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Mom is 91, chf, vascular dementia post stroke, post broken hip repair, pacemaker a month ago. 15/15 on last mini mental but can't reason her way out of a paper bag. Do we find a pulmonologist to figure out if she needs a chest tap? She is very out of breath if she rises from wheel chair to use the bathroom. Won't / can't participate in activities. Leave well enough alone?

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V, we had a care meeting yesterday. I asked them a couple of days ago on the phone and again yesterday, if it was time for Hospice. They said no. I was not all that happy to put in the pacemaker; she's got vascular dementia, but still knows us all (and of course is "as sharp as a tack" according to some folks"--she did get a 15/15 on her last mini-mental, but she can't reason from facts anymore). My brother has POA and ultimately, we decided that we should ask HER whether she wanted a pacemaker or not. It's not an extraordinary measure. She had breast cancer 22 years ago and lived with my dad the smoker, so yes, she's probably got either metastasis from the one or primary lung cancer from the other. She's lived a good long life and yes, she still has decent quality of life in the NH, enjoys her family visiting, stories and occasional visits from her greatgrandson. Wish I could get the MEDICAL staff to be a bit more forthcoming about this stuff. thanks a great deal, V. You confirmed what I've been thinking. Best, Barbara PS, thanks for the PE/Pleural Effusion clearup!
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"PE" stands for pulmonary embolus, a different problem altogether so probably sound our or spell out "effusion" when you tell or write about it. One of the few things we don't have a distinctive abbreviation for. And the nurse may have been trying to avoid telling you that although pleural effusion is most commonly caused by pneumonia, it may not be in this case. It is also probably not cardiac if just on the one side and not both...

...and, well, probably no use beating around the bush here, Ba8alou, the atypical cells and the fact that it's not going away with antibiotics suggests cancerous tumor, primary or metastatic in that lung. The decision to put in the pacemaker probably reflects a reasonably good quality of life, and you may have more decisions to make. It may be valid to limit investigations for cancer if she could not withstand treatment for it ,but every case is different and there are a lot of things to consider. It is usually very possible to keep someone comfortable and ease their breathing, even repeating the pleural (chest) tap as needed will bring some relief most likely. Ideally, if you can handle it emotionally, let the staff know you are ready, bring that box of Kleenex and ask the doc to give you the straight story.
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As usual, I should have given you guys more information. Mom is in a Nursing Home, APRN sees her every day. She's had three rounds of antibiotics, which have not cleared what they are seeing on Xray. When I asked the RN at today's care meeting what difference was between Pneumonia and PE, she said, oh, the PE is pneumonia (!). She was in the hosptial late last month when she fell and her heart rate dropped to 37 and couldn't be moved. They did a pacemaker. She is in an airconditioned environment, low salt diet. We are trying to avoid trips to the ER. She's having a blood draw today, so we will have a BNP number; cardio in the hospital said that her heart still appeared to be in pretty good shaped, but she's got aortic insufficiency. Her chest was tapped about 18 months ago; they took out a lot of fluid, found some atypical cells. we declined the bone marrow biopsy. She was left with a small, but stable PE. But it seems to be reappearing. She is no longer getting PT; she was cleared for walking with her walker alone, but is declining to do it due to her shortness of breath, except to go to the bathroom.
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Pneumonia is an inflammation of the lung(s) usually accompanied by alveolar fluid build-up, i.e. "fluid in the lung(s)." It can be viral, bacterial, parasitic, and occasionally idiopathic.

Pleural Effusion is a build-up of fluid in the pleural space surrounding the outside of the lungs. It is usually caused by other pre-existing conditions; bacterial pneumonia, cancer, PE, left ventricular failure, etc.
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Good article on pneumonia and the causes:
healthline/health/pneumonia#Overview1

Pneumonia can be caused by a fungus, virus or bacteria, or other agents

Pneumonia shots innoculate against only one kind of pneumonia.
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Pleural effusion can be associated with infections like pneumonia, of heart failure, or even tumors in the lung. To find out more exactly what is going on and if it might impact what interventions you might want if nothing else for her comfort, you should probably go to her regular non-specialist physician who knows her best, i.e. internist, family practice doc, or geriatrician. A lot of people choose to give a round of oral antibiotics under these circumstances and do other things that don't require hospital stay. It may be completely reversible with simple, tolerable treatment; it may on the other hand be hospice time. I always wanted all the diagnostic information I could get for my folks but sometimes treatment decisions were made, generally sound ones, without knowing as much as you might otherwise want to know.
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Another thing-she may have a pulmonary embolism (blood clot)going on. I don't mean to scare you, sorry. She needs medical attention...
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Pneumonia is bacterial, kind of like a spot inflamed on a lung. Effusion is fluid on the lungs which a diuretic (if it's small) can take care of it, or it needs to be tapped if it's a lot of fluid. You need to take her to a dr. She can be out of breath for a lot of reasons...
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What are her symptoms and reason why you suspect pneumonia or pleural effusion?

Signs of pneumonia are congestion, respiratory difficulty and greenish sputum. If she has those, a trip to the ER is indicated.

I'm not a medical person and could only give you a definition of pleural effusion based on one of the medical sites.

How long has she been out of breath? Is she getting any PT, or any exercise? Is she on oxygen?

Given your concerns, I think I'd take her to the ER; even if she doesn't have a pulmonary or cardiologic emergency, you'll at least know that you avoided something more seriuos, then can see follow-up doctors based on the ER diagnosis.
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Hopefully you weigh her every day. When weight jumps 2 or more pounds at a time, you are looking at fluid buildup. You stick with your cardiologist and you hide the salt. You have her sign the Advanced Directives now. You make sure you have DPOA and Health Care Proxy. You ask about when it will be time to call in Hospice. Summer heat and humidity are very hard on CHF patients.
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