Search for tag: "pneumonia"

Announcer: Need reliable health and wellness information? Don't listen to the guy in the cube next to you. Get it from a trusted source straight from the doctor's mouth. Here's this week's Listener Question on The Scope.

Interviewer: Dr. Tom Miller, we have a question here from Lisa in Sandy, Utah. She apparently had a cold and feels like she's over her cold, but yet this cough kind of is persisting. Is that something to be worried about? What is that? What's going on?

Dr. Miller: Usually, not. There's two points. One, could it be serious? Is this something that you need to worry about? And again, you go back to worrisome signs and symptoms. So if you have fever, if you either have a measurable fever and you're continuing to cough or you feel like you have a fever or you have night sweats, then that's something you need to get checked out. If you're coughing up a lot of sputum, you know, thick, gunky, smelly sputum, that's something you need to get checked out. If you have rib pain, if you're short of breath, that's something you need to get checked out.

Most of the time with a viral infection, an upper respiratory tract infection, you're sick for anywhere from three to seven days, and you get over it. I mean, you cough a little bit and you're hoarse, and then it goes away.

Interviewer: Are we talking about a cold when you say . . .

Dr. Miller: We're talking about a cold, an upper respiratory viral infection. I mean, everybody gets those in the winter and sometimes in the summer and spring, but mostly in the winter.

So what do you do? You have this cough. It's called a post-viral cough. It's not productive. It's annoying. It's probably due to the fact that the virus, which is gone after seven days, has irritated the bronchial lining and the cough receptors in your airways, and they continue to produce this cough reflex and you continue to cough. And it can go on for eight weeks, sometimes ten weeks.

Interviewer: What?

Dr. Miller: A long time. I know patients who have had chronic cough that's not productive after a viral illness, after a cold that goes on a couple of three months, and there really is no good treatment for it. A lot of those antitussives, those cough medicines you can buy at the store, they really don't work. And so it's nagging.

And sometimes though, patients who do have chronic cough might have asthma or might have asthma triggered by the cough, and so it doesn't hurt if you're really struggling with that cough to go see a physician to see if there could be something else causing it. You know that you haven't had any worrisome signs, you're not worried that you've got pneumonia or some other bad thing going on, but the cough is just driving you nuts, go see a physician about it. You might have an asthma variant of the cough, which could respond to treatment, inhaler or something like that. But a lot of times, you're just kind of stuck with it until it goes away, which is really bothersome, but we don't have great treatment for that.

Interviewer: And most of the time, that's what the case is after a cold and I continue to have a cough for two or three weeks afterwards.

Dr. Miller: Correct. Now again, the vast majority of patients that get colds, they get better, and only it's a small percentage with this chronic cough.

Announcer: Have a question? Ask it. Send your Listener Question to hello@thescoperadio.com.

Interviewer: Flu season 2016-2017 update. That's next on The Scope.

Announcer: This is "From the Frontlines," with emergency room physician Dr. Troy Madsen, on The Scope.

Interviewer: Dr. Troy Madsen's an emergency room physician at University of Utah Health Care. And a lot of times, he's going to see things happening in the community before the rest of us really even hear about it. And from what I understand, it's a pretty bad year for the flu this year.

Dr. Madsen: It sure is, and, again, I'm speaking from my perspective in the ER where we see the sickest of the sick. But I have seen some incredibly sick people who have had the flu. These are people who have come in. I've seen them. I assume they some sort of just severe pneumonia, some sort of sepsis, where the infection from a bacteria has spread through their body. I'm not finding any source besides the flu. And these are individuals where I ask them afterward, I say to them, "Well, did you get the flu shot this year?" And they say, "Absolutely, I did."

So we're seeing a resistant strain out there. We're definitely seeing people who are getting very, very sick with this who we're admitting to the hospital and I'm seeing quite a few people. And as I talk to other ER doctors, as I talk to our pharmacists in the emergency department, they say that's been pretty much reflective of what we're seeing across the board right now.

Interviewer: All right. So the flu season, you just never quite know when it's going to hit, but you're saying it's hit.

Dr. Madsen: It has absolutely hit.

Interviewer: And if you got the flu shot, you're going to want to take some other precautions as well because it could be a strain that wasn't vaccinated for.

Dr. Madsen: That's exactly right. And I don't have all the data to note how many of these strains that we're seeing now are going to be prevented by the flu shot versus how many of these are not. Again, I'm seeing a lot of cases of people who had their flu shot who are getting very sick from the flu.

But don't assume because you had the flu shot you can just walk around anyone who's sick and walk away just fine. You've got to wash your hands. You've got to try and avoid contact with people who are sick, if you can, certainly if they're family members, just practice basic health hygiene. Try to stay well, but know that you may have the flu, even if you had the flu shot and you get sick.

Interviewer: So as an emergency room physician, how do you not get the flu then? Because, I mean, you're around all these really sick people with the flu.

Dr. Madsen: Yeah, it's a challenging thing. If people come to the ER with flu-like illnesses, in the triage area, they automatically put a mask on them because it's spread by droplets when they're coughing and sneezing. That's one thing you can certainly do at home. We wear masks in the room as well. Certainly hand washing, making sure we're doing that frequently. You know, it's basic hand washing and basic sanitation practices you'd do at home as well.

Interviewer: All right. And probably can't predict this. Do you think it's going to get worse?

Dr. Madsen: I do. I mean, given the increase that we've seen just in the last couple of weeks, I expect we're going to see this get worse over the next month And it could be a pretty significant flu season for us.

Announcer: Want The Scope delivered straight to your inbox? Enter your email address at thescoperadio.com and click "Sign me up" for updates of our latest episodes. The Scope Radio is a production of University of Utah Health Sciences.

Interviewer: Why is pneumonia so dangerous? That's next on The Scope.

Announcer: This is "From The Frontlines," with emergency room physician Dr. Troy Madsen on The Scope.

Interviewer: It's a little shocking, but when you look at the top 10 causes of death, pneumonia comes in at number eight. Doesn't seem like something that should be that deadly, but it is. Dr. Troy Madsen's an emergency room physician at University of Utah Health Care. Why is pneumonia so dangerous? Why is it so deadly?

Dr. Madsen: Well, pneumonia's deadly because, you think about the ABCs, we talk about that, and that's exactly what pneumonia hits. The airway and the breathing. So the first two things, number one and two priority. When you've got something like pneumonia and it settles in, it could take a person pretty quickly, and I think it makes it on the top 10 list because really the people it affects are old people. Pneumonia has been called in the past "The Old Man's Friend", you may have heard that term. I don't know what a great friend it is, but...

Interviewer: Yeah, it doesn't sound too good to me.

Dr. Madsen: But the idea is that it's one of these things that historically has taken an older person and essentially gradually ended their life. It often eases them into death. It's often not a struggle or a horribly painful death, historically. I think that's why it got that term. But it is something, when we talk about deaths, we're talking primarily about older people who get pneumonia.

A lot of times, in those older people, you may not recognize pneumonia until it's really progressed just because older people are less likely to have fevers, they are less likely to maybe even report they have pneumonia. Maybe they don't have a good cough reflex, they've been aspirating, or breathing food or water into their lungs. So gradually, it's been building up in there. And then when you realize they have pneumonia, it's progressed quite a bit.

So these are the individuals who then come in the ER and we see them and they just have a very severe pneumonia. Maybe no one's been checking on them too much, maybe they're already a little confused all the time, and then they just seem just a little more confused and that may be the only sign of it. So pneumonia, that's who it hits, and that's who it hits pretty hard. That's really why pneumonia is one of the big killers.

Interviewer: And what exactly is going on with pneumonia? You catch it like you'd catch anything? It's a virus, a bacteria?

Dr. Madsen: Pneumonias can be caused by viruses, but typically when we're talking about pneumonias that kill people, we're talking about bacteria. The pneumonia gets in their lungs, works its way down in there, the bacteria get in there either through something they were exposed to that gets down in their lungs, or they have what's called aspiration pneumonia where they're breathing something into their lungs, and then that sets them up for a bacterial infection to settle in there.

Maybe they had a virus, maybe even the flu. The flu can cause inflammation in the lungs, weaken it, make it more likely for bacteria to settle in there. Whatever it is, typically the serious pneumonias are caused by a bacteria that get in the lungs, maybe just one side of the lungs, maybe it's both sides, maybe it's the upper part, the lower part. Different bacteria tend to attack different places in the lungs.

But the bottom line is that bacteria get in there, causes an infection that just continues to grow. That then causes them to have more difficulty breathing. They're not moving air into their lungs as well, not getting oxygen in their body. And then that infection, like an infection anywhere, can then affect the entire body, where it just causes the blood pressure to drop, causes the heart rate to go up. The blood pressure just can't sustain itself and that whole cycle is what eventually leads to death.

Interviewer: Wow. It's a little scary that you say that a lot of times people don't realize that Gram or Grandpa have it. How do I know? Is the breathing a noticeable symptom? Difficulty breathing is pretty noticeable?

Dr. Madsen: It is. It is. Difficulty breathing and, often, the signs are very subtle. Maybe your grandparent or your parent or friend, maybe they're just not acting quite right. They just seem a little different, little more confused. Maybe a little bit more of a cough. Something where in a younger person, you might think, "Ah, they just got a little something in their throat, maybe a little bit of a cold." Just even a little bit more of a cough can be a sign of something really serious in an older person.

Interviewer: So those minor coughs in an older person is something you really should pay attention to? Gotcha.

Dr. Madsen: Exactly. If someone comes in with a minor cough, absolutely. That's something where you definitely want to get a chest x-ray on them to see if they do have something down in their lungs.

Interviewer: All right. If somebody gets to you in time, is it reversible?

Dr. Madsen: It is, yeah. Most cases, we can treat with antibiotics, maybe we can treat them at home, just depending how they're breathing, how their vital signs look, looking at their blood work. Maybe they require hospitalization. But it's those severe cases where they're just really having a hard time breathing, those are the tough ones. And often, those cases, when someone comes in we have to intubate them, put a tube down their throat to breathe for them. Those are the really tough ones for them to come back from, just because it's so advanced.

Interviewer: What's the advice that you would have for somebody that has an older parent or grandparent? The takeaway that I'm taking, and maybe this isn't right, is if you're noticing the confusion and maybe just a cough that you might normally blow off for yourself, but it's an older person, take it seriously.

Dr. Madsen: That's exactly right. Don't expect them to have the same symptoms you're going to have. Don't expect them to just look absolutely miserable and have really high fevers and just be coughing incessantly. Can be a subtle cough, maybe just a little bit of a fever, something that's not even quite a fever. Or just they're a little bit more confused. Those are all signs that they probably need to get checked out.

Announcer: thescoperadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at thescoperadio.com.

Interviewer: A patient comes in to the clinic with an infectious illness that the doctor can't quite put her finger on. What's causing it? We'll talk about a new way to find out, up next on The Scope.

Announcer: Examining the latest research and telling you about the latest breakthroughs. The science and research show is on The Scope.

Interviewer: I'm talking with Dr. Robert Schlaberg, an assistant professor of pathology at the University of Utah, and a medical director at ARUP Laboratories. Doctor Schlaberg, let's imagine this scenario - a child is brought in to the emergency room with symptoms of shortness of breath, fever and coughing. There can be a lot of causes for this type of illness. First of all, how do doctors typically diagnose a patient like this?

Dr. Schlaberg: Yes, so a patient with suspected pneumonia, which this child may have, requires a battery of tests. So usually nasopharyngeal swab, an upper respiratory track specimen is collected through the nose from the child, and probably a blood sample will also be collected for culture, and then a large battery of tests is run on both of those samples. These tests generally work well if a common cause actually is responsible for this patient's disease. However, in about 20% or so of children, no cause is found with the standard approach.

Interviewer: You've helped develop a tool called Taxonomer, how is it different?

Dr. Schlaberg: So with the current approach, one has to know what a test is supposed to detect. So we call this a differential diagnosis. So the physician who sees the patient has to decide which bacteria or viruses to test for in this child. The tests we're developing aims to do away with this guess work and provide an answer or a way to detect any virus specter or fungus in a patient's sample.

Interviewer: So you perform this test, what's the output?

Dr. Schlaberg: The output is a list, or in this case a graphical representation of all microbes that are present in the patient's sample.

Interviewer: And so how do you do that?

Dr. Schlaberg: So we take the patient's sample and we extract RNA and/or DNA from the sample . . .

Interviewer: And that's the genetic material?

Dr. Schlaberg: That's the genetic material from the patient as well as from anything else that's in the specimen.

Interviewer: So basically you're cataloging all the genetic material that's in a patient's sample?

Dr. Schlaberg: Yes, exactly.

Interviewer: So how do you go about figuring out . . . when you have this long list, how do you go about figuring out which one is the likely candidate cause for the disease?

Dr. Schlaberg: So the easiest scenario is if there is a known pathogen, say influenza virus. If we find influenza virus in a patient who has symptoms that match influenza, then the general assumption is that that's the cause of the patient's symptoms. The same is true with current tests.

Interviewer: But I guess the other important thing here which we alluded to earlier is that, there are many types of influenza viruses so knowing exactly which one could help tailor the treatment for that particular person?

Dr. Schlaberg: Yes, it can, as the genetic information for, in this case influenza virus, is read out by this test and there are known changes in the genome, known mutations that can cause drug resistance. You can also, at the same time, determine if the standard therapy is likely to work or not based on those known mutations.

Interviewer: So having this really accurate diagnosis can really maybe save time and money, and just wear and tear on the patient.

Dr. Schlaberg: Yes, absolutely. Oftentimes the correct diagnosis is delayed by the need to test with multiple amounts of testing. If their first round of testing comes back negative, then the next most likely causes are tested for. This test offers the advantage that it's one stop shopping. It's a catch-all test that doesn't require follow up testing.

Interviewer: How else do you think that this tool can be used?

Dr. Schlaberg: One challenge and also great opportunity of using this testing methodology is to learn more about what other factors may influence the disease severity of a given patient, because we know that two patients who are infected with the exact same virus may present very differently. So the difference could be due to factors that lie with a patient such as genetic predispositions, but they could also be related to the nonpathogenic, normal bacteria that reside in these patients respiratory tract. So that's a very active field of investigation, how different pathogens interact with the normal bacteria, and how that can influence the disease severity.

Interviewer: Interesting. Okay, so instead of just looking for the causative microorganism, you can look at the whole array of what's in there to understand whether that's influencing how the illness manifests itself?

Dr. Schlaberg: Yes, absolutely, and all that information has been ignored previously.

Interviewer: Okay, interesting.

Dr. Schlaberg: The longer term goal is to put all of these layers of information together, and improve accuracy of the diagnosis, and better informed treatment decisions.

Announcer: Interesting, informative, and all in the name of better health. This is The Scope Health Sciences Radio.

Dr. Jones: What can you do to prevent hearing this sound in your home? That's the sound of whooping cough, the sound no mother ever wants to hear. Whooping cough is on the rise in the U.S and can be deadly to infants. This is Dr. Kirtly Jones from Obstetrics and Gynecology at University Health Care and this is the scope of the problem of pertussis known as whooping cough, on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Dr. Jones: Whooping cough is the familiar term for pertussis, a bacterial infection that causes a breathing problem in particular, a very particular cough. There has been a 1000% increase in the incidence of pertussis in the U.S since 1990. U.S has experienced a resurgence of pertussis and since 2010, we see about 10,000 to 50,000 cases of pertussis each year and it's reported in every state.

In 2012, we saw the most cases that we had seen in 60 years. There were 48 ,000 reported cases of pertussis and over 2000 of those were in infants younger than three months of age and 15 of those infants died. Most pertussis deaths are in infants who are too young to be protected by their own vaccine.

Pertussis can cause serious and sometimes life threatening complications in infants, especially in the first six months of life. In infants younger than a year who get pertussis about half are hospitalized. The younger the infant, the more likely treatment in the hospital will be needed. Of those infants who are hospitalized, about 67% will have breathing problems, stop breathing, 23% will get pneumonia and over 1% will die.

How do we protect our infants? We all had vaccinations when we were little and boosters later. At least we should have. However, the vaccination doesn't protect forever. The recommendation is to immunize all pregnant women between 27 and 36 weeks so the newborn can have maternal antibodies in their blood and that come through their placenta. This will help protect the infant until they are able to make their own antibodies from their own vaccine at about two months of age. Moms can also transmit the antibodies that they got from their vaccine during pregnancy through their breast milk.

Waiting until the baby is born to get the vaccine may be too late for the mom to get it in their breast milk and won't directly protect the baby as much. Moms should protect themselves with vaccinations. About 30% to 40% of infants who got whooping cough got it from their moms. But giving the antibodies to babies through the placenta and breast milk helps protect the baby from other members of the family. So moms could get vaccinations with every pregnancy. Easy, right?

Since 2011 when the Tdap vaccine recommendations were issued, vaccinations rates with Tdap among pregnant women have been low, when survey of pregnant women from 2011 to 2012 estimate that only 2.6% of women had received Tdap during their most recent pregnancy. Babies should also be cocooned. Every member of the family that's going to have contact with the baby should have a Tdap in the last five years. I have to get one just because I work in the hospital. The Tdap vaccine does not have any active bacteria, it doesn't have thimerosal, a mercury preservative that's concerned some groups, and severe side effects are very rare.

So what to do? Get your vaccine when you're pregnant. You can get the Tdap and the flu vaccine at the same time. Get the family members to update their vaccines to cocoon the baby in a pertussis-protected home. Breast feed your baby and get babies their own vaccines when they are scheduled for them. Let's not have to hear that cough. Thanks for joining us on The Scope.

Announcer: TheScopeRadio.com is University of Utah Health Science's radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook on TheScopeRadio.com.