My LVAD only hurts when I laugh (not)

     No, it doesn't hurt.  It never did.  You can hear a persistent whir and whoosh when you lay on your left side. It is a little disconcerting when you first hear it and the pump sound will likely freak out your LVAD partner.  Just a new body sound.  You know as you hear it that the impeller or rotor, the one moving part in the pump, is working.  It is the sound of life.   I'm grateful for the sound.  

     My HeartMate II is a continuous, axial flow, non-pulsatile device.  That means I, and other LVADs, have minimal pulse. The one moving part is a rotor, which operates on the Archimedes screw principle. The early Romans and Greeks used Archimedes type screws to raise water from one level to another.  

     The HeartMate II has no valves to break. My LVAD moves at a top speed of 9,200 rpms (hence, the working title of t his episodic narrative). To me the whoosh is a reassuring sound because it means my HeartMate II is functioning as designed.  Five plus liters of blood are coursing through me every minute of every day.  

     The LVAD itself is machined from a block of titanium stock.  Quality control is rigid.  I was told that only about 10 of 30 pumps pass the rigorous inspection. The others are not useable. Thoratec maintains that no HeartMate II has ever failed.  That doesn't mean those implanted cannot have other problems.

     Thoratec's engineers also found a way to coat the inner surfaces of the LVAD with titanium spheres that prevent continuously flowing blood from catching on the surfaces and coagulating.  Such coagulation can lead to a clot.  And clots in the pump can cause damage to one's circulatory system, including death, and when expelled from the pump, clots can cause strokes.  

     Other pump designers have had clotting problems.  HeartMate II was approved for both destination therapy (LVAD for life) and transition therapy, often called bridge to transplant therapy (those who are listed for a transplant) by the Food and Drug Administration in early 2010. It remains a leader in its field.  

     Most LVAD recipients follow a monitored anti-coagulation regimen by taking Coumadin or warfarin.  The medication helps ensure that clots don't occur because clotting is retarded by the drug. Slower coagulation means safe passage for blood through the pump.  I'm told that some LVADs also take aspirin as part of their anticoagulant regimen.  

     With the increased risk of bleeding while on anti-coagulants, I avoid the potential for falling down.  Thus, no ladders, no bicycle riding, extreme caution on ice or unlevel ground, no camel riding (one LVAD I know rode a camel without injury), no lifting more than 50 pounds, no contact sports.  I don't use a chain saw and do not start any device with a pull cord.  One friend ruptured his diaphragm starting a chain saw. Common sense should prevail.

     I take an array of meds to help regulate blood pressure, blood clotting rate, cholesterol, water retention, heart rate and associated issues.  You get used to taking the meds on a regular schedule.  Some use their cell phone's alarm clock as a reminder device.