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Archive: Dr. Tom 55
Posted March 20th, 2006

Coughed up Blood and have Questions about  Chest X-Ray
Q. Four years back I had unusual pneumonia as my LLL (left lower lobe) was affected.

Now four years after I coughed up a bit of blood and went to see my doctor and asked for chest x-ray. Results came back that my lungs are bigger and there is some shading in LLL. Can this be scarring or something more serious? By the way, I am smoker and have just quit after this.

Bob

A. Dear Bob, Better follow up on this. With a smoking history and a chest shadow, there is always the fear of lung cancer. Check with you pulmonologist or get a referral.

Dr. Tom

 

Needs Answer about Lung Nodules
Q. I am a 38 year-old mother of two young boys. I am smoker since the age of 12. My general doctor sent me for a CT Scan of my abdomen. I had a sharp pain under right rib cage, they were looking at my gallbladder. A few days later the CT place called me to come back for a few additional pictures because they saw something at the bottom of my lung. On 06-16-05 they found a right middle lobe nodule that measures 6 mm. My three month follow-up (09-14-05) the nodule measured 9-mm.

They sent me for a PET Scan (Positron Emission Tomography – a test often used to detect cancer) and saw the nodule but no hot spots (malignancies light up as “hot spots” in the image).

Follow-up 12-17-05 Impression: 1. Right middle lobe essentially unchanged when compared to 09-14-05 right hilar adenopathy. 2. Shotty left hilar nodes. 3. New patchy linear changes related to the lingual.

I don’t know what all this means. My doctor has never sat with me and explained what’s going on. Not that I haven’t tired. I had to go for another CT Scan this month on 03-06-06. When should I see a specialist? Where do I start? Should I be worried? Please help.

Melissa

A. Dear Melissa, I suggest seeing a pulmonologist now. These findings need explanation.

Dr. Tom

 

Aches and Pains Now Affecting His Home Life
Q. I am a 35-year old male; about 15 years back I had a sudden elevation in my BP (blood pressure) followed by fatigue everyday. Since then I had sinus infection gradually developed to postnasal drip and finally allergy. I have done extensive blood and urine tests, everything is normal.

Now my main problem is my right throat has been irritated for the last 10 years. I took antibiotics several times, but no use.

I have pain in somewhere in airway to the right lung when I take a deep breath. Feel like mucus membrane is damaged (dry feeling) in my lower right throat. I have recurrent pain in between my right shoulder blade and the spine.

Two years back I did sinus and thorax CT scan and all normal except mucus thickening in maxillary sinus. Recently I had a 45-degree endoscope and doctor prescribed medicines for acid reflux but I don’t think that is my main problem. I never had a bronchoscope.

My other symptoms are fatigue, pain in my shoulders, numbness on my palm, elevated BP, palpitation, headache, unexplained back pain, dry eyes, blocked right nose, dry cough recently started. etc.

No one could diagnose my exact problem.  Now it’s  affecting my family life because I am always thinking about my condition and gloomy.  Any advice highly appreciated.

Nibi

A. Dear Nibi, You have a lot of symptoms that need a diagnosis. I suggest seeing a specialist, such as a pulmonologist, or allergist.

Dr. Tom

 

Questions about Sarcoidosis
Q. Hello, I have pulmonary sarcoidosis (involves inflammation that produces tiny lumps of cells in various organs in your body.) and recently was seen by a pulmonologist who said that I have stable stage III sarcoidosis mild ILD (Interstitial Lung Disease), without adenopathy (large swollen lymph glands). Prior to my visit I was diagnosed with stage II sarcoidosis and that has changed to stage III but he said that my sarcoidosis is stable since the last visit. Wouldn’t the progression from stage II to III show progression of the disease?

Also I’ve been having chest pain and SOB but he said that there is no physiological reason for it by looking at my HRCT (High Resolution CT Scan) and suggests that it is anxiety; although I highly dispute that assessment because it occurs at rest and under no anxiety inducing situations. Having mild ILD without adenopathy couldn’t cause chest pain and SOB?

Jeremy

A. Dear Jeremy, The chest pain is probably not from sarcoidosis. You need spirometry (a test to measure lung function that can be done in a doctor’s office. See: National Lung Health Program NLHP http://www.nlhep.org/spirom1.html ). If abnormal, this may explain your shortness of breath.  HRCT does NOT test lung function!

Dr. Tom

 

How Can You Determine how Severity of Interstitial Pneumonitis? 
Q. I was diagnosed last year with interstitial pneumonitis (a group of disorders characterized by inflammation and eventually scarring of the deep lung tissues) and possible early stages of Pulmonary Fibrosis.

I went on Prednisone, which eliminated all of the coughing, shortness of breath, and low blood oxygen level.  I went on the slow tapering off program. I was off the Prednisone for about a month, and then I started coughing again. I am going to try a small dose to curb that if I can.

I would like to know if it is a good idea to have another CT Scan to see how much it has progressed. I was told a lung biopsy is the only way to tell how far it has progressed. My fear is that there is inflammation in there now that I should be treating. What is your opinion?

Betty

A. Dear Betty,  You should start with lung function testing, by spirometry (a test to measure lung function that can be done in a doctor’s office. See: National Lung Health Program NLHEP http://www.nlhep.org/spirom1.html )  to see about your airflow and air volume. A diffusion test (used to determine how well oxygen passes from the air sacs of the lungs into the blood) is often useful in interstitial pneumonitis.

See a pulmonologist. You should strive to maintain lung function, and if steroids are effective, they should be continued under the direction of your doctor.

Dr. Tom           

   

Need Respiratory Therapy Duties for School Project
Q. I am  trying to get information on Respiratory Therapy. I have to write an essay on duties and responsibilities for a respiratory therapist.

Shawn

A. Dear Shawn, Consult the American Association for Respiratory Care’s website for information on careers in respiratory care. They have a wealth of information about this interesting profession.

Dr. Tom  

 

Just Diagnosed with Severe Emphysema
Q. I was diagnosed yesterday with severe emphysema in my right lung and moderate to severe in my left lung.  I had no symptoms at all and was shocked when I heard the news. I am a heavy smoker but realize I have to stop.

Can I do active exercise?  Will I have to have treatment? A specialist who is doing an examination found emphysema but told me nothing about how it is treated.

I am a bit scared of the future.

Pauline

A. Dear Pauline, Did this “specialist” do lung function testing, i.e. simple spirometry?  The chest x-ray is not a lung function test. Your doctor should know this. Maybe you need to change doctors.

Dr. Tom

 

Worried about Mom
Q. Sir, My mom is suffering from osteoarthritis and psoriasis. She is having a very painful life and she needs to take one painkiller HIFENAC (anti-inflammatory) every day. There is swelling on the affected areas, like ankle and palms. She is taking OSTEOfOS-70 (treatment and prevention of post-menopausal osteoporosis) once a week, FLEXTRA-1500 (muscle relaxant) mg and calcium tablets every day. For psoriasis she is using diavonex cream.

Sir please help and advice some better treatment, she is only 50 years old.    

Sonal

A. Dear Sonal, This is not my area of expertise. I suggest you consult a rheumatologist. He will know about the most appropriate treatment for osteoporosis and psoriasis.

Dr. Tom

 

Strange Fibers and Particles in Home
Q. Four years ago we bought a double wide home and have had problems with white powder dust on everything; around carpet edges, TV, everything, and on our dresser we have tiny fiber like material daily...we own a dyson vacuum cleaner and we sweep up big hand fulls of this gray like material, and powdery substance, plus a sandy material.

The contents were analyzed as cellulose 60%. I have constant sinus infections, and ear problems. My husband coughs and it sounds like a dog barking. Lately, we both have had problems with vertigo and dizziness. My daughter gets severe headaches when she visits too long, plus last week she had vertigo and had to miss work for a night.

We also have water under our home and smell a dirt smell in our bathrooms. We clean sometimes two times a day to keep the dust and dirt down. I am terrified due to breathing in these particles. Any suggestions?

Ruth

A. Dear Ruth, You may have mold under your house that is causing these symptoms. I can’t imagine why you have so much dust. Is there a defect in your house?

Dr. Tom

 

Is There a High Flow Oxygen System for Home Use
Q. Is there a high flow home Oxygen system for someone requiring use of a non-rebreather mask at 15l/m day and nite?

Rudy

A. Dear Rudy, There is one high flow concentrator on the market. I can’t remember its name. Consult your oxygen supplier. This is a very high flow rate, and not achievable by conventional systems. Check with Transtracheal systems of Denver, i.e. DRScoop@aol.com. They know about high flow systems.

Dr. Tom

 

What is a Low Reading on and Oximeter?
Q. What is the reading on pulse oximeter (a machine that measures your oxygenation)  if you have low level of oxygen? 

Pat

A. Dear Pat, Normal oxygen saturation at sea level is 94-97%. In Denver it is 92-94% because of the altitude. Lower at higher levels such as Leadville, CO, elevation 10K feet, where normal is 85%. In general low levels are below 90% at most usual locations.

Dr. Tom

 

Two Different Opinions  on Results of Mother’s Scans
Q. My mom was diagnosed with non-small cell lung cancer. We were told she is a good candidate for a lobectomy (surgical removal of the lobe of the lung). So in October she had her upper left lobe removed. The surgery went well also her recovery. Her follow up with the thoracic surgeon and her oncologist two weeks later both said she was completely clean. Her PET Scan and CT Scan  came back clean. No medication or other treatments were needed just follow ups.

After three months she went for her second follow-up. Chest x-rays showed both her lungs filled with “junk”. She was told she might have gotten a cold and needed to bring up the phlegm. Her pulmonary doctor put her on steroids.

Four days later there was no change in x-rays...now my mom is short of breath and coughing up clear phlegm. The doctor scheduled her for a brochoscopy...have not received results yet but pulmonary doctor thinks it might be a tumor?

How could this be? We were told she was practically cancer free. She was even nominated to model for a fund raiser on behalf of cancer survivors! Could this be some kind of disease or bacteria? Could the cancer come back and invade both lungs in just three months? Both the surgeon and her oncologist do not think it is cancer but her pulmonary does...Very confused and frustrated ...would appreciate any advice you can give.

Monica

A. Dear Monica, I doubt if it is cancer, in such a short time. You need a diagnosis from your pulmonologist. He may well do a bronchoscopy (a diagnostic procedure in which your doctor uses a scope, a tube with a camera on the end, to take a look at the inside of the airways and lungs).

Dr. Tom

 

Any Treatment for Hyperventilation Syndrome
Q. For the past few months, I have been experiencing a series of weird symptoms including dizziness, lump-in-the-throat sensations, and chest pressure (along my breastbone).  I have had every test in the book, from a brain scan to an EKG, all normal. 

Eventually, my primary care doctor diagnosed me with possible hyperventilation syndrome.  I do not have panic attacks, etc., but rather, my ‘over breathing’ is very subtle.  I’ve been told that even subtle changes in breathing patterns can upset my oxygen/C02 (oxygen/carbon dioxide) balance, which can produce strange symptoms.

My question is: Are there any exercises that I can do to “re-set” my breathing?  My GP was at a loss as to this question; he said that there were no exercises that he knew of, because consciously thinking about your breathing can make the problem worse.

Are there really no exercises or treatment for hyperventilation syndrome?  Should I try to see a respiratory therapist?  Thanks in advance for your feedback.

Mia

A. Dear Mia, Shortness of breath from hyperventilation usually is relieved by any exercise, such as walking. Practicing slow breathing with exhalation against pursed lips, as in whistling may help. You will probably get over these symptoms.

Pursed Lip Breathing

Dr. Tom

 

Coughing for Three Months
Q. I am 36 years old. I have had a cough for about three months. This cough seems to be worst after I eat or drink. The cough sometimes will clear for a couple of days, but comes right back. The cough always starts out as a dry cough and within 30 minutes I start making a rattling sound either in my throat or chest. I am not sure which place the rattling or wheezing is coming from. I also have a milky looking stuff that I have to spit up with my cough. If I lay down or rest for a while the milky stuff comes up in a very long and very thick looking stringy blob of stuff.

I have been to the hospital and been given chest x-rays that were clear. They have said things from maybe allergies and I was given Zyrtec 10 mg. The Zyrtec didn’t work. I was told another time maybe I had bronchitis.

I went back to the hospital and took some of the stuff to show them. They said they couldn’t believe I spit it up. They made me feel as if I was crazy. I think they didn’t know what in the world I had been spitting up. They said they would do a test on it to see if it contained a  bacteria and they would let me know if it did. They said I needed to be seen by a pulmonologist.

I don’t have any insurance and will not be able to see one for a while. I was wondering if maybe you could shed some light on what may be happening to me. I have been in pretty good health. I have not had any pain and I am not running any fever. I have been getting around-100 percent oxygen. I do smoke though. I am working on quitting now.

Kimberly

A. Dear Kimberly, This is most likely heavy mucus from smoking. Key to getting better is stopping all smoking. I realize this is difficult, but you have to do it. Cold turkey method is best. Nicotine gum may help.

If this continues you need to see a pulmonologist even if you do not have insurance. You will have a lot more money when you finally stop smoking. Good luck.

Dr. Tom

 

Asthma Medication Question
Q. My daughter who is nine years old now has suffered from asthma since she was four and a half years old. She has been using steroid injections, antibiotics, antihistamines. Now for the last two years using salbutamol and steroid inhalations. But when I discontinue its use her asthma becomes worse.

Now for the last two weeks I am giving montelukast ( also known as Singular, it is a  control or maintenance drug for the treatment of  asthma) 5 mg. daily in the evening, she shows some relief. Now. I am worried about the side effects of steroids, as it may be the cause of stunted growth, reduced immunity etc. I also wanted to know the side effect of long-term use of montelukast sodium.

Which medication will be good for her?  Both the parents have history of asthma.  Please reply me.

Hasi

A. Dear Hasi, This asthma has to be controlled, not matter what drug it takes. Uncontrolled asthma will stunt growth. Inhaled steroids  will not have much if any effect on growth, and growth will be encouraged by controlling the asthma.

Montelukast is a safe drug, but I do not know about long term side effects, particularly in children. I am sure that controlling the asthma is the top priority.

Dr. Tom

 

Chewing Tobacco and COPD
Q. Does chewing tobacco make my COPD worse? 

TJ

A. Dear TJ, No, but it will often cause severe problems in your mouth. Better stop this too. DR Tom

 

Mother had Another Chest X-Ray
Q. Dr. Tom, My mother had another cat scan done and the nurse called and told her that the doctor said it looks like there’s still infection in her lungs and so they put her on another round of antibiotics to see if her lung clears up.  She will have another x-ray in a week from the day she started the second round of antibiotic.

What is the chance of this being pneumonia? Or does this sound like cancer to you? She is feeling much better and she’s not spitting up blood or passing any. I know that is one of the signs of lung cancer.

Jennifer

A. Dear Jennifer, Pneumonia may take weeks to clear. You need a follow up in three months to see if the shadows have resolved. If not, your mom needs further investigation.

Dr. Tom

Click here to read Jennifer’s previous question...

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

 

Warfarin and Severe COPD
Q. Dr. Tom, I work in home health care and have a patient with severe COPD. The internists placed the patient on low dose warfarin (blood thinning drug) therapy. The patient has been on the warfarin for approximately three months with significant results. Lungs clear, no wheezes and patient has been without oxygen therapy for past week. Patient still DOE (Dyspnea, difficulty breathing or breathlessness  On Exertion) and limited activity but improved. Patient is also on bronchodilators, inhalant steroids. However substantial improvement was noted after the warfarin therapy was started.  Can you explain further.........

Bill RN

A. Dear Bill, This is hard to explain, but you cannot argue with success. I do not know the reason why the warfarin was started in the first place. It conceivably could be for pulmonary clots, and if so, this may be the explanation. Good question! 

Dr. Tom

 

Questions about Pediatric Ventilators and Asks for a Source for Employment here in the USA
Q. Hello, I am SGT Little NCOIC of the cardiopulmonary clinic here in Wurzburg Germany.  We are doing a lot of pediatric patients and our machine does not do the predictions for the FEV1 and the FVC and I am unable to find any on the net that work consistently. Can you please email the formula that you use to find these values? 

Also we are closing (the military base) as you know, and I have a soldier here that is interested in coming up there for the sleep lab, he is certified in that and is a CRT.  He is wanting to come up there and talked to a SGT Gray.  Do you know who he is to talk to up there? I really appreciate that time and the help you give us.

SGT. Collin

A. Dear SGT. Collin, I found the following reference in my file that may be useful: Dockery DW, Berkey CS, Ware JH, Speizer FE, Ferris BG: Distribution of forced vital capacity and forced expiratory volume in one second in children 6 to 11 years of age. Am Rev Respir Dis 128:725-734, 1983. I hope this helps.

Dr. Tom

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