At Westmed, our extraordinary pulmonary experts work to provide the best care possible for patients with respiratory conditions. That commitment remains our focus during the COVID-19 crisis in our local community. We are still providing the exceptional care you expect from us, while also doing everything we can to keep you safe from the coronavirus. In this Q&A, Westmed Medical Director, Dr. Steven Meixler, provides insight about his experience with patients with COVID-19 and how pulmonologists play a role in helping patients with a variety of other challenging conditions.
What role does a pulmonologist play in helping a patient with COVID-19?
Aside from the hospitals, pulmonologists and infectious disease specialists play critical roles in evaluating, treating and monitoring patients with COVID-19. Many of the initial manifestations of COVID-19 involve the upper airway with nasal congestion, loss of smell and taste and the respiratory tract where patients have been found to have shortness of breath, pain with breathing, also known as pleurisy or pneumonia. COVID-19 patients can also develop respiratory failure, where they can’t breathe and need oxygen or even a ventilator.
A pulmonologist is critical in evaluating the severity of such issues. Pulmonologists monitor the patient, initiate treatment and provide information to the patient’s family to help them with their expectations during what can be a difficult illness.
How have pulmonologists been helping COVID-19 patients with long-term side effects of the virus?
After recovering from COVID-19, some patients have had persistent shortness of breath, persistent rapid heartbeat and neurological complications. Pulmonologists assist with monitoring the long-term respiratory affects, assessing whether there has been any permanent lung damage and evaluating for risk for blood clots. Furthermore, we give information to patients; re-assuring them and helping them get back to hopefully the highest level of function that they can.
What role have pulmonologists played in the pandemic?
Pulmonologists have played numerous roles during the pandemic: evaluating patients with respiratory complaints as an outpatient; evaluating patients in the emergency room; consulting and treating patients in the hospital; monitoring and managing patients who critically need the intensive care unit; communicating with patients and their families; and, providing virtual visit services for patients who are recovering slowly but are too sick to come into the office. Generally, pulmonologists have been available as a resource to the community to answer questions, to re-assure them and help them through their recovery period.
Is there hope for recovery in a patient with respiratory issues?
Yes, of course there is always hope! Many patients slowly recover over time, but there are unanswered questions in terms of people who had severe disease and any lasting damage or a disability that they may have. These are the issues that are currently being addressed at COVID-19 clinics, at university centers and in other medical literature. We follow those developments and implement changes in the standard of care in real-time as they come forth.
What other issues/ailments do you help and treat?
We treat a variety of ailments including asthma, respiratory infections and Chronic Obstructive Pulmonary Disease (COPD). Pulmonologists evaluate and treat a number of issues including shortness of breath of indeterminate etiology (when patients have shortness of breath and the cause is unclear), and disorders of the lining of the lung called the pleura, which can either be infectious, inflammatory or related to cancer. Additionally, we assess and treat cancer of the lung and of the lining of the lung and monitor patients with chronic lung infections like tuberculosis and mycobacterium avium-intracellulare (MAI), which is a cousin/relative of tuberculosis that is not communicable between people, but infects the lungs of people with chronic lung issues.
Pulmonologists also collaborate with other specialists when helping to treat patients. We co-manage patients of the cardiologists who have heart failure and other issues that impact our breathing, rheumatologists who treat inflammatory and arthritic conditions, which can have manifestations of the lung, allergists and with ear, nose and throat (ENT) doctors for issues involving the lung that cross over into their specialties as well.
Can you provide us with some information about the types of patients who have had COVID-19 and now need help from a pulmonologist?
COVID-19 is an equal opportunity tormenter and can affect any patient, young and old, with or without comorbidities. Patients that end up with a pulmonologist are often patients who perhaps had other comorbidities and risks who are immunocompromised or on immunocompromising medications that suppress the immune system. We also see patients who have asthma, emphysema or other chronic lung or heart ailments.
Preventing COVID-19 spread through masking, washing hands and social distancing is extremely important because everyone is at risk. Even though the groups of patients who are most vulnerable include the elderly, those with other chronic medial comorbidities and people who are immunosuppressed, everyone is really at risk and we see unfortunate cases even among people who have no risk factors.
November is also national COPD awareness month, can you share some information about how pulmonologists help patients with COPD?
Patients with COPD also have a challenging road ahead of them. Sometimes a pulmonologist helps to determine the exact diagnosis because some patients with COPD may present in a way that may make it difficult to distinguish from asthma, and some patients may have an overlap syndrome of asthma and COPD. Patients with COPD have less reversibility of their condition than asthmatics do.
Pulmonologists monitor patients to make sure they have had all of their appropriate vaccinations, assess their need for more intensive treatment, treat for flares of the disease and monitor and treat them if they have a severe flare that requires hospitalization. Additionally, pulmonologists assess patients for appropriateness for physical therapy and rehabilitation treatment, assess them for the need for home oxygen, and evaluate for other comorbidities (the simultaneous presence of two or more diseases or medical conditions in a patient) like pneumonia, blood clots, sleep apnea and other factors that may make the condition more complicated or severe.
Congratulations to Westmed physicians – Drs. Samantha D’Annunzio, Bruno DiCosmo, James Doyle, Ross Mazo, and Lisa Youkeles for being recognized as “Health Care Heroes” in a special edition of the Hartford Business Journal.
These amazing doctors were recognized for their outstanding work as a part of a team of intensivists at Greenwich Hospital. Intensivists specialize in the care of critically ill patients, most often in the Intensive Care Unit (ICU). They are the men and women who cared for the sickest COVID-19 patients at a time when there was little information on how to treat patients with the coronavirus. Please join us in recognizing the physicians who embody the word “hero” and have proven their excellence in helping others.