BREATH TAKING – a book review

We take 7.5 million breaths a year and some 600 million in our lifetime. Breath Taking is an exhaustive review of why and how our lungs work, and what happens to our lives when they are attacked and injured by disease.

Usually when we call something “breathtaking”- a sunset, a painting, a song, a mountain- we mean it is awe-inspiring, wondrous, beautiful, or astonishing. But in his book Breath Taking, Dr. Michael Stephen describes conditions that literally cause us to lose our breath- the multiple and serious diseases that affect the human lung.

Prologue: Lungs =Life

Michael J. Stephen, M.D.

BREATH TAKING

by Michael J. Stephen, M.D.

The Power, Fragility, and Future of Our Extraordinary Lungs

I was approached by the publisher , FSB Associates, asking if I would review the book, and offered a complimentary copy. Otherwise, I was not compensated for my review. Some of the links in this post are affiliate links which may help support this blog financially.

image of God and Adam on the Sistine Chapel by Michelangelo
“The Lord God formed man, and breathed into his nostrils the BREATH of life, and he became a living being.” Genesis chapter 2, mentioned in the prologue.

the breath can be used to heal the body

from the prologue

Part i-THE PAST

the lungs shaped our beginnings, physically and spiritually

We take 7.5 million breaths a year and some 600 million in our lifetime. Yet humans have not always understood breathing, how the lungs work, or even what oxygen is. In Part 1 Dr. Stephens steps into the past to relate the story of how we came to understand this critical part of our physiology.

The human respiratory system diagram- the throat, trachea, bronchi, and lungs
The human Respiratory Tract from the nose all the way down to the lungs and alveoli . (photo complimentary from Pixabay)

For years physicians tried to understand why premature babies have breathing problems, known as neonatal respiratory distress syndrome. It took a determined young woman physician, Dr. Mary Ellen Avery, to discover the cause and rename it hyaline membrane disease, descriptive of the underlying disease.

a tiny baby lying in a bed with a breathing tube
phots by Alex Workman, from the LIGHTSTOCK.COM collection, an affiliate link

part ii: the present

our lungs-and us-against the world

In this section Dr. Stephen introduces us to the interactions between the immune system and the lungs. Ideally we expect our immune system to protect our lungs from threat of infections due to pathogens like viruses-influenza and coronaviruses- and bacteria that cause pneumonia. In all of human history, including today, tuberculosis has caused more disease and death than the others combined.

But the immune system can go awry, and cause disease rather than protect us from it. Such is the case with asthma in which inflammation out of control can lead to first shortness of breath and progress into respiratory failure.

Published early in 2021, the book does not cover the COVID-19 pandemic extensively. Dr. Stephen did say this,

“The coronavirus story is one illustration of how our air is communal, that the world is interconnected, and warnings about potential global health threats need to be taken seriously. ”
WHY WE NEED TO VACCINATE THE WORLD
graphic from the Johns Hopkins Bloomberg School of Public Health Facebook page

Next Dr. Stephen devotes a large section to the “seduction of nicotine”, explaining why we should not start smoking cigarettes and why we should stop if we do.

I was intrigued by the story of a man named Buck who came from a modest background but was quite an entrepreneur. In the early 20th century smoking was becoming more and more popular, enabling Buck to make a fortune by creating and marketing a machine that rolled cigarettes.

He became so rich that he donated $100 million to a small college. The college administration was so grateful they renamed the school after him, James Buchanan “Buck” Duke. The college, now Duke University, ranks among the top universities in the United States, including the medical school. The men’s basketball program is one of the country’s most successful.

I wonder if Mr. Duke knew how addictive his fortune making product was, thus assuring his company of success?

from the Facebook page of WHO, the World Health Organization

part iii-the future

the lungs provide a vision of what’s to come

Next to the infections-pneumonia, bronchitis, influenza, COVID-19, tuberculosis -the lung disease most people know and fear most is lung cancer.

A diagnosis of lung cancer strikes fear in the hearts of its victims and their families, and for good reason. “80% of patients come ..with stage III or IV disease, both very advanced.” Compare the average five year survival rates for

  • breast cancer-90%
  • colorectal cancer-65%
  • lung cancer-18%.

Lung cancer causes more deaths per year than colon, breast, and prostate combined.

chapter 11

Lung cancer is treated with a combination of surgery, radiation, and/or chemotherapy. However, a small percentage of cancers are due to a genetic mutation that can function as a “kill switch” if found. For those who qualify, about 4%, such treatment can extend life much longer than the conventional treatment.

Another option is harnessing the immune system to attack cancer cells, and a new drug, pembrolizumab has recently been approved by the FDA.

Most important now is prevention, by decreasing cigarette smoking, reducing other inhaled carcinogens such as radon, and toxins from air pollution .

2 preserved human lungs, one normal, one damaged
Two preserved human lungs, one normal,-left, one damaged from disease-right. Photo by Dr. Aletha at the Denver Science Museum

part iv

life, love, and the lungs

Dr. Stephen introduces this section by reiterating the three main themes of his book-

  • the central importance of the lungs
  • the courage of patients afflicted by a devastating illness
  • the importance of hard work, intelligent observation, and collaboration in the advancement of medical science

He illustrates these themes by telling the story of the discovery , and advances in treatment of cystic fibrosis (CF), “the Most Heartbreaking Lung Disease”.

Again, it was a woman physician, Dr. Dorothy Anderson, who did the groundbreaking work which described the pathologic changes caused by CF, established the genetic origin of CF (a defective autosomal recessive gene), and developed the first test for CF.

My final thoughts

Breath Taking is an exhaustive review of why and how our lungs work, and what happens to our lives when they are attacked and injured, sometimes fatally .

Dr.Stephen achieves this by weaving stories of real people afflicted with lung diseases together with the scientists who studied those diseases, and the physicians who treat them.

He believes it is imperative for us to protect and improve the enivironment, especially the air we breath and challenges us to choose lifestyles that can save not only our own lungs but of everyone else on this planet. He discussed this in a piece written for Each Breath, a blog by the American Lung Association.

2020:The Year We Lost Our Breath

tops of skyscrapers obscured by smog
photo by Brandon at Lightstock.com

“The Clean Air Act (1970) was designed to protect public health and welfare from different types of air pollution caused by a diverse array of sources, and passage of this landmark legislation has saved countless lives. While we enjoy healthier air thanks to the Clean Air Act, climate change poses new risks to our air quality. We know air pollution harms health and can be deadly, and new research suggests that exposure to particle pollution can even increase the death toll from COVID-19.” (continue reading at the link)

Conclusion

  • Acknowledgments
  • Notes- more of an exhaustive bibliography
  • Image Credits
  • Index
  • Author bio on the inside back cover

The author- Michael J. Stephen, M.D.

Michael J. Stephen, MD, is an associate professor at Thomas Jefferson University in Philadelphia, and director of the Adult Cystic Fibrosis Center.

He has led numerous clinical trials and has cared for COVID-19 patients. Over the past two decades he has studied advanced end-stage lung diseases and worked with patients at diverse locales, including a Massachusetts prison hospital and a pediatric HIV clinic in Cape Town, South Africa.

A graduate of Brown University and Boston University Medical School, he lives in New Jersey with his wife and two children.

About this post

I chose all of the photos and graphics in this post, they are not from or affiliated with the book.

The two graphics were shared on Facebook by the organizations identified and I thank them.

I took the photo of the lungs which were part of the Expedition Health exhibit at the Denver Museum of Nature and Science.

The photo illustrating Genesis 2 is of course the ceiling of the Sistine Chapel at the Vatican, painted by Michaelangelo from 1508 to 1512. The photo,available on Lightstock.com (affiliate link), was shot by Rob Birkbeck.

exploring the HEART of breathing

I appreciate all of you who are following Watercress Words, and if you aren’t I invite you to join the wonderful people who are. You can meet some of them in the sidebar, where you can click on their image and visit their blogs. Use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me.

Dr. Aletha

This graphic is from SundaySocial.tv
cheesy-free faith-focused stock photos

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What the CDC recommends for fully vaccinated, pregnant, and immune compromised persons

Like weather updates about tornados, hurricanes, and blizzards, the warnings and recommendations from the CDC about COVID-19 change to reflect current findings and predictions.

This information is current as of the publication date; it is general medical information that helps doctors and patients make decisions about what is right for them. Medical recommendations and practice changes as we learn new things. If you deal with any of these issues , please discuss with your doctor before taking any action.

When I wrote the first version of this post I did not anticipate a need to update it, but have now done so 4 times. Like weather updates about tornados, hurricanes, and blizzards, the warnings and recommendations from the CDC about COVID-19 change to reflect new data about the current status of the coronavirus and its activity among the population. Now I suspect this will not be the final post in this series.

The arrival of the Delta virus variant into the United State caused a new surge of infections, mostly among the unvaccinated. Those of us vaccinated can become infected with it, but likely will not become seriously ill, need hospitalization, or die.

Breaking news – Vaccination in pregnancy

August 11, 2021
  • COVID-19 vaccination is recommended for all people 12 years and older, including people who are pregnant, breastfeeding, trying to get pregnant now, or might become pregnant in the future.
  • Evidence about the safety and effectiveness of COVID-19 vaccination during pregnancy has been growing. These data suggest that the benefits of receiving a COVID-19 vaccine outweigh any known or potential risks of vaccination during pregnancy.
  • There is currently no evidence that any vaccines, including COVID-19 vaccines, cause fertility problems in women or men.

Breaking news-COVID-19 Vaccines for Moderately to Severely Immunocompromised People

August 13, 2021

CDC now recommends that people whose immune systems are compromised moderately to severely should receive an additional dose of mRNA COVID-19 vaccine after the initial 2 doses. Widespread vaccination is a critical tool to help stop the pandemic. Read CDC’s statement.

CDC updates July 27, 2021

The CDC recommends fully vaccinated people wear a mask in public indoor settings , in areas of substantial or high transmission. (find transmission rates at this link.)

Fully vaccinated people might choose to wear a mask regardless of the level of transmission, particularly if they are immunocompromised or at increased risk for severe disease from COVID-19, or if they have someone in their household who is immunocompromised, at increased risk of severe disease or not fully vaccinated.

Fully vaccinated people who have come into close contact with someone with suspected or confirmed COVID-19 to be tested 3-5 days after exposure, and to wear a mask in public indoor settings for 14 days or until they receive a negative test result.

CDC recommends universal indoor masking for all teachers, staff, students, and visitors to schools, regardless of vaccination status.

electron microscope image of a 2019-nCoV isolate
Transmission electron microscopic image of an isolate from the first U.S. case of COVID-19, formerly known as 2019-nCoV. The spherical viral particles, colorized blue, contain cross-sections through the viral genome, seen as black dots. credit Hannah A Bullock; Azaibi Tamin, public domain
Here is what the CDC, Centers for Disease Control and Prevention, posted on their web site as of July 28, 2021.

Interim Public Health Recommendations for Fully Vaccinated People

For the purposes of this guidance, people are considered fully vaccinated for COVID-19

  • ≥2 weeks after they have received the second dose in a 2-dose series (Pfizer-BioNTech or Moderna), or We
  • ≥2 weeks after they have received a single-dose vaccine (Johnson and Johnson (J&J)/Janssen ).
Dr. Aletha inspecting her arm after a COVID-19 shot
Three days after my first vaccination the soreness in my arm was almost gone, and I had no redness or swelling. After the second shot, minimal soreness. No other side effects to report. I feel fortunate. I am now fully vaccinated.

Fully vaccinated people can:

  • Resume activities without wearing masks or physically distancing, except where required by federal, state, local, tribal, or territorial laws, rules and regulations, including local business and workplace guidance
  • Resume domestic travel and refrain from testing before or after travel or self-quarantine after travel
  • Refrain from testing before leaving the United States for international travel (unless required by the destination) and refrain from self-quarantine after arriving back in the United States
  • If you came into close contact with someone with COVID-19 get tested 3-5 days after the date of your exposure and wear a mask in public indoor settings for 14 days after exposure or until a negative test result.
  • Refrain from routine screening testing if feasible
  • Get tested if experiencing COVID-19 symptoms and isolate for 10 days if positive.
  • Follow CDC and health department travel requirements and recommendations

Travel

For now, masks are still required for everyone on public transportation, until those policies are updated. (June 10, 2021 update)

Healthcare facilities

For now, you will likely be required to wear a mask in hospitals, clinics, medical offices, nursing homes, and other facilities that provide direct healthcare.

Protocols for vaccinated and non-vaccinated healthcare workers are detailed on the CDC website.

Immune compromise

People who are immunocompromised should be counseled about the potential for reduced immune responses to COVID-19 vaccines and to follow current prevention measures (including wearing a maskstaying 6 feet apart from others they don’t live with, and avoiding crowds and poorly ventilated indoor spaces) regardless of their vaccination status to protect themselves against COVID-19 until advised otherwise by their healthcare provider.

It has been reported that the CDC may recommend a booster for these people soon.

a scientist in a lab working on covid antibodies
Centers for Disease Control and Prevention (CDC) scientist was preparing patients’ samples for SARS-CoV-2antibody testing. Serological testing is used to detect antibodies, which indicate past infection with the virus that causes COVID-19, and is important to the understanding of disease prevalence within a population. credit James Gathanay, public domain

About the Delta Variant: 

Vaccines are highly effective against severe illness, but the Delta variant causes more infections and spreads faster than earlier forms of the virus that causes COVID-19. Learn more about variants in the US.

Testing, testing, testing

Testing helps us identify cases, trace contacts, and prevent spread. With fewer cases, public health professionals can find contacts easier and sooner. Stopping spread will make the variant viruses less of a threat.

So please don’t stop seeking testing if you have symptoms; it is still important to know how many cases of COVID-19 there are. If we only know about the severe cases that required hospitalization, it will skew the statistics, and be less representative of the true extent of the pandemic.

Masks and Vaccines -“do unto others”

I’m not here to debate the use of masks. If you are not yet vaccinated, masks are an easy and safe way to protect yourself but aren’t anywhere close to vaccine effectiveness. Bottom line, get vaccinated; it’s available and easy to get. You probably won’t have to wait in line for an hour like I did. Just click on this link

VACCINES.GOV

Remember, this is a contagious infectious disease spread by direct person to person contact. It’s not just about you, we’re here for each other.

Information and misinformation

There has been much of both in the past year, some deliberate, some well intentioned, some valuable, some just plain wrong. Whenever possible, get your information directly from the source, not “a friend of a friend’s second cousin”. Here are some tips for finding reliable information

Final comments from the CDC

CDC will continue to evaluate and update public health recommendations for fully vaccinated people as more information, including on new variants, becomes available. Further information on evidence and considerations related to these recommendations is available in the  Science Brief.

CDC website

exploring the HEART of ending the pandemic

Please do your friends a favor by sharing this post on social media and even in real conversations.

I appreciate all of you who are following Watercress Words, and if you aren’t I invite you to join the wonderful people who are. You can meet some of them in the sidebar, where you can click on their image and visit their blogs. Use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me.

Dr. Aletha