Pulmonary Consultants of New York

Quality Pulmonary Care in a Private Practice Setting

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Daniel M. Libby M.D.
Brian D. Gelbman M.D.
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October 31

Will this flu shot give me the flu?
sneeze
 
Most of our patients are advised to take yearly flu shots.  This advice comes from the Center for Disease Control (CDC) guidelines that recommends the following groups of people be vaccinated yearly:
  1. anyone over the age of 50
  2. Residents of chronic care facilities
  3. Anyone with respiratory disease (including asthma)
  4. Pregnant women
  5. Anyone with neurologic impairment

The benefit of the flu shot is that it reduces the likelihood of getting influenza by 88% in healthy adults.  In elderly patients, it may also prevent pneumonia (which can occur secondary to influenza).

The only contraindication to getting the flu shot is a history of SEVERE allergy to eggs or prior flu shots. 

Our office only uses the Trivalent inactivated influenza vaccine (TIV), which is essentially a dead virus. This vaccine is incapable of causing active influenza and is approved for use in patients with weakened immune systems. This vaccine may cause minor flu-like symptoms such as soreness, nasal congestion for 24-48 hours, but, no, it can not give you the flu.



11:42 AM GMT  |  Read comments(0)

September 04

But I stopped smoking 20 years ago...

 smokers lung function

When I diagnose patients with COPD, (for Chronic Obstructive Pulmonary Disease, an asthma-like condition that affects smokers), they usually stare at me in disbelief and say "how can this be due to smoking, I quit more than 20 years ago"?

Here is how:

Understand that we are all born with more lung function than we will ever need. That is important because when we work out to our maximum, it is usually our hearts that limit how much exercise we can do.   Therefore, people can lose 20% of their lung function before they notice any impact on their exercise tolerance.  In addition, our lungs continue to grow and expand until probably around our early 20s.  After that, everyone will have a gradual decline in their lung function.  For the vast majority, this will never result in any limitations because, again, we are usually limited by what our hearts can accomplish. 

But smokers are a different story.  They will have an accelerated decline for 2 reasons. One is damage to the lung tissue itself, resulting in emphysema.  This is a silent process that usually is only noticeable when someone has lost up to 50% of lung function.  Patients usually present with gradual onset of shortness of breath.  The other process relates to repeated injury to the airways.  These patients have "chronic bronchitis" and are characterized by their stereotypical smoker's cough and frequent, repeat airway infections.  Both the airway disease and emphysema result in accelerated decline in lung function, but it takes many years before it falls below a problematic level for patients.  That is why most patients with COPD are diagnosed after the age of 50. 

There is clearly a genetic component whereby some light smokers can develop severe cases of COPD and some heavy smokers never develop it at all.  In general, we believe that threshold at which someone has a significant smoking history is greater than 10 pack years (I.e. 1 pack per day for more than 10 years).



12:17 PM GMT  |  Read comments(0)

July 30





6:43 AM GMT  |  Read comments(0)

May 12

Will this CT scan give me cancer?
Perhaps the most frequent question I am asked is how dangerous is the radiation exposure from a CT scan?
Surprisingly, there is not a clear and easy answer to this question.  I also get inquiries about chest Xrays, but understand that a CT scan is equivalent to at least 50 chest xrays. So for this topic, lets just focus on CT.
An article in the New England Journal of Medicine in 2007 raised awareness of this issue in both the medical community and lay press.  The article is a good starting point for those interested in the topic, but its perspective definitely falls towards the alarmist end of the spectrum.
Several conclusions can be taken from the article:
1. No large scale studies have been performed to answer this question, data is extrapolated from atomic bomb survivors
2. The lifetime risk of developing cancer is highest in children because growing children are more radiosensitive
3.  The typical dose of radiation to an organ is 10 millisiverts (mSv).  The average person is exposed to 3 mSv/year of background radiation.
4.  The authors estimate lifetime cancer risk as high as 0.15% for a newborn receiving an abdominal CT.  This number falls to 0.02% by age 30.
 
An important objection to this article comes via the American College of Radiology (needless to say, they do have a bias in this issue).  They argue it is erroneous to extrapolate data from atom bomb survivors to CT scans for 2 reasons:
1. Atom bomb survivors are exposed to X-rays, particulate radiations, neutrons, and other radioactive materials
2. Atom Bomb survivors have their entire bodies exposed to radiation as opposed to focused studies by CT.
 
For patients, I believe the take-home point is to ensure that your CT scans are being done with a purpose.  Frequently, patients are asked to get "low dose screening chest CT" to detect early stage lung cancer. The low dose scans has about as much radiation as 7 chest x-rays.  One must weigh the risks and benefits of performing a CT.  The radiation risk, if it exists at all, is a miniscule part of the risk/benefit ratio.  No prospective or retrospective study has linked performance of chest CT with lung cancer.  The increase in cancer risk from a chest CT, if it exists at all, would require a prospective/randomized study involving hundreds of thousands of patients and many years to complete - to say nothing of the prohibitive financial cost.



10:45 AM GMT  |  Read comments(1)

May 05

medicare approves sleep study
Effective April 1, 2008, Medicare has approved the use of home sleep studies for the diagnosis of Obstructive Sleep Apnea.
This is an alternative to performing the more elaborate test called a polysomnogram, which is considered the gold standard.  Polysomnograms collect more data, specifically EEG (brain waves) and are able to diagnose other sleep disorders such as restless leg syndrome.  However, polysomnograms can be cumbersome and require patients to spend a night in a sleep center.
Home sleep studies have been shown to accurately diagnose obstructive sleep apnea, which can easily be treated with continuous positive airway pressure (CPAP).
 



10:27 AM GMT  |  Read comments(0)

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