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Archive: Dr. Tom 112
Posted January 21, 2008

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

 

 

Can’t Seem to Shake Congested Cough
Q. Dear Dr Tom, My partner has 'linear opacities” at the left lung base which could represent subsegmental atelectasis or scar (also hyper-expanded lungs, no consolidation identified).

He can’t seem to shake a congested cough ever since he spent a lot of time cleaning walls with bleach, when we moved house three months ago. He has been on constant antibiotics.

Jan

A. Dear Jan, The cough should have resolved  by now, if it was due to irritation from the bleach. I suggest seeing a pulmonologist because of this and for a follow-up of the subsegmental atelectasis.

Dr. Tom

 

 Recently had Surgery and Now Have a Violent Cough
Q. Hi Dr. Tom I recently had a cervical discectomy at C-3/C-4 they went in through the front.

Since I have been discharged about a week I have what I though to be a respiratory infection or acid reflux and I am finding it to be something totally different that I have never experienced. Here is what happens I am pretty much ok until I lie down and fall asleep but it never fails with in 20 to 45 minutes I am up hacking my brains out, and it is violent to say the least. At first I noticed yellow phegm which progressed to green glob and now I have noticed a more liquid like but dark colored substance with some black or very dark material mixed in.

I went to my orthopedist for my first x-ray and told him. He wrote me a prescription for Levaquin. I am three days in and only getting worse. Not only that but when I am not sleeping I am fine. My lungs are clear. 

I will finish by saying I have never been a smoker of any sort of substance. Please can you give an idea of what I am up against here? I have slept 8 hours over the last 4 to 5 days because  of this. Or at least tell me what kind specialist to see. Any explanation you could give would be appreciated as I am lost here and starting to worry.

Jake

A. Dear Jake, You may have had some damage of the trachea. I suggest seeing a pulmonologist to scope the area and see if this theory is correct. This is not an expected complication of cervical disc surgery.

Dr. Tom

 

Flare-Ups and How Humidity Effects COPD
Q. I was recently in Mexico City (high altitude and worst city air in the world) and had my first exacerbation. I was there for a week and since my return three weeks ago I have noted some improvement although the chest discomfort, which began in Mexico City is still there. Can you speculate whether the discomfort will be permanent and whether I will continue to improve?

Also in earlier posts I note that proximity to the water while swimming eases breathing, yet you recommend a mild dry climate for living. Can you explain the apparent contradiction?

I'd also like to know to what extent humidity affects COPD?

Graham

A. Dear Graham, There are no easy answers to your questions. High humidity tends to prevent exercise induced asthma, by keeping the lining of the nose and pharynx moist. Most patients with COPD tolerate both a dry and humid environment. The nose is the main humidifier of the lungs. The feelings in your chest associated with Mexico City should subside, when you can avoid dirty air.

 Dr. Tom

 

What Does 75% of Normal Mean on Spirometry Test?
Q. Recent x-ray showed some scarring of lower portion of the lungs. Ex-smoker. This caused me to consult a pulmonologist.

Cause of scarring unknown it was not there in 2000 when I had chest CT Scan. Dr. suggested new CT scan, which I took In July 2007. Dr. suggested another CT scan in six months to determine if any change in scaring. Also took spirometry test in doctor’s office. Showed 75% of normal and diagnosis is emphysema. Dr. says at 80% would be in normal range.

I had difficulty taking the breathing test for some reason, such as with the mouthpiece. How serious is this 75% of normal reading? Are there any steps to improve the reading? Is the scaring unrelated to the emphysema?

Gordy

A. Dear Gordy, Emphysema is not commonly related to scarring. I do not know what the 75% relates to, ie, flow or volume. Ask your doctor who did the test.

Dr. Tom

 

Is Symbicort as Effective as Spiriva?
Q. Hi Dr. I was on Spiriva for about six months until I developed a terrible rash on my hands that became infected.  My pulmonologist put me on Symbicort and I'm doing well with it, I was also doing well with the Spiriva until the rash.  Is Symbicort (80/4.5) as effective as Spiriva?

Frances

A. Dear Frances, In general yes. They work through different mechanisms, and are sometimes taken together.

Dr. Tom

 

Need to Find a Medication for Asthma that Doesn’t Cause Side-Effects
Q. I have just been diagnosed with severe adult asthma. Albuterol and Xyponex causes airway and throat constriction, muscle stiffness and numbness.  Advair worsened my breathing. 
I am looking for suggestions in medications and natural products or vitamins to improve my breathing.  I am taking large amounts of vitamin C, which seems to have reduced some inflammation.

Felicia

A. Dear Felicia, You should see a pulmonologist or allergist who specializes in difficult asthma. There are many other drugs to try, but they need to be prescribed by a doctor who knows the details of your own situation.

Dr. Tom

 

Can Thyroid Removal Cause Snoring?
Q. Dear Dr. Tom, I had my thyroid removed about nine months ago and now have a problem with serious snoring.  What is causing this?

Edwina

A. Dear Edwina, There are many possibilities, that  are too numerous to list. Better see an otolaryngologist (doctor who specializes in disease states of the ear, nose, and throat) who can explain what is going on.

Dr. Tom

Chinese Herbs Thought to have Helped Father
Q. Hi, My father currently suffers from COPD which is a form of lung disease.  He is now 79 years old and was a smoker in his early 30's. 

He is presently in a nursing home and on a ventilator through his trachea.  The Doctor once told us that only 30 percent of his lungs is functional.  He was recently approved to receive some Chinese herbs, which my family found to assist in the treatment of COPD.  Once trying these, however, we were told that his condition was getting worse and was then taken off of the herbs.  We believe that his condition was becoming worse because he was given the herbs while still on his medication. 

Do you have any suggestions?  I know he is getting up there in age but are there any herbs out there that could prolong his life a little while longer.  Please give your expert opinion.

Drew

A. Dear Drew, I know nothing about the use of herbs in the treatment of COPD or any other disease. Some people swear by them.

Dr. Tom

 

Is a Collapsing Lung Hereditary and What are the Chances of Reoccurrence?
Q. Hi, My boyfriend has had both his lungs glued to his rib cage after suffering a collapsed lung on two separate accounts. I was wondering if it was hereditary? And also will he suffer from any problems in the future?

Lisa

A. Dear Lisa, This condition is probably not genetic, unless it is related to Alpha One Deficiency (http://www.alphaone.org/).  A simple blood test can rule out this possibility.

Dr. Tom

                                   

What is the Prognosis of COPD if One Continues to Smoke?
Q. My uncle has been diagnosed with bullous emphysema and has been given approx five years to live if he does not quit smoking. Is this true you can die from this disease? Is there not a procedure or operation he can have?

Corrine

A. Dear Corrine, Emphysema from smoking  progresses much more rapidly than in non smokers. It is indeed a fatal disease with about 129,000 deaths per year in the USA or number four in mortality. Your uncle will live longer and better if he stops all smoking.

Dr. Tom

 

Diagnosing Lung Cancer
Q. My mother is suspected to have lung cancer. I saw part of the CT films which showed the lungs (black areas) with white specks throughout both lungs. Would you say that is cancer?
I realize it is hard for you not seeing the scan itself, what do you think Dr. Tom? I'd greatly appreciate a reply.

CD

A. Dear CD, There is no way for me to tell, without seeing the films, and even then, it will take some kind of biopsy to prove the presence and cell type of lung cancer.

Dr. Tom

 

Should I be Taking Spiriva if my Breathing Problems are Due to Stress?
Q. Dear Doctor:  I have been having breathing problems.  When I went to the doctor, he examined my lungs and said that my lungs were clear and that my breathing problems were due to stress.  Even if it is due to stress, shouldn't there still be constriction heard in the lungs?  And, the doctor prescribed Spiriva for me to take, but I thought this was for more serious illnesses like COPD.
 Also, lately, everything I ingest seems to give me asthma symptoms.  A doctor put me on Hyrocortisone, DHEA and typtophan and after I take them, I get short of breath.  Do you know the real reason for this? 

I am suffering from adrenal fatigue and chronic fatigue.  Maybe this is a contributing factor. 

Carolina

A. Dear Carolann,  It is not possible for me to judge what drugs are appropriate for your condition. I suggest getting a good pulmonologist for an evaluation and following their advice.

Dr. Tom

 

Patient’s Symptoms are Perplexing
Q. Dr. Tom: Scenario: African American black male, upper 30's to early 40's, smoker, drinker, possible drugs, persistent cough approximately two years, significant weight loss, CT showed spots on lungs, sores on head that will not heal, no vomiting or diarrhea,  moved from Florida two years ago to Kansas. 

Doctors at the hospital are baffled because blood work is not showing much, if anything. Sputum is not showing anything (giving this a couple more days), they have stated that this is nothing they have seen before.

The lung specialist says that it "appears" that this male has holes in his lungs but they do not know what has caused it.  They are still planning on a biopsy for tomorrow. What comes to your mind?

Bobbi

A. Dear Bobbi, A long list of possibilities come to mind. There is no point in speculating what it might be. You need a tissue diagnosis or an infectious agent to explain these findings. I am glad you are seeing a pulmonologist.

If you do not get satisfaction, I suggest referral to the National Jewish Center which has doctors who see all sorts of unusual diseases, that exist around the world.

Dr. Tom

 

History of Pulmonary Embolism and CT Scan Now Shows a Nodule
Q. I was diagnosed with pulmonary embolisms three years ago via a CT Scan.  Had a repeat CT Scan seven months later and a chest x-ray one year later then just yesterday had another CT to rule out PE's again.

No PE's were found but a five mm lung nodule subpleurally within the superior segment of the right lower lobe was found.  They say it is nonspecific but more likely post-inflammatory in nature.  Six month follow-up CT recommended to document stability/resolution.  There is minimal scarring in both lung bases right greater than left.  There is no parenchymal infiltrate or pleural efusion.  Evaluation of the osseous structures demonstrates no osteolytic or blastic process. 

My family physician says this is nothing to lose sleep over that is is probably a result of the PE’s.  Does this make sense?  And, what does nonspecific and post-inflammatory mean.  He said nothing indicated that this is suspicious.  He is ordering a PET scan to reassure me.  Thank you for any information you can give me.

Barbara

A. Dear Barbara, I agree with your doctor. Do a follow-up in six months to see if there is any growth. I do not know if the nodule is in the region of the PE or not, and it may not be related to the new nodule.  

Dr. Tom

 

Clinical Trial Drug for Bronchiectasis
Q. Dr. Tom, Since I have traction bronchiectasis I follow any developments closely. I see in your 12/26 questions someone asked about a new bronchiectasis treatment. It indeed exists, Bronchitol, and in fact, I am trying to get involved at Hopkins with the Stage four trials.

Armand

A. Dear Armand,  Thanks for this information. I am aware of this, but do not have any specifics. 

Dr. Tom 

 

Very Frustrated about Continued Lung Problems with No Answers
Q. I am a 36 year-old, ex-smoker of 15 years but three years quit, mother of three.  Four weeks ago I experienced sudden onset of shortness of breath (SOB).  I am a school nurse and missed two weeks of work with the problem going back and forth to the doctor. I had chest x-ray, labs, PFTs, CT Scan and everything was basically normal. The x-ray and CT did show some atelectasis in the base of the left lung but seemed to be nothing new based on a previous x-ray from 2005. 

I continued to experience severe, gasping breaths. I was referred to a pulmonologist and had more PFT and an ABG then was admitted to the hospital for a PE based on a PO2 of 65.  I was in the hospital for 12 days on blood thinners.  I had more x-rays, CT’s, PFTs, ABG's (arterial blood gases), venous doppler, echo with bubbles, stress tests, VQ scans, etc.  All tests were normal, my saturations ranged from 91-99% but PO2's ranged from 54-76.

I was discharged last week on no medications but home on O2 at 2lpm w/ a follow up in four more weeks.  I just don't understand what is going on.  I still experience SOB even on O2 and my quality of life is not good right now. I also saw a cardiovascular surgeon regarding an open lung biopsy but he felt insurance would not cover it based on the negative ct results, even though I am home on oxygen 24 hours a day. 

Any advice? The pulmonologist I see said that if I am still SOB when I go back at the end of the month he is going to send me to Emory in Atlanta.  Thanks in advance for any advice for me.

Amy

A. Dear Amy,  I can understand your frustration. I do not have any answer for you either, but one must be sought. Emory is an excellent center with specialists who should be able to diagnose and treat your problem. Another option is the National Jewish Center in Denver.

Dr. Tom

 

 Will Occasional Smoking Effect Me?
Q. I have left smoking but I still have difficulty in breathing during jogging; What if I smoke sometimes? Will it have any effec?.

Abdullah

A. Dear Abdullah, Any smoking will just add more inflammation to whatever lung damage you already have. I suggest avoiding smoking completely.

Dr. Tom

 

Is it Safe to Scuba Dive if You’ve Had Previous Blood Clots in the Lung?
Q. Last year after surgery I developed a blood clot in my lung. They told me my Birth Control Pill was the reason why that happened. Now 1 year later (off blood thinners) I would like to get back into scuba diving. I ask different doctors and received different answers.

Silke

A. Dear Silke, There are no guarantees. I suggest it is reasonable to resume scuba diving since you are under treatment.

Dr. Tom

 

Love My Doctor but Not Sure about Recommendation
Q. Thank you for your valuable service. I am a 38 yr old, non smoker, female with Factor V Leiden clotting disorder. On Coumadin for life due to, two thrombosis' in brain. Mom passed away at 63 with lung cancer; was heavy smoker. I began having left sided rib pain radiating from back to front of ribcage and thoracic pain one year ago.

This began two weeks before a terrible bout of bronchitis. It has never gone away. Pain is constant and they have not been able to find a diagnosis and are treating it as a pinched nerve. I also have some chest pain, chronic coughing episodes with some phlegm and four episodes with a strand of blood in mucus. A bit of burning in chest as well. Had chest x-rays in February and August 2007 which both had normal results. I had a ct scan of chest and abdominal area last month.

It shows no masses or plural effusion but does show bi-lateral nodular atelectasis in lower lobes with a larger more prominent area in the right lung compared to left. These findings concern me quite a bit. I am very concerned with malignancy and my husband is afraid of an embolism.

My internist says this is an incidental, benign finding and no follow up is needed. What do you think? Could this be a malignancy or PE? I love my doc and do trust him but I am so tired of feeling bad and being sick. Could this all be related?

Trisha

A. Dear Trisha, It is difficult for me to tell if your PE is related to the nodular atelectasis. I doubt if it is. I suggest symptomatic treatment of the pain, and doing a follow up CT is four to six months to be sure there is no activity going on. It is sometimes hard to outguess what nature has in store, but usually time and experienced physicians can find the answer.

Dr. Tom

 

Worried about Lung Cancer
Q. I went to the hospital last night after ten days of antibiotics not working for my bronchitis they took a lung x-ray and discovered I had a very small mass in my Right lung and said I should follow up on it in two months.

Should I have gotten blood test too? My Mother presently has lung disease since age 58, and my aunt has just died of lung cancer.

I am 30 and worried now I’ ve been smoking for fifteen years.

Angela

A. Dear Angela, It is unlikely, but possible that the new mass is cancer. I agree that a follow-up in two to three months is a wise course of action.

Dr. Tom

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