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Pulmonology and critical care specialties address health risks common in West Virginia

WV Press Association

LEWISBURG, W.Va.— If you think pulmonologists always focus on a patient’s lungs, you’d be wrong.

Tom Takubo, D.O., of the West Virginia School of Osteopathic Medicine’s (WVSOM) Class of 1999, said many people don’t realize how intimately the lungs are intertwined with other organs involved in the breathing process.

“As a pulmonary specialist, you do learn the lungs at a much greater level,” Takubo said. “But the body has a lot of redundancy, and you can sometimes lose a third of your lung function before you notice a problem. When patients come to me, I’m often diagnosing heart problems, because the lungs are just one piece of the process. Lungs put oxygen into the blood, the heart has to push that blood, the blood has to carry it, and then it has to be able to jump from the blood to the tissue. If there’s a problem in any of those areas, it’s going to make you short of breath. So figuring out why oxygen isn’t getting there often falls to a pulmonologist.”

Takubo, a pulmonologist and critical care specialist, is a founding physician and partner in Pulmonary Associates of Charleston, W.Va., a lung center that was the first in the state to incorporate electromagnetic navigation bronchoscopy (ENB), a procedure that changed the way lung cancer is diagnosed. ENB allows physicians to more accurately guide endoscopic tools through the bronchial pathways.

“In the past, if you had a spot on your lung, most of the time they would have to remove a piece of the lung to biopsy it,” Takubo explained. “Half the time it was benign, but lung cancer is so dangerous that you didn’t take a chance. Because there are so many twists and turns as the airways divide, a bronchoscopy only gave you about a 14 percent chance of getting where you wanted to go. When ENB was introduced in 2008, it was a game changer. If someone had a suspicious-looking spot on the lung, you could now triangulate your exact position and get to the spot without cutting the person open.”

Takubo, who is also majority leader for the West Virginia state Senate and recently became executive vice president of provider relations for the West Virginia University Health System, completed an internal medicine residency with WVU and a pulmonary and critical care fellowship at East Tennessee State University. He said the specialties of pulmonology and critical care have enough in common that physicians considering these fields have multiple options once they finish an internal medicine residency.

“There’s a lot of overlap between what a pulmonologist does and what a critical care doctor does. Because of that, you can do a two-year fellowship and become a pulmonologist, or you can do two years and become a critical care specialist — or you can combine them and do three years. The overlap allows you to shorten your fellowship,” Takubo said.

He said one of the advantages of specializing in pulmonary medicine or critical care is that it can address one of the problems many of today’s physicians face: the potential for burnout.

“If you’re a trauma surgeon or emergency room doctor, it’s exciting, but more excitement means more adrenaline, and more adrenaline means more fatigue,” he said. “With pulmonary medicine, you get a mixture of office work, where you’re not worrying about your pager, and higher intensity things like the hospital or intensive care unit. Having that mix extends your shelf life. You’re not doing something with full intensity all the time. And critical care was challenging in the past because being on call was so difficult. But now it’s changed, and most critical care is shift work, similar to what ER physicians do, which is better for quality of life.”

It’s especially important that medical schools produce physicians who become pulmonologists in the Mountain State, where, according to the West Virginia Division of Tobacco Prevention, 25.2 percent of adults are smokers, compared with 15.5 percent nationally. Takubo said that’s just one of several reasons the demand for the specialty is high in the state.

“West Virginia has the highest incidence of smoking in the nation, and we have the coal industry, which can be damaging to the lungs because of silica dust. We’re also in the ‘Histo belt’ — histoplasma capsulatum is a fungus dropped by birds and bats, and it ends up in the soil. It causes histoplasmosis, which leaves nodules in the lungs that doctors have to do imaging on because they look identical to lung cancer. All these things keep pulmonologists busy,” he said.

Takubo, who was named to West Virginia Executive magazine’s Health Care Hall of Fame in 2022, recommends that students enter medical school without preconceived ideas about their future specialty.

“Prior to or during medical school, you may be fixated on what you think you want to do. I would instead pay attention to what you love,” he said. “I love being a pulmonary and critical care doctor and taking care of patients. I love the feeling you get when you’re at a restaurant or store and somebody stops you and says, ‘You saved my family member’s life,’ or even ‘My family member didn’t make it, but thank you for taking care of them.’ Families see how hard we work to give everybody the best chance we can, and that’s rewarding.”