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Archive: Dr. Tom 8
Posted January 25 th, 2005

Tachycardia
Q. I am a 51 yr. old. I would like to know what is low- grade tachycardia and also what it is meant by having extra-early beats?

Bertie

A. Dear Bertie, Normal resting pulse is about 60-86. Low-grade tachycardia does not have a strict definition, but it is an average pulse rate of around 100 to 110. Early extra beats are felt as palpitations (heartbeat sensations that feel like pounding or racing). They come from premature electrical activity of the heart that stimulates contraction. These premature beats can originate in the atria, the small chambers above the main pumping muscle, the ventricles, or from the ventricles themselves.

Dr. Tom

 

Too Much Medicine?
Q. I have COPD/Emphysema and I am on O2 mostly at night. It is obvious I’m over–medicated. I am currently taking these meds.

  • Avalide 12.5 1 times a day
  • Paxil CR 25 mg. once daily
  • Theocron 300 mg 4 times daily
  • Ambien 10 mg once before bed,
  • Prednisone 10 mg, two times a day,
  • Allfen 150mg twice daily,
  • Ativan 1 mg. twice a day.

Doesn't this seem a little extreme? I feel like a walking zombie most of the day, and still can't breathe real well. Thank you for your advice on this matter.

Tommy

A. Dear Tommy, Yes, that is a lot of medicine. The dose of prednisone is really excessive if you take it all the time. Better consult your doctor or get a second opinion. You could feel a lot better with less medicine.

Dr. Tom

 

Needs a Citation
Q. A few years ago, I came across a very interesting web article by you describing your continuing care of one elderly (80s-90s) emphysema patient through his last years. I mentioned it to my current pulmonolgist and she said she would be interested in reading it. Now, of course, I can't find my copy and my web searches so far haven't turned up the needed citation. Can you lead me to it? Thanks.

Ward

A. Dear Ward, You are probably referring to commentary I published in The Annals of Internal Medicine, in the section “on being a doctor.”

Frankly, I cannot find it in my reprint file. It is reproduced on page 69 and 70 of my book, The History of the University of Colorado Division of Pulmonary Sciences and Critical Care Medicine, published in 2003.

I would be happy to send you a copy of this book or fax the two pages if you give me an address or fax. This was a most fascinating patient whom I cared for from age 86-99.

Dr. Tom

 

Aspiration Pneumonitis
Q. How long does it take to recover from
aspiration pneumonitis (injury to the lung caused by gastric contents)? It has been over nine months and I still get short of breath on exercise and discomfort in upper airway upon exertion.

I developed the aspiration when I had an arthroscopy of my knee. I've never smoked and never had any respiratory problems.

Val

A. Dear Val, It depends on how extensive the aspiration pneumonia was, and what the state of your lung function was, before the aspiration. Your doctor should measure your function by spirometry (a device used to measure lung health) and see how much capacity you still have.

Dr. Tom

 

An Update from Thelma
Q. There is a stent made of Silicone made by Novatech. This is what the doctor in Boston is going to put in my trachea in April. They are made by Boston Medical Products. Thank goodness I decided to go to the Boston Doctors.

Thelma
(See Thelma's previous Questions: Question 1, Question 2, Question 3)

A. Dear Thelma, Great News! I admire your persistence. Seems like you have gone to the right place for your stent. Hope all works well for you.

Dr. Tom

 

Nutrition and Exercise
Q. My job is teaching the cardio-pulmonary rehab patients about strength training and monitoring them while they exercise. I have had quite a bit of education in the area of nutrition for the normal healthy adult, but need some education on pulmonary patients’ nutritional needs.

Many of the patients need to lose pounds in the upper body but I understand that there are some special circumstances. I also have been challenged to find a good abdominal exercise.

Sandra

A. Dear Sandra, Nutrition is a complex subject. Calories are needed for energy production. No single diet such as Atkins, Ornish, Weight Watchers, or the Zone has any magic. Losing weight, however you can manage this by increasing energy production through exercise and reducing calories, is the principle to follow. There are a number of abdominal exercises that are described in physical therapy texts.

Dr. Tom

 

Asbestosis and Pregnancy
Q. Dr. Tom, Do you know of any long-term effects on the fetus if the mother has a diagnosis of pulmonary asbestosis prior to the pregnancy?

Marilyn

A. Dear Marilyn, No, I do not, and I doubt if there are any effects at all.

Dr.Tom

 

Adding Medicine
Q. My 84 yr. old mom has COPD and asthma. She had lung cancer 14 years ago and they took half of one lung. She is on oxygen 18 hours a day, nebulizer treatments 3-4 times a day, Advair, Provental, and Singular. Can she add Spiriva? Will it be too much?

Lannie

A. Dear Lannie, Spiriva works through different mechanisms than the other drugs that your mom takes. It could benefit.

Dr. Tom

 

Needs Information About Medicine
Q. Dr. Tom, Could you please give me some information on Spiriva. Do you need to stop taking Atrovent when you are placed on Spiriva? Have you seen good results from Spiriva?

Joyce

A. Dear Joyce, Spiriva works like Atrovent, but lasts much longer, usually 24 hours. Do NOT take Atrovent too.

Dr. Tom

 

Unexpected Emphysema Diagnosis
Q. I was told yesterday from a chest x-ray, by my endo. doctor, that I had emphysema. I was shocked. I have only had this cold/allergy/sinus problem for about two months. I do take allergy shots.

I was on an antibiotic in December (allergy doctor) but on December 20 I told my endo doctor that I was not over this chest problem. He told me that I did not need to be on another antibiotic.

So now a month later I ask for a chest x-ray and he says I have emphysema. I have been going to this clinic for three years and have had all sorts of scans, even a stress test two years ago.

I guess I’m asking can this illness just show up in two months? A doctor says you have emphysema…shouldn’t he at least say. “Let me refer you to a specialist”?

Gina

A. Dear Gina, Yes, see a specialist. A chest x-ray is not an accurate way to diagnosis emphysema. You need spirometry (a device used to measure lung health). But your primary physician should be able to do this in his office. If not, definitely see a pulmonologist.

Dr.Tom

 

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