By Denise Williams | News & Views
Because it was usually accompanied by some form of exercise, huffing and puffing for air was nothing unusual for Richard Goetz — an expert-level surfer who’s taken his board all over the world. Decades after competing at the high school and collegiate levels, the Southern California native was still catching waves when he hit his 50s, not to mention practicing his favorite land-based activities like Pilates and high-intensity interval training (HIIT).
A persistent dry cough that developed in the spring of 2020, during the early part of the COVID-19 pandemic, however, would eventually lead the lifelong athlete on a harrowing health journey — one where breathing became difficult even in the absence of physical exertion and, indeed, made exercise all but impossible.
Pulmonary Plight During the Pandemic
At the urging of his retired neurosurgeon father-in-law, Richard eventually got a CAT scan and lined up an appointment with a pulmonologist at UCSF; however, because of the public health crisis, that initial 2020 visit — and others to follow — was virtual. The diagnosis was non-specific interstitial pneumonitis. Imaging and pulmonary function test results were less than ideal but, as Richard puts it, “I presented well on video.” Plus, he actually was feeling fine at that point, nagging cough aside. “[The care team] wanted to see if things got better,” he says.
Instead, they got progressively worse, the next setback coming after stifling smoke from a series of wildfires in the Bay Area took a toll on his lungs. A visit to the respiratory clinic revealed more troubling signs, including honeycombing, and providers responded with a treatment plan. Nonetheless, “things took a pretty serious dive from there,” says Richard. “I was desaturating at such a level…the only thing I can compare it to is being waterboarded 10 or 15 times a day. I was completely healthy and in good shape — that was one of my big benefits — but essentially my lungs were dying around me.”
Richard’s pulmonary performance continued to decline; and depressed and unable to exercise, he requested respiratory therapy. It was approved in February 2021, landing him in the care of Julia Rigler, BA, RRT, and the pulmonary rehabilitation (PR) team at UCSF. “The step breathing was important to keep myself from desaturating,” he recalls, describing how scarring on his lungs was blocking oxygen transfer and signaling his body to respond in a dangerous way. “They teach you how to force your body to hold your breath when your body wants to hyperventilate — the exact opposite of what you need it to do.”
Richard attended faithfully twice a week, but his condition failed to improve. “I had a portable oxygen concentrator machine, and then I got to the point where I needed two tanks just to be able to make it in and out because my oxygen use was so high,” he reports. “Physically, I was okay, but my lungs were completely deteriorating — and rapidly.”
It was Rigler who first broached the topic of lung transplantation, encouraging him to explore this option with his doctor. As it turned out, he wouldn’t have to initiate that conversation, because on April 1, weak from desaturation, Richard buckled and nearly collapsed at home.
A Riptide Recovery
He was fortunate not to fall and hurt himself, but the incident scared him and his wife Jessica so much that they immediately made their way to the emergency room, where the concern was discernable. The good news was that Rigler, the only one at UCSF who’d worked in person with Richard, had opened up a channel of communication with the advanced lung team, so they were already well aware of the critical nature of his case. Months after the onset of symptoms, Richard saw a doctor in person for the first time — and was promptly admitted.
“I had end-stage lung disease,” he states matter-of-factly. While the doctors were never able to pin down the whys, Richard and Jessica today suspect mold may have been the culprit. After some sleuthing on their own, the couple discovered alarmingly high levels of aspergillus in their rented San Francisco home, just three blocks from the beach. Tests showed levels of 21,800 parts per million (ppm) in one room of the house, exponentially higher than normal readings in the range of 200-400 ppm. That, combined with COVID isolation that kept them in the house virtually all day, every day, likely caused Richard’s immune system to detect an invader and start producing killer T8 cells to attack his lungs, they believe.
Cause notwithstanding, confirmation of end-stage lung disease spawned talk of a transplant, and Richard was listed by the end of April and in the operating room getting a new set of lungs in early June. He’s a surfer to his core, but the time leading up to his surgery date reminded him more of scuba. “I had to have a ‘dive plan,’ because I was on so much oxygen” he explains, expressing the importance of having enough tanks with him as he rushed around from appointment to appointment.
It was a relief when the call finally came notifying Richard that a good matching set of lungs had been identified, and even better news when his body accepted the transfer. He has no doubt that “all that stuff [learned in PR] was critical in getting me to the point where I could get a transplant,” but he underlines that its value didn’t stop there. “I think the ability of rehabilitation to get your body active again after you take such a huge setback is super-important,” he states with conviction. It was especially critical for him, he adds, because with COVID still circulating, he wasn’t going to risk working out at a regular gym. The controlled environment of PR was key. Knowing that he was under observation at all times provided Richard comfort and assurance that he was in good hands “in case anything went sideways.”
His insurance-approved rehab prescription ended far too quickly for his comfort; and he appealed to his insurer, unsuccessfully, for additional PR sessions. Recovery got rockier from there, thanks to the inherent complications of transplantation and the vulnerabilities of immunocompromised status that accompany it. Richard had to undergo revision surgery to fix broken wires in his chest; a nick sustained during routine dental care resulted in a bacterial infection that turned septic; and, on top of everything else, he tested positive for COVID from mid-January through March 2022, unable to shake the virus because of poor immune response. Richard has also struggled with significant weight gain because of some of the post-transplant medications he requires, making it all the more important that he work exercise back into his routine.
Getting Back on the Board
After taking time off to recover and to pursue new employment opportunities, Richard is now challenged by the time constraints of the job he started in January 2023. He also continues to be dogged by high levels of fatigue — a souvenir from his medical journey. “I’m still trying to re-set myself to the proper level of fitness,” he admits, the determination clear in his voice. He’s not at the weight or endurance level yet that he needs to return to his passion — surfing — but he hasn’t given up hope of getting back in the water and back on his board.
“The difference between optimism and hope: it’s nice to be optimistic, but if you have hope, you can actually use that as an anchor to grab onto and pull yourself to the goal,” he confides. “Being optimistic is just an attitude.”
Pictured: Richard and his surfboard, at the airport in Fiji