20: Pulmonology

Vital Visions is BACK for Season 3, with special guest, Brian Whitson, MD. November is Lung Cancer Awareness Month, so what better way to wrap up the month than having Norman Regional's newest Pulmonologist join the pod?

The Vedalas ask Dr. Whitson about restrictive and obstructive diseases, asthma and COPD treatment, smoking, life saving lung cancer screenings, Norman Regional's revolutionary ION system and more.

Dr. Whitson's pulmonary expertise really shows in the Season 3 opener of Vital Visions! 

Guest bio:
Brian Whitson, MD, FCCP, attended medical school at the University of Oklahoma, College of Medicine, followed by an Internal Medicine residency at Baylor University Medical Center.

His education culminated in a fellowship with Louisiana State University School of Medicine in Pulmonary Diseases and Critical Care Medicine. Dr. Whitson’s career has followed his enthusiasm towards pulmonary physiology and pathology as well as working with patients to restore their health.

Dr. Whitson’s most recent work in Enid included a focus on pulmonary rehab as a means of improving patient outcomes.

Dr. Whitson sees patients 12 years old and older with asthma or similar conditions.

Links:
Brian Whitson, MD, FCCP

Norman Regional Pulmonary Clinic

BOOK: $125 Heart and Lung Scans at Norman Regional

BLOG: Norman Regional Ramps Up Lung Cancer Screenings for Lung Cancer Awareness Month

BLOG: Raising Awareness for Lung Cancer and COPD in Oklahoma: Screenings, Prevention and Key Stats

WATCH: Norman Regional Ion Robotic Bronchoscopy for Lung Cancer Screenings

This podcast is for educational purposes only. The information in this show is not to be used as medical advice. If you are needing medical care, please consult with your physician.

Norman Regional is hiring! See all our open opportunities here: https://careers.normanregional.com/careers-home/

Transcript

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Welcome, friends.

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Doctor Veer Vedala here.

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And I'm Doctor Krishna Vedala.

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And we are the Vedala bros.

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Guess what, folks? We're back.

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And now with season three of our podcast.
That's right.

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Your favorite podcast, Vital Visions
with the Vedala Brothers is back,

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where we bring you insights
into health, wellness and our community.

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This season, we're diving deeper
into the stories, science, medicine,

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and strategies that shape our vision
for a healthier future.

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From breakthrough research to powerful
patient stories here at Norman,

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Regional and expert perspectives
from some of our amazing providers

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and new technologies and services
that Norman Regional has to offer.

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We're here to connect the dots and empower
you on your journey.

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So join us each episode
as we explore new dimensions in health.

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One vital conversation at a time.

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Let's get started on season three.

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Welcome back to Vital Visions,
where health meets community.

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Welcome, friends.

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Doctor Veer Vedala here with my bro

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host Doctor Krishna Vedala
And we are the for the Vedala Bros!

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Welcome back
to another episode of Vital Visions

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where we discuss all things
vital, Enriching our community.

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One topic at a time.

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CTAB.

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No wheezing bronchi or rails.

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Take a deep breath.

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Are you still smoking?

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I think we need a chest x ray.

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These are things you commonly hear from 
your doctor or your provider.

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And there's a reason for that.

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We care about your lungs.

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Good lung health is crucial
because it directly affects our ability

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to perform daily activities.

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Engage in physical exercise and maintain
a high quality of life.

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When our lungs are healthy,
we can breathe easily and efficiently,

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allowing us to stay active
and enjoy life to its fullest.

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Compromised lung function
can lead to many serious health issues

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such as COPD, asthma, infections
like pneumonia, and even lung cancer.

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In our increasingly polluted world,

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prioritizing
our lung health is incredibly important.

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And here to talk to us
regarding all things

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our lungs is a new member of our Norman
Regional family,

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Five times board
certified pulmonologist, Dr.

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Brian Whitson...

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Dr. Whitson
thank you so much for being here.

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You Bet!
My pleasure.

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Krishna, Can
you give a. A yes, of course.

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So once again, Dr.

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Whitson, we can't
thank you enough for coming by today

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and answering all of our questions
related to pulmonology.

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But the thing that just boggles
my mind is the five time board certified.

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And so just so our audience knows
Dr. Whitson is board certified

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internal medicine, pulmonology,
critical care, sleep medicine.

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And then what am I missing?

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Hospice. Hospice, That's
with my amazing. Yes.

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So it's five times board certified.

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And to all our audience members,
that is no easy feat.

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That takes a lot of commitment
and a lot of dedication and also a passion

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for medicine itself.
So thank you so much.

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And lifelong learning.

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Yes of course. Yes yes yes.

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That that also, can you just tell us
a little bit about yourself

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and so introduce yourself? Sure.

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So I was born and raised in Tulsa.

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We spent, Well,
I went to undergrad, OSU.

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OU med school.

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Did, internal medicine
at Baylor Dallas and did,

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pulmonary crit at, LSU, and,

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thought I wanted to,

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on the side ranch and farm a little bit, 
so we ended up in Enid.

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I have family there, and, I learned
pretty quickly I didn't make enough money

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to lose farming and ranching, and, 
so I quit that and just stayed a doctor.

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And, we were there for 29 years.

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Thought we'd be lifers up there.

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And, this, wonderful thing arrived.

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Called a grandbaby. Oh, yeah.

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Yes. And,
I have a single daughter in Houston.

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My two boys live in north Norman,

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and they're nurses, by the way. And,

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the older son, Nate and his wife,

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Alicia, have baby Kendrick,
and we're like, we got to be close to.

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this, right?

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And so we we moved in, actually,
after we decided

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to move, our younger
son, Blaine and, and Savannah are due.

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And so we're going to have we're a double
the the herd.

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Yeah. You're going to be busy.

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Yeah.
So we're we're really enjoying that. Yeah.

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And been here almost 6 or 8 weeks now.

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And I'm really this is really hey,
I think I mean, I love Norman.

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It's got, you know, it's a much bigger
city, but it's got a small town feel.

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Yeah.

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And I'm a huge foodie.

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And so I love the restaurants.

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Yeah.

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And, 
and especially the surrounding community.

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And I think you guys are too.

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I think we've talked about that.
A little bit.

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Oh, yeah. We like. Yeah.

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Like the, we, for a while,

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Norman was the only place that had a meal
that Taco and my wife loves Velvet taco.

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So I haven't tried.

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That. It's on Lindsay Street. Okay.

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They have very interesting,

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options.

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They've got, like, a paneer tacos,
and we're like Indian.

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I was like.

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Oh, wow. Oh, wow.

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Yeah.

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And I have to say, one of my favorite
places is tea cafe on Campus corner.

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So if we ever drive down to Norman
with my wife,

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we make it a point
to stop by Campus Corner and try tea cafe.

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Okay.
I got a great place. It's a great place.

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Yeah, yeah.

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And on the east side,
there's a place called Tarahumaras.

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Have you heard of that place yet? No.
Oh it's amazing.

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Quality says is that Indian? No.

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Tarahumara is, Mexican food.

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Oh, it's really good.

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Oh, yeah.
We used to go there all the time.

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Oh, actually,
I think I saw that. Oh, yeah.

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Yeah, yeah, it's. It's close to by Porter.

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Yeah. It's on,
Porter. It's close to the hospital.

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Yeah, yeah, yeah. I drove by that
the other day.

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I wondered, I wondered about it.

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Yeah, yeah, yeah. Okay. No good stuff.

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Okay.

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Anyways, we probably get back to the Pulomonology. 

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We're probably set. So

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food is always this right.

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Yeah. Yeah.

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So but I, I enjoy the hospital
I mean I, I really do I love our office.

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We got a great staff. Yeah. So all the.

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Staff has really been enjoyable.

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Yeah. We're so grateful
for you to be being here. Sorry.

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Because audience I already curbsided
Doctor Whitson a lot.

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And so it's been.

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And I've made sure not to bother you
that much.

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I think I've only bothered you
once or twice.

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And, You are. Very you.

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I really.

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Yeah. You're very gracious
in helping us out.

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Really appreciate it. You bet.

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So tell us, what made you, get interested
in pulmonology?

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Well, I was a swimmer growing up,

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like the pulmonary physiology
with exercise,

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and it was just kind of weird,
even even, like, undergrad and med school.

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Anytime they went to pulmonary.

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I was just fascinated by it.

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As I was finishing med school,
I thought, I want to do,

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anesthesia, 
because I liked all the procedural things.

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And, then then thought, you

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know, maybe I could do both the pulmonary
and the procedural things.

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That's where the pulm crit came in. And.

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Yeah.

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And, so did that, and, Yeah.

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That's awesome. Yeah.

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Can I ask you, like a non?

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Like you can ask me anything.

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How do you keep up with all
of your board certification?

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That's a great question.

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Well, and I just I have to tell you,
so I'm not doing the hospital anymore.

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Okay.

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And and, in fact, I called the ABIM
yesterday, and I'm like, hey,

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I'm not going to re-up because my, my,
my critical care boards are due this year.

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Oh, yeah.

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And I'm like, I'm not going to redo it.

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And I go, how do I do that?

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And they're like,
oh, we'll send you this form. You said us.

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And then after August 15th
and so I'm going to

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I'm not going to redo my crit boards.

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And so actually so, you know,
I think family

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medicine is due
every eight years, isn't it.

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It used to be. Internal med's every ten.

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Number ten. Yeah. Yes. Family
that used to be every ten years.

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But then I think they're moving.

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They just recently made a change
where they're moving to every five.

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Like you have the option of doing, 
well that, that whole three year thing

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where you had to. I don't know
if ABIM... Yeah, yeah.

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That option is becoming more available,
though.

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Yeah. Well, like a long, long wait.
They got longitudinal.

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Assessed,
right. Yeah. Functional assessment.

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And then they move the whole three year
quarterly renewal thing

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where you have to do
like a quality improvement project

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and all that every five now.
So kind of like standardized.

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Oh my. To just kind of I don't know.

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But that's where they be
I am are every ten.

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Yeah. And you know that.

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And so this I'm

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kind of toward the end of my cycle
of my 30 year research.

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I've been doing it so long.

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Yeah. And, so, yeah, I'm not doing crit.

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My slate boards are due next year.

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And, you know,

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I still want to practice for a while.

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Yeah, yeah. I'm not sure I'm
going to do for your research.

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Just for the record.

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Anyways, sir.

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Okay.

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So, like, you know,
Krishna and I do outpatient primary care.

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Yeah, a lot of common, pulmonary

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complaints
we get in the, upper respiratory infections.

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We have that asthma.

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We see a lot of patients with COPD.

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But then there's that

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whole subset of lung diseases
called restrictive lung disease. Right.

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So I think a good place to start, Krishna,
if you don't mind us to kind of start

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with that, umbrella term
and then what the difference between

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obstructive and restrictive is
and then we can delve in deeper.

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Yeah. I think that's
I think it's a great way.

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I think I was kind of go into that
with a patient today.

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Yeah.

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Because they're like they,
there's one lady that I saw,

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this week, she was just like,

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well, they said, my lungs are shrinking.

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And, and I'm like,

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well, no, you don't have restriction.

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You have obstruction.

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And so, you know, obstructive diseases
mainly deal with COPD and asthma

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in essence, and under that COPD heading,
you've got emphysema,

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chronic bronchitis and there's
a few other smattering diseases.

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But those are the main ones.

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And it's not so much
that the volumes are changing

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as much as the overall volume is.

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It's a flow issue.

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And then you can, you know, explain
to the patient that actually if you look

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at the amount of air in your lungs, it's
actually increased in COPD.

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You got all this air trapping.

229
00:09:54,284 --> 00:09:57,416
And so I usually pull up their X-ray
and say, look how big your lungs are.

230
00:09:57,816 --> 00:09:59,849
And I'm like, wow,
I don't feel like I have any air.

231
00:09:59,849 --> 00:10:00,616
Why is that.

232
00:10:00,616 --> 00:10:04,949
So you can go into,
you know, dynamic, hyperinflation

233
00:10:04,949 --> 00:10:08,715
and air trapping and all that stuff
as opposed to the restrictive diseases

234
00:10:08,715 --> 00:10:14,514
which are, literally what it says,
restricting your volumes are restricted.

235
00:10:14,981 --> 00:10:17,114
It's not a flow issue. It's just that.

236
00:10:17,114 --> 00:10:20,813
So some reason, 
your lungs are restricted in volume.

237
00:10:21,046 --> 00:10:25,279
And probably the most common thing
we see is with morbid obesity,

238
00:10:25,812 --> 00:10:29,079
you know, when people are coming in
and they're "I can't breathe"

239
00:10:29,079 --> 00:10:32,812
and you know,
their BMI is 35 or maybe higher.

240
00:10:33,611 --> 00:10:36,044
And you do
pulmonary function testing on them

241
00:10:36,044 --> 00:10:39,544
where you have them blow
and you measure how air is moving,

242
00:10:39,544 --> 00:10:42,544
how much air is going in and out,
what's the total lung capacity.

243
00:10:42,743 --> 00:10:45,943
But we also measure, to me,
one of the more important,

244
00:10:46,110 --> 00:10:50,209
facets of the function
testing is diffusion capacity,

245
00:10:50,709 --> 00:10:53,709
which measures the ability of gases
to go in and out of the lung.

246
00:10:53,875 --> 00:10:57,275
And, you know, in, in these morbidly obese
patient, their diffusion capacities

247
00:10:57,275 --> 00:10:59,541
are fine. Your lungs are good.

248
00:10:59,541 --> 00:11:00,808
They just can't expand.

249
00:11:00,808 --> 00:11:02,874
Your volumes are reduced.

250
00:11:02,874 --> 00:11:05,974
You know, a lot of times
there's another element for their

251
00:11:05,974 --> 00:11:09,373
shortness of breath is deconditioning,
which is really common whether even with

252
00:11:09,573 --> 00:11:13,539
with elevated BMI or,
being overweight.

253
00:11:13,539 --> 00:11:17,139
It's just as people get older,
they tend to be more sedentary.

254
00:11:17,505 --> 00:11:19,305
Sometimes this is
because they're not moving.

255
00:11:19,305 --> 00:11:23,305
But a lot of times we gather orthopedic
or spine issues, things that,

256
00:11:24,038 --> 00:11:27,037
disable us from moving like we want.

257
00:11:27,737 --> 00:11:30,737
But anyway, so we're under that
heading of restriction.

258
00:11:30,803 --> 00:11:33,003
That's where we see something, besides,

259
00:11:33,003 --> 00:11:36,036
so that that would be what I call
extrinsic problems.

260
00:11:36,869 --> 00:11:41,535
The other thing that can cause extrinsic
restriction would be like neuromuscular

261
00:11:41,535 --> 00:11:42,768
diseases.

262
00:11:42,768 --> 00:11:43,802
Or spinous issues.

263
00:11:43,802 --> 00:11:47,634
So, little ladies
that have the really bad kyphosis,

264
00:11:47,634 --> 00:11:49,701
they're all bent over,
you know, their lung,

265
00:11:49,701 --> 00:11:51,934
volumes are restricted,
and sometimes they can.

266
00:11:51,934 --> 00:11:54,967
I've seen oh, ladies, I mean, they're
chronic respiratory failure.

267
00:11:54,967 --> 00:11:58,233
They're hypercapnic,
their CO2 is high, their oxygen level's low

268
00:11:58,766 --> 00:12:00,933
and get really in big trouble with it.

269
00:12:00,933 --> 00:12:04,799
But anyway
so that would be another extrinsic.

270
00:12:04,799 --> 00:12:06,532
So their lungs are normal.

271
00:12:06,532 --> 00:12:09,131
But the mechanics of the chest wall are abnormal.

272
00:12:09,131 --> 00:12:12,264
And then you have true
intrinsic problems restriction.

273
00:12:12,698 --> 00:12:15,464
That's where you get in
your fibrotic conditions.

274
00:12:15,464 --> 00:12:16,430
Sarcoid.

275
00:12:16,430 --> 00:12:20,497
You know, and probably
the most common feared thing is that,

276
00:12:21,196 --> 00:12:22,696
any pathic forms of fibrosis.

277
00:12:24,096 --> 00:12:25,829
So, yeah.

278
00:12:25,829 --> 00:12:29,495
So, one of the most common, names

279
00:12:29,495 --> 00:12:33,261
that we keep hearing about ever since
the pandemic is, long Covid syndrome.

280
00:12:33,895 --> 00:12:34,995
And so we're wondering if you could

281
00:12:34,995 --> 00:12:37,994
kind of explain to our audience
what Long-Covid is.

282
00:12:38,161 --> 00:12:42,160
And, if there's really any way to, like,
how to manage it and how to treat it.

283
00:12:42,194 --> 00:12:44,727
Yeah. Does that fall into, like,
a restricted path?

284
00:12:44,727 --> 00:12:45,093
Yeah.

285
00:12:45,093 --> 00:12:48,093
So, so, you know,
I kind of divide things up

286
00:12:48,093 --> 00:12:51,526
into two, categories.

287
00:12:51,526 --> 00:12:54,725
And so, you know,
and I think when we talk about long

288
00:12:54,725 --> 00:12:58,491
Covid is we're talking about patients
that have persistent symptoms

289
00:12:58,858 --> 00:13:01,491
but not really objective findings.

290
00:13:01,491 --> 00:13:03,991
So they have the, you know, you know,

291
00:13:03,991 --> 00:13:07,223
brain fog, chronic shortness of breath,

292
00:13:07,723 --> 00:13:11,156
a lot of times
you see people and they're healthy.

293
00:13:11,156 --> 00:13:12,523
I mean, even sometimes young people,

294
00:13:12,523 --> 00:13:16,989
they cannot exercise because of chest pain
or fatigue or shortness of breath.

295
00:13:17,989 --> 00:13:19,155
And and

296
00:13:19,155 --> 00:13:23,721
you know, I for thankful-, thankfully,
there's docs that specialize in

297
00:13:23,721 --> 00:13:28,120
I don't know that there's any true
paradigm or dogma.

298
00:13:28,154 --> 00:13:30,987
Hey, you use this
and you're going to help these patients.

299
00:13:30,987 --> 00:13:34,786
A lot of times what I try to do is just
get these patients to start moving again.

300
00:13:35,353 --> 00:13:38,519
And I tell them, look, you know, it's
just like you've had this major insult

301
00:13:38,519 --> 00:13:43,652
to your body and you've got to start
maybe even past ground zero.

302
00:13:43,985 --> 00:13:46,751
You need to go backwards
and really start walking.

303
00:13:46,751 --> 00:13:51,051
But half pace and slowly, slowly build up.

304
00:13:51,551 --> 00:13:54,550
And the patients
that stay dedicated to that a lot of times,

305
00:13:54,883 --> 00:13:57,483
I don't know that they'll
get back to 100% or where they were,

306
00:13:57,483 --> 00:13:59,683
but they will see improvement
from where they are.

307
00:13:59,683 --> 00:14:01,116
And that's a non-medical therapy.

308
00:14:01,116 --> 00:14:04,115
So just getting it moving
and then you have

309
00:14:04,382 --> 00:14:08,282
what I consider not really long Covid
but patients that have true sequela.

310
00:14:08,282 --> 00:14:13,514
And you know,
I haven't seen any new cases in a while,

311
00:14:13,981 --> 00:14:17,447
but during the, you know,
the bad variants like Omicron and Delta,

312
00:14:17,980 --> 00:14:20,513
you know, you do have these
patients come out and they're six months,

313
00:14:20,513 --> 00:14:24,346
maybe more out, and they've got severe
interstitial lung disease.

314
00:14:24,346 --> 00:14:26,179
In fact, I had a patient,

315
00:14:26,179 --> 00:14:30,279
went from my practice in Enid
that got transplanted about a year ago.

316
00:14:30,279 --> 00:14:36,611
And so, I mean, just severely damaged, 
and we had some patients that,

317
00:14:36,611 --> 00:14:40,044
that survived Covid, but then later died

318
00:14:40,044 --> 00:14:43,843
from consequence of, post-Covid fibrosis.

319
00:14:43,843 --> 00:14:44,343
Yeah.

320
00:14:44,343 --> 00:14:47,776
And so that's really not, 
in my opinion, long Covid.

321
00:14:47,776 --> 00:14:51,309
Those are people that had sequela
and that could have happened

322
00:14:51,676 --> 00:14:55,442
from another viral, you know,
to not necessarily Covid specifically.

323
00:14:56,108 --> 00:14:57,708
So yeah. That's

324
00:14:58,708 --> 00:15:01,274
you know, it's just fascinating to

325
00:15:01,274 --> 00:15:04,974
see how far medicine has come that
we can actually do a lung transplant now.

326
00:15:04,974 --> 00:15:06,873
Yeah, yeah, yeah.

327
00:15:06,873 --> 00:15:11,573
This one patient I mean he
he was like severely short of breath.

328
00:15:11,606 --> 00:15:16,839
And I was so glad I, I remember
the coolest thing is when they come

329
00:15:16,839 --> 00:15:20,505
in your office after transplant
and they're not wearing oxygen.

330
00:15:20,538 --> 00:15:22,038
They are just like a new person.

331
00:15:22,038 --> 00:15:25,038
And they're just so happy to be alive.
Yeah.

332
00:15:25,371 --> 00:15:26,937
And clear on exam.

333
00:15:26,937 --> 00:15:28,904
Yeah, yeah.

334
00:15:28,904 --> 00:15:29,637
This is amazing sir. 
Just out of curiosity, 

335
00:15:29,637 --> 00:15:32,037
What is the success
ratio of a lung transplant?

336
00:15:32,037 --> 00:15:34,470
Because it's
we don't really hear about it that often.

337
00:15:34,470 --> 00:15:34,936
Yeah.

338
00:15:34,936 --> 00:15:39,736
You know, and I don't know, it kind of
depends on what the transplant is for.

339
00:15:40,269 --> 00:15:43,002
But kind of the general stat
I tell patients is,

340
00:15:43,002 --> 00:15:46,468
is that you've got
a 50% survival at five years,

341
00:15:47,501 --> 00:15:50,601
which kind of surprises patients
like that doesn't sound very good.

342
00:15:50,634 --> 00:15:53,234
I said, well,
we don't transplant everybody.

343
00:15:53,234 --> 00:15:56,667
And so when we look at transplant,

344
00:15:56,667 --> 00:15:59,666
Integris has a great center.

345
00:15:59,899 --> 00:16:03,266
Doctor Rolfe is one of the many docs there
that we work with.

346
00:16:04,065 --> 00:16:06,199
And,

347
00:16:06,199 --> 00:16:10,565
anyway, so we it's got to be somebody
that has an expected survival

348
00:16:10,565 --> 00:16:13,564
of less that,
that we would really consider, consider

349
00:16:13,697 --> 00:16:16,397
because we want that to lengthen
their life, obviously.

350
00:16:16,397 --> 00:16:17,164
Right.

351
00:16:17,164 --> 00:16:21,030
There's risk of transplant,
just from the surgery itself.

352
00:16:21,030 --> 00:16:21,730
And then you go on

353
00:16:21,730 --> 00:16:25,896
these immune suppressive medicine
so you don't reject the new organ.

354
00:16:25,896 --> 00:16:28,729
And and they can have complications from
that as well.

355
00:16:28,729 --> 00:16:30,928
Yeah. Yeah. All right.

356
00:16:30,928 --> 00:16:34,695
So we'll we'll take a little step back,
go back to that obstructive aspect.

357
00:16:36,161 --> 00:16:36,461
You know,

358
00:16:36,461 --> 00:16:39,661
like we hear about asthma,
we hear about COPD.

359
00:16:39,694 --> 00:16:42,360
We hear about the asthma
COPD overlap syndrome.

360
00:16:42,360 --> 00:16:42,993
Yeah. Yeah.

361
00:16:42,993 --> 00:16:45,493
And and you have all these inhalers.

362
00:16:45,493 --> 00:16:47,326
Just for our listeners,
could you describe

363
00:16:47,326 --> 00:16:50,326
what the difference between
asthma and COPD actually is.

364
00:16:50,359 --> 00:16:52,125
Sure. And risk factors. Sure.

365
00:16:52,125 --> 00:16:56,125
So you know when I, I think that you know

366
00:16:56,125 --> 00:16:59,958
the the lines in some regard,
I think they're getting more blurry.

367
00:16:59,991 --> 00:17:00,924
Yeah. Yeah.

368
00:17:00,924 --> 00:17:03,557
Than they're getting than
they're getting distinct.

369
00:17:03,557 --> 00:17:06,557
Yeah. You know, you know ten years ago

370
00:17:06,590 --> 00:17:09,756
I don't think we, we, we,
we had COPD and asthma.

371
00:17:10,123 --> 00:17:11,823
And now there's this overlap.

372
00:17:11,823 --> 00:17:14,922
And so even if you look
at the new goal guidelines that came out,

373
00:17:15,289 --> 00:17:18,288
they talk about
checking eosinophil counts.

374
00:17:18,455 --> 00:17:22,488
And one of the new, newer injectables

375
00:17:22,621 --> 00:17:27,087
for asthma Dupixent, which is,
which has all these tons of indications.

376
00:17:27,454 --> 00:17:29,187
Well, the probably before the year's end,

377
00:17:29,187 --> 00:17:33,286
they're going to have their indication
for COPD with high eosinophil counts.

378
00:17:33,353 --> 00:17:34,153
It's amazing.

379
00:17:34,153 --> 00:17:40,285
And so, you know, so
so when we from a biochemistry or cellular

380
00:17:40,285 --> 00:17:44,685
biology standpoint you know the difference
is is the type of inflammation.

381
00:17:45,018 --> 00:17:50,917
So normally inflammation with COPD
is more macrophage induced inflammation

382
00:17:50,917 --> 00:17:53,917
where asthma in a classic sense

383
00:17:54,217 --> 00:17:57,250
is more eosinophilic inflammation.

384
00:17:58,116 --> 00:18:03,316
And and that's
where now we're looking at COPD'ers

385
00:18:03,516 --> 00:18:08,382
or some of these COPD'ers asthmatics
that have just developed COPD.

386
00:18:08,382 --> 00:18:11,514
And we've certainly seen
I don't see as many as I used to.

387
00:18:11,514 --> 00:18:14,981
When I first started practice,
I had all these little white ladies

388
00:18:14,981 --> 00:18:19,847
that came in who, that weren't
necessarily exposed to tobacco smoke,

389
00:18:20,280 --> 00:18:23,213
but they were probably undiagnosed
asthmatics.

390
00:18:23,213 --> 00:18:26,212
And remember,
you know, modern asthma therapy

391
00:18:26,479 --> 00:18:30,045
is something that has evolved
in the last 40 years.

392
00:18:30,045 --> 00:18:30,578
Not that

393
00:18:30,578 --> 00:18:31,378
old.

394
00:18:31,378 --> 00:18:33,578
So there wasn't good treatment
to treat asthmatic.

395
00:18:33,578 --> 00:18:37,011
So now they come
in, they've got untreated allergy

396
00:18:37,011 --> 00:18:41,344
or eosinophilic inflammation
and they've got fixed obstruction.

397
00:18:41,444 --> 00:18:45,110
So by definition that's chronic
obstructive pulmonary disease right. Yep.

398
00:18:45,576 --> 00:18:48,643
And so and then you work them
up, you're like, oh my goodness.

399
00:18:48,643 --> 00:18:49,909
You've got all this allergies.

400
00:18:49,909 --> 00:18:54,608
You're eosinophils are high or I might even have
an high IGE, things like that.

401
00:18:55,042 --> 00:18:58,041
And so those are people that, you know,
we put on standard

402
00:18:58,041 --> 00:19:02,174
triple therapy with LAMA/LABA, 
different bronchodilators, 

403
00:19:02,174 --> 00:19:04,874
And inhaled corticosteroids, 
and if they're still symptomatic

404
00:19:04,874 --> 00:19:06,407
especially if they're having
exacerbations,

405
00:19:06,407 --> 00:19:08,307
we'll consider putting them on.

406
00:19:08,307 --> 00:19:11,739
And we and we've been using the biologics

407
00:19:11,739 --> 00:19:14,739
for asthma in that in that population
for a long time. Wow.

408
00:19:15,006 --> 00:19:16,905
So are you ordering like an IGE level.

409
00:19:16,905 --> 00:19:19,605
And I guess you get a CBC
that gives the eosinophilic count.

410
00:19:19,605 --> 00:19:20,238
Is that how you're determining that? 

411
00:19:20,238 --> 00:19:25,004
So, so, you know, certainly, you know,
if it's a classic COPD we'll at least get

412
00:19:25,004 --> 00:19:29,070
a CBC with, automated
or maybe diff,

413
00:19:29,770 --> 00:19:34,736
but then, we have in our system, it's,
Oklahoma

414
00:19:35,203 --> 00:19:39,702
allergy panel, so it's a rast,
and you get a total IGE as a part of that.

415
00:19:39,735 --> 00:19:40,502
Oh it's amazing.

416
00:19:40,502 --> 00:19:42,902
Okay. And it's really,
you know, I think it's helpful to.

417
00:19:42,902 --> 00:19:43,568
Yeah.

418
00:19:43,568 --> 00:19:46,735
And it's not it's not an IGG it’s
an IGE
It's actually IGE

419
00:19:47,134 --> 00:19:48,634
and I explain that to patients. Yeah.

420
00:19:48,634 --> 00:19:50,867
Well you know you got four IG’s. Yeah.

421
00:19:50,867 --> 00:19:53,234
Three for infection and one for allergy.

422
00:19:53,234 --> 00:19:54,900
Yeah. So this is it.

423
00:19:54,900 --> 00:20:00,733
You know, and you know, the cool thing
is, you know, the biologic for asthma,

424
00:20:01,199 --> 00:20:06,465
the old one is Xolair and we still use some,
but we picked up all these people

425
00:20:06,465 --> 00:20:10,765
that have these hyper eosinophilic
or hyper IGE.

426
00:20:11,698 --> 00:20:16,430
There's a condition,
ABPA allergic bronchopulmonary asoergillosis.

427
00:20:16,430 --> 00:20:17,564
Yes. Yeah.

428
00:20:17,564 --> 00:20:18,097
Yeah, yeah, yeah.

429
00:20:18,097 --> 00:20:21,096
And so these people have high IGE levels.

430
00:20:21,096 --> 00:20:25,029
They have
the rass is positive for, Aspergillus.

431
00:20:25,029 --> 00:20:25,596
Yeah.

432
00:20:25,596 --> 00:20:30,428
And, I mean, those people respond
well to these Bios Yeah.

433
00:20:30,528 --> 00:20:32,628
It's really a game changer. Yeah.

434
00:20:32,628 --> 00:20:34,994
This is actually. Krishna,
can I ask one more question?

435
00:20:34,994 --> 00:20:37,161
I'm sorry. I'm hogging all the questions.
But this is okay.

436
00:20:37,161 --> 00:20:38,761
This is something maybe practicing.

437
00:20:38,761 --> 00:20:39,827
I'm used to. Right.

438
00:20:39,827 --> 00:20:43,693
So, so in our in our typical practice
in primary care,

439
00:20:43,693 --> 00:20:46,026
I'm not starting people on dupixent.
Right.

440
00:20:46,026 --> 00:20:46,360
Yeah.

441
00:20:46,360 --> 00:20:50,326
I'm like, hey, asthma, COPD,
possibly tobacco history.

442
00:20:50,326 --> 00:20:51,692
Let's get a PFT.

443
00:20:51,692 --> 00:20:53,892
See where you're at here on my inhaler.

444
00:20:53,892 --> 00:20:56,358
Options. Take your antihistamine.

445
00:20:56,358 --> 00:20:58,458
Maybe add singulair
like this is where I'm where we're at.

446
00:20:58,458 --> 00:20:59,191
Right.

447
00:20:59,191 --> 00:21:04,824
Is do you think it's it's
it's, appropriate for us in primary care

448
00:21:04,824 --> 00:21:08,723
to, like, try and get these these, 
medicines, like dupixent approved.

449
00:21:08,923 --> 00:21:10,056
I do have to say one thing.

450
00:21:10,056 --> 00:21:10,723
I tried this.

451
00:21:10,723 --> 00:21:15,022
When I first started off because I was
a very naive, young internal medicine Dr.

452
00:21:15,022 --> 00:21:16,055
“Go getter!” and

453
00:21:17,022 --> 00:21:18,322
insurance would not approve it.

454
00:21:18,322 --> 00:21:19,888
Yeah, I did really. Yeah.

455
00:21:19,888 --> 00:21:23,888
And and and like I when I have
that thought process I'm referring to pulm

456
00:21:23,888 --> 00:21:26,321
or allergy immunology
and they're like hey like our,

457
00:21:26,321 --> 00:21:28,254
our friend Doctor Claire Atkinson,
she's like I got you.

458
00:21:28,254 --> 00:21:29,854
Veer, you know, so. Well,

459
00:21:29,854 --> 00:21:34,453
In my personal opinion is I would not have
any problem with primary care ordering

460
00:21:35,053 --> 00:21:35,619
I really don't.

461
00:21:35,619 --> 00:21:39,819
I mean, and the reason I say
that is, is your risk to benefit ratio.

462
00:21:39,819 --> 00:21:40,385
Yeah.

463
00:21:40,385 --> 00:21:45,485
Is, is, I mean, the risk with
these medicines is so low.

464
00:21:45,785 --> 00:21:48,684
Most of these we are giving
almost all of these we're giving at home.

465
00:21:48,684 --> 00:21:49,751
Yeah. Right. Yeah.

466
00:21:49,751 --> 00:21:51,950
So they can't be too dangerous. Right.

467
00:21:51,950 --> 00:21:54,950
And and they have such a,

468
00:21:57,216 --> 00:21:59,516
tremendous benefit to the patient.

469
00:21:59,516 --> 00:22:03,549
And so, you know,
I think is, is, you know,

470
00:22:04,215 --> 00:22:06,748
you know, if I was an insurance company,
I do want to make sure that there's

471
00:22:06,748 --> 00:22:09,915
proper testing
so that they have, you know,

472
00:22:09,915 --> 00:22:13,214
the high Eos or the high IGEs. Yeah.

473
00:22:13,547 --> 00:22:15,914
That they've been placed
on Maximum medical therapy.

474
00:22:15,914 --> 00:22:18,280
They're still having exacerbations.
Still symptomatic.

475
00:22:18,280 --> 00:22:18,613
Yeah.

476
00:22:18,613 --> 00:22:22,113
But that's really easy to document
the workup and anybody can do that.

477
00:22:22,146 --> 00:22:23,979
I might start ordering the Oklahoma
allergy panel.

478
00:22:23,979 --> 00:22:25,212
Yeah. Like you said.

479
00:22:25,212 --> 00:22:28,479
Well I think it's interesting too, because
you'll find some interesting things.

480
00:22:28,479 --> 00:22:32,545
You know, these are high IGE levels
that that you didn't otherwise know.

481
00:22:32,545 --> 00:22:36,778
And you you know, it's also helpful
to show the patient, hey, look,

482
00:22:37,244 --> 00:22:39,944
this is what you're reacting to
in your environment.

483
00:22:39,944 --> 00:22:44,177
You know, if they're if they've got
you know, if they've got a, an allergy

484
00:22:44,743 --> 00:22:48,343
that's crazy high too,
because they rate the allergies.

485
00:22:48,843 --> 00:22:51,842
And so if they're really high
to, let's say, Mount Cedar

486
00:22:52,242 --> 00:22:55,442
and especially these old farmhouses,
people that live out in the country

487
00:22:55,442 --> 00:22:59,408
in their houses, surrounded by the trees,
I'm like, you need to cut those down.

488
00:22:59,774 --> 00:23:00,408
You, you know.

489
00:23:00,408 --> 00:23:02,941
Yeah, get rid of those
things are a very potent allergy.

490
00:23:02,941 --> 00:23:03,274
Right.

491
00:23:03,274 --> 00:23:06,873
And, so allergy avoidance, we,
we kind of forget about that.

492
00:23:06,873 --> 00:23:09,306
You know, being b medical doctors,
we're like,

493
00:23:09,306 --> 00:23:10,873
hey, we just need to jump to medicine.

494
00:23:10,873 --> 00:23:12,539
Yeah, we need to think about.

495
00:23:12,539 --> 00:23:16,972
You know, or if there are the reaction
to kitty cats and puppy dogs or crazy high.

496
00:23:17,505 --> 00:23:19,772
I mean, dogs do that. Well, I got ten.

497
00:23:19,772 --> 00:23:20,871
Okay, okay.

498
00:23:20,871 --> 00:23:23,571
You know, you know, and for the record,

499
00:23:23,571 --> 00:23:26,671
I've never told anybody
to get rid of their dog or cat.

500
00:23:26,737 --> 00:23:28,337
They're my children.

501
00:23:28,337 --> 00:23:30,237
But I do tell them, look, how about.

502
00:23:30,237 --> 00:23:32,603
You make your bedroom?

503
00:23:32,603 --> 00:23:37,036
Yeah, like like sterile territory,
you know, no cats or dog in your.

504
00:23:37,036 --> 00:23:38,269
Bedroom, which.

505
00:23:38,269 --> 00:23:41,069
A lot of patients will do that.
But at least try to get.

506
00:23:41,069 --> 00:23:42,635
That to our all of our listeners.

507
00:23:42,635 --> 00:23:48,101
Dupixent is a monoclonal antibody
against IGE levels that correct. No.

508
00:23:48,101 --> 00:23:52,334
It's well and so they work they all work
with at different interleukins.

509
00:23:52,634 --> 00:23:55,967
So Xolair is an monoclonal antibody
to IGE.

510
00:23:55,967 --> 00:23:59,033
You're right master IV
monoclonal antibody.

511
00:23:59,233 --> 00:24:02,566
The rest work on the on the interleukin
okay.

512
00:24:02,566 --> 00:24:05,799
And I think you know
I always get them all mixed up I think.

513
00:24:05,799 --> 00:24:11,364
And Dupixent will be unique because I
think it works against two different ills.

514
00:24:12,431 --> 00:24:12,764
And so

515
00:24:12,764 --> 00:24:15,930
that's why I think they've got broad,
probably the broadest indication.

516
00:24:15,930 --> 00:24:18,363
So now we're using them on eczema.

517
00:24:18,363 --> 00:24:18,763
Yeah.

518
00:24:18,763 --> 00:24:21,863
Nasal polyposis, I mean, all these things.

519
00:24:21,863 --> 00:24:22,530
Yeah, yeah.

520
00:24:22,530 --> 00:24:27,162
You know, it
it it's really changed what you do there.

521
00:24:27,462 --> 00:24:31,162
One of the procedures I got trained
in that I haven't done in a while,

522
00:24:31,162 --> 00:24:34,295
I don't have you ever heard
of bronchial thermoplasty?

523
00:24:34,395 --> 00:24:34,928
Yeah.

524
00:24:34,928 --> 00:24:36,861
And and you know, we don't.

525
00:24:36,861 --> 00:24:38,594
I haven't done one of those in forever.

526
00:24:38,594 --> 00:24:39,061
Right? Yeah.

527
00:24:39,061 --> 00:24:42,060
Because he's biologic
for helping the patient so much.

528
00:24:42,160 --> 00:24:44,060
So you mentioned the Oklahoma
allergy panel,

529
00:24:44,060 --> 00:24:45,793
which
we're both going to start order of now.

530
00:24:45,793 --> 00:24:48,159
But one of the things we were wondering
you could tell us a little bit

531
00:24:48,159 --> 00:24:51,159
about is the new state of the art
ion system here at norman regional
.

532
00:24:51,226 --> 00:24:52,192
Oh, yeah.

533
00:24:52,192 --> 00:24:52,492
Yeah.

534
00:24:52,492 --> 00:24:57,391
So, so the ion bronchoscopy and,
and I just, you know, have to

535
00:24:58,191 --> 00:25:01,857
I give a shout out to my partner,
Doctor Garcia, because he's amazing.

536
00:25:01,857 --> 00:25:04,957
I mean, he really is
one of the best proceduralists.

537
00:25:05,290 --> 00:25:07,057
That I've ever run across.

538
00:25:07,057 --> 00:25:10,123
I think a lot of people would say he might
be one of the top guys in the state.

539
00:25:11,323 --> 00:25:11,823
Really.

540
00:25:11,823 --> 00:25:14,156
But anyway, the ion is.

541
00:25:14,156 --> 00:25:17,155
So it's a it's
a type of navigational scope.

542
00:25:17,455 --> 00:25:19,222
It's very flexible.

543
00:25:19,222 --> 00:25:23,521
And it we're, we're able to get a special
CT scan,

544
00:25:23,788 --> 00:25:27,654
run that image through a computer
and be able to navigate

545
00:25:28,687 --> 00:25:32,920
from, navigate the scope
to these remote lesions.

546
00:25:33,253 --> 00:25:38,452
In a lung that, in the past,
we could never get to and, it's it's

547
00:25:38,752 --> 00:25:40,019
it's amazing.

548
00:25:40,019 --> 00:25:43,352
And, here's some other tools,

549
00:25:43,352 --> 00:25:47,718
even some therapeutic tools that actually,
Norman, again, because of Dr.

550
00:25:47,784 --> 00:25:53,150
Garcia, is being considered for
there's like 40 sites in the country.

551
00:25:53,584 --> 00:25:58,350
And so this is a therapeutic tool
where we can actually go in and ablate,

552
00:25:58,916 --> 00:26:01,349
lesions,

553
00:26:01,349 --> 00:26:04,482
that patients can say patient couldn’t
tolerate surgery... Wow.

554
00:26:05,315 --> 00:26:07,982
And so I'm hope we're hoping
we can get this,

555
00:26:07,982 --> 00:26:11,514
because it really would be not
only would it be,

556
00:26:11,514 --> 00:26:14,514
you know, a feather in the cap
for our, in our,

557
00:26:14,747 --> 00:26:18,380
system here, but I think it'd be
a tremendous asset for our patients.

558
00:26:18,413 --> 00:26:21,146
Yeah. So, yeah, you know.

559
00:26:21,146 --> 00:26:21,746
Well, sir,

560
00:26:21,746 --> 00:26:24,746
I don't think we can, go through
this episode without talking about smoke.

561
00:26:25,146 --> 00:26:25,512
Right?

562
00:26:25,512 --> 00:26:28,312
And what kind of risk factors
it has on the lungs? Yeah.

563
00:26:28,312 --> 00:26:31,612
You know, we talked about COPD
and and we remember you in lung cancer.

564
00:26:32,178 --> 00:26:35,211
Can you, can you, you know, to
to take a little touch of that and.

565
00:26:35,211 --> 00:26:35,678
Sure.

566
00:26:35,678 --> 00:26:39,944
Yeah I mean smoking cessation is it's

567
00:26:39,944 --> 00:26:42,943
you know, it's really the foundation

568
00:26:42,943 --> 00:26:46,043
of our, of our treatment for the patient.

569
00:26:46,043 --> 00:26:49,076
And, you know, we always think
about treatment as being able

570
00:26:49,076 --> 00:26:52,909
to give a patient a prescription
or a medicine or inhaler, whatever.

571
00:26:53,509 --> 00:26:56,575
But,
you know, really, that's the foundation,

572
00:26:56,641 --> 00:26:59,341
especially in our COPD population.

573
00:26:59,341 --> 00:27:02,774
But really for all our patients
who are smoking because they're at risk

574
00:27:02,774 --> 00:27:04,740
for so many things.

575
00:27:04,740 --> 00:27:10,373
And, you know, I look at smoking cessation
more longitudinally.

576
00:27:11,939 --> 00:27:14,206
Because the success

577
00:27:14,206 --> 00:27:17,205
of smoking cessation
is really up to the patient

578
00:27:17,539 --> 00:27:20,538
and you can do anything
and everything to them,

579
00:27:20,805 --> 00:27:23,804
but until they get to the point
where they really want to quit,

580
00:27:24,104 --> 00:27:26,771
you're not going to have any success.

581
00:27:26,771 --> 00:27:30,103
And so I, I, you know,
I talk with patients

582
00:27:30,603 --> 00:27:33,603
and I'm saying, you know, we're,
we're, we're in this together.

583
00:27:34,003 --> 00:27:37,769
And I said, when you get to that point,
I said, I have to tell them.

584
00:27:37,769 --> 00:27:39,602
And I tell them blankly, look,

585
00:27:39,602 --> 00:27:43,368
you know, smoking is really bad for you
and you have to quit.

586
00:27:43,368 --> 00:27:45,035
You really need to quit.

587
00:27:45,035 --> 00:27:48,568
And when you're ready, we're
we're going to work on it together.

588
00:27:48,668 --> 00:27:51,600
The other side.

589
00:27:51,600 --> 00:27:56,900
Probably just something to talk about,
is, the lung cancer screening,

590
00:27:57,200 --> 00:28:02,432
I call it LDCT low dose CT
screening or lung cancer screening.

591
00:28:02,999 --> 00:28:05,998
And so that's one of the things,
you know, the the,

592
00:28:06,432 --> 00:28:07,732
one of the Holy Grails of pulmonary

593
00:28:07,732 --> 00:28:10,864
medicine is how can we improve outcomes
with, with lung cancer.

594
00:28:11,431 --> 00:28:13,764
And we're making great strides
in treatment.

595
00:28:13,764 --> 00:28:16,764
But still the hallmark is early detection.

596
00:28:16,964 --> 00:28:20,363
And now that we have these lung cancer,
CTS that

597
00:28:20,363 --> 00:28:24,363
we can do, 
that's that that improves mortality.

598
00:28:24,363 --> 00:28:27,562
In fact, I was at a meeting
and they were talking about how many

599
00:28:27,562 --> 00:28:30,895
screening scans
you have to do to save one life.

600
00:28:30,895 --> 00:28:35,561
And so for the low dose CT scanning,
it's like a little over 300.

601
00:28:36,094 --> 00:28:40,927
Whereas like mammography is like
I think 900 patients.

602
00:28:40,927 --> 00:28:41,693
Oh wow.

603
00:28:41,693 --> 00:28:44,060
You have to screen
to save one patient. Right.

604
00:28:44,060 --> 00:28:47,159
And then they gave another statistic
I can't remember.

605
00:28:47,159 --> 00:28:48,526
It's colonoscopy or something.

606
00:28:48,526 --> 00:28:50,592
And it was even higher than that. Wow.

607
00:28:50,592 --> 00:28:54,658
So really you know
if you're looking from a cost standpoint

608
00:28:54,692 --> 00:29:00,124
or frequency standpoint,
the lung cancer, low dose, low dose CT

609
00:29:00,224 --> 00:29:04,857
scans are probably from a cost benefit
ratio, one of the, one of the one of.

610
00:29:05,224 --> 00:29:06,423
The best things we can.

611
00:29:06,423 --> 00:29:11,089
And so the criteria just,
you know, 55 to 80, 30 pack years,

612
00:29:11,323 --> 00:29:14,356
and have quit within 15 years.

613
00:29:14,389 --> 00:29:15,455
Yeah. Yes, sir.

614
00:29:15,455 --> 00:29:19,155
Now, one of the common
misconceptions out there is that vaping

615
00:29:19,155 --> 00:29:20,955
is better than smoking. Yeah.

616
00:29:20,955 --> 00:29:23,354
So and I don't think
people really understand that.

617
00:29:23,354 --> 00:29:24,554
Yeah, they're really not.

618
00:29:24,554 --> 00:29:28,620
So would you be able to kind of
give us a better explanation of why not.

619
00:29:29,020 --> 00:29:32,520
Well, and you know, people
ask that all the time.

620
00:29:32,620 --> 00:29:33,953
Why is it bad?

621
00:29:33,953 --> 00:29:37,186
And I said, well, first of all, it's
not a regulated industry.

622
00:29:37,986 --> 00:29:39,852
We have no idea what's in it.

623
00:29:39,852 --> 00:29:43,018
I think the other thing is, is,
is especially younger people

624
00:29:43,618 --> 00:29:47,084
are smoking the equivalent of 2
or 3 packs a day,

625
00:29:47,551 --> 00:29:51,850
with these, with these vapes and,
and so it's really

626
00:29:51,884 --> 00:29:54,883
they're getting high doses of nicotine
and who knows what else.

627
00:29:55,450 --> 00:29:58,949
And you know, there's, there's,
you know, metals in these fumes.

628
00:29:58,949 --> 00:30:03,016
I mean, there's all kinds of carcinogens
that are in these fumes of the vapes.

629
00:30:03,615 --> 00:30:07,182
And so, you know,
the American college physician, the way,

630
00:30:07,448 --> 00:30:11,014
the way they rate, you know, bad things
for your lungs that people are currently

631
00:30:11,014 --> 00:30:12,314
doing is the worst thing

632
00:30:12,314 --> 00:30:14,581
is vaping. The next worst thing.

633
00:30:14,581 --> 00:30:19,380
And this is this is an unknown to, 
or a little known is marijuana smoking.

634
00:30:20,180 --> 00:30:22,613
And then the next worst is tobacco.

635
00:30:22,613 --> 00:30:26,946
So marijuana smoking
and vaping is worse than regular smoking.

636
00:30:27,445 --> 00:30:30,712
And, you know,
I always throw the caveat in.

637
00:30:30,745 --> 00:30:34,444
Look, look, I'm
not telling you to smoke okay, tobacco.

638
00:30:34,611 --> 00:30:38,044
Yeah, I'm just saying that
these other things are even worse, right?

639
00:30:38,244 --> 00:30:41,510
You know, and with the prevalence
of medical marijuana, that's something

640
00:30:41,510 --> 00:30:44,943
that's I have to remind myself to add to
the history

641
00:30:45,476 --> 00:30:49,009
is, is make sure that,

642
00:30:49,109 --> 00:30:53,742
I'm asking patients about, are you vaping
and are you smoking marijuana?

643
00:30:54,242 --> 00:30:57,308
And what I tell the medical
marijuana patients, I'm like, look, it

644
00:30:57,641 --> 00:31:00,574
I believe it's really helping you
if you're using this,

645
00:31:00,574 --> 00:31:03,640
but let's switch to the edibles
and let's let's get the smoke.

646
00:31:03,640 --> 00:31:04,807
Yeah. Yeah.

647
00:31:04,807 --> 00:31:07,007
I didn't think of
that. Yeah I think yeah. So

648
00:31:08,273 --> 00:31:09,273
because like, apparently like

649
00:31:09,273 --> 00:31:13,239
you can also develop resistance
to the amount that you're using.

650
00:31:13,239 --> 00:31:16,139
And so they might even get a maybe
an improved benefit with the edibles.

651
00:31:16,139 --> 00:31:16,905
If they change the route?

652
00:31:16,905 --> 00:31:19,305
Well they get,
they can get I think higher doses.

653
00:31:19,305 --> 00:31:21,071
I mean, so we really concentrated.

654
00:31:21,071 --> 00:31:22,738
Right, right.

655
00:31:22,738 --> 00:31:23,404
Yeah.

656
00:31:23,404 --> 00:31:27,970
And I think just a little caveat for our,
our listeners,

657
00:31:28,304 --> 00:31:29,204
Doctor

658
00:31:29,204 --> 00:31:29,870
Whitson talked about

659
00:31:29,870 --> 00:31:33,903
the lung cancer screening, and you don't
even need an order from us to get that.

660
00:31:33,903 --> 00:31:36,203
They can call it good. Yeah.
You can call and get that.

661
00:31:36,203 --> 00:31:40,335
Just Google Norman Lung scan it
and it's with the coronary calcium

662
00:31:40,335 --> 00:31:44,435
screen too, right Krishna, so they can get them
both together for like $100 I think.

663
00:31:44,435 --> 00:31:47,601
And then I think, I think I think together
they're a little over a hundred

664
00:31:47,601 --> 00:31:49,501
I think somebody
because somebody was give me the prices.

665
00:31:49,501 --> 00:31:51,200
I think it's $120.

666
00:31:51,200 --> 00:31:53,334
Oh yeah. Something like that.
So yeah. Yeah. So I think

667
00:31:54,467 --> 00:31:57,133
oh 75? $125 for both.

668
00:31:57,133 --> 00:31:57,900
$125 for both.

669
00:31:57,900 --> 00:31:58,866
I'll say thank you guys.

670
00:31:58,866 --> 00:32:02,932
Yeah, that's pretty good because it's 
then you're not only making sure that,

671
00:32:02,966 --> 00:32:06,165
you know, your lungs are cancer free,
but then you're also getting an evaluation

672
00:32:06,165 --> 00:32:08,965
of your cardiovascular risk.
And yeah, that's great. Yeah.

673
00:32:08,965 --> 00:32:12,531
Well, as you guys can see, Veer
and I both, absolutely love

674
00:32:12,531 --> 00:32:15,730
and enjoy our conversation
with, Doctor Whitson.

675
00:32:16,064 --> 00:32:18,897
You know, Doctor
Whitson is not only is he,

676
00:32:18,897 --> 00:32:21,763
you know, just a great guy in general
and a wonderful family man.

677
00:32:21,763 --> 00:32:24,329
A fellow foodie. And yes, I love food.

678
00:32:24,329 --> 00:32:26,496
And I say this one more time,
five time board

679
00:32:26,496 --> 00:32:29,662
certified, provider
that we have here at Norman Regional.

680
00:32:29,662 --> 00:32:32,428
But he's also a pancreatic cancer
survivor. Yeah.

681
00:32:32,428 --> 00:32:33,461
And Doctor Whitson

682
00:32:33,461 --> 00:32:37,161
for, for a lot of you people
that don't know him has a tremendous story

683
00:32:37,494 --> 00:32:40,627
that we were hoping you could kind of
tell us a little about your experience.

684
00:32:40,627 --> 00:32:43,560
Yeah. So, in fact, it's interesting.

685
00:32:43,560 --> 00:32:48,959
My journey started with a low dose
CT of my heart
Wow Calcium scoring, and,

686
00:32:48,959 --> 00:32:53,292
I had lost a couple of friends
in, in Enid.

687
00:32:53,358 --> 00:32:58,591
And,
I had some heart risk factors, and,

688
00:32:58,591 --> 00:33:01,924
so went got a calcium score
that wasn't crazy high.

689
00:33:01,924 --> 00:33:04,390
It was in the middle and saw my heart.

690
00:33:04,390 --> 00:33:07,357
Cardiologist is like, well,
do you get chest pain?

691
00:33:07,357 --> 00:33:10,423
I go, no,
but I get this pain between my shoulders,

692
00:33:10,656 --> 00:33:12,822
like when I exercise
and it goes away with rest.

693
00:33:12,822 --> 00:33:15,822
And so we had a heart CATH
and it was clear.

694
00:33:16,022 --> 00:33:19,088
And, man, I was ready to jump ship
at that standpoint.

695
00:33:19,088 --> 00:33:24,121
And he goes, well, maybe that pain could
be coming from your gallbladder something.

696
00:33:24,121 --> 00:33:27,187
So the ultrasound of my gallbladder
and or my liver, gallbladder.

697
00:33:27,187 --> 00:33:31,120
And anyway,
they found two tumors on my liver and,

698
00:33:31,120 --> 00:33:36,186
you know, subsequent mass and, you know,
I thought I was a goner.

699
00:33:36,186 --> 00:33:36,453
Yeah.

700
00:33:36,453 --> 00:33:41,885
And, they,
I ended up undergoing the Whipple,

701
00:33:42,885 --> 00:33:44,185
the one surgery.

702
00:33:44,185 --> 00:33:46,484
But. Yeah,

703
00:33:46,484 --> 00:33:49,684
in, in six months of chemo and,

704
00:33:51,250 --> 00:33:52,384
did I.

705
00:33:52,384 --> 00:33:55,583
And it really, to be honest,
I was just kind of expecting to die.

706
00:33:55,583 --> 00:33:56,716
You know, in a year or two.

707
00:33:56,716 --> 00:34:01,249
I wasn't planning on being around,
and I'm still here and glad to be here.

708
00:34:01,682 --> 00:34:05,282
Now, for those of our listeners
that don't know what a Whipple procedure

709
00:34:05,282 --> 00:34:07,082
is, I'm just looking this up real quick

710
00:34:07,082 --> 00:34:09,681
on Wikipedia myself
because I always have to refresh this.

711
00:34:09,681 --> 00:34:11,814
It's a major surgical operation.

712
00:34:11,814 --> 00:34:14,814
They remove part of your pancreas,
small intestine,

713
00:34:14,847 --> 00:34:18,347
gallbladder and bile duct
essentially to treat the cancer.

714
00:34:18,347 --> 00:34:21,413
So that's an it's
not an easy surgery to undergo

715
00:34:21,413 --> 00:34:24,413
and then to recover
and also to be here with us.

716
00:34:24,546 --> 00:34:26,379
That's no easy feat. So.

717
00:34:26,379 --> 00:34:28,312
Well I had I had really good treatment.

718
00:34:28,312 --> 00:34:32,645
And you know, I just
I thank God I really do I, I, I,

719
00:34:33,145 --> 00:34:36,311
I yeah treat every day as a gift from.

720
00:34:36,311 --> 00:34:37,111
From the Lord.

721
00:34:37,111 --> 00:34:38,377
Yeah I really. Do.

722
00:34:38,377 --> 00:34:38,877
Well sir we're

723
00:34:38,877 --> 00:34:42,343
really glad you're here with us
because you've been pretty awesome guy

724
00:34:42,343 --> 00:34:43,143
to get to know.

725
00:34:43,143 --> 00:34:45,410
Well thanks. I've enjoyed you guys. We just

726
00:34:45,410 --> 00:34:46,176
always enjoy our

727
00:34:46,176 --> 00:34:46,776
conversations.

728
00:34:46,776 --> 00:34:49,476
Yeah, yeah, we got to go get some food.

729
00:34:49,476 --> 00:34:52,109
Yeah. You do have to check out Norman
well sir.

730
00:34:52,109 --> 00:34:56,841
Any words of advice, any thoughts, 
that you'd like to relay to our listeners?

731
00:34:56,841 --> 00:34:58,841
Mostly patients. Yeah.

732
00:34:58,841 --> 00:35:02,574
You know, I don't I don't know that
I have any great words of advice.

733
00:35:02,574 --> 00:35:07,773
I just think that, you know, watching
watching, taking care of patients from,

734
00:35:07,773 --> 00:35:10,773
you know, flying over 30,000ft,
kind of that view,

735
00:35:10,939 --> 00:35:14,939
especially now that I'm getting older,
you know, I'm going to be 62 this year.

736
00:35:15,239 --> 00:35:18,205
Probably the two things

737
00:35:18,205 --> 00:35:22,071
that that I kind of talk
to patients about a lot

738
00:35:22,104 --> 00:35:25,204
because I have a lot of patients
that come in, they're short of breath.

739
00:35:25,571 --> 00:35:26,337
And they're workups.

740
00:35:26,337 --> 00:35:30,837
Negative is number one,
you know, try to watch what you eat.

741
00:35:31,237 --> 00:35:33,803
As much as we love food,
but watch what we eat.

742
00:35:33,803 --> 00:35:35,036
Try and maintain your weight.

743
00:35:35,036 --> 00:35:39,535
And the other thing is, is try
and maintain a level of activity, exercise.

744
00:35:40,002 --> 00:35:42,835
It just seems like the older
we get, the less we move.

745
00:35:42,835 --> 00:35:45,535
And that really affects
people's quality of life.

746
00:35:45,535 --> 00:35:51,067
And so trying to maintain
some sort of regular exercise, is good.

747
00:35:51,134 --> 00:35:52,400
Yeah. Is good.

748
00:35:52,400 --> 00:35:54,667
What's your go to exercise, sir.

749
00:35:54,667 --> 00:35:56,966
It used to be swimming laps,
I haven't got a good lap pool yet.

750
00:35:56,966 --> 00:35:58,566
okay I know they. Exist.

751
00:35:58,566 --> 00:36:04,265
But I go to our, I don't know if you've
ever been over to the senior center.

752
00:36:04,265 --> 00:36:05,798
You guys are too young. Oh, no.

753
00:36:05,798 --> 00:36:07,831
We visited,
we went there. Yeah, it's a really.

754
00:36:07,831 --> 00:36:09,731
It's really nice.
You guys should check it out. Like it?

755
00:36:09,731 --> 00:36:10,831
But you're too young to go to.

756
00:36:10,831 --> 00:36:12,931
Yeah. Oh, probably five.

757
00:36:12,931 --> 00:36:14,464
Got to be 50. Oh, okay.

758
00:36:14,464 --> 00:36:16,864
But I love that thing.
Yeah. I mean, it's really nice.

759
00:36:16,864 --> 00:36:17,097
Yeah.

760
00:36:17,097 --> 00:36:20,030
And, I mean brand new equipment,
nice staff.

761
00:36:20,030 --> 00:36:22,029
The people there are super.

762
00:36:22,029 --> 00:36:23,363
And it has a pool in it. Yeah.

763
00:36:23,363 --> 00:36:24,063
It's only like

764
00:36:24,063 --> 00:36:28,562
I think the lap area is only 16 yards,
which for me, I need a little longer.

765
00:36:28,762 --> 00:36:32,795
But, I mean, I go there,
I try to go three days a week.

766
00:36:32,795 --> 00:36:35,061
Yeah, I do cardio, do a little weights.

767
00:36:35,061 --> 00:36:36,094
Yeah, yeah.

768
00:36:36,094 --> 00:36:38,061
And so you get some resistance
training there too.

769
00:36:38,061 --> 00:36:41,427
The other thing with having a Whipple,
it helps me maintain my weight. You,

770
00:36:44,360 --> 00:36:47,026
it's a good as a positive out, but.

771
00:36:47,026 --> 00:36:49,826
Just for the record, that's not how you want to do weight
loss is have a Whipple procedure.

772
00:36:49,826 --> 00:36:51,192
Yeah. Thank you.

773
00:36:51,192 --> 00:36:52,259
Thank you. For picture.

774
00:36:52,259 --> 00:36:56,825
Worried about that, but, but,
yeah, I can eat like I used to.

775
00:36:56,825 --> 00:36:59,424
And so, yeah, if I overeat,

776
00:36:59,424 --> 00:37:01,991
you know, I just look at my wife
and I'll have to look and she's like,

777
00:37:01,991 --> 00:37:03,624
yeah, you need to go lay down to eat,
you know, like.

778
00:37:03,624 --> 00:37:04,724
Yeah, yeah.

779
00:37:04,724 --> 00:37:07,556
So yeah. But, yeah.

780
00:37:07,556 --> 00:37:09,623
So it's been. Great having. You. Yeah.

781
00:37:09,623 --> 00:37:12,756
We always, love talking with you, either

782
00:37:12,922 --> 00:37:16,555
here at the podcast today or also,
just when we curbside consult you.

783
00:37:16,555 --> 00:37:18,455
Yeah.
Thank you so much for everything you do.

784
00:37:18,455 --> 00:37:21,288
And thank you for being part of our Norman
Regional community.

785
00:37:21,288 --> 00:37:22,521
So thank you for being here.

786
00:37:22,521 --> 00:37:25,354
Yeah. Happy back.
I love to talk to you. Yeah, yeah.

787
00:37:25,354 --> 00:37:26,554
Oh, definitely.

788
00:37:26,554 --> 00:37:29,253
We could do a whole episode about COPD and asthma probably.

789
00:37:29,253 --> 00:37:30,287
Yeah. We can. Right.

790
00:37:30,287 --> 00:37:31,553
There's got to be like a pulmonology part

791
00:37:31,553 --> 00:37:34,453
2
They we need to start reviewing recipes
Oh probably do.

792
00:37:34,453 --> 00:37:36,419
That'd be okay. Oh, that would be awesome.
Yeah.

793
00:37:36,419 --> 00:37:37,419
Like a side podcast.

794
00:37:37,419 --> 00:37:40,652
Yes. I'm just I'm just saying I don't know
does one exist?

795
00:37:41,185 --> 00:37:42,785
No, but we could do it.

796
00:37:42,785 --> 00:37:44,385
What does Whitson Eat! Oh,

797
00:37:46,318 --> 00:37:47,584
I just gotta

798
00:37:47,584 --> 00:37:50,217
chatGPT that, Better titles, but...

799
00:37:50,217 --> 00:37:51,984
Well, thank you, listeners for joining us.

800
00:37:51,984 --> 00:37:54,083
This has been another episode
of Vital Visions.

801
00:37:54,083 --> 00:37:57,816
We've been sitting down
with, five time board certified

802
00:37:57,816 --> 00:37:59,516
pulmonologist Doctor Brian Whitson.

803
00:37:59,516 --> 00:38:03,515
We talked about all things lungs and
and just the positive outlook of life.

804
00:38:03,515 --> 00:38:07,282
And, do you guys have any concerns
and or having any respiratory issues

805
00:38:07,282 --> 00:38:08,848
reach out to your primary care doctor

806
00:38:08,848 --> 00:38:11,848
and then maybe see pulmonologist, maybe
Doctor Whitson, because he's amazing.

807
00:38:12,681 --> 00:38:15,814
And, this is
this has been a great episode.

808
00:38:15,814 --> 00:38:18,280
And as always, stay classy, my friends.

809
00:38:18,280 --> 00:38:19,247
And stay out of trouble.