SECOND OPINION | Pneumonia | APT | Full Episode

November 8, 2019

Major funding for Second Opinion is provided by the Blue Cross and Blue Shield Association,
an association of independent, locally-operated and community-based Blue Cross and Blue Shield
companies, supporting solutions that make safe, quality, affordable healthcare available
to all Americans. (ANNOUNCER)
Second Opinion is produced in association with the University of Rochester Medical Center,
Rochester, New York. (MUSIC) (DR. PETER SALGO)
Welcome to Second Opinion, where you get to see firsthand how some of the country’s
leading healthcare professionals tackle health issues that are important to you. Now each week our studio guests are put on
the spot with medical cases based on real life experiences. By the end of the program, you’ll learn
the outcome of this week’s case and you should be better able to take charge of your
own healthcare. I’m your host, Dr. Peter Salgo, and today
our panel includes Dr. Paul Levy from the University of Rochester Medical Center, special
guest Marie Via, Dr. Cynthia Whitney from the Centers for Disease Control, and our Second
Opinion primary care physician, Dr. Lou Papa from the University of Rochester Medical Center. Lou, good to have you back with us. (DR. LOU PAPA)
Good to see you, Peter. (DR. PETER SALGO)
We’re going to put you right to work, Lou, because we’re going to talk about Charles. Now Charles is 75 years old, is married, and
has four children. He had a hip replaced three months ago – a
normal recovery, he’s been at home for some time, but now he’s back in his primary care
doctor’s office because he has been feeling terrible. That’s the word in the chart – terrible. He’s in your office, Lou; what do you do? (DR. LOU PAPA)
Well, I’d like a little more information I think. I need some specifics on what ‘terrible’
means. (DR. PETER SALGO)
He’s coughing, coughing, coughing, and he took his temperature at home and it was 102.5. (DR. LOU PAPA)
Ooh. Is he short of breath? (DR. PETER SALGO)
Yes he is. His respiratory rate is 30, his pulse is 125,
his blood pressure 152 over 66. They listen to him, and he has no murmurs,
rubs or gallops – that is, his heart other than going fast, is okay, but he does have
decreased breath sounds at his right base. He has a history of high blood pressure, hyperlipidemia;
he’s on medication for that. (DR. LOU PAPA)
Does he smoke? (DR. PETER SALGO)
He quit 20 years ago. I don’t have how many packs a day he smoked,
but that stopped 20 years ago. He does have a history of childhood asthma. I can tell you he had the flu vaccine but
no other recent vaccinations. What are you thinking? (DR. LOU PAPA)
Well, there are a couple things that go through my head. At the top of my list is some respiratory
tract infection; with his lung examination, I worry about something like pneumonia. But he’s had a recent hospitalization, especially
an orthopedic procedure so you worry about an embolism as well. (DR. PETER SALGO)
In other words, a blood clot in his lung. (DR. LOU PAPA)
Yes. And he sounds pretty sick. He’s breathing hard, his heart rate is up,
it sounds like he’s going to be hypoxic given his age. (DR. PETER SALGO)
And hypoxic means – (DR. LOU PAPA)
His oxygen is not going to be where it needs to be. (DR. PETER SALGO)
And would a pulmonary embolism, which is a blood clot to your lung, give you a fever,
or is Lou barking up the wrong tree? (DR. CYNTHIA WHITNEY)
It can, yeah. (DR. PAUL LEVY)
It doesn’t sound like a variant of angina or coronary disease and such, which in the
elderly, you get all these overlaps. (DR.LOU PAPA)
Absolutely. (DR. PAUL LEVY)
And so it sounds respiratory, it sounds lung, but we’re still kind of on the bubble; is
it an infection or is it some other process? (DR. PETER SALGO)
Now Marie, you were feeling terrible. Why don’t you tell us about that? (MARIE VIA)
I got sick when I was out of town; I started out with a bit of coughing and real bad chills. I decided to go to a Prompt Care kind of place. By that point, by the time I got there I was
coughing so hard I actually lost control of my bladder in the examining room, I threw
up, they had to bring some kind of special blanket to wrap me up because I was shaking
so hard. (DR. PETER SALGO)
So that’s terrible. (MARIE VIA)
That’s terrible. And I could hear junk in my lungs. They examined me, gave me a flu swab, listened
to my lungs and so on and said ‘You have a cold; you have to go home and wait it out.’ (DR. PETER SALGO)
Now stop right there. With those symptoms, her doc sent her home. What do we think? Would you have done that, Lou? (DR. LOU PAPA)
Well, I don’t know what they heard on the lung examination but if she was that febrile
and chattering and shaking, that has me concerned. (DR. PAUL LEVY)
The rigors. (DR. LOU PAPA)
Yes, the rigors are much more concerning that there’s a more serious infection going on. (DR. PETER SALGO)
The rigors often associated with bacteria in your blood. (DR. CYNTHIA WHITNEY)
Yes, classic sign. (DR. PETER SALGO)
And that’s nasty. Would you have sent her home? (DR. CYNTHIA WHITNEY)
Whether or not to have her go into the hospital or not is one of the more challenging decisions
a doctor can make, and there are certain criteria. You have to understand the person’s age,
you have to understand how healthy they are at baseline, and then figure out whether they’ve
gotten (break in audio). All those things would go into it, but certainly
at this point, she’s in an urgent care center; she needs to go to a place where they have
the ability to evaluate her (break in audio) more closely and to admit her to the hospital
if (break in audio). (DR. PETER SALGO)
So let’s talk about Charles; what are you going to do for Charles right now? (DR. LOU PAPA)
Well, I’m a little concerned about Charles. A lot of it depends on his situation, but
the fact that he has such a rapid pulse rate, the fact that he’s breathing hard, (break
in audio), I think I’d be more comfortable having him go to the emergency room to get
evaluated. (DR. PETER SALGO)
All right, anybody want an x-ray? (DR. CYNTHIA WHITNEY)
Absolutely. (DR. PETER SALGO)
All right, we go for an x-ray. I can tell you they got him some blood cultures,
a sputum culture – so you’re ruling out pneumonia. What else are you ruling out here? (DR. LOU PAPA)
The pulmonary embolism is another concern. (DR. PAUL LEVY)
It would be very common to see someone present like that in the emergency department to jump
past the chest x-ray and do a CT of this. Is it an infection or is it a blood clot? And because this is something that is such
a fork in the road for decision and treatment, you’ve got to exclude the embolic event
as well as know for certain if you’ve got an infection. (DR. PETER SALGO)
So for the distinction here, the x-ray is going to show you a density in the lung – (DR. PAUL LEVY)
It’s going to show you an abnormality in the lung – (DR. LOU PAPA)
But you won’t know the cause. (DR. PETER SALGO)
So a CT scan with contrast, what they call a spiral CT, I would assume would help you
know if there’s a blood clot in the lung or pus in the lung or something else going
on. (DR. LOU PAPA)
Right. (DR. PAUL LEVY)
It’s important to state here it’s that history of the previous hip surgery that drives
you to the CT scan early. (DR. PETER SALGO)
So when we talk about pneumonia, lots of different kinds of pneumonia. (DR. LOU PAPA)
There are all different kinds. (DR. PETER SALGO)
For example? (DR. LOU PAPA)
Well, the common ones, the ones we worry about most in the community, are pneumococcal pneumonia,
which can cause a picture similar to what you had – very high fever, shaking, chills,
a lot of sputum production, they progress pretty rapidly. There are other causes of pneumonia that are
not as typical; we call them atypical pneumonias, that are not as dramatic in their presentation. It’s hard to know if this guy had come to
us, as Paul says, without the hip surgery and he was a healthy guy and didn’t have
all of those worrisome vital signs – the rapid heart rate and the rapid respirations. That’s where you would make the decision
what antibiotic am I going to use to cover this. (DR. PETER SALGO)
His situation’s a little bit different because he was on the cusp of being in the hospital
within the last couple of months and that may potentially affect some other bugs that
are in your mind. (DR. PETER SALGO)
And just to back up for a minute, we have been throwing this term pneumonia around;
everybody’s heard it but we haven’t defined it. What is pneumonia? (DR. CYNTHIA WHITNEY)
It’s an infection of the lung, of the deep tissues in your lung. (DR. PETER SALGO)
How is it distinct from somebody with bronchitis or just a bad cough? (DR. CYNTHIA WHITNEY)
Well, a bad cough can often be upper airways – your nose, your throat. Bronchitis is the tubes of the lung that are
closer to your throat, and then pneumonia is the deep tissue. (DR. PETER SALGO)
That being said, how do you catch it? (DR. CYNTHIA WHITNEY)
Well, most often you get a germ from another got the germs on their hands, off you, they’ve
got the germs on their hands, they touch you, you touch your mouth or nose, you breathe
it in. You can also get it from things in the environment. Sometimes you can get it from aspirating your
own germs. (DR. PETER SALGO)
Well, as we said, they sent him for a chest x-ray; they did not send him for a CT scan
of his chest. And they got a blood culture, looking for
bacteria in his blood, a sputum culture, looking to see if there’s bacteria in his sputum,
and the chest x-ray showed a dense, right lower lobe infiltrate. Which means? (DR. PAUL LEVY)
Which means the findings support what you found on the examination; you suspected an
area of consolidation that could be consistent with pneumonia. (DR. PETER SALGO)
Consolidation means? (DR. LOU PAPA)
It means it’s white; you don’t see that nice air-filled part of the lung. It’s kind of patchy and whited out, full
of pus. (DR. PAUL LEVY)
But the tough thing there is the right lower lung is statistically the most common lobe
for embolic events to occur. So I’m still left as a pulmonologist to
think is this infection or is it blood clot. I’m not sure I know yet. (DR. PETER SALGO)
Well, I’ll tell you what Charles’ doctors told him. They told him ‘You’ve got pneumonia’
– statistically they were probably right, but don’t they have to wait for the blood
tests or the sputum cultures to make the diagnosis? (DR. CYNTHIA WHITNEY)
Those other tests will give you additional information about what might be causing the
pneumonia, but pneumonia itself, you know it when you’ve got it on the x-ray. (DR. PETER SALGO)
Okay, so this x-ray screams – (DR. PAUL LEVY)
He’s acutely ill and there’s going to be pressure of trying to get antibiotics on
board early; he’s an older gentleman so his physiologic nerve is going to be less. (DR. PETER SALGO)
Now you mentioned early, time ticking – is it really that critical to get treating before
the cultures come back? (DR. LOU PAPA)
It is. Especially the sicker the patient is. You want to get the antibiotics in to start
the killing action. (DR. PAUL LEVY)
Peter, I want to get out there that when we look at patients who have pneumonia clinically,
we make a diagnosis and feel like we’re correct, even with the best cultures, sputum,
etcetera, half of the time we still never figure out what caused it. (DR. PETER SALGO)
Half the time. Here’s a guy sitting in your emergency room,
he’s 70 years old, fever – (DR. LOU PAPA)
Breathing hard, sounds pretty sick. (DR. LOU PAPA)
Tachycardic. (DR. PETER SALGO)
How bad is pneumonia? Can it be? (DR. LOU PAPA)
Oh, it’s bad. It’s a killer. It does kill people and people die of it every
year as well. (DR. PETER SALGO)
What are the numbers? (DR. PAUL LEVY)
The numbers are staggering if you look at people who need hospitalization in general,
you have an 8 to 10 percent chance of mortality. But if you look at the environment where you
work as well Peter, the intensive care department, 30 percent of patients who are so sick they
end up in an ICU may not make it. (DR. PETER SALGO)
Marie, your urgent care doctor told you that you had a cold, right? And go to home and wait it out. How’d that work out for you? (MARIE VIA)
It didn’t work out well. Within a few days I was having incredible
trouble going up the stairs. I’d get to the top of the stairs and just
– I couldn’t breathe. I was coughing up a lot of stuff, and finally
I literally drove myself to the emergency room. (DR. PETER SALGO)
And what happened? (MARIE VIA)
They immediately did an x-ray, they did a CT scan because they were worried about a
clot in the lung; they checked my oxygen which they said was very low. They ended up – which doesn’t make sense
– four liters of oxygen. (DR. LOU PAPA)
A good amount. (MARIE VIA)
Which they said was necessary to get me stabilized. And I ended up there for five days. (DR. PETER SALGO)
Five days in the hospital. Did it surprise you that you had pneumonia? (MARIE VIA)
Well, I had pneumonia before, about 12 years ago, and I did not have to be hospitalized
for that. I was out of work for a couple of weeks but
I wasn’t nearly so sick. So I guess I didn’t think pneumonia because
it seemed so much worse. I was really scared; I didn’t know what
it was. All I knew was that I couldn’t breathe. (DR. PETER SALGO)
Let’s just stop for a second and sum up some of the things we’ve been talking about. Pneumonia, it can range in seriousness from
mild to severe but it can be very severe. Severe pneumonia has a high mortality rate,
so the key first steps are good diagnostic assessment, an assessment of the severity
of the pneumonia, and then deciding where to treat – at home or at the hospital. Let’s move our story along a little bit,
and I can tell you more. We are talking about Charles; Charles is 74
years old, he does have pneumonia, and Marie, you’re here; you’ve also had pneumonia
and been hospitalized for it. Should Charles go to the hospital? (DR. PAUL LEVY)
I think so. The concern with him is especially some of
his respiratory numbers, his pulse and his age. (DR. PETER SALGO)
So you’re going to bring Charles into the hospital. How are you going to treat him? Two questions on the table; Lou, why don’t
you start? (DR. LOU PAPA)
Well, I’m going to make sure that he gets oxygenated. I’m going to get him hydrated; we’re going
to have IV’s in him and I’m going to get him started on antibiotics. (DR. PETER SALGO)
His doctor sent him home. They said he had a good support system, and
they decided to treat him as an outpatient. I gather you’re not okay with that; or are
you? (DR. LOU PAPA)
Well, there are times that I have where patients outright refuse to come into the hospital
and those situations, you have to make sure they have a great support system, you have
to bring them back the next day, you have to lay out very clearly parameters for them
where they’ve got to take them to the emergency room. Very often we get respiratory people to come
into the house and hook up oxygen. You really need a very coordinated effort
and a lot of very close follow-up. (DR. PETER SALGO)
They sent him home on broad spectrum antibiotics. You want to choose some? (DR. LOU PAPA)
Well, antibiotics are typically – usually we use a broad spectrum macrolides like zythromycin. (DR. PETER SALGO)
He got a zythromycin and cephalosporin as well. Good combination? (DR. LOU PAPA)
That’s pretty good. (DR. CYNTHIA WHITNEY)
It’s good. (DR. PAUL LEVY)
You might even argue it’s overkill, but that goes back to disease tempo; how rapidly
is he getting ill, is it more bacterial or atypical, and then can you get by with a macrolide
alone if it’s community, out-patient acquired? The double coverage implies increased severity
and maybe some other, oddball organisms. (DR. CYNTHIA WHITNEY)
I think with the macrolide alone you would have to worry about resistance in a guy like
this because it’s a good chance he’s got pneumococcal pneumonia and there’s a lot
of macrolide resistance. (DR. PETER SALGO)
Okay. Well I’ll tell you one thing; whatever you
may have thought about the decision to send him home, his docs really did follow up aggressively. They checked the blood cultures and they grew
staph aureus in the blood. (DR. CYNTHIA WHITNEY)
You said ‘hmmm’ – why? (DR. CYNTHIA WHITNEY)
Well, it’s not your typical community-acquired organism; it’s more the hospital variety. I would also worry about the hip. Maybe it started at the hip. With an organism like that, I think you have
to follow up. (DR. PAUL LEVY)
I was going to say, with staph in the blood, it’s the real McCoy. That’s peculiar that it would come from
the community. (DR. PETER SALGO)
Well, we’ve got lots of staphs. There’s staph aureus – that’s as bad
as it gets. (DR. PAUL LEVY)
That’s real. You can’t look away from that. (DR. PETER SALGO)
No. And it infected the lungs, so it’s staph
pneumonia; is that fair to say? (DR. CYNTHIA WHITNEY)
Okay. White cell count came back very high; I don’t
have a number for you. BUN, the kidney number, is up, which means
his kidney function is down. Now what are you going to do? Do you want to bring him in? (DR. CYNTHIA WHITNEY)
We wanted to bring him in before {laugh}. (DR. LOU PAPA)
Yeah, we kept the car running in fact {laugh}. (DR. PETER SALGO)
Marie, when they brought you in the hospital, what surrounded that decision? (MARIE VIA)
Well, I made the decision. I was just feeling no better waiting it out
and because I was having so much difficulty breathing, I just took myself to the emergency
So Cindy, you’re going to bring Charles into the hospital but he’s got staph aureus
in his blood. How successful is therapy for staph aureus
pneumonia? (DR. CYNTHIA WHITNEY)
Well, it’s tougher to treat because you can get abcesses in the lungs and you need
to get the antibiotics in there. You’d also have to worry about resistance. (DR. PETER SALGO)
Okay, so staph aureus – people have heard about this MRSA stuff; it stands for Methicillin
Resistant Staph Aureus, but what’s the MR part? (DR. LOU PAPA)
Well, it’s resistant to that whole class of antibiotic; it really narrows what you’ve
got available to use. (DR. PETER SALGO)
If it isn’t staph, what other factors do you weigh in other than the type of bug and
it’s susceptibility to antibiotics? The patient type? (DR. PAUL LEVY)
The host. The patient’s age, immuno-suppression issues,
diabetes, other drugs they might be on. And another one is what was his lung function
before this? If he had impaired respiratory function going
into the game, he’s going to be in much dire straits. In staph pneumonia, those patients have much
more sputum and the cough and clearance is so critical. If he has any consequence of his long history
of smoking at all – in other words, if he has mild COPD, that can really affect things. (DR. PETER SALGO)
COPD, chronic obstructive pulmonary disease, a consequence of smoking, asthma – these
are factors you think about. (DR. PAUL LEVY)
And he’s got the added burden too; now we’ve got staph pneumonia, but if he’s got staphococcal
bacterimia, he could actually seed that joint and cause problems for that hip down the road. (DR. PETER SALGO)
Bacterimia is bacteria in the bloodstream. (DR. PAUL LEVY)
And he’s got it. (DR. PETER SALGO)
And staph happens to be sticky. (DR. LOU PAPA)
Staph is notorious for getting these satellite areas to become a problem. (DR. PETER SALGO)
So they sent him to the hospital. On admission, temperature is 102.5, heart
rate’s still up and now he’s confused. (DR. PAUL LEVY)
Ooh, there’s the (seed). (DR. PETER SALGO)
They do a head CT, they start him on IV antibiotics, and do an echocardiogram; the head CT, why
did they do that? (DR. PAUL LEVY)
With his mental status changes in an older person, how soon do you get the head CT? Do you see if he clears up? Do you see if he improves just with hydration? Statistically in older men with pneumonia
and now maybe his low oxygen level and the acuity of his illness, confusion is very,
very common. The head CT, I’d be hoping to predict that
it’s negative. (DR. PETER SALGO)
But do an echocardiogram – what are they looking for? (DR. LOU PAPA)
The other thing – it all gets along the stickiness of staph; it can stick to anything,
including the heart valves. That’s an area where blood kind of ebbs
and flows so the bacteria can settle in on the vales and start to grow, and it’s very
destructive to valves. That can act as a new site to flick off all
new infection to other parts – it’s a mess. (DR. PETER SALGO)
Pneumonia, especially staph pneumonia, it’s becoming clear why it’s a mess. It can be nasty. By the way, Charles’ blood pressure, the
CT scan was read as negative, the echocardiogram, negative. Then Charles’ blood pressure drops, the
oxygenation gets worse – the amount of oxygen in his blood goes down. Some of his liver function tests become abnormal
over the next few hours; now what’s going on? (DR. LOU PAPA)
It’s very concerning that he’s progressing on antibiotics. He’s becoming more hemodynamic and unstable;
it sounds like there’s multi-organ involvement now with his kidneys and now his lungs and
his liver involved. It could be that he’s getting into a multi-system
organ failure picture – (DR. PAUL LEVY)
Like a septic shock. (DR. PETER SALGO)
Again, when your blood’s full of bugs and a lot of your other organs become infected
or affected by this, then this becomes even tougher. He goes to the ICU? (DR. PAUL LEVY)
Oh, absolutely. He’s there. (DR. LOU PAPA)
On yeah, he needs very intensive care. (DR. PETER SALGO)
They put him on a ventilator and the question on everyone’s mind, I’ll ask it of you
guys. Here’s a guy with a low blood pressure,
high temperature, high heart rate, staph in his blood, staph in his lungs, on a ventilator. Is he going to die? (DR. CYNTHIA WHITNEY)
There’s a good chance of that. (DR. PETER SALGO)
But he’s on antibiotics. That’s going to kill the bugs. Why? (DR. LOU PAPA)
That’s the misconception. Antibiotics are helpful tools but there’s
no guarantee with anything. (DR. PETER SALGO)
I was taught antibiotics don’t cure you; antibiotics hold the bugs at bay while your
immune system kicks in and cures you. (DR. PAUL LEVY)
The whole systemic response goes with the acuity of his illness, but I think what you’re
saying is correct. The antibiotics keep things at bay but eventually
he’s going to need his own physiology to get him through this. (DR. PETER SALGO)
He’s sick as a dog. (DR. PAUL LEVY)
Yes, he’s ill. (DR. PETER SALGO)
All right, Marie, I want to get back to you. You were in the hospital, but you weren’t
this sick? (MARIE VIA)
I was not in the ICU, thank goodness. (DR. PETER SALGO)
You were in for 5 days? (MARIE VIA)
And when you went home, how sick did you feel? (MARIE VIA)
That says it all. (MARIE VIA)
Yeah. I was so tired for so long; I literally stayed
in bed all day for three weeks. (DR. PETER SALGO)
Is this common? (DR. PAUL LEVY)
It’s very common. We often tell our patients a day in bed is
a week to recover from. You were in bed five or six days; it’s not
surprising it takes you that long to get back. (MARIE VIA)
For the first time I understood how people die with pneumonia. Not that I thought I was going to die, but
I knew I was in fairly good health and I wasn’t 75 years old but I could understand it completely. (DR. PETER SALGO)
This really knocked you for a loop, but eventually you got back to your old self. (MARIE VIA)
Yes, I feel 100 percent now. (DR. PETER SALGO)
Well, I must tell you that compared to your course, Charles wasn’t so lucky. While they were treating him, while he was
on a ventilator, while they looked at his hip to see whether that was the source of
his infection, while they gave him really good treatment and IV antibiotics, he had
a cardiac arrest and Charles died. Why do people die of pneumonia in this day
and age? (DR. PAUL LEVY)
Well, there are a whole host of reasons; a lot of it goes back to the individual patient,
their age, their heart condition and such. In his situation, you’ve got to worry about
delay in diagnosis – was he on the right antibiotic promptly – so that when his first
antibiotics he received weren’t excellent staph drugs, there wasn’t good anti-staphlococcal
coverage there. (DR. PETER SALGO)
Now, I want to get to this whole question of the vaccine. You had the pneumococcal vaccine, Charles
did not. You got pneumonia, Charles got pneumonia;
Charles didn’t get pneumococcus. Who needs the vaccine? Does it work? (DR. CYNTHIA WHITNEY)
Well the pneumococcal vaccine is recommend for everybody aged 65 and older, so he should
have had it just based on his age. And then younger people that have chronic
health conditions – heart disease, lung disease, AIDS, things like that, asplenia
That means somebody took your spleen out. (DR. CYNTHIA WHITNEY)
Right, so you’ve really got a problem with your immune system. All those people are recommended to get the
23-valent pneumococcal vaccine. We think it works against preventing the blood
stream infections; whether it can prevent a basic pneumonia from pneumococcus is really
unclear. The data are mixed on that. (DR. PETER SALGO)
So what you’re telling me is she got the pneumococcal vaccine and assuming just for
a moment that the bug that she had was pneumococcus, the bacteria against which this vaccine works,
she might have gotten much sicker had she not been vaccinated. (DR. CYNTHIA WHITNEY)
She might have gotten much sicker had she not been vaccinated, or she might have had
one of the other strains the vaccine doesn’t cover; the vaccine doesn’t cover all the
strains. (DR. PAUL LEVY)
The key feature that Cindy was pointing out is that a quarter of all the pneumococcal
strains are in the vaccine, so that means 75 percent of them are not covered, but yet
it was a vaccine that was designed to prevent the most dangerous ones – the ones that
are associated with blood stream infection and mortality. (DR. PETER SALGO)
The best advice is for those folks who meet the criteria for getting the vaccine – and
you ran through them – is to get the vaccine. (DR. CYNTHIA WHITNEY)
That’s right. (DR. PETER SALGO)
There’s no guarantee that’s going to keep you from getting pneumonia or even keep you
from getting bad pneumonia, but it’s the best we’ve got at the moment and it makes
Yes. It’ll improve your odds. (DR. PETER SALGO)
Okay, I want to pause for just a moment if we can and sum up what we’ve been discussing. Pneumonia can be very aggressive, it can be
fatal, whether it’s viral – that means caused by a virus – or a bacteria, both
kinds can be bad. It can be very virulent. Don’t delay care. Early treatment of pneumonia is associated
with better outcomes. A first good step towards prevention is getting
the pneumonia vaccine if you fall in the category of those for whom it is intended; it will
prevent a fair number of pneumonia and may make the pneumonia you get somewhat less severe. It may in fact be life-saving. Marie? (MARIE VIA)
This shouldn’t have be so gloomy at the end of a show; how are you feeling? (MARIE VIA)
I’m feeling great now. I really am feeling great and I’ve learned
a great deal from this experience. (DR. PETER SALGO)
What have you learned? (MARIE VIA)
Given that I do tend to get bronchitis easily and often, that if I start feeling like I’m
getting it, go now – don’t wait to see my doctor. (DR. PETER SALGO)
Thank you for sharing; it’s tough sometimes to come on and talk about all this. But we hope to continue the conversation on
our website. There you’re going to find the transcript
of this show, more videos about pneumonia and links to resources. The address is Thank you for watching. Again, thank you all for being here, especially
you. I’m Dr. Peter Salgo, and I’ll see you
next time for another Second Opinion. (MUSIC) (ANNOUNCER)
Major funding for Second Opinion is provided by the Blue Cross and Blue Shield Association,
an association of independent, locally-operated and community-based Blue Cross and Blue Shield
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to all Americans. (ANNOUNCER)
Second Opinion is produced in association with the University of Rochester Medical Center,
Rochester, New York.

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