San Diego Health: LVADs, Pacemakers and Heart Failure

San Diego Health: LVADs, Pacemakers and Heart Failure

August 17, 2019 0 By Bertrand Dibbert


*positive music playing* – Hi, I’m Susan Taylor with Scripps Health in San Diego, California. Your heart is failing, it’s shutting down. You were told that you
need a heart transplant but there just aren’t enough
donor hearts to go around, and sadly many people die
waiting for a donor heart, for a heart transplant,
but now there is a device called the LVAD, Left
Ventricular Assist Device, and it literally pumps
blood through the body like the heart, when
the heart no longer can. It can be a lifeline until a
donor heart becomes available. Joining us today is 54
year old Darla Calvet, who began to have congestive heart failure when she was just 39 years old, and cardiologist Dr. Thomas Haywood who is the medical director
of the Advanced Heart Failure and Mechanical Circulatory Support Program at Scripps Health, thank you
both for joining us today. – Thank you.
– Sure thing. – Darla, what started
happening to your heart in your late 30s? – Basically just a lot of fatigue, and I was traveling a lot for
work and just noticed that I had edema, which is
general swelling in your body and just an overall
tiredness that happened and inability to do the
exercise that I usually did. – And so you came home from a trip and your ankles were
swollen and what did you do? – Well, fortunately my
sister in law is a physician and so we called her
early on Sunday morning and she said need to get to
the emergency room right now with your swollen ankles. – [Susan] And did you go?
– Yes. – [Susan] Yes? Good,
(laughing) and what did they, what did they tell you
when they got there? – After some preliminary
EKGs and some testing, they told me that I had
congestive heart failure. – Dr. Haywood, what is
congestive heart failure? – Congestive heart failure
means there’s something wrong with the heart so it
doesn’t pump like it should or it fills abnormally so the
pressures in the heart elevate when that happens and so
because the pressures go up, that’s when you get swelling
because that pressure gets transmitted to the
legs and to the lungs so you retain water either
in the legs or the lungs. It makes you short of breath and gives you swelling, et cetera. – What are the causes of
congestive heart failure? – So it can be congenital
or it can be genetic, so there is heart failure
that runs in families. It can be from high blood pressure. It can be from a heart attack. Too much alcohol or other
drugs can cause it, so, or a virus, you can
just get a common virus and it can cause heart failure. – And what’s the difference between congestive heart failure
and a heart attack? – So heart attack means one
of your arteries closes, and so part of your heart muscle dies because of the closure of that vessel, whereas heart failure can
happen with normal arteries or it can happen when
after an artery closes, but heart failure means that the heart is just not functioning
well, and so you retain fluid and get short of breath. – And is it unusual for
somebody in their 30s to have congestive heart failure? – Unfortunately not.
– Really – Typically older people do get it, but certainly younger people have it. One of my friends, her
three-month-old baby had congestive heart failure and almost needed a heart transplant, but then it got better. – So when you met Darla
and you looked over what was going on with her,
what was your advice to her? – Well, she had had a
very good doctor before, so we continued much of what she did. She did need a pacemaker, and uh that did help her for a time, so we treated you for a number of years, and she was able to swim, you know. I always tell people I want
heart failure to be their hobby and not the center of their life, so I would like them to be as, have as few symptoms of possible. We were able to do that for
a number of years for her. – So there was a progression
though, wasn’t it? There was like the medication phase and then the device phase. Talk a little bit about those few things. – Well there are three or four medications that we typically use in Darla’s case when the heart doesn’t squeeze very well. You know, the heart normally
squeezes about like this, and hers was squeezing about
like this and was also dilated, so we give medicines to
unload the heart to make it so it doesn’t have to do as much work, and then we put in
pacemakers sometimes to, sometimes the heart can be uncoordinated and it re-coordinates the
activity of the heart, so we did that for her
and that, that can help for anywhere from a couple
of years to 10 years, but eventually those things
stop working as well. – But when you suggested
the LVAD to Darla, she kind of shied away
from it, because of what? – Well you know, so this is an LVAD. This isn’t exactly the one
she got. They keep evolving. These are made any good old USA. This is an example of
great American technology. We should be very proud of this. This little puppy costs about $80,000, but it goes in, this part
goes inside your heart and sucks blood out, it’s
very simple actually. This is the pump, but think of this, this pump pumps five
quarts of blood a minute, and then the blood comes out here, and there’s a tube here
that goes into your aorta. This wire comes out of you and hooks up into a small
computer that you wear on your belt and batteries,
and so that was the problem with an LVAD for her was that
you couldn’t be able to swim and swimming is a huge part of her life, so we have to tailor our
therapies for the patient, you know and, but then it
started to become inevitable that she would would
need something like this or a heart transplant. – So what can you do with the LVAD, and what can’t you do with it? – Sure, so, um, like in Darla’s case,
we were working her up for a heart transplant
because we wanted her to go just directly to a heart transplant, but she became so sick
that she almost died. She came very, very close to death, and so it became impossible to
wait for a heart transplant, so what the LVAD did was to bridge her. It allowed her to recover,
get off the breathing machine, get off the pumps that
were supporting her, and then recover and so she
had this for about 14 months and then got a heart transplant. Now the other group of
people that get LVADs are people that, for
one reason or another, can’t get a heart transplant. Maybe you’ve had cancer and so the immunosuppressive drugs would not, you just couldn’t take them, or, orcyou have other medical conditions, so actually we put in more LVADs each year than we do heart transplants. Unfortunately, there’s
only about 22 hundred or 23 hundred donors a year- – [Susan] Donor hearts, yeah. – That we can have, so,
but there’s 50,000 people that need a heart transplant or an LVAD, so the LVAD is for the people that we just can’t get a heart transplant for. – But can you, can you
play tennis with an LVAD? Can you play golf? Can you- – I did, I did play tennis with an LVAD. – You did? (laughing) – Rod Carew, the famous
retired baseball player had an LVAD for a time. You can travel.
– [Susan] He came down, he came down to Scripps
to have his LVAD put in. So you can play baseball with an LVAD. – You can play baseball. He’s going, he’s at spring
training now with his, I think he’s more coaching as an advisory role than playing but- – So you can go about with
your normal activities except the thing that you
can’t do with the LVAD is you’re saying you can’t
swim, you can’t put it in water. – So you can’t take a bath. You can take a shower,
and you can’t go swimming. Hopefully, now we are working,
they are getting smaller, and you know, we’re
trying to make batteries smaller and smaller all the time. There will be a fully
implanted LVAD at sometime I think within 10 years. – So you won’t have to power
it up with this external cord. You can do it wirelessly. – Everything will be inside,
it will be wirelessly charged. It’ll charge up at night
where you are asleep. You might wear, you might
wear external batteries part of the day but probably
you could go 4 or 5 hours, so that’ll be a major breakthrough, but we’re still working on that. – So, so Darla, tell us what happened. You went through the medicine phase and then that didn’t work, and then you went
through the device phase, you got the pacemaker, and then things got really scary at one point. – It, my defibrillator and pacemaker, I was having really severe arrhythmias, and with arrhythmia, they’re
very difficult to control, and so the team did their
best to stabilize me, but we discovered together that, you know, the organic solution was
probably the best thing for me via transplant. – And there was one point
when your heart wasn’t pumping and water was seeping out
of your legs, is that right? And your husband took you to the ER, and you were in a coma, is that correct? – Well, they had to put me
in a medically-induced coma, because I was going on life
support and some other things that it’s better if you’re
not, you know, awake for, so it was the best
choice for me, so I was- – And she was on an external pump. It’s not an LVAD, but
she was so sick that uh we had to put, use a pump
like they do in bypass surgery to actually pump her blood
and to oxygenate her blood, and so she was on that
for over two weeks or so. It was a very trying time that
was very scary for all of us. I’m glad you were asleep. I
wish I could have been asleep. – (laughing) That’s what I heard. – But she recovered from
that because she’s young and she always took
care of herself and uh, and then she could get
the LVAD, but you know, she came very close to leaving us and then we had to pull her back and then the LVAD, you know,
completed the recovery, and then she could get a heart transplant. – When you look back on that time, Darla, those years just battling
with this, what do you think? What goes through your mind? – Well, I am just really grateful. I really feel like without the advocacy that I had from Scripps that I
wouldn’t be where I am today. I feel, I tell other heart patients that, you don’t just need a doctor,
you need the right doctor, and you need an advocate that, you know, Dr. Haywood is clearly an advocate, and Dr. Baradarian who did my surgery, because they know what’s
best and they need to go to bat for you when
you can’t as I couldn’t, so I think the combination of
having the right medical team, having a loving family
with lots of support. My husband’s been a champion. – [Dr. Haywood] Oh, the
family was there all the time. – Yeah, so- – Her children, her mother, her husband. We were not gonna let
this one go. (laughing) – Alright, so hold this thought,
we’re gonna come back to it but we’re gonna talk
about the warning signs that congestive heart failure
displays that it’s progressed to the point that you really
need to consider this surgery, because it really is,
it’s a big deal surgery, so just hold that thought,
we’ll come back to that in a couple of minutes. Back in 2014, the LVAD was implanted. What was it like? – Well, I woke up from
the coma with the LVAD on, so it was an instant acclamation
that I had to do to it. But I was prepared, the
team prepared me to know that that could be
happening and so, you know, it’s very unusual to
wake up with, you know, equipment on you and part of your body, but you do acclimate
and I think for women, one of the first things we think about is, “How am I gonna camouflage this thing and what am I gonna look like?” and so when I go visit
other LVAD patients, I kinda coach them on that, and now that it’s smaller,
it’s even more manageable, so I think that it’s, for
me, it was a lifesaver. Literally was a lifesaver. – Dr. Haywood, for somebody
who’s too ill to, um, to have a heart transplant,
how long can they live with this LVAD in? – So they can live years. I mean, the pumps are very robust now. There have been patients
that have lived 10 years with an LVAD so we try to, you know, we wanna make sure that when we put one in that people have a good
life expectancy afterwards so that the heart is the major problem and that we’re not just gonna put this in and they’re gonna pass
away from something else, so we fully expect people to
live years with the device or until they get a heart transplant, but if we know they’re not
gonna get a heart transplant, then they’ll just live for years. – And when you had the
LVAD, Darla, you had to wait in order to get in good enough shape to have the heart
transplant, talk about that. – Correct, my body was
very weak from, you know, just not being well for so many months, and so really it did
help me to get stronger, and I had a react- – [Susan] Your metabolism
was really low, wasn’t it? – Metabolism was low, so
I actually went through a gastric sleeve procedure
with the LVAD intact because Dr. Haywood and Dr.
Bhoyrul who did that surgery were good friends and it
was nice to be at a place where it could happen
quickly so that I could meet the parameters that I
needed for transplant. – [Susan] What, now what
is that surgery, gastric- – It’s a gastric sleeve. It’s just, you know,
helping you to lose weight because when you have heart failure, your metabolism is
pretty much nonexistent, so you can work out forever
and not reach your goals, so Dr. Haywood helped me
work through that issue in order to get eligible for transplant. – Yeah, we had to get her to transplant, and her weight was holding her back a bit, so we’ve done this a number of times now to do simple gastric surgery
so that people lose that, there’s a weight limit for transplant, and so we have to get
you in that weight limit or you can’t get a transplant, so we- – [Susan] You don’t get on
the list for the transplant. – So we’ve done that a number of times, and very successfully, and- – I don’t think people
really understand that, that you actually have
to be healthy enough to have the heart transplant. – You have to be in very good shape. – Well, you could imagine
only 20,000 people in the whole United States get this, so they’re very selective
about who they give it to, and you know, if they’re,
and I couldn’t tolerate that you might not get one
so we were gonna get you a heart transplant one
way or another. (laughing) – So you got put on a
transplant list in 2014, and then how soon after
that did you get the call? – Well, back when I was listed, they have a 30 day wait at the hospital where I was transplanted,
and I was at day 28 when the morning that I got the call, and literally had been on my knees the night before praying for that call, so that came in and I knew immediately because I knew the area
code, and um, you know, we, at six o’clock, we got the
call, and at 10 o’clock, we were in Los Angeles
waiting for transplant. – And that happened to
be a pretty interesting, a very special day, not
only for the transplant, but for what else? – It’s my husband’s birthday. (laughing) So now we share a birthday too. – [Susan] There you go. I stole his thunder on that one. – I was gonna say, it’s his birthday, but then you were reborn
on that day as well. And so you have the transplant surgery. It’s a 12 hour surgery, and
what happens when that’s over? You’re up and walking how quickly? – Immediately after the
surgery, it’s pretty amazing. – [Susan] Within an hour? – Mmhmm. I had to call my
husband to come to the hospital because I was up walking around. – And what are you thinking
at that point? (laughing) – That it’s a miracle, that
it’s amazing, beyond belief, that it’s worth everything
you’ve been through to get to that point, including, you know, working with all the teams
that get you to that point. It’s not just the transplant team. It’s all your doctors
who have treated you. It’s all your social
workers, your advocates. It’s a process, I mean,
it really does take a big group of people to
get you to transplant. – And you were discharged
from the hospital how many days later? – Six.
– Only six days. Brand new heart and you’re
home six days later. – So one of the nice things with the LVAD is it gets you normal again, you know, so she was in really great shape. You know, some people
that don’t have the LVAD get a transplant, they’re near death too, but they don’t have the LVAD, but she was, you know, at home
exercising and everything, so she was in great shape for the surgery. – And so how is life now, Darla? – Amazing.
– [Susan] Amazing. And being an avid swimmer,
you’re back in the water? – Absolutely. – What was that like when
you went in the water for the first time after all those years? – How long had it been since? It must’ve been three years? – Three years. My Labrador drug me from my first swim and we had a great time out there, and I do ocean swims
and it’s all fantastic. I really feel like it’s just
a miracle. It’s amazing. – And what kind of exercise do you do now on a regular basis? – I do everything. I weight lift. I cross-train, I prepare
for events, swimming events, and I’ve medaled and it’s been great. – When you say you’ve medaled,
you’ve been to the what? Tell folks where you- – Well, I’m training for
the Transplant Olympics which I usually do and joining
the Southern California team has been really great. There’s a man who’s 83
that swims and has one leg, so there, and has had a transplant, so there’s a whole group
of us that are kind of enjoying our second lives. It’s great. – Could you get a gold
medal? You’re too modest. – [Susan] C’mon, this is
the year of the Olympics. You got a gold medal for what? – I’ve, my event is, I have two events, the 50 back and the 50
free, and so I’m working on improving my times on those events and getting better and better. But the transplant has
definitely helped me to achieve some personal goals. – And you’re also walking
your dog how many miles a day? – A couple miles a day,
usually four miles a day. She’s a, we’re training her to
be a therapy dog at Scripps, so she’s a Frenchie and she’ll be out here doing the rounds with
me, so it’s pretty fun. – That is so great. Dr. Haywood, let’s go back. We talked about this, we mentioned this a little bit a few minutes ago. What are the warning signs that your congestive heart failure
has progressed to the point that you really need to
consider this LVAD surgery? – You know, that’s a great question, because, you know, we wanna, you know, you have to be pretty
sick to have an LVAD, but we don’t want you to be too sick, because you can get past
the point of no return where you’re so sick then even
the LVAD doesn’t help you, so we always hope to see
patients before that, so I would say if you’ve
been hospitalized twice for heart failure or you needed, um like, IV meds to make your heart
pump stronger in the hospital, that’s a warning sign, or you know, we talked about the
medications that she was on for when your doctor has
to start stopping those because your blood pressure’s too low or your kidney function’s getting worse. Those are all warning
signs that say, you know, we’re getting what we call
Stage D heart failure, which is you know, amongst
ourselves we call it End Stage, but I don’t really like
that term because there are so many other things we can do, but it’s the warning stage, you know. Two hospitalizations,
having to stop your meds, low blood pressure, somewhat
worsening kidney function, or just you just feel bad
all the time, you know? With heart failure, we should be able to control your symptoms, if
we can’t control your symptoms, that’s a warning sign too, you know. If you can’t do many of the
things that you wanna do, I don’t think that’s acceptable, and we need to do something else. – Darla, when you reflect
back on this journey, what do you think? – I just remember that Dr.
Haywood was the only physician to say, “I will make you
better,” and that’s huge. When you’re losing hope, when you’re a congestive
heart failure patient, that’s what you wanna hear, so for me, that’s when I knew that
things would turn around, no matter what. – [Susan] And Dr. Haywood,
what is that hope that you have for all of your patients? – Well, you know, you go into medicine because you wanna help people, and we have tremendous tools
and this fantastic system here at Scripps to help people, you know? Heart failure doesn’t have to
be a terminal illness anymore. We have transplant, we have LVADs, we have monitoring systems,
many people can live very well. We call our center the
Heart Failure Recovery and Research Center because
we want to get you better. You know, and that by whatever it takes. You know, many people’s hearts
just get better with therapy. They never need a
transplant, that’s wonderful. But some people need transplants
and whatever you need, you know, we try to figure
out what’s the best therapy. What you want, what fits
your life, what you need at the particular time, but
heart failure can be treated. It’s a treatable illness. – And here is living proof right there. Thank you both very much. Scripps is repeatedly ranked
by US News and World Report as number one in San
Diego and among the best in the nation for heart care. If you would like more
information on heart failure and the LVAD, please click on the link. If you want more critical
information about your health, we take care of you from
head to toe at Scripps. Please subscribe to our YouTube channel and also follow us on social
media at Scripps Health. I’m Susan Taylor, thanks
so much for joining us. At Scripps, it’s our mission
to help you heal, enhance, even save your life. *positive music playing*