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Archive: Dr. Tom 96
Posted April 22, 2007

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

 

 

Need Help with CT Scan Interpretation
Q.
I have moderate COPD and would like an interpretation of my last CT Scan. I am scheduled to have another this month and I need to take matters very seriously and have not...I am in denial and continuing to smoke. I have the prescription for the new Chantix and plan on working with support and the prescription very soon.

My last scan read: Underlying bullous emphysematous changes are noted. Prominent calcified granuloma seen in the medial left lung base unchanged from previous study. An oblique zone of atelectasis and/or scarring is noted in the anterior left lung base. Prominent right hilar lymph node seen on previous exam is noted and unchanged in appearance from previous exam. Calcified subcarinal lymph node noted. Evidence of previous granulomatous

disease and prominent right hilar lymph node of uncertain significance and unchanged from previous study.

I guess my question is if my next scan is same or changed will I need a biopsy? Thanks for your time.

Lynn

Q. Dear Lynn, Why do the scans at all? Scans do not tell anything about lung function. Spirometry does.

Granulomatous disease is a healed inflammation and of no consequence. You must stop smoking to protect your future lung function and health.

Dr. Tom

 

When to Resume Sports Following a Collapsed Lung
Q.
My son had a sports injury where his right lung was collapsed 20%. What is the standard time frame before he can return to sports?

A. Dear Lisa, Full expansion occurs in about two weeks, and then he can return to full sports activities.

Dr Tom

 

Don’t Know What to do After CT Scan
Q. I am 43, female, recently diagnosed with high blood pressure and am on medication (pressure still high). I've been a smoker for 33 years. I recently had a lung CT Scan on my own without a doctor referral.

The CT Scan detected:
1. A .2 cm ground glass nodule density in the right lobe

2. A .2 cm nodular density in the left lobe

3. Minimal biapical pleural-parenchymal densities

4. A small bulla in right lobe

5. Relative lucency bilaterally

6. Mild thickening in the bronchial wall.

7. Fluid in the superior pericardial recess.

8. A 0.6cm right anterior mediastinal lymph note was noted.

9. Coronary artery calcifications.

I haven't discussed the results of the CT with my doctor yet. My doctor is at an urgent care facility. Do you recommend I pursue a specialist for follow-up or can my current doctor (sport med specialist, internal med) manage the follow-up?

Linda

A. Dear Linda, Your findings are minimally abnormal and do not require a follow up. However, should any follow-up be needed it should be done by a pulmonologist.

Dr. Tom

 

Exercises for People who have Interstitial Pulmonary Fibrosis
Q. I teach pulmonary rehab at a community hospital in TN. I have had an influx in IPF patients within the past year. I'm discouraged to find there is not much in the way of advice for nutrition and exercise for these patients that can be found on the web. Can you shed a light on exercises they should not be doing?

Lisa

A. Dear Lisa, The principles for exercise and nutrition of IPF (Interstitial Pulmonary Fibrosis) are similar to those used in COPD patients. There are active IPF societies, Pulmonary Fibrosis Foundation and the Coalition for Pulmonary Fibrosis, which may be able to give you more advice.

Dr. Tom

 

COPD and Avoiding Flare-ups (Exacerbations)
Q. Dr Tom, Very nice to have you back. I know that people with COPD should avoid illness, but that is almost impossible. I have a sinus infection and I am on the third dose of antibiotics. I tried Cipro, Amoxicillin, and I am now on Levaquin. I have had this for 2 weeks with productive cough. I have noticed I am a bit more short of breath, but nothing severe.

Does illness like mine always cause the lungs to permanently lose capacity, or will they rebound when the infection leaves?

It is very frustrating because you keep on trying to go forward with this disease yet at times we take a few steps backwards. Like I say, it is virtually impossible to never again catch cold or get some sort of infection. Hope you can help.

Philip

A. Dear Philip, Acute lung infections may compromise lung function for a time, but this is usually reversible. As you know, Philip, lung function testing, spirometry, is used to access the severity of your lung disease.

Dr. Tom

 

Is Bleb Disease or Lung Collapse Hereditary?
Q. Is bleb disease or a collapsed lung hereditary? If yes, how do you know which side of the family it's from—the matriarch or the patriarch? Could this be caused from smoking or quitting smoking?

Marci

A. Dear Marci, Bleb disease is usually not directly hereditary, but it may run in families. There is no way to know which side of the family bullous disease comes from.

Dr. Tom

 

Need Advice about Oxygen Tubing
Q. I am 63, have NSIP (Nonspecific Interstitial Pneumonitis). I am O2 dependent and I am looking for a way to keep the plastic O2 tubing from constantly tripping me up or hanging me on knobs and furniture. Is there anyway to tame the tubing? I prefer the continuous flow of the liquid O2 to the pulse delivery of the Helios unit, which I use for going out. Any information would be appreciated.

Linda

A. Dear Linda, One of the insidious things about oxygen tubing is that it will hook on anything: door knobs, handles, and other things seem to lay in wait for nearby oxygen tubing. My advice is, get used to the intermittent flow or the Helios of equivalent and get the tubing off the floor.

Dr. Tom

 

Risk of Second Hand Smoke and My Daughter
Q. My daughter, 8, has a friend who lives next door. Virtually the entire extended families are smokers. How dangerous is it for her to play over there, say 2-4 hours, maybe once a week or less?

Julia

A. Dear Julia, Probably no harm at all, but it is wise to remember that there is no safe level of tobacco exposure.

Dr. Tom

Note: However if there is active smoking taking place while your daughter is there, she is in danger of being exposed to harmful exposure to second hand smoke. Please read the following.

 

Coughing Up Mucus that Smells Bad
Q. I have a constant feeling of something being in the back of my throat. I also cough out hard whitish yellowish chunks of mucus that smells very bad. I was told that this “bacteria” is caused because I still have my tonsils, which houses the mucus and bacteria. Is this true? And if so what can I do to get rid of the situation? I am only 23 years old, so getting my tonsils out is still an option right?

Jenna

A. Dear Jenna, You can get your tonsils removed, but I doubt if this is the cause of the chunks of mucus, with a bad smell. I suggest consulting a pulmonologist to see if you might have bronchiectasis, which involves the larger air passages of the lungs and causes poor mucus clearance.

Dr. Tom

 

Should I be Concerned with X-Ray Results?
Q.
I have been a moderate smoker for 10 years. I have also had pneumonia a few times. I had an x-ray recently, and it noted this:

"There is a tiny linear density along the medial aspect of the left upper lung zone, which is stable in comparison to the prior study, and likely represents a tiny area of scarring". Is this something to be concerned about?

Bridget

A. Dear Bridget, The tiny linear density is of no concern. Stay well.

Dr. Tom

 

I am Taking Medication for My Lungs, But Woke up Having Difficulty Breathing
Q. I had a CT of the chest and the conclusion was:  there is marked emphysema with prominent bullous formation in the upper lobes. Last night I woke because of difficulty breathing.

My doctor put me on a Bricanyl Turbuhaler 500 mcg (2 puffs 3 x day) and a Seretide Accuhaler 500 (2 puffs 2 x day).  Isn't all this medication a little extreme and can it cause a reverse effect and shortness of breath?

Heather

A. Dear Heather, There are many causes of sudden shortness of breath at night. It would be good to get a lung function test (spiromertry) to know some basic facts about your lung mechanics. The drugs being used suggest a pulmonary process, as does bullous formation, but none of the information tells about lung function. 

Heart disease is another consideration. I suggest a consultation with a pulmonologist.

Dr. Tom

 

Pulmonary Fibrosis
Q. I'm 34! I was diagnosed with "Early Pulmonary Fibrosis". A CT Scan Embolus Study was done, but there is no blood clot in the lung. In the past, I have had superficial blood clots.

Can you please explain me the following: "The Methotrexate is of concern because of the Pulmonary Fibrosis...Unlikely that this is a very important kind of fibrosis"

Is there a good or bad fibrosis?

Irene

A. Dear Irene, There are various forms of fibrosis, which carry different outcome predictions. The fibrotic lung tissue must be correlated with the clinical symptoms. Methotrexate is used for some serious forms of pulmonary fibrosis, and sometimes causes fibrosis itself.

Dr. Tom

 

Having Lung Problems for Past Nine Weeks
Q. I'm 31 and in good health, but in the last 3 years I used the "hubbly bubbly" (frequently used as an Arabic/Turkish way to smoke) which some consider as more dangerous than cigarettes.

Before 8 weeks I had a sudden shortness of breath accompanied with a fever 37.7 degrees. Since then I am experiencing daily a tightness in my chest with no fever, completely new to me. 

I stopped immediately smoking. The severity of the shortness of breath has dramatically decreased after I have seen my doctor who did not advise me to use antibiotic at first but who prescribed me one after I informed him about the thick foamy white mucus secretions.

I would like to have your opinion in my case. Is it just a viral infection that will go with time or is it more serious. It is now 9 weeks since first it happened.

Sami

A. Dear Sami, Any pulmonary reactions lasting 9 weeks should be explained, and may be serious. I suggest eliminating the "hubbly bubbly" device, which may contain dangerous materials, or contaminants.

Dr. Tom

 

Questions About Bronchiectasis
Q. I hope you realize how important you are to all the people who have respiratory difficulties or who have family members who are inflicted with this illness.  

My question: Is there any cure for bronchiectasis? What are your recommendations for longevity with this disease?  I am 73 years old and am on oxygen 24/7.
Thank you kindly! 

Rose

A. Dear Rose, Glad to be back, but I am slowed by lots of remaining complications. I am glad that I can be of service to your family.

Bronchiectasis is rarely curable unless it localized, as can be  the case in some children or following an obstructive pneumonia. Most bronchiectasis is managed very much like COPD with oxygen, pulmonary rehabilitation, and bronchodilators. Antibiotics are also commonly used for recurrent chest infections, which is a hallmark of bronchiectasis.

Dr. Tom

 

Father has Trouble Managing his Oral Secretions
Q. Hello, My father is an 89 year-old man who resides in a nursing home His major medical problem was prostate cancer. He was placed on a G-tube in November 2004 after a bout of UTI (Urinary Tract Infection) resulting in severe dehydration. Barium Swallow in August 2006 revealing an oral dysphagia (difficulty swallowing), but no aspiration. On 3/23/07 it was decided that he could resume a PO recreational feeding program of thin liquid via spoon and purees.

He has had several bouts of UTI and during these bouts of he gets severe congestion in the throat area. Dad receives nebulizer on a PRN basis; this was ordered in January (during an UTI bout) when an CT Scan, of the lungs, revealed a slight "something" in the bronchi that was treated with a nebulizer.

Dad generally only requires suctioning when ill with UTI.  However, his ability to manage his oral secretions is inconsistent resulting in INTERMITTENT coughing, wheezing and occasional light drooling. He is often able to cough up oral secretions and occasional mucous without the aid of nebulizer.

His O2 level is generally around 95%; heart rate is generally somewhat elevated in the 90s.

Dad sometimes sneezes and rubs his nose and his eyes tear and water as well.  I'm wondering if it is an allergy.  In late 2006 we had ENT examine and dad has some fluid in the nasal cavity, but not the sinuses. The ENT (Ear Nose and Throat doctor) does not want him on medication consistently for this condition.  I feel it may be a build up of fluid in the nose that drips down the throat.  While a good sneezer, his ability to blow his nose is poor.

Can you suggest anything other than the nebulizer, suctioning or other medication that might help?

Ellen

A. Dear Ellen, Frequent use of a nebulizer followed by forceful coughing is the best way to remove retained upper airway secretions, which tend to accumulate and are a source of aspiration in many older people.

Dr. Tom

 

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