Antwine Stokes was told he had a year to live.
He was 28 years old and had congestive heart failure. At 505 pounds, he was too obese to qualify for a heart transplant and too sick to undergo the bariatric surgery that could help him lose weight.
That was five years ago.
Everything changed when Stokes came to Einstein Medical Center Philadelphia, where he benefited from the hospital’s growing expertise in a treatment for obese patients with end-stage heart failure.
“They were on top of things immediately,” Stokes says. “To me, they were supermen.”
Stokes’ blood flow was boosted with an implanted heart pump called a left ventricular assist device (LVAD) And when he was strong enough, the team coordinated subsequent bariatric surgery.
Einstein is among the hospitals pioneering the two-step treatment in the Philadelphia region for obese patients, according to VAD coordinator Timothy Robbins, and Stokes is among the first patients to benefit from it.
Indeed, Robbins is the author of an article about this approach pending publication in an international journal for VAD clinicians. “If your heart failure is bad and weight is an issue, Einstein is the place you want to go,” Robbins says.
Stokes had struggled with his weight his entire life and was ultimately diagnosed with congestive heart failure, which runs in his family.
Stokes’ heart was too weak to pump blood adequately and his health steadily declined. He had a defibrillator implanted to shock the heart back to normal rhythm in the event of a dangerously irregular heartbeat or cardiac arrest. The average life span of someone with his degree of congestive heart failure is, indeed, one year.
A Crisis and a Turning Point
On Dec. 30, 2018, Stokes was rushed by ambulance to Einstein when his defibrillator went off. He assumed it was just another in the many hospitalizations that he’d endured for months. But after two weeks in the hospital, the defibrillator went off five more times in one day.
There could be no waiting to get bariatric surgery so he could lose weight before an LVAD was implanted – and he was too weak to survive the gastrointestinal operation anyway. Congestive heart failure is a chronic disease in which the heart’s ability to pump blood grows worse over time, and Stokes was at the end stage. The only solution, he was told, was to implant the LVAD immediately, although his weight still put him at a disadvantage.
Record BMI for LVAD Implant
“He had a BMI of 75,” Robbins says, referring to Stokes’ body mass index, a measure of body weight based on height and weight. Anything over 30 – repeat, 30 – is considered obese.
“The LVAD manufacturer said he had the largest BMI of anyone receiving the implant in the country,” Robbins says. “Most centers would stop implanting LVADs when a BMI is over 50.”
But Stokes was young enough for the Einstein team to be confident that the implanted device could save him. The interdisciplinary team that reviews each case has 20 members from various departments, including a social worker, nutritionist, physical therapist, surgeon and others. The team’s treatment decisions adhere to the standards of the Joint Commission, an independent body that certifies hospital programs.
Stokes had the LVAD implanted in January of 2019, and gastric bypass surgery 10 months later. He’s had many setbacks along the way – multiple hospitalizations, for infections, a stroke and most recently for COVID. But he has lost nearly 200 pounds and is continuing to regain his strength.
Stokes hopes he’ll eventually recover enough to resume the singing he’s done all of his life, in church and as a background singer for traveling gospel choirs.
Thanks to Einstein, Antwine Stokes continues to defy the odds against him. Indeed, after having a stroke, he says, his medical team told his parents he probably wasn’t going to live to come home. But the treatment they pursued at Einstein out of life-or-death necessity worked, leading one of his doctors to exclaim: “How many lives do you have?!”
“Einstein did an excellent job of helping me handle all this,” Stokes says. “The doctors, the nurses and everyone I met during my stay – well, to me they are family now.”