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Archive: Dr. Tom 60
Posted April 25th, 2006

Readers: Read Dr. Tom’s Commentary on Spirometry to understand the importance of this diagnostic lung test.

Would Like Help in Understanding CT Scan Results
Q. Is a CT scan impression showed that I have a linear scar or linear atelectasis (a collapse of part or all of a lung by blockage of the air passage) in my right lung base. What does that mean? I thank you for your time and I hope that you can help me as that is just one of the things that the CT scan showed; other organs are showing problems also.

Katrina

A. Dear Katrina, This means an old scar, or possibly some obstruction of a lung region. It needs to be followed up at least one more time with a repeat CT in three months. Sometimes it is necessary to explore the area by bronchoscopy which is placing a flexible tube within your airways. A  pulmonologist woud be the one to do this if needed.

Dr. Tom

 

Question about Amoxicillin and Bronchitis
Q. Can I take 500 mg of Amoxicillin for my bronchitis and if so how should I take it?

Emily

A. Dear Emily, Amoxicillin is generally taken twice daily for five to seven days. It is not for acute bronchitis, but plays a role when there is bacterial invasion. Ask your doctor.

Dr. Tom

 

Drug Compatibility
Q. Is Celebrex or any other anti-inflammatory compatible with Coumadin (blood thinner)?

Eleanor

A. Dear Eleanor, Yes. The INR (International Normalized Ratio, a laboratory test that measures the time it takes for a clot to form) for Coumadin needs to be monitored.

Dr. Tom

 

Question about Lung Test
Q. I was wondering if you could look at my PFT and let me know what you think, My pulmonologist said if anything at all it would be early emphysema. I was told, by another doctor, that my DLCO (a test used to determine how well oxygen passes from the air sacs of the lungs into the blood) is probably reduced from being a former smoker. What do you think? Oh, the chest x-ray came back normal stating no acute process.

PFT results edited, see spirometry commentary.

FVC 96           
FEV1 88
FEV1%FVC 92

IMPRESSION:
Mild large airways obstructive ventilatory defect without an immediate response to aerosolized bronchodilators. Mild defect in gas transfer.

Dee

A. Dear Dee, I disagree, these tests are all normal.

Dr. Tom

 

Would Like Opinion on Exercise
Q. Thank you for responding to my previous inquiry.  With my COPD, I am doing the following proactive activities:  eating well; breathing exercise; following an exercise program from a Health Center; and riding a stationary bicycle for 12 minutes per day with no resistance set on the bicycle.

I have been advised to not ride the bike for 12 minutes, rather, ride it twice a day for 10 minutes each time.  I was also told not to increase the time over 12 minutes, although, I feel ready and willing to do so. 

I am 73 years old and am currently on 2L of oxygen for 24 hours.   What is your opinion on my exercising with the stationary bicycle?  Thank you! 

Rose

A. Dear Rose, Bicycle exercise is okay, but not as useful as normal walking for the same period of time.

Dr. Tom

 

Clamping Endotracheal Tubes when Disconnecting from Mechanical Ventilator
Q. We recently had a new trauma doctor suggest that we clamp our ET tubes when disconnecting the patient from the ventilator to say manual ventilate with bag. This not common a practice at our hospital.

Will clamping the ET tube help with loss of PEEP and are there any studies to support it?

Tracy R May RRT

A. Dear Tracy, I do not know how you can breathe for a patient with a clamped endotracheal tube. I must be missing something.

Dr. Tom

 

How Does Bronchitis Look on Chest X-Ray?
Q. What does an x-ray of a patient with acute bronchitis look like?

Nikki

A. Dear Nikki, It looks normal.

Dr. Tom

                                   

Concerned About CT Scan Follow-Up Reports
Q. I am a Caucasian woman, just turning 55 this month and I have some concerns:

I had a chest x-ray a year ago January 2005 in which they saw a small “something” in the left lung.  A CT Scan was ordered and they didn't see anything in the left lung, but found a “nodule” measuring 3 mm x 5 mm in the right lung. 

A follow-up in March 2005 found no change in the nodule.  “No other nodules seen.” 

A follow up was done in six months, October 2005 with these findings:  “the 3x5 mm small nodule in the lateral segment of the right middle lobe is again identified.  It measures approximately 3 mm x 6 mm.  This is a very slight increase in size.  The change, however, is enough that it may be simply due to partial volume averaging and a slight change in position.  I do not think this is a significant change.  I do not see any new nodules in the lungs.  There is no mediastinal lymphadenopathy. I recommend a repeat exam in 6 months.”

The follow up on 4/10/06 with the following findings:  “Again within the right lobe, a 6 mm nodule is seen.  This is unchanged in appearance.  There appears in the last CT, to be some calcification within this nodule, suggestive for granuloma.  There is actually a small nodule within the right lower lobe superior segment just posterior to the major fissure, which is unchanged in appearance since the patient's previous study in October.  This measures 2 mm in size.  On today’s study in the left lobe, superior segment, 5 mm non-calcified nodule is seen.  This was also present previously and has not changed considerably.  A very small non-calcified nodule is seen in the right upper lobe, posterior and laterally.  This is very small in size, suggestive for benign process. 

Impression:  Several small nodules dispersed throughout the lung which have not changed considerably since previous study.  This is suggestive for benign process.  Recommend follow up in one years time”.

Now, forgive me for being dense, if I am, but didn't the first reports say there were “No other Nodules,” then this report refers to several on going?  Should I be concerned, since they reports seem to be inconsistent, and maybe get some other professional involved in this, or just ignore it?  Forgive me for rambling, but this has me a little concerned.

Sandie

A. Dear Sandie, The other nodules must have been there all the time, but not appreciated. I agree that a one-year follow-up is all that is needed. All of these nodules are probably benign, and are most likely due to granulomas, which are residuals of common fungal involvement. These are very common in the Ohio and Mississippi Valleys.

Dr. Tom

 

How Can I Get a Copy of Adventures of an Oxy-Phile?
Q. Dear Dr. Tom:  I would like to purchase the book, Adventures of an Oxyphile, however, it does not seem to be at Chapters (our main book store) in Manitoba.  Any suggestions?

Thank you!

A. Dear Rose, This book is available for the cost of packaging and mailing from the AARC.

Dr. Tom

 

Asthma Symptoms Worse Since I Quit Smoking
Q. I have asthma. I smoked for over 25 years. I recently quit. It's been about 4 months now and I am still having shortness of breath. I am currently under a doctor’s care.

Have you heard other asthma patients complain of their asthma getting worse after they quit smoking?

Debby

A. Dear Debby, Yes, a variety of things can trigger asthma. There is no reason that smoking would ever help asthma.

Dr. Tom

 

Bad Taste in Mouth After Taking Amoxicillin
Q. I took 4 Amoxicillin pills one week ago before dentist appointment. I have noticed a bad taste in my mouth. The bad taste continues one week after taking the medicine. Is this a side effect of the medicine?

Jane

A. Dear Jane, This should not be a side effect of the medicine. Ask your dentist for an explanation.

Dr. Tom

 

Questions about Mycobacterium Avium Intracellulare (MAI)
Q. After a vacation in Florida a few years ago, I came home with a horrendous cough, wheezing, chest congestion and sometimes shortness of breath.  At the age of 50, I was diagnosed with asthma for the first time in my life and have since been treated with asthma meds. 

Having recently heard about similar symptoms and the MAI bacteria, is it possible that this could be “the silent epidemic” referred to in a recent news piece?  What studies should my doctor do to rule out this bacteria and should he be open to my questions about it? 

Cathy

A. Dear Cathy, There is no particular reason to believe that this adult onset asthma is related to environmental mycobacteria. You can have sputum cultures for this possibility if your doctor believes this is a possibility.

Dr. Tom

 

Very Worried about Sister in Law’s Severe Lung Condition
Q. My brother’s wife got a severe lung full of blood. We are anxious about that. The following is some description about her:

She didn’t meet any poisons. She stayed at home and never touched any chemicals and heavy metals. In fact, she is 28 and was very healthy in the past five years. And she got new baby two months ago. A week ago, she coughed and a small block of blood came out from her lung and then she was sent to a Chinese hospital.

At first, Chinese doctors thought she got tuberculosis because they found two small dark dots in her lungs. But they were wrong. Five days later, situation became severe. When they took x-ray for her again, they found all parts of her lungs were completely filled with blood.

The doctors diagnosed she got vein disease in the lungs. Now she just has 50/50 chance to get a new life. My brother is very anxious about that.

Do you have any suggestion on her disease?  Are there any good medications to help her back to normal?

Jim

A. Dear Jim, You need a diagnosis from a pulmonologist. She may have an abnormality in blood clotting that is causing lung bleeding. Or there may be a local cause in the lung. She may need a bronchoscopy to put a flexible tube in the air passages to look for an abnormality, or CT scans to pinpoint where the blood is coming from. There are many possibilities.

Dr. Tom

 

Please Recommend Physical Therapy for Patient’s Receiving Mechanical Ventilation
Q. Could you send me a physical therapy program in mechanically ventilated patient?

Haytham

A. Dear Haytham, Your question is too broad for a simple answer. There are physical therapy texts on technologies for ventilated patients.

Dr. Tom

 

Proper Treatment of Bronchiectasis
Q. Should bronchiectasis be treated the same as asthma or bronchitis?

I have had this condition for about 20 years but for the past year, the CT Scan showed more scarring and air trapping.  I am constantly coughing so that it is difficult to sleep. I understand that with this condition we should not take anything to help us sleep.

I am not on oxygen but seem to have difficulty in using any of the bronchodilators. My pulmonologist is trying different bronchodilators but I seem to cough more on them. Is Mucinex worth taking to thin out the mucus?

My biggest problem is trying to sleep. I have to always sleep on the left side, never on my back, as I have a coughing spasm. My latest inhaler was Spiriva, but it made me blurry.

I am 75 years old but otherwise healthy and exercise every day with weights and walking.

Jean

A. Dear Jean, Bronchiectasis is treated with bronchodilators and antibiotics for infections. Generally the symptoms can be controlled. See a pulmonologist who is expert in treating bronchiectasis. There are many treatment options for bronchiectasis.

Dr. Tom

 

Feels that Doctor has Left Her Hanging
Q. My doctor said I may have a lack of oxygen in my heart or to my heart, and left it hanging there. I am supposed to have another stress test in September, the one with intravenous fluid. I have had the other one.  It’s scaring me.

Jeannine

A. Dear Jeannine, See a doctor who will explain things to you and get you on a treatment plan. I suggest a pulmonologist.

Dr. Tom

 

Have Exercise Induced Asthma and are Experiencing Severe Shortness of Breath
Q. I am a 25-year -old female who has just been diagnosed with exercise-induced asthma. I have been experiencing severe shortness of breath and chest tightness which is gradually worsening for several months. The inhalers and steroids do not appear to be helping and my symptoms continue to worsen.

I have now gotten to where eating a small meal or walking up a single flight of stairs leaves me very short of breath.  I feel like there is a brick laying on the right side of my chest. 

I have had spirometry, which appeared to have normal values and a chest-x-ray that showed enlarged lungs. I have consistently demonstrated oxygen desaturation after light exertion from between 87% to 93% from a resting of 99%.  

My question is; are these symptoms are consistent with exercise asthma, and if such a sudden onset of severe symptoms is common with the disease? 

Also, I suffer from Raynaud's syndrome (exposure to the cold or strong emotions trigger blood vessel spasms that result in interruption of blood flow to the fingers, toes, ears, and nose), however lately instead of the cold, white hands and feet, my hands and feet have been purple with blue nails. Several days I have woken up with blue lips. 

As this is a new diagnosis any information or suggestions would be very helpful because I have no insurance and am only being seen at the clinic where I attend university. 

Amy

A. Dear Amy, You probably have more than just exercise-induced asthma. There are many possibilities. See a pulmonologist for a diagnosis and treatment.

Dr. Tom

 

Worried about Having Lung Cancer
Q. I am female 45 years old.  I went for a CT scan of the chest in Sept. 2004, for pain in my middle chest. They said they found a little abnormality in my lung, 3 very small nodules on both sides. Everything else looked fine.  They told me I did not have to get checked until 3 to 6 months. 

I went in January 2005; I did not want to wait 6 months. I happened to go to a lung doctor instead of my doctor.  He did not seem really concerned. When my second CT scan came back he said they got smaller and there was no need for any more CT’s. Even on the report from the imaging center they did not recommend anymore.

When Dana Reeves got lung cancer I went in August and asked for another one to be sure.  The doctor said it was not needed but if I want another one to wait a year because of all the radiation.

I am going back this week to see the doctor and letting him send me for one more. I don’t smoke, really never did—only when I went out drinking socially but not even a pack a week maybe had a few if I drank on weekends but that was about eight years ago. I did hang in bars a lot and my family all smoked so I lived with smokers.

I also have had a little breathing problem for years. My breathing test was a little off but he said not really much at all. I have sinus problems and allergies. I also have nodules on my thyroid.

I am worried because I read if you have nodules they should be checked every couple of months up until two years. I hope my doctor knows what he is talking about. He said you see different things in a CT scan letting you know if they are cancerous.

Do you think I should be checked again and how fast do nodules grow?

Angel

A. Dear Angel, The small nodules that are decreasing in size do not need further follow-up.

Dr. Tom

 

What Can I do to Slow the Progression of Emphysema and to Feel Better?
Q. I was diagnosed with emphysema in May of 2003, ended up with a fungus from soil that was eating the upper left lobe of my lung.  So had surgery to remove that lobe in October of 2003 and returned to full time work in November.

I am an ex-smoker: quit in 1999. My lung function tests say I only have 31 percent lung capacity. I am still very active in my job and at home, just slow.

I recently took an oxygen meter home to be tested overnight and the results were between 90 and 91%. I am currently on no oxygen or medication, just a lot of vitamins: C, A, E, and N-Acetyl-L-Cysteine.

Is there anything else I can be doing for myself that will help me feel less worn-out, and might slow the progression of the emphysema?

Barb

A. Dear Barb, You may benefit from a pulmonary rehabilitation program. It can help your symptoms a lot. Consult your pulmonologist.

Dr. Tom

 

In Hospice and Having Pain and Nausea, Any Suggestions?
Q. I have hospice with end stage COPD. My gall bladder quit working and I hurt and have nausea a lot. It worsens when I eat. Doctor says surgery is out of question due to COPD. I am trying, any suggestions?

Brenda

A. Dear Brenda, I cannot diagnose the cause of your symptoms from your description. Sometimes simple gall bladder drainage is possible, if there is infection. Get more details from your doctor.

Dr. Tom

Pain Control: For Families and Patients (PDF)
National Institute on Cancer

What Can I Do About Nausea and Vomiting?
American Cancer Society

 

Questions about Albuterol and Combivent
Q. Can you answer some questions about Combivent and Albuterol?

  1. Which of the two is better to use for emphysema?
  2. Which has less side effects?
  3. Which will have a longer effect?
  4. Can they be taken together, and if so how far apart can they be used?

A. Dear Marie, Albuterol is one of the two drugs in Combivent. The other medication is ipratropium. The duration of action is 4-6 hours.

Dr. Tom

 

Wife has Just Been Diagnosed with Bronchiectasis
Q. My wife just got diagnosed with bronchiectasis. Can you recommend a pulmonary specialist in Houston or Dallas and refer me to some medical website to learn about bronchiectasis?

David

A. Dear David, Here are some websites that can give you information about Bronchiectasis.

Patient Web Sites for Bronchiectasis
National Jewish Medical Research Center

National Heart, Lung, and Blood Institute

Prodigy Knowledge

Dr. Tom

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