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Archive: Dr. Tom 135

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

 

 

Waiting for Follow-Up
Q. I have a condition where both of my lungs have numerous blebs. My mother and brother have had two pneumothoraces followed by stapling of the lung to the chest wall.

I too am now having pneumothroaces, I’ve have had two in the last six years. The last one was this past May 2008. All my pneumothoraces have been on the left side.

I had numerous CT scans. Now they tell me I have a 3-4mm mass in my right upper lobe. My pulmonologist says that the scan does show that I have small ones but to come back in eight months for another scan.

Isn’t that a bit long to have to wait? Why so long? I will have a nervous breakdown wondering if this thing is getting bigger?
Marie

A. Dear Marie,
Eight months is not exceptionally long to wait for a follow-up of such a small lesion. I am sure you will worry but this has about a 95% chance of being benign.
Dr. Tom

Tests are Normal but My Husband is Still Sick
Q. My husband for the past six weeks has been unwell, he started with what seemed like a chest infection. Then they thought bronchitis. Now they are not sure and waiting to see the doctor. He now brings up mucus and mostly clear fluid from his lung and also his food both happening without a cough. A lung x-ray four weeks ago came up clear but he is still very ill, worse than ever.  He has been on lots of different medications (antibiotics and steroids) but is no better.

Please do you have any suggestions? Is this anything you have heard of and is it likely to be serious if the bloods and x-ray haven’t shown anything. Thank you for all help, which is gratefully accepted!
Louisa

A. Dear Louisa,
There has to be a diagnosis. I suggest seeing a pulmonologist, since this has lingered so long and has not responded to any treatment.
Dr. Tom

Environmental Contaminates
Q. During a recent storm my roof leaked and the drywall on my ceiling collapsed into my bedroom.  I cleaned up the insulation and drywall the following day (without a mask).  It has been a week and I have developed a very bad cough. It even wakes me up at night and I’m exhausted.  Humid weather makes it a little better.

What is it and what is the best treatment?
Frank

A. Dear Frank, 
It is probably a reaction to mold, but this is just an educated guess. Treatment is avoidance of the exposure.
Dr. Tom

What Does Cannabis do to the Lungs?
Q. Hello I was just wondering about cannabis, I’ve heard so many different stories; one say it’s harmless the others say it can cause lung cancer and stuff. Could you explain?
Brian

A. Dear Brian,
Pure cannabis, such as is available by prescription for poor appetite, does nothing to the lungs. Smoking pot causes intense lung inflammation and in the long term, emphysema and lung cancer in some patients.
Dr. Tom

Latex Allergy and Balloons
Q. I read the question about the gentleman who had difficulty breathing after blowing up a balloon. Maybe it is the beginning of a latex allergy. They did that to me when I developed my allergy to latex. Just an idea.
Alicia

A. Dear Alicia,
This is a very good idea that I did not think about when I answered the question. Thanks.
Dr. Tom

Alpha 1-Antitrypsin Deficiency
Q. I had to wonder why you didn’t recommend Alpha 1 Antitrypsin Deficency testing for Kathy’s in her question “Progression of COPD”. She had just been diagnosed with emphysema but had never smoked.
Linda

A. Dear Linda,
You are correct. I certainly should have mentioned alpha one deficiency, for which Kathy should be tested. Thanks for picking up on this.
Dr. Tom

For more information see: http://www.alphaone.org/

Sources for Good Research
Q. I am wondering if you can point me in the right direction to find out information on ventilator life expectancy?
Elizabeth

A. Dear Elizabeth,
I do not know what you mean by the term, “ventilator life expectancy”.
Dr. Tom

Teaching Home Care Patients
Q. I am an RRT working in the medical equipment area and was recently asked about non-clinical personnel teaching parents how to use the at home phototherapy blankets.  Is there anything out there that specifies that an RT or RN has to perform that education?  We do not monitor the patients at home, so we are not technically administering the treatment. What do you think?
Sarah

A. Dear Sarah,
I do not have an opinion on this. I do not know what “phototherapy blankets” are.
Dr. Tom

Feels Afraid to Take Her Medications
Q. I had an episode a few years back. I was sitting near someone who was smoking and I got dizzy.

Ever since then my asthma got much worse, and I began to overuse my short acting inhaler. I guess my question is - does using formoterol or salmeterol put me at risk, or is it better to use one of the long acting inhalers rather than overusing the short acting ones.  I am afraid of the warning they give = that they may cause death in patients.

That is what is scaring me from taking them, but I am almost forced to at this point.
Kim

A. Dear Kim,
The risk of death from the class of bronchodilators, so called long acting beta agonists, is small. These are not for acute attacks. Formoterol does work fast as well as long, but generally short acting albuterol is most commonly used for acute symptoms.
Dr. Tom

Is It Safe to Use BiPAP on a Patient with a Pulmonary Embolus?
Q. Dr. Tom, I was wondering if initiating a BiPAP was contraindicated for a patient with a pulmonary emboli?
Joanna

A. Dear Joanna,
I know of no reason why it should be contraindicated.
Dr. Tom

I Am Forty-Three and Have the Lungs of an Eighty Nine Year Old
Q. I am 43 year-old female and was told to stop working one year ago, and did.  I am on 3 liters of oxygen daily and take Spivira, Advair, albuterol. Also I have restriction due to scoliosis and obstruction from lifetime asthma. I was told at my last visit I have the lung of an 89 year-old female.

It is difficult doing daily activities now even dressing.  I just want a professional guess on my prognosis.
Alana

A. Dear Alana, 
I would have to have your spirometry and family history to be able to make an educated guess.
Dr. Tom

Nebulizer Administration Along with CPT and Vest Therapy
Q. Our facility has been in the practice of giving small volume nebulizers and CPT/Vest therapy simultaneously.  What are your thoughts on this?  Are you aware of any studies affirming this practice?
Cristy

A. Dear Cristy,
I am not aware of any studies establishing the efficacy of this combination of treatments.
Dr. Tom

Best Environment for Emphysema:
Q. I have emphysema. I live in Florida, is there a better climate to help me breathe better?
Tracy

A. Dear Tracy,
No. You need low altitude and low pollution, which is what you get in Florida.
Dr. Tom

Dad’s Having a Rough Time After Chemotherapy
Q. My Dad recently went to the hospital after fainting at home. He had just finished his last chemotherapy treatment three days before the incident.

Long story short is that the doctors did a bronchoscopy to see if there was bacteria in his lungs, to find the cause of an infection (he had 102 temperature) and his blood oxygen levels were low. The test came back negative even after waiting almost a week to try and grow something.

They did force oxygen through a mask, dad said was like trying to breathe in a tornado and he really struggled until they finally put him on a ventilator. To keep him at that 90% oxygen saturation level they need to keep his ventilator oxygen levels at 55 to 60 percent for several days. After being on steroids antibiotics and respirator he got a bit better, then took a turn for the worse.

I think the whole problem is the Bleomycin toxicity.  Is there anything you can do for this if the steroids aren’t doing the job? Are there any treatment courses that are better than others or that are proven to work?  We would like any suggestions you may have.
Laura

A. Dear Laura,
You are probably correct that Bleomycin toxicity is a problem, if he received this in the past. This makes the lungs vulnerable to oxygen injury.

Your doctors need to use the least amount of oxygen from the ventilator that will give him an adequate level of oxygen in is blood of above 90%. It is a pretty difficult problem.
Dr. Tom

Feeling Overwhelmed
Q. I am 42 years old and have had  fibromyalgia since I was 17. I have bad irregular heartbeats (I have had  two ablations for this but still), now I have just been diagnosed with moderate COPD and I take Seretide.

I feel I have no life and am fed up with living like this and not being able to do anything. Please help me.
Sue

A. Dear Sue,
I do not know enough about all of your problems, to give you any specific medical advice. Just live each day for the fulfillment it gives and hope for a better day tomorrow. Try to get out and be active.
Dr. Tom

Sensitivity to Smells and Chemicals Cause a Hoarseness in My Voice
Q. I was exposed to mold for about eight months three years ago.  I did not know it was mold and kept cleaning it up, thus making it airborne.  As a result I now have lung issues, sensitivity to chemicals, perfumes, cleaning agents, etc. and have a hard time leaving my house due to my reaction to these substances.  At the time of the exposure my voice became hoarse and I have never gotten it back.  I completely lose my voice when I’m exposed to these things or when doing any type of activity.

I have a pulmonary doctor but he does not know what to do about my voice and said that there really is nothing that can be done to reduce my sensitivity. Any suggestions? 
L.

A. Dear L.
You need to avoid these exposures. Your doctor will have to choose specific medications. You should see an otolaryngologist.
Dr. Tom

How Often Should a Tracheotomy be Changed
Q. A home care patient who has a tracheostomy (on a ventilator) was advised that the tracheostomy tube (trach tube) does not need to be changed more than every one or even two years. However, to prevent infection, I understood that at home the standard is more like 5 or 6 weeks and sooner if there is any problem.
Judith

A. Dear Judith,
When I was doing this type of medical care, I changed trach tubes about every six weeks. I am not sure this is necessary. If the trach tube does not have infection or excess secretions the interval can be lengthened.
Dr. Tom

Had Bronchitis and My Chest Still Hurts
Q. I wrote you a few months ago about my bronchitis. Well, since then I’ve have had mild chest pains almost every day. It kind of burns like heartburn all the time but its also like a dull pain on my sternum, that hurts more with deep breaths.

I am just wondering if the pain could be from the bronchitis still or is something worse like cancer or a heart attack. My x-rays from my bronchitis came up ok.

I don’t know everyone tells me its just stress but I am not sure. I just know that I don’t like it I don’t really have any info other than besides the pain I feel great!!!
Scott

A. Dear Scott, 
I am so glad you feel great. You do not have lung cancer or a heart attack. Keep well and learn to tolerate some cough from your bronchitis, if it cannot be simply relieved with medications. Avoid exposure to irritants.
Dr. Tom

Do Lung Nodules Cause Pain?
Q. A CT heart scan this month detected a non-calcified nodule in my lung. I have no symptoms other than a sharp back pain (like a muscle pull in my upper middle back). It’s possible the pain could be from golfing but I’d like to know if a nodule this small cause this pain?
Bill

A. Dear Bill,
The nodule is not the cause of your pain.
Dr Tom

Have Had Repeated Pneumonias Should I have a Biopsy?
Q. I am a 39 year-old female who got my first diagnosis of pneumonia four years ago after I left the hospital from having my daughter by C-Section.

Since then I have had four more cases of pneumonia. The pneumonia has shown up in both the left and right lobes but neither at the same time, at least not to my knowledge.

I have had a CT Scan and Chest X-ray; should I request a biopsy?
Tonya

A. Dear Tonya, 
It would be more important to check your immune system. There has to be a reason why you are so susceptible to pneumonia.
Dr. Tom

How Long Does Amoxicillin Stay in Your Body?
Q. I stopped taking amoxicillin three days ago, is it still in my system, and how long do antibiotics usually stay in your body?
Nicole

A. Dear Nicole, 
Blood levels of amoxocillin last up to 12 hours. Allergic reactions can last longer. Other antibiotics have shorter or longer times of action.
Dr. Tom

Asthma and Arterial Blood Gases
Q. Doctors told me that I have asthma, though I do not have any wheezing, only chest tightness/pressure and tight throat.  I have been taking Advair (now Flovent) for the past six years.  I recently saw an allergist and he ordered an arterial blood gas test as he suspected that I might have other lung diseases as he said I have some nail clubbing.

My question is 1. Is it necessary to have wheezing for asthma?  2. Is it common to have arterial blood gases done and is it always a very painful test?
Vivian

A. Dear Vivian,
Cough is the most common symptom of asthma.  Wheezing may be absent even in an attack. Asthma is NOT associated with finger clubbing, this suggest other lung diseases. Arterial blood gas tests should not be particularly painful.
Dr. Tom

What Nuclear Medicine Test/s Can Identify Lung Disease?
Q. Is there any information that you would be able to give me about “nuclear medicine studies to identify lung function”?  I am a practical nursing student and am researching respiratory!
Sherry

A. Dear Sherry,
There are some nuclear medicine tests for lung diseases. Most involve scans of air and blood flow in the lungs, so called ventilation/perfusion scans. They are not used very much, having been replaced with CT and PET scans. PET scans to look for nodules and nodes are radioisotope based.
Dr. Tom

Shortness of Breath at Night
Q. I stopped smoking three months ago.  I have shortness of breath at night. I am also a very nervous person. I worry about everything. Please help me.
Patty

A. Dear Patty, 
I can’t conclude much from what little you tell me. Age, sex, weight, other diseases, etc would be useful information. You need to see a pulmonologist.
Dr. Tom

Pneumomediastinum
Q. A year ago my daughter  (14) was hospitalized, for two days, with a pneumomediastinum.  Several months ago, symptoms began to reoccur, but only intermittent and less lengthy-only lasting several minutes vs. constant and unrelenting. The PFT she had two months ago showed her small airways test to be on the low end of normal. She continues to have intermittent pains with shortness of breath that resolve after rest and short breaths. The pain has only recently started to come with exercise, usually occurs while sitting, or lying down.

A chest x-ray in July revealed either an unresolved pneumomediastinum or a new one; a follow up x-ray was “negative”.

What is going on, any thoughts or suggestions?
Kathy

A. Dear Kathy,
She is having small air leaks from some weak places, called blebs on the surface of her lungs. It is also possible that she has asthma.  This air leak situations is not dangerous, but you should get a definitive diagnosis. I suggest seeing a pulmonologist.
 Dr. Tom

Oxygen Saturation Drops When I Walk
Q. I am 56 years old male. I was a smoker for 25 years till 2004 when I came to know about my lung condition. I have been diagnosed with COPDI have also been advised to maintain my SpO2 level between 88-92%

In the last, I don’t feel any problem while sitting and my SpO2 level is within the specified range but walking is really painful. Even before I walk 20 meters, my SpO2 level falls down to around 80% (without O2) Please advice.
K.K.

A. Dear K.K. 
You need portable oxygen for exercise. I would suggest enrolling in a pulmonary rehabilitation program if one is available to you.
Dr. Tom

Adverse Effects of Singulair
Q. Dear sir, I would like to know if long-term use of Singulair causes physical and mental growth retardation in children between the ages of three to six years. I have been seeing this happen in two-three of my patients.
Dr. Kenny

A. Dear Dr. Kenny, 
I have no information about and no reason to suggest that this is a problem from Singular in the young. You should consult the manufacturer.
Dr. Tom

Follow-up Answer BiPap Treatment Question
Q. My vocal cord and diaphragm were paralyzed when the nerves was severed during surgery 15 years ago.
Olive

A. Dear Olive,
Thanks for the additional information. One paralyzed diaphragm reduces your lung function about 20%.
Dr. Tom

9. Taking Antibiotic for a Long Term
Q. I have emphysema. I was first told and placed on O2 -24/7 in February 1999. Shortly thereafter I joined EFFORTS (http://www.emphysema.net/). I have been on the doxycycl hyc for a long time. I only take it for two days if I am having problems. But I have noticed when I take it I don’t have the wheezing or the mucus problems.

What are the reasons to not take it more often? I noticed if I only take one a day I do much better breathing. Any light you may cast on this will be very welcome.
Karen

A. Dear Karen,
The mechanism of this benefit is under current study. It is likely that even low doses of this antibiotic suppress inflammation. It is a safe medicine to take in the long term.
Dr. Tom

Should I Wait for Follow-Up?
Q. I took my 15 year old in to the ER last night for severe headache eye pain, lower back pain abdominal pain and a fever that meds would not control. They did blood work and a abdominal CT all came back fine except they found a 6 mm nodule in the lung and told me not to worry and have it checked in six months. What do you think I should do, should I wait six months to have it checked? 
Tonya

A. Dear Tonya, 
Yes, wait for the follow-up. This is almost certainly a benign nodule.
Dr. Tom

Using Wrong Sized Inner Cannula for Tracheostomy Tube
Q. If a tracheostomy tube has wrong size inner cannula put in, can it cause death?
Scot

A. Dear Scot,
This is unlikely because even a small inner cannula should not cause obstruction.
Dr. Tom

Is Wheezing a Sign of Lung Cancer?
Q. I am 40 year old non-smoker. I just started wheezing. Can this be lung cancer?
Maxi

A. Dear Maxi,
Yes, but this is unlikely. A much more common cause of wheezing is asthma.
Dr. Tom

Systemic Lupus Erythematosus
Q. I was diagnosed with Systemic Lupus Erythematosus (SLE)  over 10 years ago. For the past couple of years I have been having palpitations every now and then. Is this something common with SLE patients and if so, should I see a specialist for this?
Madeline

A. Dear Madeline,
SLE can have many manifestations. I suggest you do see a rheumatologist for your care.
Dr. Tom

Alpha One Antitrypsin Deficiency
Q. Thank you so much for all of the info you provide to us inquiring minds.  I am a 40 year-old female in good health, ex-smoker, quit 16 years ago after smoking one pack per day for 10 years.  I have never had any health problems except recently I began with hematuria (blood in urine), which lead to an ultrasound and an abdominal CT Scan.  We found a renal cyst, and emphysematous changes and add to that a tiny hepatic lesion, multiple gallbladder polyps and an ovarian cyst.  Radiologist mentions correlation for any history of Alpha-1 Deficiency.

My doctor reviewed all of this and said there was nothing of concern, and that he would see me as needed in the future.  I disagree with him and politely requested a PFT, and have contacted the fine people at Alpha-1 Foundation  (http://www.alphaone.org/) who will do the confidential testing.

I believe the complex renal cyst in combination with the pulmonary nodule would dictate additional studies.  My question is what, and should I see a pulmonologist and urologist?  Of course I will get a new Primary Dr. and have them coordinate care, but what do you feel is appropriate?
Lori

A. Dear Lori,
I suggest a pulmonologist for a general evaluation. Pulmonologists are good internists in most cases. Other specialists may be appropriate too, as chosen by your pulmonologist.
Dr. Tom

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