I'm not sure if you saw my last question, but they are not able to do the VATS now, she is not stable enough.

Hello, I was talking to a Dr. D. Love here the past 2 days and he knows the whole long story, but guess he's not here today.. Thanks for taking my questions, though, and I'll try to summarize..

Summary: My mom is 86, has chronic emphysema and got a pneumonia last week and her right lung quickly filled with what I think they call empyema. BTW, I'm a medical transcriptionist and know some medical terms. She went to Mt. Vernon Hospital last week and they put her on broad-spectrum antibiotics. About 3 days ago they did put a tube in and drain about 1 L but said there was another 2-3 L there that they couldn't get because it was loculated/septated fluid. They transferred her to Westchester Medical Center last night ostensibly to do a VATS procedure but today said they cannot do it because she is not stable enough, mainly her blood pressure is too low. I am not sure what is causing this low BP. We asked if they could do something else at WMC to get this congealed fluid out, and they said they might be able to put small tubes in.. Wouldn't this be a lot safer than VATS? Wouldn't this be effective as well?

I'm just trying to get my questions together for the new doctors there. I understand that if she still has a lung infection, that needs to be cleared up first. How do they test the lung fluid to see if there is still an active infection?

My mom is 86 and thin, has no other medical problems, renal and heart function very stable.. We want them to do what they can even if there is a little risk. We need to get that congealed fluid out of the lung.

Thank you.

The doctor said today that tests were negative for infection, but I see now from talking to you that he probably just meant the blood test was negative for infection. Can they check her chest fluid directly now to see if there is active infection in her lungs? How would they get the fluid from her lung to test it?

Sorry, I'm just a medical transcriptionist, not a medical professional, so appreciate if you can "spell it out" for me. Thank you!

Okay, so first I need to ask the new doctor at WMC all about if there is any ongoing infection in the lung, if they did a thoracentesis there and what did the C&S show.

The next and main question is what can they do now.. It sounds like you're saying they can try to put some little tubes in. I guess thrombolytics are useless at this point since the fluid is so loculated

I just want them to try something.. don't want them to give up on her!

I'm talking to the doctor there now. They put tubes in, left side is draining but right side where most of hte loculations are drained a little, 10 mL.

Can they keep trying? What do we request now?

Thanks again.

Okay, I was just getting to that question to him and he asked if he could call me back shortly..

If they have the infection fully under control, and her blood pressure is stable, do you think they might be able to do the VATS sometime?

Thank you.

that is good news.. She was a very light smoker but quit over 35 years ago and has no other health problems. I want them to do everything to help that they can.

Waiting for the doctor there to call me back..

thanks so much

It sounds like you're saying that an infection is the main problem, and that is affecting her BP and heart rate? Is that right?

Edit: Or could it just be the lack of oxygen that is affecting her BP? They are giving her 100% now, and the other hospital it was 80%.

Thank you.

yes, that will be my first question about mom when when the doctor calls back, about the pleural fluid..What tests have they done on the pleural fluid, are there any signs of infection, etc. ?

Do you agree that the low BP is the main reason for not doing the VATS now? I know her age is a factor, too, but just wondering..

okay, that makes sense, I guess, because they said at the other hospital that she didn't even need a platelet transfusion or anything before they drained the fluid with a needle (1 L). Her INR was fine at that point, as were her vital signs. It seems like an infection is causing the low blood pressure now.

thank you. still waiting for the WMC doctor to call back now..

okay, I just got a call back from the new WMC doctor on duty there now in the ICU. He said he didn't have time to talk, but he did reply to my question that they sent off lung fluid cultures and are awaiting results.. He said Mom is on Zosyn and Vancomycin, and he mentioned broad spectrum antibiotics. He confirmed what you said that an infection is most probably causing her low blood pressure. I am going to the hospital tomorrow and will try to get more information about this infection and will let you know. Hopefully can get more answers tomorrow, because couldn't get much tonight from them. :(

Thanks so much for your help and concern.. I really appreciate it.

Thanks..

If you have any advice on how to fight this infection, though, I would really appreciate it. I am sure they are doing their best there at WMC, but I just want to be sure we are doing all we can.. My mom is the sweetest lady in the world. :)

That's good to know about the antibiotics.. it really sounds like WMC is doing everything possible at this point, for which I'm grateful.

Thanks so much, Dr. David. I'll be back tomorrow for the last time to give you an update and say goodbye (and give you an excellent credit rating/feedback).

You have given me the most detailed and helpful information of anyone so far, so I thank you again so much for that.

Well, just thinking now - you and also someone else here have been saying that I should find out about the lung fluid cultures, etc. The doctor in the WMC ICU tonight said that was sent out today for cultures (Mom just got there Friday night). I wonder when they get the results of the cultures back if they can put her on a more effective antibiotic? I remember almost a week ago when I talked to the doctor at Mt. Vernon Hospital, he said they had put her on the broad-spectrum antibiotics.

Do you think the results of her lung fluid cultures when they come back can pinpoint an especially effective antibiotic for her? Is that why you wanted me to ask them about the cultures? When do you think they will get the C&S back?

Thanks again..

Oh, okay, that will be my first question(s) tomorrow afternoon when I go to the hospital.. "Have the lung cultures come back yet and what did they show? What are the antibiotic sensitivities?" I didn't really understand that term "sensitivities" before, but now I realize that you want to use an antibiotic that is sensitive to that particular bacteria, in other words, by "sensitive" you mean it is particularly effective against that particular bacteria. So you want a sensitive antibiotic.

Did I get that right?

I assume they did a C&S at Mt. Vernon Hospital a few days ago when they took that 1 L of fluid out by needle.. I was going to ask them tonight at WMC what those records showed about the pleural fluid C&S from Mt. Vernon. The doctors there did not have time to answer my questions tonight,unfortunately, but I will really try again tomorrow to get full details of lung fluid culture results from both hospitals. Thank you for pointing out how very important this is. I will let you know what they say. If the resident there doesn't talk to me again, should I ask to speak to an attending? I don't want to be pushy and annoy anyone there, but I now realize how important this is..

Thanks again.

One of the residents tonight said she is on Zosyn and Vancomycin. Are those considered "broad spectrum" antibiotics?

Okay, I absolutely understand the importance of the C&S now. Won't stop until I find out some answers about it tomorrow so we can find the right antibiotic for her..

BTW, years ago I had a huge tumor wrapped around my small intestine. They didn't find it for a year, and I was down to about 80 pounds by the time of surgery when it was taken out. After that I had a chronic abdominal infection, could not gain weight, everything I ate gave me the runs, etc Finally, I tried colloidal silver, just a little. Within a week, my GI symptoms were 80% better and I steadily put on weight back to my normal 125 now. Wish there was some way to give her silver, but I know that's not accepted.

Anyway, thanks again so much for all your help.