By Denise Williams | News & Views

Michael Maller looks and feels surprisingly good for a man who, by all accounts except his own, shouldn’t even be here to tell his story. The former aerospace engineer and current lung transplant survivor has become accustomed to people stamping an expiration date on his life – and just as accustomed to proving them wrong.

Not ‘Just’ the Flu

His prolonged and remarkable medical journey, in which pulmonary rehabilitation factors heavily, began with a nasty cough. When that cough began to produce blood, and Mike started running a high-grade fever and struggling to breathe, the then 59-year-old sought emergency care. He left the ER with a diagnosis of H1N1 swine flu, a prescription for Tamiflu and a pocketful of reassurance from the treating doctor, who said the patient just needed to “tough it out.” But two weeks after illness onset, persistent and worsening symptoms landed Mike in an isolation room at the University of Washington (UW) Medical Center on November 16, 2009. No one expected him to spend weeks on life support and in ICU battling for his life; but, in fact, it would be April of the following year before he crossed the threshold of his own home again.

With everything that occurred during those five-plus months in the hospital, at times it appeared all too possible that Mike wouldn’t be able to go home at all.  There were a handful of other swine flu cases at the facility, and his wife and daughter watched with sadness and growing apprehension as one, then another, succumbed to the damage wreaked by the virus. Mike himself faced challenge after challenge, darkening his own prognosis. Among the complications that arose out of his rare strain of H1N1: pneumothoraxes, pulmonary embolisms, sepsis, deep vein thrombosis, renal failure during dialysis, pancreatitis, MRSA infection and acute respiratory distress syndrome (ARDS).

The ARDS was so severe that it led to pulmonary fibrosis, an irreversible and progressively fatal lung disease with poor survival outcomes. Most people with the diagnosis, doctors informed Mike in early March 2010, pass away within 3-5 years. The news was bittersweet, coming approximately one month before the happy day he would finally be discharged from the hospital. It was the first time someone put a time limit on his mortality, but it wouldn’t be the last. By October of the following year, his projected life span had narrowed to about two years. With his condition deteriorating, it was time to consider a lung transplant.

PR Became Saving Grace

Mike was accepted to the waiting list for UW in 2012 and subsequently transferred to the UCSF lung transplant program in 2016 after relocating from Seattle to Roseville, California. In the meantime, he entered pulmonary rehab for the first time – which “dramatically” improved his lung capacity to the extent that he required oxygen only when sleeping or engaging in cardiovascular exercise. Just as things were looking up, another setback presented. When he was first hospitalized back in 2009 and doctors were trying desperately to save his life, Mike’s family gave consent to try a “Hail Mary” drug, Zanamivir. It was a blessing at the time, but ultimately caused a pancreatic cyst that by late 2017 had become pre-cancerous. Surgeons at UC Davis removed the cyst; and although the procedure went smoothly, Mike developed sepsis and suffered another bout of ARDS that had a devastating effect on his lungs. The outlook was bleak, and he remained in the hospital for a couple of months. After being released, he moved up to a higher spot on UCSF’s lung transplant waiting list.

In April 2018, Mike was fortunate to undergo a bilateral lung transplant but was not progressing as well as expected. He was determined to get better, however. “I never gave up,” declares Mike, who was intent on getting back to pulmonary rehab as soon as possible. Although UCSF remains his primary source for cardiovascular and pulmonary care, he requested to attend rehab closer to his home at UC Davis. He recalls being so weak the first day that his wife had to wheel him into the facility. By the time he completed the prescription, though, he no longer needed the chair. He was still weak, but functional. “I can’t speak enough about how improved everything was,” Mike emphasizes, pointing out how the exercises increased his strength and sharpened his coordination, for example. Ultimately, he believes, his appointments three days a week have not only improved his life, but prolonged it.

Post-transplant events – four pneumonias and three acute rejections – sometimes made it feel like he was taking two steps forward and three steps back; but Mike says rehab has been his saving grace with each setback. He credits UC Davis’ pulmonary rehab maintenance program for helping to maintain his progress, re-strengthen him or motivate him to keep going – whichever is called for at any given time. “It provides structure,” he explains. “It provides a sense of safety. I do require oxygen when I exercise, so that’s right there. It’s also a motivator to have an appointment on the calendar.” Mike also appreciates that the staff still conveys the same warm, caring feeling and level of attention to the maintenance participants as they deliver to Phase I and Phase II participants. Most importantly, he adds, pulmonary rehab continues to be his foundation for a better quality of life – a life that doctors predicted would end years ago. “I’m not shooting hoops,” the 73-year-old admits, “but I’m ambulatory” and resuming many of the activities he used to enjoy.

Still Flying High

Of course, Mike has also had to give up some of the things he loves—many of them revolving around airplanes. Before he retired, his team worked with Boeing; and he was himself a private pilot before his medical issues grounded him, although he’s well aware that his flying days are over. His air travel as a passenger is even limited now, not so much because of his lungs – portable oxygen makes that feasible – but because of COVID, since his immunosuppressed status places him firmly in the high-risk population. He doesn’t let any of that stifle his purpose, though.

“There are people who are complacent and there are people who are proactive with their healthcare,” Mike notes. “I think I fall into that latter group, in terms of trying to do everything I can to get better. And pulmonary rehab is a major tool in that.”

“We’ve got to not look back and ask ‘why did this happen?’ but push forward and ask ‘how can I get better?” he says with conviction. If healthy attitude contributes to overall health, Mike would seem to embody that concept. Thirteen years after he was given five years to live, at most, he’s here and not planning to go anywhere anytime soon. “I’m hoping to be around for a while!” he exclaims.