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Archive: Dr. Tom 47
Posted January 23rd, 2006

Need Help with Science Project
Q. My name is Matthew.  I am in 5th grade and I have asthma.  My Pa-pa died recently with ARDS and a heart attack.  He was in the MICU for 22 days.  They used a lot of different machines on him.  He was on a ventilator and Bi-Pap machine.  When he died, they used a defibrillator on him. 

I would like to do a project for our science fair about how those machines work.  I thought about making a model of the lungs with balloon and a squeeze bottle of some sort.  I also thought about using some type of electricity to ‘shock’ Jell-O.  I am not sure how to go about it.  Do you have any suggestions about where to find information?  Thank you.

Matthew

A. Dear Matthew, I am sorry about your loss.
It is not easy to show how ventilators, like BiPap work. One idea would be to take two small elastic finger covers, called a “finger cot”, which you can get at a drug store. They are like the fingers of rubber gloves. Then tie them to a “Y” tube, which you can possibly get from a druggist. The "fingers" then act like lungs, if you blow on them. Or you could use a large syringe, such as 20cc to blow them up together. This causes the pressure to inflate the balloons, like the lungs.

I would not recommend shocking jelly with an electric current. You might shock yourself. Good luck with your project.

Dr. Tom

 

Son had Cardiac Arrest due to Pneumonia
Q. Dear Dr. Tom, my son went into cardiac arrest at 11 days old due to pneumonia fortunately he was able to be revived and is fairly healthy now, except he makes a rattling sound when he breathes often.  His pediatrician prescribed Pulmicort twice daily.  What does this all mean?  Does he have the early signs of asthma?  Also will there be any permanent effects due to the pneumonia?  Any advice or suggestions you have will be greatly appreciated.

Stephanie

A. Dear Stephanie, Your will have to ask your pediatrician the purpose of Pulmicort. I doubt this is asthma at such an early age. There should be no problems from the pneumonia. Your child should be healthy. DR Tom

 

Is Weight Gain a Side Effect of Advair?
Q. I'm told I have C.O.P.D. - mild. I quit smoking after 47 years on Oct l9, 2005. I was given Spiriva to take and I wasn't noticing any difference. I am now taking Advair. Since Oct l9, 2005 I have gained l5 pounds but I am not eating anymore than normal. Are there steroids in Spiriva that would be putting this extra weight on me? Are there steroids in Advair?      

Barb

A.  Dear Barb, Advair contains a small amount of steroids. It is not causing your weight gain. Your metabolism has probably dropped some, since you wisely stopped smoking. You will have to exercise more and reduce calories. This is far better than progressive lung damage from smoking. 

Dr. Tom

 

Jitters and Prednisone
Q. Am on Prednisone 40 mg. for 4 days, 30 mg. for 4 days, 20 mg. for 4 days then 10 mg. for 4 days.  Do the jitters lessen as the dosage lessens? 

Gerre

A. Dear Gerre, Yes, the jitters should reduce with lower doses of prednisone. You did not tell me what it is for, but I assume you will not have to stay on it.

Dr. Tom

 

Home Oxygen Wants to Know Side Effects and Safety of Oxygen
Q. I have been on an oxygen concentrator for 3months, started at 3% and after several stays in the hospital I am now at 5%, but have become extremely hoarse, is this due to the high rate of oxygen and is it dangerous percent? 

Dewey

A. Dear Dewey, You are probably on 3 liters per minute or 5 liters per minute. Not percent. The concentrator makes about 92% oxygen. It is safe to take these liter flows for the long term.

Dr. Tom

                                  

How is COPD Diagnosed?
Q. I am a 40 year old with a positive smoking history and SOB on exertion. I have two questions; first, do I have early stage COPD just from the info I have provided? Second, which test would be most useful in confirming the diagnosis of early COPD, spirometry (e.g. FEV1) or pulse oximetry?

Dave

A. Dear Dave, Do the spirometry. It will tell you about airflow and air volume, and whether or not you are normal. Pulse oximetry is not diagnostic of COPD. There are many causes of a deficiency of oxygen, and you can have significant COPD and still be normally oxygenated.

Dr. Tom

 

Nodules Seen on CT Scan
Q. I recently had to have a CT test because of breast cancer. The report states that I have nodules in both lungs.  I was given a PET scan next. The nodules were not large enough to show activity. I will be given another CT scan next month. 

Are nodules usually cancerous? What if they remain the same size? Is that conclusive evidence that I have nothing abnormal in my lungs?

Jackie

A. Dear Jackie, Nodules are usually non cancerous. With a history of breast cancer, the chance of nodules being malignant increases. Have them checked for growth, in about three months. One month is too soon. Small cancers do not show up on PET.

Dr. Tom

 

Side Effects of a Tracheostomy
Q. What are the Side affects of Tracheostomy?

Cody

A. Dear Cody, They may be as simple as a healed scar after the trcheostomy closes, or narrowing of the air passage at the site of the tracheostomy. Sometimes there is bleeding when the tracheostomy is in place. Ask your doctor about your particular situation.

Dr. Tom

 

Would Moving to Higher Altitude Help Mother?
Q. Hi Dr Tom, My mother has probable emphysema and has great difficulty breathing. Even walking very short distances, she has to stop frequently to catch her breath. She lives at sea level in a climate of fairly high humidity. We want to move her to an inland city around 6 000 feet above sea level with a much drier climate, especially in winter.

Is this going to make her struggle even more to breathe? Is it putting her life more at risk?

Maurice

A. Dear Maurice, If your mother has symptoms from her emphysema at sea level, she will probably be worse at a higher altitude, because of the reduction of oxygen in the air. Get advice from your own doctor.

Dr.. Tom

 

Declining Health
Q. Dear Dr.Tom, I am a 57-year-old woman. I have chronic bronchitis for almost 25 yrs. and have very frequent flare-ups despite my healthy diet and yoga breathing for many years. My CT and spirometry are always normal but my overall health is declining rapidly due to severity of numerous symptoms.

Finally the Dr. found a lot of E. coli (strain of the bacterium in my sputum. I took Bactrim (antibiotic) for a month and got much better, but in two weeks I was sick again. Any suggestion? Do you know if any new treatment available? Doctors I saw don't know what else to do and I am getting desperate.

I live in New York but have a really hard time to find a good pulmonologist who will accept my medical insurance (I have GHI). Hope to hear from you.

Nellie 

A. Dear Nellie, The e-coli may just be in your sputum and not be an infection in the sense of pneumonia. Find a good pulmonologist for your care.

Dr. Tom    

 

What is BOOP?
Q. Dr. Tom, Could you explain to me BOOP (Bronchiolitis Obliterans Organizing Pneumonia) Thank you for your time.

Helen

A. Dear Helen, It is an inflammation of the smallest air passages and surrounding alveoli. Cause is not known, but probably involves immune mechanisms. It often responds to prednisone and other immunosuppressive drugs. You need a pulmonologist to treat this.

Dr. Tom     

 

Question Rationale for Albuterol Prescription for Increased Levels of Potassium
Q. I have an order placed for 10mg Albuterol via neb for increased K levels (potassium).  Where are the residents getting the documentation for this order?  Thank you for your time.

Dana

A. Dear Dana, Albuterol causes a transient movement of potassium into cells thus reducing the serum potassium, which is measured. It does not lower the total body potassium.

Dr. Tom

 

Antidepressants to Curb Side Effects of Quitting Smoking
Q. I’m currently taking Cymbalta (an antidepressant) for depression. I have serious emphysema/ COPD. I'm still smoking and my doctor wrote me a prescription for Wellbutrin SR 100 mg (an antidepressant). Do you think this would hurt me to take both of these drugs? I want to quit smoking and I know Wellbutrin is supposed to help you stop. Thanks for any advice.                    

Tommy

A. Dear Tommy, Welbutrin, also known as Zyban, does help in stopping smoking. I do not know if it can be given with Cymbalta, but I would be cautious. Ask your personal physician.

Dr. Tom          

 

Respiratory Therapist has Questions
Q. I am a Respiratory Therapist and I have 2 questions for you. 1. Can you defibrillate a patient that as a metal tracheostomy tube?   2. How often should inner cannulas be changed? Could you please let me know where I can find literature to back up what needs to be done?

Sara

A. Dear Sara, I haven't seen a metal tracheostomy tube used in the past 25 years. It does not interfere with defibrillation.  

Changes on the inner cannulae are determined by the accumulation of secretions. Can be done as often as needed, but at least once a day to remove the accumulation of secretions between the inner and outer cannulae. Many textbooks of respiratory care give details about tracheostomy care.

Dr. Tom                        

 

Daughter is ‘Sick On and Off’
Q. Dear Dr. Tom, I have a six-year old daughter who gets sick off and on.  She coughs pretty much and suffers from allergies, too.  When she starts to cough she looks and sounds like she is choking and tries to catch a breath.  I've taken her several times to her primary doctor.  The doctor would prescribe the same medication unless there is an infection. 

I've taken her to an allergist and that just made her worst and their medication would make her vomit and nervous.  I've taken her to specialist before and they put her on the nebulizer.  I put her on it at home when I think she needs it even though she doesn't like to use it as much. I just don't know what else to do. It worries me to see her suffer like that.  I am asthmatic, but I'm fine.  Is it true that this is hereditary? Please help us. 

Thank you for your cooperation and I hope to hear from you soon.

Elizabeth

A. Dear Elizabeth, There is a definite hereditary factor in asthma. I believe it is most likely your daughter also has asthma. See a pediatric pulmonologist.

Dr. Tom

 

Can You Scuba Dive if you Have COPD?
Q. I am a 36 year-old female and I was diagnosed with “mild COPD” by one doctor, and RAD (Restrictive Airway Disease) by another.

My spirometry test showed that my “lung age” is 39. I quit smoking in May, and have been working out regularly.  I have noticed a significant increase in lung capacity (although I'm sure I still get more winded than the average bear). 

I would like to SCUBA, but am concerned about the risks with my damaged lungs.  What is your opinion? 

Shannon

A. Dear Shannon, You should be able to scuba dive, even if you have mild emphysema, which has not been proven.

Your lung age is only slightly abnormal, meaning that you have just lost a little lung function for your age. RAD usually refers to “reactive airway disease”, which is a first cousin of asthma.

Dr. Tom

 

Arterial Blood Gas Testing on Room Air
Q. How long should a pt. on nasal O2 actually be off any supplemental O2 before drawing an ABG (Arterial Blood Gases measure the pH, oxygen content, and carbon dioxide content) if the test is asking for a room air test?  Isn't asking for a room air blood gas test on a patient who is on continuous O2 inhumane?

Kathy

A. Dear Kathy, No, it is not inhumane. It does not harm patients to have transient hypoxemia. You must wait at least 20 minutes to wash the supplemental oxygen out of the residual volume, which is elevated in emphysema. Only then will you get a truly room air arterial blood gas.  

Dr. Tom

 

Bad Taste in Mouth
Q. When I exhale with my mouth closed I have a yucky taste in my mouth like very bad breath. I am taking hormones for menopause, which is the only new thing I am taking.  I seem to have more gas than I used to also.

Michelle

A. Dear Michelle, I have no idea about this. Better see a doctor and get a good answer.

Dr. Tom

 

Respiratory Therapy Student has a Question
Q. Dr. Tom I am a respiratory student and was wondering what kind of diseases/illnesses would cause you to use your abdominal muscles when breathing. Thanks.

Desiree

A. Dear Desiree, Abdominal muscles are “accessory respiratory muscles” i.e. not usually used in breathing. They come into play in some states of muscular dystrophy, and are involved in “paradoxical breathing”, an abnormal breathing pattern that is out of sink with the main respiratory efforts, as a manifestation of respiratory muscle fatigue, in some states of respiratory failure.

Dr. Tom

 

Will move Effect my COPD?
Q. I'm moving to Denver Colorado, soon. A pulmonologist l diagnosed me as having COPD. It's true that I experience occasional shortness of breath however I swim about 15 laps in a 50 meter pool almost every day with no trouble breathing. However the Spirometry results did indicate that I was bordering emphysema. I was a moderate smoker in my twenties but quit 50 years ago.

Do you think that moving to mile high cold Denver from humid warm south Florida will hasten the progress of my disease?

Art

A. Dear Art, No. The modest altitude of Denver, like Salt Lake and Albuquerque should not make a difference. We do not have a lot of cold weather. Has often been in the 60s this month, with golfing every day.

Dr. Tom

 

Worried about Wife’s Asthma
Q. Hi Dr. Tom, My wife developed chronic asthma last spring (either moderate or severe.)  She sees an allergist for treatment and uses different medications/inhalers a few times per day.  She becomes basically disabled without them. They are treating her with allergy shots as well. She is 40.

Will she improve and will she suffer lung damage over time?

Thanks very much.

Frank

A. Dear Frank, Her asthma should be able to be controlled and if so, there will not be lasting damage. I do not have much confidence in “shots”, except in a few cases of asthma. Maybe see a pulmonologist.

Dr. Tom

 

Will Allergy to Metals Causes Problems with a Thallium Test
Q. I am 60-year-old female and I have had severe chronic emphysema for many years, my lung capacity tests were very low and no air exchange is heard in lower lungs. For the last year have had chronic asthma.

I also have GERD, osteoporosis, interstitial cystitis, beginning glaucoma, low potassium among other things.

I also am severely allergic to any type of metals, had allergy tests.  I am supposed to have a Thallium stress test with meds to imitate exercise in 2 days. I have low levels of potassium and being allergic to metals, should I be taking this Thallium test?

My regular new doctor is out of town. The nurse practitioner that ordered said nothing and I don't know if I am to abstain from food or medicines.

My medications:

  • Nebulized Albuterol
  • Combivent
  • Spiriva
  • Advair
  • Prednisone
  • Reglan 
  • Duratuss
  • Potassium (for three days)
  • Nexium
  • Evista

Way too many meds I think, but was told I needed them for asthma? 

Also will this Thallium medicine bother the cystitis, as this is very painful especially with all the meds I am on lately?

Another question Please: My father and his father had emphysema. I was tested for Alpha... and it was negative. I cough a lot and have lots of phlegm.  I have had exposure to lots of diesel fumes and shortly thereafter had an endoscopy for reflux about the same time I got bad asthma (a year ago). Could any of this be related?

Also I was exposed to asbestos when I worked in hospital 15 years ago, and again exposed when we moved to this area from soil, was tested but nothing on CT, doctor said it would be many years before it showed up. 

Could this be causing all the asthma? Any suggestions would be appreciated.

Pam

A. Dear Pam, I do not believe that there are any reasons to not do the thallium test, but this should be discussed with your doctor. Asthma and emphysema have familial factors. I do not believe the remote asbestos exposure is significant.

Dr. Tom

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