Tuesday, July 15, 2008

Doctor has double-lung transplant due to cystic fibrosis

Dr. David Salgado
From the Telegraph-Journal, New Brunswick, Canada:

By Erin Dwyer
Hampton, NB - Dr. David Salgado spent a career making other people better.

Week in and week out, he saw patients, diagnosed diseases and prescribed treatments -all the while battling his own life-threatening disease.

Dr. Salgado was diagnosed as a child with cystic fibrosis, a fatal genetic disease that causes the body to produce thick, sticky mucous, which clogs the lungs and leads to life-threatening lung infections. Last August, the 48-year-old family physician in Hampton had to give up his medical practice because his own health had deteriorated.

After 23 years of caring for his some 3,000 patients, Dr. Salgado had become the patient, relying on oxygen 24 hours a day.

"I was dying," he said in an interview.

Today, Dr. Salgado's lifelong battle with the disease is over. After a seven-month stay in Toronto where he underwent a double-lung transplant, he's home recuperating, spending time with his family and doing some of the things that a year ago seemed impossible.

Like kayaking. Doing yard work.

"That's one of my favorite activities," he said. "I still have to rely on my family and my wife to do the hard, continuous work. But I'm good at telling people what to do."

Former patients in Hampton say he is a kind and generous doctor who goes beyond the call of duty. He is a humanitarian, they say, but above all else, he's humble and private. On this day, however, Dr. Salgado spoke about his surgery and his recovery as a way to thank his former nurse, Christine Atherton, who "held the fort" while he was in Toronto, and the hundreds of Hampton residents and the Saint John medical community who rallied behind him and raised over $50,000 to help pay for his medical costs. Because of his congenital disease, he was never able to secure health or life insurance.

"I can't thank them enough. I'm not sure if I would have gone through with the whole process if it had not been for the community's support."

Dr. Salgado and his wife Sally knew at some point they would have to face his disease head on. After all, the median age of survivors (with cystic fibrosis) in Canada is 37 and he was already well into his 40s. Still, three years ago, the prospect of requiring a double-lung transplant seemed a world away.

"Three years ago, I was living a very active life and keeping up with my family and friends," he said.

In the early months of 2007, that all changed. His health began to deteriorate. Breathing became more difficult. By August, he was forced to close his practice and go on oxygen 24 hours a day. Things looked bleak. Without insurance, trying for a transplant would cause financial hardship to his family. And then there was simply the disruption to their lives while he waited to qualify.

"My wife and I had spoken. We knew this was coming," he said. "But tying your family up with this whole process, a year, two years or three years, it wouldn't be easy. And there were financial considerations. It wasn't something we would have considered."

But the turning point was when the community of Hampton rallied behind him.

When some of his patients learned he was failing fast, they organized a dance and a silent auction and set up a bank account for donations. Former mayor Jim Hovey and former patient Paula Perry spearheaded the event. In no time, they raised nearly $50,000. In the new year, the Saint John Medical Society held a fundraiser, spearheaded by Dr. Michael Morse and Dr. Greg MacLean, and raised yet more funds.

Until the Hampton fundraiser, Dr. Salgado was somewhat resigned to die with the disease. But the community's response - and the financial assistance - motivated him to apply for a transplant.

"It's been difficult to personally say thank you to everybody because there were so many."

In December, Dr. Salgado and his wife moved to Toronto to await a transplant. His brother, Dr. Mike Salgado, remembers not having any expectations prior to the surgery.

"You know the odds are sort of against you in terms of finding a donor, finding the right size donor. There's a lot of factors that can prevent you from getting a transplant. So all of these things are weighing on the back of your mind while you're waiting for the transplant. And his health was not that great leading into the transplant. We were all a little concerned as to whether he would get the transplant or not, and find a match in time."

Three months after arriving in Toronto, Dr. Salgado got the call that they had found a donor.

"It was quick because I was dying," he said. "It was do or die. Most people are obviously very sick and they don't get on the transplant list unless you're likely to die within a year," he said.

"In my case, when I finally arrived there, they realized I was sicker than they thought and was deteriorating faster than they thought."

Dr. Salgado remembers little about the surgery. He was given anaesthetic at 6 a.m. on a Thursday and awoke the following afternoon.

"It was like I had a nap," he said. "I felt good. I felt clear headed."

For 24 hours after surgery, Dr. Salgado was on a respirator waiting for the lungs to recuperate from the traumatization of the transplant. In some cases, it takes them two weeks to recover. In his case, he was walking around and breathing with a new set of lungs in less than a week.

Dr. Salgado can't say enough about the Toronto General Hospital's Multi-Organ Transplant Program. And he can't say enough about the organ donation program.

"I wouldn't be here if the program weren't what it is."

His brother shares the same respect for the donor program.

"I definitely made sure our donor cards were all signed and that my intentions were clear. Organ transplants have really come a long way in the last number of years and that's coming from a physician's perspective. It's really amazing what they can do and anyone thinking of organ donation, this is certainly an example of a real success story."

Still, Dr. Salgado wants to remain respectful of the donor and his or her family whose selfless donation has allowed him to live. He doesn't know anything about the person who donated the lungs. It's kept confidential. And he's uncomfortable about talking about it. But Dr. Salgado said he holds a special place for the donor in his heart.

"Of course I do. Every breath I take I thank the donor for the opportunity to be with my family. But it's not something that I dwell on. I have to pinch myself every once in awhile to see if this is real because it doesn't even feel like anything happened. Other than some sore muscles and some stiff joints, I feel like the same person I was a year ago.

"It's interesting," he added. "I arrived home and I looked out my back window at the back garden we have here. And I thought, we have to prune this tree or do something about that hedge, or what have you. It's as though I've picked up where I was when last healthy and the last year or year and a half is something that I've chased from my mind. It didn't happen. I don't like to dwell on the suffering over the last year.

"There is hope," he said, "that we can pick up and get on with our lives in the way that we were before and sharing time together."

Still, Dr. Salgado is cautious about looking too far into his future. He knows he runs significant risks for complications, like pneumonia and rejection. And some of the drugs he's on make him feel like he's suffering from the flu and are hard on his kidneys.

"It's like you're waiting for the other shoe to drop. But I'm remaining positive. I've always had a positive outlook."

So positive that's he's aiming to reopen his practice in the new year.

"I feel ready to open it now, but if I spend all my energy on opening my practise, I'm not focusing on my recovery," he said. "So I'm going to spend the next six months rehabilitating. It will be the first summer I've had off."

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Anonymous said...

I thought in Canada everyone had insurance because of the universal health care you have there.

Anonymous said...

Medical and hospital expenses are covered by Canada's universal health care but patients are responsible for out-of-pocket expenses such as travel and accommodation. Transplant patients must live near the hospital while on the waiting list, which could be for a year or longer.

Merv Sheppard said...

Also, in Canada, patients under 65 are responsible for their own drug costs outside the hospital.

Anonymous said...

I'm still confused by this article. It says that because his disease was congenital, he could not obtain health insurance. What kind of health insurance is being talked about if the actual surgery and associated costs are covered by Canada's universal health care system?