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Interviewer: For patients with lung disease, deciding what medical center you'll partner with for a lung transplant is a big decision and there are a lot of factors to take into consideration. But today, we're going to help answer some of those questions you might have.

Dr. Matthew Morrell, he's dedicated his career to ensuring patients who need lung transplants get them and also have the best outcomes possible. He's been at some of the biggest lung transplant centers in the United States, and now he's the medical director of The Lung Transplant Program at University of Utah Health.

Dr. Morrell, thank you for sharing your expertise. And the first question is I learned that sometimes a patient diagnosed with lung failure isn't even told that a lung transplant is an option. That really surprises me. Explain that for me.

Dr. Morrell: Honestly, it's interesting. Not a lot of people or lung doctors in the community even think this is an option. There's a lot of misinformation, miscommunication between providers and patients that are out there. So our goal has really been to reach out to providers, to reach out to doctors, to really educate them about lung transplant as a potential option.

Interviewer: So if a patient has been . . . if that's never been mentioned, or they've been told, "Maybe that's not an option," it might be a good idea to seek out a second opinion.

Dr. Morrell: That's exactly right. So we here at the University of Utah, we're always willing to talk to any patient that has any questions, even those that don't necessarily even have a referral from a lung doctor, their lung doctor isn't in the community. We've seen patients that call up and just want to say, "Hey, I want to speak to somebody that can give me more information about lung transplant," and, "Hey, am I a candidate? What makes a good candidate? What doesn't?"

Interviewer: Yeah. Obviously, you know all those things. You live it every day. Let's say a patient has been told that they are a candidate for a lung transplant, or maybe that's an option they should consider. Based on what you just said, maybe a patient thinks that a transplant would be a good option for them. Does the patient get to pick the medical center where the procedure is done, or is it kind of when I've got a cold, I'm going to go to the nearest InstaCare?

Dr. Morrell: Well, patients, yes, they have the option of choosing where they want to go to get their lung transplant. Insurance sometimes does dictate where they can go, but honestly, if a patient says, "Hey, I want to come to University of Utah," they just talk to the provider, and that provider can make that referral down to us.

Interviewer: So that's great that a patient gets to choose. In a way, that's great, right? But it also comes with a lot of decisions that have to be made, a lot of things that have to be weighed. So what would you say to a patient that's trying to make that decision of choosing a center? What are some of the things they should consider?

Dr. Morrell: Well, honestly, you want to look at the center's history. How long has that center been doing lung transplants? How many patients have they transplanted? How many patients do they transplant a year? Are they doing research in the field of lung transplantation at that institution?

And also, talk to patients that have actually had transplants there. We can give you the names of a couple of patients that have had transplants and you can call them, speak with them, and they can tell you their personal opinion about how that process was for them.

You can speak to a coordinator and get your questions addressed even before even coming to the University of Utah. And when you do come for your initial appointment, it's mostly a meet-and-greet. No pressure. It's just an information gathering. How do you feel? Have you made that bond with that physician? Is that physician someone who you can trust? Is that someone who you want to be your advocate for you going forward as you get evaluated for lung transplant?

Interviewer: One of the challenging things for lung transplantation is you're on that waiting list and you're waiting for that match, that donor match to come. And sometimes, it can just by chance come very quickly, or sometimes it might take a while. Are there things that are done at particular institutions such as University of Utah that could help increase the chances that a lung donor gets a match more quickly?

Dr. Morrell: Oh, absolutely. So we are the only lung transplant program in the Intermountain West. So that means that not only do we see a lot of patients from not only inside of Utah, but the surrounding states, Colorado, Nevada, Oregon, Idaho, Montana, parts of Arizona. We're getting patients referred to us.

On top of that, we have to get donors. If there's a donor that is in another state, that does come to us. So we do have a lot more access to some of these donors versus if you were living in a city like Los Angeles. There are a lot of other centers there. There's a handful of lung transplant centers.

And so there's a lot of competition when a donor becomes available to try and match that to a recipient versus us. We're it in the Intermountain West. So if you get evaluated and get placed on the list, your chances of getting a transplant are pretty good.

Interviewer: Another consideration with lung transplant is rejection. But technology and techniques are improving. Tell me about some of the things that are done at University of Utah Health that help reduce that risk of rejection and help treat rejection.

Dr. Morrell: We are very aggressive once a patient gets a transplant in terms of keeping an eye on someone's lung function, on their blood work. We have patients coming pretty frequently after surgery for follow-up when rejection is the highest. So if rejection is going to happen, we catch it firsthand and we deal with it.

We're involved in some of these research trials for some of these new medications to treat rejection. So if rejection is going to happen, we catch it early, we handle it, we treat it, we resolve it. And for those patients that may have rejection that is more difficult to control, we're using the cutting-edge research technology to cure rejection, to overcome it, and to improve survival.

Interviewer: Another component of lung transplantation is the average life expectancy after a lung transplant, which kind of shocked me. It's about five years. I thought it was a lot longer than that. But are there some things that you can do that actually will help stretch that out?

Dr. Morrell: We are very vigilant at catching problems if they do happen. We have access to nutritionists, a physical therapist that if someone has something that could affect their overall survival, we have access to state-of-the-art therapies even outside of lung transplant here at the hospital that can really help and improve survival.

Interviewer: What I'm really getting about lung transplantation, the skill of the team that is doing the transplant is super important. But with lung transplantation, it sounds like the work that's done before the transplant, and even the work after the transplant, is really important. And that a patient should feel as though when they're at an institution, that if they have an issue, they're going to be able to contact somebody, and that they're going to hear back from the department. I mean, it sounds like that could be a matter of getting more years out of your transplant or not.

Dr. Morrell: Exactly. There's always a nurse coordinator here on call 24/7. There's a pulmonologist on call 24/7. And along that pre-transplant side of things, as you mentioned, I want to add that we encourage patients to come early for their evaluation so we can take a look at you. And if there is a problem, if there's something we can work on, if you're a little bit overweight, we can address that, get you to lose weight. If you need some exercise, some rehab, we get you plugged into that too. If your heart needs to be looked at, we get you into the cardiologist.

We want to have that time to really optimize you, to get you in the best shape you can be prior to your surgery, prior to your transplant, to really have you be that patient that exceeds that average survival, that you're that patient that 25 years out from transplant, you're loving life, you're active, you're traveling, you're living life to the fullest, and you're as healthy as you can be.

Interviewer: So the average time of survival is five years, but you just mentioned 25 years.

Dr. Morrell: Oh, yeah.

Interviewer: It can go much longer than that.

Dr. Morrell: Oh, yeah. That's the average survival. You take everyone that's had a transplant.

So sometimes in transplant . . . and again, not just here, this is everywhere in the world. Sometimes patients are super sick at the time when they go on that list. They may have some medical problems that ultimately recur after transplant, and sometimes they die within that first year.

On the opposite end of the spectrum, we have patients that are over 20 years out. It's so rewarding to me to see these patients that are doing so well. It's wonderful. That's why I do what I do.

Interviewer: Are you pretty good at being able to determine when a patient gets a lung transplant kind of what the average survival rate might be for that particular patient?

Dr. Morrell: Yeah, I think we get a general sense when someone does come. We take a look at somebody, we know their medical history, we go into very, very good detail, and so we do know risk factors. "Hey, I say because of X, Y, and Z, because of your previous chest surgery, because you're on this medication, this specific one, that you do fall into this high-risk category. You may be somebody that we really have to hope for the best for after transplant. If we choose to put you on the list, complications may happen."

When patients come for their evaluation, we don't want to commit them to a transplant early. We don't want to potentially shorten your survival by saying, "Hey, we're going to do a transplant even though you're not quite sick enough for a transplant." We do these early referrals that allow us to work on some of these modifiable risk factors that can influence survival.

But if we have time beforehand, we'll say, "Hey, you know what? Things look good right now, but let's have you come back in six months and if you start getting sicker, if you start needing more oxygen, and if your lungs start limiting your activity level, you may kind of be pushed into that gray zone where we say, 'Okay, now is the time. Now is the time when we need to get you on that list because based upon my assessment, you may not live without a transplant longer than a year. So now may be the time to get you on the list to really improve . . .'" The goals of transplants are improve longevity, improve quantity of life, and also improve quality of life.

Interviewer: If you want to learn more, just Google "lung transplant at University of Utah Health." There are a lot of great resources on that page there, including types of lung disease and the transplant surgeries that you might need for those. There's "The 10 Things to Know About Lung Transplant," patient stories about their transplant experience at University of Utah Health. Again, just Google "lung transplant University of Utah Health" to get those stories.

Dr. Morrell, thank you very much.

Dr. Gellner: Parents know they want a good doctor for their child, but how should they go about actually choosing a pediatrician? I'll give you some pointers on how to find the best kid doc for your child on today's Scope.

Announcer: Keep your kids healthy and happy. You are now entering the "Healthy Kids Zone" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: As a parent, we all want the best for our children, so when you go to find a new pediatrician, whether you're still expecting your first baby, have an insurance change, or move to a new city, finding someone to care for your child's health is a huge decision. Just like any other long-term relationship, you need to be comfortable with the person you are entrusting your child to. So how do you find a new pediatrician?

First, talk to your friends who have kids. I know a lot of my patients come to me and the parents say, "Oh, you see my neighbor's child," or, "You see my nieces and nephews," and they all said, "I just had to bring my kids to you."

If you are just changing insurances, ask your current pediatrician who they would recommend. Often we know the other docs in the area and who would be a good fit for your family.

Another good tip is to check out the American Academy of Pediatrics' website and use the "Find a Pediatrician" tool. It will help you find a board-certified pediatrician in your area, and then you can search that provider on various patient satisfaction websites to see what others think of that pediatrician.

Many practices actually have their own websites that answer a lot of questions for you. Often, you can look at each pediatrician's profile to see when and where they did their medical school and residency training, do they have any specific areas or interests, what are the clinic's office hours, and who takes care of any concerns when the pediatrician isn't in the office. And don't forget about looking to see what insurances the practice accepts.

Some parents choose to do a meet-and-greet appointment with a prospective pediatrician. You'd have to call to see if the provider does those types of visits and if a co-pay is required. You can then check out the office to see if the staff is comfortable with kids, is the facility kid-friendly, and does the pediatrician seem down-to-earth, easy to talk to, knowledgeable, and like they really enjoy working with the little ones.

Can your child be seen the same day for sick visits? Who covers for the pediatrician after hours? Does the pediatrician go to any hospitals? Usually, we know what information parents want when they come in for these types of visits, and so we can help you make sure you're not forgetting anything to ask.

Bottom line is you should feel absolutely comfortable with your pediatrician and feel like you can trust them to have your child's best interests at heart. If the fit doesn't feel right, move on until you find the best possible pediatrician for your family.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Interviewer: You've been diagnosed with prostate cancer. What next? We'll talk about that on The Scope.

Announcer: Interesting, informative, and all in the name of better health. This is The Scope Health Sciences Radio.

Interviewer: For men that have been diagnosed with prostate cancer, figuring out the right treatment option can be really overwhelming. Dr. Jonathan Tward specializes in prostate cancer at Huntsman Cancer Institute. Dr. Tward, what treatment option would you recommend for a man just diagnosed with prostate cancer?

Dr. Tward: It's really an equally important question in a cancer that often won't take someone's life, Should they be treated? Because the treatments themselves can just as easily impact someone's sexual health, urologic bother, or bowel bother. One of the problems with prostate cancer, which is sort of unique to prostate cancer and different from other cancers, is that unlike other cancers where there's a very defined treatment paradigm, this particular cancer has many treatment options, and it is overwhelming to a lot of men who are faced with a new diagnosis of a relatively early stage cancer. Should they choose a surgery? Should they choose one form of radiation therapy or another radiation therapy? It's a big struggle for a patient who is contemplating their mortality to also have to go through the various treatment options and side effects because, honestly, when you start parsing treatment options for prostate cancer, there are essentially 20 different little ways of skinning that cat. It can paralyze people with this anxiety over 'Am I choosing the right thing? Am I not choosing the right thing?' So one of the things that I advocate for to a patient who is diagnosed is if they have an early stage prostate cancer, which is 80 to 85 percent of new diagnoses, they should speak to a urologist because the urologist will specialize in the surgical management of that disease. However, they should also speak to a radiation oncologist who specializes in the curative treatment of that disease with radiation therapy because they have non-surgical treatment options that are just as curative as the surgical option. But you're starting to choose on subtleties of different side effects.
When you're talking about sexual function, especially, this can become very important. There are certain ways of doing the surgery that will guarantee that you have erectile dysfunction whereas there are other ways of doing the surgery that will improve the probability that you don't. Or you might decide that radiation therapy in the form of external beam treatment or seed implants may have a favorable sexual function preservation rate relative to surgery, maybe, at the expense of an increased risk of a bowel bother. So men struggling with these treatment decisions are trying to balance risks of side effects to their urinary functions, risks of side effects to their bowel, and risks of side effects to their sexual function. And that's what is very challenging in terms of making treatment decisions.

Interviewer: And it doesn't sound like there's any easy way to really pick one. It sounds like you just kind of got to go through the options and then decide what's important to you.

Dr. Tward: Right. There is no way, and the reason that I advocated speaking both to your urologist and radiation oncologist is that a urologist, and rightfully so, should be biased towards 'You should get surgery' and may kind of communicate that perspective to the patient whereas a radiation oncologist may be biased that you should get radiation. But ultimately, you want the patient to hear the experts in those fields kind of discussing the details with therapy. If they're fortunate and maybe have friends who have gone through the different kinds of treatments, they can ask one friend who's had one form of treatment and another friend who's had another if they have that luxury. Or they can join a men's group where they can easily talk to men who have had different perspective. They can even include their primary care doctor in that decision making to help them kind of go through this decision and make an informed decision.

Interviewer: So there are men's groups that actually help support this sort of thing?

Dr. Tward: There are men's groups. The men's groups are not as active as, let's say, breast cancer groups.

Interviewer: Sure.

Dr. Tward: Women are very motivated to have survivorship groups and support groups, and men historically have been a little less motivated, but they do exist.

Interviewer: And you think they're a good resource?

Dr. Tward: I think they're an excellent resource, especially because it's one thing to hear a doctor tell you what you think and what you might feel, but it's another thing to hear it from someone who's gone through it. As much as I think I know about prostate cancer and what it feels like to get radiation therapy or what it feels like to get surgery, it's never been done to me. So I think there's extreme value in talking to people who have endured our therapies and the possible side effects.

Interviewer: We're your daily dose of science, conversation, medicine. This is The Scope, the University of Utah Health Sciences Radio.