However, lately, when doing my stairs, I experience occasional shortness of breath. I have a family history of stroke through my mother and father. Could I possibly have some type of blockage, even though all signs and tests appear normal? Should I request a stress test at my next physical?

DEAR READER: Yes, you should. While you don’t mention your diet, I can only assume it is a healthful one. Otherwise, it’s likely that your HDL, LDL and total cholesterol levels would be out of the normal range. You mention routine exams and lab work but don’t indicate that you have ever had a baseline EKG. You exercise extensively but have a positive family history that could be of concern. And you are 60. My guess is that you are a young 60, but because you even question the possibility of blocked arteries, you should request a stress test. Your physician should order one because of your age and the shortness of breath.

A final possibility is that your problem is arising directly from your lungs. Request a chest X-ray and evaluation for possible pulmonary disease.

To provide related information, I am sending you a copy of my Health Report “Coronary Artery Disease.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

My doctor had told me that this is normally a slow moving disease but for some reason it is accelerating in my case. Everything I have read is terribly frightening. Can you provide any information or suggestions about treatment?

DEAR READER:
Pulmonary fibrosis is a respiratory disorder in which lung tissue becomes thickened and stiff or scarred. Over time the lungs’ ability to move oxygen into the bloodstream becomes compromised. It is a serious condition with no cure.

There is no known cause but certain risk factors can increase the chance of developing pulmonary fibrosis. Cigarette smoking, certain viral infections, exposure to environmental pollutants and certain medications increase this risk. Genetics may play a role, but the extent is unclear at this time.

Another finding is that 9 out of 10 sufferers also have gastro-esophageal reflux disease (GERD). Researchers speculate that some GERD patients inadvertently breathe in tiny drops of stomach acid on a regular basis. This acid may, over time, damage lung tissue leading to pulmonary fibrosis. This is only a theory which needs more research for confirmation.

Treatment is aimed at preventing more scarring, improving symptoms, and maintaining the ability to get around and stay healthy.

Medications, such as prednisone, to reduce inflammation are most commonly administered. Your doctor may also want to suppress the immune system with medication in an attempt to reduce further damage. It is also beneficial for most sufferers to receive yearly flu and pneumonia vaccines, take anti-reflux medications and include supplemental calcium and vitamin D to prevent bone loss due to corticosteroid treatment.

Oxygen therapy is used to increase blood oxygen levels and reduce shortness of breath. Pulmonary rehabilitation may be of help by conditioning the lungs and body to keep as healthy as possible for as long as possible.

Lung transplant is a final option. It is primarily reserved for those younger than 65 that are not helped by medication and have no other medical issues.

I suspect you are already under the care of a pulmonologist (lung specialist). This specialist is most familiar with diagnosis and treatment of this disorder and will be your best resource for the newest updates in treatment. He or she should also be able to help you with referrals to specialized rehabilitation programs which may increase your existing lung capacity and keep the rest of your body as physically fit as possible.

To give you related information, I am sending you a copy of my Health Report “Pulmonary Disease”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

My pulmonologist (lung doctor) now tells me I have Churg-Strauss, however, I don’t have any symptoms of it. I have had three blood tests taken but all were negative. Can you tell me anything about this disorder?

DEAR READER:
I will do my best. Churg-Strauss syndrome is one in which blood vessels become inflamed. It is therefore, both a pulmonary disorder as well as a form of vasculitis (which simply means blood vessel inflammation).

As for your statement that you do not have any symptoms of this disorder, I must disagree. Asthma is the most common sign of Churg-Strauss, as are abnormally high (10% or higher) levels of eosinophils, pulmonary infiltrates that move or come and go, a history of acute or chronic sinus pain, damage to one or more nerve groups, and extravascular eosinophils (present outside the blood vessels).

You have already had eosinophilic pneumonia and continue to have problems with asthma. Without knowing more of your medical history and tests, I cannot determine if you meet any more of the criteria (symptoms) that would backup the diagnosis of Churg-Strauss. Most pulmonologists feel confident in giving this diagnosis if a patient meets four of the criteria but others may need only two or three.

You say you have had three negative blood tests for this disorder. Have you had any lung biopsies or imaging studies such as chest X-rays or MRIs? What makes your specialist feel confident about giving your this diagnosis?

I urge you to speak to him or her and ask why they feel you have Churg-Strauss. There is no cure but they may have treatment options in mind. Since you are already using corticosteroids (prednisone), perhaps other immunosuppressive medications may be considered.

If you would like to learn more about this condition I recommend you review an article from the Mayo Clinic website, http://www.mayoclinic.com/health/churg-strauss-syndrome/DS00855. As I have often said in the past, the Mayo Clinic does an excellent job of providing patients with easy-to-understand material about a wide variety of medical conditions.

The information provided should answer some questions you have and allow you to ask more specific questions of your physician about diagnosis, testing and treatment. An informed patient is often the best patient. It is still vital to follow the doctor’s orders as he or she knows your case best, but by knowing what to ask you can get the best help.

To give you related information, I am sending you a copy of my Health Report “Pulmonary Disease”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

I don’t do much at home but really feel good. I don’t even have chest pain. I have been to the hospital five times but only for three or four days at a time to have tests. They told me it was to check my lungs and heart valves.

I started smoking when I was 14 but quit in 1982. As long as I take all my medicine, use the oxygen and don’t get out of breath, I‘m okay. I am still able to work in the yard raking leaves. I always work slowly and use my oxygen.

My reason for writing is that a friend told me that emphysema is incurable. Is this true?

DEAR READER:
Based on your brief letter, I can only give you general information about emphysema. Since you do not give you age, gender, how long you have had the condition, what medications you are on and what procedures and treatments you have had before, I ask that you forgive me if I repeat anything you may have already tried.

First, I’ll answer your question. Yes, emphysema is incurable; however, it is treatable. But before I get into that, I will explain a bit about the condition, causes and symptoms.

Emphysema is a progressive lung disorder. It results from damage to the small air sacs and airways within the lungs that reduces airflow when breathing out. This means that “bad” air cannot be completely exhaled which causes an inadequate amount of “good” air to be inhaled. The final result is shortness of breath, even during minimal exertion.

Symptoms in the early stages are generally so mild, that they go unnoticed. Once they become more persistent and annoying, irreversible damage may have already been done. The primary symptom is shortness of breath. Others include fatigue (due to lack of oxygen), loss of appetite and weight loss (due to difficulty breathing while eating) and, uncommonly, a mild, chronic, dry cough.

Because the shortness of breath worsens as the disease progresses, most physical activity is difficult, if not impossible. In later, more severe stages, even breathing while lying down can be compromised. It is at this point that breathing requires most of the body energy, leaving little for other activities such as walking or even eating.

The most common cause for emphysema is smoking. This means that by not smoking (and avoiding second hand smoke), your chances of developing emphysema are incredibly low.

Another cause is alpha-1 antitrypsin protein deficiency which is an hereditary condition. It only occurs when two defective genes (one from each parent) are passed on to a child. Millions of people are carriers, meaning they only have one of these genes. Often they do not have problems but some may develop mild to moderate symptoms or other lung or liver disorders.

The type of emphysema caused by this condition generally develops earlier than the more common form of emphysema. Anyone who develops emphysema before the age of 40 should undergo genetic testing. Those found to be positive for the protein deficiency should inform close family members so they, too, may undergo testing. Early treatment can prevent or reduce symptoms.

Treatment includes supplemental oxygen, bronchodilators and inhaled steroids. Antibiotics may be given if bronchitis, pneumonia or influenza are also present. It is also important to get flu and pneumonia shots to reduce or prevent the chance of getting these disorders. Rarely, surgery or lung transplant are recommend only as a last resort if other options do not work.

Many individuals may experience improvement when enrolled in a pulmonary rehabilitation program. It is also important to quit smoking as this will only worsen symptoms at an accelerated pace.

As for your use of Viagra, I assume you are mistaken about the name of your medication. I am unaware of any off-label use of the impotence drug for emphysema. I recommend you return to your pulmonologist. It is important that you understand your condition and what treatments you are getting. An informed patient is a good patient. He or she will also be able to give you more information about other or newer treatment options that may be beneficial to you.

To give you related information, I am sending you a copy of my Health Report “Pulmonary Disease”. Other readers who would like a copy should send a self-addressed, stamped envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Well, I’m now grown with a family of my own and can‘t believe how history repeats itself or that I am actually asking this question. Is it safe to use this same treatment on my own children?

DEAR READER:
It depends on the age of your children. All menthol products, including Vicks, have the capability of causing breathing problems, eye and lung inflammation, liver damage, airway constriction and allergic reactions in some infants and children. These products don’t actually clear congestion or help reduce a cough; they simply increase the production of mucus and inflame their airways that are narrower than those of adults.

In fact, Dr. Bruce Rubin writes for CHEST, an official journal of the American College of Chest Physicians. After hearing of an infant who developed respiratory difficulty following a home-treatment of Vicks placed under her nose, Dr. Rubin began his studies with ferrets, whose respiratory systems are similar to those of infants. Following his studies he recommended “never putting Vicks in, or under, the nose of anybody — adult or child. Some of the ingredients in Vicks, notably the menthol, trick the brain into thinking that it is easier to breathe by triggering a cold sensation, which is processed as indicating more airflow. Vicks may make you feel better, but it can’t help you breathe better.”

Beyond Dr. Rubin’s studies, in 2008 the FDA was requested by a group of pediatricians to revise the standards for over-the-counter cough and cold remedies for children under six years of age, citing a lack of evidence they even work. There is mounting evidence the remedies can cause seizures, difficulty breathing, cardiac problems, and more. In fact, even the Vicks packaging recommends asking the advice of a physician for use on children under two years of age.

It has been noted that manufacturers are not voluntarily removing cough and cold remedies for children from pharmacy and grocery store shelves, since they do provide relief to older children when taken according to package inserts. Americans spend about $300 million every year on the plethora of products offered, despite warnings.

I am sure it will take a considerable period of time before the FDA takes a stand on whether or not to modify their present standards. In the interim, infants and young children should be under the care of their pediatricians and parents should be guided by their medical recommendations. Should any question remain because of repeated respiratory ailments, request a referral to a pulmonologist who specializes in pediatric medicine.

To give you related information, I am sending you a copy of my Health Report “Pulmonary Disease”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Dear Dr. Gott: I read your column today about the woman who had a decade long illness after her and her husband visited the Tucson, AZ area to see their daughter. You wrote that you thought the mother may have a staph infection.

I do not work in the medical profession but am sending this information along to you, since Valley Fever is misdiagnosed so much as I also thought it had been stamped out along with so many other communicable diseases.

My first wife and I both had Valley Fever as young children. We were both raised in Bakersfield, CA which is in the San Joaquin Valley. This area is also known as “America’s Bread Basket” with many farmers constantly plowing and turning the soil over immediately after harvesting a crop of some kind. I was only five years old at the time I was infected. My grandparents came down from Modesto, CA, picked me up and took me to the coast in Hollister, CA for six weeks per my doctor’s orders. I was then taken to their home in Modesto for another six weeks. After that I was allowed to return home to Bakersfield because I appeared to be healed.

This disease left a spot on my left lung the size of a nickel but so far there have been no ill effects. I am 72 years old now and also served five years in the US Navy.

My first wife’s doctor treated her with medicine and bed rest for about six months and she got well never to be bothered with it again. She never said anything about any spots on her lungs after a physical which always included a chest X-ray.

DEAR READER:
My, my your desk must have been a bit cluttered! However, I am not one to speak since my office has been known, on occasion, to be rather untidy, with all the letters and whatnot I receive every day.

Being raised on the East coast and attending medical school in the South, Valley Fever is not something I would have thought of. However, it is certainly a possibility.

Valley Fever is a fungus which grows as mold in the soil of desert areas in the Southwest United States. It usually grows at a depth of four to twelve inches. The mold spores are spread through the air when the soil is overturned, such as during plowing and other farming activities or during fires. Infection occurs after inhalation of the these spores.

Symptoms generally resemble the flu. Cough, fever, fatigue and headache are common symptoms. Given these rather benign symptoms, most doctors, especially those unfamiliar with the infection, could easily mistake the symptoms for a cold, the flu or another harmless bacterial or viral infection. Unlike these infections, however, Valley Fever will not respond to antibiotics or antiviral medication because it is caused by a fungus. Treatment consists of antifungal medication.

Individuals who are susceptible to infection include farmers and construction workers (who have regular contact with upturned soil), pregnant women and those with weak immune systems, such as children who still have developing immune systems, and those with chronic diseases.

The good news in this situation is that there is a test available. If individuals in southern California, Nevada and New Mexico, eastern and southern Texas, and nearly all of Arizona, have flu-like symptoms that have persisted despite treatment with antibiotics, antivirals, and/or various breathing treatments, need a Valley Fever test. This can also apply to individuals who have visited these areas and developed resistant symptoms.

For individuals who live in these areas, have family there or are simply interested in learning more, I recommend you go online to www.MayoClinic.com/health/valley-fever/DS00695 or www.CDC.gov/nczved/dfbmd/disease_listing/coccidioidomycosis_gi.html for more information.

Because you mentioned having a spot on your lung, I am giving you related information, I am sending you a copy of my Health Report “Pulmonary Disease”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Following an X-ray he was told he had a spot on his lung but the doctor didn’t feel it was anything to worry about. Since he hated going to doctors, he didn’t do anything abut it. Five months later he was in the hospital, diagnosed with lung cancer.

His oncologist recommended chemotherapy and told him he might have about a year to live. My father-in-law went ahead with the chemo but after only two treatments he passed away, just two months after the diagnosis.

I want your readers to know that if a doctor says not to worry about a lung spot, they should worry. Don’t wait, do something about it NOW!

DEAR READER:
I agree with you. Any abnormal lung X-ray should be further investigated to determine what is wrong. In most instances it is not cancer but there is always a possibility, especially for individuals who are past or current smokers or work in heavily polluted areas.

To give you related information, I am sending you a copy of my Health Report “Pulmonary Disease”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR READER:
Sarcoidosis occurs when inflammation causes tiny lumps of cells (granulomas). The granulomas can continue to grow and clump together to form larger lumps or groups of lumps. If many form in an organ, function is affected.

Sarcoidosis can occur in nearly any part of the body but most often affects the lungs and/or lymph nodes. Other commonly affected areas are the skin, eyes and liver. Very rarely, sarcoidosis can be found in the thyroid gland, kidneys, reproductive organs and breasts. More than one organ is involved in nearly all cases.

Symptoms vary according to what organ is affected. Besides organ specific symptoms some general ones include fever, night sweats, uneasiness, malaise, fatigue, sleep problems and loss of appetite or weight.

Diagnosis is usually suspected during a thorough medical history and physical. If the doctor suspects sarcoidosis, he or she may choose to order testing. There is no diagnostic test for sarcoidosis so all testing must be ordered according the area of the body the doctor suspects is affected.

Treatment will vary according the organ or organs affected, but most cases can be treated with prednisone. If symptoms worsen or the disease progresses, other options are available. If the diagnosis were made during testing for another illness and symptoms were not present, most cases do not need treatment and recovery takes place in time. However, some organs must be treated, regardless of symptoms or a lack of them.

Your son is on appropriate medication and should be followed up regularly by his doctor.

For others interested in learning more about sarcoidosis, I recommend the National Heart, Lung and Blood Institute’s sarcoidosis webpage. It can be found at www.nhlbi.nih.gov/health/dci/Diseases/sarc/sarc_all.html.

To give you related information, I am sending you a copy of my Health Report “Pulmonary Disease”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

If the muscle really is the cause, surely there is something I can take to reduce the pain. I feel like just a number with my doctor and fear I may not be getting the best medical care because of it.

Please give me your professional opinion: is this just a muscle problem or something else?

DEAR READER:
You have had a battery of appropriate testing with normal results. Both your heart and breasts have been ruled out as possible causes. This still leaves your lungs and the surrounding muscles. You say you had a breathing test but do not mention which one; therefore I recommend you have a pulmonology consult. This type of doctor specializes in breathing and lung disorders. If after the consultation and any additional, required testing, the pulmonologist rules out your lungs, your chest wall muscles may be the culprit. If this is the case, you are probably suffering from a strain or chest wall syndrome (inflammation of the lining around the lungs). Without proper treatment these conditions will heal on their own but often very slowly.

In the meantime, I recommend you take an anti-inflammatory medication such as ibuprofen (Advil, Motrin) or naproxen sodium (Aleve) for the pain. You may also want to try using a heating pad or cream such as Icy Hot or Castiva. If these prove ineffective, try acupressure or acupuncture. Physical or water therapy may provide with you with some pain relief also.

On a side note, if you feel your health care quality is lacking because of your physician, I urge you to find a new one. No one should feel like “just a number” at the doctor’s office. At 77, I assume you are on Medicare. If this is the case, you have the option of seeing other primary care physicians without making a commitment to them. Ask your family and friends about their doctors or ask your local hospital if they have a list of general, family and internal medicine doctors in your area. Make “Get Acquainted” visits with those that sound promising. After interviewing them, make your decision based on who best meets your wants and needs. Then ask to have your file transferred from the old to the new.

To give you related information, I am sending you a copy of my Health Report “Pulmonary Disease”. Other readers who would like a copy should send a self-addressed, stamped envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Many years ago I was diagnosed with mitral valve prolapse. It does not give me any trouble, unless it is somehow connected with my other problem. I have been diagnosed with air hunger.

Occasionally I have the sensation of a shortage of air in my lungs. This causes me to cough suddenly and take several deep breaths to relieve the feeling. I have never smoked and over the years have had several normal chest X-rays. A stress test also showed no abnormalities.

My doctor has prescribed Ativan and Buspirone daily. These seem to help somewhat but are not a cure. The problem intensifies when I have a cold and at other times for no apparent reason. This has been occurring for many years.

DEAR READER:
Air hunger is a respiratory distress condition. It is marked by labored breathing, difficulty breathing and/or the feeling of not getting enough air into the lungs. It can be very disturbing when it occurs. It is not related to mitral valve prolapse.

Your physician appears to have taken appropriate first steps in testing. I believe the next step should be a CT scan or MRI which shows more detail and may pick up an abnormality previously missed. Lung masses, cancer and other conditions need to be ruled out before you can be definitively diagnosed with a benign condition.

I would like to mention that since you appear to be responding favorably to Ativan (an anti-anxiety drug) and Buspirone (a tranquilizer), your air hunger may simply be a manifestation of a panic disorder. Perhaps a psychiatrist or therapist would be the appropriate next step to take.

To give you related information, I am sending you a copy of my Health Report “Pulmonary Disease”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure mention the title.