Have LVAD Will Travel with apologies to Richard Boone

      I've been driving for several decades and have a decent driving record.  To be practical, having an LVAD is no impediment for me to driving a car.  It is not like a person prone to seizures, for example. In some states, seizure patients have restricted driving privileges.  LVADs, for whatever reason, are not in the same category.

     After receiving my HeartMate II in April, 2010, I didn't drive until well after my hospital discharge date.  So far, so good.  I use a pillow between me and the airbag that explodes at 200 m.p.h. from the center of the steering wheel, hoping that it will lessen the impact. My wife and caregiver says I drive too slowly now.  Indeed, my road race days are a memory.

      Thoratec, most likely for liability reasons, does not recommend driving a car or truck in its LVAD Patient Handbook.
However, driving a car, truck, motorcycle, or flying a private aircraft, all involve risks.  I no longer ride my Triumph Bonneville (that's a Brit motorcycle) because of the Coumadin/warfarin blood anti-coagulant regimen I'm on. What may be a bruise to someone with normal clotting capabilities, could be a problem for me.  The Triumph sits in the garage, waiting for its day.  One LVAD acquaintance has gone on several ocean cruises and once rode a camel, a dromedary(that's the one with a single hump).

     Another issue for the motorcycle enthusiast with an LVAD is not being able to hear the audible controller alarms or see the light array that accompanies some of the alarms, including the red broken heart, because I wear the controller on a belt in a controller shaped fanny pack. If an alarm were to sound, I'd never hear it from under my full face helmet and racket of the machine itself. I would not be able to see warning alarm lights without taking my eyes off the road.  Triumphs are not as noisey as Harleys but I wouldn't trade.  It's a loyalty thing from the 1960s, when Nortons, BSAs, and Triumphs were at their zenith. The Triumph I rode had a kick starter and a Lucas headlight system. The headlight had two positions: flicker and off.  You achieved the "flicker" condition by slapping the headlight housing.  Things are better now. Hell, as everyone knows, Steve McQueen drove Brit bikes and that's good enough reason for me Lucas headlight systems notwithstanding. 

     In my household, I do the yeoman's share of the driving on the road and around town. On the road, I try to get out of the vehicle and walk around to keep blood from pooling.  Blood clots and LVADs are unfriendly.  

     I said somewhere in an earlier post of that Dolly and I have a granddaughter, our first grandchild.  She is now a lively 18 month old, living a thousand miles from Fargo.  Air travel was the practical choice for a visit as opposed to two plus days behind the wheel.

     Air travel with an LVAD installed requires some ingenuity in packing one's gear and plenty of flexibility and patience.  A wag once said the key to flexibility is indecision. In these post 9/11 times and since airline deregulation, we fly under strict scrutiny and packed like boxed matches. Indecision is out.  

     The point is that air travel for an LVAD owner is like the round peg in a square hole--it fits with room to spare.  That's in theory.  Much depends on the local TSA and the airline personnel at checkin and the flight crew. Individual experiences will and have varied. One acquaintance travels by air weekly.  He's had a few tense moments explaining to reluctant flight crew members that his carryon bags do not need to fit into the neat box airlines use for carryon size limits.

      I speak from my experience, limited as it is.  There are two significant components of air travel:  airport security and the size of the aircraft.  Just because you have to take all of your LVAD equipment and gear with you, does not mean that it will easily fit on smaller aircraft.

Here is some practical advice gathered based on my travel and those of LVAD recipients I've talked with.  Everyone knows that our airport monitors, the Transportation Security Administration, part of Homeland Security, has  written procedures for passengers with special needs like LVAD patients.

       The local airport is a regional airport and it serves a metropolitan area of roughly 150,000, including Fargo-Moorhead but also towns and cities in all directions for 100 miles.

I found that TSA workers I have dealt with, admittedly not a large sample, are congenial and accommodating.  It is extra work to check by hand all of my equipment.  The test for gunpowder residue and explosives can exhaust the test kits of TSA.

So like the Coast Guard motto, Semper Paratus (always ready), and the Boy Scouts' motto:  Be Prepared.  Pack your gear in smaller bags. Be flexible. Be patient. And, try to smile.  After all, everyone is having one of those days.

Concerned about traveling by air for the first time, I went to the airport a week before traveling to Nashville from Fargo and talked to TSA inspectors about my equipment and needs.  I did a 'show and tell,' displaying my equipment and my travel letters and telling TSA that: 

      --I needed to travel with my power module, extra batteries, and charger in the passenger cabin with me.

     --I needed to be hand inspected as well because the LVAD could not withstand the magnetometer or likely the back scatter radar body imaging scan. (The full body imaging technology is problematic for stopping the pump. The jury isn't even deliberating because I'd rather be safe than have my LVAD interrupted.) 

      --I needed a hand inspection of the onboard bags and my backup controller and equipment. And, 

      --I needed to take with me some site care supplies, including a quart bottle of Hibaclens, and 0.5 ml ampoules of saline solution. (This does not comport with the 3 x 3 in a clear one quart plastic bag).

No problem, I was told.  Show up two hours before your flight. One TSA worker said not to worry about being too specific about my “special needs” but just call the device a "pace maker." 

I had letters from the Ventricular Assist program explaining my condition and my "medically necessary" equipment.  It didn’t seem to matter to TSA.  For some devices like artificial knees and hips, a wallet size card is given by the medical facility to the patient to help explain the individual situation.  The issue with the electric powered LVAD is that it cannot undergo electromagnetic screening.  

Magnetometers and hand held wands create magnetic fields that will interfere with the functioning of the LVAD. The worst case scenario is that the pulses could stop the pump.  The LVAD is a continuous flow pump.  If it stops, the patient will likely go back to his end stage heart failure condition fairly rapidly.  If the pump stops for more than a few minutes, the experts say that it cannot be restarted without the risk of a blood clot forming in the pump.

Knowing all of this, my wife and I loaded my wheeled suitcase with my equipment, loaded a separate smaller bag with bandages and meds, in our car and headed for  Fargo’s Hector Airport. The challenge of TSA is survivable.  I cannot emphasize too much to allow plenty of time and tap into your reservoir of patience.  

In the end, it took talking to three TSA agents before I was clear on the hand inspection regimen that I required. The first time is always trying because few know what an LVAD is.  I wonder how Dick Cheney handled his frequent flights.

All of your carry on luggage pieces, minus the electronic gear, must go through X-ray, I was told. That means the bags themselves. I unloaded everything for hand inspection into three or you trays and sent the bags through the conveyor line and on through the x-ray machine.

Fargo has no body scanner and no longer uses handheld wand.

Remember, the electronic waves and electro magnetic waves created by the screening devices can cause problems for your equipment, which none of us wants or likely could endure.

     Immediately opt for a hand inspection of your gear and yourself  and resolve to be adamant in you request.

Hand inspection is slower but it was not particularly invasive.  It took about 45 minutes to get through the initial TSA security.

That is only the first concern. The question I never thought about before it arose was how is the aircraft configured for storage.

So when you get to the gate there is another issue:  where to stow your stuff. Overhead compartments and under the seat space in front of you may be insufficient.  There was no “crew closet” to stow my rolling duffle.  The aircraft was too small.  But I had no idea before arriving at the gate.  None of the airline personnel had any clue about stowage of "necessary medical" equipment.

Depending on the size of the aircraft, there may not be room for a piece of luggage containing all of your gear.  The aircraft may not have space in the cabin for your gear in one bag.  nFortunately, the airline pilot learned that there was one empty seat on the flight and permitted my big wheeled bag to be strapped into the seat for the trip to Minneapolis.

Meanwhile, my wife scrambled to obtain smaller carry on bags to repack my gear and our son rushed from our home with smaller bags. The lost and found was helpful at the Fargo airport. One of my cardiologists was to board the same flight and he immediately sized up the problem and offered to let me use one of his pieces of luggage.

Once into the Minneapolis airport, we transferred the battery charger and cord to one smaller bag, put the power module, cords and display module in another smaller bag, and had my site care supplies in another bag.
  

The larger wheeled bag was filled with miscellaneous stuff and checked at the gate.  It traveled in the plane’s hold.  The strategy of using smaller bags worked, but it was a tight fit in the overhead and under the seat.

Returning through Nashville, the process went smoother. It still took 45 minutes to clear TSA.  With more manageable sized duffles, the check in and stowage problems were significantly reduced.

By the way, you’ll need to disable the battery backup in the power module to prevent unwanted alarms during your trip.  For this purpose, you can carry a screwdriver in with the power module up to 7 inches in length.  Explain its use before it is found by TSA.

I had letters from the LVAD coordinators at Mayo that explained the no x-ray problem, the no hand wanding problem, and the no magnetometer problem.  I never had to show them to TSA and TSA did not want to see them when I offered.

Bottom line:  relax, try to keep your sense of humor, allow extra time, be flexible in packing, and stay hydrated. It takes some courage for an LVAD travel by air. If none of this makes sense, wire Palidin, San Francisco, for assistance.