- 1 week ago
In this month’s Stay Well Health Chat, Nicole Michalik from 92.5 XTU and Marisa Magnatta from 93.3 WMMR speak with Patrick Mulhall, MD, a board-certified pulmonologist and medical director of advanced lung disease at Virtua Health. Dr. Mulhall specializes in , interstitial lung disease, lung transplant evaluation, and post-transplant care.
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00:01Hi everybody, Marissa Magnata here from the Preston and Steve Show on 93.3 WMMR.
00:06Hi, it's Nicole Mohalik from 92.5 XTU and we are so excited to be welcoming board-certified
00:13pulmonologist caring for adults with lung conditions, Dr. Patrick Mohal. Welcome.
00:19Hi, thank you guys. I appreciate the opportunity to be here.
00:22So, Dr. Mohal, you specialize in the treatment of intertest...
00:26Oh, that's going to be...
00:28Introtestrial? Is that right?
00:29Introtestrial.
00:30How do you say that, doctor?
00:31It's as difficult to manage as it is to say. Interstitial lung disease.
00:35Ooh, okay. So, Dr. Mohal specializes in treatment in interstitial lung disease,
00:42lung transplant evaluation, and post-transplant care. So, what does that actually mean?
00:47Yeah, right, exactly. It's just a lot to confuse people. So, realistically, when you're looking at,
00:53you know, lung disease, there's multiple different things that we deal with, right?
00:57There's airways in the disease, and then there's what we call interstitial disease. So,
01:01if you think of the lung like a sponge, this is kind of what I tell patients, the airway is
01:07the
01:07holes in the sponge. The interstitium is the rest of the stuff in the sponge.
01:11And it's different disease processes that affect these different areas. So, the interstitium is more
01:18inflammatory or scarring lung disease. Oftentimes, we don't know what causes it. We hope we can figure
01:27out an exposure and limit that or treat that. But ultimately, usually, it's a progressive disease
01:32that we have to manage pretty aggressively, or we're talking transplant with patients.
01:37Well, so, your patients rave about your bedside manner and your knowledge and how you share
01:43information with them and your techniques of caring for them. So, we're excited to talk to you. We have
01:49so many questions. First off, you touched on it just a moment ago, advanced lung disease. What exactly
01:55does that mean? Yeah. So, you know, lung disease, as I kind of alluded to, there's a continuum,
02:01right? There's stuff that comes into the office that's kind of typical stuff a pulmonologist sees,
02:06asthma, COPD. And then there's these more progressive lung conditions that, you know,
02:13lead to more respiratory disease, more respiratory failure, chronic oxygen dependence. And that's kind
02:18of what the advanced lung disease is, or kind of complex lung disease. It's where disease will
02:23progress regardless of therapy, usually. And it can be airway-related, interstitial-related,
02:29or vascular-related. So, pulmonary hypertension, interstitial lung disease, or fibrosis,
02:34and an advanced kind of COPD. So, who is at risk for developing advanced lung diseases?
02:43Anybody with known chronic lung disease, right? So, if you have chronic COPD or chronic obstructive
02:49pulmonary disease, you are at risk for development of progression. People with known connective tissue
02:58disorders or autoimmune disorders actually can get interstitial lung disease, as that's one of the
03:02known risk factors for interstitial lung disease. People with known exposures to environmental things,
03:09particularly smoke, industrial fumes or smokes. Believe it or not, farmers get lung disease from
03:17what they breathe in in silos. People who own pigeons. So, all that stuff can set you up for
03:25interstitial lung disease. Do a lot of people own pigeons? Believe it or not, it's the most common
03:31cause of known hypersensitivity lung disease is people who own birds. Really? Yeah, most common
03:39cause. How about people that live in the city around a lot of birds? Yeah. No, you got to be
03:44a long-term exposure. Okay. Usually a decent amount of birds. Believe it or not, people who own birds
03:50tend to own a decent amount of them. Interesting. Yeah. Wow. Okay. Yeah. Well, what is it? What is
03:55it about the birds? It's antigens. So, particles on the bird feathers that cause inflammatory reactions
04:04in the lung. And it can cause an acute reaction where they have, you know, acute shortness of breath
04:09and cough. Or it can cause this kind of chronic reaction over time, the longer you're exposed to it.
04:13And that can cause, you know, these fibrotic scarring changes in the lung. One more question about the
04:19birds. Yeah. Yeah. Have we just learned this in the past couple of decades? Is it like centuries
04:26old? How long have we known this? We've known this probably 50, 60 years. Okay. This is probably
04:33what killed Edgar Allan Poe. Yeah, exactly. The raven got him. The raven. Yep. He won. Yes.
04:39All right. Yes. So, we have our bird knowledge satisfied. But wait, I feel like this is important
04:44though, because I think a lot of people just associate like lung disease. They think of like smoking
04:48and they think of like pneumonia, right? It's important. This is why we do these amazing chats
04:55with experts like you, where it's important to be aware. A lot of people probably don't realize
04:59there's all these factors that go in. So, you have to be aware of your surroundings. This is why experts
05:06are so important to listen to. So, thank you for your knowledge on that. But I think it's important
05:10that people realize there's so many factors that go into it. Not just like, oh, I never smoked. And
05:14you're like, yo, there's a lot of things that can contribute to this. Yeah. Yeah. Unfortunately,
05:19interstitial lung disease, you know, causes regardless of smoking. COPD, yeah, most of the
05:24time it's smokers. But interstitial lung disease and fibrosis, no, not necessarily. And often the
05:29times they aren't smokers. So, what are some of the warning signs that people shouldn't ignore?
05:34Obviously, you mentioned shortness of breath. But is there anything else that you can say
05:39it's important to seek care? Yeah. So, anybody who has, you know, if we break it down into different
05:47disease entities, so specifically like interstitial lung disease or fibrosis, you know, chronic cough
05:52tends to be what people go to the doctor for. So, cough that's, you know, three to six months,
05:57dry, nagging all the time, that's a concern. If you're starting to notice, you know, more dyspnea
06:03with just normal activities, dyspnea being shortness of breath, you know, you're walking up a flight of
06:06stairs, carrying your laundry, and that seems to be harder and harder and harder, that's a problem.
06:11Smelling in the legs, fingers that are kind of changing in terms of their shape, usually it's
06:16the top of the finger, we call it clubbing, usually that means your oxygen levels are low.
06:20Let me just check it out. Otherwise, we see reflux commonly in these patients. So, if that's kind
06:28of uncontrolled, that's something that might be a tip-off. And if you're seeing a doctor for
06:33rheumatologic things, certainly worth asking them if you should be seeing a lung doctor, because
06:38it goes hand in hand for a lot of these patients.
06:41Also, you mentioned reflux, really important. A lot of people just associate that with like
06:47heartburn, whether they're not eating the right foods, but this is why it's important to say on
06:51top of your care that sometimes there could be something else happening that you don't realize
06:56is the cause of that. And you just think, oh, you know, I ate too many cheeseburgers, but it really
07:01could be something else. Yeah, correct. I mean, it's the link between reflux and interstitial
07:07lung disease has not been identified, but we know that the patients that have interstitial
07:11lung disease do have more reflux and people who have more reflux tend to have more interstitial
07:15lung disease. Whether or not they're correlated, we don't know, but we know that they happen
07:19together commonly. So, certainly worth checking out. I love when Dr. Nicole enters the chat.
07:26Hey, you got good knowledge.
07:28All right. So, in an instance where serious lung disease is occurring and perhaps a transplant is
07:37the next step, walk us through that and how Virtua helps their patients.
07:42Yeah. So, my background is I was a transplant doctor before I came to Virtua. And it's one of
07:48the common themes you hear from patients is like, you know, it's too much work to go wherever I have
07:54to go to get this done, right? South Jersey does not have a transplant center. So, traveling with,
07:59you know, your oxygen tank, your family members is a robust deal. So, we decided that if we could,
08:07you know, utilize knowledge that we have here and facilities we have here, we can make that process
08:12easier for patients. So, we bring patients in that we think are, you know, high risk for
08:19progression of lung disease. And we're able to do an initial assessment in our clinics to decide if
08:25we think transplant is a viable option for them just based on, you know, social situations, their
08:30other comorbidities, their age. And we're able to kind of get insurance approval and then do all
08:36their pre-transplant testing here in Virtua here on this side of the bridge. And, you know,
08:42this testing, I tell people, this is a very expensive, best physical exam you'll ever going
08:47to get, right? It's scanned to the whole body. It's more blood work than you knew you could take.
08:52It's physical testing. It's cardiac testing. We're basically trying to determine that
08:56your lung is the only problem that you have and that we can fix that. We can fix you.
09:00So, we do all that here. And then once that person has done their evaluation, we then kind of
09:05coordinate with a transplant center as to where we can possibly get your organ. And then you come back
09:11and we can help manage that. And that's when we talk about when it comes to personalized care,
09:17where it is so comprehensive with, it's not just the lungs you're looking at, you're looking at the
09:22whole complete body and how everything works together. And that's something that Virtua provides
09:27so wonderfully. Yeah. So, it took us a couple of years to kind of refine this process. And in doing
09:35so,
09:35we had to kind of identify champions in these different subspecialties, right? As we talked about,
09:40reflux is very common. So, we have an esophageal expert that kind of sees my transplant patients
09:45to make sure that they're doing everything right and that they are optimized to go through the
09:50surgery. The same with our cardiologists. We have a nutrition team. We have a rehab team.
09:54All that stuff that just kind of makes sure that we're hitting every facet of, you know,
10:00not just lung disease, but patient disease, right? This is systemic problems that patients have as a
10:04result of, you know, one organ that's not working. Yeah. And that's the team-based care that Virtua gives.
10:10Yeah. That is just top-notch right here in our area.
10:13Yeah. It's amazing. And so, can you just talk a little bit about the term-based approach that
10:18Virtua and the types of advanced treatments and services available to help patients breathe easier
10:23and maintain their quality of life? Like, obviously, we know, like, the extreme is you have the ability
10:29to actually have transplants. But what does it look like leading up to that?
10:33Yeah. So, our goal, and I tell patients all the time, my goal is to prevent
10:37needing to get new lungs. I want to keep your lungs in you as long as I can.
10:42And to do that, really, it takes, one, an expert in identifying what interstitial lung disease is,
10:48what pulmonary fibrosis is, what even pulmonary vascular disease is. And we have that here. We
10:54have those people. We've been bringing them in just from a pulmonary standpoint over the last couple
10:58of years. So, this requires, you know, expert diagnostics. So, this is bronchoscopy going
11:05into the airway, sampling the airway with, you know, minimally invasive techniques to take pieces
11:10of lung and having an expert, you know, pathologist look at that tissue and tell me what we think a
11:15diagnosis is. We have a team of interstitial disease doctors, I'm just one of them, who run these cases,
11:22you know, every two weeks to say, hey, what do we think this is? And that involves our team, radiologists,
11:30pathologists, rheumatologists. Once we have a diagnosis, then, you know, treatment starts. And
11:34that's not always just, you know, usually for most docs, it's steroids, but there's a lot more than
11:39that now, because we know all the side effects of prednisone. So, we give medicines that modulate
11:46the immune system. So, we're lowering immune cells. These are pills. Sometimes they're infusions.
11:51These infusions are given every month, every six months. Again, stuff that we're starting to
11:57realize is helping and that we're trying here and then having good success with.
12:02Wow. When we say comprehensive, we mean comprehensive. I love it. Yeah. It takes a team. It takes a village
12:10for this diagnosis. A lot of coordinating care, not just doctors, not just, you know, radiologists,
12:16but, you know, again, nutritionists, therapists, you know, pulmonary rehab, all that is important
12:22because it is treating a whole body and a whole person. Yeah. Well, Dr. Mulhall, thank you so much
12:27for sharing all of this information with us. If you watch this video and please share it with your
12:31friends and family, you know, it could help somebody out there. And that's just what the whole idea of
12:37these Virtua Stay Well Health Chats is all about. Helping each other. Absolutely. And we say that
12:42all the time, like, you got to take care of yourself. And that's why we love Virtua so much.
12:47It is comprehensive care like you've never seen. To schedule your appointment,
12:51visit Virtua.org slash pulmonary or call 856-596-9057. Thank you so much for joining us today,
12:59doctor. Thank you.
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