Walking into a new and brighter life.

Walking into a new and brighter life.

The healthy me

The healthy me

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This I know.................

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Showing posts with label Information. Show all posts
Showing posts with label Information. Show all posts

Monday, November 18, 2013

I wish I had had the foresight to remember or jot down dates.  I will do my best to remember.
This blog was started by a frightened woman who was diagnosed with Severe Emphysema and the journey she went through to get to the healthy and peaceful life God had intended all along 
 
                                                    **** This is my testimony ****
 
 
On June 4th 2009  I went to the doctor for yet another cold that wouldn't go away, accompanied by a cough that was relentless.  After testing and ex rays this doctor (who was standing in that day for my regular doctor) came into a small room, handed me a nebulizer (for those of you who don't know what those are it is a tube attached to a small machine that delivers a mist with medicine inside to open up your airways).  I was very familiar with this since both parents had used them.  Just having them bring that machine into the room made me realize that this doctor visit would be different.  I was scared and crying.  I knew what was coming.
After the treatment was over the Dr. came into my room, saw me crying and said, "we found spots on your lungs and want you to see a Pulmonologist soon."  I had been to the doctor with both my parents who had Emphysema, but never remember one called a Pulmonologist.
She said she would make the arrangements and they would call me for an appointment.

I don't remember walking down the hall and through the lobby to my car.  I do remember getting into my car and taking my cigarettes out of my purse and throwing them away along with my lighter.  I sat there for what seemed like forever.  I remember people walking by and looking at me crying.  I knew what they had just told me.  It was a death sentence.  I had lived through it with both parents.
I can't remember driving home, or getting out of the car and walking in the house.  I do remember Bill asking me what drugs they gave me this time?

I told him it was serious, that the doctors found spots on my lungs and had told me they would set me up an appointment with a Pulmonologist.  What was so devastating to me, so frightening... to Bill was just another chance to condemn me for smoking all these years.
He exact words were "I told you those things would kill you, but you never listen to me".  So much for sympathy. 
Pretty much as far as Bill was concerned the next 3 years were just an opportunity to remind me I did this to myself... or to go to my doctor appointments and try and look like a big shot because he had been a paramedic.  Several times the doctors just told him they needed to concentrate on what was going on with me... so after a few months he quit going to my appointments with me.  If I knew I had a big or scary appointment coming up, Brittney would go with me and always ask a lot of questions on how I could be more comfortable, or if this drug would be better than this one.  I could always count on her to take care of me.

Shortly after my first visit to my Pulmonologist Dr. P, and after all the testing was done... the MRI's, The CT scans, the blood work, the blood gas test, the stress test, ALL the breathing tests....  The results were in.  I had Severe End Stage Emphysema, and with good care I could live 3-5 years.  I was put on Oxygen for use just around the house within a month.  By Christmas that year I was on O2 24 hours a day.

I began having these pains in my chest that came on like a heart attack.  I still have them to this day.  The first few I went to the Emergency room where they ran all the heart tests.. EKG, ECHO, hooked me up to the blood pressure machine and the pulse-ometer.  They would give me shots or sometimes pills of pain medication, and then usually about 4 hours later send me home telling me it was an Anxiety attack.
The first few of these Bill took pretty seriously, from then on,, most of the time he told me I was faking it to get attention.  He used to tell me that about my dizzy spells and forgetfulness too. 

I could probably tell you more about Copd/End Stage Emphysema than most doctors.  I know I could tell you more from a patience point of view.

The more your disease progresses (and Copd is a progressive disease) it begins to affect your heart because the heart needs O2 to function.  Without the O2 your blood pressure can get higher or lower, your pulse just doing the simplest of tasks can jump into the mid to high 100's.  Also without enough oxygen it begins to affect your brain and memory, and cognitive function.  It can make you stagger due to dizziness, sleepy all the time because without enough O2 your body has no energy to work off of.
Some time around 2011 they had told me I needed a double lung transplant, only I needed to lose 70 pounds before I would qualify.  They began sending my files to Standford Medical Center.  And in July I received word I would go there in August for a exam and interview.  Not just anyone who needs it gets a transplant qualifies for one.  There is quite a bit of criteria you need to meet.  They told me that we would need to be there about a week maybe longer if I needed therapy prior to surgery.  That they had housing right on the grounds for patients and their families but dogs were not allowed.  This through Bill into a frenzy.....  We can't take the Dogs??!!  What will become of them.  I suggested we find someone to stay at our house.  He decided he would just stay there 3 or 4 days, then come home to the dogs for 3 or 4 days.  So, I was going to be undergoing a DBL lung transplant and my caregiver only could do it part time because of our dogs.  I needed someone with me there 24 hours.  I am not sure how they would have worked it out?

It is an ugly disease that begins to take your life and dignity away at about the same rate. 
I was getting my affairs in order.  Making funeral arrangements, buying a plot or trying to decide if I wanted cremation.  Writing out my Will.  Filling out an Advanced Directive.  I was calling friends to say goodbye, and calling those who I had had issues with over the years to try and make amends.  I wanted to go peacefully and not with a life full of hatred and regret.  I wanted everyone to know what they meant to me.
I had a best friend who I had not spoken to in 14 years.  It was over a silly business thing that later we found out was instigated my our secretary.  Anyway... I had seen her around town over the years.  She had even said hi to me on several occasions and I would look away.  It had bothered me so much that we were apart.  I loved her, and always had.  So, in about June of 2011 I began to drive by her house.  Which is not easy to do, it is at the end of the road at the back of a culdesac, so at any time she could have been outside or something.  I drove by at lease once or twice a month until September.  Finally I worked up enough courage to pull into her driveway and walk up to the door.  I knocked and she came out and looked at me like I was a stranger.  She didn't know me!!  I had oxygen on and had gained around 130 pounds since she saw me last.  My skin was grey... I was not the Kellie she knew.  Finally a glint in her eye and she just wrapped her arms around me and we began to cry.  I told her I had come to make things right, and she told me.... they always had been. 
We began to walk our dogs together every day at the park.  Bill hated it... Hated her... Still does.
I saw a big difference in her.  She seemed to be more at peace.  Finally she began to tell me about getting born again, and all the wonderful changes in her life since then.  I was skeptical.  I had heard about all this God stuff and religion, and was just not sure about it.  After we spent about 6 months together, I asked her if I could come to church with her.

She smiled like the Cheshire Cat!  So, I began going.  Sunday morning Bible School, Sunday Service, Wednesday Bible Study and Thursday Bible study.  I began reading the Bible at home, which Bill scoffed at.

In May of 2011 we were told this man was coming to speak at our Church from Andrews Texas.  That he was a mighty man of God.  I was excited, because everyone else was exited!  Me carrying my oxygen bottles around in large purses volunteered for anything.  Be a greeter, sure... take the offering, sure! 

The man's name was R.L. Oop Shrauner.  The first night he was to arrive our little church was filled to the brim.  We greeted and greeted and was many unfamiliar faces, who had heard about this man coming.  So when this gentleman walked up to shake my hand, he said "This is about you!"  "I saw your face as we drove across the desert, you are going to get healed tonight." 

I can remember each word he said, but I cannot for the life of me remember if I answered him, or just stood there with my mouth hanging opened?  I looked at Kathie, and she had that Cat smile again and said Praise the Lord!

That night at the beginning of the service he called me up front.  He asked me my name and I told him Kellie.  He said Kellie tonight is your night.  He then took out some oil and put it on my forehead.  Asked Pastor Ann and his wife Patsy to come lay hands on me, and he began to pray.  Not like praying I had been used to, this sounded like it came directly from God.  My body began to tingle, my lungs began to get warm, and I felt dizzy.  It was over as soon as it started.  He said... you are healed praise the lord.  He told me to find a scripture to stand on, and to believe I am healed.

I went to all 3 of his meetings those next 3 days, and each day grew a little stronger in faith.  It wasn't what the man was saying.  It was  how Jesus worked through him.  How by him telling his story of struggling and wanting, but having the faith to always believe that God would provide for him.  And, God ALWAYS provided for him.  In supernatural ways. 

God works wonders through this man.  What a gift he has been giving.  A simple farmer, who is more comfortable in over-alls than suits.  Who loves his wife with everything he has.  Who also has a love of Chevy Trucks. He is just a man who listens to God.  Is quiet and listens, and then does what God has told him to do, even when it seems crazy!

So R.L. Oop Shrauner went back to Texas and through some odd occurrences with a few doctors I was sent to Portland for surgery, instead of Standford for a double lung transplant. 

On August 23rd I had both upper lobes removed from my lungs.  The doctors afterward said I was doing fine.  My stay at the hospital was nothing but terror.  Once taken out of ICU and put in my  own room, I was pretty much just shut away.  I was supposed to be gotten up once a day to walk the halls to help remove the fluid from my lungs and begin to get my strength back.  I was not gotten up once.  I did not receive one "sponge bath", or not once helped out of bed and to the toilet.  They would bring me water but never clean out my cup, just go to the faucet and fill it up.  I asked for ice, and it never came.  I had dinner the first night and threw it up on my bed and gown and they came in and changed the bed, but just wiped my gown.  I didn't eat anymore the entire time I was there.  I was on such heavy medication and a epidural in my back to help with the pain from the 5 chest tubes they had in me t, and I also had a pain pump that I could push the button when I needed it.  I am not sure which was the problem, but I was hallucinating terribly.  Dark, Scary things of the devil. 

On the night of the 4th day I called my daughter and asked her to come get me that I checked myself out.  I was supposed to be there 3 to 6 weeks. 

I came home, recovered.  Did everything they told me to and more.  I got back to church as fast as I could and life began to get normal again.  It took quite some time for the places where the tubes were removed to heal and not be sore.  But I was alive and well.

My first doctor appointment they told me I was doing well.  That my O2 stats were holding their own and they wanted me to come off oxygen during the day and while I was out, only to use it at night... or if I needed it.  They told me to not use my oxi-meter which shows what your O2 saturation levels are.  That they wanted me to gauge that for myself.  That took some time to get used it.  A couple weeks for me not to slide in on my finger, only to find out I was good.

My exams just kept getting better.  I began to come off of this medication, of this inhaler.  I was told I was doing everything right.  My blood pressure began to become normal, my O2 stats were staying at 97.  That is what a healthy lung SAT is!! 

I began to notice that I was losing weight... it seemed overnight.  My doctors told me they were not concerned with it as long as I was eating healthy and drinking lots of water.  To date I have lost 136 pounds and feel like I am in my 20's again. 

Sometimes around January of 2013 my Primary Care Doctor told me that a year ago she was preparing me to die, to help me through that process.  Today she said I am watching you live, and live life to it's fullest!!!!

Recently, I have had a injury to my rib and tissue around it.  Because I had lung pain... burning and stabbing when I was breathing in and out, I saw my Pulmonologist who sent me for ex rays and told me to come back the next day.  That same day I saw my Cardiologist... He told me I didn't have to come back anymore.  That my heart is perfectly healthy, my blood pressure is that of a much younger person, and I looked great!!

The next day my Pulmonologist told me something similar.... Kellie, your lungs are healthy.  You and I don't need to see each other for a year, unless something comes up and you need me!! 
He had asked me if I would be interested in going to a seminar with him to talk about Lung Volume Surgery and how well it works.  I told him I had no problem going and long as I could give glory to God for Divine healing.  Needless to say... there was no seminar for me.  lol


I have been DIVINELY HEALED.  It can be nothing else.  I recently got the surgeons records who performed the surgery on me and he gave me a 20% chance of coming though the surgery, and only a 30% chance of making it 6 months after.

I can tell you the work of the Lord is Magnificent.  I stood on Isaiah 53:4-5 .........................
Surely His has borne our griefs and carried our sorrows;
Yet we esteemed Him stricken.
Smitten by God, and afflicted.
But He was wounded for our transgressions
He was bruised for our iniquities
The chastisement for our peace was upon Him,
And by His stripes we are healed.

For those who don't know this scripture is talking about Jesus on the Cross.  Where He and His own Father agreed to sacrifice him so we could have life and life more abundantly.  He took those lashes (stripes) and shed his blood for us.  Then when near death he forgave those who harmed him. 

So, that's why that scripture is so important to me.  "By His Stripes we are healed".  Praise His glorious name!

Now let's continue with Gods continued walk beside me..........................................

            ***The healing is over, a new life begins to shine***

So, as I mentioned above Bill and my marriage had been rocky for years.  If truth be known it was over years before I got sick, I just didn't have the courage to leave.
I began to go to bed early (I had my own room for probably 7 or 8 years) and read the cd's of Oop Shrauner.  Actually I forgot to mention that during those dark days before surgery, I watched those cd's every night.  It kept me in the word, it reminded me nightly that I had been prayed for and healed, and it showed me how a true Christian should live and think and behave. 
Those are mighty tapes.  I also read the Bible.  I thirsted for Gods word.  Like the mulititudes I was in awe of a man so unselfish who wanted so much good for the people and they turned their backs on him. 

The more I began to learn the Bible and expect things a certain way at home..... like no cussing, or using the Lord's name in vain, or telling dirty jokes, or watching murder on T.V. every night.  I just wanted to try and live a happy, peaceful life.  I had had so many years of darkness, of sickness, of disqust from people... I had one young man in the line at Safeway push his way in front of me (while I was sick) and the lady in front said " this woman was next".. he just said, she is damaged goods, she can wait.  No one came to defend me.  It made me not want to go into public anymore. 
So... After living like that for so long I just wanted to live.  To experience life, to live by God's word... and Bill WAS NOT having it.  It started a terrible life that I was not ready for.  He became very verbally abusive.  He began drinking at 9:00 a.m. and would go until he fell into bed at night.  He would say things to pick fights and quickly I learned not to fall for the trap.  Then it just didn't matter, everything made him mad.  My diet made him come after me with hateful words, the way I dressed annoyed him, my friends and my Church made him very hateful.
I got to where I was crying myself to sleep every night.  I needed out of there. 

A couple at our Church had bought a newer car and so one night after Bible Study I asked them if they were going to sell their old car?  That I needed one to continue to come to Bible Study and that I couldn't pay much,  but I could do payments.  She told me to let her pray on it.  The next Sunday she asked me to come into the Pastor's office.  Her and her husband had a Bill of Sale for $1.00 and had the title transferred.  I told her I only had a $5.00, she said nope just $1.00.
What a blessing they were to me, and continue to be.  That car started out as my freedom from Bill.  No longer did I need to ask or beg to have the car to go to Church or to go see my friend.

Not long after that I was still trying to figure out how or where I could move to get out and away from Bill.  Kathie (my BFF) and I were driving down the road when she called a warehouse store to thank them for a great job on a carpet install she had.  They asked her if she knew anyone who wanted a job?  Kathie said YES, I had an appointment the next day.  I walked in with confidence and told them I didn't have much to put on the application since I really haven't worked in many years.  I explained about the lung surgery but assured them I was healed and healthy.  They said they liked me but needed to see a few more and they would get back to me.  As I left I said "Thank you for this opportunity and they wouldn't be sorry."  I spoke as if I already had the job.  I have never had that kind of confidence.
That afternoon Kathie and I were pulling out of a drive through coffee house when my phone rang, they wanted me to come in and get the paperwork to take over for a drug test and I had the job!   The job paid enough wages for me to move out and after 3 months I would begin to earn a commission.

Within 2 months I had enough money to buy furniture and find an apartment.  I moved out in July and have the cutest apartment ever.

Each time I have needed God he has seen me through.  He walks with me everyday.  I don't even question it anymore, I just know.  I can tell you... my life with Jesus is so much sweeter than my life before.

I am no one special.  If God can work these Miracles in my life he will do it for you too. 


Tuesday, September 4, 2012

Lung Volume Surgery benefits to emphysema patients


Lung-volume reduction surgery benefits emphysema patients

By Gila Z. Reckess
A procedure known as lung-volume reduction surgery (LVRS) appears to improve overall health and quality of life for individuals with end-stage emphysema, and these effects last as long as five years in more than half of this population, according to School of Medicine researchers.
The findings appear in the March issue of the Journal of Thoracic and Cardiovascular Surgery.
Title
Principal investigator Joel D. Cooper, M.D. (right), the Evarts A. Graham Professor of Surgery and head of the Division of Cardiothoracic Surgery, Stephen S. Lefrak, M.D., medical director of the Lung-Volume Reduction Program, and their colleagues found that the success of lung-volume reduction surgery in patients with severe emphysema is overwhelming. – Photo by Bob Boston
The procedure was developed at the School of Medicine in 1993 by the study’s principal investigator, Joel D. Cooper, M.D., the Evarts A. Graham Professor of Surgery and head of the Division of Cardio-thoracic Surgery.
“Evidence of the success of this surgery in patients with severe emphysema is overwhelming, and these latest findings confirm and underscore its potential for treating this critically ill population,” Cooper said. “This publication represents a major, interdisciplinary team effort, which depended on expertise from a variety of areas, including pulmonary medicine, anesthesiology and nurse coordination.”
Emphysema is characterized by destruction and overinflation of the lungs. As the lungs become progressively bloated, they fill the chest cavity and thorax, making it difficult to expand and contract during normal breathing.
The disease relentlessly progresses and is responsible for close to 17,000 deaths each year in the United States, according to the National Center for Health Statistics.
In select patients, LVRS provides an alternative to lung transplantation, which until recently was the only option for patients with end-stage lung disease that cannot be controlled with drugs. By removing the most diseased portions of the lung, the procedure provides the lungs with more room to expand within the chest cavity.
Though LVRS is not a cure for emphysema, studies suggest that the surgery increases breathing capacity by more than 50 percent. Such improvements allow otherwise debilitated individuals to resume many normal, daily activities, including moderate exercise.
This study is the first to examine the long-term endurance of patients following surgery.
The research team maintained a detailed database of lung function and quality-of-life assessments for the first 250 patients who underwent LVRS at Barnes-Jewish Hospital between January 1993 and June 2000.
Follow-up evaluations were performed six months and one year after surgery and again each year afterward. Patients were followed for an average of 4.8 years.
All participants first were enrolled in a rehabilitation program for about three months prior to surgery and were given medical and dietary programs to make sure they were as healthy as possible for the operation. They also remained on fitness and medical regimens after surgery.
At the conclusion of the study, more than 60 percent of the 250 patients were still alive, and only 18 patients had received a lung transplant since undergoing LVRS. Without surgery, it is estimated that half of the 250 patients would have died within three years and that those still alive after five years would have significantly deteriorated.
Overall, the surviving LVRS patients still had measurable improvements in lung function after five years. For example, patients were tested to see how much air they could blow out in one second, a measurement known as forced expiratory volume.
Six months after surgery, 95 percent of patients had improved on this test by an average of 54 percent. After five years, 53 percent of patients still had better scores than before surgery, though they were only 7 percent better.
The team also measured the amount of air left in the lungs after a deep exhale, a value called residual volume. People with healthy lungs have low residual-volume scores because very little air remains in the chest cavity after breathing out.
Evaluations six months and one year after surgery revealed that 90 percent of participants had improved residual-volume scores, and that residual-volume values declined an average of 30 percent. After five years, 79 percent still had better residual-volume scores than before surgery, and the average improvement was 14 percent better than pre-surgery scores.
Quality-of-life assessments also were positive: Almost 80 percent of patients still reported better quality-of-life scores five years after surgery than before surgery.
“This procedure is not a cure for emphysema,” Cooper said. “No matter how successful the operation, emphysema continues to degrade the lungs and progressively impairs breathing.
“However, our results confirm that LVRS can in fact extend patients’ lives and allow them to continue participating in normal activities of daily living.”
Determining selection criteria is one of the most controversial issues in measuring the effectiveness of LVRS. Therefore, Cooper’s team analyzed data from patients with potential risk factors.
The team found that individuals who required surgery to the lower portion of the lungs benefited from the procedure, but their lung function degraded faster than in individuals with damage to the upper portion of the lungs. Other identified risk factors include advanced age, male gender and very low forced expiratory volume.
“We strongly believe that patient selection is one of the keys to success for this procedure,” Cooper said. “With rigorous preoperative preparation and stringent participation criteria, lung-volume reduction surgery appears to improve life expectancy and quality of life for patients who otherwise have very poor prognoses.”

Friday, February 17, 2012

FAQ for Lung Transplant

FAQ: Lung Transplant

How do I know if I need a transplant?
Some patients with severe lung disease may benefit from transplantation. Your cardiologist or pulmonary medicine specialist may refer you to a transplant center for an evaluation. The purpose of the evaluation is twofold: first, to determine the severity of your disease and whether there are any more conventional treatments; and second, to determine whether you would be able to survive the transplant operation and have a good long-term result afterwards.
How will a transplant change my life?
A successful transplant will dramatically improve your symptoms of lung disease. Many transplant recipients can perform the same physical activities and enjoy the same quality of life as normal people. All transplant recipients, however, are committed to daily drug treatment and close medical supervision for the rest of their lives.
Is the evaluation very difficult?
The transplant evaluation is very thorough. In addition to specific lung tests, tests are performed to determine the function of all the major organ systems, screen for infectious diseases and cancer, and try and predict how well you and your family will cope with the rigors of the transplant regimen. Many of the tests, even the complex ones, are fairly well standardized and can be performed in your local community. Some tests may require you to be admitted to hospital briefly. We require that every potential candidate make at least one outpatient visit to UCSF Medical Center to meet with the transplant physicians, coordinators and social worker. Typically, most of the evaluation can be completed within a week or two. The transplant team meets weekly to discuss patient evaluations and make decisions on appropriate treatment. Patients who are felt to be good candidates for transplantation are then put on a national waiting list.
How long is the waiting list?
Unfortunately the waiting times for organ transplants are long. In 1996 in the United States, the average wait for lung transplantation was over a year. Each patient on our waiting list returns for an outpatient visit to our transplant clinic every two to three months or more frequently if necessary. While many patients can wait at home, sometimes it is necessary for patients to be admitted to the hospital to maintain them in satisfactory condition until transplantation.
What happens when an organ is available?
When the transplant team decides that a potential donor is suitable for one of our recipients, we call their home phone number or page their beeper. It is not possible to predict when a suitable organ will become available and there is a limited amount of time to be able to recover the organs successfully. It is very important that we be able to locate the recipient quickly and get him or her into the hospital in a timely fashion.
Is the surgery very complicated?
This depends on your specific situation. The transplant surgeon will review the details of the surgical procedure, the risks of the procedure and the expected post-operative convalescence during the evaluation interview.
How long will I be hospitalized after the transplant?
This depends on your specific situation. Although patients can recover sufficiently after lung transplantation to be discharged within 10 days, it is more typical for patients to be hospitalized for two weeks or more.
Do I have to stay near the hospital after the transplant?
Most patients are discharged home after transplant. Although we do not have any specific requirement about staying close to the hospital during the early post-transplant period, the frequency of follow up visits and lab tests during this interval can be a problem for patients who live far away. The social worker can help you to locate guest housing in the area.
Will I have pain after the surgery?
Generally, most patients do not report a lot of pain. You will have an incision that does cause pain and discomfort when coughing. We will give you pain medication and specific instructions to lessen the pain.
Can my family stay with me?
Your family can accompany you until you go into the transplant surgery. While you are in the intensive care unit, family members may not stay in your room. If you require assistance with locating guest housing, a social worker will be able to help you. We have very open visiting hours and encourage family members to be present. If your visitors are ill (flu or colds), they should not visit you. This is to protect you from the infection.
When can I drive? When can I return to work?
You may drive after two to three weeks, once your incision is healed. You may return to work after two to three months from the transplant surgery
What medications will I take after the transplant?
You will be on three main immunosuppressive (anti-rejection) medications after transplant. Along with the immunosuppressive medications you will need to take several preventive medications against infection.
How long does it take to fully recover?
It generally takes three to six months to fully recover from the transplant surgery. Age and previous medical history problems may cause the recovery period to take longer.
Will my insurance pay for the transplant and follow up care?
We have a financial counselor who will verify your insurance. We will obtain authorization for your transplant and follow up care.
When do I get the beeper?
You will get a beeper after you are placed on the transplant waiting list. Since this is a free program through the LifePage Program, it may take several weeks for your paperwork to be processed and for a beeper to be issued to you from the local pager company.
Is there a support group for patients going through transplant?
We have a support group for patients on the waiting list and post-transplant patients. You will be notified of the support group meetings and the topic each month.

Reviewed by health care specialists at UCSF Medical Center.
Last updated February 2, 2012
This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.

Lung Transplant (recovery)

Lung Transplant
Recovery

Once your surgery has been completed and the lung transplant is a technical success, the issue of successfully living with a transplant becomes quite involved. The two major issues are rejection and infection.
Lung transplant recipients undergo specialized rehabilitation programs. The transplant team follows patients throughout this process -- and for the rest of their lives. Patients are seen as needed in the outpatient clinic. A transplant expert is available 24 hours a day, seven days a week for questions or consultation.

Rejection and Infection

Rejection is the natural process of your body that recognizes your new lung as being foreign to the body and attempts to destroy it. This reaction originates within your immune system. This is similar to the way your body identifies a splinter in your finger as a foreign object. The redness and inflammation in the area of the splinter is an immune response. To prevent rejection, you must be treated with immunosuppressants, medications that interfere with the body's normal immune response.
We expect that you will have episodes of rejection in the first several months after transplant. The treatment requires that you receive doses of the anti-rejection medications intravenously. You will require frequent blood sampling to determine the levels of immunosuppressant drugs, as each individual is unique and requires an individualized approach. The goal is to find the lowest immunosuppressant dose that will prevent rejection and therefore minimize the risk of infection and side effects from the medications. Failure to take these medications will result in the rejection of your new lung.
Because your immune system is suppressed to prevent you from rejecting your new lung, you will be more prone to infection. We will monitor your temperature for sign of infection and your count for white blood cells, which help fight infections. Infections are generally treated with antibiotics and you will be asked to take certain medications on a regular basis to prevent certain types of infection. You may have to undergo intermittent short courses of intravenous antibiotics. The signs of infection are redness, swelling and tenderness at a surgical site. A new lung infection may begin with a mild fever, new cough and change in lung secretions.
Reviewed by health care specialists at UCSF Medical Center.
Last updated February 16, 2012

Lung Transplant (procedure)

Lung Transplant... Procedure

You can be called into the hospital for the transplant at any time. When the call comes, you will proceed to the Intensive Critical Care Unit (ICC) to prepare for surgery. Then you will be transferred to the operating room.
The surgery takes from six to 10 hours, depending on medical conditions. After surgery, you will go back to the ICC. From there, your are transferred to the cardiothoracic nursing unit, depending on your condition. The expected length of stay for an uncomplicated lung transplant is eight to 21 days.
If you are having a single lung transplant, the incision will be made on your side, either right or left, about six inches below your armpit. Your old lung will be removed through this opening and the new lung will be implanted. In the case of a double lung transplant, the incision will run across the lower part of your chest. The lung, whether single or double, is connected to the pulmonary artery, pulmonary veins and the main stem bronchus or airway. The incisions will be uncomfortable and will take several weeks to heal.

Lung Transplant (evaluation)

Lung Transplant
Preparation

Evaluation

Patients must meet a broad range of physical and psychosocial criteria to become eligible for transplantation. A social evaluation determines if transplant candidates have the psychological stability, motivation and personal support to meet the challenges of transplantation. Then the patient and family meet with the team of experts who will be with them throughout the transplant process.
Each patient's team includes a transplant lung specialist called a pulmonologist, transplant surgeon, transplant nurse coordinator, transplant social worker, psychologist and physical therapist.
  • The transplant pulmonologist completes a physical examination and determines the cause of disease during the selection process. The pulmonologist reviews the patient's current medications, assesses the risks and benefits of transplant surgery, and makes recommendations to the team. In conjunction with the team, the pulmonologist remains involved throughout the transplant process.
  • The transplant surgeon completes a general surgical evaluation, reviewing any previous operations and assessing the risks and benefits of surgery. In consultation with the other team members, the surgeon makes recommendations for transplantation. The surgeon follows the patient before transplant, performs the transplant, and continues following the patient post-operatively and after discharge.
  • The thoracic surgeons who perform the lung transplantation will meet with you for a surgical consultation. They will discuss any previous abdominal or chest surgery that you may have had and describe the surgical plan for your transplantation. The thoracic surgeon reviews your medical plan-of-care daily with the surgical resident and nursing staff. Additionally, he or she will see you in clinic after discharge.
  • The transplant nurse coordinator organizes all aspects of care before and after the transplant. The coordinator oversees the selection process and facilitates communication among all members of the team. In addition, the coordinator provides patient education, coordinates testing and follow-up care and maintains records.
  • The insurance coordinator reviews the patient's available insurance to ensure that the patient will not experience financial hardship related to the transplant or postoperative and discharge care and coordinates insurance coverage with outside case managers.
  • The social worker completes a psychosocial evaluation and provides support to the transplant patients and their families throughout the process. The social worker also makes recommendations to the team regarding the patient's psychosocial status, commitment to transplantation, and relevant financial issues.The social worker for our Lung Transplant Program will meet with you to review the program in detail and to provide any patient educational assistance you will require preoperatively.
  • Long-standing lung disease can strain your heart so you will need to be evaluated by the transplantation cardiologist. He or she will examine you and will also review your medical history, electrocardiogram and echocardiogram. The cardiologist may recommend that you have a further study of your heart with a procedure called a cardiac catheterization. This procedure will be scheduled by the Division of Cardiology and may require an overnight stay in the hospital.
Persons with cystic fibrosis are required to consult with an ear, nose and throat specialist. If minor sinus surgery is required, a short hospital stay is arranged. Several other team members conduct appropriate specialty evaluations when indicated and make recommendations to the team. These include but are not limited to the anesthesiologist, cardiologist, psychologist, intervention counselor, infectious disease specialist, hematologist and physical therapist.
Transplant candidates undergo a battery of tests that may include routine blood work, electrocardiogram (ECG) and other radiological and diagnostic procedures. UCSF Medical Center uses state-of-the-art imaging technology to obtain the most accurate diagnoses. After the medical work-up, our team designs care plans for each patient, drawing on resources from a variety of disciplines, including social work, nursing and nutrition. Patients are never out of touch with the team: an expert who knows about each case is on call 24 hours a day, seven days a week.

Eligibility

To be eligible for a lung transplant, you must meet the following requirements:
  • In general, you must be physiologically 60 years of age or less for bilateral lung transplantation and 65 years of age or less for single lung transplantation. This means that your physical condition must at least meet the typical condition of someone 60 years old or younger, or someone 65 years old or younger. Your chronological age is not a factor.
  • You must have a poor prognosis, with an anticipated 18 to 24-month survival.
  • You must have no other life-threatening systemic disease.
  • You must have demonstrated absolute compliance with medications and medical recommendations, and have good rehabilitation potential.
  • You must demonstrate emotional stability and must have a realistic understanding of the implications of organ transplantation.
  • You must have a supportive social support system.
Once all the interviews and tests are completed, the members of the transplant team review the information and make a recommendation about treating your lung disease. They may suggest further testing or other therapies prior to considering a lung transplant. It is important to remember that lung transplantation is not appropriate therapy for all patients with lung disease.

Waiting for a Lung

If accepted as a lung transplant patient, you will join many other patients who are awaiting a transplant. You will be seen on a regular basis to monitor your progress. If you are not accepted initially as a lung transplant candidate, the reasons for the decision and any further testing and therapeutic options will be discussed with you and your referring physician.
As a result of your lung condition, you may have several associated problems that must be addressed. These include:
  • Shortness of breath and increased oxygen need.
  • Decreased activity level.
  • Wasting of your muscle groups including respiratory muscles, postural or trunk muscles, and your arm and leg muscles.
  • Cardiovascular deconditioning.
  • Fear or anxiety due to breathlessness.
Evaluation in a pulmonary rehabilitation program is essential if you are considering transplantation. It is important that you be in the best physical shape as possible at the time of your surgery. Lung transplantation will improve your shortness of breath and oxygen need. Therefore, you will be introduced to the importance of exercise and activity before your transplant. This will include training your respiratory muscles as well as a biking or walking program for general conditioning. You will need to continue this program even after your transplant occurs.
We also require all patients to have an annual flu shot, a pneumonia vaccine, up-to-date tetanus shots (within the last 10 years) and H.influenzae B. vaccine.
After being approved for transplantation, patients are immediately put on the United Network for Organ Sharing (UNOS) lists. Your placement on the waiting list is determined by the severity of your condition and the likelihood that your transplant would be successful, known as your lung allocation score. Those with higher scores get higher priority when a compatible lung becomes available. During the waiting period, UCSF Medical Center provides a network of support for patients and family members, including a long-running, popular support group.
A new lung or lungs will come from a person who is an organ donor. This person has suffered an injury to the blood supply to the brain, which results in "brain death."
Organ procurement organizations work to match donors with people who are awaiting transplants. This matching is based primarily on the size of the donor and the blood type and is started through a computerized listing created by UNOS. A transplant team removes the lungs from the donor and brings them to UCSF Medical Center. While this is happening, you will be notified to come to the medical center. You will then be transferred to the operating room where an anesthesiologist will prepare you for surgery.
Reviewed by health care specialists at UCSF Medical Center.
Last updated February 16, 2012

Sunday, January 8, 2012

Laughter may be bad for lungs

COPD PATIENTS WITH SENSE OF HUMOR FEEL BETTER, BUT LAUGHTER MAY BE BAD FOR LUNGS

                                                08_art-joy1
                                          Ohio State University Research News
COLUMBUS, Ohio – Having a sense of humor is associated with improved emotional functioning and an enhanced quality of life among patients with a chronic lung illness, but the actual act of laughing out loud can reduce lung function, at least in the short term, research suggests.
The study evaluated humor and laughter in patients with chronic obstructive pulmonary disease, or COPD. Participants who exhibited a greater sense of humor were more likely to report fewer symptoms of depression and anxiety and better quality of life, and tended to report that they had experienced fewer respiratory illnesses in the month before the study.
But patients who watched a 30-minute comedy video and laughed during the viewing had lower pulmonary function afterward than did patients who watched a home-repair video that did not prompt laughter.
COPD is a chronic, progressive disorder characterized by difficulty breathing, and especially in expelling air from the lungs. It is the fourth-leading cause of death in the United States, affecting more than 12 million people, according to the Centers for Disease Control and Prevention. COPD patients are at increased risk of experiencing depression, anxiety, a diminished quality of life and frequent respiratory illnesses.
The pattern of findings in this research suggests that appreciating and perceiving humor may have a different effect than laughing aloud for patients with moderate to severe COPD, researchers say.
“This study shows that humor is really more complex than people make it out to be,” said Charles Emery, professor of psychology at Ohio State University and senior author of the study. “Yes, humor definitely has benefits, but the behaviors associated with humor in fact may not be good for all people all the time – which is a useful thing to know.
“Because these patients are at risk for depression and anxiety, one implication of this study would be that encouraging or even teaching people to use humor as a way of coping may actually be a novel way of enhancing their well-being.”
The research is published in the current issue of the journal Heart & Lung.
Kim Lebowitz Feingold, lead author of the study, performed the research for her psychology Ph.D. dissertation at Ohio State. Now director of Cardiac Behavioral Medicine at the Bluhm Cardiovascular Institute of Northwestern Memorial Hospital, Lebowitz Feingold said the project grew from her interest in the field of positive psychology.
“We wanted to look at positive attributes or traits associated with improved physical or emotional health. I’ve long been fascinated with the idea that laughter and a sense of humor can be positive for well-being,” she said.
Previous research had suggested that humor is beneficial to healthy adults because it can improve mood and strengthen immune function. Laughter also had been characterized as a behavior that may help expel stale air from the lungs. The researchers sought to determine whether the benefits of humor and laughter could extend to people who suffer from COPD.
“We know the negative emotional consequences of COPD. So I thought it was an ideal condition to serve as the focus of an examination of the potential benefits of humor and laughter,” said Lebowitz Feingold, also an assistant professor of psychiatry and surgery at Northwestern University.
Forty-six COPD patients participated in the sense of humor portion of the study, and of those, 22 participated in the portion of the study that the researchers called “laughter induction.”
All participating patients completed a number of questionnaires to assess their sense of humor, psychological functioning and health-related quality of life, as well as a brief interview about recent infectious illnesses. The assessments included the Coping Humor Scale, which measures the degree to which someone uses humor to cope with stress, and the Situational Humor Response Questionnaire, which counts the frequency of smiles, laughter and other so-called mirthful behaviors in a variety of situations. Measures of depression and anxiety symptoms were used to evaluate psychological functioning.
In the laughter induction, patients completed pulmonary function tests, and reported their mood and the severity of their shortness of breath symptoms immediately before and after watching a 30-minute video. After being randomly assigned to either a neutral or humor condition, participants watched either a neutral instructional video or their selection of one of three comedy options: Abbott and Costello, Bill Cosby or a segment of funny home videos.
As expected, the COPD patients reported more impaired psychological functioning, lower quality of life and above-average anxiety in their daily lives compared to national data on these symptoms in healthy adults. Patients also had reported an average of five sick days on which they experienced infectious illness symptoms in the previous four weeks.
But on average, the patients also reported that they used a sense of humor in their daily lives. Out of a possible score of 24 on the Coping Humor Scale, this patient sample’s average score was 19.3. As a group, they were less likely to report use of mirthful behaviors to express humor, scoring 56.6 out of a possible 105 on the Situational Humor Response Questionnaire.
An analysis of association between the patients’ sense of humor and well-being measures suggested that the higher their score on the sense of humor scales, the lower were their symptoms of depression and anxiety. A sense of humor was significantly associated with enhanced psychological functioning and better quality of life. And though the relationship was not as strong, a higher sense of humor score also was linked to fewer recent sick days.
Emery noted that because of the nature of the study, the researchers can’t be certain which came first – the sense of humor or the better well-being.
When it came to laughter, however, the results were a surprise. Patients watching comedy videos did laugh more than patients who watched instructional videos, as expected. But follow-up pulmonary tests showed that those participants who laughed also had more air trapped in their lungs afterwards, a sign of reduced lung function.
“During laughter, we’re expiring more air than we’re inhaling so it’s a potential way of ridding our lungs of stale air. COPD is characterized by this increased air trapping, so our hypothesis was that laughter would reduce some of that trapped air,” Lebowitz Feingold said. “But in hindsight, the findings make sense. With laughter, people also are introducing an increased amount of air into their lungs compared with a normal breath. These patients have trouble getting the air out, so they are taking in more air with laughter, but they cannot easily expire that air, leaving them with increased trapped air following laughter.”
She noted, too, that the study measured only the acute response to laughter.
“We can’t tell if this effect is cumulative, how long it might last, or whether it has any impact on physical health or pulmonary function long-term,” she said.
Co-authors of the study include Sooyeon Suh of the Department of Psychology and Philip Diaz of the Department of Internal Medicine, both at Ohio State. 

I wanted to post a note to this.  Since diagnosed I have had opportunity to laugh and be happy and didn't notice any change. The thing is it was just a ha ha laugh, not a belly laugh.

At Christmas on two occasion's I had an actually belly laugh, no stopping, tears streaming, can't stop... kind of laugh and noticed that even while I was out of control laughing my lungs burned.  It was like I voided them of all air, but couldn't stop laughing.  It was scary.  I have a problem emptying my lungs anyway... and when there is no air there it is frightening.  I excused myself to the bathroom both time with my O2 until I felt better.  But after both episodes I felt queasy and dizzy.


So... is laughter the best medicine?  I guess yes, unless you have severe Copd.