On May 13, a hot day in San Marcos, a garment saved Roger Hunt's life.
He was in his sprawling, wooded backyard, walking with two friends through the workshop he built himself. The visitors were a father and son advising him on mortgage and property matters as Hunt, 73 at the time, and his wife Valerie began the process of selling their house.
Outside the door, on the small deck connected to the workshop, "I remember thinking to myself and then saying out loud, 'I don't feel so good,' " Hunt said. "And that was it, I was gone."
He collapsed and for 33 seconds — the EKG printout would later show the duration and intensity of the event — Hunt suffered a cardiac event. His mind tried to make sense of it, placing him in a virtual car accident that never happened.
"I was losing control of the car, sliding down under the steering wheel to the left, and then I was shocked back, sure that there were emergency personnel there extricating me from the car accident," he said.
In reality, it was his wife, his two friends and approaching neighbors cradling and comforting Hunt, who said he felt no pain or fear before the ambulance arrived minutes later. "I actually felt refreshed," he says, resting comfortably at his home three months later.
He still has the white button-up shirt he was wearing, which was stained with blue conductive gel when he was brought back. A wearable defibrillator device called a LifeVest that Hunt had been wearing since February had activated a shock through his back and on the left side of his chest.
Hunt is doing much better since the incident and subsequent surgical implant of a pacemaker-defibrillator, working out 60 minutes four times a week and bounding around his backyard in a way he couldn't back in January when he first began feeling severe symptoms due to undiagnosed congestive heart failure. Back then, he had to visit neighbors or navigate the property with the help of a cane, walker or ATV.
But along with his heart rehab, he credits the vest with why he's still here. He can even joke about it with a catchy line: "We're looking for a lot to build on instead of my wife looking for a plot to bury my remains in," he said. "And that's really true."
How it works
Before this all happened, Hunt knew he was in trouble. Sometime likely in January, he had a minor, undetected heart problem and began to feel differently. In February, his wife took him to the emergency room and he had stents implanted.
One of Hunt's doctors, David Kessler, an electrophysiologist at Heart Hospital of Austin, said that in cases such as this, about 40 percent to 50 percent of patients make a full recovery. For the rest, the damage is permanent.
But after a first cardiac event and the chance of subsequent ones, there's a period when patients will either recover enough heart muscle to move on with their lives or when they'll require a surgically implantable device such as a pacemaker-defibrillator, as Hunt eventually did. That period can last about three months.
Before the current model of LifeVest was FDA approved in 2009, Kessler said, "I would recommend people purchase their own defibrillator. It wasn't covered by insurance." Such a device wouldn't have been effective if someone had a sudden cardiac attack when they were alone and couldn't operate the defibrillator.
The wearable defibrillator version made by Zoll has several advantages, Kessler said. It continually records EKG data that it sends via cellular connection to Zoll's headquarters in Pittsburgh and is accessible to doctors. It tracks average heart rate, steps and other data. Doctors can set the heart rate (in Hunt's case, 200 beats per minute) at which it will activate automatically. If the threshold is set too low, it can accidentally shock a patient who may be engaging in activity such as jogging, and that can be a painful experience, Kessler said.
Portable defibrillators such as the LifeVest are a passionate subject for the cardiologist. Among his personal heroes is Michel Mirowski, the Polish-born physician who escaped Nazis, eventually came to the U.S. and developed the technology that led to portable and implantable defibrillators.
"It was an immigrant to this country that Roger Hunt owed his life to, among other people," Kessler said.
Living with the vest
Zoll doesn't sell the LifeVests; it offers them as part of a $3,000-a-month service that patients will use for an average of three months. The out-of-pocket cost varies based on insurance and patients must have it prescribed by a doctor, nurse practitioner or physician assistant. The company has about 20 contractors in the Austin area who fit patients with the vests, which can be sized from 26 to 56 inches around the chest. Local representatives say about 1,000 Texans are using a LifeVest at any given time, about 45 of them in the Austin area.
Diseases of the heart are the leading cause of death in Texas at 22.9 percent, according to 2010 Department of State Health Services data. Heart disease caused 38,096 deaths in the state that year.
The LifeVest can be worn under normal clothing, but it's to be worn at all times except in the shower, a regimen that can present a problem for some patients, Kessler said.
"Many people take it off. It's a pain," Kessler said. "It does require commitment. You have to carry the battery around. It has to go right on the skin. You have to wear it while you're sleeping. If you're not wearing it, it's not going to work."
The battery charge on the pack that comes with the LifeVest lasts about 24 hours. The company provides two battery packs that patients swap out and that are rechargeable through a wall plug.
Hunt calls himself a maverick, but says that in the case of the LifeVest, he wasn't fooling around with his health. "I was going to be very diligent about using it. I read labels. I follow instructions. There’s things you just have to adjust to. I never pulled it loose in all my moving around. It stayed functional at all times," he said.
One of the most surprising things about the LifeVest is how little known it is outside of the cardiology community. Roger Hunt's wife, Valerie, who has been a registered nurse, says she shocked plenty of people back to life in emergency rooms, but had never heard of the wearable defibrillator until her husband needed it.
"I asked, 'Is there anything he can take home and wear?' Everything is so scary when you go home and don't have any control over what happens," she said.
The Hunts say that the only burden in using the LifeVest was financial. "Is it worth it?" Valerie Hunt asked. "There is no price on your life. Most of it was covered by insurance."
Back in January, Roger Hunt was suffering from depression and anxiety, symptoms he didn't know were being caused by his heart problems. "I thought, 'I'm old and things are falling apart and that's what I expect.' "
Now much more spry at 74 and mobile than he was seven months ago at 73, Roger says that having his life saved has changed his entire outlook.
"I expect different things," he said. "I think that I'm not close to the end of my existence. So I'm much more positive about nearly everything."