University of Pennsylvania Health System

Lung Transplant Update | Penn Medicine

Wednesday, September 24, 2014

Autumn Has Arrived: Time for a Flu Vaccine

Flu season has officially begun with early cases of influenza already being reported in the area. The Penn Lung Transplant team reminds you and your loved ones to get your a flu shot.

Whether you have lung disease, are taking immunosuppression (anti-rejection) medications or live with someone who does, now is the time to get vaccinated. Vaccines administered between mid October and early December should protect you through early spring.

Transplant recipients are advised to take only the injectable “inactivated influenza vaccine.” The flu shot uses killed virus and is injected into the muscle. Because the virus is inactive, you can't get the flu from taking this inoculation. Please be aware that it may take a couple of weeks for the vaccine to “take hold” and defend you against infection. Nasally inhaled vaccines made from live, attenuated virus are not safe for people whose immune systems are compromised or weakened. This season's vaccine covers both influenza and H1N1, so only one injection is necessary.

The flu vaccine is available at many locations in the community including drug stores, doctors' offices and through community service groups. If you don't have access to a vaccination in your neighborhood, Penn Medicine can provide the injection for you. Simply call the Penn Lung Center at 215-662-3202 and speak with a patient service representative to schedule an appointment in the flu shot clinic. Flu shots are being administered weekly now through December.

The flu is caused by the influenza virus. Typically spread from person to person, the virus is carried in respiratory droplets created when coughing and sneezing. However, you can unwittingly expose yourself to the flu by simply touching a surface that has been contaminated by a droplet and then touching your mouth, nose or eye. As always, handwashing is the best defense against any infection. And of course, it's important to avoid people you know are sick.

If you do get sick, please call your lung transplant nurse practitioner immediately. He or she will help to determine if you have cold symptoms or flu symptoms. While both are respiratory illnesses, they're treated differently. And treatment options are affected by how long a patient has had symptoms.

Here is a chart that may help identify what type of illness you have:

Flu symptoms

  • Slow onset of illness (over a day) 
  • Fever over 100.5°F 
  • Extreme fatigue 
  • Dry cough 
  • Terrible headache 
  • Achy muscles 
  • Chills 

Cold symptoms

  • Slow onset of illness (over a day) 
  • Low or no fever 
  • Mild fatigue 
  • Productive cough and runny or stuffy nose 
  • No headache 
  • No muscle aches 
  • No chills 
If you suspect that you may have the flu, please call your transplant nurse practitioner before coming to the Penn Lung Center. To minimize the potential spread of the virus, you may be asked to wear a mask and to sit away from other patients waiting for appointments. You may be advised not to come to the hospital at all.

Don't forget, you can get the influenza vaccine at the same time as other vaccines, including pneumococcal vaccine. So, if you are a pulmonary patient and it has been five years or more since your last pneumococcal vaccine (known as “Pneumovax"), please ask your healthcare provider to administer both injections at the same visit. (And let the lung center team know so we can keep your medical records up to date.)

Thursday, September 18, 2014

Food Drive for the Clyde F. Barker Transplant House

When a patient’s transplant journey takes them far from home, the Clyde F. Barker Transplant House offers a convenient, home-away-from-home. When a stay at the Transplant House is unexpected, guests sometimes arrive without having time to think through plans for meals. To help meet their needs in what can be a stressful time, the Transplant House team works to keep the kitchen stocked with grocery staples that provide nutrition and have a long shelf life.

If you’d like to offer support, the 2014 Fall Dry Goods Drive is a great opportunity to help Transplant House guests and their families sustain themselves in a critical time. Here’s a quick list of what would be most helpful:
  • Beans (canned or dry) 
  • Cereal (any variety or size) 
  • Coffee (Keurig K-Cups)
  • Sugar and creamer (shelf-stable) 
  • Condiments (ketchup, mayo, mustard, vinegar, etc) 
  • Fruits and vegetables (canned) 
  • Granola bars (any variety) 
  • Nuts (any variety) 
  • Pasta and sauces (any variety) 
  • Peanut butter and jelly 
  • Popcorn, pretzels, crackers, etc.
  • Rice (any style or flavor) 
  • Soup (any flavor, any size) 
  • Bottled water
  • Ziplocs baggies (various sizes)
“Dry-goods supplies help us to offer additional hospitality and care to our guests,” said transplant house manager, Kirsten King. “I can’t tell you how thankful our guests and their families are when they learn that we have a kitchen stocked with the basics for breakfast, lunch or dinner – especially for the first few meals they need while they are here. It’s hard to really describe how much it’s appreciated.”

Donations can be delivered to the Clyde F. Barker Transplant House: 3940 Spruce Street, Philadelphia, PA 19104. They can also be dropped off at the Transplant Clinic: 2 West, Perelman Center for Advanced Medicine.

If you’d like additional information or are interested in making a financial contribution to the dry goods drive, please contact Kirsten at 215-662-4540 or Kirsten.King@uphs.upenn.edu.


Tuesday, September 9, 2014

Understanding Chronic Obstructive Pulmonary Disease (COPD)

According to the American Lung Association, chronic obstructive pulmonary disease (COPD) affects approximately 12.7 million people in the United States. This disease, which is actually a combination of two separate conditions, emphysema and chronic bronchitis, accounts for more than half of the single lung transplants in the United States.

As with any disease of the lungs, understanding how the illness works inside the body can sometimes help you cope with some of the symptoms of the disease while you await transplantation. Before we get started, it might be helpful to review the different parts of the lungs, how they work and what they do. If you need a quick refresher, check the information we shared in an article earlier this summer titled, “How Do the Lungs Actually Work?

Since COPD is sometimes a mixture of emphysema and chronic bronchitis, we’re going to talk about these two conditions separately.

Emphysema, as a part of COPD, means the air sacs (alveoli) are damaged. As these fragile compartments of air break down, less oxygen is absorbed when you breathe in. The walls of the air sacs become loose, and the overall surface area of the alveoli decreases. This reduces the surface area and the amount of oxygen that can be absorbed into the body.

The other aspect of COPD, chronic bronchitis, means that the bronchi (tubes leading to the air sacs) are repeatedly or constantly inflamed. With inflamed bronchi, the lungs produce unnecessary liquid in the form of mucus, and the tubes that pass air back and forth to the lungs become smaller. Bronchitis also means that more coughing will occur so that mucus will be removed from the body.

How Is COPD Diagnosed and What Does a Diagnosis Mean?

Since COPD causes visible damage to the lungs as well as inflammation inside the lungs, a few imaging tests and physical tests can be done to figure out whether or not a patient has COPD. X-rays or CT scans of the lungs may be taken to see damage to the alveoli (a result of the emphysema in COPD). Another test is a spirometry test, which simply and painlessly examines breathing function.

What Should I Do After a COPD Diagnosis?

As with any serious health condition, it’s important to partner closely with your health care team to effectively treat the symptoms of COPD and to monitor how frequently the symptoms occur as well as how difficult the symptoms are for you to tolerate. Some common symptoms of COPD are tightness in the chest, wheezing and coughing, mucus (fluid) expelled when coughing, and frequent chest colds.

Over time, COPD symptoms typically get worse – especially if not treated properly. While you wait for lungs to become available, there are a few simple steps that may help reduce the severity of the symptoms and help prepare your body for transplant surgery.

  1. If you have been diagnosed with COPD and still smoke, it’s important to try to quit smoking. Stopping smoking slows the progression of COPD and stops the constant scarring and irritation of the lungs that smoking causes.
  2. While it may be difficult, safely increasing physical activity can help lung function tremendously. Exercise helps to strengthen the muscles of the respiratory system, and help overall longevity as well. Talk with your transplant coordinator to learn how you can add activity to your daily routine in ways that are safe with your lung condition.
  3. Maintaining a healthy diet is important to overall health. While this is important for everyone, for patients awaiting lung transplant who are diagnosed with COPD it’s especially important.
Because eating can sometimes be difficult for people with COPD, your physician may recommend nutritional supplements. If your current weight is higher than what is considered healthy for your height and body frame, it’s possible that changing your food choices and losing weight could relieve pressure on your lungs and decrease your discomfort.

For more information about COPD or steps you can take to maintain your health and prepare for transplant, please contact your Penn Lung Transplant nurse practitioner.


Friday, September 5, 2014

Penn Lung Transplant Travels Down Under

Thanks to an international traveling scholarship from the International Society for Heart and Lung Transplant nurse practitioner, Kevin Carney, MSN, CCTC, traveled to Victoria, Australia to expand his knowledge about lung transplantation and share his expertise with the Lung Transplant team at The Alfred Hospital.

Kevin’s interest in the pioneering work of the lung transplant team at The Alfred Hospital began in 2007. While he was doing research about the clinical management of a potential lung donor, the names of The Alfred Lung Transplant team members came up over and over again as their clinical experiences and observations were shared in several peer-reviewed medical journals.

The following year, Kevin traveled to the the 2008 ISHLT annual meeting in Boston and attended a symposium on donor management that was chaired by one of the leaders of The Alfred Lung Transplant team, Professor Greg Snell. At the end of the session, Kevin introduced himself to Professor Snell, and he met another Alfred Lung Transplant team member, Bronwyn Levvey – both of whom were generous with their time and happy to answer Kevin’s questions.

Since his initial meeting, Kevin had multiple opportunities to work with Bronwyn through their service on the ISHLT Nursing, Health Science, and Allied Health Council (NHSAH). During the 2011 ISHLT meeting in San Diego, when an announcement was made that the ISHLT would be awarding travel scholarships to members who were interested in expanding their knowledge base, Kevin knew exactly where he’d like to travel to learn more about lung transplantation: The Alfred in Victoria, Australia.

Kevin was awarded the scholarship to work closely with The Alfred Lung Transplant team to expand his knowledge in the following areas: effective donor management strategies, evaluating patients for lung transplantation, postoperative clinical management and outpatient recipient follow-up. Because The Alfred has been at the forefront in the use of lung donors after cardiac death (DCD), Kevin sought to understand the national and regional policies towards DCD management.

In addition to working with the lung transplant team at The Alfred, Kevin’s trip to Australia allowed him an opportunity to meet with the local organ procurement organization, Donate Life, to understand local and national organ donation protocols and policies, and to learn how they partnered with The Alfred Lung Transplant Service.

"After spending three weeks with the Lung Transplant Team at The Alfred, I believe the keys to their success are their multi-disciplinary collaboration and their commitment to clinical research and evidence based practices,” Kevin said.

He was particularly impressed by the detailed algorithms for hemodynamic, respiratory and pain management that were developed by the intensivists with feedback from the bedside nurses and lung transplant team experts.

"I would like to thank everyone who made my visit to The Alfred so successful. Without the support from Greg, Bronwyn and the rest of the Alfred Lung Transplant team, my wife and children, and The Hospital of The University of Pennsylvania's Lung Transplant team, this trip would not have been possible,” Kevin said.

Kevin went on to thank the ISHLT Board of Directors: “It’s so important that the ISHLT encourages their members to pursue the exchange of knowledge -- not only in spirit, but by financially supporting these endeavors.”