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Archive: Dr. Tom 48
Posted January 26th, 2006

Worried Mom
Q. Dear Dr Tom, My daughter was diagnosed with Tracheomalacia at birth.  No tests were run but they said it should clear up at age two.  She has also had reflux since two months.  My daughter is now twenty months and it is still not gone.  She seemed to be getting better but now it seems like the wheeze is more phlegmy, especially after she eats and at night before bed.  She sleeps fine and wakes up great. 

Should I be worried about CF or some other condition??  She has two different wheezes--one when she exerts herself, scared, excited and one after meals.  Can you put my worried over analyzing mothers mind at rest. Thanks for you time and knowledge.

Kirsten

A. Dear Kirsten, I do not know the extent or evidence of Tracheomalacia in your child. Also I am not a pediatrician. CF is not likely, but easy to test for. It would put your mind at ease. Also, I have great confidence in nature's wisdom and healing processes. She will probably improve with age and be normal.

Dr. Tom

 

Struggling with End of Life Decisions
Q. I have exacerbated COPD am on oxygen and nebulizers. I also have blockages in femoral and carotid arteries, peripheral neuropathy, CAD (Coronary Artery Disease), degenerative disc disease, history of angioplasty and on and on.

I lay in bed on oxygen gasping for breaths. I am on prednisone, blood pressure meds, also Lasix and potassium due to CHF (Congestive Heart Failure). Also last month I was in the hospital and was informed I did not have gallstones but my gallbladder does not work (hope it doesn’t get gangrene).

I live in a small town with a band-aid hospital; I am a widow and only have Medicare. Tell me why, with COPD I am on Lortab 10, 40mg oxycontin every 23 hours, Xanax, sleeping pills and on and on.

I am in so much pain, but it is either breathe or suffer. I know I am dying and I want some quality of life, when is it time to make a choice for yourself to be pain free as much as possible and deal with it? Thanks you for your very limited and precious time.

Brenda

A. Dear Brenda, You should have a doctor who puts pain relief as your top priority. You are already getting significant amount pain medications, yet since your pain is not being controlled, ask your doctor about oral morphine and do not be concerned about the warnings of "depressing respiration". When respiration begins to decrease from either the progression of disease or its treatment, carbon dioxide begins to build up. This is pleasant since carbon dioxide acts like a narcotic. It should not be of concern if this happens.

Although carbon dioxide buildup may herald death, it is also compatible with months even a few years of comfortable life. An old physician knew this fact and called it ‘sleep therapy’. I have observed this in many of my patients and have written articles about it.

You should look forward to each day for what it brings, and remain optimistic.

Dr. Tom

 

Ionic Air Cleaners
Q. Dr. Tom, I have asthma and have been thinking about buying an ionic air cleaner. I understand that they produce ozone, but their literature states that it is safe to use. Will this device and the ozone it produces affect my asthma?

Sharon

A. Dear Sharon, Ionic air cleaners take out dust.  That's about all. They do not produce ozone. They claim to remove it.

Dr. Tom

 

Wake Up Gasping for Air
Q. Dr. Tom, I have pulmonary sarcoidosis (a disease of unknown cause in which inflammation occurs in the lymph nodes, lungs, liver, eyes, skin, or other tissues) and I recently concluded a year of prednisone treatment, after which I started having this problem with sleep.

I have been forced awake gasping for air shortly after falling asleep several times a night, for the past month and a half. First thought that everyone has is sleep apnea but it occurs in the non-REM stage, within the first 10-15 minutes of falling asleep, I get a shock in my chest waking me up and gasp for air. I do not snore as well.

Do you know what could be causing this? Could it be related to my sarcoidosis? My general physician says that its just anxiety, but he says everything is anxiety, he even told me my sarcoidosis was anxiety before I had an X-Ray. Thank you.

Jeremy  

A. Dear Jeremy, Sarcoidosis can affect the upper air passages. You may need bronchoscopy (is a diagnostic procedure where a doctor uses a scope (a tube with a camera on the end) to take a look at the inside of the airways and lungs,lung tissue biopsies, can be obtained during a bronchoscopy). Consult a pulmonologist.

Dr. Tom

 

Questions about Lung Tests
Q. Can you explain what a Loring Bronschosopy is and an Airway CT Scan?

Thelma

A. Dear Thelma, I have not heard about Loring Bronchoscopy. Airways can be seen on CT. I do not believe there is a specific airway scan. What is the source of your information?

Dr. Tom

 

Best Place to Live for Mother who has COPD
Q. Hello, My mother has COPD and moved from Orlando April 1st to live with me in Seattle.  Since moving here she has had 2 bouts of pneumonia—one that caused her to be intubated (a tube into the windpipe, trachea, to open the airway to administer oxygen, medication, or anesthesia.

Her pulmonologist has suggested that living here might not be the best choice given her disease.  I'm sure the wetness and mold has not helped her, so I would like to know if there are better states in which to live when a person has COPD.  My sister lives in Wilmington, N.C and wants mom to come live with her there. Any help would be so greatly appreciated. Is there an actual ranking of states for the best breathing environment?  Thanks.

Susan

A. Dear Susan, In general a dry environment is best and at a low altitude. Gulf of Mexico is popular and other dry areas.

Dr. Tom

 

Increasing Need to use Inhalers
Q. I'm 22 years old and I know that I supposedly have had asthma all my life but I have never had a problem with it. I was starting to think that I didn't even have it anymore. I never used an inhaler even when I was sick and never even thought about asthma.

I smoked cigarettes for about 8 years and I quit about a year ago. It seems like ever since I've quit I've noticed I've had to use an inhaler maybe once a week but it keep’s increasing to where I am having to take medicine every day for it. It is very frustrating and upsetting to think this is the way my life is going to be when it used to be so normal. 

I was wondering if maybe my lungs repairing themselves are making my asthma worse or if it is just my asthma becoming more prevalent as I grow older?

Amy

A. Dear Amy, It could be the latter. You need complete control of your asthma. Some drugs, to treat asthma, are preventive in nature. See a pulmonologist.

Dr. Tom

 

Increased Phlegm since Using Spiriva
Q. Dr Lewis recently put me on Spiriva for my COPD. I find I can breathe much easier but I cough a lot more and more phlegm is noticed. I feel I must get off the Spiriva about every 5 days to lessen the phlegm. 

Is that a normal thing for Spiriva? What would you recommend?

Leo

A. Dear Leo, This is very unusual for Spiriva. I guess you had better try to get along without it, since this is not Spiriva desired effect.

Dr. Tom

 

Dad has been on Ventilator for Three Weeks and My Sisters and I Need Guidance
Q. Dear Dr Tom, My father has been in a Denver hospital since the middle of December.  He has had a bad cough for over a year.  They have had him on a ventilator for about 3 weeks before they put a trach  (tracheostomy tube) in him.  He has been sedated this whole time.  They say he has ARDS (is a life-threatening condition in which inflammation of the lungs and accumulation of fluid in the air sacs, alveoli, leads to low blood oxygen level) but they are not for sure.  They say he is healthy expect for his lungs.  He has had 4 different Doctors from the Denver Pulmonary Clinic look at him and they cannot agree on the same things. 

Two of the doctors would like to do a second biopsy on dad, which would mean putting a 2" to 4" cut in his side with a tube going into his lung. But another Dr says he is not strong enough to under go the operation.  The first biopsy was done by going down his throat and they found out that he has 3 different types of mold in his lungs. 

My sisters and I feel that he should have the second to see what types of mold there is. Is there ever going to be a good time for this or should they wait until he is stronger if he gets stronger.  It’s been a month and a half now and he doesn't seem to be getting any better to me.  Is there something that they are over looking?

Julie

A. Dear Julie You better follow your doctor's advice on this. I understand that there may be conflicting opinions. Denver has excellent lung doctors. Follow their advice.

Dr. Tom

 

Ventilator Settings for Patient with Adult Respiratory Distress Syndrome. (ARDS)
Q. Hi Dr. Tom, Could you tell me what the ventilator settings are for a patient with ARDS (is a life-threatening condition in which inflammation of the lungs and accumulation of fluid in the air sacs, alveoli, leads to low blood oxygen level). I am learning about it and I can't find what the normal settings are for a man who weight is about 160lb.  Thank you

Cindy

A. Dear Cindy, This is entirely dependent on the patient and the overall clinical situation. There is no recipe.

Dr. Tom

 

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