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Archive: Dr. Tom 53
Posted February 1st, 2006

Is it All right to Perform Chest Physiotherapy on Person who has Lung Cancer?
Q. Is chest physiotherapy (rhythmic clapping, vibration, and positioning are used to help remove mucus from the lungs) contraindicated in lung cancer?

David

A. Dear David, No, except if there is active hemoptysis (coughing up blood from the lungs) from the cancer. The mucus clearance is necessary when it is not coughed up.

Dr. Tom

 

Extended Hospital Stay has Friend Worried
Q. My cousin had surgery last week and the tube that they inserted I believe in the lungs still bubbling.  The doctor wants open her up to see why it is still bubbling.  It has been two weeks since she had the surgery. 

I would like to know what could have happened because originally the doctor said three to five days she would be in the hospital but now it now has been two weeks.  He did remove 15% of her lungs.  Do you think he made a mistake?  Is the leak his mistake or it is common?

Humaira

A. Dear Humaira, Leaks are common. They generally stop with patience. There is a tube, known as a Heimlich tube, which some doctors use to let people go home, when the leak is prolonged. It avoids the need for the suction machine. Sometimes it takes weeks for the leak to stop. Not often is another surgery necessary, but there are exceptions to this statement.

Dr. Tom

                             

Use of Vaseline and Nasal Cannulas
Q. Is it true that Vaseline can cause the plastic of a nasal cannula to break down and thus produce a spark that could cause a flame?

Katie

A. Dear Katie, No, but do not use Vaseline, because a spark, such as from static electricity, can cause a fire with Vaseline and the tubing igniting. This is not common, but Vaseline and other petroleum products should not be used with oxygen tubing.

Dr. Tom

 

Is Moving from Sea Level Location to a City of 5300 Feet a Problem for People with COPD?
Q. I am 70 and have COPD with lung age of 80 years. I am on Advair and Combivent. I need to move from a city at sea level to a city at 5300 feet. I also use a CPAP machine (Continuous Positive Airway Pressure is a machine that is used to help keep the airways open during sleep).

Would moving to this altitude be advisable or should I look for other sea level areas?

Max

A. Dear Max, In general you will do better at sea level. There is 13% less oxygen at 5300 feet.

Dr. Tom

 

What Does Hyperinflation of Lungs Mean?
Q. I am 48 with moderate COPD. I have 58% FEV1, X-ray results show significant hyperinflation. I feel good with very little shortness of breath and that is mostly due to anxiety, I think. My doctor is not concerned with the x-ray only with how I feel.

Does hyperinflation on an x-ray mean a worsening of my condition?

58% with hyperinflation
58% with normal x-ray

Would one be worse off than the other in regards to damage and progression?

Wendy

A. Dear Wendy, Hyperinflation on a chest x-ray, just says you can take a deep breath and there is lots of air in the lungs. It does not tell, “How well you can exhale the air”. The 58% FEV1 says that your expiratory capacity is reduced, but not badly so. Do not smoke and avoid all second hand smoke. You can stay healthy.

Dr. Tom

 

Difficulty Breathing and Pain
Q. I am 23 year-old male. I was diagnosed with asthma several years ago.

I recently have had some stomach and abdominal issues. I was prescribed Librax (can be used to treat bowel disorders) and Prilosec (used to treat heartburn). I was on that about a month ago and now I am still having the same issues except I am constipated. I think I have IBS (Irritable Bowel Syndrome a disorder characterized most commonly by cramping, abdominal pain, bloating, constipation, and diarrhea), but the doctor I have been seeing thinks it is a mental disorder. He is a school physician so I don't really trust Purdue all that much. How do I know I have IBS or something else?

Right now feel that I can hardly breath and had some pains under my left armpit. I have a headache with no fever and shooting pains all over specially my lower back and just under my breast mostly on my left side.

I thought of a heart attack when I first felt these pains back in December of last year, but I think I can rule that out since I have had it several times which might just be panic attacks. I am 5'8" and about 200-210LBS. I have had problems going to the bathroom and at time will go three times in a day but I will not be able to go for several days afterward.

I do not use an inhaler, but I am not sure if my asthma has gotten worse to need one? I would like some advise in how to proceed. I plan on going to my home physician if this gets worse.

Alex

A. Dear Alex, You have a lot of symptoms that do not fit into a single diagnosis. Better see another doctor who can make a diagnosis, and get you on the proper program. Don't guess about your health.

Dr. Tom

 

Still Experiencing Pain after Illness in December
Q. Last December (2005) while visiting out of state I became very ill with a serious cough and chest pain. The doctor there took chest x-rays, said I had bronchitis and very irritated intercostal muscles (muscle tissue between two ribs) from coughing.

After returning home, I went to my doctor who prescribed Celebrex (an anti-inflammatory drug). I am on Coumadin (blood thinning medication) and am concerned about taking both of these drugs, as is my pharmacist. 

The chest wall pain travels to my shoulder, back and hip. I am completely exhausted and hurting very much. I am wondering why no one will try prednisone for this.

Bernice

A. Dear Bernice, Prednisone would not be my first thought for the symptoms you have. Better see a doctor who can explain things.  

Celebrex is compatible with Coumadin. Your INR (International Normalized Ratio), which measures your Coumadin activity needs frequent checking with multiple drugs because of possible interactions.

Dr. Tom

 

Memory isn’t 100% after Fall
Q. A year ago I fell hit my head hard.  I still at times, can’t recall words I want to use.  Still my memory isn’t 100 percent, why?

Connie

A. Dear Connie, Something is wrong. Better see a doctor and see if he needs further diagnostic tests, such as a brain scan.

Dr. Tom

 

Lung Collapsed for Second Time, What Should I Do If it Happens a Third Time?
Q. About 15 years ago I had a left lung collapse, it was a Spontaneous Pneumothorax (lung collapse occurs where there is no clear cause). At that time I was 37, they inserted the tube and sent me home. When I came back four days later all was fine and they removed the tube,

So for 15 years I haven't had a problem till the other day, February 23, I woke up fine - the only thing I remember doing was twisting quickly when I was on the bed to get the dog. Then I went in the kitchen to get something to eat - I went to put the bowl down while I was standing and BANG - it hit me - extreme pain on the left side and left side of the chest - I kind of knew what it was because of my vivid memory of 15 years ago.

I went to my regular MD the next day, and they took x-rays and told me it was collapsed, but only about 25% this time. The doctor said I had two choices: either go home and come back in a few days and see if it's going up on it's own, or have the tube put in. I opted to wait.

I will know Tuesday what the new x-rays show. What I don’t understand is 15 years was a long time between the last one. If this were to happen again (I'm 52 now not 37), should I consider the pleurodesis method (a procedure to prevent recurrent fluid build-up between the lung linings), and what are side effects if any?

Cos

A. Dear Cos, Your lung will probably expand on it's own. I would consult a pulmonologist about doing a pleurodesis.

Dr. Tom

 

What are End Stages of Emphysema
Q.
My dad is 80 years old and is struggling with emphysema for many years. What are the ending stages?

Heidi

A. Dear Heidi, This is hard to define. I can imagine that he does have advanced emphysema, since he is struggling with symptoms, but I do not know about “end stage”. Your dad could live a number of years with good treatment. I assume he is on oxygen, but you did not say so. He needs to see a pulmonologist who knows about pulmonary rehabilitation.

Dr. Tom

 

What Should They Ask the Doctor?
Q. A family member went to the hospital for chest pains. She was diagnosed with esophagitis (inflammation of the esophagus) five years ago and appeared to have the typical symptoms with this visit also. She is a smoker.

They found a spot on her lung in an X-Ray and proceeded to do an MRI. The doctor originally said that the spot appeared to be a pulmonary embolism (an abnormal particle (as an air bubble, blood clot) circulating in the blood obstruction of a blood vessel and causes an obstruction in the pulmonary artery, and causes; labored breathing, chest pain, fainting, rapid heart rate, shock, and sometimes death). He later told her that she had pneumonia and said there is no embolism. Other information to mention would be that she is VERY skinny and traveled to California from New Jersey via airplane three days prior to this episode.

Why would there be a spot on her lung from pneumonia? Are there any specific questions we should ask the doctor before her release? Are there any specific tests we should request before her release? Is she o.k. to travel back to New Jersey? What should we make sure is done as a follow up after her release?

Kelly

A. Dear Kelly, Your doctor needs to sit down with you and your sister or other family member and explain all that happened. What is the final diagnosis and prognosis? I cannot tell, from your description. Ask the doctor if she is able to travel.

Dr. Tom

 

All Tests were Negative but still have Tightness in the Chest
Q. While lying down watching TV I began experiencing severe shortness of breath.  My breathlessness left me dizzy. If I stood up, I felt some relief.  After about two hours I began to get nauseated and eventually vomited. The breathlessness seemed to get better as the evening went on. I also felt as if there was a blockage that would not let air in right in the middle of my chest. There was no cough, but my chest felt as if I was coughing for hours. 

In the morning I still was having less severe episodes so I called my primary doctor and was seen “as soon as possible”. She sent me to the ER (Emergency Room) to rule out a PE (pulmonary embolism).  They performed a Spiral CT (a spiral, or helical, CT scan is a new kind of CT that produces three-dimensional images, can detect small abnormal areas, and is faster), Chest x-ray, EKG and various blood tests.  All came back negative for PE.

This is day three and I am still feeling tight in the chest and though it may not be quite as often a little difficulty breathing.  My voice seems to go hoarse on and off as well.  I eat very healthy and exercise regularly with no problem.   Do any of the symptoms I have mentioned cause concern to seek a second opinion?  Could this all be in my head?  Thank you for responding!

Marie

A. Dear Marie, It is good that PE was ruled out. I would seek a second opinion to find out what is wrong.

Dr. Tom

 

Looking for Hospital for Lung Valve Replacement
Q. I am looking for any hospital or clinic doing the Lung/Valve replacement. Can you help?

Norma Rae

A. Dear Norma Rae, Several centers are doing valve placement for localized emphysema. It is not a valve replacement. This is part of a research program sponsored by the National Heart, Lung and Blood Institute. One center is National Jewish in Denver. The NHLBI will have a list of other centers participating in this research program.

Dr. Tom

 

Student Needs Help with Project about Smoking!
Q. I’m doing project about smokers and I would like to ask you some questions.

Why do people smoke?
What really helps them stop smoking?
About what percent of teenagers start smoking?

Yadira

A. Dear Yadira, People start to smoke, often at a young age, because they think it makes them more adult. The companies that make cigarettes continue to promote smoking to kids, even though they deny this.

The best way to quit, is just to completely stop, ‘cold turkey’.

Some kids think that smoking makes them “cool”, smart and other things. This is a big mistake, because addiction to nicotine in tobacco may happen quickly.  Then they are “hooked”; the more you smoke, the more nicotine you need to feel good. Soon, you don't feel "normal" without nicotine this makes it hard to stop.

Bad business. No one should smoke. It is not healthy.

You might want to take a look at these Internet sites; they are written for kids and discuss many issues about smoking and kids.

What kids Say about Tobacco: http://www.kidshealth.org/kid/grow/drugs_alcohol/poll_tobacco.html
Smoking Stinks:
http://www.kidshealth.org/kid/watch/house/smoking.html
Smoking and Asthma: http://www.kidshealth.org/kid/health_problems/allergy/smoking_asthma.html

Dr. Tom

 

Damage due to Lack of Oxygen
Q. How long is it before the lack of oxygen starts to affect the brain?

Margie

A. Dear Margie, Complete lack of oxygen to the brain, such as in cardiac arrest, choking or other sudden interference with oxygen supply to the brain begins in just about 3-4 minutes. This is why resuscitation must take place quickly. 

Dr. Tom

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