Skilled Nursing Facility Ventilators
Q. Dr. Tom, With specific reference to discharge status from an acute care facility to a skilled nursing facility, is a patient that has a Respironics Vision unit with FIO2=. 4, IP=12cm H20 P, EP=5cm H2O P, and a rate of 4 breaths per minute, attached to their cuffed tracheostomy tube considered to be on a ventilator?
A. Dear Eric, I think the simple answer to your question is yes. Why would it be anything else?
Mucus is Hard and Gets Stuck in My Throat
Q. Lately, I have been coughing out something. It looks like mucus, but it's white and hard. I can really feel it stuck in my throat and it'll come out in chunks.
What do you think that might be? Please help me.
A. Dear Cedrick, It is most likely dried mucus. This can be very tenacious. Keep your water intake up.
Hazards of Secondhand Smoke in the Air and Clothing
Q. What research is there for babies and secondhand smoke in the air as well as on the clothing?
A. Dear Kathy, I do not know of any such research.
Sputum Production and Suctioning
Q. Based on the fact that sputum production varies per individual patient, is there any sure way to know when a patient has last been suctioned?
A. Dear CJ, No, the time of last suctioning cannot be determined by any physical sign or prediction formula.
Q. Welcome back, Dr. Tom!
A. Dear Adrienne, Thanks. Great to be back. In all I have had 51 days in the hospital for infections following a simple hip replacement. Not out of the woods yet, but back to work part time. Feels good.
Quit Smoking, How Long Does it Take for Lungs to Heal?
Q. I quit smoking a little over four months ago. I am a healthy 24 year-old female. I started exercising soon after quitting and have done 30 minutes of aerobic exercise daily ever since. While my lung function has improved considerably, I still sometimes feel some pain, burning or tightening of my chest when I exercise heavily.
Is this normal? I was smoking about 1.5 packs/day when I quit and smoked for about three years. How long does it take for lungs to heal 100%?
A. Dear Antigone, The lung usually heals in about three to six months, unless there is a lot of underlying lung damage, which is unlikely in your case. Stay well.
Chest Pain and Pulmonary Fibrosis: (Dr Tom #70 Follow-Up)
Q. Hi Dr. Tom, I hope all is well. Thank you for responding to my previous questions. My chest Wall pain which has been ruled out for any serious problems. Can pulmonary fibrosis play a role in it? I have a positive D-Dimer and High CK. Do they play a significant role in pulmonary fibrosis and should I be concerned?
A. Dear Irene, Chest pain is usually not a symptom of pulmonary fibrosis. The D-Dimer and CPK tests are nonspecific of a diagnosis.
Recently Diagnosed with COPD, What is the Best Climate for COPD?
Q. I was just released from the hospital after 21 days and diagnosed with COPD. I live in Palm Springs, CA, and it is low desert and dusty. Should I move or will I be the same anywhere I live? With heat at 112, should I move to cooler climate such as the beach area with average temperatures of 75 year round or just stay put? I am very scared about this COPD and how I need to change the way I live.
A. Dear Pamela, Your present location is okay, if you can avoid a lot of dust and stay in on very hot days. A milder climate is more pleasant, but there are not too many options. There is no one ideal place to live with COPD. Best to avoid all contact with tobacco and other smoke. Since you have early COPD your prognosis is excellent.
Side-Effects of Medication Used to Treat COPD
Q. I used Advair 250/50 forthree years for very slight COPD. I experienced many side effects and changed to Spiriva. The only side effects is that arthritis in my first finger knuckle is getting much worse (& dry mouth / no problem). Besides medication, what can I do for arthritis in knuckles or is there an inhaler for slight COPD which has no side effects?
A. Dear Melba, All inhalers have some side effects. I do not believe that Advair is needed in mild stages of disease.
Papworth Method for Asthma
Q. I am a new Pediatric Nurse Practitioner, and recently read an article about the Papworth method improving asthma symptoms. I am unable to find information on how to instruct patients on the Papworth method. Can you help?
A. Dear Diane, Sorry, I have never heard about this method of asthma treatment.
Worried that Symptoms Could Signify Serious Lung Problems:
Q. I have a little twinge that comes and goes in the center of my chest, a bit towards the right. (It is mild and lasts less than a second, but is frequent, sometimes occurring every 5 minutes.) I got very nervous about it and had it checked out at the ER-- I had EKG, blood work and chest x-ray done, and was told they were fine and not consistent with anything related to the heart. I was released with atypical chest pain. I’m a former smoker, who is concerned because this little sensation I feel isn’t going away (I’ve had it two years +) and sometimes when it happens it takes my breath away a bit. Could I have a serious lung problem that wasn’t detected via the tests I received at the ER?
A. Dear Dean, The tests done in the ER tell nothing about lung function. You should have spirometry to see if you have any reduction in capacity or flow. I do not have a ready explanation for your symptoms.