Blood Infection

[ATHENS1964]

Thanks for that. I note the following from your link:


"Is There Anything Else I Can Do to Lower My Risk for Bacterial Endocarditis?

• Practice good oral hygiene. Brush your teeth at least twice a day; floss at least once daily; rinse with an antiseptic mouthwash at least once a day. Good oral and dental health is very important for patients at risk for endocarditis."

As I said my profession is selling dental materials, I have a very good friend professor at the university with the object of research. He told me that it is good to rinse the toothbrush well before each use and that we should often leave it in a glass with oxygen or in an alcoholic solution or even in a water solution with vinegar.
Also razors are good before use rinse well with warm water. I use safety razors and blades that are very cheap about 0.20 euros each which I change every 2-3 shaves. Also ALWAYS rinse before use with hot water and often with isopropyl alcohol.
I also always have it at home and when I travel I take some doses of antibiotics in case I have an accident or a deep cut. Generally know that we all need to have a good pathologist or family doctor that we can consult at any time, still do not hesitate to go to a hospital in outpatient clinics if you are injured.

 

[pellicle]

As I said my profession is selling dental materials, I have a very good friend professor at the university with the object of research. He told me that it is good to rinse the toothbrush well before each use and that we should often leave it in a glass with oxygen or in an alcoholic solution

I put mine in a small bottle of vodka between uses
https://cjeastwd.blogspot.com/2013/05/inside-reach.html

Not sure how you get oxygen, or did you mean air?

 

[ATHENS1964]

I put mine in a small bottle of vodka between uses
https://cjeastwd.blogspot.com/2013/05/inside-reach.html

Not sure how you get oxygen, or did you mean air?

Sorry I mean hydrogen peroxide (oxygen)

 

[pellicle]

hydrogen peroxide

I'm sticking with the cheapest Vodka (Gin, Brandy ...) that money can buy ... that at least doesn't taste as foul

 

[Redone]

Hi



while you are on antibiotics it is impossible to tell if you have a blood infection because the bacteria can not be reliably cultured
So blood cultures are inaccurate or not precise while taking antibiotics? Since May 24 it shows I'm not growing new bacteria.



is a classic oral infection, it lives in the GI tract (from mouth to anus) and so unless you were shaving in a strange place a skin entrance is unlikely.
Well I do shave in some none strange places and will probably move to laser moving forward

have you had:

• dental hygiene
• bleeding gums
• a sore throat
• a colonoscopy

prior to the infection?

My dental hygiene is excellent, and I recently went to a Periodontist to be sure eveything looked good and he said, it looked great. However, I will be honest I floss 3 x a day because I have a few gaps between teeth that feel very uncomfortable if I eat and don't. I'm being much more careful about that moving forward. No bleeding gums, sore throat or Colonoscopy.



I suspect some "simplification" has occured in the communication, while the graft may have some (seems pretty unlikely given what its made of) it may exist around the placed where it was attached (to the heart or the artery). The valve itself is pyrolytic carbon, I would be frankly amazed if it has had any damage and I would expect a paper on that be appearing soon. Perhaps I'm wrong (and @nobog can set me straight) but pyrolytic carbon was made for missile tips
I looked at the TEE results from June 12 and they look unimpressive. It even says pseudoanyeurism. Not sure how the valve is damaged. I do know one of my surgeon's colleagues, a Dr I almost went with advised...no surgery.

https://en.wikipedia.org/wiki/Pyrolytic_carbon

... It is used in high temperature applications such as missile nose cones, rocket motors, heat shields, laboratory furnaces, in graphite-reinforced plastic, coating nuclear fuel particles, and in biomedical prostheses.​

This is amazing! Thank you for sharing!


good, and all of this suggests its still present. Have you had a CRP done? what was the number?
I tried to find this in my recent hospitalization blood work, but could not. I know when I showed up with the infection on May 17 it was at 300 and when discharged in the 50's.


good ...



this is likely exactly right, however I'd specifically ask about the co-administration of rifampicin and penicillin ... that will be a rough ride for your INR and you may need to bridge with heparin. Mention that combo to them, its worth a shot.
I will be mentioning this to Infectious Disease so thank you!

This paper is not on a secure server so Chrome whinges like a 5yo at the supermarket, tell it "yes" and download it. Print or send the PDF to your team.

I won't kid you, it will be a journey ...

some reading
https://pubmed.ncbi.nlm.nih.gov/16864973/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC105908/

Best Wishes

 

[Chuck C]

Hi.


"I do know one of my surgeon's colleagues, a Dr I almost went with advised...no surgery."

I'd definitely keep getting opinions, especially because there is some disagreement as to whether surgery is needed. At the same time, and I'm sure you are fully on top of this, try to get to the decision quickly. If it needs to be done, it needs to be done and no need to take on additional risk by putting it off. Some of the top cardiologists and surgeons have waiting lists months long, so that would not be practical. But, in my experience surgeons, even top ones, are often available for consult on short notice. I was able to get in to see Dr. Alfredo Trento at Cedar Sinai on short notice- like 2 days. And I was able to consult with Dr. Shemin at UCLA on short notice as well. Caution about Dr. Trento- very experienced, but he will want to operate. He wanted to operate on me when I was still diagnosed as moderately stenotic. Fortunately, 5 Cardiologists whom I consulted with and one other surgeon disagreed with him. Dr. Shemin, on the other hand, was in no hurry to push my operation in my first consult. But, when it was time he told me to get it done right away.

Anyway, I'm sure you're already on this, but now is the time to be getting several different opinions. And, I would seek both the opinions of cardiologists and surgeons.

 

[pellicle]

Hey

your quotes were embedded in mine between the tags [ quote ] and [ / quote ] so I had to search for them.

hope it goes well. Small point on proper quoting protocol above. if you don't quote properly the server will just apply the rules like a machine and make what you wrote almost invisible. Valid quotes must be between the [ ] and have no spaces. RED = invalid quotes (thus will appear directly as text and not modify the text) BLUE = valid markup quotes ... its rather like good old Wordperfect and "reveal tags"

you can either edit by hand (as I do) or when replying, select the text and add quotes from the menu:

Best Wishes

 

[vitdoc]

I just saw your post about your bacterial endocarditis. It is unfortunate that you had such a short course of IV antibiotics on the first go round. Generally people are placed on high dose IV antibiotics for extended periods - like 6 weeks for bacterial endocarditis especially with artificial valves. So your premature switch to oral unfortunately allowed the bacteria to continue to grow more readily.
I agree that the valve and probably the graft are unlikely to be directly affected by the infection. But there is tissue around the graft which does get infected. Unfortunately with foreign material and probably relatively avascular tissue around the graft and valve the effect of the antibiotics may be hindered. Probably at the base of the valve on the ring used to attach the valve to the tissue is where the infection is most active.
Probably the majority of physicians would go with a decent course of IV antibiotics and reevaluate. Possibly by good fortune the infection may be stopped and surgery might be avoided. There probably other than time little risk in this approach unless the echo studies show increasing evidence of infection spreading.
Getting the infection cleared up as much as possible probably also makes going back surgically easier and hopefully less likely to fail. Are they talking about taking both the valve and the graft out? Clearly doing both is not trivial vs just the valve. Good luck and continue to talk with your physicians about your options.

 

[ATHENS1964]

Inflammation of periodontal tissue leads to deepening of the gingival crevice and formation of periodontal pockets, acting as a reservoir for a large number of microorganisms. Periodontal infections affect the oral tissues, in addition bacteria may get entry into the bloodstream via ulcerated inflamed crevice and pocket epithelium, and the adjacent gingival microcirculation. Invasive dental procedures and normal daily activities, such as chewing and tooth brushing are the important predisposing factors for entry of microbes into bloodstream (7, 18-22). Bacteremia and low-grade inflammation because of periodontal infections may carry a risk for systemic conditions. It has been observed that periodontitis is one of the causes or consequences of developing atherosclerosis. Microorganisms or their products present in circulation may promote pathogenesis and enhance local inflammatory changes in vessel walls and thereby may promote process of clotting and clot formation (23). The periodontal disease has also been reported to be an important risk factor for nonhemorrhagic stroke (24). Several other studies have also found that there is the oral-systemic link in various conditions like infective endocarditis and cardiovascular diseases, premature low birth weight deliveries, and diabetes mellitus (25-27).
https://brieflands.com/articles/apid-55785.html

 

[Redone]

Hey



hope it goes well. Small point on proper quoting protocol above. if you don't quote properly the server will just apply the rules like a machine and make what you wrote almost invisible. Valid quotes must be between the [ ] and have no spaces. RED = invalid quotes (thus will appear directly as text and not modify the text) BLUE = valid markup quotes ... its rather like good old Wordperfect and "reveal tags"

View attachment 888606

you can either edit by hand (as I do) or when replying, select the text and add quotes from the menu:
View attachment 888607

Best Wishes

Sorry, I tried responding to each of your questions and thought I had done it correctly, but I clearly didn't. I do not have dental issues, had a colonoscopy etc. I don't quite understand how blood cultures don't reveal if you're growing bacteria or not, isn't that what they're intended for? The abcess I have is super small. I'm waiting this out. Thank you for your response!

 

[Redone]

I just saw your post about your bacterial endocarditis. It is unfortunate that you had such a short course of IV antibiotics on the first go round. Generally people are placed on high dose IV antibiotics for extended periods - like 6 weeks for bacterial endocarditis especially with artificial valves. So your premature switch to oral unfortunately allowed the bacteria to continue to grow more readily.
I agree that the valve and probably the graft are unlikely to be directly affected by the infection. But there is tissue around the graft which does get infected. Unfortunately with foreign material and probably relatively avascular tissue around the graft and valve the effect of the antibiotics may be hindered. Probably at the base of the valve on the ring used to attach the valve to the tissue is where the infection is most active.
Probably the majority of physicians would go with a decent course of IV antibiotics and reevaluate. Possibly by good fortune the infection may be stopped and surgery might be avoided. There probably other than time little risk in this approach unless the echo studies show increasing evidence of infection spreading.
Getting the infection cleared up as much as possible probably also makes going back surgically easier and hopefully less likely to fail. Are they talking about taking both the valve and the graft out? Clearly doing both is not trivial vs just the valve. Good luck and continue to talk with your physicians about your options.

I think my post and others are getting confused. I am still on IV Antibiotics and have been since May 20 although another user said, he was placed on oral antibiotics first and then IV afterwards once they figured it out. The damage on my graft/valve are not obvious to me based on the TEE. I'm going by what my surgeon told me. There's also confusion as to my comment that my surgeon is one of the very best in the Boston area and he does not want to do surgery on me at all. He would love to avoid it at all costs so with this being said, he contacted every colleague in the Boston area at Mass General Hospital and Brigham and Women's Hospital as well as other to show them my TEE results. It was about 50/50 on surgery because I have a very difficult case. He said, the valve is well seated and functioning properly, but it has been damaged and if I'm to experience anything it would be severe shortness of breath not a heart attack or stroke. I'm going to wait for now, finish the antibiotics although I believe I'm getting fevers from them as well as itchy skin, and dizziness. I've mentioned this to Infectious Disease twice now and have emailed the Dr to see if a switch to Penicillin can be made. Thank you!

 

[Redone]

Hi.


"I do know one of my surgeon's colleagues, a Dr I almost went with advised...no surgery."

I'd definitely keep getting opinions, especially because there is some disagreement as to whether surgery is needed. At the same time, and I'm sure you are fully on top of this, try to get to the decision quickly. If it needs to be done, it needs to be done and no need to take on additional risk by putting it off. Some of the top cardiologists and surgeons have waiting lists months long, so that would not be practical. But, in my experience surgeons, even top ones, are often available for consult on short notice. I was able to get in to see Dr. Alfredo Trento at Cedar Sinai on short notice- like 2 days. And I was able to consult with Dr. Shemin at UCLA on short notice as well. Caution about Dr. Trento- very experienced, but he will want to operate. He wanted to operate on me when I was still diagnosed as moderately stenotic. Fortunately, 5 Cardiologists whom I consulted with and one other surgeon disagreed with him. Dr. Shemin, on the other hand, was in no hurry to push my operation in my first consult. But, when it was time he told me to get it done right away.

Anyway, I'm sure you're already on this, but now is the time to be getting several different opinions. And, I would seek both the opinions of cardiologists and surgeons.

My surgeon doesn't want to do surgery and would like to avoid it at all costs. I made a comment that my surgeon contacted all the top Drs in the Boston area to present my case. He wanted feedback from the best surgeon's (I believe he is one of them), Echocardiology experts and had a meeting to discuss my case. He said, the feedback was about 50/50 for surgery versus no surgery.

May I ask did you get other opinions from Drs in other states where you wouldn't travel to have surgery? I'm just curious because I would do that if possible. I was on the cardiology floor when I was recently in the hospital and one of the Cardiologists wanted to start a Heparin bridge before even hearing what my surgeon had to say. I have a telehealth visit scheduled for this Friday, June 24 with my surgeon and I will be asking him more questions. My TEE is very odd because the report shows a tiny abcess or pseudoanyeurism they call it and it makes no comment as to damage of the valve. I'm not sure how the valve can be damaged when it doesn't state that, but I'll be finding out. Thank you for your feedback!

 

[Chuck C]

May I ask did you get other opinions from Drs in other states where you wouldn't travel to have surgery?

I live an hour from San Diego and 90 minutes from LA. Between the two of those cities we have some of the top valve surgery centers in the state and in the country. So, I was able to drive to all my consults.

In that I consulted with 5 cardiologists, it might sound like I bounced around more than I really did. I saw my local cardiologist. He was of the mind set that my surgery would be a very long way off, as I set the record on the treadmill test and he believed it would be 5-20 years away. I was not convinced, in that my valve area was only 1.0cm2 at diagnosis, right on the border of moderate/severe.

So, I next went to Scripps for a second opinion. The first visit was with 2 cardiologists at the same time. One was in her first 2 years practicing cardiology and they have a policy that during the first two years that a senior cardiologist joins in the consult. Dr. James joined in and I was very impressed with him. He ordered another echo to be done at Scripps. After looking at my echo, he estimated that i was 1-2 years away from needing surgery and this ended up being spot on. He also sent me to Dr. Curtiss Stinis, an interventional cardiologist at Scripps, to get his opinion and thoughts on whether I was a candidate for TAVR. So, that was cardiologist #4.

Next I headed to LA about a year later to consult with Dr. Aksoy, one of the most respected cardiologists at UCLA.

I did get one long distance consult of sorts, but it was not official. That was with a cardiologist in Canada, who is also a researcher. During some back and forth with him about some of his research he gave me this thoughts on my situation. So, ultimately I had 6 different cardiologists looking at my situation at one time or another.

I also did consults with Dr. Trento, head cardio thoracic surgeon at Cedar Sinai and Dr. Shemin, head of cardiothoracic surgery at UCLA. You could say that I was surgeon shopping, but did so before it was time for surgery. After my consult with Dr. Shemin I felt strongly that he was the one that I wanted to operate on me when the time came.

To give you an idea of how much opinions can vary and to underscore why I think getting multiple opinions is so important: My local cardiologist said that I was likely 5-20 years away from needing surgery. About a month later I consulted with Dr. Alfredo Trento, surgeon at Cedar Sinai, who told me I should get the operation right away, and he has an opening next week, even though at the time my diagnosis was only moderate aortic stenosis and I had no symptoms.

There is a saying among cardiologists: "Surgeons want to cut." There can be some truth in this. Ask a hammer what it wants to do today- hit a nail? But, I know that this is not the case with all surgeons and certainly was not the case with Dr. Shemin. Even after progressing another 14 months after Dr. Trento told me it was time, Shemin told me it was still not yet time to operate, based on my echo and lack of symptoms. But, once it was time, he got me right in.

 

[Chuck C]

my surgeon contacted all the top Drs in the Boston area to present my case. He wanted feedback from the best surgeon's (I believe he is one of them), Echocardiology experts and had a meeting to discuss my case.

I wanted to add that this is great that he did this. Not all patient situations are cut and dry and he clearly wanted to get many opinions before moving forward. I truly wish it was more common for surgeons and cardiologists to get input from their colleagues before moving forward in the challenging cases. We've heard of cardiologists getting offended when a person seeks a second opinion. Any true professional should welcome it.

Even though it appears that a lot of experienced folks have taken a look already, I would keep seeking opinions, especially as the opinions seem split about 50/50. Perhaps you will come across a team who has successfully treated someone in your exact situation.

 

[carolinemc]

Sorry, I tried responding to each of your questions and thought I had done it correctly, but I clearly didn't. I do not have dental issues, had a colonoscopy etc. I don't quite understand how blood cultures don't reveal if you're growing bacteria or not, isn't that what they're intended for? The abcess I have is super small. I'm waiting this out. Thank you for your response!

You mention an abscess, that can allow bacteria to come into the body. Good luck in getting that abscess gone and with the infection from it.

 

[Redone]

You mention an abscess, that can allow bacteria to come into the body. Good luck in getting that abscess gone and with the infection from it.

Thank you!!

 

[Redone]

Inflammation of periodontal tissue leads to deepening of the gingival crevice and formation of periodontal pockets, acting as a reservoir for a large number of microorganisms. Periodontal infections affect the oral tissues, in addition bacteria may get entry into the bloodstream via ulcerated inflamed crevice and pocket epithelium, and the adjacent gingival microcirculation. Invasive dental procedures and normal daily activities, such as chewing and tooth brushing are the important predisposing factors for entry of microbes into bloodstream (7, 18-22). Bacteremia and low-grade inflammation because of periodontal infections may carry a risk for systemic conditions. It has been observed that periodontitis is one of the causes or consequences of developing atherosclerosis. Microorganisms or their products present in circulation may promote pathogenesis and enhance local inflammatory changes in vessel walls and thereby may promote process of clotting and clot formation (23). The periodontal disease has also been reported to be an important risk factor for nonhemorrhagic stroke (24). Several other studies have also found that there is the oral-systemic link in various conditions like infective endocarditis and cardiovascular diseases, premature low birth weight deliveries, and diabetes mellitus (25-27).
https://brieflands.com/articles/apid-55785.html

This is great information! Thank you for sharing the article. I am absolutely sure this is how I got Strep B.

 

[Redone]

I wanted to add that this is great that he did this. Not all patient situations are cut and dry and he clearly wanted to get many opinions before moving forward. I truly wish it was more common for surgeons and cardiologists to get input from their colleagues before moving forward in the challenging cases. We've heard of cardiologists getting offended when a person seeks a second opinion. Any true professional should welcome it.

Even though it appears that a lot of experienced folks have taken a look already, I would keep seeking opinions, especially as the opinions seem split about 50/50. Perhaps you will come across a team who has successfully treated someone in your exact situation.

Yes, it is great and I'm definitely glad he involved many of the best surgeon's in the area to get perspective on my case. At this point I should be coming off IV Antibiotics next week if the WBC Count looks good, going on oral Amoxicillan, which has never been an issue, but this might be at a much higher dose. I also hope the PICC Line will be removed. As for surgery my plan is to wait this out and get a TEE whenever they think I need one next, but I am not going to have surgery. I want to see how many years I have left on this valve. Maybe it will last 20 years or more, who really knows.

 

[pellicle]

I also hope the PICC Line will be removed.

mine was in for a few weeks ... and compared to a canula its much less trouble (and a much lower infection risk). Personally I'd rather have mine a week too long than need another one (which I did anyway at the second outburst because the first one was removed early)

 

[Redone]

mine was in for a few weeks ... and compared to a canula its much less trouble (and a much lower infection risk). Personally I'd rather have mine a week too long than need another one (which I did anyway at the second outburst because the first one was removed early)

Next week is 6 weeks. I've read anything longer and another risk for infection. We'll see what happens because it all depends on the WBC results.