Innovative Techniques Help Veterans Breathe Easier

HOUSTON – Using advanced, minimally invasive techniques, the Pulmonary Department at the Michael E. DeBakey VA Medical Center (MEDVAMC) now offers a new Interventional Pulmonology Service to treat Veterans with respiratory problems.

Interventional pulmonology is a relatively new field within pulmonary medicine that focuses on the use of advanced diagnostic and therapeutic techniques to manage patients with lung cancer and any other diseases that cause airway obstructions. With the new Interventional Pulmonology Service, the Pulmonary Department is ready to handle a wide variety of breathing issues.

“Our bronchoscopy suite is fully equipped now. The Interventional Pulmonology Service that we assembled provides the highest level of care possible within this new field,” said Interventional Pulmonologist Roberto Casal, M.D., Bronchoscopy Laboratory director. “We have developed a great team of dedicated respiratory therapists, nurses, anesthesiologists, pathologists, and pulmonologists. The combination of advanced procedures we perform are not available at any other VA in the country.”

The Interventional Pulmonology Service offers different techniques to unblock windpipes obstructed by a tumor and improve breathing. Some of these techniques include argon plasma coagulation which is the application of heat produced by an electric current to destroy tumor tissue or stop bleeding; cryotherapy, the destruction of airway tumors by freezing the tissue; and microdebrider bronchoscopy where a rotating blade cuts a tumor and removes it simultaneously. After tumors are removed, stents (artificial pipes) are sometimes placed to maintain an airway.

Advanced diagnostic procedures such as Electromagnetic Navigation and Endobronchial Ultrasound (EBUS) are also performed on a daily basis. The former is sort of a “GPS” system that allows doctors to navigate through airways and biopsy small lung nodules. It has a very low risk of complications and a high level of accuracy. The EBUS technique uses a special bronchoscope with an ultrasound transducer at the tip that lets doctors see and take samples of objects like lymph nodes and tumors near the windpipe. This is a very safe procedure that has increased the yield of these biopsies to more than 90 percent. It is routinely done before surgery for patients with lung cancer, avoiding a more invasive surgical procedure called mediastinoscopy.

A combination of advanced techniques was recently used to treat Clara Traylor. While sedated, a rigid bronchoscope was inserted through Traylor’s throat and into her trachea, and a large benign tumor that blocked 90 percent of her main windpipe was easily removed. This non-surgical procedure was life-changing for this patient.

“When I was first referred to Dr. Casal, I could barely breathe. He recommended the rigid bronchoscopy procedure,” said Traylor. “I first saw him the beginning of the week, the procedure took place in the middle of the week, and by the end of the week, I was home breathing like normal again.”

Also an assistant professor of Medicine at Baylor College of Medicine, Casal’s main clinical interests are interventional pulmonology focusing on new and minimally invasive technologies for diagnosis, staging, and management of lung cancer; bronchoscopic management of benign central airway obstruction; management of hemoptysis and both benign and malignant pleural diseases. Casal has advanced training in flexible and rigid bronchoscopy, bronchoscopic electrocautery, LASER bronchoscopy, cryotherapy, balloon bronchoplasty, endobronchial stent placement, endobronchial valve placement, endobronchial brachytherapy, photodynamic therapy, auto-fluorescence bronchoscopy, endobronchial ultrasound, electromagnetic navigation bronchoscopy, and pleuroscopy.

With specializing training in interventional pulmonology from MD Anderson Cancer Center, he brought a wealth of knowledge and expertise to the MEDVAMC Pulmonary Department.

“I spent an entire year in fellowship training at MD Anderson for interventional pulmonology, performing more than 800 procedures” said Casal. “When I arrived at the Houston VA, I began to assemble the equipment and tools for an Interventional Pulmonary Service. Dr. Carabello, our Medical Care Line executive, and Dr. Kalavar, our chief of staff, were especially helpful once they saw the improved quality of life benefits for our Veterans.”

Using the modern techniques of interventional pulmonology, Casal has been able to assist patients who would otherwise be hospital-bound in their last days.

“Without this treatment, many patients with airway blockages would have to stay in the hospital because they would be unable to breathe without high oxygen supplements, and even morphine assistance to relieve their feeling of suffocation,” said Casal. “With the therapeutic treatments the Interventional Pulmonology Service offers, we are able to non-surgically remove blockages in the windpipe and return patients to their homes to be with loved ones.”

"Beyond a doubt, our Interventional Pulmonology Service improves the quality of life for our patients," said Blase A. Carabello, M.D., Medical Care Line executive at the MEDVAMC and the W. A. "Tex" and Deborah Moncrief, Jr. Chair at Baylor College of Medicine. "We are proud the Michael E. DeBakey VA Medical Center has some of the best doctors and nurses in the country and offers the latest, minimally invasive alternatives for our Veterans.”

CUTLINE: “When I was first referred to Dr. Casal, I could barely breathe. He recommended the rigid bronchoscopy procedure,” said Clara Traylor with Interventional Pulmonologist Roberto Casal, M.D., Bronchoscopy Laboratory director. “I first saw him the beginning of the week, the procedure took place in the middle of the week, and by the end of the week, I was home breathing like normal again.”