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Video: SIMEDHealth new pulmonologist, Dr. Allison Buel

Allison Buel, D.O., M.P.H. joined the SIMEDHealth family on August 13, 2018. She recently sat down and gave us some more details about her military background, bedside manner and gave a few messages for her patients. Check out the video below to learn more:

After graduating from the University of Florida, Dr. Buel earned her Doctor of Osteopathic Medicine degree from Nova Southeastern University and completed her Residency in Internal Medicine at Wright-Patterson Medical Center in Dayton, Ohio. She completed a Pulmonary/Critical Care Fellowship at the San Antonio Uniformed Health Services in San Antonio, Texas.

Dr. Buel has also had a distinguished military career. She served as a Major in the United States Air Force where she earned an Aerial Achievement Medal for her role in Operation Enduring Freedom and Operation Resolute Support while stationed in Bagram, Afghanistan.

Dr. Buel is triple Board Certified in Internal Medicine, Pulmonary Medicine and Critical Care Medicine. She is able to diagnose and treat a variety of pulmonary conditions and will be available to see patients in our Gainesville and Chiefland office locations. Click here to request an appointment with Dr. Buel, or call SIMEDHealth Pulmonology at (352) 375-0302.

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SIMEDHealth Pulmonology Welcomes Dr. Allison Buel

SIMEDHealth Pulmonology is pleased to announce that Allison Buel, D.O., M.P.H. will be joining us beginning Monday, August 13, 2018. After graduating from the University of Florida, Dr. Buel earned her Doctor of Osteopathic Medicine degree from Nova Southeastern University and completed her Residency in Internal Medicine at Wright-Patterson Medical Center in Dayton, Ohio. She completed a Pulmonary/Critical Care Fellowship at the San Antonio Uniformed Health Services in San Antonio, Texas.

Dr. Buel has also had a distinguished military career serving as a Major in the United States Air Force where she earned an Aerial Achievement Medal for her role in Operation Enduring Freedom and Operation Resolute Support while stationed in Bagram, Afghanistan.

Dr. Buel is triple Board Certified in Internal Medicine, Pulmonary Medicine and Critical Care Medicine and is able to diagnose and treat a variety of pulmonary conditions and will be available to see patients in our Gainesville and Chiefland office locations. Click here to request an appointment with Dr. Buel, or call SIMEDHealth Pulmonology at (352) 375-0302.

COPD: Signs, Symptoms, and Treatment

NIAID image of woman using an asthma inhaler

Almost 15.7 million Americans have been diagnosed with COPD, but more than half of adults with breathing problems do not realize they have COPD when diagnosed.

If you’ve had problems breathing and coughing, you could have COPD. Learn the signs and what you can do to relieve the symptoms with SIMED Pulmonology and Sleep Medicine Dr. Joseph Tonner on World COPD Day (November 15).

What is COPD?

COPD stands for Chronic Obstructive Pulmonary Disease. Many people confuse COPD with emphysema, but emphysema is just one element of COPD. In general, COPD encompasses emphysema, chronic bronchitis, and chronic asthma with fixed components.

Think of a venn diagram where emphysema, chronic bronchitis, and chronic asthma are three interlocking circles. Most people would be right in the middle or somewhere in between. People can have smoking-related COPD or asthma-related COPD.

Patients are rated with a GOLD criteria for COPD that ranks them from 1-4. The worse the patients get, the more medicine they need to try or add. If patients have extremely severe COPD, they get triple therapy that includes all three drugs discussed below.

Symptoms of COPD

COPD is seen more as a systemic problem than just a lung problem. It’s a low grade inflammatory problem.

A majority of patients have:
- Vitamin D deficiency
- Frequent bouts of bronchitis
- Shortness of breath
- Coughing
- Inactivity
- A history of smoking or asthma
- Phlegm

A few patients have:
- Chest pain
- Right sided heart failure or peripheral edema

If patients are not on chronic steroids, they also become more prone to osteoporosis (bone weakness).

Diagnosis

Before people see a pulmonologist, they have usually already gotten cardiac work done and know they’re not anemic and don’t have another disease. Many have shortness of breath.

A lot of times, the general practitioner made the diagnosis, but on occasion, the pulmonologist will discover the COPD. If people are short of breath and know it’s a problem with their lungs, not their heart, they should see a pulmonologist.

Pulmonary Function Testing (PFT) is usually done to determine whether people have COPD and the severity of the COPD. PFT is the gold standard of diagnosing COPD. It has three parts:

1. Spirometry – blowing out forcefully
2. Lung volume – which is performed in the body box
3. Diffusion capacity – a measurement of how easily oxygen transfers across the lung membrane

PFT testing can be done through SIMED Pulmonology. If results are still confusing, a pulmonologist might also do a high resolution CT scan, which they have at SIMED.

Living a More Active Lifestyle

Patients with COPD often times adjust their lifestyle because they are short of breath. Many end up becoming inactive, which ends up being a problem. If you don’t use it, you lose it, as the saying goes.

SIMED Physical Therapy and Pulmonology offer a Pulmonary Therapy program for COPD patients to get them back on track to doing their normal activities. Physical therapy for COPD patients mainly consists of practicing activities the patients would like to do better like walking.

Most patients want to get around better, and to do that, patients need to strengthen the muscle groups so they can do the same level of activity with a little less effort. Physical therapy helps with that.

Get Vaccinated if you Have COPD

Patients with COPD are more susceptible to infection. They should get an annual influenza vaccine which is offered through SIMED Primary Care doctors and SIMED Urgent Care.

They should also get vaccinated against the Pneumococcal disease with the Prevnar 13 vaccine and Pneumovax23 vaccine. The vaccines are a source of confusion because some patients do not understand they are both needed to prevent against the same disease.

The Pneumovax23 covered 23 strains of the disease, but an additional 13 strains were found and added to the new vaccine, Prevnar 13. It’s important to get both even though you might already have one.

Treatment with Inhalers and NebulizersElements of COPD Venn Diagram

Inhalers:

People who have smoking-related COPD do not usually get relief from inhalers, but patients who have asthmatic components to their COPD almost always get relief from inhalers. For people who have chronic asthma, the chronic airway inflammation can lead to obstruction of the airways which is one category of COPD. Asthmatic COPD can be partly reversed if the obstruction is fixed.

There are 40 inhalers that currently are available to people with COPD, and each has at least one of three different types of drugs. The drug types are:
1. Albuterols
2. Anticholinergic Bronchodilators
3. Inhaled Bronchodilators

Each interacts with the body in a different way. Inhalers may include one or two of the drugs. None so far have all three, but that may change soon as the US Food and Drug Administration recently approved an inhaler combining all three drugs to treat patients with COPD, according to The Telegraph.

Nebulizers:

Patients who do not use inhalers, either because they can’t afford one or because the inhalers are unsuccessful, can use a nebulizer solution. All three drugs found in inhalers can be put into a nebulizer, which is a liquid medication you can take with a machine that slowly feeds the medication into your mouth.

Cost of Treatment:

Inhalers can be a good option if they’re successful, but patients can run into problems with the price of an inhaler prescription. Inhalers can cost upwards of $300 a piece, even with insurance, so sometimes people simply can’t afford them. Sometimes, coupons can offer discounts to patients.

Patients may also be able to get inhalers through DME (Durable Medical Equipment) companies because they have their own pharmacies. The DME pharmacies can ship the medications to patients at a low cost, but even then alternative options may need to be considered.

Usually if patients still can’t afford the inhalers, they can consider using nebulizers which are a less costly alternative to inhalers at lower cost per quantity.

Treatment for People with Bacterial Bronchitis

If patients are found to have bacterial bronchitis, they are treated aggressively with a lot of oral antibiotics. These patients may be more steroid-responsive, so when they have an exacerbation, they get really queasy and need a short course of prednisone.

For Smokers, Quitting is the Most Beneficial Treatment

The most important thing a smoker with COPD can do is quit smoking. It’s more important than all of the medications available. While smoking is a hard habit to quit, it’s key to improving lung health.

If you’ve never tried quitting, you would first want to try to quit without medication. You could try dropping one cigarette a week, and some patients have even quit cold turkey. They made up their mind to quit and just stopped. Most patients need help though. They can take medications like Zyban or Wellbutrin. The medication with the highest one year quit rate according to journal articles is Chantix, but it has a number of side effects.

Some people might just need a nicotine replacement system. At Tobacco Free Florida, which has a website and a toll free number, you can get nicotine gum and nicotine patches and sign up for a coach. Tobacco Free Florida has helped a lot of patients. While people might argue that nicotine patches are expensive, they’re probably less expensive than a pack of cigarettes a day.

There’s help out there to quit smoking, but if you’re not contemplating breaking the habit, there’s no “magic pill.” A person has to be contemplating quitting to be successful. There are many options and treatments available for people with COPD. The most important step towards treatment is getting diagnosed and speaking with a doctor if you have any of the symptoms.


If you would like to schedule an appointment with Dr. Tonner or another SIMED Pulmonologist, call (352) 375-0302 or schedule an appointment online. If you would like to schedule an appointment with a Primary Care physician, call (352) 224-2225 or request an appointment online, or you can call Urgent Care at (352) 373-2340.

Learn more: PFT Testing
Learn more: Pulmonary Physical Therapy

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Breathing Exercises for Healthy Lungs (Easy)

Old couple walking down a road with a quote over their head about illness and overcoming it

For National Healthy Lung Month (October), we asked SIMED respiratory therapists to go over the best exercises to improve lung health. Our therapists also discussed what to do if you have breathing problems including when you should seek help.

Let’s hear what Ivonne Kratzer and Teresa Brewington, SIMED’s respiratory therapists, had to say:

Why is it important to do breathing exercises and who should do them?

People with any pulmonary disease can have problems breathing normally. The breathing problems can make performing different tasks more difficult. Learning new breathing exercises can help those with breathing difficulties more easily perform basic tasks whether those tasks are walking upstairs or reaching for a can of soup.

Breathing exercises can help people with lung problems maintain regular breathing, slow their breathing down, and get rid of secretions better. The breathing exercises offer an alternative way to breathe that will bring people close to a normal state of breathing. While most people with COPD (chronic obstructive pulmonary disease) who suffer from blocked air flow likely won’t be able to return to a normal breathing routine, they can slow down the progress of the disease.

 What do the breathing exercises help with?

The major muscles affected when you have breathing issues or COPD are the arms, legs, and diaphragm. If you’re short of breath, you’re not going to want to move as much as you should. When you’re short of breath and try to move your arms, you won’t be able to extend as much as you should. You need to work those muscles and the diaphragm (your major breathing muscle) to improve your everyday functioning.

 

Exercises:

1. Pursed Lip Breathing – The pursed lipped breathing exercise slows your breathing down and can help you relax. For the exercise, you’re going to breathe in through your nose and pucker up your lips like you’re going to kiss someone. Then you’re going to let your breath out again. The exercise is also sometimes called Smell the Roses.

Infographic and graphic design pictures illustrating pursed lip breathing exercise for people with breathing difficulties

1. Relax your neck and shoulder muscles.
2. Breathe in slowly through your nose like you are going to “smell the roses.”
3. Purse your lips like you are going to whistle.
4. Breathe out slowly through your pursed lips like you are gently “blowing out a candle.”

Try to blow out twice as long as it took you to inhale. This technique helps when you’re exercising, climbing stairs, or need help calming down.

2. Diaphragmatic (Belly) Breathing – The diaphragm is the major muscle used in breathing. It is located under the lungs. When you have a lung disease or are short of breath, you might start breathing with your arms or doing accessory breathing thinking it will help you. This type of breathing wears you out faster and prevents the base of your lungs from receiving oxygen. The base of the lungs is where the gas exchange takes place so keeping those muscles strong and using the base of your lungs to breath is important. Belly breathing requires concentration because you have to think about the way you’re breathing and what you’re doing with your muscle.

1. Sit down in a chair or lie down on your back.
2. Breathe in slowly through your nose.
3. As you breathe in, your belly should move out so your chest can fill with air.
4. Breathe out slowly through pursed lips.
5. As you breathe out, you should feel your belly move in.

Your diaphragm should move up and down during this technique. You can do this exercise while lying down or while sitting.

3. Rescue Positions to Make Breathing Easier – These positions will help keep your breathing calm.

Sitting:

1. Place both feet on the ground.
2. Lean your chest forward a bit.
3. Rest your arms on a table.
4. Open your legs and let your belly fall forward.
5. Rest your head on your arms.
6. Breathe through your nose and out through pursed lips to slow down your breathing.

Standing

1. Rest your elbows on a wall, a piece of furniture or on the kitchen sink.
2. Learn forward and put the weight on your arms.
3. Let your belly fall forward.
4. Breathe through your nose and out through pursed lips to slow down your breathing.

Many people in the hospital use these techniques to breathe easier.

The exercises should be practiced at least once a day as recommend by your physician. Once you learn them, you probably won’t even notice you’re doing them and they’ll become a part of your breathing habits. You won’t even realize you’re exercising!

What else can you do if you have lung and breathing problems?

If you have any shortness of breath, even mild asthmatics, a pulmonologist can help guide you on how to breathe better, especially in situations when you struggle most.

Avoid smoking and vaping and practice healthier eating habits (like avoiding a Polar Pop full of coke, for example). While it’s understandable that if you’re having trouble breathing, you might spend more time sitting on the couch and eating, you should try to stay active and exercise as soon as approved by your physician.

Don’t just sit around in a chair all day because you’re short of breath. Even if you’re short of breath, there’s still something you can do. Be as productive as you can, and don’t give up.

When should you see a doctor?

Most people see a pulmonologist when they are in the late stages of COPD, but more can be done if people would seek treatment sooner. Seeing a doctor as soon as symptoms present themselves and making sure you’re seeing the right doctor is essential.

Many people with COPD get misdiagnosed or avoid seeing a doctor. While they might think the issue will improve on its own, it usually only gets worse.

If you’re coughing, experiencing shortness of breath, or experiencing frequent hospitalizations, you should see your primary care doctor. Ask your doctor if they can treat the issue or if it would be better for you to see a pulmonologist.  A pulmonologist can give you a better idea of your limits and how you can get better.

Pulmonologist can help with breathing and secretion problems. Patients can learn how to move secretion out of their lungs when coughing to make it easier to breathe.

What is pulmonary rehab/therapy and why should I do it?

Patients who sit around all day can increase the strength in their legs, arms, and body through the program. They will also gain education on what’s happening with the disease in their body and how they can improve their ability to do daily activities in their lives. People who are younger or in the earlier stage of COPD benefit most from pulmonary therapy, but it can help almost everyone. 

Do you have any words of advice?

It’s important not to let the disease define you if you have breathing issues. People with COPD can get stronger and shouldn’t feel like all is lost. They should stay as motivated and active as possible.

Your illness does not define you. Your strength and courage do.

 

To visit a SIMED Pulmonologist in Gainesville, call 352-375-0302 or schedule your appointment online.

To visit a SIMED Primary Care physician in Gainesville, Ocala, Chiefland, Lady Lake or McIntosh, call 352-224-2225 or request an appointment online.

If you are interested in SIMED Pulmonary Therapy in Gainesville, call 352-373-6565 to sign up and for more information.

PFT Testing in Gainesville

woman pointing to lungs demonstrating PFT Testing to a patient

Do you suffer from shortness of breath? Consider PFT testing.

Flyer with information about PFT Testing in Gainesville at SIMED

WHAT? SIMED Pulmonology provides complete pulmonary function testing including spirometry, lung volumes by body plethysmography, diffusion capacity and MIP/MEP.

WHO? Patients with asthma, chronic bronchitis, bronchiectasis, ILD, dyspnea, occupation hazards, exposure to toxic drugs (amiodarone, chemotherapy) and those requiring pre-op evaluation.

WHEN? SIMED Pulmonology offers next-day scheduling for the 45 minute test and is open from 8 AM to 5 PM, Mon. - Fri.

WHERE? SIMED Pulmonology, 4343 Newberry Road, Suite 6, Gainesville, FL 32607

WHY SIMED? Our respiratory therapists have more than 
30 YEARS of combined experience with pulmonary function testing. For more information regarding pulmonary function tests, please give our Pulmonology department a call at the number provided below. All tests will be interpreted by either Joseph Tonner, MD or Jorge Camacho, MD, and reports will be faxed to you same day or next day.
 

Call 352-375-0302

Is the Pneumonia Vaccine Right For You?

Vaccines, Pneumonia, Infection, Disease, Pulmonology, Jorge Camacho MD, Prevnar 13, SIMED Health

"People age 65 and older should get two separate vaccines to protect against pneumonia and other infections, a change of decades-old advice, according to new health guidelines.

An advisory panel to the U.S. Centers for Disease Control and Prevention recently recommended that people get a second vaccine, called Prevnar 13, because of limitations with the older shot, called Pneumovax 23." (WSJ, Sept 1, 2014)

We ask SIMED Pulmonology physician Jorge Camacho, MD to touch base on the new indications for pneumonia vaccine (Prevnar 13) and what that might mean to you or your loved ones. 

Pneumococcal infections including pneumonia and meningitis are common and up until recently the only vaccine recommended for adults was the PPSV23.

Starting in 2014 the United States Advisory Committee on Immunization practices recommended a new pneumococcal vaccine known as PCV13 with the commercial name of Prevnar 13.
 
This type of vaccine has been shown to be very effective in preventing invasive pneumococcal infections in children causing a dramatic decrease in that type of infections. Randomized trials were done in adults finding the vaccine to be highly effective as well, because of that the recommendations changed.
 
The current recommendation is to vaccinate every adult above the age of 65 with the 2 available vaccines. The Prevnar 13 vaccine should be given first followed by the PPSV23 6 to 12 months later.  In those who have already received PPSV23, at least one year should elapse before they are given Prevnar 13.
 

There is no revaccination necessary with Prevnar13.

  • For adults 19 to 64 years of age at intermediate risk of pneumococcal disease (i.e., cigarette smokers; patients with chronic heart disease, chronic lung disease, diabetes mellitus, alcoholism, or chronic liver disease)  the recommendation is to receive PPSV23 alone. Prevnar 13 is not indicated.
  • For adults aged 19 or older who are at high risk of pneumococcal disease (i.e., patients with functional or anatomic asplenia, an immunocompromising condition [e.g., HIV infection, cancer], a cerebrospinal fluid leak, a cochlear implant, advanced kidney disease),  Prevnar 13 followed at least eight weeks later by PPSV23 is the recommendation.
  • In patients who have already received PPSV23, at least one year should elapse before they are given Prevnar 13.
  • A single revaccination with PPSV23 is recommended in adults ≥65 years of age if they were vaccinated more than five years previously at a time when they were less than 65 years of age and, in immunocompromised patients, five years or more after the first dose.
Prevnar 13 is not recommended for healthy adults below 65 years of age who do not have a specific risk factor for pneumococcal infection."

For more information on whether you should get the immunization, please contact your SIMED provider

SIMED Sleep Center Celebrates Reaccreditation

National Sleep Awareness Week is underway (March 2-8), and there’s no better time for the SIMED Sleep Center to announce that it has formally received its second 5-year Accreditation from the American Academy of Sleep Medicine.  This is the result of a thorough process including review of physician and technologist credentials, quality of our diagnostic studies and care of the patient during their stay.
 
SIMED Sleep Center is also now fully accredited for home testing.  This is an “express” version of the overnight sleep study in which some, but not all, measures are taken to screen patients and determine if future testing and treatment is needed. Under the direction of Galina Bogorodskaya, MD and a core of board certified sleep physicians representing NeurologyPulmonology and Internal Medicine, SIMED Sleep Center performs diagnostic testing to uncover such diverse ailments as sleep apnea, insomnia, incomplete REM sleep and other parasomnias including talking, walking and getting up to eat or use the restroom. 

Medical journals and popular magazines like Men’s Health recently stepped forward to remind physicians and patients alike that untreated sleep disorders can worsen blood pressure, heart ailments, metabolic syndrome and obesity.
 

We test and care for patients upon referrals from physicians throughout the community as well as those whose employment entails a need to be alert and awake. SIMED Sleep Center teams up with First Care and several local trucking/transportation companies to test and treat professional drivers who move freight, both locally and on the interstate.
 
For more information on SIMED Sleep Center, visit our page or call Van Simmons, Division