Browsing by Author "Smith, Joseph"

Now showing 1 - 4 of 4
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    Baby or Breathing? Management of Thoracic Endometriosis in a Patient Seeking Pregnancy
    (American Thoracic Society, 2025-05-20) O'Brien, Allison; Santone, Daniel; Emerson, Robert; Smith, Joseph
    Introduction: The most common site for endometriosis outside of the abdominopelvic cavity is the thoracic cavity. We report a case of thoracic endometriosis (TES) presenting as recurrent pleural effusions, with treatment confounded by the patient’s desire for pregnancy. Case Presentation: A 41-year-old female with a past medical history of uterine fibroids and endometriosis complicated by peritoneal nodules and hemorrhagic ascites was referred to Pulmonology in 2020 for a chronic right pleural effusion first seen in 2017. Thoracentesis showed an orange, lymphocyte-predominant, exudative effusion; cytopathology and infectious work-up were normal. She returned to clinic in September 2021 and ultrasound showed reaccumulation of the effusion. Thoracic surgery performed a decortication and pleurodesis in October 2021, and post-surgical chest radiograph showed resolution of the effusion. Intraoperative biopsies confirmed thoracic endometriosis. Despite encouraging her to initiate medications for ovulation suppression, the patient had a strong desire for pregnancy and declined. Unfortunately, a CT chest scan in August 2022 showed recurrence of the right sided effusion. The patient was asymptomatic and her effusion was monitored with serial imaging and ultrasound. Additional thoracentesis was deferred due to stability of the effusion, minimal symptomatology, and the increasing risk associated with serial thoracentesis for an effusion that would certainly recur without ovulation suppression. The patient continued her desire for pregnancy and declined medical management. Recently, she became more dyspneic and developed chest pain. Repeat chest CT scan in October 2024 showed a stable, moderate-sized, loculated pleural effusion. Repeat drainage is planned but due to the chronicity of the effusion, the patient is at higher risk for re-expansion pulmonary edema and trapped lung.  Discussion: Postoperative ovulation suppression, often in the form of GnRH analogues, is used to prevent recurrence of complications of TES, such as pleural effusions, hemoptysis, and pneumothoraces. For TES, medical and surgical management alone have an approximately 40% and 25% recurrence rate, respectively. Although there are no randomized control trials evaluating combined surgical-medical management, many physicians use this approach with promising results. One small study demonstrated a 0% recurrence rate of catamenial pneumothorax when GnRH analogues were used after surgical treatment. Because endometriosis causes complications in women of child-bearing age, family planning should be addressed in management of TES. Early combined surgical and medical management is the most effective approach to prevent recurrence of pleural effusions.
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    “I Didn't Know What to Say”: Responding to Racism, Discrimination, and Microaggressions With the OWTFD Approach
    (Association of American Medical Colleges, 2020-07-31) Sotto-Santiago, Sylk; Mac, Jacqueline; Duncan, Francesca; Smith, Joseph; Medicine, School of Medicine
    Introduction Academic medicine has long faced the challenge of addressing health inequities, reflecting on how these contribute to structural racism, and perpetuating negative social determinants of health. Most recently, we have constructed opportunities for dialogues about racism, discrimination, and microaggressions (RDM). As such, we created a professional development program that encouraged participants to (1) openly discuss RDM and the impact they have in academia, (2) learn about tools to address and respond to RDM, and (3) move towards the creation of inclusive environments. The target audience included institutional leaders, faculty, trainees, professional staff, and health care teams. Methods We sought to meet workshop goals by integrating anti-racist dramaturgical teaching, introducing concepts knowledge, and practicing communication tools. To assess learning and evaluate our workshops, participants completed a pre- and postsurvey. Results Results showed that 30 participants were more comfortable with discussing issues related to race/ethnicity, gender identity/expression, sexual orientation, and spirituality after participating in the workshops. Prior to the two workshops, the percentage of learners who felt confident initiating conversations ranged from 29% to 54%. After the workshops, the percentage of learners who felt confident ranged from 58% to 92%. The greatest increase, 100%, was observed in the levels of confidence in initiating conversations related to race/ethnicity. Discussion Despite medical education's commitment to cultural competence and institutional mission statements that value diversity, equity, inclusion, and justice, professional development opportunities are limited. Participants strongly agreed their participation in such a workshop was relevant and important to their professional work.
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    Multiple myeloma causing interstitial pulmonary infiltrates and soft-tissue plasmacytoma
    (Elsevier, 2018-05-19) Lok, Ryan; Golovyan, Dmitriy; Smith, Joseph; Medicine, School of Medicine
    Multiple Myeloma (MM) is a relatively rare disease and MM presenting outside the bone marrow, known as extramedullary myeloma (EMM), is rarer still. While the liver and CNS are most commonly affected in EMM, the lung parenchyma is an especially unusual site of involvement. We present the case of a 64-year-old male with known history of MM admitted with acute respiratory failure and a chest wall mass. Chest CT revealed patchy interstitial and alveolar opacities with no pulmonary masses or nodules. Bronchoalveolar lavage (BAL) was performed, with flow cytometry demonstrating monoclonal plasma cells expressing CD38, CD138 and CD56 with lambda light chain restriction. Fine Needle Aspiration of chest wall mass revealed CD138-positive cells as well. Review of the literature revealed only one other documented case of a patient presenting with both interstitial lung parenchymal involvement with MM as well as soft tissue plasmacytoma, with this occurring in a patient who had previously underwent stem cell transplant. To our knowledge, we report the first recorded case of this presentation in a patient without a history of stem cell transplantation. Furthermore, it demonstrates the utility of using BAL, rather than lung biopsy, to establish the diagnosis through less invasive means.
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    Teaching pursed-lip breathing through music: MELodica Orchestra for DYspnea (MELODY) trial rationale and protocol
    (Taylor & Francis, 2020-10-16) McGrath, Mackenzie; Smith, Joseph; Rattray, Nicholas A.; Lillie, Aimee; Crow, Shannon; Myers, Laura J.; Myers, Jennifer; Perkins, Anthony J.; Wasmuth, Sally; Burns, Debra S.; Cheatham, Ariel J.; Patel, Himalaya; Bravata, Dawn M.; Medicine, School of Medicine
    Background Patients with chronic obstructive pulmonary disease (COPD) commonly experience dyspnea, which may limit activities of daily living. Pursed-lip breathing improves dyspnea for COPD patients; however, access to pursed-lip breathing training is limited. Methods The proposed MELodica Orchestra for DYspnea (MELODY) study will be a single-site pilot study to assess the safety, feasibility, and efficacy of a music-based approach to teach pursed-lip breathing. Patients with COPD and moderate-severe dyspnea are randomized to intervention, education-control, or usual care control groups. Intervention patients meet twice weekly for eight weeks for melodica instruction, group music-making, and COPD education. Safety, feasibility, and efficacy is assessed qualitatively and quantitatively. Results This manuscript describes the rationale and methods of the MELODY pilot project. Conclusions If pilot data demonstrate efficacy, then a multi-site randomized control trial will be conducted to evaluate program effectiveness and implementation.