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Archive: Dr. Tom 46
Posted January 10th, 2006

Checking FEV1
Q. I have a Pico-1 to check my FEV1 but I can't get a percentage.  It reads 160, how do I change that into a percentage?

Ione

A. Dear Ione, 160 sounds like peak flow. It tracks FEV1 but does not equate to it. There are prediction values for peak flow that are based on age, sex and height.

Dr. Tom

 

Name of a Non-prescription Mucomyst
Q. I suffer from usual interstitial pneumonia. My doctor suggests non-prescription Mucomyst tablets. We are unable to find the nonprescription drug they are supposed to be using it in Europe. 

Diana

A. Dear Diana, This is acetylcysteine, which is available over the counter.

Dr. Tom

 

Follow-Up Report on Tracheomalacia
Q. I have written to you before telling you about having Tracheoplasty in Boston because I had Tracheomalacia.  Now I have Bronchomalagia and my Pulmonologist says nothing can be done for it.  I have had my yearly physical and I'm in perfect health except for my lungs.  I would like a lung transplant but both Pulmonologist and family Dr. say I'm too old.  I'm 71 yrs old.  I want to do so much with my family but have difficulty breathing.  Is there a hospital and Dr. who would do a transplant on me at my age?  I hate the thought of being housebound.

Thank you for you help.

Thelma

A. Dear Thelma, It is possible that stents could be placed in some major airways to help keep them open. Keep positive.

Dr. Tom                      

Click here to view Previous Q & A with Thelma

Previous Q & A with Thelma from September 9, 2005

Follow-Up From Thelma Regarding Her Tracheomalacia Care
Q. I wrote to you 3 times telling you that I had Tracheomalacia and was going to Boston, Beth Israel Hospital for a Polyethylene stent to be put in. When I went in April and the stent was put in, I could not tolerate it and had difficult breathing.

Luckily, the Thoracic Surgeon who could perform the Tracheoplasty was there. I ended up staying in 3 ICU's, at one having a heart fibrillation where CPR was done. Later found out they broke 3 of my ribs in the process.

I then went to You Ville Rehab Center and in total from April to June stayed 66 days. I just thought you should know the results.

Thelma

A. Dear Thelma, God bless you, Thelma, you have courage. Thanks for the follow-up and keep on dealing with your difficult problem. You are in good hands, and you will get better.

Dr. Tom

70 yr. woman with Tracheomalacia
Q. I am a 70 yr. old woman who has moderate emphysema but just recently my pulmonologist did do a bronchoscope and found that I had Tracheomalacia (usually found in babies.) He sent me to a specialist who seems to be stalling as he told me to go to a gastroenterologist, which I did and he did an endoscopy. Everything was fine. This specialist wants to do another bronchoscopy so he can see for himself how far down the Tracheomalacia goes. All I want is for him to put a stent in to keep the trach open so I can breathe. It is quite difficult to breathe when I shower, dress or exert myself. I have oxygen but that does not help as much as my nebulizer containing Albuterol and Ipratropium. I think the Albuterol relaxes the Trach. Is it possible for you to tell me more about Tracheomalacia in adults and what should be done and if the specialist won’t put a stent in, where can I go to have someone correct this problem? I’m getting close to being housebound. Thank you for whatever information you can give me.

Thelma

A. Dear Thelma, Tracheomalacia is a weakening of the supporting structure of the trachea (cartilage). It comes from inflammation and forceful coughing in some people with COPD. Stenting is the treatment. You need to find a pulmonologist who is experienced in stenting. Ask your pulmonologist to refer you to a doctor, pulmonologist or thoracic surgeon who is experienced in placing stents.

Dr. Tom

Tracheomalacia
Q. I sent you a question about Tracheomalacia and I did see a pulmonologist in regard to putting a stent in. Unfortunately I am allergic to the nickel in the stent.

He is going to ask the manufacturer if a non-metal stent could be made. Do you know of any stents that are not metal?

Thelma

A. Dear Thelma, Sorry, I do not know of a nonmetal stent. There are other ways to deal with trachealmalacia.

Sometimes removing the loose tissue in the back of the trachea is helpful. Check with your experts in Boston on this.

Dr Tom

Tracheal Stent
Q. Do you know of anyone who has Tracheomalacia and have had a stent put in? I want to know what they feel? Do they have trouble eating, cough or gag causing the stent to move?

Thelma

A. I have had patients with stents and tracheal procedures known as tracheoplasty. Only very experienced surgeons should do these procedures. They may help some, not all persons with this rare disorder.

Dr. Tom

 

Lots of Tests yet Still Have Questions
Q. Hi Dr. Tom, For the past 7 months, I have been suffering from chest pain, shortness of breath, and a cough with some days being better than others.  A year prior to this I had a bad case of pneumonia, which took several months to resolve. 

At that time a high resolution CT scan was done: showing mild bronchiectasis in RML and RLL.

This was also accompanied by sinusitis, which has now been resolved (as shown on a recent CT scan).

The doctors have done endless tests on me: stress echocardiogram, lung scan, CT angiogram, bronchoscopy, all kinds of blood tests (including D-dimer, a blood test that can help to identify blood clots), etc. 

The only things different or abnormal are the following:
1) Pulmonary function test showing air trapping in July 2005, which was not present in the March 2004 tests.

2004 2005
TLC
87%
122%
RV
105%
206%

FEV1 is usually around 89%.

 2) Positive perfusion scan (but negative for pulmonary emboli).  Non-homogeneous defects in both lungs with neither segmentary nor sub-segmentary perfusion defects.  No ventilation scan was performed.

3) Echocardiogram showing tricuspid valve regurgitation (estimated systolic pulmonary pressure of 28).  Previous echocardiograms in 1995, 2001, and 2004 showed no tricuspid valve regurgitation and so no pulmonary pressure was estimated.

Do you think there is any connection between these findings?  Do they separately or together have any significance?

Thanks in advance for your attention.

Sue

A. Dear Sue, Your test does show trapping. This fits with either asthma or COPD. Your tricuspid insufficiency is not described as mild, moderate, or severe. Your pulmonary pressures are only slightly elevated and of no concern. Are you seeing a pulmonologist?

Dr. Tom

 

Questions about Breathing Troubles and Possibility of Asthma
Q. Dr Tom, I've been diagnosed with Myasthenia Gravis (neuromuscular disorder characterized by variable weakness of voluntary muscles, which often improves with rest and worsens with activity, it is caused by an abnormal immune response) Rheumatoid Arthritis (an usually chronic disease that is considered an autoimmune disease and is characterized especially by pain, stiffness, inflammation, swelling, and sometimes destruction of joints), and localized scleroderma (a usually slowly progressive disease marked by the deposition of fibrous connective tissue in the skin and often in internal organs and structures).

After having energy swings and breathing problems, I was sent to have a methacholine challenge test (a test that can identify people with “sensitive” airways, often used to diagnosis asthma), but my highest at that time was 36% lung vol. and they said they couldn't do it. I have variable symptoms when the breathing gets worse (usually). Wouldn't this eliminate in itself asthma, as a related problem? My voice changes a lot of the time along with breathing troubles.            

Randy

A. Dear Randy, This may well be asthma, or”asthma equivalent". Are you seeing a pulmonologist?

Dr Tom

 

Asthma and Shortness of Breath with Exercise
Q. I have asthma and always feel so short of breath that it is making me feel like sleeping all the time.  I have no energy.  I pass all the breathing tests and stress test.  But my biggest concern that caused me to go to the doctor in the first place was shortness of breath during exertion.  Just walking sometimes. 

My heart rate goes so fast that I have to stop and can't do aerobic workouts and also feel dizzy and nauseous.  I haven't had an Allergist or Pulmonologist actively see how I react to working out. I use my albuterol before (usually in the locker room before I work out). 

Anyway, I feel like I'm going to faint a lot and also get pale.  I know this is probably asthma, but I'm not sure what else to do about it.  I've been told to just take Advair and albuterol 1 hour before.  I'm concerned because I'm always still out of breath.  Maybe just out of shape that bad that I can't work out?  People recognizing me being out of breath embarrasess me.  Any ideas on what I can do at this point?

Miss

A. Dear Miss, You really need a diagnosis from an expert pulmonologist. Much of your problem may simply be lack of physical fitness.

Dr. Tom

 

Looking for a Honest Answer
Q. Dear Dr. Tom, It is very important to me to get an honest answer to my question: My man friend is on oxygen therapy for approximately 18 hours/day and has to take puffers also. He wants to break up with me, saying that he has a bad heart and he does think that I cannot cope with that. Is this a cop-out or would he be true in his statement?

Please tell me, I need to know. My friend had to quit his job, as he was inhaling fibers from some kind of upholstery stuffing and is now on disability.

Can someone really develop a bad heart after a while?

Your answer will be very much appreciated. Also, he cannot perform like he wants to in having sex. Would this be because of the oxygen treatment?

Thank you for your answer.

Renate

A. Dear Renate, It is likely that your friend does have heart trouble along with his presumed COPD. You need a solid diagnosis from a doctor about his status. Your personal relationship is between you two. Many people with heart and lung disease can have lasting and meaningful relationships.  Heart and lung disease often cause sexual dysfunction, for which there is treatment.

Dr. Tom

 

Concerned about Shortness of Breath
Q. Dear Dr. Tom, I am 43-year-old woman, I have just quit smoking 3 months ago, after about 22 yrs about a pack a day! I think I was short of breath on exertion for a few years before quitting, but I really felt short of breath before quitting.

I went for PFT (Pulmonary Function Test) and 5mm CT Scan, an Echo (Echocardiogram, is a non-invasive method for evaluating the structure and function of the heart) and resting and exercise stress! I also went to a second pulmo (pulmonologist) to get second opinion. Both said PFT's were normal and CT scan showed tiny blebs on left lung apex (non-specific) both said probably from smoking. But not the cause of my symptoms. They feel it is anxiety related!

I' am baffled by this, it isn't like my regular short of breath its like hard to, then breathing out fully helps, (but my pft's do not indicate COPD (Chronic Obstructive Lung Disease) at all?? It doesn't happen if I am on exercise bike or after I start walking?? What is your opinion on hyperventilation syndrome, and do you believe that this could be anxiety related and could therapy help?? Please respond....Denise

Denise

A. Dear Denise, Since your shortness of breath does not happen with bicycle exercise or walking, I strongly suspect anxiety and hyperventilation. You should keep exercising. Remember, your heart and lung function are normal.

Dr. Tom

 

Pulse Oximeter Accuracy and Useage
Q. Dr. Tom, Perhaps you can answer a question a few of us from a forum have been discussing and debating about Pulse Oximeters and accuracy/inaccuracy.

Many people with COPD (emphysema in the mix) use them when exercising (plus Rehab centres use them for the folks when exercising). However; I'm of the opinion that the numbers can't be trusted if you have the big "E" since one has a tendency to retain Co2 and the oximeter can't distinguish oxygen from carbon dioxide.

In my opinion the only true way to find out is with an ABG test but that test isn't done each Rehab visit. So why use the pulse ox?

Under the circumstances, and unless I'm incorrect; I see no point in their usage.

Could/would you please clarify this?

Many Thanks

Jackie

A. Dear Jackie, A pulse oxymeter measures oxygen saturation fairly accurately, It is not affected by CO2. No need for arterial blood gasses for titrating oxygen levels while exercising.

Dr.  Tom

 

Worried About Baby’s Respiratory Problems
Q. My daughter was very healthy until she was 6 months old. Since then (she is 12months now), she has been sick constantly, mostly respiratory problems that last 3weeks or longer. She has thick green sticky mucus, and she is very congested (in the morning especially). She has constant diaper rash problems because she poops A LOT. She is on the smaller side, but not significantly underweight.

The doctor doesn’t seem too concerned. However, I am very worried. The thick sticky green mucus makes me think she may have CF. Do you think it is possible that she has CF and hasn’t been diagnosed at age 12 months?

Meg

A. Dear Meg,  CF is a possibility.  Your baby should be checked for it.

Dr. Tom 

 

Worried about 6 Year-Old’s Constant Cough
Q. I have three children who have DiGeorge Syndrome (is a rare congenital, i.e. present at birth, disease whose symptoms vary greatly between individuals but commonly include a history of recurrent infection, heart defects, and characteristic facial features).  My oldest has a cough all the time I have had him in to DR in Fargo, we go to Merit Care, they said he doesn't have Asthma but this keeps happening he has a dry hard cough almost like a barking dog cough he is 6. 

I don't know if I should take him in for a second opinion.  This has been on going for last 3 months I have taken him to his pediatrician also.  Any advise on what to do? He wakes up several times a night. I have a humidifier going all the time.  We are from MN.

Thank you.

Lisa

A. Dear Lisa, Your question is beyond my expertise. I recommend further consultation.

Dr. Tom

 

Role of Chlamydia Pneumoniae and Myrcoplasma Pneumoniae in Cause of Asthma
Q. Dr Tom: What are your feelings on Chlamydia Pneumoniae and Mycoplasma Pneumoniae being the cause of 50% adult onset cases of asthma? What tests would prove if this is the cause and what would be the treatment? Just heard a lot about this lately. Would this cause permanent damage to the lungs or is the damage reversible? Also, would PFT’s show asthma or COPD or normal if you have this infection? Thanks!

Bailey

A. Dear Bailey, Both organisms can precipitate asthma. The proof is by cultures and serologic tests. PFT can be affected or not. I assume smoking is not part of the problem. If it is, stop immediately.

Dr. Tom   

 

Shortness of Breath has Husband Worried about Wife’s Lung Health
Q. My wife will be 54 on Dec. 29, 2005.  She has been diagnosed with longstanding GERD (Gastroesophageal Reflux Disease) which has also progressed to Barrett's esophagus (is a condition in which the esophagus, the muscular tube that carries food and saliva from the mouth to the stomach, changes so that some of its lining is replaced by a type of tissue similar to that normally found in the intestine), with no indication of dysplasia (changes in cell lining).  She also has a frozen vocal cord (over 3 years now, so it's not going to suddenly start working again).

She takes Protonix  40mg (is a "proton pump inhibitor, or PPI, that reduces the amount of acid your stomach produce) twice a day, and Allegra (antihistamine) for allergies.

She coughs terribly especially at night, but during the day too.  It's an awful cough.  Her voice has changed drastically.  She has shortness of breath, although she works out at the health club 2-3 times a week.  She has a hiatal hernia (is a condition in which a portion of the stomach protrudes upward into the chest through an opening in the diaphragm) and just completed a heart stress test, with no findings other than the observation that she "seemed short of breath like someone out of shape". 

That's what worries me.  She lifts weights, and swims at the health club, and is very strong for her size.  How could she be out of shape?  Her shortness of breath is noticed by her friends, myself, and just today talking to her boss at work, he mentioned it.

I don't know if her coughing is related to the GERD, the allergies, the frozen vocal cord possibly exacerbated by sinus drainage or undetected esophageal cancer or lung carcinoma.

The gastroenterologists don't seem to be willing to answer questions.  They just tell her to keep taking her protonix.  Her physician, is really a physician's assistant, but in reality she seems to care more for my wife than other doctors have.

I just lost an old cat (20-22 years old) that was seriously misdiagnosed 4 months ago by the local vet.  I just returned from a business trip Dec. 16, and within 2 minutes of arriving home, the cat collapsed and we had to rush her to the emergency pet hospital.  Heart murmur, hyperthyroidism, high blood pressure, rapid heart beat, palpitated shriveled up kidneys and advance renal failure.  We had to put her down.  Since the vet seriously misdiagnosed the cat, now I am serious about addressing my wife's longstanding problems and ensuring that she has not also been seriously misdiagnosed.

I have a great deal more understanding of medicine and the medical arena than your typical layperson, having been in implantable medical devices for 30+ years. I don't trust the local doctor's, some of which strike me as no better than mere charlatans.

If you would render your considered opinion, which I hereby release you from any liability, I just need to hear what you would do or think I should do at this point to try and rule out the plethora of conditions that might be contributing or causing her ailments.

Thank you very much in advance for your time and consideration.

Roger

A. Dear Roger, What your wife needs is a diagnosis. Her shortness of breath needs explanation. What are her spirometry results, and oxygen levels during rest and exercise? Does she have an undiagnosed heart problem? Is there another cause for her shortness of breath? Ask both a pulmonologist and cardiologist these questions and get straight answers.

Dr. Tom

 

Concerning Questions about Care of Pneumonia Patient
Q. Is the environment a patient is housed in regards to construction dust, etc. not a cause for concern on the patient's behalf?  Can dust from construction (from remodeling or upgrading) inside a care facility housing elderly patients with respiratory problems (such as pneumonia) or cause the patient to have a relapse of pneumonia? Or is dust not a cause at all for pneumonia relapses?

  • What does it mean when a pneumonia patient has yeast in her lungs?
  • Is it normal for a pneumonia patient to be hospitalized for over 4 months with 3 of those months in ICU?
  • If this patient has been given every antibiotic possible shouldn't one of those antibiotics cure the pnemonia, or is pneumonia not curable?
  • Are the results from the cultures taken from a bronchoscopy an important factor to determining or pinpointing to the cause of the infection?
  • Should ventilator patients be housed in the same room? 
  • Is it possible that a patient who has never had seizures before, and is dropped on her head by a care facility, cause the patient to have a seizure within 24 hours of the drop.
  • When the facility rushes the patient to the hospital due to her seizure, should the facility notify the hospital of this drop?

I would so much appreciate a straight and honest answer as common sense tells me these questions I've asked are important to looking out for proper intermediate and after care in a case with a patient battling pnemuonia.  Thank you.

Andrea

A. Dear Andrea, You have so many questions, I cannot give you simple answers. I doubt that transient exposure to dust during reconstruction has precipitated pneumonia. Dusts in general are irritating. Most bacterial pneumonias can be effectively treated with antibiotics. I cannot comment on your other questions, because they are too general or I do not have enough information.

Dr. Tom

 

Have Questions about Lungs after You Quit Smoking
Q. Hi Dr Tom, I am a 21 year-old student from the UK. Over the past few years at university I have been smoking (3 years). Up until 12 months ago I was smoking around 10 cigarettes on average each day. When I quit smoking cigarettes, I started smoking more marijuana, for the last year I have probably shared 3-5 marijuana joints every other day (probably 1 whole one to myself a day on average).

Two weeks ago I stopped smoking altogether, as I have become increasingly aware of the self-destructive nature of my behavior. A week after quitting I have been experiencing some chest pains (lower and upper right and upper left). The pain is not severe, more of an awareness or a discomfort. Until earlier today I have not been coughing much at all (no mucus), although today I have been bringing up mucus specked with brown dots which I assume is the build up of tar in my lungs? These have been making me very anxious and stressed, as I have been reading online about all the diseases associated with smoking.

I have been to see my local doctor, but I did not mention it was marijuana (and not cigarettes) that I had been smoking. He suggested it was most likely musculoskeletal pain, and was unable to offer anything other than a beta-blocker for my anxiety.

I have a few questions I am hoping you might answer for me:

  • What is the likelihood that I have got something seriously wrong with me? In short, is my life in danger?
  • Do 21 year olds die as a result of smoking?
  • Could this pain be my lung’s recovering after quitting?
  • When I have been trying to sleep at night, over the last few days, I have worked myself up into a bit of a panic, is it possible my stress has been contributing to the pains I am feeling?

The only thing I do know, is that one way or another, I’m never going to be smoking again.

Any response you can send me would be greatly appreciated, I am a bit of a mess at the moment and don’t have anyone I can talk to about all this.

James  

A. Dear James, Marijuana is very irritating to the lungs. Worse than tobacco. At age 21, you will stay healthy if you simply follow good health habits. The chest pain is most likely muscular due to coughing. Get on the ball and stay well. Good health and your youth are your most important assets.

Dr. Tom

 

Lack of Ear Wax
Q. What causes ears to stop producing wax and what can be done to treat the dry itchy ears?

Rochelle

A. Dear Rochelle, I don’t know. I suggest you see an ear doctor about this.

Dr. Tom

 

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