Pneumonia due to the COVID-19 virus and acute respiratory failure with hypoxia

Rick with bikeMarch 16, 2021, was the beginning of a long journey into a new way of life for me. It’s the day I tested positive for COVID-19 – just four days before I was scheduled for my first dose of the vaccine. After testing positive, I progressively got worse and struggled to breathe. After four emergency room visits between two hospitals, I was admitted to Geisinger in Danville, PA, on March 24, 2021, with the diagnosis of pneumonia due to the COVID-19 virus and acute respiratory failure with hypoxia. Despite the different methods and treatments they tried, my condition worsened. On April 2, 2021, the doctors recommended that I be voluntarily placed on a ventilator in hopes of giving my lungs a chance to rest and heal. Unfortunately, my condition worsened and progressed to the diagnosis of acute respiratory distress syndrome (ARDS).

That following Monday, I had to be placed on ECMO (extracorporeal membrane oxygenation) to let my lungs rest. Shortly after, the doctors spoke with my wife and advised a bilateral lung transplant would be necessary to save my life. On May 6, 2021, I was life-flighted from Geisinger in Danville, PA, to the Hospital of the University of Pennsylvania (HUP), where I was placed on the transplant list as of May 15, 2021. Unfortunately, my condition worsened, and various complications occurred, including acute delirium due to multiple etiologies, severe protein/calorie malnutrition, physical deconditioning, bacterial pneumonia, and pneumothoraxes in both lungs. I had to be placed on mechanically assisted ventilation. There was nothing left they could do. I was dying. It was a matter of viable lungs becoming available as fast as possible. Fortunately, I held on and received the Gift of Life from my donor. I had a bilateral lung transplant on May 28, 2021.

Patient in hospital bedI was hospitalized for a total of 130 days, 30 of them spent at the Penn Institute for Rehabilitation Medicine due to the physical deconditioning I experienced. I was on ECMO for 59 days, received 11 units of blood, and was on a ventilator for approximately 70 days. Although I was discharged on July 22, 2021, I had to stay within a specified range of the hospital in case of a medical emergency. I officially returned home on September 2, 2021 – I was away from home for 172 days! I am still recovering physically, emotionally, and spiritually to this day. My family and I have been picking up the pieces as we try to figure out and understand this new life. My wife and I have become involved with both hospitals where I received care. We attempt to be a resource for other families with similar experiences as ours in hopes of giving them guidance, answering questions and simply listening. I have also found purpose in helping others. I am a board member of the ARDS Alliance, a non-profit organization that promotes and furthers charitable, educational, and scientific opportunities to advance awareness and research and to improve the quality of life for all those affected by ARDS.

The idea of bicycling began while I was an inpatient at the Penn Institute for Rehabilitation Medicine. Breathing better meant increasing my endurance so I wouldn't tire so quickly while physically active. That was when bicycling was introduced to me as a way to improve my lung function. Initially, I was lucky if I could peddle for three minutes before getting tired. However, by the time I was discharged, I could bicycle on a stationary bike for 10 to 15 minutes.

Patient with nurse outside

With Dr. Carol Wamsley of the Penn Institute for Rehabilitation Medicine

My pulmonary therapy continued on an outpatient basis at the Perelman Center for Advanced Medicine, where I had sessions three times a week for roughly two hours. I still worked with a stationary bike, but not as often. I completed the outpatient program and was on my own to continue being physically active with some focus on exercises the therapists recommended I continue at home.

I would love to tell you I did everything they recommended, surpassed every expectation, and became stronger than ever before. But the truth is, I struggled. I lacked motivation. I fell into a mental funk. It took me several months to realize I needed to work on my attitude. And that I needed to be physically active so my new lungs would become strong and support me through this second chance I was given.

Not long ago, I was reading a blog thread on Facebook about a man that had a double lung transplant a few years ago and took up bicycling. So far, the longest trip he's made is about 100 miles, bicycling from his home to the hospital that performed his double lung transplant and back. He is about 15 years older than me. So I thought, "If this man in his mid-sixties can do that, why can't I?" So I wiped the dust off my mountain bike after speaking with my pulmonologist and getting some guidance.

I cycled 2.5 miles on my first ride and began increasing my distance quickly. It wasn't long before I was riding beyond ten miles each ride. I started noticing improvements. For the first time since getting COVID and having my double lung transplant, I could take a nice, slow, deep breath without coughing. I could control my breathing better, "catch my breath," and slow it to a normal rate after being physically active. Of course, I was getting stronger. It surprised me how I felt like I completed a full-body workout after a long bicycle ride. I was also surprised by how much I enjoyed it.

Sometimes, I need a little push or a reason to keep going, something to keep me motivated. So I decided to participate in a 38-mile bicycling event to raise money for the ARDS Alliance. The event was called Miles for Marybeth, and she is the sister of Paula Blonski, the president of the ARDS Alliance. Marybeth had some minor surgery in May of 1998. Everything seemed fine until she developed an infection in the wound. She returned to have the sited cleaned and took a turn for the worse. She developed ARDS. She fought for eight weeks, battling ARDS, Sepsis, Leukemia, and collapsed lungs. She truly fought her hardest, but one day she slipped away, and we lost her. She was 36 years old, a nurse, a daughter, a sister, an aunt, and most of all, a best friend.

Photo of Rick smiling

August 6, 2022, after cycling 38 miles

I continued to train and bicycled every week leading up to August 6, 2022 – the day I rode 38 miles in one ride! I rode with Paula Blonski and her brother, Jim Monaghan, and had support from my family. I was exhausted, but in a good way, and we raised around $9,000 for a worthy cause. I was proud of what I accomplished. The clear thing is bicycling improves respiratory function. The increase in your breathing rate while cycling improves and strengthens the muscles around your lungs. The healthier and stronger the lung, the more oxygen-rich air it can absorb. Over time, lung capacity increases, abdominal muscles become stronger and more formed, and respiratory muscles become more engaged and work efficiently.

I admit I took a break after the 38-mile ride but will continue to bicycle as I am actively looking for my next event to participate in – that thing I need to hold me accountable. Do I plan on setting any records or finishing first place in a race? The answer is no, but I do plan on winning the marathon!

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