Wednesday, November 6, 2013
HEART Continued from 20 Pauley Heart Center’s heart transplantation program — one of the world’s oldest — at the Medical College of Virginia in Richmond. “The next big breakthrough is going to come out of (engineering schools such as) MIT and not medicine.” He added: “We can now take someone near death’s door, put in a mechanical device, rehabilitate them over several months and improve their state of health, so that when they do have the transplant, they are in much better shape.” That was what happened to Cheney, who was indeed at death’s door, his heart and kidneys failing, in July 2010, when he was rushed into surgery to receive an LVAD. It restored his health to the point that he was able to receive a heart transplant 20 months later, at age 71. “I believed I was approaching the end of my days, but that didn’t frighten me,” Cheney writes in his memoir “Heart: An American Medical Odyssey,” which he published this month with his cardiologist Jonathan Reiner. “If this is dying, I remember thinking, it’s not all that bad.”
quickly. According to heart surgeons at three Washington area hospitals, more than half of the patients who received transplants at heart centers in this area last year had previously gotten an LVAD. In 2012, about 2,000 LVADS implantations were done — a tenfold increase over 2006 — and doctors say they expect the numbers to continue to sharply increase. A 2011 study suggested that 40,000 to 200,000 patients each year would benefit from either an LVAD or a heart transplant. Ventricular assist devices — in addition to LVADs, there are units that support the right ventricle, or both sides of the heart — allow doctors to give transplants to older, sicker patients. When Felice got his new heart, 50 was the absolute upper age limit for transplant recipients, said his cardiologist Edward Kasper. Now, the absolute limit is 75. Hearts are a scarce resource, and doctors are reluctant to put them into people who aren’t likely to live very long. Cheney, who had suffered five heart attacks and undergone many surgeries, was one of the oldest patients at Virginia’s Inova Fairfax Hospital ever to receive a new heart. “Mechanical circulatory support has been a real game-changer,” said Nelson Burton, chief of heart and lung surgery at Inova Fairfax. He said he implants twice as many LVADs as hearts these days, and “I’m sure that ratio will increase as the technology improves. We’ll be putting in more and more of them.” Patients in search of a new heart face an uncomfortable reality: Most hearts become available when young people die of head trauma, usually through homicide, suicide or car wreck. Medicine is getting better at keeping such patients alive, which decreases the number of hearts available for transplant. ••• Given this fact, the future points to a device industry making gadgets that guarantee longer lives without transplant. In 2012, 40 percent of LVAD recipients got their devices as “destination therapy,” meaning they are permanent implants. Already, many LVAD recipients don’t expect ever to receive a heart transplant. Some recipients of the HeartMate II have lived with it for eight years. The device theoretically could last in a patient for at least 17 years, according to Gary Burbach, chief executive of Thoratec, the Pleasanton, Calif., company that makes it. A small percentage of LVAD patients have had the devices removed after their native hearts recovered sufficient function following a period attached to the pump. HEART » 22
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MEDICAL INSIGHT Submitted by Contributing Community Author
Dellie B. Dickinson, M.A. Licensed Professional Counselor
1716 University Avenue Fairbanks, Alaska 99709 (907) 460-2166
There’re 3 Sides to Every Story Most of us have heard the saying “There are two sides to every story”. Typically, however, within any given relationship there are three sides: yours, the other party’s and, somewhere in the middle, the reality of what really is. Too often we make the incorrect assumption that we know exactly what the other person meant, why they said what they did and the motive behind thier statement or behavior. We don’t consider that we may not have actually understood what they were trying to say and we are, therefore wrong in the motive we place on them. These seemingly small errors can have big consequences on relationships if one interprets another’s words or behaviors incorrectly and fails to challenge their own perception or interpretation. Consider this: what we believe about any given situation impacts how we feel about that situation. What we feel, in turn, impacts how we behave and how we behave impacts the relationship or the situation. It is crucial that we make sure we are interpreting the message or behavior correctly, and be willing to challenge our own beliefs regarding any given situation by checking it out with the other person. For example, you might simply say “I don’t understand. What did you mean by that?” or “That felt like criticism. Are you angry with me?” Maybe even, “You seem stressed today. Is everything ok?” This gives the other person the opportunity to clarify what they meant or how they’re feeling and you are able to challenge your own interpretation of the situation. Take, for instance, a husband and wife. She makes the statement “You are working too much. I never see you anymore!” What she is trying to communicate is “I miss you. I’ve been lonely without you”. What he hears is criticism, “You are not meeting my needs”. So, rather than responding as she had hoped with care and attention, he responds with anger and pulls away from her, as is consistent with his belief that she is being critical. This confuses the wife, as she was trying to move closer to him. She is hurt because his response does not match the message she sent him. When she senses him pulling away from her she feels rejected and believes he does not care how she feels. She attempts to pursue him, often resulting in the husband feeling attacked, which only causes him to withdraw even further. Based on this scenario, the husband did not react to the truth of the matter that his wife was lonely, but rather to his interpretation that she was being critical. She, on the other hand, did not consider that he may have felt criticized, but incorrectly assumed he was uncaring and selfish. Both interpreted the other’s comments and behaviors incorrectly and neither considered the possibility that they may be wrong in the motives they attatched to the other’s words and behaviors. Another way to think about this is that we do not respond to reality, but rather to our perception of reality. Again, how we interpret any given event determines how we respond to it. Public speaking, for instance, is a welcome opportunity for some. For others it is to be avoided at all cost. Or for some, running late for an appointment is “no big deal”. To others it is cause for significant disstress. There is the reality, “I have to speak in public”, or “I am running late”, and then there is our interpretation of that reality and what it means to us. The interpretation of that reality is what we react to, not the event itself. Healthy relationships require a certain humility and tentativeness about them; the willingness to say “It’s possible I misunderstood. Help me understand what you meant by that”. Being willing to challenge our own beliefs and hear how others experience us will go a long way in making others feel heard and cared for, while at the same time avoiding unneccessary pain and confusion within our daily relationships.
Our thanks to Dellie Dickinson for contributing this column. The article is intended to be strictly informational.
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••• Caring for the heart has many dimensions, including diet, drugs, stents and bypass surgery. But it used to be that transplantation was the only solution when a heart was beyond repair. The first transplant was done in 1967 by South African surgeon Christiaan Barnard, who had learned much of his technique at the Medical College of Virginia. Transplantation was rare — and post-transplant life expectancy was measured in months, not years — until the early 1980s, when the FDA approved cyclosporin, an immunosuppressant less damaging to the body than anti-rejection drugs used up to that point. In 1994, the FDA approved the first ventricular assist device, and in 2008 the agency approved the HeartMate II, the current leader in the LVAD market, as a bridge to keep patients healthy until transplantation. Another popular LVAD is made by Heartware International. The 10-ounce LVAD contains a finger-size pump that pushes blood through the heart. LVADs drive a flow of blood through the heart continuously rather than in pulses. As a result, the patient usually does not have a measurable heartbeat, because the device is doing most of the pumping that the heart once did. “At the hospital they liked to call us the zombies,” Einhorn said. Use of these devices has expanded
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