Family History of Cancer, Should I Wait four Months to Have Re-Check
Q. I am 58 white female. Recently two lung nodules few found; one on each lung. Never been there before one is 9mm the other is 5mm. I saw a pulmonary specialist. He wants to wait four months and check to see if they have grown.
I have had pre-cancerous polyps from my rectum and my family on my Mother’s side of the family is riddled from all kinds of cancer. I am concerned about waiting four months.
Can you help me decide if I should seek a second opinion or am I silly in my concern?
A. Dear Ellen, You are not being silly. The 9mm nodule should be biopsied now, in my opinion, or in the near future. It is still probably benign, but with your family history risk, you should proceed.
Pulmonary Function Testing (PFT) and High Resolution CT Scan (HRCT) Lead My Dr. to Changing Diagnosis
Q. Dear Dr. Tom, I am hoping that you would provide a larger answer to me as my doctor seems to gloss over my situation. He really is hard to pin down.
I have had full PFT testing.
FEV1 is 72% pre and 91% post
FVC is 113% pre and 128% Post,
FEV1/FVC is 52% pre and 58%
DLCO is reduced at 67.
My doctor first diagnosed emphysema, but then I had an HRCT with no signs of emphysema so now he says I have asthma-reactive airway disease. I know this is a better diagnosis, but I am so unsure of the findings. I mean the numbers change.
I don't smoke anymore. I quit nine years ago. Will I continue to get sicker and progress to the point of disability? I am 52. How long before I am disabled.
A. Dear Cindy, I believe that you do have some degree of emphysema, and with a reversible component. Your prognosis is good, since you quit smoking before too much damage was done. Stay well, and avoid all smoke.
More information on Spirometry
Carbonation’s Affect on Breathing
Q. Does drinking soda, or other carbonated beverages affect your breathing? If yes, why and how?
A. Dear Amy, No. It has no affect on your control of breathing.
Scoliosis and Atelectasis
A. I had a chest x-ray done on 8/18/06 that said the following:
"There is evidence of thoracic scoliosis. There are no infiltrates or pleural effusions. The cardiomediastinal silhouette and hilar regions are normal. There is minimal left lung base atelectasis."
My ribcage is distorted from the scoliosis, the right side is larger than the left side (left side more compressed). I am very worried about the finding of minimal atelectasis. The doctor said there were no significant lung findings.
Could my scoliosis be the cause of the atelectasis or is there a reason to worry about tumors of some sort obstructing and causing the minimal atelecatasis? She did not feel further follow up was needed. I have no chronic cough.
A. Dear Anna, I do not feel that "minimal atelectasis" needs any follow-up. I assume you do not smoke.
Can you in Layman’s Terms Explain CT Scan Results
Q. I'm a 57 year-old female non-smoker. Please the following "Impression" was given on a recent CT scan of the lungs:
1. "Pleural based area of nodularity involving the anterior medial aspect of the right upper lobe. This most likely represents a focal area of pleural thickening with associated parenchymal scarring; however, underlying neoplastic process cannot be completely excluded and a follow-up CT is recommended in three months time.
2. Pleural based sub-centimeter nodule within the right lower lobe distribution. This is a non-specific finding and may be further evaluated on follow-up CT in three months.
Would a PET scan be useful at this time? Also, can you please put the findings in simple layman’s terms?
A. Dear Ava, These shadows suggest old inflammatory disease. A follow-up in three months is reasonable.
How Does Spirometry Help to Diagnose COPD
Q. Dear Dr Tom, Hope you and yours are well.
Your help with lung questions with your website is greatly appreciated.
Pre FEV1 of 84%
Post FVC of 93%
FEV1/FVC of 68%.
Do I have COPD?
I read that rather than using fixed percentages to interpret spirometry results that it is more scientifically (statistically) accurate to interpret spirometry numbers in a range of normal, i.e. two standard deviations yields a 95% probability of being in an normal range.
This method of interpretation can for example interpret a FEV1/FVC ratio of less than 70% as above the lower limit of normal.
Your thoughts would be appreciated.
Thanks again for all your help over the years.
A. Dear Bob, Your tests are just outside the normal clinical prediction values for your age and height. No significance. Stay healthy.
*More information on Spirometry
Worried about Father who has COPD, Pneumonia and is on a Mechanical Ventilator
Q. My Dad has emphysema and COPD. He does not exercise and still smokes. He developed pneumonia in his left lung. He is on a ventilator at the hospital and the doctor has said he could go at any time if the pneumonia doesn't start to clear up. How bad is this?
A. Dear Ellen, It is not good, but the outlook is still favorable. Stay optimistic.
Use of Morphine Nebulizers and End COPD
Q. My Mother was put on Morphine nebulizers 10/3ml she has COPD and has been treated by her lung specialist for about five years now.
Hospice was called in about the last of June 06, my question is can you tell me about the time she has left, because I have just read that this medication is given at the end. Please answer me if you can. Thanks so very much.
A. Dear Pat, It is hard to define " at the end". She may stay comfortable with this treatment for months or a few years.
What does it mean to have Emphysema and an Enlarged Heart?
Q. My mother in law has had emphysema for 7 years. Unfortunately, she has chosen to still smoke. She has been on continual oxygen for about one year, at home. She was admitted to the hospital yesterday with swelling in her feet, and tests are showing an enlarged heart.
I have watched several family members die of emphysema, and it took each of them 10 years plus.
I am wondering where she is in the progression of this disease? In general, would you classify this as "nearer to the end?" I am trying to determine how far down the path of progression she is, so family members can have a clear picture of what to expect next.
A. Dear Rebecca, I keep saying, "it is hard to define at the end". Your mother probably has heart failure associated with her advanced emphysema, but she could sill live a long time, with good treatment. Her prognosis is better if she quits smoking, but she may be too addicted.
Why Give Zantac for Asthma and a Special Thanks from Daughter for Help with Science Project
Q. My daughter, Olivia, wrote to you in January with questions related to her science fair project. It turned out to be very interesting. Thank you for your suggestions.
As you suggested, we used a peak flow meter for the experiment. Cold-weather exercise was the bronchial challenge. The teacher discouraged her from using her meds (Advair) as a variable, therefore the revised purpose of her experiment was to find out how well her meds were controlling her asthma. She hypothesized that they were not working well because she still experienced symptoms.
We kept a daily peak flow log for two weeks and picked two consecutive nights for the cold weather exercise.
Her peak flow stayed within normal limits for the duration of the experiment and challenge. However, during the cold weather exercise she complained of "asthma symptoms" i.e. pains in chest, difficulty breathing. We also noticed that she experienced symptoms at other times during the study (respiratory infection) even though her peak flow was within normal limits.
We went to see her doctor who took her off Advair and prescribed Zantac and albuterol as needed. She has done fine with this until she returned to school two weeks ago.
Every time she returns to school in the fall she is constantly sick with rhinitis, cough and chest tightness, muscle aches and fatigue. It must be the school building? I am so confused as to which meds. she should now be taking. There does not appear to be any allergy medicine that is effective for rhinitis (I am giving her Sudafed and Claritin). What is the link between asthma and the need for Zantac?
A. Dear Mrs. Cain, Sorry, I cannot think of a reason to give Zantac for asthma.
Can you have Severe COPD and Not Experience the Symptoms Associated with Severe COPD
Q. I am very confused about diagnosis of COPD. I was diagnosed with severe COPD with the following spirometery numbers:
FEV1 0.06 (25% ) predicted
FVC 2.1L (61%predicted)
FEV1/FVC ratio of 30% in addition my
TLC was 174% of predicted and a diffusing capacity of 54% predicted.
Now for severe COPD I have read the following. People with COPD severe stage 3-4 have difficulty leaving the house. They must eat 5-7 small meals a day because the act of eating makes them breathless. They are breathless at rest. They are breathless washing and getting dressed, and most are on O2,. Many have to sleep in an upright position and they tend too loose weight. In general they are in very poor shape.
I DO NOT EXHIBIT EVEN ONE OF THESE SYMPTOMS. I am on Spiriva and Bricanyl and my condition is well under control. I work every day, and if I get short of breath, usually mild. I carry Combivent, which does the trick every time, now,
I do have COPD; but severe? What do you think Dr Tom? Can one have severe COPD and be doing what I am doing and feeling the way I am feeling?
A. Dear Philip, Yes, you have adapted very well with your program. Continue to do what you are doing, and forget about the labels about COPD or trite predictions about life style and abilities of daily living. These do not apply to you.
*More information on Spirometry
Humidified Oxygen and Larygospasms
Q. I have two questions:
1. What are the benefits of using humidified oxygen for a patient who has had a major surgery compared to using supplemental oxygen without any humidifier?
2. What is the best management for laryngospasm?
A. Dear Eduardo, The bubbling devices commonly used with oxygen do not add significant water vapor to be of clinical value.
The management of laryngospasm depends on the cause. It may be the inhalation of racemic epinephrine in mild cases or waiting for the spasm to clear, following extubation. In extreme cases an emergency tracheostomy can be lifesaving.
Emphysema and Treatment for Thick Mucus and Cough?
Q. My 80-year old father has a severe case of bullous emphysema. I have several questions I hope you can answer or shed light on.
1. At his age should we try to look for treatment or surgery? If so what type?
2. My father is constantly coughing. It sounds like a cold that is breaking up. Is there a type(s) of medication that would sooth his coughing?
3. He is constantly coughing up a white to clear mucous. He says when he's eating it feels like it accumulates in the back of his throat. Is the emphysema or something else causing this? Is there a medication to break up the mucous as I am sure it's affecting how much he eats. He is losing weight.
Thank you for any assistance you can offer in the way of answers.
A. Dear Amye, It is unlikely that your father would be a candidate to remove the bullae. If he is in otherwise excellent health, it may be possible to do either a bullectomy or what is known as lung volume reduction surgery. You should consult with a pulmonologist who works with surgeons for these procedures.
Mucus is a problem and we do not have any really effective drugs that thin mucus. Guifenesin is commonly used under a number of labels, but I have never found it very effective. Cough suppressants such as Tussionex or Tessalon Pearls are used by some pulmonologists.
Do Lung and Heart Beta Blockers Mix?
Q. Will my mother's Beta Blocker for her heart interfere with her Beta medications for her breathing?
A. Dear Nancy, Very likely the answer is yes. There are some relatively selective heart beta blockers that may spare the adverse effects on the lungs.
Choking During the Night
Q. Why do I wake up choking during the night? I have the same type of choking and loss of air-horrible tickle in my throat after eating gas-producing foods? Such as everything that's extremely healthy for you. It seems that after the gas passes--the choking stops with it!!
A. Dear Trina, You may be experiencing aspiration of gastrointestinal contents at night. You should have this checked.
Steroid Inhalers and Vocal Cord Irritation
Q. Why is it that the steroid inhalers cause such havoc with our vocal cords and seem to make us feel like our throat is swollen. People complain about this all the time but no one has come up with a reason. Rinsing and gargling do not help and for people that have to use their voice all the time in work it is very hard to handle. Thank you.
A. Dear Carol, This is a common problem. The vocal cord's muscle may become weak. It usually resolves with stopping the inhaled corticosteroids for a week or so. It may not return on once a day dosing, or even on the previous twice a day dosing. Dr. Tom
Medication Treatment of COPD and Why do Horses Get COPD?
Q. I was diagnosed with asthma about ten years ago followed by emphysema which was then changed to chronic bronchitis and then subsequently to COPD. Needless to say I have been a smoker for approx 35 years but gave up about ten or more years ago what do you reckon the future holds; bearing in mind I am now on Symbicort Turbuhaler coupled with Spiriva. Is there anything else I should be looking at such as diet/natural supplements etc.?
Anything you can suggest would be much appreciated. By the way I am a fairly physically active person using a treadmill, swimming etc but suffer from tiredness pretty much 24/7 but I am not a couch potato but I will be 70 in less than three weeks time.
How come horses get COPD when they don’t smoke?
A. Dear Elizabeth, It depends on your remaining lung function and your state of physical fitness. You may have many years of good health.
Horses sometimes get what was called "the heaves", which is an asthmatic like condition due to moldy hay. Sort of a hypersensitivity lung disease. Racehorses often cough up blood at the end of the race. This comes from excessive blood flow through the lungs during racing. It is not emphysema. Remember that only 20% of smokers get COPD and 15% of COPD patients have never smoked.
Q. When I eat I have trouble swallowing, I then feel like I have to burp but can't, and eventually start throwing up mucus. Tonight this episode lasted an hour and I almost went to the ER. At first I attributed it to allergies and excess mucus blocking my esophagus when I try to eat. I also thought maybe I eat to fast or do not chew my food enough. Could this be more serious?
A. Dear Kim, I doubt if it is serious. You should be checked for a hiatal hernia, i.e. a hernia of the esophagus that can trap food before it enters the stomach. There are other causes of your problem. Better see a gastroenterologist.
Non- Calcified Nodules Found on Chest X-Ray
Q. Recent Chest X-ray report of my husband says exactly theses words "Possible presence of a non calcified nodule on the left lung.” He is scheduled for a CT scan soon. Can you please explain me what’s going on? He is 38yearrs old and has smoked for almost tne years. He \has been clean for almost seven years. He is Diabetic too. Please help me with an explanation.
A. Dear Sel, The chest x-ray suggests a nodule that will be better visualized by CT Scan.
Having a Hard Time After Lung Volume Reduction Surgery
Q. My question is my husband had three LVRS (Lung Volume Reduction Surgery) in two weeks. After the first on the right lung he got an air leak and a week later they had to go in and repair it and take off more bulla and lung. He felt great after that was done so a week later they did the left lung.
Since then he has been worse off then he was before any surgery. He now has nerve damage on the front of his chest where he can’t stand even air to touch it. He has been impacted. Now his bottom and feet keep going to sleep on him and lower back killing him.
They were going to do MRI tomorrow but can’t because of staples; they said it could burn them and him or it could pull the staples out. He was losing weight but now is putting it back on almost over night. Can you give us any answers or hope for him? The papers they gave us said that he might have about three years or so. He was better off before surgery.
A. Dear Linda, I cannot tell from your description, what is going on. Better get the explanation from his doctors who know his whole condition.
Has a Friend who has Recently Been Diagnosed With Mild COPD
Q. I have two quick questions relating to a male friend of mine who was recently diagnosed with mild emphysema from a CT scan.
He is 35 years of age and no longer a smoker. His recent spirometry was essentially normal except for a minor but reversible airway obstruction. His FVC was 106% and his FEV1 was 100%. His FEV1/FVC% was 74 out of 77%. He is on no medication and has no breathing difficulties. My questions are:
1. Could you say something about his probable life expectancy with these values? Can he have a normal life expectancy?
2. Do you think it is necessary for him to do another spirometry in the future sometime?
Dear Ann-Christine, His lung function is normal, and the CT is not a lung function test. He should not smoke and should live a normal life.
Are Leg Cramps and Numbness a Side Effect of Prednisone?
Q. My husband has COPD. He has been taking 40 mg. Prednisone daily and recently has been experiencing leg aches and numbness in the legs. Is there a correlation?
A. Dear Janet, None that I know about.
Lung Tumor Next to Spine
Q. I went an met with another Dr. about the posterior mass on my lung he said he wanted to do a MRI next as the area, apical area, is hard to get to do a fine needle aspiration but he was worried because the tumor is next to my spine so he wants to remove it before it grows into my spine.
He said that tumors take the path of least resistance is this true? Should I wait to see if it grows, he says it will so I guess it’s better to remove it before it gets in my spine.
Is this what nerve sheath tumors do? They don’t know for sure if it is a nerve sheath tumor; he just said most tumors in this area are normal nerve sheath is this true?
A. Dear Pat, Better follow your doctor's advice. It could well be a nerve sheath tumor, or something else that needs attention.
Lost Dust Cap to Meter-Dose Inhaler, Will this Effect Delivery of Drug?
Q. Is there any information available regarding loss of MDI dust caps and whether it affects treatment?
A. Dear Victoria, It will not effect drug delivery. Try to keep the mouthpiece clean.
Son has had Spontaneous Pneumothrax, had Surgery and is Now Having Numbness and Chest Pain
Q. My 15 year old (tall and thin) son had a Spontaneous Pneumothorax
this summer. After four days in the hospital with a chest tube (two on vacuum and two on waterseal) the lung re-collapsed with the tube still in place and he was taken to surgery.
He was to have LATS to do a repair of the bleb and pleural stripping. They were unable to find the bleb, so did a wedge resection and removed a "mushy" area (path was negative) and a pleural stripping. They used an onsite device to administer intra-cavity bupivicaine. He tolerated the procedure well and went home two days later with a mostly re-inflated lung.
His last CXR was two weeks after the surgery and the lung was still not entirely re-inflated, but the thorax surgeon tells me this is normal.
It has been two months after the surgery and my son is now telling me that he has intermittent bilateral chest pain that is mild to moderate in severity. He is still numb in some places on the right side, side of surgery.
Should I be concerned? Should I take him back to the adult thoracic surgeon, whom I'm not sure about? Or find a pediatric thoracic person or a pulmonologist? Do you have any recommendations/names?
My husband and I both work in Delaware within the Christiana Care Health System, I am formerly a Penn/Jefferson (Phila) employee.
A. Dear Tracy, The recovery may be slow. Your doctor will have more information about your son, but I do not believe that there is any reason for more interventions now.
Mother is Okay When she is Sitting but Gets Winded When She is Moving Around
Q. My mother has been put on oxygen because she is not taking in enough when she breathes. She had complained of being extremely tired and exhausted. Her Doctor has done every test you can think of but cannot explain what is going on because all the tests are negative.
She is 70 years old and has never smoked nor been around anyone who smokes. She has had pneumonia once about five years ago. All we know is that she is ok if she is sitting but when she walks or moves she does not take in enough oxygen. Can you shed some light on this?
A. Dear Connie, I do not believe that her lung function tests and heart function tests are normal. Better get another opinion.
Would You tell Me About a New Pill that Help You to Quit SmokingQ. What is the name of the new pill that is supposed to help quit smoking? and, what is it's success rate? My husband needs to know what to ask the doctor for in terms of quitting smoking, because I have asthma. Please Help!
A. Dear Elizabeth, The drug is known as Chantix. It has about a 50% chance of working in the short term and 25% chance in the long term. Have your husband get a prescription from his doctor and make a final decision to quit.
Why has Husband Experienced Oxygen Desaturation after a Surgery
Q. This service you are providing is invaluable. I have read your archives and you have helped a lot of people!!
Quick history: my 33 year-old husband is a non smoker. His family history is negative for any COPD but his grandfather died of liver disease/failure. He does have controlled Hashimoto's thyroiditis.
He had surgery in early August to repair an abscessed fistula of the colon. He desaturated after surgery (had some morphine and slow respirations). After the Morphine wore off he still was desaturated (low 80's without O2... mid 90's with O2). CT scan showed lower lobe atelectasis... pulmonary suggests this plus sleep apnea contributed to 02 desaturations.
It took about five days for cyanosis in hands to resolve (was better on O2 but cyanosis would return after O2 was removed). Two weeks later he has a PFT and these are the results:
Home oximeter shows 92-95% O2 when sitting, 88-95% when sleeping, and 96-98%, when moving around.
Any thoughts? We are quite scared and confused; we have a sleep study scheduled for Sunday.
A. Dear Heather, He needs the sleep studies. He has good oxygen saturations while awake. You need a diagnosis for the problem. Dr. Tom
Lung X-Ray Shows Scattered Granulomas and Bibasilar Atelectasis after Car Accident
Q. My husband had a car wreck July 14, 2006; he had broken ribs, closed head injury, broken pelvis. His left side pain continued and he returned to the E.R. (Emergency Room) for another visit and chest x-ray seven days later.
This time his report said he had minimal bibasilar atelectasis and scattered granulomas. The bibasilar atelectasis was on first x-rays but the granulomas were not seen.
He is was healthy, as far as we knew, with no lung problems. Are these common lung trauma impressions? None of the five doctors he saw ever mentioned anything about either problem. Will these problems heal in time? I've spent many hours researching these questions and thank you in advance for any help or ideas on the matter.
A. Dear Crystal, The granulomas are healed. The atelectasis should clear.
6. Radiology Report Conclusion was COPD, Yet My Spirometry is Normal
Q. I had bronchitis for the first time and my Dr. put me on antibiotics and sent me for a chest x-ray. The doctor’s office called to tell me I had emphysema but I did not need to see the Dr. or do anything special.
The X-ray report reads : "The lungs are hyperinflated with some emphysematous changes in the upper lobes. No local infiltrates are seen. The cardiac silhouette and mediastinal contour is normal. No evidence of pleural effusion.
Conclusion COPD. No acute pulmonary abnormality identified."
I asked the office how bad it was and they had me go for a spiromety test. The results were "Normal Spiromety"
My Dr. said I'm fine but the X-ray results concern me. What does this mean? I quit smoking 6 years ago and had a chest x-ray at that time which showed no problems. What would you think of these results and should I ask for specialist?
A. Dear Bob, You quit before the damage of cigarette smoking caused significant damage to your lungs. Stay healthy.
Chest X-Ray Showed Spots, Doctor Says it is Normal in Our Area
Q. My son has chronic sinusitis and vomits off and on. A recent chest x ray showed spots, which doc said was common in our area. Prescribed allergy meds and emedic. Your thoughts?
A. Dear Fran I have never heard of emedic.
Can Weather Effect Lung Symptoms?
Q. Dr Tom. Thanks for answering so many of my questions. I am confused about something,
I have COPD with a high reversible component of asthma. (FEV1 25% of predicted, and 37% of predicted after Ventolin).
My symptoms seem to be effected by weather. The weather here in Toronto, went from very mild and muggy to cool and rainy, I have had to supplement my Spiriva and Bricynl with Combivent. After getting used to the drizzly weather I did not need the Combivent as much, why would that be? Also can a slight cold or infection effect breathing. Thanks
A. Dear Phil, I guess you got better on the other medications.
Follow-up From Long Time Reader; Question about Small Airway Disease
Q. As you may remember from previous posts, I am a 37year-old male with a history of social smoking (gave up in 2003) and childhood rhinitis + asthma. I have attended two excellent pulmonologists and despite a change from Symbicort to Advair in the last month I am still SOB.
My Doctors have re-assured me they feel there is no obstruction and very little signs of asthma. A chest X-Ray last month did not even show Hyper Inflation.
My doctors cannot understand why I have feelings of shortness of breath. I have also seen a rheumatologist on three occasions and has given me the all clear for connective tissue disease.
However the SOB is driving me nuts and present every day. Pursed Lip Breathing (PLB) helps but for some reason makes me yawn and tired. My pulmonologist maintains with an FEV1 of 100% PLB is a waste of time.
My Latest Spirometry Results:
FEV1 4.66 108%
FVC 5.39 103%
FEV1 / FVC 86.44
FEF 25-75 3.61 76%
FEV1 / FVC 76
FEF 25-75 3.87
In all my tests the FEF75 figure is significantly down at approx 55% of predicted.
Can you help by answering the following two questions?
1. In the presence symptoms, a normal DCLO and FEV1 do you not feel the FEF25-75 values must be of some significance?
2. Does the isolated increase in FVC post bronchodilator and the corresponding drop in the FEV1/FVC confirm Small Airways disease?
My own verdict on this is that there was some asthma and reversibility in 1995 confirmed by the increase in the FEF 25-75, I continued smoking and this affected this reversibility leaving me with fixed obstruction in the smaller airways. I have pressed my Doctor on this and he tells me once the FEV1, FVC+ DCLO are ok, that’s it, no need to look any further!
If this indeed is fixed obstruction in the smaller airways could this reverse over a long time? I have read conflicting reports on this? It is now three years since I stopped smoking, can further improvement be possible given I am 37.
As usual looking forward to your response.
A. Dear Conn, Forget about the FEF 25-75%. It is very misleading. Get more exercise and use PLB if you feel better.
Live for Today ( Follow up from Dr. Tom 78 )
Q. I agree quality of life is important and I just want to know how much quality for making plans etc. I know we can never know for sure but with at least a parameter we can stop dwelling on it.
I received my Oxy-Phile Book and enjoyed reading it.
A. Dear Karla: Please allow me to elaborate on you question further. You are alive today, and can expect to be alive tomorrow. Maybe you will live five more years still. But the important thing is to live TODAY.
I also face the end of my life in the not too distant future. I make the same mistake of dwelling on it too much. This ruins the enjoyment of TODAY.
So I will make a deal with you and other readers.
Here is the deal. Let us all forget about the length life, and concentrate on TODAY. Let us have two days in the week only, TODAY and TOMORROW.
With best wishes. Dr. Tom