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Archive: Dr. Tom 106
Posted November 2, 2007

Readers: Read Dr. Tom’s Commentary on Spirometry to understand the importance of this diagnostic lung test.

 

 

Can a Medication for Your Lungs Make you Short of Breath?
Q. I have COPD...FEV1 27%.  I was using Advair and Spirivia and had been very short of breath. I stopped using the Advair and the shortness of breath has improved tremendously.  Do you know why this may have happened? 

Brenda

A. Dear Brenda, This can occasionally happen with Advair. It is due to a variety of mechanisms. Try Symbicort, it has similar components, if your doctor agrees.

Dr. Tom

 

Parents Have History of Cancer and I Am Concerned about the Results of Lung CT Scan
Q. Hi Dr. Tom. I am 37 year-old female, nonsmoker. Just had third child. For several months post partum I have not felt well. Best described as a tingling, choking type feeling very low in throat, it’s extremely bothersome. I was also coughing a bit at the end of each sentence because I felt like something was pressing on my throat. Also mucus feeling almost like a drip and a throat clearing type feeling. I really felt pretty bad, to the point I didn’t want to even speak or do much of anything.

After meeting with different doctors, I heard everything from allergies, to stress. "You just had a baby, are you stressed?" to an ENT saying it was acid reflux when he used a scope down my throat. I have been on Nexium for a few months and agree I feel about 85% better.

But while I was dealing with this I had a chest CT done. Basically, my doctor urged me to because my mom has lung cancer and  is a nonsmoker. She urged me to check. I have three lung nodules: a 4mm lower lobe left lung, a 2mm nodule upper right, and a 3mm nodule lower right. I consulted with two thoracic doctors, one was even at top NYC hospital. Both said it appeared to be nothing but follow up in three months with CT Scan to document stability.

I was curious as to your take on this. From what they tell me even though report reads "non-specific" they are saying they don't 'look' malignant. What exactly does that mean? Can someone tell by viewing something as small as 2mm it doesn’t look bad? My concerns are lung cancer or a spread of cancer from elsewhere.

All these throat symptoms still concern me, but ENT says it is reflux. I also had an Upper Endo done when I had my three years colonoscopy done (because my dad died very young from colon cancer I get this every three years). Both were normal, they even biopsied upper endoscopy and was normal.

Based on the CT scan not mentioning lymph nodes or anything else unusual; do you agree most likely nothing or would you follow up w/ something sooner? Thanks.

Cheryl

A. Dear Cheryl, These small nodules are most likely healed granulomas i.e. fungal infection, which are common, particularly in the Midwest.  One simple follow-up in four to six months would be appropriate. You are on the right track with Nexium.

Dr. Tom

 

Do I have COPD?
Q. Hello Doctor, I am 40 years old and stopped smoking five weeks ago - for the final time! I have smoked a total of 11 years and around 15 cigarettes a day. I also had asthma since I was a child but the symptoms of have either gone or transformed into something different.

My question is whether I have COPD or not. I have a tight chest, no coughing but I do cough up clear phlegm with green bits in it and upon waking I have a very uncomfortable sensation in my chest. Plus I have a feeling of my chest not being relaxed and I feel that I am not inhaling enough air.

I had a spirometry test and FEV1 and FVC were fine (both above 90% of predicted) and the FEV1/FVC ratio was 72%. So my question is do I have COPD or have I somehow damaged my airways through smoking. Or alternatively is anxiety as one GP told me.  The last one -said it may or may not be COPD but said I probably have damaged my airways through smoking and prescribed an inhaler Seretide. It hasn't done much for me.

Is it likely anxiety, rather COPD since I have picked the very early symptoms of COPD that haven't appeared in spiro tests? Anyway your thoughts very welcome.

Nick

A. Dear Nick, You do not have COPD. I suggest increasing your walking and general exercise, which will help with the anxiety. Never smoke again and you will remain well.

Dr. Tom

 

What is Noncalcified Nodulat Density in the Right Middle Lobe of my Lung?
Q. I received a abdominal and pelvic CT Scan and the results read this: Small noncalcified nodular density within right middle lobe of lung is nonspecific and consider follow-up chest CT Scan to determine if this is stable or changing to exclude neoplasm. What does this mean?

Christine

A. Dear Christine, This only means that there is an undiagnosed shadow in your lung, probably a healed fungal infection known as a granuloma. A simple follow-up is appropriate at about six months, depending on the size, which you did not specify. I am assuming it is less than 5mm.

 Dr. Tom

 

What is Subsegmental Atelectasis?
Q. I am a 45 yr old male in car vs motorcycle accident. Radiology reports "bibasilar subsegmental atelectasis". What could this mean? 

John

A. Dear John, I just means, you did not take a full breath when the x-ray was taken, probably because of pain. It will resolve as you heal.

Dr. Tom

 

Worried about Daughter and Exercise Induced Asthma
Q. Dr. Tom, My daughter is a healthy 13 year old, plays select soccer, basketball, tennis and dance.  She has seasonal allergies including dust mites and has received shots for about 6 years.  She has had signs of exercise induced asthma and has developed asthma symptoms when sick.  She uses albuterol about 30 min before exercise.  Sometimes it doesn't help much.  She will be evaluated next week for Vocal Cord Dysfunction, which I think she has (her triplet sister was just diagnosed with this last week).  Allison complains mostly about intake, not exhaling. 

She just completed a PFT (Pulmonary Function Test) which showed normal across the board with the exception of DLCO.  Her number was 63.  They say normal is 70-100.  Her hemoglobin was 13.0.  They say normal is 12.1-15.1.  She is 5'3" and weighs 100 lbs.  We are currently on a wait list to see a pediatric pulmonary specialist, we currently have an appt end of Nov.

Allison was born 10 lbs 5 oz by c section after trying a unsuccessful vaginal birth she was a single birth.  My husband and I believe she had "wet lung" and was put on antibiotics after birth.  Other than that, we lived in Taiwan for 6.5 years and it was very polluted.

I have tried to research the meaning of this below normal reading to access what could be the cause and if there is treatment.

Can you help me in my quest to know what could be wrong?  I am worried after doing research that she may not be helped....this could be an abnormality of her alveolar membrane among other things.

Linda

A. Dear Linda I would have to know more about the technique used in the measurement of her diffusion test. By itself, it is low, but there may be a technical explanation for it. She may well have vocal cord dysfunction if her main problem is inspiration. You are wise to see a pediatric pulmonologist.

Dr. Tom

 

COPD and Oxygen Saturation
Q. Hello Dr. Tom thanks for your great advice and I wish you a speedy recovery.
Question 1): How can a COPD patient with stage 3-4 emphysema have a SpO2 consistently greater than 94% at rest, walk and sleep? Patient has CHF too. Patient is SOB and tachycardia with activity and at rest. 2) Does supplemental O2 help patients with normal saturations.

D.B.

A. Dear D.B. It is possible, but rare without supplemental oxygen. O2 does help the exercise tolerance of some patients with normal saturations on air. The mechanism is probably providing the extra oxygen for the work of breathing.

Dr. Tom

 

Complications and Side Effects of Bronchiectasis
Q. Dear Dr Tom, I am the very concerned about the daughter of a lady with bronchiectasis.  We are at our wits end because my Mum is constantly in and out of hospital with pneumonia but never getting enough treatment to beat it.  She has had non-resolved pneumonia for months now. 

Her consultant put her on a rotation of antibiotics, Clarithromycin, Doxycycline and another, but they don’t touch the sides of her ongoing infection.  She is also on Spiriva, Symbicort and salbutamol. 

I have two questions to ask you please: When mum is very poorly she does not get fevers (she hasn’t for years), her oxygen levels and bloods seem ok at the moment even though she is feeling really ill (the way she is when its pneumonia). Pseudomonas is showing in her sputum results.

 The Doctors seem to think there is nothing wrong and she just has to put up with it.  She has also been suffering from severe palpitations, which we think is a side effect of the drugs, but they keep fobbing her off and saying its anxiety or too much coffee, Help! 

We are really at the end of our tether and trying to get her moved to another Consultant.  But is it normal to get palpitations, and no fever/normal bloods with bronchiectasis?  Many, many thanks for your help, kind regards, Joanna.

Joanna

A. Dear Joanna The palpitations are most like coming from the drugs she is taking. You may want to see another consultant, particularly for the pseudomonas, but it is common for patients with advanced bronchiectasis and the use of multiple antibiotics to finally get infested or infected with pseudomonas, which is very difficult to eradicate.

Dr. Tom

 

Chronic Cough and Coughing Up Blood
Q. I have had a cough for over a year it is very hard more like a bark the last month I have been coughing up blood. What should I do?

Lyn

A. Dear Lyn, You should see a pulmonologist and get a diagnosis. Coughing of blood is commonly due to an important cause. You may need bronchoscopy to view the lung passages, in view of the blood.

Dr. Tom

 

Son Diagnosed with Laryngopharyngeal Reflux and Still Has Chronic Cough
Q. Dr. Tom, I wrote you about a year ago regarding my son Nicholas who is nine years old who was having a chronic cough for approx. six months, after many visits to his MD, Allergist and ENT he has been diagnosed with Laryngopharyngeal Reflux (LPR) 

He was prescribed Prevacid for six months and we thought it was successful.  Unfortunately his symptoms came back worse (chronic cough, clearing his throat constantly and difficulty swallowing at times) 

He has been scoped twice and his LPR is worse than it was initially even after six months on Prevacid 30mg.  I am concerned about long term use of Prevacid and iron deficiency or other side affects. 

My son will be ten in December and only weighs 60 lbs.  Are there any other options for treating LPR (i.e. I read about fundoplication) I am very concerned and searching for answers to help him. Thank You, Marilyn

Marilyn

A. Dear Marilyn, You should see a pediatric pulmonologist. I am not very familiar with LPR.

Dr. Tom

 

Do You Think I Need a Larger Trach Tube?
Q. I have a Trach Tube Portex size 8 inner cannula is a size 6.  Due to its small size when I move around I cannot seem to get enough air.  Would a larger tube help me?

Wanda

A. Dear Wanda,    You give me very little information for a good answer to your question. In general a larger trach tube with less airflow resistance help relieve shortness of breath if the trach tube is the cause.

Dr. Tom 

 

Chest X-Ray Said Increasing Density and Possible Scarring, What Does that Mean?
Q. Thank you for taking my question.  I had a Chest X-Ray that showed some increased density in the lingula and left lower lobe with possible scarring at left lung base.  I am panicked with the diagnosis of lung anomaly.  Does this mean that I have lung cancer?  Reason for CXR was to see if I had pneumonia.  What tests should I get?  My anxiety is high!

Nan

A. Dear Nan, I suggest consulting a pulmonologist. You need a definitive diagnosis for the increased lung density, which can have many different causes. Do not assume it is benign.

Dr. Tom

Questions about Husband’s Pulmonary Fibrosis
Q. Even though a lung biopsy was inclusive as to what caused my husband’s Pulmonary Fibrosis, we and his lung doctor thinks it was caused by his taking 100 mg of Macrodantin for a three month period to ward off an infection while he was catheterizing himself after prostate cancer radiation treatments.

 He was not monitored while taking it and I believe with his age being 73 at the time, the drug was more toxic to him.  He is in the latter stages of the disease and must be on oxygen constantly.  Will you please tell me if you think this could have caused his IPF?

Also could Spriva help my husband?

Lois

A. Dear Lois, Macrodantin is a possible cause for the fibrosis. If this is correct, the fibrosis will stablize,,or improve.

Dr. Tom

 

Active Husband’s X-Ray Showed a Small Spot
Q. My husband is a 59 year-old runner/biker. He has always been in good health and never smoked. This past August he suddenly developed a persistent cough. A chest x-ray showed pneumonia, which didn't clear with antibiotics. 

A CT Scan revealed  a "small spot" on upper left lung. His cough isn't as bad but he occasionally brings up a bit of blood, not much.

He is still very active...still running and biking. He says all through this his energy never left him.  He has no breathing problems. I believe these are good signs but I'm still so scared. He sees a pumonologist this week. What are your thoughts?

Anne

A. Dear Anne, The spot is most likely benign, by a great margin. Nonetheless, I believe it is prudent to see a pulmonologist about it.

Dr. Tom

 

Difference Between Symbicort and Advair
Q. Welcome Back Dr. Tom, you have been missed, hope you are on the mend now. 

I had used Advair 500/50 for some time beginning with 250/50.and my pulmonologist stopped it and gave me Symbicort to use now.  I am also taking 5 mg prednisone for maintenance plus all the other inhalers etc for my Emphysema  

What difference is there between the Advair and Symbicort?  Is the Advair more beneficial?   There were some reports of pneumonia with Advair....Also, my pulmonologist told me there is something new coming out that is now in phase four clinical trials?    Thanks for your answers, have learned much from this site.

Dot

A. Dear Dot, Advair and Symbicort are very similar in action. Both contain a long acting beta agonist bronchodilator and a corticosteroid. I would consider them equivalent.

Dr. Tom

 

Is there a Best Climate to Recover from Lung Infections?
Q. What is the best climate for somebody suffering from a chest infection to recover in? The person in question is in their mid 60's and also has leukemia.

Darrell

A. Dear Darrell, In general patients such as you describe prefer a mild, temperate and low altitude climate. Like the gulf coast, and other low lying areas of the South

Dr. Tom

They Say I have Mild Emphysema, What is the Outlook for Me?
Q. I'm a 51 year-old male. I quit smoking four years ago after smoking two packs/day for 25 years. EBT CT scan showed "Mild emphysematic changes" but no indication of any cancer.
PFT tests: FVC 107%, FEV1 87%, FEV1/FVC 66%, TLC 129%, VC 111, DLCO 83%.
My BMI is good and I now jog 2.4 miles a day at a 10/minute mile pace. If I think about my emphysema diagnosis my anxiety level increases. Can you comment on my outlook in terms of an estimated life span?

Mike

A. Dear Mike, Now that you have stopped smoking, you have a normal or near normal life span. Plan on at least 20 years.

Dr. Tom

 

No Insurance and Have Questions about Lung Disease Symptoms
Q. Hi Dr. Tom,, I'll spare you the ongoing saga of my illnesses, but I am currently without medical insurance and am trying to self-diagnose. Poor idea, to be sure.

I have chest pain almost all of the time, and it's tender to the touch. Costochondritis? Doubtful, as it's been a long time, just worse now. Along with the pain, I have a dry cough, upper to mid back pain directly behind the chest pain, and a raw feeling when I breathe in. Slight burping, and I do have GERD and sleep apnea. I have been diagnosed with possible asthma by the primary, yet the allergist insists I don't have it.

 Any suggestions? I can't afford my Flovent anymore, and I’m suspecting the worst. Thank you, dr. Tom.

Amy

A. Dear Amy, I cannot  tell from your description of your symptoms, what diagnosis you may have. Do NOT conclude it is bad news.

Dr. Tom

 

Have You Heard of Using Colloidal Silver in Nebulizers?
Q. Dr. Tom, I heard about using colloidal silver, in my nebulizer, will help with my COPD and constant recurrent infections.  I also have obstructive sleep apnea and wear bipap and a cardiac condition.  Should I try this alternative medicine?

Gina

A. Dear Gina, I  have heard of it, but would be wary.  I would not touch the stuff myself.

Dr. Tom   

                     

Can Antidepressants Cause Sleep Apnea?
Q. My mom has COPD (emphysema).  Dad died 10 months ago and mom has become depressed to the point of losing weight (about 40 pounds in the last year), not taking her meds, not using her oxygen, not eating correctly.  I asked her doctor about an antidepressant and was told that putting an emphysema patient on antidepressant meds could cause sleep apnea.  I had never heard of this and wondered if it is true?

Linda

A. Dear Linda, No, there is not a risk of sleep apnea. The antidepressant may make her more sleepy than normal and if she has sleep apnea, it could aggravate this.

Your mom needs friends and support people to help her with depression, more than antidepressant drugs. All drugs have adverse side effects and some have risk of serious toxicity.

Dr. Tom

 

Dr. Says CT Scan Showed Emphysema
Q. Dr. Tom Please help. I'm 43 years old with two girls ages 10 and 11. After a chest x-ray my doctor referred me to a pulmonary doctor. They found a pulmonary nodule with calcifications on my left lung. So I went for a CT scan,

Today I went to the Dr. for the results. He said there was no nodule on my lung it was just a shadow from a rib I had broke back in May. But I do have emphysema; he said it's a little less than a moderate case.

He scheduled an appointment for me to see him in 4 months, and he said not to worry that it is not serious. But he also said no smoking and prescribed an inhaler to be used only if I need it.

I just want to know how serious is this, as I have 2 children to take care of.

I would really appreciate it if you can get back to me, it would make me feel a whole lot better, right now  I don't know what to believe or think.

Lisa

A. Dear Lisa, Your doctor will need to do spirometry to determine how much, if any, your lung function has been compromised. He cannot tell this from a chest x-ray or CT. It is a fact that you must stop smoking, to protect your lungs from any further damage.

Dr. Tom

 

Short of Breath
Q. Dear Dr. Tom, At this precise time I am trying to justify why I need oxygen...both portable [LOX-unit} for daytime and nightly (more understood)

My case. I am 76 yr old male-Caucasian. In 2003 middle lobe of right lung was removed...NOT lung cancer. Sleep apnea...yes..apparatus extremely difficult to sleeping with- I have tried everything they have thrown at me. I have taken to sleep in a recliner. Drs. say...lose weight...Okay. I understand that...but weight has been the same for ten years...forty to fifty too much...5'10" wt 265 is that all there is?

At this time I am doing a test with an Oxygen meter...small unit on my wrist like a large watch with a finger reading device. one night with...no oxygen...a.m. dial reading 93. Last night with oxygen....a.m. reading 95 tonight with oxygen and NEW face mask and sleep apnea machine hook up.

I went for a walk, with a therapist, with my portable machine…after one hundred paces and I was out of breath and the oxygen level dropped to 82 on the meter!

My question: I do not understand why I have this shortness of breath with just slight activity….in Chicago area...600 ft and we go to Vail at 8500 ft. and yes it is more severe but not understood here at Chicago.

Other question: This condition seems to be worse than last year' s there deterioration or can this stabilize?

Does exercise help? What kind?

P.S. I am thinking of going to Jewish Hospital of Denver. I understand they are one of the most focused Hospitals and Staff on lung disorders. Any Comment?

Harold

A. Dear Harold, I strongly suggest going to National Jewish Hospital for a complete evaluation of your condition. Shortness of breath has many causes. Your low oxygen levels with activity suggest either lung or heart disease, or maybe both. You can improve your symptoms and quality of life with pulmonary rehabilitation, which you can also start at National Jewish.

Dr. Tom

 

Does Higher Altitudes Cause Fluid Retention
Q. I moved to Arizona from Ohio, which is a higher altitude. I live at 3300 ft. from 300 ft. I seem to be having a lot more problems here at this altitude. I have bronchiectasis and pulmonary hypertension; my body has been holding excessive amounts of fluids since coming here. Does this altitude make my disease act up more? Would it be safer to go to a lower altitude?

Barbara

A. Dear Barbara, The modest altitude may be a factor in heart strain and fluid retention. You should consider a lower altitude if all else is equal.

Dr. Tom

 

Chest X-Ray Shows Hyperinflated Lungs One Year After Lung Collapse
Q. I am a 26 year-old, nonsmoker, who had a spontaneous pneumothorax a year ago.  I had the VAT's done, where they saw no active cancer in the lung. 

I recently had a follow up with my pulmonologist, and he checked a chest X-ray.  He told me that if he didn't know how old I was, he would think I'd have full blown emphysema, due to the amount of air in my chest.  He told me I had hyperinflated lungs, but didn't tell me much after that. 

Is this something to be worried about?  What are the causes of this?

Susan

A. Dear Susan, Hyperinflation only means you are able to inhale a lot of air into your lungs. It does not correlate with abnormal pulmonary function in most cases.
You need spirometry and probably other lung function tests to evaluate your lung capacity. I suggest seeing a pulmonologist.

Dr. Tom

 

Questions about Lung Collapse
Q. If a lung remains collapsed for an extending period of time (12 hours or more), will it tend to collapse again more easily?
In the field we insert the tube without any anesthetic is it the same in hospitals?
After a lung collapse would coughing tend to re-collapse the lung?
Thank you for your valuable time.

Stephen

A. Dear Stephen, A few hours or days of collapse does no harm. Chest tubes can be inserted without anesthetic, but with lots of pain, in most cases. Small tubes that just evacuate air and not blood or other fluids are not very painful, when they are inserted. A little Xylocaine helps do wonders, however.

Dr. Tom

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