Update on Artifical Heart Patient

Therapy, care helped heart recipient regain strength
Progress is called similar to that of transplant patient
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By Dick Kaukas
The Courier-Journal
http://www.courier-journal.com/local...2601s61017.htm

It took Robert L. Tools 23 days to take his first steps after his July 2 surgery at Jewish Hospital in Louisville.

And when he did, he was well-accompanied.

Frazier Rehab Institute therapist Kathy Prescott held on to a special belt from behind to make sure Tools had support, and a team of others hovered alongside. But Tools, 59, didn't rush it.

In an interview this week, Prescott recalled Tools taking a couple of minutes to take those first four tiny steps. While he couldn't tell her what he was thinking -- tubes in his nose and throat made talking difficult -- Prescott said it was clear he was enjoying himself.

''He was smiling,'' she said.

Prescott said Tools is a very motivated patient -- willing to do ''whatever I suggest.''

His doctors, Laman Gray and Robert Dowling, said Tools is getting stronger and gaining weight, and has already regained normal function of his kidneys and liver, which were causing him serious problems before the artificial heart implant.

They credit the new heart, along with his medical care, the therapy he's been receiving and the support of his family.

TOOLS IS NOW taking regular strolls of about 100 feet, with supervision and support, usually two or three times a day. He does his workouts every day but Sunday.

It typically takes him three or four minutes to walk the 100 feet, and he does so in an open area outside his hospital room. There's always a little ''entourage'' with him to make sure he doesn't stumble, Prescott said.

She said Tools' progress is comparable to a heart transplant patient's.

''Some transplant patients are further along'' at the same stage of recovery, but others haven't been able to get as far as he has, Prescott said.

He told The Courier-Journal and The New York Times earlier that day that he didn't think of himself as making medical history. ''I think of myself as a guy who is trying to survive,'' he said.

And on Wednesday night, he made a brief appearance before the board of trustees of Jewish Hospital HealthCare Services, walking into the board's regular monthly meeting with Gray and a group of nurses.

Tools sat, told the board he was grateful for his implant and left in a wheelchair.

Alice Inman, the speech/language pathologist who has been working with Tools, agreed with Prescott that he's progressing well.

LIKE MANY OTHER patients who have had heart surgery and then required a ventilator to help with their breathing, Tools needed help with swallowing and speech.

''Although most of us don't think about it,'' Inman said, ''swallowing takes 24 muscles and several cranial nerves, as well as a lot of strength and coordination.''

Tools has gained so much strength over the past few weeks, Inman said, that ''I'm just following him informally at this point.'' She sees him regularly, she said, in part because ''I just enjoy stopping by and saying hello.''

She said Tools is able to eat soft foods like yogurt and to drink ''thin liquids'' like juices and water without fear that he will inhale them.

Tools didn't start his therapy with Prescott, the physical therapist, until the middle of July, about two weeks after the operation, because he was ''very debilitated'' from the heart problems that had afflicted him for about 10 years.

At first, he did the workouts on his back in bed, raising his arms over his head and extending them to the sides. He pulled his knees up, sliding his feet up and back.

He initially repeated each exercise about 10 times, increasing the repetitions gradually, adding a pound of weight on his ankles and in his hands, until he was ready to stand up and sit down in a chair, Prescott said.

Later, he did similar arm exercises in the chair, along with ''heel kicks'' in which he lifted his feet off the floor, and ''marching'' as he sat.

Then on July 25, he was able to stand and take his first steps.

Prescott declined to say who was in the room that day or how they reacted. But she added, ''I was happy, and I applauded. I clapped for him.''

She said Tools ''still needs support'' when he walks, but is able to do so much more confidently now.

WHEN HEART transplant pantients can walk that far, they should have few problems with the challenges they'll face outside the hospital, she said, such as getting to the kitchen, bed, bathroom and phone.

Gray and Dowling have said that it likely will be a few months before Tools gets to go home. He probably first will have to spend some time at Frazier Rehab Institute and then live nearby, perhaps in the Inn at Jewish Hospital.

In the interview last week, Tools expressed confidence about his chances of going home, saying, ''I know eventually I will.''

Robert L. Tools is motivated and willing to do ''whatever I suggest.''