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Archive: Dr. Tom 28
Posted July 28th, 2005

What are the Chance for a Lung Transplant for a 71 Year Old Patient with COPD?
Q. I am a man 71 years. My COPD came on at 66. I am now on 2liters of O2. I am in reasonably good health otherwise.

Is there any chance of a lung transplant at my age?

James

A. Dear James, Yes. The “cut off” is an arbitrary age 70, in some centers, but your general health is what is most important. Your doctor should refer you to a transplant center, if he believes that transplantation is the best thing for you.

Many at your age, live happy and meaningful lives for many years on home oxygen and other therapies for COPD.

Dr. Tom

 

Providing the Best Care for Patients with a Tracheotomy
Q. Hi.  I am a nurse on a Rehab unit where we occasionally have patients with a tracheotomy (an opening surgically created through the neck into the trachea/windpipe). I am having difficulty finding best practice information. Can you recommend any articles or references? Thank you. Dana

Dana

A. Dear Dana, There are many articles in respiratory care journals and some in nursing journals, as well as in textbooks. You should do some homework.  

Dr. Tom

 

What are Effects of Quitting Smoking?
Q. Dr. Tom, I am 23 years old and I recently quit smoking. I quit because I was having trouble breathing and I noticed a very clear connection between my smoking and my difficulty breathing. I only smoked around 10 per day for a year and a half. 

To give you some background info, I had sporadic asthma attacks when I was younger, usually spurred by my allergies. When I went to college, this disappeared and I was fine for about 5 years. I then made the mistake of taking up smoking.

About 6 months ago, I noticed my breathing getting more difficult, yet I could not quit. I took Advair, and it helped. Yet my breathing was still consistently getting more difficult, so I had to use the Advair more often.

About 3 weeks ago, I had a severe asthma attack in bed. Since then, I have not had a cigarette, but my breathing is still difficult. I am on Advair, yet I still wake up with a significant difficulty breathing in the morning. I recently had x-rays taken and the doctor said they looked fine.

I am concerned that by smoking (even for only a year and a half) I may have permanently damaged my lungs to the point that my difficulty breathing will not go away. Is this possible?

As my lungs recover and my cilia (little hairs in the airways of the lungs that beat back and forth to move mucus out of the lungs) grow back, will this condition likely dissipate? Oh, also, I do cough a bit, but there is not much mucus. When I feel the tightness in my lungs, there is not much wheezing either. What might I expect as a result of quitting? Will I recover? Or is it likely that this damage is permanent?

Josh

A. Dear Josh, The damage is not permanent. Your lungs will completely resolve the inflammation caused by smoking. But you may still have asthma that causes symptoms and requires treatment. If so, you should go to a doctor that understands and treats asthma.

Dr. Tom

         

Worried About Sister’s Recovery After Experiencing a Pulmonary Emboli
Q. My sister is 52 and has been having problems with migraines.  This last week she was admitted to the hospital with acute chest pain. She had a CT scan that showed she had a Pulmonary Emboli (a blood clot blocking an artery in the lung). 

She was released with the following information, right lower lobe infract, pulmonary emboli and pleurisy. Her blood pressure has been real low, 78/40 and she sleeps all the time, when she does get up she staggers, slurs her words.  She is on Coumadin (blood thinner). 

What should she be doing and what should we watch for?

Cheryl

A. Dear Cheryl, She should not have blood pressure this low, nor be staggering or having slurred speech, from a pulmonary embolus to a localized region of the lung. 

Something else must be going on. You need a further diagnosis.

Dr. Tom

 

Need Information about Chronic Bronchitis
Q. Hi Dr Tom, My girlfriend has chronic bronchitis.  She is now 23, first diagnosed with the condition 4 years ago, and the medical specialists attending to her at the time indicated that it could have started as much as 5 years before that (13/14 years old).  Does anyone know how chronic bronchitis occurs at this young age?

All of the articles I have read about chronic bronchitis do not talk about chronic bronchitis in teenagers.  Most of them also refer to smoking being the main cause of chronic bronchitis, yet she has never smoked in her entire life, how could she have then developed the condition? 

I ruled out any genetic defects (Alpha-1 Anti-Trypsin Deficiency), because her folks and her brother and sister are in perfect health.

She normally gets sick about 4 times a year; difficulty breathing, coughing up blood and sputum and running a fever), and it lasts between 2 weeks to a month.  Is this normal for someone with chronic bronchitis? 

Are her lungs undergoing further damage each time she gets sick?  She had a spirometery test recently, while she was sick, the results were around 68% lung capacity. Was this reading poor because of she was sick at the time? 

How does one reduce the frequency and duration of these illnesses?   Also, does being out in the cold or drink cold beverages contribute to getting sick?

As she has started displaying these symptoms at a very young age, what can her expectations be as she grows older living with the disease?  How would her quality of life be affected and what would her life expectancy.  What would your prognosis be?

I know have asked a ton of questions, any help would be really appreciated.  Thank you for taking the time to read this letter and thanks for the advice that you have provided.

Anashen

A. Dear Anashen, This is not chronic bronchitis. I suspect that she has a disease known as bronchiectasis, which commonly had repeated chest infections, large amounts of mucus and coughing blood from time to time.

Cystic fibrosis is one cause of bronchiectasis and she should be checked for this with a “sweat test”.  She needs to see a specialist to make a definite diagnosis. The prognosis is good with careful treatment by an expert. 

Let me know.

Dr. Tom

 

Heart Transplant for Someone Who has had a Mitral Valve Replacement?
Q. I have enjoyed reading the Q and A over the past year or so. I finally have a question.

I am 58 with severe COPD and have been advised to begin the 15 to 20 tests for a possible Lung Transplant. I had a Mitral valve (the valve that connects the two chambers of the left part of the heart) inserted due to Aortic Valve Stenosis (narrowing of the aortic valve) operation over a year ago and thus take Coumadin (blood thinner) every day.

I have asked around and nobody will answer whether or not I would be a good candidate for a transplant.

I have e-mailed a couple of Lung Transplant Centers outside my geographical area and none of them can recall a successful case like mine. Do you have any comment or opinion?

Jim

A. Dear Jim, It depends a lot on the condition of your heart now and how successful the valve surgery was. A consultation with both a cardiologist and pulmonologist may be needed to sort this out.

Dr. Tom

 

Can Chest Pain be Caused by Hyperinflated Lungs?
Q. Dear Dr. Tom: I was diagnosed with emphysema 16 years ago.  The disease has progressed as expected with a decrease in my FEV1 to 39%. 

I have had 3 lung infections since last November for which I have taken antibiotics and prednisone.  My normal exercise routine has been reduced during these exacerbations (worsening of condition) causing me to be physically deconditioned. 

In the past 3 months I have begun to experience chest pain upon exertion.  I have had extensive tests to eliminate heart disease and acid reflux as the cause.  My pulmonologist said off-handedly that hyperinflated lungs could be causing the pain.  He noted that my PFT's show increased air trapping. 

What he has failed to tell me is if the pain indicates an emergent situation.  If I continue to exert enough to bring on the pain, is there the chance or certainty of death, or a collapsed lung, etc. ? The pain ranges from intense to slight and it comes and goes during the day. 

I had planned to go on a 3 week European vacation in September, but not knowing just how serious hyperinflated lungs are, or this pain upon exertion is, I don't know whether it would be foolhardy for me to consider traveling.

I would appreciate any info you can give about lung hyperinflation, its dangers, what can be done about it (short of LVRS/transplantation), and if I can continue safely with my normal activities and simply wait out the pain when it comes. 

Wendy 

A. Dear Wendy, Lung hyperinflation does not cause chest pain related to activity. This sounds more like angina. Better get it figured out. The prognosis is good with the right treatment. 

Dr. Tom

                

Pulmonary Function Question
Q. I have a Pulmonary Function Testing question regarding a 71 yr old African American female who is 59 inches, has history of severe osteoporosis, and a weight of 123 lbs.

FEV1 observed: 1.06L (69% predicted)
FVC 1.07Liters (48% predicted)
TLC 3.51Liters (92% predicted) 
FRC 2.83Liters (124% predicted)
RV 2.38Liters (155% predicted)
DLCO 10.6 (69% predicted)
VA 2.65 Liters

Question:  Her lung volumes do not match up with the spirometry result numbers but acceptability and reproducibility criteria were met with VTG (Thoracic Gas Volume) attempts.  Do you have an explanation for this?

Also, she was unable to exhale 6 sec.  The Flow Volume loop and time curve did not show any obstruction pattern.  The midflows were inconsistent and greater than 134% predicted

Marilyn

A. Dear Marilyn, These are interesting values. The FEV1 and the FVC are almost the same, which indicates that she only blew out for one second. Since your results were repeatable, these values are valid.

Also in the lung volume test the difference between TLC an RV (which is the vital capicity) is 1.13 liters or close to the 1.07 you got by spirometry. Although at first glance on the spirometry, I thougt she just closed her glottis, this is not the explanation because of the repeatability of the test. A look at the flow volume curve would confirm this. Together your tests indicate a severe restrictive ventilatory defect, even though the TLC is not very low (92%). The high RV indicates closure of small airways. This would be consistent with an interstitial inflammatory disease with involvement of small airways.The low diffusion test would fit.

Bronchoiolitis Obliterans with Organizing Pneumonia (BOOP) would fit these tests, but the actual diagnosis of this particular interstitial disease would require a biopsy. If the diagnosis is BOOP, the chest x-ray and CT should be abnormal, showing diffuse infiltrates and thickened small airways. Hope this helps.

Dr. Tom                 

 

Has Pain Eight Months after Lung Lobe Removal
Q. My partner had a right lung lobectomy (surgical removal of a lung lobe) eight months ago. He is still in constant pain and has been told he may have to just live with it, is this normal?

Marie

A. Dear Marie, I suspect that a rib was removed or otherwise injured. This sort of rib pain may last a long time. It usually subsides, at least partly, with time.

I suspect that the lobe was removed for lung cancer. Sometimes rib pain is due to involvement with the cancer.

Dr. Tom

                

Questions about Vicodin
Q. Dr. Tom, I had the procedure to use TTO oxygen (a method to deliver oxygen to the lungs via a small tube inserted into the lower neck) done in January because I have severe COPD and am on oxygen 24/7.  For a short period of time thereafter I had increased coughing that I could not control. The doctor gave me Tussionex cough syrup (antihistamine and narcotic), which worked great.

When I asked him for a refill later he replaced it with Vicodin (narcotic reliever) tablets to be taken only at night and only as needed. One morning I took a Vicodin instead of a Naproxen by mistake. I was able to walk longer and further than I had in several weeks.

When I asked the doctor if I could take it everyday to increase my stamina he said, “only when you get to the point that you don't care if it shortens your life”. 

Would you explain to me why that would be the case? 

Beverly

A. Dear Beverly, I guess your doctor is afraid of your getting addicted to Vicodin. If you just use it for symptoms, and do not increase the dose, it is generally safe.

Dr. Tom

 

Education for Respiratory Therapists
Q. I have an opportunity to be trained as a Respiratory Therapist in the Army...ok...good. Now, how does that training translate to civilian skills?!... oh, yes I have a BS degree in another field 

Thomas

A. Dear Thomas, You will have to ask the AARC and their board of examiners. I believe that respiratory therapy training in the Army is equivalent to that obtained in approved RT schools, but you better check on this. You will find the profession of respiratory care to be very rewarding.

Dr. Tom                  

 

Spirometry Test
Q. If you force yourself to breathe as hard as you can just to prove there is nothing wrong with you at a Spiromerty test, can that show a false reading?

Pamela

A. Dear Pamela, No, You cannot be better than you are! This assumes that you did not bite down on a tube that is the flow transducer, such as used in the EasyOne by ndd.

If you bite down and narrow the lumen, you may increase the velocity of the airflow artificially. 

Dr. Tom

 

Can You Get Too Much Oxygen at Home?
Q. Is it possible to get too much oxygen while using at home and are there symptoms?

Mickey

A. Dear Mickey, The quick answer is no. There is too much concern about taking more oxygen than you need. The old dogma that it may drive up your carbon dioxide is wrong, unless you breathe very high oxygen concentrations from a mask. The mechanisms behind this are complicated.

You will not get carbon dioxide retention from nasal oxygen, unless you are very sick and get exhausted to the point that your respiratory muscles tire out. This is not the fault of the oxygen, but the disease state.

You still need the oxygen to support of your ventilation.

Dr. Tom

               

Define Medically Fragile Patient
Q. Please give me the best definition of a medically fragile patient?

Kirk

A. Dear Kirk, Someone that looks fragile. ie, pretty darn sick.

Dr. Tom               

 

Pulmonary Education and Research Foundation (PERF)
Q. Dear Tom, I have found your “Letters From Doctor Tom Petty” on the PERF site, as a COPD patient I read thru most of these over a period of a few weeks. I found them very enjoyable to say the least.

I notice the last letter is dated March 05 and I wonder if you intend resuming these given the fantastic work you are doing with this site.

It is good to hear how you are doing also.

Alison

A. Dear Alison, I am so pleased that you like my “Letters from Tom”. I started these in 1985. They get posted in batches some time. I have letters for each month, and hope you continue to like my simple writing.

Thank you for caring about me. I am getting stronger. 

Dr. Tom

 

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