Ticks, tissue valves and Mammals… Oh my!

As we head into the fall and the heat lingers in some parts of the country, we take the opportunity to bring awareness to the environmental factors and creepy crawlies that distract from our fall festivities.

In Texas, Lyme disease is a year-round problem; however, April through October is considered tick season. During the warmer months, ticks increase their activity and can transmit a variety of diseases:

• Anaplasmosis
• Ehrlichiosis
• Lyme disease
• Spotted fever rickettsiosis
• Tick-borne relapsing fever
• Tularemia
• Alpha-gal syndrome

Approximately 476,000 Americans are diagnosed and treated for Lyme disease each year, making the disease the most frequently diagnosed tick-borne illness in the United States. While Lyme disease is the most common, other tick-borne diseases can cause life-threatening medical conditions.

In fall 2023, Elton Youngblood, a 66-year-old avid outdoorsman from Branson, Mo., felt like his life had been turned upside down. A few months prior, Youngblood was diagnosed with alpha-gal syndrome, a food allergy associated with tick bites. Alpha-gal is a sugar found in the tissues of all mammals except humans and other primates. This new diagnosis forced Youngblood to stop eating all red meat - beef, pork and lamb. These foods now triggered a life-threatening allergic reaction. Additionally, some medications and medical products also posed life-threatening responses due to having alpha-gal in them.

In addition to the life-altering dietary changes, Youngblood had significant difficulty walking more than 50 feet, which was a drastic departure from his previously active life. As an experienced physician assistant within the Veterans Health Administration, he recognized his symptoms as heart failure and knew how serious his condition was. More than a decade prior, Youngblood's aortic heart valve and ascending aorta were surgically replaced. Due to his active lifestyle, he chose an aortic valve made of cow tissue rather than metal. This choice allowed Youngblood to avoid taking daily blood thinners and their complex management. However, he understood that his cow-tissue valve would eventually wear out and that it would likely need to be replaced in 10-15 years. His rapidly progressing symptoms indicated that time was near.

Replacing Youngblood's aortic valve would be more complex than most aortic valve surgeries. His would entail an open-heart reoperation, which alone carries more risk, and his new alpha-gal diagnosis meant he could not take many of the medications that were typically used in the operating room and for postoperative care. Due to his medical expertise and the complexity of his pending surgery, he contacted five of the leading cardiac hospitals in the United States to explore cardiac surgery with alpha-gal precautions. To Youngblood's excitement, Dr. Marc Moon, chief of adult cardiac surgery at Baylor St. Luke's Medical Center, and his team in Houston were eager to develop guidelines for cardiac surgery with strict alpha-gal precautions.

Youngblood anticipated surgery in 2025, but after he got COVID in January 2024 and was hospitalized with secondary pneumonia, his cardiac symptoms became severe. His aortic valve was deteriorating quickly. He called Brittany Rhoades, clinical nurse specialist at Baylor College of Medicine and advanced practice provider for Moon, and she assured Youngblood and his family that the team at Baylor St. Luke's would be ready when he arrived. The willingness of the team at Baylor St. Luke's to listen to all his concerns and create a personalized approach to his high-risk cardiac surgery provided comfort and reassurance to Youngblood and his family.

Moon, who joined Baylor and Baylor St. Luke's in February 2022, performed Youngblood's first aortic valve surgery during his time at Barnes-Jewish Hospital in Missouri. He knew this case would be more complex than Youngblood's previous surgery. Fortunately, Moon specializes in high-risk reoperative cardiac surgery and was ready for this unique situation.

To emphasize the level of complexity with an alpha-gal allergy, Youngblood shared that in a prior hospitalization (outside of Baylor St. Luke's), he developed a life-threatening allergic reaction when one of his meals was cooked on the same grill that was used to cook a hamburger. "I had a reaction three to four hours after eating and had swelling in my throat. They had to give me a big dose of steroids to get me through that," he said.

Due to limited information regarding cardiac surgery and alpha-gal syndrome, Moon contacted Dr. Scott Commins, a clinical expert in alpha-gal at the University of North Carolina Medical School. The surgery that Youngblood needed to replace his heart valve would require the use of a heart-lung machine and a blood thinner called heparin. Heparin is extracted from animals and poses the threat of an allergic reaction in individuals with alpha-gal syndrome.

"He provided advice regarding the level of inflammatory response in alpha-gal syndrome and measures to decrease the response," Moon said. "Mr. Youngblood was admitted to the hospital before surgery for close monitoring and treated with steroids and antihistamines to decrease inflammation and the allergic reaction."

"Teamwork is key in all cardiac surgeries; this case was especially true. We quickly identified a robust multidisciplinary team from Baylor College of Medicine and Baylor St. Luke's, which included cardiothoracic surgery, anesthesiology, cardiology, allergy and immunology, internal medicine, nursing, dietary, pharmacy and hospital leadership to ensure every detail of care was addressed," Rhoades said. "It was incredible and truly inspiring to see the level of dedication and teamwork from the multidisciplinary team."

Youngblood wasn't a candidate for a mechanical valve because it would require him to take a lifelong blood thinner, which is made from red meat animals. Moon and Commins felt a cow-tissue valve would provide the best results for Youngblood, both medically and from a quality-of-life perspective. However, there is not a lot of existing information about how long this type of valve will last in a person with alpha-gal syndrome.

The surgery was a huge success, and Youngblood was discharged home to Branson five days later. "The success of this unique clinic case is a testament to the extraordinary surgeons and physicians at Baylor College of Medicine in collaboration with the world-class nursing, multidisciplinary team and leadership at Baylor St. Luke's. This team not only provides exceptional clinical care, but most importantly they make it possible for individuals to return to their children and loved ones to make lasting memories," Rhoades said.

"Thank you [to] your team [for letting] this happen," Youngblood said.

To learn more about the Texas Tick Project, visit their website. To learn more about Alpha-gal Syndrome, visit the Center for Disease Control website.

By Brittany Rhoades, instructor and clinical nurse specialist in the Michael E. DeBakey Department of Surgery - Division of Cardiothoracic Surgery, and Gilda Martinez, instructor and nurse practitioner in the Michael E. DeBakey Department of Surgery - Division of Cardiothoracic Surgery

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