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Suggest Treatment For Severe Cough And Anemia
Question: Since 2015 he is suffering from severe cough, anemia. As soon as he lies down on bed he starts having severe cough and does not sleep, he spends night sitting on chair. Cough become more severe after evenings and continues till early morning, he has while gel foamy pelgum when he has cough. After showing several doctors and hospitals they are unable to confirm what the problem is they say it may be Pulmonary Fibrosis or lung infection etc etc. and is on medication since. Medicines work for couple of days and then again he has chronic cough. He was hospitalized for same thrice in last 8 months due to shortage or breath and anemia.
Last month he was admitted and we got to know his left side of heart had multiple block, hence he underwent CABG bypass surgery and is at recovering at home now. Post surgery also he has cough during nights. Don’t know what to do and which doctor do we show.
Last month he was admitted and we got to know his left side of heart had multiple block, hence he underwent CABG bypass surgery and is at recovering at home now. Post surgery also he has cough during nights. Don’t know what to do and which doctor do we show.
Brief Answer:
He needs to undergo detail investigations at a tertiary care centre.
Detailed Answer:
Hello XXXXXXX
Thanks for posting your query on HCM.
From your description, your patients symptoms do require proper diagnosis and treatment.
Pulmonary fibrosis is a possibility. History of lymphoma and RT for it do need to be considered. He needs to undergo HRCT chest, spirometry, diffusion studies and bronchoscopy if not done already.
I suggest you consult a local pulmonologist in a tertiary care hospital where all relevant tests can be done and a diagnosis is arrived at and relevant treatment can be started then.
In the meanwhile he should continue inhalers that must have been prescribed to him.
Take care.
He needs to undergo detail investigations at a tertiary care centre.
Detailed Answer:
Hello XXXXXXX
Thanks for posting your query on HCM.
From your description, your patients symptoms do require proper diagnosis and treatment.
Pulmonary fibrosis is a possibility. History of lymphoma and RT for it do need to be considered. He needs to undergo HRCT chest, spirometry, diffusion studies and bronchoscopy if not done already.
I suggest you consult a local pulmonologist in a tertiary care hospital where all relevant tests can be done and a diagnosis is arrived at and relevant treatment can be started then.
In the meanwhile he should continue inhalers that must have been prescribed to him.
Take care.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Hello Doctor,
Thanks for your reply. HRCT chest was done more than 6 months back and one of the doctor suggested it looks like Pulmonary fibrosis. Recently during CABG operations the surgeon had taken few samples from lungs and sent from biopsy. after the results came, cardiologist mentioned is some scares which has healed and should not cause problem. Cardiologist also suggested may be due to heart problem he was having fluid retention in lungs and hence having cough. But now even in sitting position he has cough.
Got to know Pulmonary fibrosis has no cure, can any alternate medicine be tried.
Thanks for your reply. HRCT chest was done more than 6 months back and one of the doctor suggested it looks like Pulmonary fibrosis. Recently during CABG operations the surgeon had taken few samples from lungs and sent from biopsy. after the results came, cardiologist mentioned is some scares which has healed and should not cause problem. Cardiologist also suggested may be due to heart problem he was having fluid retention in lungs and hence having cough. But now even in sitting position he has cough.
Got to know Pulmonary fibrosis has no cure, can any alternate medicine be tried.
Brief Answer:
I am not aware of any alternate treatment for it.
Detailed Answer:
What is cardiologist`s opinion about the status of heart?
I still feel that it could be pulmonary fibrosis. Heart may not be contributing much towards his symptoms. How much is the ejection fraction of heart on Echo?
The biopsy taken by the cardiologist may not have involved the affected portion of lung. So it should be repeated through a bronchoscope.
Yes Pulmonary fibrosis is a progressive disease but in many cases progress can be halted to quite some extent by proper treatment.
No, I am not aware of any alternate treatment for it.
I am not aware of any alternate treatment for it.
Detailed Answer:
What is cardiologist`s opinion about the status of heart?
I still feel that it could be pulmonary fibrosis. Heart may not be contributing much towards his symptoms. How much is the ejection fraction of heart on Echo?
The biopsy taken by the cardiologist may not have involved the affected portion of lung. So it should be repeated through a bronchoscope.
Yes Pulmonary fibrosis is a progressive disease but in many cases progress can be halted to quite some extent by proper treatment.
No, I am not aware of any alternate treatment for it.
Above answer was peer-reviewed by :
Dr. Yogesh D
Good Morning Doctor,
I have uploaded recent test reports and discharge summary received from the hospital. Request you to look at same and suggest best possible solution.
Also, if you can let us know how much more time my dad has, so me and family can be mentally prepared.
thank you.
I have uploaded recent test reports and discharge summary received from the hospital. Request you to look at same and suggest best possible solution.
Also, if you can let us know how much more time my dad has, so me and family can be mentally prepared.
thank you.
Brief Answer:
Possibility of TB infection has to be considered though far fetched.
Detailed Answer:
The discharge summary mentions mainly about his heart problem and CABG done.
The HRCT report also does not categorically say that he has pulmonary fibrosis.
What I would like to know is that has he ever suffered from TB in the past? At present is it mainy cough or he also has breathlessness? Is there any fever and weight loss? His HRCT findings say that he has bil subpleural fibronodular opacities along with mediatinal lymphadenopathy though the size of lymphadenopathy is insignificant. Besides, there are lymph nodes in both the axilla.
The possibility of pulmonary fibrosis still remains but I would like you to request his treating physician to look at the possibility of TB infection, no matter how far fetched the idea may be as it is a treatable condition.
He needs to undergo another bronchoscopy which will help in diagnosis of both pul fibrosis and TB infection. A needle biopsy of lymph gland in axilla can also help in making a diagnosis.
Its not possible to tell about longevity of your dad. As of now except for cough, there does not appear to be any life threatening issue. A diagnosis for his cough has not even been made. Do not give up hope so easily.
Possibility of TB infection has to be considered though far fetched.
Detailed Answer:
The discharge summary mentions mainly about his heart problem and CABG done.
The HRCT report also does not categorically say that he has pulmonary fibrosis.
What I would like to know is that has he ever suffered from TB in the past? At present is it mainy cough or he also has breathlessness? Is there any fever and weight loss? His HRCT findings say that he has bil subpleural fibronodular opacities along with mediatinal lymphadenopathy though the size of lymphadenopathy is insignificant. Besides, there are lymph nodes in both the axilla.
The possibility of pulmonary fibrosis still remains but I would like you to request his treating physician to look at the possibility of TB infection, no matter how far fetched the idea may be as it is a treatable condition.
He needs to undergo another bronchoscopy which will help in diagnosis of both pul fibrosis and TB infection. A needle biopsy of lymph gland in axilla can also help in making a diagnosis.
Its not possible to tell about longevity of your dad. As of now except for cough, there does not appear to be any life threatening issue. A diagnosis for his cough has not even been made. Do not give up hope so easily.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Hello Doctor,
Not sure if he has breathlessness, as he cannot explain it to us. what I have seen is he has dry cough and constantly clears his through which produces white foamy gel kind liquid. He has lost lot of weight from last 6 months and had blood transfusion every time he was admitted to hospital. His hemoglobin levels keep dropping after that. When ever he has severe cough he has high fever from 101 to 103 degrees. since last two days he has cough in nights followed by fever.
Doctors have done many chest xrays and have told, no TB.
Below are some of his earlier test reports findings-
25.05.16 - Brucella Agglutination (Slide) - Negative for Brucella Melintensis & Brucella Abortus.
27.05.16 - SPUTUM - AFB SMEAR Report - NO AFB detectable
27.05.16 - SPUTUM - GRAM STAIN Report - Many grampositive cocci seen in chain and occasional gramnegatice bacilli seen.
03.10.16 - BLOOD CLUTRE REPORT - No growth in culture after 72 hours of incubation.
04.10.16 - SPUTUM - GRAM STAIN REPORT - Many grampositive cocci seen in chain. Many yeast cells seen. Pus cells seen.
04.10.16 - SPUTUM CULTURE REPORT - Organism isolated, Cadida albicans
Antibiotic sensitivity interpretation pattern
Voriconazole / Itraconazole / Fluconazole / Ketaconazole - Sensitive, Resistant to NIL.
07.10.16 - Screening Swabs (Payment) (Nasal Axilla Groin) - Oranism isolated, Staphylococcus aureus (MRSA).
Antibiotic sensitivity interpretation pattern
OXACILLIN / CEFOXITIN - Resistant
Also, as suggested to undergo another bronchoscopy and a needle biopsy of lymph gland in axilla, can this be done now as he has surgery on 12.10.16 or do I have to wait for some more time. I have doctors appointment tomorrow, will has him for this test during my visit.
Thank you
Not sure if he has breathlessness, as he cannot explain it to us. what I have seen is he has dry cough and constantly clears his through which produces white foamy gel kind liquid. He has lost lot of weight from last 6 months and had blood transfusion every time he was admitted to hospital. His hemoglobin levels keep dropping after that. When ever he has severe cough he has high fever from 101 to 103 degrees. since last two days he has cough in nights followed by fever.
Doctors have done many chest xrays and have told, no TB.
Below are some of his earlier test reports findings-
25.05.16 - Brucella Agglutination (Slide) - Negative for Brucella Melintensis & Brucella Abortus.
27.05.16 - SPUTUM - AFB SMEAR Report - NO AFB detectable
27.05.16 - SPUTUM - GRAM STAIN Report - Many grampositive cocci seen in chain and occasional gramnegatice bacilli seen.
03.10.16 - BLOOD CLUTRE REPORT - No growth in culture after 72 hours of incubation.
04.10.16 - SPUTUM - GRAM STAIN REPORT - Many grampositive cocci seen in chain. Many yeast cells seen. Pus cells seen.
04.10.16 - SPUTUM CULTURE REPORT - Organism isolated, Cadida albicans
Antibiotic sensitivity interpretation pattern
Voriconazole / Itraconazole / Fluconazole / Ketaconazole - Sensitive, Resistant to NIL.
07.10.16 - Screening Swabs (Payment) (Nasal Axilla Groin) - Oranism isolated, Staphylococcus aureus (MRSA).
Antibiotic sensitivity interpretation pattern
OXACILLIN / CEFOXITIN - Resistant
Also, as suggested to undergo another bronchoscopy and a needle biopsy of lymph gland in axilla, can this be done now as he has surgery on 12.10.16 or do I have to wait for some more time. I have doctors appointment tomorrow, will has him for this test during my visit.
Thank you
Brief Answer:
We have to wait for bronchoscopy and needle biopsy reports.
Detailed Answer:
Yes as per your description there is no definite evidence of TB.
He does seem to be having chest infections repeatedly.
Continue with his inhalers and other medications as advised.
Let`s wait for the bronchoscopy and needle biopsy results and hope for the best.
We have to wait for bronchoscopy and needle biopsy reports.
Detailed Answer:
Yes as per your description there is no definite evidence of TB.
He does seem to be having chest infections repeatedly.
Continue with his inhalers and other medications as advised.
Let`s wait for the bronchoscopy and needle biopsy results and hope for the best.
Above answer was peer-reviewed by :
Dr. Yogesh D
Thanks for the response.
kindly advice if bronchoscopy and a needle biopsy, can this be done now as he had surgery on 12.10.16 or do I have to wait for some more time.
I have doctors appointment tomorrow, will ask him for this test during my visit.
kindly advice if bronchoscopy and a needle biopsy, can this be done now as he had surgery on 12.10.16 or do I have to wait for some more time.
I have doctors appointment tomorrow, will ask him for this test during my visit.
Brief Answer:
Needle biopsy can be done. Talk to cardiologist for bronchoscopy.
Detailed Answer:
You can go ahead with needle biopsy straight away and I don't think there is any harm in getting even a bronchoscopy done. But I suggest you consult his cardiologist for it.
Needle biopsy can be done. Talk to cardiologist for bronchoscopy.
Detailed Answer:
You can go ahead with needle biopsy straight away and I don't think there is any harm in getting even a bronchoscopy done. But I suggest you consult his cardiologist for it.
Above answer was peer-reviewed by :
Dr. Yogesh D
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