{"id":69319,"date":"2024-10-09T11:22:36","date_gmt":"2024-10-09T17:22:36","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=69319"},"modified":"2024-10-16T15:24:26","modified_gmt":"2024-10-16T21:24:26","slug":"medications-rehab-help-with-pulmonary-arterial-hypertension","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/medications-rehab-help-with-pulmonary-arterial-hypertension\/","title":{"rendered":"Medications, exercise help patient stem the tide on pulmonary arterial hypertension"},"content":{"rendered":"
<\/div>
\"Burant
Burant and her husband Kevin. Kevin encouraged Amy to keep seeking help for her disease\u2019s symptoms. Photo: UCHealth.<\/figcaption><\/figure>\n

As a kid growing up near Houston, Amy Burant lived with asthma. It didn\u2019t stop her from doing what she wanted.<\/p>\n

\u201cI played soccer and softball, did the drill team and cheerleading,\u201d she said. \u201cI never had any issue other than running in cold weather.\u201d<\/p>\n

As an adult, her health began to change. Burant moved to Colorado in 2003 and joined what is now\u00a0UCHealth University of Colorado Hospital<\/a>\u00a0as a nurse. Around 2009, she worked nights in the neuro intensive care unit when new and unusual breathing problems cropped up. The short walk from the hospital\u2019s employee parking garage to the ICU forced her to stop to catch her breath.<\/p>\n

\u201cI thought, \u2018That\u2019s not normal,\u2019\u201d Burant recalled. She reported the problem to her physicians, who bluntly told her she was overweight, needed to exercise more, and in her words, \u201cthrew some inhalers at me\u201d to treat her asthma.<\/p>\n

Burant accepted the advice. \u201cI thought, \u2018Yeah, they\u2019re right. I\u2019m just going to try harder,\u2019\u201d she recalled. Despite her efforts, though, her shortness of breath not only continued but worsened. She also began experiencing heart palpitations.<\/p>\n

The worrisome symptoms didn\u2019t stop Burant from getting the most she could from life. She gave birth to her daughter Sophie in 2009 and continued to work in the ICU until 2011. She then moved into a new job at University of Colorado Hospital, serving as a clinical scholar supervising rotations of nursing students. Her symptoms never got better, but she saw them as an unwelcome fact of life.<\/p>\n

\"Amy
Amy Burant manages pulmonary arterial hypertension by committing to a regimen of medications and pulmonary rehabilitation. Photo by Cyrus McCrimmon, for UCHealth.<\/figcaption><\/figure>\n

\u201cStopping while walking was normal; so were the palpitations,\u201d Burant said. \u201cLater, when I got better, I realized none of it was normal.\u201d<\/p>\n

Burant learned in 2013 that her symptoms weren\u2019t the result of her weight or a lack of exercise, or as she once thought, the stress of working night shifts in intensive care for 11 years. The culprit was\u00a0pulmonary arterial hypertension<\/a>\u00a0(PAH), a dangerous form of high blood pressure that creates stress on the arteries feeding blood to the lungs and the right side of the heart. There is no cure, and over time, PAH can lead to right-side heart failure.<\/p>\n

That\u2019s tough news for anyone to absorb. But Burant fought back, and today she is successfully managing the PAH that she initially feared was a death sentence. She credits her primary<\/a> and pulmonary care<\/a> specialists and the pulmonary rehabilitation<\/a> team for recognizing, diagnosing and treating her symptoms and setting her on the path to living and maintaining a healthier lifestyle that includes regular high-intensity interval training and weightlifting.<\/p>\n

She even credits her disease for helping her to see life from a new, grateful perspective and spurring her to lend her voice to helping people with PAH and other respiratory diseases.<\/p>\n

Confronting pulmonary arterial hypertension<\/strong><\/h2>\n

Burant\u2019s path to her PAH diagnosis began in 2013 with a challenge from her husband, Kevin. Leaving the ICU and the night shift routine hadn\u2019t helped her symptoms. As the six weeks of Lent began, Kevin issued a challenge. He wanted Amy to give up not seeing doctors for the problem.<\/p>\n

\"Burant
Burant and her husband Kevin with Sophie at Willow Creek Reservoir, near Granby, in 2018. Photo courtesy of Amy Burant.<\/figcaption><\/figure>\n

\u201cHe said, \u2018Your weight isn\u2019t changing but your shortness of breath is getting worse. Go see a doctor,\u2019\u201d Burant recalled. She admitted to herself that she hadn\u2019t improved and that because of her poor health, she was spending more time watching 3-year-old Sophie do things than actually joining her.<\/p>\n

With that, Burant began seeing UCHealth primary care physician\u00a0Dr. Julia Kavanagh<\/a>, who ordered a battery of tests of her heart and lung functions. After an echocardiogram \u2014 an ultrasound test that yields images of blood flowing through the heart \u2014 Burant received ominous news. Kavanagh wanted to see her in person \u2014 with Kevin.<\/p>\n

Burant learned from Kavanagh that the echocardiogram presented strong evidence that her symptoms were\u00a0caused by PAH<\/a>. A definitive diagnosis required a\u00a0right heart catheterization<\/a>, a procedure that measures the pressure in the pulmonary artery, through which deoxygenated blood flows to the lungs.<\/p>\n

A diagnosis, not a death sentence: treating pulmonary arterial hypertension<\/strong><\/h2>\n

The catheterization confirmed that Burant indeed had PAH. It was devastating news.<\/p>\n

\u201cAs an ICU nurse, I didn\u2019t understand pulmonary hypertension,\u201d Burant said.<\/p>\n

In her mind, a patient with the condition was someone hooked up to a ventilator, waiting for a transplant. She was convinced that she had only months to live.<\/p>\n

\u201cI thought of all the things that I wanted to tell my husband, to tell my daughter,\u201d Burant recalled.<\/p>\n

She told herself that Kevin would have to make sure that when Sophie attended her high school homecoming that her shoes matched her dress.<\/p>\n

In fact, her pulmonologist told her, median\u00a0survival rates for PAH<\/a>\u00a0are measured in years, not months, especially with treatments to manage the disease. You are a data point, not an aggregate number, he told her. There is no expiration date. Your curve could look different.<\/p>\n

PAH treatment employs diverse strategies<\/strong><\/h2>\n

Burant began a PAH treatment plan with multiple components. It started with sildenafil<\/a>, a medication that relaxes the blood vessels that supply the lungs. It thus reduces pressure on the lungs and strain on the right ventricle of the heart, said Burant\u2019s pulmonologist,\u00a0Dr. Todd Bull<\/a>. Today, Burant takes sildenafil, along with two other medications,\u00a0macitentan<\/a>\u00a0and\u00a0selexipag<\/a>, to manage her PAH.<\/p>\n

\u201cThe medications allow Amy to feel better, do more and exercise more aggressively,\u201d said Bull, who is also a professor<\/a> at the University of Colorado School of Medicine<\/a> on the Anschutz Medical Campus<\/a>.<\/p>\n

Bull said that diuretics, which reduce fluid buildup caused by her weakened heart, are another important part of her treatment, as are anticoagulants to prevent blood clots.<\/p>\n

A previously undiagnosed congenital\u00a0atrial septal defect<\/a>\u00a0(ASD) \u2014 a hole between the wall separating the right and left chambers of the heart \u2014 also complicated Burant\u2019s diagnosis. The ASD caused blood from the left side of the heart to flow back to the right. The high pressure on the right side created by the PAH forced unoxygenated blood back to the left, to be pumped to the rest of Burant\u2019s body, which became oxygen-starved. As a result, she requires oxygen around the clock.<\/p>\n

Amy Burant and daughter Sophie at Hidden Lake, Colorado, in 2019. Photo courtesy of Amy Burant.<\/figcaption><\/figure>\n

The treatment plan took some adjustment, Burant said. She had to get used to setting reminders to take her medications. There were insurance channels to navigate. Her 24-hour dependence on oxygen was the toughest challenge.<\/p>\n

\u201cManaging the oxygen was the trickiest part \u2014 making sure I had enough and getting more if I ran low,\u201d she said..<\/p>\n

Rehab and medications: Living with PAH<\/strong><\/h2>\n

Under the care of Bull and his team in the\u00a0UCHealth Pulmonary Vascular Disease Clinic<\/a>, Burant incorporated the treatment path in her daily life. The positive results dispelled, at least to some extent, her fears of an early demise. The diuretics stopped her heart palpitations. Wearing an oxygen backpack, she began walking short distances and riding her bike to the park with Sophie.<\/p>\n

\u201cI felt relief very quickly,\u201d she said. \u201cI hadn\u2019t thought I could live on an outpatient basis.\u201d A trip to Copper Mountain with Kevin and Sophie about a year after her diagnosis brought a welcome sense of hope. Burant couldn\u2019t ski herself, but she relished joining them on the slopes in better health.<\/p>\n

\"Alex
Alex Worl<\/figcaption><\/figure>\n

\u201cBeing present and part of it was awesome,\u201d Burant said. \u201cHiking from area to area with my oxygen was a big accomplishment for me.\u201d<\/p>\n

Building back better with pulmonary rehabilitation<\/strong><\/h2>\n

A cornerstone of Burant\u2019s treatment is pulmonary rehabilitation, which she began in July 2013 and continues regularly 10 years later. Of course, she\u2019d rather not be pushed by her PAH to a four-day-a-week regimen in the gym at UCH, but she calls it \u201cthe best place you never want to be.\u201d<\/p>\n

Pulmonary rehabilitation is a vital part of Burant\u2019s care, Bull said. For many years, he said, providers thought that exerting PAH patients was too risky. In fact, the opposite is true, he said.<\/p>\n

\u201cWe have learned that exercise benefits patients with chronic conditions, just like it benefits people without medical illnesses,\u201d Bull said. \u201cIt builds muscle mass and helps patients use oxygen more effectively.\u201d<\/p>\n

Burant said the rehab sessions not only help her to maintain her breathing capacity under the care of an expert team; they offer motivation, camaraderie and inspiration.<\/p>\n

\u201cPulmonary rehabilitation has made me feel strong,\u201d she said. She has lost weight and improved her stamina since returning to the four-day routine that was disrupted, in part, by the COVID-19 pandemic. \u201cIt\u2019s as important as the medications I take. I feel better physically, and when I\u2019m not as faithful to it, I feel worse.\u201d<\/p>\n

That perception is more than a feeling, said UCH respiratory therapist and pulmonary rehabilitation coordinator Alexandra Worl. Worl pointed to Burant\u2019s improvement on her six-minute walk test, a key measure of a patient\u2019s exercise capacity. Burant\u2019s increased by 70% after starting pulmonary rehab she and has maintained that level for a decade, Worl said. Burant\u2019s early challenge was getting enough oxygen while she worked out, Worl added. That\u2019s no longer a worry.<\/p>\n

\u201cWe learned how to adjust to that and read her needs,\u201d Worl said. \u201cNow she\u2019s independent.\u201d<\/p>\n

\"Former
Former UCHealth Nurse Amy Burant has battled pulmonary arterial hypertension for 10 years. Photo by Cyrus McCrimmon for UCHealth.<\/figcaption><\/figure>\n

The benefits of rehab in addition to pulmonary arterial hypertension medications<\/strong><\/h2>\n

The pulmonary rehab team does far more than watch over Burant and other patients as they purposefully pace on elliptical machines or treadmills. The therapists help educate patients about the shortness of breath and fatigue they encounter as they work to strengthen their lungs, Worl said.<\/p>\n

\"UCHealth
UCHealth pulmonologist Dr. Todd Bull<\/figcaption><\/figure>\n

A rehab session that produces dizziness, faintness and an inability to do everyday activities like doing laundry afterward means it\u2019s time to back off, Worl explained. But with time and consistent practice, many patients learn that their shortness of breath occurs because they are working themselves harder.<\/p>\n

\u201cIt\u2019s typical to see over time that a patient\u2019s shortness of breath rating remains the same despite an increase in the time and intensity of their exercise,\u201d Worl said. \u201cPatients learn how to interpret their symptoms as a message \u2013 not a negative one, but rather, \u2018I\u2019m exercising and therefore I\u2019m short of breath.\u2019 They embrace that signal from their body.\u201d<\/p>\n

Worl noted that after several moves, the gym has a new home, new equipment and more staff. That\u2019s key because patients referred for rehabilitation can get started quicker. Pulmonary rehab offers many proven benefits for patients, including\u00a0reducing the risk of hospital readmission and improving survival<\/a>, Worl said.<\/p>\n

As patients regain strength, their quality of life improves and working with a group \u201cempowers patients to see what they are capable of and to encourage others,\u201d she added. \u201cPsychosocial benefits are a built-in part of pulmonary rehabilitation.\u201d<\/p>\n

Pulmonary rehab and medications: Pillars for a new outlook<\/strong><\/h2>\n

Taking part in pulmonary rehabilitation contributed to another important change in Burant\u2019s outlook. For three years after her PAH diagnosis, she continued to work at the hospital in her nursing role. But she had another job on the same campus, as a patient managing a chronic illness.<\/p>\n

\"Amy
Amy Burant, center, and her husband Kevin visiting Moab, Utah, in the summer of 2023. Photo courtesy of Amy Burant.<\/figcaption><\/figure>\n

\u201cI was a nurse and a patient simultaneously,\u201d Burant said. She had worked at the bedside as a nurse with Worl and other respiratory therapists. In the pulmonary rehab gym, the same people were her medical providers. She was grateful to know them but initially found it difficult to process the change.<\/p>\n

\u201cMy peers were no longer medical staff; they were patients,\u201d Burant said.<\/p>\n

After she left the hospital in 2016, her outlook shifted.<\/p>\n

\u201cMy job became pulmonary rehab, not being a clinical scholar,\u201d she said. \u201cI felt the camaraderie. It was inspirational to see people working as hard as possible to get better. There were no excuses.\u201d<\/p>\n

A commitment to helping herself and others<\/strong><\/h2>\n

Burant now also works on behalf of others facing the challenges of PAH. In the fall of 2023, she began work with the Pulmonary Hypertension Association and the American Lung Association to support the Supplemental Oxygen Access Reform Act<\/a>. The aim: preserve patients\u2019 access to liquid oxygen and respiratory therapy, and improve reimbursement for durable medical equipment. Burant signed up to lobby in support of the legislation. She also participated on a patient panel for the American Lung Association\u2019s Moving Mountains Symposium<\/a>.<\/p>\n

The new work prods Burant to do more to help others. She asks herself, \u201cWhere else can I tell my story? Who else can I encourage? Who needs to see what is possible?\u201d<\/p>\n

Meanwhile, she continues to extend her physical limits. In the summer of 2023, Burant traveled to Moab, Utah to meet Kevin\u2019s family. She blazed new territory on the trip.<\/p>\n

\"Amy
Amy Burant, center, and her husband Kevin with Sophie during a 2024 vacation. Photo courtesy of Amy Burant.<\/figcaption><\/figure>\n

\u201cI was able to hike Arches National Park to see many of the incredible rock formations,\u201d she said. \u201cI never expected to be able to do that and to keep up with the rest of the family. It was a pretty cool experience and one that I attribute directly to my progress in Pulmonary Rehab.\u201d<\/p>\n

A visit to Dry Tortugas National Park off Key West \u2014 \u201cprobably my favorite place on Earth so far\u201d \u2014proved equally memorable. \u201cI snorkeled all day and was able to put my oxygen aside for a little bit, being at sea level,\u201d Burant said.<\/p>\n

Burant now understands life \u201cfrom both sides now,\u201d as Joni Mitchell put it. She was a patient who received a devastating diagnosis. But in part because of her disease, she also savors, perhaps more than others, the chance to live a full life. A little over a decade ago, she was preparing Kevin to raise Sophie without her. Today, she is watching Sophie show sheep and ride horses with 4H.<\/p>\n

\u201cHaving a lack of hope is hard,\u201d Burant said. \u201cNow I actually feel I can get stronger and better, whereas for a long time, I was just trying not to get worse.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

As a kid growing up near Houston, Amy Burant lived with asthma. It didn\u2019t stop her from doing what she wanted. \u201cI played soccer and softball, did the drill team and cheerleading,\u201d she said. \u201cI never had any issue other than running in cold weather.\u201d As an adult, her health began to change. Burant moved […]<\/p>\n","protected":false},"author":2143,"featured_media":78528,"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":[3357,277,2737,177,130],"class_list":["post-69319","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-stories","tag-lung-and-respiratory-care-pulmonology","tag-metro-denver","tag-pulmonary-rehabilitation","tag-pulmonology","tag-rehabilitation"],"acf":[],"yoast_head":"\nTreating pulmonary arterial hypertension with medications and rehab - 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