In this conversation, pediatric pulmonologist Dr. Irina Dralyuk discusses the importance of lung health, especially in light of recent fires affecting air quality in Los Angeles. She explains the significance of air quality indices (AQI), and its limitations. She reviews the use of air purifiers and masks, to protect lung health, particularly for vulnerable populations such as children with pre-existing conditions. She emphasizes the importance of post-exposure care, the role of vitamins and homeopathic remedies, and the impact of nutrition on lung health. Dr Dralyuk also addresses exercise considerations during times of poor air quality, school safety measures, and the current trends in pediatric respiratory issues. She concludes with an optimistic outlook on lung healing and recovery, reassuring parents about the resilience of the lungs and the body's ability to heal itself.
Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner.
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Transcript
Episode Transcript
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Unknown (00:00):
Hi everybody. I'm Dr Jessica Hochman, pediatrician
(00:02):
and mom of three. On thispodcast, I like to talk about
various pediatric health topics,sharing my knowledge, not only
as a doctor, but also as aparent. Ultimately, my hope is
that when it comes to yourchildren's health, you feel more
confident, worry less, and enjoyyour parenting experience as
much as possible. If you live inLos Angeles, or you're listening
to the news about Los Angeles,you're probably wondering about
(00:25):
the air quality after the recentwildfires, parents are asking,
Is it safe for my child to gooutside? Is it safe to send them
to school? What can we do toprotect the air in our homes?
Well, to help answer thesequestions, I'm joined by Dr
Irina dreyluke, a pediatricpulmonologist, and she
specializes in lung health inchildren. In this episode, she
gives practical guidance to keepyour family safe. We'll talk
(00:45):
about air purifiers, masking,yes, masking, school safety,
outdoor exercise, and how tokeep our lungs healthy in
general. So if you, like myself,are wondering how to navigate
air quality concerns, thisepisode is for you. Thank you so
much, Dr Irina druke for takingthe time to come on the podcast
now, let's get into it. Dr Irinadreyluke, thank you so much for
(01:06):
being on the podcast. I'm soexcited to hear what you have to
say, and I so appreciate yourtime.
Thank you so much for having me.
This is really exciting. So telleverybody.
What do you do for work?
Excellent.
So I'm a pediatricpulmonologist. I work at Cedar
Sinai Medical Center. I'm partof gear and children's. I've
been here for a few years now.
I've been running thedepartment. Now I do have a
(01:27):
partner, which is exciting. Sonow we're sharing the
department. But basically, myjob entails taking care of kids
with any and all sort ofbreathing problems that could
just be, you know, mild asthma.
It could be interstitial lungdisease, chronic issues, things
like cystic fibrosis, ciliarydyskinesia. Might have a kid who
just comes in, used to be ahealthy kid, oh, and now has a
(01:50):
real bad pneumonia, and theyneed help kind of figuring out
what to do going forward ifthey're still lingering
symptoms. And basically, at theend of the day, my job is to
help kids breathe easier.
So I'm so excited to talk toyou. Of course, I want to talk
to you. I hear the mostwonderful things about you from
the community, and also in lightof the recent fires happening.
(02:10):
We both live in Los Angeles, wehave been inundated with
questions from parents curiousabout what to do, how to protect
their children's lungs, how toprotect their lungs. They're not
sure what what to make of theair quality and how worried to
be. So I'm so excited to talk toyou so that we can get some
guidance on on how to handlethis recent situation. Sure.
(02:32):
Thank you. I think that's agreat question, kind of a great
area to talk about right now.
Obviously very relevant. This issort of an unusual situation.
La, historically has never beena place with amazing air
quality, but right now is aparticularly special time, and I
think first I would say toparents, don't freak out like
it's going to be okay, becausereally, we've dealt with poor
(02:52):
things before, both just in LAon planet Earth, this too will
pass, and the air quality willbe better eventually. Right now,
it is important to take itseriously. So what I'm seeing is
some folks get very anxious andvery worried and in a sense,
like it's helpful, but it's alsonot necessary, right? There are
things that we'll talk aboutthat people can do to help
(03:14):
prevent bad things fromhappening to the lungs. But then
I also see folks that are nottaking it seriously enough,
which I think is the moreimportant group to address.
Like, I do want folks to payattention the air right now is
not good, right? And we look atthis air quality index like it's
sort of the only thing thatmatters, and then people really
go by the AQI, like it's theBible, like, oh well, it's 25
(03:35):
but it doesn't mean a whole lot.
So one thing I want people to dois step away from this AQI. Is
there a guidance for what to doin terms of the air quality
right now and like, how to goabout their daily business?
And Dr Irina, can you alsoexplain what the AQI is? Because
I know before this point, I hadlooked and referenced the AQI to
(03:55):
see how fresh and how clean theair was. You know, I can easily
access it on my Apple phone, onthe weather app, you can scroll
down and see the AQI. Can youexplain when is it useful and
why is it not so useful? Rightnow?
Yeah, definitely. So it's thisair quality index, right that
basically talks about particularmatter in the air, and it looks
(04:16):
at certain types of pollutionparticles that are picked up.
And it's a measure. It's just ameasure. It's a metric. It's a
way to, like, the same way wemeasure our weight, we can
measure, you know, certainpollutants in the air. And it's
used around the year in allparts of the world to see, like,
how safe is the air forbreathing. So on a random month
in LA, I might look at it tosee, like, is this a good time
(04:37):
for my kid to go outside andplay? Or maybe, I think right
now it's not so great, you know,and normally it's kind of a
useful measure to just get anidea, like, is the air clean?
That's sort of how we thinkabout it, right right now, not
useful. The reason being is,these fires are not normal
fires. It's not just like we hadone little fire, a couple of
trees burned down. The problemwith these fires is, not only
are they really expensive, but alot of. Stuff has burned like,
(05:01):
we can't really know what hasburned, right? There's probably
a fair bit of plastic in all thehomes, in all the buildings,
there's a lot of hazardousmaterials we worry about, things
like lead that's being burnt upin some of the older homes,
right? So there are a lot ofsubstances where the particles
being burned and released intothe air are not adding to that
score, and so that AQI is nolonger reflective of the true
(05:23):
nature and the quality of theair that we're inhaling. So I
might say 25 but you're inhalingthings that could cause me down
the road, right, 30 years in thefuture. That's not very
reassuring. But again, I don'twant people to freak out like
there are things we could doright, and they're, they're
measures we could take toprevent this exposure from being
so dangerous.
(05:43):
So just to recap what you saidso far, this is very helpful.
Don't look at the AQI, but knowthere are things that we can do
to protect ourselves. Yes,we just, I mean, a lot of it is
really common sense with theunderstanding that the AQI is
not going to be our guidingmeasure of how we know what to
do and when to do it, becauseright now it's not an accurate
metric on what are we actuallybreathing in? Right? Makes
(06:04):
sense. So then the question is,what do we use? And that's where
it gets hazy. Kind of punintended, I guess. But there are
few things, and none of them aremathematical. Unfortunately, the
AQI is nice for anybody wholikes numbers. I love numbers.
So to me, a metric with numbersis the best, because then, you
know, I could normally tell you,if you look at Wikipedia or any
breakdown of the AQI, it'll tellyou zero to 50. You're in the
(06:26):
green zone. Everybody knowsgreen is go. My three year old
will tell you green is go,right. Yellow you gotta, like,
pause, which is like, 50 to 100and so on and so forth, right?
So people are like, Oh, it'sonly 80. That's not so bad. It's
in the yellow zone. No does notapply right now for me, right
now, 40 and above is like, Ijust think of it as the Red Zone
going forward, because I don'tknow what I'm breathing. I don't
(06:47):
want to breathe it. So if we're40 and above, I don't want to go
outside. And if I do, I'mcertainly putting on my n 95
right? I don't want to breathein plastic. And I
agree with you. I like to knowmetrics. Something simple, tell
me, when can I go outside? Whencan I want to run safely? And I
agree that it's very trickyright now that we don't have
(07:08):
those clear metrics. Yeah, but Ido know there's other factors at
play, right? It must be. It mustmatter how close you are to the
fires, how long it's been sincethe fires have burned, when
they've been put out. And sothat's also confusing to me,
because I'm not sure how toadvise patients. On that front,
I'm not sure if you, if you haveany advice, yeah,
I've got endless advice. I'vebeen giving it all day and the
(07:29):
day before and the day before.
Wait first, tell everybody, bythe way, how many news
interviews have you done thisweek? I think,
like, Well, between last weekand this week, I think we're at
like, 12 or something like that.
Thank you. Thank you for beinghere. For sure, it's been,
you know, oddly fun, becausenormally it's like a story here
and there and then, like, I'vehad days where I do four stories
or five stories, but all ofthese things are important,
(07:50):
because I think people havethese questions, right, and
there is no clear guidance, anda lot of different practitioners
are coming at it kind of in adifferent way, because everybody
thinks about it in a differentway, like, Okay, what's
practical, what's sensible, youknow? But also, when I see what
other pulmonologists arerecommending, we all seem to be
much more in the conservativeboat. And they think it's
because what we see is lungdisease. And we know that the
(08:13):
pathway from a healthy person tolung disease, it's it could
unfortunately be a littleshorter than we'd like it to be.
Okay, I've had, I'll tell youthis story, and it's not like,
it's not like it's not meant toscare people. It's just meant to
kind of give people anunderstanding of what can happen
with the lungs. Right? Lungs aregreat. They're very important.
I've had a kid, a very healthyyoung person, who was 14 when
they were exposed to a fireoutside of their school. It was
(08:35):
a fire in a building in a life.
This is all a life. And thiskid, this child, ended up
getting really, really sick.
They ended up in the hospitalfor many, many days, and this
person needed oxygen andsteroids for weeks, weeks, even
now, when this person is now incollege, they're now thriving,
and they still have what I wouldconsider symptoms of chronic
lung disease, like they willforever be my patient as a lung
(08:58):
person, they still needmedications and support, and
they can't do certain thingsthat other kids can do.
Just to ask a couple morequestions about this particular
kid, did they have baseline lungissues? Did they deal with
asthma beforehand? And How closewere they to the fire?
They were close so they did nothave any pre existing
respiratory history. This was ahealthy young person. They were
(09:19):
athletic, they were active. Theywere doing martial arts, all
this other stuff, and then theyhad this yucky exposure that,
like, triggered some kind of aweird response and caused this
diagnosis called usualinterstitial pneumonia, which is
very unusual in a pediatricpatient, right? Like, very
unusual. Took a lot of work tofigure out that this was
potentially, just literally dueto this fire exposure, smoke
(09:42):
exposure. So smoke exposure canunearth these weird reactions in
human beings. So like, out of,you know, 1000s of kids, most of
them will go on and becompletely fine, good. That's
reassuring for everybody but meor the mom of that kid who
happened to have the one kid whohad this, like, is it auto
immune? We still don't know.
They didn't have any auto. Andmarkers that showed up, but they
now have chronic lung diseasebecause of this event, right?
(10:05):
It sounds like when it comes tobeing close to fire, close to
ashes, always better to be safethan sorry. Why not
for sure? For sure? Well,definitely, definitely better
safe than sorry, because it hasthe potential to cause
permanent, long, lasting damageto our lungs. Will it for most
people? No? Will it for oneperson? Here and there? Maybe.
(10:25):
And it's worth it on a personallevel to not take that risk
within reasonable parameters.
Like we don't need to allbasically stay in our house for
the next six years. But thereare basic common things we could
do, like wear our masks, likestay inside for a couple of
weeks while it's the worst.
Like, if somebody has a house orthey're staying close to where
the fires have been or are stillburning, those are areas where
(10:47):
we don't want to go outside anddo jumping jacks, you know,
right now, indoors, onlyindoors, right? Because it's
safer. Like, there's just noreason to not wait for a couple
of weeks. Let's wait until thefires are out. Let's wait until
the smoke dies down. You know,I'm not asking for months and
months, but a couple of weeks tome is not unreasonable.
Any of my friends will know thiswhen I say this, but I love to
hike. I love to be outdoors, anddefinitely, since the fires, I
(11:10):
have been exercising indoorswhen I exercise and I miss my
hikes. But it's not worth itright now, it's not.
It's not worth it for yourlungs, because if you think
about it, why do we go outside?
Why do we breathe fresh air?
Because it's good for us, right?
Your lungs are happy. They likeit. But right now, if you do
that, they're not going to behappy. We're going to cause
damage to our lining. And one ofthe things that you know at the
very beginning of these firesthat was really troublesome is
(11:32):
the particular matter, the sizeof these molecules from these
fires is very, very small, 2.5pm, which is much smaller than
most of the junk that we'regoing to breathe in, into our
lungs. And so it what theproblem with that is it's going
to travel further down into thelittle branches of our airway,
or what's called the distalairway, the peripheral airway.
It's in that part of the airwayis also much thinner, much more
(11:53):
friable, vulnerable to damage.
So it's going to then causedamage to the part of the lung
that's more difficult to repair.
It's not nice for the lung. Wewant to avoid this, right? And
so that's another reason to wearan 95 because it goes down to a
2.5 versus like a regular COVIDmask, which doesn't but it's
also great reason to just avoidexposure, right? So right now,
going on a hike or going for arun, the things that are meant
(12:15):
to help our health and to buildour lung health, they're going
to do the opposite, right? So itmakes sense, right now, until
the particular matter improves,until we have less bad stuff to
inhale, to just do the exercisesinside. You know? Okay,
so, so all this makes sense, butI do have some follow up
(12:35):
questions to what you're saying.
So, so the first I appreciatethis actionable advice. I agree,
staying inside, and I would add,keeping your doors closed,
keeping your windows closed, andif you have a HEPA filter,
right? That's recommended aswell, to run a filter in the
house.
I love air purifiers right now.
That's probably like, the bestthing I can recommend if you if,
like, somebody listens to thisor anything that I've talked
(12:56):
about or read, if they getnothing else, air purifier, just
like, invest in a nice, decent,little air purifier, you know,
look at square footage that itcovers. Find one that's within a
reasonable price range. Like,you don't all, like, not
everybody has to have a Dysonfor $1,500 right? I'm sure it'd
be nice, but I just have aregular little lap for, like,
1900 square feet, and it doesthe job, you know. And my house
is fine. If somebody has a hugehouse, and they might need a
(13:19):
couple of extra ones for smallerrooms or, like, if there's a kid
that's very sick and they'rereally worried, get a little
individual one for that roomtoo. I think air purifiers right
now, truly, in LAare all the rage. Okay, so if
you're listening and you'regonna take one piece of advice
from this interview, make sureand get yourself an air
purifier. It doesn't matter howexpensive it is, just make sure
that it covers the squarefootage that you need. Thank you
(13:39):
so much for clarifying that,because I do see advertisements
for a variety of HEPA filtersthat really range in price, and
so it can be tricky when youwant to make sure you're doing
the right thing. So that's veryhelpful. And then the other
advice that I've been giving tofamilies is to make sure to
change the filters in theirhomes as well. Yes,
love that. That's a brilliantone. I think that's like,
(14:00):
probably one of the best thingsand the easiest things, because
some folks will go for yearswithout changing their filters,
and you're supposed to do itlike, you know, technically,
every four to six months. Rightnow, everybody should probably
just go ahead and change theirfilters, unless they just did it
right before the fires. So lovethat one. That one's perfect.
Now, my next question has to dowith masks. You brought up
masking as a as a importantprecaution to take when you're
(14:22):
outside. I know when people hearabout masks, there's such a
variety of responses. I think alot of people, I don't know,
they're tired of it after COVID,or they have mixed feelings of
it after COVID. And then for me,personally, I find wearing and
95 uncomfortable. They're hardfor me to tolerate for too long.
So in terms of generalrecommendation, are there some
groups of people that definitelyshould wear a mask, like, for,
(14:44):
for example, kids that haveasthma, the elderly? Are there
certain groups that you thinkvery strongly should wear, well
fitted and 95 mass?
Yes, absolutely. That's that'slike the question of the day,
right? Because, I mean,everybody I think has mask
fatigue. I. I would be lying toif I said I didn't. With that
being said, I like my lungs. Sohere's my mask. Okay, this one
(15:06):
my husband got from, andthat's you like your we like
your lungs. Yes, that's true. Solike, when you ask me a little
sarcastic part of me, of like,which patient groups and like
people with lungs, you know, butit's a little more nuanced than
that. So like, for me, actually,I have slight reactive airways,
and when the fires firststarted, I was running around
without a mask, kind of doing mything. You know, I walk into the
house and my husband's like, canyou please go shower and take
(15:29):
off your scrubs, because he's alot more germaphobic than I will
ever be. But now I'm, you know,getting that way with the
particles. I'll tell you why.
Like, day two, I was sitting onthe couch and I started
coughing, and I just couldn'tstop, and I couldn't catch my
breath, and my throat wasburning, and it just, it just
wasn't fun. Since then, I'vegotten smarter. So then I
started wearing this nice, cutelittle k 95 I think, from Home
(15:51):
Depot, religiously, right when Igo outside, even if it's from my
car to the house to, like, bringin groceries, and the AQI is 20.
I don't care. I don't want tohave that episode again. Now,
for patients, it's moredifficult to try and convince
people who don't have thatpersonal experience of misery,
from a respiratory standpoint,to where their kid, or have a
kid who doesn't want to wearanything, right, pants, less
(16:14):
alone a mask that would be mychild, so like, who needs to
wear the masks, all right? Folksthat are obviously still in
areas where the fires areburning, those are good
candidates for masks. I don'tcare if they have a respiratory
condition. Um, folks with thatdon't, please wear a mask. Like,
just for the love of God, just,just put on a mask. Right? If
that one is easy, I think thatone should be easy. Even if you
(16:34):
have mild, persistent asthma, oranybody who's ever had an
inhaler, just put on the mask.
It's not that like, it's reallynot that serious. This is also
where I lack a little empathy.
It's a mask. Like, yes, they'reuncomfortable. I find them
uncomfortable too. As a doctor,they have been uncomfortable
since I started medical school.
My lungs not having them thatwould be more uncomfortable to
me or like having decreased lungfunction, very uncomfortable, I
(16:56):
promise you, more uncomfortablethan wearing a mask. But going
back to your question, of myfavorite groups, so anybody with
pre existing lung conditions,emphysema, COPD stuff, right?
Anybody with lung cancer, statstuff, anybody with a trait like
the obvious thing, cysticfibrosis, ciliary dyskinesia,
babies, like babies who arepremature, for example, and now
(17:16):
they're three or four or fiveand they still have lingering
chronic lung issues. Those aresome of my patients, but I will
tell you, those parents areusually really easy because they
have the experience ofprotecting their kids lungs and
their lung health. So these arefolks who will have trained
their kids to keep their maskon. I don't struggle with those
parents, but that's not my toughgroup. It's the folks where the
kids are generally healthy, orthe adults that are generally
(17:38):
healthy and they're not used tohaving to think about how to
stay that way, right? They justtake it for granted that we're
going to stay healthy. So forthose groups, that's going to be
tough for me to convince them,like, hey, I want you to do this
thing that's very inconvenient,but they're also not my top
concern group. The top concernwould be immunocompromised
folks, you know, neuromusculardisease folks, because they're
(18:01):
going to have a harder timedoing airway clearance. So
basically, that's a lot ofpatience. And it's not just
asthmatics, it's a lot of otherfolks. I mean, I think this is a
helpful reminder, honestly, formyself included, because as you
said, a lot of us have massfatigue. I still have a mark on
the top of my nose from wearingit at 95 every day at work for a
(18:22):
year and a half. But I think youhit the nail on the head for me
when you said, Why not takeprecaution? Because who wants to
have lung issues after this isall over? So if this is just a
short period of time, it's justa couple of weeks get through
this period until the fires havelong been gone, and the air is
clear. It makes a lot of senseto be on the safe side. Yeah,
(18:45):
I think so. I mean, granted, youknow, when you see a lot of
nails, you tend to like as ahammer, right? Everything is a
nail. So I see lung diseaselike, that's what I do every day
I come to work, and that's a lotof days, because I don't take a
lot of vacation. We have a lotof sick kids. All I see is lung
disease, and I know how we getthere. And it's not, it's not
it's not hard to acquire lungdisease, unfortunately, and bad
air quality is one of the waysto get here. So like, if we're
(19:07):
in this situation, how do we getthrough this in the smartest way
possible? We do the easiestthings, like the the lowest
hanging fruit kind of thing,which is a mask, right? A mask
and an air purifier arefantastic combination to get us
through these next few weeks andget us to the other side, where
then we're not struggling withsome of these long term effects.
(19:27):
Because if we don't do anything,if we just go on about our
business right now, we go backoutside. We go back to eating
lunch outside at school, we goback to having PE at school. We
start doing our jogs and ourruns and our jumping jacks
outside. What's going to happenis a good number of those people
will have significantinflammation, and they will have
significant issues from all thedebris that's landing in their
(19:48):
lower airway. They're going tohave irritation of their lungs,
and then they're going to havechronic lung issues, and they're
going to kind of send their kidsto me, and then my adult
colleagues are going to beoverwhelmed with the number of
adults that are now havingreactive airway symptoms. And
we're going to run out ofsymbiosis. What's
going to happen? And we don'twant that? No, no, no. I think I
prescribed thatlike candy. And the thing that
people might want to think aboutis the way to treat severe
(20:09):
inflammation is steroids,usually. So for folks who don't
want to do things, let's again,weigh like the pros and cons,
wearing a mask, gettingsteroids. I would rather wear a
mask. I don't want I've neverhad steroids. I've never taken
steroids thing up, well, exceptfor the inhaled kind. But like
systemic steroids, I've neverhad a tablet of prednisone in my
body, and I don't really want tohave to get to that point,
(20:30):
right? Like, drugs are not fun.
They're they're a necessity in asituation where we really don't
have other choices. So to me,like preventing the progression
of lung disease is worth it,whether it's a mask, an air
purifier, staying indoors, kindof getting through the next few
weeks, we do have things at ourdisposal. So that's that's a
good thing, right? Like, it'sgreat. We have all these kind of
(20:52):
easy things that we could do toprevent more badness, like,
right now, we already haveenough sad stuff to deal with.
People's homes being burneddown, schools, there's a lot to
deal with. If we can at leastprotect our lungs on the other
side, then we can fix the stuff.
Right? Like, people will havesupport to buy new homes,
replace their clothes. Like,yes, valuable sometimes are not
replaced. But these are thingsdifferent, right? I can't
(21:15):
replace lung health for people,you know what's interesting for
myself, I was out of town forthe weekend during the fires.
Like many Angelinos, we got outof town for the weekend, and I
could tell. I thought maybe itwas psychological, but I don't
think so. But as soon as I gothome and I was in the valley
where I live, a certain area ofLos Angeles, I felt a little bit
of a light headache. I felt itin my chest a little bit. And so
(21:36):
I do think there's something inthe air that's not the same as
it was before. So why not keepprecautions
for sure, for sure, there's noreason not to. So okay, so
apart from the mass and thefilters, is there anything else
that we should do, for example,when I come home from being
outside, should I take a shower?
Should I use nasal saline?
(21:56):
Should I gargle? Is thereanything else that I should do
to clean my body after beingexposed to outdoor particles.
Those are all really good ideas.
I think you're not going to gowrong with any of the things you
said, right? If you're going toshower, you're going to remove
any sort of residue or anythingon your skin, your hair, any
kind of sinus rinse is always agood idea. That'll help clean
your nose if you're feelingsymptomatic, right? If you're
(22:18):
having little bit of sniffles oranything really, you can always
do a little Flonase, just tohelp with that. You can do
gargle. You can really doanything that will help you
clean out, you know, yoursinuses. You could do a neti
pot. You could do humidifier. Ithink those are really helpful.
I've recommended a lot of myfamilies use humidifiers. They
are super dry. So those are kindof nice.
(22:42):
What about other homeopathicproducts, like one that's been
going around a lot has been totake vitamin C or to take NAC.
NAC. Do you have any thoughts onthose products? Yeah,
sure. Well, vitamin C, to me, isactually very allopathic too.
You know, I think I feed my kidlots of food with vitamin C. So
I love vitamin C. I think it'svery helpful. And also just in
conjunction with that iron,because they work hand in hand.
(23:04):
So just whether it's spinach orliver, I really don't care. It
just depends on people's dietarypreferences. So vitamin C all
day, every day, right? Becausewe want to support our immunity.
NAC. I don't have any like, prosor cons. I don't use it
personally. I have not seen itsort of looked at positively or
negatively in the allopathiccommunity. I can research it and
get back to you, but I don'thave, like, personal feelings
(23:25):
about it one way or the other.
Is there anything that you wouldrecommend to promote lung
health? Sure.
Well, yes, absolutely. But youalso triggered my memory of,
like, one thing that's like, Iwouldn't even call it
homeopathic. I guess it's moreAyurvedic related that I like. I
don't personally love it,because when it just tastes
good, I'll tell you what it isin a second, and it helps me.
(23:45):
But that's anecdotal, and likethe entirety of India, like
every Indian friend I've had,which is half my colleagues, as
soon as I mentioned, liketurmeric milk, they go, Oh, my
God, my mom made that for me asa kid, right? So do I recommend
it? Yes, because it's delicious,and you just can't go wrong with
turmeric milk. Okay? This is,like, my one very non allopathic
medical advice, you know, pieceof advice is, you take milk of
(24:07):
whatever type, right? You addsome turmeric in there, you add
a pinch of black salt, and thenwhatever sweetener, like I use
honey, you can use agave,whatever, and you, you know, you
just, you could, like, boil itin a little teapot for a while,
and you get golden milk, orturmeric milk, and that's very
delicious and healthy. And a lotof people will tell you, and I
believe it, but again, it's notlike research in the kind of
(24:28):
science that I practice. So Ihave a hard time being like as a
medical like, MD, I'm notrecommending it from that. I'm
recommending it as a person. Doyou know what I mean? 100%
I love it. I actually, I relateto you all the way. There's the
there's the evidence basedmedical advice that I give, and
then there's the advice that Igive as a mom, as a person,
something that feels like itcould be a good thing to do, why
(24:48):
not? For sure,like honey and tea and lemon.
That's like a classic. Again, Idon't, I haven't done research
on it. I haven't seen tons ofarticles published like, you
know, in PubMed on honey andlemon. But do I recommend it?
Yes, every single. Should Ihave? I tell them, if you can
drink warm water or tea or honeyin your tea, or, you know, eat
your honey and lemon, I thinkthat's like the best combo. So
between the honey and lemon andtea plus the turmeric milk, I
(25:10):
think you have a couple of kindof natural remedies there that I
think are great. Ginger isalways a good thing. So ginger
tea, I think again, one of thosekind of life hacks that a lot of
cultures have used, and I loveall things ginger. Yes,
Ginger shows great, antiinflammatory properties. Taste
good. Why not exactly, we couldput it in our golden milk.
(25:32):
Yes, that's right, you can putit in everything. I think you
can just ginger and garlic. Imean, I could go on about like,
the garlic, the onion. I thinkfood is medicine. So kind of
stepping away from my biomedicalbackground, I really believe
strongly, and maybe it's part ofbiomedicine, but I believe food
is a big part of how we can keepour bodies healthy and strong,
and lungs are part of that,right? So if we eat a bunch of
junk food that will affect ourlungs, versus having a very
(25:55):
vibrant platter of fruits andvegetables and grains and nuts
and kind of healthy fats, thoseare really going to help us
fight off infection, bad air,just keep ourselves healthy. So
I recommend lots of colorfulthings on plates. You know,
absolutely yes, yes, yes. We'respeaking the same love language
here. I totally agree.
Oh my gosh, I could like talk.
I'm trying to control myselfbecause I love food. I love
(26:16):
talking about food and the colorof food like I just think it's
fascinating, and there's a lotbetween how our body responds to
disease or the potential fordisease, and the things we're
putting in fermented foods,again, not coming from my biomed
background, but just kind offrom my life background. I think
fermented foods are superimportant for our health. It
(26:37):
helps our gut and our gut helpswith our immunity. Well, that's
a win. So like, if you likekimchi, if you like natto, if
you like really, anything keyfor fermented foods or the
lungs, you know that that's, Ithink that's where lung health
is at right now.
Okay, so I love this colorfuldiet. Get your nutrients from
the food that you eat. Your foodis your medicine. Don't forget
to have the fermented foods.
It'll help your lung health.
(26:59):
It'll help your gut, andthinking about vitamin C
alongside iron to help withabsorption. I love all of this.
What about exercise? Exercising,having a good aerobic workout?
Wouldn't that help the lungs? Oris that not okay to do right
now,that's a tricky one. It's a yes
and no, I would not probablyencourage right now whole lot of
like fast paced, hardcoreaerobic exercise in areas that
(27:21):
have had significant smokeexposure I had, I think it was
spectrum news where they askedme about going running on the
beach, but they would like whatthey went running and they saw
ash. It was like, Well, no,that's a no go. No running on
the beach when there's ashflying around, it's not going to
benefit our lungs. So right now,I would go from a more
protective kind of approach,because running or aerobic
(27:44):
exercise, that's more like, howdo we build our lung health
forward? Right now, I want tothink about, how do we prevent
damage to your lung tissue? Thebest way to do that is not to
expose the lungs to morepollution, more damage, right?
So I would try and keep it easyand, like, go easy on the lungs
and not do a lot of hardcoreaerobic exercise indoors or
(28:05):
outdoors. If you're in a gym,like, I haven't gone to my gym
in the last couple weeks, if youhave a gym that's got air
purifiers, and, like, they'vereally taken measures to make
sure that the air is very clean,and you feel pretty good about
that gym, okay, you can get onthe treadmill or kind of do
whatever you're going to do.
Going to do, and I'll playpickleball, I suppose. But I
wouldn't think of that as, like,how am I keeping my lungs
(28:27):
healthy right now? It's byplaying hardcore sports. No, I
would actually, right now justtake it easy and wear the mask
and, like, focus on that is, howdo I prevent lung disease,
versus do I need to run an extramile? Not right now. Let's wait
until, like, you know, threeweeks down, then we can, like,
push our our running and ourjumping and all that stuff. But
right now, I would say peoplecan take it easy. I
(28:47):
appreciate that advice. I neededto hear that. So thank you very
much. Is there, like, exerciseat home? I just did a bar boot
camp class today. It's myaddiction, so maybe I need to
think twice about it. So thankyou,
sorry. Sorry the party duringthis century, being a
pulmonologist is really,sometimes super fun, and
sometimes, like, I feel like thebad guy, you know, because I
tell people to do the non funthings, like, I feel very much
(29:10):
like a mom, just like, I'm justmomming Everyone, no, but
it comes from a really goodplace. And as you said, this is
what you see, and so you'retrying to protect people. So I
think, I think it's great, Ithink it's great. I think it's
great to hear and you're theperson that deals with you're
the person that treats issuesthat come up with the lungs, and
you have first hand experiencethat you don't want anybody that
you know or love to deal withit. So I think it's I appreciate
(29:34):
hearing about it. Thanks.
I appreciate you saying thatbecause it is hard. Like, I
definitely get a lot of folkskind of looking at me, like, are
you want us to do what? And Ifeel bad. I don't want to, like,
be crunchy, you know, I don'twant to make people's lives
difficult or miserable. But thenI think to all my kids I've had
who've had these, like, longlasting lung problems. And I
think this is kind of funny. Ithink to like this one older
(29:55):
pulmonologist, when I talked tothem a few years back, I
thought, God, they're so gloomy.
I. And the other day, I waslike, oh my god, I'm turning
into them. This is terrible.
I'm not quite there yet, butyou're not there. I'm
not there, but I'm like, Man,the more stuff you see, the more
you realize, like, no bad thingsdo happen to lungs, you know? So
how do we prevent them? That'swhere it's coming from.
(30:19):
Okay? So just to make surewe've, we've, we've covered all
the big things right in terms ofhow to keep your lungs healthy,
how to prevent issues from thecurrent fire conditions that
we're all exposed to in LosAngeles. Yes, yes. Is there
anything that parents shouldthink about or advise their
schools when they send theirkids to schools? Any anything
that schools should takeprecautions about, that parents
should be aware of, that theyshould bring up to their local
(30:40):
schools.
Oh my god, yes, that's a bigone. And that one today, we
actually had a lot ofconversations in my clinic with
other providers. And then I hada patient come in where the
kiddo has asthma, and the schoolhas already gotten back to,
like, taking the kids outsidefor lunch and all this stuff.
And so the mom was like, Oh mygosh, I really don't want my kid
eating outside and doing allthis stuff. I got on the
principal, because this stuffmeans a lot to me. And like, if
(31:03):
this kid gets sick, like, Idon't want this kid exacerbating
right? So I just wanted to makesure we keep this kid safe. But
also I wanted to kind of figureout what's happening with the
school, and I'm having this isonly principal I've talked to,
but I'm having a lot ofconversations regarding school,
and sort of like, what do we dowith school with different
parents? So for kids like this,anybody with a reactive airway
history, I'm asking, pleasedon't have them be sitting
(31:25):
outside. I don't really carewhere they are, unless they're
in San Diego, okay, Long Beach.
I think I told one family, it'sokay. They can go outside for
their play time, but like in LAproper, let's just keep these
kids inside. No, they cannot goand eat their lunch outside and
then put their mask back on. Youcan. I can't eat through a mask,
and neither can a 12 year old.
You know what? I mean, it's justsilly. People are asking me,
like, well, what if they likeeat and then put their mask? No,
(31:46):
no, that's not an option. Sothose kids need to have a safe
place inside the school with aclassroom or a library or some
kind of a space that has,ideally, not just filters, but
air purifiers. So I know some ofthe schools have already
acquired those. Some have not.
So one thing parents can do isask their schools, what have you
done so far to make sure thatair quality in your school is
safe for our children. What areyou doing? Are you keeping the
(32:08):
doors closed? Are you keepingthe windows closed? Do we have
air purifiers? You know? Howmany square foot are they
covering? What kind of HEPAfilters or other filters do we
have the room that this kid wasgetting access to, was the multi
what is it? The multi somethingroom, multi purpose room. Thank
you very good. Yes, there'sanother part to this word. But
(32:29):
my the mom told me, like,there's no filter in there or
not, there's no air purifier,and the doors are all open. So
it's kind of like pointless. SoI asked the school please keep
this kid in a room that isappropriate. And the school is
really sweet. This thisprincipal was amazing. You know,
she's very helpful, veryagreeable. She's going to work
with the teacher. And I said,also, let the other parents know
that I called and, like, I madethis recommendation, because it
(32:49):
sounds like, from the mom thatsome of the other parents are
calling asking to have theirkids sent outside. That's the
wrong direction, inside, insideright now. Okay, ask the schools
to send your kids inside. That'sthe better place to be with the
doors closed. Okay? We don'twant our kids breathing this
stuff right now. The kids shouldbe inside right for the next
two, three weeks. Yes, the kidsare gonna go bad even get in the
(33:09):
car, drive down, go to likeNewport, and go for a walk on
the beach, and then come back toLA, which is very stinky and
smelly right now, even if wecan't smell it, put your kids
indoors, close the doors, youknow, lock them. So that would
be the school thing, right? Onething that I've noticed that's
been very interesting at thebeginning of all this, my kids
school, which has been amazing,they've sent us updates five
(33:29):
times a day on all the thingsthey're doing to keep the kids
safe, keeping them inside. Idon't know how they do it. So
this is an example of a schooldoing this, right? Where they're
doing the things, and they'rereaching out to the parents and
communicating what they'redoing. So I don't even have to
think, should I send my kid toschool? I trust that what
they're doing is good, and I seethat it's good enough, even for
(33:50):
my very high standards. I've hadother parents be like, Oh, my
school hasn't really reached outto us with anything. And I'm
like, Dude, what are they doing?
And they're like, well, we don'treally know they're going
outside during recess and lunch,like, what about purifiers?
Like, anything you know, andthey're like, We don't know.
Like, you should, you shouldtalk to your school or just keep
your kid home. Because if, ifwhat I'm hearing is your school
(34:11):
is not communicating with you,they're not doing the things.
And I agree, like, if the schoolhas done its due diligence, it's
gone through all of theirprotective sort of gears, and
they make sure they've updatedtheir filters, they've changed
the things, you know, they'veinstalled air purifiers. They're
closing the doors, they'rekeeping the kid in doors. Then
we're good. That's that's aschool that's being responsible.
(34:31):
Myself,I've gotten emails from a couple
of my kids classrooms about whatthey're doing and how they've
updated filters and keeping thedoors closed. But you're right.
If you haven't gotten an email,or you haven't communicated with
your with your child'sclassroom, it's, it's, I think
it's worth just checking in,reaching out, and making sure
that they are doing the properprecautions while your kids
at school, for sure, for sure,and keeping them indoors. You
(34:52):
know. So definitely, my clinicis seeing more volume. I'm
dealing. I'm trying to help alot of people, like by phone or
by. You know, through epic,through like our communication
within the system, because one,the volume is huge, dozens and
dozens of like questions everyday, between my cell phone, my
email and then my inbox, I'mprobably answering like 20
(35:14):
different questions a day aboutfire related stuff from like 20
different families. Wow.
Well, thank you so much for thework that you do and for guiding
people and making them feelbetter.
Well, no problem. It's, youknow, I think this is a funny
time, and I'm really glad you'redoing this, because the more
pediatricians we can communicatethis to, the easier it'll be on
the community. Because one thingI can't say, struggle, the one
(35:36):
thing that's been a point toaddress is the pediatricians, I
think because they don't see thedegree of severity that we do as
pulmonologists, they're morelikely to be sort of more human
in their approach. Like, Well,maybe you don't need to do this.
This is a little overkill data.
Like, we're okay with, you know,100 and over AQI, you can go
back to school, you can go backto sports. And I'm like, God,
please don't, please don't letanybody do anything. But I
(35:57):
can't, I, you know, I can'tforce everybody to just stay
indoors. That's also, like,unrealistic. So I think if we
can get everybody kind of on thesame page about, like, how
seriously to take this, it'llactually help the community at
large more, because I can't takecare of everybody by myself,
right? Like the pediatriciansare, like the first guard, and
then it comes to me once it'sworse, I
(36:18):
definitely I appreciate yourmessage. I hear it loud and
clear, and I'm I actually thinkit's really helpful to hear
because I do agree thatprevention is very important. So
now I'd like to talk aboutsomething optimistic. Tell me
about lung healing, because Iknow, for example, smokers that
smoked for many years when theyquit, when their lungs are no
(36:39):
longer exposed to, you know, badparticles and smoke and
carcinogens that they do, thelungs do miraculously heal
pretty quickly. Can you speak tothat so that parents that are
thinking, Oh, my goodness, Ihaven't my child hasn't worn a
mask for a week or two. Have I?
Have I caused any damage totheir lungs? Tell me about lung
healing. And is this expected,sure? So the lungs are pretty
(37:02):
magical, you know, with a caveatthat sometimes things don't go
in the magical direction, butfor the most part, lungs really
do. The body heals itself verywell, like we are designed to
heal, and our body wants toheal. So that is beyond
miraculous. It's reallyincredible, kind of like you
said with the smokers, right?
People can smoke for years, andthen if they stop and they they
(37:22):
live a healthy life goingforward, oftentimes they can
actually recover the majority oftheir lung health. So we think
about, like, I think as apulmonologist, in terms of
pulmonary function, right? Whatis somebody's pulmonary
function? We can recover a hugeamount of lost function up to a
point, right? So it's importantto also think, like, two weeks
is not going to make a hugedifference. So I don't want
parents to think like, oh mygosh, my kids lungs are just
(37:43):
going to be terrible. They'regoing to get this horrible lung
disease. No, no, we're not. Thereality is, most of the kids are
going to be totally fine. Okay?
The one kid out of 5000 or20,000 or whatever that's going
to potentially have long termeffects, that's the kid I worry
about. But the majority ofpatients are going to be okay,
especially if they take theseprecautions and whatever degree
of lung damage we're allcurrently experiencing, like
(38:06):
sitting here and probably rightnow breathing in something I
shouldn't, but I also know that,like, I'll be fine. So there's
no reason to be sort of likefreaking out or, you know,
punitive with ourselves or ourfriends or family members. If
people haven't been perfectabout masking up or not going
outside, these are just, youknow, it's kind of like food.
Nobody has a perfect eye. Well,maybe some people, but most of
(38:27):
us have a muffin here and there,or, like, a piece of chocolate
or whatever, you know, right?
Yeah, a lot of apple pie that myhusband's been making lately
because it's delicious. And,like, you know, am I gonna have
a perfect body? No, I'm not, butthe pie is delicious. But also,
like, lungs are the same way youcan take a little bit of a hit.
You know what? I mean? You don'twant to take a huge one. And the
(38:50):
funny thing to think about is,where's everybody's threshold?
We have a lot more room with ourlungs than people recognize.
What we don't want to do is getclose to the threshold. So
unless you're sitting there bylike a burning fire and just
inhaling all the fumes, oryou're just downwind from, like
a huge piece of plastic. Thereality is, you're not at your
threshold, okay, and it's goingto be a while before you get
(39:11):
there. And it's all cumulative,so over the course of our lives,
you have to think about, like,how much time do we have to
recover for our lungs right now,with this fire, or all of these
fires, there's going to be somedegree of damage for all of us
who've been in the lake, whetherwe like it or not, little,
moderate, a lot. And then timewill go by, and we'll make
choices for our lungs, and we'llrecover a good amount, if not
all, of our lung health. Andthen something else will happen,
(39:33):
and then some kid will beexposed to a vape, and then
they'll do more lung damage, andthen the parent's going to freak
out, and then they're going toquit their vaping, and then
they're going to restart, andthey're gonna restart, and
they're gonna quit again 17times. Then we'll see you in
clinic, right for vaping likeassociated lung injury, and
then, shockingly, that kid willstill have normal lungs three
years down the road. It isabsolutely crazy. Not all the
(39:55):
kids, like some of these kids,potentially, will have those
outcomes that will make. Them mypatient for the next 20 years,
but the majority of these kidswill actually recover their lung
health and be okay. So I do wantparents to kind of, like, relax
a little bit and do the rightthings. You know what I mean?
Like, I don't want people torelax so much that they go, Oh,
it's fine. The lungs will justrepair themselves. We don't need
(40:16):
to add, like, insult to injuryfor the lungs, but the amount
that we can't control for thelungs will do their job, and the
body will do its job. And allthe vitamin C you're going to
eat from those beautifuloranges, they're going to do
their job. And so the lungs willcome out, and we will breathe,
and all make it, you know,hopefully into our 80s and 90s.
So there's a lot to be said forlike, the body's natural ability
(40:38):
to heal itself with the rightchoices that a person can make
throughout their life, you know.
So what I'm hearing from you isbasically, do the best you can
and have faith that it's allgoing to work out for the best,
for sure, for sure. And then,you know, if you can go to
Hawaii, like half my family,you're doing, do that, that's
also a good option.
I agree with, with all of this,I've definitely been trying to
(40:58):
think about making lemonade fromlemon.
So you have to, I agree, yeah. Imean, look, it could be much
worse, like, God forbid, yes,these fires are not so
fantastic, right? But worsethings have happened to human
beings, like worst disastershave happened to human beings.
We will get through this. It'salready getting better. The
fires are under much highercontainment. You know, things
(41:19):
are going in the rightdirection. The winds are going
in the right direction. They'redying down. So at least it's not
getting worse, and that's a hugething, like it could have gotten
worse, but it's not. It'sgetting better. It will slowly
continue to get better, and wejust have to kind of make the
best choices we can given theresources we have. It's a great
reminderthat I want to be careful for
the next few weeks, and thenbefore I know it, I'll be back
resuming my regular hiking,right? Yes,
(41:41):
and you can call me and we'll gohiking. I'm supposed to actually
go hiking within this so we keepputting it off. So yeah, we're
supposed to go hiking. So we canall go hiking. Once this is
over, I'll let you guys knowwhere I'm emotionally ready to
go on a hike. It'll be fun.
Good, fantastic.
Thank you so much for your time.
Thank you for being here. Thisis a very timely episode. I know
a lot of people reallyappreciate hearing directly from
(42:01):
a pediatric pulmonologist, a kidlung doctor. Not that many of
you, so I really appreciate you.
You sharing your expertise.
Thank you. This was super fun. Ireally appreciate this
opportunity. Thankyou for listening, and I hope
you enjoyed this week's episodeof Ask Dr Jessica also, if you
could take a moment and leave afive star review wherever it is.
You listen to podcasts, I wouldgreatly appreciate it. It really
(42:23):
makes a difference to help thispodcast grow. You can also
follow me on Instagram at ask DrJessica. See you next Monday.
You.
Hi everybody. I'm Dr Jessica Hochman, pediatrician
(00:02):
and mom of three. On thispodcast, I like to talk about
various pediatric health topics,sharing my knowledge, not only
as a doctor, but also as aparent. Ultimately, my hope is
that when it comes to yourchildren's health, you feel more
confident, worry less, and enjoyyour parenting experience as
much as possible. If you live inLos Angeles, or you're listening
to the news about Los Angeles,you're probably wondering about
(00:25):
the air quality after the recentwildfires, parents are asking,
Is it safe for my child to gooutside? Is it safe to send them
to school? What can we do toprotect the air in our homes?
Well, to help answer thesequestions, I'm joined by Dr
Irina dreyluke, a pediatricpulmonologist, and she
specializes in lung health inchildren. In this episode, she
gives practical guidance to keepyour family safe. We'll talk
(00:45):
about air purifiers, masking,yes, masking, school safety,
outdoor exercise, and how tokeep our lungs healthy in
general. So if you, like myself,are wondering how to navigate
air quality concerns, thisepisode is for you. Thank you so
much, Dr Irina druke for takingthe time to come on the podcast
now, let's get into it. Dr Irinadreyluke, thank you so much for
(01:06):
being on the podcast. I'm soexcited to hear what you have to
say, and I so appreciate yourtime.
Thank you so much for having me.
This is really exciting. So telleverybody.
What do you do for work?
Excellent.
So I'm a pediatricpulmonologist. I work at Cedar
Sinai Medical Center. I'm partof gear and children's. I've
been here for a few years now.
I've been running thedepartment. Now I do have a
(01:27):
partner, which is exciting. Sonow we're sharing the
department. But basically, myjob entails taking care of kids
with any and all sort ofbreathing problems that could
just be, you know, mild asthma.
It could be interstitial lungdisease, chronic issues, things
like cystic fibrosis, ciliarydyskinesia. Might have a kid who
just comes in, used to be ahealthy kid, oh, and now has a
(01:50):
real bad pneumonia, and theyneed help kind of figuring out
what to do going forward ifthey're still lingering
symptoms. And basically, at theend of the day, my job is to
help kids breathe easier.
So I'm so excited to talk toyou. Of course, I want to talk
to you. I hear the mostwonderful things about you from
the community, and also in lightof the recent fires happening.
(02:10):
We both live in Los Angeles, wehave been inundated with
questions from parents curiousabout what to do, how to protect
their children's lungs, how toprotect their lungs. They're not
sure what what to make of theair quality and how worried to
be. So I'm so excited to talk toyou so that we can get some
guidance on on how to handlethis recent situation. Sure.
(02:32):
Thank you. I think that's agreat question, kind of a great
area to talk about right now.
Obviously very relevant. This issort of an unusual situation.
La, historically has never beena place with amazing air
quality, but right now is aparticularly special time, and I
think first I would say toparents, don't freak out like
it's going to be okay, becausereally, we've dealt with poor
(02:52):
things before, both just in LAon planet Earth, this too will
pass, and the air quality willbe better eventually. Right now,
it is important to take itseriously. So what I'm seeing is
some folks get very anxious andvery worried and in a sense,
like it's helpful, but it's alsonot necessary, right? There are
things that we'll talk aboutthat people can do to help
(03:14):
prevent bad things fromhappening to the lungs. But then
I also see folks that are nottaking it seriously enough,
which I think is the moreimportant group to address.
Like, I do want folks to payattention the air right now is
not good, right? And we look atthis air quality index like it's
sort of the only thing thatmatters, and then people really
go by the AQI, like it's theBible, like, oh well, it's 25
(03:35):
but it doesn't mean a whole lot.
So one thing I want people to dois step away from this AQI. Is
there a guidance for what to doin terms of the air quality
right now and like, how to goabout their daily business?
And Dr Irina, can you alsoexplain what the AQI is? Because
I know before this point, I hadlooked and referenced the AQI to
(03:55):
see how fresh and how clean theair was. You know, I can easily
access it on my Apple phone, onthe weather app, you can scroll
down and see the AQI. Can youexplain when is it useful and
why is it not so useful? Rightnow?
Yeah, definitely. So it's thisair quality index, right that
basically talks about particularmatter in the air, and it looks
(04:16):
at certain types of pollutionparticles that are picked up.
And it's a measure. It's just ameasure. It's a metric. It's a
way to, like, the same way wemeasure our weight, we can
measure, you know, certainpollutants in the air. And it's
used around the year in allparts of the world to see, like,
how safe is the air forbreathing. So on a random month
in LA, I might look at it tosee, like, is this a good time
(04:37):
for my kid to go outside andplay? Or maybe, I think right
now it's not so great, you know,and normally it's kind of a
useful measure to just get anidea, like, is the air clean?
That's sort of how we thinkabout it, right right now, not
useful. The reason being is,these fires are not normal
fires. It's not just like we hadone little fire, a couple of
trees burned down. The problemwith these fires is, not only
are they really expensive, but alot of. Stuff has burned like,
(05:01):
we can't really know what hasburned, right? There's probably
a fair bit of plastic in all thehomes, in all the buildings,
there's a lot of hazardousmaterials we worry about, things
like lead that's being burnt upin some of the older homes,
right? So there are a lot ofsubstances where the particles
being burned and released intothe air are not adding to that
score, and so that AQI is nolonger reflective of the true
(05:23):
nature and the quality of theair that we're inhaling. So I
might say 25 but you're inhalingthings that could cause me down
the road, right, 30 years in thefuture. That's not very
reassuring. But again, I don'twant people to freak out like
there are things we could doright, and they're, they're
measures we could take toprevent this exposure from being
so dangerous.
(05:43):
So just to recap what you saidso far, this is very helpful.
Don't look at the AQI, but knowthere are things that we can do
to protect ourselves. Yes,we just, I mean, a lot of it is
really common sense with theunderstanding that the AQI is
not going to be our guidingmeasure of how we know what to
do and when to do it, becauseright now it's not an accurate
metric on what are we actuallybreathing in? Right? Makes
(06:04):
sense. So then the question is,what do we use? And that's where
it gets hazy. Kind of punintended, I guess. But there are
few things, and none of them aremathematical. Unfortunately, the
AQI is nice for anybody wholikes numbers. I love numbers.
So to me, a metric with numbersis the best, because then, you
know, I could normally tell you,if you look at Wikipedia or any
breakdown of the AQI, it'll tellyou zero to 50. You're in the
(06:26):
green zone. Everybody knowsgreen is go. My three year old
will tell you green is go,right. Yellow you gotta, like,
pause, which is like, 50 to 100and so on and so forth, right?
So people are like, Oh, it'sonly 80. That's not so bad. It's
in the yellow zone. No does notapply right now for me, right
now, 40 and above is like, Ijust think of it as the Red Zone
going forward, because I don'tknow what I'm breathing. I don't
(06:47):
want to breathe it. So if we're40 and above, I don't want to go
outside. And if I do, I'mcertainly putting on my n 95
right? I don't want to breathein plastic. And I
agree with you. I like to knowmetrics. Something simple, tell
me, when can I go outside? Whencan I want to run safely? And I
agree that it's very trickyright now that we don't have
(07:08):
those clear metrics. Yeah, but Ido know there's other factors at
play, right? It must be. It mustmatter how close you are to the
fires, how long it's been sincethe fires have burned, when
they've been put out. And sothat's also confusing to me,
because I'm not sure how toadvise patients. On that front,
I'm not sure if you, if you haveany advice, yeah,
I've got endless advice. I'vebeen giving it all day and the
(07:29):
day before and the day before.
Wait first, tell everybody, bythe way, how many news
interviews have you done thisweek? I think,
like, Well, between last weekand this week, I think we're at
like, 12 or something like that.
Thank you. Thank you for beinghere. For sure, it's been,
you know, oddly fun, becausenormally it's like a story here
and there and then, like, I'vehad days where I do four stories
or five stories, but all ofthese things are important,
(07:50):
because I think people havethese questions, right, and
there is no clear guidance, anda lot of different practitioners
are coming at it kind of in adifferent way, because everybody
thinks about it in a differentway, like, Okay, what's
practical, what's sensible, youknow? But also, when I see what
other pulmonologists arerecommending, we all seem to be
much more in the conservativeboat. And they think it's
because what we see is lungdisease. And we know that the
(08:13):
pathway from a healthy person tolung disease, it's it could
unfortunately be a littleshorter than we'd like it to be.
Okay, I've had, I'll tell youthis story, and it's not like,
it's not like it's not meant toscare people. It's just meant to
kind of give people anunderstanding of what can happen
with the lungs. Right? Lungs aregreat. They're very important.
I've had a kid, a very healthyyoung person, who was 14 when
they were exposed to a fireoutside of their school. It was
(08:35):
a fire in a building in a life.
This is all a life. And thiskid, this child, ended up
getting really, really sick.
They ended up in the hospitalfor many, many days, and this
person needed oxygen andsteroids for weeks, weeks, even
now, when this person is now incollege, they're now thriving,
and they still have what I wouldconsider symptoms of chronic
lung disease, like they willforever be my patient as a lung
(08:58):
person, they still needmedications and support, and
they can't do certain thingsthat other kids can do.
Just to ask a couple morequestions about this particular
kid, did they have baseline lungissues? Did they deal with
asthma beforehand? And How closewere they to the fire?
They were close so they did nothave any pre existing
respiratory history. This was ahealthy young person. They were
(09:19):
athletic, they were active. Theywere doing martial arts, all
this other stuff, and then theyhad this yucky exposure that,
like, triggered some kind of aweird response and caused this
diagnosis called usualinterstitial pneumonia, which is
very unusual in a pediatricpatient, right? Like, very
unusual. Took a lot of work tofigure out that this was
potentially, just literally dueto this fire exposure, smoke
(09:42):
exposure. So smoke exposure canunearth these weird reactions in
human beings. So like, out of,you know, 1000s of kids, most of
them will go on and becompletely fine, good. That's
reassuring for everybody but meor the mom of that kid who
happened to have the one kid whohad this, like, is it auto
immune? We still don't know.
They didn't have any auto. Andmarkers that showed up, but they
now have chronic lung diseasebecause of this event, right?
(10:05):
It sounds like when it comes tobeing close to fire, close to
ashes, always better to be safethan sorry. Why not
for sure? For sure? Well,definitely, definitely better
safe than sorry, because it hasthe potential to cause
permanent, long, lasting damageto our lungs. Will it for most
people? No? Will it for oneperson? Here and there? Maybe.
(10:25):
And it's worth it on a personallevel to not take that risk
within reasonable parameters.
Like we don't need to allbasically stay in our house for
the next six years. But thereare basic common things we could
do, like wear our masks, likestay inside for a couple of
weeks while it's the worst.
Like, if somebody has a house orthey're staying close to where
the fires have been or are stillburning, those are areas where
(10:47):
we don't want to go outside anddo jumping jacks, you know,
right now, indoors, onlyindoors, right? Because it's
safer. Like, there's just noreason to not wait for a couple
of weeks. Let's wait until thefires are out. Let's wait until
the smoke dies down. You know,I'm not asking for months and
months, but a couple of weeks tome is not unreasonable.
Any of my friends will know thiswhen I say this, but I love to
hike. I love to be outdoors, anddefinitely, since the fires, I
(11:10):
have been exercising indoorswhen I exercise and I miss my
hikes. But it's not worth itright now, it's not.
It's not worth it for yourlungs, because if you think
about it, why do we go outside?
Why do we breathe fresh air?
Because it's good for us, right?
Your lungs are happy. They likeit. But right now, if you do
that, they're not going to behappy. We're going to cause
damage to our lining. And one ofthe things that you know at the
very beginning of these firesthat was really troublesome is
(11:32):
the particular matter, the sizeof these molecules from these
fires is very, very small, 2.5pm, which is much smaller than
most of the junk that we'regoing to breathe in, into our
lungs. And so it what theproblem with that is it's going
to travel further down into thelittle branches of our airway,
or what's called the distalairway, the peripheral airway.
It's in that part of the airwayis also much thinner, much more
(11:53):
friable, vulnerable to damage.
So it's going to then causedamage to the part of the lung
that's more difficult to repair.
It's not nice for the lung. Wewant to avoid this, right? And
so that's another reason to wearan 95 because it goes down to a
2.5 versus like a regular COVIDmask, which doesn't but it's
also great reason to just avoidexposure, right? So right now,
going on a hike or going for arun, the things that are meant
(12:15):
to help our health and to buildour lung health, they're going
to do the opposite, right? So itmakes sense, right now, until
the particular matter improves,until we have less bad stuff to
inhale, to just do the exercisesinside. You know? Okay,
so, so all this makes sense, butI do have some follow up
(12:35):
questions to what you're saying.
So, so the first I appreciatethis actionable advice. I agree,
staying inside, and I would add,keeping your doors closed,
keeping your windows closed, andif you have a HEPA filter,
right? That's recommended aswell, to run a filter in the
house.
I love air purifiers right now.
That's probably like, the bestthing I can recommend if you if,
like, somebody listens to thisor anything that I've talked
(12:56):
about or read, if they getnothing else, air purifier, just
like, invest in a nice, decent,little air purifier, you know,
look at square footage that itcovers. Find one that's within a
reasonable price range. Like,you don't all, like, not
everybody has to have a Dysonfor $1,500 right? I'm sure it'd
be nice, but I just have aregular little lap for, like,
1900 square feet, and it doesthe job, you know. And my house
is fine. If somebody has a hugehouse, and they might need a
(13:19):
couple of extra ones for smallerrooms or, like, if there's a kid
that's very sick and they'rereally worried, get a little
individual one for that roomtoo. I think air purifiers right
now, truly, in LAare all the rage. Okay, so if
you're listening and you'regonna take one piece of advice
from this interview, make sureand get yourself an air
purifier. It doesn't matter howexpensive it is, just make sure
that it covers the squarefootage that you need. Thank you
(13:39):
so much for clarifying that,because I do see advertisements
for a variety of HEPA filtersthat really range in price, and
so it can be tricky when youwant to make sure you're doing
the right thing. So that's veryhelpful. And then the other
advice that I've been giving tofamilies is to make sure to
change the filters in theirhomes as well. Yes,
love that. That's a brilliantone. I think that's like,
(14:00):
probably one of the best thingsand the easiest things, because
some folks will go for yearswithout changing their filters,
and you're supposed to do itlike, you know, technically,
every four to six months. Rightnow, everybody should probably
just go ahead and change theirfilters, unless they just did it
right before the fires. So lovethat one. That one's perfect.
Now, my next question has to dowith masks. You brought up
masking as a as a importantprecaution to take when you're
(14:22):
outside. I know when people hearabout masks, there's such a
variety of responses. I think alot of people, I don't know,
they're tired of it after COVID,or they have mixed feelings of
it after COVID. And then for me,personally, I find wearing and
95 uncomfortable. They're hardfor me to tolerate for too long.
So in terms of generalrecommendation, are there some
groups of people that definitelyshould wear a mask, like, for,
(14:44):
for example, kids that haveasthma, the elderly? Are there
certain groups that you thinkvery strongly should wear, well
fitted and 95 mass?
Yes, absolutely. That's that'slike the question of the day,
right? Because, I mean,everybody I think has mask
fatigue. I. I would be lying toif I said I didn't. With that
being said, I like my lungs. Sohere's my mask. Okay, this one
(15:06):
my husband got from, andthat's you like your we like
your lungs. Yes, that's true. Solike, when you ask me a little
sarcastic part of me, of like,which patient groups and like
people with lungs, you know, butit's a little more nuanced than
that. So like, for me, actually,I have slight reactive airways,
and when the fires firststarted, I was running around
without a mask, kind of doing mything. You know, I walk into the
house and my husband's like, canyou please go shower and take
(15:29):
off your scrubs, because he's alot more germaphobic than I will
ever be. But now I'm, you know,getting that way with the
particles. I'll tell you why.
Like, day two, I was sitting onthe couch and I started
coughing, and I just couldn'tstop, and I couldn't catch my
breath, and my throat wasburning, and it just, it just
wasn't fun. Since then, I'vegotten smarter. So then I
started wearing this nice, cutelittle k 95 I think, from Home
(15:51):
Depot, religiously, right when Igo outside, even if it's from my
car to the house to, like, bringin groceries, and the AQI is 20.
I don't care. I don't want tohave that episode again. Now,
for patients, it's moredifficult to try and convince
people who don't have thatpersonal experience of misery,
from a respiratory standpoint,to where their kid, or have a
kid who doesn't want to wearanything, right, pants, less
(16:14):
alone a mask that would be mychild, so like, who needs to
wear the masks, all right? Folksthat are obviously still in
areas where the fires areburning, those are good
candidates for masks. I don'tcare if they have a respiratory
condition. Um, folks with thatdon't, please wear a mask. Like,
just for the love of God, just,just put on a mask. Right? If
that one is easy, I think thatone should be easy. Even if you
(16:34):
have mild, persistent asthma, oranybody who's ever had an
inhaler, just put on the mask.
It's not that like, it's reallynot that serious. This is also
where I lack a little empathy.
It's a mask. Like, yes, they'reuncomfortable. I find them
uncomfortable too. As a doctor,they have been uncomfortable
since I started medical school.
My lungs not having them thatwould be more uncomfortable to
me or like having decreased lungfunction, very uncomfortable, I
(16:56):
promise you, more uncomfortablethan wearing a mask. But going
back to your question, of myfavorite groups, so anybody with
pre existing lung conditions,emphysema, COPD stuff, right?
Anybody with lung cancer, statstuff, anybody with a trait like
the obvious thing, cysticfibrosis, ciliary dyskinesia,
babies, like babies who arepremature, for example, and now
(17:16):
they're three or four or fiveand they still have lingering
chronic lung issues. Those aresome of my patients, but I will
tell you, those parents areusually really easy because they
have the experience ofprotecting their kids lungs and
their lung health. So these arefolks who will have trained
their kids to keep their maskon. I don't struggle with those
parents, but that's not my toughgroup. It's the folks where the
kids are generally healthy, orthe adults that are generally
(17:38):
healthy and they're not used tohaving to think about how to
stay that way, right? They justtake it for granted that we're
going to stay healthy. So forthose groups, that's going to be
tough for me to convince them,like, hey, I want you to do this
thing that's very inconvenient,but they're also not my top
concern group. The top concernwould be immunocompromised
folks, you know, neuromusculardisease folks, because they're
(18:01):
going to have a harder timedoing airway clearance. So
basically, that's a lot ofpatience. And it's not just
asthmatics, it's a lot of otherfolks. I mean, I think this is a
helpful reminder, honestly, formyself included, because as you
said, a lot of us have massfatigue. I still have a mark on
the top of my nose from wearingit at 95 every day at work for a
(18:22):
year and a half. But I think youhit the nail on the head for me
when you said, Why not takeprecaution? Because who wants to
have lung issues after this isall over? So if this is just a
short period of time, it's justa couple of weeks get through
this period until the fires havelong been gone, and the air is
clear. It makes a lot of senseto be on the safe side. Yeah,
(18:45):
I think so. I mean, granted, youknow, when you see a lot of
nails, you tend to like as ahammer, right? Everything is a
nail. So I see lung diseaselike, that's what I do every day
I come to work, and that's a lotof days, because I don't take a
lot of vacation. We have a lotof sick kids. All I see is lung
disease, and I know how we getthere. And it's not, it's not
it's not hard to acquire lungdisease, unfortunately, and bad
air quality is one of the waysto get here. So like, if we're
(19:07):
in this situation, how do we getthrough this in the smartest way
possible? We do the easiestthings, like the the lowest
hanging fruit kind of thing,which is a mask, right? A mask
and an air purifier arefantastic combination to get us
through these next few weeks andget us to the other side, where
then we're not struggling withsome of these long term effects.
(19:27):
Because if we don't do anything,if we just go on about our
business right now, we go backoutside. We go back to eating
lunch outside at school, we goback to having PE at school. We
start doing our jogs and ourruns and our jumping jacks
outside. What's going to happenis a good number of those people
will have significantinflammation, and they will have
significant issues from all thedebris that's landing in their
(19:48):
lower airway. They're going tohave irritation of their lungs,
and then they're going to havechronic lung issues, and they're
going to kind of send their kidsto me, and then my adult
colleagues are going to beoverwhelmed with the number of
adults that are now havingreactive airway symptoms. And
we're going to run out ofsymbiosis. What's
going to happen? And we don'twant that? No, no, no. I think I
prescribed thatlike candy. And the thing that
people might want to think aboutis the way to treat severe
(20:09):
inflammation is steroids,usually. So for folks who don't
want to do things, let's again,weigh like the pros and cons,
wearing a mask, gettingsteroids. I would rather wear a
mask. I don't want I've neverhad steroids. I've never taken
steroids thing up, well, exceptfor the inhaled kind. But like
systemic steroids, I've neverhad a tablet of prednisone in my
body, and I don't really want tohave to get to that point,
(20:30):
right? Like, drugs are not fun.
They're they're a necessity in asituation where we really don't
have other choices. So to me,like preventing the progression
of lung disease is worth it,whether it's a mask, an air
purifier, staying indoors, kindof getting through the next few
weeks, we do have things at ourdisposal. So that's that's a
good thing, right? Like, it'sgreat. We have all these kind of
(20:52):
easy things that we could do toprevent more badness, like,
right now, we already haveenough sad stuff to deal with.
People's homes being burneddown, schools, there's a lot to
deal with. If we can at leastprotect our lungs on the other
side, then we can fix the stuff.
Right? Like, people will havesupport to buy new homes,
replace their clothes. Like,yes, valuable sometimes are not
replaced. But these are thingsdifferent, right? I can't
(21:15):
replace lung health for people,you know what's interesting for
myself, I was out of town forthe weekend during the fires.
Like many Angelinos, we got outof town for the weekend, and I
could tell. I thought maybe itwas psychological, but I don't
think so. But as soon as I gothome and I was in the valley
where I live, a certain area ofLos Angeles, I felt a little bit
of a light headache. I felt itin my chest a little bit. And so
(21:36):
I do think there's something inthe air that's not the same as
it was before. So why not keepprecautions
for sure, for sure, there's noreason not to. So okay, so
apart from the mass and thefilters, is there anything else
that we should do, for example,when I come home from being
outside, should I take a shower?
Should I use nasal saline?
(21:56):
Should I gargle? Is thereanything else that I should do
to clean my body after beingexposed to outdoor particles.
Those are all really good ideas.
I think you're not going to gowrong with any of the things you
said, right? If you're going toshower, you're going to remove
any sort of residue or anythingon your skin, your hair, any
kind of sinus rinse is always agood idea. That'll help clean
your nose if you're feelingsymptomatic, right? If you're
(22:18):
having little bit of sniffles oranything really, you can always
do a little Flonase, just tohelp with that. You can do
gargle. You can really doanything that will help you
clean out, you know, yoursinuses. You could do a neti
pot. You could do humidifier. Ithink those are really helpful.
I've recommended a lot of myfamilies use humidifiers. They
are super dry. So those are kindof nice.
(22:42):
What about other homeopathicproducts, like one that's been
going around a lot has been totake vitamin C or to take NAC.
NAC. Do you have any thoughts onthose products? Yeah,
sure. Well, vitamin C, to me, isactually very allopathic too.
You know, I think I feed my kidlots of food with vitamin C. So
I love vitamin C. I think it'svery helpful. And also just in
conjunction with that iron,because they work hand in hand.
(23:04):
So just whether it's spinach orliver, I really don't care. It
just depends on people's dietarypreferences. So vitamin C all
day, every day, right? Becausewe want to support our immunity.
NAC. I don't have any like, prosor cons. I don't use it
personally. I have not seen itsort of looked at positively or
negatively in the allopathiccommunity. I can research it and
get back to you, but I don'thave, like, personal feelings
(23:25):
about it one way or the other.
Is there anything that you wouldrecommend to promote lung
health? Sure.
Well, yes, absolutely. But youalso triggered my memory of,
like, one thing that's like, Iwouldn't even call it
homeopathic. I guess it's moreAyurvedic related that I like. I
don't personally love it,because when it just tastes
good, I'll tell you what it isin a second, and it helps me.
(23:45):
But that's anecdotal, and likethe entirety of India, like
every Indian friend I've had,which is half my colleagues, as
soon as I mentioned, liketurmeric milk, they go, Oh, my
God, my mom made that for me asa kid, right? So do I recommend
it? Yes, because it's delicious,and you just can't go wrong with
turmeric milk. Okay? This is,like, my one very non allopathic
medical advice, you know, pieceof advice is, you take milk of
(24:07):
whatever type, right? You addsome turmeric in there, you add
a pinch of black salt, and thenwhatever sweetener, like I use
honey, you can use agave,whatever, and you, you know, you
just, you could, like, boil itin a little teapot for a while,
and you get golden milk, orturmeric milk, and that's very
delicious and healthy. And a lotof people will tell you, and I
believe it, but again, it's notlike research in the kind of
(24:28):
science that I practice. So Ihave a hard time being like as a
medical like, MD, I'm notrecommending it from that. I'm
recommending it as a person. Doyou know what I mean? 100%
I love it. I actually, I relateto you all the way. There's the
there's the evidence basedmedical advice that I give, and
then there's the advice that Igive as a mom, as a person,
something that feels like itcould be a good thing to do, why
(24:48):
not? For sure,like honey and tea and lemon.
That's like a classic. Again, Idon't, I haven't done research
on it. I haven't seen tons ofarticles published like, you
know, in PubMed on honey andlemon. But do I recommend it?
Yes, every single. Should Ihave? I tell them, if you can
drink warm water or tea or honeyin your tea, or, you know, eat
your honey and lemon, I thinkthat's like the best combo. So
between the honey and lemon andtea plus the turmeric milk, I
(25:10):
think you have a couple of kindof natural remedies there that I
think are great. Ginger isalways a good thing. So ginger
tea, I think again, one of thosekind of life hacks that a lot of
cultures have used, and I loveall things ginger. Yes,
Ginger shows great, antiinflammatory properties. Taste
good. Why not exactly, we couldput it in our golden milk.
(25:32):
Yes, that's right, you can putit in everything. I think you
can just ginger and garlic. Imean, I could go on about like,
the garlic, the onion. I thinkfood is medicine. So kind of
stepping away from my biomedicalbackground, I really believe
strongly, and maybe it's part ofbiomedicine, but I believe food
is a big part of how we can keepour bodies healthy and strong,
and lungs are part of that,right? So if we eat a bunch of
junk food that will affect ourlungs, versus having a very
(25:55):
vibrant platter of fruits andvegetables and grains and nuts
and kind of healthy fats, thoseare really going to help us
fight off infection, bad air,just keep ourselves healthy. So
I recommend lots of colorfulthings on plates. You know,
absolutely yes, yes, yes. We'respeaking the same love language
here. I totally agree.
Oh my gosh, I could like talk.
I'm trying to control myselfbecause I love food. I love
(26:16):
talking about food and the colorof food like I just think it's
fascinating, and there's a lotbetween how our body responds to
disease or the potential fordisease, and the things we're
putting in fermented foods,again, not coming from my biomed
background, but just kind offrom my life background. I think
fermented foods are superimportant for our health. It
(26:37):
helps our gut and our gut helpswith our immunity. Well, that's
a win. So like, if you likekimchi, if you like natto, if
you like really, anything keyfor fermented foods or the
lungs, you know that that's, Ithink that's where lung health
is at right now.
Okay, so I love this colorfuldiet. Get your nutrients from
the food that you eat. Your foodis your medicine. Don't forget
to have the fermented foods.
It'll help your lung health.
(26:59):
It'll help your gut, andthinking about vitamin C
alongside iron to help withabsorption. I love all of this.
What about exercise? Exercising,having a good aerobic workout?
Wouldn't that help the lungs? Oris that not okay to do right
now,that's a tricky one. It's a yes
and no, I would not probablyencourage right now whole lot of
like fast paced, hardcoreaerobic exercise in areas that
(27:21):
have had significant smokeexposure I had, I think it was
spectrum news where they askedme about going running on the
beach, but they would like whatthey went running and they saw
ash. It was like, Well, no,that's a no go. No running on
the beach when there's ashflying around, it's not going to
benefit our lungs. So right now,I would go from a more
protective kind of approach,because running or aerobic
(27:44):
exercise, that's more like, howdo we build our lung health
forward? Right now, I want tothink about, how do we prevent
damage to your lung tissue? Thebest way to do that is not to
expose the lungs to morepollution, more damage, right?
So I would try and keep it easyand, like, go easy on the lungs
and not do a lot of hardcoreaerobic exercise indoors or
(28:05):
outdoors. If you're in a gym,like, I haven't gone to my gym
in the last couple weeks, if youhave a gym that's got air
purifiers, and, like, they'vereally taken measures to make
sure that the air is very clean,and you feel pretty good about
that gym, okay, you can get onthe treadmill or kind of do
whatever you're going to do.
Going to do, and I'll playpickleball, I suppose. But I
wouldn't think of that as, like,how am I keeping my lungs
(28:27):
healthy right now? It's byplaying hardcore sports. No, I
would actually, right now justtake it easy and wear the mask
and, like, focus on that is, howdo I prevent lung disease,
versus do I need to run an extramile? Not right now. Let's wait
until, like, you know, threeweeks down, then we can, like,
push our our running and ourjumping and all that stuff. But
right now, I would say peoplecan take it easy. I
(28:47):
appreciate that advice. I neededto hear that. So thank you very
much. Is there, like, exerciseat home? I just did a bar boot
camp class today. It's myaddiction, so maybe I need to
think twice about it. So thankyou,
sorry. Sorry the party duringthis century, being a
pulmonologist is really,sometimes super fun, and
sometimes, like, I feel like thebad guy, you know, because I
tell people to do the non funthings, like, I feel very much
(29:10):
like a mom, just like, I'm justmomming Everyone, no, but
it comes from a really goodplace. And as you said, this is
what you see, and so you'retrying to protect people. So I
think, I think it's great, Ithink it's great. I think it's
great to hear and you're theperson that deals with you're
the person that treats issuesthat come up with the lungs, and
you have first hand experiencethat you don't want anybody that
you know or love to deal withit. So I think it's I appreciate
(29:34):
hearing about it. Thanks.
I appreciate you saying thatbecause it is hard. Like, I
definitely get a lot of folkskind of looking at me, like, are
you want us to do what? And Ifeel bad. I don't want to, like,
be crunchy, you know, I don'twant to make people's lives
difficult or miserable. But thenI think to all my kids I've had
who've had these, like, longlasting lung problems. And I
think this is kind of funny. Ithink to like this one older
(29:55):
pulmonologist, when I talked tothem a few years back, I
thought, God, they're so gloomy.
I. And the other day, I waslike, oh my god, I'm turning
into them. This is terrible.
I'm not quite there yet, butyou're not there. I'm
not there, but I'm like, Man,the more stuff you see, the more
you realize, like, no bad thingsdo happen to lungs, you know? So
how do we prevent them? That'swhere it's coming from.
(30:19):
Okay? So just to make surewe've, we've, we've covered all
the big things right in terms ofhow to keep your lungs healthy,
how to prevent issues from thecurrent fire conditions that
we're all exposed to in LosAngeles. Yes, yes. Is there
anything that parents shouldthink about or advise their
schools when they send theirkids to schools? Any anything
that schools should takeprecautions about, that parents
should be aware of, that theyshould bring up to their local
(30:40):
schools.
Oh my god, yes, that's a bigone. And that one today, we
actually had a lot ofconversations in my clinic with
other providers. And then I hada patient come in where the
kiddo has asthma, and the schoolhas already gotten back to,
like, taking the kids outsidefor lunch and all this stuff.
And so the mom was like, Oh mygosh, I really don't want my kid
eating outside and doing allthis stuff. I got on the
principal, because this stuffmeans a lot to me. And like, if
(31:03):
this kid gets sick, like, Idon't want this kid exacerbating
right? So I just wanted to makesure we keep this kid safe. But
also I wanted to kind of figureout what's happening with the
school, and I'm having this isonly principal I've talked to,
but I'm having a lot ofconversations regarding school,
and sort of like, what do we dowith school with different
parents? So for kids like this,anybody with a reactive airway
history, I'm asking, pleasedon't have them be sitting
(31:25):
outside. I don't really carewhere they are, unless they're
in San Diego, okay, Long Beach.
I think I told one family, it'sokay. They can go outside for
their play time, but like in LAproper, let's just keep these
kids inside. No, they cannot goand eat their lunch outside and
then put their mask back on. Youcan. I can't eat through a mask,
and neither can a 12 year old.
You know what? I mean, it's justsilly. People are asking me,
like, well, what if they likeeat and then put their mask? No,
(31:46):
no, that's not an option. Sothose kids need to have a safe
place inside the school with aclassroom or a library or some
kind of a space that has,ideally, not just filters, but
air purifiers. So I know some ofthe schools have already
acquired those. Some have not.
So one thing parents can do isask their schools, what have you
done so far to make sure thatair quality in your school is
safe for our children. What areyou doing? Are you keeping the
(32:08):
doors closed? Are you keepingthe windows closed? Do we have
air purifiers? You know? Howmany square foot are they
covering? What kind of HEPAfilters or other filters do we
have the room that this kid wasgetting access to, was the multi
what is it? The multi somethingroom, multi purpose room. Thank
you very good. Yes, there'sanother part to this word. But
(32:29):
my the mom told me, like,there's no filter in there or
not, there's no air purifier,and the doors are all open. So
it's kind of like pointless. SoI asked the school please keep
this kid in a room that isappropriate. And the school is
really sweet. This thisprincipal was amazing. You know,
she's very helpful, veryagreeable. She's going to work
with the teacher. And I said,also, let the other parents know
that I called and, like, I madethis recommendation, because it
(32:49):
sounds like, from the mom thatsome of the other parents are
calling asking to have theirkids sent outside. That's the
wrong direction, inside, insideright now. Okay, ask the schools
to send your kids inside. That'sthe better place to be with the
doors closed. Okay? We don'twant our kids breathing this
stuff right now. The kids shouldbe inside right for the next
two, three weeks. Yes, the kidsare gonna go bad even get in the
(33:09):
car, drive down, go to likeNewport, and go for a walk on
the beach, and then come back toLA, which is very stinky and
smelly right now, even if wecan't smell it, put your kids
indoors, close the doors, youknow, lock them. So that would
be the school thing, right? Onething that I've noticed that's
been very interesting at thebeginning of all this, my kids
school, which has been amazing,they've sent us updates five
(33:29):
times a day on all the thingsthey're doing to keep the kids
safe, keeping them inside. Idon't know how they do it. So
this is an example of a schooldoing this, right? Where they're
doing the things, and they'rereaching out to the parents and
communicating what they'redoing. So I don't even have to
think, should I send my kid toschool? I trust that what
they're doing is good, and I seethat it's good enough, even for
(33:50):
my very high standards. I've hadother parents be like, Oh, my
school hasn't really reached outto us with anything. And I'm
like, Dude, what are they doing?
And they're like, well, we don'treally know they're going
outside during recess and lunch,like, what about purifiers?
Like, anything you know, andthey're like, We don't know.
Like, you should, you shouldtalk to your school or just keep
your kid home. Because if, ifwhat I'm hearing is your school
(34:11):
is not communicating with you,they're not doing the things.
And I agree, like, if the schoolhas done its due diligence, it's
gone through all of theirprotective sort of gears, and
they make sure they've updatedtheir filters, they've changed
the things, you know, they'veinstalled air purifiers. They're
closing the doors, they'rekeeping the kid in doors. Then
we're good. That's that's aschool that's being responsible.
(34:31):
Myself,I've gotten emails from a couple
of my kids classrooms about whatthey're doing and how they've
updated filters and keeping thedoors closed. But you're right.
If you haven't gotten an email,or you haven't communicated with
your with your child'sclassroom, it's, it's, I think
it's worth just checking in,reaching out, and making sure
that they are doing the properprecautions while your kids
at school, for sure, for sure,and keeping them indoors. You
(34:52):
know. So definitely, my clinicis seeing more volume. I'm
dealing. I'm trying to help alot of people, like by phone or
by. You know, through epic,through like our communication
within the system, because one,the volume is huge, dozens and
dozens of like questions everyday, between my cell phone, my
email and then my inbox, I'mprobably answering like 20
(35:14):
different questions a day aboutfire related stuff from like 20
different families. Wow.
Well, thank you so much for thework that you do and for guiding
people and making them feelbetter.
Well, no problem. It's, youknow, I think this is a funny
time, and I'm really glad you'redoing this, because the more
pediatricians we can communicatethis to, the easier it'll be on
the community. Because one thingI can't say, struggle, the one
(35:36):
thing that's been a point toaddress is the pediatricians, I
think because they don't see thedegree of severity that we do as
pulmonologists, they're morelikely to be sort of more human
in their approach. Like, Well,maybe you don't need to do this.
This is a little overkill data.
Like, we're okay with, you know,100 and over AQI, you can go
back to school, you can go backto sports. And I'm like, God,
please don't, please don't letanybody do anything. But I
(35:57):
can't, I, you know, I can'tforce everybody to just stay
indoors. That's also, like,unrealistic. So I think if we
can get everybody kind of on thesame page about, like, how
seriously to take this, it'llactually help the community at
large more, because I can't takecare of everybody by myself,
right? Like the pediatriciansare, like the first guard, and
then it comes to me once it'sworse, I
(36:18):
definitely I appreciate yourmessage. I hear it loud and
clear, and I'm I actually thinkit's really helpful to hear
because I do agree thatprevention is very important. So
now I'd like to talk aboutsomething optimistic. Tell me
about lung healing, because Iknow, for example, smokers that
smoked for many years when theyquit, when their lungs are no
(36:39):
longer exposed to, you know, badparticles and smoke and
carcinogens that they do, thelungs do miraculously heal
pretty quickly. Can you speak tothat so that parents that are
thinking, Oh, my goodness, Ihaven't my child hasn't worn a
mask for a week or two. Have I?
Have I caused any damage totheir lungs? Tell me about lung
healing. And is this expected,sure? So the lungs are pretty
(37:02):
magical, you know, with a caveatthat sometimes things don't go
in the magical direction, butfor the most part, lungs really
do. The body heals itself verywell, like we are designed to
heal, and our body wants toheal. So that is beyond
miraculous. It's reallyincredible, kind of like you
said with the smokers, right?
People can smoke for years, andthen if they stop and they they
(37:22):
live a healthy life goingforward, oftentimes they can
actually recover the majority oftheir lung health. So we think
about, like, I think as apulmonologist, in terms of
pulmonary function, right? Whatis somebody's pulmonary
function? We can recover a hugeamount of lost function up to a
point, right? So it's importantto also think, like, two weeks
is not going to make a hugedifference. So I don't want
parents to think like, oh mygosh, my kids lungs are just
(37:43):
going to be terrible. They'regoing to get this horrible lung
disease. No, no, we're not. Thereality is, most of the kids are
going to be totally fine. Okay?
The one kid out of 5000 or20,000 or whatever that's going
to potentially have long termeffects, that's the kid I worry
about. But the majority ofpatients are going to be okay,
especially if they take theseprecautions and whatever degree
of lung damage we're allcurrently experiencing, like
(38:06):
sitting here and probably rightnow breathing in something I
shouldn't, but I also know that,like, I'll be fine. So there's
no reason to be sort of likefreaking out or, you know,
punitive with ourselves or ourfriends or family members. If
people haven't been perfectabout masking up or not going
outside, these are just, youknow, it's kind of like food.
Nobody has a perfect eye. Well,maybe some people, but most of
(38:27):
us have a muffin here and there,or, like, a piece of chocolate
or whatever, you know, right?
Yeah, a lot of apple pie that myhusband's been making lately
because it's delicious. And,like, you know, am I gonna have
a perfect body? No, I'm not, butthe pie is delicious. But also,
like, lungs are the same way youcan take a little bit of a hit.
You know what? I mean? You don'twant to take a huge one. And the
(38:50):
funny thing to think about is,where's everybody's threshold?
We have a lot more room with ourlungs than people recognize.
What we don't want to do is getclose to the threshold. So
unless you're sitting there bylike a burning fire and just
inhaling all the fumes, oryou're just downwind from, like
a huge piece of plastic. Thereality is, you're not at your
threshold, okay, and it's goingto be a while before you get
(39:11):
there. And it's all cumulative,so over the course of our lives,
you have to think about, like,how much time do we have to
recover for our lungs right now,with this fire, or all of these
fires, there's going to be somedegree of damage for all of us
who've been in the lake, whetherwe like it or not, little,
moderate, a lot. And then timewill go by, and we'll make
choices for our lungs, and we'llrecover a good amount, if not
all, of our lung health. Andthen something else will happen,
(39:33):
and then some kid will beexposed to a vape, and then
they'll do more lung damage, andthen the parent's going to freak
out, and then they're going toquit their vaping, and then
they're going to restart, andthey're gonna restart, and
they're gonna quit again 17times. Then we'll see you in
clinic, right for vaping likeassociated lung injury, and
then, shockingly, that kid willstill have normal lungs three
years down the road. It isabsolutely crazy. Not all the
(39:55):
kids, like some of these kids,potentially, will have those
outcomes that will make. Them mypatient for the next 20 years,
but the majority of these kidswill actually recover their lung
health and be okay. So I do wantparents to kind of, like, relax
a little bit and do the rightthings. You know what I mean?
Like, I don't want people torelax so much that they go, Oh,
it's fine. The lungs will justrepair themselves. We don't need
(40:16):
to add, like, insult to injuryfor the lungs, but the amount
that we can't control for thelungs will do their job, and the
body will do its job. And allthe vitamin C you're going to
eat from those beautifuloranges, they're going to do
their job. And so the lungs willcome out, and we will breathe,
and all make it, you know,hopefully into our 80s and 90s.
So there's a lot to be said forlike, the body's natural ability
(40:38):
to heal itself with the rightchoices that a person can make
throughout their life, you know.
So what I'm hearing from you isbasically, do the best you can
and have faith that it's allgoing to work out for the best,
for sure, for sure. And then,you know, if you can go to
Hawaii, like half my family,you're doing, do that, that's
also a good option.
I agree with, with all of this,I've definitely been trying to
(40:58):
think about making lemonade fromlemon.
So you have to, I agree, yeah. Imean, look, it could be much
worse, like, God forbid, yes,these fires are not so
fantastic, right? But worsethings have happened to human
beings, like worst disastershave happened to human beings.
We will get through this. It'salready getting better. The
fires are under much highercontainment. You know, things
(41:19):
are going in the rightdirection. The winds are going
in the right direction. They'redying down. So at least it's not
getting worse, and that's a hugething, like it could have gotten
worse, but it's not. It'sgetting better. It will slowly
continue to get better, and wejust have to kind of make the
best choices we can given theresources we have. It's a great
reminderthat I want to be careful for
the next few weeks, and thenbefore I know it, I'll be back
resuming my regular hiking,right? Yes,
(41:41):
and you can call me and we'll gohiking. I'm supposed to actually
go hiking within this so we keepputting it off. So yeah, we're
supposed to go hiking. So we canall go hiking. Once this is
over, I'll let you guys knowwhere I'm emotionally ready to
go on a hike. It'll be fun.
Good, fantastic.
Thank you so much for your time.
Thank you for being here. Thisis a very timely episode. I know
a lot of people reallyappreciate hearing directly from
(42:01):
a pediatric pulmonologist, a kidlung doctor. Not that many of
you, so I really appreciate you.
You sharing your expertise.
Thank you. This was super fun. Ireally appreciate this
opportunity. Thankyou for listening, and I hope
you enjoyed this week's episodeof Ask Dr Jessica also, if you
could take a moment and leave afive star review wherever it is.
You listen to podcasts, I wouldgreatly appreciate it. It really
(42:23):
makes a difference to help thispodcast grow. You can also
follow me on Instagram at ask DrJessica. See you next Monday.
You.
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