Latest / Still Caring / 12: Bringing Advanced Lung Care Back Home

Transcript

12: Bringing Advanced Lung Care Back Home · Still Caring

• 0:03
  Abby Fox (Intro): Welcome to the Still Caring Podcast,
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  presented by Stillwater Medical.
• 0:07
  Joe Akin (Intro): Here, community is at the heart of healthcare.
• 0:09
  Katon Lunsford (Intro): Through honest conversations and shared experiences
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  Abby Fox (Intro): we explore what it means to care for our health—
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  Joe Akin (Intro): and each other.
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  Katon Lunsford (Intro): Because better health takes a village
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  and you're part of ours.
• 0:19
  Abby Fox: Hello and welcome to Still Caring the podcast
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  from Stillwater Medical.
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  I am Abby Fox, the PR and marketing manager here at Stillwater Medical,
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  and I am joined today by Dr.
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  Daniel Roton.
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  Thank you so much for being in the studio with us.
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  Daniel Roton, MD: Of course, Abby, it's a pleasure.
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  Thanks for having me.
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  Abby Fox: Absolutely.
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  Well, let's just dive right in and tell us a little bit about when
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  did Stillwater become home for you, And what has that looked like?
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  Tell us about your background.
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  Daniel Roton, MD: well, Stillwater became home the day I was born.
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  I was born in Stillwater Medical Center, and I grew up in Stillwater.
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  went to Stillwater High School, was a pioneer, played football,
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  and, my entire childhood was here.
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  I left to go do my medical training, went to undergraduate, school, And
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  then did medical school, elsewhere.
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  And then, when the opportunity came to come back and work here
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  in Stillwater, it felt just right.
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  And so it's been home, since that time and it's been a blessing.
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  Abby Fox: Is that something you would've anticipated that you
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  would come back after graduating?
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  Daniel Roton, MD: No, it not initially.
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  You know, whenever I was in high school, I wanted to branch out,
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  spread my wings and things like that.
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  In fact, my, I remember my mom, when I was a senior in high school, she,
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  laid out two college applications, one to OU and one to OSU, and she
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  said, I don't care which one pick.
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  You're picking one today.
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  And, I knew that I wanted to just spread out and spread my wings a little bit.
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  So I, picked the OU one, went to OU for undergrad.
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  and I never would've thought in a million years that I would be coming
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  back, to work at Soer Medical Center.
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  But, when the opportunity arose, my old physical therapist is actually the one
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  that reached out first kind of offered the position to me, and, I knew that.
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  Pulmonary care was something that was, lacking here in Stillwater.
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  My, grandparents had both had lung issues and they had to do a lot of
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  traveling, for their doctor's offices, appointments and things like that.
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  And so being able to fill that gap here, in my hometown an
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  opportunity I couldn't pass up.
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  Abby Fox: That's amazing.
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  So for our listeners that don't know a lot about pulmonology, tell them what That
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  is And what you do as a pulmonologist.
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  Daniel Roton, MD: Yeah.
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  So, I do find I've, stopped saying pulmonology to a lot of, people.
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  just, you know, I say I'm a lung doctor, that's what I am.
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  but actually it, so it's a subs.
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  Set of internal medicine.
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  And what got me into it or interested in it was actually the critical care side.
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  So most pulmonologists are double board-certified in pulmonary medicine,
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  which is lungs And then critical care, which is, all things ICU And
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  the critical care side is actually what attracted me to the field first.
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  I loved the intensity, the, Decisions that just short response time And
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  the adrenaline essentially of being in the ICU setting, taking care of
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  the sickest of the sick patient's.
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  I also, still love the critical care side of it because, you're
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  able to develop a relationship with patient's and their families.
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  At their most vulnerable time that I think is very unique.
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  It's unlike any other aspect of medicine that I have been a part of.
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  That critical care setting is a unique experience where people are
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  at their most vulnerable and you're there to help guide them through
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  it And the trust That is built.
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  In such a short amount of time is really nothing like any other type
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  of, medical relationship, as opposed to like primary care where those
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  relationships happen over years.
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  critical care really does happen in a short amount of time, and, I like that the
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  best about critical care along the way, I developed a passion for pulmonology.
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  they always say that to people who are thinking about going into the
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  field that, ICU is what'll bring you there, but people stay for the
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  pulmonology and I think that's true.
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  Pulmonary disease is a really broad specialty.
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  has a whole host of diseases that can affect the lungs, and it's,
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  field that I look forward to spending the life time learning more about.
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  Honestly, I think, I will be learning more and more about it up until the day
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  I retire, because it's just, it's that.
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  Depth is needed in order to truly understand it.
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  So it's, really enjoyable.
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  Abby Fox: And it's developing all the time, right?
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  Like There are new technologies and new things available, at any moment, which
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  has to be exciting as a physician too.
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  Daniel Roton, MD: Very exciting.
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  I think I am in the right field at the right time.
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  it's very attractive and rewarding, for that specifically.
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  Like we're actually able to do things for certain, a certain
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  subset of these diseases that for.
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  50, 60 years, there was just really not much that could be done, And now
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  all of a sudden things are coming out, technology is happening, that we are
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  making life-changing interventions early on in disease courses that are completely
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  changing the trajectory of people's lives.
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  and that's really exciting.
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  Abby Fox: One of those that we've had a chance to talk about
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  is lung cancer specifically.
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  So talk to us a little bit about lung cancer detection and kind of how
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  that has changed since, or recently And what we're able to do now.
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  Daniel Roton, MD: So, it.
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  I mean, it is changing just since the last time, I think, since I've been here
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  and since the last time you and I have spoke, it's a rapidly evolving field.
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  lung cancer is a big problem.
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  It's, the highest, number one cause of cancer related
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  deaths in the United States.
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  and it's a big problem in Oklahoma as well.
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  I think a big portion of That is just the smoking prevalence.
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  And the problem with lung cancer is you don't develop any symptoms until it's.
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  Progressive, so someone might come in with a little tiny nodule that, could
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  be there, but if, they didn't have a CT scan, if they didn't get scanned
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  for something else, or, if it wasn't detected, no one would have any idea that
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  that nodule That is early lung cancer is just sitting in there in their lungs.
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  so asymptomatic.
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  So I think having awareness of it is the number one thing.
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  So.
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  Guidelines are, anyone who has a significant smoking history essentially.
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  if you've smoked, then highly recommend that you get a screening CT scan,
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  which is a lower radiation CT scan.
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  To identify those nodules when they're early in the disease course.
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  And then there's a lot of neat stuff That is coming out that we can do
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  to detect, whether or not these nodules are in fact lung cancer.
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  So one of them that I've been using is, genetic tests that I look for,
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  circulating DNA, in patient's blood.
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  So kind of walking you through.
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  How it happens.
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  So let's say someone decides, Hey, I've been smoking for 20 years, or I did smoke
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  for 20 years, but I quit five years ago.
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  Regardless, they've been smoking for quite some time and they've never had
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  a screening test done of their lungs.
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  And they go and talk to their primary care physician about it
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  and say, would I, qualify for this?
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  And absolutely you would.
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  And they get a low-dose chest ct.
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  And sure enough they have a, a one centimeter nodule in their lungs.
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  Well, they would normally get referred to me by that point.
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  I see them and I look at the nodule and at that time I, take their history and
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  I make a calculation of what percentage.
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  Is the risk?
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  What is the percent risk that This is a malignancy, a cancer?
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  And what is the percent that it's not?
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  And at the same time, I draw their blood and I look for circulating tumor DNA, And
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  that helps me better risk stratify whether or not This is, less than 10% cancer,
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  something that I just need to maybe watch.
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  Or This is like 85, 90%.
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  And then we are able to, if we determine that it's a high percent of risk of
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  cancer, then we are able to do a biopsy here, at Stillwater Medical Center, using
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  the latest technology we have, the ion.
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  By Intuitive, which is a robot that I use for bronchoscopy, and that's just a
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  bunch of fancy words saying that I can go down someone's airway while they're
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  asleep and take a biopsy from, of a small nodule anywhere inside of their lungs.
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  with very, it's not invasive, hardly at all.
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  I just go down their airway.
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  I take a little biopsy, I come out and it's about a 45 minute
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  procedure total, And then they get to go home that same-day.
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  And that it has very high diagnostic yield, meaning I find out what the
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  answer is about 96% of the time, And we can quickly turn around and
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  decide whether or not This is the cancer And what to do about it next.
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  Abby Fox: That's incredible because in the past there were a lot of side effects that
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  might come from getting a lung biopsy.
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  Is that true?
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  And maybe this has minimized that a little bit from the patient side.
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  Daniel Roton, MD: Absolutely.
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  So, traditionally we, broke down biopsying.
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  Pulmonary nodules that we thought were early cancer, in two separate ways.
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  One was a bronchoscopy, which is where a pulmonologist like myself goes down
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  with a camera, and uses an ultrasound.
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  But even then, they could only do it if they were real central And we could not do
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  the peripheral nodules of the lungs, and they had to be very substantial in size.
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  And then the alternative to that was radiology, taking a biopsy, using CT
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  guidance, and they do it from the outside.
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  Well, if you think about that, you know, you're going through so much more
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  tissue, you're going through the skin, you're going through more nerves, veins,
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  arteries that you have to try to avoid.
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  You're going through the ribs.
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  and there's complications that can happen from that, And then you actually,
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  depending on where the nodule is, you actually have to go in through the lung.
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  Biopsy it from the inside, and there's a high-risk of causing
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  a collapsed lung from that.
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  So the, collapsed lung was about the risk of that was approximately
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  20 to 25%, whenever they were doing that type of biopsy.
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  Whereas using the robotic approach that I do, it's less than 1%.
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  Abby Fox: Well, and I know that's another huge difference depending
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  on when you catch lung cancer.
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  Talk to us about that And the importance of early diagnosis.
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  Daniel Roton, MD: Absolutely.
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  So, if we look at lung cancer overall, we break it down into, like most
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  cancers, we break it down into stages.
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  They're stage one, they're stage two.
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  Three And then four.
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  And really what that, what determines something's stage
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  is the extent of the disease.
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  Where it's at in the body, what is involved, has it
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  spread and to what degree?
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  stage one and stage two lung cancers, meaning that they're are
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  confined right there, they have not had a chance yet to spread.
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  Those are treatable.
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  and oftentimes curable, the survival five-year survival.
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  Of someone who is diagnosed with stage one or stage two lung cancer is
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  significantly higher than someone who is diagnosed with stage three or four.
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  And so being able to detect these nodules early, meaning stage
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  one, and get them identified, get them diagnosed, and get them.
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  Treated, we are talking about in five years.
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  This is someone who can say, oh yeah, I had lung cancer,
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  but I got it taken care of.
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  And I just had a little bit of surveillance where they just watch it now.
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  but I'm doing great.
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  I don't have any side effects or anything from that versus someone who.
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  It was not treated and it progressed, and now they're stage three, stage
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  four, looking at, short term survival.
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  Unfortunately, So, it really is all about trying to find them as
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  early as possible and take care of them while we still have a chance.
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  Abby Fox: Well, and you're partnering too with the cancer center to kind of
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  speed that from the time that you're diagnosed to speed the amount of time
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  that you're put into treatment for that.
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  So tell us a little bit more about that and how you guys work together.
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  Daniel Roton, MD: Absolutely.
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  so it's, I'm very proud about this actually.
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  I'm very proud.
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  This is my hometown And we are able to do this.
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  So, We are competing with, majority of the big tertiary centers.
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  In fact, I would argue that we're doing it better because we are
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  able to do it quicker oftentimes.
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  so how it normally works is once someone is in my office and we've made
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  the decision that we are gonna biopsy this because it's high-risk, then I am
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  able to usually schedule them in for a biopsy within one to two weeks maximum.
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  Get 'em in, and get a biopsied.
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  And after that, within five to six days after that, they're already being set
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  up for their first appointment with the oncologist at the cancer center.
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  They've talked to me, we've discussed it at tumor board, and
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  there's already a plan in place.
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  So what are we gonna do about this?
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  That process that a big tertiary care center can take weeks, months.
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  Fortunately, and when you're dealing with early lung cancer,
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  every single day matters.
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  You want it as quickly as possible.
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  So the fact that we have all the latest technology here at Saltwater
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  Medical Center And then quick turnarounds, it's unbelievable
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  and I'm really happy about that.
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  Abby Fox: Well, And that must feel so good to have an impact on.
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  On the health and quality of your patient's.
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  Talk to me a little bit about that.
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  What does it feel like to help people live longer, fuller lives?
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  Daniel Roton, MD: it is very rewarding.
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  is extremely rewarding.
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  I love my job.
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  not only from the lung cancer side, the lung cancer, obviously I think
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  the biggest, wins that come in to my office are the ones that, come in.
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  Three, six months later or a year later, and I had diagnosed
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  'em with lung cancer a year ago.
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  They went and either had radiation or surgery resection, and they
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  come in and they're cancer free.
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  the, feeling, the rewarding feeling that I get from That is just, it's.
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  Nothing rivals that, That is the top most, I mean, This is
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  someone who had lung cancer.
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  They don't anymore.
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  They have their life a whole ahead of them.
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  And That is so rewarding.
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  but I also love, all my other patient's who, not even lung
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  cancer, but specifically asthma.
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  Asthma is a big deal here in Oklahoma.
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  And I found Stillwater specifically, A lot of my patient's make a, make
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  the joke that, they were doing just fine as far as their breathing is
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  concerned until they moved to Stillwater And then they found out that they
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  have an allergy to still water.
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  And it's kind of a joke.
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  But, we have a really high cedar, pollen rate here and Stillwater, and I think it
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  just agitates a lot of people's allergies, and flares up, symptoms of asthma
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  that they didn't even know they had.
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  They'll come in, they'll see me, and there's a whole host of new
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  therapies that are available for asthma that have never been there before.
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  And they're just newly developed within the last four to five years.
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  And I get these patient's on these medications and they come back and they
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  feel a hundred times better and they're able to go about their normal lives.
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  And, um, that's a very rewarding.
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  So, it's, The whole process of my job is whether it's in the ICU, whether it's
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  in the bronchoscopy room, diagnosing lung cancer, whether it's diagnosing
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  someone with asthma and helping them through that, it's rewarding in awe.
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  I couldn't be happier about that.
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  Abby Fox: Breath is so essential to life.
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  You have to have it to live, And so that's a huge thing, huge win.
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  Talk to me a little bit about how has your perspective on life changed
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  since you've become a physician?
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  Daniel Roton, MD: Honestly, it's a little cliche, but it just, it is what
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  it is, and That is Life is fragile.
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  Life is fragile.
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  And so you really do need to enjoy every day as a gift.
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  it's a blessing because we don't know when something might happen, whether it be a
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  horrible accident that winds wind up in the ICU or a cancer That is diagnosed and
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  just completely changes the trajectory of what you thought you were doing.
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  So really it.
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  life is fragile and enjoy every single day to its fullest because
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  not every single day is guaranteed.
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  Unfortunately, with that though, is how resilient human beings are, especially
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  when they set their minds to it.
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  I think I've learned so much from my patient's, the ones
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  who come in and they, have that resilient mindset from the get go.
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  And watching how they handle the steps ahead of them, diagnostic
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  steps, therapeutic steps, all of the steps ahead of them.
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  Their mentality really shapes how it all goes.
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  And I've learned the most from those types of patient's.
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  And I, I look up to a lot of them.
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  And so, that's probably the two biggest things that I would say I've taken away.
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  Abby Fox: Well, we end every conversation with a challenge to care.
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  So something that people can do for themselves or for the health of this
• 17:26
  community, to make things better.
• 17:28
  So what would be your challenge to care today to our listeners?
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  Daniel Roton, MD: the biggest one would be if you're having
• 17:34
  trouble smoking, quitting smoking.
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  I tell my patient's one, I would love to help.
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  There are pharmacological aids out there, but stopping smoking is the single biggest
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  thing that you can do for your health, not only from a pulmonary cancer wise,
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  but from a cardiovascular risk as well.
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  I think, quitting smoking and I tell my patient's, don't ever give up.
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  cause you'll have that patient that comes in and they're like,
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  I've tried to quit 20 times.
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  Well, maybe the 20 first-time is the time that it's gonna really take hold.
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  So do not give up.
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  I know it can be an uphill battle and feel like that sometimes, but
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  that would be the biggest thing.
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  I think the second biggest thing that I would, Recommend is if you have had
• 18:17
  a significant smoking history, then you really do need to have a, screening
• 18:22
  chest ct, a lung cancer screening, CAT scan, because that in and of
• 18:27
  itself could end up saving your life.
• 18:29
  Abby Fox: And is that true too?
• 18:29
  Depending on what profession you're in?
• 18:31
  Are there certain places where your exposure for lung cancer might be greater?
• 18:36
  Daniel Roton, MD: There is, especially depending on, what
• 18:39
  types of inhalants or occupational exposures you're, you are exposed to.
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  So, people who, firefighters are some increased risk.
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  And then, people who, Just breathing in a lot of different
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  chemicals and things like that.
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  Not necessarily, some of them might be lung cancer, but they're just at increased
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  risk for a lot of respiratory diseases.
• 19:01
  then asbestos is a very big risk factor.
• 19:04
  People who've been exposed to asbestos, especially like, 30, 40 years ago.
• 19:09
  When they might not even be thinking about it now, how much asbestos
• 19:12
  they were exposed to back then, it could actually be very significant
• 19:16
  for their health right now.
• 19:18
  Abby Fox: Well, thank you for being here with us today.
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  I know that hearing this, has been encouraging to me that there's
• 19:23
  always hope for a brighter future.
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  And that too, we're able to make a real difference in our community.
• 19:28
  The amount of progress that's happened, even just since you came back, is
• 19:31
  incredible, So thank you so much.
• 19:34
  Appreciate you being here.
• 19:35
  Daniel Roton, MD: Course.
• 19:35
  Thank you very much.