Heart of the Matter

Transplant patient helps cardiac rehabilitation staff gain new skills.

Troy Johnson watches a ceiling-mounted television as he pumps a recumbent exercise bike at Mary Greeley Medical Center's Cardiac Rehabilitation Center.

The History Channel is on, which somehow seems appropriate since Johnson himself made a little history at MGMC. He was Cardiac Rehabilitation's first LVAS patient and because of him, the medical center is ready for any future patients outfitted with an LVAS as they wait for a new heart.

"LVAS is sometimes considered a bridge for people until they receive a heart transplant," says Sue Tjelmeland, R.N., B.C. "The heart is failing so much that the person cannot sustain life without it."

A "Left Ventricular Assist System," or LVAS, is a battery-operated pump device that is surgically implanted into a person's body. It involves a tube that pulls blood from the left ventricle into a pump, which sends blood into the aorta. The pump is placed in the upper part of the abdomen, while another tube attached to the pump comes out of the abdominal wall to the outside of the body and attaches to the system's battery and controls. The battery pack, which looks something like a shoulder holster a TV cop might wear, is vitally important. The LVAS has to run at all times, so batteries must be fully charged and replacement batteries must always be carried. The whole unit, Johnson estimates, weighs around six or seven pounds.

A Problem Discovered

Johnson, who is in his early thirties and lives near Webster City, discovered his heart problems in November 2007. While there is no history of heart trouble in his family, there is speculation that cancer treatment Johnson successfully underwent in 1995 might have weakened his heart.

In November 2008, he received a biventricular Implantable Cardioverter Defibrillator (ICD) to help his heart pump more efficiently and correct any life-threatening rhythms. But Johnson's condition continued to deteriorate, and in May 2009 the LVAS was placed at University of Iowa Hospitals and Clinics. UI Hospitals sent personnel to train Mary Greeley's cardiac rehabilitation staff and other necessary hospital personnel on the LVAS.

"It can make for a sensitive situation," says Tjelmeland, "since you can't do CPR on someone who has an LVAS. You just try to sustain life until you get them to the appropriate medical facility."

The staff learned how the LVAS worked and what their roles and responsibilities were with a patient who had an LVAS. They are now ready for future patients, and can train any new staff.

"We probably approached it with a little anxiety in the beginning, but also excitement because it was something new," says Tjelmeland. "Troy immediately made us feel at ease. Even though we did extensive training prior to Troy's arrival, he assisted us with responding to the various LVAS alarms."

A Prepared Staff

The Cardiac Rehabilitation Center has helped patients as young as 18 and as old as 93 with various cardiac conditions. The staff of four nurses, clinical supervisor Patty Huisenga, R.N., B.C., B.S.N., and cardiology services director Shaunda Calkins R.N., B.S.N., M.S., has many years of experience.

Two staff members are nationally certified as cardiac/vascular nurses. The program itself has maintained national certification for the past six years.

"Once we receive an order for cardiac rehabilitation, we do an extensive assessment with the patient and establish individualized goals and an exercise prescription for each patient," says Tjelmeland. "We are responsible for assessing the patient's tolerance and progressing the patient toward appropriate goals, with the physician's guidance."

The Cardiac Rehabilitation Center offers a multi-phased program. Phase I is a structured education and progressive activity program for hospitalized patients and their families. Phase II (early outpatient), which is what Johnson is in, is a comprehensive, monitored exercise and education program. Phase II candidates include people who've had a heart attack, angioplasty and stents, bypass surgery, stable angina, valve replacement and repair, or heart transplant. Phase II usually lasts six to 12 weeks, depending on the needs of an individual patient.

Phase III is for patients who have completed Phase II and wish to continue a supervised exercise program.

The cardiac rehabilitation staff provides patients the tools needed to help avoid future cardiac problems and incorporate appropriate levels of exercise into their daily routine. Classes in healthy eating, emotional recovery and other topics are offered. There is also a cardiac support group.

While Johnson was cardiac rehabilitation's first LVAS patient, he wasn't the first transplant patient the staff has helped.

"We don't have transplant patients very often, but have seen a number of them over the past 15 years in our program," says Tjelmeland. "Heart transplant patients have some special requirements with their exercise progression, and we are used to dealing with that."

Steady Progress

For a guy who's fought cancer and had a heart transplant, Johnson looks great. He and the LVAS parted ways back in July, when he got the call that there was a heart waiting for him. Thanks, in part, to the rehabilitation program, he is slowly gaining strength.

"I'm hoping that by working on therapy hard over the winter, I'll be close to normal by spring," he says. "They're real good to me here. The nurses are personable and they treat me well. They let me know what's going on. There's a lot of good communication."

Johnson has always been active. He and his wife, Amanda, have three kids.

"I've been married for eight years. This makes me realize how important my family is," says Johnson. "I've had a lot of support from my wife. She's been strong through this whole thing. Couldn't have done it without her."

Until the heart problems, Johnson worked as a service manager at Prestige Farms. He owns five quarter horses, and he used to break and shoe horses. He also frequently went hunting with his beloved coon dogs. Johnson even did a little rodeo, including team roping and bull riding. It'll be a long time before he does that again, but other activities are working their way back into his life.

"I just started riding again a little while ago," says Johnson. "I ran my dogs recently, too. It felt good being out there again."