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Archive: Dr. Tom 93
Posted January 25, 2007

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

 

 

Pulmonary Hypertension
Q. The patient is on three maxed out dosages of blood pressure medications for their hypotension. The patient has no history of lung diseases or issues.  Can there be some pulmonary hypertension due to the maxed out blood pressure medications?

Rick

A. Dear Rick   Blood pressure medications for systemic hypertension, not cause pulmonary hypertension.

Dr. Tom

 

What is San Francisco Climate for People with Asthma?
Q. I live in the SF bay area of CA.  I have developed asthma here and wonder where the best places to live for asthma are.

Sandra

A. Dear Sandra, There is no ideal place of residence for asthma. In general a mild dry climate is most favorable.

Dr. Tom 

 

Just Diagnosed with COPD and Have Questions
Q. I am a 61 year old woman, non-smoker, diagnosed with moderate COPD in Dec 2006
FVC  2.44 =81%;
FEV1 1.48 =61%;
FEV1/FVC= 61%;
TLC= 5.86 Liters
CT Scan taken on Nov. 18, 2006 shows small nodules (2x3mm) in the lung parenchyma, post-inflammatory with areas of bronchiectasis in the right middle lobe/lingula BUT No definite suspicious nodules identified.
I have been given an RX for Spiriva but have the following questions:
1) Can the PFT test, which I took have inaccurate results, due to the fact that I have Scoliosis?
 2) Since I still have a 61% breathing capacity should I be taking this drug at present on a regular basis?
3) Am I much better off waiting until I am in the more advanced stage of COPD and then take the drug?
4) My specialist wants me to repeat the CT Scan and PFT again in May 2007. Is there any danger of waiting and not taking Spiriva till then?
5) According to the warning label some of the Spiriva side effects are: urinary retention, pupil dilation, glaucoma etc. Long-term studies of Spiriva usage are not available yet. Who knows what I am getting myself into? I will appreciate your honest opinion.

Tammy

A. Dear Tammy, The scoliosis will not affect your FEV1 which is the flow test and the main indicator of airflow obstruction.
Your prognosis is very good, if you quit smoking now and take influenza precautions each year. Spiriva may stabilize the lung function in people who have stopped smoking.
The small nodules are not concerning, but a follow-up in six months is wise. Women do not have urinary side effects from Spiriva, a drug which is generally well tolerated.

Dr. Tom

 

How Many Liters of Oxygen Can I Give to COPD Patients?
Q. Dear Dr. Tom, how many liters of O2/min can you safely give to COPD patient who is in a respiratory distress?

Tony

A. Dear Tony, What ever it takes to correct the hypoxemia. This may even be high flow oxygen via a non-rebreathing mask. Oxygen in an open system does not lead to CO2 retention. When CO2 retention occurs in an exacerbation of COPD, it is due to respiratory muscle fatigue.

Dr. Tom

 

Seen Lots of Specialists and Still Have No Relief of Symptoms
Q. I am a 59 year-old female who smoked for 30 years.  For several months, I have had shortness of breath, especially when exercising. It is almost continuous now - I find myself yawning to try to take a deep breath. 
My internist sent me to a pulmonary specialist who did function tests and said that my lung function was good.  I then went to a cardiologist for a stress test and the results were good.  My internist then ordered a CT of my lung and just told me that it shows emphysema.  I am now on Combivent and Flovent, but have had no relief.  What should I do - and what can I expect? 

Judy

A. Dear Judy, I do not know what you mean as "good" lung function. Is it normal?
 You may benefit from a pulmonary rehabilitation program, but a firm diagnosis should be made first. There are many causes of shortness of breath. Ask your pulmonologist about the possibility of pulmonary hypertension.

Dr. Tom

 

Husband has Abnormal Chest X-Ray and Multiple Health Issues
Q. My husband recently had a chest x-ray this past week, and the doctor has reported it as an "abnormal" scan, citing "irregular density in the rt. upper lung".  He is now to be scheduled for a CT Scan (Thorax w/contrast) for further testing. 
My question is:  What does "irregular density" in lung mean, and what specifically does a CT Scan of Thorax w/contrast check for?  The doctor said he needed to examine the "lesion" further.  The fact he used the word "lesion", is that an indication of cancer necessarily?
My husband's med. history in brief:
57 year old male - former 2-pack a day smoker who started in 1968, quit in 1997.
Morbidly obese
Has type II diabetes
Peripheral Neuropathy
Carpal Tunnel
Agent Orange, contaminant exposure, from Vietnam.
Hypothyroidism
Digestive disorders
Frozen shoulder due to post-op modified radical neck dissection done in 2003, after diagnosis in 2002 of squamous cell carcinoma at the base of the tongue (been cancer free for about 5 years now from time of diagnosis).
Two (2) damaged salivary glands due to radiation treatment
Had radiation Pneumonia back in 2002 from chemo/radiation and severe (hardened) scar tissue on neck from stitches opening up after surgery.
Does this help to paint a better picture of what this abnormal chest x-ray is about?

Donna

A. Dear Donna, A lesion simply means some abnormal shadow. It does not necessarily indicate malignancy. In your husband's case, the question of malignancy from the squamous cell cancer must be considered. And if the irradiation was on the right side of the neck, the lesion could be a scar from radiation. Contrast CT means that material will be injected into his circulation at the time of CT to see if there is vascular involvement of the lesion. Your doctor will help sort out what this lesion is.

Dr. Tom

 

Scarring and Nodularity on Chest X-Ray
Q. CT Scan showed scarring and nodularity involving the lingular portion of the left upper lobe approximately 5x11 previous scan six months ago was 9x11. Is this anything to be alarmed about?  My Dr. says no.

Toni

A. Dear Toni, I agree there is no major concern. There must have been some inflammation in this region of scarring, possibly from an infection such as a pneumonia. It will be wise to check on this again in another six months.

Dr. Tom

 

Great Site
Q. Hi, Just wanted to say GREAT SITE. I’ve added your link to my blog.
I’m a semi-retired Respiratory Therapist living with severe persistent, asthma since birth.

Stephen, Semi-Retired Respiratory Therapist

A. Dear Stephen, You are welcome. I am glad we can be useful.

Dr. Tom

 

Is Atrial Fibrillation a Side-Effect of Advair
Q. Dear Dr Tom, Since being on Advair 250 twice a day I have been experiencing atrial fibs about one every six to seven weeks lasting a second or two. When this happens I get short of breath, and tired. It is more of a "fluttering " and my heart does not pound. All is well within a few seconds.
I have COPD with a large component of asthma, and Advair has really been marvelous for me and I would hate to give it up, as I have read that atrial can be a side effect of Advair in some people.
I have seen my family physician and he says it is nothing to really be concerned about, seeing as I never have had any history of any known heart ailment. About six months ago I had an echogram done and all was normal.  
What do you think Dr. Tom? Should I replace the Advair just to see if these episodes stop, and if so what should I replace my Advair with which would be as good?
In you opinion should I be concerned. I am in fine health otherwise, and I am in respiratory rehab and I exercise by walking and treadmill, and I do not get atrial while exercising. Your kind help in this matter would be appreciated.

Philip

A. Dear Philip, It is possible that the Advair is precipitating the episodes of atrial fibrillation. There are alternatives to Advair for asthma that your doctor may want to consider. Also the possibility of ablation therapy for the atrial fibrillation is another thing to discuss with your doctor.

Dr. Tom

 

Serrapeptase for Treatment of Bronchiectasis
Q. Dear Dr. Tom: My 74 year-old mother has bronchiectatis.  I have read about an enzyme called: serrapeptase to help in the healing process of this respiratory illness.
What are your thoughts?

Rose

A. Dear Rose, I do not know anything about serrapeptase.

Dr. Tom

 

Placement of Bacteria Filter on Mechanical Ventilator Circuit
Q. Where is the right place to put bacteria filter in mechanical ventilator? Inspiratory or expiratory and why?

Ronald

A. Dear Ronald, The bacterial filter on the inspiratory side, helps to protect the patient. On the expiratory side, it helps to protect the environment in the ICU. Either or both can be used.

Dr. Tom

 

HEPA Filters
Q. I would like to ask if Thermovent HEPA can be used as filter in mechanical ventilator because here in our hospital (Hamad Hospital, Doha Qatar) use as bacteria filter.

Mr. Torres

A. Dear Mr. Torres, I do not know the answer to your question. It would depend on the resistance of the device.

Dr. Tom

 

History if Breast Cancer and has Nodule on Lung
Q. My mother was diagnosed with breast cancer eight months ago, and had a mastectomy of her right breast, and chemo with hormonal treatment. She went last week for a chest x-ray and there was a nodule on her lung, and this was compared with an x-ray done in December 2005, which of course this was not there in the old x-ray. Should this be something to worry about?
Her oncologist told her he was 100% sure it was nothing. How can he make a statement like that? He thought maybe it was scar tissue because it was around her incision sight. Please help!!

Lisa

A. Dear Lisa, The oncologist cannot be 100% sure about anything. A new lesion should be considered cancer in this setting, until proven to be something else.

Dr. Tom

 

Lung Age
Q. I am 36 and recently got a spirometry test done and the results said I had the lungs of a 48 year old. Why would this be and what does it mean?

Helen

A. Dear Helen, This means your lungs are ageing faster than you are. It is probably from smoking, and if so, you must stop to slow down this process of premature lung ageing.

Dr. Tom

 

Have had Low- Grade Fever for About a Week
Q. Hi there, I'm currently in Asia and I hope you can make heads or tails of what I'm suffering from.
I began to suffer from recurring low-grade fever for six days with muscle and joint pains. Regular analgesics worked and there were no other flu symptoms like phlegm, cough, a runny nose. On the 6th day, I saw an Infectious Diseases specialist because I had heard that these were symptoms of Dengue.
In addition to the blood tests, he had me get an x-ray and the results were a bit odd: linear densities appreciated in the left lower lung field and right base, heart is not enlarged, left suctus intact, right suctus not well delineated.
IMPRESSION:
Subsegmental atelectasis, bibasal Pleural thickening and/or minimal effusion, right.
What does that all that point to? Some cursory research says small cell lung cancer - but I've never smoked nor am I an asbestos worker. The other factor is pulmonary tuberculosis - but I'm not coughing nor do I sweat at night. Any thoughts?

David

A. Dear David, Various endemic infectious diseases are common in Asia. Dengue fever is usually severe and serious.   
Tuberculosis is also a possibility because of the environment. Symptoms are not accurate in diagnosing tuberculosis. You need sputum cultures. I do not think this is likely to be a cancer.
You do need a diagnosis, unless this just magically resolves on its own.

Dr. Tom

 

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