Ronald Kirson

My name is Ronald Kirson. I'm 51 years old and work as a training administrator for a large utility in New York. I am married and have two sons - the older one is 26 years old and a CPA and my younger son is studying for his MBA at the Ohio State University.

My internist first discovered my condition 18 years ago, when I was 34 years old. I had been diagnosed with essential hypertension at age 11 and was placed on blood pressure medication at age 18 after tests ruled out any renal involvement. It was at one of my routine visits that the internist heard a mild heart murmur and referred me to a cardiologist for a consultation. The cardiologist performed a physical examination and confirmed the diagnosis telling me that I had mild aortic valve regurgitation. When asked, I denied any recollection of ever having had rheumatic fever but did recall having had literally scores of sore throats while growing up in the 1950's.

After that initial visit to the cardiologist, the murmur was monitored by the internist several times each year when I came for my routine blood pressure checks. Sixteen years ago, I was sent for a gated stress test that uses radioactive isotopes to measure the degree of aortic regurgitation. Again, the diagnosis of aortic regurgitation was confirmed along with a trace-to-mild degree of mitral regurgitation. Shortly after that, color-flow echocardiography became available and I was monitored annually using that method. It became clear as the years passed that my heart condition was slowly deteriorating and that I would be facing an aortic valve replacement at some point in my life.

That point came during Thanksgiving week in 1999 when I received a call from my internist's office after my annual color-flow echocardiogram. A consultation was quickly arranged with my cardiologist who explained that it was time to replace the valve even though I was symptom free. My heart had enlarged further and the ejection fraction had dropped. Although the ejection fraction was still within the normal range - just over 50%, the change indicated that my heart was beginning to fail. I was scheduled for a cardiac catherization that confirmed the valve condition and also revealed that my coronary arteries were clear. We discussed the valve choices - tissue versus mechanical and the anticoagulation therapy I would need. I opted to have a bi-leaflet St. Jude Valve installed. The surgery was performed by Dr. Alan Hartman, at the Winthrop University Hospital in Mineola, New York in December of 1999.

When I awoke in the cardiac intensive care unit, I was told that all had went well and that in addition to the aortic valve replacement, a weakened spot on my ascending aorta began to leak blood during my removal from the heart/lung machine. This potential aneurysm was repaired with a Dacron patch. It was surmised that the ascending aorta was weakened by nearly 40 years of hypertension.

My hospital recovery went fairly well and uneventfully until I wound up back in the intensive care unit after building up fluids in my body due to insufficient urine elimination after my catheter was removed. Dr. Hartman has a deservedly great reputation and he was wonderful. Winthrop Hospital was fine as well, with attentive nurses and care. However, they did fail to catch the urine build-up in my body because they were not monitoring my fluid intake and output. Even though they weighed me daily, they ignored the weight gain which was a symptom of the coming problem.

I returned home after a week in the hospital, taking Coumadin and Toprol-XL. My recovery was fairly routine - some sternum pain, weakness, etc. I began the routine of INR testing at a local laboratory, calling the cardiologists office who adjusted my Coumadin dosage as the numbers varied. The Coumadin monitoring and medication changes were initially micromanaged by my cardiologist's registered PA. Although very thorough, she attempted to stabilize my INR by making far too many frequent dosing changes. After approximately 3 months post-op, the Coumadin management was turned over to my internist who had a completely different approach. He allowed the numbers to swing a bit as long as they stayed within the 2.5 to 3.5 range reasonably well. With fewer dosing changes, my INR has been reasonably stable. I take alternating daily dosage of 4mg and 5mg of Coumadin and usually maintain an INR of 2.7 to 3.8. I, like many people am extremely sensitive to small changes in Coumadin and the difference of 1 mg. per week will cause my INR to swing widely.

This routine of INR laboratory testing every 2-3 weeks continued until late last year when I followed through on my internist's suggestion to begin home INR testing. I was fortunate that my medical insurance company has fully covered the unit and supplies. I received the ProTime unit in December of 2001 and love it. The process is virtually painless and the convenience of getting my results in 2 minutes cannot be beat. I test once per week now and purposely maintain my INR at the upper end of the range - approximately 3.2 to 3.8. I'd rather be high than low. Since my diet is reasonably consistent, my INR readings don't swing widely. I would recommend the use of home testing to anyone on this high level of anticoagulation. Since my surgery, I have had several color-flow echocardiograms. The aortic valve is doing well and my heart function has recovered to its earlier high levels. They still note a mild mitral valve regurgitation which hopefully won't progress to the point of needing treatment. I found this web site on a link from the ProTime home page and have enjoyed reading the comments from the other members. I hope my story is helpful. If you need to contact me, I can be reached at kirsonron@aol.com.