Aspiration Pneumonia

[crski]

My Dad is 84 years old. When he was younger he was diagnosed with a "slight " asbestosis. He never had any lung problems until about 6 months ago. He started out with a mild cough, then slowly progressed to expelling a clear sputum. I started taking him to the doctor. The doctor was giving him meds to treat allergies. On December 28, 2005 we went to the doctor because he started running a low grade fever(100).The doctor found his blood count abnormal and admitted him to the hospital. They took a chest x-ray a determined he had pnuemonia (pneumonia). They started treating with antibiotics. He then became worse and was admitted to ICU. The next day he was put on the breathing machine (life support).The doctors kept saying they could not find any infection, but he had also kept running a fever from 99-103.5. After almost 2 weeks, they removed him from the machine. He did ok for about a day, but still was running fever. He then transferred to a Long Term Care Facility. He is still there. After 2 weeks the Dr. said they found MRSA in his sputum. So they were treating that. They also said he is anemic. He has had 12 units of blood over the last 2 months.He does have a lot of problems. He was doing good until they began giving him fluids for a high sodium count.His breathing deterioted again and had to be put back on the machine. The Doctors are telling me that there is not much they can do for him. His vitals all look good now. They say he will continue to get pneomonia over time because of his age and health condition and there is not much they can do. Are the Doctors overlooking something?

[National Jewish]

Your Dad’s lungs should be examined with a bronchoscope, which can generally be passed through a breathing tube or a tracheostomy to look inside the lungs.  A bronchoscope is a flexible tube with a small camera at one end.  In addition to looking, with the bronchoscope tiny pieces of lung tissue can be taken for further testing.  This is called lung biopsy.  If there is infection, it can usually be found in this way.

Pneumonia is often spread by inhaling infected particles or by aspirating.  Aspiration is the process of food and/or drink being swallowed into the windpipe and lungs rather than the food tube and stomach.  This is commonly referred to as “going down the wrong pipe” or “swallowing the wrong way”.  Swallowing problems are common in the elderly.  Your Dad’s history of cough followed by pneumonia definitely fits with aspiration pneumonia, which is treatable.  He should have a tailored barium swallow test if they can get him off the respirator.

A tailored barium swallow test or swallowing study is helpful in identifying swallowing problems.  This is an x-ray test using fluoroscopy to watch for problems as barium is swallowed.  Barium sulfate is a harmless chalky, water-insoluble compound (salt) that does not permit x-rays to pass through it.  It causes the digestive tract to stand out in silhouette when viewed through a fluoroscope or seen on x-ray film.  During a barium swallow test the x-rays are taken after, not as, the barium is swallowed.

The other cause of these events would be a tumor of the lung, which may or may not be cancer.  This could be present but hidden by the pneumonia.  A major question to be answered is why he's had to have 12 units of blood transfused.  Whatever is making him anemic could also be related to a problem with his aged immune system.

[crski]

I guese my plea for help is going without any response...thanks so much....

[renierae]

Don't give up, crski.  I'm new here, but it looks like the the person with the real answers (NJC-R.N.-DC) hasn't checked the board since you posted.  As for me, I don't have any answers but I want see what the answer guy/gal says because I'm in a similar boat.

My mom is 74 and has been quadriplegic for 22 years (C5 incomplete, if you know what that means).  Other than that, she enjoyed excellent health until December when she, like your dad, developed aspiration pneumonia.

Mom was admitted to the hospital on January 2, and was intubated and moved to the ICU on January 4.  She spent 6 weeks there, during which time she had a tracheotomy.  She moved to a step-down unit in mid-February, during which time she had a PEG (feeding) tube inserted.  She moved to rehab on March 3, and she should come home Wednesday.

Like your dad, her aspiration pneumonia progressed to MRSA pneumonia, and she became anemic.  In addition, she became malnourished, developed secondary infections (yeast, UTI), and ended up with a stage 2 pressure ulcer.

To recap:  My mom can't move, breathe on her own, speak much of the time (because of the vent), or eat.  The doctors think she can't be weaned from the vent, and it's only a matter of time until she gets pneumonia again.

The docs may be right.  BUT she's kicked the pneumonia and secondary infections, is no longer anemic, her nutrition is good and continues to improve, and, most important, she's happy to be alive and is loving life.  Of course she's nervous about how she'll adjust to her new situation (ventilator, PEG tube), but she's not overwhelmed by it.

Personally, I can't wait to get her back home, and I expect her to get her even healthier.  The medical care she's received has been excellent, but hospitals aren't set up to give her the intensive hands-on care that she'll get from us.

Plus, there's great psychological benefit to be gained from achieving the one goal she expressed over and over in the hospital:  "going home and sleeping next to my husband."  :)

Oh my, I've been long-winded.  Worse yet, I've been long-winded without offering any answers.  Apologies.  Please accept my post for what it is: a statement of understanding, an expression of empathy.

[crski]

I apreciate you sharing your experiences,renierae. My dad has had a PEG inserted as well. They are also talking  (again) about the tracheotomy for him.

Wow, that's great that your mom has battled through all that and is almost ready to come home. My dad is putting up quite a battle too. He's not ready to give up, but the doctor is. I've been fighting right along side him. The issue remains that they just can't seem to get rid of the infection. I have researched MRSA and the normal antibiotic treatment is Vacomycin. There is another term called VISA which is a Vancomycin resistant infection. The drug of choice for that is Zyvox. I made a doctor change today. He is specialized in internal medicine. I am going to see what he can do for my dad and ask him if we could try the Zyvox. I figure I'm not going to let them give up so easily.

Thanks again for your reply. It sure helps to talk to someone with similar circumstances, as I've been feeling really helpless and alone in this matter. Let me know how things turn out with your mom.

[renierae]

It looks like Zyvox is the brand name for linezolid, and that's what finally did the trick for my mom.  As the doctor said, "Vancomycin and linezolid are the big guns, your battleships against MRSA.  They're like the Yorktown and the Saratoga; if one doesn't work, you attack with the other."  I hope it works for your dad.

We had doctors who clearly thought our choice to fight on mom's behalf was wrongheaded; one doc actually told me flat out that my mom should be a DNR (do not resuscitate).  Be that as it may, when he understood that she wanted to fight tooth and nail to live, his treatment was aggressive as all get out.

I don't know if it makes a difference, but my mom was at a teaching hospital, and her attending doctors were "pulmonary intensivists" (pulmonologists who specialize in intensive care, I think).  Watching them care for her was like watching someone fine tune a high-performance automobile.  (Though she'd probably say she's more of a junker than a Ferrari.  LOL)

I'll be holding you and your father in the light.  I will update and hope you will too.

[rottiemom]

I have read both of your comments and I am dealing with the same needs for my daughter.  She is 21 years old and has experienced aspiration pneumonia and also ARDS, which left her in ICU for about a month.  I am looking for support to help her to cope with the loss of her speech most of the time and loss of the anything by mouth.  As a girl with other disabilites including cerebral palsy and mental retardation, its that much harder to deny her food.  She is in a wheelchair not and has very little to be happy about.  Eating was one of her joys! I am working very hard to build her back up in strength but she is scared and depressed with all she has lost and needs something to shoot for.  I would sure love to hook up with others going thru this, especially those with young children with the same problems.  What formulas have you tried thru the g-tubes and what has help to put on weight and build up strength?

[out_of_the_box]

I found this website as I search for a new solution for my Mother who has a problem with incredible phlegm which has to be monitored so closely (lots of suctioning) in order to avoid the
development of pneumonia.

She is a stroke victim requiring total care.  She does breathe on her own with an oxygen supplement.  

There was a solution for the phlegm that worked for a few years (no longer effective now) that might help you.  By accident, in the attempt to control her erratic and very high blood pressure, she ended up with the use of a clonidine PATCH.  I emphasize patch because her doctor initially prescribed clonidine pills and that just aggravated the blood pressure problem.  The Patch has a controlled release of the medication and the blood pressure swings are not as bad.

The very pleasant side effect was that the phlegm production was almost completely curbed.  This lasted for a few years.  

If you or your loved one does not have a blood pressure problem, there are a few other drugs that have the side effect of curbing phlegm.  Another one is elavil (anti-depressant).  There are others.

As with all medication, watch out for your own unique reactions to the medication.  Clonidine actually caused my Mother to have some terrible seizures.  When I finally figured out that the clonidine was the cause of the new terrble seizures, I had to experiment with the dosage so that it was enough to help with the phlegm but not strong enough to cause the seizures.  I have her on three different medications to control her blood pressure now.  

The dosage that seemed to work for her now is too low to stop the phlegm problem.  I am searching for some other solution but am keeping in mind that I could bump up her clonidine and search instead for a solution to prevent the seizures (there was another medication available to prevent seizures but I do not know what new side effects that will have).

I am trying to figure out if there is any food she is allergic to that will help resolve this problem.  It is just hard to be constantly guessing (she cannot speak, has a peg tube) and I have no assistance in managing her care and wellness.

I learned the hard way that doctors do not know what to do and had to come to the scary decision that I had to have the courage to find solutions myself.  The last course of action that a doctor provided was to reduce her water intake to the point where I knew that her kidneys would fail.  This just would have been a course where she would definitely die.  Not quite a complete termination of liquid (like Terry Schiavo) but enough that it was not an outright killing, but a definite death prescription.

So, I wish all of you well.  I have found that the internet has provided a wealth of information that allows a better chance at finding REAL solutions.  I hope you find them as I hope I can find them for my Mother.

[out_of_the_box]

Almost forgot to say... I was constantly warned about "aspiration pneumonia" in regards to my Mother.  There used to be constant trips to the ER and hospital stays due to the fact that her doctor would send us there because of infection.  

Of course when we arrived at the ER, the doctors there had their own opinions.  One trip there, when I was sure that my Mother's condition was so serious that she had to be admitted, the first ER doctor took an x-ray and said all was ok and almost discharged her.  Luckily, before the discharge, there was a rotation of doctors.  The doctor that took over reviewed her case and ordered a CAT scan.  He said she had pneumonia and admitted her for treatment.

I was so happy that the doctor really checked her out and so I filled out an evaluation letting the hospital administration know what a good job that second doctor did in carefully checking my Mother's condition.

Unfortunately, a few months later, there was an "infection" where the regular doctor again instructed me to bring my Mother to the ER.  This was to start IV medication (I was to take her home and continue the medications after it was started).  Since we were already at the ER, there were the blood tests, etc. performed.  My praises for the previous doctor worked against us as the doctors were eager to make up lies about my Mother's condition and she was admitted to the hospital.  I was told she had pneumonia again along with other things.  

When I saw that she was not being fed, and I did not believe that she had pnuemonia (pneumonia), I demanded a CAT scan to prove she had pneumonia or I demanded that I be able to take her home.

The CAT Scan proved she did NOT have pneumonia.  I ended up taking my Mother home after battling the doctors.  

Aspiration pneumonia seems to be a diagnosis that doctors love to use.  (This was their excuse for not feeding my Mother.  And the doctor that admitted her demanded that I meet with hospice staff.  When I said "NO" because she is not dying, just needing to be cared for, he said I should at least meet with their Pallative Care staff.)  

There is much more we have gone through.  But just beware, sometimes you need to demand proof of the diagnosis.