On yesterday’s episode of Grey’s Anatomy, a young patient who needed a lung transplant was also a lousy candidate for one, since he had too many risks. Instead of foregoing the whole thing, an ex-vivo lung transplant was performed on him instead.

Why does someone need a lung transplant, anyway?

There are some diseases that cause such damage to the lungs that a new lung is necessary. Such diseases include (don’t fret the confusing names – we will cover them at one time or another here on A Disease A Day) chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis, cystic fibrosis, idiopathic pulmonary hypertension and others.

So why not give everyone the lungs they need?

There aren’t that many lungs that can be donated to begin with – only about 15-20% of donor lungs are acceptable for transplantation, since lungs are more susceptible to injuries than other donated organs (such as the heart).

Even when we have found a suitable lung for transplantation, not everyone waiting for a lung will get one. Each person waiting for a lung transplant has a score, based on the lung allocation score. For example, people who have a more immediate need for the lung come before those who can wait. Other factors, such as the illness the patient has, other diseases they have, etc. determine their score.

This means that many patients, like the one on the Grey’s Anatomy episode, are left far behind in the list, with a very low chance of ever getting a lung before dying.

What’s an ex-vivo transplant and how does it help things?

This technique was invented in 2008 by a team of lung transplant surgeons led by Dr. Shaf Keshavjee at Toronto General Hospital.

What it does is perfuse a special solution into an injured lung. It lets doctors “treat” the injured lungs while they are outside the body to make them suitable for transplantation. The technique can double the number of lungs fitting for donation.

How is it done?

After the donor lungs are removed from a deceased donor, they are transferred to a protective, transparent bubble-like chamber (like the one seen on the show). Then a series of steps is taken, in which the lungs are connected to a circuit composed of a pump, ventilator and filters through which oxygen, nutrients and a special solution are injected to the lung.

The bubble-like chamber with the lungs in it. Image courtesy of University Health Network

And on a final note – why is it called an ex-vivo transplantation?

Ex-vivo in Latin means “out of the living”. In this case, the healing process for the lungs occurs outside of a human body, inside this bubble-like chamber.

Here’s a video showing the repaired lung in action -

Related posts:

1. Your Questions Answered – Asbestosis – What Work Exposure Can Do To Your Lungs
2. Wilson Disease – The Return (As Seen on House MD)
3. Superior Canal Dehiscence Syndrome – Hearing Sounds Inside Your Own Body (As Seen on Grey’s Anatomy)

Danger level: Medium

What is it?

Asthma is a disease which affects the airways, causing attacks in which breathing is difficult.

Who gets it?

In the Unites States, about 5-10% of the population (or 22 million people) are affected by asthma (6 million of them are children).

Around the world, asthma is more common in industrialized countries, such as Canada, England, Australia, Germany, and New Zealand. 2-10% (300 million) of people worldwide have asthma.

Until puberty, asthma is more common in boys than girls (twice as much). From then on there is no difference. About 2/3 of all asthma cases are discovered before age 18.

The following are considered risk factors, meaning they increase your risk of having asthma:

1. A family history of asthma – Asthma is partly genetic, meaning that if someone in your family has it, your chances of getting it are higher.

2. Frequent infections in your airways as a child

3. Living in an urban area, especially one that contains a lot of air pollution

What causes it?

Asthma causes an inflammation in our airways – these are the “tubes” that lead from our mouth to our lungs. This causes 3 things:

1. Airway obstruction – Our airways are surrounded by muscle. Normally, this muscle is relaxed, so air can move freely to our lungs and back out. In asthma, these muscles tighten and also produce a liquid called mucus. Those things cause the airways to get obstructed, so air can’t move freely.

2. Inflammation – Besides the attacks which cause momentary blocks in the airways, there is also an ongoing inflammation, which can cause long term damage to the airways if not treated.

3. Airway irritability – The airways in asthma patients are very sensitive to things healthy people usually don’t react to, such as pollen or dust. These things can bring about asthma attacks, which involve obstruction of the airways.

This video gives a graphic illustration of the process:

The following things are known to trigger asthma attacks in people with the disease (they change among different people):

a. Airborne materials, such as pollen, animal dander, mold, cockroaches and dust mites

b. Respiratory infections – Such as the common cold

c. Exercise

d. Cold air

e. Smoke

f. Certain medications – Such as aspirin, beta blockers and others.

g. Strong emotions and stress

How does it feel?

Asthma attacks include the following things:

1. Shortness of breath

2. Coughing

3. Wheezing – This is a whistling sound characteristic of asthma patients. It’s heard when you take the air out.

4. Chest tightness or pain

The severity of the disease is different for different people. In some people attacks may appear only after exercise, while in others they may come a few times a day, making their lives miserable.

This video shows someone with an attack who unfortunately ran out of medications and was waiting for an ambulance. Notice the coughing and the whistling sounds when he takes out air. (And please don’t try this at home…)

How is it discovered?

If someone comes to the doctor when they are having an attack, it can be pretty simple (as you can see in the video above) to know that they have asthma.

Unfortunately, by the time someone arrives at the doctor’s, the attacks are often gone. Besides, other diseases can have similar symptoms. Therefore these tests were invented which can discover asthma:

1. Pulmonary function tests – These are special tests done to test the patient’s breathing pattern when they breath into a machine. The pattern in asthma patients is pretty characteristic.

2. Challenge tests – Certain substances, when inhaled by people with asthma, can trigger an attack. Using these substances (such as one called metacholine) helps in diagnosing asthma.

3. Chest X-ray – Can be used to rule out other conditions (such as pneumonia).

How is it treated?

There are a few things which can be done to treat asthma:

1. Avoiding triggers

2. Medications – There are short-term drugs and long-term drugs. The short-term ones are used to control attacks. The long-term drugs are used to control the inflammation in the airways, which prevents long-term damage to them.

We won’t go into much detail about the types of drugs available, but some examples of long-term drugs include corticosteroids, beta agonists, and others.
Short-term drugs are drugs that are usually inhaled, and that cause dilatation of the constricted airways, thereby making it easier to breath. These drugs are taken through special inhalers, such as the one in the picture:

An asthma inhaler. Photo by net_efekt.

What happens after treatment?

Except in very difficult cases, these drugs help to live a normal life with asthma.

Also, about 50% of children diagnosed with asthma are asthma-free after 10 years (in adults the disease doesn’t tend to go away as much).

The bottom line – How do I avoid it?

You can’t avoid asthma altogether, since, as mentioned above, the disease is probably genetic.

What you can do is decrease your risk of having attacks, by following these rules:

1. Stick to your medications

2. Identify your triggers and avoid them – One way of doing this is to keep a diary in which you write down factors you encountered before attacks (such as cold air, a virus, cigarette smoke, etc.). Then take measures to minimize your exposure to these things.

3. Treat allergies – Asthma attacks can also be triggered by any allergies you may have. You should avoid or minimize contact with the substance you are allergic to.
Also consider allergy shots (consult your doctor about those).

4. Get a flu vaccine – Every year. The flu almost always makes asthma much worse.

On a final note, we try to give you a personal angle about diseases we cover here. This time, you can get it by visiting The Angry Asthma Mama blog and The Asthma Mom.

Related posts:

1. Understanding Heart Attacks – Part 2 – Angina Pectoris
2. Cluster Headaches – Excruciating Attacks of Headaches
3. Understanding Heart Attacks – Part 3 – Myocardial Infarction

Back in April we covered the swine flu extensively here on A Disease A Day. With time, things didn’t seem as critical as they were in the beginning (even you said so in our poll).

Now things seem to take a new direction, as the disease is taking its toll worldwide. Here are the new facts:

1. According to the World Health Organization (WHO), 1 out of every 3 people in the world (or 2 billion people) will be infected with the disease over the next two years.
2. By the time you read this, 1,012 people have died as a result of the swine flu, according to the European Centre for Disease Prevention and Control (ECDC) in Stockholm.
3. In Europe, the disease has spread to 30 out of 31 countries in the European Union. In the UK, 30 people have died of the disease and the government has promised a supply of Tamiflu drugs sufficient for treating half the population in the British Isles (more than any other country). In Spain, 6 people have died so far. In France, the country’s strategy of treating swine flu victims in hospitals to curb the spread of the virus has been abandoned, acknowledging the disease had spread too far to be contained.
4. More from the UK: kindergarten teachers have been instructed to throw away soft toys, in order to spread growth of bacteria in them.
5. In the US more than a million people have been infected with the swine flu. Fortunately, their condition isn’t life threatening. Predictions are that these numbers will grow faster come Fall.
6. 3 cities in the US – Seattle, Chicago and New York City have the highest numbers of infected people.
7. A new study published this week claims that the virus can damage the developing brains of unborn offspring, meaning that pregnant women should stay as clear as they can of anyone known to be infected.

More masks in the near future? Photo by Guerry.

What does this all mean? No one knows for sure. One of the biggest fears is Winter, a problematic time for “regular” flu, which might turn as problematic for swine flu and raise the number of casualties even further.

Related posts:

1. In The News – Swine Flu (Influenza) – All You Wanted To Know
2. China to Provide First Swine Flu Vaccines
3. The Swine Flu Poll – What’s Your Take?

Recently we started asking you for your health questions. Today we’re inaugurating this column with the first question. You’re welcome to keep sending your questions through here or through Twitter (@diseaseaday).

L. from Malta asks:

“I was told that I have Asbestos in my lungs. I used to serve in the royal navy. I would like to know if there is any means of getting rid of this asbestos from my lungs?”

L.,

To answer your question, I’ll just present you with the facts about Asbestosis, in the same way we usually do here on A Disease A Day.

Danger level: Medium

What is it?

Asbestosis is a lung disease caused by inhalation of asbestos fibers.

Who gets it?

The disease usually occurs in people with long exposure to asbestos (a fibrous mineral). This can occur in the following occupations: Plumbers, pipefitters, steamfitters, electricians, insulation workers, carpenters, laborers, boilermakers, welders and cutters, and janitors. Asbestos exposure is also seen in people working in some industries, such as construction, shipbuilding and repairing, chemicals and other manufacturing, railways, trucking, and plastic and rubber manufacturing.

You don’t have to actually work with the material to get asbestosis – people who work alongside the workers in a shipyard may get it too (which might explain L.’s exposure) and also there have been cases of wives of people exposed to asbestos getting exposed themselves through washing their husbands’ work clothes.

Today asbestos is used less (it was replaced with synthetic mineral fibers, such as fiberglass) but it’s still used in the developing world.

Usually it takes at least 10 years of exposure before the disease can manifest.

Asbestos. This mineral is made of fibers, which can be inhaled and cause damage to the lungs.

What causes it?

The asbestos fibers, when inhaled, can do one of 2 things to the lungs:

1. They have a toxic effect on the cells of the lung
2. They cause inflammation in the lung

It’s important to mention that smoking makes this worse, since it damages the body’s ability to get rid of the asbestos fibers.

As a result of the inflammation in the lung, the lung undergoes fibrosis (or scarring) – This means that its normal tissue, which enables us to breath, changes gradually to a connective tissue, that lacks the normal characteristics of the lung.

How does it feel?

This article deals with asbestosis, but it’s important to know that 2 other things can be caused by asbestos exposure as well –

1. Disease in the lung’s coverings
2. Lung cancer

In asbestosis, people who were exposed to the fibers are usually fine for 20-30 years after the first exposure (but the more fibers they were exposed to, the less time it will take for the disease to show). Then the following things can happen -

1. Shortness of breath – They will feel this when they make physical efforts. That’s because the lung can’t provide as much oxygen as it could if it were healthy. The shortness of breath tends to progress in severity with time, even without further exposure to the fibers.
2. Inspiratory crackles – These are coarse sounds the doctor can hear when they put the stethoscope on the chest to listen to the lungs.
3. Clubbing – Clubbing is raising of the fingernails. It can happen in other diseases as well.

An example of clubbing in the fingers.

With severe cases, heart failure can also occur.

How is it discovered?

There are 3 things that can help in diagnosing asbestosis:

1. A story of exposure to asbestos
2. Chest X-rays or CT scans that show the fibrosis in the lungs
3. Pulmonary function tests – These are tests that check the function of the lungs and will show that they don’t work efficiently.

How is it treated?

There is no cure for asbestosis. Stopping the exposure to asbestos will help, but the disease can progress even after the exposure is stopped. The following things can help -

1. Oxygen may be given to ease the shortness of breath.
2. Stopping smoking – It can help, since smoking makes the disease worse.
3. Treatment on time of respiratory infections – Since they tend to complicate more in people with lung problems. Also vaccines should be given when possible.

What happens after treatment?

That depends on many things, such as the duration and the extent of exposure to asbestos. Some people will have a milder disease than others.

The bottom line – How do I avoid it?

The best way to prevent asbestosis is to minimize exposure to asbestos. In the United States, by law, a worker’s exposure to asbestos may not exceed 0.1 fiber per cubic centimeter of air. Federal law requires employers in industries that work with asbestos products (such as construction and shipyard industries) to monitor exposure levels, create regulated areas for asbestos work, and provide their employees with appropriate training, protective gear such as face masks, and decontamination hygiene areas.

This movie, from 1959, created by the Bureau of Mines of the US talks about the “wonders” of asbestos. Since then, of course, its use has gone down.

For further reading you can visit this AsbestosHUB, which provides updated information about asbestos and asbestos-related diseases.

Related posts:

1. Pleural Mesothelioma – Cancer of The Lungs Caused by Exposure to Asbestos
2. Deep Vein Thrombosis – Clots in Your Veins Which Can Travel To Your Heart and Lungs
3. As Seen on Grey’s Anatomy – EX-Vivo Lung Transplant – A New Hope For Patients

The World Health Organization  has declared that swine influenza is “a public health emergency of international concern”. We are here to help you understand about the disease.

update: Since the news about the disease is spreading even faster than it does, you can stay up-to-date by following us on Twitter.

Danger level: High

What is it?

Swine influenza (or swine flu) is a respiratory disease of pigs.

Who gets it?

Normally, swine flu doesn’t infect humans. From December 2005 through February 2009, only 12 people were reported to be infected with swine flu. In most of these cases, these people had direct exposure to pigs. Since March 2009, though, the virus started spreading in humans in San Diego County and Imperial County, California, as well as in San Antonio, Texas and in Mexico. The total number of cases in the US alone in this month was 11 (the same number of humans infected in 4 years).

At the moment, no age, sex or race are known to be related to infection with the swine flu. It is known however, that since it’s spread from person to person through the air, people in contact with those who have gotten the disease are more likely to get it themselves.

What causes it?

To understand swine flu, it’s important to first understand about the influenza virus. Viruses, just like germs, are “bugs” that can spread diseases. Unlike germs, viruses are so small that they can’t be seen under a microscope. Also unlike germs, viruses don’t respond to antibiotics.

The influenza virus has 3 types. One of those is influenza A. This type causes the most severe disease in humans. It usually grows in birds, but can be transferred to other animals/humans and cause outbreaks.

Influenza Virus (from very up-close).

Influenza A has some types of its own, since it has two components on it, one called H and the other called N.

We all know that influenza occurs every year, and even people who were vaccinated against it can get it the next year. Why? Because the virus is “smart” – it can undergo changes in its structure. That’s why new types of vaccines are produced every year.

Once in a while, though, the changes are so big, that even the H and N components in it change. The vaccines can’t handle such changes. Such a change happened in 1918. It was called the Spanish flu and was caused by influenza A whose H and N components were called H1N1. It spread throughout the world and killed between 20-100 million people, since no cure was known then.

The new swine flu also belongs to the H1N1 subtype of influenza A, and contains a combination of genes from swine, birds and human flu viruses.

How does it feel?

The symptoms of swine flu are no different than those of the “regular” human flu. They contain:

1. Fever and chills
2. Body aches
3. Headache
4. Weakness
5. Cough
6. Lack of appetite
7. Other things that can happen include a sore throat, nausea, vomiting and diarrhea.

Swine flu can also lead to pneumonia and to a respiratory failure, which can lead to death.

How is it discovered?

To discover if you have the swine flu, a sample from your airways can be taken. It is then sent to the Center for Disease Control and Prevention (CDC) for lab testing.

How is it treated?

There are 4 types of drugs that can treat influenza: amantadine, rimantadine, oseltamivir and zanamivir. The new swine flue is resistant to amantadine and rimantadine, leaving the latter two as treatment options.

What happens after treatment?

Unfortunately, not much is known at the moment. The CDC believes that the drugs mentioned above can cure and prevent the disease.

There is no vaccine at the moment that can protect you from the swine flu. There are steps you can take to lower your chance of getting it or of passing it to others -

1. Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
2. Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
3. Try to avoid close contact with sick people.
4. If you get sick with influenza, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them. Avoid touching your eyes, nose or mouth. Germs spread this way.

The following video from the CDC sums it up -

You can use the comments below to discuss any of your fears or personal experiences with the swine flu.

Related posts:

1. Swine Flu – 7 New Facts
2. The Swine Flu Poll – What’s Your Take?
3. In The News – Plague – The Next Swine Flu?

Danger level: High

What is it?

Pertussis is an infectious disease characterized mainly by coughing.

Who gets it?

The disease appears mostly in children: About 50% happen before age 10. About 30% happen in the ages 10-19, and only the remaining 25% or so happen after age 20.

Most cases occur in the months June-September.

It’s important to remember that the vaccine against pertussis provides protection against it, and therefore is very important (we’ll talk about avoiding the disease later).

What causes it?

Pertussis is caused by a germ called Bordetella Pertussis. It’s mostly transferred to children from adults or adolescents carrying the germ. The disease is spread through the air from sick people.

A child with a cough. The disease is transmitted through the air.

How does it feel?

The disease has 3 stages:

Stage 1: After infection, the germ lies around in the airways for about 7-14 days, after which the disease begins. At this stage, it will look like the common cold, with coughing, sneezing, tearing and a runny nose. Usually there’s no fever.

At that stage, the disease is most infectious.

Stage 2: After a few more days, the cough changes to a cough special to this disease, which is called a Whooping cough. It’s characterized by coughing that sounds like a machine gun: there are 5 or more coughs that come one after the other, fast. Right after this machine-gun-cough comes a whoop – which is the sound made when the child breathes in to gain breath.

Here are some examples:

This stage is also characterized by vomiting.

Stage 3: This happens within 4 weeks of the beginning. It’s characterized by a chronic cough, which may last for weeks.

How is it discovered?

The doctor will take a specimen from the nose or throat, which will be searched for the germ in a library.

How is it treated?

If the child is still an infant, usually hospitalization will be required. Whether the patient is admitted to the hospital or stays at home, they should be isolated from their surroundings, because the disease is very infectious.

The treatment for pertussis is antibiotics, as well as drugs that might help with the airways (like the ones used in asthma). Sometimes, in more serious cases, the child may have to be artificially respirated,

What happens after treatment?

Usually, with treatment patients recover completely and the disease goes away completely. It’s important to remember, though, that infants younger than 6 month can develop complications such as pneumonia, seizures and others. The disease can also lead to death if untreated.

The bottom line: How do I avoid it?

There is a vaccine that prevents pertussis. It’s usually given to babies at 2, 4 and 6 months, with additional vaccinations given at 15 months and again at 4-6 years. Reported cases of the diseases has gone down 99% since the vaccine was first given.

The vaccine isn’t given only to children. Since the vaccine only lasts for about 10-12 years, adults should be sometimes vaccinated as well. Consult your doctor for this.

People who were in contact with someone sick with pertussis should be treated with antibiotics, whether they were vaccinated or not.

Now it’s your turn. Have you encountered pertussis? Share your story in the comments.

Related posts:

1. Tuberculosis – Not As Rare As You Thought
2. Subacute Sclerosing Panencephalitis (As Seen on House MD)
3. Syphilis – The 4 Stage Disease That Will Make You Want To Wear A Condom

Danger Level: Medium

What is it?

Tuberculosis (TB) is an infectious disease that affects mostly the lungs, but can affect other organs as well.

Who gets it?

A common misconception is that tuberculosis is a rare disease that no longer exists. You’d be surprised to know that about 8.5 million (!) new cases of tuberculosis occurred worldwide in 2005. Even though most of them were in developing countries (in Asia, Africa, the Middle East and Latin America), it also exists in the United States: in 2005 there were almost 15,000 new cases.

In the United States the disease can be mainly seen in immigrants and in HIV infected people. But anyone get be infected by it.

What causes it?

Tuberculosis is caused by germ called mycobacterium tuberculosis. You can see its picute s here -

You get infected by it from other infected people: when they cough, sneeze, or just speak, tiny droplets containing the germ make their way through the air. When inhaled, these droplets can infect the person inhaling them. It’s important to note that not every encounter with an infected person will get you infected: It depends on the duration of exposure and other things. For instance – when seated together with an infected person in a crowded, poorly ventilated place (such as airplanes) the risk is much higher.

How does it feel?

The disease has 2 stages:

1. Primary disease: When the germ first gets into your lungs, it seats at their middle and bottom and in most cases does not cause a disease. (The chances are higher in children or HIV infected people for a disease at this stage).

2. Secondary disease: The germ “sleeps” for years in the lungs, and can one day “wake up” to cause a disease. This time it goes to the top of the lung, where there is more oxygen. At this stage there are fever, night sweats, weight loss and lack of appetite and weakness. After a while cough develops with or without blood in it, and difficulty breathing can develop.

At this stage the disease can also spread to other organs of the body, like lymph nodes, the lung coverings, the urinary organs, the skeleton and even the brain.

If not treated, 1/3 of the patients will die within 1 year.

How is it discovered?

Tuberculosis is discovered in a number of ways:

1. Chest X-Ray: Will show round cavitations – those are hole-like wounds in the lungs, shown at the top of the lungs.

2. Identification of the germ: It can be identified by a microscope or when grown in a culture (a special environment it likes).

How is it treated?

There are a few antibiotic drugs that work against the germ causing tuberculosis. In order for that persistent germ to go away for good, treatment requires use of 4 different drugs together, taken for about 6 months. That’s because the germ is hard to reach and because using  less than 4 drugs will cause it to be resistant to treatment.

What about people who think they have been infected? Should they get treatment too?

In order for them to know if they indeed were infected, a test is performed, called a PPD skin test. If it is positive, it means you have been infected and should be treated for TB. In these cases only one of those drugs is enough, for 9 months.

You can see in this video how it’s done:

What happens after treatment?

If people stick to the treatment, usually they are cured of the disease by the end of it.

The best way to avoid it is by avoiding contact with people who have tuberculosis. If you know anyone with TB you should encourage them to seek treatment, so that they won’t be a threat to others. 

There is also a vaccine against TB called BCG. The problem is that it’s not always efficient, and it is only recommended in countries in which TB is more common.

Related posts:

1. Carcinoid Tumors – A Rare Tumor Often Not Found On Time
2. Necrotizing Fasciitis (Flesh Eating Bacteria) – Are You At Risk, and How Can You Avoid It
3. Waldenström’s macroglobulinemia – A Rare Blood Cancer That Can Lead To Strokes