Breathing Easier

September 11, 2017 Juvy Dichoso

Recently, a patient with Acute Respiratory Distress Syndrome (ARDS) was admitted to the Guam Regional Medical City intensive care unit. He was suffering from a severe case of pneumonia and deteriorating rapidly. He was not responding to conventional treatments, and needed a very high concentration of oxygen to survive.


In an effort to save the patient’s life, GRMC Pulmonologist Dr. Jose Gonzalez decided on a procedure known as “Prone Position Ventilation.” It’s a rescue procedure that involves flipping the patient over and placing him in the prone position on the bed.


Dr. Gonzalez explained that in cases of ARDS, “there are some areas of the lung that are very inflamed, and other areas that have not been affected. When you flip the patient and place him in a prone position, you improve the aeration of those areas that are less affected.”


“The actual flipping of the patient is labor intensive,” said ICU Nurse Manager Joanna Villamayor. “It requires teamwork from all of the nurses. The other half is the monitoring and continuing assessment of the patient.”


“We were able to get the breathing tube completely out, and get him breathing completely on his own” explained Dr. Anna Shapiro who, together with Dr. Pei-Chang Liu, monitored the patient day and night. “This patient wasn’t doing very well when he first arrived,” said Physician Assistant Nicole Kitchen. “Once this procedure was done, there was marked improvement.”


After two days in the prone position, the patient’s ability to breath was significantly improved, and he was discharged.


New procedures to assist cancer patients      

GRMC is fortunate to have two experienced pulmonologists on staff, Dr. Gonzalez and Dr. Michael Agustin, who have introduced a number of new procedures to assist cancer patients.


Earlier this year, Dr. Agustin successfully implanted an “in-dwelling pleural catheter” into the chest of a young woman with breast cancer. The cancer had spread to her lungs, causing fluid accumulation. The catheters are small, flexible tubes designed to drain fluid from around the lungs so that patients no longer need to undergo periodic needle aspirations to draw out the fluid. That means fewer re-admissions and lower medical costs.


The introduction of this new procedure followed the successful completion in March of an endobronchial stent operation. Dr. Agustin, with the assistance of GRMC Neurointerventional Radiologist Dr. Scott Shay, was able to implant a stent to clear a path through a cancerous growth in the lungs of a man struggling to breathe. 


Both operations, the “in-dwelling catheter” and the “endobronchial stent,” are believed to be the first of their kind ever conducted on Guam. They significantly enhance the care available on island for cancer patients suffering from pulmonary complications.


“It’s not a one man team, it’s a collaborative effort” Dr. Agustin said. He credited the support provided by GRMC’s nursing team and the hospital’s 16 respiratory therapists who ensure round-the-clock breathing support for those suffering from pulmonary diseases. “You can count on our staff to support your loved ones during trying times,” Dr. Agustin said.



Dr. Gonzalez received his medical degree at the University of del Valle in Cali, Colombia, and completed an Internal Medicine Internship at the Monmouth Medical Center in Long Branch, New Jersey. He finished his Residency at the Cleveland Clinic in Weston, Florida where he was awarded a Pulmonary Critical Care Fellowship. A member of the American Thoracic Society and certified by the American Board of Internal Medicine with a sub-specialty in Pulmonary Disease, Dr. Gonzales is married to Dr. Ana Sanchez, GRMC’s pediatric oncologist.


Dr. Agustin completed a Pulmonary and Critical Care Fellowship program at St. Elizabeth Medical Center in Boston. His finished his Residency in Internal Medicine at Memorial Hospital of Rhode Island. He received his medical degree at the University of Santo Tomas in Manila, Philippines. He is married to GRMC Infectious Disease physician Dr. Michele Yamamoto.



Both operations, the “in-dwelling catheter” and the “endobronchial stent,” are believed to be the first of their kind ever conducted on Guam.

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