Readers: Read Dr. Tom’s Commentary on Spirometry to understand the importance of this diagnostic lung test.

Supplemental Oxygen and COPD
Q. Explain the importance of low doses of oxygen with COPD patients.

Aveyan

A. Dear Aveyan, This is too broad a question for a simple answer. Long Term Oxygen Therapy, LTOT improves both the length and quality of life. Ambulatory oxygen for more than 18 hours per day is better than stationery oxygen for 12 hours a day.

The low flow concept is to give the necessary liter flow to correct the oxygen deficit. Normal oxygen saturation is 96-98% at sea level. It is 92-94 % at 5000 feet, the altitude of Denver, Salt Lake, and Albuquerque.

Usually a liter flow of 1 to 3 liters per minute will achieve an acceptable saturation of above 90% in most COPD patient.

Dr. Tom

 

How to Find a Good Pulmonologist
Q. Due to some scarring on my lung detected on a CT scan I was advised to seek out a pulmonologist. Can you suggest how I may go about making a wise, informed decision? My healthcare plan provides simply name, address, graduating university and year graduated. Google, etc. are of little help also. I'd like to assure I see someone who is up to date with the latest technologies and studies. Thank you for your time and consideration.

Dawn

A. Dear Dawn, The American Board of Internal Medicine provides a web site to see if the pulmonologists are certified and if there are any complaints about their service/care, i.e. malpractice issues. Best to inquire in your own community, by asking around. Ask doctors and nurses of your hospital. They will know who is good.

Dr. Tom             

 

Worried about Daughter’s Breathing, Especially During Sleep
Q. Hello. I have a four year-old daughter and since she turned one she has these symptoms:

• Cold and cough.
• She uses a lot of energy to breath during her sleep, she breath through her mouth.
• Sometimes she cannot breath for about 30 seconds, just a week ago she could not breathe for a minute.
• When she wakes up from her sleep she has a lot of mucus around her mouth and nose.
• She also pushes saliva from her mouth when sleeping.
• She really snores a lot it sounds like there is a lot of mucus in her chest.

I took her to see a family doctor whom I was hoping he would refer me to a respiratory specialist but did not. He gave me Zyrtec (used to treat allergies) and my girl is still having these problems. I am living in Martinsville, Virginia and I am hoping you will advise me on who to see around here and what to do.

Mavis

A. Dear Mavis, She may have upper airway obstruction during sleep. Sometimes this is from enlarged adenoids or tonsils. See a pediatric pulmonologist for an evaluation. Insist on it.

Dr. Tom

 

Problems with Skin
Q. I have been using Diavonex for psoriasis for last three months. Please suggest some permanent solution. I have psoriasis on scalp and some parts of the body.

Rajender

A. Dear Rajender, I am not a dermatologist and can not give you any advice.

Dr. Tom

 

How Severe is My COPD?
Q. Hi, Hope you don't mind another question. Just went to the pulmonologist yesterday, he has his licensed nurse check me. All she did was ask questions and did not even give me an exam. Just said to come back in September.

In June I had a spirometry, the results are:

• FEV is mildly reduced
• FVC is minimally decreased
• FEF25-75% shows severe reduction.

The static lung volumes are significant for increased RV, which is suggestible for air trapping. There is a mild reduction in DLCO. There is no significant reversibility after bronchodilators. Can you tell me exactly in terms of severity my COPD is?

Terri

A. Dear Terri, Forget the FEF 25-75% it is misleading. The other tests seem to be near normal. Go to a pulmonologist, NOT a nurse, who will explain what your results mean. They do not indicate severe COPD.

Dr. Tom

 

Where Can I Find Someone Who is Experienced in the Treatment of Adult Tracheomalacia
Q. My brother, age 55, has been diagnosed with Tracheomalacia (a weakening of the supporting structure of the tracheal cartilage).  He nearly died two weeks ago. 

A stent was placed in the trachea, but slipped down and caused problems, so today the stent was removed.  The doctor who performed the work has no answers or recommendations for my brother. 

Can you suggest a medical facility that has had experience in treating Tracheomalacia in adults? 

Allie

A. Dear Allie, Most medical centers have pulmonologists or thoracic surgeons who are experienced with tracheomalacia. In most cases, stents are helpful. Better consult another expert.

Dr. Tom

For more Q&A about Tracheomalacia, see Dr. Tom 46 in the archives.

 

Mistakenly Inhaled the Wrong Medication
Q. I accidentally put my Nexium (used for the treatment of acid reflux disorders) pill in my asthma inhaler instead of my Spiriva (a Spiriva capsule is placed into the “Spiriva HandiHaler) and inhaled it.

Three days later I had my scheduled breathing test and my DCO (Diffusion Capacity is a test used to determine how well oxygen passes from the air sacs of the lungs into the blood) was only 43% of predicted, DCO corrected was only 45%. Could the inhaled Nexium be the cause? The RCP Therapist (Respiratory Care Practitioner or Respiratory Therapist) had no idea what could cause it to be so low.

Debbie

A. Dear Debbie, You did not tell me what the DCO was before you inhaled the Nexium. I do not know what effect, if any, it would have. If you did not notice cough or irritation immediately after inhaling it, it may have not caused any harm. Be careful.

Dr. Tom

 

Good Place to Live for Asthma
Q. I moved to Sarasota, Florida to try to relieve my asthma, but even in the winter when it is dry, I'm having trouble.  I can't take most medicines, just albuterol and antihistamines.

Is there a clean place in the NC Virginia Mountains?  Where can I live where there is the cleanest air, best for asthma?  I'm thinking of going to Beckley, West Virginia to work for the summer, this is on the west side of the Appalachian Mountains.

Liz

A. Dear Liz, Beckley is a nice community. But there is no perfect place for all asthmatics to live. I recommend a trial residence.

Dr. Tom

 

How to Use Advair
Q. My six year-old son suffers from occasional asthma triggered by colds or allergies.  My pediatrician has him on Advair daily, and when he has an asthmatic occurrence-twice a day. 

She told me when his lungs are clear he can be on Advair only as needed.  My concern, is if he's been taking it nightly for almost a year, how do I wean him off safely?

Mary Rose

A. Dear Mary Rose, Better follow your pediatrician's advice on this. I believe you could start with just once a day for a couple of weeks, and then stop, but better ask the prescribing doctor.

Dr. Tom

 

Ground Glass Nodule Seen in CT Scan
Q. I received a follow-up CT Chest Scan without contrast three and a half months after the first.  It indicated that there:

• Is an apparent 4mm ground glass nodule adjacent to a vessel previously described as in the right upper lobe is unchanged. 
• An overlapping 1mm reconstructions, this appears to be within the anterior aspect of the minor fissure and may represent a small lymph node or focal pleural thickening.  This is unchanged in appearance. 
• No consolidation or mass.
• The central airways are patent.
• No adenopathy (large swollen lymph glands) or significant effusion (a pleural effusion is an buildup of fluid between the layers that lines the lungs and chest cavity).
• Heart size and pulmonary vascularity are normal. Images of the upper abdomen are unremarkable except for large gallstone, incompletely imaged.
• No aggressive osseous lesions detected.

Is this ground glass nodule dangerous?

Stephanie

A. Dear Stephanie, Probably not if it is stable for six months.

Dr. Tom

 

Best Place for Dad to Live
Q. My dad, 85, has been diagnosed with emphysema.  He currently lives in the Beaumont, Texas area.  I live in Tucson, AZ and am able to have him and mom move here.  Would it be better for him in this climate?

Shirley

A. Dear Shirley, There is no perfect climate for emphysema. Tucson is at about 2500 feet. I do not know the altitude of Beaumont. If Tucson is significantly higher, he may not do as well there, if he needs oxygen.

Dr. Tom

 

Pseudomonas Flare -Ups
Q. My daughter was born premature and spent her first 13 months in the hospital.  After some months we were told she had pseudomonas (an infection that can be resistant to antibiotics) and it grew in the airway from secretions.  She is now 19 months trached (having a Tracheotomy, an opening surgically created through the neck into the trachea/windpipe and ventilated (mechanical ventilator to assist with breathing).  She is on room air and weaning well, but the pseudomonas flares up often and causes setbacks. 

I realize now that I should get the exact names of the bacteria.  I am wondering if there is any chance that we can cure it, and if not what kinds of complications should I be prepared for.

Rhoda

A. Dear Rhoda, Pseudomonas may be an infection in the lungs, if there is significant lung damage, such as in bronchopulmonary dysplasia, a damage to the large airways and surrounding lung. Or it may just “live” in a tracheostomy site, and not be a real invader, causing tissue damage. Your own doctor will have to sort this out.

Dr. Tom

 

Could Small Leak Cause Wife to be Ill?
Q. My wife who is 36 years old has had a cough for about three months. It is kind of strange she may go two or three days feeling fine with no cough but by the third day she is having the dry feeling coming in her throat and making her cough. It causes her to spit up a white, thick, stringy looking mucus. She usually starts to wheeze in the throat after eating or drinking something and then starts spitting the mucus.

My question is could she be getting sick because we moved in to take care of her grandmother about six months ago. Her grandmother has an old home and under her house near her back room were we stay she has water standing there from a water leak that has gone without being fixed for several years. The leak is a very small one from around her bathtub and it drips under the house on the ground and just sits there. She also has some black looking mold that was on the wall.

We cleaned and painted over it when we moved in. Could this be a problem to my wife she seems to be sensitive to different things?

My son and I also get sick from time to time with vertigo symptoms and being sick at our stomach. The grandmother on the other hand claims to have never been sickened from the house.

If my wife is getting sick from the house will she get well if we move or could this stay with her if it is the problem. Hope to hear from you soon. Thanks for any help you can give us.

Ray

A. Dear Ray, Your wife may well be having a reaction to the molds in the house. This will go away when she is no longer exposed to molds. These reactions can be severe.

Dr. Tom

 

Nebulized Morphine
Q. What is the clinical absorption rate of morphine, inhaled via nebulizer?  What are the advantages of using morphine nebs (nebulizer) for end-stage COPD? 

Lynn

A. Dear Lynn, I do not have an answer. Morphine by nebulization is good to blunt shortness of breath in very advanced emphysema. Even if small amounts are absorbed, which is likely from the lungs, this will not necessarily be harmful. Oral morphine is commonly given in hospices and elsewhere, to blunt shortness of breath, and for comfort. It is a safe and useful drug.

Dr. Tom

 

Mucosal Cyst
Q. Dr. Tom, Thanks for all the time you have spent answering questions, it is such a help to us all.
I have been diagnosed with a mucosal cyst, via MRI, growing from my right bronchial. Recently I contracted bronchitis and coughed for four days straight. After this I coughed up blood for three days and told my GP. She took chest x-rays, said that all was clear and told me to come back if the blood did not stop and it did stop.

Since then I have had pain that started in my right ribcage, moved to my back (same area as front) and has now moved into my shoulder, including my right arm.

Could this be my ulnar nerve (a large nerve of the arm that passes around the elbow, and continues down the inner side of the forearm to the little-finger side of the forearm and hand) being pinched by the cyst or should I be concerned about lung cancer?

My right eyelid is also twitching. I am 32 and have smoked half a pack a day for 18 years, which makes me nervous. Can a mucosal cyst turn into cancer? Two Radiologists (a physician who interprets radiographs; x-ray, CT scan, MRI, etc.) have confirmed the initial diagnosis.

Chandler

A. Dear Chandler, A mucus cyst is not cancer. It can not cause the symptoms that you describe. When mucus cysts cause cough and bleeding, they need removal via a bronchoscope. Better see a pulmonologist if you remain concerned or have further symptoms.

Dr. Tom

 

Thyroid Gland Trouble
Q. Hi, I have many symptoms. I had Hashimoto (an thyroid gland condition that can cause hypothyroidism, lowered thyroid function) and I had a thyroidectomy, (surgical of thyroid removal of thyroid (a gland that regulate nearly every aspect of your metabolism) and parathyroid (produce a hormone that regulates calcium, phosphorus, and magnesium balance) removed about four years ago.

I have had positive blood test for pernicious anemia (a serious anemia that causes a decrease in hemoglobin content and red blood calls as well as vitamin B-12 deficiency). I had one year of B-12 shots and my test are in the normal range but I am tired and have severe panic attacks that come and go. I also have narrow angle in eyes and had laser eye surgery to open angles. My labs say thyroid level is .072 (TSH) and CO2 is one point high, cholesterol is 150, and triglycerides are 315.

I feel horrible. Do you have any suggestions about the thyroid level? Do you think there is room for taking more thyroids? Is it better to keep TSH at a lower number?

Barbara

A. Dear Barbara, I am not an endocrinologist and thus cannot give you a good answer. You need sufficient thyroid replacement. Your endocrinologist or internist can help adjust your dose.

Dr. Tom

 

Where is a Good Place to Live if You Have COPD?
Q. We would like to move in the next year although I have been recently diagnosed with early COPD. I would like to know what are some good places to move for someone with COPD? I was told Colorado was not good cause of the high elevation.

A. Dear Gina, Colorado is fine if you only have mild COPD. There is no perfect place for COPD patients to live. Live where you are comfortable. Try the area first.

Dr. Tom

 

Should I Worry about Smoke on the Walls?
Q. Can you please tell me if yellow walls that have smoke on them can still affect your health. I ask because I am doing a health fair project.

Justin

A. Dear Justin, No. No harm from walls stained with cigarette smoke, except it stinks.

Dr. Tom