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Archive: Dr. Tom 34
Posted September 29th, 2005

Thanks for the Advice
Q. Dear Dr. Tom, Thanks for the response about my mother's sudden weight loss due to end stage emphysema, I bought her Ensure supplement and she has gained 4 lbs. in a week!

Thank-you again so much, for the good advice. Take care,

JoJo

A. Dear JoJo, Glad to be of help. Also have your mom eat frequent small meals with high calorie food. Avocado, chocolate, anything that tastes good to her that she may have once avoided. Now is the time to take on those calories.

Dr. Tom

JoJo's Question from 09/12/05:
Weight Loss and Emphysema
Q. Hello Dr. Tom, My Mom has "end stage"(hate that term) emphysema and is losing so much weight. As of the last 6 months, she is down to 85lbs. from 105lbs a year ago.

I have been told this is the end due to this sudden weight loss. Is that true? Her breathing was worse but after a round of prednisone she is breathing easier but must use her oxygen at night.

JoJo

A. Dear JoJo, Weigh loss is common in advanced emphysema. Your mom should eat high calorie foods, and frequently. Take food supplements, such as Ensure, if she does not eat much at mealtime.

She may be better using oxgyen all of the time. She can still have a good quality of life, if she eats, exercises, such as walking a little twice a day probably with oxygen and gets good sleep at night.

Dr. Tom

 

Upper Chest Discomfort
Q. Dr. tom my question is kind of hard to describe but I'll try. I have been having upper chest discomfort more to the right side but centered that radiates to my upper back. It feels like it goes from one side to the other. I feel fatigued as if I had over pushed my body which I didn't do any thing strenuous. It comes and goes in its intensity.

I have had this going on for 3 days now and have had similar symptoms in the past, which occurred close to my onset of my period.

I am only 36 years old; I have a history of anemia, acid reflux, gastritis, and fibromyalgia. My confusion is what is the cause and how I can get relief from the discomfort.

Christine

A. Dear Christine, This is a difficult one to analyze. I would have to speculate.

Since it is related to your periods, I think of endometriosis, of the lining of the lung. Endometriosis is when some of the uterine lining tissue gets displaced elsewhere, and the lungs are one site. Since endometrial deposits of the pleura, which is the lining membrane of the lungs, contains pain fibers, this is a possibility. If this idea is correct, the pain should subside as your periods finish.

Dr. Tom

 

Questions about Spirometry Results
Q. Hi Dr. Tom, I hope the fishing went well, good photo. We missed you. I recently visited my pulmonologist and local hospital for my yearly check up and they did some spiromerty, I generally have an FEV1 of 4.65L

On the first attempt I blew really hard and could nearly feel my airways collapse. The noise I made performing this was something like a Moose! The result was 4.15L.

Then, I blew hard but used less effort and hit 4.56 L. this was more like it.

My FVC is around 6L.

What is going on here? Why does this happen. Is it a normal physical thing or caused by diseased lungs typical of COPD.

By the way I have Asthmatic Bronchitis, which is under observation. My pulmonologist feels the bronchitis part will go away in time!

Thanks.

Larry

A. Dear Larry, By forcing out so hard, you actually collapse the main air passages of your lungs, this make the sound. You proved this by not trying quite so hard.

Stay well, and I will also plan some more fishing.

Dr. Tom

 

Is it Asthma or Something Else?
Q. Dr. Tom, Is it asthma or something else?

I have had the following tests, multiple lung function test which results ranged from 80% - 100% of predict values, on asthma medications, MCT (Methacholine Challenge, a test that can identify people with “sensitive” airways, often used to diagnosis asthma) - which I started coughing after the 3rd "breathing treatment" but didn't hit the 20% reduction until the last amount but required 8 puffs of albuterol to get back to starting value but continue to cough for the rest of the day.

Bronchoscopy (is a diagnostic procedure where a doctor uses a scope to take a look at the inside of the airways and lungs) showed a large amount of inflammation in right lung and small amount of inflammation in left lung. All lab work came back within normal limits.

I am currently on Advair 500/50 bid, Pulmicort Resp 0.50 bid, Xopenex 1.25 QID, and theophylline 200mg BID, Allegra 180mg, and Singulair. I have required multiple courses of oral steroids just this year only being able to stay off of them for 6 weeks or less. Multiple ER, and two hospital visits.

Last lung doctor doesn't believe it is asthma but didn’t have an answer for my symptoms. The doctor took me off of Spirivia and the Advair figuring the difficulty with shortness of breath, coughing, and chest tightness was caused by all the medications.

I restarted Advair and hope to stay off of steroids for longer periods approved by Primary Care, looking at past history with better control when on the medication. Have been treated as if I have GERD (Gastroesophageal Reflux Disease) and allergy proofing has been done to best of ability.

What else could it be and what do I ask, when I visit a new doctor? Thanks for any help.

B.

A. Dear B., This could still be asthma, I am impressed with the cough you developed with the methacholine. But you should not need so much medication over the long term.

Better get a very experienced pulmonologist to help sort this out.

Dr. Tom

 

Questions about Foradil
Q. What are the side effects of Foradil? Any side effects relating to skin?

Bonnie

A. Dear Bonnie, Foradil is a bronchodilator in the Beta agonist group. Usual side effects are some mild hand tremor, and occasional palpitations. Not serious. No skin side effects.

Dr. Tom

 

Interstitial Pulmonary Fibrosis
Q. My husband is in the throws of IPF (Interstitial Pulmonary Fibrosis) and is on 6 liters of oxygen. How long is the length of this illness. I have been told around 5 years.

Beverly

A. Dear Beverly, This is an average. If it is truly the idiopathic interstitial pulmonary fibrosis, this tends to be a progressive disease. Other types of tissue injury respond better to therapy. Today there is a vigorous search for new drugs for the treatment of interstitial pulmonary fibrosis, IPF.

Dr. Tom    

 

Always Tired and Trouble Breathing
Q. I am always tired, so I went to the doctor and had blood work done. The usual, everything was ok. So what now? What can or must I do to find an answer?

I have noticed that I have to make myself breathe at times even in the waking hours. What is wrong? I just exhale and wait to see if I will breathe on my own. Help!!

S

A. Dear S, Your doctor should begin by measuring your lung function, by simple spirometry to see if lung disease is the root of the problem. You need a diagnosis.

Dr. Tom

 

Questions about TB and Smoking
Q. 1. What does it mean when you don't have TB but are a carrier of the germ?

2. People told me that when I quit smoking I would cough up a lot of gunk. I never did. Is that good or bad? It has been 6 months.

Sarah

A. Dear Sarah, If a skin test for TB is positive, i.e. shows inflammation, and hardness at the needle site, just indicates that at some time in your life, you probably did contact the TB germ. Your body most often controls this and the TB does not cause disease. You cannot infect anyone.

Great that you stopped smoking. You did not have a lot of inflammation from smoking, so there is no excess mucus to cough up. This is good.

Dr. Tom

 

Where can I Find a Percusser cursor?
Q. Where can I purchase this $40+ Gem. percusser for bronchiectais to pneumonia?

Dr. Harold

A. Dear Dr. Harold, You must be referring to a percusser, a mechanical device that helps clap your chest to help encourage the movement of mucus. Try a medical equipment store. I don't think the price is as low as $40. I could be wrong.

Dr. Tom

 

 

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