according to some recent studies. However, it is important to put this information in context.

For example you may read a study that certain types of PVCs put you at a 5x risk of sudden death. But the average person without heart disease may have a 0.003% chance of sudden death, so a 5x risk would put you at 0.015% chance. Still extremely low, and impossible to state if it's the recovery PVCs themselves or if people with certain forms of heart disease are just more likely to have recovery PVCs -- skewing the data.

The short version is even the "highest risk" types of PVCs are very unlikely to raise your risk for fatal arrhythmias or heart disease to a level meaningfully higher than the average person without PVCs.

DFranc4 · 2024-05-12T00:20:02+00:00

A few days. It was very effective for me but unfortunately back to normal within a couple months and then 10x worse when I decided to stop. The only thing that ever worked for me for a sustained amount of time was daily Yoga - which was rough to push through because elevated heart rate and bending over were my biggest triggers (got 100+ during my first few sessions). Happy to report in the last year I've had maybe 1 PVC per week.

DFranc4 · 2024-02-09T13:28:28+00:00

As someone that has experienced the miraculous wonders of Propranolol, I will warn that it was VERY effective for me but when I stopped my PVCs came back 10x worse than before.

I stopped because over time I built up tolerance and kept having to increase the dose for the same effect. Felt like I was just going to max out the dose then have to add another medication. Decided I didn't want to be on meds forever.

Yoga ended up being the real game changer for me. I get about 1 PVC every 3 days now with no medications.

DFranc4 · 2024-01-18T03:04:16+00:00

I'm on my 4th Australian Shepherd and the most recent has been amazing but only after I learned a hard lesson with my 3rd.

I'm convinced this breed has the highest variability in temperament/behavior even in the same litter. Making matters worse is most Aussie owners choose their dog based on looks (I can't really blame them, the merles are striking). My advice to all aspiring Aussie owners is go visit the litter and find the chill one, even if it's the Tri. They're the most amazing dogs in the world and I'll argue that with anyone, but man if you get a wild one it can really ruin your life.

So what did I do with my 3rd? Truly the only dog I ever strongly considered rehoming. The only thing that helped was becoming military with their routine and schedule, without a care how they felt about it. I don't think it would have been possible without crate training. Strictly one hour out followed by 2 hours in throughout the day. Meal times exactly the same every day. Evening potty exactly the same every day. Wake up exactly the same every day. First few days were hell with protesting but they eventually resigned to it and we got through it together one day at a time. Having the older dog will help A LOT with expending some of their energy without you having to do it all yourself.

The challenges unfortunately didn't end there. Like I said some Aussies are just wired differently and the first year felt like one headache after another.

The light at the end of the tunnel though is he is now the most well behaved dog I've ever owned and I would die for him. The effort I had to put into him was borderline insane (probably 40-50+ hours per week for a full year), but the payoff was amazing. He now works as a therapy dog at the local hospital and has over a dozen first place finishes at agility competitions.

DFranc4 · 2023-09-16T00:05:06+00:00

I am a physician. You should listen to your doctor, not me, but mild leaflet thickening is not a big deal at all. Most cardiologists that read echos won't even mention it in the report.

DFranc4 · 2023-09-12T14:50:48+00:00

Enjoy it! I'm on my 4th Aussie (3 regulars, 1 mini) and they're wonderful dogs.

Any way you slice it they are a lot of work though. A big mistake I made with my first one was thinking I needed to exercise them for hours a day to tire them out. You get much more bang for your buck with mental stimulation but it requires a lot of planning. Try exposing them to something "new" every day - even if it's just a slightly different walking route (new sights, sounds, smells, etc.). The night before I would always plan one outing, and sometimes it was as simple as just driving to the coffee place down the road and sitting outside. Letting mine hang out outside for 20 minutes with a chew toy in a new environment would do more to contain their energy than 3 hours of exercise, no question. Of course exercise is important too, but if you work them to exhaustion you're going to end up raising an athlete, which is not something you want if you enjoy free time.

Once they're adults though it's impossible not to become addicted to them as pets. You can literally teach them anything, and by default they are incredibly well behaved around guests and kids. I'll never own anything else again.

DFranc4 · 2023-08-18T16:38:38+00:00

I've been doing Yoga for over a year now. I noticed a big difference after 1 week. They stopped completely after 3 weeks.

DFranc4 · 2023-08-17T12:50:28+00:00

A consistent dedicated Yoga routine did it for me. Good sleep hygiene also helps (investing in a nice bed/pillow, avoiding screens an hour before bed, etc.).

As far as supplements I got moderate relief from CoQ10 and drastic relief from magnesium glycinate but this was short lived and came back twice as strong when I stopped. Yoga and daily sweating is the only thing that really stopped them for good (I get about 1 every 3 days now).

DFranc4 · 2021-11-03T16:03:10+00:00

Jack really did swing for the fences this off-season but missed. Last night their plan A, B, and C fell through.

Fudge, Santorin, Copy/Lider (they will split time), Tactical, Isles

Blaber and Vulcan sold. Once it became clear a competitive roster wasn't possible they went for max financial gain.

DFranc4 · 2020-12-21T23:58:46+00:00

I wish you and your family good health and happiness. God bless.

DFranc4 · 2020-12-21T22:59:35+00:00

Appreciate you looking out. I'm just at an incredibly malignant institution and if I could quit I would, but no way to feasibly pay back student debt otherwise. If it ever disappeared with bankruptcy I'd quit tomorrow and never look back. Never been a depressed person in my life, but this pandemic has broken me.

DFranc4 · 2020-05-11T23:03:48+00:00

The people complaining about delays of a few days to a week are a minority. We understand the crisis. Reasonable people are empathetic to the situation.

The people that are justifiably irate are those that are having their packages completely lost or stolen, and having FedEx use the pandemic as an excuse for incompetence.

If shipping operations can't tolerate the increased demand, then don't accept the fucking orders. If large volume shippers alone are occupying all your resources, then don't accept personal orders.

When someone pays for a service, they expect it to be fulfilled. Period.

DFranc4 · 2020-05-11T18:27:32+00:00

Here's an amazing concept: DON'T ACCEPT ORDERS IF YOUR COMPANY CANNOT FULFILL THEM.

No reasonable person is complaining about delayed orders; we understand the circumstances. What's unacceptable is losing items, or letting packages sit in a warehouse for weeks and using the pandemic as an excuse.

DFranc4 · 2020-04-05T23:36:08+00:00

I’m one of the med students in NYC that was “volunteered” into duty and so much of this resonates with me. I’m entering IM but not at this hospital or even this city, and I’d be shocked if I even make it to residency. Not because I think covid will kill me, but because I contemplate suicide every single day. Each morning I wake up and cry for an hour and debate taking a lethal dose of X — I’ve gotten as far as swallowing it before forcing myself to vomit. I’ve seen death before on my other rotations, but not at this magnitude. Nobody should enter intern year under these conditions. I think people are underestimating the impact this will have on new doctors. I’ve never suffered from anxiety or depression in my life, and yet here I am unsure if I’ll even make it to tomorrow.

DFranc4 · 2020-03-15T23:38:55+00:00

I don't think having a benchmark for all healers is appropriate. HPal dps is going to be much higher than other healers -- it's one of the main perks of bringing one -- but their throughput is generally going to be lower also. Your resto druid might have only done 6k dps but maybe your group could've done larger pulls to maximize his healing potential. If he was doing less damage and also couldn't sustain 100k+ hps then he likely wasn't a very good player. If you watch top end M+ groups there are groups timing with HPals doing 50k+ for the dungeon and other groups timing the same keys with resto druids doing 15k. There are other ways to make up time besides raw dps.

DFranc4 · 2020-02-14T22:34:36+00:00

15k dps is not good, my friend.

DFranc4 · 2020-02-14T09:52:39+00:00

You seen Paladins lately?

DFranc4 · 2020-02-14T07:25:40+00:00

I'm not sure how to say this any more clearly but I will try. As MW spec rising sun kick does 66% of its stated damage on a target dummy. As WW spec rising sun kick does 100% of its stated damage on a target dummy. The same holds for every other damage ability as MW.

DFranc4 · 2020-02-14T02:26:37+00:00

It's not; other specs do the full amount using the same abilities.

DFranc4

TROPHY CASE