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Archive: Dr. Tom 75
PostedAugust 10, 2006

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

 

 

Pneumothorax and Blebs

Q. My son experienced a few spontaneous pneumothorax (a collection of air or gas in the chest that causes the lung to collapse), which led to a diagnosis of congenital blebs. He subsequently had surgery on both lungs to remove blebs and abrade lungs to adhere to the chest cavity. I believe that was in 2001. He has recently felt some chest discomfort.

My question: could this be additional blebs grow? Are there any known historical complications from this surgery?

Esther

A. Dear Esther: New blebs do not grow. Because of the surgeries, the lungs are probably  "stuck" against the chest wall, which will help prevent any further collapse (pneumothorax), from any remaining blebs. It is hard for the surgeon to remove them all. The discomfort may just be from the procedure and will not progress. He should be well without any more lung leaks.

Dr. Tom

Chewing Tobacco and Effect on Breathing

Q. I have COPD.  I used to smoke and chew tobacco.  I have stopped smoking, but I can't seem to stop the chewing.  Is chewing tobacco as bad for my breathing as smoking? 

John

A. Dear John, No, but it is a risk for other cancers such as mouth, esophagus, pancreas, and bladder. .

Dr. Tom

Has had Cancer and is Worried about Recent CT Scan

Q. I was diagnosed with Stage 3 Renal Cell Carcinoma Sept. 2003.  I had a left radical nephrectomy (surgical removal of the entire kidney, adrenal gland, nearby lymph nodes and other surrounding tissue) and have been in remission since then.  I have CT scans each 3 months for follow up. 

June’s CT found 2 nodules in my left lung.  Smooth, non-calcified less than 5 mm sized nodule in periphery of left upper lobe.  Lower lobe has a linear pleural density under 5mm.  Was sent for a PET scan and had this result:  A 2 to 3 mm pulmonary nodule is present posteriorly in left upper lung, not specific as to etiology although too small to definitively characterize as to activity pattern. 

What should my next step be?  I don't want to keep waiting and then be told I have metastatic lung cancer and have waited too long.  I am 37 years old and have never smoked.

Kim

A. Dear Kim, You need a follow up scan to see of the nodules are growing. If this is metastatic renal cell cancer, there are some new promising therapies. Waiting a few months will not change your outcome. Remain positive in your thinking that you will stay or get well. .

Dr. Tom

What is Air Way Disease

Q. On July 11 I had repair surgery for nissen fundoplication. (GERD). First surgery was done in 2002. I was told that the band had slipped and had my stomach twisted into a figure eight. This second surgery had to be done the old way (open).

Now I have something called air way disease. Could you please explain what this is, and what I can do to help treat the pain I have in my lower left side, and lower left back. Any information would be appreciated. I can't seem to find anything.

Sandy

A. Dear Sandy, The term "airway disease" is not very specific. It may mean chronic bronchitis. I do not think that airway disease causes your pain. You need an explantion for this pain , and it is not "airway disease". .

Dr. Tom

Will Move to Sea Level Reduce Frequency of Pneumonia

Q. I had a total laryngectomy (surgical procedure in which the whole larynx [voicebox] is removed, and the opening [stoma] into the larynx is permanent) in 1993. I have frequent pneumonia with left lower lobe staying infilterated. My doctor thinks I should move to sea level.

I am 76 yrs old and hate to move but will do so if I can feel better.  Thank you for your help.

Billie

A. Dear Billie, You should try a vacation there to be sure you really feel better. Altitude is not a factor in developing pneumonia.

Dr. Tom

Persistent Cough; Smoked a Little as a Teenager

Q. I have a persistent cough and feel like I have a cobweb in my chest, did have pain when I breathed in but that has gone. I have had little or no coughs in my life. Smoked a little when I was teenager, now 49.

Helen

A. Dear Helen, You need a diagnosis. You could have asthma, with cough as the only symptom. See a pulmonologist.

Dr. Tom

What Causes “Spots” on Lung

Q. I recently had a CT scan done and the results showed some small spots in my right lung. My doctor feels that I am a small risk for lung cancer (I'm 50 years old, don't smoke or drink and am in good health). She seemed relatively unconcerned about it but wants to do another scan in a year.

Can you tell me what spots on the lung might mean and where they might come from? Any info would be appreciated.

A. Dear Jeff,  Most small spots, particularly in non smokers, are benign. They are due to a remote inflammatory process, sometimes a healed fungus infection. Follow up in one year is reasonable and will be reassuring.

Dr. Tom

I Take all Medication so Why do I Still Have Trouble Breathing?

Q. I am a 59 year-old female with COPD.  I take Qvar, Spiriva, Serevent and Albuterol and am on oxygen 24/7. 

My question is this, after taking my prescribed doses of these medications, why is it that I still have difficulty breathing? I stopped smoking two years ago after 40 years of smoking.  Also my doctor says that I should walk, but how can I do that if I cannot breathe? I am wondering if there are any exercises that I should be doing? 

Karlee

A. Dear Karlee, The shortness of breath comes from the increased effort you need to move air in an out of your air passages. If you walk a little more each day, you will learn how to reduce your shortness of breath. It is like an athlete in training. Get out and walk at least 15 minutes twice a day, even if this is only a few feet at first. Stop as you need, to recover, and then go on. This is one of the fundamental steps in pulmonary rehabilitation. 

Perhaps your hospital offers pulmonary rehabilitation services. If so, get a referral from your doctor. .

Dr. Tom

What’s the Difference Between a Ventilator Tube and Tracheostomy Trach)

Q. What is the difference between a ventilation tube and a trach? My sister- in-law is on a ventilating tube with 100% oxygen... and the tube is too small to run a bronchial test.  If they would give her a trach instead, they could run the test necessary to find out what infection is in her lungs. 

The doctors don't seem to want to do the trach though. Any idea why?  What are the pros and cons?

Colleen

A. Dear Colleen, A tracheostomy is an operation in the neck to be able to attach a short tube to the wind pipe (trachea). It is shorter and has a greater diameter than a "breathing tube", known medically as an endotracheal tube, placed through the nose of mouth to reach the trachea. A tracheostomy is superior for suctioning secretions, for comfort and for eating.

Dr. Tom

Questions about Alpha-1

Q. Can we trust the normal range that labs use when testing a blood draw for Alpha-1?  Is it important to be only within the range, or is a reading slightly below mid-range an indication of a problem, such as was the case in my test?  I have had COPD for over 13 years and my mother died at 63 years old of a heart attack after years of suffering with constant severe lung disease. 

My COPD is quickly worsening now and I thought since even my father suffered with Black Lung and smokers disease that I might find a genetic link there, but my Alpha-1 test was a little below mid-range.

A. Dear Rose, You need to also have a "phenotype" test done. Most Alpha-1 patients have the ZZ or SZ types. Normal is MM. There are many other types that give mild to moderate levels of Alpha-1. Some of these are a risk factor for emphysema.

Dr. Tom

Normal Lung Function but X-Ray and CT Scan Say Suspicion of Emphysema

Q. I wrote to you a while ago regarding my recent diagnosis of emphysema. I am 34 years of age and a former smoker. You advised me not to accept the diagnosis of emphysema without knowing my spirometry results. I can tell you that my spirometry and methacholine tests were both normal.

The diagnosis of emphysema was made in the following way: my lung x-ray showed a suspicion of emphysema (there were small unclear nodules here and there on the lungs and some hyper inflation). This suspicion was confirmed as emphysema by a subsequent CT-scan.

As I said, my spirometry was normal, so I am wondering if it’s still possible that I have emphysema? In other words, do you think I was rightly diagnosed?

If so, do you have any idea what my prognosis might be? Am I likely to have a normal life expectancy? I am extremely worried about all this.

Paul

A. Dear Paul, A CT scan does not measure lung function. It shows structural changes in the lungs. Since whatever "emphysema" you have has not affected your lung function you can assume that your prognosis is normal.

Tell your doctor that you are no longer worried, and to stop worrying himself. You have already stopped smoking, which is key to preventing the progression of emphysema.  Stay healthy and enjoy life! .

Dr. Tom

Oxygen and Airline Travel

Q. As you know, the FAA (Federal Aviation Agency http://www.faa.gov/  recently approved several portable travel concentrators for use on commercial airlines.

However, this may be creating some unforeseen problems. I was told of a patient who has tickets on Frontier airlines who was told they can bring their own travel concentrator, but that the airline does not provide oxygen in any form.

The "Catch 22" is that most of the home O2 companies do not provide these expensive travel concentrators as loaners, so the oxygen travelers only choices are to purchase a $3,000 machine on short notice, or "hold their breath" and travel without oxygen in a cabin that is typically pressurized to approximately 8,000 feet. Have airlines begun to discontinue the practice of providing compressed oxygen to patients who require it?

Dr. Petty, I know you have a keen interest in this topic.

John RRT CPFT

A. Dear John, Each airline can decide if they want to accept passengers who use the new, effective portable oxygen concentrators. You need a doctor's prescription and advance approval to bring an oxygen concentrator on board the airlines that have agreed to follow the Department of Transportation's approval of portable concentrators on air carriers.  So far about half do. Some, but not all of the others, will provide oxygen by prescription, at an additional cost.

Dr. Tom

Son has Tracheomalacia, What Can We Expect?

Q. I have a 17 year-old Down Syndrome boy that was just told he has tracheomalacia. We were told he had the worst case the doctor has ever seen. What kind of treatment is there for this? What kind of life do you live. How long can you live with this. Is there specialist in this field?

A. Dear Susan, There are some surgical treatments called stents  tracheaomalacia. These procedures are done only by experienced surgeons. There are also some lesser procedures that can be done by certain pulmonologists, with experience in placing stents. You need to consult a pulmonologist in your area for a referral. 

Dr. Tom

Son is an Athlete and have Questions about Spirometry Results

Q. My son recently had a spirometry test. 

FVC was 7.51 L (138% of reference of 5.43L)
FEV1 was 5.10 L (109% of reference of 4.69 L)
FEV1/FVC was 68% (reference 85%)
TLC was 8.96L (reference was 5.88 L)

He was told that he had "supernormal" lungs and was given a bronchodilator because of the reduced FEV1/FVC.  He showed an improvement of 25% in the FEV1/FVC (FVC increased to 8.04L; FEV1 increased to 136L). 

The impression states very high FVC and normal FEV1.   However the ratio appears reduced. The suggestion is that he might have possible mild airflow obstruction. 

He has been a three season athlete since age 5, including 4 years in high school, and heavily physically active since then (soccer, basketball, baseball, ultimate Frisbee, running, etc).  He is also an accomplished singer and has been singing solo and in performing choirs for well over 10 years. 

This test was done at the request of the Navy since he has been offered a four-year Navy ROTC scholarship, and they had questions about reactive airway problems.  He has used inhalants in the past, but only sporadically and in response to colds/viral upper respiratory syndromes in an effort to return to sports practices or games. 

My question is:  What does all this mean?  And what do we do with all this information? 

Roseanne

A. Dear Roseanne, Your son has supernormal lung function. It is possible that he has very mild asthma, also sometimes called reactive airway disease, since there was some response to inhaled bronchodilators. 

I do not believe he needs any treatment, but the use of an inhaler before or after exercise is reasonable if he has any symptoms. .

Dr. Tom

Can You Have TB (Tuberculosis) and Not Know It?

Q. Dear Dr Tom, Few months ago I had severe cough and cold, my physician put me on antibiotics and ordered a chest x-ray. A few days later the doctor called to update on my x ray. He found out I have fine scars and calcified granuloma (about 6 mm) due to past illness, like TB .

severe cough and fever, which lasted almost seven days. Dr. Tom, should I be concerned about it? My doctor told me not to worry . Will it turn cancerous eventually?

Richard

A. Dear Richard, It is possible to have tuberculosis and not be aware of it. Your doctor should do a tuberculin skin test, or a newer blood test to see if tuberculosis infection has ever been present in the past. Some recommend treatment for "latent tuberculosis", i.e. to eradicate any organisms that remain alive. This is reasonable if there is evidence of remote infection.

Healed tuberculosis is not a risk for developing lung cancer, but this has been a belief in the past.

Dr. Tom

How Long Do You Have to Smoke to Get Emphysema?

Q. In 1996, at the age of 36, I was diagnosed as having emphysema and I had been a smoker for only 16 years. Is this long enough to get the disease or would you have expected me to get it later in life?

There is no history of it in our family but the other part of this question is that in 1989 I was involved in an ammonia spill where I worked and 7 years later I ended up with this disease but nobody in the medical industry here in New Zealand will say that is what caused it; all they are prepared to blame is the smoking.

Raymond

A. Dear Raymond, Sixteen years is sufficient exposure to cause emphysema, particularly if there is a familial predisposition for it. You should have your Alpha-1 level measured, even if there is no family history of emphysema. Alpha-1 deficiency is one cause of emphysema in young people. There is treatment for this deficiency. It is important that you avoid all tobacco smoke.

Dr. Tom

For more information see Alpha One Association

Smoking Marijuana and Now Coughing Up Blood

Q. I've been smoking marijuana for 7 years every day and recently spit up blood and it didn't stop for few hours. What do you think it could be?

A. Dear Justin, It could well be from irritation from the pot. Stop smoking this junk! It is very harmful to your lungs and general health, no matter what the idiots that promote marijuana would like the public to believe.   

If the blood returns, see a pulmonologist for a bronchoscopy to look in your lung to try to determine the cause. 

Dr. Tom

Could Continuous Positive Airway Pressure (CPAP) Cause a Dry Mouth?

Q. I have sleep apnea.  I have developed a dry mouth, even though I use the water tank with my CPAP.  Is the dry mouth related to the 7 years use of my CPAP?

Joan

A. Dear Joan, It probably is the cause.

Dr. Tom

CT Scan Form Listed I.L.H. as a Diagnosis, What is It?

Q. I was perfectly healthy until 4 years ago when I needed a major operation on my neck for a C6-C7 decompression and cage.  Immediately after the operation I suffered a failure in my kidneys and my lung collapsed with me ending up on a CPAP machine for 4 days. About 12 weeks later I was diagnosed with a lump in my throat (which was nothing apart from infected fatty tissue). 

Soon after I was told I have developed diabetes and had asthma. I recently have had a battery tests, for my recurrent chest pain - my heart condition is within normal limits, but the say I have restricted lung capacity. I was asked to book a CT scan of my chest - which I have done, but on the form it had in the diagnosis part it had restrictive air entry and I.L.H. What is I.L.H?

Stephen

A. Dear Stephen, I do not know what I.L.H. is. Too much jargon. You need an explanation from your doctor.

Dr. Tom

Surgical Risk and COPD

Q. I have COPD and I also have a hernia (groin). The hernia is fairly large, but it does not bother me and is not sore or painful.

I went to the very famous " Shouldice Clinic " here in Toronto Canada and they said they would not operate on me unless I lost 40 pounds. I lost 35 and they said ok, and another benefit, of the weight loss, was that I could reduce my high blood pressure meds from 10 mg to 5 mg of Altace.

I am concerned about having this operation with my COPD. They use a local anesthetic, as any operation causes some stress and anxiety and that makes my COPD worse. Is it safe with my disease to have this operation?

Dr Philip

A. Dear Dr. Philip, Your doctor, who knows you best will have to make this judgment. In general COPD patients can withstand any necessary surgery.

Dr. Tom

Would Like to Get Off Prednisone

Q. I understand that prednisone can have serious side effects.  I have been on 10 MG of prednisone daily for the past two years. When my wheezing and coughing gets bad, my doctor increases the dose and then tapers it back to 10MG/.

I would like to get off it entirely.  Do you think it's possible? I supposedly have severe COPD, but have not had any significant exacerbations in the past year.  I exercise regularly and am an 83 year old female.

Patty

A. Dear Patty, In general it would be better to get you off prednisone, but it appears that you have done well for your age. Maybe you should leave well enough alone.

Dr. Tom

Tracheal Lavage and Ventilator Associated Pneumonia (VAP)

Q. What is the current information regarding tracheal lavage before suctioning? Does it promote VAP?

Lee

A. Dear Lee, There is no evidence that I know of that a local trachael lavage encourages ventilator associated pneumonia. It is a pretty standard procedure when thick secretions are a problem.

Dr. Tom

Question about a Research Project

Q. Dear Dr. Tom, Arne, my Norwegian husband was a patient of yours in the late 80's and early 90's at the time of your heart attack and when you cut back your practice and Dr. Timothy Kennedy took over.  We were living in Aspen at that time. We have since retired to Arizona in l999, but still participate in the yearly sputum test with the University of Colorado, through Dr. Kennedy, which the results are sent to our doctor here. Arne wishes to say hello to you; we have never found a doctor we had more confidence in than you and also Dr. Kennedy. Arne is still very active but the emphysema is finally slowing him down and now just started oxygen full time at home and out. Current medications are: Spiriva, 1 per day and Advair 250/50 morning and evening.

My question for you is:  Are you familiar with a research project of inserting a tube directly into the lung expelling moisture into the lung expanding the lung for easier breathing?

I am so happy to see you are still very active in your research, and also enjoying your fishing.  If you have any recommendation for a pulmonologist in either Phoenix or Las Vegas, we are closest to Las Vegas.

Thanks for listening, most importantly we are glad you are still out there. 

Joan 

A. Dear Joan, I remember you both well. As I recall, Arne used to be a ski instructor in Aspen. Glad you are both doing well. I do not know of the procedure that you describe. I know the pulmonologist at Good Samaritan Hospital in Phoenix. Dr. Bernard Levine is a former fellow and a good friend. I believe he still practices part time. Try to get an appointment with him and feel free to use my name as a referral.

Good luck to you both.

Dr. Tom  

Taking Antibiotics Every 7-8 Weeks; Can I do Anything to Reduce Occurrence of Lung Infections?

Q. I have COPD and am on Spiriva and Advair inhalers.  I get a lung infection and have to take an antibiotic every 7-8 weeks. Even though I do not feel bad I have the green excessive mucus.  I take very good care of myself and exercise everyday.  Do you have any suggestions to my problem? 

Rose Ann

A. Dear Rose Ann, You should ask your doctor,  hopefully a pulmonologist, about the underlying problem. You may have bronchiectasis, a damage and dilation to the major conducting air passages of the lungs. You should also have him check to see if your immune functions are normal. There is some reason why you have so many chest infections.

Dr. Tom

Are Results from X-Ray Serious?

Q. A recent x-ray revealed "Mild Biapical Scarring. Large calcified Mediastinal Lymph Node. The x-ray was done on July 15, 2006.  Is this revelation serious in your opinion?

Simpson

A. Dr. Simpson, No. This is most often associated with a remote infection such as a fungus.

Dr. Tom

Itchy Back where Lungs Are

Q. I was diagnosed with COPD and now when I have shortness of breath, I get itchy pains in my back where the lungs are located is this normal?

Angela

A. Dear Angela, Yes, this is fairly common, and the reason is not known. It is a nuisance, but not serious.

Dr. Tom

Anything New in the Treatment of Pulmonary Fibrosis

Q. Is there anything new in the treatment of pulmonary fibrosis caused by Bleomycin toxicity?  I received too much Bleomycin 30 years ago; and since dual valve replacement in 1999, I have even less pulmonary function. I have never had any kind of pulmonary treatment.

Michael 

A. Dear Michael, I do not know of any new treatment for the fibrosis associated with exposure to Bleomycin. I know there is a lot of research going on in this area.

Dr. Tom

Has a Tracheostomy and Swallowing Liquids Into Lungs

Q. My father-in-law has had a breathing tube down his throat for 5 weeks.  When they removed it they put in a trachoestomy but he swallows liquids into his lungs.  Can this be fixed? 

Chris

A. Dear Chris, This usually subsides with time and careful training in swallowing.

Dr. Tom

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