TAVR PH@100

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Marlen V. Ronquillo

MY surname is Ronquillo and you will find that surname across the number 77, I told the receptionist. With a smile, she made a quick scroll of the names and numbers on her laptop, then waved me in.

“In” was the Henry Sy Sr., auditorium on the fifth floor of the St. Luke’s Hospital in Taguig City where men and women of a certain age (mostly senior citizens) converged on August 31 to celebrate an event they can all relate to: the number of cardiac patients that underwent TAVR, or transcatheter aortic valve replacement, at the hospital had breached the 100-patient mark, a total of 102, since the introduction of the procedure in late 2011. Excluding the doctors and the St. Luke people, we were all mostly cardiac patients with a prosthetic valve embedded in our aortas.

In a medical context that probably performs over 100 heart procedures daily in hospitals across the country (from Angeles City to Davao City), the sheer paucity of TAVR procedure recipients after a stretch of more than six years was probably the reason the Taguig-based hospital decided to celebrate TAVR’s breaching of the century mark. Finally, TAVR has hit its stride. It was a milestone for TAVR, the PH version. I gave the headline “TAVR PH at 100“to this piece, which was in sync with the cyber age.

I was the hospital’s TAVR’s Patient No. 77. So, after receiving the e-mail to attend the commemoration of the breach, I dropped my vow to never stray out of my comfort zone (I never go anywhere and hate the word “ travel”) and attend.

What the heck. My subconscious said this: Attend, then check how many are still alive. All of the TAVR recipients that were invited probably had something along that line in their subconscious right after getting their invitations.

People find comfort in numbers. Especially the sick.

I grabbed a seat at the table farthest from the stage of the auditorium which I thought was the best place to do the mental count of the TAVR “survivors”. Seated near me was Patient No. 6, who underwent TAVR in early 2012 and is a strong woman at 81. I did not get to do the mental count.

Because the good doctor who leads the TAVR team, Dr. Fabio Enrique B. Posas, the one who guides the prosthetic valve from the femoral part into the aorta to replace the feeble valve via a catheter (clamp then collapse the damaged valve), got into the heart of the heart-related event right away.

No boring recitation of medical jargon from the good doctor, a Tom Selleck doppelganger. Just the gist of why we were there. These were the main items in Dr. Posas’ brief talk.

First, the hospital wanted you to partake of its soup (it was a full meal really and it was good.)

Second, the breach of the century mark for the TAVR procedure means the public acceptance of the procedure, an option for the “inoperable“— those desperate cardiac patients with severe cases of aortic stenosis who probably won’t survive an open heart surgery.

Third, I am not Superman and we are a team. Dr. de Castro is the “rock” of the team. He was referring to Dr. Estanislao de Castro, the heart surgeon who deftly opens up the groin part so Dr. Posas can maneuver his catheter with the prosthetic valve through a major vein into the sick aorta. You know what, after every TAVR, the whole team pauses for a moment of prayer, then breaks the silence with real celebration. Dr. Posas is by nature self-effacing and funny. At the hospital, however, he is viewed with Churchillian gravitas.

Fourth, I pray before every TAVR. My wife does too. (His kind wife was there to cheer us “second-lifers.”)

Fifth, I can’t do selfies. But for this event, there is a photo booth outside where picture-taking is free and I will gamely pose with you.

Of course, he praised the efforts of his hospital to excel and do pioneering medical work. Dr. Posas said his hospital was building the kind of pioneering medical environment that can readily access to any medical breakthrough for local adaptation. It ties up with the best doctors from across the globe and it has a tie-up with the globally famous Mayo Clinic.

That it took more than six years for TAVR to hit its stride, when it was offered as a viable option in late 2011 yet, is the reason I wrote this personal thing into a column. The moral of the TAVR story is this: hopeless patients in other disease categories may not be really that hopeless. Curiosity and research may lead one into a treatment option, not the radical treatment Steve Jobs and Steve McQueen sought, but surgeries like TAVR that can treat the “inoperable”. Options that are really viable.

In my case, I dreaded the open-heart mode of repairing my damaged aortic valve. I have a serious and long-drawn case (more than 20 years) of diabetes. I have had two coronary angioplasties. I was absent during the distribution of genetic gifts. I was really forced to look for other options. That led me to TAVR.

A townmate from Lubao, Pampanga, Mr. Bert Lingad, preceded me at TAVR operating table. In a video clip, his voice now confident and hopeful, he narrated his story which I can call “his TAVR leap of faith”.

Of course, you cannot guarantee the outcome. You always remember this line from the Beatles: Some are dead and some are living. But, at the very least, you get quality medical treatment.

From the realm of the personal, I have no idea whether the prosthetic valve can hold. There have been minor leaks in my artificial valve which Dr. Posas is plugging with medicine. On June 15, 2017, I marked one full year of having a prosthetic valve. I am praying for 10 more years but I can settle for seven.

Tender mercies, you know. And nothing can top this: Better than dead.

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