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Archive: Dr. Tom 95
Posted April 10, 2007

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

 

 

Is Emphysema/COPD Possible at the Age of 20?
Q. Dr. Tom, I am 20-year-old male. I have been having trouble breathing for over a year now. I smoked for about three years until the problem started. Had x-rays showing some hyperinflation in my lungs. I don’t really have a cough at all but I do spit up a lot of phlegm, I think from my sinuses though.
Also, my blood oxygen is always between 97 and 99. Had a CT scan and saw no problems. My heart rate was extremely high a couple days ago reaching 120.
I just took a pulmonary functions test today and have to wait a week for results and consult. So am I doomed? Is it emphysema or COPD possible at my age? I’ m pretty distressed over all this.
Hope to hear back from you. Also the therapist said that I keep ten percent more then normal air in my lungs. 

James

A. Dear James, We will need your lung function tests to begin to answer your question. In case you are NOT doomed. Most likely you have asthma and will respond well to treatment. There are some other rare possibility including emphysema, but it is very unusual for your age.

Dr. Tom

 

Recovery Time for Bronchitis
Q. Hi Dr. Tom, I was diagnosed with bronchitis around the 10 of Jan 2007. I came down with a cough in the 2nd week of December 06, which then turned into a cold, saw the doctor, but I didn't want to start my antibiotics thinking that it'll go away. I only took meds for the cold.
I felt better with the cold gone but my voice stayed coarse almost pretty much of Dec. 06. Then I was down with a cough and again went and saw the GP. He prescribed me more meds and this time I took the antibiotic but my cough never went away but got worse instead with lots of green, sometimes-even blood stained phlegm.
I went and saw another doctor who then diagnosed me with bronchitis. It is the 24th of Jan today and I’m feeling a lot better physically but the slight cough seems to be there from time to time. I am an avid tennis fan and player and I’ve got tournaments coming up from 1st Feb. to 19 April.
I am just wondering if I should carry on with my matches. Could you please advise?

Jennifer 

A. Dear Jennifer, Your cough should gradually resolve now. You should  plan to keep your matches.

Dr. Tom

 

Help Clarify CT Scan Results
Q. Could you help clarify my CT scan impressions?  (1) Minimal bilateral apical pleural-parenchymal thickening with no evidence of discrete mass or nodule.  Subpleural nodule identified in left lower lobe.  This could represent volume average from posterior aspect of ipsilateral hemidiaphragm insertion.  Possibility of a subpleural parenchymal nodule cannot be excluded. Lungs otherwise unremarkable. (2) Minimal bilateral pleural-parenchymal thickening is likely post infectious or inflammatory in nature.  No evidence of discrete mass or nodule.  (3) Evidence of splenomegaly with small, approximately 7.6 mm in diameter low attenuation lesion identified in the spleen which is too-small-to-be-characterized.  Regional osseous (having to do with bone) structures demonstrate no evidence of progressive lytic or blastic lesion.
Of note, I had intraductal papillary carcinoma in situ in 1991, right breast.  I had double mastectomies with back flap reconstruction and saline implants on both sides resulting in six surgeries and eight drain tubes during 1991 and 1993.  I have been cancer free since 1991.  No history of breast cancer in my family.
All other tests on annual physical exam (potassium, kidney function, blood sugar, blood count, liver function) all normal.  I take medication for borderline high blood pressure, which is under control, cholesterol that is under control, acid reflux under control and paxil for anxiety. Also 81 mg. Aspirin, every other day.
Dr. has recommended a repeat CT scan of the abdomen and CT scan of the chest in three months.  What is your opinion? Thank you for your help with this matter and I am quite anxious.

Sandra

A. Dear Sandra, The greatest concern is the lesion on the bones. This should not wait. Even though you have been cancer free for a long time, a metastasis remains a possibility. I suggest seeing a breast cancer specialist.

Dr. Tom

 

Worried About Lung Nodule Found on Daughter’s CT Scan
Q. My daughter had a CT last week and the doctor found a lung nodule 5mm, do I have to be concern about it?

Jose

A. Dear Jose, No. It is a very small nodule, and almost certainly benign. I would get a copy of the films for comparison, in case she has another CT scan. This makes me wonder why she had a CT scan in the first place.

Dr. Tom

 

Need Help with Understanding Lung X-Ray
Q. My x-ray said lungs are mildly overinflated and hemidiaphragms are flattened? There is post inflammatory scarring noted in both lungs apices. No acute infiltrates are appreciated, mediastinal structures are unremarkable. No acute infiltrate noted. What does this all mean?

Judy

A. Dear Judy, Essentially nothing. Forget about this radiologist jargon, which as the report says, is due to old inflammation.

Dr. Tom

 

Blood Clots on CT Scan, Now They Want to Repeat Scan in 3 Months
Q. I had a year ago what the doctor described as a spray of blood clots in my lungs. Now a year later I had a follow up CT scan and now I have scar tissue- probably from the clots. They want to repeat the CT scan in 3 months. Can you explain this to me? Should I be worried? Will this cause me any problems and why are they repeating the scan.

Mariann

A. Dear Mariann, I do not know a good reason to repeat the CT Scan, unless there is something I do not understand. A CT is not a good way to diagnose a "spray" of blood clots".

Dr. Tom

 

What Do My Spirometry Results Mean?
Q. Dr. Tom - I am 38 years old.  I have been experiencing some shortness of breath after quitting smoking (I smoked for 17 years) I don't know how to read this pulmonary function test, and I’m scared to death re: my diffusing capacity results.
I will tell you what I’m looking at:
Spirometry
FEV1 pre 3.78, % re 109, post 3.82, % ref 111
FEV1/FVC pre 83, post 86
DLCO pre 29.7
Can you please decipher these results for me? 

Michelle

A. Dear Michelle, Your lungs are normal.

Dr. Tom

Want to Get Pregnant and Worried About the Side Effects of Medication on Pregnancy and Breastfeeding
Q. I have Asthma for 10 years I used to use Becloforte (not available in USA) for 3years now my doctor changed to Seretide (not available in USA). I want to get pregnant Is there any problem with Seretide? How about breastfeeding?

Hamida

A. Dear Hamida, There is no problem with pregnancy or breast feeding from these inhaled drugs as far as I know. Ask your obstetrician to be sure.

Dr. Tom

 

Chest X-Ray was OK, but Still have Chest Pain
Q. I have chest pain. I went to doctor a week ago today. I went for chest x-ray. Said it was ok, I still have pain

Geoffrey

A. Dear Geoffrey, A chest x-ray does not begin to explain all the causes of chest pain. You may need to see a cardiologist about the possibility of heart disease.

Dr. Tom

 

How to Clean the Smoke Out a Home
Q. Is there a specific protocol for cleaning a smoker’s home for a newly diagnosed emphysema patient? I am the non-smoker who was just diagnosed yesterday.  My husband is the four pack a day smoker who quit today.  What can we do about the allergens in our home now?

Rhea

A. Dear Rhea, They will gradually dissipate with lot of fresh air.

Dr. Tom

 

Mucomyst and Bronchospasms
Q. It is true that Mucomyst can cause bronchospasm? Is that why you need to corporate bronchodilator during aerosol therapy?
A. Dear Ronald, Yes, Mucomyst by the inhaled route can be irritating, leading to bronchospasm. This is the reason it is usually used with an inhaled bronchodilator.

Dr. Tom

 

Protocols for BiPap
Q. I am looking for a respiratory driven protocol for the implementation of BiPap Vision. I would like to come up with something so that we may implement this on our own before the doctor has arrived to avoid possible intubations, also for the ER. I do not want to re invent the wheel. Does any one have one that is working well?

Rick

A. Dear Rick, There probably are some sort of protocols, but I do not like them, because they cannot fit all patients.

Dr. Tom

 

Very Worried about Dad’s Health
Q. Hi, My Dad is 56 and has severe COPD for many years. He has 20 percent lung capacity.  Also, had a pacemaker put in a little over three years ago, his heart will not work without the pacemaker.  He is on blood thinners and many other medicines. 
My parents are not telling me a lot, I think they don't want to worry me but little by little information is leaking out.  My dad is suddenly getting "papers" in order. He has to get a new pacemaker the batteries are almost dead but he has been too sick to operate. 
My question is with his heart and lung problems, is his life expectancy fairly low?  I know you can't answer for sure but my parents seem to act like it is not that bad but the more information I get I feel that it is. 
We live close but have had thoughts of moving due to work but something keeps nagging us that things are a lot worse than they let on.  Is there anything to improve lung capacity?

Gina

A. Dear Gina, It is very hard to predict the outcome in patients such as your dad. I assume he is on the maximal medications for his COPD. I do not have enough information to give you more advice. Remain optimistic.

Dr. Tom

                                   

Questions about IPPB and Incentive Spirometry
Q. I am working here in Hamad Hospital,Qatar. the Doctor always order IPPB with IS is this more effective? Is it OK to use humidification with IPPB?

Ronald

A. Dear Ronald, Both IPPB and incentive spirometry accomplish deep breathing. Humidification is definitely possible with IPPB.

Dr. Tom

 

Transporting patients Through Hospital with Oxygen Cylinder in the Bed
Q. Is there a safety concern with transporting hospital patients throughout the hospital with an oxygen cylinder in the bed with a patient?

Phil RRT

A. Dear Phil RRT, Yes. It can fall on the floor and act as a torpedo. It is heavy and can cause bruising. Better to use a lightweight liquid system.

Dr. Tom

 

Smoked Since 6 Years Old and was Told I have Emphysema
O. I have been smoking since I was six, I am now 31 and just found out I have mild emphysema. I have had a wheezing since I was 18, I only hear it when I inhale and shortness of breath has become more severe in the last year. For many years I told my doctor I didn't think it was asthma, could I have had emphysema this whole time? And being so young, how long does it take emphysema to reach the severe stage?

Van

A. Dear Van You probably do, have asthma. Emphysema does not progress to symptomatic stages, at your lung age, unless you have a familial form of emphysema such as Alpha One Deficiency. Better get checked for this.

Dr. Tom
More information about Alpha-1 Antitrypsin Deficiency (Alpha-1)

 

CT Scan Showed ‘Irritation’, What Does Mean?
Q. My dad had a thoracic CT scan recently that confirmed he no longer had pneumonia; however, the doctor noticed an irritation in his chest.  He advised my dad to consult with a pulmonary doctor.  What could an "irritation" mean?

Joan

A. Dear Joan. I have no idea. I have never heard the term "irritation's used in a CT discussion. Maybe they are referring to "inflammation".

Dr. Tom

 

When Should Spirometry Not Being Performed
Q. Do you know the latest contraindications for doing pulmonary functions on patients?

Stephen

A. Dear Stephen, I do not know any specific contraindications. Active hemoptysis or a patient so sick they cannot adequately participate would be reasons not to do spirometry. Also, spirometry is most useful when done in a clinical stable state, or after changing medications, such as starting corticosteroids in asthma or COPD.

Dr. Tom  

 

Multiple Lung Nodules and Pleural Thickening
Q. I have been a pipe fitter for 33 yrs and smoked for 30 yrs off and on. I have multiple lung nodules 5mm to 7mm. has scattered pleural thickening with some calcification. It says this on my last 3 CT Scans, but no diagnosis. What could this be?

Paul

A. Dear Paul, These multiple nodules are probably evidence of old fungal disease. But non-calcified nodules should be checked at least once in three to six months to look for growth.

Dr. Tom

 

Rising Carcinoembryonic Antigen (CEA) Level
Q. I have a rising CEA level (non smoker, but parents were smokers) & a 1cm nodule was seen a few years ago at the right lung base. Now, I have shortness of breath, coughing, hoarseness and CT scan sees the same nodular densities now in the right lower and right upper lobes and left lower lobe. There are lobulated nodular densities-may be pleural based.
Does this present as a possible cancerous scenario?

Karyn

A. Dear Karyn, Yes. This requires immediate attention. It strongly suggests what is known as a germ cell cancer. See an oncologist immediately, is my suggestion.

Dr. Tom

 

What is Atelectasis and what is the Treatment for Atelectasis
Q. Recently had a CT and it shows mild bibasilar subsegmental atelectasis. What is this and should I follow up with my doctor?

Donald

A. Dear Donald, These are areas where the lung is not well expanded. They usually go away with a deep breath. These findings are not very concerning, but should be rechecked to see if they resolve.

Dr. Tom

 

Five Month CT Scan Follow-Up Showed No Change; Now What?
Q. My 47 year-old nonsmoking husband had a 6mm pleural based, noncalcified lung nodule found when a CT Scan was done for chest pain. A follow-up CT 5 months later found no significant change; what should we look for, how should we follow up?

Debbie

A. Dear Debbie, I suggest that no follow up is necessary. Some would recommend one more follow-up in six months, but in a nonsmoker, and particularly when there is no history of lung cancer in the family, the non-growing nodule is almost certainly benign. This is a common finding.

Dr. Tom

 

Amoxicillin in the Blood Stream
Q. How long does amoxicillin show up in blood stream?

Ann

A. Dear Ann, Only a few hours.

Dr. Tom

 

Delivering Medications and Continuous Positive Airway Pressure (CPAP)
Q. How will I deliver a medicine (e.g. racemic epinephrine) if my patient is on a nasal CPAP?

Arman

A. Dear Arman, You could simply use a nebulizer intermittently with the CPAP machine. I do not know if any of the models have a portal for in line administrations with a nebulizer.

Dr. Tom

 

How to Help Lungs After Smoking Marijuana for 15 Years?
Q. I have a friend that has smoked marijuana for 15 years. They have quit and want a way to clean and restore their lungs. What is your recommendation to help them restore their lung function? No disease is present but a nagging dull pain in the back and front is their concern.

Dan

A. Dear Dan, The nagging feeling in the back of the throat is probably still from the irritation of the pot smoke. There is no way to "cleanse" the lungs, but they may heal, if treated with respect.

Dr. Tom

 

Sister is Having Surgery to Remove ‘Air Filled’ Cysts
Q. My sister is 56, smoked a pack a day for 40 yrs, she went to the Emergency Room with right pnuemothorax. She has lost a lot of weight over the last few months. She was referred to the surgical oncologist who did a CT Scan. They are taking her in to remove various "air filled cysts” in the upper section of both lungs and to repair the tear in the right one.
What are air filled cysts, could this be cancer?

Jody

A. Dear Jody, These are probably large emphysematous bullae, i.e., air accumulations in the lung tissue, from local breakdown of alveolar walls. These are almost certainly not cancer.

Dr. Tom

 

Worried About Lung Infiltrates, Could This Be Cancer?
Q. I was told today after a series of chest x-rays that I have lung infiltrations. I have been prescribed antibiotics. My doctor’s nurse was not able to give me any further information and my doctor had left for the weekend.
I am not sick or out of breath but was having some chest discomfort. I gave up smoking the first of the year after 20 years. Can you please tell me what lung infiltrations means? All info in the net sends me to lung cancer sites. Is it possible I have cancer?

Karen

A. Dear Karen, Infiltrates are a non-committal reference to lung shadows, which could be from inflammation and one form of cancer, known as bronchoalveolar carcinoma. You need follow up x-rays or CT scans to see if they have or are resolving. Dr. Tom

 

Gastrointestinal Problems Make Breathing Worse
Q. I am on oxygen 24hrs. I have a hiatal hernia and a lot of digestive problems, which make my breathing worse, after normal bowl movements and after bending over. Could the vagus nerve be pinched?
All I found out from tests were gluten intolerance, hernia stomach empties too slowly, and inflammation. I follow a gluten free diet, which helps some and I do some stretching on my own, which helps with the hernia.
My breathing gets a lot better; when these things are better. Is there anything else I can do? The Doctors say they can't do anything because I'm on oxygen. I have a lot more questions, but this is getting too long.

Kathleen

A. Dear Kathleen, A large hiatal hernia, with reflux of stomach contents can be repaired, if necessary, even in patients who require oxygen.

Dr. Tom

 

Worried that the Humidity in the Carolina’s will Effect Father’s Emphysema
Q. My parents are considering moving to the North Carolina/South Carolina area. They currently live in Manteca, California. My question, is it a good idea for my father, who is in the advanced stages of emphysema, to move to this area of the US? The summers are very hot and humid and I worry about his breathing with air conditioner all summer long and not having the ability to open a window (too hot and humid) when he’s in the shower as he has to currently.
I am unable to locate anything on the Internet about best and worse places to live with emphysema. Any help you could give would be appreciated.

Kim

A. Dear Kim, There is no ideal place of residence for patients with advanced emphysema. In general a mild dry climate is best. But your father may do well in spite of the heat and humidity of the region you are planning to move to.

Dr. Tom

 

Dangers of Flying after a Lung Collapse
Q. How soon is it safe to fly after surgery on a collapsed lung as my mums lung collapsed roughly around three years ago and wants to have her first holiday but is frightened to fly in case her lung collapses again. When she had her operation the surgeon had to glue her lung on to her chest. Will this make any difference to her flying?

Lynn

A. Dear Lynn, She should be fine to fly right now. In general it is safe to fly about two months after a procedure for lung collapse.

Dr. Tom

 

Concerned about 17 Month Daughter’s Chest X-Ray
Q. My 17-month old daughter possibly has a birth defect in her right lung. She will be having a CT later this month to find out for sure. The area the doctors are concerned about is in her right lung near the heart. It has looked the same in four different x-rays ranging from when she was six months to now. The area looks streaky and shadowy on the x-ray. Any insight in to what it could be?

Melissa

A. Dear Melissa, There are many possibilities, some important and some not. Your pediatrician will be able to advise you. If not, see a pediatric pulmonologist.

Dr. Tom

 

Have Trouble Doing Spirometry
Q.  Dear Dr Tom, I know you are very much in favor of spirometer testing but I have a problem. I was diagnosed with COPD, and have had two tests. Both were flawed. The first test my FEV1 was 25% of predicted, but I was just getting over a chest infection. My second test my FEV1 was 35% of predicted, but due to blowing so hard I passed out. I rested for half an hour but I just did not have anything left. The test was aborted.
I now have a new specialist, and he wants me to take the test again, but I have refused. I told him I do not tolerate it well, have passed out on 2 occasions, and it gives me a severe headache that can last for days after. He said he would see me without the test, just a chest x-ray.
Is there not Dr Tom a modified test I could take? I have one good blow in me, but my problem starts by repeating the same test 3-4 times. The process makes me extremely lightheaded and I faint. Could I not just blow the one time? I have a peak flow meter at home and it is fine because I only have to blow once. Any suggestions Doctor? Thanks as always

Philip

A. Dear Philip, You only need to blow out for six seconds. You need two tests to match, for assurance of a good effort. Try it again and I predict you will succeed. If you can only do one blow, this will at least tell you that much information. In other words, you cannot blow out a falsely high number.

Dr. Tom

 

Preparing to Become a Certified Pulmonary Function Technician
Q. I am a respiratory therapist, I would like to study and become certified in pulmonary function testing. I hope that you can give me some basic curriculum or classes that I could take to reach my goal.

Shirley

A. Dear Shirley, This is available from the AARC.

Dr. Tom

For general guideline and testing information regarding the Certified Pulmonary Function Examination see the National Board Respiratory Care.

 

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