Joey Wahler (Host): They can help save your life. So, we're discussing Saved by the Scan, a patient's lung cancer journey. Our guests, Dr. Rafael Alba Yunen, he's a board-certified pulmonologist and Director of Pulmonary Medicine for Southeast Georgia Health System. We're also joined by Janis Gilder, a Pulmonary Medicine patient, nice enough to share a little her courageous journey with us.

 This is Health Matters, where experts at Southeast Georgia Health System provide the inside scoop on improving what matters most, the health and wellness of you, your family, and our community. Thanks so much for joining us. I'm Joey Wahler. Hi there, Dr. Alba Yunen and Janis. Welcome.

Rafael Alba Yunen, MD: Thank you.

Host: Great to have you aboard. So first, for you, Doctor, what first drew you to your specialty of pulmonology? Was there one thing or experience or person that pushed you in that direction?

Rafael Alba Yunen, MD: No, I loved just being able to help patients breathe better, being a multifaceted, environment of being in the clinic, being in the inpatient setting. But essentially, hearing a patient say, "I can breathe better," that's very rewarding.

Host: Just wanted to help people breathe better. That sounds like a great goal to me. So, how long have you been with Southeast Georgia Health System and what brought you to it?

Rafael Alba Yunen, MD: I've been with Southeast Georgia Health System about eight to nine years. I trained in a cold environment for many years, a lot of winters. And I was looking forward for a warm environment.

Host: Gotcha. And so Janis, give people an idea, if you would, please, what was your life like before you met the doctor?

Janis Gilder: Before I met Dr. Alba Yunen, my life was not as complicated. I have worked all my life in professional positions. And so, up until I met him, I was having some breathing problems and was seeing a doctor, but was really not receiving anything that was helping. And then, when I moved to Brunswick, I met Dr. Alba Yunen. And we've stuck together since then.

Host: And so, at some point, you sought a low-dose CT scan. When was that, and then what led you to Dr. Alba Yunen?

Janis Gilder: When I moved to Brunswick from Jacksonville, I realized I needed to have another pulmonologist. I had one in Jacksonville and was treated for COPD. And naturally, I had to look up all the doctors in the area, decide who would be best for me? And I chose Dr. Alba Yunen, and I'm so thankful I did.

So, after an initial visit, then he did a CT scan just to check on my lungs and everything. And I don't know, it was several times after then, I think, that when he first found the nodule, and then another one appeared. And my memory's terrible, and he could probably tell you more than I can about it.

Host: So, Doctor, what distinguishes a traditional CT scan from a low-dose version?

Rafael Alba Yunen, MD: Yeah. Well, it's essentially that. It's a much lower dose scan that's done much faster. And to give you some perspective, a traditional CT scan will emit approximately seven millisieverts of ionizing radiation. That's sort of the scientific unit measuring ionizing radiation. So, a traditional CT scan will emit about seven millisieverts of ionizing radiation versus 1.2, 1.4 millisieverts of a low-dose CT scan, so significantly lower radiation exposure to the patient because radiation actually can harm the patient. And it's done much faster.

Now, important to know for the listeners is that even though we have a lower dose radiation CT and a faster CT, the images that we get from this low-dose CT scans are still adequate and good enough for us to be able to diagnose lung cancer early. So, it's still a great screening tool.

Host: And so, that being said, Doctor, what are the criteria for those that should get a low-dose CT screening?

Rafael Alba Yunen, MD: So, our guidelines recommend that anybody at risk for lung cancer are those that are aged 50 to 80 and that have a 20-pack year history of smoking or more. Let me explain that pack year a little bit, because people get confused. So essentially, somebody that smokes one pack of cigarettes or 20 cigarettes a day for one year, that is one pack year history of smoking.

Host: Interesting. Speaking of smoking and smokers, how should those that smoke or formerly did go about discussing a low-dose CT screening with their healthcare provider?

Rafael Alba Yunen, MD: Yeah. I mean, I think that it's an established screening tool. And many times, I see them refer to us for various of reasons. And I think primary care doctors are doing a great job. They're screening their patients every year. But certainly, us as pulmonologists, that's one of our most important screening tools that we do. So, any provider can discuss the screening with our patients. And I think primary care doctors out there are doing a great job screening patients.

Host: Gotcha. And so doctor, once a diagnosis is made, what are the typical next steps for a patient like Janis?

Rafael Alba Yunen, MD: For Ms. Janis, she was fortunate enough to fall onto that annual routine screening with low-dose CT, and um, diagnosed her early with her lung cancer. And she was able to successfully complete rigorous sessions of very focal, precise, and low risk type of radiation called CyberKnife, and this was all done successfully with curative intent.

Host: And so, my understanding, Doctor, is that it was an ion robotic bronchoscopy that Janis underwent. And so, why was she a good candidate for that?

Rafael Alba Yunen, MD: Oh, she was a perfect candidate for it. Ms. Janis had a very peripheral lung nodule or lung lesion. It was about 1.2 centimeters. And today, robotic bronchoscopy provides unparalleled benefits. One is reach. We need a tool that can help us reach to the very periphery of the lungs. Another one is stability. It's important that when we're doing these procedures that, you know, you have a breathing lung, that the tool that we're using, it's stable enough so that we can precisely do these biopsies. And the last thing is safety. This robotic bronchoscopy has shown to be very safe, very low risk of complications, particularly when you're going after lesions in the lungs that are so far in the periphery close to the lining of the lungs that sometimes you can puncture the lining and cause a complication. But the risk of doing procedures with the robot, they're very, very low. So, there's nothing like robot bronchoscopy out there right now.

Host: And Janis, we're going to get back to you in just a moment, but one more for now for you, doc. How long does a robotic bronchoscopy usually take start to finish?

Rafael Alba Yunen, MD: Many factors can really affect the timing, but I've done robotic bronchoscopies under 30 minutes and sometimes these cases do take an hour. But an average could be 30, 35 minutes, 40 minutes.

Host: Gotcha. And so Janis, how long did you wait for the results of your biopsy and what were they?

Janis Gilder: I believe I waited like one week, if I remember correctly, which was a long week, needless to say. And then, I came back to see Dr. Alba Yunen, and the results were positive for lung cancer, which actually did not shock me. I don't know why, but it didn't. But I guess, with my background of smoking for so many years, and also this other little thing that keeps playing in my mind is the fact that our house was covered with asbestos. We dipped holes in asbestos for fence posts and then, of course, Roundup and everything else. And so, it didn't surprise me at all that mine was cancer. But, of course, I would relate most of it to the smoking. So, I'll take the credit for it.

Host: Understood, Janis. And so, when you say it wasn't unexpected, were you experiencing any symptoms that led to your diagnosis?

Janis Gilder: No, I had no symptoms whatsoever,. But I just knew if it was positive, I'm quite realistic in the fact that it is what it is, and then you just go from there.

Host: Well, that sounds like a healthy approach. So Janis, how would you describe your overall experience with Dr. Alba Yunen and the Southeast Georgia Health System during your treatment?

Janis Gilder: I honestly could not have asked for a better doctor or a better support group from the whole hospital. I really couldn't. I could have gone somewhere else, which I had considered at one point because family always urges you, you need to go somewhere bigger and better, that has more available services and all like this. And when you weighed the pros and the cons, it was so much more convenient for me to be right here. I trusted my doctor wholeheartedly, so I was more comfortable being here and I would not trade the experience for anything.

Host: Doc, what's it like to hear that? Plus, the fact that it's another reminder that when it comes to this, bigger is not always better, right?

Rafael Alba Yunen, MD: Yeah, I mean, those words are my life's professional purpose, really, to be able to improve somebody's quality of life, be able to prolong life. It's just our most rewarding outcome.

Host: That's great to hear as well. How about, Janis, your experience with the Cancer Care Center and the CyberKnife treatment that you wound up undergoing?

Janis Gilder: Well, that's quite interesting, because when I first heard of CyberKnife, all I could think of was some barbaric treatment, because that word just blows me away, CyberKnife. So when I went in there for my first visit, even from the moment I got in there, the receptionist was terrific. And then, the whole staff in the cancer center were just so supportive, so informative, and I really appreciated that, which makes you to feel at ease. I know you're going to ask about the CyberKnife treatment.

Host: And so, how would you say that went?

Janis Gilder: The CyberKnife treatment, honestly, I was embarrassed, and then I felt terribly guilty. Because for CyberKnife, all you do is, or all I did, was lay on the bed, and this machine does the treatment. And then, you don't have any pain, you don't have anything touching you, you don't have any discomfort whatsoever. And I'm just laying there thinking how blessed I am for this and, at the same time, feeling so guilty for all the people that have other types of cancer that CyberKnife can't reach.

The doctor that actually developed the CyberKnife, I just hope and pray that they'll come up with one for other types of cancer. Because honestly, that's the most wonderful thing that I know of, I am so appreciative for that, and the fact that it's here in Brunswick at the hospital.

Host: Absolutely. A few other things for you too, Janis, how long has it been now since your treatment and how do you feel about the results?

Janis Gilder: Well, I had the treatment, I believe, the last week in February of this year. So, everything has gone terrific. I do have another follow up scan in a month or so. But so far, so good. And I couldn't be happier over it.

Host: And back to you, Doc, in summary here, can you remind those joining us just how crucial early detection is when it comes to lung cancer? We see a living, pardon the pun, breathing example right before our eyes in Janis right?

Rafael Alba Yunen, MD: Yeah. I mean, when you're facing the most lethal cancer in the world, like lung cancer, you want to be able to diagnose this early, because the outcomes are better, the prognosis is better. There's your proof. Anybody that falls into the category of high-risk or at-risk should get their annual low-dose CT scans, discuss it with your providers, and we're happy to help anytime.

Host: Folks, we trust you're now more familiar with the importance of lung cancer screenings. Dr. Rafael Alba Yunen, please keep up your great work. And Janus, continued good health and really thanks so much for sharing your story and your emotions. I'm sure it'll be very beneficial and very comforting as well to many people joining us.

Janis Gilder: thank you for having me.

Rafael Alba Yunen, MD: Thank you for the opportunity.

Host: Absolutely. And if you're a current or previous smoker or want to learn more about lung cancer screenings, please visit sghs.org/lung-cancer-screening. If you found this podcast helpful, please share it on your social media And thanks again for being part of Health Matters. Remember, your health matters most.