{"id":14816,"date":"2018-03-01T13:54:16","date_gmt":"2018-03-01T20:54:16","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=14816"},"modified":"2024-12-31T11:32:58","modified_gmt":"2024-12-31T18:32:58","slug":"treat-pulmonary-arterial-hypertension-with-flexible-care","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/treat-pulmonary-arterial-hypertension-with-flexible-care\/","title":{"rendered":"Flexible care puts pulmonary hypertension patient back on the snow"},"content":{"rendered":"
<\/div>
\"While
With a big assist from UCHealth, Jonathan Greenspan enjoys views like these more than 100 ski days a season. (Courtesy Jonathan Greenspan).<\/figcaption><\/figure>\n

If it\u2019s winter in Colorado and someone asks how many days you\u2019ve gotten, the answer is automatic. You do a quick mental tally of the times you\u2019ve been up skiing or snowboarding and share the number. Anything over about a dozen is pretty good. Thirty days is impressive; twice that, epic. Rarely is it much higher.<\/p>\n

Jonathan Greenspan, 55, gets 115 days or more, depending on the year. Were it not for the team at the UCHealth Pulmonary Vascular Disease Clinic – Anschutz Medical Campus<\/a>, that number would be zero, because Greenspan would be, as he put it, \u201ca pile of ashes by now.\u201d<\/p>\n

A short commute to the slopes helps: Greenspan lives 150 yards from a ski lift in Telluride. The downside is that it put him 67 miles away from the nearest hospital, in Montrose. That was a problem when his health started to mysteriously crater four years back.<\/p>\n

Pulmonary arterial hypertension<\/h2>\n

He had never spent much time in in the health care system, besides when he got hip replacements after years as a ski instructor, hiker, biker and runner wore the originals down. True, the duties and desk work of running his business of more than 50 employees \u2013 it handled the recycling for Telluride, Montrose and other nearby towns, among other activities \u2013 had added a few pounds to what had been a 5\u20195\u201d, 150-pound frame. But he was healthy, and he was a single guy who tended to just gut it out when he was under the weather.<\/p>\n

\"Jonathan
New pulmonary hypertension medications have helped Greenspan get out and enjoy days like this. (Courtesy Jonathan Greenspan).<\/figcaption><\/figure>\n

That would change. A flu left him bedridden for a solid week. It was during ski season. When he recovered, he was having to stop every 10 yards on the walk to the ski lift.<\/p>\n

\u201cI was huffing and puffing and thinking, \u2018What\u2019s going on here?\u2019\u201d Greenspan recalled. \u201cBecause I didn\u2019t frequent doctors very much, I tried to brush it off.\u201d<\/p>\n

His lips and face swelled, which he brushed off, too, as he did the added weight \u2013 around 50 pounds of it. This went on for more than two years, until he blacked out on his stairs and woke up in a pool of blood from a nasty cut on his head, brushed that off, and then blacked out again a week later. Finally, in the summer of 2014, he went to the clinic in Telluride. They sent him the hospital in Montrose.<\/p>\n

Seriousness of pulmonary arterial hypertension<\/strong><\/h2>\n

The doctors there ran tests and put him on a diuretic; he lost nine pounds overnight. Greenspan had severe pulmonary arterial hypertension, they told him. It was serious enough that they were, they told him, \u201cnot positioned to treat it at this hospital.\u201d<\/p>\n

Pulmonary arterial hypertension happens when the lungs put the squeeze on blood flow coming from the heart. It\u2019s often from the narrowing of blood vessels due to inflammation or other causes. That strains the right side of the heart, which then has to work harder to pump blood to the lungs. The symptoms were familiar enough to Greenspan: shortness of breath, fatigue, dizziness, fainting spells, and edema-caused swelling. The too-frequent end game \u2013 heart failure \u2013 was news to him.<\/p>\n

The team in Montrose referred Greenspan to UCH\u2019s Pulmonary Vascular Disease Center. It\u2019s part of UCHealth\u2019s Comprehensive Lung and Breathing Program<\/a>, U.S. News & World Report\u2019s top-ranked pulmonology program in 2017-2018. The Pulmonary Vascular Disease Center is the only Pulmonary Hypertension Association-accredited Center of Comprehensive Care<\/a> in the region. The center\u2019s team of eight specialist MDs and 10 nurses earned that accreditation through a proven ability to diagnose and care for complex pulmonary hypertension cases such as Greenspan\u2019s.<\/p>\n

Todd Bull, MD<\/a>, and Pulmonary Fellow Jeffrey Robinson, MD, took the lead in Greenspan\u2019s care. They discovered that the right side of his heart had dilated dangerously as it worked to shove blood into uncooperative lungs. This was a life-threatening illness, they told him. Fortunately, thanks to the emergence of new medications over the past several years, they had options. The strongest of them, while life-saving, are difficult to use. They must be administered continuously through the bloodstream, 24 hours a day, via a portable pump.<\/p>\n

No pump<\/strong><\/h2>\n
\"Jonathan
Greenspan, headed higher than a lift will take him, shoulders his skis for a climb to the steeps. (Courtesy Jonathan Greenspan).<\/figcaption><\/figure>\n

Greenspan didn\u2019t want a pump any more than he wanted to move out of Telluride to lower, better oxygenated quarters. The UCHealth team told him that would be a good idea, too, but, as Bull put it, \u201cMoving away from your support base is problematic for many people, so we try to work with individuals like Jonathan and come up with a plan where they can remain in the community they love.\u201d<\/p>\n

The IV medication pump, though, was a recommendation Bull and colleagues felt strongly about. No one wants a pump. But pumps can dispense high doses continuously and directly to the blood vessels in the heart and lungs that need it. They save lives. It could save Greenspan\u2019s life.<\/p>\n

Greenspan resisted. The UCHealth team made it clear that he was taking a huge risk. But Bull and colleagues also recognized that in a patient-centered care model, Greenspan the patient had an important voice. It was he, after all, who would live with the consequences of their collective care decisions.<\/p>\n

He had been staying with friends in metro Denver during his care at UCHealth University of Colorado Hospital (UCH). He returned to Telluride, \u201ckicking stones and dirt and not sharing with my friends,\u201d as he put it. He walked with a cane. He had no energy. He finally confided his predicament in a close friend who works in the medical industry. The friend told him to get back to UCH.<\/p>\n

Greenspan told Bull and Robinson he still didn\u2019t want the pump. That left oral medications as the only options. In a case as severe as his, they\u2019re often not enough, they told him.<\/p>\n

\u201cI\u2019m going to take my chances,\u201d Greenspan said.<\/p>\n

Bull, wanting to improve those chances, also enrolled Greenspan in a multi-center pulmonary arterial hypertension clinical trial<\/a> in which the Pulmonary Vascular Disease Center was a study site. It was for an oral medication designed to reduce lung inflammation, open up blood vessels and improve flow.<\/p>\n

Back to life<\/strong><\/h2>\n

At first, the medications didn\u2019t seem to do much for him. Feeling no better, he spent much of a vacation with family in South Carolina on the couch as they were out boating and sea kayaking and fishing and hot tubbing. \u201cI can\u2019t do any of that stuff anymore,\u201d he was thinking.<\/p>\n

Then early one morning he went to the complex\u2019s gym. He pedaled a stationery bike for 5 minutes. The next day, he did 10 minutes, and 15 minutes the day after that. Maybe it was because he was at sea level, but he definitely felt stronger. He called the UCH team, who gave him their blessing to keep exercising.<\/p>\n

Two years later, Greenspan is up and working out for 55 minutes before 5 a.m. every day, he said. The combination of medications, diet and exercise helped him shed 75 pounds. He\u2019s back to his \u201cwelterweight fighting weight,\u201d as he put it.<\/p>\n

\"A
A slope\u2019s-eye view of the town of Telluride. Altitude can be a problem for those with pulmonary hypertension; this sort of natural beauty and, more importantly, deep connections in the community made leaving a nonstarter for Greenspan; his UCHealth doctors respected (Courtesy Jonathan Greenspan).<\/figcaption><\/figure>\n

There are still challenges. He had to close his company\u2019s doors. He\u2019s starting up again, professionally, doing resource-recovery consulting, working security at the Telluride Ski Resort,\u00a0 selling real estate. \u201cI know myself, he said. \u201cI\u2019ll come back.\u201d<\/p>\n

In one important way, he\u2019s already back. He\u2019s on track for 120 days of skiing despite this season\u2019s thin snowpack.<\/p>\n

Oral medications and lifestyle changes were enough to turn Greenspan\u2019s health around. \u201cIt turned out he ended up being right,\u201d Bull said. \u201cWe\u2019ve gotten away with orals.\u201d<\/p>\n

Greenspan recognizes how much Bull and his colleagues have done for him.<\/p>\n

\u201cThe biggest thing I appreciate is how UCHealth handled it and turned my life around in every aspect. I\u2019m not trying to make a commercial for them, but they just blew it away. Dr. Bull was very central and involved in every single way,\u201d Greenspan said.<\/p>\n

From the beginning, the Pulmonary Vascular Disease Center team told him their job was to restore his lifestyle, he added.<\/p>\n

\u201cAnd guess what they did? They restored it.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

If it\u2019s winter in Colorado and someone asks how many days you\u2019ve gotten, the answer is automatic. You do a quick mental tally of the times you\u2019ve been up skiing or snowboarding and share the number. Anything over about a dozen is pretty good. Thirty days is impressive; twice that, epic. Rarely is it much […]<\/p>\n","protected":false},"author":23,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[2597,2994,2995,2993,2991,2990,2992],"class_list":["post-14816","post","type-post","status-publish","format-standard","hentry","category-innovative-care","tag-comprehensive-lung-and-breathing-program","tag-david-badesch","tag-jeffrey-robinson","tag-jonathan-greenspan","tag-pah","tag-pulmonary-arterial-hypertension","tag-uchealth-pulmonary-vascular-disease-clinic-anschutz-medical-campus"],"acf":[],"yoast_head":"\nTreat 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