>> THERE ARE FEW THINGS MORE SCARY THAN NOT BEING ABLE TO
BREATH AS YOU SHOULD.
WHY ARE YOU SHORT OF BREATH?
TONIGHT, "ON CALL WITH THE PRAIRIE DOC."
>> GOOD EVENING, AND WELCOME TO "ON CALL WITH THE PRAIRIE DOC."
DR. HOLM IS OFF THIS EVENING.
I'M DR. KELLY EVANS OF THE AVERA MEDICAL GROUP BROOKINGS.
BREATHING IS USUALLY SECOND NATURE, UNLESS SOMETHING
HAPPENS TO INTERFERE WITH THE NORMAL FLOW OF AIR IN AND OUT OF OUR LUNGS.
IT COULD BE A SHORT-TERM BUT POTENTIALLY DANGEROUS FLU, OR
IT MAY BE A LONG-TERM CHRONIC SITUATION SUCH AS COPD.
WHATEVER THE CAUSE, WE JUST WANT TO BREATHE NORMALLY AGAIN.
FIRST, LET'S TAKE A LOOK AT THIS WEEK'S PRAIRIE DOC QUIZ QUESTION.
PEOPLE WITH OBSTRUCTIVE LUNG DISEASE LIKE ASTHMA, EMPHYSEMA,
OR CHRONIC BRONCHITIS HAVE TROUBLE...
GETTING AIR IN?
OR GETTING AIR OUT?
VIEWERS WHO CALL IN THE CORRECT ANSWER WILL BE ENTERED INTO A
DRAWING TO WIN A SIGNED COPY OF DR. HOLM'S BOOK, "THE PICTURE OF HEALTH."
EACH OF DR. HOLM'S ESSAYS ORIGINALLY WRITTEN FOR THIS
SHOW COMES WITH A WONDERFUL ACCOMPANYING PHOTOGRAPH BY DR. JUDITH PETERSON.
WE WILL ANNOUNCE THE ANSWER AND THE WINNER AT THE END OF THE SHOW.
REMEMBER, YOU ONLY HAVE 10 MINUTES TO GET YOUR ANSWER IN!
WE ANSWER YOUR MEDICAL QUESTIONS ABOUT BREATHING AS
THEY ARE CALLED IN OR SENT TO US VIA FACEBOOK OR EMAIL.
CALL IN QUESTIONS TO 1-888-376-6225.
OR SEND US AN EMAIL TO THE ADDRESS ON THE SCREEN.
JOINING US TONIGHT IS PULMONOLOGIST DR. MICHAEL
PIETILA, OF THE YANKTON MEDICAL CLINIC.
WELCOME, MICHAEL.
WHY DON'T YOU TELL US A LITTLE BIT ABOUT YOUR BACKGROUND AND
HOW YOU BECAME A PULMONOLOGIST.
>> SURE.
THANKS, KELLY.
I'LL ORIGINALLY FROM A LITTLE TOWN CALLED LAKE NORDEN, SOUTH
DAKOTA, AND THEN SOUTH DAKOTA STATE UNIVERSITY.
>> GO JACKRABBITS.
>> I AM A JACK RABBIT, ALWAYS WILL BE.
STUDIED CHEMISTRY AND BIOCHEMISTRY, HERE AND THEN
WENT ON TO MEDICAL SCHOOL AT THE UNIVERSITY OF SOUTH DAKOTA.
WENT FROM THERE TO THE MAYO CLINIC AND DID AN INTERNSHIP
AND RESIDENCY IN INTERNAL MEDICINE AND THEN A FELLOWSHIP
IN PULMONARY CRITICAL CARE MEDICINE.
WHEN I WAS IN MED SCHOOL, I SPENT TIME AT THE YANKTON CAMPUS.
WHEN I DECIDED I WANTED TO BE A PULMONOLOGIST, THERE WAS A NEED IN YANKTON.
CONTACTED Dr. LAURIE HANSON AND HER COLLEAGUES THERE AND
CAME BACK TO YANKTON AND THAT'S WHERE I PRACTICE LUNG MEDICINE,
LUNG PROBLEMS ARE COMMON ACROSS ALL AREAS AND SOUTH DAKOTANS
WITH LUNG DISEASE DESERVE ACCESS TO SPECIALISTS SO
PULMONOLOGY IS WHERE I LANDED AND WHAT I CONTINUE TO DO.
>> YEAH, GREAT.
>> WE'LL HAVE PLENTY TO TALK ABOUT WHEN IT COMES TO LUNG DISEASE.
PRETTY COMMON.
WE SEE A LOT OF IT IN ALL OF MEDICINE AND ARE GLAD TO HAVE YOU HERE TONIGHT.
OUR TIMELY TOPIC IS INFLUENZA.
WE'RE SEEING A LOT OF INFLUENZA CASES THE LAST COUPLE OF WEEKS
LOCALLY AND I KNOW THAT'S SOMETHING THAT YOU MATTERS TO
YOU AS A CRITICAL CARE DOC, A PULMONOLOGIST SO WE WANT TO CATCH THESE CASES.
TELL ME WHAT YOU'VE BEEN SEEING IN YANKTON.
>> THE FLU SEASON IS PART OF EVERY FALL AND WINTER IN THE UNITED STATES.
DOESN'T MATTER WHAT PART OF THE UNITED STATES YOU'RE IN, IT'S
WIDESPREAD AT THIS TIME.
IT'S EPIDEMIC EVERY YEAR, WE JUST CALL IT THE FLU SEASON AS PART OF THE EPIDEMIC.
AND ANYONE CAN GET IT AND THOSE OF US WHO ARE HEALTHY, IT'S A
NUISANCE AS MUCH AS ANYTHING BUT CAN BECOME VERY SERIOUS AND
THOSE PATIENTS WHO ARE VERY YOUNG, WHO ARE PREGNANT, WHO
ARE OLDER THAN 65 OR WHO HAVE CHRONIC HEART OR LUNG DISEASE,
DIABETES, THESE KINDS OF ILLNESSES, IT CAN BE LIFE-THREATENING.
AND THERE'S NOT A REALLY GOOD TREATMENT ONCE YOU HAVE IT.
SUPPORTIVE CARE, THERE'S SOME ANTI-VIRALS THAT CAN MINIMIZE
THE SYMPTOMS AND MAYBE SHORTEN THE DURATION OF ILLNESS BUT THE
MOST IMPORTANT FACTOR IS GETTING VACCINATED, AND THERE'S
SOME MISUNDERSTANDING ABOUT HOW IMPORTANT THAT IS, AND HOW SAFE IT IS.
IT'S VERY SAFE AND IT'S VERY EFFECTIVE AND IT'S VERY IMPORTANT.
THERE'S ALMOST NO EXCUSE FOR NOT GETTING VACCINATED IF
YOU'RE SIX MONTHS OF AGE OR OLDER, AND THERE'S SOME
MISUNDERSTANDING ABOUT WHETHER IT'S AN EFFECTIVE VACCINATION.
IT'S EFFECTIVE, MAYBE NOT 100% OF THE TIME, MAYBE LESS THAN 50% OF THE TIME.
IT'S NOT ONLY 10% OF THE TIME, LIKE SOME OF THE NEWS REPORTS
MIGHT HAVE STATED AND EVEN WHEN IT'S NOT 100% EFFECTIVE, IT
DOES REDUCE IN THOSE PATIENTS WHO DEVELOP THE FLU DESPITE THE
VACCINATION, THE SEVERITY AND DURATION OF SYMPTOMS AGAIN,
MOST IMPORTANT IS TO UNDERSTAND IT'S SAFE AND EXTREMELY IMPORTANT.
>> EVEN IF YOU KNOW SOMEONE WHO HAS A FRIEND WHO GOT THE FLU
SHOT BUT ALSO GOT INFLUENZA, THAT PERSON COULD HAVE ENDED UP
IN THE HOSPITAL BUT STAYED OUT OF THE HOSPITAL BECAUSE OF THEIR FLU SHOT.
IT'S HARD TO PROVE OR DISPROVE THAT BUT WE HAVE PRETTY GOOD
EVIDENCE TO SUPPORT THAT.
>> I THINK THERE IS.
THERE'S PEDIATRIC LITERATURE THAT SHOWS PATIENTS VACCINATED
AGAINST THE FLU ARE LESS LIKELY TO DIE AS A COMPLICATION OF THE FLU.
CAN YOU EXTEND THAT TO ADULTS?
IT'S DIFFICULT TO NECESSARILY DO THAT.
YOU KNOW, THEN THERE'S THE MISUNDERSTANDING, WELL I GOT
THE FLU SHOT, I STILL GOT THE FLU, OR I GOT SICK.
IT TAKES ABOUT TWO WEEKS FOR THE FLU SHOT TO BE EFFECTIVE.
THAT'S ANOTHER IMPORTANT REASON TO GET IT EARLY IN THE SEASON.
WE START TO SEE CASES AS SOON AS OCTOBER, USUALLY PEAKS IN
NOVEMBER, DECEMBER, JANUARY, FEBRUARY.
TAKES TWO WEEKS TO REALLY BUILD UP THAT IMMUNITY AND IT'S
IMPORTANT TO GET IT EACH YEAR.
LAST YEAR'S FLU SHOT MIGHT STILL BE EFFECTIVE BUT NOT AS
EFFECTIVE AS GETTING IT A SECOND -- GETTING IT EACH AND EVERY FALL.
>> RIGHT, RIGHT.
I HAD A PATIENT ACTUALLY COME IN TO SEE ME TODAY ASKING, IS
THERE EVEN A POINT IN ME GETTING THE FLU SHOT NOW AND MY ANSWER WAS, YES.
I MEAN, THE FLU SEASON IS GOING TO CONTINUES FOR SURE ANOTHER
MONTH OR TWO AND COULD GET WORSE THAN IT IS NOW.
>> IT'S NEVER TOO LATE.
I MEAN, THE FLU SEASON, AGAIN, GENERALLY ENDS IN MARCH BUT
IT'S NOT TOO LATE AT THIS POINT TO GET VACCINATED AND THEN
THERE'S -- I GET THE QUESTION SOMETIMES, MAYBE YOU HAVE, TOO,
SHOULD I GET A SECOND FLU SHOT?
YOU KNOW, IS IT NECESSARY TO GET A BOOSTER.
IT'S NOT EVIDENCE THAT THAT'S NECESSARY.
THERE IS SOMETHING CALLED THE HIGH DOSE FLU VACCINE.
DO YOU USE THAT?
>> OUR CLINIC DOES AS A POLICY.
I HAVE SORT OF MIXED FEELINGS ABOUT WHETHER IT HAS BEEN
PROVEN TO BE EFFECTIVE ENOUGH TO TO WARRANT ITS USE.
>> WHAT I TELL MY PATIENTS, IF WE DON'T HAVE IT, I WOULD
RATHER NOT WAIT SO YOU DON'T GET ANY VACCINE SO I AGREE WITH
YOU FROM THAT PERSPECTIVE.
GETTING A VACCINE IS MORE IMPORTANT THAN WAITING FOR THE
HIGH-DOSE AND THE HIGH DOSE ISN'T INDICATED FOR THOSE LESS THAN 65.
>> IT WASN'T THAT LONG AGO THAT WE WERE ONLY TELLING PEOPLE OF
A CERTAIN AGE, YOUNG PEOPLE AND OLD PEOPLE AND WITH LUNG
DISEASE TO GET THE FLU SHOT.
OVER THE LAST TEN YEARS, WE'RE TELLING EVERYBODY TO DO IT
BECAUSE SUPPLIES HAVE BEEN ROBUST AND WE KNOW THAT IT CAN
MAKE YOUNG, HEALTHY PEOPLE SICK, AS WELL.
>> YEAH, AND I THINK THE ONE OTHER ARGUMENT I WANT TO
QUICKLY ADDRESS IS SOMETIMES PATIENTS SAY I'M YOUNG AND
HEALTHY AND EVEN IF I GET THE FLU, I'LL BE FINE.
CERTAINLY, THAT'S ALMOST DEFINITELY THE CASE.
HOWEVER, YOU'RE GOING TO EXPOSE OTHER INDIVIDUALS, WHETHER
IT'S -- YOU'RE KNOWLEDGEABLE OR AWARE OF THAT OR NOT SO IT'S A
PUBLIC HEALTH ISSUE, MUCH MORE SO THAN IT IS AN INDIVIDUAL PERSON'S ISSUE.
AND I THINK IT'S A RESPONSIBILITY WE ALL WANT TO
TRY AND RESPECT AND SO BE A GOOD HUMAN BEING AND GET YOUR FLU SHOT.
>> I MEAN, MISSING A WEEK OF WORK IS NO WALK IN THE PARK,
EITHER, IF YOU DID GET A BAD INFLUENZA.
ONE OF THE MOST COMMON LUNG DISEASE THAT IS WE SEE AS FAR
AS CHRONIC STUFF INCLUDES COPD, WHICH MOST PEOPLE HAVE HEARD
OF, PROBABLY A LOT OF OUR VIEWERS EITHER HAVE OR HAVE A
FAMILY MEMBER WHO HAS.
HOW BIG A PART OF THAT IS YOUR PRACTICE, IS PATIENTS WITH COPD?
>> SURE.
SO I THINK ANY PHYSICIAN IN GENERAL CARE, WHETHER IT'S
FAMILY MEDICINE, INTERNAL MEDICINE, OUR PHYSICIAN
ASSISTANT COLLEAGUES, NURSE PRACTITIONERS, SEE PATIENTS WITH COPD.
AS A PULMONOLOGIST, IT'S A BREAD AND BUTTER PART OF MY
PRACTICE, AN EVERYDAY PHENOMENON, MULTIPLE PATIENTS.
AND IT'S A COMMON ILLNESS.
IT'S THE THIRD LEADING CAUSE NOW OF DEATH IN THE UNITED
STATES, MOVED UP FROM FOURTH.
AND IT'S ULTIMATELY TREATABLE AND PREVENTABLE WHEN RECOGNIZED, ESPECIALLY
EARLY ON, SO IF YOU HAVE SYMPTOMS OF COUGH THAT'S
PERSISTENT, GREATER THAN EIGHT WEEKS, SHORT OF BREATH WITH
ACTIVITY, NOT EXPLAINABLE BY OTHER EASY SOLUTIONS, IF YOU
HAVE RISK FACTORS LIKE OCCUPATIONAL EXPOSURES OR YOU
SMOKE, AGAIN, THAT'S THE BIGGEST ISSUE, IF YOU'RE A
SMOKER WITH COUGH AND SHORTNESS OF BREATH, OR FAMILY
HISTORY OF SIMILAR ILLNESS, YOU NEED TO TALK TO YOUR FAMILY
DOC, YOUR P.A., YOUR NURSE PRACTITIONER, YOUR GENERAL
INTERNIST ABOUT HAVING THAT EVALUATED FURTHER.
>> YEAH, AND, I MEAN, DIAGNOSIS IS PRETTY SIMPLE BREATHING TEST
THAT MOST CLINICS CAN DO LOCALLY, SO --
>> IT'S VERY EASY.
WE CALL IT A TEST BUT THERE IS NO STUDYING OR PREPARATION NECESSARY.
RESPIRATORY THERAPIST WILL TEACH YOU OR SHOW YOU WHAT YOU
NEED TO DO, YOU'LL PERFORM THE MANUEVERS.
IT'S PAINLESS, RELATIVELY INEXPRESSIVE AND IT WILL ALLOW
US TO MAKE A DIAGNOSIS AND THEN OFFER APPROPRIATE TREATMENT.
>> YEAH, RIGHT, RIGHT.
GREAT.
YOU KNOW, THERE ARE SOME FOLKS WHO MAYBE ARE NOT SMOKERS BUT
DEVELOP COPD AND I THINK WE'RE GOING TO HEAR FROM A PATIENT LIKE THAT.
CAN YOU COMMENT ON SOME OF THESE MORE ODD CASES AND WHAT
SOMEONE SHOULD MAYBE RECOGNIZE IF THEY'RE NOT A SMOKER?
>> SURE.
SO FIRST I'LL STRESS, MOST IMPORTANTLY, SMOKING IS THE
MAIN CAUSE OF COPD IN MODERN NATIONS LIKE THE UNITED STATES
AND INDIVIDUALS WHO ARE STRUGGLING WITH SMOKING, WE
WANT TO HELP THEM BECAUSE THE USE OF CIGARETTES IS GOING TO
LEAD TO COMPLICATIONS LIKE COPD OR OTHERS.
THERE ARE CONDITIONS AND ONE IN PARTICULAR CALLED ALPHA ONE
ANTITRYPSIN DEFICIENCY, NOT TALKING ASTHMA, FOCUSING ON COPD.
ASTHMA CAN PLAY A ROLE BUT WE'LL TRY TO SEPARATE THE TWO
BUT WHERE YOU INHERIT A DEFICIENCY IN AN ENZYME, A
CERTAIN PROTEIN IN OUR BODY ESPECIALLY NECESSARY TO PROTECT
THE LUNGS FROM INJURY, THAT CAN LEAD TO DEVELOPMENT OF COPD
WITH OR WITHOUT SMOKING.
CERTAINLY SMOKING ACCELERATES THE PROCESS SO IF YOU
HAVE A FAMILY HISTORY OF, YOU KNOW, RELATIVES, AT THE
ESPECIALLY IMMEDIATE FAMILY MEMBERS WITH LUNG DISEASE
ESPECIALLY THOSE WHO NEVER SMOKED, IT'S IMPORTANT TO LET
YOUR HEALTH CARE PROVIDER HEAR ABOUT THAT.
>> THE PRIMARY CAUSE OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE,
OR COPD, IS SMOKING, BUT THERE ARE OTHER FACTORS THAT MAY
CAUSE THIS, INCLUDING GENETICS.
>> SO ALPHA ONE ANTITRYPSIN DEFFICIENCY IS A HEREDITARY
LUNG CONDITION IN WHICH YOU ARE BORN WITH A CERTAIN GENE THAT
HELPS WARD OFF INFECTIONS AND STUFF INTO YOUR LUNGS.
SO WITHOUT THIS, WITHOUT THIS GENE, WHEN I GET AN INFECTION,
IT ACTUALLY ATTACKS MY LUNGS, RATHER THAN PROTECT THEM FROM ILLNESSES.
WHEN I WAS FIRST DIAGNOSED IN 2001, I DIDN'T REALLY HAVE TOO MANY SYMPTOMS.
I KNEW THAT I HAD IT, MY FATHER WAS TESTED AND MY MOM WAS
ALREADY POSITIVE SO AT THAT TIME WE KNEW THAT CHANCES WERE
PRETTY HIGH THAT I WAS GOING TO BE A CARRIER BUT ALSO HAVE THE DEFICIENCY.
MY SYMPTOMS WEREN'T REAL STRONG.
I HAD SOME SHORTNESS OF BREATH, UPON EXERCISE GOING UP STEPS,
SO BACK THEN IT WASN'T REALLY A GAME-CHANGER IN MY LIFE.
I KNEW I HAD IT SO I TRIED TO TAKE CARE OF MYSELF AND WITH
THIS THIS DISEASE, IT PROGRESSIVELY GETS WORSE.
THERE IS NO TREATMENT FOR THIS DISEASE AT ALL.
IT'S JUST A MATTER OF TAKING CARE OF YOURSELF AND DOING SOME PREVENTIVE MEASURES.
IN OCTOBER OF 2016, MY OXYGEN LEVELS WERE PRETTY LOW UPON
SEEING MY PHYSICIAN SO AT THAT TIME I WAS PUT ON OXYGEN.
IT WASN'T QUITE 24/7 BUT IT WAS PORTABLE SO I COULD GO OUT BUT
THE OXYGEN WAS FULL-TIME AT NIGHT.
BY JANUARY OF 2017, I WAS UNABLE TO GO UP STEPS ANYMORE
WITHOUT REALLY STOPPING USING THE RESCUE INHALER AND FROM
THERE, IT'S JUST -- IT SEEMED TO TAKE A STEADY DECREASE TO
THE POINT WHERE WE'RE AT NOW, WHICH IS-IT DOESN'T TAKE MUCH
ACTIVITY ANYMORE TO GET THAT SHORTNESS OF BREATH TO COME ON.
THE BEST COURSE OF ACTION I HAVE, OF COURSE, IS MY RESCUE
INHALER AND WITH THE OXYGEN JUST TAKING SOME LOW, DEEP
BREATHS SEEMS TO HELP KIND OF GET MY OXYGEN LEVEL BACK UP
AND, OF COURSE, JUST STOPPING AND RESTING, WHAT I'M DOING,
JUST MAKING SURE THAT I SIT DOWN, RELAX BEFORE I GET UP AND
ATTEMPT ANY KIND OF ACTIVITY AGAIN.
BUT DEFINITELY THE INHALERS DO HELP AND THE OXYGEN.
THE ONLY LONG-TERM CURE FOR THE ALPHA-1 AND NOW THE VERY SEVERE
COPD THAT I HAVE IS A LUNG TRANSPLANT.
IF YOU HAVE ANY DOUBT, GET TESTED.
ALPHA-1 ANTITRYPSIN IS DETECTED WITH A BLOOD TEST, VERY EASY, VERY PAINLESS.
IT'S A STRUGGLE WHEN YOU HAVE TO BREATHE AND CAN'T GET THAT DEEP BREATH.
SO I WOULD SAY AS MUCH PREVENTION AS PEOPLE CAN AND
GET TESTED AND KNOW WHAT'S OUT THERE AND TAKE CARE OF YOURSELF WHILE YOU CAN.
>> THIS IS YOUR SHOW AND YOUR QUESTIONS ARE KEY TO OUR SHOW DISCUSSION.
CALL IN YOUR QUESTIONS ABOUT BREATHING CONCERNS TO 1-888-376-6225, OR SEND US AN
EMAIL TO ASK@PRAIRIEDOC.ORG.
AND WE'VE GOT A FEW QUESTIONS SO WE'LL JUST GO AHEAD WITH THOSE.
A MAN FROM BROOKINGS ASKS, ARE THERE KNOWN SIDE EFFECTS TO E-CIGARETTES?
>> YES, THERE ARE KNOWN EFFECTS.
SO ELECTRONIC CIGARETTES, OR VAPING, IS SOMETHING THAT'S
BECOME POPULAR IN THE LAST YEAR OR TWO.
INITIALLY WE THOUGHT AS PULMONOLOGISTS, MAYBE THIS WILL
BE A SAFE OPTION FOR OUR PATIENTS ADDICTED TO
TRADITIONAL CIGARETTES THAT ARE HAVING DAMAGE FROM SMOKING THOSE.
UNFORTUNATELY, THEY'RE NOT A SOLUTION.
SO, NUMBER ONE, THEY DON'T REALLY HELP PATIENTS QUIT SMOKING.
PEOPLE WHO USE E-CIGARETTES TO QUIT SMOKING USUALLY CONTINUES
TO SMOKE CONVENTIONALLY AND USE E-CIGARETTES.
NEXT, THEY INTRODUCE ANOTHER PART OF OUR POPULATION TO
E-CIGARETTES THAT MAYBE WOULD HAVE NEVER TRIED NICOTINE IN THE FIRST PLACE.
FINALLY, THEY HAVE THEIR OWN SIDE EFFECT.
THEY CAN BE DANGEROUS AS DEVICES WHICH MAYBE YOU'VE SEEN
ON YOUTUBE OR Facebook OR ELSEWHERE, BUT THEY ALSO HARM THE LUNGS.
THERE'S ALREADY STUDIES WHERE WE DO PROCEDURES TO TO PUT A
SCOPE DOWN AND WASH THE LUNGS OUT AND WE SEE MARKERS THAT ARE
ELEVATED CONSISTENT WITH AIRWAY INJURY, ALL PRECURSORS TO
DEVELOPING COPD THAT WE CAN SEE FROM TRADITIONAL CIGARETTES.
SO WHAT I EXPLAIN TO MY PATIENTS AND THE SURGEON
GENERAL AND OTHERS IN OUR FIELD OF EXPERTISE HAS SAID IS THAT
E-CIGARETTES ARE NOT A SAFE ALTERNATIVE TO SMOKING SO IT'S
SOMETHING I WANT YOU TO TALK TO YOUR DOCTOR ABOUT AND, YOU
KNOW, SEE IF THERE'S ANOTHER WAY THAT YOU CAN BREAK YOUR
ADDICTION TO NICOTINE BUT AVOID E-CIGARETTES, THEY'RE NOT SAFE.
>> YEAH, AND A LOT OF PUBLIC HEALTH INSTITUTIONS WORRIED
ABOUT E-CIGARETTES SORT OF PROVIDING THIS INTRIGUE FOR
YOUNG PEOPLE WHO MIGHT START SMOKING E-CIGARETTES, EVEN IF
THEY DIDN'T SMOKE CIGARETTES, WHICH IS WHAT YOU MENTIONED THERE, TOO.
>> THERE'S NOT -- UNFORTUNATELY, THERE'S NOT REALLY A POSITIVE FEATURE TO
E-CIGARETTES.
>> YEAH, YEAH.
OKAY.
A TOTALLY UNRELATED TOPIC BUT A WOMAN FROM LUVERNE WOULD
LIKE TO LEARN MORE ABOUT SARCOIDOSIS.
>> THAT'S NOT A RARE DISEASE BUT NOT COMMON.
IN MY PRACTICE, I SEE IT ALMOST EVERY DAY.
WE DON'T KNOW WHAT CAUSES SARCOIDOSIS, IT'S AN
INFLAMMATORY CONDITION, FOR SURE.
IS IT POST-INFECTIOUS, WE COULD ARGUE THAT OR AUTOIMMUNE, WE
COULD ARGUE THAT BUT MOSTLY WE DON'T KNOW.
AND THERE'S NO SPECIFIC DIAGNOSIS, NO DOCTOR CAN DO A
TEST THAT YOU HAVE THE DISEASE.
WE HAVE TO RULE OUT OTHER THINGS LIKE INFECTION AND
INFLAMMATION AND CANCER AND THEN WE SAY THIS IS MOST CONSISTENT WITH THE DISEASE.
IT CAN AFFECT ANY ORGAN IN THE BODY BUT WHERE IT'S MOST
COMMONLY FOUND IS IN THE LUNGS AND THE IMPORTANT THING FOR ALL
OUR LISTENERS TO RECOGNIZE AND BE AWARE OF IS IT'S USUALLY A
SELF-LIMITED PROBLEM OR IT'S FOUND INCIDENTALLY.
IT'S INFREQUENT THAT IT'S A SERIOUS COMPLICATING ILLNESS
THAT NEEDS TREATMENT AND THE REASON I SAY THAT IS BECAUSE THE
TREATMENT IS VERY DIFFICULT.
I TRAINED AT A PLACE AT THE MAYO CLINIC AND I SAW A LOT OF
THESE PATIENTS AND I HAD A PHYSICIAN ATTENDING THERE,
MICHAEL, WHEN YOU GO OUT INTO YOUR PULMONARY PRACTICE, YOU'LL
DO THE BEST JOB YOU CAN DO WITH SARCOID PATIENTS EXPLAINING TO
THEM YOU DON'T NEED A SPECIFIC TREATMENT MORE THAN YOU'LL BE
PUTTING THEM ON VERY TOXIC MEDICINES THAT CAN HAVE SEVERE SIDE EFFECTS.
SO I THINK IT'S IMPORTANT TO MAKE SURE YOU SEE SOMEONE WHO
HAS SOME EXPERTISE IN SARCOIDOSIS, AND MONITOR FOR
SIGNS OR SYMPTOMS OF THE DISEASE BUT THEN RECOGNIZE THAT
IT'S RARE, THAT IT CAUSES REAL HARM TO THE BODY.
IN SOME INSTANCES, IT DOES, SO I'M NOT SAYING IT'S NOT
IMPORTANT BUT IT'S REALLY NECESSARY TO UNDERSTAND EXACTLY
THAT IT'S A LIMITED CONDITION, MOST OF THE TIME, AND THAT
TREATMENT CAN BE MORE HARMFUL THAN GOOD.
>> GREAT, GREAT.
YOU SAY IT'S NOT A RARE DISEASE BUT IT'S UNCOMMON ENOUGH THAT
IT'S NOT SOMETHING I SEE VERY OFTEN AS A GENERAL INTERNIST,
SO DEFINITELY A REASON TO SEE SOMEONE WHO HAS SPECIALTY EXPERTISE.
>> IS THERE A CUMULATIVE BENEFIT TO GETTING THE FLU SHOT EVERY YEAR?
WE TOUCHED ON THAT A LITTLE BIT.
>> WE THINK THAT THERE IS.
WHEN YOU LOOK AT THE WAY THAT VACCINATIONS WORK, ESPECIALLY
THE FLU VACCINE, IT CAUSES YOUR BODY TO PRODUCE ANTIBODIES THAT
PROTECT YOU FROM GETTING THE INFECTION AND ALSO FROM THE
SIDE EFFECTS OR THE SYMPTOMS OF THE INFECTION.
AND THOSE ANTIBODIES DON'T CIRCULATE FOR A LIMITED AMOUNT OF TIME.
WE DON'T NECESSARILY KNOW HOW LONG BUT CERTAINLY THEY CAN BE
PRESENT BEYOND THE 12 MONTHS BETWEEN YOUR TYPICAL FLU
VACCINE, AND WE CHANGE THE FLU VACCINE EVERY YEAR.
SOMETIMES IT'S GOT SIMILAR COMPONENTS BUT HAS THREE OR
FOUR DIFFERENT TYPES OF FLU THAT ARE MOST LIKELY TO AFFECT
US DURING THAT FLU SEASON.
NOW, THE PREVIOUS YEAR, THERE MIGHT BE A DIFFERENT ONE OR TWO
THAT WILL OFFER IMMUNITY IN CASE THAT VIRUS COMES BACK AROUND.
>> YEAH, YEAH.
SO, IDEALLY, EVERYBODY GETS THE FLU SHOT EVERY YEAR WOULD
PROBABLY MAXIMIZE BOTH PERSONAL AND COMMUNITY IMMUNITY TO INFLUENZA.
>> YEAH.
>> ALL RIGHT.
A WOMAN FROM HOT SPRINGS WANTS TO KNOW IF SECONDHANDS SMOKE
EXPOSURE MIGHT INCREASE YOUR CHANCES FOR COPD?
>> YEP, WITHOUT QUESTION.
SECONDHAND SMOKE IS HARMFUL AND CERTAINLY INCREASES THE RISK
FOR ALL THE SAME CONDITIONS THAT PRIMARY SMOKE EXPOSURE
CAUSES INCREASED RISK FOR.
IT'S NOT NEARLY AT THE SAME LEVEL AS THAT BUT IT'S STILL A
REAL RISK AND SO IT'S UNFAIR, I THINK, TO ASK NON-SMOKERS TO BE
EXPOSED TO A HARMFUL SIDE EFFECTS LIKE SECONDHAND SMOKE.
IN OUR SOCIETY, THAT SHOULDN'T BE CONSIDERED ACCEPTABLE.
>> YEAH.
THAT'S THE REASON BEHIND A LOT OF LAWS THAT HAVE BEEN PASSED
OVER THE LAST TEN YEARS TO TRY TO PROTECT PEOPLE FROM THAT.
>> ABSOLUTELY.
>> ALL RIGHT.
A MAN FROM PARK, SOUTH DAKOTA, SAYS, I'M A PERSON THAT DOES
NOT TAKE THE FLU SHOT BECAUSE I'M ALLERGIC TO EGGS.
WHAT ARE MY OPTIONS?
>> SO, THIS YEAR, THE CURRENT RECOMMENDATIONS -- I'M GOING TO
STICK THIS IN THERE QUICK.
IF PEOPLE ARE LOOKING FOR INFORMATION ABOUT THE FLU
VACCINE, GO TO THE CENTERS FOR DISEASE CONTROL AND PREVENTION,
CDC, AND PUT IN FLU VACCINATIONS OR FLU FREQUENTLY
ASKED QUESTIONS, YOU'LL GET THE EVIDENCE.
BUT WHAT WE KNOW ABOUT EGG ALLERGIES IS IF YOU HAVE SEVERE
EGG ALLERGY, IF YOU'VE BEEN EXPOSED TO A VACCINE OR EGGS
AND YOU GET YOUR AIRWAY COMPROMISED, YOUR THROAT
SWELLS, BLOOD PRESSURE DROPS, YOU GET DIZZY OR PASS OUT, THEN
THE TRADITIONAL FLU VACCINATION IS NOT SAFE FOR YOU.
IF YOU JUST HAVE HIVES, THE RECOMMENDATION IS GETS THE FLU VACCINE.
THIS YEAR THE INJECTABLE FORM OF THE FLU VACCINE IS THE ONLY
ONE THAT'S APPROVED, NOT APPROVING THE FLU MIST BECAUSE
OF CONCERNS ABOUT ITS EFFICACY -- I WON'T COMMENT ON
THE REASONS, AND THEN THERE ARE SOME PREPARATIONS THAT ARE NOT
PREPARED WITH EGG, I THINK. I DIDN'T REVIEW THAT PART BUT --
>> THEY'RE HARDER TO COME BY.
>> BUT THERE COULD STILL BE OPTIONS FOR YOU, SO IF YOUR EGG
ALLERGY ISN'T A SEVERE ONE, IT'S SAFE TO GET THE FLU
VACCINE BUT DO IT AT YOUR DOCTOR'S OFFICE.
THAT'S THE ONE RECOMMENDATION IS DON'T GET IT AT THE PHARMACY
OR AT A FLU CLINIC, GO TO YOUR DOCTOR AND SAY, I HAVE THIS
MILD EGG ALLERGY, I WANT THE FLU VACCINE, WE'LL OBSERVE YOU
FOR 30 MINUTES AND MAKE SURE YOU DO OKAY.
>> SO THE VAST MAJORITY OF PEOPLE WHO HAVE HISTORIC EGG
ALLERGIES CAN SAFELY GET THE FLU SHOT.
>> ABSOLUTELY.
IT'S THE RARER CASES THAT HAVE A SEVERE EGG ALLERGY THAT CANNOT GET IT.
>> YEAH, GOOD.
A MAN FROM HURON WANTS TO KNOW IF THERE IS A CONNECTION
BETWEEN OBESITY AND LUNG DISEASE.
>> THERE IS A CONNECTION.
WE DON'T NECESSARILY UNDERSTAND IT 100% BUT THERE ARE STUDIES
SHOWING AN INCREASED RISK FOR ASTHMA IN PATIENTS WHO ARE OBESE.
CERTAINLY THERE IS A CONDITION KNOWN AS RESTRICTIVE LUNG DISEASE.
WE TOUCHED ON OBSTRUCTIVE PULMONARY DISEASE, COPD, THERE
IS A CONDITION CALLED RESTRICTIVE LUNG DISEASE WHERE
THE LUNG VOLUMES ARE REDUCED, THE LUNGS ARE SMALLER, THAT'S A
GOOD WAY TO THINK OF IT, AND WHEN YOU'RE VERY OBESE, YOUR
CHEST WALL IS HEAVIER AND LARGER AND THAT CAN RESTRICT
YOUR ABILITY TO FILL YOUR LUNGS WITH AIR.
YOUR ABDOMEN MIGHT BE LARGE, MIGHT PUSH YOUR DIAPHRAGM UP
INTO YOUR CHEST AND PREVENT YOU FROM BEING ABLE TO LOWER YOUR
DIAPHRAGM, DECREASE YOUR THORACIC PRESSURES AND GET AIR
IN SO OBESITY CAN BE CONNECTED TO LUNG DISEASES.
ANOTHER CONDITION IS SLEEP APNEA WHICH CAN AFFECT YOUR
BREATHING, TOO, SO, YES, IT'S GETTING THAT WEIGHT OFF OR NOT
GAINING TOO MUCH WEIGHT IS IMPORTANT FOR LUNG HEALTH.
>> YEAH, YEAH.
CAN YOU TALK A LITTLE BIT ABOUT HOW SLEEP APNEA AND HOW OBESITY
IS A RISK FACTOR FOR THAT?
>> IT'S A PRIMARY RISK FACTOR AND THE REASON IS AS YOU GAIN
WEIGHT, YOUR BODY GETS LARGER, YOUR AIRWAY GETS SMALLER, THE TISSUES IN YOUR POSTERIOR
PHALANX, THE AREA BEHIND OUR TONGUE, THEY SWELL AND AS YOU
FALL OFF TO SLEEP, THAT AIRWAY COLLAPSES AND THAT OBSTRUCTS
YOUR ABILITY TO GET AIR INTO YOUR LUNGS.
NOT A PROBLEM WITH THE WAY YOUR LUNGS WORK, IT'S A PROBLEM WITH
GETTING AIR TO YOUR LUNGS.
AND THAT CAN LEAD TO OTHER COMPLICATIONS LIKE PULMONARY
HYPERTENSION AND HIGH BLOOD PRESSURE AND OTHER
COMPLICATIONS THAT MAKE YOUR HEALTH POORER.
AND OF COURSE IT AFFECTS THE WAY YOU FEEL.
>> RIGHT, MOST PEOPLE ARE VERY TIRED, MIGHT FALL ASLEEP AT THE WHEEL.
>> EVEN IF THEY'RE NOT TIRED, THEIR MOOD IS ALTERED, THEIR
COGNITION, THE SHARPNESS OF THEIR THINKING IS ALTERED AND
THE QUALITY OF LIFE IS REDUCED.
>> YEP, YEP, GOOD.
WE'VE MENTIONED BRIEFLY ASTHMA.
NOW, ASTHMA AND COPD KIND OF FALL UNDER THE SAME UMBRELLA
OF WHAT WE CALL OBSTRUCTIVE LUNG DISEASE BUT WHAT ARE THE DIFFERENCES?
>> SO, I'LL TRY TO TOUCH JUST QUICKLY ON THE BIGGEST DIFFERENCES.
CHRONIC OBSTRUCTIVE PULMONARY DISEASE MEANS THAT YOU
DEVELOP AIR FLOW OBSTRUCTION THAT IS PERMANENT AND CHRONIC, LONG TERM.
ASTHMATICS HAVE A MORE ACUTE OBSTRUCTIVE PULMONARY DISEASE
WHEN THEY'RE EXACERBATED, WHEN THEY'RE SICK BECAUSE OF
WHATEVER TRIGGER, THEY CAN'T GET THE AIR OUT AND THEY'RE
SHORT OF BREATH AND THEY'RE COUGHING AND WHEEZING.
IT'S DRIVEN BY AN EACINAPHILIC PROCESS, A TYPE
OF CELL IN OUR BODY AND OFTEN ASSOCIATED WITH ALLERGIES.
ALLERGIES DOESN'T CAUSE ALLERGIES OR VICE VERSA BUT THE TWO ARE RELATED.
THE TREATMENT FOR AS MARK THE PATIENTS GET A TRIGGER, WHETHER
A COLD OR EXPOSURE TO PERFUME OR CIGARETTES OR WHATEVER, THEY
COUGH, WHEEZE, SHORT OF BREATH.
WE TREAT WITH STEROIDS, BRONCHODILATORS, THEY RECOVER
AND THEIR LUNG FUNCTION RETURNS TO NORMAL.
COPD, MORE CHRONIC, LESS ABOUT THE EACINPHILS AND MORE ABOUT
OTHER THINGS, DIFFERENT TYPES OF BLOOD CELLS AND INFLAMMATION.
CHRONIC EXPOSURE, SMOKING, OCCUPATIONAL THINGS.
THEY CAN HAVE TRIGGERS, AS WELL, BUT WHEN WE -- EVEN WHEN
THEY'RE NORMAL WITH THE BREATHING, THEY HAVE
OBSTRUCTIVE PHYSIOLOGY SO THEY'RE PERMANENTLY OBSTRUCTED.
THEY NEED MORE LONG-TERM MAINTENANCE WITH WHAT'S CALLED
BRONCHODILATOR MEDICATIONS, LESS ABOUT STEROIDS.
STEROIDS STILL CAN PLAY A ROLE BUT SHOULD BE LIMITED.
ASTHMA STEROIDS ARE THE CORNERSTONE OR MOST IMPORTANT TREATMENT.
>> AND ASTHMA OFTEN DIAGNOSED IN CHILDHOOD BUT NOT ALWAYS.
>> I THINK IT'S IMPORTANT TO RECOGNIZE THAT PART OF THINGS, TOO.
COPD DEVELOPS LATER IN LIFE.
ASTHMA IS TYPICALLY ASSOCIATED WITH A PATTERN OF SYMPTOMS
THAT'S PRESENT IN CHILDHOOD.
OCCASIONALLY IT'S ADULT ONSET AND THEN I DO HAVE SOME VERY
SEVERE ASTHMATTICS WHO ARE COPD PATIENTS, THEIR ASTHMA JUST
RESULTED IN INFLAMMATION THAT CAUSED THEIR AIRWAY TO REMODEL
AND BECOME CHRONICALLY OBSTRUCTED.
>> SURE, WE TALK ABOUT IN ADULTS, SOMETIMES THERE IS A
CROSSOVER SYNDROME, NOT REALLY CLEAR WHAT THE PRIMARY CULPRIT
IS AND THEY KIND OF CAN ACT THE SAME WAY WHEN IT'S SEVERE.
>> I SAW TWO TODAY, I WOULD CALL THOSE OVERLAP SYNDROME
WHERE THEY HAVE COPD AND ASTHMA AND, YOU KNOW, THEN THE
TREATMENT'S A LITTLE DIFFERENT THAN ONE OR THE OTHER.
>> YEAH, GREAT, OKAY.
A WOMAN FROM BROOKINGS FEELS SHE NEEDS TO TAKE A DEEP BREATH
EVERY NOW AND THEN TO REGAIN HER BREATH BUT IT'S NOT
ASSOCIATED WITH PHYSICAL EXERTION.
WHAT SHOULD SHE DO?
>> THAT'S ACTUALLY PRETTY NORMAL.
SIGHING RESPIRATIONS ARE AN IMPORTANT PART OF WHAT WE DO
EVERY DAY, NOT JUST BECAUSE YOUR SPOUSE HAS FRUSTRATED YOU
OR YOUR KIDS HAVE DONE SOMETHING THAT MAKES YOU UNHAPPY.
IT'S NORMAL TO TAKE A BIG, DEEP BREATH AND SIGH, AND PART OF
THAT IS TO CORRECT SOMETHING CALLED MICROATELECTASIS, WHERE
THE SMALLER PORTIONS OF OUR AIRWAY WHEN WE DON'T TAKE THE
BIG DEEP BREATHS COLLECT ON THEMSELVES AND THAT SIGHING
RESPIRATION CORRECTS THAT SO I ACTUALLY TELL PATIENTS SIGHING
IS A NORMAL PHENOMENON, MAYBE PRACTICE SOME DEEP BREATHING
AND SIGHING EVERY HOUR OR TWO TO PREVENT THE COMPLICATIONS.
NOW, COULD IT BE INDICATIVE OF SOMETHING MORE SERIOUS?
I SUPPOSE THAT'S POSSIBLE BUT IF THAT'S THE ONLY SYMPTOM OR
THE ONLY THING SHE NOTICES, IT'S PROBABLY NORMAL.
>> IF SHE'S NOT SHORT OF BREATH WHEN SHE DOES EXERT HERSELF,
FOR EXAMPLE, PROBABLY NOT A REAL LUNG DISEASE.
>> PROBABLY NORMAL.
>> GREAT, OKAY.
>> TO CORRECTLY DIAGNOSE AND CHOOSE TREATMENT, IT MAY BE
HELPFUL TO "SEE" THE LUNGS.
THERE IS AN ALPHABET SOUP OF TESTS AND EQUIPMENT TO HELP
YOUR PHYSICIAN TO LOOK INSIDE YOUR CHEST.
>> PNEUMONIA, EMPHYSEMA, PULMONARY EMBOLISM WILL ALL SHOW UP.
A CHEST X-RAY IS A TOOL USUALLY USED, THERE IS A 3D IMAGE OF A
BODY AND THIS IS FROM THE PET EXAM AND THIS BIG BLACK AREA IS A TUMOR.
THIS IS THE LUNG CANCER.
THIS IS IN THE LEFT SIDE OF THE PATIENT, LOOKING AT A MIRROR
IMAGE OF THE PATIENTS SO LEFT AND RIGHT ARE KIND OF SWITCHED.
HERE IS A CROSS-SECTIONAL IMAGE THROUGH THAT AND THIS IS THE
BIG LUNG MASS THAT WE'RE SEEING ON THIS FIRST MONITOR.
THIS MONITOR SHOWS A CHEST X-RAY, THIS PERSON PROBABLY
STARTED WITH A CHEST PRAY, MAYBE HAD SOME SHORTNESS OF BREATH OR COUGH.
WE STILL DO CHEST X-RAYS, TWO WAYS TO DO THAT, A PORTABLE
EXAM IS ONE VIEW AND A VIEW FROM THE FRONT AND SIDE.
THIS IS A TWO-VIEW CHEST X-RAY, WHAT WE CALL A P.A. AND LATERAL
ON A YOUNG LADY AND IT'S NORMAL.
IF THERE WERE PNEUMONIA, YOU WOULD SEE IT AS A WHITE AREA OR
SOMETHING, OR A SPOT OR A TUMOR THAT WOULD SHOW UP.
THE CENTER IMAGE IS FROM WHAT WE CALL A HIGH RESOLUTION CHEST
C.T., JUST DONE IN A SPECIFIC FASHION, IT'S STILL A CHEST
C.T. BUT THINNER IMAGES AND SPECIAL TECHNIQUES.
AND THIS IS -- YOU'LL SEE THE DIAPHRAGM IS FLATTENED.
YOU CAN SEE ALL THE BLACK AREAS.
THIS IS REALLY EXTENSIVE EMPHYSEMA.
THIS CHEST X-RAY SHOWS EMPHYSEMA, FLAT DIAPHRAGMS, AND
IN THE FAR RIGHT, JUST CONFIRMING THIS IS ANOTHER --
THIS IS IN THE AXIAL PLANE AGAIN, SHOWING A LOT OF EMPHYSEMA.
THIS SHOWS A CAVITY, PROBABLY BETTER SEEN ON A CORONAL PLANE
BUT THIS IS A LUNG CAVITY, COULD BE ADVANCED PNEUMONIA.
HERE'S THE CAVITY WITH A ROUND SPACE IN IT, A MASS THAT NOW
HAS CAVITATED, EITHER BECAUSE OF NECROTIC TUMOR OR PNEUMONIA.
IF SOMEBODY COMES INTO THE EMERGENCY DEPARTMENT WITH
SHORTNESS OF BREATH AND CONCERNED ABOUT A BLOOD CLOT ON
THE LUNG, THEY'LL DO A SPECIFIC TEST TO LOOK FOR THE PULMONARY EMBOLISM.
THIS IS A C.T., SPECIFICALLY DONE TO LOOK FOR BLOOD CLOTS ON
THE LUNGS, AND THESE BLACK THINGS ARE CLOTS WITHIN THE PULMONARY ARTERIES.
THIS IS WHAT WE CALL AXIAL IMAGES THROUGH A CHEST CT, SPECIAL TIMING.
THIS BLACK AREA IS EMBOLIST, BLOOD CLOT IN THE LUNG.
THERE IS ANOTHER ONE OVER HERE.
THERE'S QUITE A FEW ON EACH SIDE.
ONE OF THE CONCERNS IN SOUTH DAKOTA IS WITH A RURAL
MEDICINE, YOU DON'T HAVE THE TOOLS AT EVERY SITE BUT
PROBABLY THEY HAVE ACCESS TO A CHEST MACHINE, SO A CHEST X-RAY.
IF THERE'S SOME UNUSUAL DENSITIES OR SOMETHING, THEN
THEY CAN INVESTIGATE FURTHER WITH A C.T., AND THERE IS A LOT
OF HOSPITALS THAT WILL HAVE A C.T. UNIT SO IT'S VERY
ACCESSIBLE FOR THAT AND PRETTY COST EFFECTIVE.
I WOULDN'T USE IT ON EVERYBODY BUT IT CAN HELP DETERMINE, YOU
KNOW, WHAT THE DOCTORS ARE LOOKING FOR.
>> AND WE'RE BACK.
SO LOTS OF IMAGING CAN BE DONE WHEN FOCUS ON THE LUNGS AND WE
TAKE CARE TO TRY AND CHOOSE THAT WISELY IN A WAY THAT
DOESN'T EXPOSE OUR PATIENTS, BOTH TO UNNECESSARY RADIATION
BUT ALSO TO FINDING OF THINGS THAT ARE MEANINGLESS THAT LEADS
TO A LOT OF EXTRA TESTING AND MEDICAL CARE.
>> AND I THINK THAT'S IMPORTANT FOR ALL PATIENTS AND THEIR
PHYSICIANS TO RECOGNIZE, TESTING IS IMPORTANT BUT IT
NEEDS TO BE CHOSEN BASED UPON SYMPTOMS AND SIGNS OF DISEASE
AND THERE'S NO COOKBOOK TO MEDICINE WHEN IT COMES TO DOING
TESTS BECAUSE YOU HAVE TO DEAL WITH THE RESULTS AND MANY TIMES
THE RESULTS ARE FALSELY POSITIVE OR FALSELY NEGATIVE SO
EVERYTHING IS LIMITED TO ITS ABILITY BASED UPON THE PRE-TEST
PROBABILITY OF AN ILLNESS.
SO IT'S GREAT TO HAVE ALL THE TECHNOLOGY AVAILABLE OUT THERE
BUT YOU HAVE TO MAKE SURE YOU UNDERSTAND WHY YOUR PHYSICIAN IS USING IT.
DON'T BE AFRAID TO ASK, WHY ARE YOU DOING THIS TEST?
>> YEAH, GREAT.
ALL RIGHT.
LET'S GET BACK TO OUR QUESTIONS BECAUSE WE HAVE A LOT OF THEM.
A WOMAN FROM PIPESTONE GOT A FLU SHOT IN HER ARM THREE
MONTHS AGO AND IT STILL HURTS.
THAT'S NOT SOMETHING THAT I'VE SEEN.
DO YOU HAVE ANY THOUGHTS ON THAT?
>> NO, SO IT'S NORMAL FOR THERE TO BE SOME DISCOMFORT AFTER A
FLU SHOT, YOU SHOULD EXPERIENCE.
THE SHOT SHOULD BE GIVEN AND YOU'LL NOTICE SOME
SORENESS IN THAT AREA FOR A DAY, MAYBE TWO DAYS AFTERWARDS.
THAT'S JUST THE LOCAL REACTION TO THE FLU SHOT.
I SUPPOSE MAYBE A NERVE COULD HAVE BEEN AFFECTED BY THE SHOT.
>> SURE, YEAH.
>> I WOULD THINK IT'S SOMETHING ELSE, PROBABLY NOT THE FLU
SHOT, MAYBE A ROTATOR CUFF PROBLEM OR -- PROBABLY NOT RELATED TO THE FLU SHOT.
>> SIMILAR QUESTION, A WOMAN FROM BROOKINGS WONDERING IF
IT'S COMMON TO HAVE RASH, REDNESS AND PAIN FROM THE HIGH-DOSE VACCINE.
DO WE SEE MORE SIDE EFFECTS FROM THE HIGH-DOSE VACCINE COMPARED TO THE NORMAL DOSE?
>> NOT THAT I'M AWARE OF.
YOU CAN HAVE A REACTION AND PUT A LITTLE ICE ON THE AREA BUT SHOULDN'T BE
ANY MORE LIKELY WITH THE HIGH DOSE THAN THE REGULAR DOSE.
>> ALL RIGHT, GOOD.
LET'S STICK WITH THE FLU SHOT.
A MAN FROM SIOUX FALLS ASKS DO THEY RECOMMEND THE HIGH-DOSE OR QUADRAVALENT, AND WHY?
THERE'S ALL THESE FLU VACCINES, WHERE DO THE RECOMMENDATIONS COME FROM?
>> SO THE EXPERTS WITH THE FEDERAL GOVERNMENT WHO DESIGN
THE FLU SHOT EACH YEAR BASED UPON THE MOST LIKELY FLU STRAIN
TO AFFECT US IN THE UNITED STATES, TURN THAT INFORMATION OVER TO THE MANUFACTURERS.
TYPICALLY MAKE AT LEAST A TRIVALENT BUT IN SOMETIMES A
QUADRIVALENT, MAYBE TO SELL THEIR PRODUCT.
IS IT TO MORE ADVANTAGE?
POTENTIALLY.
THE HIGH DOSE AGAIN, YOU TALKED ABOUT THAT A LITTLE BIT
EARLIER, IT'S CONTROVERSIAL ABOUT JUST HOW IMPORTANT THAT IS.
AS WE GET OLDER OR WE HAVE CHRONIC ILLNESS, OUR BODY'S
IMMUNE SYSTEM MAYBE ISN'T AS EFFECTIVE AS IT COULD BE IF WE
WERE YOUNGER OR HEALTHIER AND THE IDEA IS TO STIMULATE IT
WITH A LITTLE MORE OF THE VIRUS TO CAUSE THAT IMMUNE REACTION TO BE MORE EFFECTIVE.
BUT I THINK IT WOULD BE HARD FOR ME TO NECESSARILY QUOTE
SPECIFIC STUDIES THAT SAID THE HIGH DOSE FLU VACCINE DOES THAT.
>> I THINK THERE ARE STUDIES THAT SAY THAT PEOPLE OVER 65 PRODUCE MORE ANTIBODIES,
WHETHER THAT TRANSLATES INTO WHAT WE CALL CLINICAL BENEFIT
IS TO BE DETERMINED BUT NOT POTENTIAL HARM THAT WE KNOW OF.
>> RIGHT, AND THAT'S ALWAYS THE QUESTION WITH VACCINATION IS
ARE WE PREVENTING DEATH WITH VACCINATIONS OR NOT AND THE
LONG AND SHORT, IT DOESN'T MATTER IF WE'RE PREVENTING SIGNIFICANT MORBIDITY, INJURY
AND ILLNESS TO OUR COMMUNITY WHEN WE VACCINATE, NO ARGUMENT ABOUT THAT.
>> CHANGING GEARS HERE, A WOMAN FROM HERMOSA HAS NOTED
CHEMICALS ON THE ROAD IN RAPID CITY THAT LOOKS LIKE A FOG.
IS IT MAGNESIUM CHLORIDE AND DOES IT HAVE ANY EFFECT ON A PERSON'S LUNGS?
>> THAT'S NOT A QUESTION I CAN ANSWER, YOU MIGHT HAVE TO
CONTACT THE DEPARTMENT OF TRANSPORTATION OR THE ROADS
DEPARTMENT ABOUT THAT.
CERTAINLY, I THINK FUMES THAT ARE PRESENT IN THE AIR CAN BE HARMFUL TO US.
YOU KNOW, YOU DON'T WANT TO EXPOSE YOURSELF TO ANYTHING THAT MIGHT HARM YOUR LUNGS.
A LOT OF THAT STUFF IS JUST CONDENSATION OR STEAM OR VAPORS AS
OPPOSED TO TRULY CHEMICAL FUMES AND I SUSPECT WHAT SHE'S
SEEING, I MIGHT BE GOING OUT ON A LIMB, BUT IS THE PROCESS OF
THAT CHEMICAL MELTING THE ICE OR THE WATER CAUSING SOME
CONDENSATION OR EVAPORATION.
I CAN'T SAY FOR SURE.
>> YEAH, YEAH, CERTAINLY.
AND THERE IS SOME REAL CHEMICAL EXPOSURE, THERE'S POLLUTION IN
LARGE URBAN AREAS THAT CAN CONTRIBUTE TO LUNG DISEASE, TOO.
ANYTHING THAT WE SEE IN SOUTH DAKOTA THAT YOU --
>> SO, OCCUPATIONAL EXPOSURES ARE A REAL PHENOMENON.
PATIENTS, YOU KNOW, IN PLANTS WHERE CHEMICALS ARE UTILIZED TO
BREAK DOWN WHETHER IT'S METALS OR CLEANING PRODUCTS OR EVEN IN
YOUR OWN HOME TO MAKE THE MISTAKES OF MIXING A BLEACH
WITH A BASE, A VINEGAR-TYPE BASIC SUBSTANCE WITH A CHLORINE
BLEACH, YOU CAN GET EXPOSED TO VERY TOXIC CHEMICALS.
FARMERS CAN DEVELOP CONDITIONS LIKE FARMER'S LUNG WHICH ISN'T
ACTUALLY DUE TO DUST EXPOSURE ALONE BUT AN ALLERGIC REACTION
TO SOME OF THE THINGS IN THE SOIL.
SO IT'S IMPORTANT EVEN IF YOU'RE NOT A SMOKER, IF YOU'RE
EXPOSED IN YOUR OCCUPATION TO CERTAIN NOXIOUS OR INHALED
SUBSTANCES TO TALK TO YOUR DOCTOR ABOUT THE SYMPTOMS.
>> YEP, AND THAT'S WHY WE SOMETIMES ASK THE QUESTIONS
THAT YOU WONDER WHY WE ASKED YOU FOR THAT, WE'RE DIGGING FOR THE EXPOSURES.
A WOMAN FROM WORTHINGTON HAS HAD A SINUS INFECTION FOR TWO
TO THREE WEEKS AS WELL AS GENERAL CONGESTION.
IS THIS THE FLU?
NO.
>> NO.
SO WHAT'S IMPORTANT TO RECOGNIZE IS THE FLU HAS A VERY
SPECIFIC SET OF SYMPTOMS AND THEY'RE LIMITED SO WHEN YOU GET
EXPOSED TO INFLUENZA, YOU'LL HAVE A SORE THROAT, TICKLE,
ITCHY SORE THROAT THAT MAKES YOU WANT TO COUGH, YOUR NOSE
WILL DRIP AND DRAIN AND MAYBE THE CONGESTION IS THE BODY'S RESPONSE TO THE INFECTION.
YOUR BODY WILL RELEASE THINGS TO FIGHT THE INFECTION THAT
THEN CAUSES YOU TO MAYBE HAVE BODY ACHES AND A FEVER.
SO THOSE ARE THE BIG SYMPTOMS, SORE THROAT, HAVE A TICKLE THAT
MIGHT MAKE YOU COUGH, YOUR NOSE IS GOING TO DRIP AND DRAIN,
MAYBE CONGESTED AND BODY ACHES AND FEVER.
FEEL PRETTY MISERABLE.
THAT'S GOING TO LAST THREE TO FIVE DAYS.
THAT'S THE TYPICAL FLU.
MAYBE A WEEK, MAYBE TEN DAYS BUT IF IT'S BEYOND, THAT YOU'VE
DEVELOPED A SECONDARY COMPLICATION TO THE FLU.
YOU'VE GOT SOMETHING ELSE GOING ON.
AND SINUS SYMPTOMS ARE COMMON.
WE ALL GET SINUS SYMPTOMS AND MOST THE TIME, THEY'RE SELF-LIMITED.
YOU DON'T NEED TREATMENT TO SINUS SYMPTOMS THAT ARE A WEEK
OR TWO LONG, MAYBE EVEN THREE WEEKS.
AFTER THAT, THEN IT'S MAYBE TIME TO TALK TO YOUR DOCTOR
ABOUT POSSIBLY HAVING A SINUS INFECTION.
NO, THAT'S NOT THE FLU.
>> A MAN FROM SIOUX FALLS USES A NON-VENTED SPACE HEATER TO
KEEP HIS HOME WARM.
IS THERE A DANGER FOR GAS LEAK IN THE HOME DUE TO THE LACK OF VENTING?
>> SO DEPENDS UPON THE FUEL SOURCE.
IS IT CARBON-BASED, LIKE A GAS OR PROPANE OR COAL OR WOOD, IF
IT'S A SPACE HEATER, PROBABLY ELECTRIC SO REALLY ELECTRIC
DOESN'T PRODUCE CARBON DIOXIDE OR CARBON MONOXIDE, I SHOULD
SAY, WHICH IS THE TOXIC THING WE WORRY ABOUT WITHOUT VENTING.
IF IT'S ELECTRIC, THE BIGGEST RISK IS THE THING FALLING OVER OR CATCHING FIRE.
THEN IT'S GOING TO GIVE YOU A BUNCH OF PROBLEMS BUT IF IT'S
BURNING A CARBON-BASED FUEL LIKE PROPANE, NATURAL GAS,
KEROSENE, COAL OR WOOD, THEN ABSOLUTELY, BIG RISK IF IT'S NOT VENTED PROPERLY.
>> YEP, YEP.
I RECENTLY SAW A PATIENT WHO LIVES NEAR IN OUR COMMUNITY AND
USES A WOOD-BURNING STOVE AND A POORLY VENTILATED HOUSE AND WE
DID HAVE TO WORRY ABOUT CARBON MONOXIDE POISONING.
I'M A CARE-TAKER FOR MY FATHER WHO IS ABLE-BODIED, HE IS NOW
87, NEVER SMOKED BUT IS NOW SHORT OF BREATH.
HE WORKED IN AN ENVIRONMENT THAT HAD ASBESTOS.
HE REFUSES TO SEE DOCTORS.
WHAT CAN BE DONE?
>> I THINK IT'S DIFFICULT TO KNOW, ASBESTOS EXPOSURE WAS
COMMON AMONG LABORERS, THOSE IN THE MILITARY AND CAUSES MOST
OFTEN A DISEASE OF THE PLEURA, WHICH IS PRETTY INNOCENT AND BENIGN.
>> THE LINING OF THE LUNG.
>> THE LINING OF THE LUNGS AND IT'S MORE OF PHENOMENON THAT'S
FOUND ON X-RAY THAN IT IS NECESSARILY A CLINICAL
CONDITION BUT IT CAN ALSO CAUSE AN INTERSTITIAL DISEASE,
SCARRING IN THE LUNG CALLED ASBESTOSIS.
TOTALLY DIFFERENT THAN THE LINING OF THE LUNG DISEASE.
ONLY WAY TO KNOW IS FOR HIM TO SEE A DOCTOR, HAVE AN EXAM, DO
A CHEST X-RAY, MAYBE A BREATHING TEST.
AT 80-PLUS YEARS OF AGE, 87, THERE IS A VARIETY OF OTHER
POSSIBLE CAUSES FOR SHORTNESS OF BREATH AND THAT'S IMPORTANT
FOR ALL PATIENTS, JUST BECAUSE YOU'RE SHORT OF BREATH DOESN'T
MEAN YOU HAVE LUNG DISEASE.
IT COULD BE YOUR HEART, IT COULD BE, YOU KNOW, ANEMIAS,
BLOOD COUNT DISORDERS, KIDNEY DYSFUNCTION, LIVER DYSFUNCTION,
SO THE LUNGS ARE OFTEN AN INNOCENT BYSTANDER TO OTHER
DISEASE PROCESSES THAT MAKE YOU FEEL SHORT OF BREATH.
>> YEAH.
>> SO IT'S NECESSARY TO TAKE A HISTORY OR TO SEE A DOCTOR AND
TALK ABOUT ALL THE POSSIBLE CAUSES.
>> YEAH, YEAH.
A HISTORY AND THE PHYSICAL EXAM GOES A LONG WAY TO HELPING US
UNDERSTAND WHAT MIGHT BE CAUSING THAT.
>> SO IF -- HE SHOULD MAYBE SEE A DOCTOR IF HE'S SYMPTOMATIC ENOUGH.
>> A WOMAN FROM HURON WOULD LIKE US TO DISCUSS THE IDEA OF
PULMONARY ARTERIAL HYPERTENSION.
>> WE TALKED A LITTLE BIT ABOUT THIS BEFORE, NOT A COMMON
CONDITION, IT HAPPENS FOR A VARIETY OF REASONS, WE'LL
SEPARATE IT QUICKLY BETWEEN WHAT'S CALLED PRIMARY PULMONARY
HYPERTENSION, DIFFERENT FROM SECONDARY.
PRIMARY IS YOUNG WOMEN, TYPICALLY, WOMEN IN THEIR LATE
20s, EARLY 30s, WHO ARE PERFECTLY HEALTHY OTHERWISE BUT
HAVE THIS SHORTNESS OF BREATH THAT'S INSIDIOUS AND WORSENS OVER TIME FOR NO GOOD REASON.
THEY DON'T HAVE -- THEY'RE NOT SMOKERS, DON'T HAVE OTHER
CONDITIONS THAT CAUSE THEM TO HAVE LUNG DISEASE.
AND THAT'S AN INHERITED PROBLEM, BASICALLY, AND
SOMETHING TO DO WITH THE SMOOTH MUSCLE IN THE ARTERIES OF THE
LUNG THAT CAUSES THE PRESSURES TO BE HIGHER AND MAKES THE
HEART WORK HARDER TO PUMP BLOOD TO THE LUNGS.
THOSE PATIENTS NEED SPECIALTY CARE, THEY NEED TO GO TO
SOMEPLACE THAT HAS PULMONARY HYPERTENSION EXPERTS.
SECONDARY PULMONARY HYPERTENSION IS MUCH MORE
COMMON AND A CONSEQUENCE ALMOST EVERY TIME OF ANOTHER DISEASE PROCESS.
WHETHER IT'S HEART DISEASE OR LUNG DISEASE, IT'S TYPICALLY ONE OF THOSE THINGS.
SMOKERS WITH BAD EMPHYSEMA WILL DEVELOP PULMONARY HYPERTENSION INDUCED BY -- LEVELS.
THE TRICK IS MANAGING IT.
PATIENTS WHO GET BLOOD CLOTS IN THEIR LUNGS WILL DEVELOP THIS.
PATIENTS WHO HAVE CONNECTIVE TISSUE IN THEIR DISEASES, RARE
CONDITIONS LIKE LUPUS AND OTHER CONNECTIVE TISSUE DISEASES CAN
GET A PULMONARY HYPERTENSION SYNDROME.
MANAGE THAT DISEASE PROCESS.
AND THOSE WHO HAVE LEFT VENTRICULAR DISEASE, CAN GET RIGHT HEART DISEASE.
MOST OF THEM IT'S ABOUT TREATING THE DISEASE THAT LED TO THE PULMONARY HYPERTENSION.
SOMETIMES ALSO BEING ON MEDICINES TO TREAT THAT HIGH PRESSURE IN THE LUNGS.
IT'S DIFFERENT THAN THE BLOOD PRESSURE WE MEASURE ON YOUR
ARM, IT CAN ONLY BE ESTIMATED EITHER BY ULTRASOUND OF YOUR
HEART OR ANOTHER TEST CALLED THE RIGHT HEART CATHETERIZATION.
>> YEP, YEP, GOOD, AND THE FIRST PORTION THAT YOU TALKED
ABOUT, THE PRIMARY PULMONARY HYPERTENSION, RARE, SOMETIMES
GOES UNDIAGNOSED FOR A PERIOD OF TIME BECAUSE WE DON'T SEE IT VERY OFTEN.
EXAMS KINDS OF LIKE NORMAL FOR A PERIOD OF TIME UNTIL THEY GET SEVERE.
>> THEY DO AND THOSE PATIENTS OFTEN ENDS UP ON A TRANSPLANT LIST.
[Overlapping Conversation]
IT'S A BAD DISEASE, A BAD DISEASE, BUT MUCH DIFFERENT THAN THE MAJORITY OF THE
PULMONARY HYPERTENSION YOU AND I SEE IN THE COMMUNITY EVERY DAY.
>> GOOD.
A WOMAN FROM TRIPP ASKS, WHAT ARE THE CAUSES FOR DVT, AND
THAT CAN BE ASSOCIATED WITH BLOOD CLOTS IN THE LUNGS.
>> YEAH, SO DEEP VENOUS THROMBOSIS RESULTS FROM CERTAIN
FACTORS WHERE THE BLOOD ISN'T FLOWING AS EFFECTIVELY AS IT
SHOULD IN OUR VEINS, OR IT'S MORE LIKELY TO CLOT, TO FORM A CLOT WHEN IT SHOULDN'T.
BLOOD NEEDS TO CLOT.
WHEN IT ESCAPES FROM THE VEIN OR OUTSIDE OF OUR BODY, IT
NEEDS TO CLOT TO PREVENT MORE BLEEDING FROM OCCURRING BUT
WHILE IT'S IN THE VEIN OR ARTERY, IT SHOULD FLOW FREELY.
IF WE'RE INACTIVE FOR A LONG PERIOD OF TIME, WHICH WE ALL
ARE WHEN WE SLEEP BUT FOR SOME REASON AFTER SURGERIES, WHEN
THERE'S OTHER INFLAMMATORY CHANGES AND INACTIVITY, THAT
BLOOD CAN BECOME MORE LIKELY TO FORM A CLOT, SO SURGERIES
MEDICAL ILLNESSES, IT'S WHY WHEN YOU GO IN THE HOSPITAL,
THEY MIGHT GIVE YOU A SHOT TO PREVENT BLOOD CLOTS OR PUT THE SQUEEZERS ON YOUR LEGS.
INHERITED FACTORS CAN PLAY A ROLE, MAYBE THAT'S WHAT SHE'S TOUCHING ON.
IF YOUR MOM AND SISTER HAD BLOOD CLOTS OR YOUR BROTHER,
YOU MAY HAVE A GENETIC FACTOR THAT INCREASES THE CHANCE THAT
YOU MIGHT HAVE A BLOOD CLOT.
IMPORTANT TO SORT OF DISCUSS THAT WITH YOUR DOCTORS, AND
THEN CERTAIN ILLNESSES LIKE CANCER CAN CAUSE YOUR BLOOD TO BE MORE LIKELY TO CLOT.
SMOKERS CAN HAVE AN INCREASED RISK FOR BLOOD CLOTS, AS WELL,
ESPECIALLY YOUNG WOMEN ON BIRTH CONTROL THAT SMOKE, ESTROGEN,
YOU KNOW, THERE'S SOME ASSOCIATION BETWEEN ORAL
CONTRACEPTION AND BLOOD CLOTS, TOO, SO IT'S MOSTLY STASIS,
ABOUT NOT MOVING LINE AFTER SURGERY OR ILLNESS AND THOSE
OTHER CONDITIONS WE TALKED ABOUT.
>> SO POSSIBLY A LOT OF FACTORS AND PROBABLY SOME THAT WE DON'T UNDERSTAND.
>> NO, MOST BLOOD CLOTS, WE DON'T KNOW WHY THEY HAPPEN, THEY JUST DID
>> A COUPLE OF MINUTES LEFT SO WE'LL TRY TO GET THROUGH THE QUESTIONS.
A WOMAN HAS NEVER HAD PROBLEMS WITH YOUR LUNGS AND SMOKED UNTIL HER LATE 20s.
AT AGE 73, SHE FOUND OUT SHE HAS SCARRING ON HER LUNGS.
SHE WORKED IN A POST OFFICE FOR MANY YEARS AND IS WONDERING IF
PAPER DUST COULD CAUSE THIS.
>> SHE'S GOT SCARRING IN THE LUNGS, TYPICALLY UNRELATED TO SMOKING.
MOST OF THE TIME WE DON'T KNOW WHY IT HAPPENED, IT'S IDIOPATHIC, BUT CERTAINLY THERE
IS INTERSTITIAL LUNG DISEASE OR SCARRING IN THE LUNGS ASSOCIATED WITH OCCUPATIONAL
EXPOSURES, OR RELATED TO OTHER ILLNESSES, LIKE RHEUMATOID
ARTHRITIS AND LUPUS AND, AGAIN, THOSE CONNECTSTIVE TISSUE DISEASES CAN CAUSE THAT.
I WOULD LOOK INTO THAT.
AND OCCUPATIONAL EXPOSURE, SOMETIMES PAPER MILLERS OR THOSE EXPOSED TO CHEMICALS FROM
PRINT AND DUST CAN DEVELOP AN INJURY IN THEIR LUNGS, THAT CAN LOOK LIKE PULMONARY FIBROSIS,
LIKE A HYPER SENSITIVITY PNEUMONITIS, A CHRONIC LUNG DISEASE.
THE THING TO DO IS LIKE THEY TALKED ABOUT ON THE IMAGING STUDIES, SEE YOUR DOCTOR, HAVE
AN EXAM, LISTENING TO YOUR LUNGS, THEY CAN OFTEN TELL IF YOU HAVE THIS.
DO A BREATHING TEST AND MAYBE GETS THAT C.T. SCAN THAT THEY TALKED ABOUT
>> YEAH, GOOD.
A WOMAN FROM ABERDEEN WOULD LIKE TO KNOW IF CONSECUTIVE FLU SHOTS CAN
CAUSE ALZHEIMER'S DISEASE.
>> NOT AWARE OF ANY CONNECTION BETWEEN FLU SHOTS AND ALZHEIMER'S DISEASE.
FLU SHOTS AND AUTISM, AND NONE OF THESE THINGS CAN BE PROVEN
TO HAVE A CORRELATION WITH ONE ANOTHER.
>> RIGHT, RIGHT, AND, YOU KNOW, AGAIN, ALZHEIMER'S BEING
COMMON, IT WOULD BE REALLY HARD TO ATTRIBUTE THAT TO FLU SHOTS.
>> I CAN'T THINK OF ANY PHYSIOLOGIC REASON THAT WOULD EVER BE RELATED TO ANOTHER.
>> RIGHT.
HAVE YOU SEEN ANY FLU IN THE HOSPITAL OR IN YOUR ICU THIS YEAR YET?
>> I DON'T THINK WE'VE HAD A CASE IN THE ICU, WE'VE HAD FLU IN THE HOSPITAL.
WE HAD AT LEAST ONE DEATH IN YANKTON COUNTY AND I THINK NOW
WE'RE UP OVER A THOUSAND FLU CASES FOR SOUTH DAKOTA THIS FLU SEASON.
>> YEP, YEP, NUMBERS AT THE ENDS OF THE SHOW.
>> OKAY, WE'LL TALK ABOUT THAT.
>> YEAH, GREAT.
ALL RIGHT.
>> AND NOW FOR THE WINNER OF TONIGHT'S PRAIRIE DOC QUIZ QUESTION.
PEOPLE WITH OBSTRUCTIVE LUNG DISEASE LIKE ASTHMA, EMPHYSEMA,
OR CHRONIC BRONCHITIS HAVE TROUBLE...
GETTING AIR IN?
OR GETTING AIR OUT?
THE CORRECT ANSWER IS OUT.
IF YOU CAN'T GET OLD AIR OUT OF YOUR LUNGS, YOU CAN'T BRING FRESH AIR BACK IN.
IT WAS ROSE MARY DRAGGER WHO ANSWERED THE QUESTION CORRECTLY.
THANK YOU FOR PARTICIPATING, AND A BOOK WILL BE IN THE MAIL TO YOU SOON!
WE'LL BE RIGHT BACK AFTER THIS...
>> BECAUSE THEY WANT YOU TO BE THERE FOR THE MANY MILESTONES
YET TO COME, BECAUSE YOU DON'T WANT TO MISS OUT ON THE LITTLE
THINGS, THERE ARE MANY REASONS TO GET LIFE-SAVING CANCER SCREENING.
ONE IN EIGHT WOMEN WILL BE DIAGNOSED WITH BREAST CANCER IN HER LIFETIME BUT REGULAR
SELF-EXAMS AND MAMMOGRAMS CAN CATCH IT EARLY WHEN IT'S MOST TREATABLE.
>> PROMISE?
>> PROMISE.
>> MAKE THE PROMISE TO GETS SCREENED.
DO IT FOR THE PEOPLE YOU LOVE.
FOR MORE INFORMATION ABOUT LIFE-SAVING SCREENINGS OR AVAILABLE FINANCE ASSISTANCE,
VISIT GETSCREENEDSD.ORG.
>> I KEEP A PACK OF CIGARETTES IN MY OFFICE.
IT WAS A GIFT FROM A PATIENT WHO DECIDED, AFTER NEARLY 20
YEARS OF MY ENCOURAGING, CAJOLING, AND QUITE FRANKLY
NAGGING, THAT IT WAS FINALLY TIME TO GIVE THEM UP.
THAT'S THE THING ABOUT CHANGING HABITS.
SOMETIMES IT TAKES A LONG TIME.
WE HAVE DIFFERENT WAYS OF UNDERSTANDING HOW PEOPLE APPROACH CHANGE.
ONE OF THE MOST UNIVERSALLY USED IS SOMETHING WE CALL "THE STAGES OF CHANGE."
PEOPLE MOVE FROM NOT BEING WILLING TO EVEN CONSIDER THE
DOWNSIDES OF THEIR CURRENT HABITS TO SEEING THOSE
DOWNSIDES AND WEIGHING THE ADVANTAGES OF A CHANGE, TO
MAKING PLANS TO DEVELOP NEW BEHAVIORS, AND THEN TO ACTIVELY PRACTICING THESE NEW HABITS.
FROM MY PERSPECTIVE, "PRACTICE" IS THE OFTEN UNDER-EMPHASIZED CONCEPT THERE.
DEVELOPING NEW HABITS, AND BREAKING OLD ONES, TAKES LOTS AND LOTS OF PRACTICE.
WHATEVER YOUR GOAL IS, BECOMING A NON-SMOKER, LOSING WEIGHT,
COMPLETING YOUR FIRST MARATHON, OR EVEN CLEANING OUT YOUR GARAGE, IT HELPS TO HAVE A
CONCRETE PLAN OF ACTION.
EXPECT SETBACKS.
I LIKE TO TELL MY PATIENTS THAT BABIES DON'T LEARN TO WALK OVERNIGHT.
FIRST THEY ROLL, THEN THEY SIT, THEN THEY CRAWL, THEN THEY CRUISE ALONG THE FURNITURE, AND
FINALLY THEY TAKE THOSE FIRST UNSTEADY STEPS.
IT TAKES THEM ABOUT A YEAR TO GET TO THAT POINT.
ALONG THE WAY, THEY FALL, A LOT.
BUT THEY KEEP GETTING BACK UP TO TRY IT AGAIN, AND IN WHAT
SEEMS LIKE THE BLINK OF AN EYE, THEY START RUNNING AWAY FROM YOU AT BEDTIME.
THERE ARE SOME TAKE-HOME LESSONS IN THAT STORY.
FIRST, CHANGE IS A PROCESS.
A DAUNTING CHALLENGE IS MORE APPROACHABLE IF YOU BREAK IT
DOWN INTO SMALLER, INCREMENTAL STEPS.
"GETTING HEALTHY" IS HARD.
GETTING TO BED HALF AN HOUR EARLIER IS EASIER.
SECOND, CONSIDER YOURSELF A LEARNER.
I LOVE TO ENCOURAGE SMOKERS NOT TO THINK OF IT AS QUITTING
SMOKING BUT AS LEARNING TO BE A NON-SMOKER.
IF YOU ARE QUITTING, AND YOU HAVE A CIGARETTE WITH YOUR
COFFEE, IT'S TEMPTING TO DECIDE YOU'VE FAILED AND THROW IN THE TOWEL.
IF YOU VIEW IT INSTEAD AS LEARNING NOT TO SMOKE, IT'S
EASIER TO FINISH THAT CIGARETTE, AND TRY AGAIN.
LEARNERS AREN'T FAILURES WHEN THEY HAVEN'T MASTERED THEIR TOPIC.
IF YOU SMOKE THAT CIGARETTE, ASK YOURSELF "WHY?"
AND THEN ASK YOURSELF, "WHAT CAN I DO INSTEAD, NEXT TIME?"
KEEP ASKING YOURSELF THOSE QUESTIONS.
KEEP GETTING BACK UP.
KEEP TRYING AGAIN.
TENACITY PAYS OFF.
I HAVE A PACK OF CIGARETTES TO PROVE IT.
>> A BIG THANK YOU TO OUR GUEST, DR. MICHAEL PIETILA, FOR
VOLUNTEERING TO TRAVEL TO OUR STUDIO TO HELP WITH TONIGHT'S PROGRAM.
THE FLU SPREAD EARLY THIS YEAR AND IT HAS ALREADY TAKEN A TOLL
IN THE U.S., INCLUDING SOUTH DAKOTA.
256 CASES WERE ADDED THIS WEEK, BRINGING US TO 1,038 STATEWIDE.
SADLY, THERE HAVE BEEN 8 DEATHS SO FAR THIS SEASON.
THE CDC RECOMMENDS EVERYONE OVER SIX MONTHS OLD GET A FLU SHOT.
GETTING YOUR SHOT NOW WILL GIVE YOU THE BEST PROTECTION DURING THE COMING MONTHS.
THAT DOES IT FOR TONIGHT.
FROM ALL OF US HERE AT "ON CALL WITH THE PRAIRIE DOC," UNTIL
NEXT TIME, STAY HEALTHY OUT THERE PEOPLE.
>> IT TRULY IS YOUR SHOW AS YOU MAY ASK ANYTHING MEDICAL AND
WE'LL DO OUR BEST TO ANSWER YOUR QUESTIONS.
NEXT TIME "ON CALL WITH THE PRAIRIE DOC."
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