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Archive: Dr. Tom 27
Posted July 19th, 2005

Worried about Father’s COPD and Pulmonary Hypertension
Q. Hi Dr. Tom, Dad is a 68 year old who suffers from COPD and pulmonary hypertension. He was put on Viagra, but it did not work. Now on Ventavis via neb along with the Viagra only 6 weeks into it, not working at all.

Now the doctor wants to put him on Flolan Pump (medication that is delivered through tubing that is permanently placed into a vein in the neck) through tugging that is however she says she is not very optimistic that it will work for him. If it does not work, he really has no other options.

Do you think the Flolan Pump may work for him even if the Ventavis via neb is not working? I am thinking that taking the Ventavis thru his COPD lungs may be hard for him where I am hoping the pump, which is a direct line, will work better for him. Do you think that is possible?


A. Dear Lisa, I doubt if the Flolan will work if the Iloprost (Ventavis) does not. The pump adds another burden. Maybe you need to give the Iloprost more time.

Dr. Tom


Pain in Lower Rib Area and Upper Chest
Q. Dear Doctor Tom, I have written before and you have kindly answered, I have a further question you may be able to help me with.

I have returned to my Pulmonologist who tells me I have a clear and normal HRCT (high resolution computed tomography) on both inspiration and expiration. I also had a body plethysmography (a test used to measure gas volumes and airway resistance) and my Residual Volume (residual volume is the volume of air that can not be exhaled) was 128% and my TLC (Total Lung Capacity) was 124%, my FVC (Forced Vital Capacity, is the maximum volume air that can be forcefully exhaled) around 108% (different tests) and the FEV1 is around 103%. My Pulmonologist tells me these are in the normal range.

By the way I am 180cm, normal build, 35year old and my FVC is 5.61liters. Anyway I am now on Spiriva and am feeling a little better, my cough has abated, my sputum decreased and the SOB is not as bad. In one way I am relieved that I have found something that works, in others it is a disappointment that I now have COPD and not asthma, although it is mild.

I have been experiencing a feeling in my stomach like my lungs are pushing down; I also have lower rib pain and an isolated pain in my upper chest. These pains have been going on over a year now. The pain particularly at my lower rib is worst after exercise.  

I personally feel this is from hyperinflation, my Pulmonologist does not think so. The question I have for you is at what point with COPD can you feel rib cage problems/pain from hyperinflation. 
Are these pains from this? If not I will return to my GP for an alternative diagnosis. My pulmonologist feels it could be related to my spleen.

Thanks for listening,


A. Dear Con, You do not have COPD. Your lung function is excellent. The mild hyperinflation does not cause rib pain.

Dr. Tom


Can Spirivia Cause Bruising?
Q. Have been on Spirivia for about 2 months. Have noticed a lot of bruising, real reddish, looks like I'm taking blood thinner but I'm Not.  Also have had a lot of soreness in one of my breast.  Do you think this could be coming from the Spirivia? 


A. Dear Gwyn, I do not know any reason that Spiriva could cause bruising. Better seek another answer. 

Dr. Tom


Numbness in Lower Extremeties
Q. I have COPD, 4 liters per minute of O2 and am 71 years old.  I have numbness in my lower extremities from navel down and  also in arms from elbows down.  Now, my feet are swelling and this is a new thing.  I am on Ventolin, etc.  Any advice? I feel like I'm walking on stubs.  Thank you.


A. Dear John, The swelling may be due to right heart problems. The tingling suggests a sensory neuritis, a nerve inflammation. You need a better diagnosis.

Dr. Tom


When is Oxygen Prescribed?
Q. As supplementary oxygen is not usually prescribed until PaO2 is less than 55 mm Hg or SAO2 is less than 89%, does that mean that no significant damage will occur until these reduced values are reached? 

Also, can you tell me briefly how these values for prescribing oxygen were determined?


A. Dear Frank, Good question. A PO2 or SAO2 of 55, or 88% respectively, is where the amount of oxygen carried by red cells, begins to drop as a linear function, as the PO2 goes lower. This is called the "sharp point on the oxyhemoglobin dissociation curve" ( a mathematical relationship, that is viewed as a graph, showing the amount of oxygen that combines with hemoglobin as a function of the partial pressure of oxygen).

Picking this point is somewhat arbitrary. But it makes sense. For example the entire population in Leadville, Colorado, lives at 10,000 feet, and has a PO2 of about 55. Most are healthy at this altitude. Peruvian Indians live as high as 17,000 feet, with a PO2 in the low 40s. But these are healthy people. So far giving oxygen to patients with only mild reductions in PO2 i.e. 55-60 has not proved beneficial.

More science is needed.

Dr. Tom


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