Readers: Read Dr. Tom’s Commentary on Spirometry to understand the importance of this diagnostic lung test.

 

 

A Tear at the Base of the Lung
Q. A recent x-ray revealed a tear at the base of the lung. Exactly what does this mean?

A. Dear Velda, It means an air leak, which will usually seal spontaneously. If not sometimes a tube must be inserted to let the air out and the underlying lung expand. Dr. Tom

Why Can’t Lung Tissue be Replaced
Q. If we can heal damaged skin and related cells, etc., from burn patients, why can’t we apply skin products to damaged parts of the lung area and find some tissue mesh to re-develop airflow pockets?

A. Dear Don, There is stem cell research going on to try to make this happen. Skin is quite a different tissue compared with lung. Dr. Tom

Popping Noise When I Breathe In
Q. Dear Dr. Tom, I am at my wit’s end. About two months ago I noticed a “popping noise” when breathing in, and it is much more prevalent when laying down or reclining. In fact, it is non-existent during the day.

Sometimes it is scattered popping, almost like “velcro crackles,” and at other times it is one or two pops. Sometimes I sense these sounds coming from my throat, and sometimes from deeper in my lungs.

I have seen my doctor twice about this, and he had recently done two chest x-rays, the latter of which was to monitor the growth of a granuloma (there was no growth).

My doctor does not seem worried by these crackles, but I am so sick of them. This morning I woke up from a dream at about 3:30 a.m., and every time I took a breath it was like a popcorn popper going off in my chest. But as soon as I got up, they disappeared.

My doctor has used his stethoscope on my chest and back twice, and has heard nothing.

What should I do? Thanks for your help. Andy

A. Dear Andy, These sounds may be from mucus in your lungs which clears with normal activities. If your doctor cannot hear them, they are not from lung damage. Dr. Tom

Second Time with Antibiotics and Still Coughing
Q. I am 26 year-old female. I don’t smoke and never have. I have had a persistent cough for about 2 months now alternating between dry and productive with green like mucus.

I went to the hospital a month ago and he said bronchitis and gave me antibiotics, took them and didn’t help so I went to the doctor the other day and he found spots on my x-ray but gave me antibiotics again. I am on the third day of taking them and am still coughing and have chest tightness.

He told me if the symptoms don’t go away after I take the antibiotics then go back and get CT Scan. I am very worried that its lung cancer.

A. Dear Victoria, I cannot tell what is going on, from what you tell me. You should see a pulmonologist and get this diagnosed and treated. Dr. Tom

Should I Get Another Opinion?
Q. I recently went to Hospital of the University of Pennsylvania to qualify for a new valve program. My Pulmonary Dr. is at Pennsylvania Hosp. and knows the Dr. at HUP very well. I took a CT Scan and both saw something that concerned them. I then had a PET Scan, bronchoscopy and a biopsy of the lung.

Now, my pulmonologist said looks pretty good but the HUP Dr. said he is still concerned and I have to wait another 6 weeks to see if it grows. If not, I can join the valve program.

My family believes my Dr.s are less than reliable and I should get a 2nd (3rd?) opinion. How can the biopsy and bronchoscopy show up negative and they still have concern?

A. Dear Pat, The doctors at HUP must be worried about some shadow that may rule out the procedure. They are the World’s experts in this procedure. Why not ask them what they are worried about? Or get still another opinion from a pulmonologist. Dr. Tom

Does a Wait and See Approach Seem Reasonable?
Q. I have been seeing a doctor every three months for a pulmonary nodule that was detected in July of 2006. Since that time it has gone from 8mm to 14mm. The doctor just continues with the wait and see attitude.

I have some chest pain, with dizzy spells and migraines. I did live overseas in Taiwan when I was younger. My sister had been diagnosed with TB in 2006 also. I have relayed this to my Dr. as well. Should I be more concerned, or just continue with the six month CT Scans. I have cancer in my family, as well as growing up with parents that smoked, but I do not. Thanks for your opinion.

A. Dear Martha, You should get the growing lesion biopsied, or at least get a PET Scan to see if it is active. You are wise to be concerned about this. Dr. Tom

Considering the Weather, I was Surprised that I Was not Short of Breath
Q. Dr Tom . I cannot figure this disease out. I have COPD with a large component of asthma. I have been ill with bronchitis since January, had Influenza A in April, and now getting over my 2nd infection this year and on my last day of Levaquin. For the first time in two weeks I went to the gym and did 15 minutes on the treadmill, which is half my normal time. I was tired in the end; not so much breathless but tired.

 In the afternoon I decided to give myself the ultimate test. I decided to go for a walk (not a stroll but a regular walk) the temperature that day (in Toronto) was 89 with a humidity index of 94. My wife said I would kill myself.

I put on an oximeter to keep track of my stats. Well Doctor you would not believe it. I WAS JUST FINE. My O2 saturation level stayed between 91& and 95% and my pulse rate was between 106 and 110. I walked for 12 minutes and could have gone longer only my hips were sore. I really was not short of breath, my shortness of breath on the scale would have been between 0.5 and 1. To have done this in that heat was nothing short of a miracle.

I know my fellow sufferers of COPD in rehab told me they would never even go outside on a hot day like that let alone walk in it for 12 minutes. Dr Tom I should have been gasping for air but it did not happen. Any answers? Thanks Phil

A. Dear Phil, I do not have a scientific explanation, but you did what you did. Great! Keep it up. Dr. Tom

Unexplained Shortness of Breath
Q. Since mid April, I have been dealing with shortness of breath, sharp right side chest pain and a feeling of having something sitting on my right lung or on the right side of my chest (it is hard to explain, but it causes a lot of discomfort). I was in the hospital for two weeks and the doctors could not find anything. I am desperate for a diagnosis. I need help.

A. Dear Donna, I am baffled if the doctors had you hospitalized with all their available tests and they still could not make a diagnosis. I guess you will have to wait on Nature to get this resolved. If it is something bad, it will rear its ugly head and be able to be diagnosed. If not, you will heal up and never know what this was. Good luck! I am always optimistic in cases like this. Dr. Tom

Strange Coloring on Chest
Q. Lately I’ve noticed slight red and purple scarring or bruised veins on each side of my lungs directly under my breasts. I’ve noticed them 3 months ago and they haven’t disappeared, nor have they gotten worse. I don’t know what causes this. I don’t label myself a smoker, but do very rarely. What could these marks be from?

A. Dear Amy, It is very hard for me to guess what these are since I cannot see them. Probably just funny looking vessels, not a disease Dr. Tom

Multiple Spontaneous Pneumothorax
Q. Fourteen years ago I had a pleurectomy on my left side due to spontaneous pneumothorax. Been fine since that is until one month ago; I start having immense neck and shoulder pain on my RIGHT side. The pain went in my neck and shoulder I had two sessions of physiotherapy then woke up with a collapsed lung on the LEFT side. 

Two weeks later the lung is all fully inflated but the pain in my neck and shoulder is starting to come back again. Could this be the lung on the RIGHT trying to collapse, but can’t due to the operation which, and is causing referred pressure onto the weak lung?

A. Dear Jayne, I do not believe so. If your left lung collapses again, you will need another pleurectomy. Has your doctor offered a diagnosis about why you have such a propensity for pneumothorax? Dr. Tom

Oxygen Saturations
Q. Dear Dr Tom, I am 75, have an FEV1 of 11%, and try to exercise as much as I can. I turn my O2 up for exercise and often forget to turn it back down, sometimes going many days with 98-99% saturation. In an earlier Q&A you said we should avoid excessive saturations (>96%) “which sometimes has consequences”. Would I be able to sense these consequences if they were to occur or should I just make a greater effort to avoid exceeding 96% regardless? Thanks, Fred

A. Dear Fred, If you feel okay with these unnecessarily high saturations, that is fine. No harm done. Rarely do people retain carbon dioxide from excessive oxygen. Most people are happy just to be at 90%, which is not enough in many cases. Keep up your practice of using oxygen this way. Dr Tom

What’s the Difference Between a Chest X-Ray and CT Scan
Q. I have been sick with coughing, low temp and congestion for a month. I have also had a several rounds of antibiotics to get rid of this. The x-ray showed a spot on each lung that the Dr. did not seem to know what it is. She said it did not look like pneumonia and was sending it to a radiologist.

I had CT Scan done two months ago and it showed a nodule 3mm in upper right but it was compared to an old ct from two years ago and there has been no significant change in it.

Wouldn’t spots large enough to show on a x-ray shown up on the ct scan? Can cancer grow that quickly? I smoked for 18 years and will never smoke again. Thank you. Holly

A. Dear Holly, A shadow that is seen on a standard chest x-ray can always be seen on CT. CT gives multiple images of the lungs. The small nodule that is stable is of no concern. Dr. Tom

Cardiomyopathy and COPD
Q. Dr. Tom, I have cardiomyopathy (with about 40%) and COPD. I was wondering if you had any ideas for me; and do you think my heart caused my COPD. Thank you Dave.

A. Dear Dave, Your heart did not cause your COPD. Heart disease is a common accompaniment of COPD. Smoking and genetic factors may explain the link, but COPD is not known to cause inflammation of organs besides the lungs.  Dr. Tom