Kaleigh
Super_Ideal_Rock
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sis-in-law update - back in ER - but good news.
- Thread starter strmrdr
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MonkeyPie
Ideal_Rock
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swingirl
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strmrdr
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:)
Brilliant_Rock
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What type of infection did they say she has? Pneumonia? Did she have a chest xray? What exactly did it show?
Or do they think the infection was related to her recent hospitalization/procedures?
Do they think the infection (?pneumonia?) is the cause of her initial chest pain or do they think this is different?
What type of ekg changes did she have when she went in the first time? Ones that could have been consistent with pericarditis? Did they repeat the ekg? Does she have a viral etiology of the elevated temp and the temp would have improved anyway with or without antibiotics?
Is she having any other symptoms? Abdominal pain? Neck pain? shortness of breath? Is the pain worse when she takes a deep breath? What does the pain feel like and where in her chest is it located? Is it radiating anywhere? Anything make it any better or worse? Coughing up blood? Long car/plane trips/bedridden? Had she been vomiting recently?
Is she a smoker? Has she been losing weight?
I wouldn't expect a dissection to give her a fever, but has she ever had a chest ct scan or a history of dissection?
You don't have to answer those questions, but has she been to her internist? It would be a good idea to take her to her regular physician/internist for a good history and physical exam - I believe you mentioned she has other health problems -some of those may place her at risk for certain conditions and a physician who knows her history well would be her best bet - ERs are not set up well beyond the admit/don't admit setting for further work up. I missed in there somewhere that she has been to the ER 3x now - I thought it was twice- the time she was admitted and worked up for chest pain, and now this time.
Fingers crossed!
Or do they think the infection was related to her recent hospitalization/procedures?
Do they think the infection (?pneumonia?) is the cause of her initial chest pain or do they think this is different?
What type of ekg changes did she have when she went in the first time? Ones that could have been consistent with pericarditis? Did they repeat the ekg? Does she have a viral etiology of the elevated temp and the temp would have improved anyway with or without antibiotics?
Is she having any other symptoms? Abdominal pain? Neck pain? shortness of breath? Is the pain worse when she takes a deep breath? What does the pain feel like and where in her chest is it located? Is it radiating anywhere? Anything make it any better or worse? Coughing up blood? Long car/plane trips/bedridden? Had she been vomiting recently?
Is she a smoker? Has she been losing weight?
I wouldn't expect a dissection to give her a fever, but has she ever had a chest ct scan or a history of dissection?
You don't have to answer those questions, but has she been to her internist? It would be a good idea to take her to her regular physician/internist for a good history and physical exam - I believe you mentioned she has other health problems -some of those may place her at risk for certain conditions and a physician who knows her history well would be her best bet - ERs are not set up well beyond the admit/don't admit setting for further work up. I missed in there somewhere that she has been to the ER 3x now - I thought it was twice- the time she was admitted and worked up for chest pain, and now this time.
Fingers crossed!
strmrdr
Super_Ideal_Rock
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Hi 
I don''t know the answers to all your questions.
She has seen her regular doctor and she just said if the pains didn''t go away she would send her to a specialist.
The specific infection they found isn''t related to the chest pain or at least I don''t think it could be.
edit: Its not pneumonia, was UT. I wasn''t going to say that on a open board it is hard to know what I can say.
On an open board I am very very hesitant to discuss her medical history.
The chest pain radiates to her left shoulder and arm and is sometimes like a squeeze and other times a burning sensation.
The did 2 contrast ct scans now of her lungs for blood clots as she has a history of them and is on aspirin therapy.
She has had a heart murmur for a long time.
When she was in there the first time she was having irregular heart beats when she got upset.
It was something like pulse---pulse---pulse---------pulse-pulse-pulse then back to normal.
I would estimate it was a 2 beet pause followed by 3-4 quick beets then back to normal.
Her pain would not get worse during the pause or after no shortness of breath that time.
They had her on 1l oxygen at that time, she said doc said it was to help calm her down o2 was 99% on 1l.
They would not answer the question of what was causing the irregular heartbeat.
Then they would do another ekg right after the irregular heartbeat. They did 5 or 6 of them total.
I asked and didn''t get an answer on what was different on the ekg she just said it showed something very little different from one a few months before.
That was the ER doc. The heart docs would not talk to me and what I got third hand is they didn''t say much of anything.
The first 2 times she was in the blood counts didn''t indicate an infection.
The 3rd time it did.
So summary is:
1st visit: admitted and did stress test released.
2nd visit: diagnosis of esophageal spasms
3rd visit UT infection.
Is she having any other symptoms? no
Abdominal pain? no
Neck pain? no
shortness of breath? asthma has been acting up but so has mine due to weather.
Is the pain worse when she takes a deep breath? no effect
What does the pain feel like and where in her chest is it located? left side radiated to shoulder and arm, squeeze sometimes burning others.
Is it radiating anywhere? yes
Anything make it any better or worse? no
Coughing up blood? no
Long car/plane trips/bedridden? no
Had she been vomiting recently? no
Is she a smoker? smoked for 5 years but quit 3 years ago.
Has she been losing weight? has lost a lot of weight over the last 2 years under her doctors care to keep her mild diabetes in check. Non-insulin dependent and is on entry level meds for it. They caught it early.
dunno what is going on but she is feeling better so I hope it is getting better what ever it was.
If she ends up in the ER again I''m going to go up there and make some noise and see if I can get answers.
If you have some ideas of questions that should be asked I would be glad to hear them.
I don''t know the answers to all your questions.She has seen her regular doctor and she just said if the pains didn''t go away she would send her to a specialist.
The specific infection they found isn''t related to the chest pain or at least I don''t think it could be.
edit: Its not pneumonia, was UT. I wasn''t going to say that on a open board it is hard to know what I can say.
On an open board I am very very hesitant to discuss her medical history.
The chest pain radiates to her left shoulder and arm and is sometimes like a squeeze and other times a burning sensation.
The did 2 contrast ct scans now of her lungs for blood clots as she has a history of them and is on aspirin therapy.
She has had a heart murmur for a long time.
When she was in there the first time she was having irregular heart beats when she got upset.
It was something like pulse---pulse---pulse---------pulse-pulse-pulse then back to normal.
I would estimate it was a 2 beet pause followed by 3-4 quick beets then back to normal.
Her pain would not get worse during the pause or after no shortness of breath that time.
They had her on 1l oxygen at that time, she said doc said it was to help calm her down o2 was 99% on 1l.
They would not answer the question of what was causing the irregular heartbeat.
Then they would do another ekg right after the irregular heartbeat. They did 5 or 6 of them total.
I asked and didn''t get an answer on what was different on the ekg she just said it showed something very little different from one a few months before.
That was the ER doc. The heart docs would not talk to me and what I got third hand is they didn''t say much of anything.
The first 2 times she was in the blood counts didn''t indicate an infection.
The 3rd time it did.
So summary is:
1st visit: admitted and did stress test released.
2nd visit: diagnosis of esophageal spasms
3rd visit UT infection.
Is she having any other symptoms? no
Abdominal pain? no
Neck pain? no
shortness of breath? asthma has been acting up but so has mine due to weather.
Is the pain worse when she takes a deep breath? no effect
What does the pain feel like and where in her chest is it located? left side radiated to shoulder and arm, squeeze sometimes burning others.
Is it radiating anywhere? yes
Anything make it any better or worse? no
Coughing up blood? no
Long car/plane trips/bedridden? no
Had she been vomiting recently? no
Is she a smoker? smoked for 5 years but quit 3 years ago.
Has she been losing weight? has lost a lot of weight over the last 2 years under her doctors care to keep her mild diabetes in check. Non-insulin dependent and is on entry level meds for it. They caught it early.
dunno what is going on but she is feeling better so I hope it is getting better what ever it was.
If she ends up in the ER again I''m going to go up there and make some noise and see if I can get answers.
If you have some ideas of questions that should be asked I would be glad to hear them.
:)
Brilliant_Rock
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Sorry - hope I didn''t make you too uncomfortable - (I posted the don''t have to answer the questions line in the prior post in case you did feel too uncomfortable, because I understood that you might not want to) - I just got very concerned from your post that something more severe was going on - that she had a temp and someone handed her a script with a generic ''must be an infection in there somewhere'' diagnosis (without an actual location) and my differential exploded (incorporating fevers into her chest pain, etc). I should have known that was not likely the case. I agree that particular infection would not cause her chest pain. I think it is definitely two separate issues. She has had testing that makes me feel much better about her work up - the ct would have picked up pulmonary emboli which is in the differential and certainly a bigger concern if she has had prior history of clots, and also would have picked up several other more serious complications (evidence of a thoracic mass, hints of a dissection, etc). Given she was in the cardiac hospital I am certain pericarditis would have easily crossed their mind and been considered already.
At this point if she were my sister I would probably be comfortable with the current course - in other words if she showed esophageal spasm on testing, then that can definitely be extremely painful and frightening for the person who has it (and extremely similar to cardiac pain) and I would see where treating that goes. I would attribute the fevers to the infection and see what happens with the antibiotics. Reassess if she gets worse, or fails to improve with the antibiotics and whatever meds they are using to try to treat the esophageal spasms. Consider a possible scope, etc at that time, but noninvasive for now.
Only thing you may or may not want to look into (and you don''t have to post the results of this here - just food for thought), but sometimes recurrent clots (especially if they are not provoked by something like a post operative bedridden state or a long car/plane trip, etc) are treated with long term coumadin. There may be very valid reasons why she isn''t on it. You may want to just inquire if her doc thinks this is necessary (or you may already know the answer!)
At this point if she were my sister I would probably be comfortable with the current course - in other words if she showed esophageal spasm on testing, then that can definitely be extremely painful and frightening for the person who has it (and extremely similar to cardiac pain) and I would see where treating that goes. I would attribute the fevers to the infection and see what happens with the antibiotics. Reassess if she gets worse, or fails to improve with the antibiotics and whatever meds they are using to try to treat the esophageal spasms. Consider a possible scope, etc at that time, but noninvasive for now.
Only thing you may or may not want to look into (and you don''t have to post the results of this here - just food for thought), but sometimes recurrent clots (especially if they are not provoked by something like a post operative bedridden state or a long car/plane trip, etc) are treated with long term coumadin. There may be very valid reasons why she isn''t on it. You may want to just inquire if her doc thinks this is necessary (or you may already know the answer!)
strmrdr
Super_Ideal_Rock
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Thanks !!
That makes me feel better.
She is feeling a little better today.
Temp is down and has just had the pains once or twice.
I was wrong about one point they did one ct with contrast and one nuclear lung scan instead of 2 ct's.
Either one should have shown if there was a lung/clot problem.
They did them the first 2 visits.
She was on coumadin for a while but with the weight lose they moved her to aspirin therapy.
I'm very familiar with it as I'm on caumadin for life after 3dvts and a PE, aspirin therapy didn't work for me got a dvt while on it.
!!That makes me feel better.
She is feeling a little better today.
Temp is down and has just had the pains once or twice.
I was wrong about one point they did one ct with contrast and one nuclear lung scan instead of 2 ct's.
Either one should have shown if there was a lung/clot problem.
They did them the first 2 visits.
She was on coumadin for a while but with the weight lose they moved her to aspirin therapy.
I'm very familiar with it as I'm on caumadin for life after 3dvts and a PE, aspirin therapy didn't work for me got a dvt while on it.
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