Dr. Amit Jauhari
Pulmonology (Asthma Doctors)
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
Please tell me an opinion on the prognosis for a patient being treated for COVID-induced bilateral pneumonia. Also, kindly tell me if she is responding to the treatment well, and do we need to get her blood reports or X-rays checked?
Hi,
Welcome to icliniq.com. Based on the reports sent (attachment removed to protect the patient's identity), my observations are 1) Initially, pneumonia was present in the lower zone in both the lungs. In the last X-ray, only the right lung is affected (although improved from earlier). 2) Patient has diabetes (on injection Insulin), hypertension, CAD (coronary artery disease). He is under antihypertensive and cardiac drugs. 3) BP (blood pressure) is continuously high. However, you have not mentioned sugar levels (Maintain sugar levels thoroughly for improvement). Overall, the situation seems better. However, if you have additional questions, do contact me. Wishing Speedy Recovery.
Patient's Query
Thank you doctor,
Is the left lung almost recovered, and the right one still has some traces? Does it look like there is any trace of fibrosis in the lungs? Also, the patient is on biphasic positive airway pressure (BiPAP) or noninvasive ventilation (NIV). I wanted to ask about the fluctuating white blood cells (WBC) levels. Why does that happen? Hopefully, the infection is not increasing. Would you suggest anything for appetite as well?
Hello,
Welcome back to icliniq.com. The blood glucose levels are well maintained. Fibrosis can be detected in HRCT (high resolution computed tomography) of the lungs. With the right lung still recovering, some fluctuations are normal. D-dimer indicates the clot-forming ability in COVID patients. High D-dimer values are considered dangerous, as clots may form, causing cardiac events. On the whole, I think the care and treatment for the patient are good. For appetite stimulation, syrup Cyproheptadine may be given after consent from the treating physician. Regards.
Patient's Query
Thank you doctor,
Also, the patient has swelling in her left leg for the past seven to eight days throughout her thighs, calves, and metatarsals. The leg is positioned in elevation as well, so I want to know why and how we can reduce this and why it is happening? She had varicose veins four years ago. Would you suggest using compression socks or a DVT pump for the same? She has sensation and does not feel any pain, though. Another point is, she is being administered injection Clexane 0.6 ml once a day, should the dosage be given twice a day. Advice on this will be greatly appreciated. Also, because she is connected to NIV or BiPAP, should we also be careful of the black fungus mucormycosis? Any hygiene tips or things to look out for in advance? Thank you.
Hello,
Welcome back to icliniq.com. Injection Clexane (Enoxaparin) dosing is correct and is being monitored by tests. The leg swelling can be due to multiple reasons, and DVT (deep vein thrombosis) prevention technique may require elevating to a certain degree to facilitate blood flow. Antifungal medication is being administered to the patient in current therapy. Consult with treating physician and send a throat and nose swab culture for bacterial and fungal pathogens. I also request you to have patience and faith in this challenging moment of your patient's health. The care and management of your patient are good, and hopefully, recovery will be soon. Regards.
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Pulmonology (Asthma Doctors)
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