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Dr. Phil, MD
Dr. Phil, MD, Medical Doctor
Category: Medical
Satisfied Customers: 42461
Experience:  Medical Doctor Trained at a Top Academic Institution
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My dad is 77 years old and generally in good health. Two weeks

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My dad is 77 years old and generally in good health. Two weeks ago on a Saturday he got a flu vaccination. Three days later he came down with flu like symptoms - tired, weak, no energy, cough, and fever that spikes to 102-103 each night. He went to see his doctor that Friday and had a test done for flu which was negative. Sunday he ended up in the emergency room and was diagnosed with pheumonia. He also had pheumonia 2 years ago. He spent all week in the hospital on IV antibiotics being treated for pheumonia. Additional tests done were complete blood work, blood cultures (both negative), xrays, and CAT scan. CAT scan showed no sign of pheumonia, but did show a bile stone in the bile duct. They advised him that this is what was making him sick and that he needed to have it removed. He had the procedure done today to remove the stone. They did not find a stone during the procedure. We are back to square one. He still feels as sick as he did when he was admitted to the hospital last Sunday. Fever still spikes every night to 102-103. Still very weak, tired, no energy, and cough. Low blood pressure was 80, but now up to 100. Very frustrating that after all week in the hospital and all the tests still no diagnosis for the problem. Any input what he could have?
Submitted: 11 months ago.
Category: Medical
Expert:  Dr. Phil, MD replied 11 months ago.
Hello. I'm Dr. Phil, licensed and practicing Internal Medicine Physician. Excellent service is my goal.

thanks for this question

So, he is no better at all?

Is he on antibiotics?
Customer: replied 11 months ago.

Yes, the hospital had him on antibiotics all week while in the hospital. They discharged him tonight and gave him a prescription antibiotic. He is no better at all.

Expert:  Dr. Phil, MD replied 11 months ago.
Did they check the urine?

Did they check the heart valves?
Customer: replied 11 months ago.

They did check the urine in the emergency room last Sunday. Nothing found. Not sure about the heart valves, but they did say that the CAT scan showed some fluid around the heart.

Expert:  Dr. Phil, MD replied 11 months ago.
Bingo.

I think that is what they missed.

Bacteria can latch onto the heart valves and cause a resistant, hidden infection

I think he has endocarditis.

He needs a heart echocardiogram
Customer: replied 11 months ago.

Wouldn't all of the antibiotics that he has been on all week help this? If not, how is it treated?

Expert:  Dr. Phil, MD replied 11 months ago.
No.

This requires 4-6 weeks of IV antibiotics

The bacteria attach tightly and form a film around themselves on the heart valve

long term IV antibiotics is the therapy
Customer: replied 11 months ago.

He has a healthy heart and never had any heart problems. Could this still happen without any prior heart conditions? Hospital discharged him and he is home tonight. Should we bring him back to the ER?

Expert:  Dr. Phil, MD replied 11 months ago.
What happens is bacteria get in the blood then stick to the heart valve and cause a secondary infection


If he is no better and still having fevers go back to ER
Customer: replied 11 months ago.

Wouldn't the bacteria have shown up in the blood cultures?

Expert:  Dr. Phil, MD replied 11 months ago.
15% of cases are culture negative endocarditis
Customer: replied 11 months ago.

Thank you for your input. We will have him get this test.


Do you know why his temperature would be normal all day and then spike to 102-103 each night?

Expert:  Dr. Phil, MD replied 11 months ago.
The infection must be releasing at night for some reason

Or perhaps he is taking meds that lower temp during the day like ibuprofen or Tylenol


Sometimes infections have weird diurnal variation like this
Customer: replied 11 months ago.

So, in your opinion, you don't think this so called bile stone that they are claiming he passed could have been the problem? They have him coming back for an ultrasound of the gall bladder and liver.


Also, could it be lymes disease? Seems like all the symptoms, but they dismissed that and didn't test for it.


Any other possible causes?

Expert:  Dr. Phil, MD replied 11 months ago.
It could be the bile stone. That is possible.

If no rash then no lyme

I think everything else was checked
Customer: replied 11 months ago.

If it was the bile stone, would the fever stop spiking now? Just checked his temperature and it was 100.1. Lower than it has been at night, but still not normal.


Also, he had no stomach pain. Is it possible to have a bile stone and no stomach pain?

Expert:  Dr. Phil, MD replied 11 months ago.
Yes its possible to have a bile stone without pain but I would expect the fever to be gone

Something else is going on

He needs to go to ER
Customer: replied 11 months ago.

One last question, if this ends up being the problem, is it a 4-6 week hospital stay? Would this be causing the low blood pressure?


Thank you for all your help.


I appreciate it.

Expert:  Dr. Phil, MD replied 11 months ago.
You're welcome

The infection is causing low blood pressure

It is making him septic.

He absolutely should not have been discharged
Expert:  Dr. Phil, MD replied 11 months ago.
Please don't forget a positive rating. I appreciate it
Dr. Phil, MD, Medical Doctor
Category: Medical
Satisfied Customers: 42461
Experience: Medical Doctor Trained at a Top Academic Institution
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Expert:  Dr. Phil, MD replied 10 months ago.
I appreciate the excellent rating.

I would be happy to help you in the future. Just ask for Dr. Phil in your question opening or bookmark this page http://www.justanswer.com/medical/expert-irondoc/

I greatly appreciate a positive rating in the customer satisfaction survey that you will receive via email. It is important for me to get your feedback. Thank you. :)

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