X-Ray Shows Pleural Thickening, Should I be Concerned?
Q. I recently had a chest x-ray and although their
impression was “no evidence of acute disease
in the chest”, one of their findings was "there
is mild apical pleural thickening". Can you
please tell me what that means and if there's reason
to be concerned? I smoked for 30 years, and quit
2 and a half years ago.
Jane
A. Dear Jane, This report is not specific for any
diagnosis. It suggests that you had some inflammation
in the upper part of your lung in the past.
Dr. Tom
Worried About Nagging Cough and Wheeze
Q. I am a 49 year old female, in good shape, and
active. Recently, the past three weeks, I have a
nagging dry hacky cough. It wakes me up at times
in the middle of the night. I am also occasionally
hearing a small wheeze on taking in a deep breath.
When I exercise (walking fast on treadmill), I feel
like my lungs aren't as healthy. Should I seek medical
attention or ride it out?
Diane
A. Dear Diane, You did not say if you smoke. If
these symptoms last more than two weeks, see a doctor
and get spirometry (see National Lung Health Education
Program at: https:// www.nlhep.org/spirom1.html ).
If you smoke, stop.
Dr. Tom
Lungs Ability to Regenerate after Second Hand Smoke
Exposure
Q. I am curious on the lungs capabilities, if any,
to regenerate or cleanse itself. If exposed to smoke
(second hand in my case) will the lungs, after continued
non-exposure to smoke begin to repair, or is the
damage that may be there permanent, without treatment?
I'm not experiencing any problems and I've never
taken even a puff of any cigarette but was exposed
when I was younger and was curious as to its potential
long lasting effects?
Chad
A. Dear Chad, Most lung injuries from second hand
smoke heal after exposure ends. You may want to
have spirometry (see National Lung Health Education
Program at: https:// www.nlhep.org/spirom1.html )
to see if your lung function is normal.
Dr. Tom
Need Advise on Where to Get Help for Weaning Mother
off the Mechanical Ventilator
Q. My mother is 73 years old and has chronic emphysema
(diagnosed about 5 years ago). Approximately 1 year
ago she fell and broke her hip. In order to perform
necessary surgery on her hip the doctors had to
intubate (the placement of a tube into the trachea
to keep airway open and can be connected to a mechanical
ventilator) her and she spent the next two months
in the hospital and the facility was making progress
with her ventilator weaning.
We were told that she needed to be put in a LTC
facility (Long Term Care facility) for further treatment.
Once in the facility, all efforts to wean her (from
the ventilator) seemed to cease instantly. When
we questioned her pulmonologist he simply claimed,
"she is not a candidate for weaning.”
As a result, my mother is experiencing a living
hell being connected to the ventilator and my family
is being destroyed financially. Any advice you can
give us would be welcome. Are there facilities in
the Rockland County, NY area where we can transfer
her to get more aggressive treatment to come off
the vent and get her life back?
Joseph
A. Dear Joseph, Most such patients can be weaned
from the ventilator, even after this period. Transfer
you mom to a facility that will do the necessary
weaning. Kindred Hospitals are good, as are others.
She has more than a 50% chance of being weaned.
These delays in weaning disturb me greatly.
Dr. Tom
Extra Resources to Finding Quality Care:
Lung Health Online Finding Care
Specific Topics you may find helpful in the YLH
Finding Care Sections are:
“Quality Respiratory Care Recognition”
Means First Rate Respiratory Care”
The purpose of this program is to help consumers
make choices about their health care by recognizing
hospitals that promote patient safety by providing
access to respiratory therapists to deliver their
care. The AARC maintains and publishes a database
of long term care facilities that meet a specific
set of requirements.
List of Long Term Care Facilities
Medicare's Nursing Home Compare Tool
The primary purpose of this tool is to provide detailed
information about the past performance of every
Medicare and Medicaid certified nursing home in
the country.
How to Go About Presenting New Product Ideas
and Retain My Intellectual Property Rights?
Q. I've been in working in the HME/RT (Home Medical
Equipment/Respiratory Therapy) arena for over 18
years. I have developed some ideas that have not
yet been utilized to improve the delivery of portable
oxygen to patients in their homes. How can I share
my ideas with a manufacturer or potential investor
(to see if they are viable), and yet protect my
intellectual property rights?
Brian RRT
A. Dear Brian RRT,* You can approach them and ask
to sign a nondisclosure agreement. If you have something
of value, you may want to patent it with an attorney,
or an interested manufacturer could do this for
you following the agreement.
Dr. Tom
* Registered Respiratory Therapist
Is Important to Identify Bacteria Type Before Starting
an Antibiotic?
Q. At the start of an infection in a bronchiectasis
patient, is it important to identify the bacteria
before starting antibiotic treatment? Or is it better
to start a wide spectrum antibiotic first, then
identify if not effective? Which is the best method?
Paul
A. Dear Paul, Empiric use of antibiotics is the
norm here. There may be more than one organism active
in bronchiectasis. Broad-spectrum antibiotics can
deal with the most common bacterial invaders in
bronchiectasis.
Dr. Tom
Oxygen Needs for Lung Patients who are Flying
Q. Could you explain to me, in detail, how to know
if a patient with COPD or any other lung disease
who is on supplemental oxygen at home needs more
oxygen if they are taking a flight.
Also if you could send me some articles regarding
this subject.
P.S. I am a resident.
Alan
A. Dear Alan, All passengers will need more oxygen
at the 8,000 to 10,000 feet cabin altitude. Look
up Dr. Jamie Stoller's article on air travel and
the COPD patient's requirement for supplemental
oxygen. Dr. Tom
Oxygen and Air Travel. James K Stoller MD. Respir
Care 2000;45(2):214-221
Doctor Says I Have Asthma but I Don't Have
Asthma Symptoms
Q. I am a 42 year-old male in good health. I just
had a physical and mentioned that I have noticed
I don't have the lung capacity that I used to when
performing aerobic exercise like running and wrestling.
My doctor gave me a spirometry test, which he says
indicates asthma and the lung condition of a 63
year old.
I don't have any other symptoms like coughing or
wheezing and don't experience asthma attacks. I
was prescribed albuterol (bronchodilator, rescue
drug) and QVAR (inhaled steroid, maintenance/control
drug), but I am hesitant to take either because
I don't think I really have asthma.
Can a spirometry test show a false reading indicating
asthma if one sustains the breath too long rather
that exhaling as quickly as possible? What other
tests should be done to confirm this diagnosis?
Also, what damage can I do to myself if I take QVAR
and albuterol and don't really need?
Peter
A. Peter If you use the albuterol and QVAR and get
spirometry done again, it may show significant improvement.
This would confirm the suspicion of asthma.
Dr. Tom
Husband's COPD and General Health is Out
of Control and He Continues to Smoke
Q. My husband is 61 years old and has emphysema
and COPD, he is on O2 and takes breathing treatments,
he still tries to work but he is going on the hospital
on a pretty regular basis, once a month and this
last time it was two weeks apart.
He still smokes and I can't get him to quit. He
has high blood pressure, depression, and now is
no longer hungry said if he eats then it's hard
for him to breath.
Is the end near? I am so worried about him and I
just need to know what to expect will it get worse
than what it are ready is.
When he has an attack he can't breathe and he gets
real scared and this time his blood O2 saturation
was 83. That's the lowest it's been. I just need
someone to help me, please.
Beth
A. Dear Beth, Your husband is probably heavily addicted
to nicotine and smoking. He needs to quit with the
aid of a physician and nicotine replacement as well
as a drug that helps to deal with depression and
nicotine withdrawal. Discuss this with your doctor.
Dr. Tom
Why is a Tracheotomy Needed for Using a Ventilator
at Home?
Q. My sister is currently in the hospital from an
asthma attack complicated by her emphysema. She
had an additional attack in the hospital and can't
seem to breathe on her own after two weeks. The
doctor mentioned a possible tracheotomy ( an opening
surgically created through the neck into the trachea/windpipe
) where she will be on a ventilator at home. I don't
understand why she needs a tracheotomy if it is
her lungs that are the problem? Could you explain?
Shan
A. Dear Shan, The tracheostomy is more comfortable
than a tube in the airway. It will allow for eating
and talking, and is a better tube for suctioning
secretions. She can be weaned from the ventilator
in time and the tracheostomy closed, when her lung
function improves.
Dr. Tom
Treatment for Lungs Vasculitis
Q. What can be done for vasculitis in the lungs?
I am on prednisone 40mg. and 3 liters of oxygen.
Pulse oximeter drops from 99% saturation to 86%
saturation if oxygen removed. Any suggestions would
be helpful.
Sally
A. Dear Sally, There are several forms of lung vasculitis.
You need a more specific diagnosis. See a pulmonologist.
There are other immunosuppressive drugs that can
be used.
Dr. Tom
Diaphragm is Paralyzed, Any Chance that
I Will Not Need Supplemental Oxygen?
Q . I am currently on oxygen 2 liters. My problem
is my diaphragm is paralyzed thus my left lung is
40% and my right 85%. Is there any medication to
take other than oxygen to keep my blood oxygen at
a safe level, so I do not have to rely on the oxygen
100% of the time?
William
A. Dear William, No, but the oxygen you use can
be portable and you can have a normal life style.
Dr. Tom
