Tuba Playing and Heart Disease

[Worth]

I've always found the people on this forum willing to share in their knowledge and experience. if you have something to contribute and prefer to send PM that's fine, but there is something for many to learn here I think.

Due to history of high cholesterol, I recently had a CT coronary calcium score recommended by my Primary Care Provider, then done and read by a local radiology group. This is the one where insurance doesn't pay and it's like $100. out of pocket. Many never get one of these. I've had no symptoms to speak of. The calcium score is one part of it, where they estimate the degree of calcification or blockage present. Like most everyone, there is some present, but not really major. Aside from the calcium score itself, the radiologist noted a "mildly dilated" ascending aorta, preaneursymal but concerning nonetheless. The radiologist recommended follow up in a year, but my primary care provider referred me to a cardiologist and I have an appointment this coming Friday.

The dilated aorta thing freaks me out as I read more and more on the internet to include a story of a 63 year old orchestral tuba player with something similar. My weight has fluctuated thought adulthood and now I am at 170 with normal BP, but have been up to 240 with significantly higher BP in the past. The cardiologist who I will be seeing is seasoned and very well respected, but is not a musician. Has anyone out there dealt with something similar with any light to shed on this? I know none of us are getting out of this alive, but at 61 I'd like to maximize the time I have. Carrying around and playing the beast is my primary concern.

Thanks to any and all for your input, I sincerely appreciate it

[Stryk]

Getting older is not for that faint of heart! I've been dealing with several conditions (kidney disease, heart issues, quasi-diabetes, and now COPD and emphysema) that keep me from schlepping around a tuba at times. The two main places I play are community band and in church. For the last few months, I have left a horn at the church and this has alleviated that issue for now. I could do the same thing with band rehearsal, as it is in a friend's band room. The issue is, I don't want to leave a good horn either place. The one I leave at church is decent - a 186 clone, but I would really rather play a GOOD horn both places. My suggestion is first to work on your health! After that, I have found a Gard Wheelie bag quite helpful. The only times that really taxes me is up and down the steps at our front door and to and from my truck to sanctuary at church. Another thing I don't use much, but I have found it helpful at times - a handicapped parking permit. About the only time I will use it is when we do concerts in a venue like our local college, or one of the local schools. It helps a lot. Hope your health improves and you get this figured out!

[2nd tenor]

A few observations which I hope will help someone:

A friend of mine lives in the USA and he’s had a few minor health issues; he’s very aware that some people are professionally competent, that some people are ethical and that some people offer a better price than others for their services. Now getting competent, ethical and well priced for health care is one mighty challenge.

Surgeon’s like to operate, they find it interesting and it gives them employment. Hospital owners and administrators like their Hospitals to be full, it keeps them in business. I guess that those things conflict with whether someone really does need an operation or not.

A Band mate here in the U.K. had heart problems and was opened up a few times over several years, the Surgeons kept him ticking by but eventually one made a small error in putting him back together and he died about two years later. The guy was a Bass Trombone player who doubled on Eb Bass, he used the lightest kit that he could find and anything that could be put on wheels or moved more easily was.

There’s always a time to have a medical intervention but these things are not without multiple risks only some of which you’ll be aware of. With those conflicts and risks in mind one might choose to defer a surgical intervention until there is little alternative and then to be reasonably selective about who does ‘the work’.

[Worth]

Getting older is not for that faint of heart! .... I have found a Gard Wheelie bag quite helpful.... Hope your health improves and you get this figured out!

Kind and candid words of support, very much appreciated. My main reason for this post was the 4.1cm dilated ascending aorta (to me more than "mild" after researching on the internet) and a well meaning friend jovially reminding me of John Ritter's (Three's Company) untimely demise. The focus is to keep it from enlarging any further I suppose to avoid some distasteful future surgery options and or OMG explosions. The upcoming cardiologist's advice and testing will solidify a game plan. The Gard wheelie bag is a great idea, something I haven't considered. I've been such a dedicated gig bag person it was not on my radar. Also all my equipment, to include bass guitar amplification, is kept in an upstairs man cave, not really the best strategy. Some great things to think of, thank you!

[Worth]

Surgeons like to operate... Hospital owners and administrators like their Hospitals to be full, it keeps them in business. A Band mate here in the U.K. had heart problems... eventually one made a small error in putting him back together and he died about two years later. There’s always a time to have a medical intervention but these things are not without multiple risks... one might choose to defer a surgical intervention until there is little alternative and then to be reasonably selective about who does ‘the work’.

Excellent advice, again very appreciated. I am a recently retired health care provider, now gainfully re-employed as a school bus driver. One of my first questions for the Cardiologist will be for the safety of my kids. That answer will tell me all I need to know. I know all too well the mindset of surgeons. Their motto is often "A Chance to Cut is a Chance to Cure." They serve a vital purpose and I thank God for their training and skills. If and when that time comes, it will not be without due diligence on my part as to whom I am seeing, what is being done, where, and of course the risks, benefits, alternatives and possible complications. Very much like servicing a prized Tuba. I'm hoping this will be a medical management scenario for the time being from what I have read, I just want to make sure I am doing my part. Thanks very much for your answer and support, good stuff.

[2nd tenor]

I would add a couple of further observations passed onto me by a friend.

# The guy with the good bedside manner is not necessarily a good Surgeon, indeed the opposite can very often be true.
# The guy with highest ‘complications’ rate might be either not be the best of Surgeons or so good at what s/he does that s/he’s prepared to tackle the really tough jobs.
# It’s not the building that matters but rather the people within it - give me a tumble down place with a top operator in it over the reverse please.
# The quality of the nursing care and recovery team matters.

Whenever one of my family members has been in Hospital we’ve always tried to have someone visiting them for as many hours per day as is allowed, it seems to make a positive difference - have someone diplomatic and thoughtful in your corner.

Some people live with monitored heart problems for years and then die of something else ... skilful monitoring and informed unbiased decision making seems wise to me.

[bloke]

Related to the topic (and NOT attempting to personalize the topic to the person who began the thread)...

...From time-to-time (depending on who hires me to play where), I might see some people who are exhausted and heavily perspiring after concerts.
In most of the concerts in which I perform, there are dozens of people doing a whole bunch of upper-body work (bowed string musicians) who don't seem to leave the stage either exhausted or perspiring.

I suspect that the more confident and technically-proficient the player (someone who isn't worried about what's going to happen when they operate their instrument, and are also very efficient at operating it - never physically exerting any more than the amount that is required), the more likely it is that they are going to be able to perform well with somewhat compromised circulatory/respiratory systems.

[Worth]

....never physically exerting any more than the amount that is required, the more likely it is that they are going to be able to perform well with somewhat compromised circulatory/respiratory systems

I think you've hit the nail on the head here. Seems common sense, but very much worth stating as the obvious is often overlooked.

[Dan Schultz]

I'm 74. I've had no health problems my entire life until just a few years ago when my VA GP noticed a heart murmur caused by a 'leaky' aortic valve. They have been monitoring it via echo-cardiograms every six months for three years. The cardiologist said it wasn't severe enough to cause problems and unless I started feeling extreme fatigue they would just continue to keep an eye on it. In March of 2020 I though I was dying. Extreme shortness of breath and fatigue along with flu-like symptoms. The VA didn't want me in the building because those symptoms are similar to COVID. They finally relented and called me in for some chest xrays. The diagnosis was extreme heart failure and I was immediately put on drugs and scheduled for further testing. They discovered that my aortic valve was bi-cuspid instead of tri-cuspid and there was a 4mm bulge in my descending aorta. My heart showed no blockages. I was referred to a 'chest cutter' who scared the Hell out of me. I got a referral to an aortic specialist and had open-heart surgery on August 25, 2021 to replace the valve and repair the aneurysm. Recovery was very quick and I was back playing tuba the week after Thanksgiving. My 'wild card' was the fact that I was in very good health except for just a bad part or two. My cardiologist was astonished and gave a lot of credit to me having been a tuba player for many years.

[The Big Ben]

Aside from the calcium score itself, the radiologist noted a "mildly dilated" ascending aorta, preaneursymal but concerning nonetheless. The radiologist recommended follow up in a year, but my primary care provider referred me to a cardiologist and I have an appointment this coming Friday.

Don't get too worked up before going to the cardiologist appointment. Thinking too much before you have expert consultation may cause you to suspect many things that aren't happening. Or maybe they are but the cardiologist it the one to give you answers. Without getting into personal details, skilled hands, eyes and brain can do much today with blood tests, EKGs and procedures which do not involve sawing the chest open.

[royjohn]

2nd tenor said:

Surgeon’s like to operate, they find it interesting and it gives them employment. Hospital owners and administrators like their Hospitals to be full, it keeps them in business. I guess that those things conflict with whether someone really does need an operation or not.

I think the above is a very astute observation. Further, if you study the history of medecine, there are lots of procedures which were once thought required which are now discredited. If you search for info on stents and bypasses at <nutritionfacts.org> you will find that Dr. Greger says that the research does not support them being effective. This is from double blinded studues, the gold standard. The cardiologist have never been able to demonstrate a positive effect. They don't tell you that. The exception is stenting during a heart attack. Angiograms show blockages, but don't show the collateral circulation in small veins that occurs naturally to remedy them. So the blockages may not mean much.

You don't really have a lot of calcification for someone who is 61 and your weight isn't real bad, either. It's a little known fact that a whole foods, plant-based diet can reverse arterial damage. It's a different way of eating and requires work to learn different ways of cooking and different food preferences, but it does work. You can read the case histories in Joel Fuhrman's Eat to Live. Returning your arteries to a healthy state would probably arrest, if not reverse, any problems with your arteries. A lot of people won't give up their meat and dairy, however. Ya pays your money and takes your choice. I lost 80 lbs on Fuhrman's diet and my bp normalized and my resting heart rate went as low as 45. Resting heart rate is a marker for longevity, as you only get so many clicks out of your ticker.

My wife says I get on this hobby horse too often, but you did ask. You are not likely to find a doctor who espouses a whole foods, plant-based diet, but you could find an internist who is not very big on surgery to consult rather than a cardiac surgeon. I wouldn't ask a roofer if I needed a new roof, either. You know what the roofer and probably the surgeon is going to say...

[Worth]

Thanks to all for the encouraging posts. I went to a well respected, seasoned local cardiologist who was similarly reassuring, especially regarding the pre-aneurysmal ascending aorta. The idea of surgery for that scares the crap out of me. Explosion of it (dissection) would be pretty instantaneous for me but a bad thing for anyone with me to observe. I figured I'd get to 70 before this type of stuff, but seems it's pretty common. They scheduled a echocardiogram and a stress test, upped the statin dosage and added a daily baby aspirin. Results will follow, but I saw many in quite a bit worse shape in the waiting room, making me feel a bit ashamed about my own concerns. Getting older is fun

[bloke]

As fallible as our bodies are, medicine is now capable of doing some wildly amazing things.
I have a relative who is about 12 years older than me that has gone through several surgeries and procedures, and every single one of them has been perfectly and completely successful. Further, every one of those procedures and surgeries required absolute pinpoint accuracy, something that just seems now to be “routine“.


I had an aunt who had open heart surgery at age 90 or so (one of those “pig valve“ things), and and was adamant that - during her recovery - she suffered absolutely no pain - neither surface pain nor interior pain.
...now this one gets a bit philosophical:
By age 98, she really wasn’t able to do much - and had always defined her own valve by what she was able to do to help others. She would daily write and say prayers asking God why she was still here. One of those written-out prayers was reproduced on the back of the program for her memorial service.
...back to the medical miracles, again...
Whenever a tough situation comes up, I can’t help but think of my friend, Ryan Anthony, who told me at a Christmas gig a decade ago or so that he had incurable bone cancer and was expected to live 18 months or so. He spent the next eight years continuing to serve as principal trumpet in the Dallas Symphony, traveling around the world raising money for cancer research, and playing trumpet concertos with symphony orchestras. I wish I were more like him.
(I didn’t mean to post so much, but - if we’re lucky enough to live long, most of is end up with health problems, and we live with them.)