Fluid management in septic patients with pulmonary hypertension, review of the literature

From Event Planner To Lung Cancer Advocate: How Terri Ann DiJulio Found Her Calling

Terri Ann DiJulio has dedicated her life to championing a cause that found her in the most unexpected way. The 63-year-old Philadelphia resident, once a busy event planner, now spends her days advocating for lung cancer awareness, a disease she knows all too well. Through years of battling the illness and witnessing its impact on her family, DiJulio discovered a powerful purpose: spreading awareness and challenging misconceptions about lung cancer.

"I'm Still Here for a Reason."

DiJulio recalls her initial diagnosis with a mix of disbelief and determination. It was in 2003, when she was 42, and experiencing chest pressure that led her to the emergency room.

"I thought it was something with my heart," she said, explaining that her doctor recommended immediate inpatient observation.

Terri Ann DiJulio (photo provided by Terri Ann DiJulio)

What doctors found instead was a small nodule on her lung. Although it was benign at the time, DiJulio's health journey had only just begun. Two years later, the nodule transformed into something far more sinister.

"When I woke up from surgery and found out that I had lung cancer, it was shocking," she said. "It took me a while to adjust to it emotionally. It was scary."

Doctors removed the lower right lobe of her lung, and the rehabilitation was grueling.

"It wasn't an easy thing 19 years ago—hospital, seven days and lots of rehab," she recalled.

Terri Ann DiJulio Advocating for Lung Cancer Research in Washington (photo provided by Terri Ann DiJulio)

But from that struggle emerged a new purpose.

"I'm just doing what I'm called to do," she said. "I found a calling through this disease. And I'm still here for a reason."

Fighting a Widespread Misconception

DiJulio's experience opened her eyes to the misunderstandings surrounding lung cancer. One of the most pervasive myths is that only smokers are at risk.

"Prevention has been drilled into us: If you don't smoke, you won't get lung cancer," she said. "Well, that's not true—anybody with lungs can get lung cancer, and no one deserves it."

According to the Lung Cancer Research Foundation, more people die from lung cancer than any other type of cancer globally. While smoking remains the leading cause, nearly 20% of lung cancer diagnoses occur in individuals who have never used tobacco. Radon, pollution, and secondhand smoke can also cause lung cancer. But DiJulio notes that the stigma around lung cancer is real.

"If you get lung cancer, people believe you caused it," she said. "I personally believe the stigma has gotten in the way of funding."

A Family's Battle

The disease continued to haunt DiJulio's family in heartbreaking ways. Not long after her initial diagnosis, five of her relatives were also diagnosed with lung cancer.

Terri Ann DiJulio and her mother Theresa who died of lung cancer (photo provided by Terri Ann DiJulio)

"My mother passed away five years almost to the day from the time she was diagnosed," she said. "Then we found out her sister had lung cancer, her brother had lung cancer, and then another uncle was diagnosed."

DiJulio's own cancer returned as well. By then, she had already endured multiple surgeries, and her options were limited.

"Now, the only surgical option was to remove the rest of my right lung because of where the tumor was located," she said.

With advancements in medical technology, however, she opted for radiation therapy instead.

"Third day of treatment, I went on a 20-mile bike ride," she noted, underscoring her resilience.

A Natural Advocate

Her journey through illness inspired her to help others navigate the same path. DiJulio began speaking at lung cancer conferences, lobbying for more research funding, and reviewing scientific grant proposals. Her work brought her into contact with other passionate advocates, like Heidi Knafman-Onda, a stage 3 lung cancer survivor and co-founder of the White Ribbon Project alongside her husband, Pierre.

Terri Ann DiJulio Attending White Ribbon Project Event (photo provided by White Ribbon Project)

"I met Terri Ann through advocacy and she was a very strong voice," Knafman-Onda said. "It felt like meeting a long-lost sister."

Knafman-Onda said DiJulio traveled to Colorado to help spread awareness about lung cancer by building white wooden ribbons for lung cancer survivors and caregivers.

Terri Ann and Heidi Knafman-Onda of White Ribbon Project (photo provided by Terri Ann DiJulio)

"She's a good soul because she's so giving," Knafman-Onda said. "It's natural…it's like second nature for her to become involved."

Pedaling for a Cause

DiJulio's advocacy work also connects her with organizations like Ride Hard, Breathe Easy, a nonprofit founded by John Matthews. Matthews, who started the charity in honor of his late mother, organizes cross-country cycling events to raise funds for lung cancer patients. DiJulio, an avid cyclist herself, has joined Matthews on several rides.

Ride Hard Breathe Easy Classic 2024 (photo provided by John Matthews)

"She's helped us raise donations and support us with her presence," Matthews said. "Whether it's a 100-mile ride in a day or 300 miles over several days, she does it with such happiness, optimism, and conviction."

Terri Ann Participating in 100 miles RHBE 2019 ride (photo provided by John Matthews)

In 2023, DiJulio helped raise $30,000 of the $70,000 total funding raised during an event for Ride Hard, Breathe Easy. The money goes toward supporting lung cancer patients with medical bills, living expenses, and wigs for those undergoing treatment.

Living Life to the Fullest

For DiJulio, each diagnosis has served as a reminder to live boldly.

"I used to think I lived the biggest life I could live and stayed in the moment," she reflected. "Then at every diagnosis, at every illness, I was able to live bigger."

After her third diagnosis, she shut down her event planning business to dedicate herself fully to advocacy.

Terri Ann DiJulio (photo provided by Terri Ann DiJulio)

"I take a lot more risks. I follow my intuition," she said. "I am 63 years old, and I just live the heck out of every minute I'm given."

Her message to others facing lung cancer is simple but powerful: "I encourage people to be their own advocate, to ask the doctor, to push the doctor for a low-dose CT scan. It could save your life."

The Road Ahead

DiJulio's work isn't finished. As a survivor and advocate, she is committed to making lung cancer a thing of the past.

"We're going in the right direction, yes, but we still need more," she said. "It doesn't have to be the leading cause of cancer death."

Terri Ann DiJulio is an avid cyclist (photo by Terri Ann DiJulio)

Through her advocacy, she continues to inspire others, raise awareness, and provide hope to those fighting lung cancer.

As her friend and fellow advocate Knafman-Onda put it, "Terri Ann is a good soul because she is so giving."

DiJulio's journey proves that even in the face of life's most daunting challenges, there is always an opportunity to make a difference.

If you know someone who has performed an act of kindness, whether it be big or small and you think they serve as an example of compassion, generosity and service, nominate them here: whyy.Org/goodsoulsform.

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Addition Of Lung Nodule Clinic Increases Access To Lung Cancer Screening For Northeast Mississippians

TUPELO — Lung cancer can be caught earlier than ever thanks to advances in lung screening, and North Mississippi Health Services is increasing access to screening with a new Lung Nodule Clinic.

A lung nodule is an abnormal area of tissue in the lung, classified in four categories based on the Lung CT Screening Reporting & Data System (Lung-RADS) — category 1 is negative, category 2 is benign in behavior and appearance, category 3 is probably benign and category 4 is suspicious.

"At this point, within our system, we're encouraging RADS 3 or 4, which are the higher risk categories that the radiologists interpret, to be referred to the Lung Nodule Clinic," said Dr. Jaime Ungo, pulmonologist at Pulmonary Consultants in Tupelo.

He has worked with North Mississippi Health Services for 25 years and splits his time between seeing patients at North Mississippi Medical Center-Tupelo and treating pulmonary and sleep disorder issues at the clinic.

Though physicians like Ungo have taken care of lung patients for years, there wasn't always a direct point of entry to see a pulmonologist. Previously, upon receiving a referral, a nurse would bring patient information to a pulmonologist and they'd look over the report to determine how quickly a patient should be seen.

NMMC's new Lung Nodule Clinic, located at Pulmonary Consultants and staffed with a designated provider to see patients, opened this fall and provides referring physicians and providers a quick point of entry.

"We're screening a lot of patients at the level of primary care with low-dose CTs," Ungo said. "So a lot of these that are a little bit suspicious, instead of burdening the primary care provider with the followup and the potential of something slipping through the cracks, we provide that quick, push-one-button referral to the Lung Nodule Clinic so they can get to see us quickly."

Low-dose CTs, which can be ordered by any health provider, are images captured using a low dose of radiation and an X-ray machine. That type of scan is advantageous for identifying lung nodules because there isn't a large radiation risk to the patient, they can be completed quickly and don't require the use of contrast material.

"A lot of these nodules are not going to be cancer, but some of them can be infections, some can be inflammations, some can be scars," Ungo said. "But the whole point is, if we have a cancer, we can catch it early at a moment that we can actually make a difference in treatment."

The criteria for lung cancer screening, as set by the U.S. Preventative Services Task Force, includes anyone age 50 to 80 that has smoked the equivalent of a pack of cigarettes a day for 20 years, has been an active smoker within the last 15 years and doesn't have symptoms of lung cancer.

Nationwide, only 13.9% of all people eligible for screening are being screened, Ungo said, and in Mississippi the number is even lower at 4 to 6%.

"The push here is to increase the awareness of screening to providers," Ungo said. "Any patient-provider interaction is an opportunity to go ahead and screen these people."

Without early screening, 80% of the time lung cancer is discovered in Stage 3 or 4. Because it has locally or distantly spread within the body at that point, it is essentially incurable by the time it is discovered.

The reason late-stage lung cancer is so difficult to catch, Ungo said, is because people are reactive rather than proactive.

"The usual scenario is you come to me because you had a change in your cough, you started coughing up blood or you started losing weight and getting more short of breath," Ungo said. "Then, as a reaction, your provider gets a chest X-ray or a CT scan, they find something and the patient comes to me."

But with early screening, the data is flipped, and 80% of the time lung cancer is caught in Stage 1 or 2 and is often curable.

"If we are proactive, it's a different ballgame," Ungo said. "We know the main risk factor for lung cancer is smoking. So if we start looking at the risk factors and screening the adequate people, then we'll find it early."

Everyone who meets the requirements for lung cancer screening should receive a yearly low-dose CT, Ungo said. The low-dose CT scan should be seen as the mammogram of lung cancer.

"We're not inventing these cancers," Ungo said. "They're there in the community. We just have to find them earlier, at a point that we can intervene and save lives."

Once a suspicious lung nodule is identified, pulmonologists can now use an Ion device, developed by Intuitive Surgical, to perform robotics-assisted bronchoscopies, during which biopsies of nodules can be conducted.

"The beauty of being able to do robotic-assisted bronchoscopy is our chances of complications is less than 1%," Ungo said. "Our yield is around 97 to 98% in getting the diagnosis, and we can diagnose things that are 9 millimeters and above."

Previously, a needle was inserted into the lung to collect a sample for biopsy. Nationwide, the risk of lung collapse as a result of those transthoracic needle biopsies was 30%.

The use of technology allows pulmonologists to diagnose patients earlier and more safely than they could in the past.

"We have diagnosed very early stage lung cancer successfully and safely," Ungo said.

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Sensitivity Reduced On Low-Dose Pediatric CT Scans For Small Lung Nodules

HealthDay News — Two lung-nodule computer-aided detection (CAD) systems demonstrated reduced sensitivity on low- versus standard-dose computed tomography (CT) scans for small nodules in pediatric patients, according to a study published online Oct. 9 in the American Journal of Roentgenology.

Russell C. Hardie, Ph.D., from the University of Dayton in Ohio, and colleagues conducted a retrospective study of 73 patients (mean age, 14.7 years) who underwent clinical standard-dose and investigational low-dose chest CT examinations within the same encounter. Two publicly available lung-nodule CAD systems that had been trained using adult data — FlyerScan and Medical Open Network for Artificial Intelligence (MONAI) — were used to process both CT scans. The sensitivities for 247 nodules measuring 3 to 30 mm were calculated when operating at a fixed frequency of two false-positives per scan.

The researchers found that the detection sensitivities were 76.9 and 66.8 percent on standard-dose and low-dose scans for FlyerScan, respectively, and 67.6 and 62.3 percent, respectively, for MONAI. For standard- versus low-dose scans, the number of detected nodules was 33 versus 24 (FlyerScan) and 16 versus 13 (MONAI) for 3-mm nodules; 46 versus 42 (FlyerScan) and 39 versus 30 (MONAI) for 4-mm nodules; 38 versus 33 (FlyerScan) and 32 versus 31 (MONAI) for 5-mm nodules; and 27 versus 20 (FlyerScan) and 24 versus 24 (MONAI) for 6-mm nodules. Detection did not show a consistent pattern between standard- and low-dose scans for either system for nodules measuring ≥7 mm.

"The findings indicate the need for caution when using low-dose protocols in combination with CAD systems to help detect small lung nodules in pediatric patients," the authors write.

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