A 67 y.o. M with end stage COPD on home oxygen, tracheobronchomalacia s/p Y-stent, h/o RUL resection for squamous cell carcinoma with Cyberknife treatment. Patient had Y-stent placed complicated by cough and copious secretions requiring multiple therapeutic aspirations.  Last bronchoscopy was at OSH, where patient had copious secretions that were aspirated.  Pt reports compliance with Mucomyst nebs and Mucinex.  Patient reports decreaed appetitie, 50 lb wt loss in 6 months.  Decreased activity tolerance.  Smokes 5 cig/day.  PET scan revealed FDG avid soft tissue mass adjacent to lung resection site with some FDG avid nodes concerning for recurrence.  On arrival, vitals were T98.6 HR86 BP106/78 O289. Pt denied chest pain, palpitations, trauma, F/C, N/V/D. Pt. presents with worsening  SOB with R shoulder pain and weakness.