Installment 88 - Ask the Doctor with Dr. Sreedevi Marakatham/Lung Institute
About Dr. Sreedevi Marakatham
Sreedevi Marakatham, MD, attended medical school at the University of Kerala in Kerala, India, followed by a three-year residency at Kingsbrook Jewish Medical Center in Brooklyn, New York. During her residency program, she continued her education and training in outpatient and inpatient care, critical care units, and emergency care. Dr. Marakatham also completed a rotation at the Kingsbrook Centerís attached nursing home, gaining valuable experience in Geriatric care. In her third and final Kingsbrook residency, Dr. Marakatham took the lead as Chief Medical Resident.
Her work experience and special interest in treating people with chronic health conditions brought her to Texas where she practices at the Dallas Lung Institute. Dr. Marakatham served at Community Oriented Primary Care, part of the Parkland Health and Hospital System. As Attending Physician in the Adult Module, she provided comprehensive primary care, health screening, immunizations, and treated people with acute and chronic medical conditions. While working in primary care, she saw a high volume of chronic pulmonary patients and was excited to find the Lung Instituteís treatment options for patients with lung disease. Listed below are Dr. Marakathamís board certification information, educational and work record, and various professional and academic honors. https://lunginstitute.com/about/sreedevi-marakatham-md/
The Lung Institute
201 E. Kennedy Blvd. Suite 700
Tampa, FL 33602
Tampa | Nashville | Scottsdale | Pittsburgh | Dallas
Questions & Answers
Q: Why do you offer two kinds of stem cell treatments for lung disease? What determines which treatment is best for an individual? And how do you determine if a patient is a good candidate?
The Lung institute offers two different stem cell treatment procedures, venous and bone marrow. In the venous procedure, stem cells are harvested from peripheral blood and in the bone marrow procedure, stem cells are harvested from the bone marrow. We review the patientís medical history and records to determine which procedure is best for the patient. For example, for a patient on blood thinners, bone marrow procedure may not be a good option. Our patient coordinators can guide the patient in the initial screening process and our physicians can help the patient to select their best option.
Q: Is your venous treatment basically the same as a PRP treatment?
PRP stands for ďplatelet rich plasmaĒ and our venous treatment is a combination of stem cells from the peripheral blood and PRP which contains anti-inflammatory factors as well as various growth factors.
Q: If a patient has prostate cancer that is not at the stage where treatment is imperative would stem cell treatments be advisable or not? What about patients with other cancers that might be in remission? No chemo or radiation is taking place if that is important.
We review each patientís medical history and records carefully before proceeding with the stem cell treatment. In general, we recommend five-year cancer free period for most cancers except certain skin cancers, before proceeding with stem cell treatment. But because of their tendency to spread to bone, any patient with history of prostate cancer or breast cancer, we exclude them from getting bone marrow procedure, but the patient can do venous treatment if he or she has been in remission for the past 5 years at least.
Q:Are the treatments for IPF and COPD the same?
The stem cell treatment we offer is the same for IPF and COPD Ė both are aimed at calming chronic inflammation and slowing the progression of the lung disease.
Q: The first time I got treatment, several supplements were recommended to me. The second time, I was told only to nebulize glutathione every other day. I felt the supplements were giving me more energy and stamina so I am continuing them. Is there any reason not to? Also, is there a reason not to nebulize the glutathione daily? I find it helps my breathing.
There is no reason not to continue using the supplements if they help you. We have stopped recommending the supplements as part of our overall protocol because it is ultimately up to the patient as to whether they would like to utilize them and how much benefit they may gain from the supplement usage. Regarding glutathione, daily use may lead to some irritation of the airways so we typically recommend use every other day to prevent any negative side effects.
Q: Can you explain what l-glutathione plus is and why you recommend it.
Glutathione (reduced glutathione, y-glutamylcysteinylglycine, GSH) as part of the protocols is utilized for its antioxidant and mucolytic properties. It is a primary factor in the bodyís ability to deal with oxidative stress. Oxidative stress has been shown to play a major role in the pathogenesis of COPD.
As a potent antioxidant it helps improve host defenses and oxygenation. Typically the mucus produced in the airway is cleared by ciliary transport and cough but this is not the case in chronic lung disease. Excess mucus in the airway lumen can result in measurable mechanical obstruction of the small airways and can impact disease pathogenesis and prognosis of airway disease, especially in COPD and can be associated with chronic expectoration, increased hospitalizations and respiratory infection related mortality.
Many of our patients noted the day after their first treatment with glutathione their breathing felt easier and oxygen levels as measured by finger pulse oximeter were elevated.
Bronchospasm has been noted in some asthmatic patients and it is felt that these patients may be sensitive to sulfites. We do not use glutathione in patients with an asthma diagnosis.
Q: You changed from adipose to bone marrow. Was it because of FDA restrictions or is bone marrow more effective or easier to extract? Do you use a local anesthetic or is a patient actually put under?
The primary reason for the change from adipose to bone marrow was because the research shows and we have found that bone marrow offers the most complete mixture of regenerative components to promote healing of the lungs. This includes the two main types of stem cells, hematopoietic and mesenchymal, and some signaling factors found in platelet rich plasma. Our procedures are all done on an outpatient basis with local anesthetic only. Using certain techniques, our providers are able to minimize discomfort resulting in patients reporting very little pain during or after the bone marrow harvest procedure.
Q: To what do you attribute some patients doing so well when they get treatment and others seeming not to get much benefit at all?
We are not exactly sure why some patients are doing so well and some not getting much benefit after the stem cell treatment. From our observation, we see that most patients who do not seem to respond well with stem cell treatment are in the advanced stages of lung disease.
Q: If a person has had stents implanted, is it still okay to get stem cell treatment?
Coronary stents are not a contraindication for stem cell treatment. We have had many patients with stents who had stem cell treatment without any complication.
Q: Do you see the cost of treatments going down in the future? Do you think insurance will eventually cover treatments? Any thoughts on the FDA's proposed regulations on adult stem cell therapies?
The cost of current treatment protocols may go down in the future because the field is ever progressing so newer technologies will likely be available as time goes on. I do not believe insurance will cover treatments in the immediate future because we still have a long way to go before they see the long term studies demonstrating the cost benefit to them for covering these treatments. I believe a personís own stem cells should not be regulated like a drug, however I do believe that there should be more quality oversight of stem cell clinics to ensure patient safety and efficacy of treatments are being monitored effectively. It is imperative that stem cell clinics and regulation agencies work together to provide access to care for those suffering now, while providing a path to continually improve efficacy and develop efficient and safe technologies.
Had UC treatment April 5th, 2007
Had autologous treatment March 19, 2010
Had bone marrow and adipose stem cell treatment (autologous) June 16, 2010