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Respiratory System and Health

Removal of diseased lungs, surgery

Lung Reduction Surgery For Emphysema patients

By Dr. W. Gifford Jones

August 9, 1998

How would you like to be attached to an oxygen tank for several hours a day? It's not a pleasant thought. But today thousands of patients are destined for this fate. The majority are smokers who have developed emphysema. Now, a new surgical procedure offers better quality of life to these people.

Emphysema causes the chest to become barrel shaped. This occurs because lung tissue loses it's ability to expand and contract and begins to work in third gear. The result, air becomes trapped in dilated lung tissue thus pushing out the chest cage.

There's little quality of life left for these people. Just going from their bed to the bathroom or even brushing their teeth, becomes a major respiratory effort.

Doctors have always found emphysema a frustrating disease to treat. Sir William Osler, one of this country's most famous physicians, was once asked how he treated emphysema. He replied, "I send them to Egypt". "For the climate?" the person asked. "No" Osler smiled, "It's just the farthest place I can think of to send them!"

Dr. Joel Cooper, professor of surgery at Washington University, says lung reduction surgery will restore some quality of life for many of these patients.

During lung reduction surgery 20 to 30 percent of the most diseased lung tissue is removed. This is made possible by the development of a new stapler using peri-strip sleeves. But how is lifestyle improved by when part of the breathing apparatus is removed?

There's a simple explanation. The chest wall and lungs normally work like a bellow that's used to fan a fire.

Patients who are barrel chested suffer from an inefficient bellows. The diseased expanded lungs press down on the diaphragm and outwards on the chest wall. This leaves little room for elasticity.

Removing a portion of the enlarged lung solves this problem in two ways. First, the less diseased lung tissue isn't crowded into the chest cage and is able to function more efficiently. Secondly, the diaphragm and chest wall are allowed to return to their normal positions.

Dr. M. Yaman, a thoracic surgeon at the University of Toronto, is one of the pioneers of this operation. He says some patients show immediate improvement following surgery. For others, it may require three to six months. By this time 80 percent no longer require oxygen.

Reducing the size of the lung does not cure emphysema. But several patients comment, "Before I couldn't walk 25 feet without shortness of breath. Now I walk four miles every day."

Who are candidates for this operation? First of all, selected patients must agree to stop smoking. In addition, they must be willing to undergo two months of pre©operative conditioning. And to follow a training program after surgery.

Candidates must also be suffering from what doctors call "pure emphysema". This means they cannot have other problems like bronchitis, asthma or heart trouble.

Unfortunately, at the moment, it's not easy to identify "pure emphysema" from other forms of chronic obstructive pulmonary disease (COPD).

Breathing tests currently used to separate the various forms of COPD do not distinguish between loss of elasticity (emphysema) and airway blockage (chronic bronchitis).

But researchers at Harvard's Brigham and Women's Hospital in Boston have identified a new way to differentiate between these two problems.

Patients swallow a small catheter that measures pressure inside the chest cage. So far 29 patients with COPD have undergone this technique. Preliminary results indicate that it is able to predict which patients will be helped by lung©reduction surgery.

But prevention will always be better than cure. And there's no better option to prevent emphysema than by tossing cigarettes away.

I am constantly amazed at the utter madness of some patients. They bury their heads in the sand. Emphysema won't strike them they believe even though the evidence is staring them in the face.

A few weeks ago an intelligent 50 year old woman arrived at my office. She had just returned from taking her mother to Florida and described the difficulties of the trip and her mother's poor health.

Her mother, a long term smoker, required constant oxygen due to emphysema. Obviously her quality of life was approaching zero on the happiness scale. But her daughter, who had witnessed this terrible decline in her mother's health, was still smoking!


W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com

My book, �90 + How I Got There� can be obtained by sending $19.95 to:

Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1

Pre-2008 articles by Gifford Jones
Canada Free Press, CFP Editor Judi McLeod