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Archive: Dr. Tom 31
Posted August 23rd, 2005

Alpha-1 Antitrypsin Deficiency (AAT)
Q. Hi Dr. Petty, I was just looking at this website via another web link.  How wonderful to see you here!!  As you know, I always follow you, even now that I am at Baxter, through Mary Burns' Newsletter. 

As I was reading the questions, I noticed a particular one where her mum had died of emphysema at age 57 but had lung problems for probably 30+ years.  You are correct that she may have had bronchiectasis because you may have had much more information, but she may also have had AAT Deficiency (a disease that is under diagnosed and misdiagnosed) - especially if she were a smoker. 
This would be something the daughter could get tested for and if she were deficient, could get treated early and if she smoked, it would possibly be quite a good motivation to quit.

Thank you for all that you do for all of us.  

Maureen RN, MN

A. Dear Maureen, You are correct. I should have mentioned Alpha one deficiency as a possibility. Nice to hear from you.

Dr. Tom

Last week’s question:

Worried about Mother Who is on a Ventilator
Q. Hi, my mother was just admitted four days ago in to the hospital with acute exacerbations (worsen condition or flare-up) of her COPD.  They have had one unsuccessful attempt at discontinuing her from the respirator (mechanical ventilator). They say she is still to weak and her bronchioles are extremely tight. 

Do you think it is a good idea that she is given a tracheotomy (is an opening surgically created through the neck into the trachea, windpipe) and then tried to wean off of that.  I am just concerned she will get stuck being on the ventilator for life. 

She is only 53, and has severe emphysema.  Smoked up to the day she was taken by ambulance.  Can someone’s lungs be that bad by such an early age?  

Jennifer

A. Dear Jennifer, A tracheostomy is more comfortable for the patient that an endotracheal tube (tube placed in the airways through the mouth or nose). It will allow for better suctioning of secretions. It is also a good step in weaning, that may take more than a few days.

Advanced emphysema in the 40s and 50s is fairly common. Women are more susceptible to cigarette smoke than men.

Your mom can still recover, and be rehabilitated to the point of a good quality of life.

Dr. Tom

 

Trouble Breathing Even with Oxygen
Q. Hi Dr. Tom.  I was diagnosed with emphysema several years ago and just recently I was diagnosed with osteoporosis.  With this ailment my doctor put me on oxygen to help with breathing because of pain in the spine. 

I am still on oxygen and have a lot of trouble breathing when moving around.  I am overweight, very much so. 

Is my breathing still from emphysema or osteoporosis or just being overweight?  I am over 65 years old and losing weight is a big problem with me.

Mary

A. Dear Mary, Oxygen often does not relieve shortness of breath. It corrects the oxygen deficit and unburdens your heart, and usually helps with exercise tolerance. But shortness of breath is mostly due to the mechanical abnormalities of the lungs and chest.

Overweight, itself, may cause shortness of breath. Keep trying to exercise, by walking at least 30 minutes twice a day. This is good for osteoporosis, and may help you lose weight and exercise more with less shortness of breath. 

Dr. Tom

                

Normal Saline Lavage for Ventilator Patients
Q. What if any research has been done on the use of normal saline (salt solution) lavage (washing out with fluid), on ventilator patients.  Also, does the AARC have anything to say on this topic?

Carol

A. Dear Carol, I do not know of any controlled studies comparing saline lavage with water, or mucus dissolving drugs, such as acetylcysteine (antioxidant drug used to thin mucus). The mechanical effect of fluid, instilled and then suctioned is clinically helpful.

Dr. Tom

 

Needs Help with a Difficult Decision
Q. Dear Dr. Tom, I am in the awful position of deciding whether or not to continue with testing for a lung transplant.

I have been told by many, that the life expectancy after lung transplant is 5 years, and that forty some medications are necessary after transplant. These medications come with their own severe problems and side effects.

I do not do well with meds and have had adverse reactions to many. I react badly to prednisone at any dose over 15mg alternate day therapy.

My FEV1 is <16%, and my Doctor's prognosis is 1 more year, 2 if I'm lucky. I'm 84 yrs & 1 week. :)

What are your feelings on transplant?

Claire

A. Dear Claire, Well, you have already lived 84 years, and will probably live some more without a transplant. Very few patients your age are considered candidates for lung transplantation. There are risks, of course.

It is not true that 40 medications are needed in lung transplant patients, but some powerful drugs are needed to help prevent rejection.

Dr. Tom

 

Will a Move to New Mexico Help My Breathing?
Q. Sir, I have COPD and I am on oxygen and Spiriva. I also have Type 2 diabetes, which is being controlled quite well with pills. 

My question is this, I am thinking of moving to Las Cruces NM where the climate is dryer than here in VA.  The sea level is about the same.

Do you think this will help my breathing? 

Thank you very much.

Earl

A. Dear Earl, It might help, but try it first, before moving your home and leaving your friends.

Dr. Tom

 

Tiny Dots on CT Scan, but No Diagnosis
Q. Results of a CT scan showed tiny dots (looked like sprinkles on a cookie) throughout both lungs. There were no masses. The doctors don't know what this is.

A needle biopsy was done but showed nothing, as dots were too small. Tissue biopsy is planned. Any indication what this may be?

Preliminary diagnosis states; milnary type interstitial lung disease. Looked this up and it could be a million things.

What do you think the CT scan means? Any possible direction we might look? Any help would be appreciated. Also coughing up blood.

Thank you. 

Pam

A. Dear Pam, If you are coughing up blood, you should have bronchoscopy (diagnostic procedure in which a tube with a tiny camera on the end is inserted through the nose or mouth into the lungs). Many "tiny dots" suggest a healed fungus, such as histoplasmosis (a disease caused by the fungus Histoplasma capsulatum, which grows in soil and material contaminated with bat or bird droppings). You do not need any biopsy or treatment for this.

Dr. Tom

 

Follow-up Question on Spirometry
Q. Dear Dr. Tom, Thank you for your reply to my spirometry question.  As far as weight, I am average to thin (5'6'', 125 lb).  Also, although I am of average height for a woman, I have a somewhat small frame.  

My chest x-ray was clear, as were my lungs (no crackles, wheezing, etc.).  I should also mention that I haven't been having any symptoms...no shortness of breath, etc., and I walk 2 - 3 miles/day with no problems.  

I recently went to a pulmonary specialist and had an exam and had the spirometry redone.  

My spirometry values (the actual values) were almost identical to the previous ones obtained at the free screening.  BUT, the percentages were very different.

FVC: 88%
FVC1: 91%
FVC1%: 87%

This was apparently because of the use of a different reference system.  HOW DO I KNOW WHICH ONES TO TRUST?

The doctor concluded that my lungs were fine, and that I neither had obstructive or restrictive problems.

Do you agree with his diagnosis?  

Thanks again.  You have a great site.

Suzie

A. Dear Suzie, I agree with your doctor. Your lungs are fine. Stay well.

Dr. Tom

Last Week’s Question:

Questions about Spirometry Results
Q. I recently had a free spirometry test (COPD screening test).  I am an ex-smoker.  I smoked about a pack a day from ages 14 - 19, and started again at age 30.  I just quit 2 months ago, and I am 39 years old.  During my 30s I usually smoked just under a pack a day.  

I was fairly confident that I didn't have COPD.  But was surprised when my results indicated a restrictive process.  My best values were:
FVC: 3.20 (80%)
FEV1: 2.78 (85%)
FEV1%: 87%

Could my low FVC value be due to my recent smoking?  Will it improve on its own with time?  Should I have additional tests?  Any information will be appreciated - I am very worried.

Suzie

A. Dear Suzie, Your results are borderline. Not really abnormal.

I do not mean to get personal, but the “restriction” could be a matter of weight. If you are not overweight, forgive the suggestion.

Dr. Tom

 

Chronic Bronchitis and Smoking
Q. Hi Dr.Tom, I have chronic bronchitis and keep getting chest infection after chest infection. Does this mean its getting worse?

Also, I am still smoking. I know I shouldn’t be, its just I suffer from a lot of stress as well so I find it harder to give up smoking.

I am not bringing up any phlegm now but my chest is so sore and I have a bad cough. I keep getting a flu achy feeling. I am worried.

Diane

A. Dear Diane, I can understand your problem with quitting. Many smokers deal with stress, anxiety and depression by smoking. But your lungs will get worse. Try again.

Dr. Tom

 

Needs Reliable Information about Lung Transplants
Q. I am presently going through the testing for VA to determine if I qualify for a lung transplant. I was anxious to have a lung transplant because of it extending my life.

Now I am starting to have second thoughts because I can't find reliable data about the success rate of patients living with a new lung. What is the normal life expectancy for a successful lung transplant recipient?

Buford

A. Dear Buford, The survival time for lung transplantation varies tremendously. The problem is lung rejection. On average the survival is about five years. But I have one patient alive 14 years after transplantation of both lungs, and others doing well beyond five years.

Dr. Tom             

                

Experiencing Shortness of Breath with Exercise
Q. Hi Doctor, I (39 years old) have been having bouts of shortness of breath with exercise for some time now and have been trying to establish if I am out of condition. I also have a chronic cough and some small amounts of sputum. Yes I was a smoker for 12 years. 

My local doctor performed an examination including spirometry. Every thing was fine and over 100%. FEV/FVC was 77%.

FEF75-25 value which was 79% of predicted

FEF75 value was way down at 60%.

My doctor is saying in the absence of anything else to point to a reason for my symptoms there is reason to suspect that this pattern indicates disease in the small airways.

If my spirometry is normal why are these low? If I was coming in for the FEF25 at 90% I would be happier that all is well.

Also does the inflammation that causes airway inflammation cause inflammation in other areas, i.e., joints, brain, skin problems.

I have seen a rheumatologist (an MD who treats rheumatic illnesses, especially arthritis) and she tells me there is no lupus etc.

Jane

A. Dear Jane, Forget the FEF 25-75% and FEF 75%. These tests are misleading, and do not necessarily relate to small airways narrowing.

Your lung function is good, and this is not the cause of your shortness of breath. Try more conditioning exercises.

Dr. Tom

 

Trouble Sleeping
Q. Am 71 yr. old female. I have COPD/emphysema, HBP (high blood pressure), and diabetes.

I am on Spiriva and Advair, Atenolol, Glipizide and Insulin.  I have difficulty sleeping and Ambien (sleep medication) only lets me sleep a couple of hours.

Any suggestions concerning Melatonin? Thanks.

Mary

A. Dear Mary, Melatonin is very safe. Give it a try. The sustained release preparations are best for a long sleep. 

Dr. Tom

 

Inhalers are not Working Anymore
Q. I've been officially diagnosed with COPD since 1998. I have only used Albuterol, Atrovent solutions and the Albuterol inhaler but they are no longer working the way they used to. 

Can you suggest other meds to update to? 

Shelby

A. Dear Shelby, There are other alternatives, such as Serevent and Foradil which are beta agonists, like albuterol, but are long acting. Also Spiriva (tiotropium) which acts like your Atrovent, but lasts for 24 hours. They can be taken together.

Dr. Tom

 

Please Help My Mom
Q. My Mom has a tracheotomy (trach) due to tracheal stenosis (narrowing of the trachea/windpipe) and is also a lung cancer survivor. 

Her latest follow-up shows that she is beating the cancer, however the radiation and chemo has left her with such breathing difficulties it is draining her will to live. 

Her trach care has become tremendous with constant suctioning of mucous. 

We assume the lungs are in the healing process after her radiation. Is there anything we can do to help facilitate the healing and reduce the mucous that is forming so often?

She hasn't had a more then 2 hours of consecutive sleep in weeks due to having to suction or mucous plugs forming.  She is already on oxygen and humidity all day as well. 

Feeling very helpless that nobody knows how to help relieve her symptoms.  Please Help...

A Loving Son!

A. Dear Loving Son, I understand the problem and there is no simple answer. The radiation, for the cancer, may well have caused lung inflammation. If so, your doctor may have tried corticosteroids. If not, it might help. Also cough suppressants such as Tessalon Pearls, help some people. Hope it subsides.

Dr. Tom

 

Shortness of Breath
Q. About a month ago I took a spirometry test during a doctor visit.  I had been experiencing SOB (shortness of breath) for some months even though I stopped smoking in January.  I thought my breathing would have gotten better by then so I was concerned. 

She gave me a breathing treatment and said I had COPD and gave me a prescription for Combivent.  I saw a Pulmonologist 2 weeks later (for sleep issues) and they did another test with before and after values.  My before and (after treatment) values were:

FVC             =85.37% (90.95%)
FEV 1.0       =83.42% (89.01%)
FEV1/FVC   =97.71% (97.87%)
PEF             =48.11% (55.46%)
FEF25-75%  =72.63% (86.64%)

I am a 44 year old female and smoked for 30 years most of them more than a pack a day.  I am also at least 80 lbs overweight.  I was told I had “small airway disease” and was given Advair and Spiriva. 

I haven't really noticed any difference after 3 weeks.  What should I do?  Should I ask for a CT Scan and blood gas work? 

I'm trying to educate myself on this disease but one day I get good information and the next day I read bad information.  How should I handle this disease?

Suzanne

A. Dear Suzanne, Your spirometry results are normal. Forget the FEF 25-75%. This test is misleading, and does not necessarily mean small airways disease, like many doctors were taught. Once we get the wrong information in textbooks, it is hard to remove it. 

Try to exercise more and lose weight. You will feel better.

Dr. Tom

 

Are Medications Causing Pain and Weakness?
Q. I take Spiriva, Foradil, folic acid, Lovastatin, Furosemide, Diovan, Klor-Con, and Albuterol as needed.  For the past six months, I have experienced pain, and a weakening in both elbow areas.  These areas are sore to the touch, and simple things like opening jars have become a problem.  Can the medications be causing this? 

Thanks for your help. 

A. Dear Tom, These pains and soreness are not from your medications. They suggest arthritis. Better see a doctor that deals with arthritis, such as an internist, or rheumatologist.

Dr. Tom

                

Grandson has Cystic Fibrosis (CF) and Needs Treatment for Excessive Mucus
Q. Dr.Tom, My grandson is 20 years old he has CF. Lots of mucus in lungs. Any ideas?

Tom

A. Dear Frank, Mucus is a big problem with CF. He should see a CF specialist. He may need to inhale antibiotics, such as tobramycin, or have anti-inflammatory treatment.

Dr. Tom

 

Trouble Keeping BiPap Mask On
Q. I have been diagnosed with mitochondrial myopathy (a group of neuromuscular diseases), which has affected my respiratory muscles confirmed by PFT’s (Pulmonary Function Tests) - very low MIP (maximal inspiratory pressure), MEP (maximal expiratory pressure), MVV (maximum voluntary ventilation).

I also have asthma and am currently on Advair and albuterol PRN (use as needed). My pulmonologist has put me on a BiPap (a machine that aids with oxygenation and ventilation) at night with 14/4 settings. I am having a terrible time getting used to the BiPap.

I can go to sleep with it on but will take it off in about 2 hrs without me even realizing until morning. My BiPap keeps up with how long I wear it and that is how I know I take it off . I don't know what to do about it with me being unaware of when I take it off.

Do you have any suggestions? I am at a loss as what to do.

Also, do you know if there is any exercises I can do to strengthen my respiratory muscles. It frightens me that this is a progressive type disease and could potentially end up with further decline of my respiratory muscle strength. Thanks for your help. I have enjoyed your site and have found it useful. Have a blessed day.

Linda

A. Dear Linda, Keeping the BiPap mask on is a challenge. There are different types of masks. You need an experienced respiratory therapist or doctor that deals with BiPap every day to help you. I do not have much personal experience with BiPap.

Dr. Tom

 

Question about Bronchiectasis and Spirometry Results
Q. Hello Dr. Tom, I was diagnosed with bronchiectasis (abnormal destruction and widening of the large airways) and later on was tested further and found out I also have Cilia Immotile Syndrome (rare genetic birth defect that causes abnormal or absent movement of the cilia).

I'm 49 years old, 5ft, weight 128lbs and have never smoked. I did have lung infection all my life since I was very young. 

Recently I had Lung function test done (Flow test, Test mode "FRONTLINE"). 

Anyway my test results

FEV1 35% Predicted

Best
Predicted
% Predicted
FVC (L)
1.6
3.2
51
FEV1 (L)
.9
2.6
35
FEV/FVC
55
80
68

What is normal and is this something I should be concern? My peak flow usually is about 300 on a good day and on bad days is about 210 -250.

Mary

A. Dear Mary, These spirometry results are consistent with your immotile ciliary condition. You need aggressive antibiotic treatment for each flare up of lung infection. This is the best way to prevent disease progression. 

Dr. Tom

 

Question about Pulmonary Function Test (PFT) Result
Q. I received a report (PFT) from my physician. There is something on this report I do not understand and the physician was unable to explain it to me in a way that I can understand. 

It appears to be generated from the machine that did the test after analyzing the results.   While I am 63 years old it is says my lung age is 98.  How is this number derived and what does it mean?  I cannot find this term in the books I have read or on the internet.  Thank You.

Renita

A. Dear Renita, Lung age is that age when your measured lung function would be normal. This means that your lung function values are below what is expected for normal persons of your age or sex.

Dr. Tom

 

Worried about Dad’s Illness
Q. Hi. My dad has just been told he is seriously ill with chronic heart failure and COPD. He is 55yrs old and also has pneumonia.

He has also been told he will not work again. Do you think he will have a good quality of life when he returns home from hospital? Is he going to die from this and if so is there a time frame in which deterioration starts to speed up? Thank you.

Siobhan

A. Dear Siobhan, It is not possible for me to answer your questions, since I do not have enough information about your dad. Knowing how severe is his COPD by measurements, his oxygen level, and the nature of his heart disease would help.

Better ask his pulmonologist about this. If he is not seeing a pulmonologist, get a referral.

Dr. Tom

 

Hate Having a Tracheostomy
Q. I had open-heart surgery and pneumonia back in December 2004, and from that was intubated on three occasions, where they ruptured my windpipe.

I had surgery for a trach (tracheotomy is a surgical opening into the trachea, windpipe). The trach mostly fell out after 6 months, so I removed it. I had it out for about a week, then went back to the doctor, who put it right back in, in his office. He then performed surgery to put in a "button" (tube that holds the tracheotomy open). He made the hole too large, and surgically inserted another trach. 

I HATE having a trach in my neck.  My question is:  Will this trach be permanent, how can you tell if its permanent, what can I do to prevent it being permanent?  I am a 40-year smoker, but am trying to quit. 

Syilla

A. Dear Syilla, Your tracheostomy site, called a stoma or mouth, can heal at any time that the button is removed. I assume that you have no tracheal damage that will require a permanent trach. Your doctor, or a consultant will be better able to decide what is best for you than I can with this limited information.

Dr. Tom

 

Would Mother Benefit from CPAP
Q. Hi Dr. Tom, My Mother has emphysema and sleep apnea. Would CPAP (a machine that aids with oxygenation and ventilation) be beneficial to her at bedtime? She currently wears her regular nasal cannula (used to deliver oxygen) when she sleeps.

Many thanks.

Tina

A. Dear Tina, CPAP can help with sleep apnea, when it is associated with COPD. 

Dr. Tom

               

Simple Chronic Bronchitis
Q. I have some questions regarding Simple Chronic Bronchitis and Chronic Bronchitis.

Is this always diagnosed by History?
Is there a test that will confirm this diagnosis? (My Bronchoscopy was Normal)
Is there a Specific Pattern that will be seen on Spirometry?
Is it progressive?

I have searched the web high and low looking for detailed information on the course of Simple Chronic Bronchitis. Maybe you might post a link when I can find more info on this topic.

Thank you for your good work.

Matt

A. Dear Matt, Simple chronic bronchitis, is diagnosed by history. There is no airflow obstruction with simple chronic bronchitis. It usually is cured by stopping smoking.

Dr. Tom

 

Could Spiriva be the Cause of Spasmodic Cough?
Q. I am taking Spiriva 18mcg (one millionth, 1/1,000,000, gram) notice coughing seems very dry & having spasmodic coughing could this be result of Spiriva?

Diane

A. Dear Diane, Sprivia should reduce coughing. Maybe you are having an unusual reaction. I suggest stopping the Sprivia for a week to see if the cough subsides. If so, then start it again and see if the cough returns. This should settle the issue.

Dr. Tom

 

Can Bush Killer Spray Cause Damage to the Lungs?
Q. Dr Tom, A friend of mind has emphysema, FEV1 of 34%. About four weeks ago she was having problems with her sinus.

The thing I am worried about is one day a man was spraying bush killer in the woods next door. My friend did not know about the spray until he came real close to her house and she smelled it. She went to see what he was spraying but by that time she had already been breathing the fumes for about 30 minutes.

Later on that day, she said her sinuses got worse, she had a funny taste in her mouth, and eyes were burning, so she bathed real well. The next day her eyes were red and shestill was tasting something bad and not feeling well.

She called her doctor and went to see him and told him what happened. He said she had a bad sinus infection and gave her antibiotics for 10 days. Ten days later, she was not better and went back to the doctor.

He gave her 10 more days of antibiotics and 20mgs of prednisone for 7 days. She got feeling better but was having to do the nebulizer treatments 4 or 5 times a day to breathe good.

What I am wondering is, could the bush killer hurt her lungs and will she never breathe better? Is there anything we can do to find this out?

Edna

A. Dear Edna, It could be that the spray was irritating. It should not cause permanent damage.

Dr. Tom                 

 

Are Kidney Cysts Something to Worry About?
Q. I was told that I have kidney cysts but that is nothing to worry about. What are kidney cysts and are they harmless?

Henrietta

A. Dear Henrietta, Many people have one or more kidney cysts. These are developmental in nature. Not a problem in most cases. When the kidneys are literally full of cysts, called polycystic kidney disease, this is a hereditary disease that often needs treatment.

Dr. Tom

 

What is the Truth About Oxygen?
Q. My uncle with severe asthma was on albuterol and was growing more winded and dizzy. His doctor took him off of the regimen and put him on oxygen only at night.  He now feels better than he has in years.  Is this a proven method? 

My mother-in-law has been to three doctors, none of which will prescribe oxygen.  They say it makes the lungs weak and dependent.  

Jane

A. Dear Jane, Oxygen does not make the lungs weak and dependent. Your doctors should know better.

Nighttime oxygen may be correcting an oxygen deficit during sleep. Nighttime oxygen is best prescribed following studies of breathing and oxygenation during sleeping.

Dr. Tom

 

Wife Quit Smoking but Husband Still Worried About Her Overall Health
Q. My wife recently gave up smoking. She is 31 and smoked 20/30 a day for 18 years. I wanted her to visit her doctor to make sure all was well. My grandmother died from emphysema. She refuses.

She has no cough but I see her at odd times trying to get a deep breath.

A nurse friend of ours recently did office spirometry with a handheld for her and her results were:
FEV1 3.54L = 104%
FVC 4.92 = 126%
PEF was 555
She is 170cm.

The thing that concerns me was her FEV1/FVC was hovering between 71 and 72% on different blows. Is this a cause for concern?

John

A. Dear John, Your wife's lung function is normal. The FEV1/FVC is normally 70%. Good that she quit smoking before any lung damage took place.

Dr. Tom

                

CPT’s (Current Procedural Treatment Codes)
Q. In establishing charges for the methacholine challenge test (a method to assess airway responsiveness), do you recommend using CPT (Current Procedural Treatment, is a method of identifying procedures and corresponding charges) 95070 or 94070? How do you distinguish between these two charges?

Julie

A. Dear Julie, I do not have the billing codebook before me, so I cannot answer your question.

Dr. Tom

 

Is Melting Plastic Harmful to Your Lungs?
Q. I was wondering if there are any long-term medical problems associated with the melting of plastic?  I was washing a plastic sports bottle in the dishwasher and it fell on top of the heating element.  The house filled with smoke and fumes before I realized where it was coming from, but I noticed that it irritated me quite a bit. 

I know the fumes can't be good, but Poison Control said that they weren't toxic.  Can you please tell me if I have anything to worry about?  Thanks!

Melissa

A. Dear Melissa, These fumes from hot plastic were probably irritating. This type of casual exposure will not cause problems. 

Dr. Tom           

 

Are There Psychological Side Effects of COPD
Q. My Sister, who is only 51, is living in Assisted Living. She has COPD, and constantly is calling 911 saying she can't breath.

She is also very depressed, anxious, and nervous. She has frequent panic attacks. She came out of the hospital today, and four hours later is in the ER. The nurse at the assisted living center said her oxygen was 83%, when the Ambulance came. The hospital is saying she's crazy and is thinking of sending her to a psychiatric nursing home.

Aren't her symptoms common for a COPD Patient? Where can I get a better pulmonary doctor? Need help ASAP!

Nancy

A. Dear Nancy, Psychological problems are common with COPD. These include anxiety, depression, preoccupations with body functions, and sometimes, panic attacks. Pulmonologists usually understand this and these symptoms generally respond to counseling. Panic attacks can be treated with drugs, directed by your doctor.

Psychological problems do not cause an oxygen saturation of 83%. This requires treatment. 

Dr. Tom

Is There Anything Else That Can be Done for My Dad?
Q. My dad has interstitial lung disease as a result of radiation treatment, when he had lymph node cancer about five years ago.  His disease didn't show itself until last year but the last few months, the increased fibrosis has occurred in his lungs, making breathing almost impossible. 

He is on oxygen and has been ruled out as a transplant candidate by just about everybody we have talked to.  He also has some damage to his esophagus, so he also coughs almost always. 

My mother listens to him cough and gag every night. I guess I just want to know if there is anything more that could be done for him, even if it is risky or experimental.  On his present course he won't be with us long at all.  Have we exhausted our options? 

He did make a trip to the National Jewish Medical and Research Center in Denver and they told us that the disease was so far advanced that there wasn't much they could do for him, other than put him on oxygen and try to make him more comfortable. 

Last year he looked and acted normal, today he can barely move.  What do we do? We feel utterly helpless, and he is losing what makes his life valuable.

Russell

A. Dear Russell, I do not have enough information to give you a good answer. He has been to an excellent medical center that understands lung diseases in general. I am sure they tried corticosteroids that are often used in radiation-induced lung and esophageal damage.

Other medications can suppress his cough and make him more comfortable.

Dr. Tom

 

Could Parrot be the Cause of Repeating Pneumonia?
Q. My mother gets pneumonia almost every year about the same period of the year, for over 20 years. Each time she goes to hospital, gets the antibiotics and the disease is over, but it comes back after about a year. 

It came back stronger this year so we decided to work harder to find the cause. We had parrots who died from breathing problems very close to the period when the disease first came out, however, we hadn't had another parrot since then.

Do you have an idea for the cause to this chronic disease? 

Shimi

A. Dear Shimi, Parrots can carry an organism that causes pneumonia, and can be the source of allergic reactions in the lungs. But with the parrot out of the house, you will need another explanation for the pneumonias.

Dr. Tom

 

Rapid Decline in Lung Health
Q. In March 2005 I was roller-skating, lawn mowing, and power-walking. In April 2005 I noticed I was getting SOB (short of breath) walking to the mailbox. I was a smoker at the time - sometimes 1/2 pack a day sometime less. It is August 2005 and now I am on oxygen 3 liters at rest and 6 liters at activity. I am getting ready to start rehabilitation.

My 8 year old is worried. And, due to needing insurance for me, my husband didn't get a job he wanted. I had to quit mine in June. 

Biopsy said: panacinar emphysema - NOT Alpha-1 (Alpha-1 Antitrypsin Deficiency Emphysema also known as "genetic" or "inherited" emphysema) but doctors say they believe it’s genes because my lungs look good other than at the very bottom.

I handmade crafts this past Christmas for gifts using spray adhesive and glossy sealers - could that have caused my breathing to go so bad so fast. FEV1 - May 1.1 June .900 Aug .800 Will any natural herbs help? Please give me any information you can—my doctor is stumped. I come from a small family and we are running thin on hope recently. Please help.

Vicki

A. Dear Vicki, You certainly need an explanation for your complex problem. I would have to have answers to many more questions than space allows, to give you a reasonable answer. If emphysema runs in your family, you may have this and not have the Alpha One abnormality.

I doubt if the adhesive material you used at home caused the problem. You should be going to an experienced pulmonologist to help sort this out.

Keep in touch and let me know what happens.

Dr. Tom

 

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