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Cathie Rowand | The Journal Gazette
Anna McDougall works on letters from Santa while connected to an aquapheresis machine at Lutheran Hospital.

Procedure removes excess fluid

Imagine spending a few days in the hospital undergoing a virtually painless procedure and walking out 20 pounds lighter.

That’s what Anna McDougall of Fort Wayne did this month.

But the 70-year-old grandmother was far more interested in being able walk at all than in her weight loss, which was a welcome side effect of a new treatment for coping with a weakened heart.

“The last time, they took 22 pounds of water off,” McDougall said, while her blood flowed out of and back into her body through a narrow tube after passing through a filtering machine about the size of a parking meter.

“Afterward, I could walk through the house again and breathe. Before, I’d just wheeze and wheeze and wheeze.”

McDougall was undergoing a procedure known as aquapheresis, which is now being offered by Lutheran Hospital to people who have been diagnosed with congestive heart failure.

Dr. Mark Jones, a cardiologist who heads the hospital’s heart failure and transplant unit, says the condition is a bit of a misnomer – patients’ hearts haven’t stopped working.

But through disease or genetic abnormality the heart has become so weak that it can’t pump blood strongly enough to meet the body’s needs.

As a result, fluid, chiefly salty water, begins to build up in and around the lungs, in the abdomen and in the feet, ankles and lower legs. The associated pressure and swelling make breathing and walking difficult and can cause weight gain, because the retained fluid weighs more than 8 pounds a gallon.

“For each patient we have a weight goal – how much fluid you take off,” says Angela Logan, a registered nurse who manages the unit where aquapheresis is done. “We can take off as much fluid as we want per hour. It’s very precise, very predictable.”

And, says Ricky Saylor, 49, of Fort Wayne, “It’s not at all” painful. Saylor has undergone the procedure twice, in July and October.

The first time, he says, he lost more than 100 pounds. His caretakers at Glenbrook Rehabilitation and Skilled Nursing Center, where he now lives after suffering two strokes, say that at about 150 pounds, he’s hardly the same person.

Before undergoing aquapheresis, Saylor says, doctors told him there was little they could do but recommend him for hospice care.

“I didn’t want that,” he says.

Saylor says that he is now able to walk with assistance and recently went on an outing to see his son Blake, 18, a senior at Northrop High School, play hockey. He says he’s looking forward to Blake’s graduation next year.

Candidates for aquapheresis, Jones says, are people with advanced-stage heart failure who have become resistant to standard treatment, medications known as diuretics. Sometimes called water pills, diuretics promote elimination of fluid through the normal channels of the kidneys and the passing of urine.

Previously, when too much fluid built up, patients would have to be hospitalized for intravenous diuretics or a procedure that removed a larger amount of blood to be filtered, Jones says. Aquapheresis cuts the amount of blood outside the body at one time to about two tablespoons.

That makes things easier on patients because there’s less chance that blood pressure will drop too much or the body’s balance of water and minerals – sodium, magnesium and potassium – won’t be upset.

The procedure, which gives the kidneys a break, also can make standard treatments work better and lessen the chance of kidney failure, he says.

“It gives you a better chance of patients staying out of the hospital,” Jones says. He said that Lutheran, which began offering aquapheresis in 2009, had the procedure in mind when it added a fifth floor, which opened a year ago.

Aquapheresis, sometimes called ultrafiltration, is offered on a limited outpatient basis at Lutheran.

Jones says the technique is helping address a pressing problem at a time when the cost of health care has become a national concern.

Statistics show that nearly 2 percent of U.S. hospitalizations are for patients with heart failure fluid buildup, with an average hospital stay of about six days and a growing number of those patients admitted again within six months, he says.

Aquapheresis at Lutheran has cut the number of days of subsequent stays by 38 percent, he says. There’s no set time for how long it takes, but it’s generally two to four days of being in the hospital.

Aquapheresis is sometimes used before and after heart surgery to promote a better outcome.

It also has been used for older women with high blood pressure who retain fluid even with a heart that appears to have nearly normal pumping ability.

If a patient’s kidneys fail after treatment, then dialysis, which removes waste by a pumping machine, may be offered, Jones says.

“It’s a question of do they want to do go down the road of dialysis. Some of them don’t want that.” he says of such patients. “I haven’t seen any statistics that show (aquapheresis patients) live longer, but they live more comfortably.”

Both McDougall and Saylor feel comfortable with their choice. McDougall passed the time during her latest round of treatment by finishing up letters from Santa for some of her 19 grandchildren, nine great-grandchildren and other youngsters she knows.

“I just can’t get over it. I’m so in awe of it,” she says of the machine by her bedside. “I just feel that the people who invented this machine are wonderful. The first time, I think it saved my life because I couldn’t hardly breathe.”

Saylor says he’s glad he doesn’t have to have dialysis. Now, he says, his caretakers watch him closely to make sure he doesn’t gain more than about 10 pounds of fluid.

“Pretty much I can lead a normal life,” he says, adding he has only one request for his doctors.

“Couldn’t they just implant a little water spout?” he says with a smile. “And when they needed to, just open it up?”