BETTER NOW: Mdm Chinnamah was diagnosed with congestive heart failure, which led to water retention in her body. The excess fluid was removed through aquapheresis.
A NEW treatment to drain excess fluid from heart failure patients, who are resistant or allergic to diuretics, is now available.
Taking care of her four grandchildren was becoming harder and harder for Mdm Chinnamah Vellasamy Kathiresoo.
A heart failure patient, she found it hard keeping up with them, as her legs had become severely swollen from fluid overload.
After taking just a few steps, she would be breathless and start wheezing.
“It was hard to walk. I had to rest every few minutes to catch my breath. Even standing in the kitchen to prepare meals for the kids became tough,” said the 62- year-old.
Having worked in a factory when she was younger, she had become used to being on her feet.
When she retired, she gained a reputation among her friends as the person to go to for catered food.
She could easily cook up a feast for 200.
But with her swollen legs, it looked like she would have to give that up, although she did not relish the idea of being idle.
Fortunately, she did not have to.
Doctors at the National Heart Centre Singapore (NHCS) offered her a new therapy known as aquapheresis to drain the excess fluid from her body.
The new therapy makes use of the ultrafiltration technique, where blood containing excess fluid is drawn out and passed through a special machine, which removes excess salt and water, and returns the blood to the body.
NHCS started using aquapheresis in October 2011 and was the first in the region to do so.
Mdm Chinnamah’s procedure was done in December last year.
Besides her, 12 other patients (at press time) have undergone aquapheresis and none were readmitted for fluid overload within the first 90 days of treatment.
NHCS estimates that about 50 patients a year will benefit from the new treatment.
Because aquapheresis helps to relieve symptoms such as weight gain, swelling in the legs, arms and abdomen, breathlessness and fatigue, patients also benefit from reduced re-admissions, shortened hospital stays and fewer unscheduled clinic and emergency room visits.
NOT PAINFUL: Dr David Sim of the National Heart Centre Singapore with Mdm Chinnamah Vellasamy Kathiresoo, who had two litres of excess fluid removed through aquapheresis.
The aquapheresis machine can run from eight to 72 hours, but most patients only require a 12- to 15-hour session, depending on the severity of their condition.
In Mdm Chinnamah’s case, after 12 hours, doctors removed two litres of excess fluid.
She stayed in hospital for two days for the procedure.
“They put a small catheter into a blood vessel in my neck, but it was not painful. I could see results within the first few hours. By the time the procedure ended, my swollen legs had returned to normal,” she said.
A few years before she underwent aquapheresis, Mdm Chinnamah had been diagnosed with congestive heart failure .
This meant her heart was no longer able to pump enough oxygen-rich blood to meet the needs of her body.
That led to water retention (in her body) or fluid overload.
“Heart failure patients will, at some point, experience one or two acute episodes of fluid retention. Some of them recover quite well and only need medication to manage their symptoms after that. Others, however, tend to come back to the hospital with fluid retention despite taking medicines and making lifestyle changes,” said Dr David Sim, Consultant and Co-Director, Heart Failure Programme, Department of Cardiology, NHCS.
Heart failure is a top cause of cardiac admissions with about 5,000 cases annually in Singapore.
NHCS sees about 1,000 such cases a year, and more than 90 per cent of them are hospitalised for fluid overload.
Patients with fluid overload typically experience breathlessness especially when lying flat, and have swelling in their legs, scrotum and abdomen.
They also suffer from abdominal discomfort.
Taxi driver Mr Soh Teow Cheng, 59, also underwent aquapheresis.
Like Mdm Chinnamah, he suffered from breathlessness and fluid retention.
But the swelling was in his abdomen, legs and feet.
“I couldn’t walk and would feel breathless after covering a distance of less than 10m.
The swelling in my abdomen was so bad, I looked like I was 10 months pregnant,” he said.
He too had congestive heart failure.
Nine years earlier he had been diagnosed with cancer, and the chemotherapy he underwent damaged his heart muscle, resulting in heart failure.
Mr Soh was put on a low-salt, low-fluid diet and treated with diuretic drugs or “water pills”, which induce production of more urine.
But he did not respond to this conventional treatment.
High doses and injectable forms of the diuretics failed to drain the excess fluid in his body, too.
He had what is known as diuretic resistance.
About 20 to 30 per cent of patients with fluid retention are diuretic resistant, which means their kidneys do not respond to diuretics.
This commonly occurs in patients with moderate to severe heart failure.
The only option open to them until now was to undergo dialysis to remove the fluid.
With Mdm Chinnamah, diuretic resistance was not the problem.
She had an allergy to almost all diuretic drugs, which left dialysis as the only solution, if not for aquapheresis.
“Although dialysis is very effective in removing excess fluid, it has its limitations. It can only be done in the Intensive Care Unit and patients need a few sessions before they can be slowly weaned off the machine,” said Dr Sim.
With aquapheresis, only a single session is needed and it can be done in the wards.
Mr Soh went through one such session in November 2011 and shed 12 litres of excess fluid.
Along with the fluid, he lost 8.8kg in weight.
However, aquapheresis cannot be used for all patients.
Those with advanced renal impairment, or very low blood pressure, are unsuitable for it.
Those who are allergic to heparin (a blood thinner that is used during the ultra-filtration process) should also not undergo aquapheresis.
These days, Mr Soh is a much happier person.
He feels a lot lighter and has returned to his usual routine.
“I no longer suffer from breathlessness. I can walk so much better, too, and am able to continue working as a taxi driver. I feel very healthy now,” he shared.
Mdm Chinnamah, too, is able to walk without having to stop and rest.
Although she no longer takes care of her grandchildren as her doctor has advised her to take it easy, she enjoys their company during the school holidays.
She intends to take on a part-time job soon to keep herself occupied, but has come to realise that her health is important too.
She is aware that the more severe her heart failure, the higher the likelihood that fluid will re-accumulate in her legs.
So, she takes her medication regularly.
“I also have to watch my fluid intake,” she said.
“I can’t take more than one litre a day.” Fluid overload can be caused by disorders of the heart, liver or kidneys.
It is important for patients with these conditions to look out for symptoms.
If left untreated, the condition can become fatal.
Symptoms to look out for:
• Experiencing more breathlessness than usual.
• Finger pressure applied on the legs leaves a depression on the skin.
• Gaining more than 2kg in weight within two days.
• This story was first published in Singapore Health, Sep/Oct 2012.