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Archive: Dr. Tom 132

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

 

 

Scuba Diving and Asthma
Q. My 16 year-old son is on Advair for mild asthma. He never really had an attack just some mild difficulty breathing—sports induced.

He recently wanted to take a scuba course but the conservative doctor just says "why take the risk?" and won’t o.k. the required medical release. We have talked to a dive company, they say they have many divers that are asthmatic, just have to know your limits (no really deep dives, no CO2 diving, etc)

My son really wants to learn and he doesn’t get excited about many sports. Please your thoughts on Scuba and mild asthma.
Cary

A. Dear Cary,
I believe that scuba diving for well-controlled asthma is generally safe. I hope you can get your doctor to agree.
Dr. Tom

FEV1 and Longevity Follow-Up Question
Q. Dr. Tom, On July 10th a lady named Cheryl posted a question about her husband having 43% lung function and you told her he might have one year of good health.  Is that correct? Only one year...it seems to go against some other questions you have answered as far a longevity with that much lung function.

Please post if that is correct as I am freaking out after reading that.  Thank you so much sir for all you do.
Mary

A. Dear Mary,
I did not intend at all to say that the prognosis was limited to one year. 43% is pretty good, and I would guess that 10-15 years would be a better guess, but it is a guess. Hope this helps.
Dr. Tom

Worried About Husband’s Shortness of Breath
Q. My husband has been experiencing increasing shortness of breath upon exertion (he's a distance runner).  PFT normal with over 100% predicted except an FEV1/FVC of 68%.  DLCO was over 100% too.  He's in his mid 50's and in excellent shape.

History of asthma as a child -- exercise controlled it.  Had a stress echo last week with normal results except for a slightly enlarged left atrium.  Pulmonary pressures normal.

What could be causing this problem?  He also is clearing his throat excessively.
Adrienne

A. Dear Adrienne,
It is difficult to guess what is going on from what you tell me. It is possible that he develops pulmonary hypertension only when he exercises. This can be checked out in centers that specialize in pulmonary hypertension. As another consideration, he could also have exercise-induced asthma.
Dr. Tom

My Baby Is Always Sick With Asthma
Q. I have a 17 month-old baby girl, she's always getting sick with asthma. She has a lot of phlegm. She'll be sick for about a week then get better, she’ll have no symptoms for about a month, then she'll get sick again, like about every month.

I just took her to see a specialist, and he told me she has scarring in her lungs. Is this reversible? She's had pneumonia twice so he said it's from that. I was wondering if this could be from bronchitis?
Claudia

A. Dear Claudia,
Although wheezing and phlegm are` very common in infants, asthma is very uncommon in young children. Typical asthma nebulizers and pills usually don't help very much.

It is very difficult to diagnose scarring of the lung without looking at lung tissue from a biopsy under the microscope. Changes seen on an X-Ray may be reversible but it is often difficult to be sure and I certainly do not suggest getting a lung biopsy unless there are very serious symptoms that suggest unusual lung diseases. I suspect that the specialist will check for reasons why she may have had a pneumonia - like immune problem or cystic fibrosis.

My suggestions are for her and babies like her is to avoid all exposure to tobacco smoke (is in not enough to just not smoke around her), to avoid using medicines like Vicks or Mentholatum rubs, to not use a vaporizer in the bedroom as high humidity promotes the growth of molds.
Dr. Bruce

Suffering from Chronic Throat Clearing
Q. I am a 59 year-old non-smoker. I have been suffering (and I mean suffering) with chronic throat clearing for the  past four years. When I say chronic, I mean most of the day and night, every day. Sometimes I get a really bad tickling in my throat, which provokes a strong cough.

I have type 2 diabetes, high blood pressure, GERD and take meds for all. I'm getting really desperate, I can't go places and have to sleep in separate room. Any ideas?
Stephen

A. Dear Stephen,
GERD seems to be the best diagnostic possibility here. I suggest seeing a gastroenterologist to be able to pursue this further.
Dr. Tom

Frequency of Ventilator Checks
Q. There has been a tremendous amount of controversy not just at our hospital but across the nation as what the standard should be for frequency checks for a patient on mechanical ventilation.  Could you share your thoughts?
Tracy

A. Dear Tracy,
I have no idea what you mean by "frequency of checks". Sorry.
Dr. Tom

Previous Radiation Treatment and Pregnancy
Q. I had radiation drink to kill my thyroid last November as I had Graves. I am now three months pregnant will this cause any problems?
Julie

A. Dear Julie,
Almost certainly not, but discuss this with your obstetrician and pediatrician when the child is born.
Dr. Tom

Quit Smoking and Worried about COPD
Q. I am 41 years old and quit smoking exactly five months ago after 25 years of smoking approximately a half pack a day.

I have historically had bad sinus - even had surgery to remove polyps a few years ago.  I was prompted to quit smoking because of some breathing problems - not necessarily a shortness of breath or wheezing but throbbing sinuses usually accompany just an uncomfortable, almost anxious feeling and it.  Of course, as a long-time smoker, I'm concerned about COPD.  Would it ever manifest itself this way?
Dave

A. Dear Dave,
COPD is a possibility. Get spirometry done to measure your lung function.
Dr. Tom

Black Spots on PET Scan
Q. My mother just had a PET scan of the chest done and after looking at her images, there are small black spots shown from the back view. What does that mean?
Joann

A. Dear Joann,
Discuss this with your doctor. Who saw the black spots?  You deserve an explanation and I do not have enough information to be able to give you one.
Dr. Tom

Mold in BiPAP Machine
Q. I have a BiPAP machine and did not clean it well.  I think it has mold in it. I am allergic to mold and now have chest tightness and am SOB.  How do I get the mold out of the machine?  I tried putting a few drops of bleach in with the water and running the machine for a few hours, but that didn't work.
Lynne

A. Dear Lynne,
I am not familiar with removing mold from a BiPAP machine. Discuss this with your supplier.
Dr. Tom

Signs and Symptoms of Lung Cancer
Q. My mother-in-law was just told two days ago that she has a nodule on her lung. She has been coughing up blood for about a month now and she has been a heavy smoker until about a week ago.

She has to go for a PET scan in a few weeks. Could this be a sign of lung cancer?
Nicki

A. Dear Nicki,
This is one of several possibilities. Discuss this with your doctor.
Dr. Tom

Multiple Pulmonary Nodules
Q. I had a CT scan for my kidney and accidentally they found multiple pulmonary nodules in both lung bases, right greater than left.  These are non-calcified and nonspecific.  I have had a cough, some shortness of breath when I exercise and my lungs hurt when I take a deep breath.  I've had these symptoms for about a month.

I smoked a bit as a teenager but never daily, and only a few cigarettes a day.  I haven't had a cigarette in 25 years.  What do you think this is?

Do you think this is lung cancer?  I'm really worried. Thank you.
Lisa

A. Dear Lisa,
These lesions are probably not lung cancer, but since they are not calcified, a follow-up exam is needed. Follow the advice of your doctor.
Dr. Tom

I Want to Learn about Pulmonary Hypertension
Q. My Dad died from pulmonary hypertension and I want to know every thing there is to know about Pulmonary hypertension because I want to help people like my Dad. Jason

A. Dear Jason,
There are several forms of pulmonary hypertension. I recommend getting the lay literature from the Pulmonary Artery Hypertension Association (http://www.phassociation.org/ ). In brief there are changes in the lung's vessels that cause increased flow resistance and strain on the right heart.

I happen to suffer from this myself. There are several treatments, and new developments all the time.
Dr. Tom

Could Weight and/or Past Smoking History be Cause of Lung Problems?
Q. I am a 36 year-old man and overweight. I've been having problems with chest congestion and my breathing. I used to walk with out any problems but now I don't even think I can walk a city block with out stopping for a rest and coughing up something.

I was a smoker for ten years but, haven't smoked in over eleven years. Please help. I have an eight year old girl and would love to be able to do things with her. Thank you for your time.
Daniel

A. Dear Daniel,
You need to see a doctor for a diagnosis. It is impossible to guess what is wrong from what you tell me. It may be as simple as asthma, a heart condition or something else.
Dr. Tom

Worried about Wife’s Coughing and Weight Loss
Q. I have a question regarding my wife. She is 38 years old and appears to be in good health but for the past year she has been coughing and has lost weight. Blood tests were done (all normal) X-ray of the chest (nothing unusual. She also found a lump in a breast, which, was diagnosed as non-cancerous. I'm worried and don't know where to go next. Patrick

A. Dear Patrick,
There is an answer and it must be found. I suggest seeing a pulmonologist. I just cannot guide you without more information.
Dr. Tom

Father’s Air Hunger is Worrisome
Q. My 81 year-old father had surgery 10 days ago for a subdural hematoma. He is recuperating from that and was transferred from ICU to a floor and fell, removing his subclavian in the process.  His right diaphragm is paralyzed don’t know why.

He remains extremely air hungry.  Since he cannot get enough air he does not sleep except for two minutes at a time.  He fights for air and is literally wearing himself down--exhausted from trying to get air.

Could the removal of his subclavian during his fall (don't know if jerked out or knocked off) caused a breathing/lung problem?  Currently back in ICU for constant monitoring.  Sonya

A. Dear Sonya,
The doctors taking care of him in the ICU have far more information than I do. Ask them what is wrong.
Dr. Tom

Want to Feel Better
Q. I am 50 years old. I had a right lower lobe lobectomy with adenocarcinoma 1a tumor grade two.  I have COPD and am on oxygen. I am an ex smoker of 10 years and a 20 year history of environmental inspections (mold, lead, asbestos).

I am on Spiriva, Advair, blood pressure medicines and Neurontin-- sometimes hydrocodone for pleural effusion and atelectasis. I have heart rhythm problems not bad but continuous- bradycardia 71%, tachycardia 18% and benign tumors and cysts on my liver.

I don't seem to be getting better I hurt all the time and recently took a PFT for a disability claim. My FVC was <23 and my FEV1 was<14 my FEV1/FVC% was<62, my DCLO was 19.93.

I am so young, I am wondering if this is low?  I want to get better, but I’m so tired. I sleep a lot.  Is this depression? Aren't these numbers low? Any suggestions as to what I can do to get back on my feet? I was self employed and just can't work like that anymore.  Thank you.  I found your site very informative.
Terry

A. Dear Terry,
Your numbers are indeed low. You need to see a pulmonologist to sort this out. There are many possibilities.
Dr. Tom

Lung Transplant
Q. First I would like to say you are a special caring person. I read your Q & A’s regularly and appreciate your candor.

I am a 64 year young female with bronchiectasis, asthma and Antiphospholipid Antibody Syndrome (associated with recurrent clotting events) on Coumadin for the rest of my life. I had a pulmonary embolism infarct in 2007.

My question: Because I have a clotting factor does this disqualify me for a lung transplant? Besides this factor am I too old? I am in good physical condition from exercising faithfully. A tad overweight though (15-20lbs).

Thanks kindly for taking your time to answer my query.
Nan

A. Dear Nan,
Thanks for your kind comments. You may possibly be a candidate for lung transplant, but not ideal because of age and your other problems. You would have to consult the lung transplant center in your area for further advice. Good luck.
Dr. Tom

Oxygen Saturations and Pulmonary Fibrosis
Q. Dr Tom, please could you give me some advice? I am worried sick about my husband. He’s undergoing tests as to find out why he has scaring in his lungs, they have ruled out lung cancer.

The doctor has said it looks like textbook pulmonary fibrosis. Today he has had further tests and his oxygen level in his blood is 98 and the other day was O2 sat was 83%

My husband is very scared and I was wondering if you could advise. Is fluctuating oxygen level in blood a sign of fibrosis? Also, what is more confusing is his bones ache even with 98 oxygen in his blood.
Lynn

A. Dear Lynn,
The fluctuating oxygen saturations may be due to changes in his liter flow, his activity, position or the progress of his disease. Your doctor will be in a better position to answer your questions than I. The oxygen level is not related to his bone pain.
Dr. Tom

Wegener’s Granulomatosis
Q. Dear Dr Petty, In 1988 my pulmonologist referred me to you with Wegener's Granulomatosis complications and I saw you for several months.  During that time I had recurring bronchi collapsing in the left lung.

Several dilatations were done over several months because of this collapsing.  Surgery was done to try to repair the bronchi but when I awoke I found out that they removed the lung.

Since that time I have been in remission with a couple of serious flare-ups.  I also seem to get nasty pneumonias, some that require hospitalization, others are treated with Levequin (antibiotic) and steroid burst. Each time I seem to become more dependent on oxygen.

I am then slowly weaned off the steroids but never seem to be able to get below 10 mg without soon getting sick again.

Do you know of any recent research on Wegener's treatment and prognosis?  Do you have any suggestions for how to get off the constant prednisone merry-go-round?

I have a lot of respect for you and appreciated being accepted as a patient of yours.
Joan

A. Dear Joan,
I remember you as if it was only yesterday. There are some new treatments for Wegener's Granulomatosis. I suggest getting in touch with Dr. James T. Good Jr, of National Jewish. He is a former fellow and an excellent pulmonologist. Let me know if you want a referral. It is critical to keep the process suppressed and if it takes prednisone, it is far better than a flare up. Great to hear from you again.
Dr. Tom

Bronchiectasis Treatment
Q. I have mild bronchiectasis (saccular) I am constantly yawning to get a satisfying breath. I had a bronchoprovocation tests (methacholine challenge) and the ventolin at the end of the session made my spirometry reading worse.

Nothing was explained to me why. So should I be on another type of reliever? Also I have read that saccular can be reversed. Have you heard this to be true and in what length of time? I don’t get many infections.
Lee

A. Dear Lee,
Bronchiectasis may behave like COPD and have a reversible component with the use of inhalers.  Saccular bronchiectasis is only treated surgically if it is localized and the rest of the lung functions normally, or nearly so.
Dr. Tom

Is COPD Hereditary?
Q. I was diagnosed with emphysema/COPD last year, at the age of 33. I had a partially collapsed lung in my mid-20's. I have smoked for several years. Is COPD, or lung conditions such as mine hereditary? I ask because my dad has COPD. If it isn't hereditary, is it normal to experience these things (collapsed lung, COPD) at my age?

My health seems like it took a plunge after turning 30--IBS, COPD, high cholesterol. I just feel so old!
Heather

A. Dear Heather,
COPD does indeed have genetic components. You should be checked on one specific genetic form, known as alpha one deficiency. There is specific replacement treatment for this.
Dr. Tom

For more information: Alpha One Foundation: http://www.alphaone.org/

Newly Diagnosed with Alpha 1 Deficiency
Q. Dear Dr. Tom, I am afraid I already know the answer to this.  Yesterday I found I have Alpha 1 deficiency (19mg/dL).  I have had worsening SOB for years, and blow one L on spirometry. 

I also smoked and attributed my SOB to that until I quit eight months ago.

My doc says I have a reasonable shot of living into my 70's and 80's with augmentation, but it doesn't look like fun.  I am 54 now and have denied SOB probably since I was a child and never even started smoking.  I just thought I was a non-athlete.  Thanks for all the good work you do.
Eric

A. Dear Eric,
Most people on replacement treatment work it into their weekly routine and tolerate it well. I would follow your doctor's advice on this. With replacement you will probably live longer and better.
Dr. Tom

For more information: Alpha One Foundation: http://www.alphaone.org/

Nicotine Gum
Q. Can chewing nicotine gum (regularly) make emphysema worse?
Deborah

A. Dear Deborah,
No, there is no chance of this.
Dr.  Tom

Quit Smoking and Experiencing Shortness of Breath
Q. I am a 31 year-old former smoker (quit three years ago) with a very heavy smoking history (25 pack years). I have been experiencing SOB off and on for the past five months. About three months ago I experienced severe back and chest pain which lasted for several days and worsened upon deep breaths.

Spirometry at the time was normal (FVC 99.3% of predicted, FEV1 94.3% of predicted and FEV1/FVC 95% of predicted). A chest x-ray taken at the time was clear. Cardiac tests were also clear. My pulmonologist ascribed the whole thing to anxiety. Following this, I had no SOB or pain for two and a half months.

A couple of weeks ago, the SOB returned and I started to experience a lot of stiffness in my chest and a very slight discomfort upon deep breaths.

There is also occasional stiffness in my back between my shoulder blades and my neck. I have had no cough during all this time. This is really freaking me out. What would you advise? Many thanks for your time.
Zak

A. Dear Zak,
I doubt this is due solely to anxiety. I suggest seeing a pulmonologist to sort this out.
Dr. Tom

Recommended Guidelines for Nodule Follow-ups
Q. My step-dad is 85 yrs old.  He has a defibrillator that keeps his heart functioning after three heart attacks and also has emphysema.  Yesterday he had a CT scan and they saw something on his right lung.

Is there a way to keep an eye on this possible nodule without a biopsy?  I'm wondered a biopsy might be too much for him. 
Mikki

A. Dear Mikki,
He should have a follow-up CT to check on growth in an interval that depends on the size of the nodule. Probably three months would be wise. A biopsy is not very risky, even at your dad's age.
Dr. Tom

Disqualification for Lung Volume Reduction Surgery
Q. Last week someone asked if a mycobacterium avium complex infection would disqualify a person for a lung transplant.  I'm wondering if a disseminated mycobacterium avium intracellulare infection would likewise disqualify a person for LVRS. 
Laurie

A. Dear Laurie,
Yes, it would at least until the infection was treated and eradicated if possible.
Dr. Tom

Mucomyst and Tylenol
Q. Does inhaled Mucomyst interfere with the effectiveness of oral Tylenol?
Kathy

A. Dear Kathy,
I have no knowledge of an interaction.
Dr. Tom

Medication and Bronhiolectasis
Q. I have mild bronchiolectasis and mild asthma.  My doctor has put me on the strongest dose of Symbicort two puffs, twice a day in addition to the strongest dose of Qvar two puffs, twice a day.  Does that sound reasonable, or too much?  I'm concerned of the long-term effects of too much steroids.
Cassie

A. Dear Cassie,
This treatment sounds reasonable to me. Your doctor knows more about you than I do, so you should follow his advice. Dr. Tom

Lung Diffusion
Q. I understand correcting the DLCO for lung size, but which value is the value to be considered, DLCO or DLCO/VA?  My brother has a DLCO of 115 which is great, but the DLCO/VA is right on the edge of normal at 76 which seems worrisome.
Adrienne

A. Dear Adrienne,
I would not worry about this borderline calculation. Still is pretty normal.
Dr. Tom

Blood Pressure and Lung Medications
Q. I have severe asthma and COPD.  My medications include, Zyflo, theophylline, Singulair, Sprivia and Advair; on occasion I use nebulizer drugs.  I have developed high blood pressure.  Which classification of blood pressure medication is best for me?
Joyce

A. Dear Joyce,
None of the medications that you are taking should cause a significant elevation in blood pressure. I would go over this with your pulmonologist. There are some blood pressure drugs that can make asthma and COPD worse. These are called Beta blocking drugs, but you are not on any of these.
Dr. Tom

Swollen Glands and Endotracheal Tubes
Q. I just had a endotracheal tubing done and now have swollen glands. Is this normal?
J.

A. Dear J.,
It is possible. If so, the swollen glands will resolve quickly. If not, consult your doctor.
Dr. Tom

I Have Stage 5 COPD, Is Laying in Bed Bad for My Lungs
Q. I have 5th stage COPD, I do get out, go to stores, etc., but I have been laying in bed a lot, is laying in bed bad for my lungs and breathing?
Flo

A. Dear Flo,
No, particularly if you get good rest. But be sure you get up and do something every day. At least walk around the house, but getting out to stores is best. This will help maintain your state of physical conditioning at least a little. Never, never, never give up.
Dr. Tom

Lung Pain
Q. I was diagnosed with asthma one and a half years ago. Nothing major. No bouts of attacks or anything. I did smoke for 20 years. I am 38 years old (female). I was also diagnosed in an E.R. with the beginning stages of emphysema about six years ago. I quit smoking immediately.

Well, I am having problems with my lungs. I have lung pain. When I breathe in it feels like my lungs are as full as they can get. So when I breathe in it feels like they are going to burst. If I inhale too deep, it causes me to cough with a lot of pain.

My doctor doesn't seem to be concerned. Am I worried over nothing? Should I seek a second opinion? Thank you for your great information.
Deanna

A. Dear Deanna,
A second opinion is always good advice. Your lungs will not burst. You will probably be better with some breathing training, to help you empty your lungs through what is called pursed lips breathing as in whistling, and not concentrating on breathing in.
Dr. Tom

Question the Need to Quit Smoking
Q. I’m a long-time smoker (45 years); not proud of it. I have had many friends and acquaintances who were also long-time smokers. Those who quit after 30+ years became very sick within the first year of quitting, or died after five years from quitting from lung related conditions.

I enjoy smoking and have thought about my friends and family who quit to “only result in getting very sick/dying.”

Is there any possibility that nicotine keeps at bay the underlying dormant diseases? Could they have surfaced “because of quitting?”

I’ve spoken to a couple of universities as well as cigarette manufacturers requesting a study looking into this possibility. I’ve offered my assistance also to help make it happen, with “not interested” as my response.

Any suggestions? Comments?
Sue

A. Dear Sue,
About one in five smokers get a disease related to their smoking but overall survival is reduced on average, in all smokers. There is absolutely no evidence that nicotine is protective of health.
Dr. Tom

Interactions with Mucomyst
Q. Should acetylcysteine (Mucomyst) be given to someone who is allergic to sulfa?
Barbara

A. Dear Barbara,
It certainly should be tolerable, but sometimes Mucomyst causes bronchospasm, so just know about this possibility. This can be overcome by using an inhaled bronchodilator first.
Dr. Tom

Risks of Instilling Normal Saline in ET Tube
Q. What is the potential risk threat to the patient by instilling normal saline down an ET tube after intubation (due to a code or respiratory arrest)?
Amanda

A. Dear Amanda,
None, as far as I can imagine. Not large amount, of course. This is common practice if there is adequate suction and there are a lot of secretions.
Dr. Tom

Mother Recently Diagnosed with COPD
Q. My mom went to the lung doctor and she has COPD and emphysema. The doctor said that one liter was gone and if she didn’t quit smoking she would be  in a wheel chair within six months. What does it mean when he said 1 liter was already gone and how will this put her in a wheel chair?
Doylette

A. Dear Doylette,
You will have to ask your doctor what he means by this statement. I can't imagine why he would say it.
Dr. Tom

Mixing Medications
Q. I have a hard time trying to tell doctors that you can't mix Pulmicort and beta 2 dilators together. And can you mix Xopenex and Atrovent together?
Bill

A. Dear Bill,
Pulmicort already comes with a beta agonist, in the form of Symbicort.
Dr. Tom

Coming Off Oxygen
Q. I was diagnosed with interstitial lung disease with hypoxia secondary to rheumatoid arthritis. Was on 80mg of predisone decreased to 25.  At the moment PFTs and CT had slight improvement in three months.

In your experience have you seen people come off the oxygen and what is the usual course of therapy for this disease.
Bernadette

A. Dear Bernadette,
Some patients can come off oxygen after successful treatment of interstitial lung disease due to RA. Be happy if this is so, but continue to monitor your oxygen saturation with a personal oximeter afterwards, particularly with exercise.
Dr. Tom

Disgusted With Medical Care
Q. Is it serious if your chest x-rays and CT scan always come back with other things but always that my lower left lung is atelectasis? Is this serious if I continued to have pneumonia six times in that last three years?

I can't work. I cough severely especially at night which keeps me up and keeps my immune system down. I catch everything that I come in contact with not to mention the frustration I feel trying to find a doctor, specialist, ENT etc. that cares enough to help research and find out what it wrong with me. 

What has happened to the medical field? It seems they only care about running you through like cattle and giving you the same medication that hasn't worked before and the most important your money?  What ever happened to trying to really find out what is wrong with a patient that has red flags going up everywhere?

I find it very sad that they really don't care.  If your problem is complicated they don't want to deal with you like a human being; they want to get rid of you because they really don't want to spend time trying to figure out with people who may have a difficult diagnosis. 
Lisa

A. Dear Lisa,
Medical care is in a sad state of affairs today. You need a good pulmonologist to get the answer and start effective treatment. Consider coming to the National Jewish Health Center in Denver. You would get an answer there. Never give up.
Dr. Tom

Questions about Blebs
Q. I recently had my yearly physical and as I used to be a smoker (broke the habit two years ago after smoking 35 yrs) my doctor found a   Bleb (CT Scan) on the top portion of my right lung. Will this go away on its own? Should I be concerned?

Can I fly (flying to the west coast for a cruise next May-5 1/2 hr flight)? I read somewhere that stated you should not fly as the Bleb can burst and cause your lung to collapse. What should I do?
Paula

A. Dear Paula,
The bleb will not go away. There is little risk of its leaking during air travel in a pressurized plane. Enjoy your health and adventure.
Dr. Tom

Chronic Health Problems and Pneumonia
Q. Dr. Tom, My dad had an open biopsy and was diagnosed with usual interstitial pneumonia with advanced fibrosis.  He also has COPD, congestive heart failure, rheumatoid arthritis, lupus, sjogrens, and atrial fibrillation. He is on blood thinners for clots in his legs, one in his thigh. He has had three heart attacks, two bypasses, a stent, and now has a pace maker and a defibrillator. 

This recent diagnosis came after two weeks in the hospital being treated for pneumonia.  I cannot seem to get a clear prognosis from the doctors.  He is extremely weak and had now entered a skilled nursing facility.  I am trying to prepare my mom for what may lie ahead.  Is it possible that he will regain enough strength to come home?  What is the prognosis for someone is this situation?
Karen

A. Dear Karen,
He could still gain strength, but this is not likely. Get your doctors to explain it all to your mom. It is their responsibility. Dr. Tom

Could These Arterial Blood Gas Results be Real?
Q. My fellow respiratory therapists and I were wondering if the following ABG results are possible. pH-6.83 pCO2-22 pO2-88 Saturation-%80. The issue at hand is if it is possible to have a saturation that is greater than the pO2. Please bear in mind that the patient’s tHb is 4.0.
Joel

A. Dear Joel,
No, these blood gasses are not possible. The Hgb does not determine saturation. It determines content. With such a low pH, you are probably looking at venous blood.
Dr. Tom

Health Problems Associated with Past Smoking History
Q. I was a smoker for over 25 years and am afraid of the damage I might have caused.  Are there any tests I can have performed to check to see how my arteries are?  I sometimes have shoulder pain and would like to prevent a heart attack.   I am also going through a time of particular stress.
Dave

A. Dear Dave,
Yes for your heart, but also get your lung function tested. Maybe you were lucky and avoided damage. Stop all smoking and stay healthy.
Dr. Tom

Is a Biopsy in Order?
Q. Ten months ago I had a chest x-ray that showed a 1.2cm nodule on my left lung, My Dr. ordered a CT Scan that confirmed that it was indeed a nodule. I then went to a lung specialist that said it was probably nothing but we should have a PET Scan to be sure.  That came back negative and by the way that was a full body scan.

I had a routine follow-up CT-scan a few weeks ago and I just got back the results that show slight increase in size and what appears to be shadows.

My Dr. is now recommending a biopsy. I must mention something that I thought was not relevant that I read could cause nodules. My questions is, is  it extreme that I should have a biopsy?
Omar

A. Dear Omar,
Yes, with growth and the present size, a biopsy is needed to prove what this is. It can still be a malignancy, even with the negative MRI, but this finding, makes malignancy less likely.  Better not guess about this and get a biopsy.
 Dr. Tom                                  

Pulmonary Fibrosis
Q. I had an MRI in my thorax, and I was told that my lungs showed some fibrosis. Is this a terrible disease? I am 39 years old and I am not a smoker.
Elena

A. Dear Elena,
There are many different types and degrees of lung fibrosis. Better see a pulmonologist and find out where you stand with this.
Dr. Tom

Quality of Life for My Dad
Q. My 81 year old dad, broke the C-2 vertebrae in his neck went in for treatment of the brace, had to wear a Miami J cervical collar for 6-8 weeks.

While in the hospital was fed french toast, which led to  aspiration pneumonia. While placing a central line he got a pneumothorax, then went into heart and renal failure. He was then placed on vent and now has tracheostomy. He is alert and responsive.  He has COPD emphysema, a pacemaker and is in poor health. 

At what point should I give up on him going home with a good quality of life??  He is on a Respironics vent with cool moisture heat exchange, how long can he stay on this. What should I look for in his respiratory status to be hopeful in bringing him home?
Margaret

A. Dear Margaret,
Your physicians will be in a better position to answer your questions than I. Your aged father has had a lot of misfortune, but he could still recover in time, to a good quality of life.
Dr. Tom

Do “Casual Smokers” Suffer from Coughing
Q. I am a casual smoker meaning I could smoke two cigarettes a week or none for a month and then ten or so in one night.

I have at the moment an irritating sensation in my lungs. When I breathe it feels quite icky... I am coughing but there is no phlegm. I had this before and got a chest x-ray and all was ok. Is this common for people who smoke on and off? It gets worse after I go to the gym.

Anyway I am not going to continue this stupidity anymore as it is too damaging...I suffer with anxiety and thought maybe it was related to that?
Marta

A. Dear Marta,
It could be that you are very sensitive to tobacco smoke and that it gives you irritation and symptoms. Stop all smoking and see if this relieves your symptoms and anxiety. Stay well.
Dr. Tom

Difference Between Oxygen Therapy and a CPAP Machine
Q. What is the difference between O2 therapy and a CPAP machine?
Pam

A. Dear Pam,
Oxygen is added to the inspired air as "therapy". A CPAP machine gives pressure while exhaling. The two can be given together.
Dr. Tom 

Is Cough a Sign of Asthma?
Q. Hello, thank you in advance for reading my question.  I am a 36 year-old mother of two.

When I was pregnant with my second daughter I developed severe bronchitis from stress.  After having her, I had a very stressful move and developed a bad cough with pain on my right side.  I had the cough for two months, and saw a pulmonologist and he prescribed Advair.  This helped tremendously.  I went off of it after taking it for two months.

I am not currently on Advair and currently do not have the coughing symptoms that I get during winter months. I seem to need it during cold weather for about a month and then the cough goes away again.

I had severe asthma as a younger child and outgrew it.  I don't understand why my Dr. thinks the cough was an asthma symptom. Please help give any advice you can.  I would greatly appreciate it.
Rosi

A. Dear Rosi,
Cough is the most common sign of asthma. You probably still have latent asthma, and your response to Advair would confirm this.
Dr. Tom

Could New Problems be a Result of Surgery?
Q. On 3/10/08 I had a right side thoroscopy and a mediastinoscopy for cancer. Results negative. On 3/24/08 I had a thoracotomy to remove the lower lobe of my right lung and a lymph node next to it, positive for cancer.

It's been a little over four months and the pain is intense in the right front side of my chest, is this normal, for how long?  Also, a new CT exam revealed small fluid in my right lung and I'm also retaining fluid in my body (arms, hands, legs, feet, etc.).  I called the surgeon and hesuggested that I see my family doctor.  What should I do?  Pain is result of the surgery? I started retaining water right after the surgery.
Angel

A. Dear Angel,
This may all be related to the cancer and surgery for cancer. I suggest seeing a pulmonologist to help sort this out.
Dr. Tom

Nitric Oxide
Q. Can you administer Nitric Oxide via a mask?  If so, who makes an analyzer and regulator for Nitric oxide?
Gerard

A. Dear Gerard,
This can be done. I do not know if it is available commercially. Ask a home oxygen supplier.
Dr. Tom

Chances of Lung Cancer
Q. My Mom is 74 with heart problems. She had a double mastectomy for "large number of pre-cancerous nodules" about 20 years ago.  She had implants done that leaked and were removed five years ago.

Now she is in the hospital for balance issues, high blood pressure, fever, cough and headaches.  Now she has the above mentioned symptoms, and her chest x-ray showed a nodule.

Do we need to be concerned about the possibility of lung cancer at her age?  She smoked for 30 years before quitting 17 years ago?
Peg

A. Dear Peg,
Lung cancer remains a possibility, even with the long interval since stopping smoking.
Dr. Tom

Should I See Pulmonologist?
Q. I am a  47 year old female who was in an auto accident one and a half years ago with chest wall contusion causing much chest pain. Complicated by asthma and chemical sensitivities.  With an attack, have very severe chest pain. 

Had a CT scan last week.  CT compared to CT of one year  ago.  Now have 3 2mm nodules in different areas of both lungs.  Dr. wants  to repeat CT in six months.  I feel I should go directly to pulmonologist as pain is so great!  Suggestions?
 Lucy

A. Dear Lucy,
Yes, see a pulmonologist, but the small nodules are probably not the cause of your pain.
Dr. Tom

Limitations of COPD
Q. Sir, I am 40 years old and smoked for 25 years. I left smoking three years back, my CT is clear, chest x-ray is clear, PFT says mild obstruction, but I am really upset due to mucus production, it is regular and nonstop problem.

I am the only earning member in my family and my business is suffering badly due to limitation of COPD. I also suffer from Avascular necrosis of the hips. Please advise my future plans to live and work to earn for my family.
Darmesh

A. Dear Darmesh,
You are very young to be having so much impairment. I do not know what is causing the avascular necrosis of your hips. Maybe you have received a lot of steroids to contribute to this. You need a pulmonologist to help you with mucus and a consultation about hip replacements. Keep on planning on working.
Dr. Tom

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