My entire experience with pneumonia, from Day One until discharge

I am writing this upon the request of several friends who would like to know the facts of the case. It is a technical piece, so you might want to skip it if your interest is not in this area. Thank you.

This summarises the pertinent points of my entire experience with pneumonia, from the very first day.  I am posting it here so that those who are interested need not go back to read the bits and pieces of news.  I will post the funny anecdotes in other posts. This is a factual piece.

Pneumonia has now overtaken heart disease to be the No. 1 killer disease in Malaysia. It is also the No. 1 antibiotic-resistant disease.

24th November 2024
I started having a very mild cough with a little bit of phlegm which I would ordinarily just ignore. But because I have to look after my grandsons, I decided I had better get it treated as I don’t want to pass it to them. So I went to our regular GP which is run by a group of young doctors. The GP that night prescribed Dexamethasone (anti-inflammatory), Bromhexine (mucolytic) and Sandoz Acetylcystein for phlegm. I am familiar with Bromhexine as my cats get it too. The GP said my lungs were clear. No need antibiotics.

26th November 2024
I did not improve. It didn’t get worse, but it was just “there”, lingering. The same. I went back and was seen by a different GP. She said since I was concerned about my grandsons, I had better test for Covid and Influenza. I agreed. So a swab test was done and I tested negative for Covid-19, Influenza-A and Influenza-B. This GP gave me a cough mixture Guaphenesin, Zecuf lozenges, Zadipro Ketotifen Syrup and a course of Azithromycin antibiotics (Aziswift) for 5 days. She said my lungs were clear. I dutifully ate all my medicines.

But my condition remained the same. It didn’t get worse, it just stayed the same. I did not improve. But I could go about all my daily chores, my morning walks, my ballet lessons without any difficulty. There was no shortness of breath too. I’ve had prolonged cough in the past during my teaching days, for as long as 6 months even, I’d eventually recover. So I thought this was one of those.

9th December 2024 (morning)
On the night before, I was having some chills. So husband took me back to the clinic in the early morning and I was seen by yet another GP. She said I was having a fever of 38 degrees. She said to check for infection, but didn’t tell me exactly what the test measured but told me I had mycoplasma pneumonia. She said it would be more effective to go on IV-antibiotics, which I agreed by then, because I just wanted to get well. So I would come into the clinic for IV-antibiotics and medicines twice a day, for three days.

So I was put on drip and given the IV-antibiotic whose name was not revealed to me even though I asked. The clinic was busy and I didn’t press for it, I just trusted the GP would do her best for me.

I much later found out that the IV-antibiotic they used was called Lincomycin, classified as a strong antibiotic. Along with the Lincomycin, they added other medication into the drip as well and based on the receipt, I think these were: Mucolex Bromhexine, Penatone Dexamethasone, Leniol Paracetamol. I was also given some oral medication which are Erdomed, Glemont Montelukast, Fexofenadine (Telfast), Uphadyl Forte cough syrup, Zadipro Ketotifen syrup and Decondine to be taken only at night. I was told Decondine would make me drowsy.

This is when all the trouble started. I took the Decondine along with all the medicine and was unable to sleep for 48 hours. It put me in a very unnatural state which was rather frightening. Isn’t the medicine supposed to make me drowsy? But the reverse happened.

Being unable to sleep was horrible, but I simply could not sleep. That was definitely bad for my recovery.

9th December 2024 (evening)

Went back for the drip. Given Lincomycin and Mucolex Bromhexine only.

10th December 2024 (morning)

Went for the drip and was given Lincomycin, Mucolex Bromhexine and Penatone Dexamethasone. Was told my lungs were clear.

10th December 2024 (evening)

Given drip with Lincomycin, Mucolex Bromhexine.

Was seen by another GP and I told him I suspect Decondine made me unable to sleep. He said it wasn’t possible as it is supposed to make me drowsy. He said my inability to sleep was due to “other factors” which he did not elaborate on.

In every visit, I was told my lungs were clear.

11th December 2024 (morning)

Drip with Lincomycin, Mucolex Bromhexine, Penatone Dexamethasone, Primat Piriton. I was not told what the drugs were for. Lungs clear.

During this time, I had trouble sleeping again.

11th December 2024 (evening)

Last drip with Lincomycin, Mucolex Bromhexine and I was given the following oral medication to follow up at home: Dayvigo Lemborexant, Erdomed Erdosteine, Uphadyl Forte cough syrup, Zadipro Ketotifen Syrup and for the antibiotics, I had a choice between Azithromycin (again) or Moxifloxacin. The GP in the morning had mentioned Moxifloxacin would be more effective, so I chose this, again, putting my trust in the doctor. I was too sick to do my own research on the drugs.

My main concern was my inability to sleep. It’s simple logic, if I could not sleep, how on earth could I recover?  The GP’s solution was to give me a sleeping pill which I declined, but she prescribed it anyway.

But she also said Moxifloxacin would need an antigastric medication and she forgot to prescribe it. I noticed that and called the clinic for the name so that I could purchase it myself. For four hours, no name was given to me.

During these four hours, I was able to find out more about Lincomycin and Moxifloxacin and discovered they were very strong antibiotic with a high potential of causing the Stevens-Johnson Syndrome which I feared.

So I decided not to take the Moxifloxacin and went to the clinic to exchange it for Azithromycin again since I was told this was also an option.

I took all my medicines as prescribed but I had trouble sleeping. It became a very unnatural condition. Even if I could sleep for 10 minutes, I kept having bad dreams. It was a condition I had not experienced before. It was like something had altered or interfered with my brain.

12th December 2024

I was busy cleaning and disinfecting the house all morning but by afternoon, I suddenly developed extreme chills and high fever. I was trembling and shaking all over, unable even to steady my hand.

Husband decided something is definitely not right, so he went to the GP’s clinic to get a referral letter and I asked for all the itemised receipts so that I could tell the next doctor all the drugs that I had been fed with.

We went to the emergency section of the hospital and waited to see the emergency doctor.

It was a long wait and I was feeling very, very cold. The fever had subsided because husband had given me two Panadols earlier. But I was trembling from the chills.

The emergency doctor ordered a chest X-Ray (which those GPs had not done at all during the 3 weeks), took blood to check for CRP which is the inflammation marker. She said the next course of treatment would depend on the results of the X-Ray and the CRP.

We waited and finally the results came. She showed me the chest X-Ray and it showed a lot of white patches, which I recognised to be inflammation based on the many X-rays I had seen of my cats. My CRP was 39.9, which may be okay, but based on the chest X-ray, I should be admitted for treatment. My lungs had probably been infected for 3 weeks now, without me knowing it. No chest X-ray had ever been ordered by those GPs. I asked for outpatient treatment as I did not want to leave my cats, but was strongly advised to be admitted so that my condition could be monitored.

She got hold of the on-call lung specialist for further advice since I was very reluctant to be hospitalised, worried about my cats at home.

The specialist saw me and said I had to start treatment straight away. He took a specimen for a rapid test of 20 bacteria and 15 viruses to check what else is going on, what other pathogens I might have besides what I was told I had – mycoplasma. Later the test results came back – I had none of the 35 microorganism. Not even mycoplasma. Yet, my lungs were badly infected.

(that night)

I was put on IV-drip and given IV-Azithromycin and IV-Rocephin (Plan A), which is the first line treatment for mycoplasma pneumonia. The drugs the clinic had given were too strong and not used by this hospital. In fact, both the emergency doctor, the lung specialist and even the pharmacist were shocked with the list of medication I had been dosed with from the clinic.

I was trembling and shaking to the point of delirium and may not remember all the details but my fever finally broke at 2.40am and I felt much better. Better than I had ever been for the past three weeks. And finally, despite all the interruptions from the nurses to administer medications, I was able to sleep.

When the fever finally broke at 2.40am, first day of admission at the hospital

I was also given oral supportive medication for cough, Telfast for blocked nose and Fluimucil for phlegm.

A urine test was done – all clear.

A sputum test was done – the culture would take 4 working days.

The GP from the clinic did follow up with me, and I took the opportunity to clarify a few things with him.

1. Why didn’t you tell me that the antibiotics were very strong ones, with a higher possibility of getting SJS?
   Reply: How do I know you are worried about SJS? Eating prawns also can get SJS. All antibiotics can cause SJS.
2. Why didn’t you order a chest X-ray when my cough did not subside?
   Reply: You yourself said you were feeling better, didn’t you?

I found such answers very unprofessional and irresponsible. Yes, indeed, I was feeling better, but this does not mean I was not sick internally. It is the duty of the medical professional to determine whether I was sick or not, tell me and to administer the correct treatment. And as for the medicines, it is also the duty of the medical professional to explain possible contraindications to me, so that I can make an informed decision.

For that matter, I also told the emergency doctor and specialist at the hospital that I was feeling fine, which I was, but I was prohibited from even going home. They insisted on admission. These are doctors who do their jobs with pride.

13th December 2024

My CRP was 64 now. That’s from 39.9 upon admission to 64 the next day. This is expected as it may rise first, then only decrease. The IV-antibiotics were continued. I felt so good. There was no more fever at all.

14th December 2024

My CRP shot up to 104, which was scary, despite having no fever and almost no symptoms except for the same lingering cough with phlegm. The specialist decided I was antibiotic resistant to the drugs, and we had to change the antibiotics.

So we changed to IV Tazocin and oral Doxycycline (Plan B). It would be a new combination and we could only hope this would work. This started at noon.

No fever. I felt fine. Lungs clear (they had always been clear). I asked the specialist if a CT scan of my lungs might help shed more light on my condition and he said it might. So I had that done. The CT scan showed nothing remarkable, it was exactly what the X-ray had shown. There was nothing new, which was a relief. The specialist had worried about abscesses but there were none.

The specialist also ordered a blood test called procalcitonin to check if the infection had entered the blood or if I had sepsis. My procalcitonin reading was low, so that was good and it ruled out blood infection and/or sepsis.

These results were reassuring. Now, it was all about waiting to see the next day’s CRP to check if the IV-Tazocin and oral Doxy will work.

I continued with the infusion of IV-Tazocin every 6 hours round the clock. Each infusion took an hour. The IV-port remained in my arm.

The specialist discussed my options. If Plan B does not work, it could be that my body is overreacting with inflammation to fight the infection, hence, the increase in the CRP. That being the case, a course of steroids might be helpful to “calm” down the inflammatory response of my body.

If Plan C does not work, Plan D would be to check for fungus. Pneumonia can be caused by bacteria, virus and also fungus.

Until now, we still do not know what caused the initial infection except from what the GP at the clinic told me – mycoplasma. Only their test was positive and it was a blood test, not a swab test. They did not explain to me whether it was an antigen or antibody test too. The hospital also tested me for mycoplasma and it was already negative upon admission. I was also negative for the other 35 microorganisms which the hospital rapid test checked. So, what caused the initial infection then? Until now, we don’t really know.

15th December 2024

Blood was taken first thing in the morning to check my CRP. This would be the all-important determining result.

The specialist came personally to inform that it’s GOOD NEWS! My CRP had gone down to a pretty amazing 63 from yesterday’s 104. Even he hadn’t expected this. He was pleased.

This means the combination of Tazoxin and Doxy is working. I am grateful we found a combination that worked. Changing antibiotics for pneumonia treatment is common, because pneumonia has now become the No. 1 antibiotic-resistant disease in the country. It has also overtaken heart disease as the No. 1 killer disease in the country. People are dying from pneumonia.

He also suggested that the multitudes of antibiotics I had received from the GP clinic had most likely made me antibiotic-resistant. That is the price to pay for having gone to a clinic, trusted those doctors, instead of to a hospital. Lesson learnt. Never do that again.

The specialist advised that it would be best to stay admitted to complete the full 3-day course (4 times daily) of the IV-Tazocin in order for it to clear off all the microorganisms that it covers. There is no exact oral antibiotic to replace Tazocin although the nearest one would be Levofloxacin. Still, Levofloxacin does not cover the broad spectrum of pathogens that is covered by Tazocin.

This is how Tazocin is administered, four times a day, by IV-infusion. The specialist told me to keep this part of my hand as clean as possible.

Plan A was administered likewise from my right arm, but after 2 days, the plastic needle got bent and it started leaking. And my arm was swollen too. So that had to be removed and now, it’s on my left hand.  Hopefully, this IV-port can last until Tuesday morning.

Meanwhile, the results of my sputum test is still not back but the specialist will call to enquire if any pathogen has been identified. Identifying the specific bacteria will enable antibiotic sensitivity tests to be done and this helps to further identify an antibiotic that might be even more suitable for my case. After all, I have become antibiotic resistant, thanks to my own bad decision to trust that GP clinic.

At this point in time, this is what I summarise: I think all the GP clinic wanted to do was to give a strong, expensive antibiotic and hope that it does the job. They did not start with the first line treatment before progressing to the second line and so on. What happened to me is that their strong antibiotic did NOT do the job. It did not kill off all the bacteria. Some were left behind and these became antibiotic resistant. That is why when the hospital used their first line of treatment, it did not work on me.

The GP clinic also did not even order a chest X-ray or the CRP to monitor my progress. I cannot fathom how they had planned to monitor my progress – just by asking me how I felt and throwing that responsibility back to me?

If the above assumption is correct, I am horrified. This is how antibiotic-resistant bacteria is created. And the fault here is the doctors themselves. I know many patients are at fault for not completing their antibiotics. I know of too many friends who do that, not knowing how irresponsible their actions are or simply not caring – they will create antibiotic-resistant superbugs. These will kill other people. And for doctors to do this, it is unforgiveable.

“Oh? You are still sick? But I’ve already given you the strongest antibiotic and if it doesn’t work, well….I got nothing else.”

Every vet I know always insists that we ensure our pets complete their antibiotics, whether it is for 10 or 21 days, it must be completed and they explain the reason to us.

Then, the chest X-ray is a basic tool of diagnosis in respiratory illnesses. Even my cats will get an immediate chest X-ray when my vets hear a crackling sound in their lungs. That was how Juno and Hiro’s collapsed lung were diagnosed. Those GPs never bothered to order one at all throughout the duration of 3 weeks where they were responsible in treating me. That was so irresponsible.

16th December 2024

Unexpected good news! My CRP dropped to 38.2 today!! And this is despite the lack of sleep too.

So, the specialist has granted me an early discharge. I just need to stay on for two more IV-infusions, at 12noon and 6pm today. Then, I’m good to go!!