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Archive: Dr. Tom 73
PostedAugust 3, 2006

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

 

Stung by Hornet

Q. Dr Tom, I got stung by a hornet three days ago and its still red, swollen, hot to touch and very itchy. Is that normal?

Cindy

A. Dear Cindy, Yes. It will take several days for this to completely resolve.

Dr. Tom

Questions about COPD Treatment Research

Q. Could you comment on the following; I have read the Japanese are doing research into tomato juice and they found it prevented emphysema in mice. They now want to try it on people with COPD, to see if their emphysema improves. Also have you heard about retinoic acid? It is supposed to regenerate lung cells. I know that stem cell research could be very beneficial to people with all kinds of lung disease, but President Bush is against it. I am fortunate to live in Canada where stem cell research is going ahead here. As well have you heard about a new drug for COPD called Roflumilast?

A. Dear Phil, I do not know about any studies about tomato juice in emphysema. It is a good antioxidant and could potentially be useful.

Retinoic acid as been studied in humans, and it does not promote regeneration of lung alveoli.

Rofumilast is under study as an oral drug that may reduce the inflammation of the air passages in COPD. Lots of good research is going on, that will finally solve COPD, or reduce its impact some day in the future.

Dr. Tom

Proper Care of Tracheostomy

Q. For a patient in LTC (Long Term Care), whose trach (tracheostomy) has been in place for some period of time should the trach get care under "sterile" or clean conditions? Can you point me to a reference, all nursing texts state "sterile"?

Karen

A. Dear Karen, Long-term tracheostomy care must be done under "clean conditions". This means hand washing, gloves, and suctioning with fresh catheters. There is no way to keep tracheostomy care sterile,in the true meaning of the word.

Dr. Tom

Shortness of Breath after Polyp Surgery

Q. I had nasal polyp surgery this year on March 29, 2006. I had a general anesthesia. When I woke up after the surgery, I couldn’t get my breath. It took a little time even while receiving oxygen.

My question is, does this weaken the lungs and how long should I wait before I have another surgery. Is there a way to strengthen the lungs. I do have asthma.

Sue

A. Dear Sue, Polyp surgery should have no effect on lung function.

Dr. Tom

Hyper-expanded Lungs

Q. I had a non-productive cough that I went to a new primary care physician for and he ordered a chest x-ray. The radiologist's "impression" is COPD based on slightly hyper-expanded lungs compared to a chest x-ray I had three years ago. My question is this: What else COULD cause the hyper-expansion?

I started a rigorous exercise program a year ago and am able to swim 20 laps 5 days a week. I have no shortness of breath. I had a lung embolism with pneumonia 15 years ago and leg surgery caused a blood clot and what I recall the ER doctor calling “clot showers” in my lung.

Before I subject myself to any more tests I want to develop a list of things that COULD explain the hyper-expansion so I can ask better questions when I go back to my doctor. Thank you for replying.

Kathy

A. Dear Kathy,Lung hyperinflation as estimated by chest x-rays is pretty meaningless. It just means that you were able to take a very deep breath and hold it. I would do nothing more about this report. You sound very healthy. If you are curious about your lung function, get spirometry done. A chest x-ray is not a lung function test!

Dr. Tom

Anxiety and Hyper-inflation of the Lungs

Q. I would like to know if hyper-inflation of the lungs can reverse itself? I am a 30 year-old male non-smoker. I smoked marijuana when I was younger, but quit over eight years ago, and have not smoked or used any substances except for very moderate alcohol use, and as little as 4 years ago maintained a rigorous exercise schedule and enjoyed a high level of endurance. I have had no past experience of breathing difficulty or other medical conditions and have never taken any medication for any medical conditions.I have been experiencing shortness of breath, and a reduced capacity for exercise.

Over the past few years I have had a problem with anxiety, and more recently I have been experiencing shortness of breath. I suspect there is a connection between my anxiety and my breathing patterns; about two years ago I started experiencing anxiety and became obsessive about my breathing. I would often breathe very deeply for long periods of time. I did this on purpose because I thought it was supposed to relieve anxiety. Over the past year the anxiety has been diminishing significantly, but I now have a reduced capacity for exercise. I began exercising again, but have difficulty and get winded very easily. My endurance started to improve a little for a short time, but recently I began breathing heavily again (again on purpose) and have since been experiencing shortness of breath and further reduced capacity for exercise. I also sigh frequently and get a feeling of being short of breath.

I recently read about a condition in which people with anxiety problems enter a cycle of hyper-ventilation, which leads to more shortness of breath, and in turn more anxiety about feeling out of breath. This cycle can repeat and lead to hyperinflation of the lungs.

I strongly suspect I have hyper-inflation of the lungs. My anxiety is almost totally under control, but I am concerned that my period of anxiety caused me to breathe too deeply and led to my current condition of shortness of breath. Does hyperinflation of the lungs reverse itself over time? In the absence of disease, can such a condition reverse itself?

Devin

A. Dear Devin, Forget about the report of hyper-inflation of the lungs. It is a pretty meaningless report. Keep exercising, and your anxiety will go away.

Dr. Tom

Rheumatoid Lung

Q. I have been diagnosed with rheumatoid lung. Why am I hoarse all the time?

Connie

A. Dear Connie, Rheumatoid arthritis can involve the lungs and the tiny joints of the vocal cords. Ask your rheumatologist about this. There are pretty good medication for rheumatoid involvement of the lungs.

Dr. Tom

Reporting Results of a Bronchoscopy

Q. Why doesn't a specialist tell a patient what they saw during a brochoscopy? Wouldn't they say more if all appeared normal?

My sister has to wait 5 days for test results. Do you think the specialist's silence indicates trouble? Whenever I had had a brochoscopy the doctor always tells me it all appeared normal, as soon as the procedure was completed.

Patti

A. Dear Patti, Some specialists are too busy to report their findings in a timely fashion. I believe thisunfair to patients. Insist on an immediate report. I'll bet that your bronchoscopist is a very busy man, and too busy to be a kind doctor. I doubt if he found any abnormality, or he would have said so immediately.

Dr. Tom

Son’s PFT Results and ICS

Q. My 11 year-old son has been on ICS for nearly three years. All of his PFTs have been normal pre and post with little variance. However his FEF number ha been as low a 70% predicted and have been as high as a 37% increase post medicine. He is asymptomatic. Any suggestions? Thanks you so much for your time.

Mike

A. Dear Mike, I do not take FEF numbers very seriously. If the FEV1 and FVC and the percent between the two are normal, forget the FEF.

Dr. Tom

Unusual Treatment

Q. I have IPF (Idiopathic Pulmonary Fibrosis) and I read an article about using 35% Food Grade Hydrogen Peroxide (HP) intravenous or orally to greatly improve my condition. The oral Program lasts 21 days starting with one drop of FG 35% HP increasing to 25 drops in a glass of distilled water, juice or aloe vera juice.

Can you ingest or take Hydrogen Peroxide intravenously?

George

A. Dear George, No. Intravenous injections of hydrogen peroxide are dangerous.

Dr. Tom

Does Helios Leak Oxygen

Q. Dear Dr. Tom: I have read that the portable conserver called "Helios" leaks oxygen even when not in use; since it is a liquid oxygen, not a gas. Have you heard that this is true?

Rose

A. Dear Rose, The liquid oxygen in the Helios, boils into the gas that you inhale. If you are not using it, a relief valve lets the gas out. This is because it is a low pressure system. You can not hear this boiling off or venting process. This is the normal function of the Helios. It is a very useful and safe system.

Dr. Tom

Why Previous Doctor Did Not Diagnosis Sarcoidosis?

Q. My doctor thinks I have Sarcoidosis. Can shed some light for me on why my previous doctor did not see this?

Sonza

A. Dear Sonza, Sarcoidosis is not a common disease and it has many manifestations. Many general physicians have not seen Sarcoidosis in their training or practice. Most pulmonologist are adept in diagnosising Sarcoidosis.

Dr. Tom

Diagnosing Emphysema

Q. I had a routine chest x-ray a few months ago, and the results saying that the lung fields do not reveal any evidence of any active disease. However, the lung fields are hyperaerated with some flattening of the hemidiaphragms consistent with pulmonary emphysema. I smoked for 20 years, but have not quit.

My doctor sent me for pulmonary function tests, as he seemed to think I did not have it when he examined me. All the PFTs were above normal and he said I do not have emphysema. Could the x-ray be wrong? Thanks

Eileen

A. Dear Eileen,Yes, the x-rays are wrong. Hyperinflation seen on chest x-rays, just means that you could take and hold a large breath. Chest x-rays are not lung function tests. This is where spirometry comes in (see National Lung Health Education Program).

Dr. Tom

Don’t Like ‘Latest Medications on the Market’; Want to Change Back to Old Medications

Q. My previous doctor of 10 years seemed to have my emphysema under control, my medication was Flovent & albuterol. However this doctor passed on and I was forced to find a new doctor; who has changed my medication to Advair and Spirva explaining this is the latest on the market for my condition.

However my breathing during the past year seems to have become more difficult; my breathing test numbers have not changed. I am 70 years old a and former smoker who quit 10 years ago. I play golf and still work part time.

My question is I want to return to my former medication and would like your opinion. Looking forward to your answer.

John

A. Dear John, I think your former medication was doing fine for you. It is a lot less expensive than the newer medications, and I suggest saving your money for golf, and going back to the old medications, that work pretty much like Advair.

Dr. Tom

Nebulizer Seems to Affected Mother’s Personality

Q. Can using a nebulizer affect my mom's personality? She's been agitated and mad at the world for a persistently long time.

Michael

A. Dear Michael, The nebulizer itself will not change your mom's personality. But there are frustrations associated with using some nebulizers that may be aggravating to your mom.

Dr. Tom

Congestive Heart Failure (CHF) and Sleep Apnea

Q. I have recently been diagnosed with CHF due to sleep apnea. I would like to know about treatments and also how much, if any, of this is reversible?

Pam

A. Dear Pam, Most sleep apnea is due to obstruction of the upper air passages while sleeping. If this is the cause, using a pressure mask, known as continuous positive airway pressure (CPAP), may be very helpful. There are some other less common treatments as well. Consult a pulmonologist about your diagnosis and treatment options.

Dr. Tom

Spirometry Results and Life Expectancy

Q. Dr Tom, My spirometry test numbers are:
FEV1 81% of predicted
FVC 84% of predicted
FEV1/FVC 68%
TLC 108% of predicted
RV 139% of predicted
DLCO 119% of predicted
I do not have shortness of breath and just wondered what these numbers mean as far as my life expectancy.

Bob

A. Dear Bob, These numbers are either normal, or pretty close. Your life expectancy should be excellent, assuming that you do not smoke.

Dr. Tom

Need Help Understanding Medical Terms in my Chart

Q. Dr Tom. Is hyper-inflated lungs temporary? Five years ago I had a severe COPD exacerbation, and my hospital chart said hyperinflated lungs and mild pedal edema. What does this mean?

P.S. I have never had a hospital exacerbation since, almost five years.; also I quit smoking five years ago.

Philip

A. Dear Philip, Hyperinflation does not mean much, when it is found on routine x-rays. It can be associated with asthma, or an exacerbation of COPD, in hospitalizedpatients. Pedal edema means you had some fluid accumulation in your feet. This may have all been due to the exacerbation. You may be over this now. Good that you stopped smoking. Stay well.

Dr. Tom

Dad has History of Lung Cancer and Now has Small Nodule Seen on CT Scan

Q. My dad was diagnosed with stage III lung cancer over 2 years ago. They recently found some small nodules in his lungs during a routine CT Scan. Does this mean his cancer has returned? They say they can't do a biopsy because they are too small is this a good sign? He had one done in April and another one now and they still haven't changed what does this mean?

Liz

A. Dear Liz, It will take a biopsy to learn if the new nodules are lung cancer. Your doctor will probably repeat the scans in about three months to see if they have grown, and if so, plan to do a biopsy then.

Dr. Tom

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