THIS PROGRAM IS MADE BY MPT TO ENRICH ALL OF OUR DIVERSE COMMUNITIES AND IS MADE POSSIBLE BY THE GENEROUS SUPPORT OF OUR MEMBERS.

THANK YOU.

CLOSED CAPTIONING HAS BEEN MADE POSSIBLE IN PART BY MARYLAND RELAY, EMPOWERING THOSE WHO ARE DEAF, HARD OF HEARING OR SPEECH DISABLED TO STAY CONNECTED BY PHONE.

LIVE FROM MARYLAND PUBLIC TELEVISION, THIS IS "DIRECT CONNECTION" WITH JEFF SALKIN.

♪♪] >> JEFF: GOOD EVENING AND WELCOME TO YOUR "DIRECT CONNECTION."

COMING UP CONTINUANCES TO YOUR QUESTIONS ABOUT CHRONIC LUNG DISEASES.

WE WILL TALK ABOUT TREATMENTS INCLUDING TRANSPLANT SURGERY AT THAT TIME IS COMING UP.

FIRST, ORIOLES OWNER DAVID RUBENSTEIN IS OUT WITH TWO NEW BOOKS INCLUDING SPEAKING OF AMERICA.

GREAT CONVERSATIONS AT THE LIBRARY OF CONGRESS WE HAD A CHANCE TO SPEAK WITH THE AUTHOR EARLIER TODAY ABOUT AMERICAN HISTORY AND A LITTLE BASEBALL.

[♪♪] IN.

>> ABOUT 12 YEARS AGO OR SO, I THOUGHT IT WOULD BE A GOOD IDEA TO EDUCATE MEMBERS OF CONGRESS ABOUT AMERICAN HISTORY BECAUSE THEY ARE WRITING THE LAWS AND MAKING SHAREHOLDER THEY UNDERSTOOD THE FACTS OF WHAT HAPPENED BEFORE IT WAS A GOOD IDEA.

I THOUGHT IT WOULD BE NONPOLITICAL.

WITH THE LIBRARY OF CONGRESS AND JIM BILLINGTON I STARTED A PROGRAM THAT I HOST AT THE LIBRARY OF CONGRESS FOR MEMBERS OF CONGRESS ONLY THEY DINNER WHERE I WILL HAVE A COCKTAIL PARTY BEFORE, THEN I WILL HAVE A DINNER WITH THE MEMBERS.

AND THEN INTERVIEW A GREAT AMERICAN HISTORIAN ABOUT SOME OF THAT AMERICAN HISTORY USUALLY ABOUT THE BOOK THAT IS MOST RECENT AND I ASK TO SIT WITH THE PEOPLE FROM THE OPPOSITE PARTY AND THE OPPOSITE HOUSE BECAUSE THEY RARELY GET A CHANCE TO DO IT.

AND THE MEMBERS LIKE IT BECAUSE THERE IS NO PRESS SEEING THEY ARE TALKING TO SOMEBODY FROM THE OPPOSITE PARTY AND IT MIGHT BE CONTROVERSIAL.

THAT IS THE ESSENCE OF IT AND I TOOK 19 OF THE BEST INTERVIEWS OVER THE 10 YEARS OF DOING THIS AND PUT THEM IN THE BOOK AND SUMMARIZE THE INTERVIEW AND GAVE MY OWN PERSPECTIVE OF IT.

>> Jeff: WHAT WAS THE BEST OF THE BEST OF BEST THE GREATEST OF THE GREAT CONVERSATIONS WHO COMES TO MIND?

>> WELL, IT'S HARD TO PICK ANY ONE PERSON.

BUT I THINK ONE OF THE GREAT AMERICAN HISTORIANS IN RECENT YEARS IS A FILMMAKER NAMED KEN BYRNES.

I'VE INTERVIEWED HIM MANY TIMES AND START WITH AN INTERVIEW OF KEN BYRNES AND TALK ABOUT MISHLE BEST LAUSCH AND BEVERLY GAUGE, EVAN THOMAS AND I HAD PEOPLE NOT HISTORIANS BUT PEOPLE I WANTED TO HAVE PEOPLE LITS EN TO.

ONE WAS ERIC SCHMIDT ON ARTIFICIAL INTELLIGENCE.

AND THE HUNT FOR OSCAR SEVILLA.

AND -- OSAMA BIN LAD ANYONE.

>> Jeff: LET ME PICK UP ON KEN BYRNES IF I MAY WHO IS OF COURSE A FAVORITE HERE ON PUBLIC TELEVISION WITH HIS INCREDIBLE ABILITY TO TAKE HISTORICAL MOMENTS THAT OCCURRED BEFORE WE HAD FILM OR VIDEOTAPE AND BRING THEM TO LIFE.

AND SORT OF CONTRAST THAT WITH SITTING AT THE LIBRARY OF CONGRESS THIS GREAT REPERTORY OF OUR HISTORY WHAT DID YOU LRN FROM HIM?

>> KEN BYRNES STARTED OUT IN NEW HAMPSHIRE COLLEGE MAKING A DOCUMENTARY ON THE BROOKLYN BRIDGE.

AND THAT WAS WELL RECEIVED BUT NOT AS MANY PEOPLE WATCHED IT AS THE EPIC CIVIL WAR SERIES THAT WENT ON FOR 12 SHOWS.

AND THAT IS SOMETHING THAT CHANGED THE FACE OF AMERICAN PUBLIC TELEVISION BECAUSE WERE SO CAPTIVATED BY THE CIVIL WAR SERIES IT ENABLED HIM TO DO LONGER TERM SERIES LIKE BASEBALL OR WORLD WAR II ON THE VIETNAM WAR AND MOST RECENTLY THE REVOLUTIONARY WAR.

>> Jeff: THERE IS A SECTION ON SAMUEL ADAMS ABOUT WHOM I KNOW LITTLE AND APPARENTLY THAT WAS PARTLY HIS DESIRE?

>> SAMUEL ADAMS WAS THE OLDER COUSIN OF JOHN ADAMS AND SAMUEL ADAMS WAS BETTER KNOWN.

SAMUEL DID NOT LIKE TO GET PUBLICITY, WHILE HE WAS A MEMBER OF THE CONTINENTAL CONGRESS HE OFTEN WROTE THIS ANONYMOUSLY HE WAS QUITE AN IMPRESS ACTIVE PERSON AND LATER BECAME GOVERNOR OF MASSACHUSETTS AFTER THE WAR.

HE WAS NOT A BEER MANUFACTURER.

BUT HIS FAMILY WAS IN THE MALT BUSINESS.

SAMUEL ADAMS WAS A GOOD WRITER.

>> Jeff: YOU MENTIONED ERIC SCHMIDT WHO WAS A KEY INDIVIDUAL IN THE RISE OF GOOGLE TALKING ABOUT ARTIFICIAL INTELLIGENCE.

WHAT DID YOU TAKEAWAY FROM THAT?

>> ARTIFICIAL INTELLIGENCE IS GOING TO CHANGE THE WAY WE LIVE AND BREATHE AND OUR LIVES WE ARE THE FIRST INNING OF IT.

A LONG WAY TO GO BUT INTERESTINGLY, ERIC SCHMIDT AFTER HE LEFT GOOGLE MADE HIMSELF INTO AN EXPERT ON ARTIFICIAL INTELLIGENCE AND HE WROTE A BOOK WITH HENRY KISSINGER.

HE WAS 98 GOING ON NEIGHBORHOOD 9 WHEN THEY WROTE THE BOOK.

AND HENRY KISSINGER WAS A BRILLIANT PERSON BUT HE DID NOT HAVE A TECHNICAL BACKGROUND AND HE DUG INTO IT AND ERIC FELT HE CONTRIBUTED TO THE WRITING OF THE BOOK.

>> Jeff: YOU HAVE A LOT OF SMART PEOPLE WORKING FOR YOU AT CARLISLE AND I'M CURIOUS WHAT IS THE THINKING ON ARTIFICIAL INTELLIGENCE I'VE READ OVER GROUPS ARE MOVING BEYOND THE COMPUTING SIDE TO THE IMPACT OF IT.

SOME PEOPLE INVESTING IN COMPANIES LIKE BARRY DILLER BUYING A CASINO ON THE THEORY IT WON'T BE DISRUPTED BY A.I.

AND OTHERS GETTING INTO BUSINESSES BECAUSE THEY THINK THEY WILL BE DISRUPTED TO THE EXTENT YOU CAN TELL US WHAT YOU GUYS ARE DOING, WHAT ARE YOUR THOUGHTS?

>> ARTIFICIAL INTELLIGENCE WILL CHANGE EVERYTHING IN OUR COMMERCIAL AND PERSONAL LIVES OVER THE COURSE OF THE NEXT DOZEN YEARS OR SO OR MAYBE LESS TIME.

AND OUR CASE OF MY OWN FIRM CARLISLE WE USE ARTIFICIAL INTELLIGENCE TO MAKE ASSESSMENTS OF OPPORTUNITIES AND SO FORTH.

AND INCREASINGLY WE AND OTHER FIRMS WILL DO THE SAME THING.

AT THE BEGINNING OF THE INTERNET ERA PEOPLE DIDN'T KNOW HOW IT WOULD HAPPEN AND HOW IT WOULD AFFECT COMPANIES AND SOCIETY AND NOW INTERNET WAS ESSENTIAL TO GETTING ON IN LIFE.

WE DON'T KNOW HOW ARTIFICIAL INTELLIGENCE WILL CHANGE OUR LIVES TODAY BUT IT WILL CHANGE OUR LIVES IN SOME WAYS WE CANNOT PUT IT OUT BUT IT'S IMPORTANT AND PEOPLE SHOULD GET EDUCATED ABOUT ARTIFICIAL INTELLIGENCE IF THEY ARE HAVING A MEANINGFUL WAY TO CONDUCT THEMSELVES IN THE FUTURE IN OUR COUNTRY.

>> Jeff: CAN YOU DRAW A LINE FROM THE HISTORIANS THAT YOU TALKED TO IN THIS BOOK, MANIFEST DEFENDANT ANY THE FOUNDING OF AMERICA AND THE FACT THAT INNOVATION IN A.I.

OR A LARGE PART OF THE INNOVATION, SEEMS TO BE HAPPENING IN THE UNITED STATES OF AMERICA AS OPPOSED TO THE OTHER WESTERN DEMOCRACIES.

CERTAINLY THERE IS A LOT IN CHINA.

THERE DOESN'T SEEM TO BE MUCH IN EUROPE.

DOES THAT HAVE TO DO WITH OUR HISTORY AS A NATION?

>> THE UNITED STATES IS A COUNTRY THAT CAME FROM NOTHING IN 1776, THREE MILLION HALF A MILLION WERE SLAVES TO BECOME THE MOST POWERFUL COUNTRY IN THE WORLD.

TECHNOLOGICAL DEVELOPMENT SINCE WORLD WAR II WE HAVE GONE PAST EVERY OTHER COUNTRY PROTECT LOGICALLY.

WE HAVE ONE RIVAL AND THAT IS CHINA.

BUT TODAY, WE'RE WAY AHEAD OF CHINA AND TODAY WE'RE WAY AHEAD OF CHINA IN TECHNOLOGY AND CERTAINLY IN ARTIFICIAL INTELLIGENCE.

I WOULD SAY THE EUROPE HAS LAGGED BEHIND IT'S NOT QUITE CLEAR WHY BUT PROBABLY BECAUSE ENTREPRENEURSHIP NOT AS VALUED IN EUROPE.

MANY GREAT ENTREPRENEURS COME TO THE UNITED STATES TO GET MONEY AND BUILD THEIR COMPANIES.

INTERESTINGLY AS WE TALK NOW AND NOBODY WATCHING THIS, THINK ABOUT WHAT EUROPEAN TECHNOLOGY YOU NEED TO GET THROUGH THE DAY.

IT'S HARD TO THINK OF ANY.

BUT YOU CAN'T GET THROUGH THE DAY WITHOUT USING AN MICROSOFT PRODUCT, APPLE PRODUCT, GOOGLE PRODUCT.

THESE PRODUCTS ARE AMERICANS PRODUCTS AND THEY NOW DOMINATE THE WORLD AND DOMINATE EUROPE AS WELL.

WHEN I TALK TO EUROPEANS THEY ADMIT THEY HAVE NOT BEEN ABLE TO KEEP UP WITH THE UNITED STATES TECHNOLOGICALLY AND HOPEFULLY IN THE FUTURE THEY WILL DEVELOP TECHNOLOGIES THAT WILL BE PROBLEM.

RIGHT NOW, EUROPE IS USING AMERICAN TECHNOLOGIES AND WE DOMINATE THE WORLD WITH ONE EXER WHICH IS CHINA.

>> Jeff: BACK TO THE SETTING THE LIBRARY OF CONGRESS, IT IS AN INSTITUTION JUST ACROSS THE STREET FROM THE CAPITOL BUT I SUSPECT THAT MANY PEOPLE WATCHING AS THE BALTIMORE WASHINGTON AREA AND ACROSS THE STATE OF MARYLAND HAVE WITHIN TO THE CAPITOL WALKED BY THE SUPREME COURT AND NEVER WALKED IN THE LIBRARY OF CONGRESS.

WHY SHOULD THEY?

>> THE LIBRARY OF CONGRESS WAS SETUP TO PROVIDE BOOKS FOR THE CONGRESS NOT FOR THE PUBLIC.

INITIALLY.

IT WAS SET NEWSPAPER 1800 WITH LEGISLATION ASIGNED BY JOHN ADAMS AND THEY AUTHORIZED $5,000 AND BOUGHT A COUPLE HUNDRED BOOKS AND MAPS.

WHEN THE BRITISH CAME THEY BURNED DOWN THE LIBRARY OF CONGRESS WHICH WAS IN THE CONGRESS.

AND NOT ONLY THE 1890s DID CONGRESS AUTHORIZE THE LIBRARY TO HAVE ITS OWN BUILDING NOW THERE ARE THREE MAIN BUILDINGS.

THE PRINCIPLE IS CALLED THE JEFFERSON BUILDING BECAUSE HE SOLD HIS LIBRARY TO THE UNITED STATES GOVERNMENT FOR THE LIBRARY OF CONGRESS WHEN IT WAS BURNED BY THE BRITISH IN 1814.

WE HAVE HAD A LOT OF LIBRARIANS OF CONGRESS.

ONE IS FROM MARYLAND CARLA HAYDEN WAS THE LIBRARIAN OF CONGRESS UP UNTIL A YEAR AGO.

SHE SERVED NINE YEARS, PREVIOUSLY THE LIBRARIAN OF THE LIBRARY IN BALTIMORE AND THE STANLEY LIBRARY.

>> Jeff: YOU HAVE BECOME A PROLIFIC AUTHOR YOU ARE COMPETING YOURSELF WITH YOURSELF WITH ANOTHER NEW BOOK CALLED "INSIDE THE OWNER'S BOX: CONVERSATIONS ON POWER AND LEADERSHIP IN SPORTS".

AND WE'RE NOT GOING TO FOCUS ON BASEBALL BECAUSE THIS INTERVIEW MAY RERUN AND IT MAYBE AN EVENTFUL OFF SEASON WE SHALL SEE.

TELL US ABOUT THAT.

THAT WAS RESEARCH YOU DID BEFORE BUYING THE BALTIMORE ORALS?

>> ORIOLES.

>> I LED THE EFFORT TO BUY THE ORIOLES FROM THE AN LESS FAMILY IT WAS $1.7 BILLION WHEN THE ORIOLES CAME TO BALTIMORE IN 1954 THE PRICE WAS 2.2 MILLION.

THE PRICES HAVE GONE UP.

I DID IT AS A PHILANTHROPIC GESTURE I FELT I SHOULD DO IT FOR BALTIMORE MY HOMETOWN.

SO I THOUGHT IF I BROUGHT THE TEAM AND REVIVED THE TEAM IF I COULD AND COULD REVIVE DOWNTOWN BALTIMORE IT WOULD BE A CONTRIBUTION TO BALTIMORE.

SO I DID IT LESS TO MAKE MONEY BUT TO GIVE BACK TO BALTIMORE.

UNFORTUNATELY IT HASN'T WORKED AS WELL AS I WOULD LIKE SO FAR.

WE FINISHED AND DIDN'T DO AS WELL THIS YEAR.

WE HAD THE MOST INJURIES IN MAJOR LEAGUE BASEBALL BUT WE HAD A GREAT STAR AND HOPEFULLY HE WILL BE A STAR FOR YEARS IN THE FUTURE AND WORKING ON STRENGTHENING THE TEAM FOR NEXT YEAR.

>> Jeff: DAVID RUBENSTEIN'S BOOKS, "INSIDE THE OWNER'S BOX: CONVERSATIONS ON POWER AND LEADERSHIP IN SPORTS" AND SPEAK EGG OF AMERICA.

WE APPRECIATE YOUR TIME.

THANK YOU.

>> THANK YOU.

THANK YOU FOR HAVING ME.

>> Jeff: WE WILL BE RIGHT BACK.

>> Jeff: NOW WE TURN TO YOUR HEALTH JOINING US IS Dr.

MIKE A PULMONARY PHYSICIAN DIRECTOR OF THE LUNG TRANSPLANT AT THE UNIVERSITY OF MARYLAND MEDICAL SCHOOL OF MEDICINE.

IT IS HEALTHY LUNG MONTH.

SO TELL US ABOUT SOME OF THE CONDITIONS THAT YOU TREAT?

>> THANK YOU FOR HAVING ME.

WHEN WE THINK ABOUT CHRONIC LUNG DISEASE AND IN PARTICULAR ADVANCED LUNG DISEASE WHAT WE'RE TALKING ABOUT LUNG DISEASES THAT IMPAIR QUALITY OF LIFE IN PATIENTS.

AND IN SOME CASES CAN BE LIFE-THREATENING.

THE MOST COMEDIES ORDERS THAT WE TREAT INCLUDE COPD, GENERALLY CAUSED BY SMOKING RELATED CHANGES TO THE AIRWAYS IN THE LUNG.

PULMONARY FIBROSIS IS PROGRESSIVE SCARRING OF THE LUNGS AND HYPERTENSION CAUSED BY PRESSURES IN THE VESSELS OF THE LUNGS THAT CAN PUT A STRAIN ON THE RIGHT SIDE OF THE HEART.

>> Jeff: COPD USED TO BE CALLED SOMETHING ELSE?

>> CHRONIC PULMONARY DISEASE.

THE MOST COMMON IS INHALATIONAL EXPOSURES, NAMELY CIGARETTE SMOKING.

>> Jeff: ARE THESE CONDITIONS AUTOMATICALLY PROGRESSIVE IN EVERYBODY?

>> MANY PATIENTS DO QUITE WELL WITH APPROPRIATE TREATMENT.

AND THEY MAY NOT HAVE PROGRESSION OF THE DISEASE.

IN SOME PATIENTS THE DISEASE MAY CONTINUE TO PROGRESS AND THOSE ARE THE PATIENTS WE GENERALLY CONSIDER TO HAVE ADVANCED LUNG DISEASE.

>> Jeff: WE HAVE A GRAPHIC ON WHAT SYMPTOMS PEOPLE NEED TO BE ALERT FOR THAT THEY MAY HAVE SOMETHING GOING ON THAT IS WORTH EVALUATION.

I WILL LET YOU GO THROUGH THIS STARTING WITH OBVIOUSLY COUGHING AND WHEEZING.

>> SO PROLONGED OR PERSISTENT COUGH AND WHEEZING IF YOU HAVE PHLEGM PRODUCTION IS SOMETHING TO BE CHECKED OUT.

AND IN ADDITION SHORTNESS OF BREATH.

AND THE UNABLE TWO TO TAKE A LARGE DEEP BREATH MAYBE WARNING SIGNS.

AND DECREASING EXERCISE TOLERANCE.

I DO WANT TO FOCUS ON DECREASING EXERCISE TOLERANCE FOR A SECOND BECAUSE THAT IS IMPORTANT.

SOMETIMES IT CAN BE EASY TO RECOGNIZE IN SOMEBODY WHO COULD WALK A COUPLE BLOCKS OFTENTIMES WE MAY HAVE SOMEBODY THAT IS QUITE FIT AND THEY MAYBE ABLE TO RUN THREE TO FIVE MILES A DAY AND THEY MAYBE FEELING WELL AT THE TIME.

BUT IN REALITY, THEIR SYMPTOMS IN TERMS OF THEIR FUNCTIONAL CAPACITY COMPARED TO BASELINE IS IMPAIRED.

THEY MAYBE ONLY BE ABLE TO RUN HALF A MILE AT A TIME AND THEY MAY FEEL WELL IT COULD BE A SIGN THAT SOMETHING IS GOING ON WITH THEIR LUNGS.

AS PULMONOLOGISTS WE TRY TO TEASE IT APART.

>> Jeff: AND A SECOND INDICATIONS THAT A LUNG ISSUE IS BECOMING MORE URGENT STARTING WITH INCREASING OXYGEN NEEDS.

>> THIS IS SPECIFICALLY RELATED TO AGAIN ADVANCED LUNG DISEASE SOME OF THE CONDITIONS WE TALKED ABOUT BEFORE.

AND SOME INDICATIONS THAT ONCE YOU ARE DIAGNOSED WITH ADVANCED LUNG DISEASE SOMETHING LIKE COPD, PULMONARY FIBROSIS AND HYPERTENSION SIGNS THAT COULD BE WORSENING SIMILAR TO THE SIGNS WE TALKED ABOUT AND REQUIRING MORE SUPPLEMENTAL OXYGEN THIS MAYBE GOING FROM TWO LETTERS UP TO SIX LITERS.

MAY EVEN BE CHARACTERIZED BY PROLONGED HOSPITALIZATIONS.

AS WELL.

>> Jeff: HOW DO WE PROTECT OURSELVES FROM DEVELOPING THESE CONDITIONS?

TO WHAT DEGREE ARE THEY PREVENTABLE?

>> SOME THERE'S OBVIOUS WAYS TO PREVENT.

COPD SMOKING IS THE NUMBER ONE CAUSE.

SO EITHER CESSATION OF SMOKING OR NEVER SMOKING TO BEGIN WITH.

AVOIDING INHALATIONAL EXPOSURES.

WEAR A MASK IF YOU ARE AWARE ARE IMPORTANT.

SOMETIMES WE DON'T HAVE A IDEA WHAT IS CAUSING THESE DISEASES AND THEY MAY COME ON SPONTANEOUSLY WITHOUT AN IDENTIFIABLE CAUSE.

>> Jeff: VIEWER QUESTION, THE WRITER HAS A BROTHER AGE 69 WITH INNER CIRCUMSTANCAL LUNG DISEASE.

TELL US ABOUT THAT AND HIS DOCTOR INDICATED HE WOULD NOT DO A TRANSPLANT AFTER 75.

THAT CONDITION AND IS THERE A CUTOFF FOR TRANSPLANTS?

>> THE DISEASE IS A TYPE OF LUNG DISEASE CHARACTERIZED BY INFLAMMATION OR SCARRING OF THE LUNG TISSUE.

THE ONE WE ARE MOST CONCERNED ABOUT OF IT PROGRESSING WHEN YOU DEVELOP SCARRING OF THE LUNGS AND THERE IS A NUMBER OF CAUSES OF THIS.

BUT THIS IS ONE OF THE MOST COMMON ADVANCED LUNG DISEASES N TERMS OF THE AGE RELATED TO TRANSPLANT, THIS CAN VARY BY CENTER.

SO FOR EXAMPLE AT UNIVERSITY OF MARYLAND OUR AGE CUTOFF IS 75 YEARS OLD.

BUT WE ROUTINELY TRANSPLANT PATIENTS IN THEIR 70s.

>> Jeff: IS IT SOMETHING THAT IS DEPENDENT ON, I GUESS MY QUESTION IS HOW FIRM IS THAT 75 CUTOFF?

SOMEBODY IS OTHERWISE RECENTLY FIT, COULD THEY BE SUB76.

>> 75 IS A PRETTY FIRM CUTOFF AT OUR CENTER.

HAVING SAID THAT I WOULD NOT PUT AN EXACT GUIDELINE ON ALMOST ANYTHING.

I TRY TO TAKE IT INTO CONTEXT WHAT ELSE IS GOING ON WITH THE PATIENT.

SO THERE MAYBE OTHER CONDITIONS THAT THE PATIENT MAY HAVE, WHICH MAY MAKE THEM NOT AS GREAT OF A CANDIDATE FOR THE TRANSPLANT.

BUT IF EVERYTHING ELSE LOOKS OKAY WE MAYBE ALL RIGHT GOING THROUGH WITH IT.

>> Jeff: HOW DOES THE PROCEDURE WORK?

THE LUNG TRANSPLANT THESE ARE BIG ORGANS I'M THINKING TO KIDNEYS, LIVER, LIVER IS A BIG ORGAN BUT YOU ARE DOING BOTH SIDES.

>> SO, IT DEPENDS.

YOU CAN TRANSPLANT BOTH LUNGS OR YOU CAN IN SOME CASES CAN DO A SINGLE LUNG TRANSPLANT AS WELL.

IT IS A SIGNIFICANT OPERATION I DON'T KNOW IF IT GETS BIGGER IN MEDICINE THAN A LUNG TRANSPLANT.

THE PROCEDURE ITSELF IS A LONG PROCEDURE FOR DOUBLE-LUNG YOU ARE LOOKING AT 6-12 HOURS IN THE OR.

THE SINGLE TAKES LESS TIME AND THERE ARE CONDITIONS WHERE WE OPT TO DO A SINGLE LUNG.

THE OUTCOMES ARE COMPARABLE BUT THIS DEPENDS ON THE AGE OF THE PATIENT AND OTHER MEDICAL CONDITIONS THAT THEY MAY HAVE AT THE TIME.

>> Jeff: WHAT IS LIFE LIKE FOR SOMEBODY AFTER RECEIVING A TRANSPLANT?

>> SO IN GENERAL AFTER A TRANSPLANT, NUMBER ONE WE EXPECT THAT THE PATIENT IS ABLE TO HAVE A BIG INCREASE IN QUALITY OF LIFE.

SO THAT THEIR LUNG FUNCTION GETS RESTORED TO NORMAL AND THEY WERE ABLE TO DO THINGS THEY WERE ABLE TO DO BEFORE THE TRAPS PLANT.

IT IS A SIGNIFICANT OPERATION THERE ARE RISKS AND DURING THAT FIRST YEAR, IT CAN BE A CHALLENGING YEAR.

YOU'RE FOLLOWING UP IN CLINIC.

FIRST YOU'RE HOSPITALIZED FOR TWO OR THREE WEEKS.

AFTER THE TRANSPLANT YOU ARE SEEING US IN CLINIC USUALLY ONCE A WEEK FOR THE FIRST FEW MONTHS AND ONCE A MONTH FOR THE FIRST YEAR.

YOU ARE ALSO TAKING A NUMBER OF MEDICATIONS TO PREVENT REJECTION AND INFECTION OF THE LUNGSES AND A LARGE PORTION IS REHABILITATION GETTING YOUR BODY BACK TO WHERE IT WAS THE MUSCLES YOU WERE NOT USING BEFORE A TRANSPLANT GETTING BACK THAT LEVEL OF CONDITIONING.

5U89 THE TRANSPLANT CAN BE LIFE CHANGING IT REQUIRES A SIGNIFICANT AMOUNT OF COMMITMENT FROM THE PATIENT AND THE FAMILY.

>> Jeff: WHAT ARE THE NUMBERS LIKE IN TERMS OF MAYBE ON ANTIQUES ROAD SHOWUAL BASIS HOW MANY OF HAD THESE PROCEDURES YOU MAY DO AND IS THE FACTOR THE AVAILABILITY OF A SUITABLE ORGAN?

>> AT THE UNIVERSITY OF MARYLAND WE DO 20-30 TRANSPLANTS A YEAR.

THE MAJORITY ARE DOUBLE-LUNG TRANSPLANTS THAT IS THE MOST COMMON PROCEDURE ACROSS THE WORLD.

>> Jeff: WHEN DOES SOMEBODY REACH A POINT WHERE MEDICAL THERAPY HAS REACHED THE END OF THE LINE AND IT'S TIME FOR A TRANSPLANT?

>> YEAH.

SO THAT'S EXACTLY WHEN WE START CONSIDERING TRANSPLANT.

SO DESPITE WHEN YOU ARE SEEING DISEASE PROGRESSION THOSE INCREASING OXYGEN REQUIREMENTS, HOSPITALIZATIONS AND INCREASES IN SYMPTOMS DESPITE ALL OF THE MEDICAL THERAPIES THAT ARE AVAILABLE THAT IS WHEN WE WILL CONSIDER A TRANSPLANT AND THE REASON WE'RE SO SELECTIVE BECAUSE THE TRANSPLANT CAN EXTEND LIFE, IT'S ALSO A SIGNIFICANT OPERATION WITH RISKS.

SO IN FACT, THE MEDIAN SURVIVAL AFTER A TRANSPLANT IS ABOUT SEVEN YEARS.

SO A LOT OF TIMES WE HAVE TO TAKE THAT INTO ACCOUNT WE'RE BALANCING THE RISKS OF THE PROCEDURE AND WE'RE WEIGHING THAT AGAINST THE RIFNS OF THE DISEASE ITSELF CONTINUING TO PROGRESS.

>> Jeff: IS IT SOMETIMES COMBINED WITH OTHER ORGANS MAYBE THE HEART?

>> YEAH.

SO HEART AND LUNG TRANSPLANT IS AN OPTION IF BOTH ARE SEVERELY COMPROMISED.

THE SAME GOES FOR LUNG AND KIDNEY.

OR LUNG AND LIVER AS WELL.

>> Jeff: WELL, LET'S GIVE EVERYBODY ADVICE YOU MENTIONED EARLIER DON'T SMOKE.

>> YES.

>> AND WHEN SOMEBODY DOES QUIT AND IT'S ONE OF THE TOUGHEST THINGS THERE IS TO DO HOW SOON DO YOU SEE BENEFIT?

>> THE BENEFITTINGS CAN BE SEEN RIGHT AWAY, ESPECIALLY IN A NUMBER OF CONDITIONS.

A REDUCTION IN COUGH, SHORTNESS OF BREATH.

THERE'S SHORT-TERM BENEFITS TO QUITTING SMOKING OR ANYTHING THAT IS BEING INHALED EVEN EXPOSURES INHALATIONAL EXPOSURES YOU CAN HAVE THE BENEFITS RIGHT AWAY.

AND LONG-TERM THE EFFECT ON YOUR LUNG HEALTH AND FUNCTION QUITTING SMOKING CAN ONLY HELP.

>> Jeff: YOU KNOW, WE CERTAINLY SEE IN REGIONS WITH A LOT OF INDUSTRY THAT YOU WINDUP WITH KIDS LIVING IN THOSE NEIGHBORHOODS HAVING INCREASED LEVELS OF ASTHMA.

DOES IT CORRELATE WITH THESE MORE SERIOUS LUNG CONDITIONS?

>> SOMETIMES.

BUT NOT ALWAYS.

SO ASTHMA ITSELF IS NOT GENERALLY A CONDITION IN WHICH WE GENERALLY CONSIDER A LUNG TRANSPLANTED FOR.

WE HAVE GREAT THERAPIES FOR THAT AND CAN CONTROL THAT.

HAVING SAID THAT WE DO OFTENTIMES HAVE PATIENTS WHO COME IN, THEY HAVE IDENTIFIED LUNG DISEASE IT'S PROGRESSING AND WHEN WE TAKE A DEDICATED HISTORY AND PHYSICAL WE DO SOMETIMES IDENTIFY EXPOSURES EARLY ON THAT THE PATIENT MAY HAVE HAD WHICH COULD HAVE CONTRIBUTED TO THE LUNG DISEASE DOWN THE LINE.

>> Jeff: IS TRANSPLANT EVER CONSIDERED IN A LUNG CANCER CASE?

>> SO IN GENERAL, THE PRESENCE OF CANCER, ESPECIALLY LUNG CANCER IS A CONTRAINDICATION TO LUNG TRANSPLANT.

HAVING SAID THAT, THERE ARE SOME INVESTIGATIONAL INVESTIGATIONS LOOKING INTO THIS ESPECIALLY FOR LOW GRADE CANCERS AND SOME CENTERS ARE EXPLORING THAT OPTION.

BUT IN GENERAL IT IS A CONTRAINDICATION.

>> Jeff: WE ARE HEADING INTO WINTER, COLD, FLU, COVID SEASON ANY THOUGHTS WHAT OUR VIEWERS MIGHT WANT TO GET VACCINATED FOR?

>> I THINK THE FLU CERTAINLY.

AND THEN TALK TO YOUR DOCTOR ABOUT VACCINATION FOR COVID AS WELL.

DEPENDING ON YOUR AGE AND CERTAIN COMORBIDITIES THE COVID AND THE R IS SV VACCINE ARE IMPORTANT ON THE PNEUMOCOCKAL.

>> DOCTOR MICHAEL KELLER, MD WE APPRECIATE YOUR TIME.

THAT IS "DIRECT CONNECTION" WE'RE BACK FRIDAY WITH "STATE CIRCLE" AND THE LATEST ON MARYLAND POLITICS JOIN US FRIDAY EVENING AT 7:00 P.M.

FOR ALL OF US AT MPT THANK YOU FOR WATCHING "DIRECT CONNECTION" AND HAVE A GOOD NIGHT.

CLOSED CAPTIONING HAS BEEN MADE POSSIBLE IN PART BY MARYLAND RELAY, EMPOWERING THOSE WHO ARE DEAF, HARD OF HEARING OR SPEECH DISABLED TO STAY CONNECTED BY PHONE.