Pneumonia and mechanical heart valves

[Blanche]

Albert has pneumonia. Last Thursday he began complaining of a head cold. By Friday, it had gone into his chest. It was mild at first, so we didn't think it was remarkable. But, on Sunday, he had labored breathing and was very sick. Took him to urgent care. An X-ray indicated pneumonia. The young doctor at urgent care apparently was not used to treating elder folk. I had to beg him for a breathing treatment and for antibiotics. He gave us some cough syrup and told me to test Al's INR twice a day.

Yesterday, Al's PCP confirmed that he has pneumonia and the start of an ear infection. He is currently on Augmentin. I am very worried about this because of his mechanical heart valve and his age. I've been doing alot of shouldhood thinking. Now, I'm wondering what I should do next? He does seem to be improving today.

Any and all ideas would be very welcome. Perhaps someone here has experience with pneumonia and mechanical heart valves? Many thanks.

Blanche

 

[Nancy]

Have they done any cultures? That would be very helpful in determining the exact cause of the pneumonia. Joe hasn't had that, but when he got bacteremia with klebsiella, that was one nasty bug that can cause virulent pneumonia and endocarditis. He was watched extra carefully by Infectious Disease, and was repeatedly tested several times to make sure everything was gone.

 

[Ross]

Nancy summed it up. Get some cultures run and see if they can determine what strain of yuck is causing the problem. Better safe then sorry.

 

[Mary]

Blanche,
Just expressing my hope that Albert makes a fast recovery.
I've had pneumonia several times in my life, and it's not a pleasant experience.
I'm glad he DOES HAVE a good nurse!

 

[Granbonny]

Blanche

Blanche

I hope Al continues to feel better....Don't know much about pneumonia...Does he have fever?... I thought if anyone had pneumonia.they would be put in hospital?...I just posted about what a bad pollen season it is going to be here in Georgia....Lots of people, sniffing, wheezing, ect..runny noses, eyes, ect....so, I guess..an X-ray would show pneumonia? Make him a big pot of chicken soup. and let us hear more..Bonnie

 

[Rich]

Blanche,
I hope he will be OK.
I have had it twice in my life, and I know it is not fun.
Depending on his age has he had a pneumonia vaccine?
It is recommended for those 65 and older.

Rich

 

[tobagotwo]

You are both in my thoughts. Here's to Albert getting well before the germ even knows he has any kind of valves.

Very best wishes,

 

[Karlynn]

Wishing Al well and hoping this germ gets kicked out quickly.

 

[Blanche]

Thank you all so much for the uplifting posts. Al is better today, but he is still very ill and uncomfortable. He is improved over Sunday when I took him to urgent care. I wish that they had taken samples to culture, but they did not. The young doctor in urgent care really didn't seem concerned at all. He actually wasn't going to give Al a breathing treatment, nor was he going to prescribe any meds. I had to muster all of my charm and grace (hehe) to convince him that an antibiotic would be called for in these circumstances.

When we saw the PCP, I hoped he would hospitalize Al. I may deal with him about that tomorrow. As luck would have it, I have an appointment for me with the PCP tomorrow. We will definately spend more time on Al's needs than on me. I am concerned because Al has had three pneumonia shots since 1990. The last one was about 5 months ago, in the PCP's office. That should cover the most common strep cause of pneumonia. That, initself, will be good reason to do cultures. Our doctor is very receptive to me and my suggestions.....I'm going to send him an email now and I plan to use the words Ross gave me, "get some cultures and see what strain of yuck is causing the problem.

There have to be some protocols in place for dealing with people with pneumonia who have mechanical heart valves. Al has already had endocardtis once, and at nearly 72, he just can't get it again...... This is an important heart topic that I have not seen here or anywhere else on the net.
Yet, it is something that all valvers could face.

 

[LUVMyBirman]

Hi Blanche,

I wish Albert a very speedy recovery. One thing my PCP recommended after surgery was the pneumonia vaccine. It may be time to vaccinate again soon. I beleive the lifespan for the vaccine is 7 years? Will be coming up on that anniversay in 2 short weeks. Strep throat is still running rampid in our area. Ton of cases in the grade school my child attends. I have had it myself this winter. Scary thing to have with this valve. My child has been free and clear. Just tells you how much time I spend volunteering

Hope Albert feels much better soon.

 

[Blanche]

Gina:

Al and I have both had pneumonia shots within the last year. Our internist is really into prevention. This should mean that Al is protected against the most common Streptococcus pneumonia. I don't know if this is good or not. The other possibilities seem much worse.
Blanche

 

[tobagotwo]

Remember that the word pneumonia is really a terminological dumping ground for a general disease state roughly defined by inflammation of the bronchial or lobar connective tissue, particularly with watery discharge. The term doesn't describe a cause.

Much pneumonia is caused by viruses, for which antibiotics are entirely ineffective. Fortunately, most of those move through quickly. Perhaps the ER doctor has seen a number of similar cases recently. The doctor may have recognized signs of causation that might not be apparent to you or me.

I'm not saying not to pursue this vigorously, but all of the remedies and culturing you are referring to are for bacteria, which may not be the culprits. The antibiotic Albert is taking should help as a preventative for secondary infections, even if the primary is viral.

If it is a virus, which is quite likely in early spring, the blood culturing would be for any secondary infection, which the antibiotic will hopefully have discouraged. It also means the chance of the cause of the pneumonia involving his valves is much less than with a bacterial agent. Be open to what the doctor says as well as what your heart says.

Very best wishes,

 

[Blanche]

Thank you for the excellent advice. You are right. I'll take your post along with me to remind me to manage my heart!

 

[Bryan B]

Blanche,

I just wanted to chime in to say that I believe you are right to cover all of the bases. I'm a case of someone who had pneumonia and it eventually turned into endocarditis. I was diagnosed with bronchial pneumonia in June of 03 and given a 5 day Z-Pack. A few weeks later I still wasn't feeling well and was given another round of antibiotics along with my first of many corticosteroid regemins. Every time I went on steroids I felt better while I was on them (and shortly thereafter), but in reality they were only masking a "growing" problem. I vote to get some cultures done for peace of mind. It would be better to find out that the "yuck" was not bacterial in nature now than to find out it was down the road. I sure wish my PCP would have had the foresight to culture me a few months earlier.

 

[Blanche]

My visit with the doctor regarding Al's pneumonia, and now my cold left some doubts in my mind. When asked about viral pneunomia, he said that there was no way to diagnose viral pneumonia so doctors assume it is bacterial and treat accordingly with antibiotics (Augmentin 875 was changed to Augmentin 1000SR). He also prescribed 4 days of steroids. Al's next appointment is Tuesday. I can live with this treat and watch approach until then.

I have confidence in this doctor and left my doctor of 16 years to be his patient too. Although he is unbelieveably busy, I can always contact him through email, which he usually answers the same day. At the end of the visit yesterday, he said "If you need me, you know how to get me." His office is less than a half mile from our home. So, I think for the moment we will let the antibiotics do their job and do some serious planning on Tuesday.

Brian, I appreciate your post because I am in desperate fear of endocarditis, which Al has already had once. You can believe that cultures are in his future....if not right now, later to be positive that the infection has cleared.
May I share your post with our doctor on the next visit? Having ancedotal data is a good thing.

I am so worried about this, it is hard to keep it out of my mind.

Blanche

 

[CCRN]

Just a thought

Just a thought

I am wondering if you might run this by his cardiologist?

 

[Bryan B]

Blanche,

You are more than welcome to share my post with your doctor. I had a lot of confidence in my doctor too. The thing is that when my bronchitis finally cleared I then had prostatitis and a host of other symptoms as time went on. He finally did cultures at my request and they came back positive (and they grew very quickly). Even then he felt comfortable treating me with 750mg of Cipro twice a day along with another round of steroids. As soon as the steroids were stopped I started to feel terrible again and he agreed to schedule an echo, which found vegitation on my aortic valve. Although I think he was trying his hardest to find the cause of my problems, I also think he should have taken cultures and done an echo earlier given my congenital heart condition. It sounds like you are on top of the situation. My only advice would be to not let things linger if Al doesn't improve quickly or if he starts to have other unexplained symptoms. I hope Al starts feeling better soon.

 

[Nancy]

Blanche-

Just wanted to share that when Joe developed his bacterial infection, he was in the hospital, and they got Infectious Disease in to see him THAT DAY, cultures were taken immediately and treatment was started asap. That is how serious they took it. They were very aware of the possibility of endocarditis and pneumonia.