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Archive: Dr. Tom 92
Posted January 23, 2007

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

 

 

Can You Measure Life Expectancy by Lung Capacity?
Q. I was wondering what the life expectancy for a person with moderate emphysema would be, at 67% lung capacity. He does not smoke anymore and is still quite active and works full time?

Cindy 

A. Dear Cindy, It is hard to calculate directly, but it would depend on the age of the patient now, and if smoking has been stopped. It should be pretty good in the absence of smoking and if infections such as influenza can be avoided.

Dr. Tom  

      

Flattening of the Hemidiaphragms
Q. Dear Dr. Tom, The report for my chest x-ray was entirely normal except for one statement:  "IMPRESSION -- There is flattening of the hemidiaphragms consistent with emphysematous changes. " I do have a history of smoking, approximately 25 pack years.  I quit smoking four months ago.  I exercise daily:  yoga, walking outside three miles in the morning and on a treadmill in the evening.  I have no shortness of breadth.  I can hold my breath for up to one minute and 50 seconds. I have hiked in the mountains up to 22 km. a day while on vacation. 
Should I be at all concerned about this report? Could the flattening of the hemidiaphragms be due to my ability to take a very deep breath, which I did when instructed to by the lab technician?

Boris

A. Dear Boris, This may be the explanation. The chest x-ray is not a good way to diagnose early or moderate stages of emphysema.  You should have simple spirometry to test what your lung function actually is for your age.

Dr. Tom

 

Worried About Dad’s Lungs After He Inhaled Dry Wall Dust
Q. My dad was removing drywall from an old house, and that day he began having a dry cough after inhaling a large amount of drywall dust. He has had the cough ever since (four months). He also reports nausea everyday and the cough worsens when it's cold. He just had a chest x-ray and spots showed up on the x-ray (the size of a fingertip). The doctors did a MRI and we are awaiting results. He says this has to be from the drywall dust he inhaled.
Could he now have lung damage? Are there anymore tests he should have done-he is 60 years old?

Amanda

A. Dear Amanda, I doubt if the short exposure has caused lung damage, but the chest shadows do require an explanation. I do not think that an MRI will be useful. A PET scan is often done on single nodules to see if they are active.
He should also have spirometry done to measure his lung function. 

Dr. Tom

 

What do You Think about Bronchaid Mist?
Q. Dr. Tom: I have used the over-the-counter medication Bronchaid for a while for the treatment of chronic asthma; it contains ephedrine. What is your professional opinion about the drug? Is it safe?  It helps my breathing but I've heard it's dangerous.                 

Bill        

A. Dear Bill, It is a short acting bronchodilator, but can be effective in emergencies. There are much better ones such as albuterol or ipratropium.

Dr. Tom

 

Not Sure Whether She Agrees With Medication Prescribed by Pulmonologist
Q. Mark, from the Efforts (Emphysema Foundation For Our Right To Survive (http://www.emphysema.net/) list, suggested I ask you this. 
My pulmonologist insists I should use Qvar even though I said I thought I felt better without it.  He said you shouldn't use Serevent or Foradil (which I recently switched to from Serevent) without using an inhaled steroid.  He said it could be dangerous. 
I said I think I would feel better without it, but I don't want to do something "dangerous". 
I have had various diagnoses - asthma, hypersensitivity pneumonitis (which this pulmonologist said is no longer a threat), non-progressive interstitial lung disease and now emphysema.  No one seems to agree on much. I like the new pulmonologist, but I don't agree on this inhaled steroid issue. 
Please help. I don't cough much and unless I catch a cold, don't have much mucous so these aren't issues.  My biggest one is SOB (short of breath).

Barbara

A. Dear Barbara, QVAR has not been studied in emphysema. Fluticasone in Advair has and can be beneficial in moderate to advanced stages of disease. I do not believe that Serevent or Foradil are particularly dangerous.

Dr. Tom

 

Questions about Pulmonary Hypertension
Q. Dr. Tom, I have heart disease. In July I had an echo. The doctor said I have pulmonary hypertension tension in the right side of my heart, 36% Grade11. I no longer see this doctor.
Is this a progressive disease? Is the 36% high? I heard about a test you could have done where a tube is inserted in your arm or leg and run in your heart to check your pulmonary pressure. I am getting more short-winded should I see a pulmonary doctor? Thank You so much.

Virginia

A. Dear Virginia, The number 36% does not relate to pulmonary hypertension. There are many causes of pulmonary hypertension, and treatment is available. A cardiac catheterization is the best way to evaluate pulmonary pressures, but an echocardiogram can give a fairly accurate estimate, and is non invasive.

Dr. Tom

 

 Worried About Effects of Second Hand Smoke
Q. Hello Dr. Tom, I am a 34 year-old non-smoker who lived in a home from birth until the age of 18 with several smokers.  I am now worried that my continual exposure to second hand smoke for so many years especially while I was so young has put me at great risk for developing lung cancer. 
About two weeks ago I starting noticing a pain in my upper back area near my rib cage. I thought I just slept wrong but now I also have some soreness in my chest but do not currently have a cold or any type of illness that I would attribute this to.  Should I be worried about these vague symptoms and see my doctor or wait and see if they subside? 
Should I be getting screened in some way to watch for lung cancer since I had such a great exposure to second hand smoke? 

Tish

A. Dear Tish, Your risk of lung cancer is very low at your age. I do not recommend screening tests for lung cancer in your case. Try to avoid all other tobacco smoke and you will stay well.

Dr. Tom

 

Are All Hospitals Equal in Treating Cystic Fibrosis?
Q. Dr. Tom My daughter has cystic fibrosis and she is 19 years old. Her doctor who she has seen since she has been about 10 years old has gone into a private practice.
When she has to go into the hospital for a tune up it is not a hospital that is associated with cystic fibrosis. The first time she was admitted they asked her if she brought her Acapella and also her enzymes. I wondered if she would get better care at a hospital where they deal with cystic fibrosis.
What is your opinion about this? Is there any difference in care and treatment? Thank you so much, I appreciate any insight that you would have on this subject.

Noreen

A. Dear Noreen, Hospitals which specialize in cystic fibrosis will be more helpful than general hospitals, where the experience with this complex disease is not as great.

Dr. Tom

 

How Serious is Basilar Granuloma
Q. Is basilar granuloma cancer? Is it bad and will they be able to treat it or will I die soon?

Michele

A. Dear Michele, Any lung cancer is serious, but there are improved treatments for most. I do not recognize the term "basilar granuloma cancer". There must be some other designation.

Dr. Tom

 

Only 23 and Have Been Diagnosed with Bullous Lung Disease
Q. Dr. Tom I am 23 years old and I have been diagnosed with bullous lung disease. I have been a heavy smoker since I was 16.
I recently spent 11 days in the hospital and they drained eight liters of fluid from the base of my left lung!!! The chest x-ray and MRI revealed that 60 percent of my left lung was nonfunctional. They had told me they do not know the cause of the infection. They said that that part of the lung might need to be removed.
Being only 23 you can imagine how scared I was. I was on drip antibiotics my whole stay. A decision was made to send me home with oral antibiotics, and to have an x-ray in 2 weeks, all went well the fluid was not accumulating. They said they think I was born with this, although the literature I have been reading does not point to the disease being a birth defect. I am very confused, with my diagnosis, when the doctors explained it to me I did not fully understand.
My question to you is, have you seen any cases of this in people my age, and if I take care of my self-quit smoking and exercise regularly can I gain some of the lost function back. If you can give me any insight on this it would be greatly appreciated. 

Vernon

A. Dear Vernon, It is possible to have giant bullous lesions that are localized. These are usually developmental disorders, and the rest of the lungs may be normal. The large damaged areas take up a lot of space and thus reduce the range that your normal lungs have to expand.  
They are usually very effectively treated by surgery to remove them. Then the underlying lung tissue has a normal space in which to expand, and you will return to excellent health.
See a pulmonologist who works with a thoracic surgeon about this.

Dr. Tom

 

CT Scan Showed Interstitial Lung Disease, Nodule, and Soft Tissue Density
Q. Recently had a CT Scan done on my lungs. It showed mild interstitial disease and a nodule in 6cm on left lung...also see 1.9cm soft tissue density in the upper right side next to the adrenal gland next to the spleen. My question is what could this be???

Alvin

A. Dear Alvin, A six cm nodule is large and must be explained. With a density of or near the adrenal gland, the main concern is lung cancer. You need a biopsy diagnosis. See a thoracic surgeon.

Dr. Tom

 

Training for First Triathlon
Q. I am training for my first triathlon and I am just looking into everything I need to accomplish before I start any hard training.  I just turned 40 at Christmas and I am married with three children, four and under.  I find myself at times having difficulty taking a deep breath.  I haven't exercised much in the past five to ten years, but you'd never know it looking at me.
Have I lost lung capacity and is there a way to increase it?  I have recently read about hydro training and was wondering if that is a good idea?  I have been to my doctor and I am having a CT scan on my heart next week as my cardiologist has diagnosed me with PVC’s, but he says they are nothing to really worry about and they work themselves out most of the time.  Any advice on increasing my lung capacity would be greatly appreciated! 

David

A. Dear David, You did not mention smoking. Your lung capacity will not increase with exercise, but your efficiency will.

Dr. Tom

 

What are the Consequences of Not Using Advair Consistently?
Q. Dr. Tom, Is Advair a medication that can be taken on occasion? I am divorced and my daughter's father is giving her Advair while she visits him, and she takes Singulair at home. It took several weeks to wean her from the Advair. What affects can sporadic use cause?

Shannon

A. Dear Shannon, Advair, will not continue to work, i.e., it will not carry over during the periods it is not used. Otherwise there is no downside for using it intermittently for symptom control.

Dr. Tom

 

Feel Like I Am Losing Ground
Q. I recently saw a new pulmonologist who did new PFT's (Pulmonary Function Tests) and those indicated a loss of 13% in the FEV FEv1 in a little over a year putting me in the 31% range. I was sick a lot during the summer and on some burst of 60 mg of prednisone and during that time I really did nothing in the way of exercise. I had been in rehab when I got ill along with three other people, one died. 
Anyway, since then is when I have felt I have lost a lot of ground...I have gained about 20 lbs in the past two years from overeating.
My primary doctor has used the term end stage but then told me not be frightened...also thinks I am in denial, maybe because I plan to move from one senior housing to another better and cleaner one...so I'm doing packing. It is unbelievable that I can do packing alone but have, all with the aid of a walker etc. I do some household things.
I am on l0 mg daily of prednisone; 200 mg of theothylline (had blood test last week and it is ok) had echo, no problems, ABG no problems. On Advair 500/50, Spiriva, albuterol as needed, O2 24/7 2 liters at rest, 3 or 4 for exercise or walking, Xanax, and Lisinopril, supposedly have I slight pulmonary hypertension. 
I am told that they have done all they can with these meds to help me.... Naturally I hate to give up and wonder if the weight gain and inactivity during the summer had anything to do with such awful PFT's. Would walking, which I am doing daily, help to prevent further problems or should I just not bother?  Sometimes I wonder if inactivity could be part of the problem, weighing so much or just the progression of the disease...any word from you would be helpful.
I just found an unopened package containing The Breather (www.betterairways.com) and wondered if you had heard of these and if they really have any value? Thanks for all your past help too...

Dot

A. Dear Dot, Regular exercise as in walking at a comfortable pace for 20 minutes twice a day will increase your abilities to do more. Your case is NOT hopeless. Try to keep fit and control your weight. I have not heard of the website you cite, but you may want to give it a try.

Dr. Tom

 

Ventilator Patient Rights
Q. Where may I find the guidelines for ventilator patient's rights?  What organization, or organizations, should I contact if a patient's rights are being violated, regarding the weaning process?

E

A. Dear E., There are many articles on patients rights. In general a patient has a right to refuse any treatment including mechanical ventilation. You do not need a lawyer to exercise the right to privacy or self-determination, these are guaranteed by the US Constitution and the common law. Consult the Robert Wood Johnson Foundation on the Five Wishes (http://www.agingwithdignity.org/5wishes.html) at the end of life.

Dr. Tom

 

Friend has Squamous Cell Cancer and I am Worried About My Scan
Q. A heart scan in September also noted a 9mm round nodule in my lower left lobe indeterminate for cancer.  The nodule was non-calcified.  Previous lung x-rays have noted "mild left basilar scarring".  I had thought that the nodule in the CT scan of the heart was that scarring.  However, a six-month follow was advised. 
Can "mild left basilar scarring be round?  And would the size of the nodule, at 9 mm, be considered "mild" scarring, if indeed these are one and the same thing? 
I am very anxious to find out, and really do not want to wait until six months is up at the end of March.  My best childhood friend had a 10mm nodule found in August, which is now tripled in size and is squamous cell cancer that has spread to other areas of his lungs, his bronchia and some of the lymph nodes in his chest.

James

A. Dear James, The 9mm nodule that is not calcified is suggestive of lung cancer. It should be biopsied by removal. See a thoracic surgeon. Often these can be taken out via a VATS procedure, which is a video assisted thorascopic procedure, which usually require only two small incisions and one day in the hospital.

Dr. Tom

*For more information on the VATS (Video-Assisted Thoracic Surgery) procedure, see the University of Pittsburgh’s educational site.

 

Want to Go to a Doctor Without Having Them Think I am Going to Sue Them
Q. I am in a class action suit. Every lung specialist I see is very negative towards me. They have a very negative position towards me because of my being in a class action suit. This is really upsetting, because when I was in the hospital with a severe stroke the doctors can't figure out why I wasn't paralyzed on the left side. 
A pulmonologist came to see me, at the request of my civilian doctor.  The first thing he said, after he told me who he was is " what do you want from me"?  Wow, was this a shock! I said who sent you, and he told me your doctor. Well all I said was I guess she wanted you to monitor my condition.
Dr, I had a bad case of kidney failure three months prior to my stroke, and this doctor made me feel like I was trying to stick him up or something. Well, I went with my wife to see him, and without any tests or even listening to my lungs he said he didn't think I had a problem. I was stunned, and so was my wife. He was so rude that I told my nephew, who is a very well known diabetes specialist in Connecticut about this and he said I should file a complaint.
Like I said to you before, the VA doctor and VA hospital acknowledges my problems with asbestosis and when you get the VA to admit anything you’ve got to be dead!
I have quite a bit of chest and back pain and rather go to my own doctors than the VA. It is very hard to get a VA doctor when you’re hurting.
 I want someone to monitor my lungs and not worry that I might sue them.
I never knew I had asbestosis until 1997, up to then all my doctors including Yale New Haven Hospital diagnosed me with breathing problems related to asthma/bronchitis.  I remember one doctor; years ago couldn't believe that I developed asthma/bronchitis at the age of 33.  Thirty-three years old was 15 years after I was exposed to asbestos while in dry dock in Boston, MA, aboard my ship, the USS Warrington DD843, a Navy destroyer. 

Joseph

A. Dear Joseph, You should be able to find a doctor that will treat you no matter what. The class action suit would have no bearing on an individual patient doctor relationship. Keep looking and you will find just the right pulmonologist.

Dr. Tom

 

Exercise Makes Heart Rate Increase and I Become Short of Breath
I have COPD. Any activity pushes my heart rate well over 100, often into 120s. I was hospitalized with an exacerbation in May 2006 and checked for sinus node dysfunction and given a couple of EKGs. They found nothing abnormal.
When my heart rate escalates, I become SOB but my O2 level will be at 95. I am on O2 24/7 and take Spiriva and albuterol as needed (about 3 times a day). I also go to pulmonary rehab 3 times a week and ride an exercise bike at home. When I get SOB it really stops me and I must sit still until the rate comes down closer to 100. Is there anything else that I can do? Is there something else that should be explored?

Mary Lou

A. Dear Mary Lou, You are doing the right thing. Keep exercising and stop when you get short of breath. A heart rate of 120 is not dangerous.

Dr. Tom

 

I Have had Thyroid Cancer and a Faint Nodule Was Seen in a Chest X-Ray
Q. Dear Dr.Tom, I had thyroid cancer seven years ago, both thyroid lobes removed, five radioactive iodine treatments.  Everything is well; feel great.
 But, two weeks ago, I was sick with a bad cough and congestion. I went to my doctor, he ordered a chest x-ray, and said my x-ray was not very impressive to a doctor, but I did have an upper respiratory infection, he prescribed an antibiotic for ten days.  I feel much better now. 
But, now two weeks later, his nurse called me to schedule another chest x-ray in a week, as they spotted a "faint nodule on the lower part of my left lung".  I am scared, they said not to worry, it is most likely a calcification, and benign, but the doctor wants to make sure it is okay. 
Is it possible the thyroid cancer has spread to my lung, even though I am thyroid cancer free? 

Melinda

A. Dear Melinda, This is not likely to be from your thyroid cancer that has been adequately treated. Get the follow-up x-ray to clarify the issue. If the nodule is calcified, you can forget about it. If not, it should be followed.

Dr. Tom

 

Excessive Sweating and Get Very Short of Breath
Q. Dr. Tom, I am a 70 yr old female 5'8" tall and weigh 138. I have been on 02 for six years. I take DuoNeb four times a day and Pulmicort three puffs before I go to bed, I use Proventil for a rescue if I'm out.
I am a M-S on the Alpha-1 scale. I went through pulmonary rehab and have kept up the maintenance program two times a week until recently.
My problem for the last eight months is excessive sweating. My pulmonary doctor had me tested for thyroid and it came back positive. He sent me to my PCP and since it was Hyperactive, she sent me to an endocrinologist. I am on 10 mgs a day of Tapazole. I went through all the hospital tests and my thyroid isn't diseased so nothing had to be done with taking it out. After all this time I am still sweating, the internist said I need to go on hormone therapy. I have never used it.
My PCP doesn't agree with using it and is sending me back to my Pulmonary Dr. because when I feel the flushing coming on, I get very short of breath and my 02 drops down to about 83%.
I've been caught a few times in a store and had to get back to my car fast. When I sit down, my 02 comes back up, I use my oximetry. Have you ever had anything like this happen to any of your patients and what have you done for them.

Pat 

A. Maybe the sweating has other causes. I would rely on the advice of your endocrinologist.

Dr. Tom

 

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