Life at 9200 rpm's: Waiting and Living

     What does an LVAD do while waiting for a heart?  I can't answer for anyone but me.  I'm enjoying the fall weather in Fargo and at Detroit Lakes.  

     Today I helped build and load a firewood rack with about a cord of wood.  The house fireplace is gas operated, but we have a chiminea that seems constantly in use.  A chiminea is an outdoor fireplace made of earthenware shaped like an upside-down fat light bulb.  It sits on a wrought iron stand and the narrow part is the chimney.

     The dogs, our four and a visiting fifth, romp in two feet of oak leaves.  Their coats smell slightly of wood smoke.

     It is overcast this afternoon and the lake is flat.  A few late season muskie fishermen ply the waters several hundred yards off shore.  I've heard that a few monster fish have been caught, photographed, and released this year. There a size limits for keeping these fresh water sharks.  

     Mounting them using a taxidermist has become prohibitively expensive.  The preferred method is to use photos to recreate a plastic resin model that replicates the fish.  That way someone can catch Mr. Muskie again, if he knows what he's doing.

     Frank Vacek, a Canadian lodge owner and guide, took a crew of us out on Lake of the Woods from Sioux Narrows, Ontario, one June in the early 70's.  Our boats all had 15 horse outboards on them.  

     As we fished along trying for walleyed pike, Frank caught sight of a muskie closely following the propeller of one of our boats.  He called out to keep the boat steady until Frank signalled to cut the engine.  It took less than a minute for all this to happen.

     Frank cast a muskie lure that must have been 10 inches long between the boat's propeller and the following fish.  He timed the cast well and called out to cut the motor.  At that point, Frank cranked the muskie lure away from the stopped boat propeller and enticed the muskie to follow.  Despite his skill, Frank couldn't tempt the big fellow to strike but the whole spectacle was worth it.

     Later, back at the lodge, Frank said he once had a muskie attack an outboard propeller.  The prop had teeth marks on it but the engine won the battle.

    My HeartMate II gives me the chance to be with family and friends.  It is the lifeline that allows me and other LVADs to wait and live.

     I read that the International Society for Heart & Lung Transplantation has data that show that about 60 percent of heart transplant recipients age 70 and over live at least six years from the time of transplantation.  About 80 percent of patients getting new hearts because of damage caused by coronary disease survive at least six years.

    The same data show that about 70 percent of LVADS survive about the same length of time after receiving a new heart.  The data involve transplants between 2002 and 2009.

     Research has shown that being on a waiting list for a heart transplant with an LVAD, has reduced the mortality rate.  My heart surgeon at the University of Minnesota in Minneapolis, Dr. Ranjit John, has been quoted as saying that mortality has been reduced for LVADs into the single digits.

    LVADs account for more people than heart transplants.In the United States about 3,000 ventricular assist devices are implanted yearly compared to about 2,500 heart transplants.  The transplant rate has not increased since 1994.


     Having an LVAD can keep a wait listed transplant candidate alive for several years.  That fact was not always the case.

     Fewer hearts are available for donation because car air bags and the use of helmets by those engaged in high risk sports have reduced the number of fatal head injuries in young, healthy men--the most common source of donor hearts.

     I am alive today because I got an LVAD.  It has been reported that as many as a third of those receiving heart transplants have a similar mechanical circulatory assist device.  What the LVAD has done for me is to underwrite my exercise and conditioning to be better prepared for a transplant, if one occurs. 

     My HeartMate II LVAD manufactured by Thoratec Inc. of California cost about $80,000.  Installation is extra.  I had my chest opened three times in 11 days to implant the pump and stop bleeding.

     A Duke University study on the cost effectiveness of LVADs cost $360,407 over five years.  A study of treatment to that former Vice President Cheney received showed the yearly cost was $167,208 for every year of life saved. 

    How does anyone assess the cost effectiveness of such treatment?  One cost effectiveness figure showed that $50,000 was acceptable with a range up to $100,000 per year of life. A European study in 2011 showed a cost of $414,275 per year of life saved.

     At 68, I'm three years younger than Cheney.  My overall health is excellent.  My LVAD has forestalled a life count down as the Society for Heart & Lung Transplantation suggests.

     I am grateful for the opportunity to be living and waitng.

     

     

    

My Life at 9200 rpm's: Heart Felt Fall Reflections, LVADs, Transplants, and Dick Cheney

     Fall brings shorter days and the area around Fargo shifts to cold weather mode. A wag once said North Dakota has two seasons: winter and road construction. 

    It snowed and rained this week just as several yards of dirt were about to be applied to the side yard.  We've had a dry year so far and thought now would be the time to address the low lying yard that attracts any available runoff water from every direction. The weather didn't exactly cooperate.

     The area of our yard turns into a swamp because of the grade. Swamp conditions and several canines do not mix well when they return to the house.  They are cute but clueless about paw prints and tracking.

     The wind borne snow, which didn't accumulate, shook off leaves from the birch, elm, and so-called seedless cottonwoods and  loosened apples from our lone apple tree on the north side of the house.  Overnight temperatures are at freezing and the daytime temps are lucky to be 10 degrees warmer.  Time to start thinking about the snowblower and gathering outdoor weather gear.

    The fill for the yard will arrive this week. Apple pie sounds good.  The snowblower won't start and needs an oil change.  I located my parka, mittens, and boots.  I'm good to go thanks to my LVAD #8358.

     Among the reflective interludes I had was one of former Vice President Dick Cheney, who had a HeartMate II LVAD for more than 20 months before he received a new heart at age 71. His story is inspiring to me. 

     He had many heart related events during his adult life, starting at age 37 with his first heart attack in 1978. He had two other heart attacks in the 1980's. and underwent bypass surgery, angioplasty, and had stents installed.  In fact, Cheney's heart treatments parallel most of the major pharmaceutical and medical procedure advancements that have developed since 1984, when he suffered his first heart attack.

     His heart condition caused him significant pause when he became a vice presidential candidate. Cheney determined that he not want his heart condition to cause a Constitutional crisis or at least a disruption in the event he was totally disabled.  

     The 25th Amendment to the Constitution,  on presidential succession in case the chief becomes incapacitated provides for the transfer of duties for the President but not what to do about a vice president who is unable to perform the duties of his office.  

     Cheney wrote in his 2011 memoir that when he joined the ticket with George W. Bush he planned to write a letter of resignation and keep it on hand where an aide could access it, if Cheney became incapacitated.  Fortunately, his heart condition never incapacitated him to the point the letter of resignation had to be submitted to the Secretary of State.

     I learned for the first time that when Cheney's LVAD was implanted, that he was unconscious for several weeks after the surgery.  His surgeon  told a New York Times reporter, who himself is a physician, that Cheney's 20 plus months with an LVAD was not free of events that were not otherwise specified.

     After all that travail, Cheney's is an amazing story. At 71, he is blazing a trail for all of us older persons awaiting the gift of a new heart.
    
     I am extremely fortunate that the University of Minnesota policy permits me at age 68 to be wait listed for a heart transplant. My part of the bargain is to stay in good overall health and maintain myself with the LVAD since congestive heart failure is a permanent irreversible condition.  

     None of my other organ systems have been compromised, I'm told, and so good health has allowed the U of MN heart transplant team's thorough evaluation of me as a candidate for transplant to give me the thumbs up.

     For patients 65 or older, it has been reported that 243 patients nationwide received new hearts in 2006, while in 2011 there were 332 heart transplants. The data comes from the national Organ Procurement and Transplant Network.  There is no data available for the over 70 group like Cheney.  

     Meanwhile, without the life giving LVAD that has stood me well these past many months, there would be no fall reflections or any other reflections for that matter.  Besides, the apple pie sounds terrific.