Dr. Tawimas Shaipanich is one of the few B.C. physicians trained to use an endobronchial ultrasound (EBUS) for the early detection of lung diseases.

10 Promise • Spring/Summer 2011

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Spring/Summer 2011 • Promise 11

by helena bryan photography brian smith

St. Paul’s Respiratory Division enhances the quality of life for patients with a range of chronic, debilitating and sometimes terminal lung diseases.

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12 Promise • Spring/Summer 2011

For the past few months, 73-year-old Wayne Wong has been honing his golf game in between the two hours a day he puts in at his law practice and the time he spends with his two grandchildren, ages five and three. He spent the American Thanksgiving weekend in the San Francisco Bay area with friends and enjoyed golfing in Palm Springs in March.

Wong doesn’t sound like a man with termi-nal lung cancer, but then, he’s always made the most of life and he isn’t about to stop now. What’s more, he has access to some of the most specialized care in the country, allowing him to continue enjoying life in spite of his illness.

Welcome to St. Paul’s Respiratory Divi-sion, located on the eighth fl oor of St. Paul’s Hospital, where eight full-time physicians see more patients with respiratory illnesses, including those with lung cancer, than any other B.C. hospital.

PATIENT-CENTRED CARESt. Paul’s Respiratory Division plays a vital role in training the next generation of respiratory physicians and in blazing new trails in lung research, aided by the presence of an unprec-edented four Canada Research Chairs – prestigious university research professorships

created as part of a national program to attract and retain some of the country’s most accom-plished and promising minds – and a Glaxo-SmithKline Professorship in Chronic Obstruc-tive Pulmonary Disease created through a partnership between St. Paul’s Hospital Foun-dation, the University of British Columbia, Glaxo-SmithKline and the Canadian Insti-tutes of Health Research. St. Paul’s Respiratory Division has developed an ambitious mission to provide the best-possible care to patients throughout the world who have lung disease. According to Dr. Don Sin, the new head of respiratory medicine at St. Paul’s and a holder of one of these Canada Research Chairs, “that means ensuring every aspect of care, including diagnosis, is centred around the patient, and simply being the best at everything we do.”

In addition to 10 beds, the division oper-ates several specialized outpatient clinics in

Dr. Don Sin (right) is a Canada Research Chair and the new head of respiratory medicine at St. Paul’s Hospital; pulmonary function test (here) is integral to establishing a diagnosis at St. Paul’s Respiratory Division; the cycle ergometer and metabolic cart (below) allows doctors to recreate a situation that leads to shortness of breath and determine the cause.

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Spring/Summer 2011 • Promise 13

Here are some initiatives that St. Paul’s Hospital Foundation is raising funds for to help the St. Paul’s Respiratory Division improve patient care through enhanced diagnostic and research capacity:

Cycle Ergometer and Metabolic CartIt looks like a bike with a cart attached to it, but this is no ordinary bicycle. In fact, it increases diagnostic capacity in St. Paul’s Respiratory Division by 50 to 75 per cent.

“A lot of people come to us complaining of shortness of breath when they exercise,” says Dr. Don Sin, head of respiratory medicine. “It used to be that they’d blow into our old machine and we’d say, ‘well, everything looks normal.’ With this new equipment, we can recreate the situation that made them short of breath and then, through the metabolic cart, interpret what

causes it – whether it’s the heart or the lungs or both.” The new machine also allows doctors to provide a more

accurate prognosis, intervening quickly, if necessary, and then to monitor the patient’s response to treatment.

Pulmonary Scholars ProgramEquipment like the cycle ergometer is only as good as the people using it, says Sin, adding that “it’s always great to have a nice machine, but we need people with the expertise to use it to best effect.”

To attract top talent in the fi eld, the division has developed its new Pulmonary Scholars Program. Thanks to the program, two new “stars” will join the division staff in the next 18 months – one will to go the interstitial lung clinic and the other will join the cystic fi brosis clinic. �

DOLLARS WELL SPENT

The EBUS, purchased with the support of donations to St. Paul’s Hospital Foundation, helped attract Dr. Tawimas Shaipanich to the hospital from Thailand; he is one of the few medical doctors in B.C. trained to use it.

The EBUS allows doctors to do in two hours what used to take two days – and to do it better. Not only can they go deeper into the lungs to take a biopsy, they can do it without surgery. The benefi ts to patients are obvious: no pain, no downtime and more peace of mind.

For doctors, the EBUS provides a better gauge of the stage of the cancer and a more accurate long-term prognosis on which to base a treatment plan. It also facilitates more targeted surgery, if that’s what’s required, because it lets doctors pinpoint where the cancer begins and ends.

Shaipanich uses the EBUS one to two times a day, minimizing the interminable wait for what could be the worst, or best, news.

Wong ended up at St. Paul’s Hospital’s Respiratory Division after returning from a trip abroad where he’d been uncomfortably short of breath and where chest X-rays revealed fl uid on his lungs. He was diagnosed with inoperable cancer after his lung was drained of close to a litre of fl uid.

“It was a devastating diagnosis at the time, because you just never expect to hear that news,” says Wong. Since then, however, his breathing is easier and he’s come to terms with living each day as it comes. Living life to

the fullest, too, has become easier to do when, thanks to Shaipanich, Wong can still enjoy the things that matter to him: golf, travel, friends and family.

In a procedure that used to take three to four days from prep to recovery, Wong was fi tted in one day with what’s known as an in-dwelling chest catheter. The temporary catheter remains in his chest indefi nitely and attaches to a small vacuum bottle that drains liquid from his lungs when needed.

When Wong travels, he takes a special travel unit with him and has the procedure done at a designated walk-in clinic.

“With terminal patients especially, whose quality of life is so important, we try to avoid big, painful procedures – ones that require hospital stays and possible bad complica-tions,” says Shaipanich.

In addition to the technology that has helped Wong continue to enjoy life, patients treated at St. Paul’s Respiratory Division have access to the latest in drug therapies.

“They can enrol in the latest cutting-edge research and be treated with drugs that aren’t even on the market yet,” says Sin. “We like to engage patients in the process of their own care. Patients are our partners to fi nd new and better solutions to lung disease.” ■ >>

For more information on how you can support the work of the St. Paul's Respiratory Division, call 604-682-8206 or visit www.helpstpauls.com.

asthma, interstitial lung disease, lung surgery and chronic obstructive pulmonary disease (COPD), as well as sub-specialty clinics for HIV patients, adults with cystic fi brosis and, soon, patients with both heart and lung disease.

Patients living in outlying areas, or those who are typically hard to reach, also receive services. The division offers regular outreach clinics in the Downtown Eastside, Gibsons, Sechelt, Hope, Vancouver Island and, occa-sionally, the Yukon and Northwest Territories.

INTEGRATED SERVICESThe emphasis of St. Paul’s Respiratory Division as a whole is on integrated care. That means patients who come to St. Paul’s have access to a full roster of services under one roof – from diagnosis to treatment to surgery.

“We try to provide same-day diagnostics,” says Sin. “You could have a bronchoscopy, CT scan, breathing test and see the doctor all in one morning.”

In fact, the division is one of only three cen-tres in B.C. with the capacity to detect lung cancer in its earliest stages using what’s known as an endobronchial ultrasound (EBUS).

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14 Promise • Spring/Summer 2011 Photographs: iStock (inhaler), Maxx Images

More than three million Canadians live with one of fi ve serious respiratory diseases: asthma, chronic obstructive pulmonary disease (COPD), cystic fi brosis, lung cancer and tuberculosis. These challenging disorders, which profoundly affect the lives of people of all ages, cultures and backgrounds, cost approximately $5.7 billion annually in direct health-care costs, not to mention the unquantifi able human costs, yet the average person knows very little about them. Here’s a primer of some of the diseases the St. Paul’s Respiratory Division treats and is working to cure.

ASTHMAThe most widely known of the respiratory diseases, asthma is often considered a children’s disease, but it’s common among Canadians of all ages. In fact, in terms of sheer numbers, more adults have asthma than children.

Common symptoms of asthma include coughing, shortness of breath, chest tightness and wheezing. During an asthma attack, symptoms intensify, leading sufferers to report feelings of suffocation, breathlessness and loss of control. Such

attacks can also be life-threatening, although deaths are rare. Most asthma can be controlled with medication and

environmental controls, and people with asthma often lead full, active lives.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)Unlike asthma, COPD is most common among people age 55 and older, meaning its prevalence will likely increase as our population ages. Characterized by shortness of breath, coughing and phlegm production, the underlying

changes to the lungs begin

many years

DEMYSTIFYING RESPIRATORY DISEASE

before the symptoms. Chronic bronchitis and emphysema are often precursors to full-blown COPD. As COPD progresses, symptoms worsen, compromising quality of life, and eventually, the disease leads to premature death.

Smoking and occupational exposures to cadmium, gold, coal or grain dusts, as well as certain fumes, are known to contribute to COPD. Outdoor air pollution is also linked to increased symptoms.

Thanks to the work of researchers based at St. Paul’s, the University of British Columbia recently ranked third in a list of the top institutions for COPD research in the world (behind the University of London Imperial College of Science, Technology & Medicine and Harvard University).

CYSTIC FIBROSIS (CF)CF is a chronic, fatal respiratory disease passed on through the genes. Symptoms, including abnormal mucus in the lungs, usually develop in the fi rst few years of life. The mucus interferes with breathing and CF sufferers are prone to serious lung infections. They are also unable to produce adequate pancreatic enzymes for food digestion leading to malnutrition. While many children in the past died before reaching the age of 20, average survival in Canada has risen dramatically.

In fact, the face of CF has changed radically in the last 20 years. Once almost exclusively a child’s disease, most individuals with CF are now living into their 20s, 30s and beyond. Adults with CF are beginning to outnumber children with the disease, but of the 38 CF clinics across Canada, about one-third provide care to both children and adults, while only 12 specialize in caring for adults. St. Paul’s Respiratory Division has one of those 12.

LUNG CANCERIn Canada, lung cancer is the leading cause of death due to cancer, responsible for about 29 per cent of cancer deaths among men and 22 per cent among women.

Treatment involves various combinations of surgery, chemotherapy and radiotherapy. People with localized lung cancer tumours can live fi ve years after diagnosis. Unfortunately, because of the diffi culty in detecting the disease at an early stage, many lung cancers progress too far for intervention to be effective. The

work of Dr. Tawimas Shaipanich with the endobronchial ultrasound (EBUS) is just one of the ways St. Paul’s Respiratory Division is trying to catch the disease

before it’s too late.

TUBERCULOSIS (TB)People with TB are infected with the bacterium Mycobacterium

tuberculosis. Symptoms include a bad cough lasting longer than three weeks, pain in the chest, coughing blood or mucus, weakness or extreme fatigue, weight loss, lack of appetite, chills, fever and night sweats.

Most people exposed to TB bacteria don’t develop the disease as the immune system either kills or controls the bacteria. However, people with a weakened immune system run a greater risk that the

infection will develop into full-blown TB. Conditions that weaken the immune system include HIV infection, treatment with immunosuppres-

sant drugs, end-stage kidney disease, cancer of the head and neck, diabetes mellitus, silicosis, being underweight, and long-term cigarette

smoking. Babies, preschool children and the elderly are also at greater risk because their immune systems are weaker than those of healthy adults. �

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