During lunch one day in the cafeteria, Gary, a San Antonio bus driver, started coughing. He thought he was choking on a piece of chicken. Then, after another bad coughing spell-;this time while he was driving-;he went to the Emergency Room where he was shocked to discover he had congestive heart failure.
Gary was referred to Dr. Michael Kwan, a board-certified heart failure and transplant cardiologist with Texas Transplant Physician Group. Gary received an external defibrillator and intravenous medication to help improve his heart's contractions. "Aside from the defibrillator going off accidentally a couple times, I was feeling fine," Gary says.
But Gary wasn't fine for long. He developed diabetes and required insulin injections. Despite several more interventions to improve the function of his heart, Gary's condition began to deteriorate. Soon he would face the ominous decision to be listed for a heart transplant. He was scared and unprepared. "It was kind of spooky at the time. If I had a transplant, I'd be so worried. Can I do it justice? If it fails, can I get another one?" Gary wondered.
There was another option. Dr. Kwan proposed a ventricular assist device, or VAD: the HeartMate II® LVAS (Left Ventricular Assist System) to pump blood throughout Gary's body and give his heart a chance to heal, possibly until a suitable heart was available for transplant. The device has a small, quiet motorized pump connected to his left heart ventricle with a lead to an external power source and processor.
While Gary was weighing his options, he had gallbladder surgery followed by a rapid decline in his health. Gary went from weighing nearly 200 pounds to just 138 pounds. His kidneys started failing and he wasn't lucid. It was almost Christmas and Gary was in trouble. "If I didn't have the surgery to implant the HeartMate II on December 24, I wouldn't have seen Christmas day," he says.
Again, unprepared for what he faced with the VAD, he was nervous. "I knew I would be limited in what I could do. I knew not to be out in heavy rain even with a big umbrella. I gave up going to the River Walk -; what if I got pushed in? I even stopped going to the movies in case something happened."
Over time, Gary became increasingly comfortable with the VAD. "I started going to the flea market again, doing more -; I started having a life again!" he says. "I started to realize that, hey, this isn't really that bad, and I managed to carry on a very, very great life."
Gary is grateful for the support of Dr. Kwan, Dr. Chandra Kunavarapu-;who joined the practice in early 2009, just after Gary received the HeartMate II -; and the rest of the team at the Advanced Heart Failure and Transplant Program. "All of the staff at the clinic were super great. I knew they were there for me all the time -; and that I would never feel alone. They made sure I never left without being sure everything was fine. It was very comforting," Gary says.
Another important element of Gary's care was his nephew, Justin, who was born shortly before Gary's heart failure was diagnosed. "When I was sick, he would put his head on my bed and hold my hand. Just him looking at me made me want to cry," Gary says. "Then when I put my mask on to change my dressing I put a mask on him, too, and he would point and say, ‘Uncle Gary has a boo-boo.'"
Gary was fastidious about maintaining his HeartMate II -; keeping clean the exit site where the lead connected to the implanted pump comes out of the abdomen, keeping the batteries charged, and ensuring that people around him understood what it was and how it worked.
He made some changes to his diet by cutting back on salt and trying to cut back on sweets -; a major weakness for Gary. He also experienced some temporary and unusual changes in how food tasted once he got his HeartMate II. "I could not eat pickles before and now I love them," Gary says. "I LOVE hot peppers, but, for a while, I couldn't find anything that tasted hot enough." Gary even ate a "ghost chili", the hottest chili pepper on earth -; the oil of which is smeared on fences in India to keep wild elephants from encroaching on farmland and villages -; and didn't find it to be that hot.
Then, in late January, 2010, an infection at the exit site would lead to an unexpected development in Gary's condition, the HeartMate II was removed and he was placed on the waiting list for a transplant.
"We passed on two or three hearts because they weren't a perfect match," Gary says, "Dr. Kwan is very particular and that turned out to be a great thing for me!"
While Dr. Kwan and Dr. Kunavarapu continually monitored Gary and weighed the options of getting him a new VAD or a new heart, Gary's heart appeared to have largely rebuilt itself. Dr. Kunavarapu told Gary he could keep his own heart and wouldn't need another VAD. For a while Gary felt tired and weak, but, gradually, after a strict regimen of cardiac rehabilitation and follow-up, his heart improved and was pumping more efficiently.
And he is excited about his renewed sense of adventure. "When I first got the HeartMate II, I was scared -; I didn't want to do that much, but it was a blessing in disguise. Now, I can plan long trips, go on airplanes, go deep-sea fishing -; anywhere!" he says. "The HeartMate II gave me my life back."
AN UPDATE: In early September, 2010, Gary was hospitalized with bronchitis which strained his heart: he would now need a transplant. "Dr. Kwan said I wouldn't be leaving the hospital until I got a new heart, so I'm thinking, great-;here goes another year in the hospital!" says Gary. But just nine days later, Gary got word that his new heart was on the way.
On September 17, Gary received his transplant and just two weeks later was released from the hospital. "I felt like I'd never had one single surgery in my life. I felt so much better-;I just wanted to run around!" says Gary.
Today, exactly six months later, Gary is looking and feeling even better-;exercising regularly in the fitness room at his apartment building, taking the stairs to his floor (unless he's carrying groceries), eating healthy food and enjoying life. Now that heart biopsies are required only once a month, he has even more time and energy to get out and do the things he has wanted to do since he got sick in the fall. "This weekend I'm leaving Bexar County for the first time since the transplant-;to go to the Rattlesnake Races at Old San Patricio," says Gary, although now that he has a new heart, he won't be racing any snakes like he did as a teenager!
Texas Transplant Physician Group serves patients at Texas Transplant Institute's Advanced Heart Failure and Transplant Program on the campus of Methodist Heart Hospital in San Antonio, Texas.
Texas Transplant Physician Group kidney transplant surgeons serve patients at Texas Transplant Institute's Kidney Transplant Program on the campus of Methodist Specialty and Transplant Hospital in San Antonio, Texas.