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Pulmonology

Some of the leading physicians in the country are working at Detroit Receiving on multiple kinds of pulmonary problems, which include sleep disorders. The following articles profile the depth of the programs.

The Pulmonary Hypertension program is especially noteworthy for the service provided to a growing number of young women who are afflicted with the disease. New medications and treatments have made a significant improvement in their quality of life. The treatments also benefit patients with COPD and other chronic respiratory ailments.

Contents:

Pulmonary Hypertension: Affecting Many Young Women

Dr. Saydain

Ghulam Saydain, MD
Vice President for Quality
Medical Director, Pulmonary Hypertension Program

What Is Pulmonary Hypertension?

Pulmonary Hypertension (PH) is “high pressure of the lungs,” a description offered by some patients. It’s a type of pressure that affects only the arteries in the lungs and the right side of the heart. It cannot be diagnosed without special tests, and it’s frequently not recognized for what it is in the early stages. It is a chronic disease that can have serious consequences if left untreated.

Pulmonary hypertension begins when tiny arteries in your lungs, called pulmonary arteries, and capillaries become narrowed, blocked or destroyed. This makes it harder for blood to flow through your lungs, which raises pressure within the arteries in your lungs. As the pressure builds, your heart's lower right chamber (right ventricle) must work harder to pump blood through your lungs, eventually causing your heart muscle to weaken and eventually fail completely. Although pulmonary hypertension isn't curable, treatments are available that can help lessen symptoms and improve your quality of life.

PH may occur without a known cause or run in families. Typically the disease involves young women; only one in four PH patients is a man. PH may be associated with other conditions like lupus, rheumatoid arthritis, liver disease, HIV/AIDS, use of weight recucing medications, scleroderma (thickening and stiffness of skin over hands , face or other parts of the body) and sickle cell disease. It has also been shown to develop in patients who have blood clots in the lungs, sardoidosis and left-sided heart disease.

What symptoms do patients have?

Unfortunately, patients may not have symptoms in the beginning. Initially, they may feel fatigued and have difficulty in breathing during physical activity. As the disease progresses, patients may have chest pain or even pass out. In the late stages, patients may develop swelling of the feet, an enlarged belly due to accumulation of water, and water collection in the coverings surrounding the heart and lungs. Unfortunately, the symptoms are vague in the beginning and so diagnosing the condition as PH may come late. If pulmonary hypertension runs in the family, or there are any other risk factors, patients and their doctors should watch for early symptoms.

What kind of tests are done?

Patients will initially have a chest X-ray and an echocardiogram ( ultrasound of the heart). To confirm the diagnosis, the patient will need a procedure to measure the pressure in the heart and blood vessels. This is an invasive but relatively safe procedure which can be done on an outpatient basis. Another important test is the six-minute walk test. This will give the doctor an idea about the patient’s ability to tolerate day-to-day activities, and whether they need oxygen therapy. There are a number of prescription drugs that can help as well.

How Detroit Receiving’s Program Helps

At our Pulmonary Hypertension program, our physicians work closely with other specialists in cardiology, rheumatology, infectious disease, hematology, sleep medicine and others to co-ordinate comprehensive care. Interested patients have opportunities to participate in clinical research or be part of national registries which are researching this rare condition. We are one of the 50 academic centers in the USA participating in a large national registry, which is the largest registry in the world related to this disease.

To contact the Pulmonary Hypertension Program at Detroit Receiving Hospital, please call (313) 745-4025.

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Are You Getting Enough Sleep?

Better Nights Mean Better Days

Dr. Pragnesh Patel

Pragnesh Patel, MD
Geriatrician with a certification in Sleep Disorders

Dr. James Rowley

James Rowley, MD
Director of the Sleep Disorders Center at Detroit Receiving

“Many people don’t realize that sleep disorders mean their sleep is fragmented and not as deep as it should be,” notes Dr. James Rowley, director of the nationally recognized Sleep Disorders Center at Detroit Receiving. “Because they’re not getting the high-quality sleep they need at night, they’re not functioning as well during the day.”

Geriatrician Dr. Pragnesh Patel adds, “Seniors need deep sleep to make their bodies and brains feel completely rested as much as younger people, if not more.” Sleep apnea, one common sleep disorder, occurs when parts of the throat collapse during sleep, blocking the intake of air. This causes the person to wake up without realizing it hundreds of times each night. Snoring is a common symptom of sleep apnea. Severe sleep apnea can lead to heart disease, stroke, impotence and high blood pressure. “If you’re feeling tired during the day, you may have a sleep disorder,” advises Dr. Rowley.

Fix Your Sleep, Fix Your ‘Wake’

Dr. Rowley works with patients in DMC Detroit Receiving Hospital’s Sleep Disorders Center, a high-tech laboratory for diagnosing sleep-related conditions. The Center at Detroit Receiving, in partnership with Wayne State University, is one of only six sleep programs in the United States to receive the Comprehensive Academic Sleep Program of Distinction designation by the American Academy of Sleep Medicine.

David Calahan at the desk of the Sleep Disorders Center. If we have a photo of the rooms without anyone in them, use that photo also

The eight sleep center labs have hotel-style amenities, such as queen-sized beds and TVs.

Diagnosis: As Easy as Sleeping

Many sleep disorders are diagnosed using a nighttime sleep study called polysomnography. This test is easy and painless: patients go to sleep as normal in one of the Center’s eight comfortable sleep labs. During sleep, patients are electronically monitored for things, such as breathing, heart rate, brain waves and muscle activity. The Center features the latest monitoring technology, as well as amenities, such as queen-sized beds and TVs.

Once the doctor knows which kind of sleep disorder the patient has, he can recommend prescriptions, exercise, relaxation techniques, or in some cases, a machine to help keep the oxygen coming to the brain. The doctors at the Sleep Disorders Center can diagnose a complete range of sleep-related conditions, including sleep apnea, insomnia, narcolepsy, restless leg syndrome, and REM sleep behavior disorder.

Many seniors have a sleep disorder, since they are more common as we get older. If you’re feeling tired during the day, you may want to come for a sleep study. They are usually covered by insurance and do not require a referral, although you will probably want to talk to your primary care physician about it first. Dr. Patel works with seniors in the DMC Geriatric Center of Excellence – Rosa Parks, at (313) 745-1741.

Detroit Receiving Sleep Disorders Center: 313-745-4525

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New Pivotal Sleep Apnea Clinical Trials Begin

Dr. Rowley

James Rowley, MD, Medical Director,
DMC Detroit Receiving Hospital Sleep Disorders Center
Vice Chief, Division of Pulmonary, Critical Care and Sleep Medicine

Dr. Badr

M. Safwan Badr, MD
Chief, Pulmonary, Allergy, Critical Care Section
DMC Harper University Hospital and DMC Detroit Receiving Hospital

The DMC’s Detroit Receiving has been selected as the first Detroit area hospital to participate in a pivotal clinical study to evaluate the safety and effectiveness of a new therapy for patients with moderate to severe obstructive sleep apnea (OSA). The STAR trial (Stimulation Therapy for Apnea Reduction) will be conducted at leading medical centers across the United States and Europe. The trials will evaluate the efficacy of an implantable therapy that works with the body’s natural physiology to prevent airway obstruction during sleep.

More than 18 million Americans suffer from OSA, or, repeated episodes of upper airway collapse during sleep. Patients with OSA stop breathing frequently during sleep, often for a minute or longer. Daytime sleepiness, depression, weight gain, increase in industrial accidents and diminished quality of life are all commonly observed in people who suffer from OSA as a result of fragmented sleep patterns. Furthermore, OSA is associated with the development of high blood pressure, heart disease and arrhythmias, stroke and diabetes.

Current treatment options for obstructive sleep apnea include weight loss, a machine called CPAP, oral appliances and surgeries. The CPAP (Continuous Positive Air Pressure) machine comes with a nasal mask to wear during sleep. Although it is the current best treatment for OSA, several recent studies show that people don’t use it as much as 50 percent of the time because of the discomfort and/or inconvenience of sleeping with the mask on.

The STAR trial will enroll patients who have tried to use the CPAP machine but have not been successful. To be eligible for the STAR trail, patients must first:

  • Have failed or not tolerated CPAP
  • Have moderate to severe obstructive sleep apnea
  • Have a body mass index of less than 32

If you think you might benefit from an alternative approach to sleep apnea and would like to enroll in the trial, talk to your primary care physician, who can receive information about enrolling their patients by calling Ms. Anita D’Souza at (313) 745-2361. If you have questions, prospective patients are welcome to call as well.

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