Episode Transcript

Daniel Lobell: (00:00)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only, and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or civic needs.

Daniel Lobell: (00:28)
Welcome to the Doctorpedia podcast. I’m your host, Daniel Lobell. And it is my honor today to be joined by not only a phenomenal doctor, but a fellow Daniel, Dr. Daniel Layish. How are you Dr. Layish?

Dr. Daniel Layish: (00:40)
I’m very well, Daniel.

Daniel Lobell: (00:41)
And before we started recording, we had a minute to at least talk about the wonderful group that are Daniels and how almost impossible it is to find one that you don’t like. Isn’t that right?

Dr. Daniel Layish: (00:53)
Yeah. I cannot think of a Daniel that I don’t like. [Daniel Lobell laughs].

Daniel Lobell: (00:57)
Hopefully I won’t change that for you today. [Both chuckle] So I love starting these interviews off by hearing a little bit about the doctor’s backgrounds, about your childhood and what inspired you to go into medicine.

Dr. Daniel Layish: (01:09)
I grew up in New York and I guess I always was interested in science and I actually decided straight from high school. I applied to a six year medical program because I knew that’s what I wanted to do. So that combines college and medical school into six years. I did that at Boston University. I just always thought that medicine was a great career to be able to help people and to be involved with science and with different areas of medical progress and stay interested. I always wanted a career, not just a job, so something that is all encompassing, I guess, in my life.

Daniel Lobell: (02:04)
Well, let me backtrack you a little bit. I’m also from New York. What part of New York are you from?

Dr. Daniel Layish: (02:09)
Oh, okay. Great Neck, Long Island.

Daniel Lobell: (02:13)
All right, I’m also from Long Island, but not from Great Neck, but Long Beach, Long Island.

Dr. Daniel Layish: (02:19)
Oh, okay. Not too far. I think it’s only about 20 minutes away.

Daniel Lobell: (02:21)
Yeah, we used to go to Great Neck for the fantastic Persian food that they have there.

Dr. Daniel Layish: (02:26)
Absolutely.

Daniel Lobell: (02:27)
I don’t know if you’ve ever been to a restaurant called Kolbeh.

Dr. Daniel Layish: (02:29)
That I have not. It’s been a little while since I left Great Neck.

Daniel Lobell: (02:32)
Well, if you ever decide to go on a nostalgic trip back, get that orange rice. Phenomenal. With the rosewater. I don’t know if you’re into that type of cooking, but…

Dr. Daniel Layish: (02:41)
It sounds great.

Daniel Lobell: (02:42)
Yeah. So you grew up in Great Neck and were your parents in medicine as well?

Dr. Daniel Layish: (02:48)
Nope. My father fixed airplanes as an electronics technician for Pan Am. I guess you could say he’s an airplane doctor.

Daniel Lobell: (02:59)
Yeah. He fixed airplanes, you fix people, between the two of you, hopefully you’ll have a safe flight.

Dr. Daniel Layish: (03:04)
Yeah.

Daniel Lobell: (03:04)
But Pan Am, that’s dated. [Both chuckle] So, and your mom, did she work as well?

Dr. Daniel Layish: (03:12)
Yeah. My mom was a social worker and she’s retired now.

Daniel Lobell: (03:17)
Okay.

Dr. Daniel Layish: (03:17)
Also kind of a healing profession.

Daniel Lobell: (03:19)
Yeah.

Dr. Daniel Layish: (03:19)
Human services.

Daniel Lobell: (03:22)
Do you have siblings? Did they also kind of go into that?

Dr. Daniel Layish: (03:25)
No. I do have two siblings, but one of them is an attorney and the other one is an entrepreneur.

Daniel Lobell: (03:34)
Okay. So you all went your own way.

Dr. Daniel Layish: (03:36)
Exactly.

Daniel Lobell: (03:38)
And you mentioned that you were very into science as a kid.

Dr. Daniel Layish: (03:42)
Yeah. I think even in kindergarten, I used to play with the skeletons, the little skeleton model they had.

Daniel Lobell: (03:50)
Yeah. Well that could go either way.

Dr. Daniel Layish: (03:52)
Exactly.

Dr. Daniel Layish: (03:52)
[Both chuckle] Some skeletons in my closet.

Daniel Lobell: (03:58)
Yeah. Yeah. It’s funny, I actually had another doctor on this podcast who specifically also mentioned that they played with skeletons as a kid. And I think that doctor went into, if I recall correctly, into bone medicine.

Dr. Daniel Layish: (04:18)
Oh, wow.

Daniel Lobell: (04:18)
Yeah. Well, yeah, as you guys say, orthopedics. As us people on the other side say, the bone guys! You know? I know that you work with people with hypertension.

Dr. Daniel Layish: (04:28)
Well, I’m a pulmonologist. So anything to do with the lungs. Pneumonia, pulmonary hypertension might be what you’re referring to. Cystic fibrosis, asthma, COPD. And then we also do critical care. So anybody that’s in the intensive care unit, so that could even be a stroke or heart attack or anybody on a ventilator… Sepsis. And then I’m also involved with sleep medicine. So sleep apnea, narcolepsy, insomnia. So it’s a pretty wide range of different things that we do.

Daniel Lobell: (05:08)
Yeah. Well, you know, you’re speaking to somebody who has struggles with some of that stuff myself, and I’ve heard that there is a relation between some of this stuff. I have asthma, very mild asthma. And I also have sleep apnea and I know that they’re making some interesting changes to the way they treat sleep apnea. I’ve heard that there are now surgeries and devices that people get implanted inside of them rather than the mask. Can you talk to that for a minute?

Dr. Daniel Layish: (05:40)
Yeah, sure. So the CPAP masks are a hundred percent effective, but not everybody can get used to the idea of having a mask on their face when they’re asleep. So some of the newer treatments, in the last few years, there’s an implanted device called Inspire, which gives a little electric stimulation to the tongue so that when you go to sleep, the tongue doesn’t flop back and block off your airway. So it’s almost like a little pacemaker device. And then when you get ready to go to sleep, you hit the button and the device starts working and then there’s nothing on your face.

Daniel Lobell: (06:22)
What if you accidentally hit it during the day when you’re drinking a glass of water? Is that like throwing a coaster?

Dr. Daniel Layish: (06:28)
That’s a good question. Yeah. It’s not a real violent shock. [Daniel Lobell laughs] So you’d probably just feel a little tickle and then you’d hopefully run over and turn it off.

Daniel Lobell: (06:39)
I feel like this is the makings of an X-Man, like you started harnessing the power of electricity inside of you or something. Anyway…

Dr. Daniel Layish: (06:48)
I mean, the masks have gotten better too. And then there’s another device that just got released a few weeks ago called Excite OSA, which also works by stimulating the tongue. But it’s something that you put in your mouth when you’re awake for about 20 minutes a day for the first six weeks. And then after that, you just have to do, I believe it’s once or twice a week as sort of a refresher and there’s nothing implanted, but it just — you can put the device in your mouth when you’re watching television and then same concept, your tongue doesn’t flop back and block off the airway.

Daniel Lobell: (07:29)
That’s interesting. So you wear the device at night as well, or?

Dr. Daniel Layish: (07:33)
No, nothing to wear at night. You put it in during the day, you do it for six weeks and it’s sort of like training for a marathon. It builds up the tongue muscle. So it makes the tongue stronger. So it doesn’t flop back and block off the airway.

Daniel Lobell: (07:48)
Wow. Very interesting.

Dr. Daniel Layish: (07:51)
Yeah. That’s brand new. That’s only in the last few weeks.

Daniel Lobell: (07:53)
Super strong tongues.

Dr. Daniel Layish: (07:55)
Yes. [Daniel Lobell chuckles] There’s even some dental devices now you can use that just move the jaw forward so that the airway has more room, so it doesn’t get blocked off at night. So yeah, a lot of people don’t know that because a lot of people say, I” don’t want to have a sleep study because I’m not going to wear one of those masks.” But now that we have so many different options, it’s really important to take care of things. And if you’re not getting a good night’s sleep, then it puts extra stress on your heart. You wake up, you don’t feel refreshed, you’re grumpy, it kind of has a lot of different impacts on your life in different ways.

Daniel Lobell: (08:37)
Well, I wear the mask every night and since COVID, I also wear a mask during the day, it’s almost never that my face is….. [Both chuckle] You could see what I look like anymore.

Dr. Daniel Layish: (08:46)
Hopefully this will all be a distant memory. COVID obviously has impacted us in the pulmonary world quite a bit.

Daniel Lobell: (08:57)
Yeah. Well, I was going to ask you about that because I think it’s impacted you probably more than any other doctor with any other specialty. I mean, it’s like the thing you’ve been training for, right?

Dr. Daniel Layish: (09:10)
Yeah. It’s, like I said, thankfully, it’s gotten a little bit better, but it’s definitely been an eye-opener because it’s been so much to learn, everything, all the information keeps coming in day by day, week by week. And we’re definitely doing things differently now than we were a year ago in terms of how we manage in the hospital, out of the hospital. Now we have those monoclonal antibodies. I helped out with recruitment for some of the research studies when they were doing the monoclonal antibodies. And so now within such a short span to see a treatment like that go from science fiction research to actually being able to help people. That’s pretty gratifying.

Daniel Lobell: (10:01)
Yeah. That’s gotta be an incredible thing to witness in such a short amount of time.

Dr. Daniel Layish: (10:06)
Just seeing the whole world come together to fight this has also been, I think for all of us, pretty — I don’t think any one of us really imagined this type of thing in our lifetime, it’s like something you hear about in the history books, polio and things like that that have been eradicated, but to see a pandemic. I think for all of us, it’s been an eye opener.

Daniel Lobell: (10:35)
Yeah. Anybody knows, who’s followed this, that the lungs are the most vulnerable part of the body to this disease. So what, if anything, have they figured out with regards to treating, say, scarred lungs from COVID, to help restore people to where they used to be?

Dr. Daniel Layish: (10:56)
Yeah, the scarring is really a tough one. It seems like the bodies can heal and we’ve seen people who are very, very sick, for example, on a respirator, and if we’re able to get them through it, then over time, we are seeing that the lungs do have a lot of capacity to heal from COVID. I think that the steroids were not used initially, dexamethazone or decadron is the one that initially was being used. Some people are using Solu-Medrol and definitely we’re seeing an impact in terms of getting people out of the hospital quicker, seeing people that maybe in the past would have had to go onto a ventilator, we can avoid that sometimes. But once the, sort of the “fire,” the inflammation, is gone, then the steroids don’t seem to help as well.

Dr. Daniel Layish: (12:08)
So we get more into a scarring phase or fibrosis. And so now, there are some studies going on. We’re involved in one of those studies, a medicine called deupirfenidone, which is a cousin of another anti-fibrotic agent called pirfenidone that’s already on the market for pulmonary fibrosis. And so we’re hoping that that will help prevent some of the scarring. But as you say, this can be a very difficult problem. A lot of people think about COVID as a nuisance, they’re out of work for a week, and then everything’s fine. But we’re seeing what some people call the long hauler syndrome where people can really have impact for months and maybe years. Some of it is in the sense of taste and smell. Some people are developing very unpleasant smells that can last for months, that can be very, very irritating. That’s not exactly with the lungs, but it’s just one of those things that can impact people’s health for quite some time to come. So I think that’s something that we’re going to have to study more and learn more about and hopefully come up with new treatments to deal with those problems.

Daniel Lobell: (13:39)
Yeah. I myself am in that category, I had COVID about two months ago and still haven’t recovered my sense of smell.

Dr. Daniel Layish: (13:46)
Wow, wow.

Daniel Lobell: (13:49)
Very little, very little I can smell if I like put my nose in the coffee, I can sort of… But I had some difficulty breathing, I mentioned earlier in the interview that I have mild asthma, but I had some pretty bad difficulty breathing as a result of the COVID and it led to me getting mild pneumonia and I was put on steroids. And that all concluded about a week ago. And I’m happy to report that yesterday for the very first time in two months, I had a very satisfying deep breath and —

Dr. Daniel Layish: (14:28)
Oh, fantastic.

Daniel Lobell: (14:28)
I forgot how — you take it for granted, but I forgot how wonderful it is to have a nice deep breath.

Dr. Daniel Layish: (14:34)
Excellent. That’s wonderful news. Hopefully the word will get out there. And I think the vaccines are very, very safe and hopefully we can spread the word to avoid some of these problems. People have different reasons that they’re afraid of vaccines and many of them are understandable fears, but I think we need to try to get past that because certainly, that’s really going to be very necessary to be able to get our lives back to normal and prevent further people from getting sick and dying from this virus.

Daniel Lobell: (15:13)
For somebody like me, do you think it’s still beneficial to get a vaccine, now that I have these antibodies?

Dr. Daniel Layish: (15:21)
At this point, everybody believes that it is beneficial. They usually recommend waiting three months after you’ve had the infection. I think part of the reason is, you had one particular strain of COVID, but the vaccine will protect you against other strains. So your antibodies would only right now protect you from that one strain that you had, but you could get reinfected by a different strain.

Daniel Lobell: (15:49)
How many strains are there?

Dr. Daniel Layish: (15:53)
I don’t know the exact number. You keep hearing about more and more. South African strain, British strain. And so we don’t routinely test in clinical practice, if somebody comes into our hospital, we just say they have COVID, so we’re not routinely testing for the different strains, but I think on a more research level, programs like the CDC, Center for Disease Control is probably getting more involved with tracking some of those different strains.

Daniel Lobell: (16:26)
Yeah. I mean, that’d be interesting to know, and then you could compare strains, like trading cards, like, “Hey, British strain, I’ll trade you for the South African.” And how did these strains develop? Did they just come off of the same initial virus and they morphed a little bit?

Dr. Daniel Layish: (16:43)
Yeah, unfortunately, it’s basically a survival mechanism for the virus if there’s a random mutation that alters the virus DNA, that then gives it some survival advantage, and then that virus starts having babies, so to speak. So yeah, it evolves.

Daniel Lobell: (17:12)
And how is it then that the vaccine covers all the strains?

Dr. Daniel Layish: (17:17)
Well, what they have in common is this spike protein. So the, like the messenger RNA viruses, they give the body immunity. Basically it’s almost like getting the answers to the pop quiz that they’ll recognize, your body will recognize the spike protein as a foreign invader. And so that will be present on all the strains. So at least as of now, the data seems to indicate that you’re better off getting the vaccine, even if you had a COVID infection.

Daniel Lobell: (17:57)
Interesting. So I’ll follow the data now that I have this three month window to… I’ll hope that they work fast. So I have an understanding of what you’re doing.

Dr. Daniel Layish: (18:08)
Yes. Yes. I don’t want you getting sick again after you just got better.

Daniel Lobell: (18:08)
Yeah. Me either. Enough is enough! Doctor, we all have to get good. We got to get healthy now. It brings me to my next question for you, which is, what type of recommendations do you have for patients in terms of building good lung health?

Dr. Daniel Layish: (18:23)
Let’s see, obviously staying away from cigarettes, quitting smoking has been shown to be beneficial regardless of age. Sometimes we’ll see an 80 year old person who says, “I’ve been smoking for 50 years, what’s the point of quitting now?” But it’s actually been shown that at any point, if you quit smoking, your life expectancy is going to be better than if you continue to smoke. Vaping is one of the bigger dangers that we’re seeing. People used to say, “Hey, I’ll quit smoking and I’ll start vaping instead. It’s better.” Some people do think it’s probably still better than cigarette smoking, but we’re seeing lung disease in otherwise young, healthy people that the only thing we can attribute it to is the vaping, especially seems to be a problem when people are cooking up the recipes in their backyard, so to speak, and vaping all kinds of things into their lungs. Really the only thing our lungs are built for is God’s air. So whether it’s cigarette smoke or vaping, we’re seeing people getting pretty sick, even young people wind up in the intensive care unit on a ventilator from what they call vaping induced lung injury, VILI. So I think that’s one of the things, I think in all fields, definitely in pulmonary, things are always changing and people do come up with new problems.

Dr. Daniel Layish: (20:11)
Certainly, you always hear people in the older age say, “If I would’ve known when I was 20, I never would’ve started smoking,” but the young people are picking up vaping and there’s money to be made. So there’s companies that are going to sell these products and unfortunately they still have the nicotine, they’re still addictive. So we’re seeing young people get addicted to these products. And so it’s hard, even when people realize it’s bad and they want to quit vaping, then it’s not so easy because they’ve become addicted.

Daniel Lobell: (20:52)
Yeah. I always thought to myself, if there was a way that we could make sort of like a vape thing, but it was steam or something that opens up your lungs or maybe has mint in it or something that could be beneficial to your lungs, that can give you the feeling like you’re smoking and you’re blowing something out, but it’s actually helping you in a way. Because I’ve been on a nebulizer, and I remember it feeling, thinking to myself, “Oh, it’s kind of like smoking.” [Daniel Lobell laughs] But what if there was a healthy thing? Have you ever heard of anything like that, where it’s like a cigarette, but it actually helps your lung health?

Dr. Daniel Layish: (21:35)
Well, I mean, obviously we do nebulize a variety of medications. I think probably in the future, we’re gonna see more of that. We now have nebulized antibiotics. Things like tobramycin can be given through a nebulizer. It’s usually not to treat an actual infection, but to suppress a chronic infection. And we’re now seeing nebulized medications for pulmonary hypertension. So to lower the pressure inside the lungs. We now have nebulized medications and they’re even looking at nebulized medications for conditions like a genetic condition called alpha one antitrypsin deficiency. Right now the treatment is intravenous. So people that have that genetic disorder have to take an intravenous injection once a week, but they’re doing studies to see if they can deliver that medication directly into the lungs.

Daniel Lobell: (22:40)
So the lungs really are a crucial distributor within the body, it sounds like.

Dr. Daniel Layish: (22:49)
Yeah, absolutely. It’s our main filter to prevent infections, viruses, bacteria. So we have mechanisms in the lung to protect us from foreign invaders. And then of course those amazing little air sacs, the alveoli, that exchange, bring in the oxygen and get rid of the carbon dioxide. And so people start noticing it, like you said, we take it for granted when everything is fine and we can breathe. But if anything goes wrong with the lungs then people know it pretty quickly.

Daniel Lobell: (23:31)
In preparing for this interview, I read that you’re a board certified internal medicine specialist, a pulmonology disease specialist, you’re certified in critical care medicine and of course in sleep medicine. So, whereas I normally ask the doctors why you chose one specialty, I’m going to ask you why you chose so many.

Dr. Daniel Layish: (23:54)
So internal medicine is the starting block for a lot of specialties. You have to do a three-year internal medicine residency if you want to become a gastroenterologist, cardiologist, pulmonologist, or some people do the three-year residency in internal medicine and go practice either internal medicine or work at a hospital as a hospitalist. So internal medicine is sort of the building block. Traditionally, because pulmonologists take care of people on ventilators, and so many patients in the intensive care unit are on ventilators, the pulmonary critical care combination is very common. So for example, I did a three year fellowship in pulmonary critical care after my three year residency. I could have done a two year fellowship for pulmonary or a two-year fellowship for critical care. But to me, doing three years gave me the two specialties instead of two years to get either of the other specialties, if that makes sense.

Daniel Lobell: (25:14)
Makes sense to me.

Dr. Daniel Layish: (25:14)
And so I like the variety. Because in pulmonary, we take care of people in the office, we take care of people in the hospital. Critical care is obviously only hospital-based and they’re sick patients, but, right now I’m taking care of a patient in the intensive care unit that I had met in the office. And sometimes we take care of folks in the intensive care unit and hopefully they get better. And then they come see us in the office and they, usually they never forget us if you saved their life at the intensive care unit. So I kinda liked that whole spectrum of, and it makes every day a little different. So some people also get involved in critical care from anesthesia. So we have colleagues that are anesthesia critical care, surgical critical care. So they take care of really sick patients in a surgical intensive care unit. Some people are now specializing in neurologic intensive care, specializing in strokes and bleeding inside the brain like subarachnoid hemorrhage. So critical care is changing a lot. It’s different than it was certainly 20 years ago when I started.

Daniel Lobell: (26:34)
Yeah. Critically so, I imagine.

Dr. Daniel Layish: (26:37)
Yes.

Daniel Lobell: (26:39)
I brought up earlier hypertension and you mentioned, of course, that one of your expertise is pulmonary hypertension. For someone like me, who has no idea what that means. Can you break it down?

Dr. Daniel Layish: (26:51)
Right. Yeah, so you have separate blood vessels in the lung. The heart pumps the blood from the left side, the left ventricle, then the blood goes to your entire body, let’s say the muscles, the kidneys. And then when the organs use up the oxygen, the veins bring the blood back through the right side of the heart. And then from the right side of the heart, it goes to the lungs, picks up the new oxygen, and then it goes back over to the left side of the heart. And then this is like an assembly line, it’s a cycle that repeats over and over again, but on the right side of the heart, if there is anything that increases the pressure inside the lungs, that’s how people can get this pulmonary hypertension. So there’s a whole list of things that can cause pulmonary hypertension.

Dr. Daniel Layish: (27:51)
Sometimes we never find out what the cause is, and the fancy word for that is idiopathic, unknown cause. But we also see pulmonary hypertension with diseases like scleroderma, which is an auto-immune disease. Certain, medications, you may have heard about a diet pill called Fen-phen that was used a while back, and so that’s now off the market because that medication caused pulmonary hypertension. You could also wind up with pulmonary hypertension from blood clots. Also from things like, you may have heard some people are born with a hole in the heart that we call an atrial septal defect or a ventricular septal defect, either a hole in the top of the heart or a hole in the bottom of the heart. And then over many years that can lead to this pulmonary hypertension. So it can be a very tough illness to diagnose because, with regular hypertension, we just measure it with a blood pressure cuff on the arm.

Dr. Daniel Layish: (29:04)
But for pulmonary hypertension, we sometimes can get a clue by doing what’s called an echocardiogram, which is a sound wave test of the heart. But usually to really confirm it with a high degree of certainty, then we have to do a more invasive procedure called a right heart catheterization to actually measure the pressures inside the right side of the heart. So because it’s a little bit more invasive than sometimes, the research actually has shown that oftentimes it can be two years from the time of a patient starting to have symptoms until the correct diagnosis is made. And oftentimes people will see multiple different doctors before somebody realizes what’s going on.

Daniel Lobell: (29:58)
Yeah. Wow. Yeah. That’s pretty wild. You can’t quite put a cuff around the lung, I suppose.

Dr. Daniel Layish: (30:10)
Exactly. A lot of progress. I mean, that’s another thing. Like in my career, I finished my fellowship training in 1997 and at that point there was only one medication that was approved by the FDA to treat pulmonary hypertension. And I believe now there are over 10 medicines to treat pulmonary hypertension. So it’s a little bit surprising how quickly things change. You go to medical school and you figure this is the “be all the end all,” and then you come out of training and you start practicing and you realize how quickly things change. And so I think that really, one of the most important things really that we learned in medical school is that you’ve gotta keep learning, how to roll with the punches, so to speak.

Daniel Lobell: (31:08)
Are people getting lung transplants? Is that a thing that happens?

Dr. Daniel Layish: (31:12)
Absolutely. Absolutely. And that’s also gotten better. The limiting step right now with lung transplants is, the organs are scarce because, basically the people that are organ donors usually have to die in a certain way, such as a motorcycle accident. So if somebody gets thrown off a motorcycle at 60 miles an hour and hits their head and the brain swells, and unfortunately that person, let’s say might become brain dead, but their heart and lungs and everything are still working, and so that would be the type of situation where, that’s how the lungs are obtained to give to somebody else. It’s very, very rare, some people have done what’s called living related lung donation. So I’ve only seen one patient in my career that got a left lower lobe from her brother and a right lower lobe from her sister.

Dr. Daniel Layish: (32:24)
And she was small enough that that’s all she needed. But normally, the lung comes from somebody who was declared brain dead. They’re trying to work on what’s called xenotransplantation. So eventually they might be able to give us a pig lung or a cow lung, because right now, the organs are very scarce, so sometimes, people have to wait months. It used to be years, but I think they changed the allocation system so that now the waiting time is less for lung transplant. So for people who are, let’s say — the criteria to get a lung transplant is very strict, so they’ll never give a the lung transplant to somebody who is still smoking. Usually it has to be six months smoke-free and they have to otherwise be in excellent condition. So you have to have good liver, good kidneys, good heart in order to qualify for a lung transplant. But yeah, that’s really been very gratifying to see some of the patients benefit and go on to live a very good quality of life after a lung transplant. Right now, it’s about 60% of people that make it to the five-year mark after a lung transplant. So that means 40% of people who have a lung transplant live less than five years.

Daniel Lobell: (34:10)
Yeah. It sounds like there’s a lot of progress still to be made there. When you told me that it used to take years to get a lung transplant and now months, my first thought was that more people were getting motorcycles. [Both chuckle]

Dr. Daniel Layish: (34:26)
I think it’s because they changed the — it used to be that you had to build up time on the list. And now they’ve made it more so that if you’re sick, you just go right to the top of the list. So I think that’s really why the waiting time went down, it’s that they changed the rules for how you can get a transplant. Everything with the transplant goes through a national organization called UNOS to make sure that everything’s fair so that people shouldn’t to be able to jump in just because they’re wealthy or famous and things like that.

Daniel Lobell: (35:04)
I wrote something down here when I was looking at what you do, which was listed as one of your areas of expertise, and I’m going to attempt to say it. I thought this was unique because I’ve never seen such a long word.

Dr. Daniel Layish: (35:21)
I think I know what it is.

Daniel Lobell: (35:21)
Let me see how close I get. Lymphongeal…..

Dr. Daniel Layish: (35:32)
Lymphangioleiomyomatosis,

Daniel Lobell: (35:37)
[Both chuckle] I’m sure it’s not something you want to get. Because — but what is it? And why couldn’t they break it up into two words?

Dr. Daniel Layish: (35:49)
So it’s a disorder that affects almost exclusively women of childbearing age, and it can cause little cysts in the lungs, which eventually can lead to shortness of breath, lung damage. It can also cause what we call a spontaneous pneumothorax where the lung collapses and has to be reinflated with a chest tube. And it can cause fluid buildup around the lung, what they call a [?] pleural effusion, and actually it’s one of the conditions that sometimes requires lung transplant. Initially people thought that because it only occurred in women of childbearing age that they would treat it with hormonal manipulation, like taking out somebody’s ovaries, but it turns out that didn’t help. And interestingly, now it’s actually treated as more of an autoimmune disease with medications that suppress the immune system. And so that’s actually been something in the last few years, that’s helped a lot of people with their disease, but it usually occurs in young women and then you can get them very, very sick, and they love to ask about it on tests because there’s a lot of little unique things that you can put on a board exam to ask about it because it’s associated with a certain type of kidney in the tumor — tumor in the kidney, I should say, called the angiomyolipoma.

Dr. Daniel Layish: (37:35)
And some people also can get — there’s an overlap with a condition called tuberous sclerosis that can cause seizures. So there’s a lot of different questions you can ask about what percentage of people have this or that. So it’s sort of well-known to the doctors taking board exams because it’s a very — a lot of questions that you can ask about it.

Daniel Lobell: (38:04)
How common is it?

Dr. Daniel Layish: (38:07)
It’s rare. I think I probably have about 15 patients that I’m following now in my practice. And by word of mouth, that’s probably more than many pulmonologists have, I don’t know the exact number in terms of like nationally, how many people have it. But it’s definitely, it’s not as common as asthma or COPD of course. But when you have it, you want someone that knows about it and knows how to treat it, of course.

Daniel Lobell: (38:49)
You’re the guy.

Dr. Daniel Layish: (38:49)
One of them. It’s — what I do in a private practice setting, let’s say something like this lymphangioleiomyomatosis, some people in academics, that’s all they would do, it’s their specialty, but I really enjoy what I do in private practice, I’m able to take care of people with pulmonary hypertension and cystic fibrosis and what we call lam, that long word that you had a hard time pronouncing, for ease of pronunciation, we just call it lam, L-A-M. So in the academic centers, the doctors that are sort of super specialists might just handle one or two of those things, but in private practice, we get to take care of a very wide variety. And I think that really keeps things very interesting, to be able to take care of such a wide variety of problems. And like I said, I feel like with my career, my job, every day is different. No two days are the same.

Daniel Lobell: (40:12)
That seems like the reason why I guess you would do so many different things, because you don’t want to get bored.

Dr. Daniel Layish: (40:21)
Exactly. [Both chuckle]

Daniel Lobell: (40:21)
I feel if I was a doctor, I’d do it the same way. I like routine, but I like it to be interesting and different and challenging.

Dr. Daniel Layish: (40:31)
Absolutely.

Daniel Lobell: (40:31)
So I know that you’re a founding medical partner with Doctorpedia and that you are involved in the pulmonary channel with Doctorpedia. Can you tell me a little bit about what that’s going to entail and what we can look for?

Dr. Daniel Layish: (40:46)
I think that the idea of Doctorpedia is to give people reliable information straight from physicians. There’s so much information now on the internet. People go to, we call him Dr. Google, sometimes before they see the doctor or after they see the doctor, and a lot of the messages and the information can be confusing. So I think it’s really important for people to have a source that they can trust and hear information straight from physicians. Sometimes we’re busy in the office and people may not get all their questions answered. So I think it’s an important way to add to the information. Not going to be a substitute for seeing a doctor, but for people to be able to research their conditions, understand what’s wrong with them, or what’s wrong with a loved one. And to be able to hear it straight from physicians and maybe they’re in a small town somewhere, where there is not a specialist in lymphangioleiomyomatosis or cystic fibrosis, pulmonary hypertension…

Dr. Daniel Layish: (42:01)
So certainly the internet has made the world a smaller place, by doing the Doctorpedia, if we can be able to get good information out to people to educate themselves. And that way maybe they can go into the doctor’s office already having some information, be able to ask better questions… I never mind when my patients read and ask questions. It sometimes could be a little bit bothersome when people wait to get on the Internet and then they decide that they know what they need, they say “I want this medicine, because I read about it on the internet.” That’s different from saying, “Hey, I read about this. What do you think? Would it be something that would help me?” That’s never offensive, but when people come in and they decide that they already know what’s wrong with them, and they just need you to write a prescription for what they want. I have a mug in my cupboard that says, “Your Google search is not a substitute for my medical degree.”

Daniel Lobell: (43:15)
[Daniel Lobell chuckles] I like that. Speaking of people self-diagnosing, I’ve done a little bit of it myself in the last day or two, and don’t get mad at me, but I’ll tell you what I think.

Dr. Daniel Layish: (43:27)
Okay.

Daniel Lobell: (43:28)
I think that I’ve developed GERD from the coronavirus.

Dr. Daniel Layish: (43:34)
That could be. That could be.

Daniel Lobell: (43:34)
And, is there any — for the listeners, GERD is — I’m sure you’d be able to tell them better than I, but based on what I’ve read, it’s an acid buildup in the esophagus, is that correct?

Dr. Daniel Layish: (43:52)
Yeah, that’s absolutely true. So the GERD stands for gastroesophageal reflux disease and what people might commonly call heartburn. And most people think heartburn is not a big deal. You take a couple of Tums and it’s gone. But for many people that have this acid build up on a regular basis, it can cause scar tissue in the esophagus, what they call a stricture that then would have to be dilated. It can cause, over many years, it can increase the risk for cancer in the esophagus. Some people get what’s called Barrett’s esophagus, which is a precursor to cancer of the esophagus into that needs to be monitored more closely. And then there’s also a whole list of things that we call the extra esophageal manifestations of GERD, which include acid hitting the vocal cord. So people can get hoarse, they can get polyps on their vocal cords.

Dr. Daniel Layish: (44:52)
It can cause a lot of coughing. So really, quite a few different ways that it can be bothersome. And some people don’t realize that it’s GERD, they might wake up in the morning and they’re coughing and they don’t really notice the heartburn, but maybe they’re having a heartburn when they’re asleep. So we call that silent reflux. And, yeah, I think part of that is diet related, eating right before we go to bed, part of it could be stress related. It can be weight related. I have not heard of it directly being related to the COVID virus. But there might be a connection.

Daniel Lobell: (45:43)
I’m going to have to go and see a doctor rather than Dr. Google, but I’ve just felt that I’ve had this acid build up there ever since I had COVID and it’s very uncomfortable.

Dr. Daniel Layish: (45:55)
Yeah. You can try, in the meantime you can try some over the counter, like omeprazole or prilosec. It’s safe to take on a short term basis over the counter to see if it’ll quiet things down, but eventually, you need to get it checked.

Daniel Lobell: (46:12)
Yeah. Well, I’ll do that. I’ll take your advice on both counts and I’ll go with the prilosec becauseI can remember the name. [Both laugh]

Dr. Daniel Layish: (46:20)
Okay.

Daniel Lobell: (46:22)
Unless the other one you think is significantly better in which case I’ll write it down.

Dr. Daniel Layish: (46:26)
No, the prilosec should be good.

Daniel Lobell: (46:29)
Okay. Thank you, doctor. I was getting a little free advice.

Dr. Daniel Layish: (46:34)
I’ll send you, I was going to say, I’ll send you my bill. [Both chuckle]

Daniel Lobell: (46:39)
So speaking of good health, what kind of things do you recommend that patients do in general to keep up with their health?

Dr. Daniel Layish: (46:53)
So we talked about quitting smoking, avoiding vaping. Of course, aerobic exercise is great for the lungs, walking, swimming, running, bicycle riding, trying to maintain an optimal weight to avoid getting overweight, or significantly underweight is also not good for people with lung conditions or to help prevent problems. And let’s see. Other than that, one thing that’s been kind of interesting that’s sort of a complementary medicine type of treatment is a salt therapy that I’ve gotten involved with. The medical term is called halotherapy, there’s a word in Greek. The halos means salt. So I have sent people now for about the last 10 years to these salt chambers or salt rooms that used to be used in Eastern Europe when people had various respiratory illnesses, but the salt seems to help fight infection as well as inflammation.

Dr. Daniel Layish: (48:09)
And it also tends to humidify the secretions. And so people with things like chronic bronchitis, sometimes chronic sinusitis or cystic fibrosis, have definitely noticed that they feel better when they go to these salt room treatments. Right now, the treatments are not covered by insurance, but they’re not terribly expensive for most people. So that’s something that, I’m hoping we’ll see more studies and perhaps eventually it will be covered by insurance. A lot of people have noticed they feel better when they’re out by the beach, so it’s kinda the same concept, but it brings the beach to you. So people that start to feel like they’re coming down with something, making a trip to one of these salt chambers or salt rooms sometimes can be a way to keep the lungs healthy.

Daniel Lobell: (49:15)
And does it affect your sodium levels?

Dr. Daniel Layish: (49:18)
It doesn’t seem to. Excellent question. Yeah, it doesn’t seem to.

Daniel Lobell: (49:23)
Well, doctor, it’s been a real pleasure getting to speak to you today and I’ve certainly learned a lot. It’s been a fascinating interview.

Dr. Daniel Layish: (49:30)
Thank you, Daniel, enjoyed talking with you.

Daniel Lobell: (49:33)
I’m going to ask you this and I know it may sound redundant because you did just tell people what they can do to stay healthy, but I’m going to ask you now specifically about yourself. What do you do to monitor your own health?

Dr. Daniel Layish: (49:46)
I’ve recently gotten one of the Peloton bicycles and I’ve enjoyed that quite a bit, especially with COVID now and we can’t travel. So with the Peloton, you can ride your bicycle in London or Rome or Abu Dhabi. So I’ve enjoyed that and you can sort of compete against yourself and you can follow your friends who are exercising on the Peloton. So I’ve been doing that every day before I go to work.

Daniel Lobell: (50:15)
I have one too, and I got it right the week before I got COVID. So I haven’t been able to enjoy it yet, but hopefully now that I’m breathing again, maybe I’ll see you in Abu Dhabi or something. [Both chuckle].

Dr. Daniel Layish: (50:34)
I look forward to it. Yeah.

Daniel Lobell: (50:36)
Thank you, doctor. And I have to tell you that you have only reaffirmed my belief in Daniels having spoken to you today.

Dr. Daniel Layish: (50:45)
Yes. Daniels are right at the top of the list.

Daniel Lobell: (50:56)
We’re a top shelf people! One Daniel to another, I look forward to watching your channel and everything you’re going to be doing on Doctorpedia.

Dr. Daniel Layish: (51:02)
Thank you so much, Daniel. Stay well.

Daniel Lobell: (51:04)
You too.

Daniel Lobell: (51:06)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only, and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs.

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