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Archive: Dr. Tom 85
Posted November 20, 2006

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

 

 

Severe Emphysema and Morphine

Q. Hello again.  Hope you are enjoying the beautiful sites of Mother Nature this lovely fall.

What is your opinion of treating severe emphysema with morphine (liquid &/or pills)?  My doctor prescribed morphine sulfate 10/MG/5 Sol Roxanol, take 2-12/ to 5 milliliters by mouth ever 12 hours.  The reason being it might help me breathe better.  You may recall I am on oxygen 24/7. I also am on 20mg prednisone, Advair 500/50, Spiriva, Combivent and Xanax.

I'm wondering if the time-released tablet might be more beneficial. Have your patients found this to be helpful?  I just don't like the thought of becoming addicted.

And, I sincerely appreciated your knowledge and opinion.  You helped so many of us by giving honest answers to our questions. 

Karla

A. Dear Karla, The morphine is very helpful in taking the edge off of struggling to breath. It is safe to use, recognizing that taking an excess dose, may supress your breathing too much. Do not worry about being addicted. You should just take enough to feel confortable, and not drowsy. There are sustained release drugs such as Mscontin, and liquid. Also alternatives such a Fentenyl, given as a lollipop or a patch, called duragesic. I think that the liquid oral morphine is easy to use, and have had good experiences with it.

Dr. Tom

Get Flu-Like Symptoms When Breathing Chemicals, Second-Hand Smoke and/or Dusts, What Can I Do Prevent These Symptoms?

Q. My lungs are very sensitive to airborne chemicals -- mainly aerosol sprays and smoke.  When I breathe in these things, the following day I develop flu-like symptoms -- body aches and chills with a fever.  Sometimes my lungs feel sick, like I’m coming down with a cold or they feel tight.  I don’t have a cough.  One time I sprayed Lysol and I was ill with these symptoms the following day.  It lasted for just one day.  However, another time I breathed in second-hand cigarette smoke and I was ill for three days with these symptoms.  This time of year it’s the farmer’s harvest dust and burning leaves that are causing me to feel ill.  I was ill for a few days and had a fever of 101 degrees. 
Is there a way to avoid getting ill from this stuff in the air?

Cindy 

A. Dear Cindy, My only suggestions is use of masks. I am not familiar with the various ones that can be used for ordinary dusts and fumes.

Dr. Tom

I have a FEV1 of 23%; How Bad Off Am I?
Q. I am 43 years old ex smoker with Alpha One Antitrypsin Deficiency. My FEV1 is 23% was told my lung function is 50% how bad off am I?

Heather

A. Dear Heather,  It all depends on your definition of "bad". Your lungs are severely impaired, but you can function well and live a long time, with pulmonary rehabilitation. Use of replacement drugs such as Prolastin may slow the progression and improve your symptoms Consult an experienced pulmonologist.

Dr. Tom             

Husband is in the Terminal Stage of Emphysema and Has Blood in His Urine, Should We Be Concerned?

Q. My husband has been diagnosed as in the final stages of emphysema, terminal. Recently, he has had a lot of bleeding in his urine; this has been going on for several months. It's not a continuous bleeding that we can see but lately it has been getting more frequent. 

His hospice nurse took some blood and urine last week. The results showed that his blood loss was not too drastic as of yet. The Dr. would like for the hospice nurse to irrigate his bladder but my husband refuses to have it done in our home right now. We are really concerned about cancer of the bladder. Do we have reason for concern?

Jan 

A. Dear Jan, You could be dealing with cancer of the bladder, but the likelihood of being able to treat this for cure is small, in view of your husband's advanced emphysema. If your husband already has a catheter in plance, this may cause enough irritation to promote bleeding. It is possible that the bleeding source could be cauterized. You would have to consult a urologist for this. Bladder irrigations are used to avoid clots which are hard to pass.

DRTom

How Do I Write Up Clinical Information about My Patients?

Q. I am currently enrolled in RT school and I m doing my first clinical rotation through the hospital and I love being able to have the hands on experience with patients, but I have trouble writing up my information. The latest write up I have to do is find a patient whose pulse ox values indicate the need for oxygen due to the need to decrease the work of breathing. I have found that patient but I’m having trouble putting my information together. Do you have any suggestions?

Kim

A. Dear Kim,    The only way to learn to write is to pick up a pen or pencil and start. Or on the typewriter. The key is to get started. Sometimes the words just flow. Try to be brief. Good luck.

Dr. Tom              

I Have Breast Cancer, What are the Side-Effects of Radiation on the Lungs?
Q. I need your advice. I was just diagnosed with invasive breast cancer and they want to do radiation on me. I am  having to make the decision whether to have a mastectomy or radiation. I am so afraid that the radiation will affect my lungs. I just don't know which way to turn. Can you tell me the effects of radiation on the lungs? Thank you Dr. Tom for your time.

Liz 

A. Dear Liz,   Radiation can cause lung damage. Usually the radiologist can minimize this with shielding and other strategies in getting the radiation to the target. Radiation irritation, called pneumonitis can be treated effectively with steroids, in many cases. I believe you should focus on getting the breast cancer controlled with whatever it takes, and then deal with any consequences of the treatment, which may not be severe. Dr. Tom                         

Have End Stage COPD, I am Doing Better But Get Scared at Night
Q. I have what the doctor calls end stage COPD. I was told in May of this year to go home and get as much in order as possible because the best they would give me was two days; I didn't believe it and here it is November and I am still here.

I haven't seen a pulmonologist as of yet because of no car and other factors. But I am better and I do a lot PLB and the only medicine I take is a neb every four hours. I do exercise in my bed and can now stand and walk some with a walker.

But, could you please tell me if you think I am living on borrowed time. I feel better and I have gone from six liters of O2 down to three. My RT comes in every three months. I also wear a VPAP at night. I am 51 years old and I want to live.

I don't know any of my numbers don't believe I have ever had any of the tests I hear others talk about. This last stay in the hospital was due to smoking with O2 on and it blew up. Burning my face. But thank God not much to the lungs.

They gave me up for dead in the hospital and told my husband that I wouldn't make it through the night because my kidneys had shut down and I guess everything else was out of wack. But I lived.

I have even gotten to go to my kitchen and make cookies for my husband’s birthday. I see the pulmo in Dec. But I get so afraid at night. Can you help me some way?

Rose

A. Dear Rose, With the determination that you obviosusly have, plan to keep on living. Day by day, and find some pleasure as you do with cooking. Say a prayer at night that you will get restful sleep and awake with a bright attitude the next morning. This is what I do, and it keeps me going. Write me again, after you have seen your pulmonologist, and again in the new year!

Dr. Tom

Worried that I Have Lung Disease
Q. Dear Dr. Tom, My clinical history is my doctor found one lung nodule on a prior CT scan two years ago and this June the report is as follows: No abnormally enlarged axillary, mediastinal or hilar lymph node is seen.  There are several subcentimeter nodular densities in both lower lobes.  The largest of these measures approximate 3.5mm. Some of these appear more prominent than on the previous studies and this may in part be due to the differences in technique.  There is no pleural effusion.  The visualized unenhanced upper abdominal structures appear unremarkable.  There is scoliosis and degenerative changes of the spine; no focal destructive bone lesion is seen.  Impression:  There are less than 4mm densities in both lower lobes as described above. 

I also had a pulmonary function test done and the results are as follows: (Pre-Bronchodilator I will list first and Post-Bronchodilator I will list second)
FVC 2.44/2.53
FEV1 1.89/2.03
FEV1/FVC 77/80

I really do not know what all this means.  I am short of breath and feel like someone is always giving me a "bear hug", I feel like I have several hundred lbs on top of my chest.  I am very worried about all of this. 

I am going to MGH this Thursday because I don't feel well and my doctor is telling me it's nothing to worry about but has given me Albuterol and Flovent to use daily.  I am very worried that I have some type of lung disease, but I can't get any answers from my own doctor.  I think he doesn't want me to worry because my husband has been in remission with lung cancer and we have three young children.

I am a former smoker (25 years 1-2 packs per week). I quit smoking two years ago, but my husband is a heavy smoker and smokes outside of the house, but the smoke is still on his clothes. Please help me and guide me in what to do.

R

A. Dear R. You do have some lung impairment, but not bad. You need a diagnosis for this and this should result from your consultation at MGH. Be sure you see a pulmonologist. The multiple small nodules are not likely to be cancer, but you need a followup CT in three to six months, in my opinion.

Dr. Tom

Is It Normal To Have Strange Sensations After a Pneumothroax and How Long Does It Take to Recovery?
Q. Hi, I was in hospital for five days with a chest drain inserted due to a spontaneous Pneumothorax.  I am 24 and with no medical  history and the left lung had collapsed by 50% so was told it was quite large.  I have been out of hospital for three weeks now and although I feel ok I have been getting the odd strange feeling in my chest at different points during the day. 

I play a lot of sport and wondered if it was normal to feel strange sensations a few weeks after a chest drain and how long full recovery normally takes.

Ryan

A. Dear Ryan, These sensations are probably from the irritation caused by the drainage tube. This irritatiion helps the lungs "stick" up to the chest wall. They are useful adhesions, that may cause strange sensations in your lung for awhile. Keep active and have fun.

Dr. Tom

Pipe Smoking and Lung Cancer
Q. Is there a relationship between pipe-smoking and lung cancer? 

S.L.

A. Dear S.L.Yes, but it is not nearly as much a risk as with cigarette smoking.

Dr. Tom

Can I Be to Dependent Upon Seretide
Q. I am 55 years old male. I have controlled my asthma successfully with Seretide 125/25. bd. the problem is that in case I miss one dose, I have to take Ventolin every two to three hours. This is worst than per-Seretide times. Is it possible I may be getting heavily dependent on Seretide ? 

Samir

A. Dear Samir,   You probably need the seretide to control your asthma, but this is not an addiction. I suggest using it as directed.

Dr. Tom

Science Project About Atmospheric Pressure on Breathing
Q. My 13 year-old daughter wants to do a science fair project to demonstrate how atmospheric pressure (high and low altitudes) affects breathing and the body and how the body can adapt.  Can you suggest where to find information that she would understand and how one might set up an experiment?

Suzanne

A. Dear Suzanne, Your can read an encyclopedia on the effects of altitude on the lungs, and  how the heart and lungs adapt to the low oxygen of altitude. Man has been able to climb Mt Everest, the highest place on earth, even without oxygen. This is possible by the heart increasing the flow of blood to the ograns, and the blood carrying more oxygen by the increase of hemoglobin that is a response to altitude. Some adjustments in the tisssue's use of oxygen, probably occur. A complex process.

Dr. Tom

Can a Bleb Cause Sharp Chest Pain?
Q. I was recently in the hospital with difficulty breathing and was told after the CT scan that I have a bleb on the apex of my left lung. I have been having sharp chest pain near my sternum I was wondering if that was a sign of this problem with my lung?  And what is the chance that this bleb with burst causing a pneumothorax?

Chanaan

A. Dear Chanaan,   I doubt if the apical bleb is causing pain near your sternum. The chance of it leaking, are small.

Dr. Tom

I Would Like to Take Part In A Cure For COPD
Q. Dear Dr. Tom, I would like to know if you know of any research clinics that may be able to help me with COPD? I would like to take part in finding a cure or at least a medicine that would slow the progression of the disease down.  I take Xopenex four times a day, Advair once a day, Spiriva once a day. 

Cindy

A. Dear Cindy, You are already receiving drugs that may slow the progress of disease. Advair is another consideration for advanced stages of COPD. I assume you have stopped smoking, which is key. Other drugs that may slow the course of the disease, are still under study.

Dr. Tom

CT Scan Results Really Scare Me
Q. I had a CT scan of my chest.  Here are the results.  What does this mean?  Does this mean that I am on my way to getting cancer of the lungs? Why and how do these nodules appear?  I am really scared.

The axillary regions are normal.  The mediastinum is normal except for clacified nodes in the precarinal region and right hilar region; these are not felt to be significant.  The region in the upper abdomen is normal except for a small punctate calcification in the right mid kidney.  The central airways are patent.  There is minimal apical fibrosis noted bilaterally which is not to be significant.  There is a minimal linear fibrosis in the right base.  There is a tiny 0.3 cm nodule in the left base, which is likely not significant. 

What does this mean?  I did smoke 1/2 pack of cigarettes a day.  I have quit.

Debbie

A. Dear Debbie, The results are not alarming at all. The 3mm nodule should be followed up in six months. You have done the most important thing to protect your health, which is stopping smoking.

Dr. Tom

Ocassionally See Blood in Morning Mucus
Q. I have severe COPD but I'm in otherwise good shape and quite active.  Every once in awhile I get very minimal tracings of blood in the morning in my mucus.  It doesn't last and I may not see anything again for six months or more. Does that happen sometimes?

Jackie

A. Dear Jackie, Small streaks of blood with vigorous coughing are common. If it continues it should be investigated further by a pulmonologist.

Dr. Tom

What is Life Like for Someone Who Has One Lung
Q. I am 47 and have not smoked in 2 1/2 years. It's been two years since I lost my lung (I did not have cancer it was an infection complicated with severe emphysema) still have a lot of questions. All the doctors can seem to tell you is, you'll be fine just don't run any marathons.

Could you please tell me what kind of life can I expect now having only one lung? Where can I find out what it’s like, How often will I be short of breath? Does being SOB all the time cause tiredness? Is it normal to gain weight after losing a lung?

Linda

A. Dear Linda, You can live a normal life with one lung. Your capacity depends on how healthy the remaining lung is. You must avoid all tobacco smoke. Some shortness of breath during exercise is to be expected and will not lead to excessive tiredness.

Dr. Tom

Bronchoscopy Training Programs
Q. Are you aware of any bronchoscopy training programs other than in-house hospital?

Terry

A. Dear Terry, No. The bronchoscopy training is mostly part of the training in pulmonology, thoracic surgery, and otolaryngology.

Dr. Tom                               

Smoked for 20 Years Should I be Concerned about Lung Nodules
Q. On and off I’ve had upper back and chest feels tight, no breathing problems. I had a CT Scan done on my chest they said I have two nodules but they do see them to be of concern. I did some smoking for 20+ years. What are your thoughts?

Dan

A. Dear Dan, Any nodule that is not calcified in a former smoker needs a follow-up. The time interval depends on the size and characteristics of the nodules.

Dr. Tom

Will I Need to be on Bi-Pap for Rest of Life?
Q. I have pulmonary hypertension and recently had a severe exacerbation with CO2 levels in the 80's. I was on a Bi-PAP machine and the numbers did come down. The ER doctors have told me that I need to have a Bi-PAP for the rest of my life.  Is this true? Any advise from you will be greatly appreciated. 

Paula

A. Dear Paula, Not for sure. It depends on the course of your lung disease.

Dr. Tom

Can Cord Blood Help in Treatment of Lung Cancer?
Q. HI Dr. Tom my father was diagnosed with lung cancer with metastasis to the adrenal gland. I am having a baby in March and was wondering if the cord blood from my baby could be used to help treat his lung cancer in any way?

Becky

A. Dear Becky, No. A good thought for your father, but no research has been done on this.

Dr. Tom

Side-Effects of Spiriva
Q. Hello, My father-in-law is on oxgyen 24/7 for emphysema, his doctor just prescribed him Spiriva. My father-in-law would like to know if there are any side-effects with this medication?

Benita

A. Dear Benita, The side effects are described in the package insert. The most common is dry mouth, which is only a mild nuisance.

Dr. Tom

I Think I Out Blew the Spirometer
Q. Hi Dr. Tom, I just had a spirometry test, and the results are interesting.
I am 71" tall, 32yrs old, and a white nonsmoker. My FVC was measured to be 10.04 (184% of normal) and my FEV1 was 6.83 (151% of normal). However these lead to a ratio of .68, which causes an “obstruction” diagnosis. Everything that I've read always refers to a low FVC or FEV1 in combination with a FEV1% less than 80%. When completing the test I continued to exhale for 25 sec before the machine said to stop. Is there a simple explanation, or should I be concerned?

Corin

A. Dear Corin, No, no concern at all. By forcing out so much air at the end of the test, you got an additional amount of volume out. This is the denominator of the ratio, and your long effort increased it. You are super normal.

Dr. Tom

Afraid Friend is Going to Trip Over Oxygen Tubing
Q. Is there such a thing as a retractable hose for the oxygen tank? My friend keeps tripping over the hose and has osteoporosis and is afraid of breaking bones.

Kate

A. Dear Kate, I wish there were. Tripping over the cord on the floor is a risk for falling. This is one reason why I prefer "wearable" oxygen, such as with a Helios or Spirit device that used liquid oxygen.

Dr. Tom

                                   
What Does a Forced Vital Capacity (FVC) Below One Liter Mean?
Q. Dear Dr. Tom, My mom has been diagnosed with Severe COPD emphysema and chronic bronchitis, her last PFT showed an FVC level of .88L I don't remember what the percentage but her doctor said anything below 1L is bad.
She is on 3L of oxygen 24 hours a day, on several medications, inhalers, nebulizers; the works, he said and besides surgery there isn't anything else he can do for her.
My question is with a FVC reading that low can you make a guess at life expectancy, should we be preparing for the worst?

Kim

A. Dear Kim, This is very low vital capacity and the FEV1 is therefore also low. But some patients can live a long time with low values with oxygen and other medications.

Dr. Tom

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