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Archive: Dr. Tom 146

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

Paralyzed Phrenic Nerve

Q. I have an unknown paralyzed phrenic nerve on my left side, causing the left diaphragm to not work. I suffered no trauma, but did have my appendix removed one year ago. My question is, what are my chances that this will come back on its own and is there anything I can do to help fix this besides surgery?


A. Dear Adam,

Loss of one diaphragm reduces lung capacity only about 15%. It is possible that the diaphragm will function again after the nerve regenerates.

Dr. Tom

Precautions when Using Inhaled Steroids

Q. With inhaled steroid do you rinse swallow or spit?


A. Dear David,

Rinse and spit is best.

Dr. Tom

Doctor Reduced Oxygen Liter Flow

Q. I have COPD. I was on two litters of oxygen and my doctor cut me down to one and a half. He said maybe I would do good with less. What does that mean, that my lungs are little better?


A. Dear Delores

I do not know the reason why your doctor reduced your oxygen flow. I see no advantage.

Dr. Tom

Thank You

Q. You've been kind enough to answer a question or two for me, just want to thank you for your being so generous with your time and good health (and fishing) to you.


A. Dear Don,

Thanks. It is nice to be appreciated.

Dr. Tom

Questions about Lungs

Q. So many questions--guess I'll just ask a few.

Would airway restriction or inflammation cause a person's FEV1 numbers to drop?

Could a lump like/choking feeling be associated with a bronchospasm?

Okay—that's all I'll ask today.


A. Dear Gary,

Both airway restriction and inflammation can reduce FEV1.

A lump in the throat does not cause bronchospasms.

Dr. Tom

Mother has had Multiple Problems Since Colonoscopy

Q. My 86 year-old Mom recently had a chest x-ray. My 90 year-old Dad said the doctor told him mom had some density in one of her lungs; what does this mean?

My mom was healthy except for some arthritis till she sent in for a colonoscopy in November. Ever since then, my mom has suffered one infection after another, has had 4 blood transfusions, two staph infections, repeated urinary tract infections and C. diff, one stroke and one mild heart attack; all in a matter of four months.


A. Dear Idolina,

Sounds like you should stay away from doctors. You will have to get an explanation for the blood loss and need for transfusions.

Dr. Tom

Oxygen Saturations and Exercise

Q. I developed SOB with minimal exercise, but my oxygen saturation stays in the 94-98%.

I have had all the heart test and everything is O.K. Do not need oxygen as my stats stay in that range all the time.


A. Dear Mary,

You may still need oxygen. Consult your pulmonologist.

Dr. Tom

Staying Healthy with Have COPD

Q. I am a 60 year old female with COPD. My FEV1 has remained between 46-49 for the past three years. I exercise five days a week, have lost my excess weight from quitting smoking and am doing my best to keep my diet in check. I still work full time and am on O2.

Do you feel that if I continue on this path I can hope to live beyond 10 years in reasonable good shape.


A. Dear Sally,

Yes I do. Your prognosis is good. Enjoy life.

Dr. Tom

Can Sarcoidosis Cause COPD?

Q. I was a pack a day smoker and in 1997 I joined the Boy Scout Leaders Program to help out with my son's troop. One of the stipulations was you can not smoke around the scouts, I quit 01/01/1997. Have not smoked a cigarette since and I did not have to go off and hide from scouts to smoke. I also have two great Eagle Scouts now too.

But, ten years later I ended up in the hospital with pneumonia and congestive heart failure. Tests were run, like the Pulmonary Function Test and I was diagnosed with COPD with emphysema.

When I smoked I never had the smokers cough, I never had any lung problems other than some upper respiratory infections and ear infections, but now I have emphysema. I thought the longer you got away from that quit date the healthier your lungs would get and even one day be like you never smoked. That really confused me and my wife, but to make it even worse, I had a biopsy and bronchial wash done and the biopsy came back with a diagnoses of sarcoidosis of the lungs.

So now I have COPD with emphysema and sarcoidosis of the lungs. Can the sarcoidosis have caused the emphysema, not my smoking?

I really felt great until that bout of pneumonia and congestive heart failure. Also to add salt to the wound I have a fibrosis scar on my heart and liver now too. I have heard that sarcoidosis usually attacks more than one organ, it that true, too?

I am presently on three lpm of oxygen 24 hours a day and a prednisone therapy program for eight weeks and see if this can be slowed down.

But back to the emphysema, is it possible that the sarcoidosis caused the emphysema not the long time back smoking of 20 years a pack a day and being quit ten years.


A. Dear Sam,

No. Sarcoidosis did not cause the emphysema.

Dr. Tom

Lung Trauma from Car Accident

Q. My colleague was involved in an accident and the doctors found blood in her lungs how dangerous it is?


A. Dear Sybil,

This is not dangerous at all. The blood will simply absorb.

Dr. Tom

Pulmonary Hygiene for Older Adults

Q. How might pulmonary hygiene measures be revised for an elderly patient with CHF and osteoporosis?


A. Dear Tamara,

I do not know how to answer your question, because you did not give me enough information in order to be able to make a reasoned answer.

Dr. Tom

Pain and Breathing

Q. I have a protruding right scapula and severe pain upon breathing. It feels like my right lung is not working. Respirologist did tests and all are clear and told me it was muscular. But I can no longer breathe lying down and I will lose my job soon as I cannot breathe comfortably sitting either. What can this be?


A. Dear Nitsa,

There are many possibilities, most are benign. It should subside with time.

Dr. Tom

Pulmonary Hypertension and Emphysema

Q. Does emphysema cause pulmonary hypertension? Is there a relationship between the two?


A. Dear Deborah,

Pulmonary hypertension is common in emphysema with oxygen deficits. The treatment is for the emphysema to restore lung function and oxygen.

Dr. Tom

Side Effects of BiPAP

Q. What are the bad side effects of using a BiPAP machine for treating mild sleep apnea?


A. Dear Sam,

Essentially none, except for the discomfort of the facial mask.

Dr. Tom

What Does Moderately Advanced COPD Mean?

Q. What is considered "moderately advanced COPD"? I am 66% of predicted with "a good pulmonary reserve" (whatever that is?). I am not on oxygen or inhalers and still quite active. I am 61 (diagnosed last year), quit smoking about 20 years ago!


A. Dear Nino,

This is a pretty meaningless term for you. Your prognosis is excellent.

Dr. Tom

Could Exposure to Wood Smoke be Harmful to Someone with COPD?

Q. I was working with a homeowner to develop a plan for remodeling their house. Unfortunately the homeowners use a wood stove to heat their home. I was at their home about five times while they were burning their stove. The last time I was there it required going outside to look at the exterior of the home, the air outside was so saturated with smoke it made me choke. I was probably exposed to the outside air for around an hour.

Since that time I have informed the owners that if they wanted me to perform the remodel, they would need to put the fires completely out. But I fear the exposure I've already had has harmed my lungs.

I guess my question is how likely is it that a few short-term exposures to wood smoke would further harm a person with Emphysema?


A. Dear Gary,

This short-term exposure will have no lasting damage to your lungs.

Dr. Tom

Can Untreated Pneumonia Cause Interstitial Lung Disease?

Q. I have recently been diagnosed with interstitial lung disease. I have begun to use a nasal and lung spray daily. I feel better after four weeks.

My question is... do you think I could have gotten this disease from untreated pneumonia which did not show signs of illness because my body is guarded with INH antibiotic taken in 2006. I am still experiencing night chills but no sputum now but did for many months previous.


A. Dear Angie,

I do not believe the untreated pneumonia is the direct cause of your interstitial lung disease. I suggest consulting a pulmonologist.

Dr. Tom

2024 American Association for Respiratory Care