October 05, 2006

Q: I am writing about my brother, who is in very bad condition due to emphysema related to many years of smoking. He is on oxygen at all times. He cannot walk 10 steps without gasping for breath. Is exercise helpful? Are there any avenues he could pursue?

A: Emphysema is one of the two chronic obstructive pulmonary diseases – COPD. The other is chronic bronchitis. Emphysema is a destruction and expansion of the millions of air sacs within the lungs. It is through those air sacs that oxygen diffuses into the blood and carbon dioxide passes out of the blood to be exhaled.

The expanded air sacs give a person a barrel chest and push the primary breathing muscle –– the diaphragm –– downward, making it ineffective in drawing air into the lungs. Emphysema’s primary symptom is shortness of breath when moving about. Chronic bronchitis fills the airways with pus. Its hallmark symptom is cough filled with pus.

There are many avenues for your brother to pursue. One is to get in a pulmonary rehabilitation programme. Many hospitals sponsor such programmes. His doctor can give him information on where they’re located.

Medicines that dilate the airways can reduce the effort of breathing for many with COPD.

A few breathing tips can help him. He should breathe in slowly through his nose, taking about four seconds. He should exhale through his mouth with his lips pursed in the position of whistling and should breathe out even more slowly than he inhales –– about six seconds. He has to learn how to belly-breathe. If he puts his hands on his stomach and feels the stomach pushing outward when he’s drawing in air, that’s belly-breathing. Bending slightly forward at the waist when he walks gives more room for the diaphragm to draw air in.

Exercise is most important. Tell him to take 10 steps if that’s all he’s able to do. Do it two or three times a day. Then go for 11 steps the next day. Keep increasing the distance, but not to the point of exhaustion.

Q: In researching the drug pamidronate for my daughter with CRPS/RSD, I read that it is also used for Paget’s disease. You recently wrote about RSD and Paget’s disease but did not mention pamidronate. Why?

A: Pamidronate, trade name Aredia, is a close relative of three other Paget’s disease drugs – Fosamax, Actonel and Boniva. It stops the frenetic activity of bone-gobbling cells that take place in that illness. I didn’t mention it simply because I ran out of space. It’s a good drug and is given intravenously.

These same drugs are also used for the much more common condition osteoporosis.

CRPS is complex regional pain syndrome. Its older name was RSD – reflex sympathetic dystrophy. It is unrelenting pain with muscle-wasting and skin-thinning that occurs after trauma like a broken bone or a sprain. The trauma doesn’t have to be major. It’s a condition that’s hard to treat and hard to deal with. Pamidronate has been used by some doctors. One reason is that in CRPS, osteoporosis occurs in the affected bone. The drug has been reported to lessen pain too. When there is more experience with it for this syndrome, I promise to mention it.

Q: I have a sore on my hand called pyoderma gangrenosum. I have been treated successfully for it, but it has come back eight times in the past four years. What causes it?

A: Pyoderma gangrenosum starts out as a small, pus-filled bump that rapidly enlarges to form an open ulcer with a violet edge. It is seen with a number of illnesses, such as ulcerative colitis, Crohn’s disease, hepatitis, rheumatoid arthritis, polycythemia (a blood disorder) and one kind of leukemia. However, in as many as half of the cases, no background illness is present, and the cause remains puzzling. It has a tendency to recur and recur.

Dr Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write to him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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