SIOUX CITY | Cash Howe knew something was wrong when he didn't have the energy to climb the basement stairs -- a task that had been once effortless for the avid bow hunter, fisherman and former Kingsley-Pierson teacher, who won the bench press at the Iowa Games three years in a row.
"That flight of stairs was so easy, and now I stopped in the middle just to get my breath," said Howe, who consistently ran a low-grade fever and had gained more than 20 pounds before the April 2015 episode. He told his wife, Sharon, "You're going to have to take me to the ER."
The 69-year-old Kingsley, Iowa, man had no idea that his heart was failing. He chalked the way he was feeling up to aging and a bout of influenza. Although Howe had been diagnosed with an irregular heartbeat years before, the diagnosis of stage 4 congestive heart failure, which he received at Mercy Medical Center -- Sioux City, came as a shock.
"(The doctor) came in the room and shut the door and he said, 'You've pushed the envelope so far that if you didn't come in and talk to me today, we probably would never talk,'" recalled Howe, who said the news felt like a slap in the face.
Howe was taken to the University of Nebraska Medical Center's Congestive Heart Failure/Transplant Clinic by ambulance.
The medical testing at UNMC revealed he was a prime candidate for a left ventricular assist device (LVAD), a surgically implanted, battery-operated, mechanical pump that helps the main pumping chamber of the heart — the left ventricle — circulate blood to the rest of the body. If Howe didn't receive an LVAD, doctors told him he wouldn't live to see his next birthday.
Jerome Pierson, Howe's cardiologist at Mercy Medical Center, said many times, in cases like Howe's, high blood pressure, a virus or valve disease is responsible for weakening the heart muscle.
Pierson said LVAD models, which feature both internal and external components, have come a long way in recent years. LVADs, which are more compact than they used to be, are a bridge to transplantation for some patients and a destination therapy for others, according to Pierson, who believes LVADs will be fully implantable at some point.
"That's what we're giving the patient as the be all to end all," he said. "We're not looking at transplantation. This is going to be their existence."
Three minutes left
One night, Howe traveled to Sioux City from Kingsley with his wife and her mother to eat at a Mexican restaurant. While leaving the restaurant, one of the LVAD's alarms went off, signaling that Howe had 15 minutes to change the battery. Unfortunately, he had forgotten the spare batteries on the dining room table back at his home, which was 30 miles away.
He called his son, Lance, and told him to meet him in the parking lot of a former steakhouse near Lawton, Iowa.
"I told him, 'Don't dink around. I've got about 12 minutes left,'" he recalled. "When that battery goes dead, so does everything else."
With just minutes to spare, Howe's son's Ford pickup truck slid to a stop in the parking lot. He hopped out of the truck and ran to Howe, batteries in hand.
"When I switched them out, I had three minutes left," Howe said.
For one year and eight days, the LVAD kept Howe alive.
On a Sunday in early May 2016, Sharon Howe answered the phone and passed it to her husband. The caller on the other end informed him a heart was available and asked, "Do you want this heart?"
Howe responded, "Sure. I do."
He packed up the LVAD batteries and headed to Omaha with his wife, who said the two-hour drive seemed to take "forever." When they arrived sometime after 4 p.m., Howe learned there was a delay in getting the heart to UNMC.