Interesting story, link below an below link full story:
http://online.wsj.com/article/SB10001424052702303365804576429792685943576.html
The Story of Dick Cheney's Heart
The former vice president opens up about his coronary artery disease, and explains how the march of American medicine saved his life.
By JOSEPH RAGO
Jackson Hole, Wyo.
'I remember when I was 14 years old, 1955, my grandfather, mom's dad, was visiting with us. He'd already had a couple heart attacks. He was 66," says Dick Cheney, who is 70 and has survived five heart attacks. "One morning I was in the house alone while my folks were outside and he hollered for help and I went up, and he was having what turned out to be his last heart attack. Got the folks and then we got the ambulance and loaded him up. All you could do in the 1950s for a guy was slap an oxygen bottle on him and take him to the hospital."
Mr. Cheney is silent for a moment, sitting earlier this week on the patio of his Wyoming home, staring at the Tetons drawn like a curtain across the sky. "By the time they got to the hospital, it was all over with," he says, finally.
Mr. Cheney, who rarely grants interviews, is reflecting on his own medical history. "I have not talked about it a lot," he concedes.
But in a word, he owes his life to American medical innovation. Cardiology has improved more in the six decades since his grandfather died than in all previous history. A new advance, often unavailable even a few years before, has always outpaced the progress of his coronary artery disease and of his career: Gerald Ford's chief of staff, a dozen-odd years in Congress, defense secretary to the first President Bush and vice president to the second. "I've been extraordinarily fortunate to live in a place and a time when all that was going on," Mr. Cheney says.
The most tangible evidence is on Mr. Cheney's person, what he calls "the gear." He is wearing a custom wool vest that holds a small computer near his abdomen and on either side two battery packs, about the size of video tapes. "They're good for about 10 hours," he says. "Put these in this morning." The gear, connected to his chest via an insulated cable, powers something known as a left ventricular assist device, or LVAD, a turbine implanted near his heart's major chamber that propels blood into his aorta and circulates it throughout his body.
"It's not an artificial heart," Mr. Cheney explains. "You still got to have a heart and it's still got to be working," but the pump helps delay congestive heart failure by relieving strain on a muscle too weak to function by itself. The average human heart beats 100,000 times a day, 2.5 billion times over a lifetime. The rotor in Mr. Cheney's LVAD spins about 8,000 to 10,000 times a minute and muffles his natural heartbeat.
The vice president's LVAD was implanted exactly a year ago, and the trauma of this major surgery lingers. He has lost a considerable amount of weight and, with it, some of his forbidding severity. He looks spry, almost relaxed.
"I'm not running any foot races," Mr. Cheney says, "but I'm able to do virtually anything I would want to do." He went quail hunting in south Texas this winter and is planning a fly-fishing trip to Montana's Bighorn later this summer. "I can't fall in," he jokes, breaking into a lopsided grin. "Whatever you do, don't fall in."
***
Ironically, Mr. Cheney's first heart attack—or myocardial infarction, when the heart is starved for oxygen because of restricted or blocked-off blood supply—may have aided his political rise. It struck in 1978, when he was 37, amid a three-way GOP primary race to stand for Wyoming's only House seat. "At the time it was sort of hard to accept all of this, but on the other hand, as I looked back on it later, I became convinced it kind of helped. It significantly advanced my name identification. I got a lot of coverage. I even got sympathy donations," he says. "It worked out."
Both Mr. Cheney's parents had a family history of heart disease, and he had been warned during a physical soon after he left the Ford White House that he was at risk. "I didn't pay any attention," he says. "And by then I'd smoked close to 20 years, and not only genetically predisposed, but I had a lot of bad habits: Drank a ton of black coffee out of the Navy mess in the White House, smoked a couple of packs a day."
Mr. Cheney was campaigning in Cheyenne. "Woke up in the middle of the night with a tingling sensation in two fingers of my left hand, that was the only symptom I had," he says. "I'll never know why, but it seemed to me I better have it checked out." A friend drove him to the emergency room, where he sat down and promptly passed out.
"When I came to, there was a lot of activity in the ER and I figured that was all focused on me," he remembers. "And I'd had my first heart attack.
"I had a great doctor, named Rick Davis. Internist. There weren't any cardiologists in Wyoming in those days. I asked Rick if this meant that I had to give up my political aspirations, and he said, no, hard work never killed anybody. And that was great advice."
A vast improvement in the standard of cardiovascular care was well underway, as new treatments like coronary artery bypass graft surgery (introduced in the 1960s) were being refined. Yet to emerge were new classes of drugs like statins to lower cholesterol (circa the late 1980s), ACE inhibitors to lower blood pressure (c. the early 1990s), and beta blockers to reduce stress hormones (c. the early 1980s). Since midcentury, the heart-disease death rate has fallen by 1.7% annually, though progress seems to have slowed in recent years and it remains the leading killer in the U.S.
Some of the decline can also be explained by a greater awareness of prevention and the decline in tobacco use. "Quit smoking after the first heart attack," Mr. Cheney says. "Never had another one after that first night."
Still, his second heart attack hit in 1984—"they always seemed to happen in campaign years"—and his third four years later, "the most serious." He needed a quadruple bypass, where surgeons rerouted blood vessels around his arteries. He listened to George H.W. Bush's "no new taxes" speech, delivered at the 1988 GOP convention, while he was being prepped for surgery in D.C. He was skiing again by Christmas.
A generation ago, Mr. Cheney's fourth heart attack, during the 2000 Florida recount, wouldn't have been detected at all. But recent diagnostic improvements meant the ability to detect the enzymes and proteins released into the bloodstream when heart muscle cells are injured. Over the next year, Mr. Cheney's doctors, led by George Washington University Hospital's Jonathan Reiner, took advantage of the new cardiology arsenal. They gave the vice president a balloon angioplasty (c. 1980s) to reopen an artery and two stents (1994), lattice metal sleeves, to prop it open.
In retrospect the most important procedure from that West Wing period was the installation below Mr. Cheney's shoulder of an implantable cardioverter defibrillator (1985), a battery-powered device about the size of a pocket watch that continuously monitors heart rhythm and delivers a corrective electric jolt if it recognizes an abnormality. "I wore that about five or six years, then they replaced it when a newer model came along," he says.
The defibrillator "turned out to be a lifesaver." Late in 2009, Mr. Cheney went into ventricular fibrillation and lost consciousness while backing out of his garage in Jackson, his jeep crashing into a copse of aspens at the foot of his driveway. "Secret Service—got their attention," he chuckles. "The ICD worked beautifully. I never even felt it. . . . A couple minutes later I was back."
***
Mr. Cheney suffered his fifth heart attack in February of last year, and by spring he was "in steady decline, less and less stamina and energy, approaching end-stage heart failure." No matter how minor, each heart attack does more and more damage, leaving behind heavy tissue that cannot contract.
As Mr. Cheney's condition deteriorated, he and his physicians considered a heart transplant but opted for the LVAD. The surgery was a huge risk given his age, sickness and the logistical fact that his surgeons would need to "go right back in in exactly the same location" as his bypass 20 years before. "Cutting through all that scar tissue, that's tougher in a sense than actually installing the LVAD, or so they tell me."
Three days before the operation was scheduled, he says, "all my systems are starting to crash—kidneys, liver, everything, blood flow just wasn't adequate to keep everything going." He was dying. "So there was a hurried-up consultation where I remember the family standing around the bed in my room and a lot of docs and the question was, do we go in, now, on an emergency basis, and start with the LVAD? I queried everybody and said, well, let's do it. I went in that night." Mr. Cheney was treated at Inova Fairfax Hospital in Falls Church, Va., among the best LVAD programs in the country.
He was in the intensive care unit for about five weeks, "most of that on the respirator, heavily sedated. Also developed pneumonia at the same time, and eventually got through that."
He spent months in rehab. "When you get to the point where you spend that much time in an ICU, you just totally waste away," he says. "Muscle mass is all gone—you can't open a tube of toothpaste, can't get in and out of the bed, need help with absolutely everything you do."
Many patients speak of open-heart surgery as a life-changing, revelatory event—the sternum sawed in half, the rib cage pulled apart, life dependent on a heart-lung machine (c. 1960s) to stand in for those organs. Did it change Mr. Cheney's outlook, his perspective? "I'd already done bypass," he says unsentimentally, with a wave of his hand.
"You could, and some people do, become so fixated on the disease that they, well, they don't get to get on with their lives. You've got to get on with your life," Mr. Cheney says. "It's never stopped me, though there's nothing in particular special about me. It's a reflection about how good the technology has grown."
LVADs were developed as a temporary bridge while patients wait on a donor, but the second generation (2005) is so improved that a growing number of patients are having them installed long-term. Mr. Cheney's LVAD may be cutting edge, but it has the feel of a cellphone from the 1980s. The pumps will become smaller, less invasive, and perhaps one day replace the heart altogether. A defibrillator was once the size of a washing machine.
***
Most economists agree that the spread of such technological change accounts for most of the climb in U.S. health-care costs—and if it has bought a lot in extending and improving lives, much of it has been financed on the taxpayer's nickel. Heart disease accounts for about a third of what Medicare spends merely on hospitals, not counting drugs or other charges. One larger question now is whether entitlements can be restrained without retarding future health-care innovation, which usually occurs at the margins and compounds over time.
"I don't think that I know enough to say, well, here's the plan. It's not my specialty. I'm more a happy customer," Mr. Cheney cautions. "We've got a system that provides for the kind of research and innovation that has provided these tremendous capabilities. That automatically raises questions about how we deliver to everybody who needs it. . . .
"But I don't think there's any way not to have that debate about how much we're going to spend on health care. We've got big budget problems, big national debt problems. . . . In finding our way forward, we've got to be able to find ways to deliver the quality care that everyone expects and that we're capable of providing to the maximum number of people."
Mr. Cheney's retirement, if that's what it is—"I've never been retired before. I don't know what that means," he says—has been dominated by subjects somewhat less tedious than health policy. Aside from his recovery, he is finishing a political memoir, due in August, which he wrote with his daughter Liz. "I did my 40 years in Washington, 40-plus, and it's time to pause and reflect and think about what I've seen and done," he says. When asked for a preview, he interjects—perhaps only half in jest—"That's classified."
Today, it's enough to marvel that he is alive. "No matter what kind of problem I've run into, there's always been a solution for it," Mr. Cheney says. "Now, obviously, there will be a point where there aren't any more solutions, and I'll have used up my time. We all do."
Mr. Rago is a member of the Journal's editorial board.
http://online.wsj.com/article/SB10001424052702303365804576429792685943576.html
The Story of Dick Cheney's Heart
The former vice president opens up about his coronary artery disease, and explains how the march of American medicine saved his life.
By JOSEPH RAGO
Jackson Hole, Wyo.
'I remember when I was 14 years old, 1955, my grandfather, mom's dad, was visiting with us. He'd already had a couple heart attacks. He was 66," says Dick Cheney, who is 70 and has survived five heart attacks. "One morning I was in the house alone while my folks were outside and he hollered for help and I went up, and he was having what turned out to be his last heart attack. Got the folks and then we got the ambulance and loaded him up. All you could do in the 1950s for a guy was slap an oxygen bottle on him and take him to the hospital."
Mr. Cheney is silent for a moment, sitting earlier this week on the patio of his Wyoming home, staring at the Tetons drawn like a curtain across the sky. "By the time they got to the hospital, it was all over with," he says, finally.
Mr. Cheney, who rarely grants interviews, is reflecting on his own medical history. "I have not talked about it a lot," he concedes.
But in a word, he owes his life to American medical innovation. Cardiology has improved more in the six decades since his grandfather died than in all previous history. A new advance, often unavailable even a few years before, has always outpaced the progress of his coronary artery disease and of his career: Gerald Ford's chief of staff, a dozen-odd years in Congress, defense secretary to the first President Bush and vice president to the second. "I've been extraordinarily fortunate to live in a place and a time when all that was going on," Mr. Cheney says.
The most tangible evidence is on Mr. Cheney's person, what he calls "the gear." He is wearing a custom wool vest that holds a small computer near his abdomen and on either side two battery packs, about the size of video tapes. "They're good for about 10 hours," he says. "Put these in this morning." The gear, connected to his chest via an insulated cable, powers something known as a left ventricular assist device, or LVAD, a turbine implanted near his heart's major chamber that propels blood into his aorta and circulates it throughout his body.
"It's not an artificial heart," Mr. Cheney explains. "You still got to have a heart and it's still got to be working," but the pump helps delay congestive heart failure by relieving strain on a muscle too weak to function by itself. The average human heart beats 100,000 times a day, 2.5 billion times over a lifetime. The rotor in Mr. Cheney's LVAD spins about 8,000 to 10,000 times a minute and muffles his natural heartbeat.
The vice president's LVAD was implanted exactly a year ago, and the trauma of this major surgery lingers. He has lost a considerable amount of weight and, with it, some of his forbidding severity. He looks spry, almost relaxed.
"I'm not running any foot races," Mr. Cheney says, "but I'm able to do virtually anything I would want to do." He went quail hunting in south Texas this winter and is planning a fly-fishing trip to Montana's Bighorn later this summer. "I can't fall in," he jokes, breaking into a lopsided grin. "Whatever you do, don't fall in."
***
Ironically, Mr. Cheney's first heart attack—or myocardial infarction, when the heart is starved for oxygen because of restricted or blocked-off blood supply—may have aided his political rise. It struck in 1978, when he was 37, amid a three-way GOP primary race to stand for Wyoming's only House seat. "At the time it was sort of hard to accept all of this, but on the other hand, as I looked back on it later, I became convinced it kind of helped. It significantly advanced my name identification. I got a lot of coverage. I even got sympathy donations," he says. "It worked out."
Both Mr. Cheney's parents had a family history of heart disease, and he had been warned during a physical soon after he left the Ford White House that he was at risk. "I didn't pay any attention," he says. "And by then I'd smoked close to 20 years, and not only genetically predisposed, but I had a lot of bad habits: Drank a ton of black coffee out of the Navy mess in the White House, smoked a couple of packs a day."
Mr. Cheney was campaigning in Cheyenne. "Woke up in the middle of the night with a tingling sensation in two fingers of my left hand, that was the only symptom I had," he says. "I'll never know why, but it seemed to me I better have it checked out." A friend drove him to the emergency room, where he sat down and promptly passed out.
"When I came to, there was a lot of activity in the ER and I figured that was all focused on me," he remembers. "And I'd had my first heart attack.
"I had a great doctor, named Rick Davis. Internist. There weren't any cardiologists in Wyoming in those days. I asked Rick if this meant that I had to give up my political aspirations, and he said, no, hard work never killed anybody. And that was great advice."
A vast improvement in the standard of cardiovascular care was well underway, as new treatments like coronary artery bypass graft surgery (introduced in the 1960s) were being refined. Yet to emerge were new classes of drugs like statins to lower cholesterol (circa the late 1980s), ACE inhibitors to lower blood pressure (c. the early 1990s), and beta blockers to reduce stress hormones (c. the early 1980s). Since midcentury, the heart-disease death rate has fallen by 1.7% annually, though progress seems to have slowed in recent years and it remains the leading killer in the U.S.
Some of the decline can also be explained by a greater awareness of prevention and the decline in tobacco use. "Quit smoking after the first heart attack," Mr. Cheney says. "Never had another one after that first night."
Still, his second heart attack hit in 1984—"they always seemed to happen in campaign years"—and his third four years later, "the most serious." He needed a quadruple bypass, where surgeons rerouted blood vessels around his arteries. He listened to George H.W. Bush's "no new taxes" speech, delivered at the 1988 GOP convention, while he was being prepped for surgery in D.C. He was skiing again by Christmas.
A generation ago, Mr. Cheney's fourth heart attack, during the 2000 Florida recount, wouldn't have been detected at all. But recent diagnostic improvements meant the ability to detect the enzymes and proteins released into the bloodstream when heart muscle cells are injured. Over the next year, Mr. Cheney's doctors, led by George Washington University Hospital's Jonathan Reiner, took advantage of the new cardiology arsenal. They gave the vice president a balloon angioplasty (c. 1980s) to reopen an artery and two stents (1994), lattice metal sleeves, to prop it open.
In retrospect the most important procedure from that West Wing period was the installation below Mr. Cheney's shoulder of an implantable cardioverter defibrillator (1985), a battery-powered device about the size of a pocket watch that continuously monitors heart rhythm and delivers a corrective electric jolt if it recognizes an abnormality. "I wore that about five or six years, then they replaced it when a newer model came along," he says.
The defibrillator "turned out to be a lifesaver." Late in 2009, Mr. Cheney went into ventricular fibrillation and lost consciousness while backing out of his garage in Jackson, his jeep crashing into a copse of aspens at the foot of his driveway. "Secret Service—got their attention," he chuckles. "The ICD worked beautifully. I never even felt it. . . . A couple minutes later I was back."
***
Mr. Cheney suffered his fifth heart attack in February of last year, and by spring he was "in steady decline, less and less stamina and energy, approaching end-stage heart failure." No matter how minor, each heart attack does more and more damage, leaving behind heavy tissue that cannot contract.
As Mr. Cheney's condition deteriorated, he and his physicians considered a heart transplant but opted for the LVAD. The surgery was a huge risk given his age, sickness and the logistical fact that his surgeons would need to "go right back in in exactly the same location" as his bypass 20 years before. "Cutting through all that scar tissue, that's tougher in a sense than actually installing the LVAD, or so they tell me."
Three days before the operation was scheduled, he says, "all my systems are starting to crash—kidneys, liver, everything, blood flow just wasn't adequate to keep everything going." He was dying. "So there was a hurried-up consultation where I remember the family standing around the bed in my room and a lot of docs and the question was, do we go in, now, on an emergency basis, and start with the LVAD? I queried everybody and said, well, let's do it. I went in that night." Mr. Cheney was treated at Inova Fairfax Hospital in Falls Church, Va., among the best LVAD programs in the country.
He was in the intensive care unit for about five weeks, "most of that on the respirator, heavily sedated. Also developed pneumonia at the same time, and eventually got through that."
He spent months in rehab. "When you get to the point where you spend that much time in an ICU, you just totally waste away," he says. "Muscle mass is all gone—you can't open a tube of toothpaste, can't get in and out of the bed, need help with absolutely everything you do."
Many patients speak of open-heart surgery as a life-changing, revelatory event—the sternum sawed in half, the rib cage pulled apart, life dependent on a heart-lung machine (c. 1960s) to stand in for those organs. Did it change Mr. Cheney's outlook, his perspective? "I'd already done bypass," he says unsentimentally, with a wave of his hand.
"You could, and some people do, become so fixated on the disease that they, well, they don't get to get on with their lives. You've got to get on with your life," Mr. Cheney says. "It's never stopped me, though there's nothing in particular special about me. It's a reflection about how good the technology has grown."
LVADs were developed as a temporary bridge while patients wait on a donor, but the second generation (2005) is so improved that a growing number of patients are having them installed long-term. Mr. Cheney's LVAD may be cutting edge, but it has the feel of a cellphone from the 1980s. The pumps will become smaller, less invasive, and perhaps one day replace the heart altogether. A defibrillator was once the size of a washing machine.
***
Most economists agree that the spread of such technological change accounts for most of the climb in U.S. health-care costs—and if it has bought a lot in extending and improving lives, much of it has been financed on the taxpayer's nickel. Heart disease accounts for about a third of what Medicare spends merely on hospitals, not counting drugs or other charges. One larger question now is whether entitlements can be restrained without retarding future health-care innovation, which usually occurs at the margins and compounds over time.
"I don't think that I know enough to say, well, here's the plan. It's not my specialty. I'm more a happy customer," Mr. Cheney cautions. "We've got a system that provides for the kind of research and innovation that has provided these tremendous capabilities. That automatically raises questions about how we deliver to everybody who needs it. . . .
"But I don't think there's any way not to have that debate about how much we're going to spend on health care. We've got big budget problems, big national debt problems. . . . In finding our way forward, we've got to be able to find ways to deliver the quality care that everyone expects and that we're capable of providing to the maximum number of people."
Mr. Cheney's retirement, if that's what it is—"I've never been retired before. I don't know what that means," he says—has been dominated by subjects somewhat less tedious than health policy. Aside from his recovery, he is finishing a political memoir, due in August, which he wrote with his daughter Liz. "I did my 40 years in Washington, 40-plus, and it's time to pause and reflect and think about what I've seen and done," he says. When asked for a preview, he interjects—perhaps only half in jest—"That's classified."
Today, it's enough to marvel that he is alive. "No matter what kind of problem I've run into, there's always been a solution for it," Mr. Cheney says. "Now, obviously, there will be a point where there aren't any more solutions, and I'll have used up my time. We all do."
Mr. Rago is a member of the Journal's editorial board.
