Posted By sab on May 10, 1999 at 13:47:50
I'm a 31 year old female. In early February I was repeatedly not diagnosed as having phenomena and I ended up with a life threatening case of Empyema. Surgery was necessary and they removed about gallon of then solidified gunk (I'm sure it has a medical name). Thoracentesis was not possible because the fluid was solidified. I was in the hospital for 21 long days running into all sorts of allergies, including every pain medicine they tried. They were never able to grow any cultures due to incorrect or ineffective antibiotics that I had been given while I had the pneumonia initially. I've seen an allergist during the last month and he has indicated that the allergies to the pain medicines I experienced during this ordeal, which presented themselves as hives and severe rashes, could have actually been due to the infection that I had but we can't be sure since the cultures didn't grow anything. While it's been three months since my surgery I am continuing to lose more than normal amounts of hair which are not growing back. I've noticed even the hair on my arms has thinned considerably and hasn't grown back in the areas pulled out from tape while I was in the hospital. Nail growth is very slow too. Initially I thought the hair loss was due to the allergic reactions I experienced. I have other symptoms that were not present prior to my Empyema ordeal so numerous I'm going to number them (1) Heart palpitations or irregular beat which drives me crazy. I have a heart murmur from Rheumatic fever as a child. They have done echocardiograms over the years including 2-1/2 years ago while I was expecting my youngest child and two while I was recently in the hospital. The results of each still haven't made it to my new MD for comparison. Nothing was too alarming I guess while I was in the hospital at least no one indicated such to me. (2) Feelings of anxiety or apprehension and nervousness - severe at times. (3) Cloudy mental function. I haven't taken any pain medicines except Tylenol for over 2 months now and still I can't seem to remember things and I seem so cloudy, like I'm working through a haze (but my vision is fine). I'm allergic to Ibuprofen, I found out during this whole ordeal, so it's been over 2 months since I've taken it in any form. I just can't stay focused on tasks at hand. (4) Fatigue continues to plague me and I know I'm still somewhat recovering but I'm so tired all of the time. I do seem to be a bit depressed these days which reminds me of the down mood swings I experienced during pregnancy. (5) Weird sudden skin rashes - typically on my neck or arms. They seem to occur when I get overheated or during physical activity and appear suddenly. They disappear just as suddenly when I remove myself from a heated conversation if that was the cause, or apply a damp cloth if the cause is heat.
My family has a history of hypothyroidism and lupus. Recent blood tests resulted in normal readings - which included CBC, Platelet count, glucose, potassium, belly Ruben, Liver functions ALK PHOS & AST FGOT, thyroid TSH, special thyroid 3T4, and ESR. My MD's initial conclusion is that my hair loss is due to stress and nutrition associated with my illness. It has been three months now and I've been taking vitamin B complex, Vitamin C, and biotin for over a month now and a multivitamin daily before that. While in the hospital they were giving me prenatal vitamins. I have had two hydroquartizone shots for surgical pain in rib cartilage, one in March and the other last Friday. The only medication I am taking is Allese 28 birthcontrol which I only recently started taking again. I tried discontinuing it for a month but it made no difference in any of my symptoms. Occasionally I will take Benadryl for allergies and Tylenol for pain. The antibiotics I took for a long duration during my illness were Vancomycin and Trovan. I was also on clindamycin and penicillin for a while as well.
Do you have any ideas as to the cause of my ailments? I wasn't even sure really which forum to post my question under but the heart palpitations seem the more concerning medically. Although the hair loss is more concerning to me psychologically. I had none of the above symptoms prior to my Empyema ordeal.
I've been trying to find detailed information on Empyema but I've only been able to find some general information. Could you direct me to a source? I'm curious as to its progression as it relates from pneumonia as a cause such as how long it takes to develop, how long the fluid takes to solidify, further complications or possible long term effects. From what I've gathered it seems to be pretty rare since antibiotics have been around and has been called 'wood lung' because of the hardening of the fluid over time.
Any direction you can give me would be greatly appreciated. Thanks for your help!
Posted By CCF CARDIO MD - MTR on May 11, 1999 at 14:03:12
Dear SAB, thank you for your detailed question. Although I'm a cardiologist, I've trained in internal medicine so I know about empyemas. I agree with your physician that malnutrition and stress may be the cause of your hair loss. In addition to taking vitamins, you should eat a hearty diet consisting of at least three meals per day to regain any weight that you may have lost during your illness. The heart palpitations may not be anything to worry about. You should search the heart forum archives where there are hundreds of prior questions on this subject. The bottom line is that if your heart is normal (the echocardiogram should determine this), palpitations will not harm you and will not portend a bad prognosis for you. Common precipitants of palpitations that should be avoided include alcohol, tobacco, and caffeine. Also, I think you may suffer from an anxiety disorder, so you should talk to your physician about treatment for such a condition.
Empyema can occur with a pneumonia and basically is a spread of the infection from the lung tissue to the pleural fluid and pleural lining that covers the lung. Pleural fluid normally is a lubricant to allow the lungs to expand and deflate in the thoracic cavity without friction. During an episode of pneumonia, bacteria can infect the pleural fluid which then becomes a huge culture medium for growth of the bacteria. The bacteria cause the fluid to become pus and to be laden with fibrous scar tissue. Thus, an empyema is very difficult to treat and must be physically drained either with an external chest tube or with an open surgical procedure. It's hard to predict who will have an empyema develop from a pneumonia, but I think you were treated appropriately at each stage. The long term side effects and complications depend on the individual patient and are hard to predict. For more information, I suggest you look in an Internal Medicine or Infectious Disease textbook.
I hope you find this information useful. Information provided in the heart forum is for general purposes only. Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions. Good luck.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.
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