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Archive: Dr. Tom 126

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

 

 

Smoking Addiction
Q. Is smoking an addiction and how do people stop smoking?

Shakori

A. Dear Shakori, Smoking is indeed an addiction, as strong as heroin, cocaine, and other destructive drugs. Most people who quit do so "cold turkey". There is no safe level of smoking.  There are a number of drugs available over the counter or by prescription that can be used to reduce the withdrawal symptoms due to nicotine, during the early stages of quitting.

Dr. Tom

 

Repeating Pneumonia
Q. Dr. Tom, I am a 33 year-old female, who is in very good health.  I eat right, exercise, non-smoker, social drinker, etc.  In the last six years I have had pneumonia four times.  This last round I informed my doctor that I thought I might have walking pneumonia since I had all the symptoms, but no fever. 

 He gave me Zithromax (antibiotic) and that was it.  I went back for the follow-up, still complaining of fatigue, and rattling in my chest, with a productive, annoying cough, back pain, and trouble breathing.  He then gave me Allegra-D, which I took, but switched to Claritin without the decongestant. At the follow-up appointment I had a chest x-ray done. 

I am feeling much better now, but still have twinges of back pain (at the lung level) but my doctor called me and said there was "density" on my chest x-ray, and I need to come in for a different x-ray.  Given my history, do you have any suggestions on what this could be? 

Jennifer

A. Dear Jennifer, There are many possibilities. I suggest seeing a pulmonologist in view of the known density on your chest x-ray. You may also have some immune deficiency that makes you susceptible to pneumonia. This needs to be checked.

Dr. Tom                          

 

Calcified Vein in Chest
Q. A CT scan has revealed that I have calcified veins in my left chest.  My symptoms have included chronic throat clearing (non-productive) and occasional cough (producing phlegm).  As a child (more than 50 years ago) I had primary tuberculosis but all chest x-rays of me as an adult show no signs of a return of the TB.  What is the cause of calcified veins in the lungs and what treatment options are available?

Richard

A. Dear Richard, I do not know what may have caused calcified veins in your chest. It is far more common for arteries, such as the coronary arteries or aorta to calcify. I suggest seeing a pulmonologist for a diagnosis. 

Dr. Tom       

 

Arterial Blood Co-Oximetry
Q. I'm searching for a listing of substances interfering with arterial blood co-oximetry please.

Geni

A. Dear Geni, Abnormal hemoglobins are the only cause of interference with co-oximetry.

Dr. Tom

 

Difficulty Weaning Off Ventilator
Q. My mother has been in a hospital for three months and it has been difficult for her to wean off the vent. When she was in intensive care got her to CPAP, but this hospital has only, I got her down a pressure of ten breaths per minute and stopped the process. I have been told she can never get of the machine.

Shes been alert all during the process and the last time they did the weaning, and stopped, she told them she did not have any discomfort. They told her blood gas was low, but my mother has had respiratory problem for a long period of time. I would like to know how aggressive we should be with the weaning.

William

A.  Dear William, Most patients can be weaned from mechanical ventilation. There are specialized hospitals that are most successful such as the Kindred group.

Dr. Tom

 

What is Recommended Follow-Up for Nodule that has Not Increased in Size?
Q. Dear Dr. Tom: Thank you for taking my question.  I am a 46-year-old female who is in fairly good health, except for shortness of breath for two weeks, but now okay; have had intermittent shortness of breath in the past for a few days at a time for about 20 years.  I just recently found out I may have asthma, still actually undergoing testing and will see a pulmonologist in June.

I had a chest CT with contrast, which showed the incidental finding of a 3 mm noncalcified peripheral nodule in the left lower lobe.  The radiologist compared this to a previous CT Scan that also showed the nodule and it was stable at 3 mm. This radiologist said that it does not need to be followed up. 

I feel this is almost a death sentence to have a nodule in the lung like this and especially noncalcified.  I am a medical transcriptionist and know just enough to be concerned enough to drive myself crazy.  I am scared to death that this is lung cancer.  I have a history of smoking for about two years in my life, quitting about 20 years ago, and now with asthma. 

I am going to talk about this with the pulmonologist, but in the meantime, like I said, I am scared to death that this is lung cancer.  It really consumes my every thought.  I really would appreciate your input on this. 

Lisa

A. Dear Lisa, There is very little chance that this is lung cancer. Your pulmonologist will confirm this conclusion, when you see him. There is no reason for a follow-up CT for a stable lesion this small.

Dr. Tom

 

I Have COPD, Will Breathing Problems Stop
Q. Dr. Tom, I am a 47-year-old female, I have COPD I do not smoke any more, as of two months ago. I don't think it is at a severe stage. I have been having breathing problems about once a month. The doctor gives me prednisone and an in haler and I use my nebulizer. My question is will I ever stop having these monthly breathing problems. It is also interfering in my job at the groceries store I work at.

Fayna

A. Dear Fayna, I do not know the degree of pulmonary function impairment, if any. You need spirometry and a pulmonologist to manage your COPD. Your prognosis is probably good.

Dr. Tom

 

Scuba Diving and Being Treated for Lung Cancer
Q. Is it safe to SCUBA dive while being treated for lung cancer? I have two, 1 cm. tumors that are responding to chemotherapy.    

Stan

 A. Dear Stan, I am not sure it is safe. Better not risk a pneumothorax just now.

Dr. Tom

 

Tampering Prednisone
Q. Dear Dr. Tom, I've been on prednisone for about three years at various doses between 60 mg and 7.5 mg. had pneumonia and then horrible mold problem. Every time I tried to get off I could only get down to 7.5 and then back up again. Now I've been steadily weaning from January at 30 mg down to 5.5 mg.

Now the problem is that I believe that my adrenals have shut down with these dosages this long. My doc says he can treat the symptoms, just get off the stuff ASAP. At this point I’ve tapered 1/2 mg every 10-14 days and done o.k.

I am asthmatic with COPD and scared to death of tapering too quickly only to have to go back up in dosage. Do you think my taper is correct or should I go slower or quicker.

I have been eating tons of anti-inflammatory foods hoping that is helping. Is this true or am I wasting my time eating this stuff that I really don't care for?

Thanks so much for your opinion. I love your website, thank you so much for your time. 

Louise

A. Dear Louise, Tapering prednisone is a very individual thing. You will have some adrenal suppression with 5.5 mg per day. I suggest tapering at 1mg increments after you are completely stable. You may have to go back on steroids if you get an asthma flare-up. I assume you are taking inhaled steroids as a strategy to suppress inflammation. Antioxidant foods make sense.

Dr. Tom

 

Inhaled Irritants
Q. I am a housewife and am working on a mosaic project in my kitchen- using hardibacker (cement backerboard), grout and tumbled travertine. I have used this material for a few months, mostly scoring with a knife and and then breaking the material. Two weeks ago, I used a handheld saw to cut the hardibacker. I was outside and not knowing the dangers, did not see it necessary to use a dust mask. It was a windy day.  I cut only a few boards, and it lasted less than 1 or 2 hours.

 Later that night I began to feel quite sick and the next two days I was in bed with dizziness, a migraine that did not respond to medicine, nausea, and fatigue. When the headache and nausea cleared, I had shortness of breath and pressure in my chest.

I went to see a doctor who gave me a bronchodilator and prescribed some cough syrup to make mucus in my lungs. I was fine for a week, and stopped using the bronchodilator.  Now the chest pressure is back. I am a worried about silicosis since most websites make this out to be a very serious illness. I wonder if I should see a specialist. 

Christine

A. Dear Christine, You will not get silicosis with such a minimal exposure. Use a mask next time.

Dr. Tom

 

Have Had an Awful Cough for Eighteen Months
Q. I am 46 years old I have had a cough for about 18 months on and off. Dr. says allergies, but no allergy tests. My chest x-ray its clear, Doc listens to my chest, it sounds clear, but I still have this awful cough

I’ve tried allergy medication nothing works. I still have this cough, sometimes its dry and others productive clear phlegm.  I am a nonsmoker; husband smokes only outside, not around me. What should I ask for next?

Diane

A. Dear Diane, You certainly need a diagnosis of the nagging cough. It sounds like your evaluations, thus far have been pretty superficial. I suggest seeing a pulmonologist to get a diagnosis and appropriate treatment.

Dr. Tom

 

Questions about Spiriva
Q. I have had sarcoidosis for 17 years, still active at times, then asthma complicated things, and now this year a lung scan showed traction bronchiectasis. Also, osteoporosis is being fought since the large amounts of steroids were taken in the beginning.

Is there a 'safe' inhaler to take that will not go against the Fosamax?

 I switched to Spiriva yesterday, but it is left over and is out dated by ten months, is it ok to use, and is it supposed to help with wheezing? So far, I don’t think it is, maybe in time? Is Spiriva as dangerous to the heart as Symbicort? 

Kay

A. Dear Kay, Spiriva is a very safe drug. It is not harmful to the heart, in the vast majority of cases. I would give it a try. The use dating is always about a year on the short side. My advice is to go ahead and use it if prescribed by your doctor.

Dr. Tom

 

Standard Dose for Home Oxygen
Q. What is the standard oxygen dosage for home use?

Ashley

A. Dear Ashley, What ever the flow it takes to get the oxygen level above 90% saturated, as estimated by a pulse oximeter. The usual flows are 1 to 4 liters per minute. Each patient has his own requirements.

Dr. Tom

 

 ‘Very Inflated’ Lungs
Q. My mother went to the doctor this past week and told the doctor that she has had a minor cough, which produces phlegm for the past year or so. Usually she only coughs when she laughs.  The doctor ordered a chest x-ray and it came back that she had very inflated lungs. 

He prescribed some cortisone meds for her.  My mother is 67 years old, very petite and energetic and has been in good health.  I do remember she had pneumonia a few years back.  I am very concerned for her and would like to understand what causes inflated lungs.  I am going to suggest that she go to a specialist.

Christa

A. Dear Christa, I agree that going to a pulmonologist is wise. I think that the casual use of prednisone is not appropriate for her situation and there is a high risk of osteopenia due to small bone structure. The report of hyperinflation on a chest x-ray is often misleading.  

Dr. Tom

 

Purpose of a PET Scan
Q. CT scans of abdomen and chest identified irregular mass 1.7/1.5 cm with adjacent scarring in right lower lobe, two radiologists suggest PET Scan. Pulmonologist feels confident it is calcified and benign. Should I have PET Scan?

Debra

A. Dear Debra, No. A PET scan is used to determine a high likelihood of malignancy. It is not used for calcified lesions.

Dr. Tom

 

Progression of COPD               
Q. I have mild emphysema after 20 years of smoking.  I no longer smoke. 
My question is, can I expect my emphysema to progress to Stage IV--and over what period of time?  Or should I expect to never move beyond Stage I?  I have read about other's emphysema getting worse as the years go on.  My other question is, should I wear a protective mask when mowing the lawn or cleaning out the shed to not make my emphysema worse?

Doug

A. Dear Doug, Since, you have stopped smoking your emphysema will progress very slowly, if at all. Your lung function will decline slowly with age. It is wise to use a mask when exposed to dusts.

Dr. Tom

 

Can I Decrease Shortness of Breath with Exercise?
Q. I have had shortness of breath (SOB) on exertion for several years, but continued to smoke on and off.  I quit about six months ago, but still had SOB.  Spirometry showed significant reduction in FEV1.  But I usually have 96-97% O2 saturation, even with treadmill. 

My doc says my case is not life threatening, but needs to be managed.  Can I improve SOB with lots of exercise and live a normal life?

Eric

A. Dear Eric, Yes. Regular daily exercise such as with walking at a comfortable pace at least twice a day, for 20 to 30 minutes, will do a lot to reduce your shortness of breath. Exercise is the cornerstone of pulmonary rehabilitation.

Dr. Tom

 

Could Shortness of Breath be Due To Arthritis on Chest Bone?
Q. I have costochondritis. I feel shortness of breathing all the time, and my chest bothers me. I have gone through so many tests but nothing could be found. I have had this problem for over 20 years. My gastroenterologist says I have arthritis in my chest bone. I need help.

Harsha

A. Dear Harsha, Arthritis of your "chest bone" is not the cause of your shortness of breath. Get another opinion from a pulmonologist.

Dr.  Tom

 

Ear Trouble, Should I See Another Doctor?
Q. I have ringing in both ears and have been dizzy (three months), I have seen three doctors one said Meniere disease, the other said I was just getting old (45) the last said fluid on the ears; my question:  should I see another doctor?  I have been on meds for fluid for one week. 

Kathi

A. Dear Kathi, Yes, see another doctor. This is not from your young age.

Dr. Tom

 

Back Pain and Shortness of Breath 
Q. I have had upper back pain since I was on a breathing machine last year! They have ruled out skeletal muscle issues. I still get short of breath, sweat a lot, and I can't even climb a flight of stairs without being short of breath and sweating. Any advise?

Tammy

A.  Dear Tammy, You need measurements of your lung function by simple spirometry and a diagnosis. I would see a pulmonologist.

Dr. Tom

 

One Doctor Says Mild Emphysema the Other One Says Asthma
Q. I had pneumonia in 2005 I have not been right since. I have had numerous lung function tests that have all showed near normal. I had a CT Scan, which showed abnormalities (when pushed the Consultant advised that I had problems exhaling – and when really pushed said that I had mild emphysema). The weather certainly plays a major part in how I feel, summer I’m great, winter when it is cold and most certainly when it is wet I feel dreadful.

Since then I have had follow up appointments where another doctor has said that he thinks that I now have mild asthma.

My symptoms are:
1. A persistent and unpleasant cough
2. Coughing up green/yellow phlegm sometimes brownish/red thick and very sticky and dark blood – I also cough up mucus casts.
3. Problems breathing - difficult to get about without becoming short of breathe especially with a change of temperature, lying down.
4. Recurring chest infections diagnosed by GP
5. Bad breath nasty taste in mouth
I am going for more lung function tests, allergy test and histamine tests, why does one doctor diagnose one cause and another diagnose something different?

Jac

A. Dear Jac, There is an overlap between asthma and emphysema. If your lung function tests are normal or near normal, and you respond to drugs that affect your airflow, the most likely diagnosis is asthma. You should do well with treatment and avoidance of irritants.

Dr. Tom

 

Could I Have Alpha One?
Q. I am a 24 year-old male with pretty severe asthma.  I have had asthma since I was an infant. I had very bad asthma as a child it seemed to be getting better in my teen years. I did smoke off and on for seven years or so maybe 15 cigarettes a day at the peak of my smoking, but much less than that the first few years.  

When I am hospitalized I usually have a virus that sets off my asthma like the flu or bronchitis or pneumonia.  But this time it wasn’t like that.  I had the worst asthma attack I have ever had, I thought I was going to die, they put me in the ICU. I missed two weeks of work. After that, I was put on prednisone but once that wore of I was bad again.  Then they gave me a steroid shot that lasted a month that helped.

Anyway my doctor sent me to a pulmonary specialist. I did the breathing test and the nurse thought I didn’t understand her directions because the results were so low. 

The doctor said he thinks I am lacking alpha1 protein and that I have emphysema and COPD as well as asthma. Does this happen for a 24 year-old to have emphysema? They did two blood tests to find out if I have Alpha1 and to see if I have allergy asthma. 

I am worried I have a seven month old son and a wife. Is emphysema something I can function with? Keep a job with?  I am a meat cutter I work in a meat-cooler at 40 degrees temperatures. Does this affect emphysema?  Should I quit my job?  Can I still live a long life?  I am very worried that I won’t be around for my family and that I won’t be able to provide for them.

Clark

A. Dear Clark, The blood tests will tell if your have the alpha one deficiency. Emphysema can occur at a very young age, such as during teen age with alpha one deficiency. With treatment you should do well and be able to function normally.

Dr. Tom

For more information: Alpha-1 Foundation at http://www.alphaone.org/

 

Normal Oxygen Saturation
Q. Dr Tom, I reside in Salt Lake City, where, in a previous post, you indicated that normal oxygen saturation levels are 92%-94%; however, when I went to my doctor for a routine checkup, he expressed concern when the oximeter attached to my finger read 92%-93%.

As a man 54 years of age, how concerned should I really be with my oxygen saturation levels?

Scott

A. Dear Scott None. Your oxygen levels are normal for Salt Lake. Your doctor should know this.

Dr. Tom

 

How Can Mum Keep Healthy
Q. Dear Dr. Tom Last month my mum suffered from high fever and doctor said she has a very serious infection, after taking antibiotics again doctor said that her lung has 70% damage and he referred her to hospital, on paper there was written she is suffering from Lung Collapse. My Mum used to smoke 20 cigarettes everyday, now she stopped smoking as doctor said SHE SHOULD STOP SMOKING IMMEDIATELY.

I am worried as doctor also said she has to pay high attention not to get sick even of a simple flu could be fatal. Could you please suggest me what else she can do to keep on getting better? Does she need to take vitamins, which Vitamin is best? Anything which could be of help, is greatly appreciated as I am very preoccupied.

Michelle

A. Dear Michelle, Stopping smoking is the most important factor in protecting lung function. Avoiding or treating infections is next. Antioxidant vitamins such as C may help. Better is the consumption of fruits and vegetables.

Dr. Tom

 

Wake Up Trying to Catch Breath
Q. Hi, I have been having problems with my breathing; I have wake up at night not able to catch my breath. I have had a sleep study done, a scope put down my nose too look for a tumor everything has came back fine. I have spells where I am awake and I stop breathing as well as when I am talking. This is very scary. But I'm not sure what else I need to do. Can you help?

Marion

A. Dear Marion, Your description of symptoms is one of sleep apnea. Are you sure you had a proper study, i.e. a formal one in a sleep laboratory to check for sleep apnea?

Dr. Tom

 

False Positive Diagnosis of COPD
Q. I have read that using a fixed cut off i.e. 70% for FEV1/FVC can lead to false positives when determining who has COPD. The ratio decreases normally with age because the FEV1 drops more than the FVC as a normal sequential of aging. Shouldn't a lower limit of normal be applied to calculate the appropriate ratio and avoid over diagnosing the elderly? Hope you are well. Your thoughts are always appreciated.

Bob

A. Dear Bob, You are correct about the FEV1/FEV ratio. This may over diagnose COPD in older people. Look at the percent of predicted for each parameter. 

Dr. Tom

 

Sleep Apnea and Attention Deficit Hyperactivity Disorder (ADHD)
Q. I would like some information and research studies on how sleep apnea affects ADHD I have ADHD similar symptoms even doctors don't seem to know, although they try different medications that have too many side effects where I cannot function.

Sue

A. Dear Sue, Your will have to read about this possible relationship. I do not know of a connection.

Dr. Tom

 

Proper Length for Oxygen Tubing
Q. We have been told that our son is going into Chronic Lung Failure. He has been put on oxygen. Does the length of the tubing matter on his home machines? We do have the tubing at long lengths to make it easier to move about the house. I do worry if he is getting the right levels of oxygen by doing this?

Pamela

A. Dear Pamela, Fifty feet of tubing is used by many. Sounds like portable oxygen would be better.

Dr. Tom

 

Stepfather has Multiple Lung Problems
Q. My Step Dad was a heavy smoker for most of his life till he had his first heart attack over 15 years ago.  Since then it's been a bit of a rollercoaster of health events from recurring heart attacks to a triple heart bypass.  He's supposedly been diagnosed with lung cancer over the past five years and has not undergone any treatment whatsoever - the docs say it's rare and have just been making quarterly scans of his lungs but have not seen the "cancer" expand or spread to other areas of both his lungs which is rare if it is cancer.   

He's now 67 and had a bullectomy and pleurodesis on his left lung in October 2007 due to suffering from a collapsed lung on two occasions.  Since the operation he finds it difficult to breathe and suffers from shortness of breath and can only walk 100m and he's out of breath - stairs are particularly difficult. 

The doctor has recently prescribed him some medication to open his airways as they say it is the reason why he is out of breath.  He also has recently developed a lump the size of wrist bone on his back/near lower left shoulder blade...could this be post surgery tissue/muscle as a result of bullectomy and pleurodesis? 

Any suggestions of where he can get support and advice to improve his breathing such as breathing exercises would be good.  Your advice would be appreciated.  Thanks, Mani 

Mani

A. Dear Mani, I do not believe the lump is related to the surgery for bullectomy and pleurodesis. It could possible be related to the lung cancer. Such slow growth for lung cancer is very rare. Are you sure of the diagnosis?

Simple walking inside, outside or in stores is the best way to remain fit. Exhaling against pursed lips may relieve exercise related shortness of breath.

Dr. Tom

 

Do Symptoms Warrant a Visit to Doctor?
Q. Good day.  I am a 36 year old, overweight but healthy woman.  I run almost every day as well as do yoga.  My lungs have been bothering me for a month now.  For two weeks the only symptom I had was tight/sore lungs (especially when I ran).  I then developed a deep cough that produces little phlegm and it is clear.  I have lost my voice and continue to cough (it has been two weeks with these new symptoms). 

I don't have insurance, so I don't want to accrue a medical debt by going to the ER unnecessarily.  Does it sound like I should be concerned?  Should I just continue to drink lots of fluids and wait it out?

Lalanea

A. Dear Lalanea, Your symptoms are not alarming, particularly since you are exercising. I suggest continuing this high activity and losing weight. See a doctor if your cough persists.

Dr. Tom

 

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