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Archive: Dr. Tom 130

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

 

 

Mom has Pulmonary Fibrosis
Q. Please: some suggestions for pulmonary fibrosis. My mom is 82, soon to be 83, and has pulmonary fibrosis. She is on oxygen and also has osteoporosis, has broken her back twice, had an operation and has problems with her nerves and GI track.

She presently takes 19 pills per day. She is hunched over but can still walk. She lives with my stepdad and he takes care of her, God bless him.

They are in Florida and I'm in Dallas, Texas. I know this is a difficult disease and suggestions on how to keep her healthy would be appreciated.
Scott

A. Dear Scott,
Pulmonary fibrosis is a group of disease states. The treatment depends on the cause. I assume she is seeing a doctor for it. Nineteen pills are a lot for anyone. I suggest seeing a pulmonologist who specializes in her problem.
Dr. Tom

Anti-TNF Drugs for COPD?
Q. Do you know if the anti-TNF drugs (Tumor Necrosis Factor are used for the treatment of rheumatoid arthritis) like Humira and Remicade have any benefit for COPD patients? I have this question because they reduce inflammation in the body.
Sharon

A. Dear Sharon,
I do not know if they have been tried in COPD. Their use has a rationale, but there are many side effects from these drugs. I hope that some studies are underway to see if they are effective in COPD.
Dr. Tom

Can Amoxicillin Give You a Sore Throat?
Q. I am taking amoxicillin for bronchitis and I think it’s giving me a sore throat, but when I get up in the morning it’s gone and comes back after I take it again. I only have two pills left to take and except for the throat and chest pain. I feel great! Can you tell me what is happening?
Scott

A. Dear Scott, 
It is possible that the sore throat is an allergic reaction to amoxicillin. I suggest not taking any more of it until you consult your doctor.
Dr. Tom

Both Parents Died of Emphysema
Q. My mother, Martha M., worked for you years ago at University of Colorado Medical Center.  I now work at our local hospital-sponsored hospice in Medford, OR. I recently spoke to our respiratory department director and told her about my mother and her difficulty in quitting smoking—even in light of the fact she worked for “this brilliant doctor who even showed her lung slabs from emphysematic patients.” 

I mentioned your name, and she said she knew of you, so I wanted to say hello, and wish you well, on behalf of my mother.  She thought you were the best person. I think you knew she died in 2000 from emphysema, as did my father in 1985. 

I have never smoked. Anyway, I hope you are doing well and if you are ever in Oregon, I would be honored to say hello in person. 
Sally M.

A. Dear Sally,
I remember your mom so well. She was a great secretary. Seems like only yesterday. Good that you don't smoke. Stay well and thanks for the message.
Dr. Tom

What About Air Purifiers?                
Q. I have COPD. Would you recommend using room purifiers?  If so, how often should they be run? 
Pat

A. Dear Pat,
I don't think they are of much use. I do not recommend them for my patients.
Dr. Tom               

Progression of COPD
Q. Here’s my story: I am 68, diagnosed with COPD 15 years ago, put on oxygen 24/7, went through rehab, and was then using oxygen only at night for the past 12 years, with a mild to moderate breathing test results. 

Now I have since gone to severe with only 50% breathing.  What, if anything, would cause his drastic change?
Lynn

A. Dear Lynn, 
Fifty percent of normal is pretty good. I do not know when your lung function declined or anything about your smoking or any lung infections. Thus I cannot answer your question.
Dr. Tom

CPAP or BiPAP for Neuromuscular Disease?
Q. I have hypoventilation at night due to an underlying mitochondrial myopathy. I had a sleep titration study and was placed on a CPAP instead of a BiPAP. I did question the tech about this as literature I have read says that BiPAP not CPAP should be used in persons with neuromuscular disease and respiratory muscle weakness, as I have. He said they have to start out on the CPAP first. (I actually slept six hours with the CPAP, I was very proud of myself.)

I received a call yesterday from the home health company who will be setting my machine up. They said my doctor had ordered a CPAP machine. I already have a BiPAP machine that I had gotten three years ago but had difficulty tolerating (no sleep study or titration with that—just pressures picked by a former doctor). I explained this to them but they said I would have to purchase this CPAP machine.

My question is: I am really uncomfortable with getting the CPAP if this potentially could make things worse for me in the long run. Am I making too much of the CPAP vs. BiPAP issue?

I have put two calls into my doctor (who is a sleep specialist) but have had no response as of yet. I am not sure what to do at this point. Can you help me?
Linda

A. Dear Linda,
I agree with your thoughts that BiPAP would be better for you, because it would assist your breathing more than CPAP. I suggest insisting on talking with your doctor about this since he is a sleep specialist. If you are not satisfied with his interest in you, I think you need a new doctor.
Dr. Tom

Can Radiation Cause Lung Scarring?
Q. What exactly does “biapical parenchymal scarring” mean? Could you get this from radiation treatment for breast cancer?
Gloria

A. Dear Gloria,
Yes, irradiation therapy can cause lung scarring, but it is not usually in the tops of both lungs, which is what "biapical" means.
Dr. Tom

Doctor’s Note Says Hyperinflated Lungs
Q. I'm a 29-year-old female. I don't have any physical health conditions. I am a healthy weight - I eat well and exercise on a regular basis. I don't drink alcohol, but I do smoke about 4 cigarettes a day and have done so for the past 10 years.

I read my medical notes and after having an x-ray, a doctor wrote that I had slightly hyperinflated lungs. No further action was taken but I am very worried and not sure what this means. Am I developing emphysema?
Emily

A. Dear Emily,
I doubt it. Slightly hyperinflated lungs just mean you took a deep breath for the chest x-ray, as you were instructed to do. It is not an abnormality. Stay well and stop the four cigarettes.
Dr. Tom

Had Exercise Induced Asthma Years Ago, Could it be Back?
Q. I am 47 years old and have walked a fast pace on my treadmill for past 20 years for 40 minutes daily. Fifteen minutes into the exercise, I feel slight shortness of breath then I recover and feel fine again throughout the workout. This is all started to be noticeable in the last two weeks.

I did have exercise-induced asthma in my 30's then it went away. Asthma runs in my family. I also have sinus and allergy problems. Any suggestion on what test I should receive or a specialist I should visit?
Donna

A. Dear Donna,
This could be exercise-induced asthma again. I suggest seeing a pulmonologist. He can have your lung function (spirometry) measured at rest and again after exercise. Exercise-induced asthma is easy to prevent with a simple inhaler that a pulmonologist would prescribe for you. 
Dr. Tom

Significance of Lung Function Testing and Life Expectancy
Q. I am a 56-year-old just diagnosed with emphysema; I’ve have had breathing difficulty since 35. I smoked 40 years, then quit.

My FEV1 is 35.5 and DLCO is 22. My pulmonary doctor said we wouldn’t talk numbers as I am doing so well.

Am I going to die soon? With these numbers how long can a person who is healthy in every other way and strong and active survive? Can these numbers be improved in any way?
Dawn

A. Dear Dawn,
You have done the most important thing to insure your health will remain good for many years. I agree that “talking numbers” is not wise. You have fairly good lung function remaining. Stay active and enjoy life.
Dr. Tom

Short of Breath and Smoking
Q. I recently moved into a new basement apartment. After about a week I noticed chest pressure and difficulty breathing at all times. There was exposed fiberglass in this basement apartment.  I was there for about one month before I moved out.

Once I moved out I healed completely and went back to normal (normal for a smoker, I'm trying to quit, easier said than done, I find). I was normal for about three weeks, then the chest pressure and difficulty breathing came back, 24 hours a day, all times, even at rest. I was put on Advair and an asthma pill, but no response after several weeks.

My chest x-ray showed a slight inflation of the lungs, though my doctor said this wasn't conclusive of anything. My PFT didn't show anything abnormal, or at least nothing my doctor mentioned. I had a CT scan today and am waiting on the results. My doctor gave me Xanax, which maybe makes it a bit more bearable but pretty much just makes me sleepy.

Could one month of fiberglass exposure do this? Could it be an infection/mold? I'm 29, no history of allergies/asthma and have not responded to asthma meds at all. I just don't understand, what are the possibilities?
Dan

A. Dear Dan,
Mold is a possibility, but probably not fiberglass. Smoking will remain a problem until you are finally able to quit. I agree, it is not easy, but keep trying.
Dr. Tom

Former Smoker and Worried about Emphysema
Q. I am 51.  My daughter died in 1996 and after getting off antidepressants, I started smoking and continued from 2000-2007 (stopped when I turned 50) less than one pack a week—a closet smoker.       

I recently had a physical. I mentioned to the doc that I had a mild, chronic cough for about one month so he had me get a chest x-ray. The x-ray tech saw a 6mm nodule so I had a CT, the CT proved no nodule, but that I had signs of mild emphysema.

I exercise regularly and have very recently climbed the Grand Canyon and Mount Whitney with relative ease. I am anxious and now seem to have all the symptoms of the disease. I had a spirometer test and I know that my FVC was 4.59 or about 93% of normal. What next should I do?
Brian

A. Dear Brian, 
If you can do all that climbing, you do not have much if any lung disease. Stop all smoking and stay well.
Dr. Tom

Can You Receive Social Security Disability Insurance (SSDI) for Emphysema?
Q. I have COPD. I was told I have emphysema a few years ago.  Spiriva caused tremors every morning.  I am now on another inhaler. I am 69 years old and cannot work due to my health problems. Would I be able to receive SSDI?
Annette

A. Dear Annette, You will have to ask social security; you are eligible for retirement now, by age.
Dr. Tom

What’s the Difference Between a Thoracentesis and Pleurodesis?
Q. My mom has had three thoracentesis and is about to have a fourth.  She has a tumor on her left lung and the fluid tested and cytology shows no cancer.  Is it feasible for her to get a pleurodesis?  Where will that fluid go if her lobes are sealed off? Ana

A. Dear Ana,
The purpose of the pleurodesis is to obliterate the space where fluid can accumulate. When successful, it eliminates the need for a thoracentesis to remove the fluid.
Dr. Tom

Doctor Says Anxiety is the Cause of Shortness of Breath
Q. I had a spontaneous pneumothorax in December 2006. Recently I have been having an increasingly difficult time catching my breath despite what I am doing, from exercise to reading a book. At times I feel a sharp pain on my side or a feeling that someone is squeezing very tight.

My doctor dismisses my concerns and says it is anxiety; however there are times when I think my lung may have collapsed again due to sudden sharp pains which eventually subside. Should I seek a second opinion or just wait and see despite my concerns.
Ami

A. Dear Ami,
Definitely seek another opinion. You may well have a recurrence of the pneumothorax. These symptoms should not be dismissed as anxiety, until all causes are ruled out.
Dr. Tom

Hypoxic Drive and Carbon Dioxide Retainers
Q. In your view of pulmonary pathophysiology, is a hypoxic drive mechanism a reality for some chronic hypercarbic patients that needs to be addressed as such, or just a theory that has little to do with actual clinical practice?  In short, in your practice, do you think that these patients are using a hypoxic drive?
Brady RRT, RCP, RPSGT

A. Dear Brady,
The whole hypoxic drive and CO2 retention is mostly a myth. Forget about it. Virtually no COPD patient breathes only by virtue of the hypoxic drive. 
Dr. Tom

Healthy Living with COPD
Q. My husband has severe COPD at 43%.  He in on medication and is in respiratory therapy.  He's about 5'8" and weighs approx 147lb. Will you please give me some advice on how to help him and what to expect.  My main question is what is the average life expectancy under these conditions?
Cheryl

A. Dear Cheryl,
It depends a lot on his age, which you did not state. 43% of normal lung function is pretty good and should allow for at least a year of healthy life, sometimes much more.
Dr. Tom

Help Settle a Dispute about Adventitious Breath Sounds
Q. Dr Tom, I am a nurse and former respiratory therapist and we are having a dispute at work regarding the term ‘decreased breath sounds.’ Can rales, rhonchi, wheezing and other adventitious breath sounds be considered decreased breath sounds?

Our Medical Director says if you have any of the abnormal breath sounds by nature you have decreased breath sounds. Help solve the argument. Some are splitting hairs!
Cindy

A. Dear Cindy,
Rales, rhonchi and wheezing cannot be equated with decreased breath sounds. Decreased breath sounds means exactly what it says, a reduced intensity of normal breath sounds.
Dr. Tom

Nodes have Shrunk but Now Have New Ones
Q. I was treated for stage II breast cancer in 2005, with nothing in lymph nodes or margins. I developed BOOP due to an allergic reaction to one of the chemo drugs at the end of my treatments.

I have had CT scans every six months since to monitor lungs. The scan three months ago shows 3 small nodules in the lungs 2-3 mm in size the follow-up CT scan a week ago shows the previous nodules have shrunk but now some new ones 2 mm in size.

I have a cough hanging on from a cold three weeks ago. The oncologist is now sending me to see a respiratory specialist. What are your thoughts?
Gayle

A. Dear Gayle,
These very small nodules deserve a follow-up up CT in about three months, in view of your history. 
Dr. Tom

Could My Breathing Medication Cause High Blood Pressure?
Q. I have COPD and have developed high blood pressure all of a sudden. I went to a cardiologist and had an echo-stress test and everything was O.K.  The doctors can find no reason for my high blood pressure. I am on blood pressure medication and it has come down a little.

Every morning when I first get out of bed my face is real red and puffy and I have this crazy feeling in my head like there is a vise on my head.  I was wondering if I might have inner ear.  What are the symptoms of inner ear?  Have been to doctor so much I just dread going back but guess I'll have to go soon if I don't get to feeling better.

Do you think any breathing medications would make me like this? Gwyn

A. Dear Gwyn,
I do not know much about inner ear symptoms. I doubt it this explains your symptoms. Your respiratory medication should not be causing high blood pressure.
Dr. Tom

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