ARH pulmonologist Ashley Thompson, DO, serves her community with homegrown care
HAZARD Hypertension is frequently called “the silent killer” because the symptoms are often unrecognized and can go unrecognized for years. Ashley Thompson, DO, a pulmonologist at Appalachian Regional Healthcare (ARH) wants to add lung cancer to the list of preventable and possibly curable diseases that often “have no symptoms.”
“The largest misconception that I encounter regarding lung cancer is that a patient can’t have lung cancer without presenting symptoms. In reality, the vast majority of lung nodules or early lung cancers have absolutely no symptoms. By the time a patient develops direct symptoms related to lung cancer, it is often very advanced and treatment options may become much more limited. This emphasizes the absolute importance of lung cancer screening through low-dose CT scans for patients over the age of 50 with a significant smoking history. We want to detect lung cancer early to give patients the very best chance at a good outcome,” says Thompson.
Thompson’s familiarity with lung cancer comes from growing up in eastern Kentucky where genetics, environmental causes, high rates of smoking, and the working conditions for coal miners leads to various lung conditions, contributing to the CDC and the National Cancer Institute ranking Kentucky number one in deaths cause by lung cancer.
To combat the scourge of lung cancer mortality, the Kentucky Department for Public Health has aggressively promoted lung cancer screening programs. Kentucky now ranks second-highest in the USA at 10.6% of the at-risk population being screened, compared to the national average of 4.5%. Kentucky still has the unfortunate rank of number one in lung cancer incidence with 54.6%.
This makes for a patient-rich environment for Thompson and her colleagues at ARH.
Born to Serve Others
Thompson is a native of eastern Kentucky, growing up in Hindman, Kentucky, in Knott County. She received her undergraduate degree at Alice Llyod College in Pippa Passes, Kentucky, and completed medical school at the University of Pikeville Kentucky College of Osteopathic Medicine. She did her internship in Internal Medicine followed by a Pulmonary and Critical Care Medicine fellowship at the University of Kentucky Medical Center. Thompson joined ARH in April of this year.
Thompson’s passion and interest in healthcare and community is shared by her four siblings. Two of her sisters are physicians, one sister is an optometrist, and her brother is a pharmacist. “This can make for very interesting family discussions,” says Thompson, whose family includes “a long line of educators, musicians, and artists.”
I attribute the primary reason I became a pulmonologist to the fact that I grew up in eastern Kentucky. This is the region of the country which is most disproportionally afflicted by lung diseases, whether it be smoking related such as COPD, lung cancer, environmental, or genetic such as asthma or occupational lung conditions like coal worker’s pneumoconiosis. From the time I was a medical student, I saw a need for this specialty and saw the fulfillment of the pulmonologists who trained me. I knew this was the way I could best serve the people of my home region,” says Thompson.
Thompson states that patients throughout eastern Kentucky, as well as the greater Appalachian region are at a disadvantage not only due to baseline genetic and environmental factors, but there are also many socioeconomic and geographic barriers to ensuring adequate access to basic healthcare. This can result in many chronic medical conditions that may be sub-optimally treated, leading to increased risk of heart disease, diabetes, obesity, and pulmonary diseases. Thompson’s osteopathic training tells her that each organ of the body does not function in isolation.
“The human body is a complex entity that has to function in harmony for true health. I understand that treatments for pulmonary conditions can sometimes have impacts on other organ systems such as the heart or a patient’s diabetes control. Therefore, it is critical for physicians to communicate with the patient’s primary care physician and other consultants to ensure a safe treatment regimen for each individual person we treat,” says Thompson.
A Diverse Patient Population
A week in pulmonary and critical care medicine can be very diverse. Some days Thompson will be in the clinic treating patients with asthma or COPD. On other days she’s taking care of a critically ill patient on the ventilator in the ICU, or in the procedure suite performing a bronchoscopy to help diagnose lung cancer. Thompson says she feels fortunate to have the opportunity to interact with patients in different settings as well as with colleagues in almost every single specialty and that is a very rewarding piece of her career.
“I’m able to treat a vast patient population in my specialty, from young adults with asthma or cough to older adults with occupational lung disease or pulmonary fibrosis. I also see patients of various ages with nodules or abnormalities found on lung imaging that help further diagnosis for these conditions,” says Thompson.
The ARH system has developed an infrastructure for interdisciplinary collaboration to ensure timely and appropriate care for each patient. Medicine is not one size fits all, and every patient needs access to the best care plan to suit their needs. In pulmonology, Thompson says that she has the opportunity to directly interact each week with oncologists, radiation oncologists, thoracic surgeons, radiologists, pathologists, and primary care providers to discuss specific complex patient conditions and needs to develop a tailored treatment plan for patients. This collaborative process can involve reviewing abnormal lung cancer screening CTs or incidental findings on imaging performed for other reasons or discussing a patient at tumor board.
“The ‘meeting of the minds’ provides the most comprehensive care to our region,” says Thompson.
Meeting Patients “Where They Are”
During the first encounter with a new patient, Thompson says it is extremely important to meet that individual where they are, physically, emotionally, and psychologically. The patient may have been referred for a consult due to years of uncontrolled symptoms that are causing distress or may have received the fearful news of a “spot” on their chest X-ray or CT scan. This can result in significant anxiety for a patient. “I always try my best to empathize with each patient and explain conditions in the simplest way possible. Sometimes that may involve looking at imaging together or making simple drawings to help explain the situation,” says Thompson.
In pulmonology, the advancement in bronchoscopic technology has had a profound impact on expanding access to care for patients. Through expansion of endobronchial ultrasound (EBUS) at ARH as well as navigational bronchoscopy through the Ion Robotic Bronchoscopy system, pulmonologists like Thompson can further aid in the timely diagnosis and staging of conditions such as lung cancer for developing treatment plans with the oncologists and surgeons.
“These techniques are minimally invasive and many times we can even provide a preliminary diagnosis the same day,” says Thompson.
As an example of the benefits of early detection, Thompson recalls that one of her most memorable cases was a young patient she met in her first year as an attending physician. The patient was not a smoker, had been treated for “pneumonia” multiple times without significant improvement, and was found to have a mass or tumor in the lower lung. She performed a navigational bronchoscopy and endobronchial ultrasound, which confirmed a lung cancer. The scope also confirmed it was an early-stage cancer and had not yet spread into any lymph nodes. She consulted with a thoracic surgery and the patient was able to undergo a resection of that portion of his lung.
“To my knowledge, at this time the patient is still completely in remission from the lung cancer and is living a happy and healthy life. Cases such as this are a reminder why prompt diagnosis is so important to ensuring the best outcomes for our patients,” says Thompson.
It’s that patient and many more cases like this that give Thompson her motivation for being a pulmonologist at ARH. It includes helping patients breathe easier and aiding with early detection and diagnosis of lung cancer in Appalachians to help improve outcomes.
“My overall career goal will always be to provide ‘more’ to the people of this region,” says Thompson.