Beating the Cardiac Odds Brings New Hope for Lehigh County Man

Don’t bet against Dan Howard.

When he was admitted to the cardiac intensive care unit at Lehigh Valley Hospital (LVH)–Cedar Crest on Jan. 9 with severe heart failure, the odds were about 1,000-to-1 against him going home.

His weakened heart wasn’t pumping enough blood to his vital organs, including his kidneys, and the situation was grim.

The heart team at Lehigh Valley Heart and Vascular Institute went to work, using a catheter to travel through one of Howard’s arteries and install an Impella heart pump, the world’s smallest, to help his heart pump and, more importantly, allow his body to recover for what lay ahead. “Our first goal was to preserve organ function,”cardiologist Nael Hawwa, MD, says.

“I believe that Dan’s resilience and desire to fight, and the immense emotional support he had from his loving family, played a large role in him getting through this life-threatening situation.” - Nael Hawwa, MD

At just 51, Howard would spend the next two months in cardiac intensive care. For most of that time, he was unconscious and unaware of what was happening to him or what was going on around him. He was on dialysis for weeks. He was on a ventilator more than a month. His heart stopped twice. “When someone is that sick, all the organ systems become compromised and start to fail,” Dr. Hawwa says.

The temporary heart pump did its job for 60 days, allowing Howard’s body to recover enough to undergo open heart surgery, where Timothy Misselbeck, MD, Chief of Cardiac Surgery, implanted a permanent heart pump known as a left ventricular assist device (LVAD) during a five-hour operation on March 14. The battery powered LVAD is inserted into the tip of the heart, pumping blood and bypassing the heart’s left ventricle, its main pumping chamber. After more time in cardiac intensive care and in other transitional units, Howard left the hospital for home on April 12.

Howard was no stranger to heart trouble when he arrived at the LVH–Carbon emergency room near Lehighton that January day. He’s had a weakened heart – cardiomyopathy – since 2014 and was hospitalized several times in the past, including in late December.

Medication helped his heart for a time after his initial diagnosis, and doctors eventually needed to implant a pacemaker and a defibrillator. After that, Howard says, he got back to his active lifestyle of working out, including riding 10 miles a day on his bicycle.

“The fluid retention in my body, which can cause swelling and other problems, eventually caught back up,” he says.

Howard says he dealt with extreme anxiety over a fear of going to sleep and not waking up.

The PenTeleData technical-support manager’s wife, Lisa, said her husband’s breathing had become more difficult and labored in the days before they decided they needed to get to the hospital on Jan. 9. “It was just to the point that it seemed like it was getting worse,” she says. Dan was transferred by ambulance from LVH–Carbon to LVH–Cedar Crest.

Howard’s fighting spirit was a key factor in how he made it through the medical morass that kept him in intensive care so long, Dr. Hawwa says.

“In addition to the heroic medical care, I believe that Dan’s resilience and desire to fight, and the immense emotional support he had from his loving family, played a large role in him getting through this life-threatening situation,” Dr. Hawwa says. “A person’s mental attitude is directly tied to their physical health. The medical care was extremely complex requiring a multidisciplinary team of more than 100 LVHN [Lehigh Valley Health Network] colleagues, including nurses, physical, occupational and respiratory therapists, nutritionists and advanced practitioners and physicians across every organ system and subspecialty as well as internal medicine residents and cardiology fellows.”

Howard freely admits he’s the stubborn type and credits that in part for his never-quit attitude. He says he kept thinking of how he didn’t want to leave his wife, their children or their new home in rural Slatedale, Lehigh County.

“He never gives up on anything,” Lisa Howard says. “My kids and I knew we couldn’t give up either. We wanted Dan to push as far as he could go. It was hard. It was a hard thing deciding what to do.”

“I’m not a religious person, but I believe there’s a lot more for me to do,” Dan says.

Howard is a music lover with a collection of 26 guitars of all types to prove it. His spirits were buoyed in the hospital when he received a surprise visit one day from one of his musical heroes, Ted Poley, the lead singer of the ’80s rock band Danger Danger, a group that opened for the likes of Alice Cooper and KISS.

Dan follows Poley on Facebook and said Poley saw his posts about being in the hospital and decided to pay him a visit.

“He showed up out of the clear blue. It was incredible,” Howard says. A jam session in the hospital was out of the question, but Howard says it was still one of the coolest things to happen through his ordeal.

He says he’s starting to pick up and play his guitars again. He’s getting back to being more of a “normal person,” he says, doing things such as walking up the stairs. But there are drawbacks with the LVAD. He can’t get it wet, so there’s no swimming, and showering requires certain precautions.

Positives can be found in many places, Dan says with a smile, such as being able to stretch out on the couch with his feet up. That’s something he couldn’t do before surgery.

The Howards are grateful for Dan’s second chance.

“The cardiac intensive care unit team was great, all of them,” Dan says. “They were on top of their game.” Dan says when he was able to communicate with his caregivers, they let him know how serious his situation was, but also made him feel he was eventually going to get better enough to go home. “That meant a lot,” he says.

Lisa says everyone involved in Dan’s care was awesome. “I love them all,” she says.

Howard’s future remains uncertain. While LVAD recipients can survive with an LVAD for years, Howard will be evaluated for a heart transplant in Philadelphia in the near future.  

LVHN does not currently have a heart transplant program but maintains a formal partnership with Penn Medicine in Philadelphia and informal relationships with the other surrounding transplant centers for patients needing a heart transplant.

“The sad part is that someone has to pass away for me to get a new heart,” Dan says. “Hopefully, I will match up with someone. I just want to get back to normal.”

Heart transplants in the U.S. hit an annual record last year with 4,111, according to the United Network for Organ Sharing. Sadly, some heart waitlist patients will die before a heart becomes available.

LVAD programs for those with end-stage heart failure are highly specialized and not all health networks have one. LVHN’s program started in 2012 and is managed by Barbara Ebert, CRNP, who has decades worth of LVAD experience, and LVAD Coordinator Kelsey Barrett.

There are two cardiac surgeons who perform LVAD surgeries. There also are five advanced heart failure and transplant cardiologists, Hawwa among them, who care for patients for years before and after surgery.

The first LVAD recipient was a 74-year-old woman who received the device in February 2013. She lived for nearly another 10 years and died from circumstances unrelated to the LVAD. More than 75 patients have received an LVAD over the ensuing decade.

“These patients can go on to live their life with very few restrictions. They get on planes, cruises and automobiles and travel to places where their heart failure previously prevented them from visiting,” Ebert says. “They go on to see grandchildren graduate from kindergarten, high school and college. They see babies born who they may not have seen without this option. They can go on living their life as they choose to live.”