- Associated Press - Sunday, February 26, 2017

LINCOLN, Neb. (AP) - The last time the army of Bryan doctors, nurses, specialists and therapists saw JoAnn York, she wasn’t looking too good.

For 143 days the 72-year-old Clarinda, Iowa, woman fought failing heart and organs in Bryan Medical Center’s ICU and acute care units.

When she left the hospital on Jan. 12, she still wasn’t walking, and was just relearning how to swallow solid foods. She was not exactly the picture of health.

But one month later, on Feb. 13, York and her husband of 50 years, Mike, returned to Bryan for a follow-up visit.

Hugs, tears and cries of joy greeted her as she reunited with more than 35 heart, respiratory, kidney, pulmonary and ear, nose and throat specialists, nurses and therapists responsible for saving her life.

“One team, one purpose,” said Sarah Schroeder, nurse practitioner and coordinator of the mechanical circulatory program at Bryan Medical Center. “A lot of people were involved in saving her. “She was resilient.”

Accompanied by her husband of 50 years, Mike, York surprised the group by getting out of her wheelchair. Talking, joking and definitely looking much healthier.

“Your color is so good,” Schroeder gushed. “You have more fullness to your face.”

York’s success story is perfect for celebrating American Heart Month, and medical advancements that can restore life when the most vital of organs - the heart - stops working, the Lincoln Journal Star (https://bit.ly/2meQ1pX ) reported.

Heart disease runs in York’s family. In 2013, doctors implanted a pacemaker/defibrillator to ensure her heart maintained a healthy rhythm.

So this past July, when York noticed shortness of breath and unusual fatigue, she blamed it on being out of shape — and told herself to get her act together.

A visit to the doctor revealed it was her heart that needed to get its act together. She was experiencing atrial fibrillation (AFib) - instead of keeping a steady beat, the right atrium of her heart was in a constant state of quivering - “much like an upside-down bowl of Jell-O,” Schroeder said.

The lower left ventricle, which is responsible for squeezing the blood in and out of the heart, couldn’t keep up and was stretching due to the buildup of blood. A normal heart ejects 55 percent or more of the blood every minute. York’s was at 20 percent, Schroeder said.

Doctors tried tweaking the heart into rhythm with medication. Twice they shocked the heart to reset it. None of those interventions worked.

They told York she needed surgery to replace her heart’s mitral valve and open up a blockage - fairly common heart procedures.

After the surgery, York was doing so well, that the family planned to return home to Clarinda.

“Then everything went downhill,” Mike York said.

York was breathing on her own, and taking short walks down the hospital hall. But each time she stood, she complained of a “full feeling in her tummy,” Schroeder recalled.

York’s legs swelled. She was exhausted. Her hospital stay was extended as doctors worked to find a prescription combination that would keep her heart in sync.

“But everything we threw at her, her body said it was not having any of that,” Schroeder said. “Each day we would see a little more decline.”

Her kidneys stopped working. Her body, unable to flush fluids, swelled like an overstuffed sausage.

A normal heart will pump four to 10 liters of blood per minute. York’s was pumping two liters a minute, Schroeder said.

She was experiencing multi-system failure throughout her body.

Doctors took her back to surgery.

“For us sitting in the waiting room, we just wanted someone to come out with a smile on their face,” Mike York said. “I just wanted to know she was OK.”

But everything was not OK. York was placed on an LVAD - a left ventricular assist device. The device, about the size of the D battery, is installed just below her heart, and picks up the slack when the left ventricle is unable to keep up with need to pump the blood out of the heart. Cables snake through the inside of her body, coming out at the side, where another cable connects to a 1.5-pound battery pack, which she must carry at all times.

She will be on the LVAD for the remainder of her life.

Meanwhile the right side of York’s heart started having problems. Doctors placed her on an RVAD (right ventricular assist device) — which pumps blood from the right atrium into the pulmonary artery and lungs.

York was kept sedated through the worst of it. She had a tube down her throat to help her breathe and another in her stomach to pour nutrients into her weakening body.

Mike York remembers how crowded his wife’s hospital room was — sometimes he had to step out to make room for more nurses and doctors.

“There were two nice ladies in there 24 hours a day,” Mike York said. “There were two trees full of pumps, and eight or nine pump bags and this R2D3 thing doing the work of her kidneys. And then there was that machine with the warming blankets.

“Oh . the noise factor - beep, beep, pump, pump . It was a foreign world.”

His wife shrugs. She remembers none of it.

The family kept a daily journal, noting visitors, procedures and important moments - good and bad. Some visitors wrote down messages.

“I’ve read it,” York said of the journal. “It scared me after the fact. Until I read the journal, I didn’t realize what I put my family through.”

Mike York stops his wife - you would have done the same for me he tells his high school sweetheart.

“It was a crappy deal, but a positive thing,” he said. “I can’t believe the support and care we received. It was just unbelievable.”

Unlike the LVAD, which is permanent, the RVAD is temporary. York was on it for one week_longer than anticipated.

For six weeks, York’s condition was touch and go. Her kidneys stubbornly refused to work.

“Then all of a sudden her kidneys started producing urine,” Sarah said.

Today, her kidney function is normal. But at their worst, York had more than 47 pounds of excess fluid in her body.

In all, York spent nearly two months in intensive care, followed by three months in SelectSpecialty Medical, a long-term acute care hospital and an acute care rehabilitation facility located on the Bryan Medical Center west campus.

Then on top of everything else, York developed shingles. And the medications designed to help her circulatory system triggered side effects, the most bothersome being a chronically bleeding mouth.

While York remembers little of her hospital stay - she does recall the pain.

“I hurt so bad, I didn’t know what was hurting worse,” York said.

It was the only time she wondered if she should give up on life.

Her muscles atrophied from lack of use. The tube down her throat prevented her from talking. She communicated through blinks and later through hand squeezes.

Mike York remembers his wife’s rapid blinking early in recovery. At first he thought it was a neurological issue, but the couple’s daughter Laurie Stogdill quickly interpreted the meaning: she wants her glasses.

The Yorks chuckle over other communication mishaps. Like when she squeezed her daughter’s hand three times in a row.

“I love you too mom,” Laurie told her mom.

But it turns out York really was telling her daughter to change the TV channel to 3.

Once the tube was removed from York’s throat she had to relearn how to swallow. A rigorous process of tucking her chin and forcing soft foods like pudding and honey to slide down her throat.

“The worst was honey,” York said.

Meanwhile, she took most of her nutrition through the feeding tube. She didn’t have solid food for nearly 60 days.

The Yorks, who had planned to spend their 50th wedding anniversary (Nov. 26) in Branson, Missouri, spent it at Bryan Medical Center.

Still unable to eat, Schroeder allowed York to taste the frosting on her anniversary cake.

On Jan. 12, York returned home to Clarinda. She’s regaining her strength. She has physical therapy three times a week. A home health nurse visits weekly.

“Walking is slow. But I can go to the bathroom by myself now,” York said. “I’m hopeful that I will get to where I am better than I was before.”

Given her determination and that of her family, friends and cadre of medical providers, the odds are definitely in York’s favor.


Information from: Lincoln Journal Star, https://www.journalstar.com

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