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Southeast Houston Pulmonology (Dr.
Louis Hamer) along with it’s sister corporation Southeast
Houston Cardiology offers a wide variety of diagnostic and therapeutic
services for patients with chronic obstructive lung disease, asbestosis,
asthma, interstitial lung disease, persistent cough and chest pain.
Pulmonary Function Testing
These tests provide essential information for the diagnosis and
treatment of lung diseases. Pulmonologists divide the testing into
several major categories: spirometry, lung volumes, and diffusion
capacity.
Spirometry measures the quantity of air a person can exhale in
a single breath. The patient sits upright in a chair and exhales
forcefully into a mouthpiece attached to a computer. The computer
quantifies the amount of air a person exhales in one second and
the total amount of air exhaled in a full breath. Patients with
obstructive lung diseases such as Emphysema, Chronic Bronchitis
and Asthma exhale less forcefully than normal resulting in a decreased
ratio of the air exhaled in one second compared to the total air
expired in an entire breath. We also repeat the spirometry after
administering a medication called albuterol to the patient. The
albuterol dilates the bronchial tubes and makes exhaling easier.
Patients with asthma or an asthma-like component to their lung disease
improve their performance after receiving albuterol.
The lung volumes portion of the testing quantifies the size of
the lungs, the amount of air inhaled with each breath and the quantity
of residual air in the lungs after a full exhalation. The computer
calculates these measurements by measuring the volume of nitrogen
gas patients displace with natural breathing and an extra forceful
breath.
Finally, we measure the ability of the lungs to extract oxygen
from the air through a technique know as helium dilution. The lungs
extract helium from air through the same physiological mechanism
they extract oxygen. During this portion of the testing, the patient
inhales a small quantity of helium and the computer measures the
difference between the amount of helium inhaled initially and the
quantity returned on expiration in order to estimate the lungs ability
to extract oxygen from ambient air.
Pulmonary function tests play an important role in diagnosing and
quantitating the severity of chronic bronchitis, emphysema, asthma
and other lung diseases.
Ultrasound Guided Thorocentesis
Some lung diseases cause fluid to accumulate in the lining around
the lung (the pleural space). This accumulation of fluid (pleural
effusion) restricts breathing and causes chest discomfort and shortness
of breath. Thorocentesis describes the drainage of this fluid (pleural
fluid) through a small tube allowing the lung to expand. In our
office, Dr Louis Hamer performs this procedure by placing a small
plastic tube in the lining around the lung under direct visualization
with an ultrasound machine.
Echocardiogram
Heart problems often cause difficulty breathing by impairing circulation
of blood and causing blood and fluid to accumulate in the lungs
(pulmonary edema). Our office employs a certified ultrasonographer
capable of performing high quality ultrasounds of the heart (echocardiograms).
These echogradiograms provide us with information about how forcefully
your heart pumps, the condition of your heart valves, the size of
your heart and the amount of pressure in the artery between your
heart and lungs (the pulmonary artery).
Bronchoscopy, Endobronchial Biopsy, Transbronchial Biopsy and
Wang Needle Aspiration
In some situations including suspected lung cancer, hemoptysis
(coughing blood), and sarcoidosis pulmonologists need to look inside
a patient’s windpipe (trachea) and bronchial tubes. Dr. Louis
Hamer uses a fiber optic scope allowing for high-resolution images
in a nearby day surgery center with the assistance of a board-certified
anesthesiologist. We insert this fiber optic tube with the diameter
of a thick pen through the mouth or nose under anesthesia. The bronchoscope
allows for excellent visualization of the trachea and bronchial
tubes and the pulmonologist can identify cancers, impacted mucous
or irritated mucosa. If necessary, we may also extract a small fragment
of lung tissue (biopsy) through the fiber optic scope and send the
specimen to a laboratory to be examined microscopically by a board-certified
pathologist. The technology allows for taking a biopsy directly
from the inside of a bronchial tube (endobronchial biopsy) or sampling
tissue outside of the bronchial tube itself under radiographic guidance
(transbronchial biopsy). In some situations we may also use a needle
placed through the wall of the tracheobronchial tree to sample enlarged
lymph nodes in the center of the chest (wang needle aspiration).
CT Guided Needle Aspiration of Lung Masses
In some cases a spot on the lungs may not be accessible through
a fiber optic scope due to the location. In these cases we will
arrange for a board-certified interventional radiologist to use
a needle to obtain a tissue sample under the direct guidance of
a cat scanner. A board certified pathologist will examine the specimen
to see if any lung cancer exists.
Vascular Studies of the Lower Extremities
Our office and ultrasonographer now have special training and certification
to perform sonography of the lower extremities to search for a deep
vein thrombosis (clot) in the venous circulation of the legs. This
offers us a tremendous resource in diagnosing and combating lung
disease, because clots forming in the legs (deep venous thrombosis)
often break apart and travel into the circulation of the lung causing
pulmonary emboli. With this technology we can detect potential pulmonary
emboli earlier and prevent complications.
Polysomongraphy (sleep studies) and CPAP (continuous
positive airway pressure)
Many patients with respiratory problems experience difficulty breathing
at night and even stop breathing periodically at night (Sleep Apnea).
We use a nearby sleep center to assess patients for this problem.
Patients sign in around 8 00 or 9 00 PM and spend the night sleeping
in the laboratory. During the night we monitor oxygen levels, chest
wall movements, snoring, heart rate, ocular movements and brain
waves (eeg). The laboratory itself has the appearance of a hotel
room with television, a full double bed and bathroom facilities.
These accommodations make patients more comfortable and allow us
to more closely simulate a typical night of sleep.
If we detect a pattern of excessive snoring and cessation of respiration
(apnea) during the night, we will usually recommend CPAP (continuous
positive airway pressure). This technology utilizes a small plastic
mask placed over the nose to blow air into the upper airway during
each breath and prevent airway occlusion and episodes of apnea.
PET Scanning (Positron Emission Tomography)
The most recent addition to our arsenal of diagnostic procedures
is positron emission tomography. This new technique allows doctors
to study solitary pulmonary nodules (spots on the lungs) and distinguish
between lung cancer and benign etiologies. The test monitors the
distribution of energy utilization in the different areas of the
lung. Lung cancer uses much more energy than benign scars or normal
lung tissue and consequently appears as positive on positron emission
tomography.
The greater Houston area now has between six and eight positron
emission tomography scanners. In many cases we will arrange for
this new diagnostic procedure in a nearby free standing imaging
center.
Home Ventilator Management
In rare cases of severe neuromuscular impairment with muscular
dystrophy, spinal cord injuries or amyotrophic lateral sclerosis,
patients lack the muscle strength to breathe independently. Patients
in this situation require the use of a mechanical ventilator at
home. Dr. Louis Hamer and his staff assist patients and their families
in managing this difficult home environment through the use of home
education and training. We also provide monitoring and round the
clock availability in the event of an emergency.
Pulmonary Rehabilitation
Many studies demonstrate an improvement in the life of patients
with lung diseases who participate in a controlled exercise program
(pulmonary rehabilitation). We offer a twelve-week pulmonary rehabilitation
program through our local hospital. The participants meet three
times a week for a period of twelve weeks. During each session the
therapists train the participants about therapeutic breathing techniques
and supervise exercise programs. Throughout the course of the twelve
weeks the participants gradually increase the duration and intensity
of their exercise, thereby improving their cardiopulmonary functioning.
After completing the program, the participants will feel well prepared
to continue exercising properly and independently in their homes.
Oxygen therapy
In some cases, patients with severe lung diseases such as Chronic
Obstructive Pulmonary Disease, Idiopathic Pulmonary Fibrosis, Chronic
Bronchitis, Emphysema or recurrent Pulmonary Edema will require
treatment with oxygen. We test and qualify patients for oxygen therapy
so Medicare and other insurance companies will pay for the treatment.
We work with a wide variety of durable medical equipment companies
offering a large variety of oxygen delivery systems including concentrators
for nocturnal use and liquid oxygen for portability.
Chest Tube Insertion
In some cases of lung disease including Chronic Obstructive Lung
Disease, spontaneous pneumothorax, and chest trauma, a hole in the
lung may result in air filling the space between the lung and the
chest wall. This escaped air collapses the healthy lung and a physician
must insert a small tube between the ribs to evacuate the entrapped
air. Dr. Louis Hamer performs this procedure in the hospital setting
with the assistance of intravenous sedation and local anesthesia.
After placement of the chest tube, patients remain in the hospital
for several days until the collapsed lung expands and the tube can
be removed.
Endotracheal Intubation and Mechanical Ventilation
For patients in emergent respiratory distress coming directly to
the Emergency Department, physicians use a temporizing measure of
endotracheal intubation and mechanical ventilation. An endotracheal
tube is a soft plastic conduit placed in the trachea (windpipe)
and connected to a mechanical ventilator (life support). This technique
allows patients to breathe with the assistance of a machine until
the appropriate medications take effect and the person can breathe
independently.
Nuclear Cardiac Stress Testing
Through our sister corporation, Southeast Houston Cardiology, we
perform nuclear stress testing in the office to detect areas of
the heart muscle receiving decreased blood flow. This simple procedure
requires an intravenous line through which we inject a medication
called adenosine. The adenosine speeds up the heart rate allowing
us to obtain pictures of your heart both at rest and with increased
stress. If the blood flow to any area of your heart decreases with
stress, this suggests coronary artery disease, which often manifests
itself as shortness of breath and chest pain.
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