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Archive: Dr. Tom 139

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

BCG Injections

Q. Several years back I was injected six times with BCG (bacille Calmette-Guérin vaccine, http://www.cdc.gov/tb/pubs/tbfactsheets/BCG.htm). After the sixth shot I became very sick. I had trouble breathing and had bronchitis and no voice for six weeks. I also ended up with a staph infection in the injected site. It had to be surgically removed.

The doctor didn’t tell me what the injections were and just said they would help to build up my immune system. After the reaction I had him put me on an INH drug (Isoniazid—http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682401.html).

One of the staff called me and told me I should really see another doctor. I took that advice and the doctor was shocked to see I was given so many injections. I was told I could never take a TB skin test. I had to be on antibiotics for six weeks.

My question is; since all this happened I get bronchitis at least every two months and sometimes it lasts for a few days and other times it can last for over a week. When I have it I sleep a lot and cough up chunks of green junk. Could any of this be from the BCG injections?

The doctor was asked to leave the hospital. Nancy

A. Dear Nancy,

This is a very strange scenario. The INH would have killed the BCG, so that is not the cause of your cough and mucus now. Dr. Tom

Concerned and Frustrated about Mother’s COPD

Q. My mother is 72 and has COPD. She smokes at least half a pack a day; she is on oxygen during the night for her sleeping. She ends up in the hospital at least two to three times a year for pneumonia related illnesses. She is constantly taking antibiotics. She takes them even when she thinks she might be getting sick.

She does not admit she has COPD.

Five years ago, I had taken my mom to emergency for a broken foot, at which the doctor at that time told me directly that my mom had COPD, her lungs were a mess, and that her biggest obstacle was she was in denial. I heard her lie to the doctor about her smoking, and that her oxygen levels were usually pretty good, which they aren’t (they sometimes are as low as 79% and often in the 80%’s).

My brother and I are getting very concerned yet at the same time frustrated with the fact that she doesn’t seem to take much responsibility for her health. I want to be able to support my mother, but find it very frustrating at times. Anything you can tell me to help me better understand this condition, the necessity to take antibiotics constantly, etc., would be very much appreciated.

I should also mention she had a heart attack 15 years ago and has high cholesterol, so is on a lot of meds. She also was an alcoholic for many years, but quit the drinking after her heart attack. She to date has never admitted that she had a problem with alcohol.

My brother and I feel at times that my mother’s illnesses are orchestrated for the sake of attention. When she gets sick, she waits until she is really in a bad state, then insists on going to the hospital in an ambulance over one of us driving her. Sorry for the long rambling. We are both feeling much guilt over how we feel towards her health problems. Laurie

A. Dear Laurie,

Sounds like the problem here is denial and a lot of self centered behavior. The tobacco addiction is very strong in patients like this. I have no specific suggestions. Try to be patient and loving, if possible. Dr. Tom

Allergies and Triggers

Q. I am now 77 and have been diagnosed with COPD and an allergy (which is unidentifiable). Although once a heavy smoker, I quit 28 years ago, and started five years later. I am taking decongestants which keeps it under control for a while but eventually it results in another episode of bronchitis.

I live in Houston, Texas and would like to know if a change to a drier climate would help. Jackie

A. Dear Jackie,

A climate change in your situation will probably not make any difference. Dr. Tom

Quit Smoking Two Months Ago

Q. I stopped smoking two months ago. At first I felt better, but now my chest gets tight. I have a tickly cough and have problems breathing. Why would this be? Dawn

A. Dear Dawn,

I do not know. If it is still due to the irritation of the previous smoking, it will soon subside. If not, see a pulmonologist. Dr. Tom

Granuloma and Coughing Up Blood

Q. I have a lung granuloma in the periphery of the upper part of my lower lung. In two years it has grown.

Two years ago I felt my lung filling up with something, then when I coughed, it was pure blood. I could feel my lung fill up with blood and then I would cough it up. It has happened again, three times.

My pulmonologist put me on bed-rest and an antibiotic three weeks ago and it started again and has happened twice. He says he is not ready to do a thoracotomy or an ablation of the vessels.

Ugh, I never know when this is going to happen. I wish he would do something.

Why is it growing? At what point will he take it out. Could it be cancerous? What type of exercise is safe for me to do? Will I bleed again and lastly is the placement of it in the periphery rare?? Amanda BSN

A. Dear Amanda,

I assume this lesion is termed a granuloma, because it is calcified. If so, the calcium may be eroding vessels. You may need surgery to stop these bleeds from recurring. You should not curtail your activities, for fear of bleeding. Dr. Tom

Constantly Wheezing But have Normal Oximetry Readings

Q. I was diagnosed with asthma as a child. My mom and brother have it as well; my mother died of lung cancer and had emphysema.

The last couple of years I have started to wheeze a good part of most days and my doctor hears it whenever I come in for my check up. He does a pulse ox and it always reads 95% to 99% and he says I’m ok even with the wheezing.

I have been to the ER three times this year for my asthma and twice they said I could be admitted if I felt a need. My lowest reading was 89 while in the ER, the doctors said my wheezing sounded awful but no pneumonia showed up on any of the x-rays. I have had nodules a few years ago show up on a CT but they have resolved and always show clear.

Why do I get so short of breath and wheeze constantly with such high pulse ox rates? I get winded with the most simple tasks. Any advice would be appreciated to bring up with my doctor?  James

A. Dear James,

You need good treatment for your apparent asthma. It is possible to have normal oxymetry and still be wheezing. You should see a pulmonologist. Dr. Tom

Mom has COPD and is Retaining Fluid

Q. My mom is 76 years old has COPD and is retaining a lot of water and is on three different water pills. What should I do? Heather

A. Dear Heather,

Follow your doctor’s advice or make a change. You did not specify the medications that your mother is taking. Dr. Tom

In Plain Words, What is Atelectasis?

Q. Please define the term bibasal atelectasis in layman’s terms, how it develops and what treatments are available. Dorothy

A. Dear Dorothy,

Atelectasis is failure of the lungs to fully expand. There are many causes and thus treatments. Dr. Tom

Can Inhaling Respirable Quartz cause Granulomas?

Q. I have been exposed to art clay dust in my job as a janitor and it contains respirable quartz. I had lung exposures over the past four years and have had many cases of bronchitis. A CT-Scan showed tiny calcified granulomas.

How can I get rid of those and would the exposure to the art clay dust dry sweeping and such with this containing respirable Quartz been a cause of the calcified granulomas? David

A. Dear David,

The calcifications may be due to the inhaled clay dust. They are harmless and need no treatment. Dr. Tom

Thick Mucus and Laryngospasms

Q. What action would you suggest, if any, for an asthma patient who developed recurring larynogspams with thick mucus impacted the larynx while clearing secretion? Bob

A. Dear Bob,

Try inhaling your bronchodilator before attempting to clear mucus. Dr. Tom

Is Tiring Easily a Side Effect of Smoking?

Q. Hello, my name is Luke. I am trying to work on a HUGE science project and I ran into a problem; I don’t know if smoking makes you tire easily? Luke

A. Dear Luke,

It usually does not cause tiredness. It is more likely to be a stimulant. Dr. Tom

Think COPD is From Chemical Exposure

Q. Hello, My name is Tye and I’m 40 years old and have COPD/emphysema, have never been a smoker or drug user.

I believe I contracted the disease from chemical exposure and aluminum dust. I’m looking for a doctor to evaluate me. I would be willing to travel and pay for your services. If you can’t could you please point me to a pulmonologist that would be willing to. Tye

A. Dear Tye,

It is unlikely that aluminum dust is the cause of your COPD. You should consult an occupational lung specialist after making sure that your correct diagnosis is COPD and not something else. A pulmonologist could do this. Dr. Tom

Is There a Gender Difference Length of Time You can Hold Your Breath?

Q. Can girls hold their breath longer than boys? Shulanda

A. Dear Shulanda,

I know of no data that suggests that gender affects breath holding. Family history may have an effect. Dr. Tom

Lung Changes after Blood Clot in the Leg

Q. Since my father has been diagnosed with a large meningioma (a type of tumor that develops from the meninges, the membrane that surrounds the brain and spinal cord) he has developed a blood clot in the leg along with mild bibasal atelectasis and mild apical pleural thickening. Are these all related? Sam

A. Dear Sam,

Not directly, but inactivity from any illness may lead to the development of blood clots that can reach the lungs, called pulmonary emboli. These may be associated with some inability to take a deep breath to expand the lungs, i.e. atelectasis. Dr. Tom

What is a PET Scan?

Q. My mother had lung cancer 15 years ago and it has been in remission. Recently she has been coughing and the doctors have done a CT Scan and now three months later are ordering a PET scan. Why would they order this test if they did not suspect cancer and if so, why have they not acted sooner? Amy

A. Dear Amy,

I cannot second-guess your doctor’s practices. A PET scan is used to determine metabolic activity and can be used to evaluate end stage lung cancer. Dr. Tom

Strange Sense of Motion

Q. Hi, Dr Tom. Hope you are feeling much better. Could you please answer this, I have COPD and the other day I backed my car into a parking space. I was about to leave the car when I got a sensation that that car was still moving backwards. It was so real I jammed on the brakes but then noticed out of the corner of my eye that the car next to me was pulling out. I really had the sense of moving, but I wasn’t. What caused this sensation, and does this have anything to do with COPD? Philip

A. Dear Philip,

Nothing to do with COPD; it was due to the relative movement of the cars. Dr. Tom

Why do you Cough Up Phlegm?

Q. Recently I started coughing up clear and sometimes yellowish chest phlegm. What could be causing this? Lynn

A. Dear Lynn,

Phlegm is usually the result of inflammation in the lungs. Dr. Tom

Healing from Pleurisy

Q. I am a 35 year-old male who recently had pleurisy that has all but cleared away. I recently began to work out and feel out of breath and lightheaded. This also occurs when I am not working out.

I was also a smoker for 15 years. I had a chest x-ray done a couple of months ago and the results came back clear. How long does it take for lungs to heal from smoking and pleurisy? Another question is should I have a spirometry for asthma or other conditions? Juan

A. Dear Juan,

Pleurisy should heal in weeks. Lungs heal after stopping smoking in several months, but the healing may be incomplete, depending on the level of damage.

Yes, get spirometry done to check on your lung function. Dr. Tom

Can You Use Atrovent and Spiriva Together?

Q. I’ve had COPD for a while. I get short of breath and need inhalers. Can I use Spiriva and Atrovent at the same time? Susan

A. Dear Susan,

Yes, but there is no reason to use these drugs together. They contain similar drugs. Dr. Tom

Tear Gas and Asthma

Q. What kind of reaction would an asthmatic have to tear gas, i.e., during basic training for the military? Sarah

A. Dear Sarah,

It would depend on the level of exposure, and the status of your asthma. There may be no symptoms or a severe asthma attack. Dr. Tom

Is Advanced Age a Reason Not to Receive the Pneumonia Vaccine?

Q. Should a 94 year old be given a pneumonia vaccine if she is now in a rehab-nursing home? Dr. Michael

A. Dear Dr. Michael,

It would be reasonable, but the antibody response to this vaccination wanes with age. Most receive pneumonia vaccine in their 50s or 60s. Dr. Tom

Side Effects of Prednisone

Q. I get chronic bronchitis about three weeks a year. Anytime I get a cold, it manifests into that and I usually spend a night or two in emergency getting masks of Ventolin and saline.

I also get prescribed prednisone. Every time I take it I get numb in my muscles in my forearm. To the point where they feel like they are asleep; it’s not at the joints either, it’s from just below my wrist on my arm to or above depending on how you look, to mid way towards my elbow.

I went to the hospital the first time this happened, and by the time they sent me for nerve testing the symptoms were gone, they waited a week or two. Is this normal for a reaction?

I’m on this right now, and I just got released from emergency. I feel like I am not myself. Is this normal? Christen

A. Dear Christen,

These are uncommon symptoms, but not dangerous. Not related to nerve damage or self limiting. Dr. Tom

Newly Diagnosed with COPD

Q. I was just diagnosed with COPD in the form of emphysema. I was told I have 2/3 of my lung capacity or 66% left.

I stopped smoking 25 years ago and was not a real heavy smoker, however I was always surrounded with second hand smoke all my life, and I had one bout of pneumonia (my dear father also worked around asbestos).

What is the pathogenesis of this disease and why is it progressive?

I now have four grandchildren who always seem to have rhinoviruses - I can’t and don’t want to avoid them, but I always now have a "tickle feeling" in my left lung (the same lung that had the pneumonia). I’ve been so good for 25 years — why do I have to die such an ugly death? Linda

A. Dear Linda,

You have good lung function remaining. You should do well. Emphysema is caused by inflammatory processes, which are related to smoking, repeated infection, some occupation and familial risk. Dr. Tom

Lots of Symptoms but Scared to Go to the Doctor

Q. For the past year and a half I’ve been feeling tired all the time, weakness, dizziness, shortness of breath (all of the suddenly I take a quick deep breath not meaning too), and have bowel problems, (after eating going straight to the restroom sharp pains right after eating getting really hot and sweaty during the pains) what could be causing these problem?

I am really scared to go see a Doctor; cancer is really bad in my family. Jessie

A. Dear Jessie,

You will need to go to a doctor for a diagnosis. I cannot offer one with the sketchy information you offer, and the doctor has the ability to examine you and do confirmatory test. Seeing a doctor now, could prevent later problems. Do not procrastinate. Dr. Tom

Buteyko Method of Breathing

Q. There is a very popular fellow that was in charge of part of the Cosmonaut training program for finding out the most efficient way of breathing and maintaining oxygen levels in space. His name is Buteyko.

Anyhow, he claims the most effective way of knowing how much oxygen reserve is in the body is to be breathing normally, and on the exhalation, hold the nose closed and look at your watch and count the seconds until you feel the slightest stress to inhale, then release the nose and you should be able to return right away to a normal breathing pattern without the need for taking a deep breath.

He said a healthy person should be able to go about 40 seconds, and very healthy 60 seconds. He said a very sick person would be at about 12 seconds or under, and it would take 15 seconds to be able to even exercise walking, and over 20 seconds to be able to do anything aerobic.

My lung function tests are in the normal range and I am really pushing it to go 15 seconds.

Is this guy crazy or what? I wouldn’t have been able to hold my breath for 40 seconds and go back to immediate normal breathing in the best condition of my life, which was pretty good.

I do notice on my Dad, who has emphysema, is constantly breathing deeply and fairly rapidly as this guy predicted, but I don’t. My breathing is more on the order of fairly deeply, but not rapidly.

I don’t know what to make of this Buteyko fellow since a lot of what he says about increasing oxygen levels are very similar to the advice they give on COPD, like nose breathing, pursed lip breathing, slow exhaling and so on. He seems to know his stuff, but really, hold your breath for at least 20 seconds with no sensation of needing to breathe, and then return to normal breathing right away, and that’s just to be at a point you would be asymptomatic. Seems a little unrealistic. James

A. Dear James,

I do not know him. Forget about his theories since your lung function tests are normal. Dr. Tom

Fatty Liver

Q. I just recently had a no contrast CT Scan and it showed a little emphysema, a little fibrosis, and a fatty liver. Dr. Tom, what exactly is a fatty liver? My pulmonary doctor says don’t worry about it. Dan

A. Dear Daniel,

Fatty liver is usually due to excessive alcoholic intake, but not always. It is usually not serious. Follow your doctor’s advice. Dr. Tom

I Inhaled Lice Treatment that is Not Intended for Use on Humans

Q. I am a 45 year old mom of three and I am in good health. Like many people, I am sensitive to things like smoke, cologne, and the chemicals in some plastics.

Almost two weeks ago I was exposed to a young girl at work who sprayed herself (hair and/or clothes) with some kind of lice treatment spray meant for use on furniture, not humans.

I sit right next to her and after about 20-25 minutes of trying to work, I had to leave—the smell started to get to me.

Since this happened, I haven’t felt myself. I have a dry mouth, a slightly bad taste in my mouth, and sometimes tightness in my stomach, almost like I want to throw up, but can’t—just an overall blah feeling. I don't know if this incident has done me any physical harm, or am I just experiencing anxiety over what happened? Lisa

A. Dear Lisa,

I doubt if any harm has been done, but your co-worker did not do you a favor. All your symptoms should resolve soon. Dr. Tom

What Does “Isolated Increase in Lung Volumes” Mean?

Q. I am 45 years old, female, quit smoking about two weeks ago. I had normal PFTs five years ago, had a case of bronchitis about four months ago, had not had bronchitis is several years. Chest x-ray had something questionable so followed up with a CT scan that came back okay.

I asked for PFTs and the doctor finally did them. I got a copy and do not understand the numbers. There is one part that reads ‘isolated increase in lung volumes is noted’.

At first the nurse told me I had emphysema. I had so many questions she suggested I come in and visit with the doctor. I went in and she said I had mild COPD. No meds or follow up required.

I feel like I need to know the extent of this and what kind of future is in store for me. I have a family that depends on me.

I’m pretty sure I have the hyperventilation syndrome in conjunction with all this. How do I know if it is emphysema getting worse or anxiety and hyperventilation? I feel like a mess! Please help. Also, I will never smoke another cigarette nor do I have any desire after all of this. I smoked for probably 25 years. Lisa

A. Lisa,

This just means that you were able to take a larger than normal breath. Forget about it. Dr. Tom

What are the Criteria for Lung Transplants?

Q. I want to have a lung transplant but don’t know where to start or whom to ask. My doctor thinks I am too old for this. I am 70 and on oxygen 3 liters-24/7. I am diagnosed with emphysema, chronic bronchitis and COPD but do sleep without oxygen, most of the time. James

A. Dear James,

You will have to consult a lung transplant center. There are many factors that determine eligibility. Dr. Tom

What Questions Should My Doctor Answer about Lung Nodules

Q. A recent chest x-ray showed a nodule in my lung. The doctor is following up with a CT scan tomorrow. What questions do I need to ask regarding the nodule? Robert

A. Dear Robert,

The key questions are size and calcification. If calcified, it is benign. If small and non calcified, it needs follow-up. Talk about family history of lung cancer, your smoking and occupations. Dr. Tom

Does it Matter Where Emphysema Develops in the Lungs?

Q. I had CT Scans done and the doctor said he saw a small development of emphysema in my lower right lung… but I read that it usually starts in the upper lung and alpha 1 deficiency is usually what starts in the lower lung… what is the difference, and should I be checked for the alpha 1? Monica

A. Dear Monica,

Emphysema most commonly starts in the upper lungs, but may start anywhere. If there is a family history of emphysema or related disorder, I do suggest a simple blood test for alpha one. Dr. Tom

Mini Thoracotomy and Restrictive Lung Disease

Q. I have undergone a mini thoracotomy for repair of an atrial septal defect, completed three weeks ago. Although my heart seems to be doing well, I have bilateral pleural effusions.

My PFT shows moderate restrictive lung disease. I had a PFT done two months before the surgery, and was diagnosed with mild restrictive lung disease, but I had a clear chest x-ray.

I may be undergoing my second set of thoracenteses.

Would I benefit from prednisone? I am wondering if my lungs are also experiencing a hyper-inflammatory response to being on the cardiopulmonary bypass machine. JL

A. Dear JL,

It is possible that a short course of prednisone will help if the effusions are related to an allergic reaction. If not, they will just subside with or without thoracenthesis. Dr. Tom

Does Constant Wheezing Mean COPD?

Q. I am a 45 year old female. Lately, I have a sense of chest tightness and dull pain that moves around my chest and sometimes into my back. I also have a constant low wheeze on exhalation, and a bit of breathlessness on exertion.

I have a history of sinusitis, and had pneumonia once around ten years ago. I have never smoked, but grew up with smokers. My father has COPD, and now I’m wondering if I have a mild case of it myself, if not asthma.

I appreciate any insight/advice you might offer. Elaine

A. Dear Elaine,

You need to know the right diagnosis, because the treatments are different. See a pulmonologist and get an alpha one test done. Dr. Tom

Pulmonary Bullous Disease

Q. What is pulmonary bullous disease and is it often found to be greater on the right lung than left lung? David

A. Dear David,

It is an out-pouching of poorly formed or damaged lung tissue. It can be in either lung. It does not require surgery unless it compromises your overall lung function. Dr. Tom

Oxygen Saturations During Flight

Q. I have COPD but do not use O2; my O2 saturation with exercise does not go below 91%, and I am usually between 94-98%.

Is it possible that although I do not use O2 on land that I would need it on an aircraft. How much does one desaturate say at 30,000 ft in the air; and if you do notice your saturation dropping to 86%-88%, is there something you can do to get it back to over 90%. Phil

A. Dear Phil,

Jet aircraft are pressurized to about 8000 feet. You will not need oxygen at that level. If your saturation drops a little, try pursed lips exhalation ( http://www.yourlunghealth.org/dr_tom/archive/41-60/drtom44.cfm) and it will probably compensate. Dr. Tom

Chronic Productive Cough

Q. It’s been 110 days since I quit smoking. Since I stopped smoking I’ve been coughing up a light green phlegm. It surfaces constantly.

A pulmonologist told me it’s a disease I will have it for the rest of my life. Is there any cure or medicine I can take? Lou

A. Dear Lou,

This cough and mucus will mostly or completely subside with the passage of more time. Use of medications depends on symptoms. Spiriva slows the rate of decline of lung function for at least two years. You might discuss this with your doctor. Dr. Tom

Fluid on the Lungs Keeps Returning

Q. My friend just had a bypass for her heart and cleaned out some gel that had formed on one of her valves. She had been going to the doctor for fluid in and around her lungs, which is not allowing her to breathe right. They have been draining her for two months before the operation. This was two weeks ago and now she is back in the hospital and her right lung is now covered with gel and is not allowing her to breathe right.

What is causing this problem? She started out with this problem and all they did was heart surgery. Need to know an answer if possible. Larry

A. Dear Larry,

You will have do get the answers from the doctors caring for her. I do not have enough information to give an opinion. Dr. Tom

Does Low Oxygen Saturations Damage Other Organs?

Q. I was diagnosed with emphysema six years ago and have a current FEV1 of 17% predicted. I take Spiriva and Advair -albuterol is not useful. I have not gone on O2 yet trying to delay the inevitable.

I have a 91%-94% saturation sitting and sleeping. When I go across the house I will go to the low 80’s and then it takes about two minutes to get back over 90%. I walk 30 minutes a day at a very, very slow pace for 30 minutes and maintain 86% to 89% during the walk. When I am through-about two to three minutes later I am back to over 90%. If it hits high 70%’s I have to immediately sit due to SOB but it is back to over 90% saturation in two or three minutes.

I obviously have to limit my activities but can visit, run errands, eat out etc.

Am I doing harm to my other organs by having this drop in oxygen saturation at various times during the day. Other people with COPD have said I will damage my other organs this way. Joe

A. Dear Joe,

You may be putting a strain on your heart. Why not use oxygen? Dr. Tom

Exercise Suggestion for Those with COPD

Q. What’s good exercise for COPD patients? I’m very overweight, and I’d like to start a diet and exercise program. Bonnie

A. Dear Bonnie,

The best exercise is comfortable walking at a pace that does not tire you out. Dr. Tom

Worried about Father’s 20% Lung Function

Q. My father is 67 years old. He was diagnosed with COPD 15 years ago, he is now down to less than 20% use of his lungs, still smokes about three packs a day, has diabetes (insulin dependent), polycythemia vera (Polycythemia vera is an abnormal increase in blood cells, primarily red blood cells, due to excess production of the cells by the bone marrow) and is having a pint of blood removed every other week.

His oxygen count was at 85 last week and is being treated for that, and now he has been told he has myopathy and discoloration in his legs.

I live away from him and am not always being told the whole story. What is his life expectancy and are we looking at the end coming soon? He tries to keep a lot to himself. Tammy

A. Dear Tammy,

He may survive a long time, but it is certainly a big mistake for him to continue to smoke. Dr. Tom

Do ALS Patients Experience Difficulty Breathing at Higher Altitudes?

Q. Dear Dr. Tom,

I was wondering if I could pick your brain?

Do you know if a patient who is suffering with ALS has a more difficult time breathing at higher altitudes (9000 feet)? I understand oxygenation would be an issue but the physical act of breathing I didn’t think so.

If you are unsure can you point me in some direction for this answer as I have a new patient who is curious and his physician didn’t know. John

A. Dear John,

You will do better at sea level in the long run. Good luck. Dr. Tom

© 2017 American Association for Respiratory Care