Follow-Up On Husband’s Condition
Q. Dr. Tom, My husband did have the blood clots in his lung and right leg. He just was released from the hospital yesterday and he is on 12.5 mg of Coumadin (blood thinner) at this point.
My question is, our family doctor said that he has no restrictions however, some other nurses, etc. have mentioned things that he should not do.
Do you have any advice on maybe some restrictions that he should be on including driving, walking a lot, sitting, etc? If you could ask him I would really appreciate it.
Thank you so much for the advice before because it was exactly right.
A. Dear Nancy, I do not know what restrictions were suggested but in general, there are none except common sense. A fall or any other injury could cause bleeding. Particularly head injury is dangerous.
But normal activities are usually possible in all persons who receive anticoagulant treatment.
Read Nancy's original letter.
Worried About Husband’s Lung Symptoms
Q. My husband was taken to the ER on the 11th (June) for shortness of breath, chest pain, and cough. They checked his oxygen level with an oximeter and it was at 90. Over the next three hours it went down to 86 so they admitted him and put him on 3 liters of oxygen. After a day in the hospital they decided to let him come home with 2 liters of oxygen.
Now, if he does anything, which includes taking 20 steps without the oxygen he is severely short of breath and starts coughing. In the last 5 days or so he has complained of severe pain in the calf area of his leg - deep pain.
The doctors were going to run a test on his lungs for a blood clot but didn't figure he had one, so they decided against running it.
Now my husband is so tired of going to ER’s, doctors, etc. and not finding anything out that he said he will wait until he can see his pulmonologist on the 27th of this month.
Is it possible that he does have a blood clot in his lung and maybe his leg? He can hardly walk because of the pain in his right calf. The only way that his oxygen levels stay up is to be on the 2 liters of oxygen 24/7.
Also he has asthma and has had several attacks in the last year. Several years ago he was told that he had restrictive lung disease.
He was in a car wreck about 7 years ago and punctured the lower lobes on both lungs and they were not re-inflated. Now has scar tissue on both of them. He uses inhalers and meds for allergies and asthma. Thanks.
A. Dear Nancy, Get your doctors to do a CT of his chest now, to rule out a lung clot. It is not wise to wait for the next clot, if this is really the problem.
Stabbing Chest Pain and Shortness of Breath with Exercise
Q. My wife has been suffering with some lung troubles for 9 years now. She has had asthma all her life.
She has an inflammation in her lungs that does not allow her to exercise with out stabbing pains in her chest and shortness of breath. We have been to the best doctors in our area and have had numerous tests taken and they cannot figure out what it is.
There was one drug that helped. That drug was Vioxx (a nonsteroidal anti-inflammatory drug). She has taken all the other alternative drugs that have replaced Vioxx and not one has helped.
We are tired of her life being slowed by this trouble and we are desperate for a solution. If you can help us in any way it would be appreciated.
A. Dear Shawn, Stabbing chest pains are not common in patients with inflammatory lung diseases. A more specific diagnosis is needed.
The response to Vioxx suggests that the problem may be pleurisy, but that is speculation. A firm diagnosis is the key to getting control of the problem.
You need to see another pulmonologist, if you have not seen one already.
Shortness of Breath and Mucus
Q. I had quite a nasty cough for around 2 months, which subsided after a course of antibiotics.
I have now developed shortness of breath (SOB) combined with production of thick white mucus. The SOB is particularly bad after exercise when my throat appears to close up.
I’ve had a clear chest x-ray, clear blood test and my GP is sure I don’t have asthma as I don’t react to any inhalers, any ideas?
A. Dear Matt, Yes, get a spirometry done to see if anything is wrong with your lungs ability to fill and empty. A chest x-ray will not often explain shortness of breath.
Exercised Induced Asthma
Q. When my 15 year-old daughter exerts herself during team practice she feels ill and nauseated.
She has been diagnosed with exercise-induced asthma since she was 10 and uses albuterol when she finds it hard to breathe.
Can she use respiratory therapy to control her breathing so she can stop using her inhaler?
A. Dear Joanne, This will not work in exercise induced asthma. She needs to take her inhaler 30 minutes before exercising.
Where to Live
Q. Dr. Tom my story began in 2003 when our house flooded 2 times in 1 year, the first time in 20+ years. I ran a wire in my leg about 6-8 inches trying to get our stuff out of the water. My leg would not heal and I was on antibiotics for months.
Long story short I ended up in the hospital being told I was dying. I developed all kinds of health problems. Plus I had dental problems from the use of all kinds of respiratory medicines, plus memory problems, and an unbelievable sense of smell.
I have been told I have everything from asthma, to allergies, to a mild case of COPD, to I am allergic to my African Gray parrot and have that bird disease, to my house is killing me because of the mold that has now developed in our basement.
I know that the mold, dust, and chemicals smells now bother me and am trying to decided where to move. Can you tell me which states, that are warm, is the best for people with severe breathing problems and difficult mold problems to live in? It would also be great if the state had good health specialist.
A. Dear Brenda, Your problem may well be due to the mold. You may need to live in a warm dry climate.
Depending on whether you need low altitude, I would recommend, Arizona, New Mexico, Colorado, Nevada, Utah, and Wyoming. But the winters are cold and windy in Wyoming.
Most small cities have good pulmonologists these days. Grand Junction, or Durango, Colorado, could be your best bet.
Mechanical Ventilation and Gastric Bypass
Q. Our hospital performs many gastric bypass surgeries on a weekly basis. We frequently see problems with mechanical ventilation due to high peak pressures. Can you refer me to any articles on mechanical ventilation for the bariatric patient?
A. Dear Darcy, Not off the top of my head.
The impedance encountered by the restriction imposed by obesity, and the surgical dressing will be an issue but otherwise the same principles of mechanical ventilation apply.
Smoking and Chronic Sinusitis
Q. I have smoked for five years, a pack a day. For the past year I have had chronic sinusitis, often I have been put on Mucinex or Aquatab or guaifenesin because I come down often with a dry, nonproductive cough. This is very frustrating.
My question is, does this sound like something related to smoking? I’d really appreciate any help you might offer me. Thank you.
A. Dear Jen, Yes, this is most likely related to smoking. Why not quit now and save at least 5 bucks a day and live 10 years longer? This is a "no brainer"!
Pulmonary Function Tests and Chronic Bronchitis
Q. Hi Dr. Tom, I have written before, but now have two questions for you. I'm female, 64 years old.
1. My PFT (Pulmonary Function Tests) shows 46% on the FEV1. Is that a number I can live comfortably with this the rest of my life?
2. I was also told I have Chronic Bronchitis. I was surprised by that diagnosis, as I don't have much of a cough and my pulmonary doc never questioned me regarding a cough. Can PFT diagnose Chronic Bronchitis? Thank you.
A. Dear Patricia,
1.This amount of remaining pulmonary function should last you for another 20 years, assuming that you have completely stopped smoking and that you have no other problems in your lungs.
2. PFTs do not diagnose chronic bronchitis, as such. They do indicate airflow obstruction, which can be from chronic bronchitis, emphysema, asthma and/or a combination of these.
Swollen Lymph Node Obstructing Air Flow
Q. My wife had a C-scan that was ordered by her pulmonary specialist. The results showed some shadows on her left lung and a spot, which appeared to be a growth of some kind near where her bronchial tube entered her left lung.
The pulmonary specialist took biopsies of the shadowed areas in her lung but could not reach the growth area. The result of the biopsy was negative for cancer. A Cardio-thoracic surgeon went in and biopsied the growth which also came back negative for cancer. The growth turned out to be an enlarged lymph node that was in a location that was difficult for the surgeon to get to.
It has been approximately two months since the biopsies were taken and her lymph node is still swollen and is pressing against bronchial tube restricting the airflow to her left lung. The pulmonary specialist believes that some type of infection is causing the lymph node to swell but to date the doctor has been unsuccessfully in diagnosing the cause of the infection.
None of the cultures that were taken during the biopsies have resulting in any bacteria growth. The doctors do not know what to do at this time. They do not know what antibiotic to give her to reduce the swelling in the lymph node and it continues to restrict her airway to left lung, she has a persistent cough, especially in the morning, she become tired with any physical exertion, and seems to have very little strength.
Have you had any similar situations come to your attention and if so, what can be done to help my wife.
A. Dear Rick, Yes. The lymph node should be surgically removed if it is causing obstruction of a major airway to the lung. This is done through a chest incision, most often. The whole node can be removed and a firm diagnosis made.
Was the node cultured for tuberculosis and tuberculosis like organisms? You need a final resolution of the problem.
How Best to Clear Throat and Lungs for a Man who has C-6 Quadriplegia
Q. DR. Tom, I’m a C-6 Quad (quadriplegic) and can’t cough due to the lack of muscle in my chest. What are the best ways for me to clear my throat and lungs when I need to?
A. Dear Rodney, There is no easy answer to your question. There have been medical devices used in the past, called "exsufflators" that cause a sudden, suction on your air passages and the clearance of retained mucus. I do not have any experience with these devices.
Newer devices are available that stimulate mucus flow are via pulsing vests (vest rapidly inflates and deflates, some vest products also provide vibration). They are commonly used in Cystic Fibrosis, but these patients have good muscular efforts and can cough vigorously.
I do not know if they would help. Spinal rehabilitation centers should know more about this that I do.