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Archive: Dr. Tom 137

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

Is Weight Lifting Safe after Repeated Pneumothorax?

Q. I recently had surgery for re-occurring spontaneous pneumothorax right side, I was told that I am now normal and will be able to have a normal life. It’s been six months now since the surgery.
I have been doing light weights for a couple of weeks and feel pretty good I still have some discomfort from time to time but exercising seems to help. My question is, is it safe for me to resume weight training and exercise. Do you think my weight training will do me more harm then good or do you think it will help?
Jon

A. Dear Jon,
It is probably safe to resume weight lifting again.
Dr. Tom

What Can I Do to Reduce Hospitalizations?

Q. I have been diagnosed with COPD/asthma. I have been intubated 17 times. I go to the ER and there is nothing they can do for me now except pain meds and a BiPAP.  I have BiPAP at home.
I am very discouraged and cannot go a day without symptoms. I am on oxygen therapy and take breathing treatments and Spiriva and Symbicort. Is there anything more I can do? I cannot spend any more time in the hospital since I lost my Medi Cal.  Please give me some help or encouragement.
Jeanne

A. Dear Jeanne,
Just keep on trying to adjust and trust in God that you will be okay. My prayers are with you.
Dr. Tom

Afraid that I Have Pulmonary Hypertension

Q. I am a 32-year-old female, 128 lbs, 5’7”, diagnosed several years ago with mildly obstructive asthma. I recently went to a cardiologist because I was experiencing rapid heart rate during exercise (180 bpm at times). My EKG was basically normal but my echo showed some disturbing findings:

– Mild to moderate tricuspid regurgitation
– A “slightly” enlarged right ventricle
– Estimated pulmonary pressures between 30-35 mmHg

I am terrified I have pulmonary hypertension now. What else could be the cause of these findings? I should also mention, if its relevant, that I have been experiencing occasional ‘pounding heart’ and SOB after exertion, although certainly nothing I found alarming enough to seek care for. I’d appreciate your insights!
Drea

A. Dear Drea, These are not very high pulmonary pressures. I suggest you see a cardiologist for more testing during exercise if these symptoms persist.
Dr. Tom

Have COPD and Feel Better Cool Humid Places

Q. I was diagnosed with emphysema last month.  I live in Sedona, AZ, it’s really windy and dusty, very cold believe it or not in the winter.  I live in an apartment that has a swamp cooler; I actually breathe better in the cool moist air. Considering all web sites suggest low altitude, warm dry climate.  Why is it I feel better in cool humidity?
I am thinking of moving to Charlotte, N.C. and I am a little afraid because it’s new and so is my COPD. I lived in Nashville (similar climate) for three years, I did OK in the summer which surprised me. Is this a good idea or not?
Debora

A. Dear Debora,
I would plan to live where you are most comfortable. There is no ideal place for patients with emphysema, who have many unexplained symptoms.
Dr. Tom

Son’s Returning Cough is Worrisome

Q. I previously posted a question about my own lung health - thank you very much for your response. 
I now have a question regarding my son, which I hope you may have some ideas about.  He is 28 years old, has never smoked and seems fit and healthy.  However last year he developed a chronic cough, which he found very irritating as, he was coughing up sputum a few times a day.  Initially he was given antibiotics to no effect and eventually he was referred to a specialist.  All the blood tests, lung function tests and X-rays were normal.  He even had a CT scan, which he was told looked normal on visual inspection, but would be submitted to further analysis.
My son never heard from the doctor after that and as the cough seemed to be clearing up (after about eight months) he never asked for further feedback. However after a few months the cough returned and is now as bad as ever—I keep asking him to return to the doctor as I feel there must be some explanation and the possibility of treatment.  I wondered if it may be some kind of allergy—his few clear months were over mid winter and perhaps that will happen again this year but no sign of any let up yet.
Various people have suggested it might be asthma but surely that would have been ruled out by the specialist’s investigations.  I do worry that he never had a final report from the doctor regarding the CT scan but comforted myself with the thought that no news was good news.
Thank you so much for this service.
Majory

A. Dear Majory,
I would not expect the CT to shed much light on these symptoms considering his young  age. Be sure he is not smoking POT, which is so commonly overlooked as a cause of a nagging cough. Asthma remains a possibility as does cystic fibrosis, as a long shot.
Dr. Tom

Feeling Terrible Since Medication was Changed

Q. I am a 65 year-old woman and was active and working up to six months ago. The month after I retired the nurse took me off theophylline which I’ve been on for eight years for COPD. I was then put on Symbicort and I have been ill ever since, my lungs have gotten worse.
They said I have asthma not COPD.  I have never had a asthma attack in my life. I have had lots of chest infections. I am back to what I was before I quit cigarettes. Funny thing my peak flow never goes down much really. Is a peak flow a diagnostic tool in diagnosing COPD? My peak flow is about 360.
Sally

A. Dear Sally,
Peak flow is not very diagnostic of COPD. I would go back to the theophylline, since you were so much better on it.
Dr. Tom

Starting Coumadin Therapy

Q. Explain why a patient that was on Heparin would have Coumadin at the same time (for a period of time) before switching solely to Coumadin only?
Tamara

A. Dear Tamara,
The effect of Coumadin takes several days to begin. In the interval heparin is often used as a “bridge” if anticoagulation is crucial.  This is a common practice.
Dr. Tom

Doctor Wants Him to Have a CT Scan

Q. My husband has had a chronic cough for several months and always is very congested (nasal and chest). He always sounds like he has a cold. We both just got over very bad colds and both had severe respiratory problems.
Yes, he does smoke and is “trying” to quit. The GP put him on an asthma inhaler and steroid nasal spray.    The doctor also wants him to have a chest CT scan with IV contrast.  I’m very worried and scared now. He doesn’t have the CT appointment yet, but I’m imagining all kinds of scenarios.
Once in a while he coughs up phlegm.  He feels fine otherwise.  Sometimes, tired but claims it’s due to his work.  His blood work was fine. Any thoughts you have would help alleviate some of the fear.
Donna

A. Dear Donna,
A CT scan is a valuable tool for screening for lung cancer in high risk patients. This includes your husband. Lung cancer is not likely, but if found early, can be readily treated and cured.
Dr. Tom 

Need Help to Quit Smoking

Q. I am a smoker. I have smoked for 30 years. I keep trying to quit but find that when I do I have trouble breathing. Is it normal to have difficulty breathing? I have no problem when I am smoking other than some wheezing. Should I use an inhaler while trying to quit? I hate smoking and really want to quit this nasty habit.
Patty

A. Dear Patty,
It is fine to use an inhaler as you  try to quit. This will help clear the mucus, that is caused by smoking and may continue for awhile after stopping. Quitting is key to your future health.
Dr. Tom

What Does MIVF Mean?

Q. We have a question. What is MIVF? In relation to questions re: respiratory medications.  Any clues you can share?
Margaret

A. Dear Margaret,
This is the maximal amount of airflow that occurs during inspiration.  It is used in some bronchodilator testing.
Dr. Tom

Get Short of Breath in Shower

Q. How can I avoid getting panicked and short of breath when I get under the shower? It scares the heck out of me.
Eduardo

A. Dear Eduardo,
Turn on all the lights in the bathroom. Have a fan, once the bathroom is warm. These two steps will help.
Dr. Tom

Low Diffusing Capacity

Q. I was sick with some type of respiratory illness about a month or so ago. When I went to my family doctor for a routine follow up to the illness my family doctor checked my oxygen saturation. I am not exactly sure why. My oxygen levels would go between 85% and 95%. As a result of that she ordered a pulmonary function test.
I had the PFT done today. While there the pulmonologist said that the test looked good except I was not diffusing my oxygen very well. He said my diffusion level was at 53%. What are some of the common causes of this?
My mother had COPD and died from it. Also asthma runs in my family and so does lung cancer. My family doctor doesn’t feel it is asthma. She hasn’t said anything else though.
Would you recommend further tests and if so what would you recommend? I just want to know how I should go about talking to my family doctor about this.
June

A. Dear June,
A number of diseases affect the diffusion test. I suggest consulting with a pulmonologist about this. The interstitial or scarring diseases are a real possibility and this is the realm of the pulmonologist’s expertise.
Dr. Tom

Oxygen Level Rapidly Falls During Exercise

Q. Two years ago I was diagnosed with hypersensitivity pneumonitis with no causal agent.  I have done several rounds of different drugs with no results until recently. Within one month my CT scan cleared.  I remained on prednisone for three more months.  My lung function tests have improved greatly and are almost back to normal. However I am still on 4LPM oxygen.
My oxygen falls rapidly during exercise.  What does this mean?  Could my body have just gotten use to the high supplemental oxygen and I just need to wean myself off?
T

A. Dear T.,
There is still a disturbance of oxygenation in the lungs, brought out by exercise. This is not the time for weaning. Are you seeing a pulmonologist? If not I suggest a consultation.
Dr. Tom

New HFA Inhalers

Q. According to an article posted on the AARC Web site (CFC Inhalers: Grand Finale, Dec. 31!), the article states that the HFA inhalers must be used differently than the CFC inhalers. Should we as healthcare providers still be encouraging the use of spacers and if necessary the open mouth technique? Are you aware of any other instructions that are now needed, and if so what they are?
Vicki

A. Dear Vicki,
The HFA’s are used just like the CFC’s, but you will notice less of a cooling effect. Open mouth technique is fine and spacers are not needed.
Dr. Tom

Yellow Sputum Production

Q. I am 27 years old and have been coughing up thick yellow sputum for over two and a half years accompanied by chronic postnasal drip.  I have seen many doctors including pulmonary, allergists, ear nose and throat, and infectious disease specialists... no one has given me an official diagnosis. I have taken Advair and had some improvement, however the mucus can still be brought up.  I have not been extremely sick as in being hospitalized or anything but the mucus and crackling is quite concerning. 
CT scans have come back relatively normal, showing some air-trapping and inflammation but no bronchiectasis.  The mucus does not smell bad and i have been tested as negative for CF. One doctor suggested that it might be from aspiration another suggested allergies.  Judging by the thickness and color of the mucus I don’t think its just allergies, though the mucus from my sinuses is clear. 
Have you ever seen symptoms like this?  Do you have any suggestions?  I am past the point of desperation.
Steve

A. Dear Steve,
You have checked on the most important things. I also suggest getting an alpha one level (for more information see http://www.alphaone.org). Otherwise, just keep ahead of the mucus by vigorous coughing, after use of a bronchodilator in the beta agonist class, such as albuterol.
Dr. Tom

Worried about Father Being Discharged to Hospice

Q. My Dad is hospitalized with severe COPD. His doctor is discharging him to Hospice saying there is nothing more they can do because he has only 20% of his lungs functioning. Is it possible he can still survive with 20% functioning and should I get a second opinion and see what tests were performed?
Thank you, I am desperate for any hope!
Robyn

A. Dear Robyn,
Yes, get a second opinion. Your dad could live many comfortable years with this degree of lung impairment. Never, never, never give up.
Dr. Tom

When Is a Spot Large Enough to be of Concern?

Q.You referenced earlier a 3 mm spot to be ‘small’. Is a 14 mm spot considered moderate to large, is it large enough to be of concern?
PJ

A. Dear PJ,
Yes. A 14 mm noncalcified node should be biopsied or followed very closely with PET scans. It needs an explanation, even though the chances of cancer are still not high.
Dr. Tom

Ayurveda as an Herbal Treatment for Lung Disease

Q. I would kindly like to receive your input on Ayurveda medicine as a treatment for lung conditions.
Paul

A. Dear Paul,
I do not happen to know about this particular herbal, but some have been helpful, such as a combination known as Protandim.
Dr. Tom

Soot from Working in Mines

Q. I went to the doctor who found diesel soot covering my voice box, from my working in the mine. I was sent to a surgeon that washed out my lungs. Now I am diagnosed with C. My question is when they washed out my lungs can they get all of the soot out? I was not aware that diesel exhaust could cause COPD. Are there studies about this?
Larry

A. Dear Larry,
You cannot wash all the soot out of the lungs. What do you mean with a diagnosis of “C”? Do you mean lung cancer or COPD?
Dr. Tom

Lungs are Bleeding

Q. I need urgent help. My partner has something wrong with his lungs that no test shows what is causing the problem. He is on life support and we are running out of time. Nobody knows why his lungs are bleeding can you please HELP!
Janice

A. Dear Janice,
I need to know what the reason for life support is. There are too many possibilities to speculate. What do your doctors say?
Dr. Tom

Baby is Coughing and Choking

Q. My baby (9.5 mos. old) has had a periodic choking cough for 11 days. He has no fever or cold symptoms and the coughing did not follow a cold. He has been seen in a pediatrician’s office three times in this period, and his lungs have sounded “normal” with each office visit. His test for whooping cough just came back negative.
I am concerned that he may have aspirated a bit of food—banana. The cough began after I observed a brief choking episode while he was eating banana. The choking/coughing subsided quickly after I picked him up from his chair. He coughs on and off throughout the day (on average a couple of times an hour), but the coughing fits are not so long (He did have a few long coughing fits at night—coughing on and off for an hour). He has vomited a few times after coughing, the last time clear fluid with some clear mucus. My question is this: does it make sense for him to have a chest x-ray at this point? How could a chest x-ray pick up a bit of soft food?
The pediatrician seemed unsure about whether or not he should have a chest x-ray. Honestly, the doctors/nurses at the office gave us very little sense of what this might be.
Any help would be greatly appreciated!
Lisa

A. Dear Lisa,
I am glad that you mentioned that the cough did not follow a cold and that he could have choked on a bit of banana. This certainly could be food aspiration. Although a chest X-ray would not show the food, it could show the results of aspirating food such as a localized pneumonia or a partial lung collapse; this is called atelectasis. If there are changes on the X-ray it would be a good idea to follow up with a bronchoscopy to remove any remaining bits in his airway.
Dr. Bruce

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