Need Advice. Patient In A Bad Way, Coughing And Struggling To Breath

BrianF

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My patient is a lab rat, who is 79 years old (in rat years) and is much loved by all the family.

If you seen him, you would notice that he has many classic hypothyroid symptoms. He has always had digestive issues. He has suffered a hiatus hernia for many years and has suffered from serious acid reflux so bad that it causes him to cough and at times he can't breath. His condition is being 'managed' by the local health service and what this means in practice is that they recommend PPIs, more PPIs and then some PPIs. When his health deteriorated again recently, as it obviously would, they prescribed steroids. Naturally, the steroids alleviated symptoms for a brief period but the patient is now in a very bad way as the course of steroids is ending and the symptoms are returning with avengance along with new side-effects associated with powerful steroid use.

The patient also has fibrosis of one lung, this was diagnosed 8 years ago, though it is a small part of the lung. I suspect this is not the root cause of the patients problem.

Unsurprising to me, the only times he has had any cessation of symptoms has been on occasions when he has been given antibiotics. Four years ago, after a serious life threatening bout of sepsis, the symptoms were eradicated for months (the Doctors couldn't understand why he got sepsis - "nobody knows how or why sepsis happens" said the highly educated, highly paid professional. Really? You don't think coughing up half digested ***t into his lungs might have something to do with it, I asked? "Certainly not", said the expert). The patient had been blasted by every antibiotic known to man for four weeks and even a special type was sent over from the states to be administered. This foreign import eventually done the job. But as I mentioned, no symptoms for a long time afterwards. Likewise, but for shorter period of 2-3 weeks when antibiotics were prescribed last year after my prompting seen the local GP succumb to the request for a prescription.

Now, my theory is that the root cause of this is hypothyroidism and the hiatus hernia. I think that without alleviating the hiatus hernia and increasing stomach acid, any benefits of further antibiotics will only be short-lived. And the patient will also be short-lived. So series is his condition.

RP mentioned that T3 could alleviate hiatus hernia temporarily and I think that thyroid supplementation would be a good starting point in forming a protocol for the patient. I would massively appreciate any suggestions, advice or help I can get on here.

Thanking you all in advance.
 

Blossom

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I'm sorry to hear about your loved ones issues.
You don't think coughing up half digested ***t into his lungs might have something to do with it, I asked? "Certainly not
I think you are on the right track and that comment leads me to think he may benefit from a swallowing evaluation if he has not had one already. In my area of the world a speech therapist is typically the person you would see to have this type of testing. Sometimes aspiration of food/drink into the lungs is obvious (due to a cough while eating) but sometimes it's trickier to pinpoint and that is referred to as silent aspiration. If it's occurring it sets up a viscous cycle of recurring pneumonia. I think making sure he is not regularly aspirating would be a good place to start. I'm sure there is more to the puzzle to explore but if his swallowing muscles are weak there are exercises and techniques that can be used to help him swallow better and protect his lungs.
Best wishes and I hope you get more input.
 
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BrianF

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With the benefit of antibiotics, have you considered giving him any of the antibiotics Peat thinks are safe to use daily, (carrot, mushrooms, bamboo shoots?)

I think the the situation is so bad at the moment that these wouldn't do much good. I view these as great ways of maintaining a relatively healthy intestine. But thanks for your input.
 
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BrianF

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I'm sorry to hear about your loved ones issues.

I think you are on the right track and that comment leads me to think he may benefit from a swallowing evaluation if he has not had one already. In my area of the world a speech therapist is typically the person you would see to have this type of testing. Sometimes aspiration of food/drink into the lungs is obvious (due to a cough while eating) but sometimes it's trickier to pinpoint and that is referred to as silent aspiration. If it's occurring it sets up a viscous cycle of recurring pneumonia. I think making sure he is not regularly aspirating would be a good place to start. I'm sure there is more to the puzzle to explore but if his swallowing muscles are weak there are exercises and techniques that can be used to help him swallow better and protect his lungs.
Best wishes and I hope you get more input.

Thanks
 
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BrianF

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My rat went to the specialist today and was advised to up the dose of steroids and keep taking the daily PPI. I'm shocked (not sue why). I live 500 miles away and I struggle to influence over the phone. I feel these 'specialists' don't know anymore than a bog standard physician and dispense the same drugs just in different doses. Very depressing, I need to do something. They are literally managing him to the grave.
 

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