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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes excessive fluid build-up in and around the lungs?

Answered by
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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 6406 Questions

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Posted on Fri, 23 Oct 2015 in Hypertension and Heart Disease
Question: Can someone be cured of a collapsed lung. My Dad has water around his lungs and congestive heart failure for 2 years. He is having a procedure where they look w a camera. They didn't mention ards.
doctor
Answered by Dr. Ilir Sharka 36 minutes later
Brief Answer:
I would explain as follows:

Detailed Answer:

Hello!

Welcome and thank you for asking on HCM!

Regarding your concern, I would explain that your dad's clinical scenario (collapsed lung) most probably seems to be related to heart failure decompensation.

So, it is not a primary lung disorder, but a complication of his chronic cardiac disorder (chronic heart failure).

Coming to this point, it is necessary to evaluate his pulmonary function compromise: if it is severe lung collapse by a large pleural effusion, thoracocentesis with fluid evacuation it indicated, to relieve the critical situation.

But the most important issue, remains his heart failure therapy optimization.

First, a comprehensive cardiovascular status evaluation should be done for this purpose. A careful physical exam to identify the degree of systemic congestion, chest X ray study, resting ECG to investigate possible uncontrolled arrhythmia, cardiac ultrasound for cardiac performance evaluation, and several lab tests, like complete blood count and PCR for excluding/confirming a possible anemia and inflammation/infection, thyroid function tests, kidney and liver function tests, blood electrolytes, fasting blood glucose, etc. could reveal potential triggering factors for an acute HF decompensation.

After performing such a thorough medical investigation, you need to discuss with his attending cardiologist for an appropriate therapy management according to the underlying disorder.

At the end, I would like to assure you that your dad's condition is almost completely manageable.

Hope to have been helpful to you!

Feel free to ask me whenever you need!

Greetings! Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 1 hour later
Thank you very much. Very thorough. My Dad has an advance directive to resuscitate. My brother talked to Dr and decided to change to dnr. The hospital did not get a copy of his directive helped by an attorney from (directive paper at rehab) hospital is aware of this. They are legally responsible for following it and getting it from rehab, right? My Dad has some dementia but he created this document about a year ago. I want to see my Dad before anything happens I am in XXXX. He is in XXXX. Thank you Dr.Sharks. Miss XXXXXXX XXXXXXX
I meant Dr. Sharka. Sorry for type-o. XXXXXXX
He also has pneumonia.
doctor
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
Just discuss with the attending doctor!

Detailed Answer:

Dear Miss XXXX!

I am sorry about your situation, but probably the pleural effusion may be caused even by pneumonia (which serves also as a triggering factor for HF decompensation). A careful differential diagnosis is necessary.

Coming to the point of DNR (do not resuscitate) I could explain that everything depends form the legal arrangements underlying these issues where your Dad lives.

But generally speaking, DNR is applied to persons who have very terminal chronic diseases, where every efforts necessary to resuscitate (if cardiorespiratory arrest will ever occur) would not yield better outcomes.

DNR is decided from the patient himself or after discussion with the close relatives and depending on the certain hospital policies it may not be necessary an attorney presence.

I don't know exactly his close clinical conditions (as I lack his concrete medical data), but I could explain that, if your Dad has asked for a resuscitation option and your brother changed for DNR, the patient option should be considered first.

You have to discuss with your brother and his attending doctor immediately and find the right decision.

Kind regards,

Dr. Iliri


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ilir Sharka 10 hours later
Thank you Dr. Sharka. My brother is very angry when he talks with me. He is emotionally explosive to everyone in family always.
I asked the rehab center to forward his health directive. I was involved in an action against a hospital who did not have directive a hen they terminated dialysis against her (my friend's)wishes. The dialysis center said it was premature. I would think a hospital and Doctor would know the implications of ignoring a resuscitate wish.

God bless you. Ms. XXXXXXX
Good news. My Dad made it through camera into pleural area. Regards-i am lucky I was assigned to you Dr. Sharka, XXXXXXX I don' know results. Dad didn't go through paperwork to put me on face sheet although he intended to before this sickness. I can't wait to see him. Thank you for your wonderful responses.
doctor
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
You are welcome!

Detailed Answer:

Dear Miss XXXX!

I am glad you have clarified important issues regarding your beloved father. I would like to give my support on relieving your actual psychological burden; and also to give my professional opinion about your Dad's clinical status.

If you need my medical opinion you can upload your Dad's available medical data (medical history, performed tests, etc).

You can ask me directly on the link below, whenever you have any further uncertainties:

http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765

Wishing you a pleasant weekend!

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 29 hours later
Dear Dr. Sharka, Hello. Now the Doctor said he has blood outside of his lungs and she doesn't know why. She said the only thing she can think of is lung cancer. They tried him off ventilator and he went into a fib so they put him back on. My Brother said my Dad wants off the ventilator. The Doctor said he will probably live for an unknown amount of time even without vent. I am going to NY maybe. Monday if I can get a flight. What do you think about what is going on Dr. Sharka? I wish my bro would talk him into staying on vent. till he gets stronger, right? He just got over pneumonia. Thank you,sir. XXXXXXX
doctor
Answered by Dr. Ilir Sharka 4 hours later
Brief Answer:
My opinion as follows:

Detailed Answer:
Dear XXXX!

I would like to explain that hemoptysis (expelling blood outside respiratory tree with coughing) may be a sign of lung cancer, but it may be present in several other lung pathologies (pneumonia, tuberculosis, pulmonary edema, pulmonary embolism, and other inflammatory and systemic diseases) as well.

It is necessary to perform additional lung imagine studies (chest angio CT or MRI) and especially bronchoscopy coupled with bronchial biopsy to rule in/out lung cancer. Several biochemical tumor markers may be of diagnostic help, too.

So, a careful differential diagnosis should be done to confirm the right responsible cause of his actual clinical symptomatology.

Keeping a patient on ventilator is done when some clinical criteria are met. I would suggest to follow his attending doctor advice on what the ongoing management strategy should be, and not refuse actual therapeutic options (this could be a polite advice for your brother).

May be additional medical tests conclude about another alternative diagnosis (other than lung cancer) with a better prognosis and longer life expectancy.

That's my opinion.

I hope that things are going to get better and your Dad's clinical conditions will improve.

You can keep me informed about all the situation when it would be possible.

I will be at your disposal for further explanations.

Best wishes,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 10 hours later
Thank you very much Dr. Sharka. I read your answer to my brother (except suggesting politely to mention to bro.). He told me he has faith in the doctors and was planning on removing vent. since my Dad asked him to. He said Dad is too compromised to withstand biopsy (not sure if that is his opinion or Doctor's. I don't know lateest-bro was meeting other bro. On way to hospital at 10:22 CA time.

Thank you very much for helping me have hope when none was there. I will let you know today. God bless you.
doctor
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
Hope things are going to get better!

Detailed Answer:
Dear XXXX!

I wish you a comfortable trip and you could find your Dad on better clinical conditions.

Let me know how things are going on!

Kind regards,

Dr. Iliri


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 24 hours later
Dear Dr. Sharka..Hello. I just tried sending you a message but it didn't confirm. Did It takego? It was latest on my Dad. XXXXXXX Thlaste other day through direct link couldn't connect when I tried accessing link. Probably my little computer. XXXXXXX
Dear Dr. Sharka, Hello. How are you, sir? I have a flight out tomorrow, Tues. as there was a mistake made with my reservation and flying with my pet cat (got Business class w/miles). Well, the doctor convinced my brother, since she explained that taking my Dad (beloved, yes) if taken off of the vent. may help him breathe on own better if it was sooner than later. I must say that my Dad did ask the doctor to please remove it. My brother did that last night and my Dad could not talk because of irritated throat, but was able to communicate with them somehow. Well this morning my beloved Father became unconscious. I will go see him right away tomorrow night. I heard that hearing is the last thing to go. Have you ever seen someone regain consciousness or talk or respond a little when they have gotten to this state? He is being transferred to the med. floor from I.C.U. and unfortunately to hospice at St. XXXXXXX Thank you for your response in advance. Please pray for my Dad. Thank you very much.
doctor
Answered by Dr. Ilir Sharka 10 hours later
Brief Answer:
I hope everything is going to get better!

Detailed Answer:

Dear XXXX!

I am sorry to hear your Dad has gotten through this state of unconsciousness.

Coming to this point, it is difficult to predict the the prognosis, as he has been transferred outside ICU and a close clinical monitoring and intensive therapy are lacking.

A careful neurological status examination, main vital signs parameters, an arterial blood gas analysis are necessary to be evaluated periodically for properly addressing the ongoing therapy and medical care.

I pray for your Dad to have the desired clinical improvements! I wish he will be able to talk to you again and feel how much you love him!

Best regards,

Dr. Iliri

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