Playing with Aortic Aneurysm

[Usedtobegood]

So I was just diagnosed with an Abdominal Aortic Aneurysm (AAA). Its smaller than the limit to require immediate surgical intervention, so that is good, but scary as heck. Cardiac surgeon says ok to play as long as my BP is down, and it is, but I am taking it very easy.

Question, do any of you on here have any experience with an AAA? How have you managed? I know there are some MD's on here so please chime in. My wife is scared I will rupture it while playing and I now those outcomes aren't too good.

I also have to play my nieces wedding on picc in 3 weeks. Thinking I should play Voluntary and Hornpipe on Bb down or sub out, but she wants me to play. Not sure anyone at the wedding would know its not in the original key.

Any info is appreciated.

[Brad361]

I have no information or experience with your medical condition, I hope you have a full recovery. But regarding anyone noticing if you play those pieces in a different (“lower”) key, I cannot imagine anyone noticing. Heck, there might be a few trumpet players in the audience who will not notice. Generally, unless a performer / band has a full blown train wreck on stage, the average audience members don’t really notice.

Brad
_________________
When asked if he always sounds great:
"I always try, but not always, because the horn is merciless, unpredictable and traitorous." - Arturo Sandoval

[Christian K. Peters]

Hello,
I believe that my dad had this condition. He played in college, but not after. It was diagnosed in his early 70's if I remember correctly. He did not have high blood pressure and he had it checked regularly by sonogram. Over the many years, it did not change/get larger or what ever they do. Alzheimer's took him in 2015 at age 85. I think that good healthcare is the key and that your doc, keeping an eye on it, is critical to longevity. Knowing the condition, and symptoms of rupture should be forefront if you ever go to urgent care.
_________________
Christian K. Peters
Schilke Loyalist since 1976

[TrumpetMD]

FWIW, I'm a physician. Let me make a couple observations.

Not all AAA's are the same. The safety of a AAA is dependent on many things, including it's location, it's size, how fast it's growing, your other medical conditions, and what you're doing to control your risk factors (tobacco and blood pressure being the most important). So in the end, there's no one-size-fits-all answer regarding safety.

Did your doctor place any limits on your activities? Here are couple ways to compare the trumpet to other activities. Playing the trumpet is similar to moderate physical activity (3-6 METs), which would be comparable to a brisk walk, moderate aerobics, sexual activity, or riding a bicycle. In addition, playing the trumpet is similar to moderate resistance weight training. These are just general guidelines, and YMMV. But they might help your doctor understand the trumpet better, and help you and your doctor decide if you need to limit your playing.

Best of luck with this.

Mike
_________________
Bach Stradivarius 43* Trumpet (1974), Bach 6C Mouthpiece.
Bach Stradivarius 184 Cornet (1988), Yamaha 13E4 Mouthpiece
Olds L-12 Flugelhorn (1969), Yamaha 13F4 Mouthpiece.
Plus a few other Bach, Getzen, Olds, Carol, HN White, and Besson horns.

[John Mohan]

Hi Mike,

Did you consider the extreme thoracic air pressure trumpet players generate on louder high notes? I think that should be taken into consideration and I don't think the OP's surgeon is aware of that phenomenon.

Note to the OP: I'm not a physician, just a (final year) nursing student, but I have had a ton of A and P courses and also have about 75% of a biomedical engineering degree. I would be very concerned about the high levels of thoracic air pressure. In other words, if I had an AAA I wouldn't play notes above the staff and I wouldn't blast out any notes.

Please play the Voluntary down an octave. It'll sound beautiful and significantly reduce the odds of making your niece's wedding anniversary a yearly day of family remembrance if you catch my drift... There's plenty of beautiful music at or below G on top of the staff. In fact, to the average non-trumpet playing human, that's where pretty much all the good trumpet music lies.

I sure hope all goes well for you.

Cheers,

John Mohan
_________________
Trumpet Player, Clinician & Teacher
1st Trpt for Cats, Phantom of the Opera, West Side Story, Evita, Hunchback of Notre Dame,
Grease, The Producers, Addams Family, In the Heights, etc.
Ex LA Studio Musician
16 Year Claude Gordon Student

[TrumpetMD]

[John Mohan]

[Usedtobegood]

Guys,

Thanks so much for the information. So my AAA is 4.5cm and I was told the cutoff for surgery is 5.0cm, and when I look at how small .5cm is...well you can understand. Based on my tests Doc says no strenuous physical activity, no heavy lifting, didn’t say anything about sex, but this was through the referral, my in person appointment is next Tuesday, which is good and bad. He’s not too concerned, but I’m freaking. I will definitely discuss all your points when I see him.

As far as playing goes I’m playing softly, nothing above the staff. I was a high note guy back in the day but now struggle over high D so I don’t really play up there anymore. I play in a community band and a brass quintet so I guess I can play 3rd in community band and 2nd in quintet. I just love playing and would hate to give it up. Ill become a “low note artiste” as my friend Pete Bond calls himself. I’ll keep you posted. For the wedding I’ll play the Voluntary in Bb on a Bb and the Hornpipe down an octave on Bb also. No one will know I agree.

John, my niece just graduated as a nurse practitioner from Vanderbilt. She enrolled in a program that was a week a month on campus and the rest through online class work. She did this and lives and works in central Wisconsin. She absolutely LOVED it and highly recommends the program. Good luck.

Love the TH family, so many great caring people on here. Well there is some arguing amongst us, that’s what families do, but we all care about each other and that is comforting. Thanks again.

[malden]

Usedtobegood

I was diagnosed with AAA of the upper Aorta about three years ago. I know exactly how you feel. It's scary.

My aneurism was measured at 4.5 and in three years it has grown to 4.7. In my case, surgery is prescribed at 5.5.

My doctor has me on medication to reduce blood pressure, which is not at all high anyway. And I have been instructed to avoid heavy weight lifting, or any heavy lifting like movements. All moderate aerobic exercise, like walking, swimming, bike riding, or sex is fine. What you want to avoid is a sudden increase of heart beat and blood pressure that would come from something like a sudden sprint or trying to run upstairs. Any sudden or violent increase in heart rate is to be avoided, so if you feel your heart pounding in your chest from any activity, stop it and let your heart rate slow to normal.

Emotional stability is also very important. Don't lose your temper or stress yourself.

When I asked about trumpet playing, my doctor said it was like moderate aerobic exercise. I have been playing the trumpet all this time with no ill effects. As regards high register playing, I don't feel an increase in my heart beat like in a sprint when I play above the staff. And it does not feel like heavy lifting to me. So I have not been concerned about it. But you do need to ask your doctor about your own specific situation.

Advances in medical technology have made surgery for abdominal AAA very safe. In some cases the disease can be treated by a stent and without invasive surgery. The same is not true for upper aortic AAA and that surgery has a high risk factor. But you should have your upper aorta checked as well. People are known to have both.

Lets us know what your specialist tells you. And remember that you are very lucky to have AAA diagnosed so it can be followed and treated. So many people are struck down by this disease without knowing and without care.

Take it easy and rest assured. If you have any other questions, just ask.

Cheers

[cheiden]

FWIW, my brother was diagnosed with a similar size aortic aneurysm for many years before a doctor decided it required intervention. In testing leading up to that surgery they discovered that the associated heart valve wasn't performing well. Turns out that an aneurysm can cause that. Long story short they repaired the aneurysm and replaced the valve in a single operation. My brother was on his feet within a day and recovered surprisingly quickly. I give his doctor high marks.
_________________
"I'm an engineer, which means I think I know a whole bunch of stuff I really don't."
Charles J Heiden/So Cal
Bach Strad 180ML43*/43 Bb/Yamaha 731 Flugel/Benge 1X C/Kanstul 920 Picc/Conn 80A Cornet
Bach 3C rim on 1.5C underpart

[Usedtobegood]

Maiden,

Thanks so much for the information and I'm happy you are doing so well! It gives me great encouragement about continuing to play.

I had a follow up with my primary care doc yesterday and she surprised us by reading the results of the CT A scan as an ASCENDING aortic aneurysm! Apparently the ER gave us the wrong discharge instructions and my wife and I were in shock and didn't realize it and neither could recall hearing ascending from the ER doc. Anyway, I was more freaked but she assured us we can keep this in check. Her advice on physical activity is similar to what you said. She gave me meds to keep my emotions in check as I have a fairly stressful job and work 11-12 hour days. She said that has to stop as well.

My Cardiac surgeon appointment is Tuesday and I will let you know the outcome.

I've decided to bail on the picc and play the Voluntay in Bb and the Hornpipe 8vb.

Thanks again and I will update as we go forward.

[malden]

Usedtobe good,

An "ascending aortic aneurism" is what I have as well. Once again, you are very lucky to be diagnosed, followed and treated. That's the good news. 4.5 is manageable. Be reassured. If you are tricuspid and have no sign of Marfan syndrome, the surgery point is 5.5.

The normal or average increase rate in an aneurism is about .05 a year, but it can be much faster or slower. What your doctor does not know is how fast your aneurism is growing. He will probably have you do another CT in six months to see what change has occurred in that time. And from that point you will have checkups every six months.

There are AAA specialist cardiac centers in some US hospitals. You should start to research them and find a good surgeon, someone who only does AAA work. The operation is high risk as they have to remove your aorta and replace it with one in dacron. So stay well, take the medication, take it easy and hope medical technology improves the surgical procedure.

Let us know what your specialist says as regards trumpet playing..I would be curious to know.

Cheers

[TrumpetMD]

[Usedtobegood]

Update.. I've had my follow up and a 2nd opinion and the go forward is to manage through controlling BP with a new CTA scan in 6 months. Restrictions are moderate exercise, no lifting objects over 30 lbs and I am cleared to play but I am taking it very lightly for now.

Thanks for all your support. Any changes and I will update.

Mark

[Rod Haney]

I have a caution for you.

I had a AAA and have had sucessful repair surgery. You could go years without any or no expansion, but make sure you are anal about the 6 month exam, it’s the only warning you will have. When you get relatively close to having the 5.5 they will probably have you take a stress test to make sure you can survive the surgery. In my case I had the 3 major arteries over 95% blocked and the only reason I was walking was because I had grown new veins around them. These were 100% cleared so I could have the surgery. Then when I went back to my surgeon after a CAT scan he informed me that the grafts used to repair AAA wouldn’t work for me as the area needing stunted also involved the areas where the kidneys and gut artery’s were and there was no such stent. Much research and found that Cleveland Clinic was doing a trial on such a stent (I was materials manager for a large hospital). So I went there and because both my parents had had aneurysms I qualified. Now I have a chance to live... but I am informed that I will need to pay 400,000$ prior to having the stent made in Germany which will take 6months, and I’m at 5.6 now. I present this to the hospital and the deny the claim due to the procedure being experimental. I’d worked in finance prior and was part of taking the hospital to self funded on insurance. Long story short we talked to the president of hosp. And he approved of operation.

Operation successful - done thru groin ( big cuts both sides) done with 2 scopes, lasted 9 hours, 3days cardiac ICU, 4 more days and release. I starTed playing again after 45 years with assurances I may blow something else out but it would NOT be that patch.

I wrote this not to scare you, but to let you know to get your ducks in order and don’t expect your doctor to have the same concerns as you. Make sure your heart can take the operation, make sure they can stent you (this surgeon had been following me 15 years and didn’t know the stents he had wouldn’t work till 1 month before I needed surgery🤯👹. I don’t need to caution you because you seem aware, but until you get it corrected I would concentrate on the notes below hi c. The stents I had are now generally available, but get the best surgical team cause this operation still has some risk of failure and complication.

Good luck, I thank GOD everyday that he made it all work out. So many things worked out I just figure he wanted me playing trumpet again, and I’m gonna make him happy!

Rod

[malden]

[malden]

[2LIP]

Sorry to hear about this. I had a pretty good scare with my eyes this year and had to take 7 weeks off the trumpet due to detached retina, steroid response, and subsequent implant of Ahmed Glaucoma Device (look that one up)! We're all getting older/odder and medical stuff starts to happen when you tax the systems. The weak spot always has issues first.

Best of luck and be careful. Listen to your body and don't mess around!

LIP

[chuck in ny]

lost a friend this way at age 62. he never knew what hit him. when he got to the hospital everyone from the orderlies to the doctor knew the deal right away. he was a lifelong smoker and overweight.
keep an eye on things. procedures continually improve making surgery better done later.
losing family and associates lets you know you are getting older.

[malden]