A Kovid patient goes home after a rare double lung transplant

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

Ms. Ramirez, 28, did not wake for more than six weeks. And then she finds out that on June 5, she became the first Kovid 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 coronaviruses, and whose only hope of survival is a lung transplant.

“I am very sure that if I were in another center, they would just stop caring and let me die,” he said in an interview on Wednesday.

His surgeon Drs. Ankit Bharat performed a similar operation on another 62-year-old Kovid patient on 5 July.

Surgery is considered a desperate remedy for people with fatal, irreversible lung damage. Doctors do not want to remove a person’s lungs, if there is a chance, they will fix it. Only about 2,700 lung transplants were performed in the United States last year.

Patients must be ill enough to require a transplant, and still be strong enough to survive the operation, recover and get back on their feet. With a new disease like Kovid-19, doctors are still learning how to affect that balance.

“This is one such change,” Dr. Bharata said. “Lung transplantation has not been considered a treatment option for an infectious disease, so people need to get a slightly higher comfort level with it.”

Two more Northwestern patients await the transplant, including one from Chicago and one from Washington DC. Bharata, who heads Vascular Surgery at Northwestern University Feinberg School of Medicine, and the Surgical Director of the Lung Transplant Program at Northwestern Medicine. Which includes Northwestern Memorial Hospital.

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

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

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

In some cases, Drs. Bharat said, hospitals waited a lot to recommend transplant. A patient being sent to his center seemed like a good candidate, but he then had major bleeding in the lungs as well as kidney failure, and surgery was no longer possible.

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

In some cases, he said, the reluctance of insurers to cover surgeries or to pay for travel to relocate patients led to delays.

“This is very new to our region,” Dr. Machuka said. “It will be a challenge for physicians to determine which patients are actually candidates and what is the time. We do not want to do it too early when the patient can still overcome Kovid lung disease and start again with a good quality of life, but also because you do not want to miss the boat and have a patient Where it sucks, the patient is very ill. “

He said that, in some cases, extensive rehabilitation has brought about improvements in Kovid’s patients who were being considered as potential transplant candidates.

Because extensive lung damage in Kovid patients makes transplant surgery particularly difficult, most patients will be referred to major transplant centers that are best equipped to perform risky operations and the intensive care that patients receive It is necessary to provide it, surgeons said.

Before she became ill, Ms. Ramirez, a paralegal of a law firm specializing in immigration, was working from home and delivering her groceries. She was in good health, but had an autoimmune condition, neuroimulitis optica, and took medication that suppressed her immune system and may be vulnerable to coronovirus infection.

She remained ill for about two weeks, and consulted with the Kovid hotline about her symptoms. At one point, she went to the hospital but then went back non-stop. She panics at the thought of being admitted, and tells herself that she will 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 rushed him to the hospital. When doctors told her that she needed a ventilator, she had no idea what they meant. He thought it meant some kind of fan, such as the word in Spanish.

“I thought I’d just stay for a few days, maximum, and come back to my normal life,” she said.

But he spent six weeks on the ventilator, and also needed a machine to provide oxygen directly to his bloodstream.

“The whole time, I had bad dreams,” she said.

Several nightmares were related to the drowning, with her family saying goodbye, with doctors telling her she was going to die.

The disease was relentless. Bacterial infection scares his lungs and pierces them. Lung damage resulted in circulatory problems, which began to take a toll on his liver and heart.

Doctors told her family in North Carolina that it might be time for her to come to Chicago to say goodbye, and her mother and two sisters traveled.

But Ms. Ramirez cleaned the coronovirus from her body and was placed on the transplant list. Two days later, on June 5, he underwent a grueling operation, a 10-hour operation.

She was nervous, rash, desperately thirsty and unable to speak, “with all these tubes coming out of me, and I just couldn’t recognize my body.”

The nurses asked if she knew the date. He anticipated the beginning of May. It was the middle of June.

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

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

Prior to his illness, he worked full time and enjoyed running and playing with his two small, timid dogs. Now, she still feels short of breath, can only walk a short distance and needs help getting up from a chair and standing up. The dogs enjoyed a lot on his return home, but his energy was a bit much. Her mother, who lives in North Carolina, took time out of her job at a meatpacking plant to travel to Chicago to recover.

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

He is eager to get back to work, but he still has a way. Her family is assisting her, and a friend started a GoFundMe page to help pay the bills.

“I definitely think I have a purpose,” Ms. Ramirez said. “It could be to help other people going through the same situation that I am, maybe even to share their story and help young people realize that if this happened to me, it would May happen to them, and to protect themselves and protect others around them are more vulnerable. And to inspire and help other centers around the world to realize that lung transplantation is an option for sick Kovid patients. “

The outlook is good for Ms. Ramirez, Drs. Bharata said, because he is young and healthy. She will remain on rejection drugs for the rest of her life. Transplanted lungs can still be ruled out, he said, but he has seen something in the last 20 years. And patients may be able to get a second transplant.

“I think from now on he will keep getting stronger and stronger,” he said. “She asked if she could go skydiving. We will probably bring it there in a few months. “

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