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Archive: Dr. Tom 85
Severe Emphysema and Morphine Q. Hello again. Hope you are enjoying the beautiful sites of Mother Nature this lovely fall. What is your opinion of treating severe emphysema with morphine (liquid &/or pills)? My doctor prescribed morphine sulfate 10/MG/5 Sol Roxanol, take 2-12/ to 5 milliliters by mouth ever 12 hours. The reason being it might help me breathe better. You may recall I am on oxygen 24/7. I also am on 20mg prednisone, Advair 500/50, Spiriva, Combivent and Xanax. I'm wondering if the time-released tablet might be more beneficial. Have your patients found this to be helpful? I just don't like the thought of becoming addicted. And, I sincerely appreciated your knowledge and opinion. You helped so many of us by giving honest answers to our questions. Karla A. Dear Karla, The morphine is very helpful in taking the edge off of struggling to breath. It is safe to use, recognizing that taking an excess dose, may supress your breathing too much. Do not worry about being addicted. You should just take enough to feel confortable, and not drowsy. There are sustained release drugs such as Mscontin, and liquid. Also alternatives such a Fentenyl, given as a lollipop or a patch, called duragesic. I think that the liquid oral morphine is easy to use, and have had good experiences with it. Dr. Tom Get Flu-Like Symptoms When Breathing Chemicals, Second-Hand Smoke and/or Dusts, What Can I Do Prevent These Symptoms? Q. My lungs are very sensitive to airborne chemicals -- mainly aerosol sprays and smoke. When I breathe in these things, the following day I develop flu-like symptoms -- body aches and chills with a fever. Sometimes my lungs feel sick, like I’m coming down with a cold or they feel tight. I don’t have a cough. One time I sprayed Lysol and I was ill with these symptoms the following day. It lasted for just one day. However, another time I breathed in second-hand cigarette smoke and I was ill for three days with these symptoms. This time of year it’s the farmer’s harvest dust and burning leaves that are causing me to feel ill. I was ill for a few days and had a fever of 101 degrees. Cindy A. Dear Cindy, My only suggestions is use of masks. I am not familiar with the various ones that can be used for ordinary dusts and fumes. Dr. Tom I have a FEV1 of 23%; How Bad Off Am I? Heather A. Dear Heather, It all depends on your definition of "bad". Your lungs are severely impaired, but you can function well and live a long time, with pulmonary rehabilitation. Use of replacement drugs such as Prolastin may slow the progression and improve your symptoms Consult an experienced pulmonologist. Dr. Tom Husband is in the Terminal Stage of Emphysema and Has Blood in His Urine, Should We Be Concerned? Q. My husband has been diagnosed as in the final stages of emphysema, terminal. Recently, he has had a lot of bleeding in his urine; this has been going on for several months. It's not a continuous bleeding that we can see but lately it has been getting more frequent. His hospice nurse took some blood and urine last week. The results showed that his blood loss was not too drastic as of yet. The Dr. would like for the hospice nurse to irrigate his bladder but my husband refuses to have it done in our home right now. We are really concerned about cancer of the bladder. Do we have reason for concern? Jan A. Dear Jan, You could be dealing with cancer of the bladder, but the likelihood of being able to treat this for cure is small, in view of your husband's advanced emphysema. If your husband already has a catheter in plance, this may cause enough irritation to promote bleeding. It is possible that the bleeding source could be cauterized. You would have to consult a urologist for this. Bladder irrigations are used to avoid clots which are hard to pass. DRTom How Do I Write Up Clinical Information about My Patients? Q. I am currently enrolled in RT school and I m doing my first clinical rotation through the hospital and I love being able to have the hands on experience with patients, but I have trouble writing up my information. The latest write up I have to do is find a patient whose pulse ox values indicate the need for oxygen due to the need to decrease the work of breathing. I have found that patient but I’m having trouble putting my information together. Do you have any suggestions? Kim A. Dear Kim, The only way to learn to write is to pick up a pen or pencil and start. Or on the typewriter. The key is to get started. Sometimes the words just flow. Try to be brief. Good luck. Dr. Tom I Have Breast Cancer, What are the Side-Effects of Radiation on the Lungs? Liz A. Dear Liz, Radiation can cause lung damage. Usually the radiologist can minimize this with shielding and other strategies in getting the radiation to the target. Radiation irritation, called pneumonitis can be treated effectively with steroids, in many cases. I believe you should focus on getting the breast cancer controlled with whatever it takes, and then deal with any consequences of the treatment, which may not be severe. Dr. Tom Have End Stage COPD, I am Doing Better But Get Scared at Night I haven't seen a pulmonologist as of yet because of no car and other factors. But I am better and I do a lot PLB and the only medicine I take is a neb every four hours. I do exercise in my bed and can now stand and walk some with a walker. But, could you please tell me if you think I am living on borrowed time. I feel better and I have gone from six liters of O2 down to three. My RT comes in every three months. I also wear a VPAP at night. I am 51 years old and I want to live. I don't know any of my numbers don't believe I have ever had any of the tests I hear others talk about. This last stay in the hospital was due to smoking with O2 on and it blew up. Burning my face. But thank God not much to the lungs. They gave me up for dead in the hospital and told my husband that I wouldn't make it through the night because my kidneys had shut down and I guess everything else was out of wack. But I lived. I have even gotten to go to my kitchen and make cookies for my husband’s birthday. I see the pulmo in Dec. But I get so afraid at night. Can you help me some way? Rose A. Dear Rose, With the determination that you obviosusly have, plan to keep on living. Day by day, and find some pleasure as you do with cooking. Say a prayer at night that you will get restful sleep and awake with a bright attitude the next morning. This is what I do, and it keeps me going. Write me again, after you have seen your pulmonologist, and again in the new year! Dr. Tom Worried that I Have Lung Disease I also had a pulmonary function test done and the results are as follows: (Pre-Bronchodilator I will list first and Post-Bronchodilator I will list second) I really do not know what all this means. I am short of breath and feel like someone is always giving me a "bear hug", I feel like I have several hundred lbs on top of my chest. I am very worried about all of this. I am going to MGH this Thursday because I don't feel well and my doctor is telling me it's nothing to worry about but has given me Albuterol and Flovent to use daily. I am very worried that I have some type of lung disease, but I can't get any answers from my own doctor. I think he doesn't want me to worry because my husband has been in remission with lung cancer and we have three young children. I am a former smoker (25 years 1-2 packs per week). I quit smoking two years ago, but my husband is a heavy smoker and smokes outside of the house, but the smoke is still on his clothes. Please help me and guide me in what to do. R A. Dear R. You do have some lung impairment, but not bad. You need a diagnosis for this and this should result from your consultation at MGH. Be sure you see a pulmonologist. The multiple small nodules are not likely to be cancer, but you need a followup CT in three to six months, in my opinion. Dr. Tom Is It Normal To Have Strange Sensations After a Pneumothroax and How Long Does It Take to Recovery? I play a lot of sport and wondered if it was normal to feel strange sensations a few weeks after a chest drain and how long full recovery normally takes. Ryan A. Dear Ryan, These sensations are probably from the irritation caused by the drainage tube. This irritatiion helps the lungs "stick" up to the chest wall. They are useful adhesions, that may cause strange sensations in your lung for awhile. Keep active and have fun. Dr. Tom Pipe Smoking and Lung Cancer S.L. A. Dear S.L.Yes, but it is not nearly as much a risk as with cigarette smoking. Dr. Tom Can I Be to Dependent Upon Seretide Samir A. Dear Samir, You probably need the seretide to control your asthma, but this is not an addiction. I suggest using it as directed. Dr. Tom Science Project About Atmospheric Pressure on Breathing Suzanne A. Dear Suzanne, Your can read an encyclopedia on the effects of altitude on the lungs, and how the heart and lungs adapt to the low oxygen of altitude. Man has been able to climb Mt Everest, the highest place on earth, even without oxygen. This is possible by the heart increasing the flow of blood to the ograns, and the blood carrying more oxygen by the increase of hemoglobin that is a response to altitude. Some adjustments in the tisssue's use of oxygen, probably occur. A complex process. Dr. Tom Can a Bleb Cause Sharp Chest Pain? Chanaan A. Dear Chanaan, I doubt if the apical bleb is causing pain near your sternum. The chance of it leaking, are small. Dr. Tom I Would Like to Take Part In A Cure For COPD Cindy A. Dear Cindy, You are already receiving drugs that may slow the progress of disease. Advair is another consideration for advanced stages of COPD. I assume you have stopped smoking, which is key. Other drugs that may slow the course of the disease, are still under study. Dr. Tom CT Scan Results Really Scare Me The axillary regions are normal. The mediastinum is normal except for clacified nodes in the precarinal region and right hilar region; these are not felt to be significant. The region in the upper abdomen is normal except for a small punctate calcification in the right mid kidney. The central airways are patent. There is minimal apical fibrosis noted bilaterally which is not to be significant. There is a minimal linear fibrosis in the right base. There is a tiny 0.3 cm nodule in the left base, which is likely not significant. What does this mean? I did smoke 1/2 pack of cigarettes a day. I have quit. Debbie A. Dear Debbie, The results are not alarming at all. The 3mm nodule should be followed up in six months. You have done the most important thing to protect your health, which is stopping smoking. Dr. Tom Ocassionally See Blood in Morning Mucus Jackie A. Dear Jackie, Small streaks of blood with vigorous coughing are common. If it continues it should be investigated further by a pulmonologist. Dr. Tom What is Life Like for Someone Who Has One Lung Could you please tell me what kind of life can I expect now having only one lung? Where can I find out what it’s like, How often will I be short of breath? Does being SOB all the time cause tiredness? Is it normal to gain weight after losing a lung? Linda A. Dear Linda, You can live a normal life with one lung. Your capacity depends on how healthy the remaining lung is. You must avoid all tobacco smoke. Some shortness of breath during exercise is to be expected and will not lead to excessive tiredness. Dr. Tom Bronchoscopy Training Programs Terry A. Dear Terry, No. The bronchoscopy training is mostly part of the training in pulmonology, thoracic surgery, and otolaryngology. Dr. Tom Smoked for 20 Years Should I be Concerned about Lung Nodules Dan A. Dear Dan, Any nodule that is not calcified in a former smoker needs a follow-up. The time interval depends on the size and characteristics of the nodules. Dr. Tom Will I Need to be on Bi-Pap for Rest of Life? Paula A. Dear Paula, Not for sure. It depends on the course of your lung disease. Dr. Tom Can Cord Blood Help in Treatment of Lung Cancer? Becky A. Dear Becky, No. A good thought for your father, but no research has been done on this. Dr. Tom Side-Effects of Spiriva Benita A. Dear Benita, The side effects are described in the package insert. The most common is dry mouth, which is only a mild nuisance. Dr. Tom I Think I Out Blew the Spirometer Corin A. Dear Corin, No, no concern at all. By forcing out so much air at the end of the test, you got an additional amount of volume out. This is the denominator of the ratio, and your long effort increased it. You are super normal. Dr. Tom Afraid Friend is Going to Trip Over Oxygen Tubing Kate A. Dear Kate, I wish there were. Tripping over the cord on the floor is a risk for falling. This is one reason why I prefer "wearable" oxygen, such as with a Helios or Spirit device that used liquid oxygen. Dr. Tom Kim A. Dear Kim, This is very low vital capacity and the FEV1 is therefore also low. But some patients can live a long time with low values with oxygen and other medications. Dr. Tom |
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