Making Rounds
Breathing Easier
People from all around the Sandhills come to the Lung Nodule Clinic, referred by primary care physicians and often fearing the worst.
“When patients come to see me, most of the time they’re scared because they think I’m going to tell them they’ve got cancer,” said Irlene Locklear, MD, a pulmonologist who heads the Lung Nodule Clinic. “Their doctor will tell them, ‘You’ve got a spot on your lung.’ They don’t tell them how big it is or sit down with the CT scan.”
But Dr. Locklear does, and much of the time, she’s able to show patients just how small the spot is. “A lot of times patients think they have a big old mass sitting in their lungs, and it could be a little 6-millimeter nodule the size of a stick pin,” she explains. Those moments of relief — and the care that Dr. Locklear and her team provide across the board — create bonds among patients and providers.
Milton and Donna Sue Bass, a husband and wife from Bladen County who are both followed at the clinic, refer to Dr. Locklear as family. “She’s easy to talk to,” Donna Sue said. “I feel good about sitting there with her.”
Dr. Locklear has been seeing Milton for years, treating his time in Vietnam. Her care has given him back the ability to do things he couldn’t before, like help around the house.
“I can walk outside a lot, too, and see my birds and tend to my little tomato bushes and cucumber bushes,” Milton said. “I’m able to do those things on account of Dr. Locklear.”
The Basses say they trust Dr. Locklear and the staff of the Lung Nodule Clinic completely. So when Donna Sue’s primary care physician needed to refer her to a pulmonary specialist for what turned out to be a mycobacterial infection, she insisted on seeing Dr. Locklear.
“She’s just fantastic,” Donna Sue said.
A graduate of the University of Oklahoma College of Medicine, Dr. Locklear has served in the Lung Nodule Clinic since it opened 13 years ago. She primarily works with patients with newly diagnosed nodules that may or may not be malignant tumors, doing workups that could involve a bronchoscopy, biopsy, CT or PET CT scan or other procedures.
“We’re doing a lot of procedures that are noninvasive,” Dr. Locklear said.
Among the most cutting-edge tools is an Illumisite platform for navigational bronchoscopies. This allows Dr. Locklear to precisely pinpoint the location of extremely small nodules to biopsy them in real time, which enhances the accuracy and safety of the procedure.
“We map out a pathway, so we can go straight to the nodule rather than guessing where it is based on an X-ray image,” Dr. Locklear explained. “We can go after smaller nodules — 1 or 1.5- or 2-centimeter nodules — that we might have otherwise sent to radiology for CT-guided biopsies. That’s good, because with CT-guided biopsies the risk of lung collapse is 10 percent, but with navigation bronchoscopy it’s less than 1 percent. Some of our patients are high risk, so we do that.”
Another noninvasive method Dr. Locklear employs is called EBUS, short for endobronchial ultrasound, which is often used to biopsy mediastinal lymph nodes or masses in the mediastinum, the area of the chest between the lungs that contains the heart.
“Several years ago, those patients were going to thoracic surgery,” Dr. Locklear said. But now they can get an endobronchial ultrasound at the Lung Nodule Clinic instead. “That is much more noninvasive than having the patient go for general anesthesia and get a mediastinoscopy.”
In the event that a patient’s nodule is malignant, Dr. Locklear determines the best next steps, which could be a referral for surgery, chemoradiation or another procedure that can be done in Cape Fear Valley’s Cancer Center. She monitors all her patients as they are treated in the Lung Nodule Clinic, taking special care to have them seen quickly for follow-up procedures “so that they’re not sitting home anxious and scared.”
That level of care and compassion is cherished by patients like the Basses.
“If she feels like you need a few extra minutes, you’re going to get that,” Donna Sue says. “If you’ve got a question to ask her, she’s not looking at that watch, like ‘I’ve got to get out of here.’”
Dr. Locklear’s pleasant demeanor eases the stress of every appointment. Milton puts it simply: “She’s got a smile on her face that’ll put a smile on yours.”
If you are ages 50 to 80 years old, currently smoke or have quit smoking within the last year, with an average smoke history of smoking one pack of cigarettes a day for 20 years or two packs for 10 years or more, talk to your doctor about scheduling a yearly low-dose CT scan.
