Posts

Dr. Jonathan Kiev answers questions about lung cancer.

Got questions about lung cancer? Dr. Jonathan Kiev has answers.

Dr. Jonathan Kiev

Dr. Jonathan Kiev

Written by Dr. Jonathan Kiev, a cardiothoracic surgeon at UK HealthCare.

November is Lung Cancer Awareness Month, so now’s a great time for me to answer some common questions about the disease.

Lung cancer is a major problem in Kentucky. Unfortunately, our state leads the nation in both lung cancer incidence and deaths.

The good news is people who are at high risk for lung cancer – specifically, those who have a history of smoking – are eligible to undergo low-dose CT screening for the disease. This diagnostic test allows us to find lung cancer at a much earlier stage, giving us more time to potentially provide life-saving treatments. Even better news? The UK Markey Cancer Center has a Lung Cancer Screen Program for patients at high risk.

So, who’s at risk for lung cancer and what causes the disease?

First and foremost, if you smoke, seek help to quit.

Smoking is by far the No. 1 cause of lung cancer, and it causes head and neck cancers, too. It’s responsible for a variety of health problems not seen in non-smokers. In addition, hypertension and peripheral vascular disease are directly related to smoking, which is why getting on a nicotine cessation program is the first step.

(Related: Check out our tips for conquering a smoking addiction.)

Your doctor will take into account your current health and health history to decide if you are at risk for lung cancer. They will then order the appropriate blood tests and imaging (chest X-ray and CT scan) to see if you have developed early signs of the disease.

Can working in a coal mine or around asbestos cause lung cancer?

Any inhaled substance or chemical can cause lung cancer over repeated exposure, so the short answer is yes.

More importantly, exposure to these types of substances in high-risk professions can lead to other chronic lung illnesses as well. Patients in these professions need to be followed by specialists who understand their occupational risks and hazards.

What is lung cancer staging?

Staging is a way for your physician to determine the type of lung cancer that you have, and whether it has spread to your lymph nodes or to other organs.

Lung cancer can spread to the brain, bones and the adrenal gland. These are all treatable areas, but we like to catch the tumor as early as possible. Staging allows physicians to determine which therapy is best for you: surgery, radiation, chemotherapy or a combination of those. Additionally, your prognosis and risk of recurrence are linked to cancer stage.

How is lung cancer treated?

There are different options to treat lung cancer, so it’s important for you and your family to seek second opinions and find a physician who understands your priorities.

Surgery is best used for early-stage tumors that are smaller, but we can also perform successful operations for larger tumors that have spread to the chest wall. Radiation is available to patients that are not interested in or are not healthy enough to recover from a major chest surgery.

How is lung cancer surgery performed?

Thoracic surgeons specialize in the latest oncology techniques to successfully perform lung cancer surgery.

Typically, surgeons use small incisions and a camera to remove the diseased segments of the lung and its surrounding lymph nodes. Occasionally, a larger incision between the ribs is necessary (this is called a thoracotomy) if the tumor is large or centrally located.

Is robotic surgery available for lung cancer?

Yes, robotic surgery has been available for about 10 years, and it allows your surgeon to remove the affected lung or areas of the lung.

Robotic surgery provides a three-dimensional view, allowing surgeons to better see the areas they’re operating on.


Next steps:

chronic cough

Got a chronic cough? Knowing the cause might help you find relief.

Dr. Jonathan Kiev

Dr. Jonathan Kiev

Written by Dr. Jonathan Kiev, a cardiothoracic surgeon at UK HealthCare.

Coughing all the time can be a major annoyance to you and those around you. Even worse, chronic cough can affect your sleep, your job performance, and your overall health and well-being.

So, what causes chronic coughing and what can be done to find relief? I answer those and other questions below. Check it out.

What causes chronic cough?

Chronic cough is very common and can be caused by many things. Your doctor will work with you to narrow down the possible causes of your cough and help you find a solution.

Other symptoms that accompany a chronic cough can tell you more about what’s causing it. These symptoms include a stuffy or runny nose, the frequent need to clear your throat, hoarseness, and heartburn. If you have chronic cough and also have shortness of breath or are coughing up blood, you should see your doctor right away.

Does smoking cause chronic cough?

Yes, it can. Hot cigarette or cigar smoke can irritate the membrane and lining of the nose and the throat, which can cause chronic cough. Secondhand smoke is also a common trigger of chronic cough.

Quitting smoking can help you find relief from chronic coughing, in addition to having an array of other health benefits. Talk to your doctor about products and programs that can help you quit.

Can work hazards cause chronic cough?

Work-related irritants, including soot and dust, can also cause the condition. To prevent inhalation on the job, many employers will provide a mask to employees working around paint, woodworking materials, concrete dust and other particles that can be easily inhaled.

High-risk professionals who work around asbestos – including shipyard workers, fiberglass industry professionals and insulation installers – should be especially cautious and take active measures to prevent potential inhalation.

What are some of the less common causes?

Food entering the airway instead of the esophagus is a very common cause of coughing. In children, swallowed objects, such as peanuts or a small battery, can become lodged in the airway and cause coughing. (Always do your best to keep batteries and other choking hazards out of children’s reach.)

Less commonly, lung cancer can be the cause of chronic coughing. Your doctor will use X-rays and other tests to look for early signs of the disease.

Asthma and sarcoidosis (an inflammatory disease that can affect the lungs) are two conditions that can cause a chronic cough. These conditions require active management by your doctor to minimize coughing and to prevent these diseases from causing organ damage.

What happens if I cough up blood?

Sources of bleeding need to be looked at more aggressively. Your physician may recommend a CT scan or referral to a lung specialist (pulmonologist) who may recommend a bronchoscopy to pinpoint the source of bleeding.

I’ve heard people say that severe coughing can cause a broken rib? Is that really possible?

This is not an uncommon story. A hard cough may, in fact, fracture a rib, cause dizziness, or cause a patient to lose bladder control or even pass out.

Many patients are not able to lie flat because it aggravates their cough, causing them to feel like they’re choking. These are symptoms of severe chronic cough and require urgent evaluation by a physician.

How is chronic cough treated?

It really depends on what is causing your cough.

Many medicines, especially certain blood pressure medications, can cause chronic cough and can be adjusted to provide relief.

Patients with postnasal drip often have chronic cough and may need specific medicines to prevent the irritating trigger of excess mucus.

Patients who have GERD or gastrointestinal reflux can have irritated vocal cords, which can also cause chronic coughing. These patients can be prescribed acid-blocking medication to provide relief, and in some cases, may require surgery.


Next steps:

COPD

Dr. Jonathan Kiev answers common questions about COPD

Dr. Jonathan Kiev

Dr. Jonathan Kiev

Written by Dr. Jonathan Kiev, a cardiothoracic surgeon at UK HealthCare.

Chronic obstructive pulmonary disease, or COPD, is a potentially debilitating lung disease that makes it difficult to breathe and tends to get worse over time.

There are two main types of COPD: emphysema and chronic bronchitis.

If you or a loved one has been diagnosed with COPD, you might be unsure of what comes next. I’m here to answer some of the questions I hear most often about the disease.

What causes COPD?

About 18 million Americans suffer from COPD, and the vast majority of cases – between 85 and 90 percent – are caused by smoking.

What type of doctor treats COPD?

Generally, a pulmonologist (lung specialist) or a thoracic surgeon (lung surgeon) will decide if you need oxygen, whether you would benefit from pulmonary rehabilitation, and what type of medicine or surgery would be appropriate for you.

What is a bronchodilator?

Bronchodilators are medicines that help relax muscle airways. They can be prescribed in either short-acting or long-acting form and can come as an inhaler or a pill.

Bronchodilators are the most popular outpatient treatment for COPD – they are effective in treating symptoms and will improve your ability to exercise. Occasionally, steroids will be added to your treatment regimen to help reduce the frequency of breathing flare-ups and improve your quality of life.

What are PFTs?

PFTs are pulmonary function tests. These tests allow your doctor to evaluate your overall lung function and the severity of your symptoms. Based on the results of your PFTs, your doctor can then make treatment recommendations for you.

Over time, your doctor may reorder PFTs to gauge your improvement after being on medication.

What is pulmonary rehabilitation? Does it work?

Pulmonary rehabilitation is usually performed at a hospital or healthcare facility and can help increase your exercise capacity, reduce your breathlessness and improve your quality of life. Most patients benefit from pulmonary rehabilitation programs, which usually last between six and 10 weeks.

It’s not uncommon to be afraid or anxious when you’re short of breath. The good news is pulmonary rehab can also help improve these symptoms of anxiety and depression that we sometimes see in patients.

Is surgery an option for patients with COPD?

Some COPD patients form blebs or bullae – blisters on the lungs that are similar to a bald spot on a tire. These areas are prone to rupture, which could potentially lead to a collapse of the lung. Some of these blebs become so large that they actually press down on good portions of the lung and make breathing more difficult.

In these cases, your doctor may recommend surgery to remove the diseased portions of the lung. This can help prevent a future collapse and free up good portions of the lung to help improve your breathing.

Is lung transplant ever an option in COPD?

Absolutely. In fact, about 85 percent of current lung transplant candidates worldwide have emphysema-related diseases, including cystic fibrosis, pulmonary fibrosis and pulmonary hypertension.

Transplants are not done if the patient has active cancer, uncorrectable heart disease or is currently smoking or abusing substances. Lung transplants are performed at specialized centers, and patients who undergo this procedure often have very good outcomes.


Next steps:

lung nodule

Your doctor says you have a lung nodule. Now what?

Dr. Jonathan Kiev

Dr. Jonathan Kiev

Written by Dr. Jonathan Kiev, a cardiothoracic surgeon at UK HealthCare.

Your doctor tells you that a chest X-ray shows a spot on your lung. It might sound scary at first, but these spots, or lung nodules, are not an uncommon occurrence.

What are lung nodules and what causes them?

Lung nodules are small masses of tissue in the lung that can be cancerous, although the majority are non-cancerous.

Dust and chemical exposure, infection or other tumors can all cause a lung nodule to form. Most people have no symptoms at all and lung nodules are accidentally discovered during the evaluation of something else.

Conversely, people who smoke or who have smoked in the past may also have nodules, which sometimes progress to an invasive cancer. That’s why it’s so important for a specialist to look at your X-rays for further evaluation.

Do lung nodules cause pain?

Pain is rare, especially if the nodule is very small. A CT scan will reveal even the tiniest of nodules, and your doctor can then correlate it with your symptoms. Rarely, if the nodule is near a rib, there could be associated pain.

Why does my doctor want me to get my old records?

An X-ray or CT scan is a snapshot in time; it shows what is happening now.

For comparison, a doctor may ask you to get old hospital records or X-rays to see if your nodule was there in the past, if it’s grown or if it’s stayed the same size. Benign nodules usually don’t change in size, while nodules that are associated with cancer can grow or spread.

If I have a family history of lung cancer, should I be concerned?

Secondhand smoke increases the risk of lung cancer, so most physicians will screen family members of lung cancer patients more frequently. Cancerous nodules that are discovered earlier are more easily treated.

Unfortunately, that the vast majority of lung cancer patients have no symptoms at all, which is why only 15 percent of people who have lung cancer are diagnosed early.

My radiology report said that my nodule was suspicious. What does this mean?

Nodules that are deemed suspicious have certain characteristics, and your care team may want to do additional testing to find out whether your nodule is cancerous.

If your nodule is large enough, your doctor can do a needle biopsy, which involves placing a small needle in the nodule to remove some of the tissue for further testing. In some cases, a surgeon will need to do a surgical biopsy, which involves making a tiny incision to remove the questionable tissue for testing.

Why was I referred to a pulmonologist?

Pulmonologists specialize in lung disease. Through a procedure called a bronchoscopy, they are able to access different areas of the lung and perform biopsies of abnormal areas.

Additionally, they can assess your breathing function and make useful recommendations for inhalers and other medicines as well. They work in close collaboration with thoracic surgeons to form a multidisciplinary lung care team.

Should I consider lung cancer screening?

Lung cancer screening was developed several years ago to detect lung cancer in people who are at a higher risk of developing the disease.

Lung cancer screening is recommended for patients who are at high risk for lung cancer. Low-dose CT screenings are recommended for patients who:

  • Are ages 55-80.
  • Currently smoke or have quit within the past 15 years.
  • Have a 30 pack-year smoking history, meaning the patient smokes one pack of cigarettes per day for 30 years, or two packs per day for 15 years.
  • Have no current symptoms of lung cancer.

The low-dose CT scan takes about 30 seconds to perform, and there is very little radiation exposure to be concerned about. Most insurances will pay for the scan, and many hospitals have programs to help offset the cost as well.


Next steps:

Got heartburn? Get answers.

Dr. Jonathan Kiev

Written by Dr. Jonathan Kiev, a cardiothoracic surgeon at UK HealthCare.

GERD stands for gastroesophageal reflux, a scientific term for garden-variety heartburn.

It’s a common medical condition that can cause pain and aggravating symptoms. Although over-the-counter medications can alleviate the symptoms of GERD, it’s still important to talk to your doctor about your heartburn so that they can assess the underlying cause of the problem.

Here are some of the questions I hear most frequently from my patients about GERD, why it happens and how it’s treated.

Why do I have pain?

Your stomach contents are acidic, which helps you digest food. However, if that acidic fluid gets into your esophagus, you may experience burning and discomfort. Over time, that acid may actually injure the lining of your esophagus and cause the lining to change.

This pattern of repeated injury can be very harmful and can lead to precancerous conditions if not treated.

Why does GERD occur?

There is a valve in between the esophagus and the stomach that prevents acid reflux, but many things can disrupt this valve or cause it to relax. When that happens, acid can sneak into the esophagus.

Being overweight, being pregnant, eating certain foods and even certain occupations that cause the body to be bent over promote acid reflux and the development of heartburn.

I went to the emergency room because I had chest pain, but my heart was OK. Is this normal?

Yes. GERD symptoms like chest pain or burning may mimic the symptoms of a heart attack, and the emergency room will always consider heart issues first as they can be life threatening. If that happens, you may receive a “GI cocktail” to help alleviate the pain and burning and to differentiate the pain from a heart-related condition.

Do the medicines I see on TV work?

Over-the-counter antacids shut down the pump in the stomach that creates acid to help reduce pain. When you take antacids, you still may have reflux, but the fluid being regurgitated into the esophagus no longer burns the lining.

Patients who take medication but continue to experience hoarseness, food regurgitation or bad breath may require a surgical procedure since the active reflux is still occurring.

What are treatment options if I don’t want to take medicines?

The most reliable procedure to prevent reflux and even allow the esophagus to heal from the chronic damage of GERD and acid exposure is a procedure called a fundoplication. This operation involves wrapping the upper part of the stomach around the lower portion of the esophagus, which recreates the valve mechanism that is no longer working.

This should stop your heartburn and allow your esophagus to heal.

Who can do this operation? How long does it take?

Minimally invasive surgeons and thoracic surgeons are trained to perform this procedure, and it takes a little more than an hour to complete.

Most patients do very well and are able to stop taking medication.

Can heartburn cause esophageal cancer?

Chronic acid reflux may change the lining of the esophagus, causing a condition known as Barrett’s esophagitis. This condition can lead to esophageal cancer.

This is why it’s important for your doctor to understand the cause of your heartburn and monitor the lining of your esophagus on a regular basis.


Next steps:

hiatal hernias

Q&A with Dr. Jonathan Kiev: What to know about hiatal hernias

Dr. Jonathan Kiev

A hernia is a medical condition that occurs any time an internal organ or tissue bulges into an area where it shouldn’t be. Hernias don’t always cause noticeable symptoms, but they can cause serious problems if left untreated.

In honor of Hernia Awareness Month, we sat down with Dr. Jonathan Kiev, a new cardiothoracic surgeon at UK HealthCare, to discuss a specific type of hernia called a hiatal hernia.

What is a hiatal hernia?

A hiatal hernia occurs when a portion of the stomach sneaks out of the abdomen above the diaphragm. This occurs fairly frequently and can cause symptoms of pain, heartburn and bloating depending on the size and location of the hernia. Most patients have no symptoms at all, and the hiatal hernia is only discovered incidentally during another test or procedure.

Why do hiatal hernias occur?

Hernias occur because of a weakness in the tissue. This can be caused by aging or even trauma, which may have caused a disruption in the abdominal wall layers. Pregnancy and obesity are known to contribute to the development of hiatal hernias, as well.

Can patients do anything to treat their hernia?

Generally, the answer is no, unless there are symptoms or if the hernia is large enough to require surgery. Patients who have heartburn or gastroesophageal reflux disease, or GERD, are given medications once they are evaluated by their physician to be sure that there are no other more serious medical conditions.

When is surgery for hiatal hernia necessary?

If the symptoms are disabling, like the person is having difficulty swallowing or they’re having food get stuck after eating, then surgery is appropriate. If a patient is anemic – a condition where their blood doesn’t have enough healthy red blood cells – sometimes the hernia can be the cause of anemia, and this can be relieved with surgery, as well. Rarely, a large hernia can become trapped, and emergency surgery is necessary to relieve the constriction.

How is a hiatal hernia diagnosed?

Beyond a good health history and physical exam, a physician may order a swallowing test with dye or a CAT scan to see if the stomach is above the diaphragm. Specialized tests by a gastrointestinal doctor might include an endoscopy, which looks at the lining of the esophagus and stomach for evidence of acid that may cause irritation.

What can patients expect if they need surgery?

Surgery can be done through the abdomen or the chest. Thankfully, today’s techniques allow the procedure to be performed with tiny incisions in a couple of hours so recovery is quick and pain is minimal. Most patients go home in a day or two and recuperate over the next several weeks.

Most patients go home in a day or two and recuperate over the next several weeks. Surgeons that specialize in minimally invasive procedures and thoracic surgeons are experts in the repair of hiatal hernias. Your physician can refer you to a surgeon in your area.

Are dietary changes necessary after surgery?

Patients can still eat all the foods that they enjoy, although they may be encouraged to modify their intake and meal frequency.

Is a follow-up necessary after this surgery?

Surgeons like to follow their patients closely to be sure that these hernias don’t come back. We know that the larger hernias have a higher likelihood of recurrence, and special procedures are done to minimize this. Overall, the results of this surgery are excellent, and patients are very satisfied afterward.


Next steps: