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Archive: Dr. Tom 3 Transtracheal catheter Sherry A: Dear Sherry, Very good for selected patients. TTO conserves oxygen, is cosmetically pleasing to some and removes the need for nasal canulae. Care of the catheter requires a well-indoctrinated patient. It should not be used where mucus or infections are problems. Dr Tom
Lung nodules that remains undiagnosed I have major COPD, Sleep Alpena, and on oxygen 24/7. My doctor does not believe I am able to handle biopsy or surgery. The question is have you seen a case such as mine, and is there a national database for researching it? Pat A: Dear Pat, This is a problem with CT scanning. Too many nodules, mostly benign are found. The ones that grow are probably cancer, but this requires follow-up at 3 to 6 months. PET will not light up small nodules that are the beginning of cancer. The whole field is changing. Dr Tom
SOB with increased humidification Mike A: Dear Mike, I am not sure. Maybe the air is more dense or viscous. This is an observation of many people. Dr Tom
Advanced stage of COPD Her lung doctor said in March she is in the last stages of her disease. He said her lungs are just gone. How long does this last? What can I expect to happen to her? Jennifer A: Dear Jennifer, It’s hard to make predictions. Many patients with COPD in so-called advanced stages can live for months or even years with help from pulmonary rehabilitation techniques such as breathing training and some conditioning. Oxygen prolongs life as well as its quality. Don’t give up. Dr Tom
COPD/Alpha–1 - Antitrypsin Deficiency Ginny A: Dear Ginny, There are several families with what looks like emphysema due to Alpha one, but with normal levels. There are other familial factors. This is under intense study. Don’t let ANY ONE of your relatives smoke! Dr Tom
Transient Tachypnea of the Newborn (TTN) Chad A: Dear Chad, I know nothing about transient tachypnea. Better see a pediatric pulmonologist. Dr Tom
An acute exacerbation since 9-08 I’m still ill and do not know what’s up. Now testing for possible fungus. Doing other X-ray blood work to determine an underlying cause of such acute duration. Am I doing the right thing? Ken A: Dear Ken, I cannot give individual advice to any patient. I assume you are under good care from what you tell me. Stay with your doctor and follow his/her advice. Dr Tom Long term benefit of inhaled corticosteroids Jacqueline A: Dear Jacqueline, The answer to your question is not settled. Today inhaled corticosteroids are recommended only for moderate to advanced COPD. Dr Tom
Husband quit smoking It is very scary and he has seen a doctor that said it was just his lungs cleaning themselves out. Well that doctor doesn’t live with him nor does he sit my husband up in the middle of the night from a dead sleep when he starts suffocating. He was on the nicotine patch, but tried to stop using it too just incase that was the cause, well it is still happening as of last night 3AM. What is causing this?? He is not sick, no fever, no mucus, and feels fine. It occurs out of nowhere, awake or dead asleep, and no warning it’s coming on. Can you help us? I thought quitting should make you feel better! He was fine while smoking! He just turned 28. Thanks Melissa A: Dear Melissa, Stopping smoking can be hell for a while. I doubt if this choking is from stopping smoking. I wonder about vocal cord abnormalities or sleep apnea. Better see a pulmonologist. Dr Tom
Oxygen assessment Jean A: Dear Jean, I do not use a formula based on age. Generally a PO2 of 55 or less or SAO2 88 or less is the indication for oxygen, but this should be put in the context of the patient and the apparent clinical consequences of hypoxemia. These are normal values for Leadville, Colorado at 10K feet. CO is not used in deciding about oxygen, but is a definite reason to quit smoking. Dr Tom
CMV and SIMV Linda A: Dear Linda, Pass the word salad please! CMV means continuous mechanical ventilation and may be in the assist or control mode. SIMV, means synchronized intermittent mandatory ventilation. A rate is set, but the patient can also breathe at his own rate. When the set rate comes in, it is synchronized with the patient’s own drive to breathe. Dr Tom
Pulmonary Hypertension Meryl A: Dear Meryl, Pulmonary hypertension is not a contraindication for pulmonary rehabilitation. The six-minute walk test is used as a measure of benefit for therapies aimed at pulmonary hypertension. Many patients have exercise limitation due to the reduce output of the right ventricle, but this may be overcome with medications, and graded cautious exercises. Dr Tom
Noninvasive Positive Pressure Ventilation (NPPV) Pam A: Dear Pam, Not usually. Dr Tom
Medication question regarding a patient Rhonda A: Dear Ronda, I cannot comment on individual patient care. Rhythm disturbances are fairly common with oral albuterol. Dr Tom
Croup tent Sharon A: Dear Sharon. No. I do not know of any controlled studies about croup tents in bronchiloitis, but their use has been popular. Dr Tom
Medications Tach A: Dear Tach, It is hard to improve on a patient with no symptoms and no findings in the chest. I would not give medication in this instance. Dr Tom
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