How to Increase Calories but Limit Carbohydrates
Q. Dr, My father an ex-smoker has emphysema and Wegener's Granulomatosis (an uncommon disease, in which the blood vessels are inflamed) of the lungs.  He is on inhalers, etc. has lost about 7 pounds in the last month. 

The doctor has told him to eat a low carbohydrate (carb) diet to decrease retaining CO2.  How can we get more calories into him and still keep it low carb.  He has difficulty tolerating soy products--please help—I am seeing him disappear.

Carol

A. Dear Carol, I know about Wegener’s Granulomatosis, having treated several patients successfully.

Forget about restricting carbohydrate. True that carbohydrate does create more CO2 than fat or protein when it is metabolized. But this is only an issue, and a minor one, in critically ill patients, who have excessive metabolism, and are on a respirator. Carbohydrate is the most available energy source and your dad should ignore the advice to limit it.

Dr. Tom

       

Will Prednisone Affect my Diabetes and Glaucoma?
Q. Dear Dr. Tom, I am slowing down a lot and it’s hard for me to walk from room to room. My Dr. wants to put me back on prednisone and claims that will give me a better way of life. I am diabetic and am taking eye drops for glaucoma. I'm against taking prednisone for fear of my glaucoma getting worse. What do you suggest would be best for me to do? Thanks in advance.

Henrietta

A. Dear Henrietta, All but small doses of prednisone will affect your diabetes. They will not worsen glaucoma. If you need prednisone to become more functional, my advice is to take it, and adjust your diabetes management if necessary.

Dr. Tom

 

Home Oxygen Concentrators and Oxygen Toxicity
Q. Hi. I am looking into buying an oxygen concentrator/compressor for my home. I have read that oxygen at certain concentrations can be toxic. And also that breathing concentrated oxygen over long periods of time can cause tissue damage and toxicity.

I was wondering if you could tell me what concentrations are safe for daily use? 

Johnathan

A. Dear Johnathan, All concentrators are safe for daily use. I raised the question about possible lung damage from long term oxygen, but it is far from settled. I would forget about it and take whatever oxygen you need.

Dr. Tom         

 

Pain in Breast and Rib Cage Area
Q. I'm having pain under my right breast and rib area that circles around to my back.  I had my gall bladder removed due to gallstones 2 months ago.  Could the pain still be coming from that or do you think it could be lung related.  I'm not the typical gall bladder patient.  I'm 34 5'7 and 146lbs. 

Melanie

A. Dear Melanie, I do not believe that the gall bladder surgery is the reason for the pain distribution that you now have. I do not know the cause. Hope it just goes away.

Dr. Tom

                

What Causes Emphysema?
Q. My mum died 15 years ago of emphysema at age 57. When she was 18 she developed pneumonia and it resulted in a scarred lung. She then developed asthma a few years later then emphysema. For as long as I remember she had chest problems, getting flu every year also. Are there connections to these?

I have never had breathing related illness (I am 47). What are the chances of me inheriting emphysema? I did have a chest x-ray about 10 years ago, which showed some increased volume but another x-ray a year ago did not show this.

Emphysema scares me. Please tell me if the reason my mum got emphysema was due to lung scarring and asthma. 

Beverley

A. Dear Beverley, She may have had a disease that is sometimes confused with emphysema, called bronchiectasis. This is a dilatation of the large air passages of the lungs, due to infectious damage. It is common to have frequent chest infections with bronchiectasis.

You did not say if your mum smoked or if you do. If you are worried about emphysema, get a simple spirometry test to see if your airflow and volume are normal, or reduced.

Dr. Tom

 

Shortness of Breath
Q. Hi Dr., I am a healthy 47 year-old male. Never smoked. Good BP and cholesterol. I had echo stress last year and did great with ejection fraction of over 65.

The last 3 weeks while playing soccer I have been having a real tough time catching my breath. I also seem to be clearing my throat a lot and have even had a bad itch in throat area, forehead and ears. When I was tested last year they also did a pulmonary and spirometry and I do not have asthma. Could you recommend any next steps?

Wondering if I may have a bad lingering virus. A recent chest x-ray last week was normal.

John

A. Dear John, I believe that you must rule out pulmonary hypertension, which is high blood pressure within the vessels of the lungs.

An Echocardiogram (ultrasound is used to view the heart) can help to detect this, but your cardiologist must focus on right ventricular function, which is more difficult than with a left ventricle ejection fraction. An echo may also indirectly indicate the presence of pulmonary hypertension.

Dr. Tom

 

Life Expectancy and COPD
Q. Hi Dr Tom, Do you think the life expectancy for people with severe COPD has increased over the past few years? 

I have an elderly relative with severe COPD and it seems the treatment she gets now during an exacerbation is much more effective than even 5 years ago. Especially in terms of antibiotics- they seem faster and more powerful than a few years ago. 

It seems to me that your chances of surviving an acute exacerbation now are very, very good and surely that must make the life expectancy figures for this disease out of date.

I am interested to hear your opinion.

Jane

A. Dear Jane, Great question. 

Yes, people with COPD are living a lot longer than even ten years ago. Effective treatment including smoking cessation is the reason. Best to diagnose COPD early when, with treatment, the life expectancy is normal.

Dr. Tom

                

Does Alcohol and Affect Oxygen Levels
Q. Does the drinking of whiskey or any alcohol affect the oxygen gas in the blood stream? Thanks.

J.

A. Dear J., No. But if you get drunk, it affects the ability of your tissues to use oxgyen. Just have a glass or two a day.

Dr. Tom

 

Is There a Rationale for Giving 100% Oxygen When Patient is Dying?
Q. I am a Registered Therapist with 30 years experience, and I still have problems with the following:  When a patient is quote “ready to expire” and all the papers have been signed and all the family is in agreement, why do some physicians place the patient on 100% NRB (non-rebreather mask)? 

When I questioned the physician, they always respond, for “comfort measures”.  But why prolong what has already been determined, as I have seen some patients linger for long periods of time due to high concentrations of oxygen being delivered.  Your thoughts would be greatly appreciated.

Gary Lynch RRT

A.Dear Gary, You are absolutely right. I am afraid that giving oxygen in such situations is more ceremonial, than therapeutic. If the patient is not struggling to breathe, at the end of life, do not give oxygen to prolong the process.

Oxygen is ONLY a comfort measure, when it relieves dyspnea (difficulty breathing or breathlessness).

Dr. Tom