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Archive: Dr. Tom 119
Posted March 13, 2008

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

 

 

Can Ride Stationary Bike Yet Have Yet Tire Quickly When Using the Treadmill?
Q. I am 24 years old 6'1” 255 lbs. I have recently quit smoking. I am back to working out three days a week. I am currently taking a multi-vitamin and blood pressure medications.

I can currently ride a stationary bike for about 11 miles but on the treadmill I cannot run more then four minutes with out having to slow down.

I do have asthma and take an inhaler before I work out. My question is; are my lungs too severely damaged for me to be able to run or is this something that will just take time or should I try and push my self a little more.

Ryphil

A. Dear Ryphil, There is no point in pushing yourself to uncomfortable feelings. You are already doing a significant amount of exercise. Keep it up.

Dr. Tom

 

Confused by Three Different Diagnoses
Q. I have smoked a pack or less a day for 30 years. I have had pain in the left side of my chest, right along the sternum, on and off for almost a year now.  When the pain is active, I have a lot of clear to white phlegm in my throat that seems to only be on the left side as well.  Sometimes, I can feel the pain on the inside of my upper left arm too.

I have been to several doctors.

They first suggested costochondritis and prescribed Ultram (used to treat moderate to severe pain) and Norflex (used to relieve the pain and discomfort associated with musculoskeletal injuries and condition) for a week, which seemed to help.

The second suggested GERD and prescribed Nexium for six weeks, which also seemed to help.

The third suggested a crushed T-4, 5 or 6 vertebrae and prescribed Darvocet, which has helped as well.

I did have a chest x-ray and a CT Scan.  The chest x-ray showed some "nodes" which prompted the CT Scan.  The CT Scan came back normal.  Another x-ray was done of my cervical spine which showed a degenerated disc.

I'm very confused and frustrated by three different diagnoses, and am not sure which doctor I should place my trust in?

Based on my symptoms, what would seem like the most likely cause of the chest pain?  Are there any tests you would recommend to help me sort this out? I would like to determine the cause of the pain so it can, hopefully, be corrected instead of being placed on different medications every time.

Also, I worry about "what if it's cancer?" although all three doctors told me that cancer would not usually be painful?  I appreciate any suggestions you can offer.  Thank you for your time.

Maryann

A. Dear Maryann, It is not possible to make an accurate diagnosis with such limited information. If your symptoms persist, I suggest seeing a pulmonologist to get a definitive diagnosis. My guess is that you have muscular pain and that it will subside. Dr. Tom

 

Will a CT Scan Determine if Lung Node is Malignant?
Q. My dad is 61, he was just diagnosed with a 6mm right mid lobe lung nodule. He is scheduled for a CT scan in a day or two.  Will this be able to tell us if it is a malignancy or will we probably just need to have a follow up CT in a few months? He is a smoker or did smoke.

Kyle

A. Dear Kyle, A CT scan will not make a diagnosis of cancer, an accurate diagnosis requires tissue. However, it can give indications of the likelihood of cancer and whether or not a follow up is needed.  

Dr. Tom

 

What Does the CT Scan Mean?
Q. I am a 54 yr. old female who smoked for two years as a teen and do not smoke or drink now, but have lived around second hand smoke until the last 15 years. Both of my parents were smokers and died of cancer (esophageal and lung cancer)

I have had problems with repeated chest colds and bronchial infections over the last few years.  In 2007 I had an infection every couple of months. Around Feb. 7th I got the flu that then developed into an infection in my lungs.  After being sick for two weeks I went into my GP who took a chest x-ray that resulted in a cloudy area of the right middle lobe.  I then took a CT scan.  The results are still not clear to me.  They were checking for pneumonia.  They have yet to tell me it is or isn't pneumonia.

The CT scan report came back as follows:  Page #1 "There is a question of the Right Middle Lobe Nodular Opacity (referred to as mass-like opacity) within the right middle lobe near the right heart border.  Lungs are otherwise clear. Heart is normal size. Biapical pleural thickening is noted.  CT scan is recommended for further assessment." Page #2 "There are small lymph nodes within the mediastium measuring less than 1 cm. Negative for adenopathy.  Lung windows reveal vague opacity within the medial right middle lobe, as well as small area of vague opacity within the posterior right upper lobe.  A dominant mass is not seen.  There are no pleural effusions. Follow-up in three months is recommended after appropriate antibiotic therapy to assure resolution."

Negative for adenopathy was good to see as I think that means no sign of cancer.  Or maybe it doesn't?  My Dr. has suggested I see a pulmonary doctor which, will be my next step, however she has refrained from giving me a diagnoses for some reason.  In fact she won't even speak with me about it she gives me this recommendation through the nurse.

The antibiotic has helped as the congestion is better as well as the cough but my back is still hurting when I breathe and I am fatigued with increased activity.  I'm getting better but not there yet. 

So from the above description can you tell me your opinion of what I have?  I would appreciate it as the waiting is driving me crazy.

Kathy

A. Dear Kathy, My comment about your CT report is that it is ambiguous. It says mediastinal nodes, but no adenopathy. This is contradictory.

Insist that your doctor give you advice about what to do next.

I cannot be of much help just reading a report like this. Your cancer risk is real in view of your family history, so a CT follow-up is wise.

I would be guided by a doctor who will communicate directly with you; that is the doctor's prime responsibility.

Dr. Tom

 

Will Traveling to a Higher Altitude Effect My Pulmonary Fibrosis?
Q. I have pulmonary fibrosis but I am not on oxygen.  Is it okay to fly to a conference in Fort Collins, CO?  I live at close to sea level.

Kathleen

A. Dear Kathleen, Probably. You should find out what your oxygen level is at sea level first.  This is done in a minute with a simple oximeter, which most doctors have in their offices or clinics. FT Collins is at 5000 feet altitude. 

Dr. Tom

 

I Have Fibrosis and Low Diffusion Capacity (DLCO)
Q. I ahve been diagnosed with Dequamitive interstitial pneumnia with fibrosis and honeycombing.

My DLCO is only 36% and my TLC is 86% and FVC is 71%. Is there anyway to increase the DLCO number?

It appears I'm on my way out. I'm on oxygen and walk a treadmill twice a day and walk three miles in the a.m. and three miles in the p.m. Is there anything else I can do? Thank you. Jeff

Jeff

A. Dear Jeff, Keep a good attitude, and hope that your disease is stable. You should be seeing a pulmonologist.

Dr. Tom

                                                                 

Mother has Pseudomonas and has Been on Antibiotics for Six Months, Is this Normal?
Q. Dear Dr Tom, I am writing a question on behalf of my mother who has recently developed pseudomonas in her lungs.  She is on an antibiotic through a nebulizer everyday to try and clear infection. She has been on it now 6 months and was wondering what’s the long-term outcome.

Will she always have to be on her antibiotic through the nebulizer.  I would be very grateful if you would send me a little information on this as we haven’t been given much information on this.

Denise

A. Dear Denise, This is unusually long for a course of antibiotics. Your doctor is probably just trying to suppress the infection, rather than eradicate this organism, which is difficult.

 Dr. Tom 

 

Worried about a Blood Clot
Q. I was told that my blood test showed positive for a blood clot but then told that the CT Scan only showed a nodule so check again in a year.  I am feeling like something more is definitely wrong with me like a blood clot.

Ann

A. Dear Ann, There is no question to answer here. 

Dr. Tom

 

Can Lung Infiltrates Causes Pain in Chest?
Q. I am a 32-year old 'on again, off again' (though more off than on over the last several years) smoker.  I was diagnosed with pneumonia two months ago.  The radiologist's report read "right lung infiltrate", but no other abnormalities.  I took antibiotics and the cough went away within a few days.

The problem now is that I am still having pain in my back below my shoulder blade where the 'infiltrate' was/is.  It is not excruciating, but it does not go away, and occasionally my chest hurts, too.

I had a follow up x-ray, and was told there is still 'minimal infiltrate'.  The radiologist told me he wouldn't recommend a CT Scan right now, but at what point should this pain go away, or, rather, at what point should I do something else about it?

Bryan

A. Dear Bryan, The pain is probably of muscular origin, and will subside. I do not believe it is due to the pneumonia. 

Dr. Tom

 

What is an Infiltration in the Right Apex?
Q. What is the finding of “having local infiltration in right apex of the lung” what is a possible diagnosis.

Bernadet

A. Dear Bernadet, This finding suggests a long list of diagnostic possibilities. See a pulmonologist about it.

Dr.  Tom

 

Could Swollen Lymph Nodes be Due to Advair and/or Asthma?
Q. I have just had a biopsy done on several mediastinal lymph nodes that appeared swollen after a CT scan to up to 4 cm X 2 cm.  After the biopsy the results came back that they were normal. 

The doctor is not sold that there isn't a problem because there were two other lymph nodes (hilar nodes) that are swollen as well that he didn't want to retrieve at the time of the thoracotomy.  Could this swelling be anyway associated with my Advair use for asthma?

Alfred

A. Dear Alfred, No, this is not the explanation for the swelling.

Dr. Tom

 

Piece of Advice
Q. Hi Dr. Tom, I am a Respiratory Student and was wondering if there was one piece of advice you could give, what would it be? 

Brandon

A. Dear Brandon, Yes. Always put the patient first, no matter the consequences to you. If you follow this simple principle, you will do well by your patients. 

Dr. Tom

 

I am Concerned About My Friend
Q. My best friend was told today that she has a rod in her lung. What that mean?

Diane

A. Dear Diane, I have no idea. This is not common terminology for a pulmonologist.

Dr. Tom

 

I am Eighteen and Having Lung Problems
Q. I'm 18 years old and I have been having lung problems since I was about 15. I got sick in about October, like I do every year after school starts, but I seemed to be sick for a good month or two and at one point I lost my voice and sounded like a guy, very deep and raspy for a couple weeks and had a lot of built up mucus.

After that I felt better I noticed that walking uphill to school became harder and seemed as though my lung capacity was almost half of what it was before I had gotten sick. I couldn't afford to go to a doctor so I dealt with it and went on with my daily life.

Three years later when I was graduated high school and working in a bank I got sick again not quite as long as the last time but I was coughing stuff up and it was hard to breathe, last a couple weeks I'd say and after that it seemed as though my lung capacity had been cut in half again.

Now on occasion when I stand up out of bed I am short of breath or feel dizzy and when I do simple activities that most teens do such as stand up off the floor get in bed and pull the covers over me and my heart feels like it's beating out of my chest.

I've never had allergies growing up, but my dad has them, and he also has asthma, which I'm sure I have but have never been to a doctor for it. I also grew up with my father in body shops around dust and fumes and such and I think that could have something to do with it. I haven’t been to a doctor since I was like 12 maybe 13, I think, I don’t really remember.

I know I should go to the doctor but I just wanted to see if you had any insight on the

Hannah

A. Dear Hannah, Yes. Go to a doctor to find out what is wrong.

Dr. Tom

 

I Have Alpha 1 and Am Worried About My Future
Q. I am a 41year old female with alpha 1 emphysema (http://www.alphaone.org ) my FEV1 is 41% I have shortness of breath often and some pain throughout my body.
I am very scared in regards to my condition as for I do not know what the future holds for me what can I do to improve my condition where I won't have so many symptoms and I could live a somewhat normal life. I thank you for your time and appreciate your respond

Heather

A. Dear Heather, You can have a pretty normal life span, with good quality. You should see a pulmonologist and discuss replacement therapy.

Dr. Tom

 

Using a Trampoline for Exercise
Q. Hello, and thanks for taking my question.  I am 46 years old and have moderate to severe emphysema.  I have read a couple of different articles that bouncing on a trampoline for 10 minutes twice a day is beneficial to the lungs.  Is that accurate in any way?

Judy

A. Dear Judy, No. It can also be dangerous if you fall. Just do normal walking for your exercise, which is important.

Dr. Tom

 

Can You Damage Your Lungs by Coughing?
Q. I’m 29 and I’ve been smoking since I was 16 and last year I got a bad cold during the summer and coughed bad for about four months. Now I have an irritating pain not that bad but it worries me. Can you damage your lungs by coughing for an extended period of time and if so can they heal the pain that is on the left part of my body right below my shoulder.

Ricky

A. Dear Ricky, Coughing will not damage your lungs. It may be a sign of continuing lung damage, and should be treated by a pulmonologist.

Dr. Tom

 

Terrible Lung Infection that Never Seem to Go Away
Q. I have bronchiectasis, sinusitis, migraine headaches, and staphylococcus aureus, streptococcus pyogenes, and pseudomonas aeruginosa colonized in my lungs. 

I have been ill and getting progressively worse since I was 6 months old.  I am now 33.  I have been tested for cystic fibrosis, tuberculosis, primary ciliary dyskinesia, asthma, and none seem to fit. 

I am immune to many antibiotics and now receive IV treatments of Tobramycin (antibiotic) for two weeks every month.  The infection never clears completely. 

I cannot afford the payments for this treatment by myself. Can you recommend a physician/specialist in Montana? Can you recommend a group that may be able to help me with my treatments?  What do I have, what is my medical condition?

Tricia

A. Dear Tricia, You know you have bronchiectasis and this explains your resistant infections. See a pulmonologist in Billings, or elsewhere in Montana, to get on a regular treatment program. This is important to prevent or forestall progressive loss of lung function.

Dr. Tom

 

I have COPD and Live in Los Angeles Near I-10 Freeway
Q. I have been diagnosed with Moderate Emphysema.  I live in Los Angeles very near the I-10 Freeway.  My question is:  Would it be better for me to move to a hot humid climate such as Florida rather than staying in the smoggy weather of Los Angeles?

Vicky

A. Dear Vicky, It could be beneficial. You should try a trip there for a couple of weeks to see how you feel.

Dr. Tom

 

Worried About Taking Steroids
Q. I have COPD and a new doctor. He has prescribed Proventil inhaler, Doxycycline, Qvar inhaler and Prednisone 20 MG tablet (three tablets every day. I've never been given both types of steroids at the same time. Is this a bit much?

My oxygen level was 88% when I went in, had two breathing treatments with albuterol and it dropped down to 86. It was closing time and he made another appointment in one week. After I got home and read all the material I got concerned. I'm just taking the inhalers and antibiotic. I'd sure like your opinion.

Mischelle

A. Dear Mischelle, This is a lot of medicine, but may well be appropriate for your condition. You should discuss your concerns with the prescribing doctor.

Dr. Tom

 

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