A Covid Patient Goes Home After a Rare Double Lung Transplant

The last thing that Mayra Ramirez remembers from the emergency room at Northwestern Memorial Hospital in Chicago is calling her family to say she had Covid, was about to be put on a ventilator and needed her mother to make medical decisions for her.

Ms. Ramirez, 28, did not wake up for more than six weeks. And then she learned that on June 5, she had become the first Covid patient in the United States to receive a double-lung transplant.

On Wednesday, she went home from the hospital.

Ms. Ramirez is one of a small but growing number of patients whose lungs have been destroyed by the coronavirus, and whose only hope of survival is a lung transplant.

“I’m pretty sure that if I had been at another center, they would have just ended care and let me die,” she said in an interview on Wednesday.

Her surgeon, Dr. Ankit Bharat, performed a similar operation on a second Covid patient, a 62-year-old man, on July 5.

The surgery is considered a desperate measure reserved for people with fatal, irreversible lung damage. Doctors do not want to remove a person’s lungs if there is any chance they will heal. Over all, only about 2,700 lung transplants were performed in the United States last year.

Patients must be sick enough to need a transplant, and yet also strong enough to survive the operation, recover and get back on their feet. With a new disease like Covid-19, doctors are still learning how to strike that balance.

“It’s such a paradigm change,” Dr. Bharat said. “Lung transplant has not been considered a treatment option for an infectious disease, so people need to get a little bit more of a comfort level with it.”

Two more patients at Northwestern are awaiting transplants, one from Chicago and one from Washington, D.C., said Dr. Bharat, who is the chief of thoracic surgery at Northwestern University Feinberg School of Medicine and surgical director of the lung transplant program at Northwestern Medicine, which includes Northwestern Memorial Hospital.

A patient is to be flown in from Seattle next week, and the Northwestern team is consulting on still another case with a medical group in Washington, D.C. Other transplant centers are considering similar surgeries, Dr. Bharat said.

Last Friday, a Covid-19 patient underwent a double lung transplant at the University of Florida Health Shands Hospital in Gainesville, Dr. Tiago Machuca said.

While other centers have sought to refer cases, most of the patients had other serious medical problems that ruled them out, he said.

In some cases, Dr. Bharat said, hospitals appeared to have waited too long to recommend a transplant. One patient being referred to his center seemed like a good candidate but then had major bleeding into the lungs as well as kidney failure, and the surgery was no longer feasible.

“I think people need to recognize this option earlier and just start at least talking about it before it gets to that point,” Dr. Bharat said.

In some cases, he said, insurers’ reluctance to cover the surgery or to pay for travel to transfer patients has led to delays.

“This is so new to our field,” Dr. Machuca said. “It will be a challenge for physicians to determine which patients truly are candidates and what’s the timing. We don’t want to do it too early when the patient still can recover from Covid lung disease and resume with good quality of life, but also you don’t want to miss the boat and have a patient where it’s futile, the patient is too sick.”

He said that, in some cases, extensive rehabilitation has brought about recovery in Covid patients who were being considered as possible transplant candidates.

Because the extensive lung damage in Covid patients makes transplant surgery especially difficult, most patients would be referred to major transplant centers that are best equipped to perform the risky operations and provide the intensive aftercare that patients need, the surgeons said.

Before she became ill, Ms. Ramirez, a paralegal for a law firm specializing in immigration, was working from home and having her groceries delivered. She was in good health, but had an autoimmune condition, neuromyelitis optica, and took medication that suppressed her immune system and might have made her more vulnerable to the coronavirus infection.

She was ill for about two weeks, and consulted with a Covid hotline about her symptoms. At one point, she headed to the hospital but then turned back without going in. She dreaded the idea of being admitted, and told herself she would recover.

But on April 26, her temperature reached 105 degrees Fahrenheit, and she was so weak that she fell when she tried to walk. A friend drove her to the hospital. When doctors told her that she needed a ventilator, she had no idea what they meant. She thought it meant some kind of fan, like the word in Spanish.

“I thought I’d just be there for a couple of days, max, and get back to my normal life,” she said.

But she spent six weeks on the ventilator, and also needed a machine to provide oxygen directly into her bloodstream.

“The entire time, I had nightmares,” she said.

Many of the nightmares involved drowning, her family saying goodbye, the doctors telling her she was going to die.

The disease was relentless. Bacterial infections set in, scarring her lungs and eating holes in them. The lung damage caused circulatory problems that began to take a toll on her liver and heart.

The doctors told her family in North Carolina that it might be time to come to Chicago to say goodbye, and her mother and two sisters made the trip.

But Ms. Ramirez held on, cleared the coronavirus from her body and was placed on the transplant list. Two days later, on June 5, she underwent a grueling, 10-hour operation.

She woke scarred, bruised, desperately thirsty and unable to speak, “with all these tubes coming out of me, and I just couldn’t recognize my own body.”

The nurses asked if she knew the date. She guessed early May. It was the middle of June.

She was not told she’d had a lung transplant until several days after she woke up.

“I couldn’t process it,” she said. “I was just struggling to breathe and I was thirsty. It wasn’t until weeks later that I could be grateful, and think there was a family out there who had lost someone.”

Before her illness, she worked full-time and enjoyed running and playing with her two small, scrappy dogs. Now, she still feels short of breath, can walk only a short distance and needs help to shower and stand up from a chair. The dogs were overjoyed at her homecoming, but their energy was a bit much. Her mother, who lives in North Carolina, took time away from her job at a meatpacking plant and traveled to Chicago to help her recover.

Ms. Ramirez said she was learning to use her new lungs and getting stronger every day.

She is looking forward to getting back to work, but she still has a way to go. Her family is assisting her, and a friend started a GoFundMe page to help pay the bills.

“I definitely feel like I have a purpose,” Ms. Ramirez said. “It may be to help other people going through the same situation that I am, maybe even just sharing my story and helping young people realize that if this happened to me it could happen to them, and to protect themselves and protect others around them who are more vulnerable. And to motivate and help other centers around the world to realize that lung transplantation is an option for terminally ill Covid patients.”

The outlook for Ms. Ramirez is good, Dr. Bharat said, because she is young and healthy. She will be on anti-rejection medicines for the rest of her life. Transplanted lungs can still be rejected, he said, but he has seen some last 20 years. And patients may be able to receive a second transplant.

“I think from now on she’ll continue to get stronger and stronger,” he said. “She asked if she could go skydiving. We’ll probably get her there in a few months.”

Source link

Related posts:

Massive explosion rocks Lebanese capital Beirut
Dear Dr... how our email style reveals much about our personalities
Für Kinder steigt in den Ferien das Unfallrisiko
Researcher seeks safer, more effective leukemia treatment
Schlüsselgen für die Bildung von Herzklappen entdeckt
Macron announces coronavirus bonus for France's homecare workers
Red Onions Linked to Salmonella Outbreak, Officials Say
How we found coronavirus in a cat
MAFLD: Körperliche Fitness ist bedeutsamer als reiner Gewichtsverlust
Coronavirus Live Updates: Fight Over Aid Package Drags On
Insufficient evidence of reduced COVID-19 incidence at high altitudes
Macht eine „Immunthrombose“ das Coronavirus so gefährlich?
Niger marks 60 years of independence from France
Cameroonian migrant killed in Morocco after police find forest encampment
Norway cruise ship passengers with coronavirus reach 43
Studie: Candida-Cluster verursachen in unterschiedlichen Krankenhäusern schwere Infektionen
France facing ‘highly likely’ second wave of Covid-19 in autumn or winter
The reluctant candidate taking on Europe’s ‘last dictator’
France risks losing control of coronavirus: science council
Erstes Medikament gegen Hepatitis D von der Europäischen Kommission zugelassen
Trump’s ‘inexperienced and unqualified’ ambassadors leave US allies aghast
Blood test could diagnose baby brain damage just hours after birth
„Sicherer als ein Flug nach Mallorca“: Vorbereitungen für RESTART-19-Experiment laufen
African American BMi associated with severe COVID-19 and ICU admission
Glücklose „Glückspille“: Fluoxetin bessert funktionelle Fähigkeiten nach Schlaganfall nicht
Latin American virus cases top 5 million
Stranded men rescued from Pacific island after writing SOS in sand
Immunization programs yield high 'return on investment,' saving hundreds of billions of dollars
Millions back under lockdown in Philippines amid surge in virus cases
This 'actions-speak-louder-than-words' student puts public policy studies to work
Norway restricts cruise ship arrivals after Covid-19 outbreak on vessel
Penis microbiota predicts if a man's female partner will develop bacterial vaginosis
Fortschritte beim Bluttest auf Alzheimer
Tackling the bioethics challenges raised by COVID-19
Trial of Algerian journalist and press freedom icon Khaled Drareni starts in Algiers
New York attorney probing Trump and his business over 'criminal conduct'
How COVID-19 changed the way patients responded to a heart attack
Isaias strengthens back to a hurricane forecast to hit Carolinas and East Coast
Dementia on the Retreat in the U.S. and Europe
WHO advance team ends visit to China to probe COVID origin
Doubt cast on wisdom of targeting 'bad' cholesterol to curb heart disease risk
Asthma drug (beta2-agonists) can boost sprint and strength performance in athletes
Israeli jets strike targets in Syria after attempted attack in Golan Heights
Trump says he will only allow TikTok sale if US government gets a cut
2.5% of Italians had COVID-19, far more in the north
Half of low-income communities have no ICU beds
Greater financial integration generally not associated with better healthcare quality
Neue effektive Behandlungsform bei akuter Leukämie
An averted glance gives a glimpse of the mind behind the eyes
Gewissheit in nur 15 Minuten mit graphen-oxidbasiertem Schnelltest zur Infektionserkennung
Child sleep problems associated with impaired academic and psychosocial functioning
COVID-19 oder nicht? Röntgen-Software kann bei der Diagnose unterstützen
Former king Juan Carlos to leave Spain amid probe over financial scandal
Covid-19 Testing Is in Short Supply. Should You Still Get a Test?
Racial discrimination linked to suicide
Neue dermato-onkologische Strategien werden beim ersten digitalen Deutschen Hautkrebskongress vorges...
France halts ratifying extradition treaty with Hong Kong in wake of security law
Scientists Worry About Political Influence Over Coronavirus Vaccine Project
Four-stranded DNA structures found to play role in breast cancer
Schulbeginn: Deutsche Dermatologische Gesellschaft (DDG) empfiehlt Hände desinfizieren statt zu viel...
How the city is adapting to keep visitors safe
Is Telemedicine Here to Stay?
The effects of COVID-19 on emergency visits, hospitalizations
FMT: Präzisere Therapie durch genaueren Blick ins Mikrobiom
Drugmaker Sanofi charged with manslaughter over birth defects
Share Your Medical Bills for Coronavirus
Outbreak hits Norway cruise ship, could spread along coast
Nicht invasiver Bluttest erkennt Krebs vier Jahre früher als herkömmliche Diagnoseverfahren
Videos of Nigerian wedding massacre, mass burials go viral amid call for end to ethnic violence
Rules on outdoor mask-wearing go into effect for parts of France hardest hit by Covid-19
Providers: How Has Covid-19 Changed Your Practice?
Poverty is the most significant obstacle to happiness and well-being for children in England, report...
Boehringer Ingelheim steigert Umsatz - Biermann Medizin
Hundreds of militants remain at large after Islamic State group attack on prison
Spared from fire, Notre-Dame's organ set for lengthy restoration
‘The Biggest Monster’ Is Spreading. And It’s Not the Coronavirus.
A snapshot of how everyday life changed during the first coronavirus lockdown
COVID-19: Steigende Fallzahlen, aber keine akute Überlastung des Gesundheitswesens
A Hospital Forgot to Bill Her Coronavirus Test. It Cost Her $1,980.
US adds 47,508 COVID-19 cases in 24 hours
Wie viele Menschen sind heute schon immun gegen SARS-CoV-2?
John Hume, who won Nobel Prize for Northern Ireland peace process, dies at 83
Some 8,000 evacuate as California wildfires spread east of Los Angeles
Global virus cases top 18 million as Australian city imposes curfew
Umfrage: Kassenpatienten bekommen Arzttermine etwas öfter sofort
Lebanon's foreign minister steps down amid crippling economic crisis
Australian city begins curfew as global virus cases top 18 million
Online raus aus der Internetsucht
Philippine capital returning to lockdown as virus surges
Eisenmangel verringert die Wirksamkeit von Impfungen
Global coronavirus cases top 18 million as WHO warns of 'response fatigue'
Trick des Immunsystems: Wie sich die T-Zellen-Antwort bei chronischen Virus-Infektionen verändert
Melbourne begins six-week curfew to stem rise in coronavirus cases
Italy inaugurates new Genoa bridge two years after deadly collapse
Moderater Alkoholkonsum korreliert mit besserer kognitiver Funktion
Former pope Benedict XVI 'extremely frail', says German newspaper report
US entering 'new phase' of Covid-19 outbreak, say White House experts
Microsoft says it is still pursuing TikTok purchase after talks with Trump
US poised to announce measures against TikTok and other Chinese apps
Soldiers killed in attack in central Mali, political crisis continues

Leave a Reply

Your email address will not be published. Required fields are marked *

Next Post

Detaje si u kontabanduan 12 shtetas sirianë

Thu Jul 30 , 2020
Mëngjesin e djeshëm, në fshatin Vërmicë të Prizrenit, policia ka arrestuar dy persona të dyshuar për kontrabandë me migrantë. Policia ka bërë të ditur se të dyshuarit janë arrestuar dje rreth orës 07:45, njëri nga të cilit është kosovar e tjetri shtetas i Sirisë. Të dyshuarit sipas policisë dyshohet se […]