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A 'Pleurality' of Promisesby Ron Gilmore  William Lunn, M.D. In the obscure field of pleural diseases, there have not been many options in the past for treating patients with certain lung and airway disorders. William Lunn, M.D., an assistant professor of medicine-pulmonary and director of interventional pulmonary at BCM, is among the vanguard of U.S. physicians addressing varied breathing problems through the use of existing technology and practices. Pleural diseases are among the most prevalent cases seen by chest physicians and primary care doctors. An estimated 500,000 patients with pleural-related problems are recorded each year. The most common causes are congestive heart failure, pneumonia and complications following surgery. Pleural disease leaves its sufferers with an over-whelming build up of fluids in the lung and in the open areas between the lung and chest wall known as the pleural spaces. The result? Lengthy recovery periods and sometimes death from suffocation. It can be, as Lunn has witnessed many times, a very painful ordeal. Through the use of endoscopic procedures and devices such as microdebrision and airway stents, he is shortening the recovery time for many patients who have experienced airway obstruction caused by either tumors or pleural effusions (fluid in the chest wall) resulting from surgery or cancer therapies. I was encountering patients who were literally suffocating. Some had received a trach tube that they could end up needing the rest of their lives. I thought there must be a better way. Frustrated by the options available when he began his practice, Lunn learned of physicians in Europe and at a few U.S. health centers who were working with endoscopic procedures for pleural diseases. "I was encountering patients who had tumors or benign conditions in their airways, and there wasn't much treatment. Many were literally suffocating," said Lunn. "Some patients who wound up with a tracheotomy and a trach tube due to radiation therapy or trauma of some sort could easily wind up needing the trach for the rest of their lives." Lunn said he thought "there must be a better way." There was. In the late 1990s, he consulted with Dr. Jim Harrell at the University of California at San Diego, who was making inroads into the burgeoning field. "I was stunned. Jim was able to take common problems that were very difficult to treat, and within 20 to 30 minutes, solve them," said Lunn. "Patients who entered surgery barely able to breath and miserable were hugging and thanking him once in recovery. They were able to breathe normally. The ability to make such an immediate impact on a patient's outcome intrigued me." Since that time, Lunn has perfected his own technique, and through the collaborative capabilities offered by the BCM Complex Airway and Pleural Disease Center—an umbrella of experts in otolaryngology, cardiovascular surgery and pulmonary medicine—he has been able to take advantage of a variety of diagnostic and therapeutic measures including minimally invasive surgical correction, rigid bronchoscopy, microsuspension laryngoscopy, thermal-based procedures such as LASER, argon plasma coagulation and electrocautery, image-guided lung/lymph node biopsies, and others. GeAnna Stevens, 48, is a typical patient. In 2004, she was diagnosed with breast cancer, and as a result of radiation treatment, her lungs began filling with fluid. Through a microincision, she was fitted with a lung catheter which allowed the fluid to drain. Stevens, who describes Lunn as "an awesome doctor," began to see relief soon after, and today she is well on the road to recovery. Another patient, 18-year-old Meredith Sellers, benefited through the implantation of a special airway stent. It replaced a trach tube that had been put in following a car accident last year that left her seriously injured. Suffering from traumatic brain injury and compressed fractures of the spine, Sellers was in a coma and on ventilation for two weeks. She experienced problems breathing when a trach was put in and removed, only to have it reinserted. During the weekend of Thanksgiving, she was seen by Lunn who fitted her with the stent which kept her airway open. Although she required a couple of different stents due to her small size (5'1"), she was finally able to breathe normally. "Thank God for Dr. Lunn—he saved my airway!" she said. The challenges are many for physicians faced with the often misunderstood problems associated with pleural disease and airway obstruction. Thanks to innovative use of existing methods and the introduction of new therapies, those challenges are a little easier to, well, swallow. |
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Volume 2, Issue 3, Fall 2006 |
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