Late last summer, emphysema sufferer Billy Happel scared the daylights out of his wife, Katherine, on the second floor of their home in West Bend. But she couldn’t have been happier.
The amusing incident showed how much Billy benefited from a bronchoscopic lung volume reduction (BLVR) procedure performed in July.
“Climbing stairs left me really short of breath, so I hadn’t gone upstairs for a long time,” said Billy, 68, a retired paper mill worker. “Katherine was startled when she looked up and saw me standing behind her. She said, ‘What the heck are you doing here? You haven’t been upstairs for years!’”
Jonathan Kurman, MD, and Bryan Benn, MD, PhD, both interventional pulmonologists and Medical College of Wisconsin faculty members, lead the Froedtert & MCW interventional pulmonology team. Dr. Kurman performed Billy’s BLVR procedure at Froedtert Hospital, which ranks in the top two for the number of BLVR procedures performed in the state.
“This level of experience provides confidence for people who choose our team for BLVR,” Dr. Kurman said.
Hard To Breathe
A former heavy smoker, Billy was diagnosed in 2004 with emphysema. Over the years, his condition progressively deteriorated to the point that his pulmonologist, Eric Olafsson, MD, prescribed nighttime supplemental oxygen therapy.
“His condition was getting worse,” said Dr. Olafsson, who sees Billy at the Froedtert & MCW Pleasant Valley Health Center in West Bend. “But he was still fairly active, which made him a good candidate for the BLVR procedure.”
“I was getting scared because, at times, it was so hard to breathe,” Billy said.
Dr. Kurman said patients with extreme emphysema previously had two options and both involve major surgery with higher mortality risk. One is lobe reduction surgery, in which a surgeon removes one of the lung’s three lobes (upper, middle or lower). The other is a lung transplant, typically a measure of last resort.
The minimally invasive BLVR procedure is like a lobe reduction but without surgery. The procedure, which requires general anesthesia, takes about a half hour.
“Because people with emphysema can’t completely exhale, air gets trapped in the lobes, causing them to overinflate,” Dr. Kurman said. “The lobes press against each other and the diaphragm, creating breathing difficulties. The BLVR procedure deflates enlarged lobes by blocking airway passages with tiny one-way valves that prevent air from entering damaged lobe areas, while allowing trapped air to escape.”
About the size of a fingernail, endobronchial valves are made from a nickel and titanium alloy that’s strong, flexible and covered with a silicone material. To deploy the valves, doctors use a tiny fiber optic camera called a bronchoscope that is inserted through a breathing tube in the throat. Billy had five valves placed in the lower lobe of his right lung.
“Following the procedure, it can take between a few days and a couple of weeks for the lobe to deflate and for patients to notice an increase in their lung capacity, allowing them to walk farther, stand longer and be more physically active,” Dr. Kurman said.
Billy said he had no qualms about the procedure because Dr. Kurman explained the procedure so thoroughly. And he raves about the care he received.
“I was so impressed with how kind everyone was, from the guy checking cars in the parking lot to the nurses to my surgeon,” he said. “I hate to say that going to a hospital was a great experience, but it was. Everything was amazing.”
Rehabilitation Builds Strength
“He did fantastic,” said Patricia White, BSN, RN, cardiopulmonary rehabilitation nurse. “Patients commonly feel hesitant about exercising because it makes them uncomfortably short of breath. But we start slowly and build up exercise time and workload. People are surprised to find they can do more than they thought they could.”
Billy said it helped that he was an avid walker and had lost about 35 pounds five years ago. “My doctors told me walking was the best exercise I could do,” he said. “I can breathe better after I exercise.”
After the procedure, Billy set some primary goals: to walk without oxygen from his car to various baseball fields to watch three of his grandsons play Little League, which he did all summer, and to not always think about breathing.
“I don’t think much about it anymore,” he said.
Billy also wanted to walk up the stairs to the second floor of his home without being winded — and no longer scaring his wife. Mission accomplished.