Biopsy Procedure is a Heart Transplant Necessity

The folks at the U of MN are making plans for my first "heartaversary" status visit.  It will include a biopsy and a series of other procedures and tests. The chances of rejection are ever present and life long.  The body has a one track approach to a "foreign organ":  kill it.

Everyone fortunate enough to receive an organ transplant is subject to having the organ--heart, kidneys, liver--attacked by the body's self-defense system. To even the odds for survival, cardiologists use a drug regimen that suppresses that self-defense or immune system.  But even with immuno-suppressant meds, the body still wants to annihilate the foreign organ.

A significant problem in the "rejection" arena is that the recipient of the gift of life doesn't feel a thing. There are likely no symptoms or pain.

One of the methods of determining whether a heart transplant recipient is rejecting the donated heart is to take some tissue samples from the organ and have a pathologist examine them under a microscope.

There are two types of rejection: acute cellular (most common) and humoral or vascular.

The pathologist can assess "rejection" by examining cells, looking for signs of the body attacking the new heart.  Typically, rejection occurs in the first few months after the transplant operation.  My "acute rejection" was detected after less than three months.  My episode of rejection lasted for a week. I'm told the treatment is high doses of Prednisone (a steroid) by IV for 72 hours.  The dosage for me was 1,000 mg per day and was administered in the hospital. 

The protocol at the U of Minnesota is to have regular biopsies during the first year on a set schedule with additions as necessary.  I think I'm over a dozen so far since last June 8, and there are three months left before my first "heartaversary".

For those who do not know about the procedure, here is what happens.

Typically for me, I report an hour before the scheduled procedure to the Cardiac Catheterization Lab. My vital signs are recorded and a nurse reviews all my medications with me.

The procedure is performed by a cardiologist under sterile conditions.  The whole area is painted (in this case blue) with a liquid that kills whatever is on my skin.  

Lidocaine, a topical anesthetic, is injected into my right neck area at the Jugular vein. A small cut is made in my neck to allow the cardiologist to insert a Swan-Ganz catheter into this large vein.

Pressures on the right side of the heart are measured to determine my heart's efficiency.  All pressures have been good so far.

Another catheter is guided through the Swan-Ganz into the right side of my heart.  This catheter has the capability to take tiny samples (usually four to six) of the heart tissue.  These are the samples that are examined to determine rejection.

The doctor uses X-ray and Doppler machines to guide the catheters  during the procedure which lasts about 20 minutes.

Once the pressures are assessed and the samples are taken, the doctor removes the catheters.  Pressure is applied to the wound site, the blue dye and I leave with a Bandaid.  Someone complained about the Snoopy Bandaids that were used for a long time after the procedure. 

They were among the first bandages to be latex free but were discontinued after the complaint.  This last time, a week ago, I asked for a Snoopy Bandaid, was told the lab didn't use them anymore, but the nurse obliged me by drawing a dog on my bandage before applying it to my neck.

There is another procedure called an Allomap used for testing for active rejection.  I may write about that later.  That's enough information unless you are a cardiology resident, right?

Thoughts on getting a new heart: it's a team effort

After my most recent visit to the U of MN Heart Clinic in Minneapolis last month, I came home thinking how little I know about heart transplant after care. 

I have become aware that everything that happens to the other organ systems post-transplant is interrelated. 

A heart transplant can cause a myriad of unexpected consequences.

The anti-rejection medications interact with other medications and issues arise.  The suppression of the immune system is unpredictable and you can more readily develop infections from bacteria, viruses and fungi.

The point is I don't know what I don't know. Fortunately, the cardio team finds answers.  Experience counts. And they all have the help of other transplant team consultants.

 I now have

--one principal cardiologist and a host of heart consultants (the cardio team has the final say about my care and treatment); 

--a nephrologist for my kidneys, which seem to have issues that are likely drug induced based on my regimen of the anti-rejection meds;

--an infectious disease doc, sorting out my pneumonia susceptibility; 

--a dermatologist, sorting out pre-cancerous lesions;

--an endocrinologist, helping me with steroid induced diabetes;

--an ophthalmologist, helping with drug induced eye issues,  and 

--a consulting transplant pharmacist.  

That's at least a thimble full.  There will undoubtedly be more.

Every day brings a challenge and a new issue, it seems.  No one promised fair winds and following seas.  The new heart is only the first step.  Clearly, it takes knowledge and work to maintain and to keep the gift of a new heart. 

Without the help and support of my caregiving wife, I literally would not be here. She is at once: a factotum; an advocate, ever  vigilant and an effective cross examiner of the team of doctors and nurses.  She gets answers and results.

It takes time to accept the reality of the constant vigilance and preparedness.  My next scheduled clinic follow up is later this month.

Over the drill ground (called the grinder) at Coronado, California, home of Navy SEAL training, there is a slogan on the building that fronts the drill area:  

                                The only easy day was yesterday.

The SEALs are a "mission driven" outfit.  When a SEAL team completes a mission, and survives--often in the face of death--the team faces a new day and a new mission.  The implication is that surviving yesterday guarantees no easy future.  So "the only easy day was yesterday."

The slogan takes on new meaning for me with each passing day. The saying was first used when the SEAL teams were formed during the Kennedy Administration. 

If it's good enough for them, it is more than good enough for me.