Where To Go To “Quit Smoking”?
Q. I have been a smoker for 50+ years and now have asthma, emphysema, bronchitis, COPD, etc!  Many dollars have been spent on hypnosis, laser treatments, over-the-counter patches, gum and lozenges with no results.  Is there a rehabilitation hospital or center that I could spend maybe three months to kick the habit?  I live in Louisiana but would travel anywhere to get help.

Dee

A. Dear Dee, I do not know of such a facility that specializes in smoking addiction.

You might try a drug addiction center, such as the Betty Ford Center in Rancho Mirage, California  (800) 854-9211.  After all, nicotine is more addicting than most drugs, including narcotics. Good luck and keep trying.

Dr. Tom

 

Am I a Candidate for a Bullectomy?
Q. How much of a chance is there for a surgeon to consider bullectomy surgery when you have already had a pleurodesis (a procedure to prevent recurrent fluid build-up between the lung linings) on that lung? My surgeon seems real hesitant to do this. If my breathing ever gets really bad is this something they will or can do?

Ringbo

A. Dear Ringbo, This won't be possible on the side that you had a pleural scarring operation. If you had both sides done, I believe it is out of the question. Hopefully you won't need any surgery for your emphysema. It helps only a select few.

Dr. Tom

 

Help For an Extremely Dry Nose
Q. For a month now I have been experiencing a very dry nose, which is causing me to wake in the night and open it up in order to continue sleeping.  I have tried Ayr gel and spray, Lanocane and RoEzit. Nothing seems to work.  I have replaced my concentrator water bottle and run two humidifiers in my home.  Any suggestions of what is going on?

Valerie

A. Dear Valerie, This may be a problem, particularly in dry climates. The “bubblers” on the oxygen system add little water to the air, because of condensation. You might try a water-soluble jelly such as KY.

Dr. Tom

 

Nutritional Supplements
Q. I am caring for a patient who has a rare form of muscular dystrophy.  His family has some questions about supplementing his daily food intake with liquid nutritional supplements. Can you recommend a type of nutritional supplement that will provide some needed nutrition without compromising respiratory function?

Trish

A. Dear Trish, I know of no nutritional supplement that will help any kind of muscular dystrophy. Lots of antioxidant vitamins are tried, but there is no evidence that they work.

Dr. Tom

 

Concern for the Pope’s Speaking Ability
Editor’s Note: Sister Esther’s question was submitted shortly before Pope John Paul’s death.
Q. Dear Dr. Tom, I had the privilege of meeting you many years ago in Denver. 

As a respiratory therapist, I found that your compassion for patients left such impression on me that I boldly called you about a patient in a small rural town in southwest Minnesota - Jackson.  Your willingness to help was communicated to me the very compassion that I see you continue in your years of retirement.

At that time your kindness brought me to Denver for a conference on pulmonary rehab - scheduled around Holy Week! I have since completed a doctorate in agronomy, and after work in that field I was sent to Rome.  I lived, worked, and studied for another doctorate in the shade of St. Peter's Basilica. I am now in Denver, teaching at the Seminary and working at the Archdiocese.

Now, finally, I arrive at my question.  It is well known that Pope John Paul II has diminished, yet remains an icon of suffering. It was with great sorrow that I watched my beloved pontiff try to speak for the traditional Easter blessing.  I know that he had to have a tracheotomy because of laryngeal stenosis (narrowing of the airway). What I do not know is if there is anything we can do to help him with phonation?

It has been many years since I have been active in the field, and I do not recall working with patients with Parkinson's disease.  Is it because his intercostal muscles are weak?  Why could he speak after his tracheotomy and not now?  As you can tell, I am again coming to you with the suffering of one that I love and asking a question about what seems to be pulmonary rehabilitation.

Thank you in advance for your counsel, even if it is only for the consolation of one who has compassion on all pulmonary patients.

I remember you in my prayers as I am now living in Denver.

Sister Esther

A. Dear Sister Esther, I remember meeting you at the conference organized by Louise Nett at the Landmark Hotel.

The Pope was beloved by millions around the world. When he had a tracheostomy, he probably did not have much airflow around the tube to be able to use his voice. Patients with Parkinsonism have a low-pitched monotone voice anyway due in part to the lack of muscle mobility, which is so disabling in Parkinson's disease.

The Pope remained a powerful spiritual leader up until the very end. May God rest his soul.  

Dr. Tom

P.S., Dear Sister, I am not retired!

 

Oxygen Reimbursement
Q. I had blood clots enter my lungs in May of 2000. I was put on oxygen. Now I have been diagnosed with fibromyalgia, multiple chemical sensitivities, asthma, and when I exercise or walk up one flight of stairs, my heart rate goes from 80 to 150 immediately. Someone said it is possible the oxygen is not getting to my tissues fast enough. I still need oxygen for this. My question beside this is do insurance companies ever approve oxygen based on all of this versus the destaturation rate? I have to buy my own oxygen if I want to work out or go on a hike in the hills?

Holly

A. Dear Holly, Most insurances companies will not reimburse for simple shortness of breath while exercising without a significant drop in the oxygen level, even if an increased heart rate is present.

Dr. Tom

 

Stopped Smoking for 2 Years
Q. This August will be two years since I stopped smoking.  I am still having difficulty breathing.  After short walks or having to speak for long periods of time I get short–winded. I had smoked for 36 years, is this a healing process?

Carmen

A. Dear Carmen, Some of the inflammation caused by smoking continues to smolder along even after stopping. Better get spirometry to see if you have airflow obstruction. Maybe you would respond to inhaled bronchodilators or other drugs to improve your airflow.

Dr. Tom

 

How Much O2 Tubing is Too Much?
Q. Is there any guideline or article regarding the maximum length of the oxygen tubing to be used connected to an O2 concentrator? I guess there must be some O2 lost if the tubing is too long. How many liters should I approximately add to compensate this O2 concentration loss?

Gerardo

A. Dear Gerardo, You do not have to increase the flow of oxygen, even if you are using 50feet of tubing. All of the oxygen that enters the tubing reaches your cannula and nose.

Dr. Tom

 

Worried About Mother’s Scan
Q. My mom went for a scan last August as they found a shadow on her X Ray. They confirmed that the shadow was indeed there after the scan and recommended another one in three months. We just got the results from that scan and nothing has changed; the shadow is still there. Now they want to send her to a specialist/radiologist, who will do a test with a camera (not too sure of the name of this test).

I am scared for my mom. Do you guys think its cancer? Wouldn’t they have found something in the scan if there was cancer? I am just so scared for her. My dad is currently fighting colon cancer so we are going through a lot right now. I would appreciate your honest opinion, even if you do suspect it's cancer I would rather someone be upfront with me. I would rather know now, not then. Wouldn't a scan be precise enough to detect cancer? Thank you from the bottom of my heart for answering this email. 

Julie

A. Dear Julie, The scan cannot detect a cancer with certainty. It only gives an image.

A biopsy of some sort will be needed to make the correct diagnosis. This may be done by a needle or a scope inserted between the ribs in most cases. You must have a tissue diagnosis to be sure.

Dr. Tom

 

Is My Son Too Young for Seretide?
Q. My child has been told that he has asthma about two years ago. They have put him on Seretide 250 (not available in the USA). He went to see the nurse for a check-up yesterday and she told me that it’s only for children over 12. Can you help me please?

Tina

A. Dear Tina, These are FDA labeling rules, called indications. Your physician may decide to use any drug outside of these labeling indications. This is perfectly legal.

Dr. Tom

 

Calcium Deposit on the Lung
Q. I have been told I have a calcium deposit on my lung. Should I do anything about this?  Is it dangerous or will it go away?  Thanks, Juanita

Jaunita

A. Dear Juanita, Isolated calcium deposits, such as in nodules, are benign, not malignant. Nothing needs to be done, unless they are related to silicosis or asbestosis, but even then, the calcium, called calcification is not a problem.

Dr. Tom

 

When to Change Oxygen Equipment
Q. I am on oxygen from a concentrator.  I have a 50-foot hose with a cup for distilled water on it for humidity.  How often should I change the hose and the cup?  Thanks.

Lori

A. Dear Lori, I do not believe it is necessary to change the hose. The “bubbler” does not add significant water to the oxygen. It just shows that the oxygen is running. I do not use a bubbler with my oxygen. If you do, change the water once a week.

Dr. Tom

 

Thick Mucus in the Morning
Q. When I wake in the morning I have mucus in my mouth. It is thick and gooey. When I spit, it does not come out easily. I also noticed my tongue is a dark white color and it’s hard to brush off the mucus. My nose is often stuffy with mucus. What’s wrong with me? Does Percocet pain medication cause problems? I also take birth control pills.

Tamara

A. Dear Tamara, I doubt if this is due to the Percocet or birth control pills. You can brush your tongue with toothbrush and toothpaste. We do not have any good drugs that thin mucus.

Dr. Tom

 

Signs and Symptom of COPD
Q. I’m 40 and I smoked 20 a day for over 10 years and now find that I cannot get a deep satisfying breath most of the time. This is going on now over a year.

I saw a pulmonologist a year ago and he did some breathing tests and said I seemed normal to him. He said all numbers were over 100% and my FEV1/FVC was over 70% and that this meant I did not have COPD.

Is this inability to get a deep breath the start of COPD or the earliest sign? Will it go away? I haven’t smoked in two years.

My other problem is when I sleep and then wake up, my breathing is not right. Its like my lungs are stuck together. They feel not right and my breathing is not good for a half an hour. I have read an answer to a question from someone with a similar complaint on the Med Help site and they say this could be an early sign of emphysema (I guess because it means the airways may be a little floppy).

Have you seen this before (with a normal FVC/FEV), my pulmonologist tells me she has not heard of this symptom. Should I have more tests, if so which ones?

Paul

A. Dear Paul, Your symptoms are not early signs of emphysema. Great that you stopped smoking. You might consider breathing retraining.

Dr. Tom                       

                    

Trouble with Patient’s with Tracheotomy Tube
Q. I work in rehabilitation mostly with CVA/stoke patients. Every now and then we get patients that will have a tracheostomy. Mostly we end up pulling the trach tube and all is well.

For the first time for me I have a patient that we are unable to pull the trach (secondary to tracheal stenosis). The patient is unable to tolerate a Passy-Muir Valve. 

What I need to know is, what do these patients do at home? Where can I look up information?

She is 98% with room air and an HME (humidification system) causes her to have something like a running nose, but located in the trach. When I check for secretions in the disposable trach there is not enough to suction. After I instill saline, all I get back, when I suction, is the saline. Do all trach patients wear HME’s all the time? Also do they wear aerosols humidification at night? Please help.  Thank you.

KC

A. Dear KC, The tracheal stenosis may require attention, such as mechanical dilation. Most trach patients use humidifiers, but some do not. Tracheostomy patients do not use the normal humidifying function of the nose.  

Dr. Tom

 

Feeling Dehydrated
Q. Can the use of oxygen cause one to become dehydrated easier and faster? I am having trouble with cramps and have been taking potassium, but once in awhile the cramps get worse for a few days and then better for sometimes weeks on end. I was wondering if the days that I do not drink as much water have anything to do with it.

This never happened before I went on O2 24/7 and I rarely drank water before that.

Joan

A. Dear Joan, Oxygen will not cause dehydration. Remember to drink lots of water.

Dr. Tom

 

Chronic Cough
Q. Both my wife and I have gone to see a doctor about our cough for over three months, all the doctors say is to take more Z-Pak (antibiotic) and it’s probably a virus. But the coughing up of mucus is still there.

Carl

A. Dear Carl, Z-packs do not treat viruses. Excess mucus is a sign of inflammation in your airways. You need a diagnosis, probably by a pulmonologist.

Dr. Tom