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Archive: Dr. Tom 37
Posted October 21st, 2005

Blood in Saliva
Q. Hi Dr. Tom, For the past several months I have been waking up with a dry mouth and small amounts of blood mixed in my saliva. I have no real discomfort and it subsides as I rinse and gargle. I only seem to experience this when I wake up in the morning, the rest of the day I am fine.
I am concerned because of the presence of blood and I am a former smoker. I am a 35 yr old male. Sometimes I feel some sinus congestion.

Can it be sinuses and can one have a sinus infection without knowing it? I have no breathing problems such as shortness of breath, chest congestion or any respiratory related problems.

I would appreciate your professional opinion. Thank you for your time.


A. Dear Anthony, You need a good examination of your nose, pharynx and mouth, by an otolaryngologist (a doctor whose specialty is with the ear, nose, and throat). There are many possibilities here. Some are minor and others of major importance. Get a diagnosis.

Dr. Tom


Caring for a Child with Breathing Problems
Q. What should you do when caring for a child with breathing problems?


A. Dear Meghan, It all depends on what kind of breathing problems. See your pediatrician.

Dr. Tom


Albuterol in a Pill Form
Q. I am an RRT working in a pharmacy. A physician’s office called today looking for Albuterol in a pill form. The name "VoSpire" was given. I cannot locate anything on the Internet!

Have you heard of such?


A. Dear Dee Dee, Look in your Physician's Desk Reference (PDR). VoSpire is 8 mg of sustained release oral albuterol, given every 12 hours.

Dr. Tom


Need Advice to Quit Smoking
Q. What is the best way to quit smoking?

I have heard that the use of 2 methods is the best, i.e.) the patch and medication. In your opinion, which nicotine replacement is the best?

I am well educated about the effects of smoking on my lungs and have many reasons to quit, but the withdrawal is just too much. Any help would be greatly appreciated.


A Smoker

A. Dear Smoker, The first step is to pick a quit date, where you really intend to stop. Next, get the patch for dealing with nicotine withdrawal. Also get the gum, 4mg, if you are a heavy smoker to also take if the patch won't work completely. Give it a three-week try.

If you fail, do the whole thing over about two weeks later. It will finally work for you. Let me know.

Dr. Tom


New Respiratory Therapist has a Few Questions
Q. I am a fairly new respiratory therapist and I have 2 questions that I would like to ask.

First of all, are bronchodilators effective (at any level) in the treatment of CHF (Congestive Heart Failure)? I see doctors time after time order bronchodilators in patients with CHF who have no history of pulmonary disease. In the general management of CHF I have been unable to find where bronchodilators are part of the treatment.

My second question concerns the use of Mucomyst (medicine that destroys or dissolves mucus). I was taught in respiratory school and I also have heard other respiratory therapist state that Mucomyst has no therapeutic value in a patient, after 14 days of use.

The drug manufacturer does not support that theory in their package insert; and, I have not been able to find a study of any kind that supports it either. So, does Mucomyst work beyond 14 days?


A. Dear SM, Bronchodilators do not work for congestive heart failure. They have some dangerous side effects, possibly lowering potassium and causing arrthymias.

Mucomyst works for more than 14 days, but many people find it irritating. Good luck with your future career!

Dr. Tom


My Lung Defusing Capacity is Dropping
Q. I have COPD with both obstructive and restrictive components, as well as scoliosis (curvature of the spine). In the last 15 months, my DLCO (defusing capacity of the lungs or how well oxygen passes from the air sacs of the lungs into the blood) has dropped from 10.6 to about 2.0 (DLCO is 32.5%).

I just saw a pulmonologist who suggested it might be interstitial lung disease (IDL).

I just had a chest x-ray and HRCT (High Resolution CT Scan.). The CT showed old scarring in the lower lobes but no interstitial disease.

I can't get a follow-up appointment with this doctor for two more months. What else could cause this dramatic drop in DLCO if it's not ILD?

Is there any way to increase my DLCO?


A. Dear Sandra, doubt if the DLCO has really dropped this much. Probably, an error. Do not worry about it, if you continue to feel well.

We should treat the patient and not the numbers.

Dr. Tom


Believes the Sport of Blowgun Could be Beneficial to Patients
Q. Dr. Tom, I was surfing the web, and found a post by Jock Elliot on your website questioning you about Dr. Hironori Higuchi's paper (published about 1990), regarding the health benefits derived from participation in sport blowgun target shooting. Dr. Higuchi is a well-respected physician with a specialization in dermatology, and training in geriatrics. He also has done extensive work with sports rehabilitation for quadriplegics and hemiplegics in Nagaoka, Japan.

Jock listed these benefits as:

  • Decrease of stress
  • Better digestion
  • Increased lung capacity (due in part to better utilization of normally “dead air” pockets);
  • Abdominal muscle and organ strengthening (due to the super-oxygenation of the blood
  • “Massage” of the organs from the use of the diaphragm in deep breathing)
  • Stimulation of the autonomic nervous system
  • Increased focus due to directed concentration

I wish to clarify the details of the good doctor's thesis. The benefits are not derived from shooting the blowgun, but more from the increased oxygen levels in the bloodstream, and relaxation of one's system by using a technique similar to psycho prophylaxis (known in the USA more familiarly as the Lamaze pre-childbirth breathing and relaxation technique). As you are aware, this is also a technique being used by many surgeons when their patients are in a pre-operative condition, allowing them to benefit by reduced stress levels.

In the sport, when properly executed, this technique brings an individual into a calm, relaxed state prior to the actual shooting. The lungpower to shoot a blowgun is minimal. It's more in the technique of expulsion, than in emptying one's lungs into the barrel of the blowgun, as most people would believe.

More specific information about the "Sport Blowgun Health Method" can be found on the website of the USA based "National Sport Blowgun Association" at: Follow the link on the main page to the information about the health method.

I believe based on these additional facts, that participating in the sport, using this relaxation and breathing technique would be beneficial. These benefits of course would not reverse damage, but if started as a rehabilitation regime, along with standard medical therapy would result in a decreased recovery time. Also, since this is usually a sport that is non-solitary, the benefit of additional socialization would also aid in a reduced recovery time.

Pictures of many quadriplegic and hemiplegics as blow gunners are found on the "Japan Sport Fukiya Association" website (a link to it can be found from the NSBA "Partners" page). The sport has been popular there for over a dozen years, with well over 600 competitors at their last national competition. This is perhaps the only sport where male and female, young and old, handicapped and non-handicapped compete on a completely equal basis. The only concession made, is that the target height for a wheel chair bound competitor is lowered from the standard 120 cm to 90 cm.

Dave BS, EdM, SDNA
Co-Founder, National Sport Blowgun Association
International Fukiyado Association certified Instructor

A. Dear Dave, This is quite an "infomercial”. I believe that breathing coordination and relaxation can be beneficial.

Dr. Tom

The original question about blowguns
Posted May 4, 2005

Are There Health Benefits Associated With the Sport of Blowgun?
Q. My name is Jock Elliott. I am a fulltime freelance writer. I have written about high-tech and medicine for thirty years.  I am also the National Correspondent for the National Sport Blowgun Association. One of our associates from Japan claims health benefits from blow gunning. These include:

  • Decrease of stress
  • Better digestion
  • Increased lung capacity (due in part to better utilization of normally “dead air” pockets)
  • Abdominal muscle and organ strengthening (due to the super-oxygenation of the blood
  • “Massage” of the organs from the use of the diaphragm in deep breathing)
  • Stimulation of the autonomic nervous system
  • Increased focus due to directed concentration

I figured that if anyone knew if these claims have any validity, it would be someone in respiratory care. I called the American Association for Respiratory Care and they referred me to you.


A. Dear Jock, An interesting question. Blow gunning takes breath control and a good force to blow the object toward its target. At a minimum, it should be a good sport and relaxing.

It will not change underlying lung function, but might improve breathing coordination. I doubt if the other claims are valid.  

Dr. Tom


Vocal Chord Dysfunction
Q. What are the symptoms of vocal chord dysfunction and what are the current treatments/medications?


A. Dear Becky, Vocal cord dysfunction can masquerade for asthma, with wheezing and shortness of breath. The tip off is noise on breathing in, i.e. stridor (a harsh vibrating sound heard during respiration in cases of obstruction of the air passages). Confirmation can be by a flow volume loop looking at the inspiratory curve, (obtained with a spirometry test) and confirmed by laryngoscopy (a procedure where a scope is used to visually examining the interior of the larynx). Treatment is in voice and breathing control. Not drugs.

Dr. Tom


Questions about Pneumothrorax
Q. Dr. Tom, I realize that the popular belief is that spontaneous pneumothorax (collapsing of lung) is unrelated to emphysema or COPD. I had many, (5) or more episodes many years ago and I have been reading literature on the Internet that says that they are at least casually linked together. In other words at some time down the trail after PSP it is plausible to cause or have an affect.

"The sub pleural blebs found in patients with so-called idiopathic spontaneous pneumothorax suggest that pneumothorax could possibly be an early manifestation of pulmonary emphysema in these subjects.

What is your opinion? I have read several articles like this.


A. Dear Jim, These are usually congenital blebs, that are not related to diffuse emphysema. They can also relate to local inflammatory processes in the top part of the lung, but again, not related to diffuse emphysema.

Dr. Tom


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