Cancer In The Lungs

>> on "health matters television for life"... many of us don't think twice about taking a breath, but those with lung disease say you should never take it for granted... breathing can be a problem. >> there are days i can get up and go for hours,

and days when i get up and can't walk five feet without getting out of breath. >> and the simplest tasks become a struggle. >> there are times now when i get out of air just drying off after a shower. >> from copd to lung cancer,

we'll explore warning signs, treatments, and important things you can do to reduce your risk of lung disease. >> "health matters" is made possible by viewers like you, the friends of ksps. and by providence healthcare. >> i'm dr. andrew boulet,

and when my wife had a cardiac arrest, i chose providence because i knew that everything for her complex care was available from the emergency room, to radiology, to the nursing staff, to the specialists we need for her care.

>> i'm arnie peterson. i'm an orthopedic surgeon, and i work in the sacred heart providence medical group. when i needed my hip replaced i chose providence because of the professionalism and the care i knew i would receive. i never thought twice about

going anywhere else. >> good evening. i'm teresa lukens and welcome to "health matters." from the time we rolled the open of this show about one minute ago, we've all taken a dozen or so breaths. we do it without thinking about

it. but for people with lung disease, no breath is taken for granted. asthma, copd, pneumonia and lung cancer are just some of the disorders that fall under the heading of lung disease, which is the number three killer

in the united states. we have a lot to talk about in the next hour. let's meet our panel of experts. dr. michael mccarthy is a pediatric pulmonologist with providence health. his specialties include cystic fibrosis and pediatric adult

allergies. dr. jiten patel is a pulmonologist with providence health. he specializes in interventional procedures, particularly those for lung cancer screening. dr. stephen thatcher is a radiation oncologist with cancer

care northwest and practices out of sacred heart medical center. among his specialties is stereotactic body radiotherapy. i want to thank you all for being here today. it's a mouthful, dr. thatcher. it's okay. we'll get to that in just a

moment. i want to encourage all of you to send in your emails or please call us with questions tonight. it's an excellent opportunity to ask our panel of experts questions while we have them here. let's first talk about each of

your specialties as pertains to our topic tonight of lung dr. thatcher, let's start with you. >> i'm a radiation oncologist which means i treat cancer with aidation. i design plans for different tumors and how to best

effectively treat the tumor. >> this is a specialty that has become very advanced in the last few years. >> it's really an exciting field to be in. advances have happened rapidly. it's been a great benefit to patients, of course.

it's exciting to be in. >> explain the term that i stumbled over at the beginning of the show. >> sure. the name is sbrt or stereotactic body radiation therapy. it's a fancy way of giving a high powerful dose of radiation

to a pinpointed part of the body. >> we have been able to do that similarly -- gamma for the brain but it's been more difficult to do in the lung. as you breathe, tumors move. it's right next to the heart. the heartbeats.

it's difficult to localize that. now with newer techniques we're able to do a four-dimensional ct scan. we can limit the motion of the diaphragm in some ways. get a ct scan that will help us plan it. focus 50 beams or so in that one

spot and basically zap it. >> dr. patel. >> i'm a general pulmonologist with a special interest in lung cancer as well but ideal with asthma, copd, scarring of the lungs. i do help with transition from pediatrics to adult medicine.

it's the whole gamut of breathing, breathing difficulties, coughing, wheezing. pulmonary medicine has made profound changes in the past 10 years with the fda approving several medicines for pulmonary fibrosis, the paradigm of

inhalers available through different proprietors on the market is great. lung cancer screening has changed how we look at cancer and how we're catching it earlier as two-thirds of cancers are diagnosed in late stages and non-curative.

we're making early advances to diagnose it earlier. and biopsy earlier. it's just a fun field to be in. i'm excited to talk about it. >> dr. mccarthy, you deal with the kids. >> i do. i'm a pediatric pulmonologist

and one of my special areas of interest is cystic fibrosis. that's an interesting and wonderful field because it's a very serious condition that used to shorten life spans tremendously, but as advances have been made, our patients are living longer and longer and we

now are treating about half of our patients in the cystic fibrosis clinic are adults. we've had a couple adults in their 60s we've treated with cf. and we also see a lot of asthma and miscellaneous other lung diseases that children suffer

from, and we duress praw torry al you are gentlemen saz as to those conditions. >> this time of year we're start seeing a lot of flu. that's going to come into play for both adults and kids. is this the time of year we should be getting our flu shot

to make sure we don't end up with a respiratory condition like the flu? >> absolutely. i think as you start into later stages of september, october, early november, this is where it's very important for our patients at higher risk with

copd, known asthma, adolescent onward to elderly patients on o2 oxygen therapy who have copd or asthma or immunocompromised should be getting it. >> kids as well. i think universal flu shots for young children in probably up to all age groups.

i strongly encourage that. but particularly kids with lung disease. i agree, this is the percent time. you always get a little concerned each year when people get their flu shots too soon in august, if they're available,

because often you're going to -- the flu season is going to be a bit later, and your protection may have worn off. this is perfect timing. halloween. >> this can be quite serious. when we say the flu, so often people think of stomach virus

but the influenza is actually a respiratory condition or can be. >> yes. flu, people are always saying i have the flu and you're right it's confused with the stomach flu which is not the flu. also there are so many other respiratory viruses, but the

real flu, when the shot protects against, is not here yet, and will probably come december, january, even as late as march. >> is there any truth when people are fearful of getting a flu shot because they think they're going to get the flu from the shot?

>> well, it's false premise. it's an immune response to -- covering a previous virus. live vaccines aren't used for influenza. having said that, it's viruses from previous years we sort of compile the vaccine from. you probably add to that --

having said that, it's not a live virus. therefore you don't get infected with immunization. >> you're not going to get the flu by getting a flu shot. >> no. >> we have our first call coming in from steve here in spokane.

hi, steve. >> caller: hi. >> thank you for calling. do you have a question? >> caller: i have a question. my wife died of acute respiratory distress syndrome four years ago. can the doctors explain what it

is, how it occurs and what should be done to treat it. >> dr. patel? >> the -- a pretty complex disease seen usually in a critical care environment in the icu, but ards is where we're all breathing 21% oxygen, ambient air and with that our oxygen

levels are 96 to 100%. ards is an acronym that develops when you have an enormous gap between what we absorb from the ambient air. it requires additional oxygen to keep our blood levels normal with oxygen. it leads to stiffened lungs, wet

lungs, edema, ball gameness of the air waists. and it leads to respiratory failure. that's when your oxygen level drops less than 88%. it leads to intensive care admission. then depending on whether it's

mild, moderate, severe, sort of is a surrogate for how long you may be on a respirator or breathing machine. the treatment is time. you have a pro inflammatory state where the lungs are very boggy and moist. >>> you don't absorb oxygen

well. oxygen is a basic nutrient of life. so is glucose. when you're not getting fed the oxygen, other organs tend to fail. the heart has to work harder. kidneys need to work harder.

unfortunately you start developing other organ dysfunction or failure. it's a lot more complex. >> is it rare? >> it's a bit of a loaded question because i see that as an intensivist in that sort of clinical context in the icu, but

it is rare overall. but it's a syndrome where you have a deprivation of oxygen absorption related to whatever -- causes. a person with pancreatitis, infection, pneumonia, whatever it may be, may lead to your lungs failing.

time on the respirator. allowing your lungs to heal. >> dr. thatcher, lung cancer, is smoking still the number one cause? >> but there are other reasons people get lung cancer as well? >> true. radon exposure can be -- you

know, actually non-spokers can get lung cancer, but by far number one is smoking for sure. >> what are some of the warning signs if somebody starts to feel somebody symptoms? 92 well -- >> well, unfortunately, most of lung cancer presents late.

so it's tricky to catch it in the early stages. but, persistent cough, coughing up blood, shortness of breath, occasionally chest pain, which are all pretty vague symptoms. that's why it can be kind of difficult to catch early. >> and then the screening

process, if somebody presents with those symptoms, they would go through a screening process? >> yeah. often they would show up in an e.r. or primary care doctor and get a chest x-ray. oftentimes you would see some sort of mass and then you get a

ct scan, and then we would -- there's a whole list of things that happen after that. biopsies, pet scans. >> is radiation always used? >> not always. cancer care is very much a team sport. you have surgical oncologist

that do surgery, chemotherapy, radiation, pulmonologists that stent the airways. there's a lot of different tools in our toolbox for cancer. >> talk about the radiation therapy a little bit more and what people go through. i know there used to be a lot of

side effects. are we still seeing that when it comes to radiation therapy? >> certainly there are side effects. it depends a lot on what stage you have. if you catch a lung cancer in stage 1, it's actually pretty

easy to treat from a radiation standpoint. oftentimes the surgery is the standard. but if the patient can't get surgery, you can get stereotactic body radiation where patients don't notice anything but maybe fatigue.

often we treat stage 3 lung cancer with six weeks of radiation and chemotherapy and you have fatigue, pain, swelling. there can be more side effects the higher the stage. >> are people living longer? we're getting -- each field has

progressed. dr. patel can talk about it as yes, even in stage 4 people are living longer now because of stepwise progression in all fields. >> the key is catching it early. >> we're fortunate to have dr. thatcher and his colleagues

locally and regionally. having said that, the paradigm shift has changed because like he said, most of the cancers in lungs are diagnosed very late in stage and so the earlier we can diagnose it, it's better. the ncc guidelines, united states preventative task force,

has compiled through evidence of over 20,000 patient encounters where if you're between -- your mid-50s to mid-70est who have a 30 pack or tobacco history or quit within 15 years or active smoker, one should get a low dose ct scan to diagnose for lung cancer.

we have talked about mammography. the odds of catching an actual breast cancer, and you can correct me, is about one in 900 screens. but if you get your high risk patients you can catch one in 300ct scans.

that's profound. we always catch like -- we're talking about placing patients in remission for cancer or subdoing or abating the growth. but can you imagine actually curing a lung cancer where your mortality is almost 100%. you can prolong life, but i

think it's profound that we can cure a stage 1 cancer but we have to catch these a lot earlier. there is palliative treatments available within the airway that we can do to help abate some of the symptoms of coughing, wheezing, shortness of breath

but sometimes the symptoms are caught later in stage. you may have a cough because you have post nasal drip or someone comes to the primary care doctor with an infection that does not go away or feeling weak or fatigued or have had three courses of antibiotics and still

feeling poorly. that's where -- and we're very fortunate. we've got a very astute primary care group of physicians in town that can facilitate chest x-rays followed by ct scans for lung cancer screening, catch the disease much earlier.

>> we have patty calling in from newport. hi, patty. >> hi. thank you for taking the call. >> caller: i had a couple questions bun quick one. can you have a lung problem and still have a clear x-ray?

and the other one is, is there a or lupus-like disorders, can that involve the lungs or the bronchial that can cause quite a bit of cough or that sort of thing? >> short answer, patty. >> well, you know, repeat your first question again.

>> caller: well, if you have a clear chest x-ray, can you have a problem with your lungs? you can have an underlying lung disorder and miss 30 to 40% of actual pathologies on a chest x-ray. it depends on the quality of the chest film, how the contrast is.

there's a lot of technical aspects to a chest x-ray, but you could have an abnormality and not see it on a basic chest film. as far as your second question, connective tissue disease is -- lupus itself can have lung manifestations as well as

diseases like scare durham a, systemic, rheumatoid arthritis. you have four pillars of building tissue, call general 1, 2, 3, 4. if there's an abnormality it can manifest at lupus or rheumatoid if your immune system overacts and it can attack your lungs and

cause inflammation. it can be very subtle. it can cause cough. it can cause wheeze. shortness of breath. or you're not able to complete your basic activities. it could be very subtle. kit happen over weeks to months

to years. it can lead to vation color disorders in the lung as well called pulmonary hypertension where if you imagine your lungs in a figure 8 your heart sits in the middle, the body is on the bottom. passively -- but that pipeline

between the right heart and the lungs, the pressures can rise in certain connected tissue patients and can present with shortness of breath, swelling of the ankles, coughing, wheezing. and it's as a result of high pressures on the right side of the heart and lungs.

rheumatoid arthritis has 20 different manifestations in lung, everything from nodules to fluid buildup to scarring of the it can lead to nodules. it can lead to rib pain. it can lead to voice problems. that's a great question. >> so autoimmune diseases come

into play quite a bit. when it comes to kids, dr. mccarthy, they can't always tell you if there is a problem, so parents need to be watching for breathing issues, whether it's asthma or allergies or things that may arise. what can you tell parents about

watching their kids or looking for those signs if there happens to be a problem. >> i think one of the telltale signs is abnormal cough. it's actually difficult in kids, maybe in adults, too, to define the difference between a normal cough and abnormal cough.

how long should your cough go on after a cold? should it last a week? should it last a month? does it seem excessively severe. does it keep you up all noit? most astute parents will have a gut feeling about it, and i think most kids grow up sort of

being labeled as -- that's a coughing kid. other kids will grow up and they're not really a cougher. but cough is the biggest thing that i think parents can be clued into watching for. a lot of coughers are asthmatics.

that's a common cause of abnormal cough. speaking about asthma, if you have more severe asthma, which is sort of the classical what we all think of asthma, wheezing, shortness of breath, ending up in the emergency room, that's not going to escape attention.

nobody has to be taught how to look for that. you are going to know something is wrong. so i really emphasize and probably a lot of the new patients we see in our practice are kids that have, for years, just been abnormal coughers and

they have missed a lot of school and so on, and that's something that i think we can often help with. >> where do you begin then as a doctor if a kid comes in as being a cougher, having that issue? >> i ask a lot of questions.

i think the truth is most often in the history and, of course, the parents are the surrogates for the children, the young children, but kids are very astute, too, and they can describe what it feels like. so we want to know all sorts of things about under what

circumstances the symptoms occur, what makes it worse, what makes it better, what medications have been tried by your primary care doctor. just getting a strong feel of all the subtleties of the symptom. >> we have mary in spokane.

>> caller: yes, actually it's a three-part question concerning interstitial lung disease and pulmonary fibrosis. can you have both of those conditions at the same time? or does the interstitial lung disease go away? but i know the pulmonary

fibrosis does not. and if a person has an increasing cough that wasn't there for a little while but now there's more cough, does the person need to contact his doctor? >> that's a great question. interstitial lung disease is an

umbrella term for framework lung if you imagine your lungs like this room has several walls, you have paint, 4 by 4s and insulation. your lungs have a structure. interstitial lung disease is where you have matting down orkin king or portions of

4-by-4s not working properly or they're kinked. those areas fail. under the umbrella interstitial lung disease, there's different clinical manifesttations, one being cough, sometimes shortless of breath, sometimes swelling of ankles, sometimes a pneumonia

that doesn't go away. sometimes it presents over months and years. sometimes it's subtle. pulmonary fibrosis and interstitial lung disease it's one of the several types of interstitial lung disease. without getting too academic,

there is interstitial pneumonitis you get with connective tissue disease that's idiopathic that we don't know why. sometimes tobacco related lung there is drug-related interstitial lung diseases. so the astute patient should

prompt the attention of their primary doc and most docs will go with a chest x-ray. >> darlene in edmonton, hi, darlene. >> caller: hi, there. >> do you have a question for our doctors? >> caller: i do.

i wanted to know what tools are in their toolbox for copd. are there nid new treatments out there? is there any hope for copd patients, or is it all totally progressive, downhill? >> copd. that's actually an umbrella term

as well. >> it's an acronym for chronic obstructive pulmonary disease. there are two parts, breathing in, breathing out. breathing in is an active, in spraw torry. breathing out is two-thirds and passive.

copd is a disorder of exhalation where you lose elasticity in your lung. the equal to that would be filling up an empty bottle with water and turning the bottle upside down. equally you have flow of air into the lungs but you can't

express it out. so patients feel -- they're just in or they cough or wheeze. thankfully there are -- they are progressing in -- therapies are there. there are some subtle things. patients with copd, unfortunately it takes 10, 12

years before we get lung function tests. it almost takes lnl 20 years before diagnosed. while they are actively smoking or secondhand smoke or occupational exposures, there are several reasons, not just tobacco.

having said that, by the time we get the tests, most the lung function is lost, around two-thirds. having said that the loss of lung function is precipitously lost in the first 10 to 12 years and patients can be completely asymptomatic without cough,

cheese, shortness of breath. when they finally get to the primary complaining of lung -- they're already at the severe level of loss of lung. in a nonsmoker you lose about one ounce a year of lung function or volume. active tobaccoists lose around 4

a year. in englandly followed 860 men. they watched their lung function every six, 12, 18, 24, so forth for 10 years. the retention of that study was pretty good. but what they saw was this decline and that's how i know 3

to 4 ounces is lost per year. you may be asymptomatic until you hit 40 or 50. all of a sudden you can't do the basic things you take for what we know also when they did stop smoking they continued to follow them for that 10-year period.

the loss of lung function is reduce to that of a nonsmoker within a year. >> so you can start to direct -- >> not back to normal for your cohorts but thecally kline lung function comes to that of a nonsmoker after a year or two. not talking about the coronary

benefits of quitting tobacco. so there's some interest there where we should be talking about stopping smoking, tobacco cessation. 98% of our game. then there is therapy. asthma is not the same at copd. copd is not asthma.

we had a certain set of inhalers we gave all patients who are coughing or wheezing. the gold criteria, which is consortium -- the faux -- facilitate copd management they have given us a nice form of how we treat copd. there are different inhalers out

there that are available that include long-acting muscle relaxers in the airways. your muscles are a tree, like a tree the airways get smaller and smaller but the middle airways are wrapped by muscle and in a copd patient that airway is thick.

the muscle layer is very constrict. so flow of air through a narrow passageway leads to coughing, wheezing, shortness of breath. these medicines relax that muscle. they also -- they can also dry up secretion.

if we get patients earlier on the therapies, the declined lung function we know prospectively decreases. that means less symptoms. so there are therapies available. we make great strides in the last five to 10 years with copd

management. but the key, 98% begins with not smoking or quitting tobacco. >> i want to stay on the topic of copd. when diagnosed a patient has to deal with a lot of things from managing the symptoms of the disease to juggling oxygen

bottles and inhalers. it's a major life change that continues to evolve as the disease progresses. but it can be a quality of life especially with the right coaching. we met a local man who found out that with just a little built of

help he can maintain an independent lifestyle. >> how's your breathing today? >> this year don owens was a regular at the st. luke's rehabilitation institute for pulmonary rehab. >> breathing can be a problem. there are days i can get up and

go for hours, and days when i get up and can't walk five feet without getting out of breath. >> he was diagnosed 12 years ago with chronic obstructive pulmonary disease. >> i smoked for about 45 years. i had pneumonia at an early age. >> owens says he's always led an

active life, and at first after diagnosis, his copd didn't bother him. but the disease is progressive. and over the last two years, his need for oxygen has doubled. >> i can't go anywhere without making sure i'm going to have enough oxygen to get through the

day, >> and things that used to come easily are not so easy anymore. >> when his doctor suggested he enter a pulmonary rehab program, owens was resistant. >> i'm used to doing things on my own. it bugs me to have to ask people

to do things for me now. >> but as things got more difficult, he decided to give it a shot. >> i'm active, but i've come to realize that i need the structured exercise so i came back to luke's to get the structure back in my life.

>> now owens is a graduate at st. luke's. the exercise portion of the program helps patients with endurance, and helps them make the best use of their oxygen. but this program goes well beyond exercise. >> our goal with pulmonary rehab

is to help our patients gain a better understanding of their we have a variety of education topics that cover more than just pulmonary topics that they get to learn, like we go through anatomy and physiology, we want to help patients understand disease processes.

>> owens still does not like asking for or receiving help. >> fortunately my wife has a good sense of humor about things like that. >> but he has to admit that pulmonary rehab has made his life better. >> i want to do the best i can.

and sitting around is not really an option. >> once a patient is referred by their doctor to the pulmonary rehab program at st. luke's, they attend three one-hour sessions per week for approximately 12 to 24 weeks before graduating.

dr. patel, don owen had a wonderful attitude about how he lives his life. he wanted to make sure he stayed active. how important is it, say the program that he went through at st. luke's to maintain his lifestyle.

>> i think it's great. these are the subtle loss of activities of daily living mr. owens smoke about, not bathing, not able to button his own shirt. basic activities of daily living. it progresses with copd, but we

can catch it with therapy. there is a level of muscle memory. if you don't use it you lose it. what's refined here we know through exercise physiology is if you work through that shortness of breath and understand why you're short of

breath you can do that treadmill at 1, 2, 3 mets. these acronyms is how they measure his lung function. a huge -- huge studies i'm sure in pediatric medicine looking at cardiopulmonary rehab. we're coming there,, we're pushing patients through that

sense of breathlessness. you're going to do fine. they watch your oxygen levels, heart rate, blood pressure. we can rebuild and recondition you and help you cope with that level of breathlessness. if you don't know why you're breathless it provokes anxiety

and anxiety, that stifling sensation and they work with them on the psychosocial level >> we have an email, and this is for you, dr. mccarthy. this woman, susan, is in oak nog uncounty and she says i'm in my counties -- i'm a cf carrier. two siblings died of this

can my grandchildren and their parent be screened to see if they are at risk? if one of my children shows no sign of cf, could they still be a carrier? >> i love this question. this is great. cystic fibrosis is a genetic

disease, and the advances made in the last 20 years or so in terms of understanding and identifying the specifics of the gene are just incredible. and the practical ways for screening. and the answers are, first of all, in terms of the children

who don't have any signs of cf, absolutely. people who carry the gene don't have any recognizable symptoms, and that's one of the mysteries of the disease. but it's very important to be aware of that. and the gene is common, too,

about 1 in 20 to 1 in 30 people in the population, primarily caucasian population, carry it. so it's out there, and it's around. when you have a family like this, then you're highly on the alert for carriers, and what we usually -- we can do it a few

different ways, but the basic answer is, yes, all these individuals in the family who are of -- pertinent -- of childbearing age and interested in having children and so on and so forth can be screened. a few years ago we could just screen for a small number of the

possible mutations. now we can screen basically for every possible mutation by different ways. it's kind of expensive, though, as you might expect. and one of the things we like to do in -- at least certain cases, is to refer families to our

genetics clinic. we have a wonderful genetics clinic at providence and get some help with sort of mapping out who is likely to carry the gene, who is not likely to carry the gene, and hone in on really who should be tested. but it's great -- it's just a

fantastic example of what geneticists have done for us through the years. >> and a way for families to stay proactive and know that information. >> we have mary in moses lake with a question tonight. hi.

how are you doing? >> very well. thank you. >> caller: yes, i do. i've got sarcodosis of the lungs and i've had it since 1999. i got three -- a quarter of my left lung left. i've been on oxygen for the last

six years now. i was wondering, i know bernie mack died of it, and i was wondering how i got this and is it part of cancer or what is it? >> sarcodosis is a rare disease. we don't know why patients get the demographics is typically

40, african american, equatorial countries, norwegian countries, certain thigh j -- east in endeny, north indian heritage. there is a bit of a bias in north america. having said that, we don't know what we do know, it behaves like an auto immune disorder where

you have a hyperfunctioning soldier that starts secreting or spewing out this pro inflammatory cell type and it leads to injury in the lungs, lymph knows, in the eyes, kidneys, liver, and it can be subtle. two-thirds of patients don't

even know, but it was incidentally found with enlarged lymph nodes. of the remaining patients who do progress it can lead from -- leave the lymph nodes and progress into the tissue of the lung. and if it continues to progress,

it leads to chronic airway inflammation and the framework, interstitial disease process kicks in, and it can lead to there's different stages, 1, 2, 3, 4, and it's a progression from lymph node to the periphery of the lung. treatment is watchful, waiting

and it resolves in majority of patients. if it doesn't, the option is high-dose steroids. if you don't -- if -- or the scarring in the lungs progresses, then there is steroid sparing medications as >> i want to get to another

email from shirley in spokane valley. shirley says i developed rad after a bad cold. i have been taking singulare. i have a sporadic cough and some seasonal allergies. what other treatment might i need?

rad? >> another acronym used when i was growing up. reactive airways disease. i tend not to use that. i don't know if you do -- >> i agree. >> what i recall rad is a temporal relationship.

there is a time of whatever insult to the lungs and then usually 12 to 16 weeks later the coughing, the wheezing, shortness of breath resolves. we know that's usually result of exposure to something, in this case a virus. you can get a post-viral

bronchitis that can last 12 to 16 weeks. rads is now used in a -- exchange for asthma as sort of a chronic inflammatory disease. asthma now is defined as allergic, nonallergic. how it presents -- it varies. you don't just call it allergic

asthma anymore. it could be due to obesity. it could be related to reflex. post-nasal drip. i would argue that maybe it's not rads and it's asthma. she may have allergic asthma, and the national guidelines for asthma that we all sort of -- is

our bible, you start singulare and add 1 al albuterol inhaler. or if you're having nighttime symptoms we add on therapy like an inhaler with a steroid. then something with a higher dose steroid. i would imagine your phone caller probably has asthma

rather than rads. >> so an antiquated term. >> i believe it to be. >> gary in edmonton with a phone call. hi, gary. i've got a question that is just a little bit -- might be a follow-up on the previous

question. i'm suffering from two chronic diseases. so i get into poor health once in a while. anyway, i'm using -- i got a cold and i have a very deep mucus and i'm using a mucus mist now via nebulizer and i am

wondering if there are other alternatives i could use or consider to help clear this congestion? please. >> it's actually -- six to eight programs per year. so if you have it biannually it may be an exacerbation of a

condition like post-nasal drip. your food pipe sits behind your windpipe and you might have silent reflux. you may have this bile that comes up and drops on to your vocal chords and causes you to have this cough twice a year. post nasal drip may be subtle.

one-third drip forward. one-third have sinus congestion. a third drip back. you have episodes of violent coughing. if it settles in and it occurs in like the previous caller calls it, patients -- well -- will be determined reactive

airway disease because if you aspirate some of that stuff into your lungs it makes your lungs inflamed and that's what causes the coughing and wheezing to last for several weeks. there are bronchodilators you can get depending on what symptoms they come with and on

clinical exam it may predicate a certain treatment. but i think you probably want to venture in and see your primary and talk about additional therapy and see if you have silent reflux or nasal drip or asthma, if a smoker, perhaps copd.

>> dr. thatcher, i want to work you back into the conversation and talk about the radiation treatments for lung cancer and how specialized they've become. do the treatments now affect any of the other organs or are you so generalized now -- or zeroing in on that lung particularly for

lung cancer that you can avoid any damage to any of the other organs? >> well, yes and no. again, it all sort of relates to what stage and the burden of disease someone has. if they have a large tumor right next to the heart certainly

there could be some damage to the heart. but oftentimes with our newer treatment techniques we're able to sculpt the dose and beam much better than in the past. we're also able to line up each day -- we have what we call -- it's a ct scan that's mounted on

to our machine that gives the radiation. we can make millimeter adjustments each day to give us more accuracy. but even with that, if you have a lymph node that has cancer in it right next to the esophagus you still will potentially get

that pain with swallowing when you have a treatment. honestly, a lot of times the biggest thing to worry about is -- a lot of times you have a patient who has been a lifelong smoker, they don't have graipt lungs to begin with, get cancer and any normal lung you damage

on top of that, sometimes they notice that. oftentimes it's the lung itself that we're worrying about. but i guess the short answer would be it depends. >> typically how long are treatments? >> the actual -- usually it's a

daily treatment. the treatment -- the radiation itself is probably 5, 10 minutes. it's quite quick. but it takes -- lining you up takes as much time as it does to treat you. it's pretty quick.

you can be in and out of the office in 30 minutes. >> what about lifestyle during that treatment time. can you expect to feel ill or -- >> usually not. radiation in the chest usually does not make you feel nauseous. often some mild fatigue can

accompany that. usually the first treatment is easier than the second half of treatment. it's that second half of treatment that if -- if the tumor is near the esophagus you can get pain with swallowing. also depends on whether we're

giving chemotherapy along with but the very focal stereotactic type of treatments we have that treat the one lung nodule or tumor, that can be done in as short as five treatments and they can walk in and walk out. radiation, you never see it, you never feel it.

nothing crazy happens while you're getting it. you walk in and you walk out. it's quite easy to get the radiation itself. it never hurts. >> and brian, hi, brian. >> caller: hello. >> do you have a question?

>> caller: i was wondering if the doctors have heard anything in regards to last week i heard a brief mention of an fda drug that was near approvals to reduce lung cancer by 50%, and i didn't know if it was a treatment, the symptoms, and i was wondering if that was

attributed to the cuban medical research that's recently been available to the u.s. medical field with the border being opened up. i heard that the cubans had it in their medicine cabinets a couple years ago. >> dr. thatcher, have you heard

any -- >> i'm not aware of that. i don't know of any medicine that can necessarily prevent lung cancer itself. the main -- it's obviously many lifestyle things we can do to prevent. it main one would be not

smoking. not aware of any preventative medicines that would prevent it. >> other than not smoking, which is obvious and comes up quite often on "health matters," what are some of the other things we can do reduce our risk of lung cancer.

>> we do radon testing -- >> radon is prevalent in the spokane area? >> yeah, yeah. i think it's maybe 5 to 10% of causes of lung cancer. asbestos. if you had asbestos exposure. there are certain mining

communities, northwest montana has a few of them. can be predisposed to that. but other than that, just living a good, healthy life never hurts good diet, exercise can only help you. if you do happen to get ill or have cancer, people who are fit

coming in always do better than someone who's not. >> asbestos, i know dr. mccarthy this was one of the questions i wanted to talk to you about, kids being exposed to asbestos. sometimes you don't when this is happening.

we have older homes in spokane. that can also happen. is there a risk for kids exposed >> i think the risk is long term. i often have patients ask this question and the simple answer is, if patients coming to see me because of a cough or recurrent

pneumonia or something like that, it has nothing to do with asbestos exposure in the home. but they're young children and they're going to live a long life, and the cancer risk will potentially catch up with them if they've had that kind of exposure.

but it's kind -- it's kind of a misunderstanding that a lot of patients have who are bringing kids in to see me. >> we have vicki in newport. hi, vicki. >> and your question? >> caller: i have been diagnosed with bronco stasis,

and i would like to know more about this, how it comes about, what can be done for it, is there a cure. i get out of breath especially at night, especially lately. so i would like to try to understand this lung disease a little better.

>> not sure if the term is correct. bronco stasis or brawn he can ect sis. it's a lung disease related to chronic inflammation. usually -- in the -- it can be an immune -- it could be an autoimmune disorder.

it could be from childhood early infections, recurrent pneumonias, recurrent aspiration. what it does is lead to chronic airway inflammation and those chronically irritated airways start to kink on themselves and that leads to stasis of sputum

and that leads to then colonization or growth of bugs that grow over years and it presents with coughing or it can mimic asthma. it can mimic copd. it tends to settle in the base of the lung on both sides. it could lead to tacky mucus,

sputum. it can become acutely inspected every so often. it can be indolent and progressive. there is cystic fibrosis -- >> are they related? >> not related. the adult population is slightly

different unless they come -- the non-cf element is airway clearance meaning what you and i take for granted that ciliary hair-like rhythmic sputum escalator that allows peripheral mucus to be recruited into the central airways for you and i what we take for granted, spit

up or swallow, these patients don't. it can sort of colonize. i guess dr. mccarthy could talk about the cf as well. >> what you're saying is it can be caused by many different underlying conditions, and in my world cystic fibrosis is the big

one, but that's the kind of lung damage that occurs in a patient with cystic fibrosis. in that case it's because the secretions are thick in the lungs to begin with from the underlying abnormality, and then you get infection, you get thicker secretions, and you get

that kind of damage. people born with low immunity of one sort or another, which is not common, it's rare to have a true immunodeficiency, but those who are can end up getting it. but treatment is a variety of things, treating infections one way or another, either

chronically or intermittently, trying to raise the secretions with percussion and ways of encouraging stronger cough and thinning the see creases. but it depends partly on what's the underlying cause. >> is this difficult to diagnose?

because it does -- >> mike most things there's a latency between symptoms starting and when we actually see the patients. there are several encounters through different levels of providers. once it's diagnosed through cat

scan and clinical intuition, the treatment is reasonable. it's like dr. mccarthy said, recruiting the secretions using percussions, using a vest. it's kind of intuitive. we actually try to get them to cough more with percussion therapy, thinning out the

secretions. >> it becomes more productive that way? >> we want them to get it out. it's better out than in. in the adult realm it's using mucolytics, using bronchodilators, like albuterol, using percussion devices two or

three times a day. that's part of the routine. >> we have another email. this one from karen. karen rights, what is vactor's syndrome, how rare is it and what can be done with for a person with it. >> i don't know how common this

is. it's birth defect basically, and i don't think the cause is known. it arises during a certain part of fetal development, a certain month along the way as the fetus is developing and the letters stand for different organs

involved, but -- and people can have one part or several parts of the syndrome. but basically the trachea, the development of the large airway is affected, the esophagus, which is the swallowing tube, that is affected, the spine can be affected, that's v for

vertebrae, and it's -- there's a wide spectrum of presentation because of the -- number one, the severity, number two and exactly which organs are affected. it's multiple birth defects. frequency, i don't really know the number.

do you know -- >> i don't recall. >> it's somewhat common in our practice, but that's because patients are referred to us from widespread area. and the -- the kind of treatments are quite variable because again it depends on what

the difficulties are. but it can cause breathing problems, swallowing problems, often early surgery is required to fix the underlying problems. but then there are lingering difficulties with reflux, with swallowing difficulties, with sawf inning of the airways so

that it's difficult -- you might even end up with bronc ect sis because of that. it can be quite a challenge but people can also do well dissecting out the different parts and dealing with them with the tools that we have. >> leslie here in spokane, hi,

leslie. thank you for waiting. >> caller: oh, thank you for taking my call. i'm someone who presently has copd from second-hand smoke, and i have seasonal allergies, asthma, and i presently have pneumonia.

my question is, i have a number of treatment routines that i'm -- and modalities that i use. when i've done all the nebraska liesing, when i've used the oxygen 24/7 and the inhalers and i still can't catch my breath, and the coughing continues to

what i would consider a historical level, but it's -- hysterical level, that signals to me that i need to call 911, or go get further help? >> that's a very good question. >> she describes severe asthma, and it's based off symptoms, and having chronic wheeze and

shortness of breath not relieved with the regimen and the keyword she said routine and she has a regimen she does do, i heard allergies, i heard asthma/copd, secondhand smoke. >> and pneumonia. >> again, asthma, copd, exacerbations, worse e worsening

of symptoms can behave like it's not the same. the academic part of me tells me maybe her asthma is not controlled very well. can patients get copd and not smoke? that's why we don't have smoking in public places or in

airplanes. i grew up in a time where if you went to the bathroom you walked through the smoking area. i'm thankfully not symptomatic of any cough or wheeze nor do i have copd or asthma but when we grew up there was this chronic inflammatory response, and she

was obviously susceptible. plus she describes coughing episodes that are violent. most asthmatics and probably a third if not more have a post-nasal drip syndrome. so it drips down duty vocal cords. it can lead to violent episodes.

having said that, your upper airways, lining of your mucus membranes in your nose and sinuses are the same up to the 20th generation of airway. so when smoal durs, this smoal durs and this smoalders and vice versa. >> when she gets into an episode

like that -- >> she does the right thing by asking for help immediately. and the sense of air hunger is profound and an asthmatic -- if you can imagine breathing through a straw 40 times, you may be able to empathize with the hunger for air.

but there are asthma plans, action plans and it involves with a young asthmatic who then develops chronic asthma into adulthood. she should have a plan and monitoring her peak flows and looking at if she has worsening symptoms.

she should have an action plan that she and her primary doctor can take. you may need steroids or you may need i.v. steroids or need to be hospitalized. having said that, prevention is a big thing. secondhand smoke, avoidance, get

on top of the allergens. find out what you are allergic to. i am a big advocate for sinus rinses. you use basically distilled water and a salt -- the water and salt is a desiccant and dries up the signances.

it can alleviate some of the discomfort. at least maybe reduce some of the post nasal drip. she may not be cognizant of it. she is doing -- calling the right -- doing the right thing by calling 911. >> and we see kids presumably

fairly shortly after they've developed a problem, maybe they've had it for a year or two, and asthma is -- every asthmatic is a little different from every other asthmatic and it's always a learning process, and there's no gray, black or white answer for this kind of

you know, you feel short of breath. can you get in your car and get to the e.r. or do you need 911? we don't really know. and the asthmatic has to kind of teach us. and certainly it's better to be safe than sorry.

and so we -- and then after -- you know, so there may be some unnecessary runs to an emergency room, and then after a while the family learns and they know what to look for and they know twh to call us and they know when to head to the hospital. >> we have run short of time.

that was a very fast hour. i want to thank you all of you for being here. i want to thank all of the callers and the emails we received on "health matters" this evening. big thank you to the panel for being here and sharing their

expertise. if you're looking for more information on lung health, we've posted some very helpful links on our website ksps.org. join us on "health matters" on november 17th when we will focus on managing pain. i'm teresa lukens.

have a good night.