Checkup

Breathing Easy

Special Lung Surgery Improves Quality Of Life
for Some Emphysema Patients

The Ellenburgs savored their Bahamas cruise so much, they are now planning another one to Alaska.

Thomas Ellenburg thought he was out of shape. He started getting short of breath changing oil in the diesel engines he worked on. It turned out that Ellenburg, who smoked two to three packs of cigarettes a day, had emphysema. He had to retire in 1999. By 2003, he needed oxygen around-the-clock.

Resigned to a slow, miserable death, the Tallahassee, Fla., resident thought his visit to Mayo Clinic last year would probably be his last trip. "I knew if they couldn't do anything for me that I would die from chronic emphysema," he says. It turned out he was a candidate for a surgical procedure called lung volume reduction surgery (LVRS), which can make breathing, and life, easier for certain patients with emphysema.

Emphysema is an irreversible and fatal lung disease that affects about 2 million Americans. It causes the tiny air sacs in the lungs, called alveoli, to lose elasticity and their ability to exchange oxygen. The damaged alveoli break down and form larger sacs that retain air. This rigid and inflated lung tissue fills up more space in the chest cavity, flattening the diaphragm. As a result, breathing becomes increasingly difficult.

During LVRS, surgeons remove one-third to one-half of the upper lobe of each lung, making room for the diaphragm to return to a more normal position. This makes it easier for patients to breathe.

"There are very few things we can offer patients with emphysema," says Mayo Clinic pulmonologist Dr. Joseph Kaplan. "LVRS offers patients a chance to regain some activity."

Ellenburg went through six weeks of pulmonary rehabilitation, which included exercise therapy to prepare him for LVRS.

"My lungs had gotten so enlarged that whenever I ate, my stomach would push up against my lungs, and I couldn't breathe," he says. "If I was a real panicky person, I don't think I could have handled it."

Mayo Clinic cardiothoracic surgeon Dr. John Odell did Ellenburg's surgery June 15. Ellenburg stayed at St. Luke's Hospital for a week to recover and resume rehabilitation and exercise therapy.

Mayo Clinic transplant pulmonologist Dr. Cesar Keller helps evaluate candidates for LVRS. "By the time these patients have lung volume reduction surgery, they are no longer responsive to medical therapy," he says. "There is nothing else to offer except a surgical approach."

A lung transplant may be a surgical option for some patients, but it comes with a price.

"Patients have to be on immunosuppressive therapy, with all the complications that can arise from that," Keller says.

Keller participated in the National Emphysema Treatment Trial (NETT). This five-year, multicenter trial, supported by the National Heart, Lung, and Blood Institute and the Centers for Medicare & Medicaid Services, ended in 2003. It helped determine which patients might be helped by LVRS, and, more importantly, which would not.

Before his lung volume reduction surgery in June 2004, Thomas Ellenburg — here with daughter Tina and wife Nancy — needed oxygen around-the-clock to help him breathe.

To be considered a candidate for the surgery at Mayo Clinic, patients must meet criteria established by NETT. Those criteria include having disease predominantly in the upper lobes and lung function between 20 and 45 percent as measured by a special breathing test called FEV1. This test measures how much air a person can forcibly exhale in one second.

"Mr. Ellenburg's lungs worked at only 39 percent of their expected capacity before surgery," says Kaplan. "Last December after surgery, he was up to 60 percent. That's a substantial jump. You can't get that kind of improvement with medicine — not even close."

What Ellenburg once thought would be his last trip turned out to be the road to new life. Since his surgery, he and his wife, Nancy, have been on a long-dreamed-of cruise to the Bahamas.

"I found out that cruising is the way to go," Ellenburg says. "To be able to walk on and off that ship without the aid of oxygen was just fantastic."

Not letting any precious time go to waste, the couple is planning another cruise to Alaska.

Read the news release from Feb. 14, 2005.

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