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Transplant doctor climbs mountains

Her quest is to teach that transplant recipients can live a full life

By Michael Smith
MedPage Today Staff Writer

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Dr. Heather Ross is shown atop Mount Matier in British Columbia.

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TORONTO, Canada (MedPage Today) -- Dr. Heather Ross, medical director of the cardiac transplant program at Toronto General Hospital, doesn't just recommend rehab, she lives it with her patients.

What could be better rehab for a heart-transplant patient than cross-country skiing? So Ross just spent a winter weekend teaching Aaron Knox, who has a new heart, how to cross-country ski.

But there's a lot more to the story than that. Ross, 43, and Knox, 30, are going mountain-climbing together. The skiing lesson was just the first step in a challenging -- and chilly -- adventure.

It's not just any mountain they plan to climb. In December, Ross and Knox will fly to Antarctica to climb Mount Vinson, the highest peak in that icy wilderness. If they're successful, Knox will be the first heart transplant patient to climb the 16,000-foot mountain.

It's all part of a quest to increase awareness of the transplant program at Toronto General, aimed at persuading more people to sign donor cards and to raise money for some aspects of the program.

Above all, the climb is to demonstrate that people with a transplanted heart -- despite some important physiological differences -- can have just as adventurous a life as the next person.

But first Knox has to learn to ski.

"I was a bit worried when in the first 10 minutes, he tipped over about four times," Ross laughed. But in the end, Knox got the knack and he and Ross skied about 4 1/2 miles.

Next stop, Antarctica.

"The lesson that transplant patients have taught me is that life is precious, it is fragile and unpredictable, and you have to live each day to its fullest," Ross said.

It was not, actually, a lesson that Ross needed. She started testing her physical limits when she was still in grade school. At age 11, she did a 100-mile bicycle trip. She has been a parachutist, a mountain-biker, a rock-climber and a skier.

But the idea of climbing mountains with transplant patients really took off in 2004, when she was part of a pioneering team that climbed Mount Sajama in Bolivia with a heart transplant patient and a kidney transplant patient.

All transplant patients share one problem -- the medications that they take to prevent rejection can have adverse effects on muscle. But heart transplant patients have an additional problem doing hard physical exercise.

In the normal heart, Ross says, a nerve called the vagus nerve keeps the heart rate slow when a person is resting. As exercise begins, the nerve slowly allows the heart to speed up until, after a few minutes of warm-up, the adrenal glands kick in and give the heart an additional boost.

But a transplanted heart comes without a vagus nerve; it's always beating at about 100 beats per minute. To avoid straining it, the transplant patient needs a long, slow warm-up until the adrenalin kicks in.

Despite that, Ross says, the Mount Sajama climb -- "a most amazing experience" -- showed her and others that heart transplant patients aren't limited to a quiet life.

And Knox -- who was waiting for a transplant at the time -- took the lesson to heart: "Aaron just kept saying, 'I really want to do something, I want to have an adventure, I want to live my life,' " Ross said.

Ross decided to make it happen -- they would tackle Mount Vinson.

For Ross, adventure is the foundation of her life. Even her choice of specialty, she says, was based on its heart-pounding aspects. Cardiac transplant medicine, she says, is fast-paced, complex, and needs life-and-death decisions to be made in an eye-blink.

"Some people use the term adrenalin-junkie," Ross said, "but I prefer to be called an adventure-seeker."

The downside of the adventure, of course, is that her patients don't always do as well as Knox.

"There's an epidemic of heart failure," Ross said, "and a large number of the patients I meet and get to know die."

One way to deal with that is to do a better job selling the transplant unit. If all goes well, the Antarctic trip will increase the number of donors, but Ross hopes it will also raise money for the hospital's mechanical heart assistance program and for research into ways to avoid or reverse heart failure.

In Canada's taxpayer-funded medical system, a heart transplant is paid for, but mechanical devices to keep a patient alive while waiting for a new heart are not. Ross says it's essential to raise private money so that such machines are not always on the shelf.

And she holds out hope that research into stem cells or regenerative medicine will one day make transplants a thing of the past. "I would dearly love to put myself out of business," she says.

In the meantime, Ross has the Marginal Donors.

The Marginal Donors is an R&B band started by a medical colleague. Ross is the lead singer. In transplant parlance, a "marginal donor" is a person over the age of 40.

"This job has a lot of stress," she said. "As a release of tension, to stand up with a microphone and pour your guts out in song in front of 1,500 people is a remarkably good feeling."

The Marginal Donors started playing every now and then, usually at medical meetings. But they're starting to pick up other gigs and they're putting together a demo CD, Ross said.

"We keep getting invited back, which feels really good."

Aside from helping her deal with the stress of transplant medicine, Ross says, singing in the band has another perk:

"My favorite thing is that I get to wear skin-tight leather pants and sequins."

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