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Archive: Dr. Tom 77
PostedAugust 24, 2006

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

 

 

Scratched Lung

Q. What is a scratched lung?

Phyllis

A. Dear Phyllis, I have never heard this term.

Dr. Tom  

Aromatherapy and Those with Lung Disease

Q. Hi Dr. Tom! I attended the EPA/ARCF conference in Grand Rapids, MI last week. I was impressed with the amount of relevant information given to me. I work in a SNF/LTC (Skilled Nursing Facility/Long Term Care) in Muskegon where our oxygen dependent chronic lungers are increasing in numbers and their associated end stage disease weight losses alarm us.   

 Because we are an “Eden” facility our company Eden experts have strongly suggested the use of aromatherapy in the form of essential oils that are put on patients to “stimulate” their appetites in the dining room. On occasion other patients near them react strongly to the smell with a paradox reaction of nausea and some of our patients and nurses are allergic or have asthma, COPD etc and object to their widespread use.

Further, the information I have read suggests that the elderly lose a lot of their ability to discern smell as they age, and so the cost of the oils is largely wasted. My belief that airway maintenance trumps aromatherapy attempts that are nebulous at best, and highly immeasurable while just introducing another irritant into the closed air environment of our facility. May I have your opinion of this practice?

Carolyn

A. Dear Carolynn, I agree that there is no scientific basis for aromatherapy. Odors can be offensive and obnoxious. They may even stimulate bronchospasm. I suggest elimination of what I believe is witchcraft.

Dr. Tom  

Trouble with Nerves after Laparoscopic Surgery

Q. After ovary removal done laparoscopically and a bowel twist two weeks after surgery, I then found I couldn't take deep breaths. My abdomen became tender and bloated (especially after meals) and then I began having a pulsating sensation in my throat. That changed to feeling like I continuously have to swallow.

Did the carbon dioxide from surgery cause this? I'm being treated with Neurontin to work on the vagus nerve. Could it be the phrenic nerve? Doctors suspect adhesions on the vagus nerve. HELP! It's been a year and a half of misery...

Marcy

A. Dear Marcy, This is a tough one for me. It certainly is NOT due to the carbon dioxide that would dissipate quickly. I do not see how the procedure could have involved either the phrenic or vagus nerve. Certainly not the vagus innervation in the lungs.

Dr. Tom  

Follow-Up Question about Restrictive Lung Disease ( Dr Tom 75)

Q. Thank you for the helpful answer to my question dated August 10 on PFT results.

Please one more question, you agreed that I may have mild restrictive lungs as well as COPD. Can this restriction have been caused by my many episodes of bronchitis through the years and if so does this type of restriction progress like COPD.

At 59% can I possibly have a future of 20 years or more. I quit smoking and do not get bronchitis as much or severe anymore, I do use antibiotic at first sign of a cold. I am 48 now.

Wendy

A. Dear Wendy, I do not believe that the bronchitis causes airflow restriction. You should have a good prognosis, particularly since you quit smoking.

Dr. Tom  

Burning in Chest Relieved after Deep Breath

Q. I have a periodic burning in my chest right in the center. I have had a heart test, a lung x-ray, and CT Scan. I spent several days in the hospital then I had a scope to the stomach and all. I think it’s my lungs as when I have this attack now I discovered that deep breathing helps and the burning stops so what do you think?

Jolene

A. Dear Jolene, I do not have an explanation for your symptoms, or the relief you get by deep breathing. Sounds like you have found a solution to the symptoms yourself.

Dr. Tom  

Hope Others Learn from My Experience

Q. Dr Tom. Please publish this in your lung health as a warning to others. I believe, Dr. Tom, that I have had COPD for at least 10 years, but it was only diagnosed 5 years ago. I was a smoker, age 50, with sputum, cough, and I just thought it was due to smoking. Then I started to get short of breath and figured it was due to aging and being overweight and out of shape. Five years ago I had pneumonia and it was at that time I was diagnosed with COPD.

I never heard of COPD. I thought it was part of the pneumonia and the doctors took it for granted that I knew I had this disease because I was diagnosed with severe exacerbation of COPD. When I was admitted they asked if I had a family doctor, but upon their diagnosis did not ask if I was seeing a specialist. They discharged me and I was a lot better, but over time the breathing got worse ( three more years). It was only then that my family doctor sent me to a specialist.

I could have been helped many years before if COPD was explained to me at the hospital. I thought COPD went away with proper treatment, seeing at the time I was feeling better, no need to see a doctor.

Please tell other physicians not to take for granted their patient know their condition. Also if the hospital would have told me the severity of this disease I could have received the proper treatment years ago.

Fortunately now it is under control, but I did lose some quality of life, over those years that I was no informed.

Phil 

A. Dear Phil, You are absolutely right. Doctors are slow to diagnose COPD. They desperately need to do spirometry on all current or former smokers, and anyone with chronic cough, dyspnea on exertion, wheeze or mucus hypersecretion. These are the recommendations of the National Lung Health Education Program (NLHEP).

All doctors who see patients like you should either have a spirometry in their offices that they use daily, or refer to a doctor or laboratory that can provide this service. You cannot treat a disease until you diagnose it!

Thanks for the opportunity to speak out on this. I have been trying to get spirometry established for over 30 years. The "Flat Earth Society" opposes this concept.

Dr. Tom  

Lung Problems have Worsened as I have Gotten Older

Q. I am a 23 year-old female.  When I was in the 5th grade I had an episode at school to where I had difficulty breathing.  My mother took me to the doctor and he put me on an inhaler with a diagnosis of bronchial spasms.  He also said that it would heal, as I got older.  I was also exposed to a great deal of second hand smoke. 

As I got older I personally restricted how much exercise that I did.  I would feel a tightness in my chest and I hated using my inhaler.  Throughout the years I would have bronchitis or even pneumonia.  When I was older I thought my lungs were just out of shape so I started running a little.

 I felt confident that I was improving and I decided to join the Army in 2005.  I was 22 at the time.  During basic I had troubles, but I withstood them and finally graduated. 

I am now in New York and started having even more problems.  I now can't run a mile without needing an inhaler.  I was diagnosed with asthma by the pulmonologist. They also found that my left lung is not fully developed and the lower portion showed no activity in the CT scan.  I am scheduled for a bronchoscopy, and I am nervous.  What could have happened and how can I be cured?

Brandi

A. Dear Brandi, You certainly have asthma. You may also have a congenital abnormality of some of one of your lung's development. You can have a normal life with the use of anti asthma medications, but you may have some limitations.

Dr. Tom  

Life Expectancy and Emphysema

Q. My doctor won't be straight with me.  What is life expectancy when you have emphysema with severe hyperinflated lungs? Still smoking.

Deborah

A. Dear Deborah, It depends on your age and what percent of normal is remaining in your lung function. Still, there is quite a range in survival, usually many years. Your survival and quality of life will be MUCH better if you stop. Do it now, rather than later. Get help for a smoking expert.

Dr. Tom  

Worried about Shortness of Breath

Q. My wife experiences shortness of breath leading to hyperventilation and anxiety attacks. CT scans are clear, as are all blood tests. We have seen a neurologist, pulmonologist, had two psychological evaluations, with no diagnosis. She is getting weaker by the day. they have given her Zanax and trazadone to keep the anxiety in check. She has no prior history of anxiety problems.

One day she was a busy nurse the next day and still now she can hardly walk up a flight of stairs. It has been over a month now and we are no closer to a diagnosis; after fifteen visits to ER’s and specialists.

Craig

A. Dear Craig, I cannot believe that you have NOT had spirometry (National Lung Health Education Program), a simple test to measure lung function. Get it done by a pulmonologist who knows what he is doing. You need a diagnosis, and not a psychologist or neurologist. 

Dr. Tom  

Need Help Understanding X-Ray

Q. My lung x-ray showed these results; noncalcified subpleural mass measures 18.2 x 18.9 x 24 mm with surrounding subsegmental atelectasis. Could you please tell me what this means? Thank you so much for taking the time to read this.

Bucky

A. Dear Bucky, This shadow means that a portion of lung is collapsed and there may be a tumor in it. A diagnosis is advised, which means a biopsy to rule out lung cancer.

Dr. Tom  

Is a Nebulizer Good for Baby Son?

Q. Sir, This is Mani from India, My Boy is just 16 months old. He got cold a month back; we are following the pediatrician's instructions. He advised us to give nebulizer daily 2 times. We did it for a day or two, afraid of Nebulizer medicines. For now, we are in Monsoon season. Now we hear sound Gurrrr-Gurr-Gurr when he breathes. Yesterday we went to doctor's office and gave him nebulizer. Please advise what we should do immediately to see him normal.

Mani

A. Dear Mani, A nebulizer will not harm your child. I do not know what more advice I can give you. Better follow the advice of your local doctor.

Dr. Tom  

Endobronchial Valves

Q. Dr. Tom, I am a Respiratory therapist (What is a Respiratory Therapist). I have interest in the new procedure of Endobronchial Valves.  This sounds awesome from what I have read.  Do you have any information on this research? 

Also, I was told a complication might be a pneumothorax.  Please comment on this procedure of hope for COPD patients.

RC

A. Dear RC, This is a research procedure, designed to reduce the volume of localized blebs  and bullae (an air- or fluid-filled sac/s in the lung; like a blister). I do not know the outcome of this research that is going on in several places.

Dr. Tom  

Recurrent Pneumothorax

Q. Is recurrent pneumothorax common between family members, and what are the main causes?

Jennifer

A. Dear Jennifer, Recurrent pneumothorax is often due to congenital blebs (an air- or fluid-filled sac/s in the lung; like a blister) on the surface of the lungs. This process is not known to run in families.

Dr. Tom  

Lung Transplant and Cytomegalovirus (CMV)

Q. I am waiting for a lung transplant. Today I was advised that I do not have CMV, unlike 75% of most people making it more difficult to find a compatible lung.  My FEV1 is 15%, so at age 61, I am running out of time. 

My doctor wanted my authorization to transplant a CMV donor's lung if necessary.  He said in the last few years this works but it would require taking another drug, Valcyte, for 6 months. I have a lot of confidence in this doctor and institution.  I would appreciate your opinion.

Bonnie

A. Dear Bonnie, The CMV virus is common and can be transmitted by transplantation. But it is treatable and this should not rule out necessary lung transplantation, in my opinion. Dr. Tom  

Does Size of Mouthpiece Affect Spirometry Results?

Q. I recently had a pulmonary function test, I started doing the test with the regular mouthpiece and then they changed me to the small mouthpiece.

I got different results with each mouthpiece.  Does size of the mouthpiece matter or alters the results? 

I have been told by a doctor that I have asthma based on little air on chest-x-ray and I am only able to blow up to 250 on the peak flow meter, then, after doing the peak flow meter, I will be short of breath for 2-3 days. So, I don't do it. 

But I guess according to the pulmonary function test with the small mouthpiece I am ok.

Maria 

A. Dear Maria, A very small mouth piece may increase the flow velocity from your lungs and give a falsely high reading on the spirometer. But I doubt if these are used in spirometry testing.  Use a normal size mouth piece for accurate results.

Dr. Tom

EZ-PAP and Hand Held Nebulizer (HHN)

Q. When using the EZ-PAP in conjunction with a HHN, does it really matter which is closer to the patient's airway, the EZ-PAP or the HHN?

Paul

A. Dear Paul, No.

Dr. Tom  

Body Composition and Spirometry Normal Standards

Q. Dr Tom. I would like to bring to your attention the possible miscalculation of spirometer testing. I know that the person doing the testing uses your individual information i.e. height, weight, sex, and race and your results are compared with a “standard” of people like yourself.

What I think they have missed is the composition of the individual and I will explain. I am 5 foot 6 inches tall and I weigh 210 lbs, but my chest is extremely thick. My doctor told me he has never seen such a thick chest in someone my size. This was confirmed when I had an Echo heart test and they could not get a decent picture. The aorta picture was unrecognizable.

Now I feel this would also have an effect on the spirometer test, with such a thick chest the lung capacity would be diminished because the lungs would be restricted to some degree, therefore the spirometer results would possibly be faulty to a degree.

Philip

A. Dear Philip, I do not believe that a muscular chest or neck will affect spirometry testing.

Dr. Tom  

X-Ray Showed Bronchitis?

Q. I had a chest x-ray three weeks ago. I had pre-op today and I told the nurse who phoned the place I had it done to get the report. She came back and said I would have to have another, that the one I had recently showed I had bronchitis. No one ever let me know nor any medication called in for me for the infection. What should I do?

Suzie

A. Dear Suzie, I do not believe that a chest x-ray is accurate in diagnosing bronchitis.

Dr. Tom  

Should You Use Petroleum Based Lubricant During a Bronchoscopy

Q. Dr. Tom, Many of the pulmonologists where I work are using white petroleum jelly instead of a water-based lubricant when performing a bronchoscopy via an endotracheal tube. 

I am having a difficult time finding supporting data for this, but find several cautions against using petroleum-based products with O2.  Can you shed some light?

Larry

A. Dear Larry, Petroleum based lubricants should not be used with bronchoscopy, because the material may remain in the lungs and cause inflammation. I do not know any bronchoscopist that uses petroleum based lubricants for this procedure.

Dr. Tom  

Is it Okay to Mix Pulmicort, Albuterol, and Atrovent?

Q. Is it okay to mix Pulmicort with albuterol and Atrovent in the same nebulizer during a treatment? The hospital I use to work at we did and now I'm working at a new facility and they say you can't. Who's right?

Claudia

A. Dear Claudia, These drugs are compatible and can be used in the same nebulizer.

Dr. Tom  

Father has Skin Breakdown with BiPAP Mask

Q. Dr. Petty, My father is on BiPAP-S/T (a machine that aids with oxygenation and ventilation) every night. He has developed a small ulceration at the bridge of his nose.  I have searched everywhere for a solution; I have bought several face masks, including a full face mask (which covers his whole face) which was not tolerable for him.  I have not found anything to help. He covers his ulceration with a band aide and some Biafine every night after using hydrogen peroxide on it.

Nasal gel masks are not an option as he has Wegener’s Granulomatosis (an uncommon disease, in which the blood vessels are inflamed) and it has affected his sinuses and his lungs. I believe that dura...(like skin covering)-forgot the name of it, does not allow oxygenation to the site.    

Sorry for the length of the question, but I have tried everything I can think of. I am an RN--do you have any suggestions.  I am afraid that some day we will reach bone and will be in a mess.

Carol

A. Dear Carol, You present a very difficult problem. Some sort of cushioning is needed, but it seems you have tried everything. I wonder if some sort of gel placed in a condom, to make a very flexible and malleable cushion, would work.

Dr. Tom  

Follow-Up X-Ray for Possible Tuberculosis (TB) Exposure

Q. I recently went for a chest x-ray for a follow up for possible exposure to TB and the chest x-ray shows probable calcified left basilar granuloma-  please explain this and which specialist I follow up with? I am very worried.

KS

A. Dear KS, This is most commonly caused by a healed fungus. It is not cancer and should not concern you.

Dr. Tom  

Mixing of Medications

Q. My Dr recently added Spiriva to my asthma treatment in addition to combination of Serevent and Pulmicort. I would like to do away with the Serevent and Pulmicort as I seem to respond well to the Spiriva. Would you recommend this? Also is Spiriva unsafe to use with Serevent?

Scott

A. Dear Scott, Spiriva is compatible with Serevent. Both drugs are bronchodilators. You may be getting maximum bronchodilatation from the Spiriva, which would make the Serevent unnecessary. Give it a try.

Dr. Tom  

Low Diffusing Capacity

Q. My lung volume is good, my DLCO is only 70% predicted, In 2002 I was exposed to bleach in a steam cleaner on white rugs that had not sucked up the water , I smoked and also had no flue on furnace while the furnace was being repaired, carbon monoxide testers went off, In hospital Blood Gases were low, PFT were all under the ATS acceptable cut off and DLCO was 62 it took 5 years for it to go up.

I didn’t know until recently PFT how bad it was the last 5 years.. I thought I only had mild COPD from smoking, I smoke a pack a day. NOW scared out of my mind I want to quit, I don’t want to be on oxygen.

What else can be done to help someone with a low DLCO? And if I stop can it go above the ATS and back to normal?

Sheryl

A. Dear Sheryl, You must stop smoking no matter what. There are new drugs that help deal with nicotine withdrawl, such as varenicline (Chantix) which has just been released. By stopping smoking you can protect your diffusion function (DLCO). Don't give up.

Dr. Tom  

Life and Breath Video

Q. How can I find and view the "Life and Breath" video?

Yarblom

A. Dear Yarblom, The links to Life and Breath video produced by the American Association for Respiratory Care video are:
Watch the video online with RealPlayer:  
High Bandwidth       • Low Bandwidth (modem)
Download the video for playback on your computer:  
 • QuickTime (253 MB, highest quality)       • Windows Media Player (47 MB)

There is also a video we did on pulmonary hypertension that may still be available from the Pulmonary Education and Research Foundation.

Dr. Tom  

Lung Damage and Smoking Marijuana

Q. Hello Dr. Tom. I've had this question on my mind for quite some time, but I didn't know who to go to. I am a 17 year-old male and I've been smoking marijuana almost everyday for the past year. I was wondering how much lung damage could have been done to my lungs, and how much lung capacity I may have lost, because I want to go out for wrestling next year at my high school.

I don’t know how many of my alveoli sacks I've destroyed, or if my lungs will gradually regain their capacity over time if I quit smoking. I hope you get this and respond, because I think you're the one to talk to about this, and I need your analysis.

Eric

A. Dear Eric, Marijuana is very irritatiing to the lung passages. Probably you have not done much damage to the alveoli. You could get spirometry for reassurance. Stop the grass and get on with your wrestling and the rest of your life.

Dr. Tom  

Hyper-Aeration of Lungs

Q. I'm 53. Some years ago, a physician diagnosed me with hyper-aeration of the lungs. For about 10 years, I made animal balloons as a hobby. These are tough to blow up, and require a lot of pressure from the diaphragm to inflate.

Could that have caused the condition? Is it something to be concerned about? I've been thinking of taking up the hobby again, but don't want to blow anything up but the balloons!!

Bob

A. Dear Bob, Blowing up balloons will not damage your lungs. Have fun.

Dr. Tom  

Conflicting X-Ray Reports

Q. I had a CT scan of the chest with contrast and multiplanar reconstructed images in February 2006 because of chest pain. The scan said I had multiple mediastinal and hilar lymph nodes and findings are most pronounced about the subcarinal region.  There is a 4mm noncalcified mass in the left upper lobe.  It could be a noncalcified granuloma.  It said no additional focal mass or nodule is identified.  There were areas of mild interstitial scarring or atelectasis  with no focal consolidation.  There is some minimal apical scarring more pronounced on the left.  They then suggested it could be lymphoma or sarcoidosis. 

In 4 /06, My next CT scan of the chest with intravenous contrast, basically said the 4mm nodule on the left upper lobe was stable with mild mediastinal and bilateral hilar lymphadenopathy. 

On 8/5/06 I had another CT scan of the chest with high resolution images this report said the 4-5 mm nodule in the left upper lobe was stable and the 3mm nodule in the upper right lobe was also stable; I never had a nodule in the right upper lobe according to the other reports.

I called my doctor and he called the radiologist and they say it showed up because of the high-resolution images given on this CT scan but it was also there all along?  Now I'm really confused. 

The Oncologist I went to see didn't even know that there was a nodule on the right.  The report said to have another CT scan of the chest in six months.  Is this appropriate? Also this report said there are 1cm in size lymph nodes in the bilateral hilar and there is small lymph nodes in the mediastinum measuring about a centimeter in size in the pretracheal region and AP window as well as a bit larger in the subcarinal region measuring about 1.5 cm in size. 

They say they all appear to be about the same as previously seen.  They say the differential diagnosis would include reactive adenopathy versus lymphoma versus sarcoisosis. 

My mother passed away at the age of 69 with small cell lung cancer and my sister passed away at the age of 43 with small cell lung cancer. My Oncologists' theory is that it's Low Grade Non-Hodgkins Lymphoma since I feel pretty well most of the time. 

Just recently I have some leg pain which has been waking me up at night. It's just a dull ache which could be arthritis because I do have osteoarthritis in my hands.  I'm on 600 mg. Lodine for that 2xdaily. 

Please answer some of my concerns as I just found out about this other nodule on the right upper lobe that was never on any of my other reports but now say it was there all along. I should tell you I am a 56 year old female who feels good most of the time. 

Kathy

A. Dear Kathy, In view of your family history, you should have a biopsy. This may require a mediastinoscopy done by a surgeon. In a mediastinoscopy a small incision is made in your neck and a scope passed into the middle part of the space between your lungs and heart. This allows for a biopsy for mediastinal and paratracheal nodes. It is not a risky procedure and would give you an answer.

There are good treatments for various lymphomas. Often sarcoidosis of just the lymph nodes does not require any treatment.

Dr. Tom  

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