Replacement still ticking 17 years after transplant

By Michael King
Post-Crescent staff writer

KAUKAUNA — Bill Rammer's heart stopped beating for good in January.

He was hospitalized for a few days but has since returned to his part-time job.

The failure of Rammer's heart was only a minor setback for the 70-year-old Kaukauna man, who is something of a modern medical miracle.

Almost 17 years ago, he had a second heart transplanted into his chest in a rare "piggyback" operation at University of Wisconsin Hospital and Clinics in Madison.

A few traditional heart transplant patients from UW are still living after 20 years, but the long-term success of the piggyback transplant in Rammer's case has been unexpected.

Since the transplant, Rammer has lived an active life, enjoying bowling, golf, following the Green Bay Packers and seeing the couple's five grandchildren.

"I'm different," he said. "Right now (UW officials) are following almost 200 heart transplant patients down there. I'm the only piggyback.

"It almost seems like a miracle," said Rammer, an engineer who designs, builds and tests agricultural equipment. "With my old native heart providing a little bit of boost, I had quite a bit more energy than I think most transplant people do."

For Diane Rammer, his wife of nearly 49 years who thought she lost her husband in 1990, the extra time has been a godsend. "For him to live this long, it's very rare," she said.

Diminished heart capacity

"My native heart has completely stopped," Rammer said, recalling his third heart attack on Jan. 13 while at home. "I had kind of a sick feeling in my chest and a slight pain in my left arm. It was a rather mild heart attack, compared to my first one."

In January 1987, Rammer was cutting firewood north of Green Bay when he knew something was going wrong. He was rushed to the Kaukauna hospital and then transferred to Appleton Medical Center.

"That first heart attack was so bad that they never really expected him to come out of it," said Diane Rammer. "They shocked him three times."

Dr. Rob Wilson, a cardiologist at the Appleton Heart Institute at AMC, recalled that the artery on the front wall of Rammer's heart was blocked. It was reopened through balloon angioplasty "but it was too little, too late. Too much time had elapsed so we had a lot of damage to the front wall of the heart."

As an otherwise healthy and active 53-year-old, Rammer returned to his normal activities despite the heart's diminished capacity.

In January 1990, he suffered a second heart attack, as the artery on the side wall of his heart became obstructed. Again it was surgically opened up but the additional damage left him weak and short of breath. With only about 30 percent of his left functioning, he was referred for a transplant.

By summer, his condition had worsened.

"I got so sick. I couldn't do anything. I couldn't sleep. I didn't feel like eating. Nothing tasted good or smelled good," he said.

"He had two to three weeks to live because everything was shutting down," Diane Rammer said.

A 'medical phenomenon'

"He (Rammer) is for many reasons a medical phenomenon," said Dr. Niloo Edwards, chairman of cardiothoracic surgery and director of heart transplant program at the University of Wisconsin Hospital and Clinics. He said the piggyback transplant was "fairly popular" in the early stages as "sort of a backup" but has been "used less and less over the years."

Edwards said the piggyback procedure "originally was devised as a way to support people who were dying who couldn't get a suitably sized heart." With the advent of mechanical assist devices, the need for piggyback assists faded.

He described the piggyback transplant as "putting a pump basically in series with the patient's native heart. This heart almost like pumps for half the heart. It's half a transplant, if you will," said Edwards, who has performed about 300 heart transplants.

Wilson said a regular heart transplant was not an option for Rammer due to high pulmonary pressure.

"If you had put a new heart into Bill and hooked it to his own lungs, which you have to do, it would have overwhelmed the new heart," he said. "The new heart would have failed, a pressure overload. So they left his own heart there to buffer that pressure."

Unending gratitude

Rammer has undying gratitude for organ donors, saying they deserve credit for helping others survive. "It's that decision by the donor and the donor's parents to make these organs available. That's the greatest blessing in the world."

In his case, a 14-year-old Milwaukee area girl gravely injured in a car crash near Marshfield provided what Rammer called "the extra special heart" he desperately needed.

"She donated a lot of organs," he said. "I'm just one of the lucky ones."

Over the years, Rammer and his wife have continued to send flowers to her family on her birthday and for the holidays. He talked to them on the phone years ago but they never met in person.

Understanding his limits

Five weeks after his native heart gave out, Rammer was back on the bowling lanes at the Super Bowl.

"I hit my average," he said. "I had a 190 my first game."

He admitted getting "a little tired toward the end."

On Friday, Rammer had his final cardiac rehab session at Appleton Heart Institute. It helped him to understand his new exertion boundaries now that he's using just the single heart.

Simple things like using steps require him to be aware of his new limitations. "I catch myself going up steps too quick and I get to the top and I'm out of breath," he said.

"It's kind of a total slowdown. After all, I am 70," he said. "Slowing down is obviously something I'm going to have to do."

He credits his wife for aiding his recovery by being "extremely supportive all through this. It's just a great blessing to have all this (extra) time."

Michael King can be reached at 920-729-6622, ext. 33, or mking@postcrescent.com.