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Hi, I am sixty-two-year-old woman who was diagnosed about 2

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Posted on Wed, 27 Mar 2019
Question: Hi, I am sixty-two-year-old woman who was diagnosed about 2 weeks ago with a hiatal hernia and esophagitis. About 5 days later I developed a respiratory infection which my doctor believes could have been started due to aspirating some stomach contents after throwing up. Monday evening, after 5 days on amoxicillin and prednisone, I wasn't getting any better so my doctor sent me to the emergency Room for more imaging and to see what else could be done. When they repeated the EKG and traponin levels they were both elevated from 10 days prior so I was automatically admitted to the hospital. Cardiologist initially thought I might have pericarditis so he ran an ESR test which came back at a very high 75 but other symptoms are not consistent with pericarditis so he suspected a blockage. Yesterday I had a heart XXXXXXX and they found two blockages, 1 at 70% in 1 at 99% and inserted stents. So, cardiac wise I'm doing fine now. My EKG this morning reported normal sinus rhythm which is great. But I'm wondering about these other issues and what should I ask the doctors to do while I'm still in the hospital to help diagnose why I have the high ESR, what to do about the esophagitis and hiatal hernia and this respiratory infection which still is not clearing up after 7 days on a very high dose of amoxicillin. So I would appreciate any feedback the you can give me. I just want to know what I should ask and expect from the doctors before I'm released to go home and what additional diagnostic tests should be done. Oh, the GI issues are complicated a little because I had gastric bypass surgery (rny) about 2 years ago. Thank you
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Answered by Dr. Ramesh Kumar (1 hour later)
Brief Answer:
Please go through detailed answer dear patient.No cardiologist is going to put two stents at a time in a patient having pneumonia or any other severe lower respiratory tract infection unless its an emergency or patient presented with massive myocardial infarction.Even if he will put a stent he would just stent the artery with 99% blockage to prevent a M.I and would left the 70% blocked artery to be stented once patient is infection free.Therefore before stenting complete blood count kidney function tests etc are done.Very likely now you are having an upper respiratory tract infection at present.

Detailed Answer:
Hello and Thanks for asking query on HealthcareMagic my dear patient,
I have gone carefully through your details.
As you said you had esophagitis and respiratory tract infection initially.Any infection would cause inflammation in respective tissue.ESR is an old school test and is just a marker of inflammation.Inflammation present any where in body(from head to toe) would show elevated levels of ESR however in today's context when we have much superior tests and investigations to rule out even the intensity of infection like serum PROCALCITONIN going on values of ERS is just like using a rifle in era of automatic guns(just for explaination). ESR now is usually used in patients of either Tuberculosis or Artritis.
Hiatel hernia is one of the most common cause of esophagitis.The word esophagitis means swelling or inflammation of esophagus.Due to hernia the contents of stomach are refluxed back into esophagus.The wall of esophagus get inflamed in coming in contact with gastric contents and acid hence gets swelled up.Very likely your doctor is going to keep you on proton pump inhibitor like Rabeprazole(inhibits the secretion of excessive acid) along with Domperidon 30 mg tablet once(Its a prokinetic drug which prevent reflux of acid and stomach content back into esophagus.Mylanta and other antacids could also be given along with it.
Only in very few cases in which medical management fails A Nissen fundoplication is performed for a hiatal hernia. This procedure uses laparoscopic repair or keyhole surgery. This surgery is minimally invasive and only requires the surgeon to make a few tiny incisions in the abdomen but as you already had a gastric bypass i don't think doctors would even consider that.

Very likely your respiratory tract must be clear by now.Respiratory tract is divided into two parts upper respiratory tract and lower respiratory tract.Cardiologist is not going to put two stents at a time unless you have a massive heart attack if you are still having lower respiratory tract infections.For this you may ask a CT scan of chest to be done.Very likely now you are having Upper respiratory tract infection that would clear up after few days and there is as such nothing to be worried about if CECT chest is normal.

So to cut short-
1)ESR as off now has no significance any inflammatory condition would cause it to rise.
2)Before discharge get a CT scan of chest done to see if infection(lower respiratory tract) is resolved.
3)Ask your Gastroenterologist to add antacids and PPI's as suggested above.
4)In the very first week post stenting take walk inside hospital and your house.In second week you can walk to your garden.In third week you can walk upto 300-500 metre's a day,After 4th week you can do what ever you want except very heavy weight lifting.
They are going to do a stress test and 2d echo 4 to 6 weeks post stenting.
5)What dose of Amoxy you are on;1000mg thrice is a ok dose,Better idea is to ask your doctor to put you on augmentin which is a combination of amoxicillin and clauvalinic acid.

Hope i was helpful,
Follow ups are welcome,
Get well soon.
If you find the answer helpful do rate it any suggestions to make it better are welcome.
You can also take a print out and use a marker to mark important points to discuss with your doctor.
Get well soon!


Above answer was peer-reviewed by : Dr. Kampana
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Answered by
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Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2465 Questions

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Hi, I am sixty-two-year-old woman who was diagnosed about 2

Brief Answer: Please go through detailed answer dear patient.No cardiologist is going to put two stents at a time in a patient having pneumonia or any other severe lower respiratory tract infection unless its an emergency or patient presented with massive myocardial infarction.Even if he will put a stent he would just stent the artery with 99% blockage to prevent a M.I and would left the 70% blocked artery to be stented once patient is infection free.Therefore before stenting complete blood count kidney function tests etc are done.Very likely now you are having an upper respiratory tract infection at present. Detailed Answer: Hello and Thanks for asking query on HealthcareMagic my dear patient, I have gone carefully through your details. As you said you had esophagitis and respiratory tract infection initially.Any infection would cause inflammation in respective tissue.ESR is an old school test and is just a marker of inflammation.Inflammation present any where in body(from head to toe) would show elevated levels of ESR however in today's context when we have much superior tests and investigations to rule out even the intensity of infection like serum PROCALCITONIN going on values of ERS is just like using a rifle in era of automatic guns(just for explaination). ESR now is usually used in patients of either Tuberculosis or Artritis. Hiatel hernia is one of the most common cause of esophagitis.The word esophagitis means swelling or inflammation of esophagus.Due to hernia the contents of stomach are refluxed back into esophagus.The wall of esophagus get inflamed in coming in contact with gastric contents and acid hence gets swelled up.Very likely your doctor is going to keep you on proton pump inhibitor like Rabeprazole(inhibits the secretion of excessive acid) along with Domperidon 30 mg tablet once(Its a prokinetic drug which prevent reflux of acid and stomach content back into esophagus.Mylanta and other antacids could also be given along with it. Only in very few cases in which medical management fails A Nissen fundoplication is performed for a hiatal hernia. This procedure uses laparoscopic repair or keyhole surgery. This surgery is minimally invasive and only requires the surgeon to make a few tiny incisions in the abdomen but as you already had a gastric bypass i don't think doctors would even consider that. Very likely your respiratory tract must be clear by now.Respiratory tract is divided into two parts upper respiratory tract and lower respiratory tract.Cardiologist is not going to put two stents at a time unless you have a massive heart attack if you are still having lower respiratory tract infections.For this you may ask a CT scan of chest to be done.Very likely now you are having Upper respiratory tract infection that would clear up after few days and there is as such nothing to be worried about if CECT chest is normal. So to cut short- 1)ESR as off now has no significance any inflammatory condition would cause it to rise. 2)Before discharge get a CT scan of chest done to see if infection(lower respiratory tract) is resolved. 3)Ask your Gastroenterologist to add antacids and PPI's as suggested above. 4)In the very first week post stenting take walk inside hospital and your house.In second week you can walk to your garden.In third week you can walk upto 300-500 metre's a day,After 4th week you can do what ever you want except very heavy weight lifting. They are going to do a stress test and 2d echo 4 to 6 weeks post stenting. 5)What dose of Amoxy you are on;1000mg thrice is a ok dose,Better idea is to ask your doctor to put you on augmentin which is a combination of amoxicillin and clauvalinic acid. Hope i was helpful, Follow ups are welcome, Get well soon. If you find the answer helpful do rate it any suggestions to make it better are welcome. You can also take a print out and use a marker to mark important points to discuss with your doctor. Get well soon!