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Archive: Dr. Tom 94
Posted January 30, 2007

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



Weight of Portable Oxygen Tanks
Q. Do the oxygen canisters come in lightweight?  I have a sister that uses the large canister in her home.  She is a very tiny woman and finds the weight of the travel canister very heavy.  She is a very tiny petite woman with COPD.


A. Dear Mary, Liquid oxygen canisters weigh about 4 1/2 pounds full. Some of the gas canisters filled at home weigh about the same, as does an M6 cylinder that can be delivered by your supplier. The range of liquid is considerably greater than from a compressed gas system.

Dr. Tom


How to Return to My Normal Exercise Program After Thoracotomy and Pleurodesis
Q. I just had the thoracotomy and chemical pleurodesis after experiencing a spontaneous pneumothorax. Before the surgery, I was an avid exerciser (weight lifting, running, swimming). My doctor was not too illuminating about how I should reengage in these activities. It has been five weeks since my surgery. When and what should I start doing activity wise? 


A. Dear Nicholas, You can return to full activity as soon as you feel comfortable doing the things you used to do. It will not affect the pleurodesis. Gradually work back to your normal routine.

Dr. Tom


Signs and Symptoms of Sleep Apnea
Q. I have been diagnosed with sleep apnea (low to moderate); however, I have no other symptoms of sleep apnea.  I do not snore, choke in my sleep, have breathing pauses, wake with a dry mouth or headaches.  I have insomnia (trouble falling asleep) so any sleepiness during the day, could be caused by that. 
Is it possible to have moderate sleep apnea and not have any other symptoms?  It seems the sleep clinic was most enthusiastic about diagnosing sleep apnea but not doing anything about my insomnia.


A. Dear Nicole, Most patients with sleep apnea do not have insomnia. The symptoms of sleep apnea range from none to daytime sleepiness, morning headache, irritability, and loss of erectile function in men. Hypertension may also be related to sleep apnea.

Dr. Tom


Lung Nodule and Spots on Lung
Q. What is a lung nodule in the lungs? Is there a possibility to be a cancer disease and what about the spot?


A. Dear Sheila, A nodule is a spot seen on a chest x-ray or a CT. If it is calcified, it is always benign. If not, it may be malignant and should be followed or biopsied, particularly in smokers.

Dr. Tom


Will Smoking Show-Up on Chest -Ray
Q. I have been smoking for the last four years.  Will it show if I take an x-ray of my lungs?


A. Dear Anisha, No. There are no signs of smoking seen on chest x-rays, until severe emphysema occurs or lung cancer develops.

Dr. Tom


Best Treatment for COPD
Q. What is the best treatment for COPD? Should I continue to exercise?


A. Dear Deborah, Exercise is good for all stages of COPD. There are many treatments for COPD, beginning with bronchodilators and inhaled corticoidsteroids in moderate or advanced stages of treatment. You need spirometry to tell about the severity of your COPD. Stopping smoking is the first and most important treatment.

Dr. Tom


Preventing VAP and Microaspiration when Repositioning Endo-Tracheal Tubes
Q. Are there any protocols to order to prevent VAP and any microaspirations -when you repositioning the ET tube from side to side change?  Do you need to deflate cuff fully?
Thank you for your time


A. Dear Joann, There are protocols followed in some hospitals. I generally do not believe in protocols. The ET tube needs regular replacement at intervals depending on the clinical situation.

Dr. Tom


Need Help With Medical Jargon
Q. What does this mean?
Interval mild worsening of the ill defined small ground glass opacity throughout both lungs fields, which likely represents worsening of the underlying process.
Stable mild mediastinal and hilar lymphadenopathy.  Multiple contiguous 5mm axial CT were obtained from lung apices to the level of ardrenal glands. Mildly enlarged mediastinal and right hilar lymph node measures 13 mm in short axis and the subcarianl lymph node measures 14 mm in the short axis.


A. Dear Karol, You have shadows on the lungs that are abnormal and some enlarged lymph nodes. These findings need to be explained by your doctor to fit your own situation.

Dr. Tom


Diagnosed with Pseudomonas Pneumonia, Now they Say I Have Emphysema and will Need a Lung Transplant
Q. I am 48 years old. I became ill the end of November with flu like symptoms and SOB. I have had asthma since I was 20 so was not concerned about the SOB.

I went to the doctor and for three weeks I was on antibiotics (Avelox and Zithromycin).  Nothing worked so the doctor put me back on Avelox again.  On 1/2/2007 I began my second treatment with Avalox.  Within five minutes of taking the first pill - I went into anaphylactic shock.  I smoked for 30 years and I quit right then and there. I have never been so scared in my life not being able to take that breath.  Paramedics were called and I was admitted into the hospital. 
Due to anaphylaxis with Penicillin, Keflex and now Avelox, the doctors were cautious about what antibiotic to put me on.  They had me on Zithromax.
After extensive testing, CT MRI, chest x-rays and sputum sample, I was diagnosed with Pseudomonas Pneumonia.  They treated me with inhaled antibiotic, IV antibiotic and after 12 days I went home with an additional seven days of Cipro. 
The doctors say I have emphysema throughout both lungs. I do not understand how just two months ago - I was working, playing with my grandson, shopping, etc with no problem. Now I am sob on walking, have chest tightness, right side under my breast cage feels tights.  Is it possible that they are wrong about the emphysema and that the pneumonia just made it look like emphysema?  They are saying I will need a lung transplant.


A. Dear Laurie, Pseudomonas infections can cause a lot of lung damage, but I agree that it is strange for advanced emphysema, requiring lung transplantation to occur so suddenly. I think that your doctors should give you a better explanation that I can, based on the limited information I have. You should have detailed pulmonary function tests, and tests for alpha one deficiency.

Dr. Tom

For more information on Alpha One Deficiency:


Diagnosed with Pleurisy Three Weeks Ago and My Chest Still Hurts
Q. I was moving furniture and hurt myself. Went to ER they said I have costochronditis and gave me naproxen. I wasn't getting better. One week later went to ER said I had Pleurisy. My question is when should I expect to feel better? How long will my chest hurt? Hurting for more than three weeks. When I think I am feeling better it hurts again.


A. Dear Robin, Pleurisy chest pain usually resolves in a few weeks, depending on what is causing it. If it does not clear completely soon, I suggest getting another opinion.

Dr. Tom


Continue to Cough, Doctor Says its Gastroesophageal Reflux Disease (GERD) and Post Nasal Drip
Q. Chronic cough over a year now - chest CT Feb 06 resulting in no findings - have complained of SOB lately - had PFT -- all within limits -- cough is more dry although every once in awhile it has some yellowish in it - I have also complained of chest pain -- had a thallium stress test that was also fine - my doctor says GERD and post-nasal drip -- Aciphex helps but I still cough -- and I had a CT of neck because I complained about trouble swallowing and that was all ok -- advise?


A. Dear Lisa, The chronic cough can be from GERD. There are ways to confirm this diagnosis, with specific tests. The other approach is to try acid suppressive drugs such as Prilosec, which should be prescribed by your doctor.

Dr. Tom


What is Granulomatous Disease?
Q. I have been having numerous infections after sinus surgery in 2005.  The latest is having pneumonia (after having the vaccination). I just had a CT scan of the lungs and it stated that I had healed granulomatous disease.  Could you explain this further? 


A. Dear Michelle, These CT findings refer to multiple calcifications that are due a healed fungus disease of the lungs. Usually due to histoplasmosis, which is very common in the Ohio, Missouri and Mississippi valleys.

Dr. Tom


Frequency of Pneumonia Vaccination
Q. How often is a pneumonia vaccine required?  A respiratory patient said he was just every 21 years.  Is this new?


A. Dear Debra, Current recommendations are to repeat the pneumonia vaccine one time, five to six years following the initial immunization.

Dr. Tom


Asthma and Gastroesophageal Reflux Disease (GERD)
Q. I developed asthma and I am about 60 years old. I didn't have any problems until I had reflux at night and inhaled the acid in my sleep.  This happened a second time, and afterwards I progressively continued getting short of breath.  I had the tests done, and a bronchoscopy, and my pulmo said my lungs were operating at 44% capacity and I wouldn't improve but would do well on Advair and albuterol, which I have so far. Is there documentation about the effects of GERD causing asthma?


A. Dear Ron, Yes. The most definitive test is an acid probe, left in your esophagus while you sleep. It detects the presence of even small amounts of acid reflux. It is also common practice to try an acid suppressive drug, even without a definitive diagnosis, such as Prilosec, which is given in the dosages that require a doctor's prescription.

Dr. Tom


A ‘Pulled” Chest Muscle from Coughing, Still Hurts a Month Later
Q. About a month ago, I went to the doctor with a severe cough and I had bronchitis.  I also told him that I had a pain in my right side (under my bra line) when I lie down or get up from sleeping. He said I probably pulled a muscle from coughing so much.  A month later, it still hurts.  Is this common with pulled muscles or could I have bruised a rib? 


A. Dear Sarah, It is more likely to be a bruised or even a fractured rib from severe coughing. Muscle pain usually resolves more quickly.

Dr. Tom


Best Practices for Lung Health
Q. Can you tell me what are some basic practices to promote lung health?
Do you advocate hepa filters in the home, not using sprays, using natural fibers, using air cleaners in the home, natural cleaning agents? I know this is a lot of things to question. It's just that we hear so much on the news that is becomes confusing.
Do you have a list of things everyone can do to promote good lung health? I love getting in the steam room ... is this good for your lungs?


A. Dear Sue, I do not have much confidence in room air filters. Avoid sprays as much as possible, and any environmental tobacco smoke.

Dr. Tom


What is Parenchymal Scarring?
Q. I just received results of a CT scan, which stated I have mild pleural and subpleural parenchymal pulmonary scarring in the chest.  What does this mean and is there any treatment for it?


A. Dear Jackie, Parenchymal scarring is x-ray jargon for scars on the lungs.

Dr. Tom


Is Inhaling Cigarette Ash Dangerous?
Q. Is it dangerous to accidentally inhale cigarette ash, say if it is blown into the air off an ashtray? Would this be more or less dangerous than passive smoking?


A. Dear Jim, No. The ash is of large particles and probably does not reach deep into your lungs

Dr. Tom


Doctor Told Me to Quit Using Oxygen During the Day
Q. My Dr.. told me to stop using O2 during the day.  I am trying but I am having problems with confusion, nausea and goofiness when I go without it for too long.  If my O2 levels aren't the problem what else could it be?  Numbness and vision problems are also some of my symptoms as well as memory and an inability to do simple tasks until I put my O2 back on.


A. Dear Pam, You need to use an oximeter at home to monitor your oxygen levels on and off of oxygen. There is no reason to stop the oxygen during the day if you need it. 

Dr. Tom


COPD or Asthma?
Q. I have been having shortness of breath and pain in my shoulder blades. My breath gets stuck in my neck. Two chest x-rays are normal, CT scan of lungs normal. My respirologist did PFT tests and shows mild case of asthma. He would like me to Stage 1 exercise test.

I have gone to emergency four times due to shortness of breath. They have sent me home stating anxiety. They said my oxygen level was at 99 and my lungs were fine.

Could this be a more severe case of asthma or COPD? I am a smoker and the pump my doctor gave me to try for the slight asthma has not helped. My respirologist asked if I was taking any anti anxiety medication since he felt I was anxious and this may the cause of the breathing. Do you have mid back pain with asthma or COPD?


A. Dear Nitsa, You need to have a definitive diagnosis. Some of your symptoms sound like vocal cord dysfunction. Ask your doctor about this.

Dr. Tom


“Normal” Ranges for Oxygen Level
Q. What is considered a 'normal' range of oxygen?  For example: a person with pneumonia or congestion, what percentage would be considered serious?


A. Dear Debby, Normal oxygen saturation is 94-98% at sea level. It is 92-94% at 5000 feet, which is the altitude of Denver, Salt Lake City and Albuquerque.  

Levels lower than about 85% are considered serious, particularly if sudden and associated with lung diseases.

Dr. Tom


2024 American Association for Respiratory Care