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Archive: Dr. Tom 76
PostedAugust 22, 2006

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



Dangers of Keeping Oxygen in Cars

Q. What information do you have for patients that travel with their oxygen tank in their car and leave it there while they shop or go to work. What are the potential hazards of this practice?


A. Dear Michael, There are no hazards from an oxygen tank, meaning a compressed gas cylinder when left in a car. Liquid oxygen boils off slowly, and if the car has no air leaks, a small amount of excess oxygen may build up. No problem, because opening a door or window for a minute or two dissipates the oxygen. All portable oxygen systems are quite safe.

Dr. Tom

Albuterol in Treatment of High Potassium

Q. Why does albuterol help patients with high potassium levels? Should we give the medication via MDI or nebulizer?


A. Dear Leane, Thealbuterol temporarily drives the potassium into the cells, thuslowering the serum level. This does not reduce total body potassium and is only a stop gap measure for hyperkalemia. A nebulizer gives a much higher dose of albuterol and would be better than an MDI for this purpose.

Dr. Tom

Thyroid and Pulmonary Nodules

Q. Dear Dr. Tom, My husband has smoked two pack of cigarettes a day for ten years and on pack a day for the last 14 years. Last fall the doctor discovered nodules (goiter) on his thyroid. He had a fine needle aspiration and they were not able to obtain enough cells to make a definite determination of anything. He has no symptoms from the goiter.

He recently had a CT scan of his lungs in June, which revealed tiny pulmonary nodules (My husbands energy is usually on the low side.)

His doctor said there is nothing to be concerned about and wanted to see him again in Aug./Sept. 2006.

My husband does not like to do follow up procedures/appointments. He was supposed to have a follow-up FNA on his goiter last March and chose not to go through with it. He has high cholesterol and will not take his medicine- just to give you an idea of the type of personality I'm dealing with.

What is the likelihood of a person who has nodules on their thyroid and tiny pulmonary nodules and is there any cause for concern? If, there is something to watch for what would that be?


A. Dear Elizabeth, He needs a tissue diagnosis of the thyroid nodule to rule out malignancy.A follow-up of the pulmonary nodules to check for growth would be wise.

I recognize that somepatients do not want to follow advice such as this, but the problem will not be solvedby denial. "It is what it is, and you would be better off to know the answer", I tell my patients.

Dr. Tom

Feel Short of Breath (SOB) Since Quit Smoking

Q. I quit smoking three weeks ago and I feel more SOB at times and feel I cannot clear my lower lung bases sometimes I know it’s been a short while. Why do I feel this way?


A. Dear Joe, You may temporarily have more mucus to clear. Cigarette smoking is irritating and this results in mucus being cleared by the watery secretions that tobacco stimulates. By stopping, this process subsides, and so will the mucus. You should have your lung function measured by simple spirometry, to tell about your lungs mechanics. This may shed more light on the shortness of breath.

Dr. Tom

Normal Saline and Suctioning

Q. Is there an article showing that ET suctioning with normal saline can irritate the lungs?


A. Dear Joyce,I do not know of such an article. Saline lavage is a common procedure in tracheal suctioning.

Dr. Tom

How Good is Formoterol and Budesonide and How Safe are They?

Q. Are Formoterol 12 mcg and 0.5 Budesonide nebulizer solution safe and how good are these medication?


A. Dear Yelena, Yes, these are good, safe medications. Together they promote bronchodilation and a reduction in inflammation. They are used mainly in asthma, and, in combination, are similar to Advair.

Dr. Tom

Got Myself in Shape; Now Dr. Said I have COPD

Q. Four years ago this month I quit drinking alcohol, after 20 years of alcoholic drinking, at age 51. Two months later, in October, I had my last cigarette after 31 years of smoking.

At the time I quit drinking, my resting heart rate was above 100, blood pressure was 139/90, and my weight was 230 (6'1"). My triglycerides were too high to measure LDL (Low-density lipoprotein).

On March 1 of the following year, my new doctor told me about metabolic syndrome. I went directly from his office to a sporting goods store and bought a treadmill. My first walk lasted about ten minutes. Since then, I've exercised every day.

For a couple of years it was on the treadmill, increasing to 50 minutes a day. Three months after I started the exercising, I had some chest discomfort while on the treadmill. Because of my history, they did a cardiac catheterization and found a 60% blockage in the LAD Left Anterior Descending Artery). Not enough to intervene. I'm being monitored.

Last October I had discomfort again and another catheterization was performed. My blockage had decreased. I moved out on the street about a year and a half ago. I now run four miles a day and 6.2 miles (10K) on Saturday. I ran Atlanta's Peachtree Road Race (10K) on July 4th this year in 55 minutes. I'm now 55 years old. My resting heart rate is in the mid 40s. My blood pressure is consistently in the 100/60 range. My LDL is in the 60s (without medication), HDL (High Density) in the 50s, triglycerides in the 50s. I weigh 160 pounds.

Now my question: it seemed like I was having problems on occasion swallowing and hoarseness. I went to an ear, nose, throat guy who ordered chest x-rays and barium swallow x-rays because of my history. The x-rays found a hiatal hernia. The doctor also said I had COPD.

Other than that, I have no symptoms. I have no problems with breathing on my runs when on level or downhill portions. On extended uphill grades, I have to breathe hard after a while. That has gotten better through the years, though. I do not cough, and only rarely produce mucus. Usually, that occurs on the rare occasion when I'm having drainage.

Does all COPD progress into severe lung disease? In reading the info on the Internet, it seems so. Can it be predicted that my running will soon begin to produce difficulty in breathing? Am I at risk while exercising with mild COPD? I love the running and do not want to give it up.


A. Dear Ed, I doubt if you have much COPD as judged by your running ability. But even if you have mild COPD, it is good to run and keep in shape. Exercise will not make COPD progress.

Get spirometry (National Lung Health Education Program) done to see if you have any COPD at all. See a pulmonologist if necessary for this simple test of your lung function. Congratulations on your impressive rehabilitation. Stay well and enjoy life!

Dr. Tom

Lung Transplants and Lung Volume Reduction Surgery (LVRS)

Q. Dr. Tom, My husband, Tony, was recently diagnosed with emphysema. His Fev/Fvc1 scores are pre 27% and Post 29%, which I know are low. He has hyperinflation (barrel chest) I am worried he just turned forty and, yes, smoked since age 13 though he just quit!

My question is his CT Scan showed "centrilobular type emphysema" what does this mean? What can we look forward too. The pulmonary doctor hasn't mention anything about transplant. He did state that Tony wouldn't be a good candidate for surgeries cause his FEV1 measured at 1.07 liters.


A. Your husband is young to have advanced emphysema. He should be checked for Alpha one defficiency. This is often present in patients with emphysema at a young age.

Centrilobular emphysema is in the center of tiny lung units, known as lobules, containing a tiny air passage and its alveoli. Most centrilubular emphysema is in the upper lobes and this distribution, most commonly gives good results in lung volume reduction surgery, in selected patients.

Dr. Tom

For more information see Alpha One Association

How Do You Determines Liter Flow from Oxygen Equipment and How Do You Determine Proper Oxygen Liter Flow?

Q. What determines pulse or continuous setting on oxygen equipment and proper liter flow?


A. Dear Donald, The proper liter flow for a patient is determined by the results of testing at various flows, usually one to three liters and seeing the results with a pulse oxymeter.

The pulse dose setting is NOT a liter flow, but it may be roughly equivalent in certain patients. Pulse doses vary with different devices.

You need to monitor with pulse oxymetry. This is known as titration.

Dr. Tom

Enough Oxygen and Not Enough Nitrogen?

Q. I recently went to my lung specialist and told him that I am occasionally short of breath although I am on 24 hour oxygen at two liters . My oximeter readings are about 94-96%.

He told me that I was receiving enough oxygen but not enough nitrogen. Could you please explain this to me? Is there anything I could do to increase my nitrogen?


A. Dear Rose, Your doctor is wrong. The air contains about 79% oxygen and 21% oxygen. When you breath in supplemental oxygen, you increase the oxygen, and the nitrogen in the air stays the same. It is diluted a little by the additional oxygen, but this is the objective, i.e. to get more oxygen to your lungs. If you remain short of breath, with normal oxygen levels in the blood, this is due to the increased effort in breathing.

Dr. Tom

Believes Mother’s House is a Danger her Asthma

Q. How can I prove to my Mother that her home may be causing her asthma condition to get worse? She has a bad mildew smell after years without painting house or replacing old carpeting. She also has had a sewage backup into the crawl space area that has been cleaned up but may have left more potential asthma triggers into her home.

Is it better to move into a new home or try to update the old house?


A. Dear Michael, Your mother should take a vacation and not be in her house at all for at least two weeks and see if her asthma gets better. Then have her go back to her home and see if her asthma gets worse again.

It would be good to measure peak flows with a simple had held measuring device while away from home and on re entry to her home environment. It is hard to clean upwell-established mold in some old homes.

Dr. Tom

Information about Peanut Allergies and Albuterol

Q. Where can I find documented info about not taking albuterol if you have a peanut allergy?


A. Albuterol will not have any effect on peanut allergy.

Dr. Tom

Off-Gassing from New Mattress

Q. We recently bought a Tempurpedic mattress and have found the fumes to be cause for concern. The Tempurpedic company says the off-gassing will lessen over the course of a few weeks and that the fumes are harmless.

Do you know of any independent research that has been done to back up this claim? What are you thoughts about these fumes?


A. Dear Michelle, I have no knowledge about the rate of off gassing for matress fumes. I do not know their composition. I know the odor may be irritating to some asthmatics. Maybe the mattress industry can answer your questions.

Dr. Tom

Drinking Alcohol Seems To Decrease My Shortness of Breath

Q. I would like to know why that when I have been drinking alcohol that I never seem to get/be out of breath? I can dance, run or generally do most things that normally make me short of breath. If I am short of breath before I start drinking it doesn’t seem to get any better though.


A. Dear David The alcohol may blunt your drive to breath, and thus you are not so aware of breathing. This is okay. Don't overdo.

Dr. Tom

How Often Can You have a Chest X-Ray?

Q. I had a chest x-ray two months ago...too soon to have another?


A. Dear Kathy, No, not if necessary. A simple chest x-ray has very little radiation.

Dr. Tom

What does “Unremarkable” Mean in Regard to Test Results

Q. I recently had and CT with IV contrast and there was something stated that I did not understand; lung base appears unremarkable . Could you please shed some light on this for me?


A. Dear Keisha, Unremarkable, is just a long and confusing word for NORMAL. Radiologists use this language, but it can be confusing to patients.

Dr. Tom

Needs Direction on What to do Next

Q. Thanks for answering my last question; I feel lost on what to do next. I have had extreme fatigue in the last year that has only gotten worse in the last four months. The doctor has checked CBC, thyroid, glucose and everything is o.k. I’ve tried vitamin B12, herbs, etc. Nothing has helped.

I do not feel comfortable in waiting a year and seeing if the mediastinal mass grows.

I also don’t understand how the radiologist can say he thinks I have the appearance of a nerve sheath tumor, can you get a nerve sheath tumor on the apical posterior mediastinal area; and how can they tell what it is?

I want to ask my doctor to biopsy this but he acts like it’s nothing; saying I am young I don't smoke etc.. I’m 43 and I have been around second hanad smoke in my job and also with my parents who smoked.

Should I find another doctor for a second opinion? I can't see waiting a year he also said it hadn't grown in 3 1/2 months so he acted like I shouldn't worry about but as you see I am worried. Thanks for your direction.


Dear Pat, Definitely see another doctor and get an answer. It is the unknown that creates anxiety.

Dr. Tom

Metabolic syndrome is a cluster of conditions that occur together, increasing your risk for heart disease, stroke and diabetes

2024 American Association for Respiratory Care