Dr. Harold “Corky” Dillon had flown Air Force fighter jets before going to medical school and specializing as an ophthalmologist. He rode his KTM 300 dirt bike harder than a man in his seventh decade probably should. He ran in 10-mile bunches. He worked out with weights, hard, three times a week. He worked 70-hour weeks helping run the Denver Veterans Administration hospital.
Dillon, now 62, did all that until blood clots in his legs lodged in his lungs, scarred over and became something called CTEPH (Chronic Thromboembolic Pulmonary Hypertension). By the time Dr. Todd Bull introduced Dillon to the team at UCHealth University of Colorado Hospital on the Anschutz Medical Campus (UCH), the Denver Veterans Administration executive could hardly make it up a flight of stairs – though he was still working the 70-hour weeks. Most people in Dillon’s condition can’t work at all, Bull told him. And without serious medical intervention, Dillon probably wouldn’t be doing it much longer.
That was in 2017, when the stage was set for what would be a remarkable collaboration among pulmonary specialists, surgeons, pulmonary rehabilitation experts, and not least a patient whose effort and determination was an inspiration to those who watched him overcome debilitating disease.
Bull, a University of Colorado School of Medicine pulmonologist and the director of UCHealth’s Comprehensive Lung and Breathing Program, had run a series of tests on Dillon to arrive at the diagnosis of CTEPH. The disease is rare: with most patients, blood thinners clear pulmonary embolisms before they scar over. That hadn’t worked for Dillon, so it would take surgery.
“Minimally invasive, right?” Dillon asked, well aware of the wealth of catheter-based options in modern medicine. One of them, called an embolectomy, can remove lung clots. But not if they’re scarred over.
“No,” Bull said.
Bull then introduced Dillon to another medical term he’d never heard of – a surgery called a pulmonary thromboendarterectomy, or PTE. UCH, which has performed a half dozen successful PTEs since November 2018, is among the few medical centers in the country doing them now. But at that time, the procedure wasn’t in the hospital’s portfolio.
Why did so few hospitals do PTEs? Consider what’s involved. The body is chilled to 68 degrees – about 30 degrees below a normal core temperature (hypothermia kicks in at 95 degrees). That’s so the patient’s brain and vital organs aren’t damaged when the heart is intentionally stopped and drained of blood for the roughly 20-minute sessions during which surgeons, in an open procedure, go in and remove scarred clots. If there’s more to be done after 20 minutes, and there usually is, they repeat the exercise two or three more times. From start to finish, the surgery takes at least eight hours.
“There aren’t many bigger surgeries,” Bull said.
To the coast
In late 2017, Bull’s team was working with doctors at University of California San Diego (UCSD) as UCHealth prepared to become the Rocky Mountain region’s sole institution to offer PTE surgery. They had UCSD’s strong support not only because of the long relationship developed through referring CTEPH patients for surgery, but also because UCSD’s program was so busy that the waitlist had stretched to six months – which was how long Dillon would wait. Those preparations involved UCHealth cardiothoracic surgeons Dr. Jay Pal and Dr. Christopher Scott observing surgeries. They also encompassed preoperative and postoperative care and touched many medical specialties: surgery, critical care pulmonology, critical care anesthesia, radiology, nursing, operating room management and others.
In late 2017, during a visit to San Diego, Bull briefed the UCSD team on Dillon’s case, and they agreed with Bull’s and the UCHealth team’s view that Dillon was a good PTE surgery candidate.
By the time Dillon’s turn came on May 30, 2018, he was still working more than full-time but couldn’t walk up a flight of stairs without 15 minutes of gasping recovery. He was sleeping, poorly, while upright on a basement couch.
The procedure took 10 hours. Dillon’s heart was empty, cold, and still for 52 minutes of that. Before his wife Bonnie, daughters Candace and Cara and their husbands entered the ICU afterward, staff warned them that he’d look rough. His family instantly noted his color and realized how ashen their husband and father had been.
“It was amazing how quickly his color came back,” Bonnie said. “He looked so much better.”
Pump up the oxygen
But this had been a stem-to-stern incision, and the recovery early on was, as Bonnie put it, “a long journey.” The UCHealth Pulmonary Rehabilitation team would play a big role along the way. On Mondays and Wednesdays from late June through late October, Dillon worked with respiratory therapists, exercise physiologist Brian Hemenway, and even dietician Holly Prehn at various times. Among their approaches was to boost the flow of supplemental oxygen while Dillon was on the treadmill stepping to tunes ranging from Roger Miller’s “King of the Road” to One Republic’s “I Lived.”
If the goal is to minimize the need for added oxygen, why pump it up during exercise? Because that lets pulmonary rehab patients work harder than the weakest link their cardiovascular system – their lungs – would otherwise allow, improving the patient’s overall fitness. Then with time, the pulmonary rehab team can cut back on the supplemental oxygen, says Alexandra Worl, a respiratory therapist and UCH’s Pulmonary Rehabilitation coordinator. She adds that her team closely monitored Dillon’s blood oxygen levels, keeping them at around 90 percent even with the added oxygen.
Dillon was a model patient and an inspiration to her team as well as fellow patients, Worl says. He wanted to improve at least a bit each session – maybe he would go faster; maybe he would boost the slope of the treadmill’s incline. He got back into his basement weight-training routine and did that three times a week in addition to treadmill work and long walks at home and around the neighborhood. He became a rare pulmonary rehab patient who jogged, not walked, on the treadmill. By his last session on Halloween day 2018, he had to be told to walk, not jog, the six-minute walking test. He had stopped using any supplemental oxygen at all by September. Dillon had managed 360 meters during the test when he had started four months earlier. The treadmill band rolled through 630 meters this time, and Dillon was just getting started.
Climbing his first 14er – in the snow
At the beginning of 2019, he set a goal of walking 11,000 steps a day despite his hectic schedule as chief of staff at the Denver VA hospital. Anyone with a sports watch will recognize this as a number you hit only with help from a five-mile run, a solid hike, or a very long walk. He kept getting stronger, and, by early June, had set his sights on a solo trek up Mount Bierstadt, a Colorado fourteener. It would be his first.
Bonnie wasn’t enthusiastic about the idea, but she had also been married to the man for 39 years. She teed up a smartphone family-tracking app and insisted that Dillon text updates as long as there was wireless coverage. The snow lay so thick it masked the trailhead – and, much of the way, the trail itself. Predecessors whose tracks he followed had opted to head more or less straight uphill. Borrowed snowshoes saved the day until about 13,500 feet, when thunderclaps turned him around. There had indeed been no coverage as the ascent had continued. She got a text from her husband when he was back at the parking lot.
“I was a nervous wreck,” Bonnie said.
Dillon’s next conquest would be the Peachtree 10K in Atlanta, which he didn’t tell Bonnie about until after he’d already entered, either. That race, which he had run years earlier, was in early July. Despite temperatures in the mid-80s and high humidity combining for red-flag conditions, Dillon finished that one in an hour and a half – in the middle of his age group. He continues to walk, run, and work out and has his sights set on getting back on that KTM 300 dirt bike.
Bull described Dillon’s turnaround as “just an amazing clinical response.”
“Not a lot of people climb 14ers,” he said. “It’s great to see and very rewarding to be able to have participated in his care.”
Holly considers it more than participation.
“It was just a miracle from God, because probably if we were anywhere else, another doctor might not have recognized what he had because it’s pretty rare,” she said.
Moving to Denver’s rarefied oxygen environment challenged his lungs, Dillon said, but in the end saved his life. He described care as “remarkable in every facet,” from the diagnosis to the surgery on through intensive care and pulmonary rehab.
“I just can’t thank them enough. I’m about to have some tears, here,” said a man who once ejected from a doomed military jet. “I thought about it, and the mot juste that comes to mind with regard to my medical care is ‘splendiferous!’”