Pneumonia

[Mave]

Last week I posted in the nodule forum as a recent chest CT scan showed a nodule on my right lung. My doctor was been baffled as to the reason none of the treatments/antibotics, nebulizers, prednisone etc., weren't having an effect on the illness. I posted in the forum and asked for suggestions to the ongoing pneumonia I've had since December 07 and the nodule.

The person ( think it was Davy) suggested a sputum history and a TB test. I printed this out and showed it to my doctor and he complied. I was able to cough up a small amount of sputum from deep in my lungs and it went to the lab.

Within 2-3 days my family doctor called and I was asked to come in. He showed me my lab report which I have a copy.

I have Pseudomonas +4 (heavy). It says white blood cells +2 (few), Epithelial cells +1(rare) Organisms +4 negative bacilli, +1 Mixed oropharyngeal flora. I haven't a clue as to what any of this means???

My doctor contacted a specialist and was advised I have (3) IV treatments per day of Tazocin 4.5g every 8 hrs. along with Cipro taken orally 750mg.

I've been on this course of treatment for one week now and I haven't noticed any improvement with my peak flow which has stayed at 400 since this all began.

Is this the right course of action now? Also what further tests do I require to know if the bacteria is gone from my body?

Also is it possible that the bacteria has damaged my lungs after three months of fighting it?

Should I have a liver and kidney function blood test? Also is it a good idea to be on acidophilus?

I look forward to hearing from you!

[Davy9]

They have identified a heavy growth of pseudomonas aeruginosa bacteria from your sputum sample. It is a gram negative bacteria. They will have also identified which antibiotic this particular organism is sensitive to which they will give you. Your are getting the correct course of treatment, in the correct manner.

Your peak flows are not just reflective of where this infection maybe localized. They reflect the ability of the lungs to blast air out as fast as possible. They are more related to airways resistance. That said, this infection may be keeping them inflamed or irritated enough to keep them compromised. Or they could just be tight for other reasons. I'll suggest this. If you conduct peak flow measurements frequently the trauma of that effort can keep airways irritated. Give them some time to calm down. Do you also use inhaled aerosolized medications like bronchdilators and/or inhaled steroids?

Complete your course of antibiotics. Symptoms like the nights sweats and fatigue should improve. They should conduct a follow up chest Xray to assess the status of the nodules. Pseudomonas can cause permanent lung scarring so the nodules may remain but not be acute. If all else is well just think of them like you would any other scar on you body. If you continue to remain symptomatic with fevers, sweats, nausea, light headedness, etc..., then let your MD know.

But, you now have a specific infectious culprit identified that can be targeted for treatment and that is good news.

[Mave]

Hi Davy

To bring you up to date on things. For 3 weeks I had IV's every eight hours along with Cipro. I'm now off the IV's and just finished Avelox for two weeks, now I go on Zithromax for two weeks. I also had my TB test and my chest x-ray has been sent away to the TB Center.

I was informed I'll always have the Pseudomonas Aeruginosa and not allow myself to get run down, under stressful conditions, catch a cold etc. As soon as I see my sputum change color I take it in to the lab as I have a standing order. I recently had a pneumovax booster as well.

With the bacteria and bronchiectasis is it possible to have my lungs washed out with an antibacterial solution? Would that get rid of the bacteria? My doctor told me because of all the scarring and pitting the bacteria stay hidden and I will always have it.

With my pulmonary functions tests I was 79% which is good, although I still feel I lack air and puff and pant considerably. Should I have an oxygen test as well?

I wanted to thank you for suggesting the course of action. Without the sputum history I still would be suffering and mostly likely in a very bad state.

[Davy9]

Hi Mave,

They certainly have attacked the Pseudomonas aggressively. If the organism has pocketed in that nodule or in areas of airway pocketing (bronchiectasis) then the blood bourne antibiotic may not have had access to all of the offending bugs. They can go into the lungs with scopes and try to lavage specifically sites of infection, but they can only go so far. They can do lung lavages but I'm not certain that they would do them with antibiotics. They do them in conditions where the lungs have a generalized need to have something removed and they use the least irritating stuff they can. They are done in surgery so that they can access one lung at a time. More radically if they can be certain that that nodule is a source for this organism and that antibiotics are not reaching them they can employ surgery to move that area. Lobectomies are recommended for patients with hard to treat TB and they also work for chronic, localized, encapsulated infections from other organisms.

The advice to keep healthy and to be aware of early signs of lung infection is just plain common sense. Perhaps you have a predilection for lung infections because of asthma, prior smoking or just because of chronic lung problems. Pay attention to your health and learn what is normal lung behavior for you. In winter wear snoods to warm up inhaled air. Eat well, stay well hydrated (assuming no kidney or heart problems). Just maintain good health and learn what those early signs of lung infections are so you can intervene on them ASAP.

There are many values on a PFT so I don't know what you refer to as 79%. But they do have this study for future comparison if they should need to. Shortness of breath with exercise can be low oxygen or just a poorly conditioned body. An easy way to see if the oxygen is impacting your exercise is to use a pulse oximeter under work load. A pulse oximeter measures O2 saturation through the skin (usually through a finger sensor). Normals would be above 95% and they become problematic when at around 85%. What you do is get the value while at rest then do some work that tires you out while wearing the sensor (they are usually portable). If the value drops when you work then you need to have the cause of that assessed. That can be caused from lung or heart conditions. If it is from your lungs then they might consider supplementing O2 while you exercise and while you sleep. If you tire out and do not desaturate dramatically then you're just poorly conditioned and can recondition yourself to enhance your physical durability. In any case you should get a structured conditioning program so as to not overly stress your system while rehabilitating. Your want to get stronger but you do not want to harm yourself getting there.

[Meave]

When I had the PFT they showed me the test result and it was 79% which they felt was very good. I feel my problem is trying to get more air into my lungs rather then exhaling it. I'm glad you replied as I have an appt. with my doctor tomorrow. I'll mention the pulse oximeter. I've been inactive for 5 months. Before becoming sick I used to hiking or walk 4-5k's each day without problem. Now the simpliest tasks cause me to run out of breath. I become very fatigued, lightheaded and no energy. I have to literally force myself to do something then I fall in a deep sleep for several hours, which is abnormal for me.

From the chest ct scan it also showed a hiatal hernia. I wasn't aware I even had one. The doctors feel acid reflux, along with asthma and several bouts of pneumonia have scarred and pitted the lungs over the years. I'm on Nexium twice aday for the acid reflux. I didn't feel like I had stomach aliments either.

I'm also getting some sort of gadget to monitor my sleeping for one night as well.

Thank you for your advice about the scoping. That sounds like something I would want to avoid unless necessary. I am very interested in the pulse oximeter as I want to get fit without causing harm.

[Davy9]

Hello again Meave,

Your prior health status is encouraging. I would ask them to explain what they mean by "scarred and pitted" lungs. Having a hiatal hernia is one thing but to have one that has repeatedly resulted in aspiration events with lung damage is another. BTW aspiration does not lead directly to pseudomonas but it can pave the way to allow it to start. Aspiration of gastric content is just very acidic and it always results in immediate coughing and irritation. I can't imagine that you would not have experienced some discomfort under those circumstances.

Try and get a clear idea of the current status of your lungs, if they will heal, by how much and how you can help them do so. Let them know that prior to this event that were were active and that you hope to return to some level of that activity again.

The sleep study could be one to assess acid reflux which is often worse when people lie down (there is such a thing as anti-reflux posturing for sleeping). Or, the study could be one to assess the existence of sleep apnea. That is where breathing becomes impaired enough while sleeping to desaturate (again by pulse oximeter). This can be caused by upper airway obstruction or from other causes.

With the pulmonary function test there are so many different values they measure. You would be amazed at what can be learned from measuring what goes into and comes out of the lungs and in what fashion. Perhaps you've seen pictures of athletes on stationary bikes hooked up to full tilt breathing head gear. From that they know the work performed, when the work crossed from aerobic to anaerobic, what types of foods are being burned (carbs or proteins, etc) and many other things.

Anyway just keep learning more about your situation.