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Treatment for cough, breathing problem and FACIAL WEAKNESS.

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Hi,

I would first like to thank you for your services.

PS : Due to the upload system limit i have uploaded all reports of her here:- http://backups.ssn24.com/testreports/ 

Well things got started from last 10 days, my aunt was all fine and doing great back then but suddenly she got starting coughing slowly which then after next day became more and more coughing, we didn't took the cough seriously but after 2 or 3 days she said she is facing some breathing problems which doing work. We were not sure why she was facing this and told her to relax and we felt the issue can be due to rainy season or can be due to humidity. But after 6 days she was facing real weekness and too much breathing problem, she can't even talk as if she talks she looses the breath.

After all this we admitted her to a Hospital nearby and the Hospital doctors took some tests i.e Blood Tests, CT Scan, Bronchos Test, etc. I have attached all reports with my question. The thing we are most concern is with the Doctors, it's been 8 days in hospital now but the doctors still didn't started any treatment. They said every report of her is clear so they can't even figure out the disease yet so results in no treatment.

I thought to give a try to Doctor Spring to check if you guys can help somehow or can even tell us what to do next. She is day by day getting weak, and everyday she is facing with unconsciousness.

Just today she started having fits, she got one attack just today morning at 10.00 am.

I spoke to the doctors they said currently they are providing her Broad Spectrum antibiotics and they already done the Culture test which shown Negative results. They also said while with the Spectrum Antibiotics they are providing her Steroids along the way so i think both all together is causing her problems in breathing, as she is now facing more trouble in breathing then she used to have. Overall, i am seeing her going down day by day and we are loosing hope. Doctors itself supposedly seems uninterested they are just making money. It's been overall 9 days in Hospital and i see no improvement in her, only the downfall.

We actually got very down yesterday when someone told us that this type of diseases are untreatable and she will be the same whole life with Support system like Nebulizers etc.

We discussed further with the doctors and they told us this :

1. Pulse Rate : 98 /min
2. Blood Pressure : 110 / 60
3. SPO 2 : 80% (It was last checked at 11 Am)

I have also attached few more reports as well please take a look at them as well. Also, she is actually suffering from severe back pain what can be the cause for that. She sometimes also feel like vomiting, just today she said she is having some back pain so doctors put up Volini Gel on her back due to which she got unconscious and feel like vomiting.

Currently doctors have stopped giving AZURAN, for now they have started giving these :

1. Pirfenidone Tablets 200mg (1BD)
2. Medrol 16 mg (1BD)
3. Acetylcysteine 600 mg (1OD)
4. Sodium Valporate Injection 100mg/ml IV Infusion

It is a kind request please suggest some course of actions for her so that she can be treated well and little faster. She has shown no such improvements in all 9 days in hospital. Even my family members are expecting some fast recovery now, we are upset seeing her in same situation from last 15 days.

All the reports are uploaded here as well :- http://backups.ssn24.com/testreports/


Category: Pulmonologist

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Category: Allergy and Immunologist
Dr. Jacob George Pulinilkunnathil is online now

Expert:  Dr. Jacob George Pulinilkunnathil replied 4 Days.

Hello.
Thank you for posting query at DoctorSpring.com
I request you to cool down, not to lose patience or faith in doctors and keep a presence of mind.
I do agree that i gather nothing from what information i have got.
So did your aunt have a productive cough? was sputum being produced? Was she ABSOLUTELY normal prior, being able to walk 500 metres on a level ground if needed, at a decent pace?
If the answer is yes, then we are dealing with something in blood-clots/ infections.
I didn't see any antibiotics in the short list that you provided.
I need to have a complete blood count, electrolyte, RBS kidney function and liver function test also- which i am sure must have been already done.
I do believe an ECHO to evaluate heart function is also done by now.can i have that report too?
I disagree with the decision of pirfenidone, as there is nothing in CT scan to suggest IPF - a disease for which it is used.
However, other medications are rationale.
However the investigations provided are incomplete.
I suggest you to request a treatment summary from the doctor and attach it as a mail, so that we may be able to give some valuable inputs.
Local application of volini will not cause any of the effects mentioned. it was a mere coincidence.
Looking forward for your reply,
Regards.


Patient replied :

Hi,
Thanks for getting back to us!
"So did your aunt have a productive cough? was sputum being produced?
>> No, she didn't have the productive cough it's just was a dry coughing she just coughes + feeling breathless all the time.
Was she ABSOLUTELY normal prior, being able to walk 500 metres on a level ground if needed, at a decent pace?"
>> Yes, she was all good before even we been to holidays before she went ill.
Here's are all the reports that you asked :
1. Blood Report : http://backups.ssn24.com/testreports/BloodReport.pdf
2. Bronchos Report : http://backups.ssn24.com/testreports/BronchosCopyReport.pdf
3. Summery 1 : http://backups.ssn24.com/testreports/Course1.jpg
4. Summery 2 : http://backups.ssn24.com/testreports/Course2.jpg
Other reports :
IMG_0016.jpg | IMG_0017.jpg | IMG_0019.jpg | IMG_0020.jpg | report1.jpg | report2.jpg
Let me know if anything else is needed. Please see what can be done!
Thanks


Expert:  Dr. Jacob George Pulinilkunnathil replied 3 Days.

Hello.
I do guess your aunt is having rheumatoid arthritis. Rheumatoid arthritis affecting the lungs is a difficult to treat condition and can present in various forms.
The present form is Cryptogenic organising pneumonia and treatment is steroids ( Medrol). i think they are also continuing azoran as the response is poor.
I don't think i have much to suggest.still i would like to get an echo done so as to assess the heart- especially right heart function.
The disease will take 2- 3 weeks to resolve ,and requires high dose of steroids. it is probably too early to suggest ventilator / nebuliser at home.
The seizures which occurred has nothing to do with the present condition and is probably due to the meningioma in brain.
I would advise heparin so as to prevent clotting of blood in periphery, passive limb exercises, and pulse steroid therapy for 3 days.
Regards.


Patient replied :

Hi,
Thanks for getting back to us!
"So did your aunt have a productive cough? was sputum being produced?
>> No, she didn't have the productive cough it's just was a dry coughing she just coughes + feeling breathless all the time.
Was she ABSOLUTELY normal prior, being able to walk 500 metres on a level ground if needed, at a decent pace?"
>> Yes, she was all good before even we been to holidays before she went ill.
Here's are all the reports that you asked :
1. Blood Report : http://backups.ssn24.com/testreports/BloodReport.pdf
2. Bronchos Report : http://backups.ssn24.com/testreports/BronchosCopyReport.pdf
3. Summery 1 : http://backups.ssn24.com/testreports/Course1.jpg
4. Summery 2 : http://backups.ssn24.com/testreports/Course2.jpg
Other reports :
IMG_0016.jpg | IMG_0017.jpg | IMG_0019.jpg | IMG_0020.jpg | report1.jpg | report2.jpg
Let me know if anything else is needed. Please see what can be done!
Thanks


Expert:  Dr. Jacob George Pulinilkunnathil replied 2 Days.

Hello.
I think the follow-up you have sent was the same you sent yesterday night.
I do suggest an Echocardiography (ECHO) of the heart to assess any cardiac problems as a cause of breathlessness.
I think the working diagnosis will be COP (Cryptogenic Organising Pneumonia)- which is difficult to treat, however the management is in the same line as what is going on.
Unless we have another cause for breathlessness from the ECHO, we shall continue likewise.
Regards,
Dr. Jacob George P.
MD, FCCP.


Dr. Jacob George Pulinilkunnathil
Category: Allergy and Immunologist
Experience: 
Residency, Post Graduation: MD, Respiratory Medicine, J L N Medical College, Ajmer, Rajasthan (2012).
Medical School, Internship: MBBS, Government Medical College, Kottayam, 2001-07 
Indian Diploma in Critical Care Medicine (IDCCM) - Medical Trust Hospital, 2013-2014.
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