Search for tag: "pulmonary"

There have been concerns by some parents that they don't want their kids wearing masks because they believe their child will be inhaling their own carbon dioxide with prolonged mask wearing and that will cause oxygen deprivation. Some say that children will inhale up to six times the safe limit of carbon dioxide.

Let me help clear the air on this one. It's not true. Here's the science behind the truth. Carbon dioxide poisoning or hypercapnia from re-breathing the air we normally breathe out doesn't happen because carbon dioxide molecules are extremely small, even smaller than the respiratory droplets, which is what we are protecting against when we wear the masks. They cannot be trapped by cloth or medical masks or any sort of breathable fabric. Those tiny molecules just pass right through the material.

Surgeons, nurses, respiratory therapists, all of us in the medical profession, in fact, wear our masks for hours and hours during the day. Studies done by having surgeons wear oxygen monitors during their entire time in the operating rooms show that masks have no effect on the amount of oxygen they have in their bodies.

If your child is wearing their mask properly, covering their mouth and their nose and fitting snugly over their face with the ear loops or ties, then your child will be protected from the respiratory droplets we don't want going through the breathable fabric, but still letting them breathe in oxygen and exhale carbon dioxide through their masks.

The bottom line is masks work. Last year during what is usually a very busy winter season, I hardly saw any sick kids. Now we are seeing RSV and rhinovirus and all sorts of other winter viruses because people have loosened up on mask wearing and viruses are taking advantage of that. Hospitals are full with kids who are having respiratory virus complications. I've had parents of children with asthma tell me that since their kids wore masks, the last school year, they didn't get sick and didn't have any asthma flare-ups. We can do this.

The kids I've spoken to have no problem wearing their masks. They like to coordinate their masks with their outfits and get cool ones with princesses and superheroes on them. I tell them they actually are little heroes. They tell me they have no problem wearing masks all day at school either. My own kids even say that they're so used to their masks, they don't even think about them anymore. And they're in junior high and high school. So mask up. And if you have any other concerns about COVID and COVID precautions, be sure to talk to your child's pediatrician.

Interviewer: Treating chronic thromboembolic pulmonary hypertension, also known as CTEPH. We're going to find out more about that surgery next on The Scope.

Announcer: Health tips, medical news, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: You've been diagnosed with CTEPH and we've already learned about the condition, its symptoms, and stuff like that in our earlier podcast. But today, we want to talk about the surgery that treats it. Dr. Craig Selzman is a heart surgeon and one of the directors of the Chronic Thromboembolic Pulmonary Hypertension Program at University of Utah Health Care. So in case somebody didn't hear the first podcast, just briefly sum up what's going in the heart that causes this disease?

Dr. Selzman: It's actually, believe it or not, it's in the lungs and so the lungs are sandwiched between the right side of the heart and the left side of the heart. And so what CTEPH is, we'll just call it CTEPH, it is a form of what we call pulmonary artery hypertension. So pulmonary artery hypertension is high blood pressure in the pulmonary circulation. And there are a number of causes for it for which CTEPH is one of them.

This particular situation is a form of PAH, pulmonary artery hypertension, that is related to having blood clots that come from your legs or the lower extremities usually and get lodged into the lungs. We call that a pulmonary embolism. It's very highly morbid, causes a lot of problems, and it's lethal. It's one of several leading causes of cardiopulmonary death that can happen acutely.

And so what happens also inside the lungs is that the lungs actually start to remodel. You could almost imagine like you have some stuff in your sink and it gets into drains and it's kind of there, but you could imagine that a year or two later, it kind of forms and becomes part of the wall of the pipes. And that's what's happening inside your lungs and it becomes very hard for them to do their job, which is to take in oxygen and get rid of carbon dioxide.

Interviewer: So then over time, is it the stiffness that's causing that problem, that build-up of stuff in there that's causing the stiffness?

Dr. Selzman: That's right. We want our lungs, you know, you want your lungs to look like the sponge that you just bought out of the store. You open it up, it's this very light, airy, and it's just . . . you could kick it and it would maybe go up in the air, but it's not this heavy wet sponge that you've just finished cleaning the dishes with. That's what you want your lungs to look like. And you want all those little holes because all those little holes allow oxygen to go back and forth. But if you don't have good blood vessels that go to all those little holes, all of the ability of your lungs to do that work become compromised.

Interviewer: So during this surgery, what do you do to fix it when you go in there?

Dr. Selzman: So believe it or not, this is a roto-rooter operation. What we do is we have to do this, it's a major heart operation in the sense that we have to open up your breastbone. We do have to open up the pulmonary arteries. And then what we do is we open up the pulmonary artery and we actually peel out the inner layer of the blood vessel wall.

And so, sometimes, there's actual blood clot that you remove, but it's not really just the blood clot. It's you have this really thick rind that's layering out along the blood vessel wall and you have to remove this whole rind in order to allow the blood flow to get out to the periphery of the lung where it does all of its work. In order to do this, it's a major operation, you have to go on the heart-lung machine.

We actually have to take the body temperature very low because there's a lot of blood that gets in the way when you're doing this and so you need to be able to see. And so, sometimes, we actually have to even turn the circulation of the patient off and the only way to do that is to take the blood temperature very, very low to protect the brain and other organs. So it's not something that we take lightly. It's a very relatively conceptually, straightforward operation but has some pitfalls if you don't do a lot.

Interviewer: How long does it take for an average for you to do the procedure?

Dr. Selzman: Probably three to six hours.

Interviewer: Okay.

Dr. Selzman: And a lot of that time, the nitty-gritty work is actually only maybe less than an hour, but the prep time to get ready and to take the temperature down and then to bring it back up, it does take some time.

Interviewer: And you're able to go in and get most of that, if not all of that, usually cleared out?

Dr. Selzman: We are fortunate because we have really good preoperative testing so it might be that all of the lung is affected, but sometimes, it'll be just half the lung or, you know, three-quarters of the right lung and two-thirds of the left lung. And so we can kind of target that.

There are some disease processes with these pulmonary embolisms and the CTEPH that is stuff that we cannot fix. And that is the stuff that gets way, way deep out into the periphery of the lung and we just physically can't do it. When people have pulmonary hypertension related to that kind of disease, there' really only one out outside of medical therapy and that would the lung transplantation.

Interviewer: Got you. So I think you just answered who makes a good surgery candidate. If it's affecting the outside part of your lungs not so much, but if it's more in the main part.

Dr. Selzman: Yeah, I think that's a good way of thinking about it, you know, from a technical aspect. The more proximal or the less further out into the periphery defines some of the patients that we would just not even think about doing.

Interviewer: Got you. What kind of preparation does the patient go through leading up to it? Is it just typical surgery preparation, you just want to be healthy?

Dr. Selzman: Yeah. Unfortunately, you know, some of these patients aren't so healthy.

Interviewer: Because they have a hard time breathing, right? Which makes it hard to exercise and move.

Dr. Selzman: Exactly. And, you know, and also risk factors, which led them to have developed blood clots in their legs. You know, it's sometimes the blood clot is the classic traveler across country on an airplane and they're not moving their legs and they get the blood clot in the leg and then they later that day they walk around and then they get acutely short of breath and they might not even know that they had something happen.

As a matter of fact, about 40% of patients that have pulmonary embolism don't even know that they have it and a lot of CTEPH comes without an antecedent diagnosis of pulmonary embolism. And it's just something that happened that nobody . . . you just didn't know you had it. It's kind of like the silent heart attack. "Oh, I didn't know I had a heart attack, doc." It's the same kind of thing. "I didn't know I had a pulmonary embolism, doc." And so that can happen and it can be kind of very sublime, if you will, the development of the disease.

Interviewer: Got you. And then what's the recovery time look like after the procedure normally?

Dr. Selzman: Usually, in the intensive care unit for two or three days and then up on the floor for several days. Everybody is a little bit different how they do this. In the more severe cases, you can actually be in the hospital for several weeks because there's part of the lungs that aren't used to having seen blood flow and we acutely remove this stuff and then we get what's called reperfusion injury, which means of the lungs which hadn't had a lot of blood flow all of a sudden gets this rush of blood that comes to it. And that's called reperfusion and sometimes that can be very troublesome to deal with.

And so, yeah, this is not an easy physiologic process for the patient. I mean, the lungs are going through a lot of stuff. Obviously, it's very central and core, you know, heart and lungs. And so, you know, if the lungs are working good, then the heart works good. But if the lungs aren't working good, then it affects the heart and it can be a problem.

Interviewer: So you're taking a little bit of time off from work?

Dr. Selzman: Oh, yeah.

Interviewer: Probably.

Dr. Selzman: This is a major heart operation, but the cool thing about this as, you know, as big as of a procedure as it is, we just have some great stories that come back. I mean, you see these people that are on oxygen at home and then two weeks after surgery, they come and see you in clinic and they're off of oxygen and they say that, "Wow. I haven't been able to take a deep breath like this in years." And then you see them a year later and they're just so thankful because they can breathe because we see this in lung transplant.

You know, at the University of Utah, we're kind of lucky because we're one of the, we're really the only lung transplant center in the entire region. You know, you have to go to Denver or Phoenix or in California. And so we see great stories and when you see people that can't breathe, you know, just imagine you're down swimming and you're underwater. I mean, that's what these people are. And so when you allow the folks to actually take a deep breath and also the plastic hose of the oxygen just gets really old. And so it can be an incredibly gratifying thing to do for a patient.

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Announcer: Health tips, medical news, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: CTEPH is a hard to diagnose disease that about one in 1,000 people will develop. And because it is relatively rare, many patients and even doctors haven't heard of it. The symptoms can easily be confused with other diseases and what makes it even harder to detect is many people don't have any symptoms or the symptoms that they do have are mistaken for other illnesses. Dr. John Ryan is a cardiologist, one of the directors of the Chronic Thromboembolic Pulmonary Hypertension Program at University of Utah Healthcare. So it's so hard to diagnose, how do people even find out they have the disease.

Dr. Ryan: No, it's really tough. So it is, as you describe, Chronic Thromboembolic Pulmonary Hypertension so it is a cause of pulmonary hypertension. Pulmonary hypertension is elevated pressures in the lungs. So, oftentimes, if people are short of breath, if they're fatigue, if they have some leg swelling, they might get an ultrasound of their heart, and then that might show that they have high pressures in their lungs. And that's where the pulmonary hypertension is.

So then, when you look at the causes of pulmonary hypertension, a lot of pulmonary hypertension is caused by problems with the heart, a lot of it is caused by problems with the airways, such as emphysema, COPD. Some of it is caused by exposures to things such as methamphetamines. And rarely, within pulmonary hypertension, you can have it caused by chronic thromboembolic disease or chronic pulmonary embolisms.

The reason this is complicated is because some people won't know that they've had a previous pulmonary embolism. So if we want to talk about pulmonary embolisms, because I think that will be the first thing to talk about and then we can go into the chronic pulmonary embolism or chronic thromboembolic pulmonary hypertension, the abbreviation for this is CTEPH. So pulmonary emboli are common and pulmonary embolism is common, you have a clot in the lungs.

A lot of folks will have family members who have this, sometimes they themselves have had it. It can happen after a hip replacement, it can happen after a long-haul flight, which is something that you've come across before, and that's where you have a clot in your lungs. In 97% of people who have clots in their lungs, that's a classical way they head back to their regular everyday life.

In 3% of people, that's not the case. In 3% of people, they end up with this chronic pulmonary embolism, which can either be recurrent pulmonary embolisms, so they have one and they have another and another. Or it can be that the clot doesn't actually go away. Whereas, 97% of the time, the clot dissolves. In 3% of people who have pulmonary embolisms, the clot may not dissolve and therefore, they're left with this blockage in their pulmonary vasculature.

The analogy I kind of give among other analogies, which at least people humor me and tell that my analogies are very good, but the analogy that I give here is that a clot in your lung is like a car crash on the freeway. All the blood flow stops. And then, eventually, the crash gets cleared. In chronic thromboembolic pulmonary hypertension, that crash does not fully get cleared, you're instead of having four lanes, you're now down to one lane. So you end up with just this one trickle amount of blood going through because the clot has never gone away. Or the vessel has changed in response to that clot and folks get short of breath.

However, what makes it hard, and the thing you've asked me in the beginning about, you know, why is this so hard to pick up, what makes this hard is, first of all, it is in . . . of all the causes of pulmonary hypertension, it's least common. Fifty percent of people who have it don't know that they had a blot clot sometime in their life. They think this was never picked up or it was missed clinically.

But the importance of it is that it is a curable form of pulmonary hypertension so you can get treatment. And that's what our program specializes in here. We specialize in the management, the surgical and medical management of chronic thromboembolic pulmonary hypertension. We're the only program to do that in the [Inaudible 00:04:03], one of the few programs in the country. And you can, again, cure people of their disease by medically managing this or surgically managing this, most particularly. And that's a pretty positive thing.

Interviewer: I'm still confused as to how I would know that I had it. I guess the first thing is . . .

Dr. Ryan: The first thing you'd be short of breath. You'd be short of breath with fatigues.

Interviewer: Those symptoms, yeah.

Dr. Ryan: So you'd have symptoms similar to heart failure. The symptoms themselves are not that dissimilar to heart failure. And then at some [inaudible 00:04:29] along the line, someone will do an ultrasound of your heart and they would do an echocardiogram. And on the echocardiogram, you would see that the pressures in your lungs are high.

Interviewer: Okay.

Dr. Ryan: So then you have pulmonary hypertension. And then, as a workup for pulmonary hypertension, people look to see, did you ever have any blood clots, either by asking you specifically or there are some scans that you can do on the lungs to see if there are any signs of old blood clots.

Interviewer: So you can actually see those also?

Dr. Ryan: Yeah.

Interviewer: So it's a little bit of a detective game that you've got going on.

Dr. Ryan: It is, yeah. I mean when you have the diagnosis, first of all, when you have a diagnosis of shortness of breath or when you have a diagnosis of fatigue, that's obviously, as you alluded to, when the detective game starts. And then, once you get diagnosed with pulmonary hypertension, then you start looking into the different cause of pulmonary hypertension. So a lot of these are going on all at the same time.

When you have pulmonary hypertension, people start looking, it is caused by the heart, it is caused by the lungs, it is caused by the airways, it is caused by the vessels in the lungs, it is caused by clots. So all of these things are being looked at, at the same time. And then, if you find that there are clots in the lungs that have never gone away, in some regards it's almost kind of a eureka moment. You've found the cause of this pulmonary hypertension and now you can treat it.

Interviewer: So if you continue to have these symptoms and they're not just going away and you've received treatments for other forms of pulmonary hypertension, then that's when you consider, "I could be in this 3%."

Dr. Ryan: Yeah. Hopefully, before you get treatment of your pulmonary hypertension, people have figured out what type of pulmonary hypertension you have. The analogy that we use for this is pulmonary hypertension, in many regards, is similar to cancer. There are lots of different types of cancer. There are lots of different types of pulmonary hypertension. We don't treat all cancer types the same. Bowel cancer is very different to leukemia, say, and so on. So that's the same idea that we do with pulmonary hypertension. You find the cause of pulmonary hypertension, then you treat it.

Now that being said, of the people who have pulmonary hypertension, 1% of them will have chronic thromboembolic pulmonary hypertension so it's the least common form of pulmonary hypertension. That being said, it's the most curable form or pulmonary hypertension. So in some programs, in some practices, we'll guess and you can be . . . you're right, 90% of the time or 99% of the time, you might be right. But if you or me are that 1% who don't have these other forms of diseases, then you're getting the wrong treatment.

Interviewer: Got you. And you said surgery is the treatment?

Dr. Ryan: Yeah.

Interviewer: How effective is it?

Dr. Ryan: Surgery is the cure. Yeah, so it's really rewarding that you can go from being very debilitated, very short of breath, very fatigued, not able to do the things you want to do, and you undergo a major surgery. It's an open heart or open lung surgery where the clots in the lungs are removed and you're on bypass. Your chest is opened and the clots in the lungs removed and that changes the blood vessels are fixed. And then you come to the ICU afterward, you come to the floor after being in the ICU, you enter into a rehab program. But down the road, you'd then do very, very well and you go from being very, very sick to essentially having a normal life expectancy and doing very well.

Interviewer: Are there consequences for not treating?

Dr. Ryan: The disease progresses without treating so you got sicker. The strain on your heart gets worse and, ultimately, the heart can go into heart failure, which is what drives a lot of the symptoms. And then, of course, you can have future PEs as well, or future pulmonary embolisms on top of it. So you can have your disease and then have another pulmonary embolism. So those are kind of the consequences of not treating it.

Interviewer: Any final thoughts for somebody that's experiencing these symptoms and thinks they might have it?

Dr. Ryan: Yeah, so two things. One, surgery isn't actually for everyone. There are some people who, even in 2017, still have inoperable forms of chronic thromboembolic disease. That doesn't mean you're out of options, it just means surgery, right now, is not an option for you. But there are other medicines available that can help you do better. They're not a cure, but they can help you do better.

And so I think the main thing is to ask your doctors, "Do you need to look to see if this is blood clots?" Again, oftentimes, as I said, people don't look fresh. It's rare, it's uncommon, there are much more common causes and people don't know that they have blood clots. I think people also assume that they would know if they had blood clots, that you and I would know if we have blood clots. So I think it's worth asking your doctor, "Did you check for blood clots." And this is an easy, straightforward, low-cost test.

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Dr. Miller: We all know smoking's bad for you, but if you quit, will you live longer? We're going to talk about that next on Scope Radio.

Announcer: Health information from experts supported by research. From University of Utah Health, this is thescoperadio.com.

Dr. Miller: Hi, I'm Dr. Tom Miller and I'm here with Dr. Nate Hatton. He's a pulmonary specialist, a lung doctor that works here at the University of Utah. Nate, tell me a little bit about smokers and, if a smoker decides to quit, are they going to live longer, and happier?

Dr. Hatton: Smoking has tons of health-related consequences, from heart disease to lung disease, to peripheral vascular disease. I mean, the number of bad things smoking causes is almost innumerable. As a pulmonologist, there are two things that smoking causes that most people are aware of. One is lung cancer, the other one is what we call COPD, or chronic obstructive pulmonary disease. And basically, that disease means that you have trouble exhaling. So the air comes in very easily, but you can't exhale very easily, which makes you short of breath, and makes you feel poorly, and over time, you can actually become dependent on oxygen and have a very poor quality of life because you become so debilitated from your smoking-related disease.

Dr. Miller: Now, what I understand is, once that starts in a smoker, it continues. It doesn't stop. You can't reverse it, is that correct?

Dr. Hatton: The lungs, for whatever reason, don't heal very well. Once you develop emphysema, which basically destroys lung tissue, or is the destruction of lung tissue, you can never . . . the lungs have no regeneration capacity and so once this process starts, there's no way to reverse the process or actually "fix the lungs." You're always going to have this disease and, unfortunately, it sort of . . . once the fire gets started, it tends to smolder and things tend to get worse over time.

Dr. Miller: So smart money would say to stop smoking now before it ever starts.

Dr. Hatton: Yeah, I mean, we know, as mentioned, smoking causes all sorts of things. If you quit smoking, whether you're 40, 50, 60, or 70, there is a great amount of data that says you will live more days and more years from that point forward.

Dr. Miller: Do you have some numbers of that?

Dr. Hatton: Well, the most compelling number is, even at 70 years old, studies have shown that you may live up to a year longer.

Dr. Miller: And how about if you're 50 or 60?

Dr. Hatton: It's probably in the number of three to five years.

Dr. Miller: What about that quality of life?

Dr. Hatton: The sooner you quit, the less lung disease you will have, which means your quality of life will always be better. The more you smoke, the more you're sort of perpetuating this lung damage and ultimately, you will need oxygen and become disabled. And so quitting smoking earlier before you have any of those symptoms or lung damage issues will obviously enhance your quality of life.

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 you what you want to know. Check it out at thescoperadio.com.

updated: January 15, 2019
originally published: November 8, 2016

Announcer: Examining the latest research and telling you about the latest breakthroughs. The Science and Research Show is on the Scope.

Interviewer: Tibetans thrive in the high mountains of the Tibetan Plateau, conditions that most others just can't survive in. My guest, Dr. Josef Prchal, a professor in internal medicine at the University of Utah, led a study; identifying an 8000-year-old variation in the DNA sequence of Tibetans that help explain their amazing adaptation.
Today, I'm also joined by first author of the study, Dr. Felipe Lorenzo, and Dr. Tsewang Tashi, who is also an author on the paper and a native Tibetan. Dr. Prchal, Tibetans and lowlanders like us adapt very differently to high altitude conditions, what are the differences that you're interested in?

Dr. Prchal: The obvious difference is that if lowlanders go to very high altitude, they may die, but if you stay there for a long time, there are some chronic consequences which are not suitable for reproduction and for thriving in this high altitude. There are many and some of them we will not fully understand, but one of them is, what we call, pulmonary hypertension; that the pressure on the lungs is so high that it interferes with the circulation and you get, eventually, heart failure.
The other well-known adaptation is the level of oxygen tightly controls how many red cells we make. It means if we don't have enough oxygen, we make more red cells. So if you go to high altitude where the oxygen pressure is lower we make too many red cells. That's called polycythemia. That means the blood gets too thick and it's not very suitable for them, but it has been known that most of the Tibetans have a normal level of hemoglobin in very high altitude and this is something which gave us tools to study this.
And we selected then the Tibetans who had high hemoglobin and low hemoglobin, and that allows us to look at the genetic differences in these two populations. And with a graduate student here from department of genetics, Tatum Simonson, we selected these two population, did, at that time, the state of our genetic studies and we were able to look at the fingerprint of the genes of interest. We selected about 300 genes and 10 of them had clearly selected, that means they achieve much higher frequence in Tibetans, in those who were adapted well to high altitude.
And these adaptation mutations then must have some beneficial effect and so that was the first lead. And at two of the genes, which are selected, had something to do with how the body responds to oxygen, so one of them, a gene called PHD2 is a negative regulator of master regulators of response to hypoxia which is called HIF.

Interviewer: And what does the gene do?

Dr. Prchal: It decreases the over-response to very low oxygen. So sometimes our physiological responses may be detrimental. And so by modulating the intensity of the response, I think that was one of the benefits.

Interviewer: Dr. Lorenzo, you've been on the trail of this gene for a long time. It must have been satisfying to find it at last.

Dr. Lorenzo: It's really a challenge actually. Sequencing that region of a gene we just recently reach took me like six to nine months of trial and error. Finally, when we get it, it was just like you win a lottery and it's something to move on.

Interviewer: So when you saw it, you knew that was the one.

Dr. Lorenzo: Yes, because it's reproducible, it's there, it's common in our sample, and not common in the controls, so there's a story to tell.

Interviewer: So if the variation was selected for it, it must be important.

Dr. Prchal: If a gene happens to be beneficial in a given environment, with each generation the prevalence of these genes will increase. And so, again, if the Dr. Lorenzo's mutation of variant is find of 85% of Tibetans, it must be beneficial.

Interviewer: Dr. Tashi, you're a native Tibetan, it sounds like you guys went through great lengths to gain acceptance by the Tibetan community.

Dr. Tashi: So I join here in 2012 in University of Utah and one day Dr. Prchal approached me while I was in clinic and he was very excited that I was a Tibetan and I was kind of surprised.

Interviewer: Who's this guy?

Dr. Tashi: Initially, it seemed to me that he just wanted some blood and I said, "Well, that's easy. I can get some friends and get some blood."

Interviewer: Were you one of the ones sequenced in this study?

Dr. Tashi: Oh, of course, yes.

Dr. Prchal: He is.

Dr. Lorenzo: One of the first ones.

Dr. Tashi: And later on as the study progressed, I realized the significance of the whole study and this is a new potential, a very groundbreaking discovery, in a sense, and the importance that it would have, not only for the science as a whole. But being a Tibetan and also something uniquely Tibetan that's potentially the result of this, then we decided, okay, we should go and get involved more Tibetan. Actually, we went there twice and they don't really like to give blood because when you hear blood, it's kind of "Wow."

Interviewer: Yeah. But once you were able to explain it to them, and probably the fact that you are a Tibetan yourself and you're willing to undergo this, that helped them to accept it?

Dr. Tashi: Yeah, that was one of the major helping point.

Dr. Lorenzo: This is why Tsewang is a key for the success of this study because Dr. Prchal and I went actually to the community. It took us six to nine months talking to them and we got two samples.

Dr. Tashi: It's really difficult.

Dr. Prchal: We were well received.

Dr. Tashi: When it came to collecting blood, they just backed out. So it's really a key to get them into the study, and it really did go well.

Interviewer: And in the end, how many took part, the Tibetans?

Dr. Tashi: For here, locally, we have 26 or 28 and then I brought it 60 plus.

Interviewer: Wow.

Dr. Prchal: Well, began probably more than 200 samples.

Dr. Lorenzo: More than 200 in China.

Dr. Prchal: Yeah, more than 200 samples.

Interviewer: It's important for you to get letters of support from high leaders in the Tibetan community, including the Dalai Lama.

Dr. Prchal: The Dalai Lama was contacted by a principle physician called Dr. Dorjee, who easily organized all these Tibetan health care in exile community and that only happen through Dr. Tashi. And Dr. Dorjee has contacted Dalai Lama, explained to him what we try to do, and Dalai Lama felt a better of the Tibetan adaptation would be helpful to Tibetan community, but also to humanity at large. And I think that Dalai Lama is very ethical man and when it comes to ethic issues, I think it's very important to him.

Interviewer: What are the implications of this work?

Dr. Prchal: There are many human disorders which are regulated by oxygen; not only the pulmonary or lung diseases, brain edema, but also cancer. So we think that delineation of this Tibetan adaptation and deeper understanding of this can eventually lead to better understanding of common human diseases.

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Interviewer: Weed killer, fertilizer, insecticide. How dangerous are they? We're going to find out next on The Scope.

Announcer: Medical news and research from Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope. It's springtime now, a lot of people are out in their yards working on their lawn. Weed killer, fertilizer, insecticide commonly are used on lawns these days. We're going to find out how danger they are. We've got Brad Dahl who's a poison specialist from Utah Poison Control Center in the studio with us today. Brad, how dangerous are these things, weed killer, insecticide, fertilizer?

Brad Dahl: Well if you use them appropriately they're really not that dangerous. The real danger is that somebody might use them inappropriately, store them inappropriately, mix them up incorrectly so that they're too strong. Somebody accidentally drink them or a child get into them and then we potentially have a problem.

Interviewer: Let me just run through a few scenarios where people might get exposed to these on their skin. Let's say I'm out mixing some liquid week killer and I get some undiluted product on my skin. How dangerous is that?

Brad Dahl: It's not incredibly dangerous but if it stays on your skin very long it can make it really red and sore.

Interviewer: How long is too long?

Brad Dahl: Anything more than 10-15 minutes you're looking at risk for what we call a chemical burn.

Interviewer: And how long is that burn going to persist?

Brad Dahl: It depends on how bad it is. It can be days.

Interviewer: Really?

Brad Dahl: Yeah.

Interviewer: So the best thing to do would be...

Brad Dahl: When you get something on your skin, wash it off. Soap and water. Nothing fancy. When it all comes down to it nothing works better than soap and water for removing a lot of chemicals.

Interviewer: So soap and water, it's just that easy. You get that on your skin. You wash it off with soap and water. You go back out to work.

Brad Dahl: That is correct.

Interviewer: So you shouldn't wait and think, "I'm taking a shower in a couple of hours?"

Brad Dahl: Yeah. That's a bad idea. The biggest problem is that these are mostly irritants to the skin and it can cause chemical burns. It's just getting them on the skin and leaving them on so long that they end up with these burns, that's the real problem. I've had plenty of people who do that and they end up calling me because, "Ow, this really hurts. What do I do now?" It's kind of too late at that point. It's like burning your finger on the stove. Once you've done it, you've done it.

Interviewer: When I spray weed killer on some of the areas of my lawn I use a lawn sprayer and sometimes we use the lawn sprayer to spray our trees. Let's say I've got some tree spray or some weed killer and the wind blows some of that back onto me. Maybe it gets into my eye. Maybe it gets into my mouth. What kind of trouble am I in there?

Brad Dahl: As far as your mouth goes it's probably not enough to cause a problem. Certainly if you can taste it very strong you might want to rinse your mouth out with some water. You don't need soap for that. Just water is fine and spit it out and that should be fine. Getting in your eye, same thing. Luke warm water is what you want to use. A lot of people think you have to rinse your eyes with cold water because when you put cold water in your eye sit feels better because it's numbing the eyes and they think oh wow, that really helps. It doesn't get it out as well. Go for luke warm water for the eyes.

Interviewer: We mentioned fertilizer. We fertilize the lawn once or twice during the year. For instance at my house we use the granules and we put that out on the grass. How long before it's safe for my kids to go play on the lawn barefoot or even to just be out on the lawn or for me to go out on the lawn barefoot?

Brad Dahl: It's probably safe right away. The big problem with that stuff is again if it gets on your skin and it stays on very long it will make it red and sore. As soon as you've watered it in and it's dissolved, it's really not much of a risk.

Interviewer: What's if it's on there in dry granule form.

Brad Dahl: It's not that big of a problem if you walk on it. I wouldn't recommend barefoot because again it can make your feet sore but it's not a real serious risk.

Interviewer: Occasionally we'll get yellow jackets at the house so they'll be up in the eaves. We put traps out and stuff but that's never enough to take care of the problem so sometimes I have to get out there and spray the nest down. Let's say the insecticide blows back on me.

Brad Dahl: The number one thing when you're using a spray can is to make sure it's pointed in the right direction.

Interviewer: Obviously, yes.

Brad Dahl: Daily we get people who are spraying it directly into their face because they're not paying attention to which way the sprayer was pointed. That's the number one thing. If the wind is blowing always try to stay upwind of where you're spraying that would be the smart thing to do. Again, if you get enough on your skin that you can feel it and it's wet, wash it off with soap and water. If you can taste it just rinse your mouth at. It really shouldn't be that big of a problem.

Interviewer: How dangerous are insecticides for kids? Let's say a kid sees some ants or something out on the sidewalk and runs into the garage, grabs a can of insecticide, goes out there and tries to spray the ants and doesn't have the sprayer pointed in the right direction and sprays it on his face or gets it on his hand.

Brad Dahl: That's a really good question. If you bought it at the store premixed it's probably going to be really safe. It's not designed to hurt people it's designed to kill insects which is much tinier. The poisons that are used in these things, the insects are much more sensitive to them than we are. Our bodies break them down really quickly so they're really not that dangerous to us. A lot of times there's more chemicals in there to get the stuff in the solution that are actually more irritating to us than the actual pesticide is. If a kid is playing with it and they get it on them you want to wash it off as soon as possible. If they get it in their mouth it's better just to give them something to drink than to try and wash a two year olds mouth out. The amount that they swallow is not enough that's going to hurt them at that point. You just don't want it sitting around in their mouth so get them something good to drink. People often wonder what's the best thing to give my kid to drink when they eat something that's bad for them. My answer is whatever they will drink freely. So, if they don't like to drink water, don't give them water. Plus, usually these things taste nasty and if you give them water it's going to still taste nasty and they won't want to drink that. Give them something that tastes really good. Something they like a lot and you don't have to give a lot. Some people think it says on the bottle I have to give 88 ounces. No you don't. You only have to give enough to push it down to the stomach. So, a couple of good swallows is fine and we never want to force fluids on a little kid because we don't want them to gag and we don't want them to throw up.

Interviewer: Why wouldn't you want them to throw up?

Brad Dahl: Because all of these things really aren't that dangerous in the gut. Again, it's the contact time on the tissue in the mouth and throat that's the sensitive tissue. We'd rather it go down to the stomach and it keep going from there. If you bring it back sometimes kids will gag and a little bit will go into their lungs and that's a real problem. We don't want it in there. Of course, it can be more irritating to their mouth coming back up. It's better just to have them drink and keep it down.

Interviewer: It sounds to me like these three things, weed killer, fertilizer, and insecticide are pretty safe to use if you're using them as directed and you're following instruction and you're not over-concentrating them but the thing you really want to be concerned about is avoiding accidental contact so especially with kids so keeping stuff where they're not going to get it, first of all. Then when you're using it wearing some protective equipment.

Brad Dahl: Yeah. That's always a good idea. People like to go out during the summer wearing no shirt. Short. No shoes. They get the stuff all over them and again, that's a really common call I get. I'm in the house now, I've showered and now my feet are really sore and I've been spraying stuff all day. At that point it's too late to do anything.

Interviewer: Has there ever been a situation where a person has called from getting a fertilizer, insecticide or weed killer on themselves or ingested it to the degree that you've actually recommended a medical intervention?

Brad Dahl: Yeah. We've had people that have had the concentrated solutions and they for whatever reason had it in a container that was not the original container, not a sprayer and somebody grabbed it and drank it thinking it was a beverage. We had to send them in for an evaluation for that. That happened. Again, leave things in the original containers. Make sure if you use a sprayer that it's marked appropriately so people know what's in it so there's no mystery about it. Never use old beverage containers to store things in your garage because somebody is going to come by. You might know what's in there but you'd be surprised how many people come into other people's garages and go, "Hey, there's a sports drink. I think I'm going to have some of that and then it turns out to be insecticide.

Interviewer: If you use these things correctly and keep them in their normal containers and you just use a little bit of common sense you're probably not going to get yourself into trouble with either of these things.

Brad Dahl: That's brilliant. That's all I can say about that. Brilliant.

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Interviewer: It's time for another From the Front Lines with Dr. Troy Madsen, emergency physician at the University of Utah Medical Center. As an emergency room physician you see things first-trends, what is happening right now? What is it we need to be aware of?

Dr. Madsen: So right now the big thing we're seeing and the big thing people are talking about is air quality. As the temperatures go up in Utah we get ozone that develops. This is stuff in the air that can then get in your lungs; if you have lung problems like asthma or emphysema, it can really make things worse.

Interviewer: So in the E.R. you're seeing increased cases of this?

Dr. Madsen: We are. We're seeing more cases of people coming in who are having trouble breathing, definitely just in the last few days.

Interviewer: And that's attributed to air quality? No doubt about it.

Dr. Madsen: It is. I hadn't seen the numbers we've had recently until just now and just looking at the ozone levels and the fine particulate matter, this is all the stuff that's released from forest fires and different range fires. We are seeing our numbers up, associated with that.

Interviewer: So what's going on exactly, you've got the bad air, somebody breathes it in, and what's going on at a physiological level?

Dr. Madsen: Yeah, so the big thing that's going on, for people who have asthma or emphysema, there lungs are already sensitive, so when you get this stuff in your lungs, if you get this ozone in there or these particles in the air, it just causes the lungs to get inflamed. They produce more mucous, they just get really inflamed and red, if you were to look at them and see them, and then they get really tight. So these are people who already are more likely to have their lungs just tighten up, where their airways just can't get air through them. This just makes things that much worse.

Interviewer: So what can you do for a person like that?

Dr. Madsen: So the big thing is if you already know you have asthma or emphysema, make sure your medications are refilled, make sure your inhalers are full, and make sure you're using them. Do you have preventive medications? Be sure to use those on a daily basis. If you start to have trouble breathing, use your Albuterol or whatever you're using to help you out. And if things get really bad, come to the E.R. A lot of these people we're having to keep overnight on breathing treatments and on steroids to try and get their lungs opened up.

Interviewer: What about healthy people, is it going to affect somebody that's healthy as well?

Dr. Madsen: So the big thing we're seeing with healthy people is a lot of times they're getting what feels to them kind of like allergies or a cold, clearing their throat a lot, having a lot of congestion maybe runny nose, stuff that feels kind of like allergies, maybe their eyes are watering a little bit, so it's causing some of these issues with them as well. So I would say if you're younger, if you're healthy, get outside, exercise, enjoy it but try and do it more in the morning when it's not quite so hot, because as the day gets hotter, that ozone, that stuff in the atmosphere builds up more and can be more of a problem.

Interviewer: How long are we going to have to endure?

Dr. Madsen: Hard to say, yeah, in terms of what we have in line and in store for us, I think it's really going to depend on what happens with fires. I sure hope that we don't see forest fires and issues like we had last summer. I can say I've never seen a summer in the E.R. like last summer, in terms of the number of cases we had of people with trouble breathing. It was worse than what we see in the winter, which is usually pretty bad, so let's just hope it doesn't get to that point.

Interviewer: So it's really the fire particulate matter more than the heat and the ozone that's causing the problems?

Dr. Madsen: Well I think what happens, the ozone is there, it's always there with the heat, we know about it, people who have asthma kind of know what to watch out for but then you throw that smoke in on top of it, for the bad forest fires, and that's when things really get bad. People usually aren't prepared for that and that's when we start to see a lot of problems. It kind of pushes people over the edge who already have some issues.

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