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Archive: Dr. Tom 89
Posted December 21, 2006

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



How to Cope with Severe Emphysema
Q. I have severe emphysema and the disease has progressed too far for lung reduction to be of any help. Is there a book or recommended regiment to follow to cope with emphysema, I am on oxygen 24/7 2 liters pulse at rest and 2 liter continuous exercising. I attend Pulmonary. rehabilitation 3 days per week and am on Spiriva and 500 Advair. I appreciate your help.


A. Dear Don, Coping involves getting up and dressed every day, and doing whatever exercise you can tolerate both inside and outside the home. Walking a little more each day promotes physical conditioning. A booklet called "Essentials of Pulmonary Rehabilitation" A Do It Yourself Program can be downloaded. This gives general advice about treating all aspects of COPD.  I also wrote a short book, "Adventures of an Oxyphile", which is available from AARC.

Dr. Tom


How Can I Tell if My Son Needs More Help?
Q. My 9mo old son has been a wheezer right now he is coughing and wheezing pretty bad; he has been put on a steroid along with albuterol treatments how do I know when he needs more help; and if it RSV??


A. Dear S., I am not a pediatrician, who could best answer your questions. RSV is an acute illness, and should not be a persistent problem.

Dr. Tom


Family History of Lung Disease and Now I am Experiencing Disease Symptoms
Q. I am 52 year female. Diagnosed with rheumatoid arthritis 7/05. My father died of emphysema age 67, 3 brothers younger died of lung disorder, and older brother died of lung cancer age 49. My twin brother died COPD age 51. All smoked of the brothers smoked and my only living sister has emphysema (smokes)
I do not smoke. I have now dyspnea; chest pains, fatigue. PFT test ok but DLCO was 75. Have chest pains heart pounds upon exertion.
Was taken off of methotrexrate, had HRCT scan last week result a noncalcified 4x3mm oval subpleural nodule anterolateral aspect right middle lobe. I have a pulmonary function test (#2) next week.
I am concerned of cancer. Radiologist report states no fibrosis at this time w/ a 1 yr follow up for pulmonary fibrosis. I feel worse every day. Am seeing a lung specialist, appt#2 in 10 days. Any ideas? He has also ordered the Alpha 1 blood test (not back yet).


A. Dear Stephanie, You could have alpha one deficiency, for which there is replacement therapy. Follow your doctor’s advice. He will be able to explain your symptoms and diagnosis, better that I can, from this limited information.

Dr. Tom

More Information on Alpha One deficiency


Very Worried about Mother’s Failing Health, She is Now Coughing Up Blood.
Q. I am very concerned about my mother... About 3 or 2 1/2 years ago she lost her left leg to cancer (sarcoma). The cancerous tumor had gone thru her papillary vein. Who knows how long it had been cancerous and had been going thru her blood system!
She did have a PET scan prior to her leg being removed. They told her if she wanted to live longer that her leg would have to be removed above the knee. Back when she had the PET scan she did have some spots that showed up in her lungs and one very close to her heart.
Well last year her gynecologist doctor felt a little lump and told her to get a CT Scan, which I had my old work do (the PET scan facility) well the look on the doctors face you knew he did not want to tell us...she has a mass in her pelvis wall pushing against her bladder. The same side her leg was instantly thinks it has to be cancerous, it was about the size of a lemon or a tad larger (back then) it probably has grown by now.... we went to see a surgeon, as you know there is no cure for sarcoma (chondrosarcoma), I think is what they first called I) so the surgeon said he would not suggest the surgery as it is fixed (could be the pelvis wall, intestines, anything in that area) the surgery could make her worse.
 Since nothing can be done for her she is not going to doctors as she does not want to be messed with, which I don't blame her, I told her to enjoy her life as much as she can....that is a little history of her health
Now for the past couple of months she has been coughing and it's getting worse...I suggested that she should go to the doctors...even though I know she is against it...don't think she will go cause I know they will want to do a chest x-ray...or maybe even a CT of the chest given her medical history. She doesn't want to know if the stuff in her lungs is worse (which I don't even want to imagine since it has been 3 years since her lungs have been looked at).
 Today she told me she has been spitting up blood and grayish stuff...I am really getting worried and I do not know what to do... Would this in your opinion be a sign of disease (cancer)??? My mom is all I have left its hard cause I do not know how to help the person I love and care about so much, my mom. If you could tell me anything regardless if it is good or bad that's fine.... I just need some kind of insight.... 


A. Dear Jessica, This is most likely due to her Chondrosarcoma. Your mother seems to have coped with this very well so far. I doubt if there is any magical treatment that will change things much, but your mom's positive attitude will probably sustain her for a while. Spending time and money on endless tests, is sometimes not the best course of action. I believe you and your mom should know that her future is in "God's hands", and this will probably give you some comfort.

Dr. Tom


I am Confused by the Medical Jargon About Pulmonary Function Test Results
Q. Dr. Tom, I had asked a couple of months ago about an anomolie that was found during a CT scan.  After a bronchoscope, the doctor had diagnosed hypoplastic lower left lobe. 
I recently received a copy of my medical records.  My doctor had diagnosed me with Chronic Obstructive Asthma.  I have searched and searched.  I cannot find a thing about this.  I have viewed my spirometry results.  They confuse the snot out of me.  After all of the data there is this little paragraph that reads; “The forced vital capacity is normal.  The FEV1 is out of proportion.  The obstructive index is therefore reduced.  Expiratory limb of the flow volume loop does suggest airflow obstruction.  No significant bronchodilator response is identified.  Total lung capacity is normal.  Residual volume (RV air that remains in the lungs at the end of full exhalation) suggests air trapping.  The diffusion capacity is normal and remains normal when corrected alveolar volume.  Airways resistance is somewhat elevated with concomitant decrease in airway conductance.  The arterial blood gas shows mild respiratory alkalosis with reasonably normal oxygenation for age.  The above complete pulmonary function study is consistent with at least mild obstructive ventilatory impairment with underlying air trapping. 
This is all a second language for me.  Do you believe that my diagnosis is correct or could it be something else?  I am a soldier in the US Army.  They are wanting to medically chapter (discharge for medical reasons) me.  I want to make sure I am diagnosed correctly.  I am 23 years old. 


Q. Dear Brandi, I do not believe you have COPD at your young age and with these interpretations. I would do better with the raw numbers, FVC, FEV1 and the FEV1/FVC ratio, RV and the percent of predicted.
Your diffusion test is normal, which argues strongly against the diagnosis of COPD. You should request a consultation with a pulmonologist to get a clear diagnosis.

Dr. Tom


Over the Past 2 Years Have Developed a Strange Breathing Pattern
Q. I am 47—female, smoked for 4 years, custom spray painted autos for 2 years (mostly without protection), and took Phen-Fen for 18 months. I regularly exercised at the gym and was in excellent health until about six years ago, when I suddenly developed an unexplainable intolerance to my usual routine. 
Symptoms included: a marked change in the ability to breathe during normal exercise activity (weight lifting-not aerobic), an unusually elevated heart rate of at least 180 beats per minute along with feeling very ‘sick’ during and after sessions, each time leaving me incapacitated for hours afterward.
I went to a several different doctors, but with no resolution.  In 2002, I tried again and had some tests done, but when it seemed there would be no answers again, I discontinued going but continued more futile attempts to exercise—until I finally had to give up completely. After I quit trying to exercise, I then only had the symptoms whenever I over-exerted myself.
However, during the past two years I have developed a strange breathing pattern that appears to be continuous now—resting or not. Although it is subtle, it seems to be like a cycle repeating itself, sometimes as often as every 5 to 10 minutes. It consists of: a period of shallow breathing (chest feels compressed) > progressing to an increasing sense of an air deficiency, sometimes with heart palpitations and followed by an urgent need to inhale deeply. My chest expands---but is then followed by a long exhalation and a strange seeming deflation of the chest area and then a period of very comfortable (normal) breathing and then back again to shallow breathing and so on, the cycle repeats.
However, it seems to have begun so gradually that I am usually not aware I am even doing it. I only first noticed it in public after realizing that I was receiving unwanted attention from people around me, at the exact times of inhalation—(usually in quiet situations). I do not think the inhalation sound is loud—just perhaps, not ordinary. But it is not a ‘wheeze’ sound.
I recently obtained my 2002 records, which consists of twelve pages of mostly undecipherable significance to me; although there is some clearly favorable information in it such as, ‘cannot hear any wheezing, rales, or rubs’, and ‘PA pressure is not elevated’, and it mentions a good echocardiogram result.
However, what is unclear to me are such notations as ‘lungs appear hyperinflated’, and also the following statement, “ One thing is important, even though she had a 25+% decrease in FEV 0.5 to FEV ratios in an outside pulmonary function test, when she was given the bronchodilator she did not feel well.  Her tachycardia increased and this will not be an option.”  As a layperson, I do not understand what this indicates, if anything.
I know something is abnormal with the way I breathe now—but what I really want to know is, could it be something serious? Unfortunately, because I no longer have adequate health insurance, I cannot burden my family with unnecessary medical expenses while seeking an explanation for something that is possibly insignificant in the first place. But in addition to that, I am unmotivated over the thought of going to any more doctors for this problem, even if I could go.
So, sans a major reason otherwise, my intention is to do nothing, and to continue tolerating it.  My only concern is whether it could be more serious than I realize. Therefore, I hope you can tell me, without using just an ‘err-on-the-side-of-caution’ kind of answer, 
(1). Do these symptoms sound like anything serious—as in ‘life threatening’ serious? No
(2). If so, do you think it could it be prevented from worsening? NA
(3). Finally, if you have an idea of what it might be…can you tell ME, so I’ll know too?


A. Dear Susan, You present a very complex set of symptoms, for which there is no ready explanation. Exercising to a heart rate of 180 is dangerous.         
You have had a number of tests such as the echocardiogram that are reassuring.
I suggest that you may be having "hyperventilation syndrome", which causes you to over-breathing in certain situations. This is very likely the case if your breathing becomes normal with ordinary walking. Give it a try.

Dr. Tom 


Is There a Problem With Taking Azmacort and Aspirin Together?
Q. Dear Dr. Tom:  I have had asthma since the age of 2--kicked off by exercise or environmental factors, esp. dust/dander, etc. A few years ago my General Practitioner (G.P.) prescribed Advair.  At the time I had a great deal of skipped heartbeats, to the point where it became bothersome.  About a year ago another G.P. put me back on Advair 250.  It worked BUT, not long ago, I suffered a rather serious cardiac arrhythmia.  I would like to come off Advair. 
My question is this:  What might be a good alternative to it?  I have used Azmacort but am on aspirin to help thin the blood and prevent superficial vein thrombosis and have heard Azmacort can react with aspirin.  So, other than Azmacort, what might be a suitable alternative? I carry an albuterol inhaler in case of emergency but rarely use it. 


A. Dear Stephen, Aspirin can precipitate asthma, but usually not a the low, i.e. 81 mg dose to help blunt platelet activity to prevent heart attacks. Otherwise it is compatible with inhaled corticosteroids such as Azmacort and others.

Dr. Tom                                                                     


I am a Smoker and Have Begun to Experience Problems with Breathing
Q. I recently joined the military and started an exercise program to get ready for basic training.  I am a smoker, have smoked about half a pack a day for about twelve years. 
I ran a mile on a treadmill indoors and was able to complete the mile in 8min and 40 seconds, my chest and throat hurt but I was fine a little while later.  At drill we had to run a mile outside in 30 degree weather and I had difficulty breathing for about three weeks, including spitting up mucus and chronic coughing.  I wrote this off as being sick and being a smoker.  The other day I ran a mile again in about 42 degree weather and I'm having a lot of trouble breathing again. 
It has been two days and my breathing, coughing, and spitting up mucus are worse than ever.  Could this be asthma?  If so why would it only happen when running long distance and not during short distance and other exercises?  It is obvious that I need to quit smoking but are there other things I can for better respiratory health?  Is it possible that my breathing patterns are the cause (possible hyperventilating or something?


A. Dear Sara, This is quite possibly, exercise induced asthma. The intensity may vary with level of exercise.  It is not hyperventilation syndrome (see question 6). Get a consultation with a pulmonologist, if available on your post; at least an internist.
And, YES, quit all smoking.

Dr. Tom 


Doctors Say There is Nothing Else They Can Do for Father and I am Worried About Him
Q. My father has COPD, and congestive heart failure. He is on oxygen, steroids, and a lot of other medication. He has been in and out of hospitals; he is very much over weight.
The doctors say there is nothing more they can do for him, except to watch him. He has stopped breathing once already, and it took the doctors awhile to get him breathing again on his own. He has said to the family that he knows his life is almost over, and that the Lord is watching him. But I can tell that he is scared. How long do people usually live in they are in this shape? And do you think he knows that it is near?
Also my daughter is pregnant and he has stated that he would love to see his 1st great grandchild, do you think he is fighting to see this child. I know you can not tell me when the day will come, but how much worse COPD get for him?  


A. Dear Revia, Many people with advanced COPD can continue to live longer than their physicians predict. Having a goal, such as seeing a new grandchild may be a motivating factor. Being at peace with God is fine, and gives him comfort.  

Dr. Tom


What Does Basilar Scarring of the Lung Mean?
Q. I just had a chest x-ray done and it showed left basilar scarring... what could cause this? Should I be worried? Do your lungs heal themselves?
Any help would be greatly appreciated.


A. Dear R., This is most likely due to a remote infection, such as a pneumonia. The lung can heal itself, but sometimes this process results in scars.

Dr. Tom


Thanks for Your Help
Q. I don't have a question at this time (I have in the past and you have been a big help!-Thanks). Just wanted to say I hope you have a great holiday season. Thank you for your willingness to share your wisdom and experience.


A. Dear Linda, You are welcome. It is nice to be appreciated.
Merry Christmas to all.

Dr. Tom


Cold Always Settle in My Chest
Q. I am 55 and once a year get a cold that quickly settles in my lungs. I get shortness of breath and lethargic. I have mucus but it is the normal color. I feel lousy for 10 days or more.
I am concerned as to why it always settles in my lungs. I have never smoked, exercise regularly, eat ok, maintain a normal weight, take supplements.
My Mother smoked excessively when I was young. I had pneumonia in college.
Is there anything I can do to increase my lung health? Once I get ill, is there anything I can do to get better? I do not have insurance and have not had a current chest x-ray. If I were to see a doctor which specialist would you suggest?


A. Dear Janet, This is fairly common. You may have some developing underlying lung problem, even though you have not smoked. I suggest seeing a pulmonologist when possible for reassurance, or a specific diagnosis.

Dr. Tom


How Long Can one Live with Multiple Health Problems?
Q. My father in-law has bullous emphysema, one lung is gone and the other only has 40% lung capacity.  Additionally, he has diabetes.  He has stopped smoking but is quite overweight.  He is still drinking.  He does albuterol treatments and some others I am not sure of.  How long can he exist in this condition?


A. Dear Deborah, He can survive a long time, depending on his age and other disease states that he may have. It is great that he has stopped smoking.

Dr. Tom


Isn’t Being Short of Breath Something That Should Be Seen Promptly?
Q. Dear Dr. Tom, I have been short of breath for over two weeks. I went to a doctor who prescribed standard asthma medication. This had no effect whatsoever. My symptoms persisted so I returned and requested a chest x-ray. The x-ray showed some possible scarring.
I was referred to a lung doctor (sleep specialist really) and he has ordered a CT Scan and some other blood work and a physical exam.
Christmas is approaching and he cannot see me until after the first of the year. Isn't time of the essence when you can't breathe and there is a potential problem on your x-rays and lungs?
I am trying to see another doctor now. Shouldn't I go to a pulmonary specialist instead of a sleep doctor? He was the only one available at the time. 


A. Dear Cynthia, Yes, do see a pulmonologist. Many sleep specialists are not pulmonologist’s. You need a diagnosis and appropriate treatment.

Dr. Tom


What Do You Think About Using Soap and Water to Clean Tracheostomy Tube at Home In between Tracheostomy Tube Changes?
Q. I am the manager of a DME company that supplies home ventilator therapy.  A local ENT office has recommended recently to two of my patients that they change their tracheostomy tubes every week and since most insurance only pays for 1 per month, he has them washing the tubes with soap and water and reusing them.  I have never heard of this and cannot find any information to support or refute this procedure. 
What are your thoughts?  Do you know of any resources on this subject? 


A. Dear Chris, This is a pretty standard and safe procedure. The aim is to get the device clean and free of secretions.

Dr. Tom


2024 American Association for Respiratory Care