Wednesday, September 12, 2007

A somewhat surprising doctor visit

Hi everyone:

Patty had her routine appointment with Dr. Costanzo yesterday, although "routine" turns out to be a huge misnomer. The doctor said that based on Patty's present condition, she is re-evaluating whether or not Patty should stay on the transplant list; in her words, "I think you're too healthy for a transplant right now." Without using words like "miraculous", she did say that she continues to be truly surprised at how remarkable Patty's turnaround has been since last year. Her heart sounds relatively normal through the stethoscope, and her lungs sound clear. Dr. Costanzo needs the results from Monday's stress test and from an echocardiogram scheduled for this Friday before she will make concrete suggestions to the doctors at UCH.

So, if thoughts of transplant are moved to the back burner for a while, what's next for our patient? First, they want to increase her dosage of beta blockers and ACE inhibitors, two classes of drugs that have positive effects on damaged hearts. Historically, Patty has not tolerated these drugs very well -- they have caused her blood pressure to plummet. She is going to be monitored very closely, and the doses will be increased very slowly. Patty has also been given the blessing to do aerobic exercise (walking, inline skating, etc.), but no weight training, sit-ups or crunches. Patty hopes that exercise will give her more energy to tackle her work days.

Dr. Costanzo also wants to make the case for upgrading Patty's pacemaker to a biventricular device, so that it more evenly regulates the motion of the right and left ventricles. Biventricular pacing has been shown to reduce the amount of heart remodeling that takes place. Finally, Dr. Costanzo is considering Patty for a study that could involve wrapping a section of Patty's heart with a Paracor HeartNet (, a mesh device that reinforces the walls of the heart. This could later be removed if a heart transplant again becomes a priority.

The hope with all these activities is to postpone the need for a transplant as long as possible, at which time doctors may be in a position to approve the heart transplant with accessory liver transplant (I discussed this briefly on an earlier date.) Dr. Costanzo is very enthusiastic about the promise of this as-now experimental treatment.

I then presented Dr. Costanzo with a "what if" -- what if we receive a call over the next couple of days telling us they have a heart for Patty; in essence, she said, "What have you been doing with all the calls you've been receiving so far?" Point taken.

We are cautiously optimistic about all of this. Comparing the Patty of today to the Patty of last summer is a night-and-day proposition; she really is doing remarkably well. We are inclined to be a bit guarded in our hopefulness, though, because we witnessed Patty doing very well before, only to see her condition take a sudden downturn. For now, though, this seems like the best possible news, so we'll take it as a real plus and go from there.

Thank you, everyone, for everything you have done and continue to do to help our family. Patty, the kids and I could not have made it this far without your kindness. I'm happy for my wife and friend; she totally deserves this good news.


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