Brief Answer:
Congenital heart disease with lung infection

Detailed Answer:
Hello XXXX Thank you for consulting in Health Care magic.
I am a pediatrician and my field of interest is pulmonology (lung problems ) and my special interest are intensive care (ICU) and infectious diseases.

Will point the issues first, followed by few questions and my suggestions -

Issues with your son -

1. A congenital heart disease - structural heart defect by birth - which is not a major concern now.
2. Bilateral (both sides) lungs infection or pneumonia (as depicted in the report)
2. He is on antibiotics now - I would say good antibiotics _ Piperacillin-Tazobactam and Meropenem.

Questions -

1. What was the birth weight and what is the current weight?
2. Is there any history of recurrent serious infections apart from this lung infection?
3. Is he on a ventilator?
4. How is his fever now?
5. Is he requiting oxygen now and if so how many leters per minute and by what device - Face mask or venturi or hood?
6. Is there any shock?
7. Anybody else in the family is having congenital heart diseases or serious infections or early death?
Kindly get back to me with answers to the above questions and if you do not understand any of the technical terms you can as well approach your treating doctor for help and get back to me.

Suggestions -

1. Please take a photograph of your son's X-ray which they have taken and upload it - if there are multiple X-rays - upload them in a numbered sequence and date wise.
2. As the X-ray report says - probably pyogenic - I would prefer a change or antibiotic from Piperacillin-Tazobactam to Vancomycin.
3. Apart from I would like to have a look at the X-ray images you are going to send over and also based on your answers to my questions - I would get back to you.

Hope my answer was helpful for you. I am happy to help any time. Further clarifications and consultations on Health care magic are welcome. If you do not have any clarifications, you can close the discussion and rate the answer. Wish your kid good health.
Dr. Sumanth MBBS., DCH., DNB (Paed).,

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Brief Answer:
Congenital lobar emphysema - not severe pneumonia

Detailed Answer:
Hi...XXXX
I have gone through your son's X-ray images and I put forth these possibilities -
1. The pneumonia is not very severe and there is a very good chance that your son will come around well.
2. The X-ray shows a emphysematous expansion of the right lung herniating into the left side - suggestive of congenital lobar emphysema.

Coming to your questions -
1. Is the infection caused by the VSD - No infection is not cause by VSD, but VSD can predispose to recurrent infections in the lung.

2. How severe is it - It is not very severe, there is not much to suggest that it is pyogenic - meaning pus in the lungs - it is treatable.

3. Is he going to be alright - Yes definitely he is going to be alright. Do not worry. I think you are in sae hands.

I wish your kid a speedy recovery. If you need any future medical consultation and suggestions, I will be glad to help. You can approach me at the following link. Please find the link below.
www.healthcaremagic.com/doctors/dr-sumanth-amperayani/67696

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Brief Answer:
No surgery for VSD or CLE immediately

Detailed Answer:
HI....

1. Congenital lobar emphysema (CLE) is a congenital lung condition where on one side lung (most commonly right) will become more expansible and expand into the opposite side. We need to do a CT scan chest after your kid comes out of the present infection. It doesn't require any immediate surgery. But in future if the CT scan confirms the diagnosis, and if the expanded lung is causing recurrent infections or problems, then a lobectomy of that particular lobe of the right lung need to be done. But don't worry about this till the CT scan of the chest confirms the diagnosis.

2. The VSD your son is having is very small (less than a centimetre) and doesn't require immediate surgery. But at the same time, right now it is too premature to tell, whether it will close automatically. We need to follow up your son with serial follow up Echocardiograms once in 3 months or 6 months depending on his condition and then we will know if he requires a surgical correction. As I said above - even this is not a problem where immediate surgery is required.

A small request - if possible keep me posted about your son's recovery and also if you prefer to do a CT chest as I suggested in future - about the diagnosis of Congenital Lobar Emphysema.

I wish your kid a speedy recovery. If you need any future medical consultation and suggestions, I will be glad to help. You can approach me at the following link. Please find the link below.
www.healthcaremagic.com/doctors/dr-sumanth-amperayani/67696

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Brief Answer:
He will definitley come out - don't worry

Detailed Answer:
Hi XXXX
He is going to be well.
He will definitely come out of this grim situation...please do not worry.
Both these problems are not very severe - do not worry.
I am a father myself and know how it is to see your loved ones on bed.

I have so many years of experience in ICU and one thing I have observed in all these years - I will tell you as a friend and philosopher. This is not scientific, but more philosophical and spiritual. Please do not think that a doctor is talking unscientifically.

Kids who are in ICU - even though the kid is very sick, if the parents are 100%confident that the kid will come out, it happens so. There are an opposite group of parents, even though the kid is not severely sick will keep on being pessimistic about the kid's health and it is not good for the health of the kid.

I do not know your religion, but in Hinduism in Bhagavad XXXXXXX the Lord has spoken, thus, - Yadbhavam Tadbhavathi...meaning...what you think, that you will become. So I urge you and your wife to be 100% hopeful of your kid and he will definitely be alright. I believe in this principle as it has helped me a lot of times in my life. Being optimistic definitely helps.

I wish your kid a speedy recovery. If you need any future medical consultation and suggestions, I will be glad to help. You can approach me at the following link. Please find the link below.
www.healthcaremagic.com/doctors/dr-sumanth-amperayani/67696

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Brief Answer:
He is recovering - dont worry

Detailed Answer:
Hi XXXX
1. I did not find any new reports which you have uploaded.

2. I am very happy that the oxygen requirement is very minimal which is a very very good sign of recovery. Very glad to know that the infection is reducing and gone.

3. The old X-ray report say that it is a pus filled infection in the lungs but I do not think so. But still I stand by my diagnosis of right sided congenital lobar emphysema and as I have already said - it is not an emergency - but definitely a CT scan of the chest is needed please.

4. Passing bubbles in the stool could be a normal phenomenon when the kid is on antibiotic and unless there is blood in the stools - you need not worry. The treatment I prefer would be to start on "Probiotics" for a period of 5 days (ECONORM XXXXXXX one XXXXXXX twice a day for 5 days - after discussing with your treating doctor there).

I wish your son a speedy recovery and bright future...keep me posted please.
Regards - Dr. Sumanth

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Brief Answer:
It is not infection-only collapse-he is recovering

Detailed Answer:
Hi XXXX. Don't worry.

Still no sign of X-ray image here.

I usually do not comment on the reports without seeing the X-ray directly...but will clarify the report to you as you are anxious.

The report says -
1. Left lower lobe collapse - This is not infection and gentle physiotherapy will make it normal.

2. Hyperinflation of right lung with herniation across the mid line - this is the same as I diagnosed and told you about congenital lobar emphysema (CLE) in our 1st conversation itself - so do not worry.

3. Focal pulmonary collapse in right upper zone - this is also not an infection and will completely become normal after gentle physiotherapy.

Your son is on recovery path and don't worry.

Regards - Dr. Sumanth

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Brief Answer:
Suggestions on treatment options

Detailed Answer:
Hi XXXX I know about his VSD problem as I never forget my patient's clinical history.

Suggestions -

1. I have seen your son's photographs now and as the report has rightly said - there is right upper lobe and left lower lobe collapse and herniation or right lung.
The explanation is the same as I have suggested to you before.

2. You can come over to XXXXXXX XXXXXXX Kamakoti CHILDS Trust Hospital, where I practice, its an exclusive paediatric hospital, where every thing can be taken care of. I am sorry to say this. But I don't think it is required as he is on the recovery path.

3. Other options are - XXXXXXX or XXXXXXX which have bigger hospitals with more facilities....Hope you are not feeling that I am giving you a very tedious journey option. But one thing is make sure with your doctor if your son can travel so far without oxygen as of now. Otherwise - continue treatment there and after he is cured, get him evaluated at one of these cities I suggested.

Regards - Dr. Sumanth

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Brief Answer:
He will be fine - Definitely

Detailed Answer:
Coming to your queries -

1. He will definitely be fine.
2. My best suggestion to you is to go to a nearer city like XXXXXXX or XXXXXXX and there will be good treatment options. You might find even a better doctor than me there....who knows. Unnecessarily don't come this far.
3. In this hospital, we can take care of everything except cardiac surgery, but by God's grace, your son's vsd should close by itself.
4. Your son's problem might be big for XXXXXXX but to be XXXXXXX the doctor there has done a very good job with minimal facilities he has. I appreciate him very much.
5. Expenses cannot be estimated now & at the same time...after seeing your son, I might not even admit him if he's very stable.
6. If your doctor is saying, nothing much can be done now there, why don't you ask him, which is the nearest & best place there.
7. Again ask your wife to read - Bhagavadgita part of my previous msg few days back. Unnecessary apprehension will give negative results for your son. Tell her to be confident. HE IS 100% GOING TO BE FINE.
Regards - Dr. Sumanth

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