Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
As the patient arrives in the bronchoscopy suite (or if
the patient is already in the hospital), an intravenous
catheter (IV) will be started for administration of medication and fluid.
The patient is then connected to a monitor for continuous
monitoring of the heart rate, blood pressure, and oxygen
level in the blood. If needed, supplemental oxygen will be
supplied either through a ½ inch tube inserted into the
nostrils (cannula) or a facemask. Medication is then
given through the IV to make the patient feel relaxed and
sleepy for the flexible fiber optic bronchoscopy. If rigid
bronchoscopy is to be performed, an anesthesiologist will
be present to induce and monitor the general anesthesia.
Patients will be lying on their back with oxygen
supplemented through the mouth or the nose. Prior to the
insertion of the flexible bronchoscope, a local anesthesia
with topical lidocaine is given in the nose and to the back
of the throat. The flexible bronchoscope can be introduced
either through the mouth or the nose. Some patients may require a special tube called an
endotracheal tube to be inserted through the mouth, passing
the vocal cord, and into the trachea to protect and secure
the airway. Once the bronchoscope is in the airway, an
additional topical anesthetic will be sprayed into the
airway for local anesthesia to minimize discomfort and
coughing spells. The rigid bronchoscope is inserted by
mouth only. This is usually done after the patient is
under general anesthesia.
Flexible bronchoscopy rarely causes any discomfort or
pain. Patients may feel the urge to cough because of the
sensation of a foreign object in the "windpipe." Again,
this feeling can be minimized by pre-procedural medication
given for relaxation and local anesthesia with lidocaine.
The procedure usually takes between 15 to 60 minutes. If a
specific area needs to be more thoroughly evaluated or an
abnormality is detected during the procedure, samples can
be collected by several methods listed below:
Washing - Squirts of salt water (saline) are injected
through the bronchoscope into the area of interest and the fluid is then
suctioned back. This process is repeated several times to obtain adequate
samples, which are then submitted to the laboratory for analysis. Brushing - A
soft brush is inserted through the bronchoscope to the area of interest. Cells
around the airway are collected by brushing up and down the airway. The
samples are also sent to the laboratory for analysis.
Needle aspiration - A small needle is inserted into
the airway and through the wall of the airway to obtain samples outside of the
airway for analysis under a microscope.
Forceps biopsy - Forceps may be used to biopsy
either a visible lesion in the airway or a lung lesion.
Abnormal tissue that is visible in the airway is usually
easily biopsied. However, a mass that is in the lung
tissue is deep within the lung and usually requires a
biopsy using special x-ray guidance (fluoroscopy).
Specimens obtained are sent to a pathologist for inspection
under a microscope.
Pneumonia is inflammation of one or both lungs with consolidation. Pneumonia is frequently but not always due to infection. The infection may be bacterial, viral, fungal or parasitic. Symptoms may include fever, chills, cough with sputum production, chest pain, and shortness of breath.
Lung cancer kills more men and women than any other form of cancer. Eight out of 10 lung cancers are due
to tobacco smoke. Lung cancers are classified as either small cell or non-small
cell cancers.
Bronchitis is a disease of the respiratory system in which the bronchial passages become inflamed. There are two types of bronchitis, acute and chronic. Symptoms of acute bronchitis include frequent cough with mucus, lack of energy, wheezing, and possible fever. Treatment may require medication such as bronchial inhalers and predinsone. Supportive treatment is focused on relieving the symptoms with fever reducers, cough suppressants, and rest. Treatment may be more aggressive in patients with pre-existing conditions such as empyema, COPD, or cigarette smoking.
COPD (chronic obstructive pulmonary disease) is a disorder that persistently obstructs bronchial airflow. COPD mainly involves three related conditions, chronic bronchitis, chronic asthma, and emphysema. Symptoms of COPD include chronic cough, shortness of breath, frequent respiratory infections, wheezing, morning headaches, and pulmonary hypertension. Treatment of COPD is focused on the related condition(s).
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Cystic fibrosis is a disease of the mucus and sweat glands. Cystic fibrosis is an inherited disease. The outcome of the disease leaves the body malnourished, bulky and fouls smelling stools, vitamin insufficiency, gas, painful or swollen abdomen, infertility, susceptible to heat emergencies, and respiratory failure. There is no cure for cystic fibrosis, treatment of symptoms is used to manage the disease.
A pneumothorax is free air in the chest outside the lung, that causes the lung to collapse (collapsed lung). There are two types of pneumothorax, spontaneous or primary pneumothorax and secondary pneumothorax. Symptoms include sudden chest pain, shortness of breath, rapid heart rate, rapid breathing, cough, and fatigue.
Interstitial lung disease, is a term to describe a certain lung condition. Causes of interstitial lung disease include lung infection, exposure to toxins in the environment (asbestos for example), medications (chemotherapy), radiation therapy, and chronic autoimmune disorders. Common symptoms of interstitial lung disease include a dry cough and shortness of breath. Diagnosis and treatment depend upon the cause of the condition.
Bronchiectasis is a condition in which the bronchial tubes of the lung become damaged. Inflammation from infection or other causes destroys the smooth muscles of the bronchial tubes. Bronchiectasis is a form of COPD (which includes emphysema and chronic bronchitis). There are three primary types of bronchiectasis: 1) cylindrical bronchiectasis; 2) saccular bronchiectasis; and 3) cystic bronchiectasis. Bronchiectasis may also be acquired or congenital. The most common symptoms of bronchiectasis are recurrent cough and sputum production. There is no cure for bronchiectasis. Treatment is often geared toward controlling the symptoms of bronchiectasis.
Valley fever (coccidioidomycosis) is a disease caused by the inhalation of the Coccidioides immitis or C. posadasii fungus. Symptoms are flu-like and resolve over two to six weeks. Infection typically requires no treatment, though there are many antifungal drugs to treat valley fever.
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