Lung issues discovered during patient’s recovery from freak accident

February 19th, 2020
Inpatient rehabilitation in Broomfield helpedd Fran Berger recovers after a bad fall.
A quick pre-Thanksgiving trip turned into a months-long healing and recovery process, but Berger has made the best of it. She received critical care through inpatient rehabilitation in Broomfield. And there was a silver lining: her lung nodules came to light. Photos by Cyrus McCrimmon for UCHealth.

Fran Berger had come to Colorado in late October to visit family and friends. She had intended to be back home in upstate New York well before Thanksgiving.

Instead, she had to make due with a spring return to New York. The culprit: a short, dark stairway in Longmont. She missed a step and down she went.

Family members whisked Berger, 67, to UCHealth Longs Peak Hospital in Longmont. In the emergency room, a portable X-ray machine painted to look like a giraffe made her chuckle and momentarily helped her forget the pain she was in. The giraffe’s images showed why she was in such pain: she had broken her right ankle, then come down hard enough on her left knee to break her kneecap (a.k.a. patella).

Injuries to the right and left legs have left Berger with plenty of rehab – and time to read.

Fran Berger reading a book to grand kids with her walking nearby.
Fran Berger is an accomplished storyteller. While recovering from a bad fall, she enjoyed reading and sharing stories with her grandchildren, Miles, 8, and Sophia, 11.

Dr. George Chaus is an orthopedic trauma surgeon who was on call at UCHealth Longs Peak Hospital that Friday night. The ankle injury was a fracture of the medial malleolus – the big bone on the inside of the ankle which is actually part of the tibia. Chaus put that back in place with screws. Fixing the broken patella involved a combination of screws and wires to close the inch-wide gap now separating fragments of Berger’s left kneecap. The fixes took about two hours in the operating room. From the perspective of a man who puts victims of serious car accidents back together, both were routine. The combination, though, would make Berger’s recovery anything but.

She had a thick plaster cast from toes to knee on the right side and wasn’t allowed to put any weight on the recovering ankle. Then on the left side, she had a brace from ankle to upper thigh. She could put weight on that leg, technically speaking – but wasn’t allowed to bend it, period. Plus, there was the pain.

Berger had read a UCHealth pamphlet on opioids and concluded that she wanted to get off them as quickly as she could. She called in a hospitalist, they talked it through, and she went on a combination of tramadol and acetaminophen that took the edge off the pain without risking an opioid addiction that would cause much more of it over the long term.

Inpatient rehabilitation in Broomfield

By the following Wednesday, Nov. 6, Berger was transported to the UCHealth Rehabilitation Unit at Broomfield Hospital. She would spend another week there, doing physical therapy and occupational therapy for three hours a day. In addition to exercises to strengthen her core and other muscles, the wheelchair-bound Berger spent time working on how to get in and out of a vehicle. She didn’t have to go to the parking lot to do it. In the gym a couple of doors down from her fourth-floor room, there was a facsimile of a car.

“You’re kidding me,” Berger said to the physical therapist.

“I’m not kidding you,” he said.

Fran Berger needed inpatient rehabilitation in Broomfield after a bad fall.
Suffering a bad fall and hurting both legs was tough during Fran Berger’s trip to visit friends and family in Colorado. Thankfully, during her recovery she got to spend time with her grandchildren, and by chance, she learned about lung issues that may need treatment.

The idea is to figure out how a patient with unique injuries – and Berger’s certainly qualified – might best navigate from wheelchair into a vehicle. The faux car’s height can be adjusted to mimic a slow-slung sedan or a jacked-up truck. They worked out a process that could accommodate a stiffly braced, extended left leg and a broken, heavily casted right ankle and practiced it several times.

Then the day before she was to transition to a long-term rehabilitation facility – she had spent a week at UCHealth Broomfield Hospital – Berger’s blood oxygen level plunged. Her providers ordered a CT scan to look for blood clots, just in case. Instead, they found lung nodules – lots of them.

A lung nodule is a lump in the lung smaller than 3 centimeters (1.18 inches) in diameter. Berger had been diagnosed with one several years ago in Albany, a few miles from her home in Castleton-On-Hudson, New York. Most of the time, they’re benign, says Dr. Ali Musani, a CU School of Medicine and UCHealth lung specialist, who is one of only a handful of fellowship-trained interventional pulmonologists in Colorado. The nodules are often granulomas, which form when the immune system walls off an infection. Musani says lung infections such as histoplasmosis (a fungal infection common in the Ohio and Mississippi River valleys) and valley fever (common in the deserts of California and Arizona) are common causes, but that lung nodules can form in the wake of scars from tuberculosis or other diseases. Berger wondered if mold in her 200-year-old New York home might be the culprit.

To Aurora

Musani practices at UCHealth University of Colorado Hospital on the Anschutz Medical Campus  in Aurora, which is where Berger went next for an initial consultation in mid-December. By then, she had been at a rehab facility in Westminster, where she continued to do physical and occupational therapy and slowly recover, for about a month.

The initial news was good: odds were that her nodules weren’t cancerous. Doctors will learn more in early March when Berger is scheduled to return for follow-up appointments at the UCHealth Pulmonology Clinic – Anschutz Medical Campus. The four-month gap from the initial CT scan at UCHealth Broomfield Hospital and the follow-up at Anschutz is deliberate, Musani says. They’ll be able to compare the November and March CT scans to see if the nodules have grown. If not, they’ll keep an eye on scans for a couple of years, at which point they can be confident that the nodules are benign and therefore require no additional treatment. If they appear to be growing, Musani and colleagues can combine an understanding of growth rates, nodule size and shape, and such factors as smoking status and family history to accurately calculate the risk of cancer.

When Berger returns in March, things will happen fast. Prior to her arrival, Musani and colleagues including a thoracic surgeon, a medical oncologist, and a radiation oncologist will have looked over her case in a multidisciplinary meeting. They’ll have booked appointments with an oncologist and a surgeon preemptively, so that, if a scan points in those directions, they don’t have scramble to get on her schedule. Often, all four specialists meet with the patient at the same time, Musani says.

“Our model is to provide comprehensive care in the shortest-possible time period for out-of-state patients so they’re not lingering here for days or even weeks,” he added. “So we try to get them appointments with multiple specialties that we think might be needed for that patient, and if an appointment turns out to be unnecessary, we cancel it.”

To Denver

By early January, Berger’s broken ankle was strong enough that a walking boot provided ample support, and she was allowed to gently bend her knee while seated. She could get around with a walker, though she still used a wheelchair too. Back in late October, she had packed for a week; she had taken her tumble nine weeks earlier. Her room at the rehab facility smelled of clove aromatherapy. Taped to the door of a cabinet were 19 Christmas cards. She had celebrated Thanksgiving with family in the facility’s social room. Her brother-in-law had wheeled in a smoked turkey and various side dishes on a luggage cart. A month later, Berger was given a half-day pass to spend Christmas Day with her daughter Zarah Levy’s family and other relatives in Denver. Besides that, she had been rehabbing and healing.

After being discharged from inpatient rehabilitation in Broomfield, Berger got to spend a couple of weeks in Denver with Zarah, husband Josh, and grandkids Sophia, 11, and Miles, 8. Fortunately, she loves to read and spent plenty of time reading to the children and entertaining herself with books. Before she could head back to New York, she had to be able to climb stairs so she could handle the steep ones in her home.

Fran Berger needed inpatient rehabilitation services in Broomfield after a bad fall. She then got to recover at her daughter's home in Denver.
Berger wrapped up her rehab with her daughter’s family in Denver before heading home to New York. Here she’s flanked by son-in-law Josh Levy and grandson Miles, left; and daughter Zarah and granddaughter Sophia.

Berger knows health care as a patient and as a certified massage therapist and reiki practitioner, and has worked with many providers over the years. She lauded the new UCHealth Longmont and Broomfield rehabilitation facilities and had been amazed by the food. She had kind words for her doctors, nurses, and therapists. This was an energetic, independent woman who, after a single misstep far from home, found herself suddenly reliant on so many others.

“I can’t say enough about the people,” Berger said. “I felt 100-percent ‘heard’ – not just listened to, but heard. Because there was a response, and there was a change if requested.”

She paused for a moment to reflect.

“That’s really important. When we’re dependent on the people around us, we’re very vulnerable,” she said.

About the author

Since 2008, Todd Neff has written hundreds of stories for University of Colorado Hospital and UCHealth. He covered science and the environment for the Daily Camera in Boulder, Colorado, and has taught narrative nonfiction at the University of Colorado. He was a 2007-2008 Ted Scripps Fellowship recipient in Environmental Journalism at CU.

His latest book, "The Laser That’s Changing the World," tells the story of the inventors and innovators who saw, and ultimately realized, the potential of lidar to help solve problems ranging from smokestack-pollution detection, ice-sheet mapping, disaster recovery, and, ultimately, autonomous-vehicle guidance, among many other uses. His first book, "From Jars to the Stars," recounts how Ball Aerospace evolved from an Indiana jar company - and a group of students in a University of Colorado basement - to an organization that managed to blast a sizable crater in the comet 9P/Tempel 1. "Jars" won the Colorado Book Award for History in 2012.

Todd graduated with a business degree from the University of Michigan, where he played soccer, and with a master’s degree from the Fletcher School of Law and Diplomacy at Tufts University. Before becoming a journalist at the turn of the millennium, he was an IT and strategy consultant. He once spoke fluent Japanese and still speaks fluent German.

When not writing, he spends time with teenage daughters and wife Carol, plays soccer, and allows himself to be bullied by a puggle he outweighs by a factor of seven.