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Archive: Dr. Tom 77
Posted September 8, 2006

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

 

 

Tired of Being Tired all the Time

Q. Dear Dr. Tom, My O2 saturation levels are usually between 75 and 80% when at rest. Lately I feel that my lungs are having to work twice as hard to pump oxygen to my heart.  Top that with dizziness, chest pains, headaches and swelling with water retention. 

My medical provider just keeps increasing my medication.  I'm really getting tired of all the meds and need to know what questions I need to ask to get them to perform the right test to fix the problem rather than continue to treat symptoms.

I don't want to sound like a hypochondriac but the bottom line is that I'm tire of being tired all the time. And yes I have emphysema. 

Sheilah

A. Dear Sheilah, I assume you are on oxygen. You did not say whether your oxygen saturations at these levels while on oxygen or breathing air. Oxygen should increase your saturations to above 90%. This may improve your condition. Also there are medications for pulmonary hypertension, which may well be present in your case. Ask your doctors about medications for pulmonary hypertension, and an echo to estimate your pulmonary pressures. High pulmonary pressures put a strain on the right part of the heart, and may be the reason for your fluid retention.

Dr. Tom

Pleural Thickening and Parenchymal Scarring Something to Worry About?

Q. I had a chest x-ray recently for a severe dry cough over a five day period.  The results showed chronic biapical pleural thickening and mild parenchymal scarring.  Is there any reason I should request any further testing (my physician hasn't suggested anything further).  I'm 51 and in fairly good health.

Sharon

A. Dear Sharon, These common chest x-ray findings are usually due to a remote and healed inflammatory process. You need CT scanning for more detail, if you smoke or have a family history for lung cancer, or asbestos exposure.

Dr. Tom

Lung Function Loss after Lung is Removed

Q. Due to recurrent colon cancer, I had the upper left lobe of my left lung removed in 2000.  I've often wondered how much lung volume or lung capacity I have lost due to this lobectomy?

Rick

A. Dear Rick, Probably only about 20%. There are two lobes on the left, but the lower lobe expands to fill up some of the volume, after the upper lobe is removed. You can know for sure by having your doctor do simple spirometry to measure your remaining lung function.

Dr. Tom

Removing Cigarette Odor from House

Q.  Are there any lung safe plug in air scent fresheners? I 'm trying to get rid of a horrible cigarette smoke odor in the house that I just purchased (end stage COPD and lung cancer). Please help,

Rich

A. Dear Rich, It is very hard to get rid of these odors. Lots of fresh air is the best. I do not put any faith in so called air fresheners. They cover up one bad smell with another.

Dr. Tom

Passing a Kidney Stone

Q. How does a man know when he has passed a kidney stone?

Linda

A. Dear Linda, There is a great amount of pain in passing a stone. Great relief is noticed as soon as the stone is passed. Sometimes there is some bleeding in the urine. Once in a while you can see the stone in the toilet. You can also urinate through a tea strainer to try to identify a small stone.

Dr. Tom

Coughing and Short of Breath for Six Months

Q. Dr. Tom, I am 54 years old. For the last 6 months been having what I thought was heart attack symptoms; fluttering, sporadic beats and pain in my far left side of chest plus shortness of breath especially at night or activity.

I went to the hospital and the usual tests determined that my heart was fine. It’s been four months since the hospital checked and I am so fatigued from the coughing and ache. I feel that it may be lungs.

I have had a cough most of my life, (dry with swallowing of phlegm), but now it somehow seems related to the other symptoms. I also cannot raise my left arm more than shoulder height without almost passing out (fatigue). I am so tired. Please help. Do you think its some kind of lung thing?

Ginny

A. Dear Ginny, You need to see a pulmonologist. Your symptoms suggest that the problem originates in your lungs. There are lots of possibilities.

Dr. Tom

Intense Pain Months after Pleurodesis

Q. I have a four spontaneous pneumothoracies in my right lung and had the pleurodesis procedure at the end of November last year, 2005.  Since then I still had pain after but it soon started to ease and I got back to work.  Six months later the pain is getting worse. Taking deep breaths is really painful and I constantly feel tired. 

I have been to my doctor several times and she has come to the conclusion that I take Co-codamol and ibuprofen everyday and just ignore it.  It feels like   I'm taking nothing for the pain and I don't want to be constantly taking painkillers.

I have also been to the A & E and had several chest x-rays but they say they can see the pleurodisis and it looks fine and my lung looks healthy.   

So why am I having such intense pain?  It feels like I have a chest drain constantly stuck in my lung.  I am now seeking alternative medicine through a herbalist; but the mixture she has given me has still had no effect. 

I'm at a loss of what to do.  I feel my doctor is not interested, as every time I go to see her she rolls her eyes when she sees it's me.  I feel I'm wasting people’s time and I'm trying to take my doctor's advice and just ignore it but is there anything else I can do?

Elizabeth

A. Dear Elizabeth, This pain can nag on for some time. I suggest taking pain killers such as ibuprofen or even hydrocodone , for relief. No reason to suffer while the inflammation that produced the pleurodesis subsides.

Dr. Tom

Can the Growth of Lung Nodule be Caused by Respiratory Medications

Q. My Doctor has recently found two nodules in my lungs one 3mm and the other one grew from 6.4mm to a 7mm is there any chance that Advair or any other asthma inhaler can be the cause of this?

Keith

A. Dear Keith, No. If these nodules continue to grow, you need a biopsy. A change from 6.4 to 7mm is not significant.

Dr. Tom

Bad Pain on Right Side of Head

Q. Dear Doctor, Some times I have a very bad pain on the right side and “in my throat”, too. When I go to a high altitude, for example mountains the right side of my face begin to unfeeling (insensible) and my right eye, teeth, temple and the right side of my noise begin to the severe pain so that acetaminophen or Excedrin or anything similar not reduce my pain.

My CT scan and MRI didn't show any thing wrong and no one understand what is the cause. I went to almost 30 doctors but they can't realize the cause, please help me and I am 21 years old for the sake of God help me.

Mona

A. Dear Mona, A CT of your sinuses or middle ear should show something. You should go to a neurologist, if these symptoms continue. It sounds like some air pocket, somewhere, expands with altitude, but I cannot be more specific.

Dr. Tom

Would Like a Know an Estimate on Time Left for Me

Q. I have read longer questions on your site so I hope you can comment for me on this:  Full Pulmonary Function Test with and without bronchodilator.  FVC moderately/severely reduced.  FEV1 severely reduced. FEV 1/FVC ratio is reduced.

Spirometry reveals severe obstructive ventilatory function. Following administration of nebulized Albuterol, no significant response in FEV1 &FVC. Does not rule out a response to chronic bronchodilator therapy. 

Shape of expiratory flow volume tracing suggests that obstruction is present. Pattern of an increased residual volume & a normal FRC and TLC is consistent with air-trapping or selective expiratory muscle weakness. The specific airway conductance is decreased implying an increased resistance when lung volumes are taken into consideration.

Diffusing capacity is severely reduced. Causes of a reduced diffusion capacity include loss of effective surface area for gas exchange, decreased pulmonary capillary blood volume, anemia or carboxyhemoglobinemia. 

The reduced diffusing capacity in conjunction with an obstructive ventilatory dysfunction suggests the presence of emphysema.

Conclusions: severe emphysema. FEV1 is slightly reduced from 4/01 study. Diffusion capacity is unchanged from 4/01 study.

I am on oxygen at night with Bi-Pap, and have portable oxygen for going out.  I am also using prednisone (by the way does it cause ugly round dark colored blotches on arms?  Dr. Aronsky says that is what they are from.)

My main question is and I would like as direct a response as you can give based on this 2004 Interpretation submitted:  I am 64..........is there much more time left for me?  I can never get a "guesstimate".  My other meds are Advair 500, Combivent, Nifedipine for blood pressure and Flonase, and regular vitamins and Zantac.  I have morphine but I choose not to use it often.  Thank you ever so much.  I am in Longview, WA

Karla

A. Dear Karla, It is difficult to give accurate predictions about survival. Quality of life may be more important. You did not give me the FEV1 number. If around 1.0 liters, you may live five or more years. Sometimes, longer. This assumes avoidance of all tobacco smoke.

Dr. Tom

Question the Practice of Cleaning a Tracheotomy with Peroxide

Q. I have heard that peroxide was harmful to the skin if used doing tracheostomy care, since peroxide is toxic to the airway.

In the average nursing homes today, there are not many respiratory therapists and teaching the nurses how do trach care has been a long haul for me. Specifically using peroxide mixed with normal saline to clean around the stoma site.

Nursing does not use peroxide in wound care anymore, wouldn't you consider a fresh stoma site or old to be considered an open wound? I need this clarified for me to use in teaching them. If there are any documents that say this and is accepted protocol could you help me see a written addendum of this? Thank you in advance,

Patricia

A. Dear Patricia, The important thing is to keep the stoma clean. Soap and water, saline or peroxide are fine and not harmful to tissue.

Dr. Tom

Normal Pulmonary Function Test but Still Short of Breath

Q. If my pulmonary function test was normal (although I have questions about the way it was performed), but I still have tightness in my chest and difficulty breathing, short of breath.  I get 250 reading with the peak flow meter, what does all these mean?

Do I have asthma?  In my chest-x-ray there are some little tiny white dots, is this normal?  Thank you for your help!

Maria

A. Dear Maria, There are many causes of shortness of breath, that do not relate to abnormal spirometry. Your peak flow of 250 may be low, depending on your height. You will need a pulmonologist to make a diagnosis, based on all the facts of your case.

Dr. Tom

A Few “Hospital” Questions

Q. 1. Can Clinical Practice Guidelines be used as departmental policies and procedures?

2. With HIPAA in mind, can ventilator check monitoring sheets be left on the ventilators at bedside?

Jorge

A. Dear Jorge, Yes and no. It all depends on the standards of practice in your hospital. Monitoring sheets at the bedside should not be a problem. HIPPA rules are confusing and often misinterpreted. They are overrated, in my opinion, and may do more harm than good.

Dr. Tom

A Few Questions about Carbon Monoxide

Q.  Is histoplasmosis symptoms like carbon monoxide poisoning? Can carbon monoxide poisoning come from bat feces?

Brandi

A. Dear Brandi, No.

Any Complications from BiPAP

Q. What are the complications of using Bi-PAP?

Dana

A. Dear Dana, Trouble with the mask and skin irritation, in some patients is the main thing.

Dr. Tom

What Constitutes End Stage COPD

Q. My FEV1 is "about 20%". My weight has gone down too, and remains at 79lbs. My ability to ambulate has grown much worse. I have been hospitalized 2 times a year for a number of years.

I assume that this constitutes "end stage" but is there any way to estimate how long I might live under these conditions. I really don't feel that bad...just tired and breathless.

Catherine

A. Dear Catherine,    It is hard to make predictions about survival. Many patients with so called "end stage COPD" live a number of years. The important thing is quality of life and having a meaningful day, each day that remains.

Dr. Tom  

What’s Your Opinion of Combivent?

Q. I am 78 years old and a pulmonologist told me I have COPD. I suffer occasional shortness of breath. The recommended to take Combivent twice a day. It seems to help. I would like your opinion of Combivent and are there any other medications that you can recommend?

Art

A. Dear Art,  Combivent is a very good bronchodilator product that contains two different medications. It is relatively inexpensive and can be taken three or four times a day.

Dr. Tom

Can Lung Nodules be Caused by Post-Inflammatory Changes?

Q. I had a CT scan which showed "multiple nodules", likely caused by "post-inflammatory changes."  I frequently have trouble exhaling; my chest frequently makes a sound like crinkled cellophane when I breathe;

I have been spitting up green/yellow mucus frequently with thin red or black lines. I'm usually very tired. 

I have never smoked, but was subject to secondhand smoke as a child/teenager because my mother smoked. My daughter (nurse) said she didn't think the "multiple nodules" went together with "post-inflammatory changes."  What do you think? 

MaryEllen

A. Dear MaryEllen, Multiple small nodules are frequently caused by inflammation, most usually a fungus infection. Your multiple nodules probably do not explain your symptoms. Dr. Tom

Thanks for Your Reply to Previous Question

Q. Dr Tom, I was having a very depressing time, looking for info on COPD, when I come across your site, and started to read, and to my amazement found a question from a girl, that was so exactly my situation that I couldn’t believe it, until I realized it was from ME! haha,

I had forgotten I had asked you for advice Just wanting to say thanks so much for replying, I really appreciate it.

Angie

A. Dear Angie, Your are welcome. Glad I could be helpful to you and others.

Dr. Tom

Can’t Find an Answer to My Shortness of Breath During Exertion

Q. I am 25 and have had a problem all my life; I distinctly remember this problem at age three.  Long story, but my parents wouldn't let me see a doctor.  I cannot run, climb stairs, walk uphill, without feeling like I'm not getting any air, even though I feel the air go into my lungs and am breathing normally. 

If I push myself, I will become dizzy and pass out (did that many times as a child being called a sissy).  It would take 90 sec of running to pass out, which is about as long as holding my breath I would guess.  I know albuterol makes it harder for me to breathe, I've gotten it when I've had bronchitis, and tried it again later, when I was recovered. 

As an adult, I have had 2 doctors, and told both of them I wanted to know what my problem is.  One gave me a spirometry, results were excellent, and said I must not have a problem.  The other told me "If you only have the problem when you run, don't run".  So I kind of gave up, since doctors are expensive when they waste your time. 

I guess my questions are...do you have any suggestions, like "Its urgent to get this diagnosed right now because ..." ?  Is a pulmonologist the right kind of specialist to see, anyway, if I can get past the bureaucracy? 

Ann

A. Dear Ann, There has to be a diagnosis for your problem. I am surprised a pulmonologist cannot give you an answer. I suggest seeing a cardiologist. I cannot speculate on a diagnosis. You should not be limited by these symptoms, unless there is a clear explanation.

Dr. Tom

Don’t Know if I Buy What My Doctor is Telling Me

Q. I received a copy of my CT chest Scan without contrast and I don't understand what my doctor is telling me or not telling me.

Impressions
1. Emphysema with asymmetric apical scarring, left greater than right. Given the prominent soft tissue associated with the left apical scarring the possibility of scar carcinoma must be entertained, Further imagine with PET could be performed to exclude the possibility of metabolically active disease.

My doctor told me that Cancer was not seen, but wanted to double check, Don't know if I can buy that one. Sounds to me like the radiologist is asking for a  PET to see how far the cancer has progressed.

Josephine

A. Dear Josephine,  A PET scan could rule out cancer. It cannot differentiate between cancer and an active inflammatory process. I think a PET scan is a reasonable thing to do, in view of your CT findings.

Dr. Tom 

Really Want to Quit Smoking; Could Cough be Symptom of COPD or Lung Cancer

Q. I, regretfully, have been a smoker since I was 12-13. I am 27 now and want to quit really badly. It is so hard for me, more than I can describe, but I will quit because I really have no choice if I want to breath freely.

My issue is that I have the constant need to cough up phlegm and I'm always sort of hacking away, though I'm never successful really in getting any out. It's not even a cough. It's almost like clearing my throat but it's deeper.

I seem to get flare ups lately and it's been getting worse over time. Right now I feel like there's something caught in my lungs. I can breath but it feels really tight, there's no pain, I just can't get any phlegm out. It seems to just fade away after time and then something will cause it to start up again, sometimes causing me to loose sleep. It doesn't seem to be brought on by physical exertion and it gets worse when I lay down. It's obviously pretty embarrassing at work too.

I'm starting to think I may have something besides a smoker's cough. My dad and grandpa (my mom's dad) were diagnosed with lung cancer. I realize how stupid it is of me to smoke with my family history among the danger alone. It's a stress release mechanism. Could I get lung cancer this young? Or maybe I have COPD or Emphysema? This has only really bothered me in the last couple of years and very much so this month. Your help is very much appreciated. Thanks for your time.

Joslyn

A. Dear Joslyn, It is highly unlikely that you have lung cancer or emphysema at your age. Most likely, you have chronic bronchitis from smoking. It is essential that you stop smoking. I suggest consulting a smoking cessation clinic or expert who specializes in addicted smokers.

Dr. Tom

Medication Controlled Asthma; What about Scuba Diving?

Q. I am a 26 year old male suffering from controlled asthma.  I take regular preventive medication: Becloforte - 2 puffs, morning and evening, daily -- Serevent 2 puffs, morning and evening, daily.  Since I have been taking this medication (almost 8 years) I have never suffered any acute asthma attacks, and have rarely had to used Ventolin.
 Taking this into account, would it be safe for me to engage in scuba diving?

Mark

A. Dear Mark Probably yes. Give it a cautious try.

Dr. Tom

 Follow-Up Question on Person’s Size and Spirometry

Q. Dr Tom. Thanks for answering my previous question regarding a large frame chest and neck possibly having effect on spirometer.

I thought a large chest would restrict breathing. If you are correct (and you're the doctor ) could you answer this. I have a friend who is obese, he weighs 350 lbs, and he has trouble breathing and does not have COPD. He is constantly out of breath and his breathing at times appears shallow.

Now, if he took a spirometry test, with no asthma and no COPD, do you still feel that the spirometry test would not be influenced by his size and that his body mass is restricting his breathing to a certain degree.

Phil

A. Dear Phil,    A person with this degree of obesity would very likely have restricted breathing that would be documented by spirometry.

Dr. Tom

Last weeks Question:
Body Composition and Spirometry Normal Standards (Dr. Tom 77)

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  

Don’t have Symptoms but Dr. Prescribed Medication

Q. Can Spiriva Handihandler (Tiotropium bromide inhalation powder) be stopped after two dosages or will it create some harmful side affects? The doctor that recommended the prescription but I really don't have the symptoms or health like patients with COPD.

Pooja

A. Dear Pooja, Spiriva can be stopped at any time.

Dr. Tom

Worried about Wheezing and Hyper-Inflated Lung

Q. Dear Dr Tom, I am 41 year-old male, I started smoking at 14 and now I am a 27 year-old smoker. I have had wheezing for more than five years and also stuffy coughs.

I went to a doctor and ask him to get an x-ray from my chest and the result came hyper inflated lungs. Since that day I started cutting smoking from one pack to 6-7 cigarettes a day.

My question is am I going to be able to get rid of this thing from my lung or is it going to stay with me for the rest of my life? I asked many people, some say if I quit smoking it'll go a way; and some say there is no cure for hyper inflated lung.

I am worried. I don’t want to die because of this. I am also a house painter and work with chemicals. Please tell me how bad my situation is and if there is a way to get this thing out of my life.

Ray

A. Dear Ray, Hyperinflation is not a problem in itself. It is still better for your health if you stop all smoking. Cutting down is good, but not nearly as good as complete cessation.

Dr. Tom

Recently Diagnosed with Breast Cancer, X-Ray Shows Granuloma in Lung

Q. Recently been diagnosed with breast cancer and have done treatment, just noticed my CT scan on chest said "1 cm in diameter calcified granuloma in the posterior basilar aspect of the right lower lung. 

My breast cancer was not in lymph nodes but stage 11.  Is this something you believe I should be concerned about?  Always feeling uneasy these days.

Sal

A. Dear Sal, No. A calcified mass is not cancer.

Dr. Tom

How to Get Body Healthy After Illness and Alcohol Over the Years

Q. I had a subdural brain bleed four months ago I think it was from to much alcohol over the years. I have stoped drinking what should I do to get my body healthy again. I am 40.

Selena

A. Dear Selena, You have done the right thing to stop drinking. Eat right, exercise and do not smoke. You will remain healthy.

Dr. Tom

Does Lung Scarring Need to be Monitored?

Q. Hi Dr. Tom, I am a 33 year old female.  Since I was young, any chest colds that I get turn into months of bad coughing, (sometimes up to 10+ months.  I currently have a cough that has lasted for about 3-4 months.  I have never been a smoker.  I have also had x-rays that have shown that I have scars on my lungs.  The scars have remained the same for at least five years. 

The doctor looking at the scars did not advise that they need to be watched or monitored, but I am wondering if I may have some sort of chronic lung problem. Thanks in advance for your help.

Suzanne

A. Dear Suzanne, Localized lung scars will not progress and do not pose a problem to you, unless you get more infections, resulting in scars.

Dr. Tom

Where to Live for Healthier Breathing

Q. Doctor, I have COPD but do not need oxygen, was wondering if Panama City, Florida would be healthier for my breathing that Southern Arizona.

Les

A. Dear Les, Probably, because of the lack of pollution at the gulf. But it will make little difference.

Dr. Tom

End-Tidal Carbon Dioxide Concentration (ETCO2) and Extracorporeal Membrane Oxygenation (ECMO)

Q. How effective is an ETCO2 reading when a patient is hooked up to ECMO, with an intubated patient?

Rick

A. Dear Rick, I do not know. ECMO does eliminate CO2, and the end tidal measurement should still reflect arterial blood CO2.

Dr. Tom

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