Transplant gives Fargo native, UND med student new outlook on being a doctor

FARGO -- Andresa Carlson didn't want to say it out loud, even though she knew what was wrong.

If she said it out loud, then it would be real.

But the pain became too much even for the stubborn University of North Dakota medical school student. After Christmas break, Carlson went to see her cardiologist.

The eventual diagnosis came as no surprise. Her 23-year-old heart was failing, finally succumbing to the disease that had held her back physically her entire life and robbed her of an older sister.

The Fargo South High graduate and Concordia College alum needed a heart transplant, and soon.

But neither she nor her doctors expected it to happen as quickly as it did.

"To put it simply, she got lucky," said Dr. Sudhir S. Kushwaha, a cardiologist and medical director of the heart transplant program at Mayo Clinic in Rochester, Minn.

Now in recovery, Carlson possesses a new outlook on medical school and a strong desire to resume her studies.

"I feel like I've gained a lot of knowledge about how patients see things and what things look like from the other side," she said. "It's amazing how different it looks."

History repeats itself

Maybe it was because she couldn't run a block without getting winded and sick to her stomach, or because her father is a psychiatrist, or because she was so often exposed to medical settings.

For whatever reason, Carlson said she's always been more interested in math and science than in sports, which her heart condition put out of reach.

Carlson was born with dilated cardiomyopathy, a disease that causes the heart's primary pumping chamber, the left ventricle, to become enlarged and pump blood to the body less vigorously than a normal heart. The disease doesn't cause symptoms in all patients, but it can be life-threatening, according to Mayo Clinic.

Carlson's older sister, Melissa, was 3 months old when, a few days after Christmas in 1983, she became puffy and wasn't taking to her bottle. She was admitted to the pediatric intensive care unit at what is now Sanford Medical Center in Fargo, and within a few days was diagnosed with dilated cardiomyopathy.

Melissa died Nov. 7, 1984, just short of 14 months old.

Andresa was born about three years later. When the same symptoms arose, her parents recognized them and immediately brought her to the same cardiologists who had treated Melissa. The diagnosis was the same, and doctors put Andresa on medication to manage the disease.

Dilated cardiomyopathy can be caused by a gene abnormality that sometimes runs in families, but doctors haven't pinpointed the abnormality in Carlson's case, Kushwaha said.

Carlson's heart condition worsened during her senior year at South High. In April 2006, she started having palpitations and arrhythmias, leading doctors to implant a defibrillator in her chest.

After earning her diploma that spring and a chemistry degree from Concordia in 2010, Carlson started classes last fall at the UND School of Medicine & Health Sciences in Grand Forks.

"I started feeling pretty bad in about November, and I just kind of went with it," she said. "I've had to adapt to pain all my life because I've never had good health."

By December, she was barely able to climb the stairs of her second-floor apartment. "I knew that I had a big problem," she said, and she had educated herself enough about her heart to know it was the likely culprit.

Still, she kept quiet about it until the visit to her cardiologist on Jan. 7. He referred her to Mayo Clinic for a heart transplant evaluation and advised her to take a leave of absence from med school, which she refused to do.

She would change her mind a few weeks later.

Transplant happens fast

Two weeks into spring semester, Carlson collapsed from walking up a flight of stairs and decided to take a leave from school.

Her five-day transplant evaluation began on Valentine's Day. On the fourth day, doctors discovered her heart was in worse shape than thought and admitted her to the ICU, recommending a transplant as soon as possible. Carlson landed on the waiting list two days later.

Her case was "a little bit atypical," Kushwaha said, because she was sick enough to be placed immediately into Category Status 1A, the highest-priority category for those waiting for transplants. Her small size and rare blood group also worked to her advantage, as did her age and good chances for a successful recovery.

"Besides dying, I was very healthy," Carlson quipped.

Carlson was told she may have to spend two months in the ICU while waiting for a donor.

Eleven days later, a match was found.

"I was totally flabbergasted, and I think even the doctors and nurses were pretty surprised, as well," she said.

"The fact is, she was probably the only one for whom that organ was appropriate," Kushwaha said.

Carlson was booked for a transplant that afternoon, on March 1. The process happened so quickly, her parents couldn't get there from Fargo in time to see her into surgery.

Carlson spent the next 12 days hospitalized in recovery, taking immunosuppressant drugs so her body wouldn't reject the foreign heart. She moved March 13 to Gift of Life Transplant House in Rochester, where she's staying during rehab.

Future 'unlimited'

Three to five times a week, therapists run Carlson through exercises to build stamina and strengthen muscles. She wears a heart monitor during the workouts, as well as a mask to ward off viruses that could attack her weakened immune system.

The transplant house requires patients to have a constant companion, a role that's been filled by family and friends, including her mother, Mary Stenson; her father, David L. Carlson; and her two older sisters, Elisa Marchione of Grand Forks and Shanna Carlson of New York. An aunt from Vancouver, B.C., also took three weeks off from work to stay with her.

Carlson won't be playing any contact sports with her new heart, as a side effect of one anti-rejection drug has sapped 11 percent of the bone density from her spine and made her more prone to fractures. But she's regularly doing an hour of exercise on the treadmill and elliptical machine during rehab.

"I would never have been able to do (that) before this," she said.

Based on historical data, heart transplant recipients have a 10-year survival rate of 50 to 70 percent, Kushwaha said. But Mayo has former patients who are still doing relatively well 20 to 25 years after their transplants, thanks to some novel approaches to immunosuppressant drugs, he said.

"Now, she has a normal heart which works very well, and she should be really unlimited," he said.

Carlson plans to return to medical school in August and repeat her first semester with a healthier body and mind. She hopes her experience will make her a better doctor.

"It's made me more excited to eventually be a doctor," she said. "You know, being on this side of medicine really sucks sometimes. It's painful, and sometimes it's confusing and depressing and sad.

1/2: Andresa Carlson works out earlier this week on an elliptical machine with exercise specialist Shawn Leth as part of Carlson's rehabilitation for the heart transplant she received on March 1. Carlson is wearing a mask to guard against viruses that could attack her immune system, which has been weakened by anti-rejection medication. (Forum Communications Co.)

2/2: Andresa Carlson, 23, a Fargo native and medical school student at the University of North Dakota, is seen recently in the courtyard at Mayo Clinic in Rochester, Minn., where she underwent a heart transplant on March 1. Carlson said she hopes to return to UND for fall semester. (Forum Communications Co.)