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Idaho Falls man reflects on dramatic change following life-saving treatment at EIRMC

Health & Fitness

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Margaret Squires and Mike Mooney | Nate Sunderland, EastIdahoNews.com

IDAHO FALLS — At the height of Mike Mooney’s health problems, even the simplest tasks felt nearly impossible.

Dressing was an ordeal that could take up to 40 minutes. He needed an extra set of hands to get in and out of the shower. He had trouble speaking more than a few words without having to stop and catch his breath. Even thinking became a challenge.

“Everything was fuzzy. My brain was getting less blood, and I had a hard time focusing,” he said.

It was around Thanksgiving 2016, and Mooney’s health and life expectancy were in sharp decline. The problems stemmed from his heart, which had gradually lost the ability to pump sufficient blood to his muscles and organs.

The result was a man who was so sick, doctors feared to operate on him.

“My doctors weren’t sure I could survive open-heart surgery,” Mooney said.

There was another option, though. Mooney’s doctors told him about a relatively new procedure called transcatheter aortic valve replacement, or TAVR. It involves internal heart surgery using subcutaneous catheters and X-rays rather than scalpels and clamps.

Doctors thought the procedure would not only save Mooney’s life but might also mitigate many of the debilitating symptoms that had been plaguing him for years.

Getting sick

Mooney’s heart problems weren’t the kind people typically think about. There was no sudden chest pain, no dramatic collapse. He never had a heart attack.

One day, he simply started getting tired, and it never went away.

At the time, Mooney was close to ending a long career in journalism. He was working as a night editor at the Post Register in Idaho Falls in 2015.

“I was really beat up and tired all the time,” he said. “I went on vacation, and the vacation did no good. So long story short, I ended up retiring before I had planned to because I hadn’t been feeling good.”

Retirement didn’t help though, and over the next year, Mooney stayed tired. At first, he attributed it to getting older, but then he got sick and the illness hit him hard. He began thinking the problem might be more than exhaustion.

“I just could not recover from it,’ he said.

His doctor recommended Mooney get his heart checked and they discovered a dramatic change. His heart was working at 20 percent of its capacity.

Mooney was referred to Dr. Edward Setser, a cardiothoracic and vascular surgeon at Eastern Idaho Regional Medical Center, and to a team of cardiologists at the Idaho Heart Institute in Idaho Falls.

His doctors performed further tests and found Mooney had aortic stenosis, a condition he had unknowingly developed as a child after being exposed to rheumatic fever. Aortic stenosis is a blockage of the aortic valve, but it’s not a quick disease. It can take years or decades for the valve to calcify, gradually shrinking the amount of blood allowed through. Eventually, that blockage leads to diminished heart capacity.

“With a lot of patients with aortic stenosis, the heart gets tired of trying to pump blood through an opening that is extremely small,” said Amber Kent, a cardiac nurse and coordinator of the TAVR program. “If we can treat the aortic stenosis by opening that valve back up, eventually the heart will relearn to contract normally again.”

The traditional treatment for aortic stenosis is open-heart surgery, where a surgeon opens up a person’s chest cavity and manually places an artificial valve in the heart.

There was debate among Mooney’s cardiac team about the best course of action. Some doctors recommended immediate surgery, believing Mooney’s condition could lead to a heart attack. Setser disagreed. He thought, given the amount of time Mooney had lived with the condition, the doctors should work on bolstering his heart first to increase his chances of surviving surgery.

Over the next few months, doctors did bolster Mooney’s heart function, but never near its previous capacity. Besides a failing heart, Mooney had other health difficulties, including diabetes and hypertension, which further increased his risk of complications from surgery.

The entire process lasted into 2018 when doctors finally concluded that Mooney was just too sick for surgery.

Setser wasn’t ready to give up, though.

“(Setser) said, ‘We can’t do open-heart surgery on you, but there is this TAVR procedure, and I think you’re a perfect candidate for it, so that how we’re going to proceed,'” Mooney said.

A model of a TAVR inside an aortic valve | Nate Sunderland, EastIdahoNews.com

TAVR

A transcatheter aortic valve replacement is different from open-heart surgery in that everything is done via catheters — long, thin tubes meant to travel through in veins and arteries and operate inside the body.

A TAVR begins when a surgeon pokes a hole in the groin of a sedated patient and inserts a catheter into his or her femoral artery. Doctors guide the tube through the artery until it connects with the heart. A bioprosthetic valve is then placed inside the aorta, which forces it to expand and allows the free flow of blood. These artificial valves are created from pig or cow tissue.

EIRMC has been capable of providing the procedure for the last five years. Staff recently implanted their 100th valve, a milestone for the hospital.

Dr. John Chambers, an interventional cardiologist with the Idaho Heart Institute, performs TAVRs at the hospital. He said EIRMC has been working toward providing a large array of cardiac procedures, and TAVR was part of that push.

“We continue to be on the leading edge of cardiovascular technology,” Chambers said. “This procedure allows the quality of life of our patients to be improved, and it prolongs their lives.”

It’s also minimally invasive, and the recovery time is generally only two days, rather than five for open-heart surgery.

Kent said it’s especially good for local patients because most are elderly, and this allows them to stay close to home.

TAVR is also a relatively safe procedure, although Chambers said there have been some complications in about 10 of the 100 procedures performed.

Mooney was one of those 10.

He tells EastIdahoNews.com the procedure itself went off without a hitch, but during recovery at the hospital, things took an unexpected turn.

“My sister was in the room and noticed my numbers were coming down … and before I knew it, I became a code blue,” Mooney said.

A code blue indicates a patient is in cardiac or respiratory arrest and needs immediate resuscitation.

In Mooney’s case, his heart rate had dropped to about four beats per minute. A defibrillator was quickly attached to his chest, and medical staff shocked him repeatedly as they wheeled him down the hallway to install a pacemaker to keep his heart beating.

“I remember telling the doctor, ‘This hurts,’ and (Chambers) said, ‘I know it hurts, but its keeping you alive!'” Mooney said.

Chambers said that in some cases, a TAVR can disrupt the electrical impulses in the heart, which causes it to slow severely. Most patients recover from the disruption quickly, but in some cases, like Mooney’s, the disruption never resolves. As a result, Mooney will have to have the pacemaker for the rest of his life.

Due to the complication, Mooney was in the hospital for four days, but he began noticing a positive change almost immediately.

A catheter used in the TAVR procedure | Nate Sunderland, EastIdahoNews.com

Looking forward

Mooney said one his first realizations was that he suddenly felt normal.

“I just felt like a different person,” he said. “I could walk up the stairs, and I had to spend about a month recalculating my brain and realizing, wow I can do these things again.”

Mooney’s wife, Margaret Squires, said that when he was in heart failure, she had to help him with everything from dressing to getting off the couch. But his recovery was miraculous.

“Not long after his surgery, he started walking the Greenbelt … and when I’d go with him, he was motoring faster than I was, and it was hard to keep up,” she said. “It’s nice to have my husband back because he wasn’t the man I married when he was in congestive heart failure.”

Both Kent and Chambers say Mooney’s recovery is normal for people following a TAVR procedure. In most cases, once the blockage is taken care of, the symptoms resolve, Chambers said.

It’s now been nearly a year since the procedure and Mooney feels better than ever. He said he’s back doing all of his favorite things, such as playing his clarinet and saxophone and spending time with his family.

“When I look back, I’m just so far ahead of where I was,” Mooney said.

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