Hearts On Call
The Saginaw News

Living with congestive heart failure sometimes feels like stretching against a bungee cord attached to a hospital bed.

Since having a heart attack about two years ago, 38-year-old Tracy Bender's heart has weakened. Like many others with similar problems, he was trapped in a cycle in which fluid would build up in his body and lungs, sending him to the hospital monthly.

"I'd gain so much weight I couldn't breathe," Bender said. "It feels like something's sitting on your chest."

But the Buena Vista Township man has stayed out of Covenant Medical Center for four months now.

In late April, he joined a test for a Congestive Heart Failure Treatment Program through Covenant HealthCare System. The project asks him to take charge of preventing his symptoms, through a strict regimen of diet, physical activity and daily weight monitoring.

"It's all about having your mind made up to do the right thing, because it's your health on the line," Bender said.

Congestive heart failure is a progressive weakening of the heart muscle. Approximately 700 patients a year enter Covenant Medical Center because of the condition. Nationwide, more than 400,000 new cases are diagnosed a year.

"It's kind of a catch-all term," said Dr. Peter Fattal, a cardiologist with Michigan CardioVascular Institute. "We're dealing with effects of injury to the heart muscle from a variety of causes."

But the many types of the condition share one thing in common, he said: "There's no cure."

Bender is by far the youngest patient in the pilot program, which is free to the first 20 patients, said coordinator Virginia Roland, a clinical nurse specialist in the hospital's cardiology department.

Roland said she asked cardiologists to refer their toughest cases.

"Our goal is to keep them out of the hospital," Roland said.

Every morning, the patients get on a talking digital scale that asks a series of 11 yes/no questions, answered by pressing buttons. The quiz covers shortness of breath, new coughing, increase in swelling and other symptom changes.

A modem transmits the answers and weight to a computer in Roland's office in the basement of Covenant Medical Center Cooper. Changes in symptoms or weight, or a missed weigh-in, signal her to call.

Usually, a little counseling on changing diet and exercise corrects the problem in a few days. If needed, Roland calls the patient's doctor to change medications or set up an office visit.

Already, the daily records have shown dangerous changes in two patients. By catching them early, they stayed out of the hospital.

"We like them to understand why we're doing what we're doing," Fattal said.

In heart failure, the chambers no longer pump blood forcefully enough to carry it throughout the body, providing needed oxygen to muscles. More importantly, the blood goes at lower pressure through the kidneys, which filter wastes and excess salt and water.

The kidneys assume the low blood pressure meaning the body is either dehydrated or has lost a lot of blood, so they release hormones that cause water retention, Fattal said. The patient rapidly gains weight.

Anything that burdens the kidneys - especially salt - speeds the cycle.

Eventually, breathing becomes so labored from fluid in the lungs that the person ends up in the emergency room, Roland said. Doctors use intravenous diuretics, which cause the kidneys to pump out more fluid.

To prevent getting to that point, Roland calls as soon as she sees weight gain.

She asks if they're eating salty foods. Almost everyone says no. Then she asks what they've eaten. Split pea soup with ham, they answer. Frozen dinners. Bacon.

"Or, I find out they're addicted to pickles and can't eat just one," she said. "They just truly don't realize how much they are eating in terms of salt."

Bender said it's hard sticking to the regimen. His doctor says he shouldn't pack more than 270 pounds on his 5-foot-11 frame.

"It's like they take everything away from you," he said. "It's kind of hard, you know, to turn down restaurant food."

Mostly, though, Bender leaves the salt out when he cooks. His family has followed suit. Two of Tracy and Mattie Bender's children still live at home. Sometimes, Bender forgets to weigh in, even though the scale sits in the living room between a chair and end table. For that reason, he tries to weigh in twice a day, just in case he missed one.

On disability leave from a fertilizer plant in Reese, Bender said his goal is to have more employment than baby-sitting his 1-year-old grandson. Every time he's tried to go back to work, he's ended up in the hospital.

"One of our goals of therapy is to restore people to completely normal functioning," Fattal said, including work.

"We can accomplish that goal in a lot of patients," he added.

The program allowed 79-year-old Thomas Seymour and his wife, Annabelle, to summer at their cabin in Lewiston, as they have done since he retired as a tool and die maker.

Just after Christmas, when Thomas Seymour stayed a week in the hospital with heart failure, the northwest Saginaw couple thought they'd have to stay home this year.

"This (machine) is just a blessing," Annabelle Seymour said. "It gives me a sense of security."

Seymour said he's feeling better, but "toward the end of the day, I get a little tired."

Like Bender, the couple has found it tough to stick to the diet restrictions.

"One week, we had corn on the cob, and he likes salt (on it)," Annabelle Seymour said. "Then I made soup and we were eating saltine crackers. He started gaining weight, and they called us.

"Once in a while, we sneak in a little something."

In a study done more than 20 years ago of tens of thousands of heart failure patients, half died within one year of diagnosis and just one in four were living five years later, Fattal said.

Today, the mortality rate is still high, although patients are living much longer with the help of new medications.

Instead of bed rest, doctors now recommend physical activity. Exercise makes the muscles more efficient at extracting oxygen from the blood, Fattal said, so the heart doesn't have to work so hard.

Roland said she hopes the program helps the patients feel happier as well as healthier.

Hospitals also have a financial incentive to keep patients feeling better and at home.

"We have a population that's getting older and getting sicker, and we are faced with limited resources," Fattal said.

Roland spends about 20 minutes a day calling patients.

A one-week hospital stay can cost about $19,000.

"I'm collecting a fair amount of data I will be presenting to insurers," Roland said.

Roland delivers the scales herself so she can see the patient's living conditions and recommend other service agencies if needed.

In one woman's home, she looked up through the ceiling and saw sky.

"It's hard to remember to watch your diet and take your medicine if you have a hole in the roof," she said.

As the program grows, Roland hopes to add social workers.

After six months, if patients undergo fewer hospital admissions than those without the monitoring, insurers might pay for the scales and Roland's time.

The next step is stopping people from developing heart failure in the first place.

The condition is directly related to a history of high blood pressure, Fattal said. People need to stop smoking, eat less salt, control cholesterol and exercise.

"Everything we do to reduce heart disease would reduce the need for these types of treatments," Fattal said. "Put me out of a job."