New Lungs, New Life
By Rich McManus
As if nothing like a debilitating case of cystic fibrosis -- followed by a double-lung transplant and a rugged postoperative course -- had occurred to him, NIDR oral medicine fellow Dr. Henry Lancaster wrapped up his 3-year training stint here July 2 and is preparing for a new job as assistant professor of oral medicine at Indiana University School of Dental Medicine in Indianapolis.
"This is exactly what I have been training for," said Lancaster, who returned to hearty greetings from colleagues at NIH June 5 after having spent the previous 6½ months in New Orleans, at first anxiously awaiting a donor who would match his requirements for a transplant, then getting the new lungs on Feb. 9 at Ochsner Foundation Hospital, then emerging from a harrowing 100-day postoperative course that saw him descend, due to medication, into a nadir of depression. Several other complications, including five operations to repair scarring inside his lungs, conspired to delay his return to NIH from April until June. That was time enough for Lancaster and his wife Joanne, an NICHD immunologist, to decide that, fun though it may be, New Orleans is too hot and muggy for their tastes; she got a job at Eli Lilly & Co. in Indianapolis and the couple will relocate there this month.
"We wanted to get back to the Midwest to be closer to my family," said Henry, who grew up in Peoria, Ill. (see Sept. 23, 1997, NIH Record).
Though the NIH chapter of their lives closes with what seems a fairy-tale ending -- recall that they were sent off last fall with a rousing Irish dancing fundraiser in a packed Masur Auditorium, and that the money raised that evening proved invaluable in allowing the young couple to afford daunting financial burdens -- Henry's restoration was hard won. While he was up walking and biking the levee on the Mississippi River very shortly after the operation, outpacing both Joanne and his own body ("He had to build up muscles to get his body in shape with his new lungs," she said), Henry soon fell into major depression brought on by high doses of steroids.
"The physical part [of recovery] came almost right away," he recalls. "I was on a 45-minute workout regimen every day. I could walk around easily, whereas before the operation, just walking down the hall in Building 10 was wearing me out. But then the drugs began to have very bad side effects. My mood swings grew into a case of clinical depression.
"They start you out on very high doses of these drugs," he recalled. "The steroids prompted a month's worth of really severe depression. I was aware that it was something due to the drugs, but we were afraid it would be permanent. There was just a lot of fear and anxiety, and I could not get out of it.
"I would be totally afraid to get out of bed and leave the apartment," he remembered. "I'd just sit there in depression like a zombie."
"It was so unlike Henry," said Joanne. "The doctors knew he was having problems, but it was too early to remove the medications. It went away when the drug levels were reduced."
"When they lowered the prednisone, it's amazing how fast [the depression] went away," Henry said.
"We knew people who were having similar bad effects, and even worse," Joanne recalls. "It's just a nasty drug."
Henry still must take about 21 different drugs each day, for a total of 50 pills, and will remain on medication for the rest of his life. And side effects remain, but these are relatively minor. The couple's biggest concern is chronic rejection of the transplanted organ: "That's a long-term worry," he said. "There's nothing I can do to assure it won't happen."
Despite the trials of recovery, Henry is pleased with the outcome. "Yeah, I feel as good as I anticipated [before the operation]," he said. "I had some serious doubts during the worst of the side effects, but you get used to the (pill-taking) routine."
"It's not a completely normal lifestyle," observes Joanne, "but it's nowhere near as complicated as it was before the transplant."
Nowadays, Henry's sadness is likely to be prompted by a rainout of his beloved volleyball rather than a medical problem. "I can do lots of stuff now," he says, taking deep breaths to demonstrate his new capacity. "I'm biking, walking a lot, starting to jog, and use the Stairmaster -- those things are enjoyable. I can do it now and not be exhausted."
He says he had to unlearn the hunched posture he had unconsciously adopted to aid his labored breathing, and reports he is mercifully free of a chronic cough that could keep both of them awake at night.
Other than having to visit his physicians every 6 weeks or so for checkups, Henry can now lead a fairly normal life. "I'm just hoping that everything keeps going up and up," he said.
The new career in Indianapolis seems a particularly just reward considering that Henry, rather than taking his ease while awaiting the transplant, continued to work at Louisiana State University's department of oral medicine before the operation.
The Lancasters depart with warm regard for the NIH community, which responded generously to their financial straits. "It's amazing what (financial needs) you don't anticipate," said Joanne. "The drugs that Henry has to take are extremely, extremely expensive. We really couldn't have done it financially at all without help. We are very grateful."
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