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Archive: Dr. Tom 123
Biopsy of Nodule Difficult Due to Position of Nodule I just turned 39 years old three days ago. I have never smoked. However my father just passed away from Idiopathic Pulmonary Fibrosis, he was 75 years old and never smoked. I can't stop fearing the worse. Every time I look at my children I cry. Please advise me. Thank you so much, Bethann A. Dear Bethann, Your chances of having lung cancer are so small that they should be of no concern. The nodule is almost certainly a healed granuloma. You may seek the reassurance of a follow up CT is six months or so. Stay well and enjoy your children. Dr. Tom Tracheostomy Humidification Reppert A. Dear Reppert, I am sure there are some studies on this. I suggest consulting the literature. Dr. Tom Changing Medications Joanne A. Dear Joanne, I do not know about the exact equivalent doses between Advair and Symbicort. Most pulmonologists prescribe 160/4.5mg, which are budesonide and formotorol, respectively. Dr. Tom Something in My Apartment is Irritating My Lungs and Skin I now have to wear a mask at home because the air is so heavy. Question 1) How can I identify what is in the air and how can I get this “stuff” out of my apartment? Opening windows simply stirs up the air and makes it harder to breathe. Joe A. Dear Joe, There are air samplers used by OSHA (Occupational Safety and Health Administration https://www.osha.gov/ ) and EPA (Enviromental Protection Agency https://www.epa.gov/ ). I do not know of any air test for inhaled antigens. You may be dealing with molds, as a guess. Dr. Tom How Much Is Too Much Radiation? I am concerned about the amount of radiation I have been exposed to. Is it safe to have an x-ray done since I've already had two CT Scans? Mary Jane A. Dear Mary Jane, The amount of irradiation from a simple chest x-ray is tiny compared with a CT. I wonder what the two CTs were for. Dr. Tom Treatment for Pulmonary Fibrosis They have prescribed prednisone but I have read that it does not do a lot to stop the disease. Do you know of any new drugs for IPF that will soon help people suffering from this? If so what drug looks like it holds promise to help stop this disease from getting worse. Tim Whitehouse A. Dear Tim, There is no established treatment for this form of advanced IPF. I suggest consulting with an institution that is involved in testing new drugs. Denver’s National Jewish Medical and Research Center would be an excellent choice. There are drugs used for various serious diseases that have a rationale in IPF, and sometimes they are effective on an anecdotal basis. Dr. Tom Dusty Desert or Warm Humid Location? My breathing is a struggle here, is it the high level of humidity. Which is worse for me the dry dusty desert or the warm humid climate? Lori A. Dear Lori, You can tell which is worse for you, by how you feel on a daily basis. Dr. Tom Does Recording Wrong Smoking History Effect Spirometry Results My results are below. If you could, please comment on the change in the results as well. Thank you for all you do. 2003 Dave A. Dear Dave, Only the fact of smoking history is recorded, and does effect prediction for normal values. Your tests are normal. Stay well. Dr Tom Priority of Monitoring Chest Tubes Kate A. Dear Kate, It depends on the purpose of the chest tube. That is, is it draining blood, air, or just there for long-term treatment of a residual space. It should be checked along with vital signs and oxygen saturations. Dr. Tom Are there Dental Side Effects to Spiriva? My teeth were excellent before the Spiriva treatment for COPD. What are your thoughts about this? Leona A. Dear Leona, I am not aware of dental problems from Spiriva. Dr. Tom Can Drinking Water Raise Your Blood Pressure? On this particular day my blood pressure was a little lower than average but nothing to get alarmed about. My recovery blood pressure was a little lower than the beginning reading. The RRT ask me to drink some water to bring my blood pressure back up. I promptly walked about 20 feet and drank about 2 to 2.5 oz. of chilled water and walked the 20 feet back to my seat. The RRT checked my blood pressure and it had gone up but not that much if it had been low enough to cause any concern to begin with. My question is, did my drinking any amount of water raise my blood pressure? What if any is the relationship between drinking water and ones blood pressure? Thank you for your time and consideration. Rusty, EFFORTS member (Emphysema Foundation for Our Right to Survive https://www.emphysema.net/ ) A. Dear Rusty, There is no relationship between drinking ordinary amounts of water and blood pressure. In states of severe dehydration, rehydration with water and electrolytes would help raise blood pressure. Dr. Tom Signs and Symptoms at the End of Life His O2 drops down to 70% when he gets up and goes 10 steps to the bathroom, I also noticed his urine is now reddish brown and cloudy and stinks. He slept somewhat is a upright position so he wouldn’t cough so much. His legs never hang down, he keeps them up and sort of under him at all times and they are so white in color. His face is most of the time red, and sometimes he looks blue. Is this what I can expect for the closing of his life with me. He has 30 percent of the lungs left over three years ago. He still smokes seven cigarettes daily and won’t give them up. With everything I’ve told you is he getting closer to death? I know you are not a predictor, but please tell me what to be looking for. I would like to have my two sons here with me when it happens if possible. A. Dear Debbie, It is hard to predict the time of death in advanced COPD. It is clear that your husband has very advanced disease and not long to live. He will most likely die in his sleep. Death from COPD is rarely uncomfortable for the patient or the prepared family. Dr. Tom Does Nebulized Lidocaine Help Bronchospasms? Derrick A. Dear Derrick, Nebulized lidocaine has been used in very dilute concentrations to combat serious bronchospasms. I do not recommend it in children. You would have to consult the literature to find out the preparations that have been studied. It is certainly not in common use. Dr. Tom Diaphragm Paralysis and Treatment My concern is that I have a right diaphragm that is paralyzed. My left lung functions at 30% and the right at 60%. My question is, once a diaphragm is paralyzed is there any hope of improvement to that diaphragm? There has been some talk in my medical group about tacking down that diaphragm to help my breathing but that there hasn't been a lot done in this area with adults. There is a surgeon here that has done this on children with positive results. Have you heard of this being done on adults and what would be the risk? Thank you for your kindness. Marylin A. Dear Marilyn, The cause of the diagphragmatic paralysis is a factor in its future evolution. Sometimes it is reversible. There are operative techniques to fix the diaphragm in a lower position. You would have to ask your surgeon about this. You can get along well with only one functioning diaphragm. Dr. Tom Twenty One Years Old and have Breathing Trouble I spent a year in Iraq driving a tank for 13 hours at a time. I quit drinking two and half months ago to get ready for Ranger school. I currently dip and don't smoke. However, I have been having trouble breathing lately. It’s an odd feeling to tell you the truth. I don't have any trouble while exercising but after feel short of breath. When I’m in class I feel either anxious or like I’m going to quit breathing. My arms and legs have been falling asleep on occasion while sleeping and sometimes when I’m sleeping it feels like either my heart sputters or I quit breathing for a second and wake up freaking out. This happens like once or twice a week but my lungs feel heavy all the time. I’m a college student and I don’t have much money. Can you give me some advice sir? Casey A. Dear Casey, You may have sleep apnea, which should be considered by your doctor. Also the fact that your shortness of breath follows exercise suggests the possibility of asthma. You need spirometry before and after exercise and probably a sleep study. Maybe you can get this when you are enrolled in ranger school. Find a way to get an evaluation, because you should not have to live with these uncomfortable symptoms. You probably can get control with simple medications. Dr. Tom Quit Smoking but Worried about Lungs I work out regularly. When I do an intense cardio workout, I notice my lungs will crackle at the early part of the workout. I am worried about this, since I am a former smoker. What could this be? How concerned should I be? Amanda A. Dear Amanda, No concern. You probably have a bit of mucus that you notice as you start exercising. Stay well and enjoy life. Dr. Tom Chest Pain When Breathing Deeply Alex A. Dear Alex, Pain on deep breathing has many causes, particularly in older people. If you are concerned, I suggest seeing a pulmonologist, but at your young age, I doubt if there is anything serious behind these transient symptoms. Dr. Tom Mother has Hospice Care and Pain is Not Under Control What we need to know is she has very dark urine and her out put has slowed way down, as well as having a major head ache for the last two days. To me it feels as though she is swelled up in the base of her skull going up into her head and now she is swelling throughout her body at a rapid rate if you have any ideas please let us know. Ty A. Dear Ty, No person should suffer undue pain. Morphine by mouth is safe and will control most pain. I do not know the reason for the dark and scanty urine volume. One would consider dehydration, but with the swelling, this is most likely from fluid retention. Push for pain relief with enough narcotics, and do not try to figure out the details of her urine color and volume. You mother is near the end of life, and in a hospice where comfort is the highest priority. Dr. Tom
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