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

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Posted on Sat, 30 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. 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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Follow up: Dr. Ilir Sharka (0 minute later)
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. Oh, the GI issues are complicated a little because I had gastric bypass surgery (rny) about 2 years ago. Thank you
doctor
Answered by Dr. Ilir Sharka (1 hour later)
Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello!

Welcome to Ask a Doctor service!

I passed carefully through your question and would explain that the high ESR levels could be related to the inflammation and pulmonary infection.

As amoxicillin in high doses is not very effective, I would recommend switching to another antibiotic like: Cefriaxone or Levofloxacine, which are better drugs for pneumonia.

Anyway, it should be better choose the antibiotic based on the type of infectious agent. For this reason, I would recommend broncoscopy and bacterial culture of the bronchial secretions in order to choose better the proper antibiotic based on the type of bacterial infection.

Regarding reflux and pneumonia, I agree with your doctor that GERD could lead to aspiration pneumonia during the night.

Regarding hiatal hernia, there is not a specific treatment besides surgery. I would recommend PPI (Omeprazole, pantoprazole) or antiacids and avoiding large meals. It is important to avoid spicy food and trying to eat in small portions more frequently during the day.

It is also important continue taking anti-platelet agents (aspirine and clopidogrel), considering your coronary stents and regularly check your blood lipid profile for dyslipidemia.

Hope to have been helpful!

Wishing all the best,

Dr. Ilir Sharka, Cardiologist


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Ilir Sharka (0 minute later)
Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello!

Welcome to Ask a Doctor service!

I passed carefully through your question and would explain that the high ESR levels could be related to the inflammation and pulmonary infection.

As amoxicillin in high doses is not very effective, I would recommend switching to another antibiotic like: Cefriaxone or Levofloxacine, which are better drugs for pneumonia.

Anyway, it should be better choose the antibiotic based on the type of infectious agent. For this reason, I would recommend broncoscopy and bacterial culture of the bronchial secretions in order to choose better the proper antibiotic based on the type of bacterial infection.

Regarding reflux and pneumonia, I agree with your doctor that GERD could lead to aspiration pneumonia during the night.

Regarding hiatal hernia, there is not a specific treatment besides surgery. I would recommend PPI (Omeprazole, pantoprazole) or antiacids and avoiding large meals. It is important to avoid spicy food and trying to eat in small portions more frequently during the day.

It is also important continue taking anti-platelet agents (aspirine and clopidogrel), considering your coronary stents and regularly check your blood lipid profile for dyslipidemia.

Hope to have been helpful!

Wishing all the best,

Dr. Ilir Sharka, Cardiologist


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (2 days later)
Thank you So much for your response. I am on a slew of new medications, including most of the ones that you mentioned above. A lung doctor saw me before I left the hospital and he said this is just upper respiratory at this point. However, I am still coughing a lot and I think I'm wheezing. I'm still on the amoxicillin and he started me on an Asmanex inhaler and fluticosone. I was discharged two nights ago. I am really struggling today with emotions. I guess that's normal but I'm just at loose ends. I'm extremely tired and very cold, I just cant get warm. I've also lost 20 pounds from the admission weight they had me at in the hospital Monday evening. I know it's probably just fluids but it seems extreme for 5 days! I look forward to hearing back from you. Thank you!
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Follow up: Dr. Ilir Sharka (0 minute later)
Thank you So much for your response. I am on a slew of new medications, including most of the ones that you mentioned above. A lung doctor saw me before I left the hospital and he said this is just upper respiratory at this point. However, I am still coughing a lot and I think I'm wheezing. I'm still on the amoxicillin and he started me on an Asmanex inhaler and fluticosone. I was discharged two nights ago. I am really struggling today with emotions. I guess that's normal but I'm just at loose ends. I'm extremely tired and very cold, I just cant get warm. I've also lost 20 pounds from the admission weight they had me at in the hospital Monday evening. I know it's probably just fluids but it seems extreme for 5 days! I look forward to hearing back from you. Thank you!
doctor
Answered by Dr. Ilir Sharka (10 hours later)
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello again!

Thank you for the additional information!


As you are feeling cold, have you measured your body temperature? It may be fever, probably related to a pulmonary infection, as you tried just one antibiotic and fever persisted.

The fact that you have lost some weight, could be related to diuretics, which help put away excessive water.

Anyway, if these symptoms persist, I recommend going to the ER for a physical exam, a chest X-ray study and inflammation tests ( complete blood count, PCR, ESR).

It is also necessary checking blood electrolytes, as you have lost a lot of fluids.

I remain at your disposal for any further questions whenever you need!

Let me know about everything!

Best wishes ,

Dr.Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Ilir Sharka (0 minute later)
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello again!

Thank you for the additional information!


As you are feeling cold, have you measured your body temperature? It may be fever, probably related to a pulmonary infection, as you tried just one antibiotic and fever persisted.

The fact that you have lost some weight, could be related to diuretics, which help put away excessive water.

Anyway, if these symptoms persist, I recommend going to the ER for a physical exam, a chest X-ray study and inflammation tests ( complete blood count, PCR, ESR).

It is also necessary checking blood electrolytes, as you have lost a lot of fluids.

I remain at your disposal for any further questions whenever you need!

Let me know about everything!

Best wishes ,

Dr.Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Ilir Sharka

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

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. Oh, the GI issues are complicated a little because I had gastric bypass surgery (rny) about 2 years ago. Thank you