Tip:
Highlight text to annotate it
X
Dr. Rubeiz
My name is Dr. George Rubeiz. I'm a internal medicine based physician, board certified
in internal medicine, but also subspecialty trained in both pulmonary medicine as well
as critical care medicine.
What is your specialty?
I'm one physician of a group of approximately 18 physicians and our group is known as Community
Pulmonary and Critical Care Medicine. We take care of most of the inpatients who are fairly
sick at Community North as well as Community East hospitals. We also take care of outpatients,
predominantly for pulmonary diseases. We have a couple physicians who do sleep medicine.
So as a group, we encompass internal medicine, pulmonary critical care, as well as sleep
medicine. We tend to be involved in the care of the sicker patients rather than the straightforward
cases.
What special procedures do you offer?
Our latest introduction of technology has been what we call "EBUS"--that's E-B-U-S--or
endobronchial ultrasound. And what this procedure allows us is to identify tumors that are within
the chest, but not directly visible in the bronchial tubes or the trachea.
Can you tell us more about the EBUS procedure?
Just to orient you, this is a copy of the catscan. This is an image obtained in the
middle of the chest. This would be the patient's back; this would be the patient's front. This
would be the right side and this would be the left side. Everything that is densely
black represents the lungs. These two black spots there represent the airway. And this
is the airway to the right lung--what we call going towards the right upper lobe. In this
image, everything that is gray is tumor here. And everything that is lighter gray or whitish
is a blood vessel. And you can see that in this case, the tumor is wrapped around the
airway as well as the blood vessel. The traditional way of trying to obtain a biopsy from a tumor
such as this one is perhaps to try to stick a needle between the ribs into the tumor.
You can see that there are lots of blood vessels here. This may result in bleeding. This will
definitely puncture the lung and may result in a collapsed lung. The other way that we
have done in the past would be to go in this airway and somewhat hope that we don't hit
a blood vessel and stick a needle in. Now under ultrascopic guidance we can tunnel through
the scope into that airway, and we can exactly see where these blood vessels are and where
the tumor starts and where the tumor ends. And under guidance, we stick a needle right
in the center of that tumor. This allows us to obtain a diagnosis very quickly that has
a very high likelihood of being diagnostic. Our success rate in establishing a diagnosis
is approximately 85%. And this procedure will allow us to make a diagnosis in a very quick
manner because I have the pathologist standing at the bedside of the patient while I'm doing
the procedure. When we obtain the specimen number one, the pathologist looks at it under
the microscope. If the diagnosis is established, we may stop there. But typically it takes
three, four or five separate samples until we're sure we've sampled every single gray
area that you can see here. This is done safely. So far, we have not had a single complication
that was serious.
Can you tell us about one of your patients?
We had a patient who came in who was extremely short of breath, and we knew from the catscan
that there is a high likelihood of lung cancer. With the bronchoscopic ultrasound, that EBUS
procedure that I just described to you, we're able to bring the patient down to the suite
and within an hour or two are able to obtain a diagnosis. The pathologist at the bedside
confirmed a diagnosis of small-cell lung cancer, which is a very aggressive form of tumor.
Within four hours after making the diagnosis, the patient had consented to being given chemotherapy
and started on treatment. Two to three days later her airway improved dramatically. We
were able to send her home without any complication and right now she is still getting her outpatient
chemotherapy and is doing fine. She was able to enjoy the holidays at home.
How can patients and physicians contact you?
Sometimes patients call us directly, though we almost always prefer having a referring
primary care physician calling our office or making, initiating a referral.
What do you enjoy about practicing at Community Hospital?
I'm proud to be affiliated with this institution. What I have seen over the past ten to twelve
years is dramatic improvement in patient delivery, patient care. Community Hospital is patient-centric.
They really care about patient outcome and safety. And we continue to strive towards
improving our quality of care.