Friday, August 21, 2015


                As I mentioned before, Dr. Malte is a pulmonologist working with us now.  He’s helping with all the patients a little but also our lung cases.  In the USA most of the chronic lung problems I cared for were complications of smoking: COPD, asthma, and lung cancer.  Here we have lots of lung cases but none are from smoking.  Smoking is very rare here.  I’ve had a couple patients who admit to occasional cigars, but never cigarettes.  Here the people cook with wood and work in silver, copper, and gold minds.  Also this time of the year at the end of the dry season everyone burns their fields. I still see a lot of COPD (destruction of the lung walls and hairs that move mucus and over production of mucus because of smoke and pollution) and asthma.  I also see a lot of tuberculosis (TB) and scarring from old tuberculosis infections.  Here if you have a patient with plural effusion (liquid levels at the base of the lungs) its TB until proven otherwise.  There’s also a lot of patients with pulmonary fibrosis (scar tissue of the lung as a result of chronic inflammation).  I have patients with pneumoconiosis and silicosis (chronic inflammation caused by toxins/metals they have breathed in while working.  I gave a bunch of my chronic lung patients’ appointments with the pulmonologist.  I’m thought he’d like the challenge.  I think he’s still trying to figure out how to treatment patients in our setting---where people who don’t have a lot of money have to pay for their CT, where the bronchoscopy is broken (pray for a new one), and where the medicines we have available are very limited. 
                This last week he saw one of my ladies who I’m treating for an Aspirgiloma (a ball of fungus in the lung).  She doesn’t want surgery (because she’d have to go to Cusco, and they don’t trust their own Peruvian doctors very much), so I’ve been treating her with Itraconazol 400mg every day for 4 months now.  The aspirgiloma is getting small little by little.  Average treatment length is between 2 and 13 months.

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