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Archive: Dr. Tom 3

Transtracheal catheter
Q: What are your feelings on the Transtracheal Scoop Catheter? 

Sherry

A: Dear Sherry, Very good for selected patients. TTO conserves oxygen, is cosmetically pleasing to some and removes the need for nasal canulae. Care of the catheter requires a well-indoctrinated patient. It should not be used where mucus or infections are problems.

Dr Tom

                

Lung nodules that remains undiagnosed
Q: I have numerous nodes in both lungs, the largest being 9 millimeters and the rest are 4 millimeters or less. CAT Scans, PET scan (Positron Emission Tomography is a test often used to detect cancer) have not been able to discover what the nodes are.

I have major COPD, Sleep Alpena, and on oxygen 24/7. My doctor does not believe I am able to handle biopsy or surgery.

The question is have you seen a case such as mine, and is there a national database for researching it?

Pat

A: Dear Pat, This is a problem with CT scanning. Too many nodules, mostly benign are found. The ones that grow are probably cancer, but this requires follow-up at 3 to 6 months. PET will not light up small nodules that are the beginning of cancer. The whole field is changing.

Dr Tom

 

SOB with increased humidification
Q: What is the mechanism that makes patients feel SOB on days with high humidity or in the shower?

Mike

A: Dear Mike, I am not sure. Maybe the air is more dense or viscous. This is an observation of many people.

Dr Tom

 

Advanced stage of COPD
Q: I have been taking care of my mom who has COPD for 8 months.  The only thing she can do for herself is feed herself.  I bathe her; take her to the bathroom, etc. 

Her lung doctor said in March she is in the last stages of her disease. He said her lungs are just gone.  How long does this last?  What can I expect to happen to her?

Jennifer

A: Dear Jennifer, It’s hard to make predictions. Many patients with COPD in so-called advanced stages can live for months or even years with help from pulmonary rehabilitation techniques such as breathing training and some conditioning. Oxygen prolongs life as well as its quality. Don’t give up.

Dr Tom  

 

COPD/Alpha–1 - Antitrypsin Deficiency
Q: I have severe COPD, as do my 2 sisters and 2 brothers. The doctors say its not Alpha–1-Antitrypsin Deficiency related, yet I guess I’ve never believed it because of the five siblings having COPD. Of course we all smoked but I’ve read that 20 or 25% that smoke have emphysema. Maybe you can explain it. Thanks for any enlightenment.

Ginny

A: Dear Ginny, There are several families with what looks like emphysema due to Alpha one, but with normal levels. There are other familial factors. This is under intense study. Don’t let ANY ONE of your relatives smoke!

Dr Tom

 

Transient Tachypnea of the Newborn (TTN)
Q: I have a nephew that was born 2 days ago and he has TTN. He has been air lifted to a specialist and I feel that I am not being told everything about his condition.  How serious can this get, and is it life threatening?

Chad

A: Dear Chad, I know nothing about transient tachypnea. Better see a pediatric pulmonologist.

Dr Tom

 

An acute exacerbation since 9-08
Q: I was in the hospital 9/8/04 with an “exacerbation”. It is 10/28 and I am still in an “acute attack”.

I’m still ill and do not know what’s up. Now testing for possible fungus. Doing other X-ray blood work to determine an underlying cause of such acute duration. Am I doing the right thing?

Ken

A: Dear Ken, I cannot give individual advice to any patient. I assume you are under good care from what you tell me. Stay with your doctor and follow his/her advice.

Dr Tom

Long term benefit of inhaled corticosteroids
Q: Dr. Petty, in your opinion does the use of inhaled corticosteroids have any long-term benefits for patients with mild to moderate COPD?  Thank you!

Jacqueline

A: Dear Jacqueline, The answer to your question is not settled. Today inhaled corticosteroids are recommended only for moderate to advanced COPD.

Dr Tom  

 

Husband quit smoking
Q: My husband quit smoking 3 or 4 weeks ago and he has been in hell. Ever since he quit, he has started a terrible dry cough that then turns into the closing of his throat or something, and he can’t inhale for about 15 seconds. Then after it is over he burps (I guess from gasping for air and in taking a little).

It is very scary and he has seen a doctor that said it was just his lungs cleaning themselves out. Well that doctor doesn’t live with him nor does he sit my husband up in the middle of the night from a dead sleep when he starts suffocating.

He was on the nicotine patch, but tried to stop using it too just incase that was the cause, well it is still happening as of last night 3AM.

What is causing this?? He is not sick, no fever, no mucus, and feels fine.  It occurs out of nowhere, awake or dead asleep, and no warning it’s coming on.

Can you help us? I thought quitting should make you feel better! He was fine while smoking! He just turned 28. Thanks

Melissa 

A: Dear Melissa, Stopping smoking can be hell for a while. I doubt if this choking is from stopping smoking. I wonder about vocal cord abnormalities or sleep apnea. Better see a pulmonologist.

Dr Tom

 

Oxygen assessment
Q: When comes the time to assess an elderly patient for home O2, do you take in consideration one of these formulas: Normal PO2= 110-age / 2? Also, when comes the time to assess a smoker for home O2, do you take the carboxyhemoglobin into account?

Jean

A: Dear Jean, I do not use a formula based on age. Generally a PO2 of 55 or less or SAO2 88 or less is the indication for oxygen, but this should be put in the context of the patient and the apparent clinical consequences of hypoxemia. These are normal values for Leadville, Colorado at 10K feet. CO is not used in deciding about oxygen, but is a definite reason to quit smoking.

Dr Tom

 

CMV and SIMV
Q: Explain the difference between CMV and SIMV.

Linda

A: Dear Linda, Pass the word salad please! CMV means continuous mechanical ventilation and may be in the assist or control mode. SIMV, means synchronized intermittent mandatory ventilation. A rate is set, but the patient can also breathe at his own rate. When the set rate comes in, it is synchronized with the patient’s own drive to breathe. 

Dr Tom

 

Pulmonary Hypertension
Q: In the American Association of Cardiovascular and Pulmonary Rehabilitation manual, pulmonary hypertension is a contraindication for Pulmonary Rehab, yet some institutions will allow these patients to participate. What are your thoughts on this?

Meryl

A: Dear Meryl, Pulmonary hypertension is not a contraindication for pulmonary rehabilitation. The six-minute walk test is used as a measure of benefit for therapies aimed at pulmonary hypertension. Many patients have exercise limitation due to the reduce output of the right ventricle, but this may be overcome with medications, and graded cautious exercises.

Dr Tom

 

Noninvasive Positive Pressure Ventilation (NPPV)
Q: Should external humidification be used with all NPPV units?

Pam

A: Dear Pam, Not usually.

Dr Tom

 

Medication question regarding a patient
Q: My patient has an atrial fibrillation that caused a palpated heart rate of up to 180.  Cardiologist stated that this was due to the low potassium levels and increased the potassium.  A thyroid scan was also ordered to rule out any causes.  The Pulmonologist blamed it on the Xopenex and went from QID with a PRN to q6 only with no PRN. Atrovent was ordered by itself for PRN.  Is this advisable?  (Patient does not respond to albuterol and has had some tachycardia.)

Rhonda

A: Dear Ronda, I cannot comment on individual patient care. Rhythm disturbances are fairly common with oral albuterol. 

Dr Tom

 

Croup tent
Q: Is croup tents with 02, CPT, and frequent nebulizers, always indicated for bronchiolitis?  Do you have studies to support using or not using any of these modalities?

Sharon

A: Dear Sharon. No. I do not know of any controlled studies about croup tents in bronchiloitis, but their use has been popular. 

Dr Tom

 

Medications
Q: How can a doctor keep re-ordering Aerosol Treatment with bronchodilator and anticholinergic drug when the patient’s lung is clear and there are no symptoms? Is there any scientific justification to this practice?

Tach

A: Dear Tach, It is hard to improve on a patient with no symptoms and no findings in the chest. I would not give medication in this instance.

Dr Tom

 

 

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