good evening and welcome to doctors on call I'm Dr Mary Owen associate dean of Native American Health and director of the center for American Indian and minority Health at the University of Minnesota medical school I'm also a family physician for the Fondulac band and I'm your host for our program tonight on lung problems influenza pneumonia and empyema the success of this program is very dependent on you the viewer so please call in your questions tonight or send them in ahead of time to our email address ask pbsn north.org the telephone numbers can be found at the bottom of your screen our panelists this evening include Dr Andrew Thompson an infectious disease specialist with a spirus St Luke's Dr Jason wall a family medicine physician at the duth Family Medicine Residency program and Dr Jason werin aosth with Essentia Health our medical students answering the phones tonight are Olivia Hoff from Rushford Minnesota amik cth from Rochester Minnesota and Jossy Larsson from Lichfield Minnesota and now on to tonight's program lung problems influenza pneumonia and empyema welcome friends so before we get started with some of the questions that are sent in one of the things that we talked about at the beginning is that some of you are hospitalist can you can one of you explain what a hospitalist is versus a clinician versus how about sure yeah um a hospitalist is the could be a family medicine or an internist uh General prce practice general practitioner that works primarily in the hospital um they're the person that you might run into if you get admitted to a ICU or a med surge unit or a regular Hospital unit and so you take care of any patients who come into the hospital or the the scope of practice is pretty broad um and so there are both pediatric and adult hospitalists um and yeah I think virtually kind of covers the whole gamut of adult and child problems and Dr Wall you work with residents so what does that mean for our audience correct uh when you graduate medical school that's sort of partway through your journey and when you uh you can pick a specialty you can pick um Family Medicine is three years Pediatrics three years Internal Medicine three years and then like surgeries five or six years depending what specialty and sub specialty so here in duth we're very fortunate to have a family medicine program that's been around for 50 years now and we've provided to Somewhere Over 150 doctors to mainly rural Minnesota and so when people come here they work with us for 36 and T months and then they go out and take care of their communities and they do everything in the hospital they work in the ICU the critical care unit the for uh I can think of like our colleagues up in cook Minnesota yeah they are they're work in the Ed they're work in the hospital they're work in the clinic all all in a single day yeah very cool and Dr Thompson you told me you work a little bit in the clinic and then also the hospital so what does that look like yeah so I'm I'm an infectious disease specialist so um I take care of some patients in the hospital with complicated infections then I follow them up in clinic um and I also see uh maybe difficult or unusual infections that people send to me in clinic who calls you to take care of the patients in the hospital uh these guys okay or um um many of my colleagues in the hospital so people will consult you they'll ask for help yeah yeah very cool thanks you guys so on to some long questions though Dr Thompson I know this is your favorite question is it too late to get the flu vaccine it is not too late to get the flu vaccine now would be a perfect time to get a flu shot what you want is to get vaccinated at least a couple weeks before flu comes to our community and flu rates are still very low so we haven't seen a lot of influenza yet this year but it'd be good to get vaccinated before you gather with a lot of family over the holidays okay and before flu comes and when's it too late to get one well there's not really a hard and fast date we can see influenza all through the winter and even into the spring um so um getting one is better than not getting one but I'd say now before Thanksgiving is what I usually tell people okay Dr W you want to ask add question oh I just had a question I've heard this um you know usually with the cold dry weather it seems like flu always comes you know January February but I've heard it always comes like from like the Far East and moves um you know like it hit the West Coast first and then you know work its way East is that is there any truth to that um when I look at Maps I usually see it starting in the South and moving northward um it can vary from year to year um and nobody really knows why it um is so seasonal we think of it as being dry air but there are places where it's not so dry and um there's more to learn about the seasonality of it I'm GNA get those guys a lot but I have one specific question for you Dr Thompson that I just thought of um that someone asked me recently what do you think of this Aven flu that's in the news is that something for us to be worried about I would say it's not something for most people to worry about um uh the interesting thing about it is it has gone from Birds to other mammals including dairy cows um and a few humans and even recently a few humans that have had no known contact with uh cows or birds or anything um it it could be very serious um at this point it's not for the human population um so it's something we need to watch closely most people shouldn't worry about it okay thanks for that Dr Wall um Paul and duth wants to know is there any advice on best treatment options for pulmonary fibrosis I can I can answer that uh quickly in that uh that is a serious disease and the best recommendation as a primary care you know I I know a fair amount about a lot but that's something where you go see one of our colleagues in pulmonology and because they're specialized tasks evolving treatments you want to be with um a pulmonologist so that you can make sure that they're monitoring the progression of the disease and that they're also keeping you a priz of the latest sort of um uh standard of care and Cutting Edge treatments for pulmonary fibrosis um I try to advise a lot of people to you know sometimes workplace exposures and and uh can lead to pulmonary fibrosis so you know Upstream to that I'm trying to make sure people are you know wearing proper if they're working with silica dust and in certain environments I'm making sure that they're wearing proper um respiratory protection but if you have the disease I'd recommend you see a pulmonologist so they might come in to see you first and then you're going to um examine them a little bit see what you think it might be and then when you find that's out then you go on and get a CT scan and then from there um when there's evidence of the pulmonary fibrosis I would talk to the pulmonologist okay thank you Dr weer anything to add to that done well I would just add you know especially if you've got even the start of any kind of chronic lung problem just doing the basic things like no smoking avoiding any kind of other sort of um inhalants that are going to be toxic to the lungs it's just good practice for all that stuff and anything we can do to improve your your basic physiologic function in the lungs is is better yeah all right I got another one for you are there any vaccines available for pneumonia who should receive this vaccine and another common question is does this mean that you won't get pneumonia once you get that vaccine that's am yep yeah so good question uh the pneumonia in the bacterial sense there are vaccines um uh usually based on age and risk factors and so um the primary one that we'd like to vaccinate against is Strep pneumonia um and there is a vaccine for that pneumonia can be viral pneumonia too and that's why we talk about influenza um covid vaccine things like that that are going to prevent those other types of pneumonia from developing so um the will it prevent what was the second part to that question it will do Dr Thompson you can answer this too well if you get the num mle vaccine does it mean that you will not get strep pneumonia it will reduce your risk of getting strep pneumonia there's other types of pneumonias that you can get um but that is a very common uh cause of pneumonia and so your overall risk of getting pneumonia and having problems related to pneumonia is much less i al also point out um if you are vaccinated against strep pneumonia and you get pneumonia if it's one of the types of strep included in that vaccine you you're likely to be less ill it might prevent you from being hospitalized it might prevent you from dying so ites it's not perfect doesn't prevent all pneumonia but it will May reduce the severity of disease which is really important for people who already have illness right chronic illness like hypertension or uh diabetes right absolutely yeah and or particularly for people that have like no spleen um you know but yeah I think we used to have there was the pcv7 then PCV 13 PCV 20 PCV 23 so they've kind of captured up the 23 different subtypes of the pneumonia that they're trying to protect against so hopefully it'll keep getting better and better yeah Y and the recom recomendations sometimes change so the best thing to do is to ask your doctor the recommendation is to when to get it how many to get of any vaccine so check in um Dr Thompson what is micoplasma pneumonia uh micoplasma is a kind of a different type of bacteria it's not like a lot of the um bacteria that will cause pneumonia or cause ear infections um uh it causes what what we sometimes call walking pneumonia um because people people can be sick but not so sick they can't get out of bed um you might not know it though it causes cough it causes fatigue it can cause other things as well there has been a lot of um micoplasma or walking pneumonia in the past few months in our community anything to add to that friends difficult to diagnose we often um will you know look at the entire picture and then offer treatment and um you have to use a certain class of antibiotics and so it's seems to have been a little bit more pneumonia among young people too lately feeds you seen that in our Clinic yes yeah okay all right you're not off the hook Dr reader okay how can new moms navigate RSV flu with newborns over the holidays actually anybody can take this one maybe our our friend in the middle can take this one Dr Wall well we now have the RSV vaccine and uh there are some you know specific I can't remember when uh um uh the uh exact cut offs are based on um ages uh that would be something that's that your clinic would know but the RSV vaccine is out there and it is responsible for a lot more illness and severe illness um much on par with influenza uh and so this vaccine's out there and I really would urge the um people at risk The Young and the old to seek out this vaccine and uh talk to their Clinic about getting it yeah it doesn't seem to be the same RSV that we used to encounter it does seem to be making people sicker yeah and maybe Dr Thompson but I I know they looked at it it causes a number of deaths not far off from influenza oh yeah we've had uh a lot of hospitalization in uh last year was a big RSB season so the um the vaccine especially for older folks um makes a big difference um and for newborns and infants um it's it's actually a different type of vaccine it offers protection through giving an antibody so um is really helpful especially for premature uh infants to help protect them okay great I could just add to that that the simple things like washing your hands hand desanitizing things like that frequently throughout the day especially if you've gone out and come back in it makes a huge difference um in protecting yourself and the people around you um if you're sick you know wear a mask when you're around other people um or just stay home if you can I know it's not possible for everybody but thanks Dr rer what's the difference between COPD and empyema are they the same thing I difference I I I don't really parse out the the name like that I I think of it all as a chronic lung problem um that's developed over somebody's lifetime usually as a result of a kind of you know regular injury to the lung and in most cases that's due to smoking um and uh it's something that we can diagnose in the clinic um and What patients often experience is a chronic cough um some sometimes occasional fleem production um and really short of breath especially when moving around uh the best thing you can do if you're worried about empyema or COPD is to stop smoking um or try to avoid try to improve your environment um if if it's secondhand smoke that's that's doing that to you so okay speaking of smoking um Dr Wall the caller this is a call from Ashlin they know someone the caller knows someone who has bronchitis and rhinovirus are both of these conditions related to the lungs uh yes bronchitis is a chronic usually associated with smoking uh can certainly be associated with allergies or other um environmental irritants but the Bron the bronchioles the air the larger Airways of the uh lungs become chronically inflamed leads to a lot of mucus production chronic cough and chest discomfort and then rhinovirus um rhino meaning nose um you know is one of the common viruses that causes common cold upper respiratory tract infection type symptoms and can certainly affect you know both the upper and lower Airways as well okay anything to add Dr Thompson no uh just that we can put a name to a lot of these viruses now that we didn't really know before because we have more sophisticated testing some of these nasal swabs can really identify is it micoplasma is it rhinovirus so we have these words out there that we didn't have a name for before mhm great um this is a good one I'm and I'll let anybody take this one I a senior who has COPD and I recently got my covid shot and had a reaction for 4 days I'm wondering if this is normal and should I continue getting this shot um as far as vaccines go they all come with a risk of side effects and that's just your body kind of recognizing that it's a it's a antigen that it's got to rev up your immune system and get get ready so that when it does actually see that virus it's able to respond in kind and and prevent you from getting very ill from it um as to the specific point of should he um get this vaccine again I'd say talk to your regular doctor so they can get a full picture of everything that you went through and what You' experienced and they can make a solid recommendation as to if you should get that one or not but um just broadly speaking vaccines are safe um they all have some side effects that um people tolerate on different levels um but they are safe and helpful and the the data to support the efficacy of the covid vaccine is pretty unequivocal as far as if you take a group of people that get the vaccine and that don't and they get covid you know there are going to be a lot more deaths in the unvaccinated group that's a highly uh tested vaccine as well all right Dr Thompson do you build up any immunity to infectious diseases over time without vaccines yes you build up IM immunity to infections uh after having the infection um vaccines uh give you that protection without having the infection it's better to never get measles and have had the vaccine than to get measles and risk all the potential complications of that from Death to brain damage um uh so I'd rather build my immunity without getting sick if I can and there's also the uh a problem with we are com um contributing to spread throughout our community when we don't get vaccinated so it's not just about ourselves right right it's not just about the individual it's about the community as well okay thank you all right Dr weer what's the difference between flu and pneumonia we talked about this a little bit sure pneumonia refers to an infection in the lungs um flu would be a specific type of virus that can cause an infection in the lung um you can get pneumonia from either viruses like influenza or covid um but you can also get pneumonia from bacterial um uh organisms like strep pneumonia and things like that all right we have no more questions from our audience so let's ask each other some questions uh what do you see the most of in your office uh the most of I see complicated infections and there's a really broad spectrum of that sometimes it's artificial joints that get infected sometimes it is uh bone infections uh sometimes it's heart valve infections I can't say there's one thing Dr wal preparing for this show I wanted to sort of uh put out there to anybody in the audience who might have cop COPD which stands for chronic obstructive um pulmonary disease uh that there are some new guidelines that have been out that recommend perhaps um the the medications that are uh now recommended uh there's less of an emphasis on taking inhaled cortical steroids and more of an emphasis on taking this class of medications called long acting muscarinic Agnes so I would encourage people go meet with your doctor and make sure that your medication regimen is optimized for thanks Dr W that's great Dr weer what would you like to tell the audience yeah um something I was thinking about just in preparation of this is just how much um really severe disease we see in the hospital um and how a lot of that is um from other complicating factors like chronic lung disease with empyema COPD um and how these viruses and bacterias you know while one person can do really well and and uh survive and get over certain um infections pretty easily other people with um these other problems uh and then broaden that to diabetes and um other chronic kidney disease things like that you're just at such a higher risk for developing more severe disease and ending up in the hospital and having a much higher risk of both theability and then you know worst risk would be death and so I I think that's why it's so important that we always talk about these things every cough and cold season um to talk about getting vaccinated reminding everybody to wash their hands and then doing the best to can for your health um by taking care of your chronic problems seeing your regular doctor um with some frequency and trying to talk through what sort of lifestyle modifications we can all make um so that um the people around us the people that are fragile um don't end up um sicker um than they are sorry I had no you're a teacher go ahead one other uh was that for people that have smoked or are currently smoking um in case um the audience wasn't aware we offer lung cancer screening now and it's actually been the the age for screening starts at 50 now so um if you're 50 and you smoke or I've ever smoked talk to your doctor about lotos there's a a certain CT um x-ray scanning protocol that they use to look for lung cancer thank you Dr W that's excellent reminder uh is there any Dr Thompson you've got off for a second there is there any treatment for a long haul covid and Associated symptoms now that's a great question um because we had a novel infection a new infection that uh affected many many millions of people we're seeing um new complications from that now long covid is a little hard to Define and we're still working on you know trying to come up with a a clear definition of it um but it's basically lingering symptoms after having a covid infection that aren't due to something else um there are some other infections that that may be similar uh may cause similar lingering symptoms but really what helps is what helps with a lot of things is uh consistent Rehabilitation so um working on improving stamina improving lung function um we don't have any particular drug treatments or other treatments but it's really Rehabilitation that's key how do you know when someone has long covid because it's such a I mean all yeah anybody uh first of all we have to establish that they had covid you can't get long Co if you've never had covid so we have to establish that by history and maybe by testing um and then try to correlate their symptoms with the timing of the infection but it's not easy are you seeing this much in clinic with people concerned Dr wall or Dr reader well I I think the times that I have seen it and I in addition to my hospitalist work I also round in some of the nursing facilities around the twin ports and I I do think that I to some extent they they've identified that it's contributed to cognitive um impairment um and in the nursing home we already have a number of people who have cognitive impairment and I I often wonder if that's contributed in some way um to to those changes in in some of my our patients that we see there Dr Wall you look like you were going to add something oh no I was just going to Def uh I think we'll see some recommendations come out in the coming years about some general criter for diagnosing and some general treatment guidelines um and right now I think um Andrew maybe I don't think there are any clear recommendations as far as how to treat it other than just taking a comprehensive approach of you know good sleep exercise and then just uh wherever there might be a deficit working on um trying to address that through therapy and prevent reinfection with covid yeah Dr Thompson since we have your infectious disease anything else that you really want to emphasize as far as vaccines tonight no I was actually going to add uh regarding the earlier caller who said they got significant side effects from the covid vaccine I I do too like I get significant side effects the day uh after maybe even another day after I get the vaccine but that's your immune system proving that it's working it's activating it's recognizing this new pathogen and other vaccines can do that as well you're not getting sick you're not getting the flu from the flu vaccine it's your immune system showing that it works there's some data it's not um that strong that you might have better protection if you got side effects from the vaccine not that you don't if you didn't get a a bad reaction but um that's what vaccines are designed to do if you're healthier do you tend to get a stronger response I don't know that there's a clear correlation okay I've heard some people with that um one last question I'm going to ask you is the RSV vaccine one and done or should you get it an annually Dr Wall I should know that but I'm pretty sure it's um it's meant to be every year yeah okay it's I think it's one and done okay thanks for now we'll know more yeah it's a newer It's relatively newer vac so yeah well then they're figuring out how long it actually lasts all right thanks you all I want to thank our panelists Dr Andrew Thompson Dr Jason wall and Dr Jason weeren and our medical student volunteers Olivia Hoff amama cth and Jossie Larsson Thanksgiving is next week so it'll not be a show but we'll be back on in December 5th thank you for watching and good night e e e e e