Back then, the tiny fraternity of heart transplant patients was so small, it
seemed like everyone who had the operation knew each other, said Velez.
There were regular meetings. Friendship and an emotional support system
were forged through shared experience. And everyone knew their number.
"They would say 'Hi. What number are you?' I was 174," he said proudly.
Today, much has changed. Preservation methods have improved for donor
hearts, as have therapies designed to keep patients alive until a suitable
heart can be found. At TUH, the surgical team is poised to achieve a
milestone of 1,000 heart transplants -- as it continues to distinguish itself
as a leader in the field.
All this progress makes Velez smile -- not only because he is proud to serve
as a living example of the program's enduring success, but also because his
son, Joel, recently received a new heart at Temple as well.
Like Father, Like Son
Joel Velez has always respected his father's strength. He enjoys telling the
story of how quickly his dad recovered after his heart transplant. "He
started walking every day -- rain, sleet, or snow. His doctors called him the
roadrunn," said the younger Velez. Eventually, he could do two full laps
around Lake Carasaljo in their hometown of Lakewood, N.J. "That's like 10
or 12 miles," explains the son.
But it wasn't always like this for Neptali Velez, 68. Sidelined by a
deteriorating heart caused by cardiomyopathy at age 50, his cardiologists
recommended him for transplantation. Since the heart transplant had been
pioneered at TUH, there was little doubt as to which hospital Velez and
his doctors would choose to help save his life. Within five months of going
on the transplant waiting list, a suitable heart was found.
Velez remembers staring in disbelief at the chirping beeper his surgeons
had given him to alert him when a donor had been found. "I thought it
was a mistake, so I ignored it," he said. "Three beeps later, they called
my family to tell them to find me. Then, I knew it was for real."
It's been 18 years since Velez became heart transplant patient #174. He
still makes regular visits to TUH for checkups, though most of his trips
these days are for the series of intensive checkups his son, #993, will
receive throughout the first year following his recent transplant.
Like his father, Joel Velez was diagnosed with cardiomyopathy -- albeit
at age 39. For him, the last three years have involved frequent
hospitalizations, the use of a ventricular assist device (VAD) to preserve
his old heart until a new one could be found (an alternative that didn't
exist in his father's day), and his own heart transplant surgery in April.
While the road to transplant was frightening, Velez had complete faith
in the TUH transplant team, particularly because his transplant was
done by a surgeon who had been part of the team that operated on
his father: James McClurken, MD, Director of Cardiothoracic Surgery and
Vice Chair of Surgery for Temple University School of Medicine.
A Generation of Transplants
"We have learned so much since our first heart transplant," said McClurken.
"When we were just beginning, we were reluctant to travel any real
distance to retrieve a donor heart because good preservation solutions
weren't available. We were limited to 50 miles then. Today, with better
preservation techniques, we can go more than 1,500 miles for a heart
for one of our patients."
Personally, McClurken has traveled as far as Edmonton, Alberta -- nearly
2,400 miles -- for a donor heart. He happily reports that the recipient
continues to do very well.
"We have also improved on the implantation process," he adds. "And
with the addition of newer therapies and devices like VADs, we have much
better ways of keeping a patient alive until we can find a heart."
Terri Hollander is Coordinator of the VAD Program at TUH. "A surgically
implanted VAD provides temporary support to the heart until it is strong
enough to be weaned off," she explains. "For a transplant patient, the
VAD takes the load off the heart and pumps the blood around the body,
enabling the heart to rest."
Joel Velez was one such patient to benefit from a VAD. He was very sick
when he arrived at Temple University Hospital. "I was going downhill
physically," he said. "They told me that I had an enlarged heart; to walk
around the corner was a struggle."
Velez was initially fitted with an assist device that provided support for
his heart. "Along with physical therapy it bought him time until a heart
was available," Hollander explained.
A Change of Heart
While TUH was the first in the region to perform a heart transplant, it
wasn't alone for long. Hospitals throughout the area soon followed
suit, many of which were staffed by transplant physicians who gained
significant experience at Temple. This was good news for patients;
however, it meant increased competition for Temple's pioneering
program.
In 1997, when there were just three programs in the Delaware Valley,
TUH performed a record 82 heart transplants. Those numbers saw a
decline after 2000, and the number of programs has increased to five.
Today, equipped with new team members and a new strategy for
reaching potential patients, the program is reaching increasing
numbers of patients as it prepares to celebrate the milestone of
1,000 heart transplants -- a volume achieved by only three other
hearttransplant centers in the nation.
"We have a tremendous wealth of experience on our team, from our
clinical staff to our administrators and coordinators," said James
Fitzpatrick, MD, Associate Professor and Interim Medical Director of
the Temple Heart Transplant Program. "Through increased outreach
to these physicians, we have the chance to remind them that we are
not only the first heart transplant program, but that we also remain
one of the most successful."
For example, Temple's post-transplant survival rate at one year is
96 percent, exceeding the national average.
Heartfelt Wishes
"Receiving a new heart is like receiving an opportunity to live your life
again," said Fitzpatrick. However, it's a road that's not without its
obstacles. Once discharged, patients must return to TUH weekly for
the first six weeks for tests, then every other week for the next six
weeks, and then monthly for the remainder of the year. After that
first year, they must come in for checkups four times a year.
As he sat in the waiting room with his father on a recent return visit,
Joel Velez wasn't sweating the small stuff like frequent office visits.
He was simply marveling at how quietly his new heart was beating.
"Having just walked from the parking garage to the car, my old heart
would have been going boom, boom, boom,right now," he said.
"Before my transplant, my heart was barely able to do its job."
And speaking of jobs, Velez said he hopes to speed his recovery
-- no doubt with the help of some walks around the lake with his Dad
and 5-year-old daughter Alyssa -- and get back to work as a truck
driver next year. His father hopes his son can achieve his goal,
though he had to change careers following his surgery.
Regardless, Joel Velez is hopeful. Like the staff of the Heart
Transplant Team, as well as his beloved -- and long-suffering
-- New York Mets, he thinks 2008 may be his year.
"I'm very optimistic," he says. "How could I not be? Even the Mets
have a shot at first place."
-- Steven Bates
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