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LVAD as a Destiny

My name is Brian August. I'm an attorney, start-up advisor, keyboardist, Beatlemaniac, heart-healthy foodie, and tech entrepreneur living in Brooklyn. In 2025, after years of completely debilitating exhaustion following treatment for prostate cancer, I was diagnosed with Congestive Heart Failure (CHF) which quickly progressed to End Stage CHF. I was left with only three choices: get a transplant, get an LVAD (left ventricular assist device), or get a shovel.

On March 24, 2026, 2 days before my LVAD surgery, I was granted the seemingly impossible wish of playing the grand piano in the Mount Sinai Hospital lobby. I knew this could be my last time doing the thing I love the most. I became the only person ever allowed to leave the Cardiac Intensive Care (CIC) Ward, for any reason. I was connected to a barrage of equipment, including a life-saving contraption called a balloon pump. It took a village of doctors, nurses and technicians to make this performance happen. They gave me 15 minutes. Since I play in an Elton John band, it was fairly obvious. My mini-performance left me, and others, in tears, and became the inspiration for my GoFundMe Video.

As I write this, I have no heartbeat and no pulse. I'm alive because of my LVAD, a battery-powered pump about the size of a toy hockey puck. It was surgically implanted during a brutal 9½-hour open-heart procedure. My LVAD has a magnetically levitated rotor that circulates blood around my body, since my heart can no longer do that on its own. The battery must be swapped out every 6 to 8 hours for the rest of my life. While sleeping, I disconnect the battery and get power from a cable plugged into a wall outlet. Sadly, the cable isn't quite long enough to reach my bathroom. Urinating has become a nocturnal mission, to put it mildly.

This isn't the first time I've gone to battle with a potentially fatal condition. I beat leukemia in 2000, and I am now living with incurable prostate cancer. My heart failure is very likely the inevitable price I'm paying for both of those fights (more on that below). A heart transplant is off the table because of my metastatic cancer.

Some patients get an LVAD "as a bridge" while waiting for a transplant; others get one simply to extend their lives as much as possible — "LVAD as a destination". I have a different take. A destination is merely somewhere you end up. A destiny is a new existence you actively pursue and embrace as life-sustaining. It's something you carry in the depths of your heart and soul. So I'm calling my journey LVAD as a Destiny. My destiny.

You are my friend (or friend of a friend), and I need your help. Your generosity will provide me with an element of stability in my ongoing struggle. It will enable me to maintain a roof over my head, deal with that terrifying pile of bills, buy groceries, deal with my day-to-day expenses, and get through 4 critical months of cardiac rehabilitation, starting next week. If I can make it through to the beginning of 2027, I will focus on rejoining the human race, starting to work again, and attacking life with the same optimism I've always had. I'm also completely resolved to becoming an advocate, advisor, creative strategist, and forceful voice for the entire LVAD community.

Any donation, however small, will mean everything to me. And if you are willing to share my story, that may matter even more. Because every one of you belongs to circles and networks I simply don't have access to.

To learn more about my odyssey, keep going.

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Help!

When I was younger, only 26 and fresh out of Law School, I helplessly spent the next 12 months watching my younger brother slowly die from Hodgkin's Disease. I knew right then and there that this would be the worst moment of my life, no matter what else happened.

11 years later, at the age of 37, was diagnosed with AML Leukemia. From 1998-2000, I spent over 100 days in room 10 West 102 at Mount Sinai Hospital. I had 75 blood transfusions and 7 rounds of toxic chemotherapy. After a 3+ year long, hellish, heavyweight brawl with leukemia, I was victorious. Five years later, my cancer was considered cured. I felt invincible, with Jeff's spirit as my Guiding Light.

In 2020, during the throes of COVID, I was diagnosed with advanced and aggressive prostate cancer — Gleason Stage 9, with a PSA of 154. We threw everything at it: beam radiation, radioactive pellets, hormones. Ultimately, I endured a multi-year, three-pronged set of immunotherapies aimed at curing the disease. That effort ultimately failed, and it soon became clear that I had incurable metastatic prostate cancer. It is currently being effectively managed, and I don't think I'll die from it, but I'll almost certainly die with it. My life has changed in so, so many ways, but my sense of invincibility remains unscathed.

I'm So Tired

What tormented me during 2024 and the first half of 2025 was profound, never-ending, soul-crushing exhaustion. Entire days went by where I barely got out of bed save for meals and bathroom breaks. My concentration, working memory, mental flexibility, and decision-making were a wreck. My mind was on the blink. I had regular bouts of nausea, dizziness, and even occasional depression. All this left me unable to work in any serious capacity.

My suffering was attributed to the ongoing prostate cancer treatment, which prevents my body from producing testosterone — you may know this as "chemical castration." While fatigue was to be expected, this was more like fatigue on steroids. My oncologist agreed that my level of exhaustion was extreme, but still fit within the parameters for someone who had undergone ADT (androgen testosterone deprivation) therapy while still receiving Lupron injections every three months. Logic pointed to this being cancer-related. But something else was lurking. My heart was failing.

During the spring of 2025, my weight kept increasing. I had no real sense of how bad things were getting. I was much more than just exhausted. I was bloated, wheezing, and experiencing shortness of breath from doing mundane things. A few moments in particular stood out. The first happened at a friend's house out on Long Island. Beth (the love of my life and amazing LVAD caretaker) and I decided to take a walk into town, no more than half a mile away. We walked down the driveway, made a right turn, and got as far as the first stop sign, no more than 200 feet from where we started. I turned to her and said, "We're done. I just can't walk any further. We need to go back to the house."

A Day in the Life

That was followed by other telltale moments that arrived in rapid succession. First, I became completely out of breath simply from brushing my teeth. A few days later, I found myself gasping for air after trying to tear a large bite out of an Italian hoagie on crusty bread. On May 22, 2025, I dragged myself to the local DMV to update my driver's license. My photo was barely recognizable. I'd put on over 25 pounds in water weight. Beth and I now call that ID photo "Moonpie." A few days later we went to the emergency room in Brooklyn. I was almost immediately transferred by ambulance to a heart center in Manhattan.

Moonpie

A major contributor to congestive heart failure is the drug administered to me more than two decades earlier, during the three years I underwent cancer chemotherapy. That drug, Daunorubicin, is an anthracycline — one of the most aggressive forms of chemotherapy. As a doctor once boasted, "We're taking out the big guns." Anthracycline cardiotoxicity is also one of the best-documented drug-induced heart failure mechanisms in oncology, and has its own name: Anthracycline-Induced Cardiomyopathy. It has been known to emerge months, years, or even decades later. I was also experiencing the double whammy of the accumulating effects of my ADT therapy.

The phenomenon I was experiencing is known as cardiac masking. My heart was already failing, but the diagnosis went undetected because the symptoms of CHF overlap almost identically with the symptoms of prostate cancer treatment. My oncologist was currently treating me for that exact disease and it made perfect sense to assume that it was the problem. In reality, however, I was simultaneously progressing through the early stages of congestive heart failure. It's why, when the CHF was finally diagnosed, it was essentially irreversible. Oh boy.

Getting Better

My cardiovascular issues necessitated that I have a pacemaker and a defibrillator installed in October 2025. Soon after, I had a surgical procedure called a right heart catheterization. It showed an Ejection Fraction (EF) of 20. Less than two years earlier, my EF was 52. It is possible to reverse a declining EF, but absent significant improvement, the only path was "advanced therapies." By 2026, my EF had dropped to 12. I had end-stage congestive heart failure, and was left with three choices: get a heart transplant, get an LVAD, or get a shovel.

Right away, I was deemed ineligible for a transplant. Metastatic prostate cancer completely disqualified me. Transplant recipients need lifelong immunosuppressants to keep their body from rejecting a new heart, and those same drugs would compromise my ability to fight the cancer, should it ever flare up again — which it usually does. Mount Sinai's transplant board at made the right call. No transplant for Brian.

I was put on an intra-aortic balloon pump to help my heart do its job and keep me alive until the surgeon could implant an LVAD. Two days later, on March 26, 2026, I had nine-and-a-half-hours of open-heart surgery. They brought me up to my room afterward, and other than a brief moment of being roused for a quick awareness test, I slept straight through until the next morning. I awoke on March 27, 2026 with a new lease on life. What followed was unrelenting, excruciating pain, especially my ribs, which had been brutalized. I had a total lack of focus and more profound exhaustion. Doctors, nurses, and technicians swarmed over me day and night. Sleep was hard to come by.

Barely two weeks later, Beth, the love of my life and official caretaker was pronounced qualified to change my surgical dressing. Within a matter of days, they all but kicked us out the door. Though I was facing a 6-to-9-month, pain-filled recovery window, my care team knew that I needed to face the rest of my life head on, ready or not.

Tomorrow Never Knows

Every aspect of my daily living has radically changed. I can never go swimming again. Any remotely daredevil sport like skiing is out. I have a ball and chain permanently tethered to me in the form of a weighty lithium battery and a sleek-looking control device. They go everywhere I go — sometimes in a little satchel, sometimes in a cross-body bag, sometimes tucked into my underwear. Twice a week, I break out my waterproof shower bag, showerproof my dressing and take a glorious shower, immediately followed by applying a new dressing change under full sterile conditions.

Recently, I've taken to wearing the Under Armour 6-pocket football girdle, turned inside out. It really works. Your thighs bear the weight. Most people have to lug around two batteries and a controller, but I'm in clinical trials for the next-gen LVAD called BrioVAD. It's lighter, smaller, and needs only one battery. With a little luck, it will be approved by the FDA and available on the market in 2027.

I will not surrender to the void.

With a Little Help from My Friends

I am deeply grateful to everyone who has stood by me. It's been a reckoning, and has shown how lucky I am to have people who love me, and a few who even like me.

Difficult challenges no doubt lie ahead. But everything I've been through, the death of my brother, one disease after another, every wrong turn, every next brilliant idea, every failure, has produced a blueprint for my future. Build something that doesn't exist yet, a role that pulls together everything I am: the attorney, the survivor, the guy who can talk to any doctor in the room, the creative who won't quit. Position myself at the intersection of a fast-growing medical technology, help the people who live with it, the people who implant it, and the people who make it. The role is still being written. My life has led me here.

Just a month ago, I was on my way to what was supposed to be my first cardiac rehabilitation session. Instead, I passed out in the Times Square subway station from extreme lightheadedness caused by my blood thinners and other things. With the help of a few quick-thinking strangers and NYPD officers, I did make it to rehab, which consisted of lounging in a Lay-Z-Boy chair, sipping salt water, and eating crackers and peanut butter. My three-month regimen of rehab now starts this week. Gonna try and do my best, with a little help from my friends.

The End

I need resources to get me through the beginning of 2027. To cover my numerous living expenses, to pay my rent, and to give me the freedom to complete critically needed cardiac rehab. Maybe Beth and I can even find a new apartment with a power cord long enough that I can pee in the toilet.

With a bit of luck, I fully intend to rejoin the human race, start working, and make music again in a meaningful way — and begin to write the next, and best, chapter of my life.

We all know that I'm not truly invincible. But it sure does help to believe I am.

And in the End, the Love You Take, is Equal to the Love You Make