Heart to HeartMar 01, 2019 ● By Amy Richmond
Both Frisco residents break the stereotypical mold of what you might envision a heart transplant patient to be. Andrea Shine, 54, is a petite mother to four boys and two step-sons, a data analyst at United Healthcare, a former personal trainer and an avid golfer. Deborah Fleischer, now 68, formerly worked as a receptionist at a Plano medical office and used her lunch breaks to walk the mall every day. If you met them on the street, you would never guess they were the proud owners of new hearts.
Executive Director Dr. William C. Roberts, MD, of Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, is the leading cardiac pathologist in the nation and the editor-in-chief of The American Journal of Cardiology, in addition to a list of titles and awards.
To say he is a busy man is an understatement, but, since 2014, he has willingly donated his time to sit down with heart patients, post-transplant, to show them their old heart, point out what went wrong, and reveal what is normally invisible to the naked eye. “We have shown hearts now to about 130 people,” Dr. Roberts states.
“It blows my mind, really,” Ms. Shine says as she waits to see her old heart. “It is just amazing to think that it was once in my body, and now I am going to get to see it and understand what happened and what went wrong.”
Earlier in the week, prior to seeing her heart, Ms. Fleischer had similar thoughts. “I was hoping to find out if it was something genetic, because if it was, I wanted to make sure both of my kids knew about it … and to see if there was anything I did.”
The road to a heart transplant is an arduous one, with a sundry of paths as unique as the individuals themselves. Ms. Shine was the epitome of good health, with no blood pressure or cholesterol issues and no symptoms. But, as she approached her fifties, her family history and her mother’s death from heart problems at age 58 prompted her to get a baseline with a cardiologist in December 2013. Surprisingly, an EKG revealed some slight abnormalities, and further testing revealed a weak heart. “The power of the heart and how it pumps blood through the body is measured through an ejection fraction, and mine was low – 20 to 25 percent,” Ms. Shine recalls.
Despite medication, a defibrillator and eventually a PICC line that dripped medication directly into her heart, Ms. Shine’s condition quickly began to deteriorate. Where she had once run, she walked. Climbing a single set of stairs caused her to rest on the top stair and fluid began to build up in her abdomen (as opposed to her ankles, as most people in her condition would expect).
“She was such a warrior,” her husband, Jeff Shine, recalls. “She still went on vacation. She went to my parents’ house for the summer.”
“I was trying, you know,” says Ms. Shine. “I thought, this is life, and I am just going to keep going forward.” Until, one day, a doctor pulled Mr. Shine to the side and said his wife had only six months to live.
Similarly, Ms. Fleischer only found out she had a heart issue when, in her fifties, prolonged exhaustion from a flu-like virus caused a doctor to order an x-ray. Since an x-ray from a year prior had shown a normal-sized heart, Ms. Fleischer was quite surprised to hear her heart was now enlarged.
A team of doctors, a cocktail of medications and two defibrillators helped sustain Ms. Fleischer for approximately 20 years, as she cared for her son who had developed Guillain-Barré syndrome and her father who had Alzheimer’s. When her second defibrillator shocked her in the parking lot of a grocery store and then later again at home, Ms. Fleischer says she finally became scared enough to consider a heart transplant.
But, getting a new heart is akin to winning the lottery. As Dr. Roberts told Ms. Shine during her Heart-to-Heart session, “Out of about 330 million people in the U.S., approximately six million are eligible for heart transplants. The number who have transplants in this country each year is about 2,300 … and it is a shame because we just cannot get donors.”
So, the few hearts that do become available only go to those who have passed a stringent vetting process. A potential candidate must agree to weeks of intensive testing to ensure their body is otherwise healthy and disease-free. And, once approved, the waiting game starts.
It was 2:10 a.m. when Ms. Shine got her call. “I remember I was just so nervous all of a sudden. This was real. The surgeon comes on and says, ‘Ms. Shine, I have a beautiful new heart for you,’” she says as she chokes back tears.
After the call, you have just two hours to get to the hospital, but Ms. Shine’s husband says they were there in 25 minutes. And after eagerly waiting for it to arrive, Ms. Shine finally got her new heart. “It was September 5,” she says with smiling tears. “My second birth date. My brand-new life.”
After waiting for 41 days, Ms. Fleischer got the call while she was at work and raced to the hospital as well, only to later learn the donor heart was not viable. With her life on the line, the disappointment was indescribable. Her second call rendered a healthy donor heart, and her transplant was successfully completed on June 27, 2013.
Both Ms. Shine and Ms. Fleischer sat with Dr. Roberts, on separate occasions, to hold their old hearts and hear his pathological explanation.
Ms. Fleischer learned she had no cholesterol in her arteries and that one side of her heart was enlarged from unknown causes, which had been putting a strain on her mitral valve. She says, “Dr. Roberts explained that a lot of people think their heart condition was caused by a virus, but he has never seen a virus on the heart.”
For Ms. Fleischer, Dr. Roberts’ diagnosis was non-ischemic idiopathic dilated cardio myopathy. “It was a relief to me, that I did not cause it myself through what I ate or lack of exercise,” Ms. Fleischer states. “It gave me a sense of closure and of sincere gratitude that this program was available at Baylor. I could identify that this was part of me and now this is behind me.”
For Ms. Shine, Dr. Roberts’ diagnosis was arrhythmic right ventricular cardio myopathy (dysplasia), and he suspected she had inherited a gene (only recently identified in the last few years) from her mother. Despite Ms. Shine’s pristine health condition and no cholesterol in her arteries, the adipose (fat) tissue that normally insulates the heart had begun replacing the muscle wall of the heart. In fact, the muscle wall of the right ventricle was almost entirely adipose tissue. This explained why her heart was so weak – the muscle in her right ventricle was almost non-existent. Dr. Roberts then recommended Ms. Shine follow up with Robert L. Gottlieb, MD, PhD, FACC, whose areas of clinical expertise include cardiovascular genetics.
Both women returned to work within three months of their transplants and both had their eye on a trip to Italy, as a well-deserved ending for their difficult journey. Most emphatically, though, both have become avid supporters of organ donation.
When Ms. Fleischer was recovering, she encouraged well-wishers, “Please, in lieu of flowers, become a transplant donor.” And Ms. Shine says, “I think organ donation is probably one of the most unselfish gifts you can give to someone. I have so much respect for the family, and I think about them every day.”
Ms. Shine is also quick to mention donatelife.net. And you use the Health app on your iPhone to become a donor in a matter of seconds. She also encourages others to know their medical history and act on it, as well as maintain a healthy lifestyle.
Time will tell how these women’s stories might help save someone else’s life.