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Archive: Dr. Tom 42
Posted December 9th, 2005

Questions about Zicam
Could the use of Zicam gel cause a dry cough?


A. Dear Peggy,
Not likely.

Dr. Tom


Welding and Vocal Cords
How does welding gases affect our vocal cords?


A. Dear Robert,
Welding gases are irritating. Do you also smoke?  If so, this is the most likely cause.

Dr. Tom


Questions about Spirometry Changes
I have posted before. I won't go into detail again but my question is, if the methacholine challenge (a test that can identify people with “sensitive” airways, often used to diagnosis asthma) doesn’t show asthma, what could cause a reduction over a four year period of the FVC and FEV1 from 110 range down to 92% range? I fear emphysema. One doctor said early emphysema, but the new pulmonologist, who did the methacholine challenge, says nothing’s wrong but can't answer why my numbers are steadily dropping. Thank you.


A. Dear Paula,
It could be that different instruments gave different values. Ninety-two percent of normal is still well within the range of normality.

Dr. Tom


Supplemental Humidification with Oxygen
I have a question regarding humidity added routinely for patients on low flow oxygen. I had always understood that oxygen set under 4 lpm (liters per minute) by nasal cannula does not need supplemental humidity. Now I have relocated in the dry southwest and MDs and RNs all want bubble bottle humidity added to patients on 2 lpm. Is it necessary due to the climate?


A. Dear Tori,
No, the bubblers do not add any significant moisture. They just make noise and cost money.

Dr. Tom


Would Like a Diagnosis
I am a 73-year-old retired school teacher who retired on disability at age 49 because of MS (multiple sclerosis, an autoimmune disease that affects the central nervous system, the brain and spinal cord). I was unable to stand on my feet for entire class periods and became extremely fatigued easily.

About 10 years later, I was diagnosed with a sarcoma of the breast [cystosarcoma phyllodes-soft tissue sarcoma] and I had a mastectomy. My cancer did not reappear and their feeling was that I should take nothing that would interfere with my autoimmune system.

In general, my health has been good and I function very well [drive, cook, entertain, etc]. My major health problem is controlled hypertension.

Three years ago, we lost two daughters to cancer within eight months of one another. The stress was unbelievable. On one visit to the second daughter while she was in the hospital, my feet swelled up and she (a respiratory therapist) put her pulse oximeter (a machine that measures your oxygenation) on my finger when I entered her room. My O2 level was 71! I went to my internist the next morning and was examined for heart failure and had an echocardiogram. My heart was fine.

After that episode, I was fine but began to feel very tired all the time. I had expected an MS reaction to the situation and thought little or nothing of it. I am/was a smoker and at some point began to smoke "as much as I could"- or at least that is my memory of the episode.

I soon became [as I know now] very paranoid and did not want anyone to know there was something wrong with me. I began to feel less and less well, lost my appetite and energy, and as I remember, just smoked all the time and hoped nobody would notice that there was something wrong.

Another daughter who is a nurse wanted me to go to the doctor and I said that I would. My feelings, as I remember them, were that I had to "get ready for IT" although I had no idea what IT was.

On my last conscious day, I went out to put a hold on our mail and the whole world had turned blue. My family called an ambulance and I was in intensive care for a week, near death with a CO2 reading incompatible with life. My internist fought the urge to intubate (placement of a breathing tube that can be connected to mechanical ventilators for the purpose of delivering air and/or gases into the lungs) me and I slowly recovered.

I was discharged with O2 to use when I need it and purchased a pulse oximeter. On room air during the day, my O2 readings vary but always return to 90-93. I sleep with 1/2 liter of O2.

I have no cough, no wheezing, no shortness of breath and good breath sounds when examined. My docs have changed my diagnosis from terminal emphysema, to COPD to MS! What do you think?


A. Dear Pat, 
You obviously do not have “terminal emphysema”. 

You need to have spirometry and other lung function tests such as a diffusion test (a test to determine how well your lungs take in air and moves the oxygen into the bloodstream) and lung volumes (this test not only measures the amount of air you breathe out when you exhale but also measures the amount of air that remains in your lungs after complete exhalation) to make a diagnosis. Your pulmonologist will be able to make a diagnosis and provide an estimate of your prognosis with these tests.

It is hard for me to understand your previous acute respiratory failure, but it was nicely reversible. Let me know your test values, when you get them done.

Dr. Tom                               


Questions about CT Scan Results
Dr. Tom, I've just had a CT scan and was told by the doctor that I either have calcium deposits or scarring in my lung.  What would cause this and should I be concerned?  She told me I needed to see a pulmonologist.


A. Dear Jill,
Calcifications and scarring are from old inflammatory processes. Go ahead and see a pulmonologist to get more information. I do not think your CT results suggest a malignancy.

Dr. Tom


Problems with Getting Good Care
I moved from Florida to Maine last February. I started with an internist when I arrived and I have liked her very much. Also her nurse has been great. That is until my last cold, which began like out of the blue.

She treated me with one antibiotic and then with Levaquin 750 mg (antibiotic). I had coughed terribly with this cold and my nose was running constantly. The first antibiotic she used for five days and Levaquin for seven days. When I was still coughing up green I called again and nurse said they "had done all they could for me as I had taken top-of-the-line antibiotics and did I understand that?"      

When I first called I got the shock of my life because my family had traveled from S.C. to me for a short visit and I didn't want them to catch my cold either so mentioned this in my conversation and the nurse said "to hell with them, they could catch a cold grocery shopping, we only care about you" and so I hung up. I have coughed for the past two weeks but seem to be getting it under control with some tussinex (cough suppressant) left over from the pneumonia.

I have very severe emphysema, with about 30% of lung function left. I had thought maybe with this cold I could have used a script of prednisone too but she said no, and since then I'm wondering if I should go to another doctor or pulmonologist.

Since my doctor is brand new and the nurse had asked me how long samples of Spiriva lasted, I wondered if they knew enough about emphysema. I am not sure yet what to do. There have been a couple things that happened when ordering nebulizer meds and 02 that made me wonder. They seemed so nice and personable, but that won't help in a crisis. Am I being too sensitive??? 


A. Dear Dot,
No, your doctors are not serving you well. See a pulmonologist.

Dr. Tom


Worried and Smoking
. I've been a smoker for 25 years and have been trying to quit. I do well for a few weeks and then start back up. I've been noticing that I also over smoke, if you will, when I go back to smoking. Lately I've been having breathlessness and my lungs hurt when I smoke. In my upper left chest area I feel soreness. When I press on it I can tell it's tender. Sometimes when I breathe deeply, I feel tingling in my hands. Could this be a tumor? I have no coughing or spitting up blood. But my lungs used to never hurt when I smoked before.  The tender spot worries me some, it’s between my collarbone and shoulder, and it moves when I breathe. I am still working on quitting. 

Thank you for answering my question. 


A. Dear Patricia, 
You did not state your age, or intensity of smoking. You need spirometry to test your lung function. A chest x-ray is in order, in view of your symptoms. You need a diagnosis and a firm commitment to quit. Good luck.

Dr. Tom


2024 American Association for Respiratory Care