Dear Doctors: Can a doctor rule out walking pneumonia just by listening to your chest? My daughter and husband both have pneumonia, and I have been feeling weird. There’s no cough or fever, and my oxygen is at 99% saturation, so the doctor said I’m fine. But it’s days later and my chest still hurts, and I still feel tired and breathless. What can I do to be taken seriously?
Dear Reader: Your letter contains two important questions -- one about health and one about health care. We’ll begin with your first question about pneumonia. This is an infection that can occur in one or both of the lungs. It affects the millions of tiny and fragile air sacs, known as alveoli, that deliver oxygen to the bloodstream. The source of the infection is often bacterial, but can also be viral, fungal or environmental.
When someone has pneumonia, the alveoli fill with fluid or pus. This causes symptoms such as a cough that can produce mucus, fever, chills, shortness of breath, chest discomfort and exhaustion. It’s also possible for a mild case of pneumonia to be asymptomatic. That means that although the infection is present, the visible or measurable signs of the disease are not. The medical term for this is atypical pneumonia, commonly called walking pneumonia.
Because the symptoms of walking pneumonia can be subtle, it can be difficult to diagnose. The classic wheezing and crackling breath sounds associated with a more severe case of the illness are not always present. So to answer your question, no, walking pneumonia can’t be definitively ruled out based only on the absence of breath sounds. Additional diagnostic clues that doctors often look for include shortness of breath, fatigue and a sensation of tightness or heaviness in the chest.
Diagnosis of atypical pneumonia may include X-rays to check for fluid buildup and lab tests to try to identify the pathogen. If the cause is bacterial, doctors will prescribe antibiotics. People often begin to feel better several days after beginning antibiotics. However, full recovery can take anywhere from several weeks to more than a month. It is important to finish the full course of antibiotics that have been prescribed. Because the inflammation and fluid in the alveoli reduce the oxygen available to the body, it is also important to take it easy during this time.
And now for the health care part of your letter. We’re very sorry you felt your doctor did not take your concerns seriously. This kind of breakdown in communication can leave you confused, frustrated and worried about your health. Worst of all, you can be left with an unresolved medical concern. It’s an important issue and has been a recurring topic in reader letters over the years. We will address it again in an upcoming column and will include strategies that have helped people get the most out of their medical visits.
(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)