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Archive: Dr. Tom 54
Posted March 9th, 2006

Can Spot Seen on Chest X-Ray be Pneumonia?
Q. My mother who is 64 years old has recently gone to the doctor due to falling on ice. She has heart trouble and pleurisy (an inflammation of the pleura, the lining of the lungs, causing pain). They did a chest x-ray and said that she had a mass. They also said that there’s something on the lower left lung and on the upper right lung. They also did a cat scan and then changed the mass to “spots.” She had a skin test done on Friday and the results came back negative today.

They have given her an antibiotic in case the spots are from pneumonia. They said the spots would be gone in seven days if it was pneumonia so in seven days, from the first day, they will do another chest x-ray to see if the spots are still there.

What else could this be? She has been having to sleep sitting up due to the pain in her chest, but taking the antibiotic she says her chest isn’t hurting with every breath anymore. Do you think the spots are caused by something that the antibiotic is going to take care of?

Jennifer

A. Dear Jennifer, The spots need to be followed closely. They could be a variety of things, both benign and malignant. If there is a growing spot or mass, it needs to be biopsied.

Dr. Tom

 

Lots of Testing
Q. Please excuse the length of this email question. Basic history: smoker for 33 years and have been diagnosed with right lower lobe pneumonia on September 2004; recovered and quit smoking then August 2005 had bouts with recurrent bronchitis and one episode asthmatic bronchitis; ever since have been SOB (Short of Breath) at times.  I walk treadmill 3 x 1 1/2 hr with no problem; saw pulmonologist September 2005 for persistent SOB and recurrent infection.

I had spirometry (see: National Lung Health Educatoin Program, NLHEP; http://www.nlhep.org/spirom1.html). All results were considered to be normal. I had chest x-ray read as normal by a radiologist and pulmonologist (a physician who specializes in the diagnosis and treatment of lung disease). Pulmonologist feels I had some hyperinflation with some scarring and fibrosis. 

I do not understand how the radiologist can read normal chest x-ray and the pulmonologist sees it another way.  Anyway, the pulmonologist put me on Advair 2x day. It seems to help but I still get SOB with chest tightness at times and I use Combivent prn (as needed).  I am very confused, if I have what are apparently normal tests:  spirometry, lung volumes, diffusion capacity, and arterial blood gases (this test is performed by collecting a sample of blood from an artery and is used measure the pH, acidity, oxygen content, and carbon dioxide content of the blood).

Do I have COPD despite apparently normal spirometry? I am rather confused and the pulmonologist cannot seem to give me an answer.

PFT results as follows:

Initial PFT results
FVC: 125 % predicted
FEV1 109%
FEV1/FVC  87%
FEF 64%
FEF max 148%
MET pre drug 1.12 

PFT after inhaling a bronchodilator
FVC 124% predicted
FEV1 110% post
FEV1/FVC 89%
FEF 72 %
FEF max 143%
MET  1.00

Thank you for any in put you can give me.  I love your Internet site, very insightful and helpful. 

Michele

A. Dear Michele, You do not have COPD. You may have a problem with small airways, suggested by one of your tests. You could have exercise-induced asthma (get asthma symptoms during exercise) and be normal between events. Stay with your pulmonologist for future developments.

Dr. Tom

 

Could Loss of Taste be a Side Effect of Drug?
Q. I have lost my sense of taste. It's most frustrating, to say the least! Someone suggested that it maybe a side effect of Flovent, which I've been taking for many years. Do you know if this is a possibility? If so, is it reversible if I go off the Flovent? Do you know if Symbicort would have the same side effect?

Suri

A. Dear Suri, I suppose this could be the answer. I have not heard of this side effect from Advair. Or it could be from sinusitis. I do not know if this is a side effect of Symbicort. I doubt it.

Dr. Tom

 

Cold or Hot Climate for Emphysema
Q. Does climate matter when you have emphysema...Would Florida be better than being in a cold climate?

Elaine

A. Dear Elaine, In general warm climates are better for COPD.

Dr. Tom

 

Nitric Oxide
Q. I want to know if there are any studies or guidelines about using Nitric Oxide (NO) on non-intubated (a term that refers to a tube that is placed into the trachea to keep airway open and can be connected to a mechanical ventilator) patients.

Tariq

A. Dear Tariq, I do not know of them. NO has been used in research, with mixed results. I doubt if there are guidelines.

Dr. Tom

 

Should I see a Pulmonologist
Q. I am 70 years old and have COPD.  Should I see a pulmonologist instead of my internal medicine doctor?  Also, I'm on Combivent. I smoke and have tried to quit many times.  I’ve tried the patch, hypnosis etc. to no avail. 

Shirley

A. Dear Shirley, Yes, the pulmonologist will have more experience in dealing with you problem. You MUST find a way to stop smoking.

Dr. Tom

 

Air Space Disease?
Q. I am a respiratory therapist and recently a radiologist has been identifying “air space disease” on chest x-rays of patients who have COPD and even a few who don't.  This is the first time I have heard of it and several nurses are asking me to explain it.  I haven't a clue.  Are you familiar with this description and could you explain it to me, so I can explain it to them?

Sarah

 A. Dear Sarah, This is a vague designation, that does not have much specific meaning.

Dr. Tom

 

Have Pain in Back, is this a Sign of Lung Cancer
Q. For the last few weeks I have had pain in my back, under my shoulder blades. Sometimes it is on the right and sometimes the left. It feels like it is deep inside. I do not have to be moving for this to happen. I was worried because my Mom had been a heavy smoker and I was exposed to it for 20 years. I don't know if this could be a symptom for lung cancer.

Norma

A. Dear Norma, I doubt if this is a symptom of lung cancer, but if you remain concerned, see a pulmonologist and get a CT scan, or at least a chest x-ray.

Dr. Tom           

                    

Can Drugs Cause Hair Loss?
Q. Since June I notice my hair is getting thin. I have been trying to figure out what can be causing it. In June my doctor changed my sugar diabetes pills to Avandia and Glucotrol and also I started on Spiriva.

Spiriva did not help me so I discontinued and stood with my Combivent which I have been using for at least four years and had no hair loss. I am also using Cozaar for high blood pressure and have been using that for quite a few years. Can these new drugs be causing hair loss?

Marie

A. Dear Marie, I do not know a mechanism that would explain hair loss from these drugs.

Dr. Tom

 

Where to Live with COPD
Q. What part of U.S. is best for COPD?  

Jim

A. Dear Jim, Wherever you are comfortable and have friends. Best is a low altitude and a mild dry climate.

Dr. Tom

 

Does Over–Inflated Lung Mean COPD?
Q. I was diagnosed with COPD about a month ago. I am 39 years old. I do not have many symptoms. My doctor said my lungs were over–inflated. I have requested other test to confirm COPD; he said that was not necessary.

I quit smoking 37 days ago. The oxygen in my blood was checked a couple days ago and was 100%. Should I go for a second opinion on the diagnosies on COPD? Could it have been a mistake? I have been on three inhalers (Spiriva, Advair, albuterol) for about four years, always believed it was for asthma. Please help me figure out where I should go from here.

Gina 

A. Dear Gina, Hyperinflation does not mean COPD. It just means you can take a large breath. If you feel well, forget the follow-up.

Dr. Tom

 

Supplemental Oxygen and COPD
Q. I have heard that there are concerns with the administration of 100% oxygen to a hypercapnic  (excessive CO2 in the blood stream) COPD patient, that they may actually quit breathing.  Is this true and if so, why?

Travis

A. Dear Travis, This is not true. This is an old misconception. It was once argued that giving supplemental oxygen would stop the “drive to breathe,” which normally is stimulated when oxygen levels are low. This is not what happens when you take supplemental oxygen, even with chronic CO2 retention.

Dr. Tom

 

I Exercise but Spirometry Results Indicate COPD
Q. I'm 78 years old and I swim about 30 laps in a 50-meter Olympic pool every day without experiencing any shortness of breath. My spirometry results tells my pulmonologist that I have COPD or even emphysema.

I do on occasion experience some shortness of breath when walking some distance or climbing a couple of flights of stairs. What do you think?

Art

A. Dear Art, I think it is more likely that you have a degree of exercise-related asthma. You don't get this while swimming due to the humidity. Inhaled bronchodilators can be used to prevent exercise-induced asthma. Tell your doctor about this idea of mine and see what he says.

Dr. Tom

 

Feeling Ill Could this be a Side Effects of a Drug?
Q. I have recently been diagnosed with high blood pressure and put onto Diovan.  The side effect I am experiencing are pins and needles, extremely ill feeling and painful kidneys. Could this be as a result of the medication. Should I see my GP (general practitioner doctor who treats a variety of medical problems in patients of all ages)?

Valenta

A. Dear Valenta, Better to see an internist who will have more experience in this area.

Dr. Tom

 

Questions about PET Scan
Q. In October 2005 my father (COPD & emphysema) had triple by-pass surgery, went great, followed by lung surgery five days later for many blebs (air or fluid filled sac in lungs).  He had a full body PET Scan (Positron Emission Tomography a test often used to detect cancer) which was "intensely PET positive - w/SUV of 7.” 

However his surgeon feels this could be a false positive PET scan and this is a result of post-operative changes.  I do trust his surgeon, as he's the only one that's actually seen dad's lung.  He wants to wait 2 months before taking another chest x-ray... too much radiation for now.  Could this PET scan be a false positive and could these changes really be post-operative changes?

Linda

A. Dear Linda, They could be due to the inflammation of surgery, but if intensely positive, this may not be the answer. Better have the follow-up as your doctor suggests. Two months won't matter if you are dealing with a malignancy.

Dr. Tom

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