What can be done for a case of Sepsis

Judy Siegel Itzkovitz

I am a 77-year-old man. About 18 months ago, I was treated for sepsis, and before that, I felt very tired and had little energy. I spent five weeks in the hospital for treatment. A doctor told my wife that I would probably die from this illness. I still feel very tired, and can do very little, insofar as work is concerned. I am taking 10 different medications, some for a heart condition, I had a coronary bypass operation about 11 years ago. There are times now when my heartbeat is very slow and my blood pressure is low. Is there anything that can be done concerning this? D.G., via email

Prof. Charles Sprung, a sepsis expert and head of the critical care unit at Hadassah University Medical Center in Jerusalem’s Ein Kerem, answers:

Sepsis is a potentially life-threatening complication of an infection and occurs when chemicals released into the bloodstream to fight the infection trigger inflammatory responses throughout the body. This inflammation can trigger a cascade of changes that can harm multiple organ systems, causing them to fail.

If sepsis progresses to septic shock, blood pressure drops dramatically, and this may lead to death. While anyone can develop sepsis, it’s most common and dangerous in the elderly and those with weakened immune systems. Early treatment of sepsis, usually with antibiotics and large amounts of intravenous fluids, improves chances for survival.

Patients with sepsis have at least two of these symptoms: a body temperature above 101 F (38.3 C) or below 96.8 F (36 C); a respiratory rate of more than 20 breaths a minute; and a heart rate faster than 90 beats a minute. Severe sepsis also involves at least one of these symptoms: much less urine output, a sudden change in mental status, respiratory difficulties, abdominal pain, abnormal heart pumping, or a lower platelet count.

Sepsis can cause several long-term problems, some of which you describe. Unfortunately, it is impossible to know what is the cause without a serious medical consultation. The answers may be determined by a complete history and a physical exam by a conscientious physician with a lot of time and patience.

My mother, who is 97 years old, fell on her backside four weeks ago and was told by the doctor that her tail bone is broken. She must rest and also must try to move a bit and walk a bit to activate her healing. She can hardly walk and can’t sit for long. She tells us that she suffers from a burning pain. She was told to take Panadol to ease the pain. What can we do to help her: M-T.H., Mauritius

Dr. Steven Velkes, head of the orthopedic department at the Rabin Medical Center-Beilinson Campus in Israel’s Petah Tikva, replies:

Unfortunately, there is not much they can do besides symptomatic treatment with analgesics (painkillers) and to move her about as much as possible to prevent pressure sores and pneumonia.

I am a 33-year-old African woman. Please, I need medical help – I am suffering from an ulcer. E.O., Nigeria

Prof. Shimon Bar-Meir, head of gastroenterology at Sheba Medical Center in Tel Hashomer, Israel, says:

Describing your symptoms may lead your doctor to suspect that you have a peptic ulcer, but it probably won’t help determine the type of ulcer, because the symptoms of stomach and duodenal ulcers are so similar. To make a specific diagnosis, your doctor may conduct several tests.

Endoscopy, in which a flexible fiber-optic tube is inserted down the throat to give the doctor a direct view of the inside of your esophagus, stomach, and duodenum, is the most accurate diagnostic test to diagnose a peptic ulcer. This makes it possible for the doctor to determine the presence and cause of bleeding and test for any bacterial infection. During this exam, your doctor may also conduct a biopsy to check for cancer.

For people who can’t have an endoscopy, a barium swallow (or upper gastrointestinal series of X-rays) can also allow your doctor to identify and locate the ulcer and determine its type and severity. The test requires you to drink a “barium milkshake,” which has a liquid that will show up on an X-ray. You may be asked to eat only bland, easily digestible foods for two or three days before the test. After drinking the chalky liquid, you lie down on a tilting examining table, which evenly distributes the barium around your upper digestive tract and allows the X-ray to capture images at different angles.

The chief goals of treatment are reducing the amount of acid in the stomach, strengthening the protective linings that come in direct contact with gastric acids, and – if your ulcer is caused by bacterial infection — treating the H. pylori infection with medication.

Your doctor will likely prescribe triple therapy, which is a combination of antibiotics, such as amoxicillin and clarithromycin, along with a proton pump inhibitor, such as omeprazole (Prilosec) or esomeprazole (Nexium). Metronidazole (Flagyl) can be substituted for amoxicillin in patients who are allergic to penicillin. In patients who have been repeatedly exposed to these antibiotics, or in areas where there is resistance to clarithromycin or metronidazole, quadruple therapy with bismuth (Pepto-Bismol), a proton-pump inhibitor, and 2 antibiotics (like metronidazole and tetracycline) is more effective. Regardless of the regimen, all medications should be taken for 10 days to two weeks.

I hope such treatment is available where you are.

If you want an Israeli expert to answer your medical questions, write to Breaking Israel News health and science senior reporter Judy Siegel-Itzkovich at judy[at]israel365.com with your initials, age, gender and place of residence and details of the medical condition, if any.

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