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'signs of' emphysema in chest x-ray -- don't trust docto...
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'signs of' emphysema in chest x-ray -- don't trust doctor

Spirometry = within normal range, blood gas test negative for emphysema, ski at 8,000 feet and one of the fastest guys on the mountain, 45 years old, swim regularly, no symptoms other than vague shortness of breath on severe smog days (I live in L.A., the air the past few years is the filthiest I have ever experienced).  My doctor told me I have "signs of" emphysema in my chest x ray, and I'm having trouble believing her, as I understand emphsysema will only show up on x rays in middle to late stages, which obviously I do not have.  She has not returned my phone call for 4 days after I asked "Do I have emphysema, yes or no, what stage?"  I think she told me this to get me to stop smoking, which I have done.  But the fact is, I smoked three low tar cigarettes a day, and if there's something wrong with my chest x ray, I need to know what it REALLY is, because right now, my biggest risk factor for COPD is SMOG.  If there's a problem, I should consider finding another job and relocating.

Also, I have a tremendous amount of responsibility with work and family, stress is a serious threat to my health, and if these are scare tactics, I feel it is extremely irresponsible and unethical.  If anyone else tells me how great it is I stopped smoking, I will start screaming.  What concerns me most now is misdiagnosis.  What I need to know is if anyone else had a similar experience with a physician or similar diagnosis.  Thanks for your patience, sorry if I sound angry, but if this is a recognized tactic to get people to quit smoking, I need to know.  Thanks again, WB.
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The inappropriate suggestion that one's chest X-ray shows "signs of emphysema" is not done to encourage one to stop smoking.  The chest X-ray is a poor indicator of emphysema. Hyperinflation can be seen on x-ray in emphysema as well as asthma. The radiologist might have noted that there was hyperinflation, suggestive of emphysema.  Spirometry is a much better measure of emphysema.

You should have further pulmonary function testing to determine if you have asthma or signs of some other pulmonary disease.  Smog can be a major factor leading to increased shortness of breath in persons with asthma.

You and your physician appear to have a communication problem.  If you wish to continue to be her patient, you should sit down and express your reservations.  Also, most people mean well when they commend you for quitting smoking.  You truly have made a good choice.  You might want to smile and shrug it off.
8 Comments
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Avatar_n_tn
*You can ask for a copy of the radiologist's report to see what his opinion was. I routinely get these from the doctor or nurse at the time of the appointment, or when they are available.

*You could seek a 2nd opinion of the x-ray interpretation; this can vary widely from one doctor to another. If the x-ray was really suspicious, I would think a CT scan would be next.
You should be seeing a pulmonologist.

I've had a series of CXR and CT scans with different interpretations. One doctor will say there is serious cavitation and necrosis and the lobe should be removed; another will say there is a minor 5 mm cavity probably indicating some traction bronchietasis and an area of low density probably indicating a benign tumor with gradual improvement of condition.

I expect you have been prescribed an albuterol or Combivent inhaler to see if it helps.
Link:
http://www.fda.gov/fdac/features/1999/299_emph.html
Every Breath You Take
Preventing and Treating EMPHYSEMA
"X-rays: X-rays are not often helpful in early-stage diagnosis of emphysema, but in moderate to severe cases, a reasonably accurate diagnosis can be made with the plain chest x-ray and computerized axial tomography (CAT) scanning. Some of the more common appearances on the chest x-ray include flattened diaphragms, loss of blood vessel markings, and the appearance of a reduced size of the heart."
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Avatar_n_tn
Thank you for your thoughts... in fact, my doctor called me today, and clarified.  In fact, what the radiologist observed was slightly enlarged lungs-- no flattening of the diaphgram, nothing weird with the blood vessels, or the other symptoms you mentioned.  The doctor conceded that diagnosis of early stage emphysema by chest x-ray alone was far from 100% predictive, and in my case even less so, because I am underweight and very athletic, and patients like me tend to present with larger lung volume.  Also, she had not reviewed my spirometry (within normal range) when she diagnosed me -- her bad -- and the radiologist did not know my history when he concluded that my lungs were enlarged (not my doctor's fault).  So, this is looking a bit like a blown diagnosis... but certainly a wake-up call for lifestyle change.  Don't think I'll do the spiral CT, too many false positives, and in any case, at my stage, the course of action is the same: No smoking, lots of exercise, and avoid exercise on smoggy mornings.  I may have been a bit hard on my doctor, I know my HMO works them very, very hard.  Thanks for your comments, you guys are great, best of luck, great bulletin board.  Good health to all  -- WB
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Avatar_n_tn
Thanks, RJC, very helpful observations.  The diagnosis seems very wacky to me as I only have slight shortness of breath on the very worst smog days.  Yesterday the smog was noticeable, but not very bad... and I'm swimming breast stroke and crawl and I only need to breathe every second or third stroke.  In April, I visited New York and clocked my fastest time bike riding around Central Park in over ten years-- by several minutes.  This is not the only potentially misdiagnosed problem.  I am taking blood pressure medication, (lisinopril) possibly because my BP was taken on days when it may have been abnormally high due to recent prednisone (for cluster headache.)  I took HALF the recommended dose, and my BP is now 109 over 57, and I'm torpid, listless and depressed.

However, I really want to be patient.  (That's why they call us 'patients.')  My doctor is young and overworked, and I want to very diplomatically work on this problem.  Also, I'm stuck with this health care provider for now, so I'm gonna try to work with her.  If this continues, of course, I'll have to try another doctor or provider.
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Avatar_n_tn
I think my experience is similar to yours.  I had a chest x-ray done about 2 months ago at the ER because I thought I was having a heart attack.  Come to find out it wasn't a heart attack.  It was an anxiety attack.  But I had all the classic symptoms of a heart attack.  My blood enzymes and EKG checked out normal and a chest x-ray was ordered, much to my horror because I'm a heavy smoker for 20 years.  I was terrified at what could be lurking inside my lungs.  The ER doctor told me everything was fine.  My mother was with me and she's the one who had the courage to ask the doctor how my lungs were.  The doctor said they were good and clear and my heart was good, too.  We breathed a deep sigh of relief and went on our merry way.

Well, quite by accident I got a hold of the radiologist's interpretation and besides my heart being "grossly normal," he also wrote that my lungs appeared to be moderately emphasymatous.  Final impression:  Moderate emphysema.  I've been on double-duty Xanax since yesterday after finding that out.  I haven't stopped thinking about it and I can't stop crying, either.  I am so angry that I wasn't told about the emphysema!  Makes me feel like because they know I'm a smoker, they probably think, "You already killed yourself, so there's nothing we can do for you anyway," like some homeless junkie or something.  So, go on your merry way and continue to keep killing yourself.  

Quite by coincidence I just so happened to have had a routine doctor's appointment for a check-up yesterday concerning a follow-up to my arthritis and showed him the radiologist's report.  He didn't understand why I wasn't told, but he was rather encouraging to me by saying that a chest x-ray is really a poor diagnostic tool with respect to confirming emphysema.  If I wanted to pursue it, he said a complete pulmonary study should be done with a pulmonary specialist.  He then listened to my chest and said he didn't find anything indicative of anything resembling emphysema, either; and he told me not to worry.  

I'm like you, Wildbuck.  I run and walk and exercise.  In addition to that I dance with my daughter who is 23 and is very athletic and in the best of shape.  She gets breathless before I even do.  I run and play with my grandson.  We play catch and he's too little to be able to catch anything, so I chase after the ball, and I'm OK.  Heat and humidity doesn't bother me, either.  We just moved and I packed and hauled all kinds of heavy boxes.  I didn't get short of breath.  There were a few times where my heart started pounding like it was going to explode out of my chest because the box I lifted full of encyclopedias must have weight about 100 pounds easy, but it wasn't because I was short of breath.  I regularly climb three flights of stairs, and other than my legs hurting, I still breathe.  My mother is 74, never-smoker, who has calcified spots on her lungs and saw a pulmonary specialist and had all kinds of breathing tests done.  She passed them with flying colors, and she can't keep up with me - and I'm the one that's supposed to have moderate emphysema????

Shouldn't these doctors TELL people these things?  Is there any such thing as asymptomatic emphysema?

At any rate, it is a wake-up call; and I don't know how I'm going to do it because I'm just absolutely "in love" with my smoking habit, but I will have to give the cancer sticks up.  It makes me mad and sad because I don't do anything else like drink or do recreational drugs.  I don't have a lot of money to where I can go on wonderful vacations or go shopping to destract me, either.  All I have is stress in my life, and I really, REALLY enjoyed my cigarettes.  It's going to be difficult, but I hope it's not too late.  I read of how some people get in the late stages.  I don't want my daughter wheeling me around in a wheelchair with an oxygen bottle stuck up my nose.  I don't want her bathing me or wiping my butte, either, in front of my grandson.  I don't want to predecease my mother who just lost her mother (my grandmother) last October to another scourge - cancer.  I don't want to be a burden on her, or suffer myself.  I understand it's not a pretty way to die.  So in a way, maybe this is good.  Some say there are no coincidences.  I guess it's time to start taking care of myself better than I have been.

Sorry for the long post.  Any comments will be greatly appreciated.
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I moved 3000 miles to be able to live a little longer. When i was diagonsed with Mixed Obstrubtrictive Sleep Apenea the doctors learned I had skin peices even in my lungs. I was told I had lost the elastisticity in my lungs to expand them well enough to burn my metabolism.  Also I learned I had extrinsic and Intrisic asthma along with some COPD disease not sure what kind on top of Diabetes and Ostoarthitis in many injuried and privious broken bones.

So now I live in the high desert and things are looking better,
exceopt these doctors seem to not believe me.  Someone comes to Church with viral Bronchotis and I am down for 6 weeks finally I end up in ER with my chest so tight,  i have silent lungs and some blood in my sputum.  Now the first Doctor that night diagonsed me with Asthmatic Bronchontis, Viral Bronchotis, and Chrontic Bronchotis and sent me home for 2 days and 5 weeks of bed rest. I came back 2 days later and the next Doctor looking at my x-ray found no lung disease at all and she was trying to push patience threw.

Well the P.A.C. first only looked at the second Dictirs paper I told him read the first doc the second one literally said "I want the 7 count cbc then I will probably not find anything wrong  and I can discharge her we need the beds."  Now the P.A.C. is going to schedule a C.A.T. and he collected my sputum cause a week before there was blood in my sputum.  My quiestions are:
Can they see Asthma on a C.A.T.?  What are they looking for in my sputum?  My mother when she died had an unknown lung disease when they started to open her up and the Doctors said her lungs were so disinagrated they could not understand how she was breatheing, so can they tell if, you have an unknown lung disease?  I smoked from age 5 to age 36. # packs a day when I quit the last and fourth time I am now 42 years old and now 1 whole person size bigger since then and unable to lose the weight but every time I get near smoking my lungs get progressivly worse then when I quit. I mean, they do not get to where I can handle being around smoking better it seems to get worse even though I do not smoke. So Asthma, does not get better, does it sound like emphesemya?  My Grandad died of emphysema at age 50.
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Avatar_n_tn
I moved 3000 miles to be able to live a little longer. When i was diagonsed with Mixed Obstrubtrictive Sleep Apenea the doctors learned I had skin peices even in my lungs. I was told I had lost the elastisticity in my lungs to expand them well enough to burn my metabolism.  Also I learned I had extrinsic and Intrisic asthma along with some COPD disease not sure what kind on top of Diabetes and Ostoarthitis in many injuried and privious broken bones.

So now I live in the high desert and things are looking better,
exceopt these doctors seem to not believe me.  Someone comes to Church with viral Bronchotis and I am down for 6 weeks finally I end up in ER with my chest so tight,  i have silent lungs and some blood in my sputum.  Now the first Doctor that night diagonsed me with Asthmatic Bronchontis, Viral Bronchotis, and Chrontic Bronchotis and sent me home for 2 days and 5 weeks of bed rest. I came back 2 days later and the next Doctor looking at my x-ray found no lung disease at all and she was trying to push patience threw.

Well the P.A.C. first only looked at the second Dictirs paper I told him read the first doc the second one literally said "I want the 7 count cbc then I will probably not find anything wrong  and I can discharge her we need the beds."  Now the P.A.C. is going to schedule a C.A.T. and he collected my sputum cause a week before there was blood in my sputum.  My quiestions are:
Can they see Asthma on a C.A.T.?  What are they looking for in my sputum?  My mother when she died had an unknown lung disease when they started to open her up and the Doctors said her lungs were so disinagrated they could not understand how she was breatheing, so can they tell if, you have an unknown lung disease?  I smoked from age 5 to age 36. # packs a day when I quit the last and fourth time I am now 42 years old and now 1 whole person size bigger since then and unable to lose the weight but every time I get near smoking my lungs get progressivly worse then when I quit. I mean, they do not get to where I can handle being around smoking better it seems to get worse even though I do not smoke. So Asthma, does not get better, does it sound like emphesemya?  My Grandad died of emphysema at age 50.
Blank
Avatar_n_tn
I moved 3000 miles to be able to live a little longer. When i was diagonsed with Mixed Obstrubtrictive Sleep Apenea the doctors learned I had skin peices even in my lungs. I was told I had lost the elastisticity in my lungs to expand them well enough to burn my metabolism.  Also I learned I had extrinsic and Intrisic asthma along with some COPD disease not sure what kind on top of Diabetes and Ostoarthitis in many injuried and privious broken bones.

So now I live in the high desert and things are looking better,
exceopt these doctors seem to not believe me.  Someone comes to Church with viral Bronchotis and I am down for 6 weeks finally I end up in ER with my chest so tight,  i have silent lungs and some blood in my sputum.  Now the first Doctor that night diagonsed me with Asthmatic Bronchontis, Viral Bronchotis, and Chrontic Bronchotis and sent me home for 2 days and 5 weeks of bed rest. I came back 2 days later and the next Doctor looking at my x-ray found no lung disease at all and she was trying to push patience threw.

Well the P.A.C. first only looked at the second Dictirs paper I told him read the first doc the second one literally said "I want the 7 count cbc then I will probably not find anything wrong  and I can discharge her we need the beds."  Now the P.A.C. is going to schedule a C.A.T. and he collected my sputum cause a week before there was blood in my sputum.  My quiestions are:
Can they see Asthma on a C.A.T.?  What are they looking for in my sputum?  My mother when she died had an unknown lung disease when they started to open her up and the Doctors said her lungs were so disinagrated they could not understand how she was breatheing, so can they tell if, you have an unknown lung disease?  I smoked from age 5 to age 36. # packs a day when I quit the last and fourth time I am now 42 years old and now 1 whole person size bigger since then and unable to lose the weight but every time I get near smoking my lungs get progressivly worse then when I quit. I mean, they do not get to where I can handle being around smoking better it seems to get worse even though I do not smoke. So Asthma, does not get better, does it sound like emphesemya?  My Grandad died of emphysema at age 50.
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Avatar_n_tn
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