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Let's talk pneumonia and pulmonologists...


PeterPan
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This is horrible, but I have it AGAIN!  And I had it in January 2015, so just a year and a half ago too.  The physician's assistant at Urgent Care referred me to a pulmonologist, but what he thought would be a 1-2 day referral is literally a wait till February.  I think the guy thought the pulmonologist would do follow-up care.  I'm on a z-pack.  

 

What does a pulmonologist do?  Will I want to see him in February?  Or should I try to get an appt in the big city (drive an hour) and get into one sooner?  I asked why I was getting this again, and the pa just said usually it's weak immune system.  But the pulm would be looking at my breathing, yes?  So is something up with my breathing?  Did that guy hear something when he listened to my lungs and I'm a ticking time bomb?

 

Fwiw, I do not have asthma.  I've been exercising, doing really well.  Both times this pneumonia has occurred when we had deaths in the family and very high stress.

 

Any tips for me here on what I should be pursuing?

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On my phone but... immune system testing wouldn't hurt (IgG total and subclasses, igm/ige/iga total). I may have additional thoughts on alternative treatments when I get home if you want.

 

ETA, home now.  Did they say what type of pneumonia it was?  Mycoplasma and c. pneumonia (aka cpn) have entire worlds of internet discussion and controversy to go along with.  AFAIK, zithromax is typically prescribed for suspected mycoplasma (commonly walking pneumonia) but I don't know whether zith is also used for a regular bacterial pneumonia, for which penicillin or amox or similar would also be typical.

 

Prairiewindmomma reminded me about the vax.  One of the tests ds failed was the antibody test for s. pneumonia; essentially, he does not currently show a response to the Prevnar vaccine he had when he was a baby.  This failure is a component of his immune deficiency diagnosis (we elected not to do Pneumovax, which would make it more official for insurance).  Anyway, all this to say, there's a vax for s. pneumonia.

Edited by wapiti
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I saw a pulmonologist this summer after I had pulmonary emboli and my breathing was still difficult.

She diagnosed allergies from across the room. After a quick Physical exam , she gave me meds for the allergies and ordered a lung function test to happen 6 weeks later, giving the allergy meds time to help,out my breathing.

The lung function test tells them what's going on in your lungs, like COPD, asthma and such. I am terrible at describing things in writing, or typing on my IPAd, but Google lung function test for more info. The test happened and I saw her immediately after and she had the results already.

 

February is way too long to,wait. But such is life ...I had to wait over a month, and compared to 4 months that doesn't sound too bad.

Edited by KatieinMich
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I do have asthma and got pneumonia in Dec of 2013 right before Christmas and saw the pulmonologist at the end of February.  I had already had lung function test ordered by my internal medicine doctor.  He did more specialized testing, ordered a CAT scan of my lungs, put me back on antibiotics, and put me on nasal sprays, Singulair, and Spiriva along with upping my Advair to the higher dose. I was soon breathing much better.

 

For you, without asthma, they will still probably do a lung function test.  Have you had a pneumonia shot>  Have you gotten the flu shot this year-make sure you do since flu can have pneumonia as a side effect.

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Levofloxacin is a common antibiotic to try if you fail recovery with a z-pac.  Nodding in agreement with those pointing out the importance of spirometry and other lung function tests, followed by the appropriate followup: allergy testing, immunology visit, whatever.  OhE, drive to the big city and get seen sooner. This is worth the drive.

 

FWIW, I know that for me stress + sleep deprivation + any other thing (allergies, viral exposure, huge change in weather) = viral infection for me. If I don't catch the viral infection early on, I usually end up with a secondary bacterial infection.  It took a few hard years to recognize the pattern, but I now have a protocol I follow in the first 24 hours of being ill because I'm immunocompromised.

 

Note that if you get the PPSV-23 (I looked it up and this is the correct name) shot that a followup is recommended 5 years later.

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If you are thinking exercising without wheezing = no asthma, then I would not have asthma either, and I most certainly do. :-) I am pretty sure mine is some kind of cough-variant asthma, but I know that only from Dr. Google. I have a diagnosis of asthma, but no one said "cough variant" ever to my face. My asthma is extremely well controlled now, but allergies set it off initially. Before that, I had reactive airways (not as a diagnosis, but as an observation of my own--one of my kiddos has reactive airways but no formal diagnosis of asthma and has zero chronic issues). Everyone I've talked to that has asthma like mine is prone to pneumonia (well, parents I've talked to whose kids have this kind of asthma--I think the kids don't notice the triggers, and then de-compensate fast, and i don't know any adults who say they have it). I have not had pneumonia, but I've been severely compromised over stuff before that "shouldn't" set off an asthma flair, whatever that means. I can go from fine to horrid with bronchitis very quickly, though I now have more reliable ways to catch exacerbations early. (Things like peak flow meters were so laughably off for me that my allergist told me to stop using them.)

 

Fwiw, I do not have asthma.  I've been exercising, doing really well.  

 

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I'll try to address all the questions!  Just maybe not in order.  

 

Yes, that seems to be the pattern: stress + viral = bacterial.  And yes, my immune system is not good. I had MCS and food allergies and was reacting to EVERYTHING.  We got that to improve, but at this point in life my immune system is better than it was but not enough better to keep this from happening.  So my body will try to fight for weeks but not work up the courage, not get it done, then get really sick.  It's actually worse than just plain getting sick.  It's a known issue for me.

 

I've heard of IG testing in context of food allergies, but it hadn't occurred to me (duh) that they do it to quantify immune system functioning overall.  Hmm.  What is the appropriate doctor to do that?  GP?  Specialist?

 

Allergies.  Just your normal, mundane things like dust, a little grass here or there, mild dog.  And yes I have a *small* indoor dog that I keep bathed.  As long as he's bathed and we sweep, it's at mild nuisance level, not really a noticeable thing.  As a teen I had enough symptoms that I took a prescription for it.  I no longer have those symptoms, would not want the scrip, and would be really upset if I paid $300 to see the doc and that's all they said/found/were looking for.  Are you saying that mild levels of exposure that are not giving outwardly visible symptoms (congestion, itchy eyes, whatever) are giving me lung problems that make me prone to this?

 

Lung function test.  Did my first episode of pneumonia cause damage?  Do I breathe too shallowly?  What are they looking for there?  I exercise and just turned 40.  I keep reading COPD, and I don't *think* I fit that demographic.  I don't *expect* something there.  I don't want to miss things if that's the issue, but I don't want to pay $$$ for tests I don't need either, kwim?  Like I'm going to have to PAY for this, kwim?  So how do they know if there's warrant to do the lung test?  Are there signs or things they hear or symptoms or indications?

 

Um, now for the blow your mind parts.  No vaccines, not since I was in high school.  The last doctor I was to, save for the pneumonia in 2015, was 2001.  The guy was very alternative (and I'm into alternative), but he made me way MORE sick instead of better.  That's no OB, nothing.  I'm pretty much on the live and die without 'em track. And I'm NOT entirely standard med.  It's just for where I was with my body, the doctor was causing more harm than good. At this point I'm willing to see something if they're asking something that explains why this is happening or what to do about it.  But I can't blow money needlessly to feed a burgeoning system.

 

Just as a question, why wouldn't getting pneumonia give you some antibodies if it was bacterial??  

 

And yes, if I'm sure I know WHY I'm going and want I'm wanting, I can make some calls to the big city.  I would think I could get much faster access.  

 

I'm a little perturbed because the PA blew me off, saying the cough would go away when the antibiotics kicked in, which was stupid.  I'm now coughing more, not less. He said on the x-ray there was one (infiltrate? I forget the word). I walked in, so maybe walking pneumonia?  But I needed to be in bed, lol.  But not the all over my lungs because I went in much earlier.  I know what it is now.  I woke up the whole house at 4am with crackling lungs and coughing, so I decided it was time to go in, game over.  But before I was sick at that level for a week before I went in.  At that point recovery took MONTHS.  

 

Anyways, that was to say I've read a little in passing mentioning the mycoplasma thing, but I know nothing about it.  I think this bout is much more mild because we caught it sooner.  I'm assuming now that the funeral stuff is done and I can rest, I'll have a chance to get well.  I was up late and early this morning making a funeral picture video, ugh. Other people are taking care of ds and food.  It's just crazy here right now.  

 

You know what else is weird?  First time, the doc gave me cough syrup with codeine, an inhaler, knocked me out, and I slept while the zpack did it's biz.  A few days later I could walk and slowly began to mend.  This time, the PA says he can't give an inhaler, have to have a pulmonologist for that, doesn't give me cough syrup, nothing.  So does that mean it's BAD to use those?  I don't know, the PA just seemed sort of tentative.  He kept asking why my ears were so clean and whether I used q-tips.  I'm like hello, I said no, I know what a q-tip is, I only use a wash cloth.  But nobody has clean ears apparently without q-tips, so he was calling me a liar while I'm sitting there with pneumonia.  If he hadn't been twice as big as me (he was overweight) I might have whacked him. But my mother was with me and she thought he was off too, not really addressing the big concerns.

 

Prairie, if you have a method that works, I'm all ears.  I hadn't been sick AT ALL since the last time.  When I started fighting this bug 2 weeks ago, I did normal good things (probiotics, lemonade, C, blah blah).  I tell you though, both times now, there has been a point where it just crossed over and then it was hopeless.  And I had been feeling tightness in my lungs for several weeks.  I didn't have a cough or crackling.  I thought it was my thyroid, because that's a place my low thyroid symptoms show up, with sort of a shortness of breath.  I thought it was because I was stressed.  Oh, and I take lots of raw garlic.  And it was enough for a year and a half!  Just not now, sigh.

 

 

 

 

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If you are thinking exercising without wheezing = no asthma, then I would not have asthma either, and I most certainly do. :-) I am pretty sure mine is some kind of cough-variant asthma, but I know that only from Dr. Google. I have a diagnosis of asthma, but no one said "cough variant" ever to my face. My asthma is extremely well controlled now, but allergies set it off initially. Before that, I had reactive airways (not as a diagnosis, but as an observation of my own--one of my kiddos has reactive airways but no formal diagnosis of asthma and has zero chronic issues). Everyone I've talked to that has asthma like mine is prone to pneumonia (well, parents I've talked to whose kids have this kind of asthma--I think the kids don't notice the triggers, and then de-compensate fast, and i don't know any adults who say they have it). I have not had pneumonia, but I've been severely compromised over stuff before that "shouldn't" set off an asthma flair, whatever that means. I can go from fine to horrid with bronchitis very quickly, though I now have more reliable ways to catch exacerbations early. (Things like peak flow meters were so laughably off for me that my allergist told me to stop using them.)

You're blowing my mind here.  I will look into it.  But you're saying you have allergies that cause consistent low levels of constriction?  What is causing the asthma? How does it show up to know you have it?

 

I'm reading about this some more.  I don't know.  But I agree, there was no in-between.  It's not like I had a cold for a week and it turned into pneumonia.  I just started having fevers, went to bed, and two days later had a scrip.

Edited by OhElizabeth
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You're blowing my mind here.  I will look into it.  But you're saying you have allergies that cause consistent low levels of constriction?  What is causing the asthma? How does it show up to know you have it?

 

I will try to PM you. Asthma doesn't mean I have constriction all the time. I have very well-controlled asthma, so I don't have constriction all the time. It's episodic. My spirometry has shown excellent lung function for a long time. 

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Oh Elizabeth, I am so sorry . It's tough trying to figure out the illness and it's worse when Drs are no help.

When I got sick back in May, two PA,s from two different clinic passed me off as having sinus infection. I had both lungs full of clots !! I could have died. Letters were written on my behalf. See a Dr. . Insist on it. No to anybody less than a Dr.

Sorry , I didn't use to feel this way.

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FIrst of all, you don't get immunity from bacterial infections.  You only get them from viral infections.  SO you can keep getting strep or staph or anyone of the many other infections over and over again.  Secondly, the lung damage that occurs in pneumonia makes you susceptible to getting pneumonia again.  It can be from the same bacterial infection or from a different one.  The pneumonia vaccines help prevent many of them but I got one that isn't in the vaccine and is usually in alcoholics and people in long term care.  I got it because I am on immunosuppressants and can get all sorts of things easily.  

 

I would really urge you to get a pneumonia vaccine and a flu vaccine.  You are at additional risk for getting lung complications if you get the flu.  Having pneumonia caused by influenza brings about a real risk of death. 

 

Lung function tests are not just for COPD.  They are for checking how well your lungs are working.  There are myriad of lung conditions, not just asthma or COPD.  Furthermore, exercise is only one type of asthma trigger.  My asthma isn't triggered by exercise.  It is triggered by smoke, perfumes, illnesses, and mold.  Different people have different triggers.  You also don't have to have wheezing to have asthma.  I very rarely have wheezing but do have tightness in my chest.  

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Oh Elizabeth, I am so sorry . It's tough trying to figure out the illness and it's worse when Drs are no help.

When I got sick back in May, two PA,s from two different clinic passed me off as having sinus infection. I had both lungs full of clots !! I could have died. Letters were written on my behalf. See a Dr. . Insist on it. No to anybody less than a Dr.

Sorry , I didn't use to feel this way.

 

I am sorry you had a bad experience with PAs! 

 

There are poor providers at all levels of medicine, and there are complicated patients that appear just fine on even a very thorough exam (or who literally are fine one hour and decompensate or even die very rapidly the next). It's an art as well as a science. 

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More random two cents:

 

What you describe as tightness could easily be wheezing via constriction, no?  In my mind, there are two parts that usually come along with asthma, the constriction being one and excess mucus production (?) being the other.

 

The inhaler would either be albuterol (short acting) for wheezing or a steroid (longer acting) for....wheezing.  How totally lame that the PA wouldn't give you one if it was explained that it was helpful in the past, but might make sense if there were no wheezing present, i.e., no need for it/won't help.

 

AFAIK any doc can order very basic, simple immune system testing though they may not know how to read the results well.  Our current allergist is an immunologist, for example.  We've never been to a pulmonologist.  (Our allergist does spirometry on my asthma kid - I have no clue what it costs.)

 

For now I'd see about getting better and beefing up your immune system, as if it's that simple LOL (I can talk a good supplement game though results are another story).  For me personally, sleep has a huge effect - these days, if I miss a few nights of good sleep, I can count on coming down with something; probably I have lots of stuff hanging around just waiting for a chance to grow.  The immunologist explained to me once about the immune system during sleep (maybe it was for humoral immunity) but now I can't remember the details.

 

I totally hear you on the vax.  Not relevant yet if this is, say, mycoplasma pneumonia and not Streptococcus pneumonia.

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I am sorry you had a bad experience with PAs!

 

There are poor providers at all levels of medicine, and there are complicated patients that appear just fine on even a very thorough exam (or who literally are fine one hour and decompensate or even die very rapidly the next). It's an art as well as a science.

I have also had wonderful experiences with PAs, and I should have said that earlier. I guess I am still a little shocked about the whole experience I have been thru this year, therefore I do stand by my thoughts for OhElizabeth.

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I have also had wonderful experiences with PAs, and I should have said that earlier. I guess I am still a little shocked about the whole experience I have been thru this year, therefore I do stand by my thoughts for OhElizabeth.

 

It is AWFUL to have something missed by a clinician. Truly. Something like that? Traumatic, not just awful. 

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I remember you and I had pneumonia within a week or two of each other back in 2015. When I was getting my flu shot last year, the technician and I discussed the pneumonia vaccine. She said it was recommended if you were 50 or over. I said I wasn't quite, but that I had had pneumonia the previous winter, and if I ever had it again I would want the vaccine. And she replied that that was the recommended course--if you aren't 50 yet but have had pneumonia more than once you should get the vaccine. So far 2015 is my only case, so no vaccine yet. But I'm over 50 now, so I guess I could!

 

My dad is a pulmonologist, but I don't remember ever hearing much about pneumonia patients. He always had the sickest of the sick--patients in ICU, COPD, emphysema. I don't know that I would be in a rush to see a pulmonologist for a second case of walking pneumonia. I mean, if it was recommended I would probably do it, but I wouldn't consider it an emergency situation. 

 

Hope you heal up a lot faster this time. Oh, and the PA who diagnosed me prescribed both a zpack and an inhaler (I didn't need cough syrup).

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I need to learn more about the lung damage from the pneumonia.  The PA blew us off when my mother mentioned it.

 

I'm coughing significantly more today, and kbutton was connecting it to allergies.  Someone is visiting with a dog I know I'm allergic to.  So her connection of allergies and lungs may be more on than I dreamed.  They're leaving Sunday, and tomorrow is Friday.  If I had to, we could ask them to leave Saturday.  It's really kind of awkward.  I would have to be dog-gone sure, haha.

 

Ali, oh my, now I do remember that!  So your dad is a pulm?  Wow.  I don't know why, but I really liked the idea when the PA said it.  It just seemed like such a practical thing.  I think it's just this sense of this is my fault, I eat right, I do things right, something is going on, and if a pulm can be concrete about it and not voodoo and guessing then I wanna see a pulm.  

 

Ok, here's a question.  Say my lungs are prone to this due to some sort of mild asthma or constriction connected to allergies.  Is a pulm still the right person if it's allergies driving the process, or is it someone else?  And if I'm prone because of my immune system, then is an immunologist the correct one to run and read the tests, or can the pulm do that?  

 

I think somehow the PA and I weren't really communicating very well.  I mean, I was sick, and he was picking up dots, lots of dots.  And I'm starting to wonder if he's dots weren't lack of confidence, don't know what I'm seeing so I'm just looking at random stuff, or if he was actually SEEING a ton of little dots and putting them together.  Because the first time (2015) that md didn't look for dots and didn't refer off.  But this guy did lots of little dot collection and was really pesky asking and checking stuff.  So I'm just wondering if he was connecting the dots.  

 

Yesterday, before the dog came, I was ok without the inhaler and just wanted it.  Now I need the inhaler just to stop constantly coughing.  It's pretty dramatic.  So I definitely buy this idea that something is aggravating what's going on.  

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Firstly, if you wanna get in quicker you could also check allergists in your area. They usually have basic lung functions test capabilities and are pretty familiar with mild/moderate lung issues. They can also order immunology tests. While I'm not a very allergic person, I see both a pulmo and an allergist to manage my severe asthma.

 

Also, asthma isn't just constriction, but also inflammation. That's a big thing that many discount.

 

But two rounds of pneumonia in 18 months? While that's cruddy, and I hope you feel better soon, I wouldn't be overly concerned yet.

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Something similar happened to me a number of years back.  I ended up with pneumonia twice within a year or a year and a half.  Both times it came on very suddenly with tremendous pain and high fever.  My dh is a doc and called the ambulance one of the times because I was in so much pain I could hardly move and I was hyperventilating. I ended up in the hospital for 3 days both times.

 

I do have bad allergies but I have always had bad allergies.  We actually concluded that it was brought on by acid reflux in my cases and I was put on meds for that. 

 

Since then I have always taken a flu shot every year and I have also had the pneumonia shot.  i have never had it again, although I was really scared for the first couple of years that every time i got sick it might turn into pneumonia.  It has now been about 10 years or so.

 

I hope you figure it out.  It is really scary when it is happening to you.

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:grouphug:  :grouphug:  :grouphug:

 

You've had some great feedback so I won't bore you with more except to say that Mom ended up seeing a pulmonologist for similar issues.  It did help her tremendously but she had to be VERY proactive about medications.  He tossed a lot of meds at her without really getting to know her long term situation.  She is exceedingly sensitive to medications and had every reason to be concerned.  

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I thought about this overnight and concluded the dog visiting is definitely a problem and is making it worse.  I went to CVS this morning and got some Zyrtec, and it seems to be helping.  I'm going to see if they'll take their dog to a self-service wash place and wash him.  

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Firstly, if you wanna get in quicker you could also check allergists in your area. They usually have basic lung functions test capabilities and are pretty familiar with mild/moderate lung issues. They can also order immunology tests. While I'm not a very allergic person, I see both a pulmo and an allergist to manage my severe asthma.

 

This is a good point.  In my area, we were directed to the allergist first and the pulmonologist was a step up from that, for when the allergist had run out of ideas for managing lung function.

 

Back when ds had pneumonia twice in six months including the hospitalization, the ped had us switch from our random allergist to the allergist at the major asthma hospital located in our city.  From time to time, a possible referral to pulmo was mentioned, but we ended up just changing allergists again instead (away from the asthma hospital allergist to someone more outside the box, long story).

Edited by wapiti
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With this additional information, I would see an allergist first. Most have some degree of close familiarity with immunology. Taking zyrtec is probably not your most effective strategy for dealing with inflammation. I would also pick up a bottle of Flonase nasal spray (fluticasone is the generic and runs $8 a bottle).  The topical corticosteroid will help bring down some of that swollen tissue in your upper respiratory track.  Be sure to sniff as deeply as you can as you take it (and I would take it morning and night).

 

The other things that *I* would do:

1. take elderberry 4x/day (anti-inflammatory, antibacterial)

2. drink peppermint tea alternatingly with water with honey and lemon

3. no dairy, no sugar, no processed foods

4. probiotic for 60 days (to counter the antibiotic and then to re-colonize your gut)

 

At the first sign of becoming ill, I start elderberry. I don't take it prophylactically because I have RA, but I do take it at the first tickling in my throat or any hint that I am becoming ill for three days. It has strong antiviral properties.  Even if I do become sick, I continue taking it.  Per my doctors, if I start with a high fever, I get seen that day.  I get high fevers rarely, and it is always a sign that my ship is going down.  In the last two years, we have started giving me antibiotics on day 2 of a high fever.  I really, really hate antibiotics, but this seems to be the only thing that keeps me from becoming incredibly ill.  A minor cold to my husband is six weeks of me being very, very ill.

 

After I recover, I have to be very diligent about hand washing, changing clothes after being in public, not eating off of buffets or getting salad off of the salad bar or out of the bulk bins in grocery stores (don't eat the samples!)....for at least a couple of months.

 

I have well controlled asthma, I only ever have problems when I am sick. But man, it's truly awful when I get a respiratory infection.  Hugs to you!

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The visitor's dog is why I'm taking the zyrtec, and that dog came after the pneumonia started.  So while there's a process there that's getting aggravated, I don't know if it explains why pneu in the first place.  

 

I switched over to coconut milk years ago, eat minimal/only occasional sugar, and cook from scratch. Yup, have been doing the tea and yes we do lemons.  I used to take elderberry years ago.  Can't remember why I stopped.  It was when my immune system was really bad, and basically I was getting sick anyway and not finding it enough.  

 

I don't have any autoimmune disorders (yet) that I know of, but I know things change, sigh.  

 

That's interesting that your docs are so pro-active.  Because of my sensory and how under-sensitive I am, I probably had fevers for days before I realized.  By the time I realized I was sick and went to bed, it was total flashback, because it was THE SAME as when I went to bed with pneumonia the first time.  

 

Well I need to go rest.  I decided to skip the funeral.  I washed the dog, bought ds a suit at the last minute, etc. and I'm wiped.

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Prevnar is 13 strains

You may be thinking of the Pneumovax which is 23 strains.

Ideally high risk individuals and those over 65 should get both, Prevnar first and then Pneumovax one year later.

 

Ok, I'll just ask.  Are any of these available *without* heavy metals?  It's not that I'm so radically opposed to vaccines, but I think it's just criminal all the harmful crap they put in them.

 

And I bumped into a lady from the hospital who said levels are really high right now, that the hospital is full of people with pneumonia, like it's winter, and that it's a really bad strain.  So I think I better rest and get well, so I don't end up there!   :glare:

Edited by OhElizabeth
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Cough syrup is generally a bad idea with pneumonia. Effective coughing helps in clearing secretions. Now if you're coughing because of bronchospasm then a bronchodilator inhaler would be helpful. I'm not sure why the PA couldn't prescribe that (perhaps it is restricted for him, many states do have some restrictions on midlevel prescribing although that seems odd). If it was a midlevel issue he should have discussed the case with his supervising/collaborating physician and got them to write it if they felt it was indicated.

 

We're either of your pneumonias imaged? Were both in the same lobe/lobes? In the event they were did you have radio graphic resolution of the first pneumonias confirmed? If yes, yes, and no then at a minimum repeat imaging of some form to ensure resolution would be reasonable. A high resolution CT may be appropriate depending on the full clinical picture. I would think your internist should be able to do all of this. They should also be able to order a full set of PFTs with or without ABG if they feel that is warranted. If any of this initial work up is concerning or you are not improving then they should be able to get you in with a pulmonologist more quickly by calling and speaking to them directly.

 

Good luck!

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The adjudivant for the pnevnarl vaccine is .125mg of aluminum....which is comparable to what you'd get eating chocolate, pasta, and bread in an average diet.  https://enveurope.springeropen.com/articles/10.1186/2190-4715-23-37

 

The pneumovax vaccine has the proteins suspended in a saline solution with .25% phenol for the preservative. Phenol is found in foods like apples and peanuts and it's used as well as in toiletries and cleaning products and and it's cleared through your body in urine.

 

When I did the risk/benefit analysis, I got the vaccines.

 

 

 

 

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I have a pulmonologist appt for Wed.  I feel much better about that.  If I'm magically better, we talk prevention.  If I'm not, we get things figured out.  Win-win.  Wish I had called the big city two days ago.  I was too sick to think of it.  

 

Now to bed.

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Cough syrup is generally a bad idea with pneumonia. Effective coughing helps in clearing secretions. Now if you're coughing because of bronchospasm then a bronchodilator inhaler would be helpful. I'm not sure why the PA couldn't prescribe that (perhaps it is restricted for him, many states do have some restrictions on midlevel prescribing although that seems odd). If it was a midlevel issue he should have discussed the case with his supervising/collaborating physician and got them to write it if they felt it was indicated.

 

We're either of your pneumonias imaged? Were both in the same lobe/lobes? In the event they were did you have radio graphic resolution of the first pneumonias confirmed? If yes, yes, and no then at a minimum repeat imaging of some form to ensure resolution would be reasonable. A high resolution CT may be appropriate depending on the full clinical picture. I would think your internist should be able to do all of this. They should also be able to order a full set of PFTs with or without ABG if they feel that is warranted. If any of this initial work up is concerning or you are not improving then they should be able to get you in with a pulmonologist more quickly by calling and speaking to them directly.

 

Good luck!

 

That explains why the lady on the phone in the big city office wanted disks of CT (first word) or x-rays (humble, less preferred seemingly).  I had no clue they could CT for that.  Where I live, you say you're still sick and they say oh well.  That's seriously how it rolled.  I should have gone to the big city before, I agree.  Well now I'm being less dumb.

 

And yes, the PA said he wasn't allowed to prescribe the inhaler, and it really frustrates me.  They ought to have had a complete MD there to resolve stuff like this.

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Oh, and the hospital websites are saying pulmonologist care of pneumonia is the NORM here.  So the PA wasn't off-whack referring me, and it's not jumping heads or overkill.  Apparently they could have referred me before.  I guess people using Urgent Care are 2nd class citizens.

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I'd have your doctor check your Vitamin D levels.  I was terribly sick last winter.  One doctor said pneumonia, one said it wasn't.  I'm still thinking it could have been whooping cough, but no matter what it was, it was awful.  It took 2 months to get over it.  

 

I started taking Vitamin D3 this summer.  My son just caught a cold this week, and usually I end up with one whenever he does.  I did not get sick.  

 

I'd look into Vitamin D and lung issues/pneumonia.  Here are a few articles, but there are a lot more.  

 

http://advances.nutrition.org/content/2/3/244.full

 

https://www.vitamindcouncil.org/health-conditions/pneumonia/

 

I wouldn't do the pneumonia or flu shot either.  

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Have any of y'all actually been to a pulmonologist?  I think the doc is probably a nice fellow, so I'm not worried about that.  It's just my mind is getting a little stir crazy with what that PA might have seen on the x-ray or with me that clued him in that we needed to do this.  I mean, it's not a pretty list.  (asthma, fibroids, cancer, blah blah)  I don't smoke, nothing.  I do have chlorine exposure at the pools, high stress, etc. 

 

I don't know, just talking out loud here.  And I'm kind of bummed because, now that things have settled down, I actually feel MORE tired than I did before.  I'm hacking and wheezing, with only this old, expired inhaler for company.  Is it *safe* to do an albuterol inhaler more frequently than every 4-6 hours?  I really had to do it at 2-3 last night.  I was just hacking and hacking from the wheezing and the way it catches.  The 2nd dose calmed things down and I got some sleep.  I'm just getting kind of worried.  

 

And today was my last day on the antibiotic.  You'd think I'd be GLAD, but instead I'm worried! I know it's a sin to worry, but I'm just saying mathematically I'm concerned.  This happened last time too, where it ended way before I was actually well.  I think before I just waited a couple days to let the antibiotic finish it's gig and then I started big doses of probiotic.  That was my plan.  I just wish I were magically more well at this point.  I'd feel more confident.  And I don't recall needing the inhaler this long, even though the pneumonia was much more severe last time.

 

The (store brand) Zyrtec seemed to help the overall symptoms (itching eyes, etc.) while the highly allergenic dog was here.  I didn't take it today and was hacking all day and wheezing.  I took it tonight, and the wheezing and hacking has calmed down some.  It's still there, but it's peskily manageable, instead of leaving me wondering if my head will explode from coughing so much.  I need my dh to see if he can get the last rug swept that that dog was on.  We can even sweep the main floor and dog beds for good measure, hmm.  I'll set him to that.  Who needs to watch football when you can be sweeping, lol.

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My kids have been to a pulmonologist regularly. They did breathing tests - like "breath into this tube and try to blow all the candles out that are on the computer screen." Then the dr administered albuterol and they re-do the test. Pretty painless.

As far as taking albuterol, I was told 2 puffs every 4-6 hours, BUT, if it didn't seem to be working well within twenty minutes we could give another. I'm not sure how that would translate for adults.

I'm so sorry you are still feeling awful. Hopefully you can be seen ASAP in case you need stronger treatments. Nebulizers can be great when albuterol isn't cutting it.

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Could you see a regular doctor before you get into a pulmonologist? 

 

Unfortunately, doctors around here have a long wait.  I had been on a list to get in as a new patient with a doctor (just some randomly selected doc) and I canceled the appt.  It was for 6 months after my last pneumonia, and apparently I wasn't planning on getting sick again, ever, lol.  So no, I don't have a GP and therefore can't get in with anyone.  And if you knew my health history and how odd it is, you'd get why I was nervous.  I haven't seen ANY doctor in 15 years except for those moments in urgent care.  And yes that means a home birth with a midwife.  Nothing.  And I could go for free.  I just haven't.  I do take my kids.  I just haven't.  

 

That's why I thought it was so odd when I was so favorable to the pulmonologist thing.  I think I was hoping he'd be very concrete, sort of get my feet wet with the idea.  But for mammograms and being hassled to have them examine you for this and that, I'm just not onboard with it. 

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My kids have been to a pulmonologist regularly. They did breathing tests - like "breath into this tube and try to blow all the candles out that are on the computer screen." Then the dr administered albuterol and they re-do the test. Pretty painless.

As far as taking albuterol, I was told 2 puffs every 4-6 hours, BUT, if it didn't seem to be working well within twenty minutes we could give another. I'm not sure how that would translate for adults.

I'm so sorry you are still feeling awful. Hopefully you can be seen ASAP in case you need stronger treatments. Nebulizers can be great when albuterol isn't cutting it.

 

Thanks for explaining that.  

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If you are thinking exercising without wheezing = no asthma, then I would not have asthma either, and I most certainly do. :-) I am pretty sure mine is some kind of cough-variant asthma, but I know that only from Dr. Google. I have a diagnosis of asthma, but no one said "cough variant" ever to my face. My asthma is extremely well controlled now, but allergies set it off initially. Before that, I had reactive airways (not as a diagnosis, but as an observation of my own--one of my kiddos has reactive airways but no formal diagnosis of asthma and has zero chronic issues). Everyone I've talked to that has asthma like mine is prone to pneumonia (well, parents I've talked to whose kids have this kind of asthma--I think the kids don't notice the triggers, and then de-compensate fast, and i don't know any adults who say they have it). I have not had pneumonia, but I've been severely compromised over stuff before that "shouldn't" set off an asthma flair, whatever that means. I can go from fine to horrid with bronchitis very quickly, though I now have more reliable ways to catch exacerbations early. (Things like peak flow meters were so laughably off for me that my allergist told me to stop using them.)

 

This sounds like my husband. He was finally diagnosed with asthma. But doesn't do much about it :( He also has bad seasonal allergies now. (And allergic to dogs and cats, though he still pets and loves on dogs because he loves them so much) And if he gets bronchitis it just about always progresses to pneumonia unless we are very careful.  (it happened three years in a row which is what is finally got him to go to the doctor and figure things out)

Edited by vonfirmath
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The rule of thumb for albuterol is every 4 hours, though my understanding is that it wears off in 2.5 hrs (I have never heard of 6 hours and we've had albuterol in our house for >10 yrs).  We have done as close as every 2 hours in a sick situation, though that is typically a sign to have steroids involved, either inhaled or oral.  In-office, we have done albuterol (either inhaler or neb) back to back if the first set of two puffs wasn't enough after a 5-10 min break to let it work.  The only danger I know of is that heart rate will go up.

 

Tip:  when you're very sick, see if you can keep up with the albuterol every 4 hours *around the clock* including the middle of the night for a few nights.  It can make a huge difference.  (need to balance against difficulty going back to sleep after waking)

 

Oral steroids are a tricky question with pneumonia, reducing inflammation so you can breathe vs reducing inflammation that fights infection.  Breathing comes first, obviously, but it depends on the status of the breathing.

 

Be sure you are using the inhaler "correctly."  There is a technique (ds gets quizzed on it annually).  A spacer helps if you have it.

 

If you want to see someone who knows what they're doing and can't get into the pulmo soon enough, I wouldn't hesitate to see an allergy and asthma specialist.  They also do spirometery.  They should also be able to look at your x-ray and refer to pulmo as needed.

 

If you really want to track things, you can get a pulse oximeter, though a lower oxygen level is more of a late sign.  It was very helpful for me on those rare occasions when we needed to decide to head to ER in the middle of the night or to wait until doc opens in the morning.  (Personally, I haven't found peak flow meters to be very useful, though they ought to be)

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This sounds like my husband. He was finally diagnosed with asthma. But doesn't do much about it :( He also has bad seasonal allergies now. (And allergic to dogs and cats, though he still pets and loves on dogs because he loves them so much) And if he gets bronchitis it just about always progresses to pneumonia unless we are very careful.  (it happened three years in a row which is what is finally got him to go to the doctor and figure things out)

 

Yeah, I think the PA was just connecting a lot of little dots and saying it was time, that we don't need to let this happen again before referring off.  

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Went to the pulmonologist.  Yes on the bit of asthma, yes to the blessed (non-expired) inhaler, and said if things don't chill with the inhaler and within the next week or so to call back and he'll give me a Singulair scrip.  He is hoping the inhaler, used selectively, is enough to tamp it down and avoid need for the daily.  

 

So that seems like a good plan to me!  He's going to re-do the x-rays in two months to make sure the pneumonia has cleared, but my temp was good today (98.5, wow!).  

 

So now that I have an inhaler that actually works and isn't expired, I'm hoping it's enough!  The doc himself was fine, very non-interventionist, young, someone I can work with.  I feel good about having that established relationship.  And he says if anything upper respiratory happens like that again, they'll be aggressive.  It's a bit of a hassle to drive to the big city, but I got good service and have a way to follow up.  So I'm pleased.  

 

He did ask the normal things y'all said (flu vaccine, gp, blah blah).  I'll have to think on that.  I don't know what a gp would want from a nice little, slightly plump, 40 year old who exercises and is still somewhat overweight.  I don't know what it would get me or why I'd want to do that.  Just thinking out loud there.  Really, I'm not onboard with mammograms or pap smears, so I'm not sure what's left.  My blood pressure is fabulous, my weight is going down, and I eat right.  

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GP can help with basic care, referrals, and being a home base should you end up requiring many specialists along the way.

 

 

My mother is facing the complication of not having a GP now that she is older. She has heart issues and is battling cancer for the second time. If she had already been established at a GP, she could have been checked out before she needed to be in the ER resulting in a stage 4 cancer diagnosis.

 

She dislikes doctors, and medical interventions too. But not having a GP has been a stumbling block, and continues to be.

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