Growing up, he worked the family dairy with his seven siblings and later became a professional bull and bronc rider. Jack Silva was tough as nails.
At 72, the cowboy shares a different message: “Tough will get you dead.”
Silva stands tall in his turquoise, button-down shirt, black leather waistcoat and veteran-pinned felt cowboy hat. Beneath his rugged appearance, though, is a heart that’s been failing for almost 11 years.
Silva says he shouldn’t have hesitated to see a doctor and he should have listened more closely to his body.
“I figured, I’m tough. I can handle it,” he said.
Identifying heart disease early
Silva’s family has a history of heart disease. In fact, he is the first Silva man to live past the age of 70. His grandfather, father, one brother, and two sisters have all experienced heart issues.
Silva has heart failure, a condition in which the heart doesn’t work efficiently. It’s usually results from a heart being weakened or stiffened by a heart attack or other factors that damage the muscle’s tissue, including high blood pressure or cholesterol, diabetes or obesity.
“And if it is truly dead tissue, it doesn’t work again, and we can’t get it back, at least with the current modalities,” said Dr. Lance Richards, a cardiologist with UCHealth Heart and Vascular Center – Medical Center of the Rockies. “Heart failure naturally progresses as the heart gets more tired and declines.”
Heart disease is the leading cause of death for both men and women as well as people of most racial and ethnic groups in the United States, according to the Centers for Disease Control and Prevention.
UCHealth Heart Failure Clinics throughout Colorado’s Front Range use a multidisciplinary team of cardiac-specialized nurses and doctors to provide individualized care to address specific heart failure concerns of each patient.
“There are all sorts of different types of heart failure — it’s very heterogeneous,” Richards said. “It’s complicated, and usually these patients have multiple issues that are contributing to their condition.”
The signs and symptoms of heart failure
It was about 11 years ago that Silva first suspected something was wrong. He and his wife, Tina, were living on their 15-acre property in Virginia.
“I was eating Rolaids — a lot,” he recalled.
Then one day he woke feeling particularly unwell, but he decided to head out to work nonetheless.
He was just going to “tough it out.”
But when he wasn’t able to put on his pants — the sheer effort left him breathless and in pain — he decided he’d put Tina at ease and head to the hospital instead.
“I have a really good woman — she takes care of me,” Silva said.
Doctors first thought he had GERD, or gastroesophageal reflux disease, and were going to send him home when Tina insisted she wasn’t about to take her husband home to die. She pushed for more tests.
Those tests revealed that Silva had experienced multiple small heart attacks.
The start of heart disease
In September 2008, doctors placed five stents in Silva’s coronary arteries, after which he started his first cardiac rehabilitation program.
To help rebuild the strength of the heart muscle and improve cardiovascular health, patients are referred to cardiac rehab after a significant heart event. The program is supervised by a medical team that provides personalized instructions on exercise, lifestyle changes and diet to help the patient recover.
At that point, Silva weighed 315 pounds — 100 pounds more than he does today.
“I told the lady at rehab I’d do whatever it takes,” Silva said. “I’d eat cardboard if I had to — but she told me I didn’t need to do that.”
Over the next year, Silva reduced his weight to a more manageable level, but despite his motivation to improve his health, his heart continued to worsen.
Dealing with a failing heart
In March 2009, Virginia doctors put a battery-powered device called an implantable cardioverter defibrillator (ICD) under the skin on Silva’s chest to keep track of his heart rate. Thin wires connected the device to his heart so that if an abnormal heart rhythm was detected, the device would send an electric shock to restore it to a normal beat.
His doctors told him his heart probably wouldn’t make it more than five years.
Silva returned to rehab, but his heart was just too weak. “I couldn’t do it,” he said.
The following week, Silva was back in the hospital for more procedures and while on the table, he said, he had what he believes was an “out-of-body experience.”
“Someone told me that I could choose to stay or go, but they said staying would be a lot harder,” Silva recalled of that experience. “As you can see, I decided to stay.”
And in April 2009, Silva underwent a quadruple bypass.
“They told me I’d probably be dead by Christmas,” he said.
Heading to Colorado as a new heart disease patient
Stubbornness runs in the Silva family. When Silva told his siblings of his shortened life span, none of them would dignify the prognosis with an end-of-life visit to Virginia. So, Silva decided he’d return to his home state to spend his dying days around his three brothers and one sister, who still lived in Colorado.
“We put a camper shell on the back of our truck,” Silva explained. “The hell with them — those doctors who said I couldn’t come out here (to Colorado). They said I’d never make it, and if I did, I wouldn’t find a doctor who’d be willing to care for me.
“Sometimes we’d only travel an hour before I’d have to get in the back to rest, but I was going to come say goodbye to my family.”
After selling their Virginia home and making the trek to Colorado, Silva and Tina moved in with Silva’s brother in LaSalle, Colorado.
Finding a cardiologist in Colorado
Another Colorado relative helping Silva was the first to come across the UCHealth Heart and Vascular Center – Medical Center of the Rockies. She passed the information on to Silva, who, after a bit of research, called the office.
He explained his situation and how doctors out East had told him no one would take his case.
“I told them to give me the best you got — and they did,” Silva said.
Silva first met UCHealth cardiologist Dr. Thomas Downes in 2010.
As a member of the UCHealth team, Downes was able to access the resources within his own group to connect Silva with clinical cardiac electrophysiologist Dr. Russell Heath.
While Downes managed Silva’s medications, Heath put in Silva’s new defibrillator. He also treated Silva’s ventricular tachycardia — a very fast heartbeat in the heart’s lower chambers — with ablation, a procedure in which the area of the heart causing the arrhythmia is cauterized.
A trust in the team approach
For the next several years, Silva’s heart failure was well-managed. And during that time, Downes transitioned out of medical practice to become UCHealth’s Chief Medical Officer for Poudre Valley Hospital and Medical Center of the Rockies, so he needed to transfer Silva’s care to a new cardiologist.
“I told (Dr. Downes), ‘No (nonsense). Give me the best guy for my condition,’” Silva said.
It was 2014, and Richards was creating the heart failure clinic in northern Colorado. Downes assured Silva that Richards was an excellent doctor for the job, but Silva wanted to be certain.
“My first visit with Jack, he interviewed me for the first 30 minutes,” Richards said. “He wanted to know what kind of doctor I was; how we’d work together. He knew he needed someone he could trust and work alongside.
“I actually had to have a second visit to be able to ask my questions,” Richards continued. “That’s atypical, so I knew right away that Jack was going to be compliant and a good team member in his health care.”
Being involved as a heart disease patient
Every visit with Richards, Silva would arrive with a binder of personal information, a log of daily blood pressure, heart rate and weight readings, as well as notes on his exercise, diet and sodium intake.
Symptoms of heart failure that should be tracked
Shortness of breath.
Changes in heart rate.
Weight. Weight gain of more than 2-3 pounds in a 24-hour period or more than 5 pounds in a week can be one of the first signs of worsening heart failure.
Swelling. Patients can experience fluid buildup (or an increase in swelling), often in the ankles, lower legs and feet.
Confusion or impaired thinking. Too much sodium or too little oxygen in the blood can results in changes in mental state. This could include memory loss, or worsening symptoms of depression or sadness. Welcome the feedback of others, as they may be the first to notice these mood changes.
“Jack follows and trends these things to extreme accuracy, so he is the first to know if his weight trends up, or what happens when he skips an exercise,’’ Richards said. “He can tell, and he contacts us to either help him make adjustments, or he gets right back on that horse.
“For someone with his chronic heart condition, that can be very difficult to do. But one of the things that’s let him live so well for so long is that active participation in his health.”
People with heart disease need to track these details because their condition can worsen by small degrees over time, often going dangerously unnoticed, according to the American Heart Association.
Noticing the symptoms of heart diesease in time
After years of successfully managing his heart failure, Silva began to experience worsening symptoms in the summer of 2019.
“Weight gain, shortness of breath, less energy — these are all classic symptoms of heart failure,” Richards said. “So we did a work-up of Jack and found that his heart was very weak, but it had also gotten enlarged.”
Jack had two leaky heart valves and had developed slowed electrical conduction through his heart. It is the solving of such complications on which the multidisciplinary cardiac team thrives.
“Richards got a hold of everyone and put a team together,” Silva recalled. “That’s what I like, to be part of a team.”
Richards collaborated with interventional cardiologists and the valve and electrophysiology clinics to figure out the next steps. An angiogram showed that Silva’s arteries were clear, so there was no need for more stents or surgery. But they also found his valve was too leaky to fix, so one alternative was to implant a special type of pacemaker.
A cardiac resynchronization therapy (CRT) pacemaker is used for patients whose left and right heart chambers do not beat in unison, according to AHA. Heath again performed Silva’s implantation.
Richards advised Silva to visit with his partners in Aurora, specifically Dr. Amrut Ambardekar, an advanced heart failure and transplant cardiologist with UCHealth Heart Failure Clinic – Anschutz Medical Campus.
“There have been a number of different treatment options and advances in medications over the years,” Ambardekar said. “We looked at the MitraClip (mitral valve therapy) and LVAD, as well as the CardioMEMS, a pressure monitoring system currently in a clinical trial stage at all three of UCHealth’s sites (northern Colorado, metro Denver and southern Colorado).”
One of the more advanced therapies for Silva could be an LVAD, or left ventricular assist device. It is a surgically implanted device that takes over for the main pumping chamber (left ventricle) of the heart.
Silva decided not to go this direction with his care.
“LVAD is for the sickest of heart failure patients who can’t undergo heart transplants,” Richards explained. “Jack decided that living with a heart pump and going through major surgery was just not what he wanted his quality of life to be, which is very reasonable.”
Finding the right heart failure treatment for you
Silva continues to beat the odds, a credit to his heart team — both inside and outside the hospital — his attitude, his involvement in his own care, and his support group.
“One of the unique things about Jack (is that) statistically, his chance to ever making it five years was 50 percent, and making it 10 years with that degree of heart function is 25 percent, if not less,’ Richards said. “He’s definitely beating the odds.
“One reason he’s beaten the odds is who he is and what he’s done to take care of his body despite the situation he’s found himself in. He really cares for his health and advocates for his health. He knows what is going on with his body and pays attention.”
It’s a lesson that Silva said he had to learn the hard way and why he tells people today that “tough will get you dead.”
“When I was in trouble, I didn’t go to the doctor right away, and it damaged my heart,” he said.
But since then, he’s led by example and followed every instruction from his doctors and his cardiac rehab team, who have stressed the importance of support and joy in your life.
“We can focus on the clinical and medical side of it, but if the patient doesn’t have that outside social support system to help him with daily life, giving him meaning to life, we often see our medical treatments fail. The patient doesn’t thrive like they would. That’s really half the pie,” Richards said.
For Jack, that half of the pie includes his wife, Tina, his family and his community.
“Heart failure is a very serious condition that has a high degree of mortality in it,” Richards said. “Similar to cancer, people are scared when they are diagnosed. But it doesn’t have to mean the end is near soon. We have a lot of new and old heart therapies that are allowing our patients to live longer, happier and healthier.”