Doctor's Soul is in his Lungs – UK Surgical Chief has Passion for Music, Home

Lexington Herald-Leader (KY) –
Author/Byline: Jim Warren Jwarren@herald-Leader.Com

The University of Kentucky's new surgical chief aims to put UK on the medical map as a leader in the development of the artificial lung.

In the meantime, he's never without his harmonica, and he sits in for a band called Soul Patch.

Dr. Joseph P. "Jay" Zwischenberger, a Kentucky native, has been working on plans for an artificial lung for 25 years. He brought the project with him when he came from the University of Texas to become chairman of surgery at UK in May.

He says he hopes to implant one of the devices in a patient at UK within about three years, if things go well.

"The exact timing would depend on the FDA," Zwischenberger said. "Given length of the regulatory process, the first patient most likely will be done in Europe or perhaps in China. But let's put it this way: I want the first patient in the United States to be done here."

Much has been written about the artificial heart over the past two decades. Louisville's Jewish Hospital, for example, has been a pioneer. Work on the artificial lung has received much less coverage, although researchers were making attempts to build such devices as early as the 1930s. Now, at last they seem to be getting close.

An artificial lung would be a mechanical device that would infuse the blood with life-sustaining oxygen and remove carbon dioxide. There are devices that can do this now. The heart-lung bypass machine, for example, is used in operating rooms every day to keep patients alive during open-heart surgeries.

Another machine is called the ECMO, for Extracorporeal Membrane Oxygenation. It can provide cardiac and respiratory support for patients whose lungs are diseased. But such devices are intended for only short-term use.

A patient with a full-fledged artificial lung could use it for days or weeks at a time. But the device would not be a permanent replacement. Instead, doctors expect to use it as an interim tool that could keep lung-disease patients alive while they awaited life-saving transplants.

"The artificial lung is going to happen," Zwischenberger said. "It's just a question of which of the six or seven centers around the country that are working on it comes up with a device that is the most practical and applicable, and has enough safety to be worthwhile."

Helped resuscitate Model A

Zwischenberger, 55, has been interested in mechanical devices since he was a teenager in Louisville.

When he was 14, his father bought a Model A Ford that barely ran, and they spent the next two years restoring it. Zwischenberger drove the car all through high school, and later proposed to his wife, Sheilah, in it. He still has the car. In fact, he has six antique Fords, one of which he plans to display next month in the Keeneland Concours d'Elegance, which benefits the Kentucky Children's Hospital.

Zwischenberger -- "Zwisch" to his friends -- also was a pilot for a while. He even took aerobatic lessons, but he gave them up because of air sickness.

Music is another strong interest. He played guitar in a rock band in Louisville in the late 1960s, and when he went off to college at UK his mother gave him a banjo. He was hooked on the instrument, took lessons from Lexington's own five-string virtuoso J.D. Crowe, and later played with various bluegrass bands in Texas.

Some years ago he took up the harmonica with equal zeal, and now, in his spare time, he sits in with a local band called Soul Patch. He carries a harmonica at all times, even at work.

"You can't go anywhere without your harmonica," Zwischenberger says.

All his other interests notwithstanding, medicine is Zwischenberger 's ultimate passion. The interest grew after he came to UK in the early 1970s as an undergraduate, and it quickly led him to medical school. After completing his medical degree at UK in 1977, he spent the next few years at various hospitals around the country, perfecting his skills as a cardiothoracic surgeon.

While at the University of Michigan, Zwischenberger worked with Dr. Robert Bartlett, a pioneer in the development of the ECMO, and he later worked on ways to improve the machine. The association sparked Zwischenberger 's interest in the artificial lung, and he still calls Bartlett his mentor.

State has special need

Zwischenberger estimates that more than 2,000 patients could use the artificial lung each year. The device could be a boon to many patients in Kentucky, which has some of the nation's highest rates of lung cancer, emphysema, bronchitis, chronic obstructive pulmonary disease and other lung ailments related to the state's traditionally high rates of cigarette smoking.

In severe cases, the only treatment for many of these illnesses is lung transplant. But demand for donor lungs greatly exceeds the supply, and patients might wait up to two years before new lungs become available. Many die before they can get a transplant.

Although some proposed artificial lung designs would require patients to stay in bed or move around only a little, Zwischenberger contends that a device that would allow full movement is a better way to go.

The device he and his colleagues are working on would be connected to blood vessels via a tube in the neck or groin, and it would consist of little more than a pump about the size of a 35mm film canister and a gas-exchange device about as big as a soft drink can. A patient wearing one would be free to walk around.

"We've learned over the years that patients who are bedridden are much poorer candidates for transplant," Zwischenberger said. "Several things happen when you stay in bed – nutrition deteriorates, muscle tone deteriorates, your immune system deteriorates. It's clear that the more patients can walk around and live normally, the better off they are."

Zwischenberger and other researchers think an artificial lung could save many patients, keeping them alive while they waited for donor lungs to become available. It also could aid patients with other kinds of lung problems, allowing their lungs to rest and recover while the artificial lung took over.

"I don't see it as a long-term artificial organ, or a mechanism by which a patient could smoke guilt-free," Zwischenberger said. "But the technology could be a safety net for patients who are desperate, and provide an alternative so that they could receive either a lung transplant or have their natural lungs recover.

"It would allow the patient to live another day and receive new treatments that are evolving."

Link to HL story: http://www.kentucky.com/950/story/728900.html