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Want second opinion for Interstitial lung disease

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Pulmonologist
Practicing since : 2003
Answered : 593 Questions
Question
To Dr. Gyanshankar XXXXXXX

I just wanted your opinion. Another Dr. on here thinks I have Interstitial lund disease.

Do you think that could be?
Posted Mon, 20 May 2013 in Lung and Chest disorders
 
 
Answered by Dr. Gyanshankar Mishra 9 minutes later
Hi,
Thanks for posting your query.

1. Your CT scan had shown Right upper lobe infiltrates. That is highly unlikely of ILD or interstitial lung disease where the lesions are not localised infiltrates but bilateral interstitial shadows with predominance in the lower zones.

2. It is very unlikely to be ILD.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Want second opinion for Interstitial lung disease 15 minutes later
ok, That is great to hear. So it couldnt be the start of it, with it not showing on the ct scan?

They gave me second round of prednisidone since this initially happened. I have been on for two days and feel better. Less tightness. Still some noticable tightness.

I am afraid that heavy exposure to respirable dust was so XXXXXXX I hope you are correct and I will be better in a few months. I am trying to keep hope.

Thanks Doctor

Follow-up: Want second opinion for Interstitial lung disease 6 hours later
So do you think ILD or other fibrosing would have shown up on the xray by now? i did have that other xray last week, and its been three months since my incident. The Dr. said the xray last week was fine.

I guess it is just the tightness in my chest and dry cough are my only symptoms.

i do not cough involuntarily which is weird. It is only when i try and cough to see if phlegm is coming up and that is maybe two or three times a day. still no phlegm.
The other Dr. on here thought my cough receptors may have been damaged?
The dryness when i do cough is much better then originally. Even better then two weeks ago. It is still some raspy but not really bad anymore.

I am not sure about dyspnea. I go for small walks only and feel ok. I am afraid to exert yet. I want to go slow, but maybe i should jog just to see how it feels?

What happened what so traumatic. I think i told you that when i left the house my lungs felt on fire and hollowed out. My mouth was twitching when i breathed. I still can not believe i did not die. I just kept thinking it was cleaned up, but so much dust intitally in the first few days I am afraid my thresh hold tolerance was really really passed at that point. That is why i am hesitant to believe i will survive this and have a normal health, but i do hope it is possible.

Thanks Dr.

XXXXXX



 
 
Answered by Dr. Gyanshankar Mishra 1 hour later
Hi,
Thanks for the follow up. After going through the follow up query, I would like to comment the following:

1. Oral prednisolone should help reduce the airway inflammation.

2. Its good that you are feeling better.

3. Airway cough receptors may sometimes be damaged in such heavy exposure, but that is never permanent. They heal with time and should be fine. There is never loss of cough reflex.

4. It does not seem like ILD.

5. There is every chance that you will survive this and lead a normal life. wait for 6 months to 1 year.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Want second opinion for Interstitial lung disease 25 hours later
Doctor,

If there is more lung damage when will it show up on xray or CT?
I think you said at least one year before?

The other Dr. said ILD on here. He must mean silicosis? it would have to be the acute, which is the worst kind. Can you tell me why you do not think it is?
I know it just showed the small infilitrates on CT but maybe the other signs have not shown up yet? My chest is still so tight. I want to feel like i am getting better, but i am not sure.

The other Dr. on here asked if I have chest pain, and I told him yes, but maybe it is just once in awhile when i take a deep breath.

My lungs feel so dry when i wake up in the morning. Bad taste in my mouth the last few days. May be the new round of prednisdone tho.
 
 
Answered by Dr. Gyanshankar Mishra 12 minutes later
Hi,
Thanks for the follow up.After going through the follow up query, I would like to comment the following:

1. Your recent chest xray did not show any abnormality.

2. A follow up xray /ct thorax after 1 year will delineate the actual picture.

3. At most the end result will be a locised fibrotic scar and that does not hamper your lung function much.

4. The ct picture at present is not suggestive of ILD.

5. No matter what you try to change the nomenclature of the lung affection, the treatment has to be the same that you are recieving.

6. Thus conservative management with regular follow up is required. Avoidance of any possible dust exposure is advocated.

7. Since this was your 1st Ct scan it is difficult to ascertain whether this has recently developed or is existing from previously.

8. In silicosis you do get upper lobe involvement. But the management has to be the same.

9. A ct scan at 1 year follow up will really make things clearer.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Want second opinion for Interstitial lung disease 38 minutes later
I may have forgot to tell you, but last week at my appointment the Dr. said it was a very small something on the upper lobe from the initial CT scan. He did not seem concerned at all.

I hope you are correct about the rads. But i had that bad inflammation, and still do.

So my symptoms, still RADs?

I just feel like i have so many bad things going against me. It was a fine dust. heavy exposure. I slept in it. and it was recently fractured with a high silica content....

I think If i recover from this it will be a miracle.
oh, and how long do you think i should stay on the prednsidone? They only gave me five days worth. i feel like i should have stayed on this the entire time. Maybe i would have been healed up by now. Tomorrow is my last dose and I feel like i need to call them and ask for more.

and what do you mean,
8. In silicosis you do get upper lobe involvement. But the management has to be the same.
what do you mean by management?

And my chest does not seem tight as it was before, but now a general heaviness. i do not know if that is an improvement or something i should be concerned?
Its crazy but, maybe i do have acute silicosis. I should not even say it, but maybe i need to accept the possibility. I seem to have all the symptoms.

I was there for that week, my chest felt like crystals, and then we left for a week, had the hardwood floors finished and we thought that would take care of most of the remainder dust. I went back for almost another week and realized there was still more dust. I was not going to get better but worse. I left and that is when my chest felt like it was on fire and felt all hollowed out. I have been in this motel ever since. My bodies defenses must have broken down.

I just did not realize what it was and how XXXXXXX even when i did find out about it. I just wanted new flooring.....
 
 
Answered by Dr. Gyanshankar Mishra 5 hours later
Hi,
Thanks for the follow up.After going through the follow up query, I would like to comment the following:

1. Its good that the upper lobe involvement is very small and if your doctor has seen the lesion and is confident then it is definitely an insignificant change.

2. The management means that you should continue the inhalers for a period of 6 weeks to 3 months and then as per the opinion and assessment of the treating doctor.

3. You are feeling better is a good news.

4. A short course of oral steroids are recommended and a short course means anything less than 2 weeks. Thus prednisolone can be continued upto a maximum of 2 weeks under supervision of your doctor.

5. To me it seems to be an episode of RADS which is gradually subsiding.


I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Want second opinion for Interstitial lung disease 16 hours later
Hi Doctor. I know i have to stop bothering you.

I think I may have forgot to tell you in the beginning about my lungs feeling on fire and very inflammed, almost hallowed out. Major symptom. Can that be Rads still?

Also still constricted when i take deep breaths and some pain occasionally when i take a deep breath in the center of my chest?

Its crazy what i put myself through. Now i just hope that it is not acute silicosis as it sounds like a horrible way to go.
 
 
Answered by Dr. Gyanshankar Mishra 16 minutes later
Hi,
Thanks for the follow up.After going through the follow up query, I would like to comment the following:

1. Yes, you clinical picture is consistent with RADS.

2. It will take time to be fully asymptomayic and your disease seems to be on the the declining trend.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Want second opinion for Interstitial lung disease 5 minutes later
but I do feel like I am getting better slowly. My lower back and back where tight before and now just chest. It is more of a heaviness. I wish it could just clear out. I am afraid I damaged my pleura so bad. and the silica is not going to clear out ever. The prednisidone is probably helping. tonight is my last dose. I am trying to get another week of it prescribed.

You have given me so much hope with the Rads prognosis, but I am so afraid this is more. The dry cough when i do cough. inflammed lungs. I am so afraid the worst is yet to come for me if it is acute silicosis or ILD.
 
 
Answered by Dr. Gyanshankar Mishra 5 minutes later
Hi,
Thanks for the follow up.After going through the follow up query, I would like to comment the following:

1. In point 2, I have mentioned that your disease is on the declining treand i.e you are improving.

2. The residual symptoms that you have should be improved with regular use of an inhaler. I suggest that you consult your doctor regarding bronchodilator+ steroid inhaler (eg. formoterol +budesonide) rather than plain budesonide inhaler.

3. Please do not worry.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Want second opinion for Interstitial lung disease 3 hours later
yeah, They gave me Ventolin right when this happened and i have been taking it with the budisodine also.

But what about my Pleury? It felt on fire and hollowed out so bad. I have talked to concrete guys who did it for years and never experienced that. and you were right, that tile does have a high silicate content. I have watched my dog suffer also. He was all tightened up and very ill looking. I came so close to putting him down.

As far as I have come since this happened, Its just so hard to believe I can walk away from this and have normal lungs again someday. There was just so much dust floating in that house and are exposure was so much in that week. Even sandblasters do not sleep in it.

I hope you are right for our sake. If you are right, then i will come to your clinic in India next year and shake your hand and thank you in person.
 
 
Answered by Dr. Gyanshankar Mishra 6 minutes later
Hi,
Thanks for the follow up.After going through the follow up query, I would like to comment the following:

1. I do not think you have pleural involvement else CT scan would have picked it up.

2. You need to continue both ventorlin and budesonide for a quiet some time till further review and that will help you definitely.

3. We all need to learn from our past mistakes.I am sure, in near future you will be more than pecautious in avpoiding such dust exposures.

4. What has happened cannot be changed and hence you should try not think about it.

5. I will be more than happy to see you fully asymptomatic , hale and hearty any time!

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Want second opinion for Interstitial lung disease 8 hours later
Dr, I did not tell you before but when I smoked I was a heavy smoker kind of. I seemed to have a sleep apnea before this happened. It is now coming back but worse. I am feeling breathless when i try and sleep.

Can you please convince me why you think RADs? And why not silicosis or ILD?

you keep telling me not to worry, but those other two are haunting me. I have to make plans, living will, funeral plans, etc. for myself. I dont know what it will take for the Dr. here to diagnose me with something. they said two weeks ago that I am clinically fine, but my chest is so heavy most of the time, and still dull pain when i take deep breath.

My dog looks worse everyday. It is reflecting upon me and my situation.
 
 
Answered by Dr. Gyanshankar Mishra 2 hours later
Hi,
Thanks for the follow up. After going through the follow up query, I would like to comment the following:

1. Your clinical profile and ct scan findings are not suggestive of ILD. ILD has a long history, short history is not seen in ILD. Similarly considering the ct picture, less likely to be silicosis at this stage.

2. If you have symptoms of obstructive sleep apnea, you need to undergo a sleep study.

3. If you were a heavy smoker in the XXXXXXX then that is the cause of slight impairement of pulmonary function test found.

4. If you doctor is of the opinion that you are clinically fine that means there are no clinical signs at present.

5. Veternary diseases and human diseases are different. So please do not compare your condition with that of your pet. Get your pet examined by a veternary specialist.

6. It will take 6 months to 1 year to be completely asymptomatic. Being ex smoker you may have underlying COPD. If you exact PFT report is available, that may be useful.


I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Want second opinion for Interstitial lung disease 11 hours later
Hi, just two quick questions.

I read that the macrophages actually die when they engulf the silica, and then release the particle back in the lung where it does it again. So then it does not really get pushed back out of the system?

Also, It says that RADS has to have an onset within 24 hours of first exposure. I did not really get sick until after almost a week.

I hope you are right with RADS. It seems impossible that I can heal from this. It was such a heavy exposure. fine particles. My pleura felt like it was on fire and iflammed so bad. Doesnt that have to be serious like acute silicosis? everything seems to point in that direction.

Except I do feel like i am getting better. very slowly. But from where i was, I had to get better. Now i feel like i have a kinda dull thing in the center of my chest with occasional dull pain some restriction still.
I also have this bad taste feels like it is coming out of my lungs when i try and cough. like dust? Will that go away?
 
 
Answered by Dr. Gyanshankar Mishra 1 hour later
Hi,

Thanks for the follow up. After going through the follow up query, I would like to comment the following:

1. Your xray and ct scan findings are not compatible with acute silicosis. It is due to a mild form of airway reaction due to inhaled silica dust. As I have pointed out before changing the terminology is hardly of any importance. Since silica is a part of the ust you inhaled but there are no xray or ct changes suggestive of acute silicosis. Its less likely that you were completely asymptomatic when there was such heavy exposure as it is normal human reaction to atleast cough on exposure to dust!

2. Even if you would like to call it acute silicosis there is no difference of treatment. It is the same that you are recieving now.

3. You xray and ct do not have any obvious abnormality is a very big positive for you. So it is highly unlikely that you will progrss to sever disease as you fear.

4. You may continue chest exercises, incentive spirometry and inhaler therapy.

5. Symptomatic resolution will take time as mentioned in previous posts.

6. Body defences do have the capacity to drive out the dust paticles or else in our life time so much of dust particles would have deposited in our lungs.

7. Yes silica is toxic for macrophages but in your case not much damage seems to have been done since your chest xray, ct scan and pft do not show any major abnormality. You need to believe your treating doctor's words that you are clinically fine in absence of any clinical signs.


I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Want second opinion for Interstitial lung disease 5 hours later
Its not that i want to call it acute silicosis, its just that what it is called. It is the only thing i can find that seems to match severe symptoms that i had. It is still dry when i cough, and i am hoarse. Maybe the ILD too. i know i breathed in so much of that dust with the silica. I probably breathed in the same as a sandblaster for a few months in an enclosed area. All that respirable silica is inside of me and not coming out. How do people survive that and be normal again?

But you said it takes at least one year for this to show up on my ct or xray. So the major fibrosing could be starting now. The Ct at two months and xray at three month are probably irrelevant.

I thought it was my lower back that was sore before, but now i realize it was probably my kidneys. Another major organ that is probably messed up for life now.

I really appreciate everything you have done and said to me. You have given me hope. Its just so hard to believe that I will be fine, after what i have been through. it was such a toxic and big affect on me. How can that just be RADs? How do people survive from something like this is hard to believe. i should have left the house.
 
 
Answered by Dr. Gyanshankar Mishra 18 minutes later
Hi,

Thanks for the follow up. After going through the follow up query, I would like to comment the following:

1. Acute silicosis has acute presentation including "xray, ct scan and pft" along with "clinical findings". Non of those matching acute silicosis is there except for the presence of history of exposure. Acute silicosis does not manifest after 1 year, it has to manifest at the first presentation to your doctor. No picture of ILD either.

2. Your management is optimal as per your clinical presentation. There can be no alteration in your management.

3. You can get your kidney function tests done along with ultrasound abdomen to clear your doubts regarding kidney involvement and I am very sure both will be normal. In fact even if you go for a renal scan there is very high chance that it will be normal.

4. I repeat there is no change in medical management that can be done. Medical follow up is required.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Want second opinion for Interstitial lung disease 16 hours later
Hi Dr. I am going to try and get back to the clinic tomorrow. I will get my PfT and send it to you..maybe I should get a copy of my CT an xray?
Does rads have that very inflammation of the lungs?
Also dry cough?
 
 
Answered by Dr. Gyanshankar Mishra 2 hours later
Hi,
Thanks for the follow up.

1. Yes, RADS causes inflammation of airways of the lungs and dry cough is seen in RADS.

2.Reviewing your reports will definitely help.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Want second opinion for Interstitial lung disease 4 hours later
Yes. but I feel I had severe inflammation in the king cavity. What was it,?
 
 
Answered by Dr. Gyanshankar Mishra 49 minutes later
Hi,
Thanks for the follow up.

1. As per your ct report there are no signs of inflammation of lung parenchyma. Also there is no development of lung cavity.

2. The reports need to be trusted.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Want second opinion for Interstitial lung disease 1 hour later
Its just. I know how bad it was inflamed. It felt so hollowed out. Like I hit a point of no return. most of the sharp tightness seems to be gone. But a dull lack of function feeling. Maybe 70
percent of normal function. IM so afraid this is chronicles and now terminal for me.
 
 
Answered by Dr. Gyanshankar Mishra 5 minutes later
Hi,
Thanks for the follow up.

1. Yes I understand, the initial symptoms are quiet heavy but since no anatomical damage has been caused, the chances of good recovery are very high.

2. This is not a terminal illness! your ct scan and xray are normal. If ever there develops complications (very less chances), it will be localised and not diffuse.

3. The picture of early lung inflammation in such cases on ct is ground glass opacities. No such picture has been commented on your ct!

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Want second opinion for Interstitial lung disease 14 hours later
Hey Dr. I just wanted to ask if think I should have a bronchoscopy? I am now feeling like I stayed alive for a reason. I want to get better all the way. I have an appt. Tomorrow at the mayo in lacrosse with Dr XXXXXXX If he doesn't agree then I think IM going to the top guys in Rochette
I can't stand living like this. I need some answers and IM tired of suffering
, I meant to say. I will get a copy of my tests too for you to see. I read that in the acute form of silicosis, not always shows on xray and when it does it is diffuse. As opposed to the chronic.
 
 
Answered by Dr. Gyanshankar Mishra 54 minutes later
Hi,
Thanks for the follow up.

1. Yes many times the xray fails to pick up such changes. But ct has a very good sensitivity to pick up early changes of alveolitis or airway inflammation at the smallest level.

2. If your doctor is doing bronchoscopy then a lavage and cytology along with tblb-biopsy may be of help. But the final decision rests with your treating physician / pulmonologist since he has examined you clinically. Ct does show ground glass opacities in the early stage.

3. Seeing your reports will definitely help.


Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Want second opinion for Interstitial lung disease 55 minutes later
Yeah. It just seems they do not believe me of my symptoms. my chest XXXXXXX so tight and restricted I don't know if I can go on another year like this. Maybe if they do a broncho scopy it will knock some of it loose? Or how about a whole lung lavage?
 
 
Answered by Dr. Gyanshankar Mishra 58 minutes later
Hi,
Thanks for the follow up.

1. You will definitely go through very well this year and many more years.

2. The decision regarding bronchoscopy should best be left to your treating physician / pulmonologist as it will always be his call.


Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Want second opinion for Interstitial lung disease 16 hours later
Hey Dr. I just wanted to thanks you for everything. I feel my condition is getting worse. breathless XXXXXXX And just dull feeling lungs. My appointment
Tomorrow. IM gonna ask for pain meds and maybe oxygen. Its gotta be acute silicosis. it was just so much dust.


 
 
Answered by Dr. Gyanshankar Mishra 2 hours later
Hi,
Thanks for the follow up.

1. You need to go ahead with your appointment with Pulmonologist.

2. Get your oxygen saturation / oxygen therapy.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Want second opinion for Interstitial lung disease 1 hour later
I just got back from the emergency room. They said IM fine. Vitals and another xray. Oxygen seemed low. It was like 95 the entire time. now I feel ok. This was just such a traumitizing thing for me. I feel like the biggest fool for staying at that house. My mind and body may never heal all the way from this.
 
 
Answered by Dr. Gyanshankar Mishra 1 hour later
Hi,

Thanks for the follow up.

1. The oxygen saturation is normal. Its range is from 95 to 99 %.
2. Since your clinical evaluation is normal, your investigations are normal, there is very less reason for you to worry.


I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
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