Breathing Made Easy
When Brandon Beal got the call that new lungs were available for him, his mother had just finished chemotherapy for breast cancer and was getting ready to start her radiation treatments. “That had to be put on hold,” says Margie Beal. “We’d been waiting since October for that call, and we had to be there.” She and Brandon came to Barnes-Jewish Hospital soon after, where she quickly discovered that the experienced transplant support team at the hospital cared for the whole family. After Brandon’s transplant, staff members helped connect Margie to a radiation oncologist at The Siteman Cancer Center, and she was able to receive her treatments while helping her son recover. Both patients are currently doing well and have good prognoses.
Diagnosed with cystic fibrosis at age 2, Brandon has been living with increasing disability. As the milestone 1,000th adult lung transplant at Washington University Medical Center, he reaps the benefits of years of experience and team refinements that, combined with the 400 lung transplants done at St. Louis Children’s Hospital, have made this the largest volume lung transplant program in the world. After turning 29 the end of July, Brandon is doing things he hasn’t been able to do for years.
“I couldn’t walk from my bedroom to the kitchen without shortness of breath,” Brandon says. “Until the call came for the transplant, I lived with my sister, whose husband has been stationed in Iraq. She helped me when I needed it. My whole family has been supportive.”
Brandon said it was scary to be put on a transplant list, but when his breathing became exceedingly difficult, not being on it was even more frightening.
His double-lung transplant took place Jan. 21, 2009. Since then, things have been different. “I ride my bike, walk and swim. I’m thinking about going back to work soon. My best friend Kim and I bought a house for us and her 4-year-old daughter. She’s always been with there for me, and now I can help her, too.”
Brandon and his family just took their first trip without oxygen. Says mom Margie, “It certainly made packing much lighter, not having to lug oxygen and his treatment equipment.”
Coordinated Care Makes Sure All Your Needs Are Met
All lung transplant patients and their families are managed by an experienced team that has core functions, bringing in other specialists as needed. This means that the transplant surgeons, pulmonary specialists and respiratory therapists are all standard personnel. Other team members include cardiologists, and in Brandon’s case, a diabetes specialist.
Colleen Becker, RN, MSN, has been involved with the lung transplant program since it started in 1988. At that time, she was a staff nurse in the surgical intensive care unit (SICU) where the transplant patients were cared for after surgery. Over the years, she has taken on the education of her peers for these cases, managed nursing divisions and intensive care areas. She is now director of perioperative services with responsibility for the operating rooms and pre- and post-anesthesia units.
“There are concerns unique to lung transplant patients,” Becker says. “They have trouble breathing and are very fearful of the surgery, needing reassurances that their breathing will improve.”
“Over the years, the lung transplant program has developed coordinated precision,” Becker says.
“All members of the team are trained and drilled on the specific care of someone with one or two new lungs, how to support them, and their breathing.”
Even the physical therapists are specifically trained for lung transplants. “Their whole stay has an integrated team approach,” Becker says. “Because of all the transplants Barnes-Jewish Hospital team members have done, the times for surgery, SICU and hospital stays have all gone down.”
Lessons Learned in 21 Years of Lung Transplant
In 1988, Joel Cooper, MD, started the lung transplant program at Barnes-Jewish Hospital after completing nearly 40 successful lung transplants at the University of Toronto. “During the 1980s, lung transplants became successful therapy in a number of programs around the world, contributing greatly to the refinements in technique and selection of donors and recipients,” says G. Alexander Patterson, MD, chief of cardiothoracic surgery at Washington University and surgical director of the lung transplant program. “Operative mortality rates improved during that time because techniques for transplantation became more standardized. Long-term results also improved because of increased understanding of life-long immunosuppression.”Patterson, who joined the program in 1991, says patients see immediately how seriously all team members take their job.
“It’s a highly sophisticated operation with a large team,” Patterson says. “Surgery is only a part. The fact that we’ve done so many lung transplants speaks to the remarkable commitment by Washington University and Barnes-Jewish Hospital.”
MichaelPasque, MD, has been involved as a surgeon in the program since its start in 1988. “The program here at Barnes-Jewish could not be in better hands,” Pasque says. “Dr. Patterson would be recognized by 19 out of 20 cardiothoracic surgeons as the best lung transplant surgeon in the world. A similar statement could be made about Dr. Burt Trulock as the best lung transplant pulmonologist in the world. No single surgeon or pulmonologist has taken care of more patients.”
Pasque lists some of the more notable advancements in lung transplantation that have taken place at Washington University:
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Development of the sequential bilateral lung transplant operation, which replaces both lungs with donated ones during a single operation.
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Treatment of pulmonary hypertension, an increase of blood pressure in the lungs, and cystic fibrosis by lung transplantation.
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Improvements in lung preservation from the laboratory to the operating room, resulting in better transplants and surgeries.
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Tailoring of immunosuppressive drug regimes used to prevent organ rejection after transplant.
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The use of cardiopulmonary bypass in lung transplantation, a technique that temporarily takes over the function of the heart and lungs during surgery and maintains a consistent circulation of blood and oxygen to the body.