Pneumonia-Help a brother out...

[JensHolsten]

Hi guys-

I thought I would post here thinking maybe ya´ll might have some helpful tips. I am currently in Patagonia on a dream trip to climb the amazing peaks here. Problem is, this trip has been a nightmare. Upon arriving I got sooo sick. Puking, bad headache, high fever, extreme muscle weakness, and a insane cough. After about five days I started to feel a bit better. I was recovering I thought. After a few days of feeling better I started to get extremely bad pain in my left side. The pain was excruciating and shot up my upper left side, into my shoulder and neck. I was whacked. I barely made it to the small clinic in El Chalten where they took x-rays. This was on 1/14/08. They told me I had fluid in the lung and prescribed Amoxicilina/Acido Clavulanico. I took this for one week. The pain lessened, but was definetely not gone. I went back for a second x-ray and some fluid was still present. They told me to keep on the original antibiotic prescribed. I did, but also got my hands on some zithromax, which I have been taking also. Nine days later I feel better, but still have sharp pain in my left side and shoulder when I take a deep breath. I don´t feel sick, just have pain. I am almost out of the antibiotics and am supposed to go to the doctor again in a few days for another x-ray. If I can´t get rid of the pain in a few days I think I will head home...I haven´t done anything but be sick for almost three weeks now. I haven´t even hiked out of el chalten. Kinda hard to climb here when you´ve been weakened by three sick weeks. I was just wondering if anyone had any useful info or experiance. I know this stuff is hard to sort out in a forum like this, but I am looking for any useful info I can get my hands on at this point. Thanks guys,

 

Jens

[Sherri]

Wow, Jens, that sucks. I sure hope you figger out what's going on and feel better soon(and in time to enjoy some of those spectacular surroundings) :kisss: .

[sampdx]

Hey Jens - I don't know what you tell you about the pneumonia; all I know (after having a milder case of it myself on a ski around Crater Lake) is that you have to rest and be sure it's gone or it can last longer. I do know that taking a lot of antibiotics is hard on the digestive tract, and it's good to take acidophilus at the same time. Sorry to hear you've been sick on your trip.

[ClimbingPanther]

The "insane cough" can produce a cracked rib or torn ligaments/cartilege/etc in the chest. This sort of structural damage can cause the pain you're feeling, and it may take a good deal of time to heal. If you can tell exactly what bone/joint/region the pain is coming from, it's probably structural. The pain can also be just from the inflammation associated with pneumonia. If it feels more internal, it's probably the pneumonia itself.

[mneagle]

Jens, you could have a real problem. I'm an actual lung doctor, so I know what I'm talking about. If there's anyway you could send me a copy of your x-ray I could give you more specific advice but I would doubt they have the ability to digitalize their x-rays down there.

 

When they say you have fluid on your lungs that could mean 1 of 2 things. Either they are referring to consolidation within the lung from an infection or they may mean that fluid has accumulated outside the lung (between the lung and the chest wall) which is called a pleural effusion. More specifically, if the fluid accumulates due to an infection in the lungs it is called a parapneumonic effusion. This fluid can be very inflammatory which can cause big problems. The worst case scenario is that the fluid itself is infected in which case we call it empyema. This would be extremely bad.

 

The antibiotic that they gave you is very broad spectrum and should cover most bacteria but it was a good idea to use the azithromycin to cover atypical bacteria. Unless you are immune suppressed it's unlikely that you have a fungal infection.

 

If you have an effusion and the fluid is still present then it should be drained. If you let inflammatory fluid sit in the chest for too long walls can form in the fluid and form multiple pockets that can be difficult to drain. A fibrous "peel" can form around the outside of the lung as well. We call this a trapped lung and it can often require surgery to fix.

 

Here's what you should do: get your ass home. If you can't get home right away then get the x-ray and if a pleural effusion is present find a local lung doctor or surgeon and get them to drain it. They should do a fluid analysis and if the fluid looks infected or very inflammatory they may put a tube in to drain the fluid for a few days. If the fluid is already walled off they may consider putting lytics (streptokinase, urokinase or TPA) to try to chew up the walls but they may not have it. If lytics don't work then surgery is usually needed.

 

If there is no effusion but just consolidated lung from pneumonia then the antibiotic and rest may be all that are required, so a lot depends on the x-ray.

 

This is what an effusion looks like in a kid (R=right side):

 

In an adult:

 

 

Edited January 23, 2008 by mneagle

[iluka]

I second exactly what mneagle said. A rib fracture due to coughing is certainly possible but some of what you describe is consistent with having a pleural effusion (fluid buildup in the chest cavity around the lungs) and you need to get this possiblity evaluated. If it is, in fact, what's going on antibiotics alone will likely not make it go away.

 

mneagle mentioned seeing you can get the clinic/hospital who did your chest-xray to give you a digital version of it that you can forward to him. Most hospitals in the US now handle their x-rays electronically but a small clinic in a remote area where you are probably doesn't. If the clinic can't get you a digital version, try to take a digital photo of the x-ray yourself and then forward that on.

[JosephH]

Here's what you should do: get your ass home. If you can't get home right away then get the x-ray and if a pleural effusion is present find a local lung doctor or surgeon and get them to drain it.

 

Having been plagued by pneumonia over the years, and particularly this past year, I'd say he's giving you some sound advice - get home or get to Buenos Aires or somewhere real. Make getting healthy the priority - live to climb another day...

[JensHolsten]

Hi guys-

Thanks for helpful comments. Bottom line is I am trying to get out of here as soon as possible. I am definetely more interested in my health than climbing. These mountains are not going anywhere. Thanks mneagle for the specific info, I really, really appreciate it. I am trying to get home as soon as possible.

 

Jens

[RuMR]

Jens, you need any $$$ to get home??

Let me know, bro....