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Has Peripheral ILD And Underwent CABG. Having Severe Shortness Of Breath, Running Nose And Mild Fever. Suggest The Cure?
Question: Hi my dad has peripheral ILD. He recently underwent CABG (2.5 months back).
He was recovering well, but now has severe shortness of breath. Last month he could walk for 20-25 min twice a day.
But now, Simple tasks like going to the rest room, walking cause severe breathlessness. He needs to sit down for 5 minutes before he catches his breath again. He was having running nose, cough, mild fever and was treated for viral infection. Also was given an anti allergic medication. Now his cold and cough are down, but SOB is still there.
His ECG, and other heart related parameters are normal. XRay also does not show fluid accumilation.
Blood test shows the following
high esr(93 mm/hr)
high wbc count (0000 /MuL)
smear (wbc eosinophilia, normocytic normochromic).
Just adding few more details. When he is at rest his SO2 levels are about 95-97. On smallest of exertions (going to the rest room, walking etc) his SO2 levels drop to about 85-88. Once he rests for a few minutes it comes back to 95 levels in about 10 min.
His pulse rate is in the also slightly high throughout about 110-120. And BP is about 140/90
He was recovering well, but now has severe shortness of breath. Last month he could walk for 20-25 min twice a day.
But now, Simple tasks like going to the rest room, walking cause severe breathlessness. He needs to sit down for 5 minutes before he catches his breath again. He was having running nose, cough, mild fever and was treated for viral infection. Also was given an anti allergic medication. Now his cold and cough are down, but SOB is still there.
His ECG, and other heart related parameters are normal. XRay also does not show fluid accumilation.
Blood test shows the following
high esr(93 mm/hr)
high wbc count (0000 /MuL)
smear (wbc eosinophilia, normocytic normochromic).
Just adding few more details. When he is at rest his SO2 levels are about 95-97. On smallest of exertions (going to the rest room, walking etc) his SO2 levels drop to about 85-88. Once he rests for a few minutes it comes back to 95 levels in about 10 min.
His pulse rate is in the also slightly high throughout about 110-120. And BP is about 140/90
Brief Answer:
Please find detailed answer below.
Detailed Answer:
Hi XXXX,
Thanks for writing in to us.
Shortness of breath is very common after coronary artery bypass grafting. Primary causes include atelectasis (collapse of small air sacks in the lungs), and fluid within or around the lung (pleural effusion). There are other causes to be evaluated like decreased lung expansion or any infection like pneumonia. Pneumonia often presents with associated coughing and fever. The possibility of any decreased blood flow to the lungs (pulmonary embolism) also needs evaluation.
As you have said, ECG is normal and X XXXXXXX is also normal, we will not think in terms of severe pneumonia. However, complete recovery from viral respiratory infection might take some time. High blood count does indicate possibility of a mild infection. Being diabetic may prolong his recovery. As there is improvement on taking rest, it might not be closely related to his heart condition.
If you father has any of the following symptoms, he must consult his doctor immediately:
•Chest pain or shortness of breath that does not go away when you rest.
•Pulse feels irregular -- it is very slow (fewer than 60 beats a minute) or very fast (over 100 to 120 beats a minute).
•Have dizziness, fainting, or you are very tired.
•Have a severe headache that does not go away.
•Have a cough that does not go away
•Are coughing up blood or yellow or green mucus.
•Have problems taking any of your heart medicines.
•Weight goes up by more than 2 pounds in a day for 2 days in a row.
•Wound changes. It is red or swelling, or it has opened, or there is more drainage coming from it.
•Have chills or a fever over 101 °F.
Regarding activity which he can do in the few weeks after surgery,
•Do not stand or sit in the same spot for too long. Move around a little bit.
•Walking is a good exercise for the lungs and heart after surgery. Don't be concerned about how fast you are walking. Take it slow.
•Climbing stairs is okay, but be careful. Balance may be a problem. Rest halfway up the stairs if you need to.
•Light household chores, such as setting the table, folding clothes, walking, and climbing stairs, should be okay.
•Slowly increase the amount and intensity of your activities over the first 3 months.
•Do not exercise outside when it is too cold or too hot.
•Stop if you feel short of breath, dizzy, or any pain in your chest. Do NOT do any activity or exercise that causes pulling or pain across your chest, such as using a rowing machine or weight lifting.
Hope your query is answered.
Do write back in case of doubts.
Regards,
Dr.Vivek
Please find detailed answer below.
Detailed Answer:
Hi XXXX,
Thanks for writing in to us.
Shortness of breath is very common after coronary artery bypass grafting. Primary causes include atelectasis (collapse of small air sacks in the lungs), and fluid within or around the lung (pleural effusion). There are other causes to be evaluated like decreased lung expansion or any infection like pneumonia. Pneumonia often presents with associated coughing and fever. The possibility of any decreased blood flow to the lungs (pulmonary embolism) also needs evaluation.
As you have said, ECG is normal and X XXXXXXX is also normal, we will not think in terms of severe pneumonia. However, complete recovery from viral respiratory infection might take some time. High blood count does indicate possibility of a mild infection. Being diabetic may prolong his recovery. As there is improvement on taking rest, it might not be closely related to his heart condition.
If you father has any of the following symptoms, he must consult his doctor immediately:
•Chest pain or shortness of breath that does not go away when you rest.
•Pulse feels irregular -- it is very slow (fewer than 60 beats a minute) or very fast (over 100 to 120 beats a minute).
•Have dizziness, fainting, or you are very tired.
•Have a severe headache that does not go away.
•Have a cough that does not go away
•Are coughing up blood or yellow or green mucus.
•Have problems taking any of your heart medicines.
•Weight goes up by more than 2 pounds in a day for 2 days in a row.
•Wound changes. It is red or swelling, or it has opened, or there is more drainage coming from it.
•Have chills or a fever over 101 °F.
Regarding activity which he can do in the few weeks after surgery,
•Do not stand or sit in the same spot for too long. Move around a little bit.
•Walking is a good exercise for the lungs and heart after surgery. Don't be concerned about how fast you are walking. Take it slow.
•Climbing stairs is okay, but be careful. Balance may be a problem. Rest halfway up the stairs if you need to.
•Light household chores, such as setting the table, folding clothes, walking, and climbing stairs, should be okay.
•Slowly increase the amount and intensity of your activities over the first 3 months.
•Do not exercise outside when it is too cold or too hot.
•Stop if you feel short of breath, dizzy, or any pain in your chest. Do NOT do any activity or exercise that causes pulling or pain across your chest, such as using a rowing machine or weight lifting.
Hope your query is answered.
Do write back in case of doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks dr XXXXXXX
But how do we confirm the cause and treat his sob. He is finding it very difficult to do his regular work.
as i mentioned before.. post cabg, he was recovering very well. He could walk for 20-25 miinutes at a strech. But after the cold, cough, fever... he has developed sob. He would have bouts of cough which would stop only after he vomits a bit of phlegm. Now the cold and cough has decreased.
Any suggestions on further diagnosis/treatment?
thanks
But how do we confirm the cause and treat his sob. He is finding it very difficult to do his regular work.
as i mentioned before.. post cabg, he was recovering very well. He could walk for 20-25 miinutes at a strech. But after the cold, cough, fever... he has developed sob. He would have bouts of cough which would stop only after he vomits a bit of phlegm. Now the cold and cough has decreased.
Any suggestions on further diagnosis/treatment?
thanks
Brief Answer:
Infections to be considered and treated if present
Detailed Answer:
Hi XXXX,
You are welcome and thanks for writing in to us.
I reviewed the information that he was doing well after surgery. In the elderly, the immunity of the body may decrease after a viral infection. This causes a secondary bacterial infection to attack the patient. As a consequence, the symptoms of the viral and bacterial infection overlap each other. Viral infections like flus are time limited but bacterial infections need complete treatment.
In my opinion, a sputum culture might shed light on any bacterial growth obtained. If he is having fever, a blood culture also can show bacterial organisms. In the post operative period, this is one of the important situations to be considered as the white blood cell count is marginally high and your father also has diabetes.
Local surgical wound also needs to be examined for healing.
Please feel free to write back with an update.
Hope this helps.
Regards,
Dr.Vivek.
Infections to be considered and treated if present
Detailed Answer:
Hi XXXX,
You are welcome and thanks for writing in to us.
I reviewed the information that he was doing well after surgery. In the elderly, the immunity of the body may decrease after a viral infection. This causes a secondary bacterial infection to attack the patient. As a consequence, the symptoms of the viral and bacterial infection overlap each other. Viral infections like flus are time limited but bacterial infections need complete treatment.
In my opinion, a sputum culture might shed light on any bacterial growth obtained. If he is having fever, a blood culture also can show bacterial organisms. In the post operative period, this is one of the important situations to be considered as the white blood cell count is marginally high and your father also has diabetes.
Local surgical wound also needs to be examined for healing.
Please feel free to write back with an update.
Hope this helps.
Regards,
Dr.Vivek.
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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