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Life After a Heart Transplant

Posted Aug 24 2008 1:49pm
DAVID R. MARKS, MD: What you're watching right now is a new heart arriving at a hospital to be transplanted into the chest of a heart transplant recipient. When that's done, the battle's not over.

I'm Dr. David Marks. Welcome to our webcast. To take us into the post-op period, we have two guests: Frank Torre, who is a former Major League baseball player, had a transplant very recently, and he's going to tell us about his experiences. Welcome.

FRANK TORRE: Good to be here.

DAVID R. MARKS, MD: Next to him is Dr. Mehmet Oz. He is a heart surgeon, and he worked on Frank for his transplantation. He's at Columbia Presbyterian Medical Center. Thanks for being here.

MEHMET OZ, MD: Wonderful to be here.

DAVID R. MARKS, MD: So, Frank, tell me, how difficult is the post-op period?

FRANK TORRE: Well, within about five days I didn't have a wire on my body, which in itself was a miracle. The most difficult part that I had been through -- because it's been three and a half years now -- was getting used to the medicines and working with your pre-care and post-care -- and I have a little barrel of dynamite, Donna Mancini -- but that's the most difficult thing, working to balance the rejection and infection medicine and trying to suppress your immune system, and then taking different medicines for the side effects. But once you get used to the procedure -- and I watch my diet, I exercise, and I drink a lot of water -- and it's worked for me that way, because I've been able to live a very, very normal life.

DAVID R. MARKS, MD: Is this normal, to feel that good so quickly after a transplant?

MEHMET OZ, MD: It's absolutely normal. In fact, one of the beauties of this operation is that although many fear it, it is in fact a safety net. It allows you to return to a quality of life, a level of existence you never would have anticipated. I remember when Frank first came up from Florida he was moribund, not just physically but emotionally. He really thought there was no future, and many patients are amazed to find that you can live 20 years with a heart transplant, and in fact 90 percent of patients not only survive the operation, but 60 to 70 percent go more than five years. This is one of the most important aspects of heart transplantation, from my perspective, because we worked out the technical issues of how to sew a heart in the sixties. In fact, the operation has been done for three decades. But for an entire decade in the 1970s, the world abandoned heart transplantation. What changed that was the development in the early 1980s of new drugs that were able to suppress certain parts of the immune system without making you completely open to infection. That's one of the major benefits that the pharmaceutical industry has offered us in modern medicine.

DAVID R. MARKS, MD: What are these medicines?

MEHMET OZ, MD: There are several classes of medications. The mainstay, what changed the entire face of heart transplantation, is cyclosporine. This is actually a fungal derivative, something that we don't usually want to take into the human body, but in fact, in this setting it was found by scientists that you could suppress certain chemical markers, so I could prevent the immune system from being stimulated by preventing the cells to talking to each other. This doesn't prevent you from responding to a bacteria or another ailment that would otherwise kill you. So it's a beautiful way of selectively cutting back on your body's desire to kill this foreign body inside your chest -- the new heart.

DAVID R. MARKS, MD: There are other medicines, though?

MEHMET OZ, MD: There are several other medications that are very important and which we've built upon cyclosporine. There are drugs that prevent the bone marrow from producing too many white cells, and there are several new classes of these drugs as well. In addition, there are steroids, which is something that is feared by many because it makes you look not too good and makes you act strange, but in fact it's a nice way of calming the immune system. If you put these new classes of drugs together and combine them with what we currently have available, which are very selective blockers against very specific types of antibodies and immune cells, we've got a whole potpourri of drugs that we can use to specifically target your therapy. This has changed the face of heart transplant surgery. So although we get all the glamour as heart transplant surgeons because we can sew the organs in, the battle is won and lost in the postoperative period by physicians who are able to tailor your therapy using new drugs that have been developed over the past two decades.

DAVID R. MARKS, MD: You alluded to some of the side effects. Why don't you go through some of the most common ones?

MEHMET OZ, MD: The most important side effect is infection, still. Although these drugs are very effective at minimally hindering your ability to resist infection, they do hinder, in fact, your ability to fight off invaders from outside. So for someone like Frank, my biggest concern is that although I'm preventing from killing his heart, he'll develop infections. In addition, some of these drugs are toxic to the kidneys, and many patients after heart transplantation will in fact have renal problems, and that's one of the problems that we're guarding against, and newer drugs are coming out that may help us more along these lines.

Now, on the other side of the equation is the problem of not taking enough immunosuppressive drugs. This is a problem with rejection. So we survey patients frequently, checking the pressures in their heart, but also the arteries of their heart, to make sure that they're not killing their organs. That's an important factor, because if you're killing your heart, when it dies we have very little we can do to help you.

DAVID R. MARKS, MD: Do you have any problems?

FRANK TORRE: I've had problems from time to time, and most of them have, as Dr. Oz has mentioned, have been with infections and most of them -- practically all of the infections I've had -- have been involved in my kidney, but because of your pre-care and post-care doctor, we stay right on top of them, and they have been able to deal with them. Some have been a little more major than others, but with medication and putting a more urgent scenario to it -- because the few times that I've had to go back and stay in the hospital -- and now I'm almost my own doctor, because I can tell when the symptoms are coming on, so therefore I guard against it and I communicate. I've interrupted my doctor's sleep a few times with problems that I've had, but they have a well-oiled machine going now, and the big thing that Dr. Oz said that is most critical -- and that's why I appreciate it and people who have gone through it -- is the quality of life, because three to five years prior to me getting this transplant, I didn't have a life. I had pain all the time. I had an appetite, yet I didn't feel like eating. I had soreness all over. I had no energy, and I just thought, being in my mid-60s, that this was what life was all about. But now, with the transplant and with all the systems they've put in place, I have a better quality of life since I've been about 50 years old.

DAVID R. MARKS, MD: How long was it before you could resume all your normal activities after the transplant?

FRANK TORRE: I was walking two miles a day within two weeks.

DAVID R. MARKS, MD: Is that typical?

MEHMET OZ, MD: It's very typical. In fact, we went to Yankee Stadium after you were discharged for a photo shoot for Life magazine, and he was almost running around the field. But what Frank said is so important that I want to reemphasize it. Although you shouldn't medicate yourself, and perhaps being your own doctor can be dangerous, you are the world's expert on your body, and if you are attuned to that and pay attention to what you can learn on the Internet and by paying attention to your body, you can help your doctors a lot by telling us when what we're doing is probably not in your best interest, because you don't feel well, and alerting us earlier to problems that you may be having. So an alert patient is the best patient.

DAVID R. MARKS, MD: That'll be the last word. Thank you both for joining us. Thank you for joining our webcast. I'm Dr. David Marks. Goodbye.

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