♪ ♪ ♪ ♪ THE ICONIC PHOTO OF THE COAL WORKER WITH BLACK DUST ON THEIR FACE DIDN'T TELL THE STORY OF WHAT WAS IN THEIR LUNGS.

STAY WITH US AS WE TALK WITH Dr. NAUREEN NARULU, ABOUT COAL WORKERS PNEUMOCONIOSIS BLACK LUNG DISEASE NEXT ON "KENTUCKY HEALTH."

>> "KENTUCKY HEALTH" IS FUNDED IN PART BY A GRANT FROM THE FOUNDATION FOR A HEALTHY KENTUCKY.

DEPTHS OF DESPAIR DO NOT AFFECT ALL PLACES, PEOPLE OR OCCUPATIONS EQUALLY.

ASK THE COAL MINORS AS THE FRIENDS OF KENTUCKY LICENSE PLATE INFER ARE THE ONES THAT KEEP THE LIGHTS ON.

THOUGH WE ALL BENEFIT GREATLY FROM THE LABOR OF THE COAL MINER, THEIR WORK EXACTS A GREAT TOLL ON THEM IN BOTH SHORT AND LONG-TERM.

PERHAPS THE MOST PERNICIOUS CONSEQUENCE OF COAL MINING IS COAL WORKERS PNEUMOCONIOSIS OR BLACK LUNG DISEASE.

I CANNOT SAY IT BETTER THAN THE PROTAGONIST IN THIS HAZEL DICKENS SONG BLACK LUNG WHO LAMENTED.

BLACK LUNG, BLACK LUNG BIDING YOUR TIME.

SOON ALL THE SUFFERING I'LL LEAVE BEHIND.

BUT I CAN'T HELP BUT WONDER WHAT GOD HAD IN MIND TO SEND SUCH A DEVIL TO CLAIM THE SOUL OF MINE.

TO HELP US GET A BETTER UNDERSTANDING OF COAL WORKERS PNEUMOCONIOSIS OR BLACK LUNG WE HAVE AS OUR GUEST, Dr. NAUREEN NARULU.

Dr. NAUREEN NARULU IS CURRENTLY AN ASSISTANT PROFESSOR IN THE DEPARTMENT OF CARDIO THORACIC SURGERY AND SPECIALIZES IN LUNG TRANSPLANTATION AND CRITICAL CARE MEDICINE.

SHE IS A GRADUATE OF THE INSTITUTE OF MEDICAL SCIENCES AND RESEARCH IN INDIA, COMPLETED A RESIDENCY IN INTERNAL MEDICINE AND FELLOWSHIP IN PULMONARY DISEASE AND CRITICAL CARE MEDICINE AT THE ZUCKER SCHOOL OF MEDICINE AT HOFSTRA STATEN ISLAND HOSPITAL.

SHE THEN DID ANOTHER FELLOWSHIP IN LUNG TRANSPLANTATION AT STANFORD UNIVERSITY.

Dr. NAUREEN NARULU, GLAD TO HAVE YOU HERE WITH US TODAY.

>> HAPPY TO BE HERE.

>> HOW BAD DID I BUTCHER PNEUMOCONIOSIS.

>> NOT AT ALL.

THAT WAS AMAZING.

YOU GOT IT RIGHT.

>> I DID.

WHAT ABOUT THE MEDICAL SCHOOL?

HOW CLOSE WAS I ON THAT.

>> YOU GOT IT RIGHT, TOO.

>> INTERESTING.

SO, TELL ME, WHAT IS BLACK LUNG DISEASE?

>> SO BLACK LUNG DISEASE, ALSO CALLED COAL WORKERS PNEUMOCONIOSIS IS A LUNG DISEASE CAUSED BY BREATHING IN COAL DUST OVER A LONG PERIOD OF TIME.

WHAT THE DUST DOES IS GOES INSIDE THE LUNGS, CAUSE INFLAMMATION AND CAUSE SCARRING AFFECTING THE LUNG TISSUE GREATLY AND IMPAIR THE ABILITY TO BREATHE BY THESE PATIENTS.

SO USUALLY IT AFFECTS THE COAL MINERS MORE.

THAT'S WHY IT IS CALLED BLACK LUNG DISEASE.

>> WHEN WE TALK ABOUT PNEUMOCONIOSIS-- I WAS GOING TO SAY THAT DISEASE, ANYWAY, WHEN WE TALK ABOUT THAT DISEASE,IS IT JUST ONE OR IS THIS AN UMBRELLA TERM FOR SEVERAL DIFFERENT DISEASES, WHICH BLACK LUNG IS PART OF.

>> COAL WORKERS PNEUMOCONIOSIS IS THE UMBRELLA TERM FOR A LOT OF DISEASES CAUSED BY OCCUPATIONAL EXPOSURE TO DIFFERENT DUST.

YOU CAN HAVE PEOPLE EXPOSED TO DIFFERENT DUSTS WITH THE PATIENTS WHO ARE EXPOSED TO COAL DUST.

AND WHEN THEY ARE EXPOSED TO BARILIUM AND SO IT IS AN UMBRELLA TERM.

>> YOU MENTION FIBROSIS AND INFLAMMATION.

HOW DOES IT GET INTO THE LUNG TO CAUSE THAT AND EXPLAIN THE CHANGES YOU TYPICALLY SEE.

>> GREAT QUESTION.

WHENEVER THE COAL DUST SETTLES DOWN IN THE LURNTION IT'S VERY, VERY FINE IN QUALITY AND QUANTITY AND VERY, VERY SMALL IN SIZE.

SO WE INHALE IT AND AS WE INHALE IT, THE BODY'S DEFENSE SYSTEM KICKS IN AND IT DECIDES TO FIGHT IT OFF.

BUT BECAUSE IT'S SO SMALL, IT CANNOT FIGHT IT OFF SO IT CAUSES A LOT OF INFLAMMATION OR SWELLING, AS YOU MAY SAY AND THAT COULD LEAD TO SCARRING.

OVER TIME, IF THE SCARRING KEEPS PROGRESSING, IT WILL CAUSE FIBROSIS, IRREVERSIBLE DAMAGE TO THE LUNG IMPACTING THE LUNG FUNCTION AND ABILITY TO BREATHE.

>> IS THIS AFFECTING THE TUBES THAT CARRY THE OXYGEN IN OR AT THE AVIOLA, THE BUSINESS END OF THE LUNG.

>> THE AVIOLI, AND THE DISEASE MOST COMMONLY, THEY'RE INVOLVED, BUT WITH COAL WORKERS PNEUMOCONIOSIS AND SILICOSIS, THE LIMB NODES GET INVOLVED, CALCIFICATION CAUSES EFFECT BECAUSE THAT WOULD IMPAIR, FOR EXAMPLE, WHAT GOES IN THE ESOPHAGUS IMPINGED BY THE LIMP LYMPH NODES AND MAKES IT VERY CHALLENGING FOR THESE PATIENTS.

>> ARE THESE PARTICLES SMALL ENOUGH TO GET INTO THE BLOODSTREAM?

>> NEAR THOUGHT THEY CANNOT GET INTO THE BLOODSTREAM UNLESS AND UNTIL THERE IS A CONNECTION BETWEEN THE LUNG AND BLOOD VESSELS, IT SHOULD NOT GET IN THE BLOODSTREAM.

IT USUALLY STAYS IN THE LUNG AND CAUSES THE INFLAMMATION AND SCARRING.

BUT BECAUSE OF THE DAMAGE TO THE LUNG, OTHER ORGAN SYSTEMS COULD BE AFFECTED.

>> IS THIS LIKE A C.O.P.D., OBSTRUCTIVE PULMONARY DISEASE OR JUST ANOTHER TYPE OF PRESENTATION?

>> SO IT CAUSES MORE OF A RESTRICTIVE PATTERN BECAUSE OF THE FIBROSIS BROASES AND DAMAGE TO THE AVIOLI BUT THERE IS ANOTHER COMPONENT IF THE PATIENT IS SMOKING ALONG WITH BEING EXPOSED TO COAL DUST OR SILICA DUST, THEY COULD HAVE A COMBINATION OF BOTH, C.O.P.D.

AND THE PATTERN BECAUSE OF COAL DUST.

BUT IF I HAVE TO CLASSIFY A SIMPLE PLANE, IT WOULD BE RESTRICTIVE LUNG DISEASE.

>> THEY CAN'T GET THE DEEP BREATH IN.

>> EXACTLY.

THEY CANNOT TAKE A DEEP BREATH IN BUT FINE WITH WE CANS HAILATION AND THERE IS A PROBLEM WITH THE LUNGS TO THE BLOOD VESSELS.

>> DO YOU SEE BECAUSE OF THIS RESTRICTION OF THE LUNGS, DOES THAT HAVE ANY IMPACT WITH THE PRESSURE OF THE BLOOD COMING IN AND OUT WHEN YOU SEE CARDIAC PROBLEMS, TOO?

>> DEFINITELY.

WHENEVER THE LUNG IS SCARRED OR THE LUNG IS STIFF, IT'S VERY HARD FOR THE HEART TO PUMP THROUGH THE LUNG TISSUE BECAUSE THAT'S HOW THE BLOOD GETS OXYGENATED.

OVER TIME, WHAT HAPPENS WHEN THE HEART HAS TO WORK OUT SO MUCH TO GET THE BLOOD THROUGH IT, THE PRESSURE IN THE LUNG GOES UP AND IT'S SOMETHING CALLED PULMONARY HYPERTENSION AND PROLONGED PULMONARY HYPERTENSION OR UNTREATED PULMONARY HYPERTENSION CAN LEAD TO SOMETHING CALLED RIGHT SIDED HEART FAILURE AND THE PATIENTS WILL HAVE ISSUES WITH THE FLUID RETENTION, LOWER EXTREMITY SWELLING AND FATIGUE AND PHYSICAL INTOLERANCE.

>> HOW COMMON IS BLACK LUNG DISEASE NOW?

>> IT IS FAIRLY COMMON IN THE AREAS WHERE THERE IS A BIG COAL MINING INDUSTRY, SPECIFICALLY IN THE APPALACHIAN AREA, WEST VIRGINIA, KENTUCKY AND OTHER AREAS NEARBY.

SO IF YOU DO QUALIFY ALL OF THEM, 30 TO 40%.

BUT SINCE I MOVED HERE IN KENTUCKY, THE MAJOR POPULATION THAT WE SEE AND THAT I REFER TO FOR LUNG TRANSPLANT EVALUATION, THE MAJOR POPULATION IS COAL WORKERS, MINERS.

>> THE PEOPLE WHO YOU ARE PRIMARILY SEEING FOR CONSIDERATION OF LUNG TRANSPLANT ARE MINERS.

>> YES BECAUSE WE ARE IN THE KENTUCKY AREA AND I'M GLAD THAT THEY'RE COMING IN.

THEY ARE IDENTIFYING THEIR SYMPTOMS AND SIGNS AT THE RIGHT TIME AND AFFORDED THE RIGHT TIME BECAUSE THAT IS REALLY, REALLY IMPORTANT.

>> I NOTED YOU ARE NOT AN EXPERT ON COAL, BUT THERE ARE OTHER EARSZ OF THE COUNTRY-- OTHER AREAS OF THE COUNTRY, WE OAM, THAT THEY DO MINING.

DO THEY SEE THIS AS MUCH AS WE DO AROUND HERE?

>> I DON'T THINK SO.

I THINK IT'S MORE FOCUSED IN THE APPALACHIAN AREA.

I'M NOT SURE WHY THERE WOULD BE DISCREPANCY.

>> AND IT TENDS TO BE MORE COMMON FOR THE PEOPLE IN THE MINES OPPOSED TO STRIP MINING?

>> I WAS LOOKING AT THE DATA FROM THE NATIONAL INSTITUTE OF OCCUPATIONAL SAFETY AND HEALTH.

THERE ARE EQUAL NUMBER OF MINERS WHO ARE ABOVE THE GROUND, THEY CALL THEM SURFACE MINERS AND I'M NO EXPERT ON THE MINING INDUSTRY, BUT THEY'RE SURFACE MINERS.

THEY ARE EQUALLY OR COULD BE AFFECTED BY THE COAL DUST AND ALSO THE PEOPLE WHO DEAL WITH THE TRANSPORTATION AND PROCESSING OF THE COAL.

>> REALLY.

>> THEY COULD GET INVOLVED, TOO.

SO IT'S NOT JUST THE PEOPLE WHO ARE DOWN IN THE MINES WHO HAVE TO WEAR PROTECTIVE GEAR.

I THINK IT'S EXTREMELY IMPORTANT FOR PEOPLE WHO PROCESS AND ALSO TRANSPORT THE COAL.

THEY HAVE TO WEAR THE PROTECTIVE GEAR AS WELL.

>> NEVER THOUGHT ABOUT IT LIKE THAT.

WHAT ABOUT FAMILY MEMBERS?

IS THE MINOR-- MINER CARRYING DUST HOME WITH THEM?

>> THE FAMILY MEMBERS ARE NOT THAT AFFECTED BY THE COAL DUST BECAUSE AS I SAID THEY'RE VERY, VERY FINE PARTICLES.

THEY TEND TO DEPOSIT DOWN IN THE LUNGS OR CROWN VERY QUICKLY, NOT DIRECTLY AFFECTED BY THE COAL WORKER DISEASE ITSELF, THE CAREGIVERS, BUT I WOULD LIKE TO EMPHASIZE THAT THERE IS A BIG CAREGIVER BURDEN THAT WE SEE IN THE FAMILY MEMBERS OF THE LOVED ONES WHO SUPPORT THESE PATIENTS WITH BLACK LUNG DISEASE, NOT TO MISS THE FINANCIAL BURDEN, EMOTIONAL AND PHYSICAL.

THERE IS A LOT OF BURDEN ON THEM.

>> THEY'RE NOT COMING HOME WITH MATERIAL ON THEIR CLOTHING LIKE SECONDHAND SMOKE WHERE OTHER PEOPLE GET INVOLVED.

>> NOT SIMILAR TO TOBACCO OR SMOKING.

>> YOU TOUCHED ON IT A LITTLE BIT.

IF SOMEONE IS A CIGARETTE SMOKER, AND OTHER EXACERBATING FACTORS WITH THIS?

>> YES, ANY KIND OF INFECTIONS.

IF YOU DON'T HAVE A GOOD IMMUNE RESPONSE IN YOUR LUNG AND IF YOU HAVE FIBROSIS OR SCARRING, YOU ARE MORE PRONE TO HAVE INFECTIONS SO THESE INFECTIONS ARE GOING AROUND, COVID, FLU, OTHER VIRUSES COULD IMPACT THE PATIENT POPULATION MUCH MORE EASILY THAN THE OTHER POPULATION.

>> WHAT IS THE TYPICAL PATIENT, IF YOU CAN SAY A TYPICAL PATIENT?

HOW ARE THEY PRESENTING?

WHAT ARE THEY COMPLAINING?

>> IT DEPENDS UPON THE STAGE OF THE BLACK LUNG DISEASE.

THREE DIFFERENT STAGES.

THE FIRST STAGE IS SIMPLE BLACK LUNG DISEASE IN WHICH THE PATIENTS ARE MOSTLY ASYMPTOMATIC.

THAT'S JUST THE BEGINNING OF THE BLACK LUNG DISEASE.

THAT MEANS THEY HAVE INHALED SOME DUST, THERE MAY BE SOME SCORE SCARRING OR NODULES BUT THE PATIENTS MAY HAVE A LITTLE BIT OF COUGH INTERMITTENTLY, USUALLY NO ISSUES WITH OXYGENATION AND SOME SHORTNESS OF BREATH ON EXERTION.

THE NEXT STAGE IS THE COMPLICATED BLACK LUNG DISEASE.

IN THIS PATIENT POPULATION, THEY HAVE MORE SCORING.

IF HAVE YOU TO IMAGINE THE SCARS JOIN TOGETHER TO FORM A MORE BIGGER SCAR.

THEY GET MORE SYMPTOMATIC, MORE COUGH.

COULD BE PRODUCTIVE, USUALLY DRY.

THAT MEANS BRINGING UP PHLEGM.

SHORTNESS OF BREATH, IF NOT AT RISK THAN WE CANS ERRINGS AND FATIGUE AND WEIGHT LOSS.

WE SEE THAT.

CAN I TALK MORE ABOUT THAT WHY THERE IS A WEIGHT LOSS.

AND THE THIRD DISEASE IS THE BAD ONE, THE PROGRESSIVE MASSIVE FIBROSIS, THAT'S THE SEVERE FORM OF COAL WORKERS PNEUMOCONIOSIS AND THAT DISEASE, THE WHOLE LOBE, IF I MAY SAY, OR DIFFERENT PARTS OF THE LUNG GET INVOLVED BECAUSE OF FIBROSIS AND ALL THE SCAR.

SO THE LUNG TISSUE IS SEVERELY DAMAGED.

THAT'S IRREVERSIBLE.

THESE PATIENTS ARE VERY SICK, OFF AND ON DO REQUIRE OXYGEN COUGH AND THE ONLY MANAGEMENT OUT THERE FOR THEM IF THEY'RE OTHERWISE HEALTHY IS LUNG TRANSPLANT.

>> WE CALL IT BLACK LUNG.

OR YOU CALL IT BLACK LUNG DISEASE.

ARE THE LUNGS REALLY BLACK?

THEY ARE.

ACTUALLY, YES, THEY DO.

I WISH I HAD SOME PICTURES FOR YOU TO SHARE WE SOME SEEN PATIENTS THAT UNDER WENT TRANSPLANT AND REMOVED THE LUNGS AND HAVE THEM IN THE O.R.

THEY'RE BLACK IN COLOR BECAUSE OF THE COAL AND THE PIGMENT THAT'S THERE IN THE COAL.

>> ARE PEOPLE COUGHING THE MATERIAL UP.

>> USUALLY THEY DON'T.

THEY MAY HAVE SOME BLOODY PHLEGM OR BLOOD IN THEIR SPUTUM BUT USUALLY THEY DON'T HAVE THIS, A RUSTY COLORED PHLEGM BUT NOT BLOCK.

>> PERSON COMES IN, EARLY STAGE.

YOU ARE SUSPICIOUS.

HOW DO YOU MAKE THE DIAGNOSIS.

>> FIRST A GOOD MEDICAL EXAM, MEDICAL HISTORY TAKEN FOLLOWED BY PHYSICAL EXAM.

IF THERE IS A SUSPICION OR THEY GIVE YOU OCCUPATIONAL HISTORY OF COAL MINING IN THE COALS OR BEING NEAR THE COAL AREA, THAT SHOULD RAISE A RED FLAG.

PHYSICAL EXAM WE TEND TO LISTEN TO OUR PATIENTS, WHEEZING UPON EXAMINATION OR CRACKLES IS ONE.

WE START DOING IMAGING.

IMAGING INCLUDES CHEST X-RAY.

THAT'S THE FIRST ONE.

>> SO PLAIN EXEFT EXAI.

WE CAN SEE NODULES OR SCAR TISSUE.

AND IF YOU HAVE A STRONG SUSPICIOUS AND THEN WE DO AN X-RAY AND CHEST C.T.

AND THAT CAN HELP US.

WE DON'T NEED CONTRAST FOR THAT.

AND THEN WE CAN EASILY SEE THE DIFFERENT CHANGES LIKE FIBROSIS, RADICALIZATIONS, USING MEDICAL TERMINOLOGY AND SCAR TISSUE AND PROBABLY LISTEN NODE INVOLVEMENT.

THEN AT THE SAME TIME OR ON A DIFFERENT DAY, WE GET THE BREATHING TEST DONE, THE PULMONARY FUNCTION TEST, PFT.

WE CAN DO A FULL PULMONARY FUNCTION TEST OR SOMETHING CALLED A SPIRAL METRIC IT'S QUICKER AND THAT COULD HELP US SEE IF THE PATIENT IS INHALING APPROPRIATELY.

AND IF THE LUNG, IF THERE IS ENOUGH OXYGEN GOING FROM THE LUNG TO THE REST OF THE BLOOD TISSUE AND BLOOD ORGANS.

>> SO I GUESS A SIMPLE TEST, IF YOU HAVE A CANDLE, AND THEY COULDN'T BLOW OUT THE CANDLE.

>> THAT WOULD BE ONE WAY.

TAKE A DEEP BREATH AND YOU ARE NOT ABLE TO TAKE A DEEP BREATH, THAT'S THE FIRST COMPLAINT.

THEY GET SHORT OF BREATH, EVEN WALKING A SHORT DISTANCE.

WHENEVER WE DO THE TESTING, THERE IS SOME TERMS CALLED FVC, FORCE CAPACITY AND DIFFUSION CAPACITY IS DOWN IN THE PATIENT POPULATION.

>> DO YOU EVER HAVE TO DO BRONCOSCOPY, TAKE A LOOK DOWN AND IS THAT DIAGNOSTIC?

>> IF WE ARE SUSPICIOUS THAT THERE COULD BE ANOTHER PATHOLOGIC PROCESS, ALONG WITH THE COAL WORKERS PNEUMOCONIOSIS, NECESSITY, THEY GO FORWARD WITH BRONCOSCOPY F. THERE IS A LYMPH NODE HYPE THET HYPOTHETICALLY, WE DON'T KNOW IF IT IS CANCER OR PNEUMOCONIOSIS.

THAT'S WHERE WE WOULD TAKE A SAMPLE FROM DOING A BRONCOSCOPY WITH A SAMPLE.

>> THE DIAGNOSIS OF YOU CAN SAY, BASED UPON YOUR HISTORY, YOUR PHYSICAL EXAMINATION AND THE C.T.

SCAN FINDINGS THIS IS WHAT THIS PATIENT HAS.

DON'T NEED TO DO ANYTHING ELSE.

>> COUPLED WITH THEIR SPECIFIC HISTORY, AS YOU SAID, COMING FROM THE MINES.

>> GIVEN THE INCIDENTS OF THIS-- BY THE WAY, ARE WE SEEING IT MORE IN YOUNGER COAL MINERS OR OLDER COAL MINERS.

>> UP UNTIL THE 1970s AND 80s, I DID MY RESEARCH-- >> YOU ARE THE DOCTOR.

>> 1970s AND 1980S THERE WAS A DIP IN THE POPULATION OF PATIENTS DIAGNOSED WITH THE PNEUMOCONIOSIS.

PROBABLY THE REGULATIONS AND GOOD PROTECTIVE CARE.

BUT THE PAST COUPLE OF YEARS THERE WAS A REPORT FROM 2018 AND 2020 FROM THE SAME NATIONAL INSTITUTE OF OCCUPATIONAL HEALTH, THE YOUNGER MINERS ARE BEING DIAGNOSED WITH MASSIVE FIBROSIS.

NOT EVEN WORKING 20 YEARS IN THE MINES AND DIAGNOSED SOONER WITH SEVERE FORM.

THEY'RE EXPOSED TO ZILKA SILICA, ALONG WITH THE COAL DUST, THE SILICA COULD BE FOUND IN THE ROCKS AND WHEN THEY CUT THROUGH THE ROCKS GOING TOWARDS THE MINES THEY'RE EXPOSED TO THE SILICA CAUSING MORE SCARRING AND FIBROSIS SO SFATS WHERE WE SEE IT IN YOUNGER POPULATION UNFORTUNATELY.

>> GIVEN THAT WE ARE STARTING TO SEE A RISE IN THE INCIDENTS THEN, SHOULD OR IS THERE AVAILABILITY OF SCREENING THIS POPULATION LOOKING FOR DISEASE?

AND DO YOU THINK THAT WOULD BE WORTHWHILE?

>> I THINK THAT IS A VERY GOOD THING TO LOOK INTO, SPECIFICALLY IF THEY ARE WORKING IN THE MINES FOR SAY A FEW YEARS, FOUR YEARS, FIVE YEARS, I THINK, IF I'M NOT WRONG THERE ARE SOME PROGRAMS OUT THERE WHERE THEY DO RECOMMEND THAT WITHIN FIVE YEARS OF WORKING IN THE MINES, YOU SHOULD GET X-RAYS AND HAVE A PHYSICAL EXAMINATION.

THAT SHOULD REALLY HELP.

AND AS WE HAVE SEEN WITH THE LUNG CANCER RATES INITIALLY GOING UP AND THEN GOING DOWN WITH THE SCREENING PROCESS, WHICH CHEST C.T.s THAT HAS REALLY HELPED US.

IF WE START LOOKING INTO 9 COAL WORKERS NUM PNEUMOCONIOSIS, THAT SHOULD HELP US.

>> YOU MENTIONED WEIGHT LOSS AND SAID YOU WOULD COME BACK AND EXPLAIN WHY.

>> A LOT OF MY PATIENTS COME IN AND SAY WHY AM I LOSING WEIGHT?

IF THE PROBLEM ISN'T THE LUNG-- THEY HAVE THE SAME QUESTION.

THE COAL IS NOT GOING INSIDE MY LUNGS.

THE COAL IS NOT GOING INSIDE MY MUSCLES BUT WHY AM I LOSING WEIGHT?

WE HAVE TO UNDERSTAND IT IN A WAY FOR THE PATIENTS THAT THIS OXYGEN, WHICH IS BEING PRODUCED IN THE LUNG OR BEING HELD IN THE LUNG, IF THAT'S BEING IMPACTED, THE REST OF THE BODY WOULD ALSO NOT GET THE OXYGEN.

AND THESE MUSCLES AND TISSUES WHEN THEY DON'T GET THE OXYGEN, THEY ARE FATIGUED.

THEY ARE IN METABOLISM IS HIGH BECAUSE THEY'RE TRYING TO BREATHE FAST, RESPIRATORY RATE IS HIGH AND NOT GETTING THE OXYGEN AS MUCH AS THEIR MUSCLES AND TISSUES NEED AND THEY GO INTO ANABOLIC PHASE AND LOSE THE PROTEIN AND THEY LOSE A LOT OF MUSCLE MASS.

>> IS THIS A TERMINAL DISEASE OR IS IT ONE THAT YOU MENTIONS HOW IT CAN IMPACT FAMILY AND QUALITY OF LIFE?

NOT SAYING IS THAT ALL BUT THAT CAN BE FAIRLY SIGNIFICANT.

>> THIS DISEASE DOES NOT HAVE A CURE.

THERE ARE TREATMENTS AVAILABLE THAT COULD HELP THE QUALITY OF LIFE AND THE BREATHING ABILITIES BUT THERE IS NO CURE AND YOU CANNOT REVERSE THE DAMAGE THAT HAS ALREADY BEEN CAUSED.

SO TO CALL IT A TERMINAL DISEASE, I THINK IT DEPENDS UPON THE STAGE.

IF THE PATIENT IS IN THE PROGRESSIVE MASSIVE FIBROSIS PHASE THEN IT IS A TERMINAL DISEASE.

AN END STAGE LUNG DISEASE IS WHAT WE TERM IT AS.

EVEN AT THAT POINT, THEY DO HAVE AN OPTION FOR LUNG TRANSPLANT IF THEY ARE HEALTHY OTHERWISE.

AND I THINK THEY SHOULD EXPLORE THAT OPTION.

>> BEFORE WE TALK A LITTLE BIT MORE ABOUT TRANSPLANTS, GENERALLY SPEAKING FROM THE TIME DIAGNOSIS IS MADE TO A TERMINAL EVENT BECAUSE END STAGE LUNG DISEASE, HOW LONG ARE WE TALKING URGE?

IS THERE A NUMBER?

>> I'M NOT SURE IF THERE IS ANY STUDY OUT THERE THAT TELLS US THE EXACT NUMBER, BUT THE WAY IT PROGRESSES, AND IF THE PATIENT IS SMOKING, THEN, OF COURSE, THE RATE OF EXPONENTIALLY RAISES BUT IF NOT, I WOULD SAY FIVE TO 10 YEARS.

>> SO HOW DOES LUNG TRANSPLANT FIT INTO THIS?

PLEASE TELL US.

>> ABSOLUTELY.

SO WHEN YOU ARE IN THE-- WHEN A PATIENT IS IN THE LAST STAGE OR END STAGE OF THE BLACK LUNG DISEASE, THAT'S THE PROGRESSIVE MASSIVE FIBROSIS, THE SO MUCH SCARRING THAT NO MATTER HOW MUCH OXYGEN THEY'RE ON, THEY'RE NOT GETTING THE ENOUGH TO THE REST OF THEIR BODY.

AND IF THEY ARE DEEMED A GOOD CANDIDATE, THEN THEY DO UNDERGO A TRANSPLANT.

USUALLY THAT COULD BE A BUY LATERAL LUNG REPLACING TWO LUNGS OR SINGLE LUNG.

MORE OFTEN THAN NOT WE GO FOARD WITH THE BUY LATERAL LUNG TRANSPLANT FOR THIS PATIENT POPULATION.

AND IF THERE ARE MORE EDUCATIONAL VIDEOS FOR THE HEALTHCARE PROFESSIONALS OUT THERE, LIKE SOMETHING YOU WERE DOING AND THE PATIENTS ARE MORE AWARE OF THIS, THEY WOULD BE REFERRED TO THE LUNG TRANSPLANT CENTER SOONER THAN LATER.

IT WOULD BE BETTER FOR THE PATIENTS AND EVEN FOR US TO SEE THEM SOONER AND TALKING LIKE A LUNG TRANSPLANT PHYSICIAN AS I MANY, SEE THEM SOONER BECAUSE WE CAN SAY IT IS TOO SOON FOR A TRANSPLANT.

YOU DON'T NEED IT BUT WE CAN DO EVALUATION, KNOW THEM AND TELL THEM WHAT TO LOOK OUT FOR AND KEEP A CLOSE EYE ON THEM.

FOR EXAMPLE, SEE THEM EVERY SIX MONTHS OR EVERY YEAR IN OUR CLINIC.

AND WHENEVER, IF SOMETHING GOES WRONG, BECAUSE AS I SAID, THEY'RE VERY MUCH PRONE TO INFECTIONS OR BACTERIA.

IF SOMETHING GOES WRONG, WE CAN KEEP A CLOSE EYE ON THEM AND BE READY.

>> YOU SAID THAT TOO EARLY, BUT WE KNOW THE THIS IS A PROGRESSIVE PROBLEM SO SUMMARIZE.

IF A PERSON SAYS I CAN'T WORK ANYMORE.

IS THAT AN INDICATION THAT MAYBE TRANSPLANT IS NOW TIME FOR THEM?

OR WHAT ARE THE INDICATIONS FOR YOU TO SAY OKAY, NOW IS THE TIME FOR A TRANSPLANT.

>> WORK ANYMORE, FIRST, AS SOON AS THE DIAGNOSED WITH COAL WORKERS PNEUMOCONIOSIS THEY SHOULD NOT BE EXPOSED ANYMORE TO COAL DUST OR SILICA.

YOU SHOULD NOT BE EXPOSED ANY FURTHER.

ANY OTHER KIND OF WORK THAT'S NOT IN THE CRITERIA, THE CRITERIA IS STRINGENT ABOUT THE PULMONARY FUNCTION TEST OR THE BREATHING TEST.

HOW RAPIDLY IT'S GOING DOWN OR HOW MUCH OXYGEN THEY'RE NEEDING.

SO THERE IS A WINDOW FOR TRANSPLANT.

HOW I EXPLAIN THIS TO PAY PATIENT, EITHER YOU CAN BE TOO EARLY FOR THE WINDOW MEANING THE RISK OF THE SURGERY IS HIGHER THAN THE BENEFIT.

OR YOU ARE TOO BEYOND THE WINDOW, TOO LATE FOR A TRANSPLANT EVALUATION BECAUSE YOU ARE TOO SICK TO UNDERGO A MAJOR SURGERY.

SO IT'S A VERY NARROW WINDOW WHERE THEY HAVE TO BE AND THAT'S WHY THE EARLIER WE HAVE THEM, WE CAN IDENTIFY THIS PATIENT POPULATION, WE CAN TALK TO THEIR FAMILY MEMBERS AND MAKE SURE THEY'RE VAIK NATEED.

MAKE SURE THEY'RE VACCINATED AND IF THEY NEED A TRANSPLANT THEY WILL BE READY FOR IT.

>> TELL US ABOUT AFTER THE LUNG TRANSPLANT IN THIS POPULATION.

DO THEY HANDLE IT WELL?

>> THEY HANDLE IT WELL.

THEY ARE LIKE ANY OTHER PATIENT THERE IS A LOT OF REHAB INVOLVED.

IT DEPENDS ON HOW STRONG THE PATIENT WAS BEFORE THE TRANSPLANT F. THERE WERE ANY OTHER ORGANS INVOLVED.

FOR EXAMPLE, IF THE KIDNEYS ARE OKAY, THE LIVER ARE OKAY TO HANDLE THE IMMUNOSUPPRESSION THE LONG-TERM ON THE TABLE IF HAVE YOU TO USE A BYPASS ON THE TABLE FOR THE SURGERY AND IF THEY DO, THEY HAPPEN THE TO HAVE SIMILAR OUTCOMES TO OTHER PATIENTS WITH LUNG DISEASE AND C.O.P.D.

>> ARE THEY KEPT ON MEDICATIONS TO PREVENTED REJECTION AND DOES THAT HAVE ADVERSE IMPACTED ON THE PATIENT POPULATION.

>> YES AND NO.

SO FOR THE REST OF THE LIFE THEY'RE ON IMMUNOSUPPRESS ANTS AND PROPHYLACTIC MEDICATIONS, ANTIBIOTICS.

ARE THERE SIDE EFFECTS?

YES, THERE ARE A BUNCH OF SIDE EFFECTS.

FOR THE FIRST YEAR POST-TRANSPLANT WE KEEP THEM ON VERY HIGH DOSE OF IMMUNOSUPPRESS ANTS ALONG WITH PROAF LATTIC-- PROPHYLACTIC OR JUST GO DOWN ON THE GOAL.

THERE ARE SIDE EFFECTS OF IMMUNOSUPPRESS ANTS AND PROPHYLACTIC MEDICATIONS.

BUT AND THAT'S WHY THEY NEED THE CAREGIVERS TO BE PRESENT THERE, A SOCIAL SUPPORT TO HELP THEM GET THROUGH THIS SO IT'S NOT AN EASY WALK IN THE PARK.

I DON'T WANT TO MAKE IT SOUND LIKE THAT.

BUT IT'S ONE OPTION THAT IS ABLE FOR THE SICK PATIENT POPULATION.

>> PLEASE TOUCH MORE ON THE CAREGIVER.

I'M SURE THAT YOU GET TO KNOW THE PATIENT AND THE FAMILY AND SUPPORT SYSTEM QUITE WELL.

HOW IS THIS DISEASE?

I IMAGINE THIS HAS A TREMENDOUS IMPACT ON THEM ALSO.

WHAT ARE SOME OF THE THINGS YOU HEAR FROM THE CAREGIVERS.

>> UNFORTUNATELY, IT DOES HAVE A MAJOR, MAJOR IMPACT ON THE CAREGIVER.

FIRST AND FOREMOST IS THE FINANCIAL STRUGGLE.

THERE IS A CHANGE IN THE FAMILY DYNAMICS SO THE SPOUSE OF THE PARTNER HAS TO PICK UP BECAUSE IF IT'S EASY FOR US TO TELL THEM NOT TO DO ANYMORE OF THAT MINING OR STAY AWAY FROM THAT JOB, BUT THEN THE ROLES REVERSE AND THE SPOUSE AND PARTNER HAVE TO PICK UP.

THE CHILDREN HAVE TO PICK UP AFTER THE ADULTS, PICK UP A JOB.

PSYCHOSOCIALLY, EMOTIONALLY AND PHYSICALLY, CAREGIVER BURDEN AND YOU CAN SEE THE SIGNS IN THE CAREGIVERS LIKE FATIGUE, MENTAL EXHAUSTION, PHYSICAL EXHAUSTION.

AND I JUST WOULD LIKE TO POINT OUT THAT CAREGIVER BURDEN IS A REAL THING.

>> DO YOU HELP ADDRESS THAT?

>> WE DO.

WE HAVE A STRONG SUPPORT SYSTEM FOR A LUNG TRANSPLANT PATIENTS AND THEIR CAREGIVERS.

THERE IS A SUPPORT GROUP AND OUR WONDERFUL SOCIAL WORKERS AND THEIR TEAM REALLY LEAD IT REALLY WELL.

AND THERE ARE SUPPORT GROUPS OUT THERE FOR THE COAL WORKERS, TOO, WITH BLACK LUNG DISEASE AND IF THEY ARE LOOKING INTO SUPPORT GROUPS, I THINK THEY SHOULD START LOOKING INTO THAT SO THEY CAN GET APPROPRIATE THERAPY AT THE RIGHT TIME.

>> QUICK ANSWER.

IF I AM CONCERNED I MAY HAVE BLACK LUNG DISEASE.

AM I SEEING MY PRIMARY CARE DOCTOR OR COMING TO SEE YOU?

>> PRIMARY CARE DOCTOR FIRST AND THEN THEY SHOULD REFER YOU TO A LUNG DOCTOR, A PULMONOLOGIST.

>> WELL, I REALLY APPRECIATE YOUR BEING HERE WITH US TODAY.

THIS IS A PROBLEM THAT WE KNOW ALL TOO WELL HERE IN KENTUCKY.

SO THANK YOU VERY MUCH.

AND I WANT TO THANK YOU FOR BEING WITH US TODAY.

I HOPE YOU HAVE A BETTER UNDERSTANDING OF THE CAUSES AND COMPLICATIONS OF PNEUMOCONIOSIS AND PARTICULAR BLACK LUNG DISEASE F. YOU SUSPECT YOU, A FRIEND OR LOVED ONE MAY HAVE THIS DISEASE, FOLLOW HER ADVICE AND SEEK TREATMENT.

IF YOU WISH TO WATCH THIS SHOW OR ARCHIVED VERSION OF PAST SHOWS, PLEASE GO TO KET.ORG/HEALTH F. YOU HAVE A QUESTION OR COMMENT ABOUT THIS OR OTHER SHOWS, WE CAN BE REACHED AT KYHEALTH@ket.org.

I LOOK FORWARD TO SEEING YOU ON THE NEXT "KENTUCKY HEALTH" AND IF YOU HAVE CONCERNS ABOUT BLACK LUNG DISEASE.

THERE IS A LOT OF INFORMATION OUT THERE OR LOOK TO THE FOLKS AT UNIVERSITY OF KENTUCKY OR GIVE Dr. NAUREEN NARULU A CALL.

SHE WILL HELP YOU OUT.

THANK YOU FOR BEING WITH US.