Roxana Bonilla is a patient at JPS Health Network who was diagnosed with a rare genetic condition known as Tracheobronchopathia Osteochondroplastica (TO), when calcified nodules are present in the larger airways. This involves the space inside of the trachea and bronchi and results in the obstruction of one's airways.
Many people with TO are asymptomatic and live their entire lives not knowing that they fall into this population. Unfortunately, Bonilla's case was far too extensive to overlook. Bonilla was suffering from calcification over her entire trachea, extending into the left and right sides of her lungs. The progression of her case was leading to the loss of pulmonary function.
Like others with this condition, the presence of Bonilla's symptoms was delayed. Initially, Bonilla thought that her symptoms were correlated to her weight. She began working towards her weight loss goals, many of which she achieved. However, the shortness of breath did not subside. It wasn't until her friends and family noticed a change in her voice that she sought help.
"Whenever I walked, my coworkers would mention that my breathing sounded agitated. I constantly sounded like I was out of breath,” said Bonilla. “My sister began noticing, too. She always watched me put on my makeup, and one day, as I was getting ready, she kept asking if I was okay. She said I sounded like I had asthma. That's when I decided that I needed help.”
"I want to thank Dr. Patel, Dr. Wickwire, and JPS. Dr. Patel and Dr. Wickwire are my two angels," Bonilla said. "They have given me my life back. Without them taking the chance on my surgery, I don't know what life would be like. To anyone who may need help in the future, trust them. They will take care of you."
After an initial checkup with her primary care doctor, she was informed that she would need to see a pulmonary specialist. This is where her journey with JPS and Paras Patel, MD, Interventional Pulmonologist, began.
Dr. Patel's work with Bonilla began with a pulmonary function test and CT scan, which showed the extent of her condition. After gathering the images of Bonilla's trachea, he presented the case to ENT Surgeon Peter Wickwire, MD.
Dr. Wickwire spent ample time analyzing the case, weighing Bonilla's options, and deciding how to proceed. With Bonilla's best interest at the forefront of Dr. Wickwire's and Dr. Patel's minds, she was referred to another hospital.
"Because of the complexity of this case, I knew she would benefit from a team of subspecialized individuals," Dr. Wickwire said.
Bonilla visited three different doctors before eventually finding herself in Dr. Patel's clinic again. By this time, hope had dwindled, and Bonilla did not know if she would find normalcy. Her case's challenges were risky, and many doctors erred on the side of caution.
"I remember calling Dr. Patel and telling him, 'I give up.' I couldn't find anyone to perform the surgery I needed, and I had lost hope. I was ready to stop trying," Bonilla said.
However, Dr. Patel and Dr. Wickwire would not let this happen. They knew Bonilla needed help, and she needed it soon. The two prioritized honesty and safety with Bonilla and assured her they would dedicate themselves to performing this procedure.
"Seeing her sitting in a chair in my clinic, unable to breathe, I knew I couldn't let her leave again. Her symptoms were going to gradually get worse within days, months, and years. If we didn't do anything, she would have nothing left. We decided to take the chance and see if we could get her back to feeling like herself," Dr. Patel said.
Bonilla began her journey to a new quality of life. Before this procedure, she could not play with her children, go on walks, or do anything that required strenuous effort. Taking a shot at this surgery meant she would be able to experience life in a way she hadn't before. This surgery would help Bonilla breathe again, one of the most basic functions in life.
It was unrealistic to attempt to complete Bonilla's procedure in a single day. Bonilla was placed under general anesthesia, and oxygen levels were kept low, so it was important for Dr. Patel and Dr. Wickwire to prioritize her safety. With this in mind, the decision to divide this procedure into multiple steps was made.
"Each time she came for the procedure, we knew we did not want her under general anesthesia for a prolonged period. We operated in short segments. We would send her home, let her heal, and then bring her back until we cleared the calcification. It was a long process, but it paid off," said Dr. Patel.
The actual operation posed many risks for Bonilla. With the extensiveness of her condition, the doctors need to work tediously and trustingly together. JPS physicians value the ability to exercise multidisciplinary practices. Working together and asking for second opinions significantly increases our ability to treat patients.
"I couldn't take care of all of it myself, and Dr. Patel was also having issues using only his techniques. So, we realized that if we put them together, we could meet in the middle and give her a full tracheal treatment that helped her breathe considerably better," said Dr. Wickwire.
"I worked on the part of the airway closer to her vocal cords, under her vocal cords, the subglottic airway, and the mid-tracheal airway. I used familiar techniques to treat her condition with lasers to try to resurface and recontour the inside of her windpipe. This allowed Dr. Patel to go further into her airway and finish clearing the obstruction."
Even with such a daunting case, Bonilla felt supported by her care team. She remembers each step of the process being explained to her in detail, and her doctors only proceeded once she felt comfortable with her treatment plan. Dr. Patel and Dr. Wickwire cultivated a trusting environment for Bonilla, igniting hope in a once defeated patient.
"Returning to Dr. Patel's office, I was unsure what to expect. He explained to me how he and Dr. Wickwire would complete the procedure and made sure I understood," Bonilla said. "I felt so relieved that I was finally going to get help. I am so appreciative of them both. I trust them always to do what they think is best."
Bonilla's faith in her doctors gave them the opportunity to change her life. Over the course of a year, Bonilla underwent procedures that enhanced her quality of life one step at a time. Finally, Bonilla's tracheal condition was mitigated.
"After suffering for so long, I could come home and play with my kids. I could be there for them the way I always wanted to. I no longer struggle to breathe. My life is no longer restricted," Bonilla said.
For Dr. Patel and Dr. Wickwire, this operation was monumental. The pairing succeeded in granting hope to the hopeless. Though the doctors had many challenges along this journey, nothing was ever too intimidating. The two moved eloquently through each procedure until they were sure that Bonilla's quality of life would significantly improve, keeping their mind open to learning along the way.
"Roxana has taught me a lot. She has taught me that I'm able to take on things that I didn't think I could. She has also taught me that Dr. Patel is an excellent partner in my journey in medicine. I'm grateful to both of them," Dr. Wickwire said.
Dr. Patel and Dr. Wickwire's talent and capability are tremendous. Bonilla's case has taught them that practicing medicine is not just black and white -- taking a chance to learn and grow is worthwhile also.
"This was a special case for us," Dr. Patel said. "It was a remarkable moment to see how significantly we impacted Roxana. We were proud of ourselves but, mostly, honored to see how much happier Roxana was."
Bonilla's life post-operation has dramatically improved. Though she does not refer to this life as "normal," she emphasizes how much better it is. She no longer experiences the frequent shortness of breath; she can work, have long conversations with her mother, and continue moving her life forward.
"I want to thank Dr. Patel, Dr. Wickwire, and JPS. Dr. Patel and Dr. Wickwire are my two angels," Bonilla said. "They have given me my life back. Without them taking the chance on my surgery, I don't know what life would be like. To anyone who may need help in the future, trust them. They will take care of you."