follow-up to crackles with question

Thread view:

Enable EMail Alerts

Start New Thread

Thread rating:

Damian - 26 Aug 2005 02:27 GMT

Back in June I had an X-ray because my lung Dr. heard crackles the xray
was ok. Since that time I was on a month long taper of prednisone,
biaxtin (10 days), and now I am doing 15 days of doxy. I also take
Advair 250/50, spreva, QVar 80 3 puffs 2x a day and ventilin as needed
( 2-3 times a day four or five days a week). I had a CAT scan last
week and it showed non focal infiltrates in my upper left lobe.
Starting Sunday night I have had intermittent moist lungs like croup,
it clears up for a few hours then starts up again. I am going to be
going to Sri Lanka (tsunamia relief) in 2 weeks and I am concerned that
this will not be gone. My Dr is on vacation and I won't see him till
Tuesday. Any suggestion on how to get this under control or what I
might suggest to him? My trip is for 25 days and if I go over like
this it will be a long time without quality medical care. I am taking
biaxtin, cipro, and prednisone with me but I would rather be better
before I go then trying to decide over there what to do next. Any
suggestions would be appreciated.

Thanks,
Damian

Reply to this Message

00doc - 26 Aug 2005 02:38 GMT

> Back in June I had an X-ray because my lung Dr. heard crackles the xray
> was ok. Since that time I was on a month long taper of prednisone,
[quoted text clipped - 12 lines]
> before I go then trying to decide over there what to do next. Any
> suggestions would be appreciated.

What you are describing doesn't sound like asthma and has been going on
longer than you would expect for the usual pneumonias. It sounds like it is
time to see a pulmonologist. You are already on just about all the meds that
I would imagine anyone could suggest.

Any idea why he is combining the Advair 250/50 with the Qvar? If he is
looking for a larger dose of steroid why not just use the Advair 500/50 (not
to mention the fact that you are also on oral steroids).

Any history of TB exposure? You should at least have a PPD (TB skin test)
and some testing for other causes of lung inflammation (like Wegener's
granulomatosis, sarcoid, TB, rheumatoid arthritis, lupus, cancers, fungal
infections, aspiration....it goes on). PFT's would also be useful. At some
point you will need a bronchoscopy if things do not become clear with
non-invasive testing and treatments.

You at least should have the lung function characterixed and oxygen levels
checked prior to flying. If it turns out you are prone to low oxygen levels
then getting on a long airplane ride may be a mistake.

Signature

00doc

Reply to this Message

Damian - 26 Aug 2005 22:23 GMT

> > Back in June I had an X-ray because my lung Dr. heard crackles the xray
> > was ok. Since that time I was on a month long taper of prednisone,
[quoted text clipped - 35 lines]
> --
> 00doc

00doc,

My dr is a pulmonologist and I am not sure about the Advair 500 but I
will ask him when I see him Tuesday. I do get hoarse sometimes and
this combination seems to work pretty good. But I am willing to give it
a try if it would result in a cut down of puffers.

I have not been exposed to TB but I can't take the test as I had a BCG
vacination years ago in hopes of stopping erythermamulti-form(sp). I
got quite an infection from it and was told never to take the test.

At my last office visit(2 weeks ago)the dr spent about 20 minutes going
over all my pfts for the last couple of years. Then ordered the CT
scan looking for a sub glottic obstruction, which I didn't have.

When I am sitting around doing nothing my oxygen levels seem ok. When
I add stairs, packages or laundry I do huff an puff a bit.

The CT Scan report also said he did not think it was a discrete mass
rather a 3cm patchy area of increase density (his words).

Thanks for your response your feedback was very much appreciated.
Damian

Reply to this Message

00doc - 27 Aug 2005 14:36 GMT

> My dr is a pulmonologist and I am not sure about the Advair 500 but I
> will ask him when I see him Tuesday. I do get hoarse sometimes and
> this combination seems to work pretty good. But I am willing to give it
> a try if it would result in a cut down of puffers.

In that case I suspect that he added the Qvar rather than going up on the
Advair because you were already getting hoarse on the Advair and he was
hoping that Qvar would exacerbate the problem less. He may also just be
looking for the differences in deposition. Personally, I would just try it
and see what happens before adding another puffer but there is more than one
way to skin a cat. If he is really convinced of the deposition advantages of
Qvar he could just go with that as the steroid and use Serevent or Foradil
as a second inhaler (but then there wouls still be two). In the end I guess
it depends on how you feel about the risk of a sore throat vs buying and
using the extra inhaler.

I suspect that if he is a pulmonoloigt that he will be discussing
bronchoscopy with you soon. He is correct to do the non-invasive things
first but it does sound like that is the direction you are heading.

> I have not been exposed to TB but I can't take the test as I had a BCG
> vacination years ago in hopes of stopping erythermamulti-form(sp). I
> got quite an infection from it and was told never to take the test.

BCG alone is not a contraindication to the PPD if it was given in the
distant past (that is a change in thinking from a few years ago). It sounds
like the reason you can't have it is because of the previous infection. I
had a roommate in med school that unwisely allowed someone to put a PPD on
him despite a previous strong reaction so I have seen the scar that can
result. When I was in India they had a serologic test for TB (blood -
antibodies) but I have never seen anyone order it in the US so I am not sure
if it is available. In the US I was always taught that it was useless but I
suspect that those Indian docs know a thing or two about TB.

> At my last office visit(2 weeks ago)the dr spent about 20 minutes going
> over all my pfts for the last couple of years. Then ordered the CT
> scan looking for a sub glottic obstruction, which I didn't have.

Glad you have had them done. But this does support my suspicion that this is
not a case of straight forward asthma.

> When I am sitting around doing nothing my oxygen levels seem ok. When
> I add stairs, packages or laundry I do huff an puff a bit.

Airplane cabins are pressurized to about 8000 ft. The oxygen tension is
significantly lower. Normal people will have a 6 point drop in O2 saturation
but that would be a lot more if there is some impairment due to the "S"
shape of the curve. They just don't notice it because all they do is sit. If
you had a treadmill on the plane you would notice. When people use chronic
O2 they are usually advised to increase the liter flow by 1 or 2 lpm when at
altitude. You may want to specifically ask him about your sats and what to
do while flying. You can't use regular O2 tanks on airplanes so the airlines
are used to providing them when needed. They just need to know in advance.

> The CT Scan report also said he did not think it was a discrete mass
> rather a 3cm patchy area of increase density (his words).

No, I understood that. The stuff I was talking about would apply to the
infiltrate.

> Thanks for your response your feedback was very much appreciated.
> Damian

No problem.

Signature

00doc

Reply to this Message

Damian - 31 Aug 2005 01:27 GMT

> ><snip>
>>
> In that case I suspect that he added the Qvar rather than going up on the
> Advair because you were already getting hoarse on the Advair and he was
> hoping that Qvar would exacerbate the problem less. He may also just be
> looking for the differences in deposition. >

I spoke to the Dr. about switching to Advair 500. He said that he
would like it better if I didn't make any changes until he got the lung
problem cleared up. He said we could discuss it at a later appt. I
agreed.

Glad you have had them done. But this does support my suspicion that
this is

> not a case of straight forward asthma.

The Dr said he spent quite a while going over the CT Scan and he
thinks it is
small spot of pneumonia. He said if the spot was larger the
radiologist would have called it that but because of the size he
didn't.
I stop the doxy on Friday because it seemed to be not working. My
sputum turned yellow after 12 days on it. Today I started Cipro for 10
days. So I am hoping that this will clear it up. I am going to submit
a sputum sample to see if it is something different or needs a
different antibiotic.
So I guess I am on the discovery path. I leave in 2 weeks for 25 days
so I am hoping all is well by then. If not I will keep my fingers
crossed and hope for the best or resume the hunt for an answer when I
get back.

Again thanks, at least I know if we don't find something to clear this
up the hunt is not over.

Damian

Reply to this Message

00doc - 31 Aug 2005 03:56 GMT

> The Dr said he spent quite a while going over the CT Scan and he
> thinks it is
> small spot of pneumonia.

For three months?

I hope he is right.

Signature

00doc

Reply to this Message

Damian - 01 Sep 2005 18:09 GMT

I also hope he is right. I have had trouble in the passed getting
infections to clear up. I had pneumonia once that took about 5 months
and about 4 different antibiotics so maybe this is just like that one.
It had been about 10 years since that time but I have to think positive
and believe that my Dr does have my best interest in mind.

I also know that you give very good advice so I will push for more test
if this round doesn't clear it up.

Thanks again,
Damian

Reply to this Message

Damian - 05 Sep 2005 21:54 GMT

> > The Dr said he spent quite a while going over the CT Scan and he
> > thinks it is
[quoted text clipped - 6 lines]
> --
> 00doc

Just a quick update. I had an Xray on Friday and it appeared clear.
Although the Dr did say that the best thing would to get another CT
Scan as they see better then standard Xray. I also started prednisone
on 40mg in the morning and 20mgs at dinner. I am doing a taper with a
stay at 25mgs in morning and 15 mgs at dinner till Friday. I am going
to talk to the Dr on Wednesday and again on Friday. This morning I
still had thick yellow junk yesterday was a lot lighter yellow. This
has been the pattern so I am not as hopeful as I was yesterday. I have
4 days left of Cipro. The sputum culture didn't show any exotic
growth. Time is running out as I only have a week left before I leave.
Any suggestions?

Damian

Reply to this Message

mcs - 26 Aug 2005 19:31 GMT

Damian
you smoke? Just wondering where do you live ( area) ?

> Back in June I had an X-ray because my lung Dr. heard crackles the xray
> was ok. Since that time I was on a month long taper of prednisone,
[quoted text clipped - 15 lines]
> Thanks,
> Damian

Reply to this Message

Damian - 26 Aug 2005 22:24 GMT

> Damian
> you smoke? Just wondering where do you live ( area) ?

No I don't smoke. I live in the Northeast.

Reply to this Message