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Archive: Dr. Tom 107
Posted November 14, 2007

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

 

 

“Hot Spot” Seen on Nuclear Stress Test
Q. I have moderate COPD. After a nuclear stress test, the cardiologist who was analyzing the results said I had a "hot spot" in my chest and recommended I see my primary care physician and get a CT Scan. The scan showed two spots and a number of much smaller spots in both lungs.  A pulmonologist said that it was almost certainly lung cancer. 

I then saw an oncologist who ordered a needle biopsy. I went for the biopsy and they did another CT Scan and saw that the lesions had shrunk and were now too small to biopsy.  The oncologist then said it was almost certainly not cancer but could be some kind of inflammation.  He ordered another CT Scan in four months.  What could have caused the spots and is there still a risk of lung cancer?

Larry

A. Dear Larry, These spots were most likely some form of inflammation, due to a subclinical infection. Now that they are getting smaller, meaning your body is successfully combating the inflammatory process, lung cancer is very unlikely.

I suggest waiting the four months for a repeat CT scan, as your oncologist wisely suggests.

Dr. Tom

 

Will FEV1 Increase if I Lose Weight?
Q. Dear Dr Tom, I was diagnosed with COPD. I am on Spiriva and Advair 100/50.  My last PFT showed a FEV1 and FVC ratio of 53% and FEV1 of 1.7 liters. I don't smoke, I quit in 1995.

I am morbidly obese with a BMI (Body Mass Index)  of 55.3. I have obstructive sleep apnea and obesity hypoventilation syndrome. I am trying to loose weight on Weight Watchers so I can avoid a gastric bypass.

One of my questions is as I lose weight will my FEV1 increase? From what I read morbid obesity decreases FEV1 and reduces lung volume. I also have Bipolar disorder and am so depressed that I have lost all will to live, since all I can think about is having COPD. I just eat because of the depression and don't exercise because I don’t’ have the willpower and the weight makes it hard. I'm trying to change and exercise more and doing the Weight Watchers.

I just need to know how long a FEV1 of 53% can be in terms of life span? If I had hope of a future I would be more motivated to loose weight and exercise. Right now I feel like it is hopeless and the COPD is going to kill me soon. I hope you answer my question because I need to know.

Linda

A. Dear Linda, Your FEV1 will increase substantially if you lose weight. I understand your bipolar disorder is a great challenge for you. Try to have faith that you will get better and live. If you really want to live, you can, and for a good long time. Good luck.

Dr Tom

 

 Can Asthma Exacerbations Cause Short Term Memory Loss
Q. I just turned 51 this past weekend. I have had respiratory problems all my life. Two years ago I was diagnosed with reactive airway disease that has since been re-diagnosed as asthma after a full morning at the hospital having lung function tests run.

I have had short-term memory loss for approximately six months as well as a marked drop in paperwork processed and some mistakes made at work that I truly believe are due to my asthma. This is causing my employer to take disciplinary actions against me. I have tried to explain that I am trying to get my asthma under control but they act like my health issues are just an excuse to avoid my work.

I have asked for reasonable accommodations that they have yet to follow through on what they agreed to do. Is short-term memory loss a side effect of acute asthma exacerbations (flare-up)? And if so, do you think my memory will improve once I have my asthma under control?

ng a hard time getting it controlled due to the stress at work. I work for the state of Washington Dept of Social & Health Services.

Liz

A. Dear Liz, Asthma should not be the cause of your short-term memory loss, unless it is related to a profound drug reaction, or a period of low oxygenation. I suggest looking for another cause of the memory problems.

Dr. Tom

 

Questions asked Before Surgery and Lung Diseases
Q. I have what I believe is chronic asthma. It does not bother me much. My question is when asked before surgery "Do you have COPD?" What should my answer be?

Lorie

A. Dear Lorie, Answer YES, and you will be correct. Your doctors will be alert for any breathing problem during surgery. You may need corticosteroids, if you have received them in the past, and certainly if you are using them now.

Dr. Tom

 

Should I be Concerned about Calcification?
Q. Hey Dr. Tom, I have a calcified lymph node in my left lung. As a child I was constantly tested for TB and the other diseases that are linked to this problem. All were negative.

Now that I am 20 years old the lymph node is still swollen and starting to concern me. Should I be worried or will this problem take care of its self over time?

Tara

A. Dear Tara, The calcified lymph node is not a threat to you, because it is a healed inflammatory process. You will always have it show up on chest x-rays and CT. These never turn into cancer. I suggest ignoring this benign process.

Dr. Tom

 

Inhaled Aluminum Dust and have had a Cough for Three Weeks
Q. Hello, I have had a cough for three weeks. I inhaled aluminum from die grinding with a scotch brite pad which produced like a powder and think I inhaled a lot of it at work. Not thinking to wear a mask.

Any ways I have gone to doctor once and she gave me a steroid shot and some antibiotics. That didn't help.

Cough seems to be letting up some. But when I get around cold air conditioning seems to make me have a coughing spell. Guess the cold air does something. Sometimes I cough so bad it makes me throw up. There is mucus sometimes that comes up but usually just dry. What do you think I should do? I would appreciate any information.

Clayton

A. Dear Clayton, The aluminum dust was probably irritating and caused cough. Also cough begets cough, because your airways stayed irritated. It should gradually resolve.

Dr. Tom

 

 

I Do Not have Insurance, Is a Pulmonary Function Test Worth the Cost
Q. Hi Dr. Tom, After endless respiratory infections, I decided to see a pulmonologist. I have been coughing up mucus everyday for over a year. It varies in color. It started off gray to yellow, now its mostly clear with a little yellow hear and there. I had an X-ray (normal).

The pulmonologist is sending me for a PFT. However I don't have insurance, but he said it was a good test that would show him a lot. I really want them to do a sputum test. Due to the lack of insurance and that it costs $300 just to talk to him, never mind the $900 for the upcoming PFT.

My question is in order to cut to the chase should I demand a sputum test on the next visit? My other symptoms have been shortness of breath. Discoloration of my lips. Only recently did I realize how blue and white they get at times, because they are pink when I wake up now. Do you have any suggestions on what it could be that could be causing this? I do have minor scarring on my lungs from a previous CT Scan.

I am worried about that now because I know that those are a symptom a certain lung cancer...Is that something that can not appear fully now, but later on unmask itself further? Hope you can help me with these questions...

Susan

A. Dear Susan, There is no way that the pulmonary function tests should cost any where near $900. The insurance reimbursement for spirometry, which is the simple test you need to measure airflow and volume out of your fully inflated lungs is $37. Sadly, these simple tests with new and accurate hand held spirometers are not in common use. Shop around.

I do not think a sputum culture will be accurate for organisms in your lungs, unless very specific organisms are the concern, like TBC, which does not to be a consideration in your case. Lung cancer is also unlikely. Try to find a pulmonologist who is reasonable in their pricing and use of technology.

Dr. Tom

 

Do CT Scan Results Need to be Followed by a Pulmonologist?
Q. Dr. Tom, I recently had a CT Scan done to check for kidney stones as I have been experiencing sharp pains in my back and right flank side. On the results it stated that the lung bases demonstrate bibasilar dependent atelectasis, also two indeterminate pulmonary nodules involving the right middle lobe measuring 4mm in diameter.

Should I see a pulmonary doctor for this or wait the three months that my family doctor suggested and run another CT? Could you also tell me simply what does this all mean?

Connie

A. Dear Connie,  The bibasilar atelectasis just means that you did not have full inflation of your lungs when you did the CT. The indeterminate nodule of 4mm should have a follow-up in three to six months.

Dr. Tom 

 

Side-Effects of Plueradesis
Q. My father recently had a medical thoracoscopy with talc pleurodesis because he had a lot of water in the lining of his lung.  All his biopsies came back normal.  It has been several weeks now, and he is still in a lot of pain.  He recently went to the emergency room and was given a chest x-ray and was told he has calcium deposits on his lung.  Is this from the talc? How do we get rid of the calcium?  Should he be in so much pain?

Bernadette

A. Dear Bernadette, Significant pain may be an initial result of talc to form a pleurodesis. The question is, what is the reason for the fluid accumulation. Could be from cancer, heart failure of infection.

Talc shows up as calcium and there is nothing to do about it. I think you need a firm diagnosis to be able to know exactly what you are dealing with. 

Dr Tom

 

Recovering from Bronchitis
Q. Hi Dr. Tom, My Mom has been dealing with chronic bronchitis on and off for five months now. She has been on four different antibiotics and prednisone. She was in the hospital twice in one month. How can she get her strength back she is very weak.

Ava

A. Dear Ava, You don't give me much information such as age, the other diseases your mom may have etc. In general it takes about six weeks to recover from the insults of pneumonia. She should eat a diet high in calories and try to walk as much as possible.

DR Tom

 

Daughter is on Eight Medications a Day but Do No Think Medications are Working
Q. My daughter is nine years old and has been battling allergy induced asthma her whole life. She was born at 29 weeks gestation.

She is now up to approximately eight medications daily. Her spirometer test go anywhere from 56%-96% and now in the past couple of month they are going back down to 61%.

Why would her levels drop and her being on all the meds she is not working. Her meds consist of Advair 500/50 x2, Nasonex, Prevaicd, Singular, Zyrtec and when needed predisone, xopenex and Pulmicourt.

Was just really wondering why her levels would drop with all the medications.

Angela

A.  Dear Angela, I am not a pediatric pulmonologist. Better get your answer from the doctor who is prescribing all these medications.

DR Tom

 

Questions about CT Scan and Blood Work
Q. Dear Dr. Tom, I am 29 years old and recently, having major back pain, went to the doctors. In doing MRIs on my back (I have two herniated discs) they found enlarged lymph nodes.

I was sent for a CT scan and they also found a 4mm subpleural nodule in the right middle lobe. Last week I went for a follow up CT scan and they found that it is calcified and stable, but now they also see ground glass density in the right lower lung.

Aimee

A. Dear Aimee I cannot make a diagnosis, form this information. Nothing sounds particularly alarming. I would keep the appointment with the pulmonologist.

Dr. Tom

 

Do Spirometry Results Explain My Shortness of Breath?
Q. Hi Dr. Tom, hope you are better. I sent another email as a follow-up to mine of August 7, 2007. It was wanting to know spirometry results.  Here is my complete Spirometry test results:

FVC Predicted 2.77   Actual Pre-Drug 3.06    %Pred 110
FEV1 Predicted 2.01   Actual Pre-drug 1.91   %Pred 95
FEV1/FVC Predicted 72%    Actual Pre-Drug 63    % Pred 86

My TLC was
Predicted 4.48 Actual 5.73    %Predicted 104
RV Predicted 1.71  Actual 2.86 %Predicted 168
RV/TLC Predicted 38 Actual Pre Drug 50 %Pred 131
The doctor put on last page Normal FVC and FEV1
Mild obstructive disease confirmed by increased residual volume - severe
Increase and a Mild increase in total lung capacity.
Mild obstructive disease with hyperinflation.

Would this obstruction be giving me the shortness of breath even though my FVC and FEV1 are normal.  According to my doctor I should not be having SOB like I do.  I am really confused and getting worried.  There are days that I do not have it at all, but today it was so very hot and humid and it really was bad. Every time I try to catch my breath it hurts my chest.  I do a lot of walking on the outside as well as on my treadmill and I occasionally get short of breath, but use pursed lip breathing and it works, but on days I have it nothing works. I am wondering if I am just having panic attacks when it does occur.

Peggy

A. Dear Peggy, Your shortness of breath is not explained by your pulmonary function tests. Your doctor should search for other causes, such as heart disease, anemia, or just poor physical conditioning.

Dr.  Tom

 

Effects of Weight on Scoliosis and COPD
Q. I have severe scoliosis with COPD. I have been on O2 now for 10 years. I am 55 years old. I am 4 ft. 7 inches and weight 160 lbs.

Sometimes my breathing seems really restricted and other times I do better. I am on two liters of O2 and use BiPap to remove CO2 at night. I know I need to lose weight, my stomach feels tight a lot of the time. Do you think loosing weight and exercise will help my breathing, I use to do exercise about eight years ago and did well.

I worry that my disease has just progressed, but do you think loosing 60 lbs and getting on an exercise schedule would help my breathing.

Cathy

A. Dear Cathy, Yes I do. The restriction to breathing from the scoliosis is made worse by the increased weight. You should do much better with systematic weight loss and more exercise. Do not go on a crash diet, but pick a reduced calorie diet with the aid of a diet book, or just common sense, ie sweets.

DR Tom

 

Please Help ME  Understand CT Scan Results
Q. Dr. Tom I am a breast cancer survivor of almost three years.  I had a lumpectomy.  Chemo and radiation...lymph nodes were cancer free.  My question is a CT scan showed a 3-4mm pleural based noncalcified nodule and a calcified granuloma at the right lower lung.  Also pleural thickening noted at the lung apices.  They also said may be a tiny pericardial effusion.  Can you break this down and tell me what all of it means?

Carol

A. Dear Carol, Only the noncalcified nodule bears repeat scanning. The small amount of fluid around your heart is common, but not alarming in your setting. Regular follow-ups are the standard of care for survivors of breast and other cancers.

Dr. Tom

Non Calcified Nodular Density
Q. I had a CT scan completed on 10/3/07 and they noticed a 3mm noncalcified nodular density on my left lung base, What should I expect when I do to see a chest specialist and how bad is it?

Anesia

A. Dear Anesia, I do not see any reason to be alarmed. A 3mm nodule should be followed for any growth in four to six months. Most of these small, noncalcified nodules are benign. Dr. Tom

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