- 1 week ago
In this month’s Stay Well Health Chat, Andrew Salciunas sits down with Syed Riaz, MD, Interventional Pulmonologist at Virtua Health, to discuss early detection, cutting-edge diagnostics, and minimally invasive treatments for complex lung conditions.
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00:00This edition of our virtuous Stay Well Health Chat.
00:03I'm Andrew Salchunas.
00:04You can catch me every single morning on Kincaid and Salchunas,
00:076 a.m. to 10 a.m. on 97.5 The Fanatic.
00:10And I absolutely love doing these every single month.
00:12I have so much fun doing these as somebody who's married to somebody in the health care,
00:16somebody who has a mother who's been in health care forever.
00:19I love being able to get more and more information because I feel like I know stuff
00:23and then I quickly find out that I don't know enough.
00:26And that's why we do these Stay Well Health Chats.
00:28And this week, this month, I am lucky to be joined by Dr. Zaid Riaz.
00:33And he's an MD, board-certified interventional pulmonologist,
00:37which actually means something specifically to me because I had a buddy of mine,
00:40a very good close friend of mine, who unfortunately had a pulmonary embolism way back.
00:45He's good, thank God, the beauty of health care.
00:48So I'm happy to be able to speak with Dr. Riaz today,
00:51who's been caring for adults with lung conditions in South Jersey.
00:55You have received medical degrees from Lahore-Nishtar Medical College.
00:59You completed your pulmonary and critical care medicine training
01:02at the University of Hospital of Brooklyn and University Hospitals of South Alabama.
01:06As I say, every single time I do these hits, Doc, the longer the bio, the better.
01:12Thank you so much for coming on today.
01:13We really appreciate it.
01:15Yeah, it's a pleasure.
01:15Thanks for having me.
01:16So a lot of people, when they hear pulmonology, they think of conditions like COPD or emphysema.
01:23What other diseases or conditions do pulmonologists treat?
01:27Yeah, so we treat a variety of conditions.
01:30As you mentioned, COPD, emphysema.
01:32A lot of patients with COPD, but there are other conditions,
01:38asthma, scarring, inflammation, we call it interstitial lung disease.
01:46That's also a broad spectrum of diseases which cause fibrosis in the lungs.
01:53We are an important part of also lung cancer diagnosis and management.
01:59Obviously, we work closely with thoracic surgeons and oncology,
02:02but as an interventional pulmonologist, that's one of the main focus
02:08because we have to diagnose those massive nodules
02:12so either thoracic surgery, radiation, or medical oncologists
02:17can work it up or can treat it accordingly.
02:22We also deal with, as you mentioned, pulmonary embolism.
02:27That's quite common.
02:28You get blood clots and blood vessels in the pulmonary, we call them pulmonary arteries.
02:34We, as interventional pulmonologists, we also deal a lot with airway problems.
02:42Your airways can be stenotic, they are narrow, they can collapse,
02:47they have some benign tumors, malignant tumors, we deal with them,
02:51and pleural effusions also.
02:52These are the fluids which you accumulate outside your lungs in the space or the sac.
02:59We call that pleural cavity.
03:00So, pleural diseases, including pleural effusions, we deal with them.
03:04So, I think these are the majority of the conditions which we treat as pulmonologists.
03:09So, that's a lot more than just COPD and emphysema.
03:13So, my question for you, with all the stuff, all the information you just gave us,
03:18what are sort of some of the symptoms you might be looking for?
03:20Again, I told you, I have experience.
03:22My old college roommate clearly had a lot of trouble breathing,
03:25and that's when he started saying, all right, I got to go to the doctors and get this checked out.
03:28So, other than just maybe shortness of breath,
03:31what are some things that you should be keeping an eye on with your own health
03:34where you say, all right, it's time for me to go to Virtua and speak to a healthcare professional?
03:38So, yeah, other than shortness of breath, you may not notice,
03:43but if you are waking up with difficulty breathing at night,
03:47you are coughing, weight loss, because some of these conditions,
03:52you don't necessarily have the lung-lung symptom, but appetite has gone down,
03:58you are having weight loss, your heart rate is going up.
04:02So, these are some other things, especially the reason we emphasize, especially lung cancer.
04:08Early-stage lung cancer, you are not going to have any symptoms.
04:12Unfortunately, by the time the patients seek medical attention regarding the lung cancer,
04:20it's going to be advanced lung cancer.
04:23It's not like you can't treat it.
04:25You will still be able to treat it, but it's not an early-stage lung cancer.
04:29So, we need to, so it could be, you could be asymptomatic.
04:33Uh, uh, and, uh, pulmonary embolism, the blood clots, dizziness, headaches, passing out,
04:40those are some other things to look for.
04:42So, primarily, I would say chest pain, shortness of breath, cough, unexplained weight loss,
04:48uh, degrees of appetite, things to look for.
04:51By the way, you mentioned also trouble sleeping.
04:55You also completed your sleep medicine training at Temple University Hospital.
04:58Go out.
04:59I am also an owl, so I respect you even more, Dr. Riaz.
05:03All right.
05:04Obviously, when it's time to get treatment, sometimes surgery is a part of it.
05:07Could you explain what robotic-assisted bronchoscopy is and what it's for?
05:11So, uh, robotic, uh, system navigation bronch, we were actually the second, uh, hospital system
05:19in the state of New Jersey to have that, uh, platform.
05:23Uh, I'm talking about years back, uh, when I started doing, uh, robotic navigation.
05:29So, navigation system has been in place for a long time.
05:32Uh, it's just the robotic, uh, it's in the last, uh, uh, few years.
05:36What basically the main, uh, role of using a robot navigation system is basically a GPS
05:44system, uh, which help us get to the nodules.
05:47What are the nodules?
05:48These are small spots or growth, uh, in your lungs.
05:51And the reason, uh, we emphasize or we, uh, take close attention to these nodules because
05:59lung cancer also start as a small nodule.
06:01Then it grows.
06:03And then unfortunately it can spread to the lymph nodes.
06:07It can spread, uh, to any organ in the body.
06:10So that's the whole idea.
06:13Try to catch these nodules as soon as possible.
06:18That's why we have a comprehensive lung screening program here at Virtua.
06:22We are in high risk patients, uh, who are smokers, even if they have quitted, but they are within
06:27the last 15 years of their, uh, smoking history, uh, active smokers or, uh, age group.
06:35Uh, it used to be 55, 74.
06:37Now it has been brought into 50 to 80 year old high risk patients.
06:42We do serial, uh, once a year, low dose gats can find these nodules.
06:47The thing is now with the robot navigation system, we can go after small nodules.
06:54It used to be, I think 10 millimeter, maybe the bigger the size, the better, but now we
07:01can go eight millimeter nodule, which a few years back, you would just keep an eye on it.
07:06So what, uh, basically what we do, we mark the nodule as our target.
07:12This robot system help us navigate pretty close to the nodule.
07:18I would say the sensitive, the diagnostic yield right now is above 90%.
07:22So basically you put a small camera, you go into their airways, you navigate through the
07:29airways.
07:29There's a GPS system next to side by side.
07:32I have a virtual view where I'm looking in the airways with my camera and then I have
07:37the GPS system.
07:38This robot system helps me to navigate and try to match it as close as possible.
07:44Once we are in the nodule, we confirm with ultrasound, special x-ray machines, take biopsies.
07:49And, uh, uh, 90, it used to be interventional radiology, uh, yield 90 or above.
07:57They used to go from outside.
07:59Right now we can, as a bronchoscopist, uh, I can go in and, uh, sample these nodules as
08:06small as eight millimeter, any part of the lung.
08:09So we, we, we make a diagnosis.
08:11You establish the diagnosis of lung cancer.
08:14If it is negative, then you wash these nodules.
08:17If it is positive, the goal is if you have adequate lung function, send these patients early
08:23to your thoracic surgeons, they can take them out.
08:25So your lung cancer is good.
08:28That's why this emphasis is on catching the nodules early, go after these nodules and robot
08:34system is state of the art, uh, to get to these nodules, uh, even small as, as small as eight
08:41millimeters.
08:42Now it's amazing.
08:43You mentioned that the team of virtual is the second hospital to do that.
08:47Uh, you're also the only South Jersey health system to offer the Zephyr valve.
08:52So first and foremost, explain what a Zephyr valve is so that the people watching can know
08:58exactly what you're talking about and who would it benefit the most?
09:01Yeah.
09:01So as you mentioned, we are the only center in South Jersey, which offers Zephyr valve
09:06for lung volume reduction.
09:08So basically the procedure is called BLVR, which is a bronchoscopic lung volume reduction.
09:14Uh, this is done for severe emphysema COPD patients who have what we call hyperinflated
09:21lungs.
09:22So yes, they have severe COPD, but they have hyperinflated lungs.
09:26Their lungs have what we call air trapping because of the destructed lungs.
09:31They cannot get rid of that extra air from their, uh, lungs adequately.
09:36So lungs are, uh, you can say larger or hyperinflated.
09:40What it does, unfortunately, the more hyperinflated the lungs are, it's going to affect your muscles
09:47of breathing, including one of the main muscles, which is diaphragm.
09:51Uh, we all, when we breathe, our diaphragm moves up and down.
09:56That's the dome shaped diaphragm we are born with.
09:59Unfortunately, the COPD patients, they have such hyperinflated lungs.
10:03They just put so much pressure on their diaphragm.
10:06Diaphragm is flat.
10:07It just makes sideway movement.
10:10So they are at mechanically disadvantage breathing wise.
10:14So what we do, severe COPD patients, you have to undergo, uh, some further testing to see
10:22if you are a candidate because you need to have emphysema.
10:26You need to have significant hyperinflation and air trapping.
10:29Uh, and then those patients can get, uh, uh, qualified for, uh, valve placement.
10:36So, the goal of this treatment is to make their breathing better, uh, to improve their activities
10:44of daily lives.
10:45So if they're walking 10, 15 step, our goal is they can walk 25, 30 step.
10:50They are on oxygen, huffing, puffing.
10:52Hopefully we can improve their quality of life.
10:55So they can do, they can go to their mailbox, they can do their grocery without getting significantly
11:00short of breath.
11:01They can have normal conversation with their, uh, family members.
11:05So this Zephyr valve is, uh, one way, uh, endobronchial valve.
11:11So what we do, we put a small camera, which is, uh, we call it bronchoscope.
11:17We go through their mouth, go into their windpipe.
11:20Uh, we already know based on the preoperative, uh, workup, which part of the lung or lobe to
11:28treat, we go after the lobe, which is the most diseased based on our, uh, pre-procedure, uh,
11:35workup.
11:36So what we do, we put these end, these endobronchial valves, one way valves in, in that lobe.
11:41So one lobe has different airways.
11:44We call them segments.
11:45So I go into different segments, take the measurements and just deploy the valves, uh,
11:50uh, there.
11:51So what these valves do as they are one way valves.
11:55So whenever patient breathes in, it closes.
11:58So it would not let the air go into the, that part of the lung, but when they exhale or
12:03they breathe out, the air can come out.
12:05So that helps at electuses or shrinkage of that part of the lung.
12:09So when that lobe shrinks, the whole lung automatically by default is going to shrink.
12:15So now instead of large hyperinflated lungs pushing on diaphragm, there's no more room to
12:21expand.
12:22Certainly you have smaller lung because you did the lung volume reductions and then they
12:27can move their lungs better.
12:29It, uh, the diaphragm starts working better.
12:31It starts to go back to the original dome shape.
12:34So that helps with the mechanics of breathing and, uh, severe COPD patients, carefully selective.
12:41Uh, they will definitely benefit is becoming a more standard of care.
12:47You have severe COPD.
12:48You have tried all the medication.
12:50You are rehab.
12:51You are either waiting for transplant patients.
12:54And some patients are not interested in transplant.
12:56And some is just the weight, just, uh, uh, the bridging therapy.
13:00Okay.
13:01Your transplant might not happen two years down the road.
13:04Do you want to improve your breathing during the meantime?
13:07We put the valves in, make their breathing better till they get their lung transplant.
13:10Or if there is a contraindication, they can't get lung transplant.
13:14So we have this to offer.
13:16It's minimally invasive, way less, uh, risk.
13:21Surgeons used to do lung volume reduction surgery.
13:24They would just cut the most diseased part of the lung.
13:26But unfortunately, uh, the, the morbidity and mortality was quite high complications were
13:33high risk of death was high, but this bronchoscopic lung volume reduction, uh, the mortality risk
13:40is pretty low.
13:413% FDA approved it eight, nine years ago and thousands and thousands of patients are benefiting
13:48from it.
13:49So doc, you're giving us so much incredible information.
13:53I really appreciate it.
13:54And the team of virtual has so much to offer, right?
13:57Talking about the robotic assisted programs that you have when it comes to procedures,
14:01the Zephyr valve that you have the only healthcare system in South Jersey to have that Zephyr valve,
14:06the incredible doctors like you and your team at virtual.
14:08But what makes the virtual lung program so special, so unique other than what we've already
14:13talked about?
14:14Somebody watching this is probably saying, Hmm, I should check this place out.
14:17What else would you have to say to somebody that's wondering which healthcare program they
14:21should go with to check out their lungs?
14:23Yeah, I think, uh, uh, we, our main emphasis since I started and even before that has always
14:32been to make this a comprehensive lung program.
14:35And last, uh, few years we have achieved that.
14:43We have, uh, uh, uh, pulmonology where our main focus is, we are trying to make it a comprehensive, uh, program at par with any
14:52other tertiary care center.
14:53We have different, uh, uh, uh, sub specialties.
14:57Like we have, this is my field is interventional pulmonologist.
15:01We have a large group of physicians.
15:03We have a large group of physicians.
15:04They see the patients, patient needs procedure.
15:06They come to me or, uh, my other colleague, uh, who is another interventional pulmonologist.
15:12We do the procedures for them.
15:14We have a large group of patients back to our colleagues and they, uh, then based on our
15:18diagnosis, based on the tissue diagnosis, they manage the patients.
15:22But in, in addition to interventional pulmonology, we have an advanced lung clinic, uh, where our
15:28colleagues are, uh, seeing this end-stage COPD interstitial lung disease of fibrosis patients,
15:35pulmonary hypertension patients.
15:37So basically these are severe lung disease, diseases, uh, and, uh, they work, uh, quite
15:45closely with us.
15:46If they think there is an appropriate candidate COPD wise who were sent to them for transplant,
15:52they said, you are a candidate or maybe you are not, or you have a waiting period.
15:57Why don't you go see the interventional pulmonologist and get evaluated for VALS?
16:01Then we are also working on, uh, developing the pulmonary hypertension program.
16:06That's also a field of pulmonology where patients can be really sick, cox independent, shortness
16:12of breath.
16:13Uh, uh, uh, another main thing I would say is, uh, our close collaboration with our thoracic
16:21surgery program.
16:22Uh, we are quite lucky here at Virtua, uh, because we don't work as a separate pulmonology and
16:29thoracic surgery.
16:30We all work together is if you want to say thoracic program, medicine program.
16:35Uh, if I have cases, complicated cases, my thoracic surgeons are there to back me up any
16:42time.
16:43Patients come to me.
16:44I evaluate them.
16:45If I think they would need surgery, I send them to thoracic surgeon, vice versa.
16:50Some patients get directly sent to thoracic surgeon.
16:52They said, no, why don't you go see our interventional pulmonologist get the procedure done because it's
16:57more suited for them.
16:58So, uh, I think in that, from that aspect, uh, is quite unique.
17:04The collaboration between all, uh, oncology, thoracic, uh, surgery and us, uh, pulmonology,
17:12including the interventional pulmonology, that's quite, uh, unique and it's, I would say state
17:16of dark art, whatever we are trying to do is just to try to give the patients, uh, uh,
17:23the best, uh, management, best care possible at par with any other, uh, academic tertiary
17:30care center.
17:31And I know the team at virtual really stands by that always looking for what's best and
17:36what's next.
17:37So you mentioned the Zephyr valve and how all of a sudden that's kind of become like a common
17:41practice where you guys are doing this.
17:43And it's like, all right, let's minimally invasive, let's, let's do this.
17:46So what's the next future advancement in pulmonology?
17:48What's, what's the next trend, right?
17:50What are some of the goals that the team at virtual is setting for the future and not necessarily
17:54just here in September of 2025, October of 2025?
17:58Yeah.
17:59Yeah.
18:00So, uh, we are, we still have some work to do on pulmy hypertension.
18:05We are trying to get more staff, uh, uh, so we can, uh, help those patients, uh, as far
18:15as interventional pulmonary is concerned.
18:17Uh, one, uh, problem or one downside I have, I see when patients have high expectations, they
18:28come in severe COPD patients, they come in, they think, okay, I'm severe COPD on Pazima.
18:33I, I should get valves.
18:35And unfortunately, despite extensive workup, no matter what you do, uh, they may not be
18:41candidates.
18:42So the, the reason they sometimes fail the testing, they have what we call collateral ventilation.
18:49The lobes are interconnected.
18:51So the air leaks from one, one part of the lung to the other.
18:55So in those cases, the valves are not going to work.
18:58So there right now studies are being, uh, being, uh, done where, uh, they do, they put
19:04a sealant in the, in the, in the lungs, try to seal that, uh, area.
19:09So that's, we're looking forward to once that's approved, we'll start doing it here.
19:13We just want to continuously evolve, uh, as an interventional pulmonary program, try to
19:18provide our patients, uh, the standard of care state of thought.
19:22So I think that's probably is going to happen in next few years.
19:26This is gonna evolve a lot.
19:28Then the things which are being looked at other than the valves, coils are being looked at.
19:34These are basically small metal coils you can deploy in the airways.
19:37That also helps to shrink the lungs.
19:39Studies are being going on.
19:41And once and if it gets approved with the, uh, acceptable safety profiles, obviously we'll
19:47start doing it here at some point.
19:50And, uh, I think in the robotic navigation, uh, uh, uh, field with the integration of the
19:56advanced imaging, I think that's also going to keep evolving.
20:00So, uh, our yield right now is above 90.
20:04Hopefully it will be 98 in next couple of, uh, uh, years.
20:09Uh, so whatever is, uh, the, uh, uh, uh, the standard of care, we just, uh, adapt accordingly
20:16and we'll continue to evolve.
20:17All the support, uh, is there at Virtua, the administration, the, the lead physicians,
20:23the colleagues, uh, everyone works together and we, we try to, uh, uh, uh, continue to evolve
20:31accordingly, uh, with the time.
20:34Dr. Reyes, a lot of incredible information.
20:37This is why you went to five different universities and colleges to get all these.
20:41I didn't even mention that you got your interventional pulmonary training at University of Wisconsin.
20:45So five different colleges and universities, this is where you get all that incredible
20:49information.
20:50And this is why the team at virtual health always has the best doctors and best people
20:54to work with you to take care of you.
20:56If you need more information, especially when it comes to pulmonology, go to virtua.org slash pulmonary.
21:03That's virtua.org slash pulmonary.
21:05And of course, watch this entire video because you are getting so much information
21:09from Dr. Reyes and the team at Virtua.
21:11Doctor, thank you so much for joining me today.
21:13I really appreciate it.
21:14Great.
21:15Thank you for having me.
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