THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Friday, March 10, 1995 TAG: 9503100344
SECTION: LOCAL PAGE: B1 EDITION: FINAL
SOURCE: BY MARIE JOYCE, STAFF WRITER
LENGTH: Long : 106 lines
As Donald E. Wilkins' lungs deteriorated, he learned to cut corners.
In the store, he'd plot his route to find the shortest distance to his destination - extra steps meant extra breaths, and an emphysema patient can't afford extra breaths. He'd park illegally, just to get close to the door. He'd think out his sentences beforehand - if he kept them short, he might be able to finish before his breath ran out.
But these days, Wilkins, 62, is speaking in paragraphs. And he's been walking the entire perimeter of Wal-Mart without stopping to gasp for air.
Wilkins has benefited from a new surgery that challenges the conventional wisdom about treating emphysema patients.
Emphysema is an often-fatal disease that afflicts more than a million Americans, several times the number of lung cancer cases.
It causes microscopic air sacs in the lungs to grow together into bigger air sacs, making the lungs less efficient at getting oxygen into the blood. As the lungs swell, they push out the rib cage.
In some cases, the deteriorating lungs also stretch out the diaphragm - the muscles at the base of the lungs that control breathing. Eventually, the diaphragm has no room to work.
The new operation benefits those who have the stretched diaphragm. The surgeon cuts away about 20 percent of the most damaged lung tissue, restoring the lungs to their normal shape and size. The diaphragm has enough room to do its job, and the patient breathes better.
It sounds simple, and the idea has been around since at least the 1950s. But it wasn't done until about 18 months ago because doctors believed that removing any of the damaged lung would make it even more difficult for an emphysema patient to breathe, said Dr. Joseph R. Newton Jr., the South Hampton Roads physician who operated on Wilkins. Newton is one of the first doctors in the state to perform the procedure.
The new surgery was pioneered by Dr. Joel D. Cooper at the Washington University School of Medicine in St. Louis.
The American Lung Association calls the treatment ``promising,'' but remains cautious about its benefit for most emphysema patients.
There are different types of emphysema, and the surgery won't work for all of them, said Dr. Norman H. Edelman, scientific consultant for the association. It's not clear how many people could be candidates, he said. Cooper has estimated that about 25 percent of patients could benefit from the surgery; he has used it only for those whose disease was so advanced that they needed a lung transplant.
``We'd like to see some controlled trials,'' said Edelman.
Traditional treatment for emphysema includes the use of inhalers, oxygen, and antibiotics to treat infections. Patients also can see improvement by quitting smoking and undergoing physical rehabilitation. These are still by far the most common treatments and likely will remain so, doctors say. The lung-reduction surgery is still so radical that few hospitals have attempted it. And the surgery is not a cure, said Newton. Emphysema is a progressive disease.
But the surgery does improve the patient's shortness of breath, enables him to move around more and improve his overall health by exercise, and, in many cases, ends his dependence on oxygen machines. ``They're living on the margin,'' said Newton. ``A 50 to 80 percent increase in their lung function means a lot to them.''
Wilkins can attest to that. In fact, Wilkins and his wife, Sallee, came to Norfolk from Pennsylvania for the surgery. His niece is a nurse at Sentara Norfolk General Hospital and had overheard Newton talking about his plans to try the technique.
Before the operation a month ago, Wilkins says, he was completely dependent on an oxygen machine, which he wheeled around on a little cart. He still needs it when he does a lot of walking. But he can sleep without it now. He doesn't need it when he sits and chats with someone. He's hoping he may be able to get rid of it altogether, since it takes several months for the body to fully realize the benefits of the surgery.
The long-term effects of the surgery aren't known, said Newton, although most of those who had the surgery 18 months ago in St. Louis are still doing well.
Newton has received calls from emphysema patients as far away as the Bahamas who want the new operation.
On Monday, he's scheduled to perform his second surgery, on Nikki Spade of Virginia Beach.
The procedure is expensive, requiring weeks of hospitalization and care before and after. Newton hasn't had enough experience to know the average cost to a patient, but he estimates that the surgery and related costs could be about $10,000 to $15,000.
So far, he said, doctors have been able to get insurance companies to pay because the surgical technique is similar to one that's been approved for operations to remove the enlarged air sacs of emphysema.
Don Wilkins tugs on the front of his shirt to show how loose it is since his bowed-out ribs have started to subside. A month ago, the shirt was about to burst its buttons.
``Here I am, sitting here breathing, not using oxygen, and feeling good about it. To me that's great.'' ILLUSTRATION: Color photo
LAWRENCE JACKSON/Staff
A new type of lung surgery has greatly added to the mobility of
62-year-old emphysema patient Donald E. Wilkins.
Graphic
JOHN EARLE/Staff
WHAT IS EMPHYSEMA?
[For complete graphic, please see microfilm]
by CNB