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Archive: Dr. Tom 4
Posted December 9th, 2004

Acid Reflux 1
Q: How can acid reflux affect breathing?


A: Dear Andrea, Acid reflux causes irritation of the distal esophagus. Since the esophagus and lung have common developmental pathways and nerve supply, reflex bronchospasm may result. In extreme cases of reflux, there is enough regurgitation to aspirate irritation stomach contents and cause lung irritation and also bronchospasm. Acid reflux should be treated with drugs that diminish acid production in the stomach.

Dr Tom


Acid Reflux 2
Q: I have had a dry cough for over a year. My chest x-rays and breathing tests show that my lungs are clear.

My doctor suspects acid reflux but I think it is a postnasal drip. I have been taking Prilosec for almost 8 weeks and it seems to be getting worse instead of better. Any suggestions would be appreciated.


A: Dear Gladys, Since you have been taking Prilosec that essentially stops the formation of acid, I believe you have eliminated this possibility. Post-nasal drip is a common cause of dry hacking cough. This needs to be pursued.

Sometimes cough is the only manifestation of asthma, so a trial of bronchodilators and maybe an inhaled corticosteroids could be helpful.

Dr. Tom


Dust and secondhand smoke
Q: I have been diagnosed with COPD. I have worked in a box room, with cardboard and dust, for 19 years. We are not required to wear any type of mask. We have air and heat in there, but I haven't seen any other kind of air venting. Could this be a part of my breathing problems? Please let me know, as this is a big problem for me.  Thank You


A: Dear Brenda, Yes, this could be the problem. Do you cough on weekends or on vacations? If not, your workplace environment is suspect. This is particularly true of cough returns on resumption of work in the same environment.

Dr Tom          


Best climate for COPD
I have emphysema and asthma. I reside in Naples, Florida, an extremely humid climate. Would it is beneficial for me to live in a considerably dry climate such as northern Arizona?

Also, I have just started on Spiriva, what are your findings on this therapy?

Thank you very much for your opinion.


A: Dear Cecilia, You have two questions here.

1. Naples is at sea level. Northern Arizona is at some altitude. Probably best to remain in Naples.

2. Spiriva is a good long acting bronchodilator, and studies thus far are favorable in many cases of COPD. It is taken by the inhaled route, once a day.

Dr Tom


Peak Flow Meter
Q: Is there any data or studies to help determine the usefulness of peak flow monitoring in emergency departments?  Do you think they are indicated?


A: Dear Harold, Yes, there are some published studies.  Some suggest that a variation in home peak flow measurement is predictive of an asthma attack. Other studies do not support this conclusion.

Dr Tom


Relative on a ventilator
Q: A relative of mine had an operation to save her life. She had a perforated ulcer. She is now on a ventilator and has a tracheotomy. Before the operations she was breathing fine.

We have been told that she cannot breathe on her own more that 45 mins, and they cannot guarantee if she will be able to breathe without the ventilator

Do you know of any rehabilitation centers in Chicago, Illinois?


A: Dear Jane, Your relative should return to the level of breathing that she had before the emergency surgery. Careful progressive weaning will help her regain the ability to be liberated from the ventilator.

There are many rehabilitation centers in Chicago, such as at Rush. Also consider transfer to the Kindred Hospital in Chicago that specializes in patients that are temporarily ventilator dependent. My prediction is that your relative will make a good recovery. It takes time.

Dr Tom


Q: I have had COPD for years, My question is; why are my oxygen saturations best when I am laying down and they drop when I sit up and drop into the down to 80’s when I stand, no matter what liter flow? Have been ruled out for any significant heart problems.


A: Dear Jeanne, What you have is called “orthodeoxia.” Sometimes this occurs with associated liver disease. You will need an expert to sort this out.

Dr Tom


Pack Year
Q: How do you assess the pack year smoking history of a patient who smokes a pipe?  For example, a patient stated he smoked a pipe for 45 years.


A: Dear Karla, I do not know how to convert cigarette years to pipe years. Probably the same. Let's just estimate equivalent to 45 pack years of cigarettes. Pipe smoking is no safer than cigarette smoking. 

Dr Tom


Granular calcium deposit
Q: My question is about granular calcium deposit on my left lung lymph node.  I was told several years ago that I had a small spot on my lung and was told not to worry it was just scar tissue from past infections.

Ten years have gone by and now I was told during my last chest x-ray that the spot is now about 2.5 inches wide.  I am still told not to worry about it, but I am having other symptoms now.

Should I be concerned about this spot and whom should I see about it?


A: Dear Monica, This suggests a benign tumor, possibly a hamartoma. These can grow slowly and reach a size that causes symptoms. You need to see a pulmonologist.

Dr Tom


Chest pain when eating sweets
Q: Why is that when I eat, or drink something that is very sweet, my chest starts to give me pain. Sometimes if I breathe hard it feels that something is stabbing me, from the side of my chest.

The only way I can control it is by not drinking or eating sweet things. This is being going on for about 5 years. I went to the doctor but can’t he can’t tell me anything.


A: Dear Pedro, You have me scratching my head. Is it true if you use artificial sweeteners? How about sour things? Hope you find the solution.

Dr Tom


I am 75 year old, on oxygen 24/7, but I am reasonably healthy. I now qualify for lung volume reduction surgery (LVRS).

In your opinion, does this surgery help and for how long? What is your experience with patients who have had this surgery?


A: Dear Stephen, Lung volume reduction surgery helps a small portion of patients with advanced emphysema that has failed to improve their exercise with pulmonary rehabilitation. They should have localized emphysema in the upper part of one or both lungs to qualify for the surgery. The decision has to be made between you and your pulmonologist.

Dr Tom


I use Advair 500/50. I rinse my mouth and gargle but I still get thrush, which makes me have a bad productive cough.  What else should I be doing?


A: Dear Tobey, You can also use an antifungal mouthwash. Ask your doctor or pharmacist.

Dr Tom          


Pediatric patient Question
Are there any clinical studies that show there is a benefit of using mist tents for a pediatric patient who is not hypoxemic in the treatment of any respiratory illness.


A: There is no good study of mist tents that I know about. I am an adult pulmonologist and internist, and may not know all that is going on in Pediatrics. 

Dr Tom


Q: In hospital 9/8 “exacerbation” and it is 10/28 and am still in “acute attack,” taking daily meds of alb_iprop in nebs+ 4mg albu 2 x's daily+800mg theophilline+Advair500 2x's+singuliar+40mg prednisone daily for duration+4 rounds antibiotics+aciphlex. I'm still ill and do not know what’s up – now testing for poss fungus or other x–ray blood work to determine an underlying cause of such acute duration. Am I doing the right thing? 

A: You really need a pulmonolgist to help sort this out. Assuming you have asthma, it should be responding by now. I suspect some other immune/inflammatory process. Keep seeking the answer.

Dr Tom


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