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Cardiomegaly with Pulmonary Edema/ Sever Pneumonia and Emphysema

Pt. E.E,46 y/o, f, single, presently residing in Real, Calamba, Laguna City. first consulted our FPIP office on 9/r/2015. History revealed that patient has been experiencing difficulty of breathing since 3 years prior to consultation. Since then, she has been hooked to oxygen up to the time she consulted. She claims she has been in the hospital almost every other week. And when she is at
home she is confined to the four corners of her room because she cannot tolerate walking due to difficulty of breathing. She was diagnosed of having cardiomegaly with pulmonary edema and was on the following medications Doxicycline Galvus, Pred 10, Ciprobay, Lanoxin 250 mg. Furosemide 40mg, Viagra, Montelukast, Trimetazidine, Salbutamol nebulization and Seretide 250,
Initial PE revealed a BP of 120/80, CAR 85/min, RR 28/min. There is exertion on respiration. She has red lips, pink palp conjunctiva, on auscultation, there is absent breath sounds on left upper lung field and crackles all over the rest of her lungs. There is grade 1 edema on lower extremities.
She was assessed with Atelectasis, L Upper Lobe, cardiomegaly (by CT scan) severe pneumonia, and Emphysema.

She was advised to decrease oxygen concentration to 1 liter per minute and BN
of 2 sachets after lunch and 2 at bedtime which she started on 9/9/2015 irregularly. She made a follow up on 9/16/2015, and claims she no longer need the inhaler and can withstand no oxygen during waking hrs (15) hrs, there is less fatiguability, she did not bring her oxygen tank with her when she consulted and her aura is better than when she first came in. She claims she felt much
better, lesser coughing. no difficulty of breathing, on PE, she is still pink, with pink palpebral conjunctiva, auscultation of the lungs revealed clearBS on the upperlobes, but still with crackles on the middle and lower lung fields, no more edema, the condition stayed like this and her dosage of meds were maintained including her BN dosage, however, there are periods of lag in her intake of bionormalizer. She started to take bionormalizer regularly starting January 6,2016, from then on patient's condition start to improve dramatically, oxygen at night was decreased to 0.5 /min. Medications were started to be tapered on Jan 20, 2016. Furosemide and lanoxin were tapered to half tab per day, patient start to taper oxygen from half liter per minute to none and continuously experience improvement of condition. On Feb 3,2016, patient showed us results of
her latest chest X-ray showing heart not enlarged, meaning there is no more cardiomegaly, upper lobes are cleared with signs of pneumonitis on the lower lobes. Patient claims less coughing and can already travel without oxygen, she claims to have a better social life and was able to do tasks at home like doing their laundry and the like. At present, patient is still on 2 after lunch and 2 after dinner intake of BN and nebulization of nss with bionormalizer.

- From Dr Kaye's case