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Dr Basu
Dr Basu, Experienced Specialist
Category: Health
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Experience:  MD
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Im 55, female, have had SLE for 25 years. Currently on 20

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Im 55, female, have had SLE for 25 years. Currently on 20 mg prednisone and 150mg Imuran daily for aggressive SLE.( Backgound: in 2009 I had a crown placed and 6 days later I became very ill; found out I was septic and the tooth infection has spread to my blood. I just thought I had a flare at first; probably did but things went wrong suddenly. It was like I stood up, took a step and then it felt like I had crashed head first into a brick wall. It was that sudden. I felt really awful....worse than usual because it was so sudden; like turning on a light switch sudden. I knew it wasn't right, and it scared me so I called my husband and told him Id become very very sick and he needed to come home immediately to care for me. Id never done that before so he knew it was real and bad. Weird thing was.... after a half hour I didn't feel so awful anymore. Just like I was flaring. It was strange. Later, I took my BP and it was 54/38. Surely that was wrong. I repeated it twice. Same thing. But, I didn't feel awful... and I thought I should be feeling awful if my BP was so low. My flare was confusing me. It took several friends to convince me to go to the ER, and so I did. 3 hours later I was on a vent and in ICU. Septic.... blood infection, went into pneumonia.... 2 weeks in hospital but pulled out and survived. Duh)

Two weeks ago I had an old crown removed, decay underneath removed and temp crown placed. 12 days later I had night sweats. For me this means I have an infection someplace. That morning I went to dentist as preplanned, and told her my tooth was extremely tender and could she check if I have an infection before we proceed with the next crown to replace? Xray showed I had a deep abcess (tooth had root canal three years prior) and started on clindamyacin, then referred to oral surgeon for a repeat root canal in a week. However, that afternoon was called to be told they had looked at xray again and saw the tooth was fractured and could not be saved. So was set appointment in a week to have it extracted. But, within 8 hours, by late evening, my face had swelled up and I was in bad pain. Got thru the night, called dentist at 6 am (is personal friend) because had night sweats again, pressure was all backed into my ear and bad pain in the left eye lower orbital bone and jaw was swollen terribly and eyes were swollen shut on left side. Horrible pain. We went right over to the office. Had the tooth extracted and xrayshowed infection had spread big time. Was an awful experience. Smelled horribly when tooth came out. Was puss and infection. Both oral surgeon and dentist worked to clean out the infected area and sutured me up. This is my concern: First, I WILL flare because of this sometime between now and thenext 48 hours. It will be an "awful really bad terrible" flare... I always flare from any type of trigger... but with this type of occurrence the flare to come will be my worst kind. Its just a given. Sorry. Its what I live with. But I will get thru it. This type of awfuly bad flare will leave me so weak I will not be able to stay awake much at all. I will be out of it most of the time and feel extremely sick It usually attacks my GI system with this kind of flare, so I will have screaming cramping with diarrhea for several days. I had 75% of my colon removed this January and this flare will just create lots of diarrhea and screaming cramps. I will be too weak and fatigued to get out of bed or off the couch. I will need help getting to the bathroom at times.My head will hurt awfully bad the entire time and there will be nothing for relief. You just have to get thru it. One side of my legs/hips/knee will swell, get hot, hurt to just touch it and my toes on that foot will scream. Its coming, but I always get thru it; eventually it subsides and I get better. By day 7 or 8 I will turn the corner and be up and around again and begin to be able to eat. So, this is what will be coming. Im used to it. This is NOT why Im asking you a question. This is just background for you; so you know what will be happening and why it is hard to know if things are more serious.
I don't want to get the flare symptoms confused with something more serious taking place this time. But you can see why it can all just blend together. Especially if it becomes one of my "awful awful terrible bad flares". Last time all I had that was different was the sudden "like I flipped a switch" suddenesss of a feeling that I was horribly sick.... different from the bad flare feeling. Its subtle and yet was quite dramatic so that I knew something bad had happened and so called my husband. I never do that. Ever. So he knew and I knew things were going south fast. it was strange because even thou the BP was so low... I was walking around and felt it ws no big deal. What should I watch for this time? What would let meknow we need to head to Memphis to the hospital? a list of watch for?
Submitted: 3 years ago.
Category: Health
Expert:  Dr Basu replied 3 years ago.
The views expressed by me are for educational purposes only and do not establish a doctor patient relationship.

mysticdoc : Hi there,
I am Mysticdoc, experienced Internal Medicine Specialist.
I am here to help you with your concerns.
mysticdoc : Thanks for the detailed information.
mysticdoc : Lupus and daily use of imuran and prednisone do lower your immune system making you a high risk patient for any serious infection.
mysticdoc : dental works can be the source of serious infection as well.
mysticdoc : Your past experience is making you more careful this time understandably.
mysticdoc : The typical signs of infection like fever, body aches may not be seen in your case due to the use of immunosuppressive agents.
mysticdoc : Hence, in your case, atypical signs like fatigue, dizziness, ofcourse worsening of pain and swelling, mental confusion, nausea, vomiting should raise the alarm for immediate evaluation.
mysticdoc : I will prefer IV antibiotics in your case than oral antibiotic initially.
mysticdoc : Usually, your dentist should have given you IV vancomycin or ceftazidime to cover for any spread of infection then switch to oral antibiotic.
mysticdoc : Since this did not happen, you should continue oral antbiotic for now.
mysticdoc : Please look out for any of the above signs or any change in your current situation.
mysticdoc : Please remember, the threshold for you should be low for ER visit or hospital admission to prevent any serious complications.
mysticdoc : Best wishes,
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