{"id":39075,"date":"2021-04-16T10:01:29","date_gmt":"2021-04-16T16:01:29","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=39075"},"modified":"2022-08-09T10:37:04","modified_gmt":"2022-08-09T16:37:04","slug":"colorado-first-covid-19-patient-receives-double-lung-transplant","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/colorado-first-covid-19-patient-receives-double-lung-transplant\/","title":{"rendered":"In Colorado first, UCHealth COVID-19 patient receives double lung transplant"},"content":{"rendered":"
<\/div>
\"Bryan,
Bryan Raymond, Colorado’s first COVID-19 patient to receive a double lung transplant, and Trinity Raymond with their children. From left: Ryder, Rivyr, Raegyn and Renzey. Photo courtesy Bryan and Trinity Raymond.<\/figcaption><\/figure>\n

Monday, April 12, was a cool early spring day in Colorado. Under a pale blue sky, the world slowly warmed as it returned to life after a long winter. It was a fitting day for a man in the midst of his own hard-earned reawakening to leave the hospital.<\/p>\n

Bryan Raymond, 37, rolled through the doors of UCHealth University of Colorado Hospital<\/a> on the Anschutz Medical Campus<\/a> more than 12 weeks after he arrived, clinging to life against a brutal attack of COVID-19. He came to UCH unable to breathe without machines. He now takes breaths on his own through a new set of lungs.<\/p>\n

Bryan is the first person in Colorado to receive a double lung transplant after a COVID-19 illness. The successful surgery on March 6 made for a bold headline. But his own determined struggle, aided by many hands that supported him as he teetered on the edge of life and death, paints the full story of his survival.<\/p>\n

His fight is far from over. He will spend the next three months recovering in temporary housing near the hospital with his wife, Trinity, while his medical team carefully monitors his health and helps rehabilitate his body, battered by COVID-19 and long stints on a breathing machine. His lung transplant surgeon, Dr. Robert Meguid<\/a>, likes his chances.<\/p>\n

\u201cHe has a tough hill to climb, but he has all the resources to succeed,\u201d Meguid said. \u201cHe has every reason to do it. He is totally a fighter and a survivor.\u201d

Para ver las p\u00e1ginas web de UCHealth en espa\u00f1ol, vaya a UCHealth.org y presione el bot\u00f3n \u201cSelect Language\u201d (es decir, seleccione el lenguaje) en la esquina superior derecha de la ventana. Luego, en el men\u00fa desplegable, seleccione \u201cSpanish\u201d (espa\u00f1ol), o cualquier otro idioma que desee.<\/div>\n

Support near and far for life-saving care<\/strong><\/h2>\n

The wellsprings of Bryan\u2019s strength flow some 750 miles away in Malta, a small town on the high plains of northeastern Montana, about an hour from the Canadian border. His four kids, ages 3, 5, 11 and 15, are there, anxiously waiting to see their dad after months of absence. Trinity\u2019s parents watch over them, supported by meals and assistance from neighbors. The Malta community cheers Bryan and his family on with fundraisers and notes of encouragement as well as prayers that bolster their faith.<\/p>\n

\u201cSmall-town Montana has stepped up,\u201d Trinity said.<\/p>\n

Bryan’s story is also a testament to the staunch medical support he and Trinity received in Montana and Colorado. It reveals how much effort, skill and determination sustaining a single life requires.<\/p>\n

Sudden COVID-19 strike<\/strong><\/h2>\n
\"Dr.
Dr. Robert Meguid performed Raymond\u2019s double lung transplant at UCHealth University of Colorado Hospital. Photo by UCHealth.<\/figcaption><\/figure>\n

As is true for so many, COVID-19 invaded the Raymonds\u2019 lives without warning. Bryan worked for Phillips County, blading gravel roads, while Trinity taught fourth grade at Malta Elementary School. In their spare time they liked to help out on the ranch Trinity\u2019s parents own. He officiated basketball games, chasing high school players up and down the court. The kids raised animals for 4-H and took them to the fair. The whole family enjoyed camping beneath the wide Montana sky.<\/p>\n

But on Nov. 30, 2020, their world changed. Bryan tested positive for COVID-19. He had a fever and shortness of breath. Trinity recalled the first few days of his illness as \u201cnot too bad,\u201d but on Dec. 9, his oxygen levels plunged into the mid-70s (90 or above is normal). Providers at the Phillips County Hospital emergency room quickly sent him by air to Billings Clinic Hospital<\/a>, about 200 miles south. He promptly went to intensive care.<\/p>\n

A week later, his condition deteriorated to the point that he needed a ventilator to breathe. The same day, staff told Trinity that his failing lungs needed a higher level of mechanical support from ECMO (extracorporeal membrane oxygenation), a term she\u2019d never heard. Providers inserted a cannula into a vein in his leg, through which blood flowed to a machine that oxygenated it and returned it to his body through another cannula in his neck. ECMO, his providers hoped, would allow his COVID-ravaged lungs to rest and recover.<\/p>\n

Even on ECMO, however, his lungs did not improve. The Billings team wanted to transfer him to another hospital for even more intensive care, but a bed did not open up until Jan. 7, 2021, when UCH accepted his transfer. He flew the next day to Colorado, desperately ill.<\/p>\n

Free of COVID before being listed for transplant\u00a0<\/strong><\/h2>\n

Bryan faced a stark challenge. He would need a lung transplant to live, but before he could be listed, he had to recover sufficiently to survive the surgery. Yet he still tested positive for COVID-19 and his body was deconditioned from three weeks lying in a bed, sedated and connected to the ECMO machine.<\/p>\n

\"Dr.
Dr. Muhammad Aftab managed Bryan Raymond\u2019s long stint on an ECMO machine at UCH. Photo by UCHealth.<\/figcaption><\/figure>\n

He needed physical therapy, but that required surgery to reposition his ECMO cannulas, said Dr. Muhammad Aftab<\/a>, assistant professor of Cardiothoracic Surgery<\/a> with the University of Colorado School of Medicine<\/a>.<\/p>\n

\u201cWe wanted him to walk. He was losing muscle mass,\u201d Aftab said. Without discontinuing ECMO support, Aftab and his team removed the cannula from his leg and repositioned it as the second one in his neck so that he would be able eventually to move. The ECMO team also put Bryan on dual oxygenators to maximize support for his lungs, Aftab said.<\/p>\n

With the newly positioned cannulas, Bryan could move \u2013 at least in theory. But the goal of being able to walk on his own seemed impossibly distant. He was in a COVID-19 isolation room, drifting in a fog of sedation. Trinity could communicate with him \u2013 or attempt to \u2013 only through FaceTime. It would not be until Feb. 6 that he finally tested negative for COVID-19 and moved to the Cardiothoracic Intensive Care Unit (CTICU).<\/p>\n

Miniscule yet monumental movements toward lung transplant program<\/strong><\/h2>\n

Yet even in the isolation unit, physical therapists began the slow process of helping Bryan’s depleted muscles regain strength with range-of-motion exercises. In the CTICU, the work continued. He inched from sitting up, to sitting on the edge of the bed, to standing with assistance, to edging to a chair and back.<\/p>\n

\u201cIt took multiple weeks of tiny steps to get that strength back up,\u201d Trinity said.<\/p>\n

\"Anesthesiologist
Anesthesiologist Dr. Tim Tran helped to manage Bryan\u2019s ECMO sedation as a member of his critical care team. Photo by UCHealth.<\/figcaption><\/figure>\n

The arduous recovery was complicated by other factors. Bryan remained on ECMO and was closely managed by Aftab along with a team of intensive care specialists, nurses trained on ECMO, and perfusionists, who manage the ECMO machine. His sedation was difficult to manage, recalled Dr. Tim Tran, an anesthesiologist who was a member of his CTICU team. With less sedation, it was easier for Bryan to reengage with the world, but weaning him safely was a delicate task.<\/p>\n

\u201cEvery time we tried to lighten his sedation, he would cough, which would reduce the ECMO flow,\u201d Tran recalled. \u201cThen we would have to re-sedate. It was hard to find a happy spot.\u201d<\/p>\n

Under the watchful eyes of nurses, physical therapists, cardiothoracic surgeons, pulmonologists, intensive care specialists and many others, Bryan slowly edged towards the goal set by Dr. Alice Gray<\/a>, director of Lung Transplant Pulmonology at UCHealth. It was simple but daunting. He would have to be able to walk on his own before he could be listed to receive donor organs.<\/p>\n

\u201cEssentially all our effort was to prepare him for that,\u201d Aftab said. \u201cIt was non-stop work for two months.\u201d<\/p>\n

\"Bryan
Raymond handles a basketball during an occupational therapy session on March 23 after being Colorado’s first COVID-19 patient to receive a double lung transplant. Photo courtesy of Nikki A. Rae Photography.<\/figcaption><\/figure>\n

Montana motivation to undergo a double lung transplant<\/strong><\/h2>\n

Bryan achieved that goal on Feb. 26 after he twice walked about 250 feet, unassisted. He didn\u2019t have to manufacture the motivation to do it.<\/p>\n

\u201cI\u2019m kind of one sometimes that when I get challenged, I make sure I push hard to meet or beat that challenge,\u201d he said. \u201cThis was life or death, honestly. It was walk and get your lungs or not walk and not get on the transplant list.\u201d<\/p>\n

About a week after he met the requirement, the UCHealth transplant team procured a pair of donor lungs, which Meguid successfully transplanted in a lengthy procedure March 6. Meguid emphasized he was again but one member of a large support team, including chief thoracic surgery fellow Dr. Neil Venardos.<\/p>\n

Gratitude for lung donors<\/strong><\/h2>\n

Both Bryan and Trinity are quick to note the team\u2019s unseen, but most vital member: the donor who supplied the lifesaving lungs.<\/p>\n

\"Bryan
Bryan Raymond sits up on his own, something he was unable to do for many weeks while he fought COVID-19. Photo courtesy of Nikki A. Rae Photography.<\/figcaption><\/figure>\n

\u201cIt\u2019s a hard reality to come to the fact that somebody had to pass away in order for my husband to live,\u201d Trinity said. \u201cSomebody had to go through something horrible. It\u2019s something you never wish on anybody. At the same time you are wishing for those lungs.\u201d<\/p>\n

Bryan also relied on red blood cell transfusions throughout his hospitalization, another donor gift that too often goes unappreciated, Trinity added.<\/p>\n

\u201cThis has opened our eyes so much more to truly relying on donors,\u201d she said.<\/p>\n

Colorado’s first COVID-19 patient to receive double lung transplant<\/strong><\/h2>\n

The transplant surgery was just one milestone on a long and still unwinding road. Bryan remained on ECMO during the procedure and for five days following. The CTICU team gradually decreased the support to ensure his lungs could function without it, Tran said.<\/p>\n

\u201cIt was a scary day when they took out the cannulas,\u201d Trinity said. \u201cBut the team knew what they were doing.\u201d<\/p>\n

A new set of lungs doesn\u2019t mean instant recovery. After weeks on ECMO, Bryan lost the muscle strength needed to take deep breaths. His bout with COVID-19 had shrunken his old lungs and his chest cavity with it. He needs long practice on breathing techniques to recondition his muscles and expand his new lungs, along with the chest cavity.<\/p>\n

The day of his COVID-19 diagnosis, Bryan weighed 245 pounds. A little more than four months later, the disease and 12 weeks on ECMO had shaved his weight to 175. Weeks of work to prepare for surgery led to more rounds of hard work, this time to rehabilitate: 75 to 90 minutes a day each for physical and occupational therapy, along with some speech-language therapy.<\/p>\n

\u201cI\u2019m learning to get up stairs again, step over a curb, get into a car, shower, be able to stand up and cook,\u201d he said. \u201cYou have to train yourself to do all that again.\u201d<\/p>\n

Meanwhile, the Raymonds took classes from the hospital\u2019s transplant coordinators to prepare for post-transplant life. That includes managing a strict medication regimen, watching for signs of organ rejection, guarding against bacterial infection and more. For a year after they complete the three-month monitoring period, they will have to make the long trip from Montana back to UCH every month for checkups.<\/p>\n

COVID-19 and double lung transplant survivor<\/strong><\/h2>\n
\"Bryan
Bryan, Colorado’s first COVID-19 patient to receive a double lung transplant, relearns activities of everyday living, like brushing his teeth, during an OT session. Photo courtesy of Nikki A. Rae Photography.<\/figcaption><\/figure>\n

For all the changes and challenges, they feel nothing but gratitude for the many providers at UCH who continue to help them through their ordeal.<\/p>\n

\u201cThere have been so many teams at this hospital that have helped so much,\u201d Trinity said, from physicians, nurses, physical therapists, occupational therapists and many more to the custodial staff member who noticed a change in Bryan one day and alerted Trinity to it.<\/p>\n

\u201cThe CTICU staff became pretty much family to us,\u201d she said.<\/p>\n

Now out of the hospital, Bryan toils toward his next big payoff: reuniting with his children, who have been without him ever since he fell ill.<\/p>\n

\u201cI can\u2019t describe how hard this has been on our kids,\u201d Trinity said.<\/p>\n

Aftab said that despite his devastating illness, Bryan had crucial factors working in his favor: he was young, active and healthy, with no underlying medical problems except well-controlled multiple sclerosis.<\/p>\n

\u201cHe was also determined to recover, with a very supportive family who helped us help him,\u201d Aftab said.<\/p>\n

The ECMO team also had the prior experience of caring for more than three dozen COVID-19 cases the past year, he noted. That experience yielded many clinical lessons, he added, but the most fundamental could be applied to patients like Bryan and his family.<\/p>\n

\u201cWe\u2019ve learned to never give up and to fight hard every day,\u201d Aftab said. \u201cLet\u2019s be optimistic as well as realistic and be prepared for setbacks because recovery will not be smooth sailing. Persistence is extremely important.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

Monday, April 12, was a cool early spring day in Colorado. Under a pale blue sky, the world slowly warmed as it returned to life after a long winter. It was a fitting day for a man in the midst of his own hard-earned reawakening to leave the hospital. Bryan Raymond, 37, rolled through the […]<\/p>\n","protected":false},"author":2143,"featured_media":39079,"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":[7],"tags":[4859,4860,3329,3357,4501,702],"class_list":["post-39075","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-stories","tag-coronavirus","tag-covid-19","tag-inpatient-rehabilitation-and-therapy","tag-lung-and-respiratory-care-pulmonology","tag-lung-transplants","tag-surgical-care"],"acf":[],"yoast_head":"\nCOVID-19 patient to receive double lung transplant - 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