February/March 2013 9

The first year of marriage is a blur. Most people actually survive it, but the picturesque

scene of the wedding day – a train of white, dresses made of taffeta, ascots and bow ties, ring bearers and flower girls – lovely though it is, soon morphs. Putting two lives together, who have come from different raisings and sometimes even different cultures can be messy. We enter the first year of marriage with the image that we are two rosebuds waiting to bloom. We end the first year of marriage feeling like two locomotives that have collided, speeding at 75 miles per hour.

Years 2-8, in the healthy marriage can be downright magical. You both adjust, make your own contracts with one another about the division of labor, time spent together and apart and then--children come along. Hopefully, both parents celebrate new lives and share moments together that will never be shared again and will never be shared with anyone else.

Some call it the “7-year-itch”. Others call it a developmental crisis. Many couples find themselves in s struggle in the 7-10 year mark. Why is this? Couples need a mission. In the first years of being together, the mission is getting to know each other. Sometimes, just pure survival. As children come along, the mission shifts to not accidentally maiming of them. As children get into the two’s and three’s, it is our mission to not be maimed by the children! When they start to school, especially the youngest one, couples begin to feel mission-less. By now, we have gathered all of the data on one another. We have heard all the stories. There is no new information coming out regarding the other person that you find enchanting, endearing or engaging. The stories are now repeats. In fact, as one begins a tale, the other may be able to finish. It is at this critical point that the guy may be in the midst of middle management career demands and wives may have lost themselves and their affections into the lives of their children. While there is nothing wrong with hard work or good parenting, it is a subtle temptation to lose the marital mission in the process.

This is where the “hard work” of marriage comes in. People talk about it, but few actually know where to begin to “work hard” at marriage. There are many things to do, but one building block of marriage revitalization is often overlooked. Couples often forget how to have fun. Simple really. It happened so naturally in dating. The bliss of a new relationship seemed to override any activity that may not have been independently enjoyable. With time, independent recreation became the norm. After all, someone had to be with the kids. As children get older, parents can live vicariously through the little one’s activities – T-ball, soccer, basketball, music, dance and school activities. When married 7-10 years, nine out of ten troubled couples who come into counseling predictably shrug their shoulders and look at each other cluelessly in answer to the question of, “what do you do for fun?” What they don’t realize, is that it takes the hard work of being intentional about planning time together and planning fun together.

Here’s four questions to ask to begin the process:1. What have we done before that we would enjoy doing again?2. What have we done before we would like to try again?3. What have we never done we would LOVE to try?4. What have we never done we would be willing to try?

Next – put it on the calendar, pay the deposit, trust someone with your kids and get to it.

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February/March 2013 11

By Sandra V. Dee, MD, FACC

What You Need to Know About Valvular Heart Diseasehypertension and heart disease. Medications are given to improve symptoms, reduce the workload of the heart and regulate irregular heart rhythms. Anti-platelet medications like aspirin or Plavix prevent clots and may be prescribed for patients with VHD who have experienced transient ischemic attacks or TIA’s. Anticoagulants like Warfarin are prescribed in patients with atrial fibrillation.

Balloon dilatation for stenosed valves uses a catheter that is inserted through the blood vessel into the narrowed valve which is then stretched or widened. Surgical repair or replacement may be necessary depending on the patient’s age, medical condition and specific valve affected. Replacement valves may be made from animal tissue (bioprosthetic, bovine or porcine) or mechanical (metallic). Patients with mechanical valves are maintained on life-long anticoagulation with Warfarin due to higher risk of blood clots. Surgery may be done as open heart or with minimally invasive techniques.

The newest way to treat stenotic aortic valve called TAVI (transcatheter aortic valve implantation) or TAVR (transcatheter aortic valve replacement), was recently approved by the FDA for patients who have severe aortic stenosis who are poor surgical candidates for traditional open chest surgery. A replacement tissue valve is passed through the groin using a catheter through the femoral artery and guided to the diseased valve, which is then inf lated with a balloon, securing the valve in place. The procedure is performed in a hybrid suite with cardiac catheterization and surgical capabilities by a team comprised of interventional cardiologists, cardiothoracic surgeons, imaging specialists and anesthesiologists.

Recent advances in the treatment of VHD can save the lives of patients who are deemed ineligible to undergo the standard open heart approach. It is essential to maintain a heart healthy life style, continue taking your medications and follow up regularly with your heart doctor even if your valves have been repaired or replaced.

Dr. Sandra Dee specializes in women’s heart health, clinical, non-invasive and interventional cardiology with The Jackson Clinic. She received her medical degree at the University of Santo Tomas, Manila, Philippines. She completed her Cardiology Fellowship at the University of Tennessee in Memphis and Interventional Cardiology Fellowship at the University of Virginia. Dr. Dee is Board Certified in Cardiology.

Valvular heart disease (VHD) is a type of heart disease that involves the heart valves, which are one-way doors that

direct the flow of blood. Degenerative valve disease is the most common form of VHD in the United States, while rheumatic heart disease accounts for the majority of valve pathology in developing countries. The heart has four valves: mitral and aortic (left side) and tricuspid and pulmonic (right side). Blood is pumped through the heart in one direction. A normal functioning valve opens to allow blood to flow through and closes to prevent backflow of blood. Diseases of the valve could be due to regurgitation or insufficiency (incompetent or leaky valve) or stenosis (stiff or thickened valve not allowing enough blood flow). Regurgitation occurs when the valves don’t close properly and blood flows backward instead of forward, making the heart work harder, which leads to enlargement and decreased pump function. Stenosis happens when the valves are thickened or fused, which also leads to more work for the heart. VHD may be present at birth or due to infections, heart damage or heart attack.

Causes of valvular heart diseaseThe presence of a heart murmur does not always indicate heart

disease. It may be present in a person with a normal heart. Before the advent of antibiotics, rheumatic heart disease was the most common cause of VHD. Valve disease may be congenital, that develops before birth, like an abnormal shaped aortic (bicuspid) or narrowed pulmonic valve. Acquired diseases could be from weakening of the valves as in mitral valve prolapse (myxomatous degeneration), build up of calcium causing thickening of the valves (calcific degeneration), infection (rheumatic fever, infective endocarditis), heart attack or coronary artery disease, cardiomyopathy (weakness of heart muscle), radiation treatment, connective tissue disorders, tumors, and use of anti-obesity drugs like Fen-phen, which have been removed from the market after being linked to VHD.

Signs and symptoms of valvular heart diseaseSymptoms depend on the type and severity of valve disease.

If the onset of valve disease is sudden and severe, the symptoms can occur quickly. If the disease occurs slowly, the heart has time to adjust and you may not have significant symptoms until the valves deteriorate. Patients with diseased heart valves may present with symptoms of shortness of breath, fatigue, weakness, dizziness and loss of consciousness. Symptoms may be more pronounced with activities, although they could occur even at rest. Some patients complain of palpitations, chest pain, leg swelling and weight gain. Congestive heart failure, disease of the heart muscle, irregular rhythms and blood clots may develop.

. Diagnosis of valvular heart disease

Physical examination by auscultation or listening to abnormal sounds or murmurs, your doctor will be able to tell you if you have valve disease. Diagnostic tests are also utilized like chest x- ray which may show heart enlargement if the valve is not functioning properly. Electrocardiogram reveals atrial or ventricular enlargement or the presence of abnormal rhythms. Echocardiogram or ultrasound assesses the size, shape and thickness of the valve openings and the pumping function of the heart muscle. It also determines the severity of the stenosis or regurgitation. Cardiac catheterization or angiography identifies whether the valves are not closing properly or leaking. This test also confirms the presence of coronary artery disease, and will indicate whether patient will also need coronary artery bypass surgery aside from repair or replacement of the heart valves. Cardiac CT or MRI may also detect abnormalities of the structure and function of the heart valves.

Treatment of valvular heart diseaseThe goals for treatment of VHD are to protect the valves from

further damage, lessen symptoms, repair or replace the valves. Patients without symptoms or have minimal symptoms may be observed for some time until there are indications to repair or replace the poorly functioning valves. Patients should continue to maintain a healthy life style, avoid excessive salt intake, refrain from smoking, excessive alcohol intake, control risk factors for

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