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Old 08-04-2008, 05:47 AM   #1
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lung function test - can anyone explain the results?

I have finally had a test of lung function today, after being breathless since the beginning of my chemo, and more recently experiencing discomfort when I take a deep breath. Unfortunately, at the end of it, I was simply given a print-out, with no explanation of what it means, and no follow-up appointment. In order to save costs, I am obviously intended to take it along to my next chemo appointment, and ask whichever registrar is on duty to explain it, which means waiting another week.

I will probably now trawl the internet trying to find out what this stuff means, but I was wondering if anyone here might be able to help me out?

For each test, parameter is listed, which I assume refers to what is being measured. They are all abreviations, but I can look them up. The next columns are unit, Lower, pred, Upper, Meas and SR. I assume this refers to the lower limit of the normal range, the predicted value (probably the mean), the upper limit, and the measured value (i.e. mine). I have no idea what SR represents, but assume it is some sort of statistic to represent the degree of deviation of the measured value from the predicted value, as this figure is negative when the measured value is below the predicted, and positive when it is above the predicted.

The three tests reported are Spirometry - Flow Volume, Body-Plethysmography, and CO Diffusion.

All of the measures on the Spirometry test seem to be normal, and either close to, or above the predicted vaules.

The body plethysmography test is divided into volumes and resistance. The volumes tests are all close to the predicted values. However, the resistance measures are not. The two parameters reported are RAWtot, and sRAWtot. The measured values for both of these are 0.00.

The CO diffusion measure also does not appear to be normal. The parameter TLco(Hb) has a predicited value of 10.31, and a range of 7.99-12.64. My score was 6.60, which is clearly way below the normal range.

I would really appreciate it if someone could explain some of this to me. On the basis of these figures, it looks to me like there is definately something wrong with my lungs now, and I do not like the idea of waiting another week to find out.

Thanks
Simon

 
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Old 08-04-2008, 11:48 AM   #2
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Re: lung function test - can anyone explain the results?

hey,
i had to have a repeat test during my chemo cause of the bleomycin which they had to stop but according to the nurse that did the tests they were the exact same results as the first one i did. however, last week i was doing CO tests on placement and unless you are a smoker it should be below ten. 0-4 is if you live in a non polluted area but if you live in the city then the number is going to be closer to 10 but shouldnt be above it. but of course i dont know if chemo would affect that.
i dont know if that helps any.
Amanda
x

 
Old 08-04-2008, 12:57 PM   #3
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Re: lung function test - can anyone explain the results?

Hi Amanda.
I have spent the afternoon reading up on this, but I may have misinterpreted some things. Are we definately talking about the same test? This one involved exhaling, then taking a full lungfull of air with some carbon monoxide. You hold your breath for 10 seconds, then exhale fully. The test compares the amount of CO inhaled, with the amount exhaled to assess how much CO was absorbed by the alveolar cells. I thought that the TLco(Hb) figure represented the amount of CO absorbed, and that a low reading is indicative of the alveolar cells not working properly. Is that not the case?

It seems that this test is highly sensitive to Bleomycin Induced Pneumonitis, although it is not that specific, as other factors can affect this figure. I may be wrong, but I am taking this result to mean that the bleo has affected my lungs.

Best wishes
Simon

 
Old 08-06-2008, 02:19 PM   #4
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Re: lung function test - can anyone explain the results?

hey,
yeah we are talking about different tests. this one measured how much CO you have in your lungs without having to breathe it in first. the scale was between 0-80 so definatly not the same test.

it was really near the end of my treatment (i think the last 2) and i was getting short of breath walking up my stairs etc and they said that there have been links to the bleo damaging the lining of the lungs and so they would stop it and i had to have repeat peak flow tests etc and the nurse said they were all the exact same as when i first started treatment but they kept me off the bleo anyway just in case.

sorry i wish i could be more help, i dont know what any of it means and i cant find it in any of my text books

speak soon
amanda
xx

 
Old 08-07-2008, 04:25 AM   #5
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Re: lung function test - can anyone explain the results?

Hi Amanda,

similar situation, only I started getting out of breath after about the first month. My consultant had told me that bleo could do this, and if I developed a cough or breathlessness, I should mention it and they would drop the bleo. I mentionned it every single time I went in, and nobody took any notice until the last couple of cycles. Trouble is, once you start treatment, you have no further contact with your consultant. The drs you see are either junior docs, who change every couple of months, or a registrar, who in my case was somewhat disinterested. I now even get out of breath walking from the car park to the hospital, and it's not getting any better.

On the one hand, we have a great system here with free healthcare at the point of delivery. The downside is that the NHS was never designed to deal with the current volume of patients, so you end up with enormous delays for both tests and treatment, and treatment protocols which cut corners. I was quite amazed when I read you had a PET scan. As far as I know, there are hardly any PET scanners in the UK. Edinburgh and London are probably the only places where you will find one. As for fMRI, I believe all the scanners are university-owned: don't think there is a single one being used for non-research clinical work. In Bristol, you can opt to have your chemo in a new treatment centre that has been set up. This is completely nurse-led, with no doctors on site at all. I feel distinctly uneasy about the way this is all going.

Best wishes
Simon

 
Old 08-07-2008, 11:04 AM   #6
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Re: lung function test - can anyone explain the results?

yes i agree with you. politicians shouldnt run hospitals. doctors should run hospitals. its all wrong.
we dont have a PET scanner in edinuburgh (not sure why seeing as its got one of the largest cancer centres) i had to go to aberdeen. i was told it is up to the health exec where i would get the scan and the choices were either aberdeen or darlington!

i have to say, i have never seen anyone apart from my onc. (except a few months ago when she was at a conference) i saw her every 2 months during treatment and when i was in with the flu for a week she came up to the ward to see how i was. she is a really good doctor and head of the department but i still get the feeling that its all because of how badly i was treated before my diagnosis that i see her, she never appears to have that many patients. i have never had to wait to be seen by another department if i go through her. like i had funny marks on my arm shortly after i finished chemo and she sent me to dermatology that day whereas if i had taken that to the gp i would have been given cream for a few weeks and then maybe a blood test and be told to be in the sun more etc. but she does everything straight away. i guess its not a good thing cause i depend on her more than my gp but i have started seeing my new gp more so thats helping.

cant you try and make an appointment to see your onc? or call them and ask for them to call you back? they are your named doctor so you have the right to see them. i dont trust junior doctors, hell, all the nurses i work with dont trust junior doctors!
there was one doctor on site at the chemo suite but she wasnt all that great, she prescribed me with 2 months supply of valium and didnt tell me what it was for and i took it twice a day every day for months and my mood got so low i thought about killing myself.

for the remaining treatments i was still out of breathe and was for awhile after but it did go away and i felt great. after all the side effects went away there was this one day that i woke up and i just felt full of energy and it was the strangest feeling like i hadnt felt like that for absolutley years or something. i guess everyone is different but i wouldnt worry too much about still being short of breathe just now, although if you notice it gets worse then i would demand they repeat the tests.

xxx

 
Old 08-10-2008, 03:21 AM   #7
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Re: lung function test - can anyone explain the results?

Hi Amanda,
thanks for the reassurance. As you can tell, I am really worried about the breathlessness and the cough, having read all about Bleo-induced pneumonitis and pulmonary fibrosis. My own consultant is on holiday at the moment, and it is really difficult to get to see them. The lymphoma clinic is on a thursday, and you typically have to wait several weeks to get in there.

I'm really annoyed that I kept bringing this up, from around the second cycle onwards, but it took until cycle 5 for the registrar/staff grade to take notice and refer me for a test of pulmonary function. I had asked him at least twice before; the first time he just told me I was being anxious, and the second time he laughed and said by the time anything shows up on the tests it is too late anyway, so they are a waste of time. The junior drs I've met in oncology generally don't know very much, but they do seem more likely to listen to what I have to say, and go ask someone else. Burnt out registrars/staff grades generally can't be bothered. Unfortunately, the NHS is creating more and more of these kinds of posts.

Last chemo tomorrow, so will take the print out along to get an explanation. I'll let you know what they have to say.

Best wishes
Simon

 
Old 08-11-2008, 08:11 AM   #8
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Re: lung function test - can anyone explain the results?

I managed to see a Dr today. This one was a new haematology registrar, so at least not the disinterested staff grade who you normally get lumbered with. He read through my notes, looked over the pulmonary function printout, and then told me there was nothing in there to explain why I was short of breath. He then told me the test result were normal. I responded that they were not, and pointed to the CO diffusion test results. He looked at them, and said they were ok. I then pointed out which figures showed the normal range, and which figures were mine.
"That's a little bit low" he replied.
"No, it's way below the normal range", I replied.
He clearly did not understand the printout, but then said it was probably the Bleomycin that had caused the problem, and there was nothing that could be done about it now. I then asked about if it was due to inflamation? He started going on about scaring, so I pointed out that before you get this there is usually a phase of inflamation, called Bleomycin Induced Pneumonitis, which sometimes responds to prednisolone. He did not seem to know anything about this, but agreed to phone respiratory medicine.

The upshot is that respiratory medicine have said they will see me, but there is likely to be a 6 week wait for an appointment. They will also refer me for a high definition CT of my lungs. I would have preferred something quicker, but this is the NHS, where nothing moves fast, and people die whilst waiting to be treated.

It just seems like as soon as you get one piece of good news, i.e. that the HD has gone into remission, there is something else to worry about.

 
Old 08-13-2008, 09:40 AM   #9
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Re: lung function test - can anyone explain the results?

simon im so sorry to hear that. that is awful. is there no way you can call the deptartment and ask if they have any cancelations? or cant you call and speak to your consultant and say that you think it's ridiculous that you have to wait 6 weeks for a scan and you want one asap?

take care

x

 
Old 08-13-2008, 01:11 PM   #10
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Re: lung function test - can anyone explain the results?

I've not had much luck with speeding up appointments, as the different departments all seem to have their own criteria for prioritising. When I had my laparotomy in December, my blood pressure went haywire, which the surgeons suggested could be the sign of an adrenal tumour. I was referred to an endocrinologist, and also a cardiologist because I was getting episodes of tachycardia and chest pains. Both appointments took around 6 months.

I will see how the breathlessness develops over the next couple of weeks. The bleomycin was dropped from the last 3 chemos, so I thought I might start seeing some improvement by now. It feels like it is getting worse, but maybe that is because I am now paying more attention to it. If nothing starts to improve, I will have to start complaining.
sx

 
Old 08-18-2008, 01:01 AM   #11
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Re: lung function test - can anyone explain the results?

im sorry they are taking so much time with this. i am pretty sure that my breathlessness didnt get any better til weeks after i had finished my treatment, actually i remember coming home and climbing the stairs and feeling like my lungs were going to collapse and that was after treatment. it was weeks before i felt any better, but it did go away eventually and i felt healthier than i had done in years. i still occasionally get the feeling, even when im lying down watching tv, that my heart seems to beat really fast for a minute or so and my breathing speeds up too but then it goes away. i used to get that more frequently during treatment. but i was always told it was anxiety.

how are you feeling today?
xxx

 
Old 08-18-2008, 04:30 AM   #12
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Re: lung function test - can anyone explain the results?

Hi Amanda,

I am starting to get over the last AVD treatment, which was a week ago. The last couple have wiped me out completely for at least a week, whereas the earlier ones tended to wipe me out for 3-4 days.

My breathing is not improving at all. I get a very hoarse voice after each chemo, and this has continued despite dropping the bleo. This time was particularly bad, as I could hardly speak for a few days, but that is a little better today. I would say my breathing feels slightly worse since the chemo last monday. I have noticed that I can feel slightly breathless even when I am just sitting down. What has got worse is the cough, and the feeling of discomfort when I take a deep breath. I particularly notice this at night, and I have had to start sleeping on my back, because it feels uncomfortable on my side. I am also coughing a lot in the mornings. If it was just breathlessness, I could put it down to fatigue and lowered red blood cells counts, but the cough and chest discomfort clearly point to my lungs as the cause.

I think I need to phone my oncologist, and get see if he can speed things up.

sx

 
Old 08-19-2008, 04:09 AM   #13
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Re: lung function test - can anyone explain the results?

I have phoned my oncologist today, although I got the predictable "he's in clinic all day". His secretary has left a message for him to phone me tomorrow. We shall see if he does. I have encountered very few consultants who are prepared to phone their patients. I am so sick of constantly having to battle this health system in order to get proper treatment.

 
Old 08-19-2008, 09:03 AM   #14
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Re: lung function test - can anyone explain the results?

To my great surprise, my oncologist phoned me back within an hour, and said to come into clinic this afternoon. I maybe take back some of what I said earlier, although the clear message is just get in touch with your counsultant, and cut out the registrars.

Unsurprisingly, no appointment has been allocated for my CT scan yet, but he did say he would chase it up. They took another chest X-ray, to rule out a chest infection. No evidence of fibrosis, but mild fibrosis would not show up on an X-ray anyway. His theory is that the bleo is not behind the current problems, and even if it is, he thinks the changes will be reversible. Not sure I share his optimism, on the basis of the information I've found on the net though.

Interestingly, he suspects the doxorubicin may be to blame, even though it is not one that is commonly associated with lung toxicity.
He described a clinical trial he took part in, where they looked at the effect of gemcitabine, which is know to cause lung problems. All patients had regular pulmonary tests, but some only had the gemcitabine introduced after three months. Even before the gemcitabine was introduced, these patients showed a decline in pulmonary function. This was therefore attributed to one of the other drugs in the regime, most probably doxorubicin.

His prediction is that my breathing will gradually improve, although he suspects it may take a few months to do so. I suppose that is some reassurance, although it does not help me with the fact that I cannot breath properly, and cough all the time at the moment.

 
Old 08-19-2008, 10:28 PM   #15
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Re: lung function test - can anyone explain the results?

Hi.
I haven't read exactly all of your posts, but I developed breathing problems from pneumonitis last January, after my chemo and radiation was through. My "team" agrees that it probably was the "B" in the "ABVD," but mostly it was caused by radiation (20 rad's). They started me on Prednisone---pretty high doses. Then, I tapered off. Last month was my last dosing.
Now, I'm just using an inhaler (Combivent) and apparently, my breathing is coming along...although, I still get winded climbing stairs and when walking briskly.
I was very concerned about Pulminary Fibrosis...but, I guess this was caught in time.
I don't know if this information is helpful to you, because our situations sound different.
Just wanted you to know, breathing problems can be fixed.
By the way, I was also given a very good cough syrup. If you want to know the name, let me know.
And, of course, it never hurts to breathe nice, deep breaths in the shower when it's nice and steamy.
Good luck to you....
S.

Last edited by singer78; 08-19-2008 at 10:30 PM.

 
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