Here's a patient, 73 years old, white male with congestive heart failure, CHF, chronic kidney disease, CKD, diabetes mellitus, DM, EF or ejection fraction of 25% He was full of fluid, edema in his legs, he was basically on death's door
They put a left ventricular assist device in him, which is basically a pump outside the heart with two tubes, one that goes from the left ventricle to the aorta When you listen to the heart there is a [imitating buzzing sound] And some people don't even have a heartbeat, so there's no lub-dub
It's just the [imitating buzzing sound] But he had a lub-dub that kind of thing Pretty sick guy and no one was going to touch him He can't even get a heart transplant, because he weighs too much And what happens? He gets sent to me
So we put him on a low-carb high-fat diet or a keto diet, we include the sodium restriction, a water restriction and a vitamin K restriction because he is taking Warfarin or Coumadin, which is an anticoagulant It's okay, you just monitor these things and you don't get so afraid that you can't do something You just monitor these things a little more So it's a little more intensive There are home daily weights which you already knew, he is home monitoring his PT/INR, which is the blood thinner
Over one year he has lost 44 pounds, from 313 to 269 pounds, his exercise tolerance has improved, his insulin requirement decreased from 100 units a day to 45 units a day People asked, "What about the kidneys?" His creatinine, measure of kidney function, improved from 18 to 15, the lower the better in terms of the creatinine And his most recent left ventricular ejection fraction is 40%
He came back just a few weeks ago, that's the reason I brought this here And he said, "You know, Doc, they're thinking about an explant program, "a starting one "And what they are going to do is they are going to put me in the hospital "and they are going to turn off the pump and see how I do
And then they might even take out the LVAD, the heart assist device Wow! So we now have about a dozen folks with LVADs, some we've sent on to heart transplant, some who are feeling so well, they're thinking about just leaving the LVAD in and not doing the transplant, because a transplant is no cakewalk I mean it's a big deal, you're on anti-rejection meds afterwards and all So there's even consideration now of the LVAD being removed Essentially this would have been, if this all goes according to plan and he does great, that basically his heart failure which was
he was on death's door He got abridged to get on to a low-carb diet He had a ventricular device, he lost weight, and maybe the low-carb, the ketones, we don't know, helped things And what a save!