Janet MacFarlan was used to huffing and puffing. The 68-year-old retired West Bend, Wisconsin, native regularly lifted and walked with 50-pound bags of food during her time working as a fruit-filling mixer in the food service industry. Despite being diagnosed with emphysema, a chronic disease that limits the ability to breathe properly, in 2002, she had essentially no noticeable symptoms aside from losing a little bit of her breath while walking up the stairs – something she chalked up to old age. But one morning in 2017, she experienced a different kind of huffing and puffing.

“I got up one morning, and mind you, I don’t live in a big house, but I had to stop midway from my bedroom to my bathroom to catch my breath,” Janet said. “I could not breathe. That was my wake-up call.”

Janet quit smoking and started exercising to help her improve her lung capacity. She was put on medications and issued inhalers to help her breathe. Her condition improved, which allowed her to walk several miles a day and lift weights, but then a bout with costochondritis, an inflammation of the cartilage that connects the ribs to the sternum, paired with her scoliosis made it extremely hard and painful to breathe. She was given oxygen to take at home, and she was afraid of the future.

“I was afraid my days were numbered,” Janet said. “I went a year on oxygen with really limited improvement. I needed it to simply get up and go to the bathroom. I didn’t really go anywhere and couldn’t do anything, and I lived like that for a year. Then I heard about the valves.”

Bronchoscopic Lung Volume Reduction

By reading online forums about chronic pulmonary conditions and doing further research, Janet discovered bronchoscopic lung volume reduction (BLVR). Proven to decrease shortness of breath and increase the ability to walk farther, this procedure improves the quality of life for adults with emphysema who remain symptomatic despite optimal medical therapy with medications, inhalers, pulmonary rehabilitation and oxygen. Approved by the FDA in July 2018, BLVR is only available in southeastern Wisconsin at the Froedtert & the Medical College of Wisconsin health network.

“This minimally invasive procedure is done under general anesthesia and only takes about half an hour,” said Jonathan Kurman, MD, director of interventional pulmonology at the Froedtert & MCW health network. “We go through the airways with a small camera that’s the diameter of a pencil to place valves that block off the lobe that is most affected by emphysema. This allows the air that someone is breathing to be more effectively distributed and the muscles that people use to breathe to work more efficiently.”

Seeking a Higher Quality of Life

Janet felt like she met the criteria necessary for this procedure, but she knew it wasn’t being offered everywhere, only at prominent hospitals. She called Froedtert Hospital in October 2019 and asked if the health network was providing BLVR to patients. Much to her delight, she was told yes, and was asked if she’d like an appointment with Dr. Kurman.

Janet made an appointment for November 2019, where Dr. Kurman explained the procedure and showed her what the valves looked like. He also reviewed the criteria that she’d have to meet in order to have the valves placed, such as having less than 50% of lung function and an isolated diseased lung lobe, among other qualifications. She also needed to undergo noninvasive pulmonary tests and imaging to determine whether she was eligible for the procedure. Fortunately, Janet met the requirements and liked what Dr. Kurman had to tell her.

“After the results came back from the heart and lung tests I did, he told me that he’d be able to put the valves in me,” Janet said. “Another strong factor in his decision was my dedication to exercise. I wasn’t going to have these valves put in and then be a couch potato!”

Procedure and Recovery

Janet had the valves placed successfully by Dr. Kurman in February 2020. She had a hospital recovery stay of five days, as doctors monitored her for any possible complications, but none occurred. If BLVR patients do face a complication, such as a collapsed lung, it is fixable, and the patient still retains the same amount of benefit from the valves compared to someone who didn’t have a complication. Janet’s case was relatively straightforward, and after 24 hours of bedrest, she was up and walking in the hallway, feeling better already.

“They told me I may not feel better immediately, but I really did feel better right away,” Janet said. “I noticed it right away.”

“At the longest, it only takes a few weeks for patients to notice an increase in their exertional capacity and they’re able to live life again,” Dr. Kurman said. “These patients have a horrible lung disease at a relatively early age, and despite their and their doctors’ best efforts, they are largely incapacitated because of their respiratory status. To be able to offer them this new technique is really great.”

Breathing Easy

Once home, Janet’s routine of going to the gym for exercise was halted due to the COVID-19 global pandemic, but she was determined to find an alternative to keep her workout commitment. She ordered a treadmill for her house and has begun lifting weights at home. Now able to huff and puff as she pleases, Janet is back to living with confidence and doing routine things at home, such as showering, cleaning and cooking, without fear of collapsing. Her mental health has strengthened as well, a supplemental positive outcome from her BLVR procedure.

“Depression can snake into your life when you have lung problems, because you just really can’t do anything anymore,” Janet said. “But now, thanks to these valves, I feel wonderful. It’s like my spirit is restored! I didn’t have a future before, but now I have one that I can make plans for. This procedure is the closest that I’m ever getting to a miracle. It’s not a major surgery, just a major change. I’m grateful for the next breath I get to take. Plus, my husband says that now I get to walk and talk at the same time!”

If you or someone you know is struggling with emphysema, call the Froedtert & MCW pulmonary medicine clinic at 414-805-6633 or request an appointment online.

Featured image of Zephyr® Valve, courtesy of Pulmonx®

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