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Archive: Dr. Tom 90
Posted January 3, 2007

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



What Type of Exercise is Good for Emphysema?
Q. With moderate emphysema does exercise help and what type of exercise do you suggest?


A. Dear Robert, The best type of exercise is simple walking. Do for at least 30 minutes a day. Indoors or out. The more exercise the better. Indoor stationary biking or treadmill are fine. Some upper body exercise with lightweight dumbbells is often helpful. See essentials of pulmonary rehabilitation.

Dr. Tom


Stumped About Lung Biopsy Results
Q. In 9/2006 I had an EBT for cholesterol screening.  The test showed an 8x8mm noncalcifid nodule in the lower left lung.  A PET scan as ordered because of the nodule size and the results showed three nodules located in the paratracheal, hilar (15mm), and lower left lobe (12mm) with high metabolic activity.
 A lung biopsy showed that the nodules were not cancerous and cultures from all three areas were determined to be negative or any type of growth. 
I was tested for Cocci (Coccidioidomycosis) histoplasmosis, and other fungi all with negative results.  My doctors have told what they are treating me for that the disease is active and there is necrosis of lung tissue... but they do not know how. Any ideas?? 


A. Dear Paula. The biopsy should have given a definitive diagnosis, if enough tissue was taken. If only a needle biopsy, there may be difficulties in interpretation. There are many diagnoses to consider. Better consult a pulmonologist.

Dr. Tom


Spontaneous Pneumothorax
Q. What happens to the part of the body/lung that spontaneous pneumothorax affects?


A. Dear Normaan, Spontaneous pneumothorax is a leakage of air within the lung to the space around the lung, called the pleural space. There are no particular consequences of this. The lung will re-expand either spontaneously as the air outside the lungs is absorbed. Sometimes the air needs to be evacuated by a chest tube if the pneumothorax is large or causes much shortness of breath. The part that leaked seals over usually. Occasionally it requires surgery.  

Dr. Tom


What are Apical Scarring and Atlelectasis?
Q. I just had an x-ray done to r/o pneumonia. My report says: there is minor chronic biapical pleural scarring. Minimal right basilar atelectasis is noted. Otherwise the lungs are clear. What does this mean?


A. Dear Maggie, There has been some inflammation of the lungs in these regions in the past. A simple follow-up in six months to access any change would be wise.

Dr. Tom


Another Look at X-Ray and Now Another Diagnosis (Dr. Tom 88)
Q. Hi Dr. Tom, I recently wrote to you in regards to CT results indicating that I had "enumerable tiny nodules seen mostly upper lobes, in range of 1 to 2mm in size."  These results seemed fairly innocuous.  Nonetheless, having asthma and having been born at 6 months, I forwarded a disk copy of the CT to my pulmonologist. 
He looked at it with a different radiologist and they have concluded that the CT instead shows a 5mm scar on the left upper lobe and one 2mm nodule in the right upper lobe.  How can these results be so different?  Since my pulmonologist now wants to do a follow up CT do I have to be concerned about cancer in relation to either the scar or the nodule? 
As I indicated before I am a former smoker (quit while pregnant over two years ago, smoked a bit after the baby's birth and no cigarettes now for about five months).  Some websites seem to indicate that solitary nodules in former smokers have a malignancy rate of 60%!  How soon should I be getting additional CT scans?


A. Dear Lora, Different pulmonologists or radiologists may draw divergent conclusions from these small shadows.   This is not likely to be a cancer. It is not a solitary nodule. It is small and a follow up CT could be done in six months.

Dr. Tom                


Need Help to Stop Smoking
Q. I just found out, 12/15/06 I had COPD, - 50% lung left-I smoke. I want to stop completely-Can’t do it on my own, I tried Zyban, Nicorette gum & patches with no help. It got me sick with too much nicotine going in body-Please I really need advice before its too late I want to stop but I do need help!


A. Dear Karen, There is a new drug now out that deals with nicotine addiction in a new a more basic way, than other approaches. It is called Chantix and has shown some excellent results in patients who have failed other stop smoking methods. Give it a try with the guidance of a pulmonologist that is experienced in smoking cessations.

Dr. Tom


COPD and Asbestosis
Q. What are my chances of survival with COPD related to asbestosis? I don't drink and haven't smoked in 50 years .


A. Dear Joseph, It depends on your age and degree of lung damage now. It is probably pretty good, since you have been off smoking for so many years.

Dr. Tom


Afraid That I have Chronic Lung Infection
Q. I am having constant burning across both my front and back chest. This has been going on for five weeks. I have lost 10 lbs, and am very tired. I get a low-grade fever 99.2 when the burning is intense.
I am afraid it is chronic lung inflammation and I don't know what test could be done to prove it. It is too early to show on a CT scan and nothing is showing up yet in the blood test. I am afraid it is going to turn into pneumonitis as I am feeling the burning everywhere. What type of test could prove the inflammation other than HRCT and blood test?


A. Dear James, A simple chest x-ray would show a pneumonia or lung abscess. I think you should see a pulmonologist and get a diagnosis, rather on trying to guess what test would be helpful.

Dr. Tom


Does Lung CT Scan Results Explain the Pain I’ve Been Feeling?
Q. I have a dull ache on my right side when I take a deep breath. Sometimes I feel it in my chest and sometimes my back, and sometimes both. Duration over one month.    
CXR showed possible nodule right upper lobe.  CT showed bilateral pleural and parenchymal nodular scarring upper lobes--especially at apices. Pleural thickening bilaterally extending to involve the superior aspects of the major fissures.  Minimal somewhat nodular scarring present in the superior segments of the lower lobes adjacent to superior aspects of fissures.  Slight thickening associated with anterior aspect of the minor fissure.  Peribronchial thickening is present especially in right upper lobe posteriorly.  Changes likely chronic.
Do any of these things explain the pain I am feeling?  I have never smoked.  They recommend repeat CT once a year, but I think I should see a pulmonologist.


A. Dear Evelyn, I agree, you should see a pulmonologist. The CT and chest x-ray findings do not explain your symptoms, in my opinion.

Dr. Tom


Will Vinegar Help a Cough?
Q. Thank you for your time. For about the past four years my wife has developed a chronic cough toward the winter months.  It lasts usually about a month.  This year it has gone on longer, it's been almost two months now.  It is all the time except when she's asleep. 
Not 20 seconds go by without her coughing, and sometimes she goes into coughing fits badly.  She's gone to the doctors several times, and they keep trying different antibiotics.  And now they say that it might be acid reflux. 
She wants to try to take a tablespoon of vinegar to see if it helps, we've heard that it can.  I was just wondering if you might have some suggestions. Thank you again for your time.


A. Dear Eric, I can see no reason why vinegar would help. You need a diagnosis. I suggest seeing a pulmonologist. There are many possibilities to explain this severe cough.

Dr. Tom     


How Long Does it Take for Bacteria to Grow in an Edotracheal Tube?
Q. How many hours will it take for a bacteria to colonize in an ETT post intubation?


A. Dear Elnora, It varies on the situation. Usually about 48-72 hours. The age and comorbidities of the patient, previous antibiotic use, and maybe the hospital that the patient receives care are the major variables.

Dr. Tom


Having Trouble Breathing, No Diagnosis but was Given Advair
Q. Dr. Tom, I am forty, non smoker, January this year I had some bronchial spasms and noticed wheezing that was getting worse, small chunks of mucus would come up mostly in the morning no cough, x-rays were clear and was given antipatriotic but it remained, it got to the point that breathing was difficult. I got on the treadmill and ran and it broke up and came out, since then I would have a cough just in the mornings with a little mucous, green or brown/yellowish.
I have an irritated throat and feels like I have mucus coming from my voice box but hard to get up, feels like I can't swallow and my chest burns a lot mostly in the morning through the evening and settles down at night, I have trouble talking sometimes like my larynx is messed up, a lot of throat clearing, and a lot of mucus.
Went to a pulmonologist and a spirometry test was good and 02 was 100%, He gave me Advair 100/50 and I don't have a cough anymore but have to clear my chest in the mornings, I have cut back to every night or every other night with the Advair cause it seems to irritate my chest. I do have allergies and my sinuses seem to be aggravated when my condition is bad some days,
Any suggestions would greatly be appreciated, I feel my Pulmonologist did not do enough testing, he quickly put me on Advair with 12 month refill, stated he has had similar problems for 35 years. If it gets worse we need to talk and sent me on my way. I have not been diagnosed with anything, but don’t want to wait for it to get worse if I can prevent it. What should I request or do to find out what is going on,
Thanks in advance for any information.


A. Dear Duane, I agree that your pulmonologist put you on Advair too soon, and without a diagnosis. You most likely have asthma or an"asthma equivalent". Advair is okay for maintenance treatment of asthma in many patients, but not all. Some do get irritation.  I suggest seeing another pulmonologist or an allergist. You need a diagnosis and complete control of you symptoms.

Dr. Tom


Daughter had Oxygen Saturation of 49% but Did Not Show Signs of Low Oxygen Level
Q. I have a four year old daughter who has had two, well they say, asthma attacks in two months that have sent her to the hospital for a week at a time.
The last time the ER was going to send her home. She did not present to them as having an attack only heart rate was high. Upon my suggestion they did a blood gas and it was 49% it took five days to get her back to 96%. Can you tell me why her sat level would go so low without any presentation of asthma? The Drs and respiratory staff had no answer for this other than asthma.
They were all shocked. It scares me because I have no clue that it drops that low, I took her to the ER just because I am her mom and her heart rate acted to high, but there was no tugging or anything.
Please give me a answer to this no one else seems to know and it is too scary for a four year old to go through. Can it be something other than Asthma?


A. Dear Cindy, This one is easy. The technician that intended to hit an artery, actually sampled venous blood, and the saturation from this is normal.

Dr. Tom


I Don’t Understand Dad’s CT Scan Results
Q. My father had a chest scan in October 2005. I have the scan and didn't understand the terminology: "Total body radionuclide bone images were obtained after administration of 26.0 mCi of Tc MDP and demonstrate degenerative changes and uptake with the shoulders, sternoclavicular joints, both hips and in the feet.  Additional uptake is also seen in the sacroiliac joints.  The aggregate findings are compatible with multifocal degenerative changes.  No abnormal uptake is seen in the axial or appendicular skeleton to suggest metastatic disease or acute trauma.  
Then he had a CAT scan back in November 2005, it said "Bulla or bleb formation identified along the medial margins of the right and left lung are most pronounced posterior to the carina.  There is no sizable pleural or pericardial effusion.  There is no pneumothorax.  There is a 1.7 X 1.1 cm noncalcified mass within the left upper lobe.  There is minor, somewhat nodular interstitial opacity within the left lung base superior to the left hemidiaphragm.  A precarinal lymph node is identified with measures 1.3 X 1.0 cm in cross-sectional diameter.  There is otherwise no pathologv lymph node enlargement in the mediastinum or pulmonary hila.  Imaging of the upper abdomen demonstrates a 2.3 X 3.2 cm fluid density mass superior to the left kidney which likely reflects exophytic cyst."


A. Dear Christy,The radionuclide scan shows multiple areas of bone degeneration, most likely due to age. The noncalcified nodule and lymph node require follow-up. for growth, or biopsy now; depending on your father's condition. The other findings are radiologists jargon for benign and unimportant changes.

Dr. Tom


 Can You Live a Normal Life With the diagnosis of Mild Emphysema?
Q. Dear Tom, I wrote to you a while back regarding a friend of mine who was diagnosed with emphysema after a CT Scan. He is 34 and a former smoker. He is not Alpha-1 deficient. His last full pulmonary function test showed that his lung function is still pretty good. His FVC was 105% and FEV1 was 100%. The CT Scan showed "mild emphysema".
He has become quite depressed and seems to view this diagnosis as a death sentence despite his doctor saying that his lungs wont get worse as long as he never smokes again and that he can expect normal life expectancy. My question Dr. Tom is do you agree with what his doctor told him?
Is it possible for someone to be diagnosed with emphysema at such a young age and still have a normal life expectancy? His doctor reasons that the fact that the CT Scan shows only "mild emphysema" and that his FEV1 is 100%, and that he has quit smoking and started treatment means he can expect a normal life expectancy. Would you agree with this reasoning? I would really appreciate it.


A. Dear Ann, He certainly has a normal life expectancy. I wonder why the CT scan was done at all! I see no reason for it, based on what you tell me.

Dr. Tom


Had CT Scan,  Do I have Anything to Worry About?
Q. I had a CT Scan. Borderline mediastinal nodes noted. Most pronounced in right upper paratracheal and subcarinal mediastinum. Borderline right hilar lymph nodes noted as well. Small bilateral axillary lymph nodes noted. Anything to worry about?


A. Dear Charlene, Probably not. Depends on your age, and why the CT was done in the first place. I guess a simple follow up in six months is wise, now that these  "borderline" findings are reported.

Dr. Tom


What are the Side-Effects of Trimeth Sulfa DS?
Q. What are the side-effects of Trimeth Sulfa DS 800/160mg?
What can happen if a person is allergic to Trimeth Sulfa DS 800/160mg?


A. Dear Melissa, There is a long list of side effects and adverse reactions. Rash is one of the most common and dangerous. Read the package insert that comes with the prescription and you will see.

Dr. Tom


Having Pain in the Rib Area, but My Doctor Does Not See Any fractures
Q. Dear Dr. Tom- I recently was diagnosed with "walking pneumonia" and treated with antibiotics.  My first x-ray showed lower left lobe infiltrate and the second showed no effusion but subtle apical pleural parenchymal changes.  Neither X-ray showed fractures of the ribs and yet after two months I still have pain in the lower left back and front rib area.  My Dr. thought at first that I had fractures, but I apparently do not.
 Why then, does this pain in the rib cage not clear up?  It is not as severe as before and I suspect there are no fractures, it must be some kind of inflammation or something.  My Dr. left a message on my answering machine that I need no further care for my pneumonia.  Should I see a pulmonary doctor or is this discomfort normal for this long a period.


A. Dear Lesly, The pain in your front rib area is most likely from the cartilage that attaches to these ribs. It will subside. You do not need to see another doctor about this.

Dr. Tom


Should Niece See a Pediatric Pulmonologist?
Q. My niece who is two was just diagnosed with Asthma.  This will be her third winter with a croupy cough and bad cold.  Her Pediatrician put her on Pulmicort and Albuterol treatments.  It's been almost two weeks and she still has this cough and mucous production. 
Should her mother see a pediatric pulmonologist or should she continue with her current doctor?  Also is there a support group for new mom's in Michigan? 


A. Dear Leona, She should see a pediatric pulmonologist for sure. I do not know about support groups in your area.

Dr. Tom


CT Scan Shows Mild Emphysema, Spirometry is Normal
Q. Dear Dr Tom, I would like to ask you a question regarding how lung function declines with emphysema.
I am 37 yrs old and recently had a CT Scan of my thorax with showed mild emphysema. I have had regular spirometry tests in my doctor’s office since the diagnosis which always show "normal ventilatory function". My last one showed FVC 108% and FEV1 107%. I was a smoker but stopped a year ago.
I am on Brycanyl and Pulmicort now but to be honest besides a slight cough, I have no problems. My doctor seems to think that as long as I never smoke again, I won’t have any problems. This kind of statement from my doctor, although positive, confuses me. It confuses me because I thought that emphysema was progressive.
My doctor tries to explain it to me by saying that any lung function I loose from here on will be "age-related decline" and nothing to do with the emphysema. When I try to get him to clarify what this means in terms of the progressive nature of emphysema,
I can’t seem to get a clear answer. I suppose what I want to ask you is this--Does someone with only mild emphysema who stops smoking when their lung function is still good have the same rate of lung function decline as a healthy person? If so what does that actually mean in terms of the PROGRESSIVE NATURE of emphysema? I mean should I be worried about this emphysema or will I be ok as long as I never smoke again from here on? I would really appreciate some clarity once and for all on this.


A. Dear Kieren, Your lung function is normal now, and will stay normal for age, assuming you do not smoke again, and avoid other tobacco smoke or industrial fumes and dusts.

Your doctor is correct that you, as everyone will have an age related reduction in lung function, but you have plenty of reserve. Emphysema is not progressive in young people who stop smoking and do not have the rare alpha one deficiency that runs in families.  You have a normal life expectancy. Go ahead and enjoy it.

Dr. Tom


Firefighter Worried About Upcoming Spirometry
Q. I have a pulmonary function test coming up for my job as a firefighter.  The last couple times I have taken it, I have failed.  But then upon further test, have been told I'm fine.  Am I not blowing into the tube correctly?  I'm 28 years old, and am in great shape.  I don't understand it.  It could jeopardize my job.


A. Dear Curtis, Nothing to worry about. Be sure you take a very full breath, and the blast it out for a full six seconds, to be sure your lungs empty as much as they can. The tests are usually done at least three times to find the two values that closely match, indicating good and consistent efforts.

Dr.  Tom


Treatment for Pleurisy
Q. I have had pleurisy for two and a half weeks. I've been to the doctor and he has me taking 800mg of ibuprofen three times a day. It seemed to be getting better last weekend there was only a dull pain that I noticed when I thought about it so I started taking the ibuprofen only once a day. Now it seems to be flaring up again and I don't want it to get worse. I started taking ibuprofen three times a day again yesterday, but it seems worse today. Is there some other remedy that will work better? Will using a humidifier help?


A. Dear Jamie, There are many causes of pleurisy, so my answer is not going to cover all possibilities. Most pleurisy is self-limited and due to an infection, usually a virus that inflames the lining of the lungs that contain pain fibers.   
Ibuprofen is good for symptomatic relief. It does not deal with the underlying cause, which will need further investigations if the pleurisy continues for many more weeks.

Dr. Tom


What is an Irritated Lung?
Q. Dear Dr. Tom:  Thank you so much for this beneficial website!   It is an excellent support for the people with respiratory challenges.     My 74 year-old Mother has been diagnosed with bronchiectasis and asthma.  She is on 2L oxygen 24-7.  She recently coughed up some blood.  The hospital took a CT SCAN and said there was some irritation on the lung (no nodes/ no lung cancer).  What is meant by an irritated lung?"  


A. Dear Rose, Irritation is not a very descriptive word for lung problems. It probably is used to indicate the inflammation from infectious organisms that complicate bronchiectasis. The liberal use of antibiotics is the most common treatment for the infectious complications of bronchiectasis.

Dr. Tom


What is a Granuloma?
Q. Dr. Tom, In Nov. of this year I had a pre-op chest x-ray it showed changes in a calcified granulomatous. What would cause this to change? I thought calcified granuloma was like a scar. How can it change?


A. Dear Tanna, There are a number of causes of a granuloma. A granuloma is the lung's tissue reaction to some infection, or environmental stimulus. All healed granulomas are benign, and are caused by some fungus that your body kills. The term granulomatous refers to multiple or clusters of granulomas. You can forget about them.

 Dr. Tom


Breath Sounds that Reminded Me of a Noises Heard in a Haunted House
Q. We have a patient on the ventilator who, upon presentation to the ED, had breath sounds that sounded like a haunted house!  There were lots of almost moaning sounds.  Not your typical rales or rhonchi!   This mainly occurred upon exhalation.  Chest X-ray was relatively clear.  Blood gases were horrible.
Any ideas on what to call the breath sounds (besides adventitious) and what should we be looking for?  She is much better today and will be coming off the vent later today but I have never heard anything like this! 


A. Dear Tina, I cannot guess what caused these strange sounds. Must have been related to retained secretions and possibly bronchospasm.

Dr. Tom


Recently Diagnosed with Moderate COPD
Q. Dr. Tom: I am a 61 years old woman, non-smoker, non-drinker, 5'3", 105 lbs, no familial history of COPD, working indoors.
I have been diagnosed on Dec. 22, 2006 with “moderate obstructive lung disease with hyperinflation and gas trapping" but "no restrictive lung disease".
FVC 2.44=81%;
FEV1 1.48=61%;
TLC=5.86 Liters; RV=3.42 Liters; FRC PL=4.18 Liters.
My CT Scan taken on Nov. 18, 2006 shows small nodules 2mm & 3mm in the lung parenchyma, post-inflammatory. Areas of bronchiectasis can be seen in the right middle lobe/lingula. A prominent precarinal lymph node is identified 10x7mm. No definite suspicious nodules identified.
My specialist gave me RX for Spiriva to slow down the progression of the COPD. Would it really? What are my other options? What is the life expectancy in a case like this?


A. Dear Tammy Your life expectancy is probably normal. You still have a lot of lung power remaining. Spiriva may slow down decline, but there is no certainty of this. It is pretty expensive, but very safe.

Dr. Tom


Will Lung Nodule Interfere with Getting Pregnant?
Q. We re planning to have a baby but I found out that I have 3mm in lung nodule but can I get pregnant if I have it?


A. Dear Tammie, Of course. Do not worry about it. It is most likely from a remote infection.

Dr. Tom


Are the Cardiac Side-Effects of Advair and Spiriva Different?
Q. What is the difference between Qvar and Advair.  Recently, I had a heart arrhythmia (stress test showed heart was fine) and I know Advair is associated with arrhythmias.  Would Qvar be a possible substitute?


A. Dear Stephen, Qvar is an inhaled corticosteroid about equivalent to the fluticasone in Advair. It is the beta agonist in Advair that is associated with arrhythmias.

Dr. Tom


Confused by What ‘Other Etiologies’ Means
Q. Dr. Tom, my mother was recently hospitalized for COPD and severe bronchitis. Her doctor did a CT of her chest and found a 2cm spot. He said it could either be a scar or nodule or a malignancy. He did order a P.E.T. scan and the report reads: Examination shows no evidence of abnormal activity. Presumably the lesion seen on CT is the result of parenchymal scarring. Other etiologies would have to include a very low-grade inflammatory or neoplastic process such as bronchoalveolar carcinoma.
I know they said her P.E.T. scan did not light up and they said that was good. Her doctor said they will repeat the CT scan in two months. I am just concerned about what he meant by other etiologies would have to include inflammatory process or carcinoma. What do you think?


A. Dear Shelby, Alveolar cell cancer may not "light up" on a PET scan. This is the only worrisome possibility. I think a follow-up to look for growth is wise. 

Dr. Tom 


Smokes and Then Compensates His Shortness of Breath with Increasing Oxygen Liter Flow
Q. Hi there, I have a resident in my care home who is a smoker and on oxygen. He takes his O2 off to smoke. When he returns from smoking he is ++SOB and turns his O2 way up thinking he is compensating.
I want to explain to him about CO2 retention. Can you give me the words for a layperson to explain he is not benefiting himself.


A. Dear Sandy, I agree he is not compensating for being off the oxygen, but he is also NOT hurting himself. Forget this myth about oxygen at low liter flows causing CO2 retention.

Dr. Tom


Lung Transplant Center
Q. Dr. Tom, can you recommend a lung transplant center in the Northwestern United States? How does one get a referral to a transplant program?


A. Dear Karin, I know there is one at the University of Washington in Seattle, and probably also in Portland. You will need a referral, from a pulmonologist.

Dr. Tom

University of Washington Medical Center


2024 American Association for Respiratory Care