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Archive: Dr. Tom 138

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

Home Oxygen

Q. I was diagnosed with emphysema July 2008.  Trying to find an oxygen system that will meet my needs to stay out long periods from home.  Metal canisters are too heavy for me (4’9” tall, 74 lbs, 67 yrs old), liquid oxygen doesn’t last too long when I’m outside.  Would Medicare pay for two systems for me to take outdoors?
On the Efforts web site ( it seems that a lot of patients have two outdoor systems that Medicare pays for.  My delivery system, Lincare, says I can only have one kind and only one canister to fill liquid with. My doctor is no help. What are your thoughts on this?

A. Dear Thea,
The Marathon Helios system will give you the greatest range and liter flow. It weight is only about eight pounds full. I suggest giving it a try. I believe you are correct that Medicare will only allow for one type of ambulatory system.
Dr. Tom

How Should I Clean My Oxygen Cannula?

Q. I use an oxygen nasal cannula. What are the care and cleaning process of the cannula, and how long should I wait to clean it?

A. Dear OA,
You can clean every day or so with soap and water. Replace the cannula when it becomes discolored or stiff.
Dr. Tom

Does Oxygen Help a Cold?

Q. Does it help a cold to breathe oxygen?

A. Dear Carl,
Dr. Tom

Is It Alright to Mix Brovana and Budesonide?

Q. I have recently been taken off Advair and am now nebulizing Brovana and Budesonide. When I read the instructions each of these meds said NOT to mix with other medications.
When I called the pharmacy to see which one I should use first the pharmacist said I could mix them together. When I told him what the leaflet said he said to use the Brovana first.
I posted a question on a COPD forum and asked if anyone else was using these two meds and how they were using them. The person who responded said they had mixed them together from the beginning at the instruction of her doctor and her pharmacist both.
Can you give me your opinion as to whether it would be okay to mix the two together?

A. Dear Beverly,
I have no experience with Brovana. I know of no reason why the two medications cannot be mixed.
Dr. Tom

Have had Lung Problems Since October

Q. October 2008 I was diagnosed with pneumonia. The next week I was told I also had bronchitis and asthma. It is now December 4, 2008 and I am still having problems breathing and short of breath with a dry cough. Last week I had chest x-rays. My primary doctor told me the x-rays look good. I have an appointment to see a lung specialist. What should I do to help myself?

A. Dear Romona,
I suggest following the advice of the pulmonologist. He can look for underlying causes of your continued symptoms.
Dr. Tom

Lung Cysts

Q. I am a 47 year old nonsmoker and was recently diagnosed with scatted lung cysts. I have no symptoms and my spirometry tests were normal. I have seen two pulmonologists. One said no problem and the other said may be a problem and to come back in six months for another CT. I am worried so do you think this will be a problem in the future like cancer or something?

A. Dear Phil,
These are likely congenital cysts. They require no further attention. They will not become cancer.
Dr. Tom

Mother Has COPD and Is Getting Worse

Q. My mother is 74 and has COPD.  It seems to be getting worse. She has increased shortness of breath, wheezing, extreme tiredness, and has very poor quality of life right now.
Her only medication for COPD right now is albuterol through a nebulizer four times a day and oxygen that is so hard for her to carry around she only wears it at home.  Because she seems to be getting worse, I took her to the doctor. 
He did not do any lung function tests (these haven’t been done since she was diagnosed in 2000), would not give her an inhaler because he said it might cause osteoporosis and cataracts, told her all her other symptoms were from her age, and refused home health care to have a respiratory therapist come in and assess/help her situation.
I think she needs to see a pulmonary specialist, but she is so disgusted with how she’s been treated that she doesn’t want to go to anymore doctors. What is the general standard for treatment of COPD?  Shouldn’t she be on some other medications?

A. Dear Marielle,
Spiriva may slow the decline in lung function, but it is expensive. No other medications have been shown to cause more than symptomatic relief. Your mother would still be better off seeing a pulmonologist.
Dr. Tom

How Long Does it Take to Get Better?

Q. I had a cough for about a month.  I went to my physician the first time and she prescribed an antibiotic and prednisone. My cough was not getting better so she prescribed me Advair, Terbutaline sulfate, and a decongestant/cough suppressant. She also said I could use Albuterol by nebulizer if needed. 
A few days later at night I have a bout of coughing and I start to have trouble breathing.  I go to the emergency room and they said I have vocal cord injury. They prescribed voice therapy, with only whispering or no talking. 
My question is how long does it take to get better?  Can I still use the nebulizer with albuterol if needed? I still cough a little.          I’ve tried to call the doctors but I can’t speak and the doctors say they can not speak with anyone over the phone.  Any help would be appreciated.

A. Dear Gloria,
The vocal cord injury may resolve slowly and may require a form of injection therapy to restore voice. The process should resolve in a few weeks.
Dr. Tom

How Many Types Of Emphysema are There?

Q. I asked my Dr. about the stent and IBV valve (in clinical trials, (, if they would work for me—he said not with my type of emphysema. How many types are there?

A. Dear Dave,
There are basically two types of emphysema, known as centrilobular and panlobular, respectively. I do not see how the type would affect the placement of an otherwise necessary stent.
Dr. Tom

Weather Affects Breathing

Q. What is the reason that breathing is labored when outside in cold weather and in higher elevations?

A. Dear Kathy,
Cold air may cause bronchospasm. Higher altitudes have less oxygen. These factors affect people differently, depending on their general health and any pulmonary disease they may have.
Dr. Tom

Advair and Oral Care

Q. Can you advise how to prevent hoarseness and dry cough after taking Advair? I rinse my mouth, gargle with salt water, and brush my teeth after Advair—I am also on Spiriva.

A. Dear Kathy,
Many people have this problem from Advair. It is usually due to a weakness of one of the voice muscles from the steroid. The powdered preparation is most likely to cause this. You can switch to the wet inhaler. Also wait a few days until the hoarseness subsides and reinstitute the Advair once a day. Spiriva is usually not the cause of these symptoms.
Dr. Tom

Can Using Oxygen Cause Crusty Eyes?

Q. Since I starting using oxygen at night, my eyes are crusty in the morning. Can it be from the oxygen use?

A. Dear Costanace,
Probably not. Crusty eyes are very common. Just steam your face with a warm washcloth for a minute each morning.
Dr. Tom

Black Spot in Phlegm

Q. I was sick a few weeks ago with a cough.  The phlegm was light green, but eventually got back to normal.  Since then I have quit smoking (the green stuff), after 12 years. My cough never fully went away, and now I have black spots in my phlegm.
I read on a few sites that this might just be my lung’s cleansing themselves since cannabis is a bronchial dilator.  It has become less frequent that I cough this stuff up, but it is still there.  
I have no chest pains or anything. I plan to see my doctor if this persists for too long, but just wanted to see if it could just be my lungs expelling whatever has been in there, because some sites say it could be signs of lung cancer.

A. Dear Pavel,
This is very unlikely to be a manifestation of lung cancer. Your lungs are probably ridding themselves of some of the junk you have smoked. Grass is as bad or worse than tobacco, so stay smoke free.
Dr. Tom

Blood in Phlegm in the Mornings

Q. I am a 35 year-old male and I have been suffering for the past week with flu like symptoms and heavy coughing bringing up phlegm. On Tuesday last week, I got up to go to work as I was feeling better, and brought up some blood stained phlegm, but it is only first thing in the morning. I am coughing all day and bringing up phlegm, but none of it has blood in it.
I was worried about this and went to see my doctor. My doctor listened to my chest and said it was clear, and he thought that due to my age and my history it is highly unlikely that anything sinister is going on. Should go back to see him, and he will send me for a chest x-ray?
Also, yesterday I had a pre-employment medical for a new job I am starting and I had to carry out a lung function test. The results of the test said that I have a lung age of under 20 years old, which I supposed is a good thing.
I was wondering, if there was something wrong with my lungs. Would it show on a lung function test and would I expect to see more blood in my phlegm throughout the course of the day whilst I am coughing?
I am inclined to leave it a week to see if it reduced or stops, as my sore throat and cough hopefully get better.

A. Dear Steve,  
This will likely resolve on its own. Your young age makes lung cancer a very remote possibility.
Dr. Tom

Complication of Radiation to the Lung

Q. My husband has stage 3B lung cancer (currently in “remission”) and has been told by his pulmonary doctor that he has a large (approximately 3-in.) cavity (he described it as a "hole") in his lung, probably caused by radiation treatment.  He has explained to us about infection, collapse, etc.  Could you please give me some more information?  I am having trouble finding comprehensive information online.

A. Kathy,  
There are several possibilities including the radiation or even the lung cancer. Your doctor will have to figure it out for you. I have much less information than he does.
Dr. Tom

Microbacterium Avium

Q. What does Microbacterium Avium mean?

A. Dear Judy,
It refers to a tuberculosis like organism, that can cause disease in humans. It is not spread by humans, and is found in soil and water.  It is more difficult to treat than tuberculosis and requires an expert to select the drugs than can cure the disease.
Dr. Tom

Recovering from Lung Infection

Q. After six weeks of a bad cough it finally subsided with a couple rounds of a z-pack.  I am still experiencing chest pressure and pain under my right rib cage.  Could right hilar prominence be associated with my symptoms?  Should I be worried about a larger problem or do the lungs take longer to rebound after an infection?

A. Dear Linda,
If you have right hilar enlargement, it needs an explanation. It is probably not causing your symptoms.
Dr. Tom

Can Spirva and Combivent be Used Together?

Q. Pursuant to the a previous post from two years ago: “Spiriva can also be used with Combivent, but this is not common, and the ipratropium part of Combivent is similar to the tiotropium of Spiriva. Not dangerous, but also not recommended.” Is it still not a recommendation to use these medications together?
Newly Diagnosed with COPD

A. Dear Newly Diagnosed with COPD,
My previous answer stands. There is essentially no reason to use Spiriva and Combivent together. Use albuterol as a rescue inhaler.
Dr. Tom

Chronic Cough

Q. I’m a normally healthy 20 year-old female university student who has had a cough for almost five months and shortness of breath for at least a month.  I do have allergies, most likely grass pollen (getting allergy skin tests tomorrow) and no family history of allergies or asthma or anything lung/breathing related.  I also have two cats living with me, one I’ve had for 14 years and the other roughly a year.
When I got it checked out by a GP, the only abnormal finding was inflamed nasal lining (only did physical exam and history).  I was prescribed a nasal spray (Flonase at two sprays in each nostril twice daily) and have been using it for almost three weeks.  I haven’t noticed anything different in regard to the cough or shortness of breath.  I have noticed after using the spray, my shortness of breath is completely gone for about 15 minutes and I feel great. 
I don’t understand this because it is only getting into my nose/sinuses and I still feel short of breath when breathing through my mouth.  Any idea of what would cause that?  Also is the dosage too high considering I’m very little and only weigh 90 pounds and I’m at the very high end of dosing?

A. Dear Tamara, The Flonase may  be absorbed and if so, may be affecting your lungs. It is possible you are dealing with a mild case of asthma. I suggest seeing a pulmonologist to be sure about what you have.
Dr. Tom

Alternative Treatment for Lung Transplant Candidate

Q. My father just found out he is a candidate for a lung transplant. His doctor did mention experimental medications and stents. Could you please tell me more and what your opinion is on each treatment?

A. Dear Kara,
I know of no experimental medications that are established as helpful for patients in need of lung transplantation. You did not tell me what the lung disease is, so I will speculate that it is a scarring disease. There are some studies of new medications for this form or progressive lung disease. Stents are for local obstruction of major airways.
Dr. Tom

Sterile Water Instead of Saline to Manage Secretion

Q. Does using 0.45% saline instead of sterile water for trach patients help in the management of copious secretions?

A. Dear Estelle,
I do not believe it makes much of a difference. The saline is more physiologic and less irritating.
Dr. Tom

Pain Under Rib Cage

Q. After six weeks of a bad cough it finally has subsided with a couple rounds of antibiotics.  I am still experiencing chest pressure and pain under my right rib cage.  Could right hilar prominence be associated with my symptoms. Should I be worried about a larger problem or do the lungs take longer to rebound after an infection?

A. Dear Linda,
Right hilar prominence is not  the cause of pain under your right rib cage. If you truly have hilar enlargement, its cause must be determined. I suggest seeing a pulmonologist.
Dr. Tom

Spirometry Results

Q. I am a smoker (trying to quit) and do drink alcohol (3-4 drinks/day). I am 48 years old and weigh 215 lbs. I know that I have hemochromatosis.
I recently had a complete exam done through my employer; my results that are outside of the reference range are as follows:
FEV1  64%,  % of predicted
FVC 66%,  percentage of predicted
FEF 25-75   54%
Blood chemistries:  SGOT  57 GGTP  150, C-reactive protein 2.0).
I also get phlebotomy every three months due to my hemochromatosis. Should I be concerned with any of my results?

A. Dear Stu,
You should discuss your results with your doctor. He knows far more about you than I can gather from your brief outline.
Dr. Tom

Nasal Polyps

Q. I’m a 54-year old female, nonsmoker, active, in general good health. For the past six months, I’ve been going to an ENT (ear, nose and throat) doctor for persistent postnasal drip and a sinus infection. I had told him that the postnasal drip and clogged sinus was primarily on the left side. After the sinus infection cleared, he prescribed Xanax for the postnasal drip, saying that I focused the postnasal drip.
Because I was very clogged, and there was a whistling sound sometimes when I breathe through my nose, I went to see him again. He looked and said that a nasal polyp had grown into the nose. He prescribed more antibiotics, gave a shot in the nose, and said it would be necessary to remove the polyp.
My question… if there’s only a polyp on the left side, what are the chances that it’s malignant?  I’m very worried about this.

A. Dear Wendy,
This is not a malignant polyp, but requires treatment for symptoms. Giving Xanax (benzodiazepine), even if it is for one nostril, is stupid, in my opinion. Get the polyp treated including surgery if needed, but beware of the doctor who gave you Xanax.
Dr. Tom

Asthma Induced Asthma and Balloon Blowing

Q. I have exercise-induced asthma and asthma symptoms when I have a cold, but I’ve noticed in the last few years when I blow up a balloon, after three puffs, I start to get tingly like a lack of oxygen and I feel like I could pass out.  Should I have my lungs checked out?

A. Dear Tammie,
No. These symptoms are probably from hyperventilation as you prepare to blow up balloons. You always take several deep breaths before blowing, I will guess.
Dr. Tom

Finger Numbness and Oxygen

Q. I have COPD and I’m on oxygen 24/7.  My question is, some of my fingertips are numb, does the oxygen have anything to do with this?

A. Dear Shirley,
Not directly. There is no reason to make fingertips numb from oxygen.
Dr. Tom

Complications of Fluid on the Lung

Q. My dad has just had fluid drained from his lung and now the doctor is saying the lining on his lung has thickened. What does this mean? What problems can it cause?

A. Dear Shelia,
There are many causes for this including; malignancy, infection, and heart failure. I suggest you see a pulmonologist for diagnosis and treatment.
Dr. Tom

Can I Rapidly Improve My Spirometry?

Q. I was recently diagnosed with asthma. I never have had an attack, but my FEV1 was low during a routine physical, it’s about 67%. Two months ago the asthma doctor put me on Asmanex and said within 18-24 months he feels I will be up to 80%.
My problem is that my current employment is ending and in January I will take a physical for my new job, but I have to pass the spirometry with a 70% on my FEV1.
I told my asthma doctor this and he changed my medications to Advair a week ago. I am also using an albuterol inhaler three times a day as maintenance. I haven’t shown any improvement yet.
Is there something I can be doing in preparation for the spirometry in two weeks, that may improve my chances of getting the 70% on my FEV1?

A. Dear Ray,
I would follow your doctors advice and see what results you get. There are other options.
Dr. Tom

Heavy Smoker

Q. I am a heavy smoker. I have severe pain between my shoulder blades. I cough constantly and this produces phlegm. I also suffer with asthma and have had pneumonia in childhood. Please help.

A. Dear Peter,
You need a diagnosis. See a pulmonologist.
Dr. Tom

Annoyed at Apartment Neighbors Smoking

Q. I am not a smoker and live in a single room apartment in a dorm style building. My upstairs neighbor smokes intensely. I have had sore throats for the past year. It has been suggested to me it may be due to second hand smoke. Is there a device that can measure if my neighbor’s smoke is seeping through the walls/floor and harming me? When both our windows are open, it smells awful, and I am forced to close the window.

A. Dear Mike,
The devices would have to measure products of cigarette smoke in the air and this takes complex equipment, air samplers, etc. In short, there is no easy way to do this.
Dr. Tom

Recovering from Thoracodomy and Pluradesis

Q. I just had a thoracodomy and pluradesis about three weeks ago. How long do you think it will take to recover completely from this? I just can’t seem to get my energy back to where I was before.

A. Dear Michelle,
You should get your maximum improvement in about six months. Get as much exercise as you can as you recover.
Dr. Tom

Have Bronchiectasis and Need Advise about Keeping Weight On

Q. I am interested in new approaches that will help muscles with anabolic drugs.  I have bronchiectasis and lost 15 pounds, most is muscle. I read your article in COPD digest (

A. Dear MaryAnn,
There are oral androgen steroids that can improve muscle mass or at least slow progression.
Dr. Tom

Questions about Home Oxygen and Those With Pulmonary Fibrosis

Q. My mother-in-law has pulmonary fibrosis, is on medication. Oxygen saturation at rest was 94% and after exertion 72%. She has been advised to use oxygen for 18 hours, from a machine that uses water to make oxygen.
Is there anything like too much oxygen? Can there be some side effects of this therapy? Is 94% not a good saturation?

A. Dear Vasudha,
A 94% oxygen saturation is ideal.  She will not get too much oxygen from her system. I am not familiar with the device that makes oxygen from water, presumably at home. Good luck in the coming year.
Dr. Tom

Exercise Following a Collapsed Lung

Q. Back in 2001 my sister who was about 19 years of age had her lung collapse three times within two months.  She was hospitalized and they told her that she had polyps in her lungs, I believe that they scraped them out.   Anyway since then she has not had any further problems; she is a nonsmoker and has decided she would like to start an exercise regimen. 
The question is, can she do cardio as hard as she would like in order to get her heart rate were she needs to lose weight or does she need to worry about her lung constantly as she works towards getting her respiratory system strong enough to keep up with a strong run in the near future?

A. Dear Lisa,
In view of her successful procedures, to avoid further lung collapse, she should be able to  partake in any physical activity, including those who push the heart rate.
Dr. Tom

Looks Like Grandmother is Exhaling Smoke

Q. My grandmother is 96 and has never been a smoker.  She uses an oxygen tank but is still very mobile. 
Several people have witnessed her exhaling a smoke like substance.   Her primary care physician has not been concerned.  She has not had a chest x-ray.  What could this be a symptom of?

A. Dear Leslie,
This is a new one for me. Since she is a non smoker, I am sure she is not exhaling smoke. You will have to show a doctor about this to get an idea about what is causing it. Looks like it is not a bad indicator since she is 96. God bless her.
Dr. Tom

I Have Had Pneumonia Three Times Since July

Q. In July of this year I experienced a sudden onset of severe left chest pain, nausea, SOB and I passed out. Thinking I was having a heart attack, I went to the emergency room. After all of the usual tests for heart attack, everything came back normal, except I was found to have pneumonia; completely atypical pneumonia, no coughing, only a slight fever. Very SOB and they had trouble keeping my O2 saturations up. Ended up with bilateral pneumonia.
After a week in the hospital, I was released. Took me a long time to recover. After about a month I felt some better. In October of this year, I had another sudden onset of left chest pain, SOB and fainting. Ended up in the hospital again with pneumonia again. Again I had not been sick. I was told the pneumonia was in the same place and probably had not resolved from the first time. Recovered more quickly this time.
On November 15, had another sudden onset of left chest pain, SOB. Again went to ER. Had lung CT and chest x-ray. Was told I had fluid in my pleural cavity and atelectasis in my left lower lung. After about a day I felt good enough to go back to work.
My question is why do I keep having these attacks of severe chest pain and SOB? I am really concerned. I am also fearful of passing out from the pain. I have been on antibiotics off and on since July of this year. I have heard of a fungus of the lungs. The pain is bad and comes on so quickly. I just don’t know what to do.

A. Dear Gladys,
This needs explanation. I do not have enough facts. I would request a full explanation from a pulmonologist.
Dr. Tom

What Would Be the Harm of One Last Cigarette?

Q. I am 20 years and just recently got a blood clot on my left lung. I haven’t had a cigarette since before I went to the hospital so I am doing good about that.
The doctors have put me on two blood thinners.  It’s been a day since I went to the hospital and I am craving a cigarette. I was just curious if I had one cigarette as my last one if that would hurt me in any way? I was just wondering your opinion on this and would appreciate if you could get back to me.

A. Dear David,
One last cigarette will cause no harm. Those that follow will.
Dr. Tom

Dispelling the Myth

Q. Respiratory Therapists ( are trying desperately to erase the old myth about the hypoxic drive relating to oxygen therapy for CO2 retainers.  Can you recommend any resources for us to site in our defense when trying to convince other Respiratory Therapists (RTs), RNs and physicians who refuse to take our word for it?  This is such a frustrating topic.
Dan RT  

A. Dear Dan RT,
I have been frustrated by this myth for years. Most reviews of oxygen point out that when CO2 retention occurs, it is due to extreme V/Q mismatching. The hypoxic drive is a weak back-up system for travelers to altitude. Empirically, we showed in 1967 that controlled low flow oxygen, will not lead to CO2 retention. See Bigelow, et al. Am Rev Respir Dis, 1967.
Dr. Tom

Normal Oxygen Levels at Higher Altitudes

Q. Dr Petty you were the original author of the NOTT Trial (Nocturnal Oxygen Therapy Trial) that Medicare uses for oxygen reimbursement criteria. I am the Respiratory Director at Vail Valley Medical Center in Vail Colorado.  We are at 8,150’ altitude and our patients that have surgery and anesthesia or medications post anesthesia often require oxygen, also patients with acute altitude sickness. I would like to know if there is any research that shows oxygen requirements at altitude?  Also are their any studies that show effect of an oxygen saturation below 90% at altitude in normal patients. 
Medicare and the insurance industry is refusing to pay for oxygen either post op even if SaO2 is 88% or acutely sick i.e. acute mountain sickenss.  And it is private pay for our patients. This is directly effecting patient care.  And we are putting our patients at risk by sending them home without oxygen.  Please help.  I am trying to change the Medicare regulations.

A. Dear Christy,
Most people at Vail will have normal oxygen saturations about 90% or less. There are no standards for prescribing oxygen at altitude. Even in the NOTT, all centers were at sea level except Denver. Outcomes were generally the same.
Dr. Tom

Adverse Affects of Weather and Pulmonary Fibrosis

Q. My dad has pulmonary fibrosis and we want to know if weather can affect him, and if so what kind of weather is best for him?

A. Dear Alexis,
Weather is not shown to affect pulmonary fibrosis.
Dr. Tom

Frequency of Ventilator Tubing Changes

Q. How often do you change ventilator tubing with an HME (heart moisture exchanger)? I thought it is whenever tubing is soiled or malfunctioning. Some say every seven days. Which is it?

A. Dear Aaron,
It can be either. Changes are needed of course when the tubing is leaking or contaminated. Once a week is also reasonable if all is going well.
Dr. Tom

Afraid that Not Being Able to Get a Full Breath is Something Serious

Q. For the past eight months I have had issues getting a full breath and my chest is almost always tight. I have had asthma and I was on Advair for a couple of years. I have had a chest x-ray, breathing tests and test to check the function of my heart and the doctor says all results are normal.
What I feel now is that I am not responding to my inhaler. This started around the time I quit taking birth control. I had a very fast pulse until I got off of Advair.
I am worried that despite the testing I have COPD or something worse. I have considered the possibility that I may have hyperventilation syndrome or some other panic disorder but I am not convinced.
My grandfather died of emphysema and alpha 1-Antitrypsin Deficiency ( but I was tested for this and the blood tests said I was fine. That was about seven years ago. Should I be retested?
Any advice you have would really help.

A. Dear Rad,
You do not have emphysema and do not need to be retested.  See a pulmonologist if your symptoms persist. They may just subside.
Dr. Tom

Can’t Seem to Get Off Oxygen

Q. I have COPD. After a stay in the hospital, I had to come home on oxygen. I had to do this last year also, but was better within six weeks and no longer needed oxygen. 
This time I cannot seem to keep my oxygen levels up enough to come off of 24 hour use.  Will it ever improve enough to come off oxygen, or is this the way it will be from now on?  Is there any thing I can do to improve my condition of oxygen use?

A. Dear Kathy,
I cannot answer your question, because I do not know your age, diagnosis, level of pulmonary function and other factors. Maybe you can get off again. Ask your doctor.
Dr. Tom

Neck Pain

Q. I am a 47 year-old female and have had a pain in my left shoulder for quite some time. It is more like an ache and it is in my neck if I turn to the left and also in my left arm. It goes away if I take an anti-inflammatory.
I am now worried sick it could be lung cancer, but would the pain be there all the time?

A. Dear Jack,
This is almost certainly not due to lung cancer. Ask your doctor what is causing these symptoms. I do not have enough information.
Dr. Tom

Re-Exposed to TB

Q. I am a Respiratory Therapist ( that has been exposed to TB.  I tested positive a few years ago and underwent treatment for 11 months and have regular chest x-ray follow-ups.  
Recently I was exposed again to TB.  Is a chest x-ray adequate or should I have CT or some other kind of test?  I am not having any symptoms of TB at this time. Thank you so much for your opinion.

A. Dear Aut, 
You do not need a CT scan.  A sputum test for TBC organisms would be the ideal way to follow you.
Dr. Tom

Don’t Know What Number to Set My Oxygen On

Q. I am on oxygen for sleeping time only, and the settings start at two and up. No one seems able to tell me what to set it on! So I put it on 2.5 but I have no idea if that is right or not!  I am in FL for the winter and my doctor is in Michigan. She simply told me to call the company and none of the oxygen people can tell me.

A. Dear Shirley,
You need a pulse oxymeter so that you can set your own liter flow to achieve acceptable saturation of above 90%. Oxymeters are accurate and now quite inexpensive. The oxymeter will tell you the net results of your liter flow on your oxygenation.
Dr. Tom

What Causes Sleep Apnea?

Q. What causes Sleep Apnea? Is this a problem in the brain? Is this inherited?

A. Dear Robert,
There are several forms of sleep apnea. One form, central sleep apnea, may be inherited as a defect in the body’s response to the need to breathe. The most common is obstructive sleep apnea, which has many causes.
Dr. Tom

Proper Tracheostomy Care

Q. When doing tracheostomy care is it acceptable to use sterile water instead of normal saline? A nurse said it was okay to use sterile water but I wanted your opinion.
Pat RN

A. Dear Pat RN,
Yes, this is perfectly acceptable.
Dr. Tom

Difference Between Medications

Q. We have a doctor who states he read where it is necessary to give one albuterol UD and one Atrovent UD for nebulizer treatments instead of a DuoNeb and he keeps ordering it this way.
I was wondering what the significance was for this? Is there something out that says DuoNebs aren’t as effective? Please give me an explanation, since our doctor can’t.

A. Dear Mary,  
They are the same drugs. Duoneb is albuterol plus Atrovent. Your doctor may be confused on this or is considering dosing differences.
Dr. Tom

2024 American Association for Respiratory Care