DEAR DR. DONOHUE: I have had repeated coughing attacks. My doctor called them chest colds and prescribed antibiotics. More recently, I began to cough all day and all night. I decided to see a lung specialist. She says I have bronchiectasis, something that is not familiar to me. She has me taking a few tests and then will prescribe medicine. Would you fill in some details? – M.K.

ANSWER:
In the days before antibiotics, bronchiectasis (BRAWN-key-EK-tuh-suss) was a common disorder. Sections of the bronchi – the airways – are stretched out of shape and become the breeding ground for bacteria. Because of the bacteria, the airways fill with pus. Patients cough and cough to rid their lungs of the pus. Sputum is usually thick and yellow, filled with pus and lung secretions.

Cystic fibrosis, an illness you might be more familiar with, is one kind of bronchiectasis. You are not likely to have it since it mostly strikes in childhood. (There is a variant form that can come on in adulthood.)

Prior lung infections such as pneumonia can destroy airways and produce bronchiectasis. That’s the reason it was so common before antibiotics were available. It can still follow lung infections even in this day of antibiotics. People who had whooping cough as children can come down with bronchiectasis later in life.

In some patients, bronchiectasis emerges as a consequence of another illness. Rheumatoid arthritis is an example. Up to 3 percent of people with rheumatoid arthritis also have bronchiectasis.

If the diagnosis is confirmed, there are many things that can help you. Learning how to promote airway drainage is one of them. Such information is best taught by your lung specialist or a respiratory therapist. Medicines that open up airways are often prescribed. Antibiotics delivered into the lungs by a spray are another way to assist bronchiectasis patients. If the process is limited to an isolated section of lung, a thoracic surgeon can remove that section. Such is not the usual case.

DEAR DR. DONOHUE: I have smoked cigarettes since I was 18. I am 46 now. I stopped smoking cold turkey more than a month ago. I had no withdrawal symptoms, and I have not been tempted to start smoking again. However, since I stopped, I have had trouble with insomnia. I wonder if it is related to not smoking. Could it be? – V.A.

ANSWER:
Insomnia is on the list of nicotine-withdrawal symptoms. It usually disappears in a matter of weeks. Yours might just be hanging around a little longer than usual.

If the insomnia doesn’t depart, there is a way of combating it. Try using the low dose of a nicotine patch. That provides enough nicotine to combat nicotine-withdrawal symptoms.

If sleep returns, you have proven the nicotine-withdrawal connection.

You don’t want to get into a habit of using the patch constantly. Begin to use it less and less frequently. Tapering nicotine can often ameliorate withdrawal symptoms.

DEAR DR. DONOHUE: My husband has a soft lump on the back of his right wrist. He says it doesn’t hurt him.

I worry because his mother and father both died from cancer. Could this be a cancer tumor?

I need to m
ention that he is a carpenter. Could that be the cause of his lump? – M.N.

ANSWER: Feel the lump. Is it soft and somewhat squishy? If it is, the most likely diagnosis is a ganglion.

Ganglions arise from tendons or joint linings. The back of the wrist is the most common site for them. Why they form is somewhat of a mystery. Repetitive trauma could be a factor, and since he is a carpenter, the two might be related – the ganglion and his occupation. However, I have to add that repetitive trauma has not been proven to be a factor in ganglion production.

A doctor can give you a definite diagnosis. If the ganglion bothers your husband or if it interferes with wrist action, a doctor can remove the gelatinlike material inside the ganglion. After collapsing the ganglion, doctors often instill cortisone to prevent recurrence. If it comes back — and ganglions often do — then surgical removal would be the next step.

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


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