"Hey, shut up!" Have a Heart, Bonnie Raitt.
That was Dr. J.'s reaction to the hateraide and vitriol spewed at his master, the Sith Lord and all around great guy, Vice President Cheney, for having the unmitigated gall of receiving a heart transplant and surviving the operation.
Dr. J., of course wishes nothing but a speedy recovery and a long life of inducing apoplexy, fits of !!!!EleVeENET!Y!!!!, acute hypertension and strokes in his critics.
Just as a frame of reference, a patient is not 'given' a heart. They are loaned a heart. We actually take it back, piece by piece...in the form of endomyocardial biopsies. They start off pretty frequently, and as long as there is no rejection, they can be tapered in frequency, ultimately to yearly.
The way it works is that one receives a heart transplant and the gets bombed with IV immunosuppression (ATGAM or OKT-3, or the like) acutely to shut off the parts of the immune system that attack foreign tissue. The patient then starts taking oral immunosuppression. Steroids are taken for about a year long taper (depending on how the biopsies go), and cyclosporin or tacrolimus is the backbone of long term treatment. Steroids or steroid sparing mycophenolate mofetil or rapamycin may be added in cases were rejection is a sticky wicket.
Now before you get jealous of Mr. Cheney's new ticker, organ transplantation is trading one set of problems for another (ideally less onerous) set. One has to deal with organ rejection, opportunistic infections, risks of malignancy and kidney failure from the rejection meds and things that Dr. J. isn't thinking of off the cuff. Once the patient gets out of the first year, things get easier. Dr. J. even knows patients who have had tickers for 20 years. Others have had to have the swapped out for a second through no fault of their own.
Given the choices, like Cheney, Dr. J. would take a transplanted organ over a VAD because there isn't the stroke risk, type of infection risks and a drive hose sticking out of your belly that is associated with the VAD.
The left is pillorying Mr. Cheney for using 'government health care' to pay for his transplant (one of Dr. J.'s high school buddy is the biggest spewer of this invective). We do not know this as fact as he is sufficiently wealthy to write a check, and his Halliburton retirement package may have an even more gold plated retirement healthcare package than the one provided at taxpayer cost (doubt it, but it is possible and none of our business). Secondly, the gold plated Federal Employee retirement health insurance packages are Blue Cross Blue Shield and other private insurers who are providing a benefit paid for with tax dollars. If you have a problem with Mr. Cheney having health insurance as part of his federal benefits, you may need to take it up with your congressman, and consider switching parties as many conservatives are more troubled with generous federal employee retirement packages. Trust Dr. J. when he says, if the progressives have their way, no 71 year olds would be getting heart transplants.
They would just have to take painkillers...where have I heard that before? Oh yeah:
Or for the laughrageous version that actually uses President Obama's chilling and Orwellian words:
Actually, other than his heart disease, from what Dr. J. hears, Mr. Cheney is in remarkable health. If he had significant peripheral vascular disease, he would have been an unlikely VAD candidate. While the press labels him as a former smoker, he last smoked a cigarette in 1978, which is in stark contrast to our current White House occupant who has reportedly grabbed a drag or two since taking office. As a consequence, Cheney would be more likely to be listed than the President, who would have to demonstrate a series of negative urine cotinine screens before being listed for transplant. Not even Mitch McConnell knows for sure if the President has truly quit or not since taking office. He takes the President at his word, but...I digress.
The other quip is that Cheney is too old. Cheney has been too old since he was a kid, since he was a freshman congressman, since he had his MI at age 37, younger than any of your infarct free Gormogons, so get over it! You boomers can't stand that he's the ONLY adult in the room.
There is no cut off for heart transplant.
Older patients don't do as well, so the cut off is 70 for many programs typically, but doctors do weigh non-cardiac life-expectancy, if they're younger than stated age. And he's a spry 71. Also a patient's social support is weighed in. Can they take their pills every day, are they able to take care of themselves, AND have someone to help, should they be unable. V.P. Cheney is about as put together and can do as a person can get, so make no mistake, that heart will get the very best care a heart could possibly get from its owner.
Now there is always the dumb luck factor. Dr. J. once had an ICD put in a 78 yo patient with cardiomyopathy but otherwise looked great and had family that lived into the 90s. He died of pneumonia a year later. Just like Dr. J. was wrong in that case, there is always a chance that something could happen to the Vice President. While his critics are praying that that is the case (sickos!) it must be noted that no one has a crystal ball.
Now finally, Vice President Cheney waited longer than average for his heart and we don't know anything about the donor.
There are alternative donor programs where hearts that would otherwise be rejected are being used in patients with HIV cardiomyopathy (who have less rejection issues interestingly), and in the elderly. We don't know if the Vice President received the heart of an 18 yo or something that wouldn't have been used otherwise. Why? It's none of our business.
Lastly, while it appears that the V.P. waited longer than average, he might have waited less than the reported 20 months. Many VAD patients are 'delisted' for 6-8 months after surgery as they tend to do very well without the need for a heart for quite some time. They then get re-listed. If this is the case. He waited about a year. Knowing nothing about his blood type, this might be on the long side of normal for a type O or really long for an AB.
So left wing critics, Dr. J. think's he popped all of your trial balloons, so just let Mr. Cheney recover and then try to argue something of substance with him.
Oh, you won't because you'll lose!
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