Lifeat9200rpms: Stroke SITREP

     Support groups for LVADs are important, in my view, because they give the pump owner a chance to compare notes, get answers, and share practical experience.

     My LVAD support group in Fargo meets monthly at Sanford Clinic and Hospital.  It is for those with LVADs and those with heart transplants, some of whom have had an LVAD before receiving a heart.

     At our meeting this week, a compatriot LVAD, who has had his pump since December, 2009, four months before I got mine, came to our meeting using a cane.  Something was up.  He never used a cane before.

     I learned that he had a stroke recently and had to be hospitalized.  Strokes are generally of two types: bleeding and clotting.  His stroke resulted from clotting.  He was told that his continuous flow LVAD damaged blood platelets. I have the same pump and have been fortunate so far not to have a stroke. Platelets are the clear cell fragments carried in the human blood stream that aid in clotting.  Apparently when they are damaged, platelets start the clotting process. And that can cause problems, including a stroke.

      He was told that his pump speed of 9,000 rpm's combined with his low INR (the International Normalized Ratio for clotting) caused the platelets to break up, leading to his stroke.  Once hospitalized, his HeartMate II pump speed was reduced to 8,800 rpm 's and his INR was increased.  The INR of a normal healthy person is about 0.5. The INR target range for most LVADs is 2.5 to 3.5. 

     The point is that since continuous flow pumps are machines, significant variations in clotting capability combined with pump speed can cause problems.  My pump speed is the working title of this journal: 9,200 rpm's. My INR range is 2.0 to 2.5.  I check it almost weekly.  All LVADs follow an anti-coagulation or anti-clotting regimen using Coumadin/Warfarin and some also use aspirin. 

     As a result of his stroke, my compatriot can no longer drive a car, because the drivers licensing authority suspended his license because of the stroke.

     He is recovering relatively well.  His speech is somewhat impaired but getting better.  He hasn't lost his sense of humor.

     Being on the list for a heart transplant is another issue.  The heart transplant listing authority, UNOS (United Network of Organ Sharing) rules require that those LVADs who suffer a stroke be downgraded from category 1-B to category 7.  Essentially, those in Category 7 are temporarily out of consideration for a donated heart, should one become available.

     There are many aspects to medical and self-management after an LVAD is implanted.  Despite all of that, my quality of life is excellent.  My wife and I just hosted our 18-month old granddaughter and her parents, which I would not have been able to do without the miracle that is my pump.