Archive for the ‘Cardiology’ Category

Behind Those Doors

November 21, 2010

Karen Thurston Chavez is Co-Founder of the support group Broken Hearts of the Big Bend (BHBB) and a good friend. We met when I spoke at BHBB’s Congenital Heart Defect Symposium last year and we trade e-mails at least once a week, keeping up with each other and discussing the latest issues affecting the Heart Defect community.

Karen’s blog has a most unusual post you need to read – in September, she was able to shadow her son’s heart surgeon for a day at Shands Children’s Hospital in Gainesville, Florida. But then something she didn’t expect happened:

I figured I would sit in on conferences and consultations he had with families whose children were having, would be having, or just had open-heart surgery to repair their congenital heart defects.  I guessed that I would sit and watch while he handled administrative work. I was right. I did all those things.

I did not think I would step into his operating room.

So I’m sending you over to her blog for today’s post. Karen will help you get scrubbed in and then walk you into the Operating Room as Dr. Mark Bleiweis performs open heart surgery.

SHADOWING MY SON’S HEART SURGEON

Heart Defects and the 2010 Midterms

November 8, 2010

With the recent victory by the Republican Party in the 2010 midterm elections, another, larger issue looms: The Republican Party ran on the promise to repeal the Affordable Care Act and replace it with other forms of health care reform. If they can’t do that (And most likely they can not), they will refuse to fund it. And with Republicans in control of House of Representatives – where all bills that allocate money originate – this is a threat they can make good on.

This is not good news at all for Congenital Heart Defect patients. The Congenital Heart Futures Act which was once a stand alone bill, was “folded” into the Affordable Care Act. So if the Affordable Care Act is repealed, there goes the Congenital Heart Futures Act. And if it is unfunded, the Congenital Heart provisions won’t be funded either. In an ironic twist, the sections dealing with Congenital Heart research and funding never were funded to start with. We wouldn’t have lost anything, because we never had anything to start with. Just words on a piece of paper.

Tell George Washington that the Declaration of Independence is just words on a piece of paper, and let me know how that goes for you.

We can go to Washington, meet with our legislators, and request funding, but there is no guarantee. Every other worthy cause will also be in DC, trying to make sure that they get their money, too. And since we were never funded in the first place, that puts us way down on the list. After all, if we never received any money at all, there must not be much to these heart problems. If it were serious, we’d be throwing cash at it! (They don’t call it an invisible disability for nothing, folks!)

The new legislators won’t take office until January 20, 2011, so we have a little time to prepare. We can’t really prepare a strategy yet, but we can get set in our minds what we are working for.

This isn’t a party issue. It is not Republicans vs. Democrats. People of all political walks have heart defects – an unborn child’s heart begins to develop early, and often the heart is forming before the mother even knows she is pregnant. This doesn’t benefit this side or that side, it benefits people. Because a house divided cannot stand, and a house united cannot fall.

This isn’t for us. This is for our children and their children. This is for the parents who sit in the Intensive Care Unit and fear that their child’s next breath may be the last one. This is for those who have to live with medication, scars, blood draws, and the knowledge that they are different, outsiders, alone.

A lot of people believe that Conservatives and Progressives are so far apart that they can’t even order lunch together. I choose not to believe that. I think we can all work together to bring Congenital Heart Defects under control and eventually condemn them to the dustbin of history.

On the cutting edge

November 5, 2010

Do you think my child needs one of those medical information bracelets? He had Transposition of the Great Arteries but his doctor said he was fixed after his surgery.

Yes, I would certainly get a Medical Information bracelet. I personally use MedicAlert, because you aren’t limited by whatever you can squeeze onto the bracelet. MedicAlert is a little more expensive – you have to pay for both the service and the jewelry – but you can have so much more information. I don’t just have a heart defect, I’m also in Heart Failure, you can’t read my pulse, my blood pressure, or give me an injection in my left arm because of my Blalock-Taussig shunt, and I take a small bucketful of medication every day. A “bracelet” that listed all that would be as long as my arm! (just try getting it through airport security!) With the MedicAlert bracelet, you discuss your detailed health information with a nurse over the phone and your bracelet comes with a telephone number and a numerical code. If something happens and you can’t speak, emergency personnel can call the number and enter the code, and they will have instant access to all of your information. Most of their bracelets are waterproof, so you can wear them in the shower – after all, it can’t do you much good if you have passed out in the bathroom and your bracelet is lying on your bedside table.

The Medical ID bracelet is important and could save your child’s life… but that isn’t the reason for today’s post. The second part of that statement made my hair stand up: He had Transposition of the Great Arteries but his doctor said he was fixed after his surgery.

Holy cow! Read this carefully, it is very important that it be understood: A heart defect can not be fixed. The word “fixed” implies that it is good as new. It isn’t. A heart can be repaired through surgery, which means that it can be made to function – perhaps not in the normal manner, but it is functional.

It is hard to believe that there are still doctors who tell Heart Parents that their kids are “good as new!” They used to tell them that, back when I was growing up – because they didn’t know any better. There weren’t that many Cardiac Kids around, so no one really had any idea what the future held for these children. But this child had been born with a critical health problem, had survived a delicate surgery, and would get better. He or she might not have as long or as full a life as the other kids, but we had won this battle. Now go, get out there and enjoy your life! And for years that was the common practice, because kids with heart problems didn’t live as long as other children. As an example, Cardiologists at Johns Hopkins Hospital told my parents that if I needed a second operation, it would probably have to happen ten years in the future. My parents asked what kind of surgery I would need, and after a long, uncomfortable pause the doctors admitted that they didn’t know. “That operation probably hasn’t been invented yet.”

But then something totally unexpected happened: Cardiac Kids grew up! As we grew, we had more heart problems – some of them related to our original defect, and some of them new. Doctors had new tools they could use to help us out, either a new drug or a better surgery. They could do a lot more with Catheterizations, too. And while we were proving that we could grow up, doctors were discovering that those heart problems were still popping up, sometimes years after we had been “fixed.” And their thinking started to change.

Today, most Cardiologists will tell you that your child’s heart has been repaired – and he or she will always need specialized cardiac care. Their heart is misshapen, blood vessels run the wrong way, it has holes where there shouldn’t be any, and has been altered by surgery. Even after they grow up, Heart Children will always have to make allowances, take medication, go see their Cardiologist, and stay on top of their health. And they will have to do this forever – because even though their heart is functional, it isn’t normal. No it isn’t fair, but this is the way it is.

And if your Cardiologist is telling you your child is “fixed”, you seriously need to consider finding another Cardiologist. Because this one is living in the past.

And Cardiac Kids live their lives right on the cutting edge of medical science. We always have, and we always will.

Flu!

November 3, 2010

Doctor: “What’s wrong with you?”  Patient: “Flu.”  Doctor: “Looks like you crashed!” – Old Joke

Ready for Cold and Flu Season?

Colds and Flu can be rough on someone living with a Congenital Heart Defect. We tend to heal slower than others, and with our less than perfect Circulatory Systems, chest colds can be a nightmare. Whenever I catch a cold, it’s usually going to hit me harder than the next guy. The same cold that will keep him in the bed for a day could keep me in the bed for several days. That is, if I can lie down. It is liable to clog me up to the point that when I lie down, I feel as if I am drowning. Often I wind up sleeping upright in the big recliner in the living room, tucked under a blanket.

Heart parents today have a yearly debate, trying to decide how to care for their child during the winter months. Some parents just bundle them up tighter than usual, others decide that the best thing to do is to go into lockdown, rarely coming out during the winter months. My parents were of the “bundle him up” group. Not because of any instructions from my Cardiologists, but rather the lack of instructions. I was born in 1966 and most of my childhood that I can remember occurred during the 1970’s. The ’70’s were “back then” as far as Congenital Cardiology was concerned – no Pediatric Cardiologist had a good answer for most of my parent’s questions because there weren’t that many Cardiac Kids around. The usual answer was “I don’t know!” or something close to it.

I had a Cardiologist who wasn’t much on the bedside manner – a visit to his office was almost like playing hockey and continually being slammed into the walls – but he was pretty smart. He told my parents that “If you want him to be a normal child, you have to treat him as close to normal as possible.” So my folks just let me go – with limits. During winter I had on so many clothes I felt like a turtle; if I fell over there was no way I could get up. I’d just lie there and roll around on the ground. If someone at church was sick I had better not sit near them, or move as soon as I realized that they were ill. I missed a few services over the years when several people had colds, and even missed a few days of school for the same reason (which highly irritated one teacher!) But I muddled through. I caught the occasional cold and suffered through it, but that is a normal part of childhood.

I can’t say this is what you should do, only your Cardiologist can advise you on what to do during Cold and Flu Season. And be sure to ask your Cardiologist – your Primary Care doctor will have good advice, but you have a heart defect. Ask the doctor who specializes in hearts, he or she will have a better answer.

Most of the time – not always – the Flu Vaccine will be recommended for us. If you are in doubt, again – ask your Cardiologist. As a general rule we’re told to get “dead virus” vaccinations. At the current time vaccinations in the United States can be either “dead virus” or “live virus”. Live virus vaccinations have actual, living virus cells in them – they are weakened, but they are living. With a dead virus vaccination the virus has been deactivated. Even deactivated, the body still realizes that a case of the Flu is present and starts building antibodies to stop it. As far as I know, only the FluMist vaccination is a live virus formula.  Be certain to inform the person giving the vaccine that you have a chronic health condition and need the dead virus formula.

While you should always be cautious, you should never be scared to live your life!

Dreams of a Funky Heart

October 26, 2010

Beginning to get things together for the trip to Atlanta. The weather is predicted to be a low of 39 Friday night (Brrr!) with a high of 70. (No, I still do not like cold weather!)

And yes, I am smart enough to realize this is an American Heart Association event, and I do understand that the Heart Association does not support Heart Defect causes very well. That’s not the point. Emory University Hospital is a major sponsor and has entered a team; my Adult Congenital Cardiology group is based at Emory and they have entered a “mini-team”! We’ll have bandannas to mark us as CHD survivors, parents, and healthcare professionals. We’ll be well represented!

And I signed up for a Survivor’s cap, so I’ll have another hat to add to my collection. That may not be a good thing, I already have more hats than I have heads to wear them on. That will just thrill Momma!

It’s not about the hat, or the walk, which group I belong to, or even who is sponsoring it. It’s really about going and participating and being counted. Because when I was a little fella, I grew up thinking that there were very, very few kids around with a broken heart. The American Heart Association (back in the days when they were the only resource for any information on the heart) published a book titled When your Child has a Heart Defect. They only listed TEN different defects – I was too young then to realize that they had grouped several of them together. All of the defects of the blood vessels were grouped together, and the structural defects were grouped into Right Atrium Defects and Right Ventricle Defects. Add to that fact that there was very little known about left-sided heart defects in the early 1970’s, and as a result not many defects were covered. So the way I understood it, there were only ten different defects… there couldn’t be that many people who had one.

That “logic” made sense to me back then. So maybe by going, some Cardiac Kid can see me, and all the other adults living with broken hearts, and realize there are more out there than he/she knew about. And perhaps they will realize that they can beat that broken heart.

A Funky Heart can dream, can’t he?

Your Choice (My Answer)

October 14, 2010

Yesterday I asked Funky Heart! readers the question Given a choice, would you devise a cure for Congenital Heart Defects, or prevent them? To make it a little bit more difficult I added a stipulation: Your choice would have no effect on the other group – developing a cure will not prevent new cases from occurring; preventing heart defects will not cure those who already have them.

The question generated a lot of debate and discussion (as I hoped it would). But what would I choose to do? The answer might surprise you: I’d choose to prevent Congenital Heart Defects.

Preventing all future heart defects would isolate those of us who already have them… the need for Pediatric Cardiologists would drop as would the need for surgeons with CHD repair skills. You can assume there would be the need for a number of surgeons as CHDers could easily need heart operations later in life, but perhaps not as many as before. The number of Cardiologists would also decline, slowly – there would be a need to serve the current number of patients but that would drop as the patients begin to age and no new cases occur.

Older Heart Warriors would have to increase their efforts to inform and educate younger patients and their families. Not being boastful, but this would be the perfect job for an organization that I am a member of, the Adult Congenital Heart Association (ACHA). We’re already working toward a similar goal: adolescents with a heart defect tend to fall away from good cardiac care as they reach adulthood. They no longer visit their Pediatric Cardiologist; nor have they found an Adult Congenital Cardiologist. A good percentage of them may not even realize that they need an Adult Congenital Cardiologist.

The ACHA is working to prevent this from happening, to makes sure CHDers get good care all of their lives. Currently the Bethesda 32  report outlines care guidelines for the Adult Congenital Heart Defect patient and the ACHA’s Vision 2020 Project is a program designed to provide a seamless transition path – from Pediatric Cardiologist to well-trained, competent Adult Congenital Care Cardiologist without a break in care.(Bethesda 32 may be a name you are not familiar with. Every year, experts from the American College of Cardiology meet in Bethesda, Maryland to devise proper care guidelines for a segment of cardiology. The 32nd time they met (the year 2000), they devised guidelines for the care of adults born with a Congenital Heart Defect. You may not be familiar with the name, but the Bethesda 32 Report is very important to the CHD Community. You can read a good summary by CLICKING HERE.)

In the fictitious world we’ve created – one in which all new CHDs can be prevented – older Heart Warriors would have to step forward. We’re the voice of experience, we’ve literally been there and done that. And in this brave new world, we’re a lot more important. Now, we’re going to have to be teachers – teaching the younger generation how to take care of themselves, what to do and what to avoid. And we’re going to have to help each other out, too… the number of Adult Congenital Cardiologists will also begin to drop. After all, in this world where CHDs can be prevented, why specialize in a field that in time, will no longer exist?

This will cause problems, but I believe they can be overcome. We’re all in this fight together, and as Benjamin Franklin said, “We must all hang together or surely we will hang separately.”

CHD and Childbirth

October 12, 2010

“…sometimes, important things get ignored or don’t get said.” – Judge Tolliver, The Jack Bull (1999)

Can a woman with a heart defect bear a child?

The answer is… perhaps. The question varies from woman to woman. Having a defect does increase the chances of having a child with a heart defect, and I am sure that is a “gift” that no parent wants to pass on. Perhaps the better question is should a woman with a Heart Defect attempt to get pregnant?

I can’t answer this question… you need to discuss this with your Cardiologist. Sometimes a defective heart can’t take the stress of nine months of pregnancy. Other times, with the help of a OBGYN trained in high risk pregnancies, the mother can have a child. And there are women who have a CHD who won’t need any extra precautions at all. As I have said before, every heart defect is a little different, and affects the owner differently. A friend of mine should not, under any circumstances, get pregnant… but she and her husband are exploring other options. She’s on her way to becoming a momma, just taking a different path. I’ve met Heart Moms who are really Heart Moms – they’re the one with the defective heart. I’ve met young women who are supremely frustrated because their Cardiologist keeps telling them it would be a bad idea, and I have met childless women who seem to be at peace with their situations.

Any CHDer, but especially a woman thinking of having a child, needs to think it through completely and discuss it with your doctor. Your Primary Care Doctor needs to be consulted, but you really need to consider the opinion of your Cardiologist.  A recent study conducted in Germany showed that nearly half of the women with a Heart Defect had not received any counsel about pregnancy or contraception. And nearly 20% were taking birth control that was contraindicated for them. (In other words, they had a health problem that was listed in the “Do not take this drug if you suffer from…” section.)

The bottom line is that all CHDers – male and female – are best served by looking after themselves. Our health challenges are so specialized that “sometimes the important things don’t get said.” It’s your health, your body, and you have to look out for yourself. The only exception is when you are young; then it’s your parents job to ask the questions. And teach you how to do the same when you grow up.

Off the page

October 10, 2010

Have you seen the newest Facebook craze? It’s a quick little game named “Find out how long you have left!” Answer a few simple questions and you get something like this:

John Doe has 42 years, 106 days, and 19 hours left. ENJOY!

*Snort* Yeah, right. There are way too many variables that have to be considered to make an accurate lifespan prediction. And what happens if you accidentally step in front of a moving bus?

John Doe has 0 years, 0 days, 0 hours, and 3 seconds left. ENJOY!

That could ruin your whole day!

My Atlanta Cardiologist was out-of-town during one of my appointments, so I was being seen by his partner. I don’t mind that a bit – she’s playing at the top of her game, too. It had been on my mind for a while, so I asked her THE QUESTION: Doc, how long do you think I’ll be around?

She rolled her eyes. “We’re pretty much off the page already! But as well as you are doing, if you keep taking care of yourself you should live a good long time.”

The key point, of course, is taking care of yourself. That can be applied to the heart healthy as well as the average CHDer. Keep your butt planted on the couch, you’ll wither away. Get up, get out, keep moving and doing things, you’ll last longer. There were two gentlemen in my community who retired about the same time. One came home, planted a garden, did some home improvement projects he had been meaning to get to, stayed active and lived for 15 years. The other one moved a comfy chair onto the porch, put his feet up on the porch rail and watched the world go by…. and was dead inside of two years. The moral of this story is obvious: If you want to live, tear down your porch rail and sell your chairs!

It’s not that hard to stay active. You really don’t even have to think about it. Take the steps instead of the elevator. Or you’re like me and you despise steps. What then? Simple… park at the far end of the parking lot. That little stroll will do you good, and it adds up, too. Have good friends – not the kind that have more drama than the local picture show. In a true friendship there are going to be hard times, of course, and you’ll be there for each other. But if your friend has so much drama in their life that they could export it to China…. you can do better. Keeping your nerves on edge is hard on your system.

Don’t take a shovel with you to the dinner table, you don’t need to eat that much. Eat good foods. I’m one to talk, I’ve been a junk food junkie all my life, but I am always working on it! Being put on a low sodium diet to prevent my heart from taking the day off is a hell of a convincer! A good rule of thumb is foods ending in with an OH! sound usually aren’t good for you. Doh-reet-OH!, Cheet-OH!… you don’t need those very often. About the only exception is the Cheer-e-OH!

Do the little things to take care of yourself. Fasten your seatbelt, and don’t drive like Mario Andretti. Even Mario keeps his speed under 200 Miles Per Hour when he’s on the public highways!

As I often say, Every heart deserves to live a lifetime. But you have to do your part, too.

Exhausted

October 9, 2010

By now you have heard or read of the unusually high number of Congenital Heart Defect (CHD) deaths during the past week. There have been at least six (some have stated that at least ten have passed, but I personally know of six. I’m not certain of the others.)

I’ve become e-mail friends with Joshua’s mom. Joshua was born August 16, 2010 and departed October 6. His mother was by his side practically the entire time, but what’s more, Joshua was never stable enough to travel. He never saw the world outside of the hospital.

52 days of hospitalization, two major heart operations…. the costs are going to be enormous. Joshua’s family is certainly physically exhausted, and before all is said and done they’re going to be fiscally exhausted.

When I was in the Intensive Care Unit after my first surgery in 1967, the cost was $66 per day. After I had a stroke in 2002, Intensive Care was $2200 per day. Note that in both cases the price quoted is basically a “rental fee”. It pays for the right to lay in the ICU bed for 24 hours. It does not include the cost of seeing a doctor, specialized nursing staff, drugs, or monitoring devices. I’ve stayed in hotels that cost $66 per night, but I have never stayed in a $2200 per night hotel. I doubt that I ever will.

The “average” Congenital Heart Surgery and hospitalization could easily cost $100,000. Where is a young family supposed to get that kind of money?

From Death, Life

October 5, 2010

Greater love hath no man than this, that a man lay down his life for his friends. – The Gospel of John; Chapter 15, Verse 13

I hate that he’s gone, and I hate everything about the CHD that took this perfect child from us. Nothing can replace him, and nothing will help us “get over” this. It is too much. – Comment left last night by Ewan’s mom.

Lord, yes. Nothing can replace him, and nothing should. This was a life cut much too short. It’s been a rough week in the Congenital Heart Defect (CHD) family, as at least six CHDers of all ages have passed. Always the optimist, my hope is that someone, somewhere learned something new from one these cases. And perhaps they can couple that new knowledge with what they already know and find the key that unlocks the mystery.

Older CHDers can help, too. Something has kept us going much longer than anyone predicted…what? When I shuffle off this mortal coil I plan to leave my heart to medical research. Let them poke and prod as much as they want, I won’t mind. And perhaps someone can figure out why some of us are only granted an hour upon the stage and then are heard from no more, while others seem to be here tomorrow, and tomorrow, and tomorrow.

There is a reason why that happens… what is it? We haven’t found it yet. But I live in the hope that if something – anything – is gleaned from such a sad event it will be knowledge. Even if all that is learned is what not to do, that helps bring us one step closer.