Pneumonia

[Sam'smom]

Hello:  since I had my baby 2-1/2 years ago, I have had pneumonia 5 times.  I am always tired.  I recently had a CAT scan and bronchiscopy to see if there was possibly something more wrong with me.  Nothing unsual found. My right lung, middle lobe is where the pneumonia continues to reoccur.  

I have always been healthy.  I used to workout 5-7 days/wk. prior to having Sam.  During and after the pregnancy, I have not worked out at all.  I am 5'6, 130 lbs.

Please help.  I have seen several doctors in Montana of which I have been misdiagnosed, given antibiotics for penumonia without even knowing for sure whether I had pneumonia and the last doctor (specialist) who has given me 4 refills of doxycyclein to continue to take until I feel like the penumonia has disappeared.

Thanks.

[Ellis]

If you have to lose a lobe, the Right Middle Lobe is the one,
since it has only 5% of total lung capacity. There is an
endoscopic operation called a thorascopy which uses 3 holes and
results in minimum hospital stay compared to the more traditional
thoracotomy [open chest operation]. However this is major
surgery and you may want to watch and wait for a while. Some
antibiotics are better than others for treating particular
infections. You may be able to minimize the number of infections
by daily postural drainage of mucus, drink lots of water, maybe move to a warmer climate, control upper respiratory symptoms like rhinitis and sinusitis, etc.

If you want to consider surgery, ask for a referral to a thoracic
surgeon at a top rated thoracic surgery hospital, who does a
lot of thorascopies. However be sure the pulmonologist agrees
that surgery is the best way to go.

[Sam'smom]

Thank you for confirming exactly what my Dr. told me since my question was posted.  He also suggests I get a Hi Res CT to see if there is more damage than in the middle lobe before any surgery.

When I asked for his recommendation on what I should do, he said he would like me to continue with the doxycyclein for the next 2 refills of my prescription.  I have already taken 1 full prescription and am at the end of the second, and so have the 2 refills remaining.

I told him I could not see any light at the end of the tunnel as far as getting better, since I've already had the pneumonia 5 times in the last 2-1/2 years.  I am terribly tired and Sam is full of energy.  I need to get better asap.  This is when he recommended the Hi Res CT Scan and said I should make the decision I felt was right if I felt this is what was draining my energy.  Secondly, he said if I decided to not have surgery I could basically stay on antibiotics forever to keep the infection out.  I asked if this could be harmful to my body building up an immunity to the antibiotics, and he said he didn't see it as a problem.  I was going to get a second opinion so I could hopefully make the right decision.  I will take your recommendation and schedule an appt. with a board certified pulmonologist.  Thank you very much.

Finally, I've been healthy up to this point, and really have no concept of surgery.  How dangerous would this surgery be and can you tell me what the procedure is to remove this lobe?

PS  Do you think the cyst I have developed in one of my salivary glands under my tongue could be related to the pneumonia?  I am having laser surgery to remove it on Monday, May 13 by an oral surgeon recommended by my dentist.

[National Jewish]

This is called the Right Middle Lobe (RML) Syndrome. For discussion purposes, I shall assume that you truly have had 5 pneumonias, all in the RML.
The RML does not drain well and having infection in that portion of lung does predispose one to recurrent infection. While the RML may appear normal on CAT scan when you are not having pneumonia, there is a good chance that it is not. A good chance that the infection never completely clears.
There is a strong likelihood that if you are to be cured, you will need to have the RML surgically removed.  Before proceeding to surgery, you should seek consultation with a Board Certified Pulmonologist.