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 Archive: Dr. Tom 68
Acetylcyteine and Cystic Fibrosis Q. I was impressed that you somewhat concur with my choice to continue taking N-Acetylcysteine (NAC). It seems every article I can find on it, is positive, and for many different conditions. Although I do not have Cystic Fibrosis, some of the characteristics of my condition are similar, and I thought this article may be of interest to you. I believe NAC is an amazing, unprescribed multi-purpose anti-oxidant. I feel great! Armand A. Dear Armand, There is a good rationale for acetylcysteine in chronic mucus hypersecretion states, and probably other lung diseases. Dr. Tom Pressure Around Chest Could this be Serious? Q. I often experience pressure and tension around my upper chest, shoulder blade and middle back areas. It appears to begin (sometimes) not long after rising from bed and even sitting too long. I often try to sleep elevated upright with about three pillows because I have a history of back discomfort throughout the night from sleeping on surfaces like a mattress. Gabriel A. Dear Gabriel, The fact that your symptoms are less during exercise is reassuring. I do not believe your symptoms are due to scarring from influenza. Dr. Tom Could Myasthenia Gravis Cause Hyperinflation of the Lungs? Q. I have had Myasthenia Gravis (MG) (a disease in which the immune system attacks the body’s own tissues) for 22 years and often have chest tightness, shortness of breath with little exertion (talking or climbing a small flight of stairs), a cough which is worse in winter, I have fatigue and have lost 12 pounds in the past 2 years. I have been waking up some nights gasping for breath, especially, after a work out at the gym. Karen A. Dear Karen, No, MG does not cause hyperinflation of the lungs. The diagnosis of hyperinflation by chest x-rays is not accurate and is pretty insignificant. Dr. Tom How Can I Get Rid of a Chronic Cough? Q. I’ve been diagnosed with Chronic Pneumonitis (an inflammation in the lungs). I’ve had a bronchospopy (a diagnostic procedure in which your doctor uses a scope, a tube with a camera on the end, to take a look at the inside of the airways and lungs. Lung tissue biopsies can be obtained during a bronchoscopy), and needle biopsy as well as a surgical biopsy. All showed no signs of cancer. However, I still have an 8cm mass in the right lower lobe of my right lung. Loretta A. Dear Loretta, The large mass needs an explanation. See a pulmonologist. It needs a biopsy or removal, if it cannot be otherwise explained, in my opinion. Dr. Tom Any Precautions for Travel to Armenia? Q. I have asthma and I want to travel to Armenia located by Turkey and Iran. Would it hurt me to walk the streets in that country if I have an inhaler? A. Dear Meredith, No. Just use it as you do regularly. Dr. Tom Also see: Apical Scarring and Shortness of Breath (Four Questions) I. Q. I was a crime victim about a month ago. The doctor who treated me at the ER recommended several CT scans, one of them was a CT of the cervical spine. II. Q. I had a cat scan in October 2005. I was told I had some lung scarring on the right upper lobe. I am a smoker for 25 years and I have been trying to quit. I am very concerned about what this can turn into. I have been having a lot of shortness of breath lately and have suffered with heart palpatations for some time now. The cardiologist can't find anything wrong with my heart. I do have a lot of anxiety and panic attacks at times. How worried should I be about the lung scarring? III. Q. What is biapical scarring? And is it dangerous? Is it curable? IV. Q In my myelogram (X-ray or CT scan of the spine) report, incidental note was made of minimal biapical scarring demonstrated of the imaged upper lungs. What does this mean? Is it dangerous? What could cause it? Magdalia, Karen and Sharon A. Dear Magdalia , Karen and Sharon, The apical (top part of lungs) scarring on both lungs, may not have any significance other than it could be a result of some remote infection. It does not require any further attention, unless your doctor suspects something more. Dr. Tom Poor Spirometry Results but I Feel Good Q. Could you answer this? My spirometer test was poor, but it was my first time and I found this test to tax even an Olympic sprinter. I am on Spiriva and bricynel, and I have good stamina. I start my day at 5am and sometimes finish at 8pm. Phil A. Dear Phil, The results may be inaccurate. The test should not be stressful. I wonder what tests were done. Dr. Tom Mold and Swamp Coolers Q. I have been looking for information on the growth of mold and mildew, bacteria in "swamp coolers" and its effect on people with COPD. Rusty A. Dear Rusty, If, molds are present they can cause allergic reactions in the lungs. The molds need to be removed. Dr. Tom Worried about Mother’s Health Q. Hi, My mom age 62 recently lost my father after 44 yrs of marriage and isn't coping well at all. She has severe COPD, oxygen 94%, SOB, and breath sounds? She is 5' and has been losing weight rapidly since dad passed, weighing only 78 lbs, I'm starting to worry. Sandy A. Dear Sandy, Your mom needs to see a pulmonologist and get a handle on her problem. Certainly she needs treatment and must stop smoking if she can. She may also be depressed. Dr. Tom Can Oxygen Cause Shortness of Breath? Q. I was put on oxygen 7 months ago after a bout with bronchitis, and a lung test that showed low oxygen levels (85). Was told that this was temporary, but am still on oxygen, and breathing has gotten much worse. Can oxygen therapy cause problems if you receive it when you don't really need it? Shirley A. Dear Shirley, No. The oxygen will not cause breathing problems. You need to be assessed to see if you really need it. Dr. Tom Questions about “Spots” On/In Lymph Nodes Q. My mother is 69 years old and has emphysema; she has been on oxygen for about 6 or 7 years now. She just went in for test results last week and was told her lung capacity is now 30%. She had a CT scan of her chest, and she was told that she had "spots" on/in her lymph nodes. They told her to come back in three months and they would do another CT scan, and she was told that they would not do surgery to have anything removed. Debbie A. Dear Debbie, Although there is a strong relationship between emphysema and lung cancer, the report of "spots" on her lymph nodes is not at all certain. Your doctor will have to determine if they need to be pursued further. Patients with poor lung function can often still have surgery to remove associated lung cancer. Dr. Tom Numbness and Heaviness in Legs Q. Hi, Mum is in last stages of COPD don't think she has too long left with us now. She has developed numbness in legs and very heavy what could this be? Julie A. Dear Julie, This could be a result of the advanced COPD, but this is not certain. I cannot speculate further. Ask your mom's doctor. Dr. Tom How to Deliver Oxygen after a Laryngectomy Q. I had laryngectomy (is the partial or complete surgical removal of the larynx) surgery last year and now my COPD has flared up. Do you know of any way for me to receive oxygen without using a cannula? I should be on it 24/7 but I am presently using a child's size mask hung around my neck on an elastic cord. It is not very satisfactory. My doctor has written me off as "good as dead” and does not even wish to see me until November. In the meantime, his nurse is happy to renew prescriptions for both antibiotics and steroids - neither of which my doctor has ever discussed with me. PLEASE HELP ME! I stopped smoking and everything is falling apart!! A. Dear Margaret, It is quite practical to give oxygen directly to the laryngectomy opening, with a small mask. You may want to use a humidifier with this set up. Ask your oxygen supplier about this. Remain positive. Dr. Tom Could Shortness of Breath be a Side Effect of the Drug Eligard? Q. Dr. Tom, I have emphysema but this is a question concerning a drug I take for prostate cancer. Tony A. Dear Tony, I do not know much about Eligard. The physician's desk reference does not report shortness of breath, but it may be a possibility. I do not know a substitute. Ask your urologist or oncologist. Dr. Tom Would Like Answers to Treatment that My Brother Received after Surgery Q. My brother recently passed away after an aortic root replacement. After surgery the doctors worked for hours trying to get his lungs to expand and accept air from the ventilator. During this time they were giving him massive doses of bicarbonate soda. At first this would work for approximately 10 minutes, but as time went on the length of time decreased until finally it worked no longer and he passed. Can you please give me all of the who, what, when, where, and why’s of this procedure? Thank you very much. Tina A. Dear Tina, I suspect he had damage to the origin of the aorta that required surgery. It may have been a long operation with blood loss and shock. This may have caused a lung injury called the Acute Respiratory Distress Syndrome. I suggest you discuss this with the surgeon. Dr. Tom
Love Triking But Wonder about Road Exhaust and Whether a Respirator Would Help Q. I have COPD and Sarcoidosis. The Sarcoid was diagnosed through an open lung biopsy. I've discovered the recumbent trike for exercise, fun and better breathing. The problem is vehicle exhaust...it chokes me and makes me wonder how much more damage am I doing to my lungs (fibrosis and granulomas scattered evenly both lungs) inhaling all the road exhausts AND what respirator will filter vehicle exhaust best? Sharon A. Dear Sharon, It is possible that vehicle exhaust, particularly from diesel, may cause lung irritation and injury. A high efficient filtration mask may help, but sometimes they have such resistance that deep breathing may feel restrictive. Dr. Tom Questions about Mother’s Care in the Last Day of Her Life Q. My mother was hospitalized for four weeks with COPD and was using an oxygen mask the last week of her life and on morphine I.V. as needed. Sharon A. Dear Sharon, In general oral morphine is not as rapidly effective as intravenous morphine. Morphine is useful at the end of life to reduce suffering. I do not know any reason to change from it. Oxygen can be given many different ways. I feel it is likely that your mother knew of your presence and died in peace, in spite of what you observed. Dr. Tom No Growth of Spot in Nine Years Q. Dr Tom, this is the question I submitted but I never asked you. What cause this spot to grow from 5m to 9m in 4 years. In 1997 I had a 5 m spot on my lung. In 2002 a CT scan showed the same spot. Because it didn't grow, they said likely a granuloma. Last month I had another scan and this spot measured 9 m. My question, since I can trace it back 9 years of being there what's the chance of that spot being cancer? Liz A. Dear Liz, Essentially no chance. Some benign lesions such as hamartomas, grow very slowly and are always benign. Dr. Tom Breathing Exercise Q. I would like to know, if you know of any "exercises" or therapy, for the following: I want to change my breathing patterns. I inhale and "hold" (for lack of a better term) and talk out, and eventually breath out. So, I am breathing in while talking (or holding my breath, to some extent) instead of exhaling. I have been doing this for a long time, so I would like to change this pattern? Any thoughts or suggestions Bill A. Dear Bill, I suggest a rapid inhalation and breathing out slowly against pursed lips as in whistling. Dr. Tom What Can I do About Air Hunger? Q. I have mitochondrial myopathy (neuromuscular disorders in which the primary symptom is muscle weakness due to dysfunction of muscle fiber), which has affected my respiratory muscles. As a result of the NMD, I have air hunger. Do you have any helpful suggestions on how to deal with the air hunger? It is very frightening. Sometimes these episodes last for a while. Linda A. Dear Linda, It is reasonable to use oxygen and low doses of tranquilizers or narcotics such as codeine, under the direction of your doctor to help reduce these uncomfortable symptoms. Dr. Tom Would Like to Get Off Prednisone Q. My FEV1 is <12% and is very poorly managed. After many courses of prednisone therapy, I have weaned myself to 10 mg alternate days. I would like to wean completely, but my pulmonologist said I'm destined to be on that dosage for life (he is a wonderful man, but depends on large doses of prednisone too quickly). I also use pulmicort inhaler, and the usual neb meds. Clare A. Dear Clare, It is likely that the prednisone is doing more good than harm. You may need to continue with it to keep on going. Dr. Tom
Husband Still Smokes, Is Albuterol O.K. for Him to Take Q. My husband is a smoker and sometimes has chest pains like he is short of breath. Is it ok for him to use albuterol through a breathing machine as with asthma patients? Sharon A. Dear Sharon, It is okay and safe, but it will not do as much good if he continues to smoke. He should completely stops smoking. Dr. Tom Results of X-Ray are Worrisome, CT Scan is Recommended Q. I just got chest abnormal chest x-ray results and a CT scan is recommended. I am a 13 year breast cancer survivor, DCIS-non invasive (Ductal Carcinoma In Situ breast cancer that stays inside the milk duct of the breast in which it started). The findings on the x-ray: asymmetric subpleural nodular opacity in the right apex, indeterminate. The lungs are hyperinflated. No pleural fluid. Jane A. Dear Jane, There are multiple possibilities for these shadows. They need a follow-up. Dr. Tom Lung Problems and Can’t Get an Dr. Appointment for Three Weeks Q. I went to the ER on Thursday for chest pains and shortness of breath that started two days prior. CT scan showed alveolar collapse in both lungs. One week later I am still experiencing the chest pain and shortness and painful breathing. I cannot get an appointment with a pulmonogist for three weeks - what should I do? I am in pain and very concerned. Thank you! Elaine A. Dear Elaine, Insist on seeing one sooner. Someone in your area should be available for urgent appointments. Dr. Tom Choosing Breathing Devices Q. Can you tell me when you would use Ez Pap instead of Incentive Spirometry or IPPB. What patient would be an ideal candidate for Ez Pap therapy? Should Ez Pap be chosen for COPD patients over Incentive Spirometry because of the positive airway pressure? A. Dear Respiratory Student, There is no set recipe for the use of these devices that are intended to help expand the chest. Dr. Tom Define Physiological Abnormalities of the Lungs Q. Dr. Tom, here is what I've learned in school and in the field. Examples of V/Q mismatch and pulmonary shunts: emphysema, bronchiectasis, and chronic bronchitis examples of V/Q mismatch--atelectasis, P.E. examples of pulmonary shunts. Could you possibly go over these two different physiological abnormalities in the lungs? Thank you in advance for your willing to share your admirable knowledge to us. Efrain A. Dear Efrain, Ventilation-perfusion matching is designed to put the airflow where the blood flow goes in the lungs. In diseases of the airways, there is usually a disruption of this matching. Dr. Tom Nebulized Saline for Pediatric Patients Q. I would like to know the updated recommendations of using nebulized saline (only) in pediatric patients. I can't seem to find information on it at all. Cathy A. Dear Cathy, Nebulized saline is used to stimulate cough and mucus flow. You will have to look up the various recommendations. Dr. Tom Noncalcified Nodules, Should I be Concerned (Two Questions) I. Q. My CT scan was found to have two non-calcified nodules in right lung. 5mm. unchanged since 2004 and to have follow-up CT in Sept. 2006. Could these be cause for concern? II. Q. Dr. Tom: I had a CT scan done in Sept. 2002. Quite by accident I was found to have 2 nodules in my right lung, approximately 5mm and one 13mm. Subsequent CT in 3 mos. and six months showed no change, except at the 6 month CT scan a nodule was found in the left lung. Was told this new sub centimeter nodule could have been missed previously due to how scan was done. At yearly CT in Sept. 0f 2005 no change in right lung and no mention of nodule in left lung. Was told to have repeat at the 2 year mark in Sept. 2006. Carol and Carol A. Dear Carols. Do not be concerned about these small non calcified nodules that are stable at two years. They are almost certainly benign. Dr. Tom Rybarvin is not Made Any Longer, Is There a Substitute? Q. I have been using Rybarvin inhalant or its equivalent for about 68 years. It was administered with a Riddopag inhaler. Is there another liquid inhalant available? Ernie A. Dear Ernie, I do not know about your old inhalant. I doubt if it was very effective. The newer ones you are using can cause dry mouth, but not unusual dreams. Dr. Tom Chest Congestion after Taking Friend’s Zoloft Q. Hello. I am 27 and a smoker of 15 years. Recently, having been under quite a lot of stress, I began taking a friend's sample pack of Zoloft (antidepressant). Less than a week later, I began suffering from a lower back pain that would wake me after a few hours sleep. It was sharp and acute and came and went with the timing and intensity of my breathing. I immediately stopped taking the Zoloft. Joshua A. Dear Joshua, Do not take Zoloft without a doctors's prescription. I do not have an explanation for your symptoms, based on the information you present. Dr. Tom Worried about Friend’s Lung Health and the Recommended Procedure to Clear the Lungs Q. Dear Dr. Tom, One of my friends in Sri Lanka is a Buddhist monk with a condition that requires a hospital procedure. The Doctor Writes; Michael A. Dear Michael, I believe the "doctor" is misleading the monk, that a procedure will remove the mucus from the lungs. Dr. Tom Pain in Chest and Worried it Could be Cancer? Q. I am a 28 year-old male and have been smoking 1 pack a day since I was 17. For a about a month now I wake up in the morning with lung pains mainly on my right side. I have totally stopped smoking 5 days ago, and the pain is still there. I have no cough, I don’t think I have any shortness of breath, I have had a chest x-ray but have not seen the results yet. Brian A. Dear Brian, I do not know the cause of the pain. It is not lung cancer at your age. You should stop smoking anyway to save your health. Dr Tom 33. Possibly Moving From Tampa to San Antonio, What are your Thoughts for my Four Year Old with Asthma? Q. Dear Dr. Tom, thank you for taking my question. I live in Tampa Florida with my son (4 y/o) who has asthma. First diagnosed when we moved to this area from Germany. Cari A. Dear Cari, San Antonio will have its own allergens, but it is not a damp moldy place. Your son should do fine there. Dr. Tom Lungs Ability to Regenerate after Smoking 20 Years Q. What are the facts with regard to lung regeneration once you are successful in giving up smoking? Celene A. Dear Celene, Some healing of the inflammation in the air passages occurs. No regeneration of the lungs is known to occur, but further damage is avoided. Always correct to stop smoking. Dr. Tom Home Oxygen and Quality Control Q. I'm a doctor from Vietnam, I have plan with oxygen therapy home care. Could you tell me about the standard of the oxygen, how to quality control from oxygen supplier. Could you answer me or introduce somebody to help me. Thank you very much. Hanh A. Dear Dr. Hanh, All suppliers in the USA have a quality control system for their products. Concentrators should be checked with an oxygen meter to see if their output is according to the manufacturer's specifications. Dr. Tom Can Inhalers Cause Scarring of the Lungs? Q. I am a nonsmoker but have a little scar tissue on my lungs. I have been using Serevent inhalers for a while for my asthma. Is it possible that the inhalers I use could have caused it...I am 62 yrs old and have been using inhalers for a long time. Thank you. Jim A. Dear Jim, The Serevent inhalers will not scar your lungs. Dr. Tom Follow-up to Previous Asked Questions Read previous questions in Dr. Tom 62 and Dr. Tom 63 Q. Hello, I've been bugging you over the past couple months regarding my lung perils. David A. Dear David, It is most likely that you do have asthma and need treatment for it. Dr. Tom
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