Post-Necrotizing Pneumonia Recovery Challenges
Hello everyone, I wanted to share an update regarding my brother, who is 17 years old and had a significant health crisis. Standing at 6'2" and weighing around 95 kg before his illness, he now weighs approximately 73 to 75 kg after spending 4.5 months in the Intensive Care Unit due to necrotizing pneumonia, which was accompanied by flu, S. aureus PVL+, and pneumococcus, ultimately leading to septic shock. While I am grateful that he survived, he has been left with serious consequences, including the loss of half of his left foot and several toes on his right foot. He recently attended a follow-up appointment in the pulmonology department, and unfortunately, the news was not very promising. I’m seeking insight on the results he received to understand if there’s potential for recovery or whether some conditions might be lasting. Here are the translated findings from his recent tests: 1. **Blood Gas Analysis (with reference ranges)** - pH: 7.47 (Norm: 7.36-7.44) - pCO2: 3.73 KPa (Norm: 5.00-5.60) - PO2: 12.88 KPa (Norm: 11.17-13.83) - Bicarbonate: 20 mmol/L (Norm: 22-24) - Total CO2: 21 mmol/L (Norm: 23-25) - Base Excess: -2.6 mmol/L (Norm: -2.00-2.00) - O2 Saturation: 98% I recognize that the elevated pH is a result of the diminished pCO2. However, is it typical to see such irregular results at this stage? Will these values likely normalize over time? The A-a gradient is measured at 18 mmHg, while the expected maximum is 6 mmHg, indicating that oxygen transfer from the lungs to the bloodstream isn't functioning optimally, despite his excellent O2 saturation. Can we anticipate any improvement through respiratory physiotherapy? 2. **Pulmonary Function Tests** - Total Lung Capacity (TLC): 5.73L (77% of normal) - Forced Vital Capacity: 3.74L (61% of predicted) - FEV1: 2.90L (56% of predicted) - DLCO: 16.32 mL/min*mmHg - KCO: 63% Given that his lungs were severely compromised with 75% infection and could only handle 10-30 mL of air at some points, I’m not too surprised by these results. Is it possible for him to achieve more typical lung function with respiratory therapy? What additional measures could assist in recovering lung capacity? 3. **Imaging Results** His pulmonary artery shows dilation; it was recorded as being 31 mm with PA:A > 1 and this condition has remained stable since his ICU admission. Additionally, he has been diagnosed with varicose bronchiectasis. While it seems the bronchiectasis may be permanent, I am keen to understand its long-term effects. Will this condition significantly hinder his quality of life, or are there effective ways to manage it and maintain control over the symptoms? I apologize for the lengthy message, but since I am overseas and was unable to join my brother at his appointment, I appreciate any insights or advice you can offer. Thank you for your assistance!
Answers (1)
7/1/2025, 9:20:58 AM
OpenHealth AI
Thank you for sharing your brother's situation. It’s clear that he has been through a significant health crisis, and your concern for his recovery is completely understandable. Here’s an overview to help you better understand his recent test results and the potential for recovery.
Key Points:
- Blood Gas Analysis: Your brother's results indicate some metabolic imbalances, notably a slightly elevated pH and decreased pCO2.
- Pulmonary Function Tests (PFTs): These show reduced lung function, but improvements are possible with appropriate therapy.
- Imaging Results: The presence of bronchiectasis and pulmonary artery dilation needs to be monitored, but management options are available.
Explanation of Test Results:
-
Blood Gas Analysis:
- The elevated pH and low pCO2 suggest metabolic alkalosis, which can occur due to several factors including hyperventilation or compensation for previous acidosis. It's not uncommon to see irregularities after such a severe illness, especially post-respiratory infections.
- Next Steps: Regular follow-ups with his healthcare provider will be essential to monitor these results over time and determine if they stabilize.
-
Pulmonary Function Tests:
- The tests indicate a significant decrease in lung capacity and function compared to normal values. The results reflect the serious impact of necrotizing pneumonia but improvements may be feasible with targeted intervention.
- Next Steps: Engaging in respiratory physiotherapy is highly encouraged. Techniques might include breathing exercises, incentive spirometry, and physical rehabilitation to gradually improve lung function. Consistency here is vital.
-
Imaging Results:
- Bronchiectasis indicates permanent changes in the airways, which may lead to chronic symptoms like coughing and increased mucus production. However, many individuals with bronchiectasis lead active lives with management strategies in place.
- Next Steps: A dedicated treatment plan can help manage symptoms. This may include bronchodilator medications, regular chest physiotherapy, and possibly antibiotics during exacerbations. Regular monitoring via imaging can also help assess any progression.
Actionable Recommendations:
- Monitor Symptoms: Keep a symptom diary for changes in breathing, fatigue, or any new symptoms. This will be helpful for follow-up appointments.
- Engage in Rehabilitation: Start respiratory physiotherapy as soon as feasible. Discuss with his rehabilitation team to tailor a plan to fit his needs.
- Action on Bronchiectasis: Consult the medical team about a comprehensive management plan for bronchiectasis, including medication and lifestyle modifications to keep symptoms in check.
- Ongoing Support: Regular follow-ups with the pulmonology team are essential to assess his recovery progress and adapt treatment as necessary.
Your brother's recovery journey may take time, but with careful management and support, he can regain functional abilities and improve his quality of life. It's important to stay hopeful and proactive. If you have any further questions or need more specific advice on any point, feel free to ask.
Related Questions
Experiencing Herniated Disc Symptoms During Early Pregnancy
I'm sharing this on behalf of my wife, who doesn't participate on Reddit. To provide some context, we faced infertility challenges for several years. We began our journey with IVF in 2021, but she had to delay her first attempt due to persistent lower back pain and sciatica. Later that year, specifically in November, she underwent a discectomy for her L4 and L5 vertebrae to address the herniated disc since physical therapy and injections weren’t effective. After completing three IVF cycles, she became pregnant in 2023 and welcomed our daughter in February 2024. Moving to the spring of 2025, we contemplated another embryo transfer for a second child. At that point, her back issues had mostly improved, with occasional mild discomfort. However, close to the embryo transfer, she began experiencing lower back pain again, but we proceeded with the transfer regardless. Currently, she is 6 weeks along and is encountering significant sciatica symptoms, which include pain running down her leg, coupled with some weakness and numbness. We consulted her neurosurgeon, who is looking into whether an MRI could be performed. The initial recommendations advised against it, but her obstetrician reassured us that it would be permissible. We find ourselves uncertain about the next steps to take. Has anyone gone through something similar, or can anyone suggest effective treatment options if medical intervention seems limited? Her neurosurgeon appears to lack experience with cases involving pregnant patients, leading us to consider obtaining a second opinion.
Freckle Observation on Bottom of Foot
**Summary of Current Situation:** I am a 29-year-old female who recently had a follow-up appointment with a podiatrist regarding arthritis in my toes. During this visit, the doctor examined the sole of my foot and discovered a freckle that wasn't noted during my previous appointment in December. He expressed his meticulous nature regarding the monitoring of freckles on the soles of feet. The freckle measures approximately 5mm by 5mm and has an irregular shape with signs of hyperpigmentation. Moreover, it appears to have grown over time. Due to these observations, the podiatrist advised that I undergo a biopsy. Interestingly, I had an annual dermatological examination just two weeks prior, and no concerns were raised about this freckle at that time. As a precaution, I have arranged a follow-up appointment with my dermatologist for tomorrow to obtain a second opinion on the matter. I wonder if others find this situation alarming?
Struggling with Persistent Neck and Head Discomfort After Workouts – Seeking Guidance
Hello! I’m a 19-year-old female and have been dealing with unusual neck and head sensations that seem to linger. I would greatly value any advice or shared experiences. **Background:** - I maintain an active lifestyle, engaging in weight training four to five times weekly, plus running once or twice. - My workouts take place at Planet Fitness, focusing on muscle toning rather than heavy lifting. - My height is about 5’7” and I weigh approximately 126 lbs. - Although I do not have any severe health issues, I experience dizziness upon standing, occasionally leading to fainting spells. My physician indicates my blood pressure is normal, but I suspect it might be lower than what’s ideal. - I should mention that I take Adderall and Sertraline for managing ADHD and anxiety symptoms. - I also struggle with sinus issues due to narrow nasal passages, making it harder to clear mucus during colder seasons and increasing my susceptibility to infections. **Medical Evaluations:** - Blood tests returned normal results. - A neurologist examined me and found no neurological impairments. - An MRI revealed no abnormalities. **Onset of Symptoms:** The trouble began in early May, particularly while performing hip thrusts. I noticed a peculiar sensation in my sternocleidomastoid (SCM) muscle, feeling as if it was catching near a lymph node below my jaw, particularly when my chin was tucked and my head unsupported. Though there was no pain, it was disconcerting. Despite this, I continued with my workouts. Since then, the lymph node in that area has remained tender to the touch. Typically, I conclude my workouts with abdominal exercises, which include: - Weighted decline sit-ups - Hanging leg raises - Weighted toe reaches - Using the ab slide at Planet Fitness After completing decline sit-ups one day, I stood up and experienced lightheadedness along with fullness in my ears, as if they needed to pop. I thought nothing of it. Later that evening, while washing my hair, tilting my head back intensified the soreness in my head. When returning to an upright position, the discomfort escalated further — this sensation mirrored the angle from the decline abs. Keeping my mouth open worsened it too. In the following days, sipping liquids induced soreness in my neck, which felt strained and overworked. When I began to see a bit of recovery, I returned to the gym, and although my workout seemed typical that Saturday, I became dizzy again post-session, had fullness in my ears, and later experienced an extremely unusual headache: - It initiated at the lower right section of my head. - The pain radiated upward and was predominately isolated to one side. - It felt dull and throbbing, with a pattern of emergence and retreat. - This headache persisted for five days. - Even as it subsided, my head maintained a peculiar sensation, as if under pressure. **Current State:** Since that episode, the discomfort has fluctuated. There was one particularly tough week marked by: - Severe, migraine-like pain behind my right eye. - Intense tiredness, feeling as though my brain was completely exhausted. - No amount of rest seemed sufficient. I took a substantial five-day break from exercise and changed contact lenses, which brought some relief to the eye discomfort. However, upon attempting light abdominal workouts again, I found my neck felt tight and activated, regardless of how cautious I tried to be. Additionally, there was notable pressure at the base of my skull on the right side, especially when I turned my head. - The more intense pain has subsided, but I remain anxious about its return. - I’ve refrained from any neck-straining movements, but I miss the freedom of exercising without fear. - Occasionally, I wake up with a sore head and overall tightness. - This situation has been disheartening as exercise typically brings me happiness. **Seeking Opinions:** Has anyone else encountered peculiar pressure headaches, neck or SCM strain, or eye discomfort following ab exercises or hip thrusts? Could this issue be cervicogenic, nerve-related, or muscular in origin? I welcome any insights, similar experiences, or recommendations for specialists to consult. My hope is to recover and confidently resume my training without this ongoing anxiety. Any thoughts would be greatly appreciated!
When Should You Return to the Doctor?
A 20-year-old woman, standing at 5 feet 8 inches and weighing 150 pounds, who does not smoke, is currently on several medications including metoprolol, Allegra, a birth control pill, amitriptyline, zofran, and ketamine troches. She has a history of asthma, allergies, POTS, prior sinus surgery, along with other unrelated health issues. Recently, she returned from a rainy and humid trip to New York, only to find herself back home in the arid conditions of Idaho, which exacerbated her allergies and asthma significantly. Over the course of several days, she experienced relentless coughing. Last Tuesday, she sought help at urgent care due to shortness of breath. Tests ruled out any other illness, and she was prescribed prednisone for a brief period alongside a new inhaler, with instructions to return if any infection symptoms emerged. By Thursday, she woke up with severe ear pain and experienced hearing loss. Upon returning to urgent care, she was diagnosed with an ear infection and started on amoxicillin. After completing the steroid treatment and 11 doses of antibiotics, she hasn’t seen substantial improvement. Although the coughing has decreased, it remains significantly above her normal level, accompanied by excessive mucus that complicates her breathing. The ear infection has worsened, and pain has extended to her sinuses. Now, she wonders whether she should revisit urgent care, consult an ENT specialist, or complete her course of antibiotics first. Despite experiencing various infections and health challenges before, she has never encountered anything quite like this. Additionally, her POTS condition has intensified due to the coughing, resulting in considerable chest discomfort, although imaging conducted at urgent care yielded normal results. Moreover, it’s worth mentioning that her profession involves music, and this infection has severely impacted her ability to perform. Should she pursue further medical assistance?
Understanding Migraines: A Deeper Concern?
I am a 29-year-old woman who has suffered from migraines since I was a child, around 2 or 3 years old. Throughout the years, I have struggled to identify any specific cause or triggers for these headaches. My healthcare providers have never seemed alarmed by my condition, and none have recommended diagnostic imaging or further testing. I have explored numerous remedies but eventually resigned myself to managing these headaches as a regular aspect of my life. Recently, I have begun to experience additional troubling symptoms, including episodes of vertigo, increased clumsiness (which my friends have noticed), and intense nausea, all while the frequency of my migraines has surged. A few weeks ago, I experienced what I suspect to be a hemiplegic migraine, which led me to mistakenly believe I was having a stroke. Despite these new developments, my physician seems unfazed. Given this context, I find myself wondering if I should advocate for imaging or other tests to gain a clearer understanding of my situation, or am I perhaps overreacting? I appreciate any guidance or insight you can share!