My Life at 9200 rpm's: Undetected Heart Disease in U.S. Soldiers, LVADs, and the road not taken

Heart disease has been called the silent killer.  One of the reasons is that a person with the condition might not show any symptoms and would be unaware of the danger lurking in the form of plaque in arteries, particularly the coronary arteries, which supply blood to the heart muscle itself.  Heart disease kills about 600,000 Americans each year, accounting for about one of four deaths.  

A recent study of U.S. service members deaths in Iraq and Afghanistan, reported by Reuters and carried on the Fox News website, showed that nine per cent of the 3,832.  That is more than 1 in 12 military members.  

The study covered men and women deployed for service in the Operation Iraqi Freedom/New Dawn and Operation Enduring Freedom between October 2001 and August 2011.  The lead investigator, a physician, is from the Uniformed Services University of Health Sciences, Bethesda, MD.

The autopsies were originally performed to give the families of the service members a complete picture of the cause of death for their loved ones.

Not all were combat casualties. Some fatalities were caused by unintentional injuries. Ninety eight percent were male and two percent were female. 

The most interesting aspect of the study was that none of the 3,832 individuals was diagnosed with heart disease before deployment to the war zones.  Routine pre-deployment medical exams found nothing to worry about heart  wise. The average age of those in the study was 26. 

But the study gives some insight into the overall general heart health of our young, physically fit soldiers, sailors, airmen, and marines.  Of the 3,832 cases, about 9 percent or about 331 individuals showed signs of plaque build up in the coronary arteries. The study found that about 25 percent of the 331 personnel had artery buildup that was labeled severe.

One drawback to such a study is that it deals with a select group that may not be representative of the population as a whole because the military is all volunteer.  Earlier studies involved individuals who were subject to the Selective Service draft. Below is a link to the story.
http://www.foxnews.com/health/2012/12/26/1-in-12-in-military-has-clogged-heart-arteries/

What this study tells me is that even without symptoms, high cholesterol can lead to narrowing of the coronary arteries.  By the time of a stroke or a heart attack, it may be too late to treat. 

Speaking from experience, heart conditions can kill you and you don't even know you've got the condition. I did not recognize what I had.  It was congestive heart failure and it had a good hold on me. 

I did not know  exactly what symptoms I should be aware of but I did not pay attention to the symptoms I was having: wheezing, shortness of breath, fatigue, among others. 

I'm certain there were many signs I missed, all of which worsened over a several month period.  When my health deteriorated and I hit the wall, I was as surprised to learn that I had end stage congestive heart failure. 

It took being close to my last hours on the planet before I accepted my condition.  In my condition, choices are limited. There was nothing I could do about it.  Acceptance was the only option. Now I have a mechanical circulatory support system and it has made all the difference.

My HeartMate II LVAD has allowed me to take the road less traveled by.  And that has made all the difference.

My Life at 9200 rpm's: You can save up to 8 lives as an organ donor

The U. S. Department of Health & Human Services reports a good answer to the question Why Donate? The proposed answer:

"Because you may save up to 8 lives through organ                    donation and enhance many others through tissue donation.  Last year alone, organ donors made more than 28,000 transplants possible."  You can read more on the agency's website:  organdonor.gov.

Cornea and other tissue transplants helped another estimated 1-million people recover from bone damage, trauma, spinal injuries, hearing impairment and vision problems. However, thousands die yearly waiting for a donor organ that never comes in time.

I am on the heart transplant waiting list through the University of Minnesota Medical Center, having been listed on Hallowe'en 2011.
A HeartMate II LVAD gives me the chance to wait without the concern of many whose lives depend on a suitable donor organ.  


My LVAD is literally a life saver. But I am one of the grateful few with end stage congestive heart failure who can afford to wait.
Most others with end stage organ issues confront an unwelcome but inevitable consequence, death.

Based on the waiting lists and available statistics, about 79 people a day receive organ transplants in the U.S. but 18 people die every day waiting for a donor organ.  Currently there are some 116,000 people on waiting lists for various organ transplants. Some people are listed on lists at more than one transplant center, which is confusing.

Statistics are so sterile. Talking about the data, you forget that each of the numbers represents a human being.

After reviewing the website organdonor.gov, I learned some things I didn't know:  most people can donate, age is not a deterrent, most medical conditions do not disqualify a donor, and there is a need for minority donors.  

That need is caused by the greater likelihood that minority groups suffer three times as many end-stage kidney failures, which can be attributed to high blood pressure and other conditions that cause kidney damage.

Visit the website and make an informed decision to donate life.  You can register your preference for the Dakotas, Minnesota, and Wisconsin at www.donatelifemidwest.org

My Life at 9200 rpm's: the dreaded driveline infection

LVAD #8358, my HeartMate II, is performing as designed, keeping me going, and giving me the opportunity to be on the waiting list for a heart transplant at the University of Minnesota.  

For the last 32 months with an LVAD I escaped a driveline infection, but I'm battling one now. Who knows what happened?  Even with a heightened awareness of the potential for infection, bacteria can cause problems. The driveline exits the abdomen of LVADs and it is treated as a wound site, with sterile dressing changes at regular intervals.

I have read and have been told that a site infection is quite common in LVAD implants because the wound site is tender and susceptible to tears.  Essentially the driveline is unsecured except for external Velcro tabs that hold it in place on an elastic binder.  The binder is used to hold the wound dressing in place and as a place to attach Velcro tabs to immobilize the driveline after it exits my abdomen. Immobilization is a relative term because the driveline can still be moved or tugged.


At any rate, the seal at the wound site is fragile and can be broken with the slightest tug on the driveline.  Driveline tugs sometimes occur.  I have been fortunate that no significant tugs on the line have occurred. 

Although the site is maintained as sterile, a break in the seal of the skin at the wound site is a fact of life for an LVAD. The break in the seal, even a slight one, can lead to an infection.

 As you may know from earlier posts, the driveline is another name for the percutaneous lead that carries power to the LVAD.           Percutaneous means through the skin.  Thoratec, maker of the HeartMate II LVAD, is developing a device that will be fully implantable with no external driveline.  It follows that with no wound site there would be no infection issue.

A Thoratec engineer talking about research and development said that a fully implantable LVAD with power system is some years away, five at a minimum.  The batteries that I carry will be miniaturized, implanted with the LVAD pump unit, and will be recharged using an external system.  The combination of miniaturization and external charging, will allow an LVAD to be fully immersible.  

Being waterproof would be a great improvement over the system I use, which must be protected from rain, bathing, showering, swimming, wading, boating, fishing and the host of other wet activities.

But that is in the future.  For now, LVADs' lives are maintained with the electrical system as it exists.  The potential for tugs and movement of the driveline is always present.  Either of those driveline movements could create the conditions that cause an infection. 

A friend's driveline site became so infected that he needed inter venous antibiotics and was hospitalized. The break in the seal of his drive line site was an unforeseen consequence of taking a shower.  His water resistant shower bag, in which LVADs secure their electronic system controller and two batteries, fell off its hook and yanked on his driveline. He had used the shower bag and hook for years with no negative consequences.

Now, he must take oral antibiotics until he receives a heart transplant or until his LVAD is replaced.  The problem is that just because the infection is controlled at the driveline exit site, that doesn't mean that the infection is resolved.  

The infection can migrate along the driveline to the heart. It is possible for the infection could "seed" the pump itself. Since the pump has no blood circulation of its own, the infection could last on the pump even if the driveline site is clear of infection.  That is a dangerous situation, potentially fatal.  Hopefully, long term antibiotics can keep the infection at bay.  No guarantees.

In LVAD living as in life for everyone, there are no guarantees, there are no assurances, there are no promises.  I am fortunate to be among the few of hundreds of thousands of congestive heart failure sufferers with an LVAD.  Not many can say they have another chance at life.  

My Life at 9200 rpm's: The future at 60 minutes per hour

Doing Navy duty in London some years ago, I grabbed a colleague by the collar as he stepped off the curb of a busy street without looking to the right.  As a "colonist" from across the pond, we don't drive on the left.  For us it is the wrong side of the road 

My friend, I'm sure was imbued with the warning to look both ways, but in London the memory failed him. He looked left and began to plunge into oncoming traffic from the right. He narrowly avoided having a double decker bus ruin his evening.  

The point is that neither of us knew or could count on surviving the rest of our assignment in a foreign land.  All we had were dinner plans at a rushed pace before returning to our North Audley Street hq, across from the U.S. Embassy at Grosvenor Square.

We were working port and starboard watches, 12 hours on, 12 hours off.  The change came on the 7's:  0700 and 1900 daily for three days and then we would switch to the other's schedule.  This went on for nearly a month. But all of that could have changed in a flash, a matter of seconds. 

There's always something to learn about "driving" an LVAD so to say. Be prepared for the unexpected.  That doesn't mean that I'll have the answer, but being alert helps.

Clearly, depending on an LVAD to survive, sharpens the focus on the minutes in an hour.  It hasn't become a distraction or an obsession by any means.  

But planning has to be practical and realistic.  When, leaving my house, I carry a pack with spare batteries and a spare system controller. Yesterday, the small battery in my LVAD system controller began to sound an alarm, one quick beep, twice in an hour. What's up with that?

This had not happened before.  The beep was so quick that it was difficult to capture visually.  The second time, I caught a glimpse of the yellow light as it was going dim. 

I called the U of Minnesota to talk to an LVAD coordinator, and, after a brief conversation, we got to the bottom of the issue. The problem was solved by changing the battery module.  I had two spares on hand and, in a pinch, I could take the one in my spare system controller.

But when the initial signal sounded and showed, I had no fixed idea about the outcome.  Did I have 60 minutes, 60 hours, 60 days?

Accepting that I and my equipment are a working experiment, you have to be prepared for the unexpected.  This is not an exact science.  There is some art involved. As the saying goes, you can plan the plan, but not the outcome.  

Semper Paratus (always ready).