Episode Transcript
[00:00:00] Speaker A: From Riverside Health System. This is the Healthy youy Podcast where we talk about a range of health related topics focused on improving your physical and mental health. We chat with our providers, team members, patients and caregivers to learn more about how to maintain a healthy lifestyle and improve overall physical and mental health. So let's dive in to learn more about becoming a healthier you.
I am really excited to have with me in the Healthy youy studio today, Dr. Anna Laurie. Dr. Amalauri is a board certified pulmonologist and a critical care medicine specialist with Riverside Pulmonary and sleep specialist. Welcome, Dr. Amalori.
[00:00:42] Speaker B: Thank you. Thank you for having me.
[00:00:44] Speaker A: It's awesome to have you. It's been too long. We've talked about it for a while. We're going to be talking about breathing easy and talking about winter common things that happen during the wintertime as it relates to respiratory problems. Problems. But first, I want to start out by just understanding how did you end up in this line of medicine?
[00:01:02] Speaker B: That's an interesting question. I say that because I did not consider pulmonary critical care specialty for the longest time. I was actually interested in pediatrics when I was in med school. And then it wasn't until my intern year in residency that I got exposed to pulmonary critical care medicine.
[00:01:21] Speaker A: Okay.
[00:01:21] Speaker B: I had a rotation in the medical ICU and I just fell in love with a specialty. I got a chance to take care of really, really sick patients. And majority of these patients had pulmonary conditions. So we're talking asthma exacerbation, COPD exacerbations, a lot of respiratory failure.
[00:01:36] Speaker A: Right.
[00:01:37] Speaker B: And it was through that process that I really enjoyed the pathophysiology of pulmonary conditions. I learned about the disease process. It was fascinating to me and that's why I decided to devote my career into this field. A lot of patients with lung disease, the conditions are not necessarily curable. Many of them are treatable. So I've had the opportunity to take care of a lot of wonderful patients over years and build that rapport, build that trust. So when I see these patients come in the next visit, they're feeling better, they're breathing better, their symptoms are gone, their quality of life is improved. For me, it's all about the quality of life, keeping them as functional as possible. Seeing that really motivates me and makes me happy that I'm making a difference and making an impact in the patient's lives. Keeping them out of the hospital and just teaching them ways to improve their overall lung health.
[00:02:33] Speaker A: Right. You're definitely an overachiever.
And I'm A former critical care nurse, so have worked closely with intensivists and pulmonary specialists. And that collaboration and rapport is so important in the treatment of the patient.
[00:02:47] Speaker B: Absolutely.
[00:02:48] Speaker A: So did you always know you want to be a doctor?
[00:02:50] Speaker B: Yes, kind of. I know it was. Yeah, that was, that was very easy for me to know from when I was young, like in, in elementary school. I just already knew. Yeah. Medicine.
[00:03:01] Speaker A: All right. All right. So, Dr. Anna Lori, before we dive into this topic, we've already talked about what really inspired you. So first we want to talk about more of winter specific things and then what people can do to kind of avoid some of those things.
[00:03:23] Speaker B: So in the winter, in particular, patients have, a lot of patients develop lung conditions, and some people that are, that have no chronic lung problems actually end up showing up with bronchitis or newly diagnosed asthma in the winter.
[00:03:40] Speaker A: So what is, so what is bronchitis? Just for our viewers who may not have a background in medicine, and then what is copd? What are some of those conditions and what causes those, of course, things.
[00:03:51] Speaker B: So bronchitis is a. Just a term to say inflammation of the bronchial tubes, which is one of the tubes in the, in the airway. So we have the trachea, which is the main airway, and then divides into two parts, the main bronchi, and then they branch out. So bronchitis is an inflammation of the bronchial tubes or the breathing tubes, not necessarily an infection inside the tissue of the lung itself.
COPD is chronic obstructive pulmonary disease, which typically occurs from smoking. We have different types. One is emphysema, one is chronic bronchitis. Essentially, they're, you know, they're both, they're both copd, and it's usually from smoking. That's the main reason.
[00:04:31] Speaker A: Okay.
[00:04:31] Speaker B: There are other reasons for patients to have copd, certain deficiencies or, you know, biomass fuel exposure, things like that. But in this part of the country, the main reason why people develop it is from smoking.
[00:04:44] Speaker A: Okay, okay.
Are there things that individuals can do, obviously, avoid smoking? Right. We know smoking cessation is so important.
[00:04:58] Speaker B: Absolutely.
[00:04:59] Speaker A: But are there things that individuals can do to not have those things become an issue during these cold seasons?
[00:05:08] Speaker B: So there are several things we can do. I think I'll take a step back to kind of explain why. Okay. We have issues in the, in the winter.
[00:05:16] Speaker A: Okay.
[00:05:16] Speaker B: In the winter it's very cold. So what ends up happening is that the air is cold and it's dry and it irritates our, our breathing tubes, our bronchi yes. And patients with, for example, asthma and copd, they already have a low level of inflammation in their airway. So when you add on this cold air and it irritates them, it causes what we call bronchoconstriction or bronchospasm, and it makes it very tight and very hard for them breathe. And this can happen even in people who don't have asthma or copd.
[00:05:47] Speaker A: Right. So that's regardless of the weather.
[00:05:48] Speaker B: Exactly. Regardless of the underlying condition. Yes. But just. But by virtually being so cold.
[00:05:53] Speaker A: Right.
[00:05:54] Speaker B: It can predispose all of us to having some kind of broken constriction. Also, you know, in the winter, many times we stay indoors because it's so cold. And if your environment in the house is not conducive, see, there's a smoker. You're more exposed to, you know, to that. Also, indoor allergens. A lot of mold in the house that people may not even know. Or, you know, mold or dust particles in their heating system.
[00:06:20] Speaker A: Right.
[00:06:21] Speaker B: Or even their pets, you know, animal dander. They're more exposed, so they get. They end up being exposed to that, and they can get sicker in the winter.
[00:06:30] Speaker A: That's why people have, like, dehumidifiers.
[00:06:31] Speaker B: Exactly. Control. Exactly. Because it's so dry.
[00:06:35] Speaker A: Right.
[00:06:35] Speaker B: And that irritates our area. So having that humidifier is extremely important, you know, in the cold. In the winter also, a lot of viruses tend to replicate more in the winter, and they last longer. They just stay longer in the air compared to the summer. And our immune system is not as strong, so we have these little fine hair like projections in our. That line our respiratory tract. Yeah, the cilia.
Yeah, the cilia. Yeah. Yep. So it's bringing back memories, huh? Good memories.
[00:07:05] Speaker A: Good memories.
[00:07:06] Speaker B: Okay, good.
[00:07:06] Speaker A: Yes. The foundation is so important.
[00:07:08] Speaker B: Good. So these cilia, the hair like projections, they line our nose and our respiratory traction. And what they do is they are the first defense mechanism. So when you inhale dust or particles, things that contain viruses, it traps them, and then you. You kind of sneeze it out as mucus or snot. Yes. But your cilia doesn't work as well in the cold weather, so it's not beating as much. So as a result, you're more, you know, you're pretty. You're more predisposed. So all these things just make it really hard in the winter. That's why a lot of people end up falling sick. And not to mention, if it ends up raining, then you build up mood spores, and then you can develop sinusitis which is another reason why a lot of patients get, come, come down with asthma exacerbation or, you know, bronchitis or things like that.
[00:07:57] Speaker A: As we think about that, just keeping yourself eating healthy, proper exercise, drinking water.
[00:08:04] Speaker B: Absolutely.
[00:08:05] Speaker A: All of the things to keep your immune system strong will be important.
[00:08:08] Speaker B: Absolutely, absolutely.
[00:08:10] Speaker A: Okay, talk a little bit about, and I want to talk a little bit about this because of the ICU or intensive care can be such an isolated area.
What does your treatment plan look like when someone enters your space? Like when we talk about critical care, Talk a little bit about what that niche is and how important it is to the recovery of a patient. Because sometimes when people think about that, they think about it's, it's so critical. But you know, a lot of patients do get out of the intensive care. They get there early enough.
[00:08:46] Speaker B: Absolutely.
[00:08:47] Speaker A: And it's so important to help them to gain their respiratory strength and recover.
[00:08:52] Speaker B: I mean, so the critical care, critical care medicine is a field that specializes in taking care of patients who have really, they're really sick.
[00:09:01] Speaker A: Right.
[00:09:01] Speaker B: And a lot of these illnesses are respiratory, but there are also some that are not. So we have septic shock, acute renal failure, many conditions across the different organs, organ systems that we can take care of. So in the icu, we end up seeing a lot of patients who come in, say for example, with a COPD exacerbation. So they come into the er, they can't breathe, they're really short of breath. We give them breathing medications with them antibiotics, we give them steroids. If they're still not feeling better, we may augment their ability to breathe by putting them on a machine we call a bipap. It can be a non invasive one. And if they still don't get better, then we may have to put them on the invasive ventilator, which a lot of people, what they call it is life supports, or they say we do put them in a coma. Essentially we're taking over their ability to breathe. So we put in a breathing tube and then we put them on the ventilator. So that ventilator is essentially breathing for them while our antibiotics, our steroids, our breathing treatment, all of that works. Once the patient starts to recover, then we start to reduce the support on the ventilator and eventually we get them off. When they're on the ventilator, we pick them up every day, day. We make sure that, you know, they're being cleaned, there's a proper hygiene, all of that, they're on prophylaxis, prevent blood clots, but It's a, in many patients that without that they would not survive. So having that, you know, having an ICU and being able to take care of these critical care patients is extremely important. There are many conditions that would, you know, patients would not survive if they didn't have icu, you know, care. So it's a, it's a pivotal part of medicine.
[00:10:40] Speaker A: Absolutely. And even with pneumonia, of course, of course, can end up needing many times, many times.
[00:10:47] Speaker B: And, and that's why it becomes important to also know, like the, the red flags, right?
[00:10:53] Speaker A: Absolutely, Absolutely. Absolutely.
[00:10:54] Speaker B: So there are many pneumonias that we treat, you know, as an outpatient. People come in with the cough, shortness of breath, and then we do a chest X ray. They have a pneumonia. You can give them antibiotics. Right. And some of them feel better. But we always let them know if you're not feeling better, let us know. Because if you don't feel better, that pneumonia, number one, it could get worse.
You could develop complications. Complications including buildup of fluid or what we call empyema, where pus surrounds. And in some cases we need to put, place a chest tube to drain that. Some patients, the pneumonia just gets really bad that it shuts them, their system down where they develop what we call septic shock and then they may end up needing the ventilator coming to the icu. So knowing, you know, you know, being aware of the things to look for is important. If you're not getting better after being given antibiotics, not getting better, meaning you're having like high fevers, that'll be a reason to come to the hospital. If you're having shortness of breath, you know, or severe chest pain, if you're not able to keep anything down, because if you're getting antibiotics but you're vomiting, you're, you're not getting those medications, so you're not getting treated. So that's, that'll be another important reason, reason to come to.
[00:12:09] Speaker A: And fluids, right?
[00:12:10] Speaker B: Yeah.
[00:12:11] Speaker A: Dehyd. Yep, I've seen that.
[00:12:13] Speaker B: Absolutely, absolutely.
You need to be able to keep things down. If not, you're not going to get better. You know, having severe tightness in your chest. So any, if you're having symptoms like that, despite being treated with antibiotics or any kind of treatment your primary care or your physician gives you, you need to let them know.
[00:12:32] Speaker A: Great points, great points, great information. What is your role on the, on the care team? Because, you know, it takes others to manage a patient sometimes. So you're a specialist, but there are other specialists, there's nursing personnel and other Health care professionals on your team, what does that look like in managing the patient? I mean, because you're like, you're like the air traffic control in some ways.
[00:12:59] Speaker B: Yeah, it's a, it's a team. It's a team effort. You know, it's teamwork. There is no, there is no health care without teamwork. And I think that's what makes Riverside great as well as, you know, working like my pulmonary practice in my icu, have a lot of great team members. So, you know, for example, in the clinic, if I'm prescribing a medication, if it requires a prior authorization, you know, having the CNA work on that is important.
[00:13:23] Speaker A: Absolutely.
[00:13:24] Speaker B: The pharmacist is also important in ensuring that they dispense the right medication.
The cnas or the MAS get phone calls from the patients, they triage it, and they ask them specific questions. If you're having side effects, they're able to tell them, based on what I've given, the information I've given them, this is what they need to do so they can improve. In the hospital, teamwork is, is extremely important, particularly in the icu, because then the medications were off. We're. I'm ordering. The nurses are the ones that are giving it. The pharmacists are checking it, making sure it's accurate. The physical therapist and occupational therapists do an exceptional job, you know, getting the patients up.
[00:14:02] Speaker A: Right.
[00:14:03] Speaker B: So the patients, even though they're on the ventilator, which is the life supports that a lot of people, you know, consider it as they're able to sit them up, they're able to move them so that they don't get deconditioned, so that when the underlying condition has gotten better, we're not starting from scratch, those patients can start moving as soon as possible. So, you know, getting them move, you know, moving up and going is important. The case manager is extremely important. They, from day one, already thinking about a discharge plan. Will this patient go? Are they going to go home or to a facility? Would they need rehab? So all of us working together is extremely important to getting that patient whole. It's not just the disease. Yes. The disease is one part of it, but that is affecting an individual.
[00:14:48] Speaker A: Right.
[00:14:48] Speaker B: And we need to take care of the individual, not just the disease.
[00:14:51] Speaker A: So good information, it's a lot of pieces to the puzzle.
And you're responsible for putting all those pieces together sometimes.
[00:15:00] Speaker B: Exactly.
[00:15:01] Speaker A: Does that become challenging?
[00:15:04] Speaker B: It does, it does. I mean, there. It could get overwhelming, you know, days, but. And I think that's why we have ways to distress and. But yes, because you're taking care of human beings, you're not just. They're not numbers, they're not just, you know, disease processes you, you know, even if, even if their disease gets better, what about them as a whole? If you go into the room and they look sad, you know, like it's not just, okay, my COPD is better, but then I'm having this problem at home or at work. So that also weighs on you. It's not just a matter of making the condition better so you take care of that individual. It's just, it's, it's the whole picture.
[00:15:45] Speaker A: Yeah, absolutely.
Well, wow. Thank you for so much. That's great information. And your reputation precedes you.
[00:15:55] Speaker B: Thank you.
[00:15:56] Speaker A: The, the staff, the team members, the providers, they all have so much respect for you. And so I appreciate, and I know they do, your dedication and commitment. So thank you. You can come back anytime. So, you know, I always tell our viewers that, you know, you know, our goal is disease prevention and health promotion. So this information is so helpful. Keep up with all of your, your visits, your primary care visits, and to your point, you know, know yourself and when something's not feeling right or it doesn't resolve, reach out so that they can evaluate you and treat. Early treatment is so important.
[00:16:37] Speaker B: Absolutely. And apart from, you know, early treatment, even the prevention. So the vaccines. Right. Absolutely. Overemphasize the importance of the vaccine. So anybody six months and above should be getting the flu vaccine. The CDC recently changed their guidelines, so it was 65 before for pneumonia vaccine. Now it's down to 50. So everyone 50 and above. Yes, you should be getting a pneumonia vaccine.
A lady never tells.
[00:17:07] Speaker A: Good to know that, because the timelines are changing. It's for a reason.
[00:17:12] Speaker B: Exactly. So you should be getting a pneumonia vaccine if you're 50 and above. Now, if you have a chronic lung condition, so you have asthma, copd, interstitial lung disease, or any chronic lung condition, you should be getting a pneumonia vaccine as early as age 19.
[00:17:26] Speaker A: I did not know.
[00:17:27] Speaker B: Yes. So again, these pneumonia vaccine, the flu vaccine, the COVID 19 vaccine, being up to date on that is important to help you get better and prevent you from getting really critically ill.
[00:17:40] Speaker A: Absolutely.
[00:17:40] Speaker B: And also, again, stop smoking. You know, I, I say that to every patient. If you're smoking, you're reducing your immunity, your immune system. You're not going to be able to fight infections as much. Your cilia doesn't work as much. Which are the projections that help, you know, clear out your. Any Kind of mucus in your airways, so you need to stop smoking. And also things that they can even do like in their house. Number one, if you know you have a lung condition, making sure that you clean your, you know, vents, making before you turn on your, your heating system is extremely important. You know, limiting candles.
[00:18:16] Speaker A: Yes.
[00:18:16] Speaker B: You know, in the winter, a lot of people use candles, you know, for the ambience and. But again, they release all these chemicals that can make things worse. So limiting that is important. If you have a fireplace and you, you're going to use that, making sure that the flu is open, the chimney is important when you're cooking and turn on that vent, because if not, that smoke is going, you're going to inhale it and that's going to trigger, you know, an acute, an acute problem.
[00:18:45] Speaker A: So, yeah, I didn't even think about those things. And four of the five that you mentioned are opportunities that I have as well. And then I think there's a misconception. I know I've heard that there's a misconception that if you do two or three of the COVID vaccines, you don't need the other ones coming out.
So I'm sure you've heard this.
[00:19:04] Speaker B: Yes, yes, yes. No. I would encourage anyone, particularly with lung conditions, to get to be up to date with their Covid vaccines.
Yes. The people feel like once I've gotten it, that's it, but it runs out. It's not. The immunity is done forever.
[00:19:17] Speaker A: Okay.
[00:19:17] Speaker B: So once a new batch comes out, if you do have a chronic, medical, chronic lung condition in particular, you should be getting it. Absolutely. And you know, apart from that, there's also that the misconception that when you get the vaccine, you get the illness. You know, I've had, right. Patients tell me, you know, I got flu shot and I got the flu. And I, I always tell them, you can't get it from the vaccine. The vaccine doesn't, doesn't give you. We're not introducing a live virus into you. That's the only way for you to get a disease from the vaccine. So it's, you don't get a live out, you don't get a live virus. So the vaccines do not give you the disease. They prevent you from getting the disease, as in a severe way.
[00:19:57] Speaker A: Right.
[00:19:58] Speaker B: But did, you know I give you the disease? Yes.
[00:20:00] Speaker A: I'm going to throw this question at you.
What do you think about now? We're hearing about diseases that we thought we had eradicated in, in this country. What are your thoughts on that? Somebody asked me that recently, so I wasn't prepared to answer.
[00:20:13] Speaker B: Yeah.
[00:20:16] Speaker A: We can refer them somewhere else.
[00:20:18] Speaker B: But that's a loaded question.
[00:20:21] Speaker A: That's a hard one.
[00:20:22] Speaker B: That's a loaded one. But.
[00:20:23] Speaker A: So vaccination is the key, Right?
[00:20:25] Speaker B: I will say that maybe that's the.
[00:20:28] Speaker A: Problem is avoiding vaccines.
[00:20:30] Speaker B: Avoiding vaccine. I think there's a lot of misconception about vaccines, thinking that it causes several.
[00:20:35] Speaker A: Other issues, especially in children.
[00:20:36] Speaker B: Exactly. So I know some parents are scared and they feel like they're protecting their kids, but in the long run, it's actually harming them as well as the community because all the disease, some of these diseases we've already eradicated, they're not coming back. We should be talking about them anymore.
[00:20:52] Speaker A: Right.
[00:20:52] Speaker B: So it all comes down to vaccination.
[00:20:55] Speaker A: Yes, we have to get immunologist on.
[00:20:57] Speaker B: Here to talk about that one. Exactly.
[00:20:59] Speaker A: I think I, I appreciate that.
[00:21:02] Speaker B: Yes.
[00:21:02] Speaker A: Thank you so much.
[00:21:03] Speaker B: Of course, of course.
[00:21:04] Speaker A: Yes. Come back anytime.
[00:21:06] Speaker B: Thank you. Thank you for having me. I'm very, I, I'm really honored to be here. Yes, yes.
[00:21:11] Speaker A: You're doing great work.
[00:21:12] Speaker B: Thank you.
[00:21:13] Speaker A: I appreciate you. Thank you. All right. And to our listeners, thank you so much for joining us on the Healthy you podcast. I hope you found this episode helpful. Share it with your friends and any loved ones that may from this episode. Don't forget to hit subscribe. Check out our Riverside website for more resources on staying healthy during the winter, especially these respiratory things that are coming up that Dr. Anna Laurie talked about. Stay warm and well and safe and we'll see you next time from Riverside Health System. This is the Healthy youy podcast where we talk about a range of health related topics focused on improving your physical and mental health health. We chat with our providers, team members, patients and caregivers to learn more about how to maintain a healthy lifestyle and improve overall physical and mental health. So let's dive in to learn more about becoming a healthier.
