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Archive: Dr. Tom 56 What Can I do for Husband who has COPD? Katherine A. Dear Katherine, You need to take your husband to a pulmonologist that is interested in COPD. Stopping smoking is the first step along with medications to improve airflow. Pulmonary rehabilitation will help most people with advanced COPD. Home oxygen is very useful for selected patients. There is no simple recipe, for the treatment of COPD. Dr. Tom
Have Asthma and Want to know Best Cities to Live in for Those Who Have Asthma Jennifer A. Dear Jennifer, Lots of places are good. Pick a community with low air pollution. The west coast of Florida and the Gulf of Mexico are good for most, or non-industrial communities in the Midwest or West. There is climate or location that suits all asthmatics. Dr. Tom
Certain Smells cause Chest Pain Terri A. Dear Terri, Patients with asthma commonly get chest tightness, when exposed to the things that bother you but usually not chest pain. Chest tightness is due to bronchospasm and may be a factor in COPD. Dr. Tom
Beneficial Supplements for Health Lungs Paul A. Dear Paul, No good studies. However, there is good reason to take antioxidants, such as vitamin C, selenium, and Coenzyme Q10. Calcium supplements with vitamin D are also good as a preventive for osteoporosis, which is common with COPD. Dr. Tom
Is Exposure to Crystalline Silica Something to Worry About I am generally healthy, and active, although I've also had some dull abdominal and upper back pain. I had an x-ray in January, and my doctor and radiologist said it looked fine (they are aware of my concern). I was just in yesterday for a full slate of PFT's, and am hoping that they come back normal. I had some slight asthma that went untreated when I was a kid, and I do have pretty severe allergies to cats and dogs and other allergens. My question is, first and foremost, what are your thoughts on my silicosis fears? (dumb way to phrase that) Also, can asthma cause a constant slight wheeze, rather than episodic wheezing? Also, when I play tennis or run on a treadmill, I don't have any trouble breathing. Curious if asthma can behave like this, or what your thoughts are. If my PFT’s are not normal, I plan on seeing a pulmonary doctor at the University of Chicago Hospitals. Craig A. Dear Craig, I doubt if short exposure to silica is enough to cause silicosis. It usually takes months or years of continuous exposure. Mild wheeze that is intermittent is common in asthma. Your lung function may be normal between periods of asthma. See this link for more information on Crystalline Silicosis: Health Effects of Occupational Exposure to Respirable Crystalline Silica National Institute Occupational Safety and Health (NIOSH) HAZARD REVIEW. Dr. Tom
CT Scan Showed a Lung Nodule Cardiac Calcium scoring CT showed a 3mm nonspecific nodule on my upper left lung. My primary doctor says I can wait until my physical in a few months to discuss this finding? Does that sound right? R. A. Dear R. Yes. The great majority of tiny nodules are benign. But it is wise to get a follow up in about six months to see if there is growth. Dr. Tom
Back Pain I am now going to a pain clinic. I am on two kinds of muscle relaxers and hydrocodone. They do not help. It’s going on three months now at this clinic and I don't want to become dependent on these pain pills. Are there any more tests for the back after having surgery? I asked for a disc o gram{?} but the docter says there’s no room to stick needles in because of the fusions surgeries. Any ideas and is second opinion allowed? Reymarie A. Dear Reymarie, I am no expert on back pain. I have a lot of problems myself. MRI is the best way for neurosurgeons to evaluate back pain due to degeneration or disc disease. Dr. Tom
Spot on Lung Today four days after the x-ray she called to tell me she found a spot on my left lung. Now I have to do more testing. I never smoked or drank, but my parents smoked all of my life. They are cancer survivors, twice. My mom had lung cancer and had one lung removed. I am worried it could be cancer, but could it be only from the pneumonia? Thank you Ada. Ada A. Dear Ada, This needs a follow-up. Your risk factors for lung cancer are; your family history and exposure to environmental tobacco smoke. The spot could still be a resolving pneumonia. Dr. Tom
Told That She Was in the Beginning Stages of Emphysema I had a chest x-ray that shows mild hyper- inflation. The report on the x-ray report states: 1. Mild hyperinflation, which is probably on the basis of over inflation secondary to the patient's young age. 2. No acute infiltrate is present. I have for many years, become short of breath easily. I have never been checked for asthma. I also hear a wheezing when I breathe in. This wheezing is almost everyday. I am only 34 years old and I do not smoke. The doctor did not conduct any other test. I had a spiromtery test done at a different office and the results were
The report said that these results were normal. I just don't understand how I can have emphysema. Is there anything else this could be? Cindy A. Dear Cindy, These results are normal, except the FEV1/FVC. Normally this is above .70. Hyperinflation on a chest x-ray does not mean anything. You could still have asthma, which would explain your wheezing. The spirometry may just have been done while in remission. You should be tested again when you are wheezing. Dr. Tom
Can Staph Infections Affect on the Lungs You may recall from a previous post I have normal spirometry with an FEV1/FVC of 77 or 78. I also have had a constellation of symptoms that have continued for nearly three years including; pleurisy (is an inflammation of the pleura, the lining of the lungs, causing pain), excess sputum, SOB, vague joint pains, nasal crusting etc. I also had asthma as a kid and smoked for most of my adult life. I went to my general practitioner two weeks ago with tendonitis, bursitis (is inflammation of the fluid-filled sac, bursa. that lies between a tendon and skin, or between a tendon and bone) and painful boils under my arm and on my side requesting that he get to the bottom of this as it had been going on so long. The boils were new, everything else was ongoing, and previously connective tissue disease was ruled out. Here’s the thing, he diagnosed me as having a Staph (Staph, staphylococcus, is group of bacteria that can cause a many diseases) infection in my blood and put me on Klacid (antibiotic) for two weeks. It has helped and the joint pains and boils cleared quickly. The excess sputum remains. My questions for you are: Could this Staph infection potentially be the cause for my pleurisy? Can a staph infection affect the lungs? Because I may have some chronic bronchitis am I more likely to get these infections? Conn A. Dear Conn, This should not be due to staph, which usually is an acute (means sudden or severe; symptoms appear, change, or worsen rapidly) infection. Dr. Tom
Will Medication for Rheumatoid Arthritis Impact Lung Transplant Elgibility? Jill A. Dear Jill, I am not a lung transplant expert. I doubt if the medication will affect your transplantation status. Dr. Tom
Carbon Dioxide Retainers and Oxygen Our staff MDs and Pulmonologist still write orders as this is the case. I am willing to accept this as no longer the case, but what information or studies I can cite to discuss with them as well as educate my fellow Respiratory Therapists? Linda A. Dear Linda, This is a long story. Your doctor is wrong, and you are right. We did the first blood gas determinations in 1965 in people with COPD exacerbations (worsening condition or flare-up). We found no CO2 retention at 1 to 3 liters, even if PO2s went above normal. Most modern doctors no longer believe this old myth. Dr. Tom
Unable to Tolerate the Mask Connie A. Dear Connie, Yes, but you should be able to use nasal canulae, at controlled low flow. Your doctor should not be afraid of long term CO2 retention. Dr. Tom
Long History of Lung Problems I did smoke for 43 years and quit 10 years ago. I am now diagnosed with COPD - emphysema. My CT Scan shows many large bullae (enlarged air sacks), diffuse but primarily in the lower lungs, worse on the left side. Because of my prior lung surgery and diffuse bullae I am not a candidate for LVRS (Lung Volume Reduction Surgery). I get quite SOB and have a FEV1 in the mid-20% range. Is there anything that could be done to help my symptoms, short of a lung transplant? Mary Ann A. Dear Mary Ann, The techniques of pulmonary rehabilitation should help you with SOB. For more information on Pulmonary Rehabilitation see: Frontline Advice for COPD Patients (PDF) - Pages 35-53 Get going and Take the First Step to Healthy Exercise:Pulmonary Rehabilitation is a Safe Place to Start an Exercise Program For more information on LVRS: The National Emphysema Treatment Trial (NETT): Lung Volume Reduction Surgery (LVRS) Dr. Tom
Lots of Phlegm Arline A. Dear Arline, Excessive mucus is a big problem. N-Acetyl Cysteine, available over the counter may help. Dr. Tom
Spots on Lung Jason A. Dear Jason, Your stage of COPD will be judged by spirometry. The spots need follow up in most cases. Dr. Tom
Questions about Selecting a Tracheostomy Tube What are the pros and cons of this foam fill trach with this type of patient. Garrett A. Dear Garrett, I cannot give you a simple answer here. Sounds like you have a trach tube that is doing okay. Dr. Tom
Follow-up Question I had a chest x-ray and the full PFT testing, and all were shown as normal and healthy. I had told my doctor that I was exposed to some silica dust for a couple of weeks about three years ago, so they are aware of my past exposures. I work in a professional office, so there's no trouble there. I feel well about 95% of the time, but the constant slight wheeze (which is at the very end of my expiration) bugs me. My doctor said the spirometry tests show that I didn't have asthma. I'd love to hear your thoughts. I am a healthy 27 year old man, and although I'm a bit overweight (6'2" and 245 lbs), I exercise regularly. Craig A. Dear Craig, Sorry, I cannot answer your question with any certainty. With a persistent wheeze, you may want to see a pulmonologist and have a bronchoscopy which is placement of a tube to see what is going on in your large air passages. Dr. Tom
Is Exposure to Cystalline Silica Something to Worry About I am generally healthy, and active, although I've also had some dull abdominal and upper back pain. I had an x-ray in January, and my doctor and radiologist said it looked fine (they are aware of my concern). I was just in yesterday for a full slate of PFT's, and am hoping that they come back normal. I had some slight asthma that went untreated when I was a kid, and I do have pretty severe allergies to cats and dogs and other allergens. My question is, first and foremost, what are your thoughts on my silicosis fears? (dumb way to phrase that) Also, can asthma cause a constant slight wheeze, rather than episodic wheezing? Also, when I play tennis or run on a tread mill, I don't have any trouble breathing. Curious if asthma can behave like this, or what your thoughts are. If my PFT's are not normal, I plan on seeing a pulmonary doctor at the University of Chicago Hospitals. Craig A. Dear Craig, I doubt if short exposure to silica is enough to cause silicosis. It usually takes months or years of continuous exposure. Mild wheeze that is intermittent is common in asthma. Your lung function may be normal between periods of asthma. Dr. Tom
Pulmonary Function Testing (PFT) Results Lung volumes:
Spirometry:
While doing a short walk in my doctor’s office with an oxymeter attached to my finger, my saturation went to 88%, while at rest it was 96%. I am 62" tall and weigh 128 lbs. My age is 64. I am quite perplexed by the figures, and my physician is not very responsive in answering questions. I very much appreciate your comments and your time. Lisa A. Dear Lisa, Your lung function test, which contain too many meaningless numbers, do not make sense. Better see another pulmonologist and get an answer. Your drop in oxygen as measured by a finger oxymeter is abnormal, and requires an explanation. Dr. Tom
Questions about Rapid Progression of Lung Problems I contracted viral pneumonia in December 2005. I was admitted to the hospital and received an “early” CT scan. They told me I have damage in both my lungs and one doctor told me I have the “lungs of a person who has smoked for 60 years!” I am now on oxygen 24 hour at a 2L level. How could so much damage occur from July/05 to December/05? Is this common? Rose A. Dear Rose, The apparent rapid progression of disease is very unusual. You need an explanation of this whole picture. I do not doubt it, but the possibilities are many and a suggested diagnosis would require speculation. Dr. Tom
Is Supplemental Oxygen Addictive? I'm not sure how to answer him, because I'm not sure if I am using the oxygen as a crutch. I only use it when needed; I have a pulse oximeter and use it when my saturation levels drop to 90% or lower, and remove it on rest and when my levels are again acceptable (94%). Patricia A. Dear Patricia, You will not get addicted to oxygen. From what you tell me, you are using your oxygen correctly. Dr. Tom |
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