May 7, 2012 12:06 am by Pohla Smith / Pittsburgh Post-Gazette

About a year ago, Jean Magazzu was diagnosed with bronchitis, but after two courses of different antibiotics, her symptoms remained. by June, she had extreme shortness of breath.

“I couldn't get up and walk across the room without having to rest,” said Ms. Magazzu, 44, of Mt. Lebanon. a single mother and the office and development coordinator for Outreach Teen and Family Services, she went to St. Clair Hospital's emergency room, where a scan showed she had blood clots in her lungs.

After spending the night at St. Clair, she was transferred to Allegheny General Hospital, where she was immediately put on blood-thinning medication. During her stay of about a week, doctors conducted tests that found that the blood pressure in her lungs was three to four times above normal; the right side of her heart also was enlarged. They placed a filter in the large vein that brings de-oxygenated blood from the lower part of her body into her heart's right atrium to prevent any more clots from reaching her lungs.

Ms. Magazzu had a rare disease called chronic thromboembolic pulmonary hypertension, better known as CTEPH. It's a condition that eventually would have killed her if she had not undergone a complex surgery at Allegheny General on Feb. 9.

This delicate surgery called pulmonary thromboendarterectomy removes the clots from the pulmonary arteries and restores blood flow. it is done at about 10 medical centers across the United States, and Ms. Magazzu was the first patient to undergo the procedure at Allegheny General. to become proficient, a team led by cardiothoracic surgeon Robert Moraca underwent six months of training under David McGiffin at the University of Alabama at Birmingham. Dr. McGiffin was present for Ms. Magazzu's operation.

Before Ms. Magazzu's case, Dr. Moraca said, Allegheny General sent such patients to Birmingham, one of the two best-known centers for the surgery in the nation. The other is the University of California, San Diego, where the procedure was developed.

The condition is caused when a clot breaks off in the legs (or, sometimes, the upper extremities), travels through the circulatory system, on through the right side of the heart and gets lodged in the lungs. If the body doesn't dissolve it, more can form on top of it, causing a network of scar tissue. “So it propagates itself,” said AGH cardiologist Raymond Benza.

“The body's response to that is to try to seal off that artery so no more clots can form there, so the vessel closes down,” he said. The result is not unlike a plugged-up drain, creating a tremendous back pressure in the right heart,” he said.

As the pressure builds, the right heart tries to keep up by getting larger and larger. “When it does, it loses its elasticity” and its ability to pump blood to the lungs. “People are dying … from a type of heart failure,” Dr. Benza said.

Most times patients and their doctors do not know clots are traveling to the lungs, so it goes undiagnosed. “It's only recognized when people start to develop early symptoms of heart failure — swelling in their ankles, edema in their bellies, fatigue, shortness of breath, and then, when the disease becomes more prominent, they start passing out when they try to do things,” he said. “That's because no circulation is going beyond these clots.”

The first line of treatment is to try to dissolve the clots with anticoagulants. If that doesn't work, surgery follows. without surgery, Dr. Benza said, “it's uniformly fatal,” with patients living less than a year once heart failure becomes prominent.

Drugs are being developed to help those with inoperable disease that may prolong survival, he said, but they are not a substitute for the surgery in those who qualify for it.

The surgery involves opening the chest and can take from four to 10 hours. The patient is put on a heart-lung machine, and the body is cooled down to about 68 degrees. “The reason we do that is we need to shut blood supply off to the body and lungs and open up the right and left pulmonary arteries and begin to take off their scar tissue,” Dr. Moraca said.

“We work very quickly and efficiently to remove the scar tissue, so we do it all at once in sort of one long block,” he said.

Once it's removed, doctors restart the heart, re-warm the patient and close up the surgical area.

Ms. Magazzu, who has a congenital condition that causes the blood clots, said she could tell her breathing had improved within a couple days, although she was still exhausted from the surgery.

She went back to work part time the last week of March and two weeks later reported feeling very well.

“My breathing is great,” she said. “My stamina could use a little improvement — I haven't been real active over the last nine months. … I can walk up a flight of steps now without having to stop.”

The survival rate can be more than 95 percent in patients who have the surgery done at experienced centers, Dr. Benza said.

To prevent further problems, Ms. Magazzu will have to take anticoagulants for life and keep a filter in the vein leading to her heart.

Her prognosis is “to live a normal life expectancy for a young woman,” Dr. Benza said. “Her heart is healed. her right ventricle is normal now, and she's going to have an amazing prognosis.”

i get lower back pain. frequent urination not much at night at all. jut after waking i can sleep 6 hours and wake up and urinate but then after i wake at least 2 hours after i wake up i urinate every 30 to 45 mins for 2 or 3 hours. and i still got the golf ball feeling in rectum at times. i have been very stressed lately and anxiety is so bad making me depressed. also my sex drive is not like it used to be im 28 and urologiest did rectal exam and urine test and complete blood count at emergency room when first went.. also electrolytes were fine kidney are working normal… how long will this last? is so annoying also get some pelvic pain at tiems.

kidney problems from diabetes? Avoid sugar. get tested by a doctor familiar with diabetes.

I was running up a flight of concrete stairs and I tripped and fell face forward into the edge of the stair. Pretty ruthless experience! I ended up in the emergency room with stitches and I had to get surgery to fix my shattered nasal bone that was broken in 3 pieces. till this day I feel heavy and numb when I touch my nose and lift my eyebrows. I've been feeling dizzy at least a couple of times a week. does anyone know if a heavy break to my nose could cause dizzy spells? any input would be really appreciated.

I'm a bit worried that I overdosed on paracetamol around 20 hours ago. I might have taken in over 4 grams. how long do symptoms take to appear? I've felt nothing at all, except for a bit of pain around where the liver is positioned, nothing major, just ticks of light pain occasionally. should I still be worried if nothing happened in 20 hours?

Hi there,

Could I suggest a trip to your local a&e hospital (or emergency room) and make it urgent. Paracetamol poisoning can take 3 or 4 DAYS to hit the liver, so as yet you are definitely NOT out of danger.

Please please go to the hospital and get medical attention.

I wish you good luck and a beautiful and happy future.

PS let me know that you are ok when you have seen the docs

Hello, I was wondering if anyone here would have a bit of insight on this issue. I'm 18 years old, and over the past couple weeks I've been having weakness and slight tingling in my legs, as well as muscle spasms and fatigue. I've had on and off lower back pain for a couple of months. I've also had a couple cases of lightheadness and dizziness.

About two days ago, I woke up and the left side of my face was slightly numb and I had a sharp shooting pain in the left side of my head. I went to the emergency room and the doctor told me that he did not believe that I had a stroke and that I had an inflamed nerve in my face.

The next day, I went to my doctor to get a more through check-up and he said that everything looked fine. he did a physical examination of my nerves, looking into my eyes, testing my reflexes, etc and said everything was fine. My EKG was normal and I had blood work done in February and all that was normal.

My main concern was that I might have Multiple Sclerosis based upon my symptoms, but my doctor did not seem to think an MRI was needed based upon all my blood work and my physical examination, and told my that he thought my issues might be more psychological.

Sorry about that overflow of information, haha, but my more specific question is, is it unlikely for me to have Multiple Sclerosis or some other type of nerve related disorder if my neurological examination showed no problems? any other comments are really appreciated as well. Thank you!

get a new doc–andy doc that would dismiss something as psychological without fully tetsing is a quack…

teh only ways you ccan tell if it is MS is a spinal test or MRI to look for lesions–regular blood tests wouldn't show anything

Appointments were made to see the doctor, but he lacked the energy to go.

Finally, he “dragged out of the house” to see a doctor.

The physician who saw Michael, then 17 years old, said the teenager was depressed, according to the family.

Three months later, Michael visited an emergency room. Neely remembers the date: Aug. 7, 2008.

Emergency surgery was performed that day. Another operation followed Aug. 18 for the benign tumor on his brain stem, the part of the brain that controls basic life functions.

Neely spent weeks in a coma.

“We didn’t know if he was going to live or die,” said his mother, Dena.

His 18th birthday was celebrated in the intensive care unit.

Near the end of that September, Michael went to a facility for rehabilitation. He was there five weeks for a “crash course in how to walk, talk, eat” and other actions.

He left rehabilitation in a wheelchair. Today he walks with a cane.

“I’m ridiculously mentally tough because I have to be. That’s the only way I’ll stay alive,” he said.

While Dena has continuously searched for answers, Michael is uninterested in understanding his brain tumor.

“Ignorance really would be bliss,” he later wrote in an e-mail.

His passion is reading. He enjoys the satire of mark Twain and “darkly hilarious” Stephen King. He wants to be a professor and teach American literature.

He loves music. David Bowie and Morrissey are some favorites. his favorite TV show is “Lost.” He spends a lot of time online.

Neely is candid and honest about his fears and loneliness. He knows no one else his own age with a brain tumor. Adding to the isolation is the recent loss of a dear friend to cancer.

Dena said the nearest support groups for people with brain tumors are in Asheville, N.C., and Charleston.

The greatest change Dena has seen in her son is the anger. How does one rid him of that bitterness?

Dena considers Michael, now 20, a “miracle.” she said he’s fortunate to be able to walk and no longer need a feeding tube.

The American Brain Tumor Association projected 62,930 new cases of primary brain tumors would be diagnosed in 2010.

Primary brain tumors begin in the brain. Metastatic brain tumors are cancer cells that originated elsewhere in the body, perhaps the lungs, breast or skin, and traveled to the brain.

Brain tumors can be benign or malignant and are measured on a scale from 1 to 4. the higher the number, the more aggressive.

Rare and hard to figure

Brain tumors are seen more often in children and senior citizens.

Dr. Sharmila Mehta, with Palmetto Hematology Oncology, said brain tumors account for 2 percent of all cancer types.

In 2008, there were 1,600 new cancer cases diagnosed or treated at Spartanburg Regional. there were 33 brain and other nervous system cases.

Mehta said brain tumor symptoms can often be nonspecific.

They might initially be overlooked or appear as something else, such as depression or fatigue.

When should people be concerned? As opposed to a migraine, Mehta said headaches associated with brain tumors typically are dull and consistent, and they can be severe enough to wake someone.

Changes in brain pressure can worsen the headaches or cause nausea and vomiting.

“Typically the nausea and vomiting is worse when you change the pressure in your brain, and usually that’s done by changing position — bending down, crouching, stooping, sneezing, coughing, having a bowel movement,” Mehta said.

Other symptoms can include weakness, seizures, difficulty with communication, mood swings, memory loss or passing out.

Each part of the brain is responsible for specific functions. the location of the tumor and what it compresses also determines symptoms, Mehta explained.

“That’s why some of these symptoms are so nonspecific, because it really depends on where the brain tumor is growing,” she said.

There are more than 120 types of brain tumors, Karen Shires, a nurse in the Neurosurgery Department at Emory Medical Center in Atlanta, said at a recent brain tumor symposium at Gibbs Cancer Center.

Michael Neely said he was diagnosed with a meningioma tumor. although it is benign, it is now considered cancerous, since it has returned.

He had an operation in February 2010 and another last June.

The brain, which weighs about 3 pounds, along with the spinal cord, comprises the central nervous system.

“the central nervous system is the core of our existence. It controls our personality — thoughts, memory, intelligence, speech and understanding, emotions” and more, according to the ninth edition of the “Brain Tumor Primer” provided by the American Brain Tumor Association.

“there are approximately 100 billion neurons in the human brain, and that’s about the same number they approximate as the stars in our galaxy,” Shires said.

When a brain tumor is suspected, a doctor might order a neurological examination.

Shires said one of the first procedures usually performed is a CT scan; an MRI scan also might be performed.

“a definitive diagnosis is done with pathology,” she said. “the pathology report tells the type of tumor, the location, specific information to identify the tumor, for example, primary (or) metastatic.”

Treatment options can include surgery, chemotherapy and radiation.

The second half of the symposium was led by Dora Il’yasova, an associate professor at Duke University Medical Center, who studies the epidemiology of brain tumors.

She presented data from studies on risk factors for primary malignant brain tumors in children and adults.

But as she noted in her presentation, the lower the rate of cancer, the more difficult it is to study. Children and adults also must be studied separately.

“Epidemiologists in this field realized that no one can do a definitive study on brain tumors — not only on childhood brain tumors, on any brain tumor. We have to come together and try to put our data together and our expertise together to study this terrible disease,” she said.

Researchers are studying chemicals, genetic predispositions and other risk factors to better understand what causes tumors and what the risk factors are.

Dena will keep searching for answers, too.

“It seems the more knowledge you have about it, the more you can fight it,” she said.

“the scarier it is,” Michael interjected before she finished her sentence.

“Sun Tzu (an ancient Chinese philosopher) says to know thy enemy and you can never lose, though there are hundreds of battles,” he said. I guess that’s true — I mean, he’s a great philosopher on the art of war. and what is living, if not war?”

He likens his battle to a three-act play.

Act I was the hospital and rehabilitation that culminated with his learning to walk.

He’s nearing the end of Act II.

“I’m going to read, and read a lot, and study, study to use this awesome brain of mine,” he wrote in an e-mail.

The climax of this act is when he earns his GED and enters college.

“I may still be using a cane. I may still have physical disabilities. I may have them the rest of my life. but I’ll be OK with that, because it doesn’t define me. and I’m so glad Act II is finishing now, so early in my life.”

The last act has yet to begin. but Michael is confident “it’s going to be the longest and best chapter yet.”

about 8 days ago i was diagnosed with heat exhaustion…

i went to the emergency room and i was treated…

i have been doing better, however i still continue to have migraine headaches and fatigue…. when will this go away and is there anything else i can do???

thanks.

If your young child has ever awakened in the middle of the night crying, having difficulty breathing, and with a cough that sounds similar to that of a barking seal, then you are already familiar with a childhood illness commonly known as croup.

Personally, I didn’t have any idea what croup was until my then 2-year-old son woke up during the middle of the night with this horrible, horrible cough. I couldn’t believe this loud barking noise was coming out of my sweet son. He was having such a hard time breathing that I rushed him to the emergency room and spent four to five hours there having his chest x-rayed and having a doctor look at him, only to find out that he had croup. this emergency room trip cost almost $1,000.

His symptoms lasted only two days and then they were completely gone. About six months later he woke up in the middle of the night with the same cough, but this time I knew what to do and didn’t have to take him to the doctor. He recovered quickly on his own after two sleepless nights. I want to share our experience so if it happens to you, you also will know what to do.

First of all, croup is most often caused by the same viruses that cause the common cold. Two kids can get the same virus, and one will get croup and the other may not. My other son has never had any symptoms of croup. some children seem to be more prone to this illness than others. Research has shown that children born early or who have breathing problems such as asthma are more prone to getting croup.

Croup is most common in children under three years of age. the younger the child, usually the worse the symptoms are. there are some things you can do at home to relieve these symptoms.

Your child may or may not have symptoms before the coughing occurs. both times my son was sick he did not have any cold symptoms before the cough. However, both times his twin brother was sick first, so we knew he was exposed to a virus. After the coughing episodes, he displayed common cold symptoms (e.g., runny nose, coughing).

The barking cough is the result of a narrowing of your child’s air passage. the effect of this is worsened by your child’s crying. the harder they cry, the harder it is to breathe. if your child is crying, try to calm him or her down as quickly as possible.

If you see at any point that your child is having too much difficulty breathing, and it appears he or she is not getting enough oxygen, you should immediately go to the emergency room. if it appears your child is breathing okay but you cannot get the cough under control, there are things you can do to help shrink the air passageways.

Cool-mist humidifiers will put moisture into the air and help your child breathe more easily. Steam from a hot shower will also help reduce symptoms. during winter months, taking your child out into the cold, even if it is the middle of the night, is often the best way to get relief for your child fast. for some reason this croup cough only acts up at night. I was told at the emergency room that bringing my son out into the cold to take him to the hospital had almost eliminated his symptoms before he got there!

If none of these things work, as a last resort, there are medications a doctor can give your child to reduce the swelling that is causing the cough. Symptoms generally only last a couple of nights then disappear. it is a good idea to sleep in the same room as your child while they are experiencing this cough. one night of hearing your child cough like this and trying to catch their breath would cause you to not let them out of your sight! the second time my son went through this I slept in our guest room with him with the humidifier in the room and he was able to get comfortable enough to sleep. the next day you wouldn’t even have known he was sick except for a little bit of a runny nose.

Rachel Paxton is a freelance writer and mom of five. for resources for the Christian family, including parenting, toddler and preschool activities, homeschooling, family traditions, and more, visit Christian-Parent.com

I think I may have passed a kidney stone which is now in my bladder, but I'm not sure. about a week ago I started having a lot of pain and cramping feelings in the side of my lower abdomen and some minor cramping in my bladder accompanied by urgency to "go". the next day, the pain in my side was less, but the pressure in my bladder was more. the doctor put me on antibiotics thinking it could be an infection, but there is no burning when I go. After 4 days on antibiotics, I still have pain and pressure in my bladder. could this be a stone and not an infection?

Extreme pain when you need to urinate.

Talk to your doctor again, or talk to another doctor.

YOu need to see a doctor soon. see if you can get in to see a urologist.
It could be stones. most people with stones have such bad pain that they end up in the Emergency Room.

Ask the doctor if he culturled the urine. if it doesn't show an infection you don't need to be on an anti biotic.

There is a disease called Interstisial Cystitis that the doctor might need to check you out for if you don't have stones or an infection.

You definatlyl need medical care.

I am suffering on my fourth month with an pain that has not properly been diagnosed before someone replies "you need to see you doctor" I want to let you know that I have visited 2 family doctors, 2 urologist, emergency room visit, dermatologist and more.

My main symptom is a pain in the middle of the head of the penis, with different reoccurring symptoms that are constantly changing.

Started out with blood in urine (3 days)
Extreme itching around penis, testicles and anus
inflammation of the tip of the penis
Color change on the head, red blotches
Itching around the anus, lower back pain.
Sometimes I see dark areas on the head of penis, other times it looks normal.
I am uncircumcised and the foreskin to me looks darker almost like an ashy color.

One doctor said it was urethritis another thought Balanitis, and the third Prostatitis. what makes it hard is that these were all visual diagnosis, I have begged pleaded and requested formal testing but they inform me that its not done… it makes it harder that my visual symptoms come and go and no discharge, rashes or growths

I have been given a whole slew of topical creams (which led to infection of the head (balinitis)
Been given Ciprofolaxin for a month with no results
Now i am on Doxycycline which targets another bacteria i guess…

Been tested for all STD's and all have been negative, my doctor physically checked my prostate (said it was normal), urologist scoped my bladder, I function 100%. and every time I schedule an apt my symptoms get magically better.

I am afraid my insurance is not going to keep paying for my claims and I have to make each visit work, but every time I go there the doctor doesnt even TRY!

What should I do? should i go to a MAYO clinic? I cant talk to these doctors prior to my visit so unfortunately they cant blow me off until I in the examination room and they charge my insurance 200 bucks!

Suggestions please would be greatly appreciated…

thank you.

If I were you I would go to a Mayo clinic and get a definitive diagnosis.

Does not sound at all like prostatitis.