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Archive: Dr. Tom 60
Would Like Help in Understanding CT Scan Results Katrina A. Dear Katrina, This means an old scar, or possibly some obstruction of a lung region. It needs to be followed up at least one more time with a repeat CT in three months. Sometimes it is necessary to explore the area by bronchoscopy which is placing a flexible tube within your airways. A pulmonologist woud be the one to do this if needed. Dr. Tom
Question about Amoxicillin and Bronchitis Emily A. Dear Emily, Amoxicillin is generally taken twice daily for five to seven days. It is not for acute bronchitis, but plays a role when there is bacterial invasion. Ask your doctor. Dr. Tom
Drug Compatibility Eleanor A. Dear Eleanor, Yes. The INR (International Normalized Ratio, a laboratory test that measures the time it takes for a clot to form) for Coumadin needs to be monitored. Dr. Tom
Question about Lung Test PFT results edited, see spirometry commentary. FVC 96 IMPRESSION: Dee A. Dear Dee, I disagree, these tests are all normal. Dr. Tom
Would Like Opinion on Exercise I have been advised to not ride the bike for 12 minutes, rather, ride it twice a day for 10 minutes each time. I was also told not to increase the time over 12 minutes, although, I feel ready and willing to do so. I am 73 years old and am currently on 2L of oxygen for 24 hours. What is your opinion on my exercising with the stationary bicycle? Thank you! Rose A. Dear Rose, Bicycle exercise is okay, but not as useful as normal walking for the same period of time. Dr. Tom
Clamping Endotracheal Tubes when Disconnecting from Mechanical Ventilator Will clamping the ET tube help with loss of PEEP and are there any studies to support it? Tracy R May RRT A. Dear Tracy, I do not know how you can breathe for a patient with a clamped endotracheal tube. I must be missing something. Dr. Tom
How Does Bronchitis Look on Chest X-Ray? Nikki A. Dear Nikki, It looks normal. Dr. Tom
Concerned About CT Scan Follow-Up Reports I had a chest x-ray a year ago January 2005 in which they saw a small “something” in the left lung. A CT Scan was ordered and they didn't see anything in the left lung, but found a “nodule” measuring 3 mm x 5 mm in the right lung. A follow-up in March 2005 found no change in the nodule. “No other nodules seen.” A follow up was done in six months, October 2005 with these findings: “the 3x5 mm small nodule in the lateral segment of the right middle lobe is again identified. It measures approximately 3 mm x 6 mm. This is a very slight increase in size. The change, however, is enough that it may be simply due to partial volume averaging and a slight change in position. I do not think this is a significant change. I do not see any new nodules in the lungs. There is no mediastinal lymphadenopathy. I recommend a repeat exam in 6 months.” The follow up on 4/10/06 with the following findings: “Again within the right lobe, a 6 mm nodule is seen. This is unchanged in appearance. There appears in the last CT, to be some calcification within this nodule, suggestive for granuloma. There is actually a small nodule within the right lower lobe superior segment just posterior to the major fissure, which is unchanged in appearance since the patient's previous study in October. This measures 2 mm in size. On today’s study in the left lobe, superior segment, 5 mm non-calcified nodule is seen. This was also present previously and has not changed considerably. A very small non-calcified nodule is seen in the right upper lobe, posterior and laterally. This is very small in size, suggestive for benign process. Impression: Several small nodules dispersed throughout the lung which have not changed considerably since previous study. This is suggestive for benign process. Recommend follow up in one years time”. Now, forgive me for being dense, if I am, but didn't the first reports say there were “No other Nodules,” then this report refers to several on going? Should I be concerned, since they reports seem to be inconsistent, and maybe get some other professional involved in this, or just ignore it? Forgive me for rambling, but this has me a little concerned. Sandie A. Dear Sandie, The other nodules must have been there all the time, but not appreciated. I agree that a one-year follow-up is all that is needed. All of these nodules are probably benign, and are most likely due to granulomas, which are residuals of common fungal involvement. These are very common in the Ohio and Mississippi Valleys. Dr. Tom
How Can I Get a Copy of Adventures of an Oxy-Phile? Thank you! A. Dear Rose, This book is available for the cost of packaging and mailing from the AARC. Dr. Tom
Asthma Symptoms Worse Since I Quit Smoking Have you heard other asthma patients complain of their asthma getting worse after they quit smoking? Debby A. Dear Debby, Yes, a variety of things can trigger asthma. There is no reason that smoking would ever help asthma. Dr. Tom
Bad Taste in Mouth After Taking Amoxicillin Jane A. Dear Jane, This should not be a side effect of the medicine. Ask your dentist for an explanation. Dr. Tom
Questions about Mycobacterium Avium Intracellulare (MAI) Having recently heard about similar symptoms and the MAI bacteria, is it possible that this could be “the silent epidemic” referred to in a recent news piece? What studies should my doctor do to rule out this bacteria and should he be open to my questions about it? Cathy A. Dear Cathy, There is no particular reason to believe that this adult onset asthma is related to environmental mycobacteria. You can have sputum cultures for this possibility if your doctor believes this is a possibility. Dr. Tom
Very Worried about Sister in Law’s Severe Lung Condition She didn’t meet any poisons. She stayed at home and never touched any chemicals and heavy metals. In fact, she is 28 and was very healthy in the past five years. And she got new baby two months ago. A week ago, she coughed and a small block of blood came out from her lung and then she was sent to a Chinese hospital. At first, Chinese doctors thought she got tuberculosis because they found two small dark dots in her lungs. But they were wrong. Five days later, situation became severe. When they took x-ray for her again, they found all parts of her lungs were completely filled with blood. The doctors diagnosed she got vein disease in the lungs. Now she just has 50/50 chance to get a new life. My brother is very anxious about that. Do you have any suggestion on her disease? Are there any good medications to help her back to normal? Jim A. Dear Jim, You need a diagnosis from a pulmonologist. She may have an abnormality in blood clotting that is causing lung bleeding. Or there may be a local cause in the lung. She may need a bronchoscopy to put a flexible tube in the air passages to look for an abnormality, or CT scans to pinpoint where the blood is coming from. There are many possibilities. Dr. Tom
Please Recommend Physical Therapy for Patient’s Receiving Mechanical Ventilation Haytham A. Dear Haytham, Your question is too broad for a simple answer. There are physical therapy texts on technologies for ventilated patients. Dr. Tom
Proper Treatment of Bronchiectasis I have had this condition for about 20 years but for the past year, the CT Scan showed more scarring and air trapping. I am constantly coughing so that it is difficult to sleep. I understand that with this condition we should not take anything to help us sleep. I am not on oxygen but seem to have difficulty in using any of the bronchodilators. My pulmonologist is trying different bronchodilators but I seem to cough more on them. Is Mucinex worth taking to thin out the mucus? My biggest problem is trying to sleep. I have to always sleep on the left side, never on my back, as I have a coughing spasm. My latest inhaler was Spiriva, but it made me blurry. I am 75 years old but otherwise healthy and exercise every day with weights and walking. Jean A. Dear Jean, Bronchiectasis is treated with bronchodilators and antibiotics for infections. Generally the symptoms can be controlled. See a pulmonologist who is expert in treating bronchiectasis. There are many treatment options for bronchiectasis. Dr. Tom
Feels that Doctor has Left Her Hanging Jeannine A. Dear Jeannine, See a doctor who will explain things to you and get you on a treatment plan. I suggest a pulmonologist. Dr. Tom
Have Exercise Induced Asthma and are Experiencing Severe Shortness of Breath I have now gotten to where eating a small meal or walking up a single flight of stairs leaves me very short of breath. I feel like there is a brick laying on the right side of my chest. I have had spirometry, which appeared to have normal values and a chest-x-ray that showed enlarged lungs. I have consistently demonstrated oxygen desaturation after light exertion from between 87% to 93% from a resting of 99%. My question is; are these symptoms are consistent with exercise asthma, and if such a sudden onset of severe symptoms is common with the disease? Also, I suffer from Raynaud's syndrome (exposure to the cold or strong emotions trigger blood vessel spasms that result in interruption of blood flow to the fingers, toes, ears, and nose), however lately instead of the cold, white hands and feet, my hands and feet have been purple with blue nails. Several days I have woken up with blue lips. As this is a new diagnosis any information or suggestions would be very helpful because I have no insurance and am only being seen at the clinic where I attend university. Amy A. Dear Amy, You probably have more than just exercise-induced asthma. There are many possibilities. See a pulmonologist for a diagnosis and treatment. Dr. Tom
Worried about Having Lung Cancer I went in January 2005; I did not want to wait 6 months. I happened to go to a lung doctor instead of my doctor. He did not seem really concerned. When my second CT scan came back he said they got smaller and there was no need for any more CT’s. Even on the report from the imaging center they did not recommend anymore. When Dana Reeves got lung cancer I went in August and asked for another one to be sure. The doctor said it was not needed but if I want another one to wait a year because of all the radiation. I am going back this week to see the doctor and letting him send me for one more. I don’t smoke, really never did—only when I went out drinking socially but not even a pack a week maybe had a few if I drank on weekends but that was about eight years ago. I did hang in bars a lot and my family all smoked so I lived with smokers. I also have had a little breathing problem for years. My breathing test was a little off but he said not really much at all. I have sinus problems and allergies. I also have nodules on my thyroid. I am worried because I read if you have nodules they should be checked every couple of months up until two years. I hope my doctor knows what he is talking about. He said you see different things in a CT scan letting you know if they are cancerous. Do you think I should be checked again and how fast do nodules grow? Angel A. Dear Angel, The small nodules that are decreasing in size do not need further follow-up. Dr. Tom
What Can I do to Slow the Progression of Emphysema and to Feel Better? I am an ex-smoker: quit in 1999. My lung function tests say I only have 31 percent lung capacity. I am still very active in my job and at home, just slow. I recently took an oxygen meter home to be tested overnight and the results were between 90 and 91%. I am currently on no oxygen or medication, just a lot of vitamins: C, A, E, and N-Acetyl-L-Cysteine. Is there anything else I can be doing for myself that will help me feel less worn-out, and might slow the progression of the emphysema? Barb A. Dear Barb, You may benefit from a pulmonary rehabilitation program. It can help your symptoms a lot. Consult your pulmonologist. Dr. Tom
In Hospice and Having Pain and Nausea, Any Suggestions? Brenda A. Dear Brenda, I cannot diagnose the cause of your symptoms from your description. Sometimes simple gall bladder drainage is possible, if there is infection. Get more details from your doctor. Dr. Tom Pain Control:
For Families and Patients (PDF) What Can I Do About Nausea and Vomiting?
Questions about Albuterol and Combivent
A. Dear Marie, Albuterol is one of the two drugs in Combivent. The other medication is ipratropium. The duration of action is 4-6 hours. Dr. Tom
Wife has Just Been Diagnosed with Bronchiectasis David A. Dear David, Here are some websites that can give you information about Bronchiectasis. Patient Web Sites for Bronchiectasis National Heart, Lung, and Blood Institute Dr. Tom |
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