Breathing easy

A pulmonologist and a surgeon advise how to

BREATH EASY

Lung infection and it aggravating to pneumonia have been major issues during the Covid-19 times leading to many persons losing their lives. Both surgical and non-surgical managements were employed to save many lives too when the pandemic raged. While Dr Praveen Valsalan, Pulmonologist at Aster Medcity, Kochi, has been at the forefront of the fight, Dr Nasser Yusuf, Cardiothoracic Surgeon with Chest Hospital, Calicut and Sunrise Hospital, Kochi, went one step further exploring newer surgical possibilities in providing relief to the patients. Insightful views emerging from them are important in Covid-19 management and leading a healthy post-Covid life too. Dr Praveen Valsalan highlights pulmonary rehabilitation

Dr Praveen Valsalan says that pneumonia can be caused by various organisms including viruses. “So Covid by itself can cause pneumonia which can sometimes be severe and can cause difficulties with breathing needing ICU and ventilatory requirements. The chance of Covid patients developing secondary infections and subsequent pneumonia due to other bacteria and viruses is also very high, as this disease by itself and some drugs will reduce the immunity. Secondary pneumonia which usually happens a few days after developing Covid, can also be severe enough to cause significant morbidity needing ICU admission and ventilation,” says Dr Praveen. Dr Praveen says that pneumonia that the Covid disease causes will heal by scarring. “This healing process causes fibrosis. The percentage of patients who have progressive fibrosis is less than 5%. Many patients can have residual fibrosis which will over time heals. We need to prevent secondary infections from happening to prevent the progression. Similarly graded supervised exercise called pulmonary rehabilitation helps these patients to overcome their difficulties in the long run. It will also help to reduce long-term complications,” Dr Praveen said.

The secondary problems that happen to the lungs may require cardiothoracic management. “That includes problems like pneumothorax, presence of air leaks in lungs due to Covid and secondary infection sequels, etc. These patients will definitely benefit from pulmonary rehabilitation. Aster Medcity has a very good post-Covid pulmonary rehab program where a lot of Covid patients post-disease returned to normalcy. It helps in improving their physical and psychological well-being and helps to get back to normal life much faster.” The pulmonologist opined that Black Fungus, technically called mucormycosis, caused a threat only in a very small subset of the population during Covid-19 phase. “This fungus usually hap-

pens in immunosuppressed populations. And Covid is one of these. So early detection is the rule. Earlier the detection, the faster the chance of improvement and the lesser the chance of complications including death. These patients require drug treatment and in certain cases surgical management also,” Dr Praveen Valsalan said. Dr Nasser Yusuf unveils the surgical options

According to the surgeon Dr Nasser Yusuf, when Covid strikes and boils develop in the lungs leading to breaks and pus, it leaves a tsunami-like trail of destruction in the lungs, heart, and brain. “In fact, no guidelines exist for patients who require surgery for post-Covid complications and there is a lack of evidence or precedent. But still, we, as part of a multi-center trial based in Italy, embarked and found that a group of patients benefited from surgery. And in a first in the country, a Rajasthan boy’s ruptured lung was repaired through surgery,” Dr Nasser Yusuf said.

“Patients may have crippling fatigue, continued breathlessness, cough, hemoptysis, chest pain, recurrent infections for weeks and months, after Covid had left their body. These issues are not limited to patients who suffer from severe Covid, but having mild forms of infection. The more serious complications include lung fibrosis leading to breathlessness and clots in blood vessels.

“In localized infection and pneumonia, removal of the diseased segment or lobe brings relief to the patients who have symptoms of cough, fever, chest pain, etc. Sometimes a cavity forms within the lung which can enlarge and cause bleeding and recurrent infection. At times fungus starts growing in the cavity and forms a ball leading to Aspergilloma. Excision of this cures the problem,” Dr Nasser Yusuf said. “In some patients, after recovery from Covid infection, a portion of the lung is permanently destroyed by bronchiectasis (multiple number of small cavities which appear like the honeycomb). This can only be treated with surgery,” Dr. Nasser Yusuf said.

On the benign side, on many occasions when a patient with Covid has been investigated, especially with CT scan, surprises have been thrown up such as early TB and its complications and cancerous and non-cancerous growth, which could otherwise have become serious in the future.

On the surgery outcome, he said that the quality of lungs and life improves while patients can ambulate with minimal or no requirement of oxygen, thus converting them from respiratory cripples to productive humans. “They are relieved from symptoms like cough, breathlessness, hemoptysis, fever etc. Surgery may be done through a small scar in the chest with minimal pain leading to quick recovery and productive life,” Dr Nasser Yusuf added.

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