February 7, 2020

I had surgery on my lungs this morning.  I am currently hospitalized, fighting a severe pneumonia with a large pleural effusion.  

Read below for my cautionary tale of waiting too long to take antibiotics or seek medical treatment.  If you avoid antibiotics for too long, infections can get dangerously out of control. 

Even young functional medicine doctors who regularly compete in triathlons get sick.

WARNING: Some mild graphic images of my health journey are included. Viewer discretion is advised.

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This story started 34 days ago.  I have been having fevers and night sweats every night for 34 days.  Unbelievable, right?  Believe it.

January 3, 2020

The fevers and night sweats started January 3, 2020, and I have been tracking it regularly with my Oura Ring, which measures body temperature every night. 

Despite having fevers and night sweats, I had minimal symptoms other than fatigue and brain fog.  I presumed it was a virus since I had lots of sick people coming into the office.  In addition, I had just come from a plane ride after traveling to Louisiana for Christmas.  I kept telling myself that “tomorrow would be better.”  That tomorrow never came.

January 18-19, 2020

After 15 days of fevers and night sweats, I began developing some minor coughing that wasn’t productive of any mucous.  I still didn’t think much of it.  I had signed up for a half marathon months prior in Houston, and I didn’t want to miss it.  While sick, I drove to Houston to compete in the race.

The race was cold.  It was 6am.  The temperature was in the 40’s and windy.  I was bundled up for the race more so than most of the other runners, but I didn’t think much of it.  I frequently feel colder than others, so I dressed for the occasion.  I had ear warmers, thermal long sleeves, a thermal windbreaker jacket, spandex pants, shorts, and thermal socks.  I was shivering and freezing standing next to people with a shirt and shorts.  It started to dawn on me that I was sicker than I expected.

I hadn’t exercised since the fever, so I knew that I wasn’t going to have a good race.  I ran slower than I knew I could run.  I made it 7 miles at a 9 min / mile pace.

(My prior to illness goal was 8 min / mile).

At mile 7, I developed severe right rib and diaphragm pain that was restricting my running to 0.2 miles at a time.  I ended up walking the majority of the remaining 5.1 miles.  I finished the race in 2 hours and 20 minutes, which I considered quite an accomplishment, considering my state of illness.

It took me an hour to get back to my hotel due to the race traffic blocking off the roads.  I was frozen down to the core of my being.  It took me 30 minutes in the hottest shower possible before I could stop the shivering and feel my fingertips.

It was dawning on me that I was really sick.  Something was wrong.  But, I didn’t want my staff to know because they wouldn’t let me see patients.  I didn’t want my family to know because they would worry about me.  So, I minimized symptoms and told everyone that I finally started antibiotics.

January 20, 2020

I finally started an antibiotic.  A lame one.  I started azithromycin, which is not the best choice for pneumonia due to resistance patterns of bacteria.  I chose azithromycin because it’s rather gentle on the microbiome.

Over the next several days, I began feeling better.  I had more energy and was able to skip ibuprofen / Tylenol dosages.  I thought I was on the mend!

Too soon to say that.  Although I had finally started an antibiotic, it wasn’t powerful enough, and I got worse.

I began developing chest pains from the pneumonia as well as excruciating diaphragm spasms when I laid down at night.  The coughing got worse, and it became productive of thick mucous from my bronchial tissues (deep lungs).  The coughing triggered debilitating diaphragm and rib pains.  It was the worst in the middle of the night when laying down.  I would lay semi-upright on pillows to help, but it still happened.

One night, my spasms were excruciating enough that I couldn’t sit up in the bed without triggering a spasm that threw me back down on my back with an extreme “attack” of shortness of breath and chest pain.  It took me 2 hours to get it under control enough to crawl downstairs to get more ibuprofen.  I was fine by the morning, so I went to work.  Yet this became a nightly attack for the next 10 days.

Despite this, I kept pushing forward … stubbornly taking the maximum amount of ibuprofen allowed in a day.

January 21, 2020

During this time, I was taking lots of ibuprofen to manage my fever / body aches in order to continue seeing patients and working.  Due to the stress of the race and ibuprofen, I developed a severe case of gastritis (stomach lining erosion).  This woke me up at 1am, and it lingered for hours.  I had to cancel my patients for the day at the last minute because it was too painful.  I went home to recover using Heartburn TX, DGL, and Intestinal Repair Complex, which works like magic!  My pain was completely gone within 4 hours of taking it.  I haven’t stopped taking them since I have continued using ibuprofen to function.

A few days after the gastritis resolved, I began noticing significant short of breath and hyperventilation with small tasks like walking up a flight of stairs.  I had also begun having chest pains in my right chest and diaphragm, which was causing spasms and severe pain.

January 31, 2020

After 10 days of the lame antibiotic not working, I finally went in for a Chest X-ray after my family, friends, and staff begged me to investigate further.

The Chest X-ray was not good news.  It showed that I had 2 lobes of my lungs infected with pneumonia:  Right Middle Lobe and Right Lower Lobe.  These 2 lobes consist of approximately 40% of my right lungs.  It also showed a small pleural effusion.  The pleural effusion was small and was only taking up 5% of my lung space.   

A pleural effusion is an accumulation of fluid outside of your lungs yet inside of your chest cavity.  In essence, as the fluid accumulates, it compresses your lungs like a vice grip.

At this time (28 days of fever and night sweats), I finally upgraded to the correct antibiotic (levofloxacin).  I began having severe chest pains and diaphragm spasms where the pneumonia and effusion was accumulating.

Again, I waited because I thought the antibiotic was going to work.

After 5 days of intense pain relieved only by ibuprofen, I was unable to fake the amount of breathing difficulty and pain that I was having.  My staff noticed me breathing heavily after walking the small flight of stairs to get into our office.  I was short of breath during my patient consults, and people were beginning to notice.

No one knew the severe attacks of pains that I was having in the middle of the night throughout all of this.  I continued lying to my parents telling them how I was feeling better in order to prevent my mother from worrying.  It turns out that they didn’t believe me.

February 5, 2020 @ 8am

I swung in for a repeat Chest X-ray before my first patient that morning.  Upon walking out, the staff let me see the X-ray since I’m a physician.  I was immediately alarmed at the image.  My brain immediately went into denial about how bad it was, but I was finally, utterly scared that I might die from this infection.

February 5, 2020 @ 10am

I scurried to the office with my X-ray CD and immediately started my first consult.  We finished a little early, so I called the radiologist after pulling the images up on my computer.  I was scared.  The radiologist did not help.   He answered the phone like this, “Dr. Oubre – this is your chest x-ray? … You are in big trouble.  I’m not going to sugar coat it.  You need a doctor other than yourself, and you need to get this drained … TODAY!”

My mind is now in full blown panic mode.  I don’t have a doctor, so I called my ex-wife (Kelli Oglesby, MD) who is the smartest family doctor that I know, and I knew that she would know how to navigate my stubborn personality.  She suggested a STAT CT scan and began making phone calls to pulmonologists.

February 5, 2020 @ 11am

Arlinda, my wonderful medical assistant and second mother, swooped in and helped me get a STAT CT Scan at ARA downtown.  The CT scan confirmed the Chest X-ray:   I had a severe, worsening double pneumonia with a large effusion.  The fluid outside of my lungs in my chest cavity was now occupying 50% of my right chest cavity.  In essence, it was strangulating my right lung into the size of a grapefruit.

February 5, 2020 @ 11:30pm

In a scared, emotional state, I called my parents. I couldn’t hide the bad news any further.

Me:  “Dad, I have bad news.  I am very sick, and I am going to need drainage of the fluid around my lungs.  I need you guys to come to Austin.”

Dad:  “Okay, we are 1.5 hours away.”

Me:  “What do you mean? You live 7 hours away.”

Dad:  “We didn’t believe you, so we left this morning at 5am to force you to seek treatment.”

Unbelievable.  I have the most wonderful parents, and I am extremely blessed and grateful for them.  They haven’t left my side since they got here.  They even shared a crappy couch made-for-1 in the hospital overnight.  Thank you Mom and Dad! I love you!

February 5, 2020 @ 12pm

Arlinda and I drove home to meet Kelli and my parents in order to come up with a plan.  We were not having much luck finding a pulmonologist that could drain the infection in office the same day.  Kelli made the executive decision that I would require more than an outpatient drainage, and she advised me to go to the ER immediately.

February 5, 2020 @ 2pm

I arrive in the ER to find an absolutely amazing team of nurses, administrators, and an awesome ER doctor.  The wait time was minimal, and the care was STELLAR and full of compassion … and humor!

Thank you:  Barry, Collin, Dr. Ajay Yadav, and all of the other nurses that I cannot remember your names.

They quickly get IVs in both arms as well as lots of blood tests to rule out sepsis (bacteria in my bloodstream).  They pulled a lactic acid level despite me not needing one.  Tell me I’m wrong, Barry!  I’m still waiting to win that bet!

Dr. Yadav reviewed the X-rays and CT scans, and he was able to get a thoracic surgeon to evaluate me within an hour. Unbelievable speed and efficiency!

February 5, 2020 @ 3pm

Dr. Dan Fortes, a thoracic surgeon, shows up in record time.  He is kind, empathetic, funny, and straight to the point.  On top of that, his skills are exceptional.  Without hesitation, he tells me that he needs to insert a tube into my chest right now if I wanted any hope of avoiding surgery. 

A chest tube is an extremely painful procedure where a physician makes a cut between your ribs and inserts a tube into your chest (smaller than a garden hose).  Then, they connect the tube to a box that applies suction in an attempt to get all of the fluid out of your lungs.

He reassures me that he has techniques to reduce the pain of a chest tube placement, and I don’t believe him.  But, I’m hopeful!

…He was absolutely right.  He has neat techniques to reduce the pain of insertion.  It was still painful, but it was significantly lower than every other chest tube insertion that I’ve seen in my entire career.

The tube is inserted and half of a liter of fluid gushes out of my chest cavity.  

Good news:  The fluid is clear, which means it’s most likely not infected and not cancer!  The fluid is simply an inflammatory drainage secondary to the severe pneumonia.

Bad news:  It was supposed to drain 1.5 liters of fluid.  This means that I will most likely need surgery, but Dr. Fortes gave me 48 hours to drain the remainder of the fluid.

February 6, 2020 @ 1pm

My Chest X-ray is minimally improved, and I have only drained 200mL of the 1000mL that needs to be drained.  Dr. Fortes team decides to place a medication called TPA into my lung cavity.  This drug is an enzyme designed to break up fibrous tissue and disrupt the loculations (or pockets) of fluid that is trapping the fluid.

The TPA is pushed into my chest cavity through the tube, and the tube is clamped to prevent it from draining.  I now have 4 hours to rotate like a rotisserie chicken in order to work this medication all around my chest cavity.  If I can’t break it all up, I need surgery.

Despite significant amounts of pain changing positions (laying on the tube, moving side to side, sitting up, and lying down), I endure the pain in order to get the TPA worked all around my lung cavity.  I really don’t want surgery!

February 6, 2020 @ 5pm

It’s time!!!

My nurse in the PCU (progressive care unit – It’s like a lower acuity ICU) is going to unclamp the tube in order to see what comes out.  We are all excited, and Mitch is too since he hasn’t had much experience with chest tubes.  It is the moment that we’ve been waiting for.  My parents are waiting.  Kelli (my doctor and ex-wife) is with there.  We are ready, so I lay down to get in position.

The tube is unclamped, and it’s a huge success!  Approximately 400mL (half of a liter) flies out of my chest.  However, this causes a severe, excruciating diaphragm and rib spasm that I cannot control.  I cry out for them to clamp the tube in order to stop it.  They quickly clamp the tube, but it doesn’t stop the pain.  It is excruciating and unrelenting.  It is preventing me from breathing, and I’m gasping for air in agony.  I can manage to get just enough air to not require an emergency.

With the suggestion of Kelli, the nurse asks my hospitalist physician (Dr. Pothala) on the phone to get an emergent order of pain medication.  Within minutes, Mitch has IV pain medication in hand, and he quickly gets it into my body.  This is enough to drop my pain from excruciating to severe where I can breathe without hyperventilating.

We are still hopeful that more fluid will come out, so we unclamp the tube to let the remaining half a liter come out.  Hopefully it will be less painful.

Bad news:  It’s dry.  Most of it came out already.  The rest is still trapped.  At that moment, I now realize that surgery is most likely my only option.  I am saddened and scared.

Thank you Mitch for being a stellar nurse.  He was calm and collected in a wacky situation.  He was able to focus and accomplish tasks despite the chaos and unpredictable outcome.  Skills of an experienced nurse and future nurse practitioner!  Good luck, Mitch!!

February 6, 2020 @ 7pm

Dr. Fortes swings by at the end of a very long day for him.  He has already been working in the early morning, but he made the effort to come see me anyway, which I will forever be grateful.  He confidently tells me that surgery is my only option, but he appeases me by doing a Chest X-ray to see if I got it all.  Of course, he was right, and I was wrong.  My lungs were not empty, and I will definitely require surgery.

February 7, 2020 @ 7am

I am wheeled to the pre-op area, awaiting surgery.  Dr. Fortes, anesthesia, and nursing teams all swing by to get me prepped for surgery.  Anesthesia comes by with 2mg of Versed to help calm me down and prep me for surgery.  After he puts this in my IV, I don’t remember anything.  Lights out.

Surgery goes well, and they got the rest of the loculated fluid out of my chest cavity.  They examined the outside of my right lung after fully collapsing it under anesthesia.  Then, they re-inflated my lung and looked at the inside of my lungs with a bronchoscope.

Hours later, the first thing I remember is waking up, coughing with intense pain in my chest.  It quickly fades after the coughing stops.  I’m held in recovery for an hour or so.  Then, I am wheeled back to my PCU room.  I look at my chest to find a new battle scar that has been glued shut.  This is the hole they created.  Another scar for waiting too long to seek treatment.

The rest of my day goes rather smoothly.  I am able to walk and do more than I had previously, and I am feeling confident that I’ll be out soon.

Surgical wound under my right nipple from the incision used to insert a camera into my chest cavity. The chest tube from the ER is still in place.

February 8, 2020

Day 4 with a chest tube sticking out of the right side of my chest.  It hurts more today than yesterday.  I am able to do less.  I cannot walk as far.  It hurts to move more.  I cannot sleep as well.  I am beginning to get concerned as to why I’m getting worse.  Exhaustion from the frequent interruptions overnight by the nursing staff is beginning to weigh on my psyche. 

Dr. Fortes’ partner, Dr. Medbery, comes by to do a post-op check, and she informs me that during surgery, Dr. Fortes placed a long-acting nerve block that is beginning to wear off.  This is why I’m feeling worse.  She says that everything looks good, and we will take the chest tube out tomorrow.

The night goes terribly with lots of pain with any sort of movement.  I am still short of breath due to the pain associated with breathing.  Coughing and burping causes immense pain throughout my right chest cavity.

At this time, I am on a significant amount of narcotics to help limit the pain.  As you can imagine, the constipation that has set in is becoming unmanageable.  I am chugging Natural Calm (Magnesium Citrate) in order to start the engine.  As I expected, I ended up overdoing it and paying the price for it all night long.  I’ll spare you the details.

I am visited by friends and family who continue to show their love and support for me.  They are positive and uplifting.  They help me realize that this is not forever, and I will get better.  They reassure me that everything at work is going smoothly, and I don’t need to do anything.  They promise me that my patients are doing fine, and they understand that I can’t help them right now.

I continue to walk around the hospital and practice breathing exercises. I am willing to be the best patient that I can be in order to get out of the hospital!

February 9, 2020 @ 11am

Another night of terrible pain, frequent interruptions, and minimal movement.  I am anxiously awaiting the chest tube removal, yet I’m also secretly scared of how much it will hurt.  Dr. Medbery comes by to remove the tube.  A Chest X-ray is done prior to the removal to make sure that I have not worsened.  Everything looks great, and she begins to reassure me that removing the chest tube will not hurt much at all.  I’m not inclined to believe her, but Dr. Fortes made me the same promise for inserting the chest tube … and he was right.  She undresses the tube, and she quickly removes the 12 inches of tube from my chest cavity.  It did cause a searing pain at the chest wall where it came out, but it was brief.  She quickly stitched the wound shut, and she said I should start feeling relief quickly.  She was right.  My chest began to hurt much less with less spastic feelings in my ribs. My dad noticed me using my right arm above my head (unintentionally), which I hadn’t done in a week.  As it turns out, this chest tube sticking through my ribs was causing a constant stabbing pain that would not go away.

Chest tube finally removed and waterproof bandage applied.
The second chest wound from surgery is glued shut, and it does not require a bandage.

By 2pm, I am given discharge instructions and finally allowed to leave the hospital.  I slowly hobble to my dad’s car with the little dignity that I have left.  I get home to see the loving, smiling faces of my children.  I am relieved that I will get to see them grow up.  I have never been this close to death, and I don’t plan to repeat it.

After about 2 hours of being awake, I went to bed.  Finally, without any interruptions in my sleep (other than pain), I sleep 16 hours straight.

Over the next several days, I continue to regain my strength and stamina as well as reduce my pain.  Tramadol was causing blurry vision, so I have only been using Ibuprofen to manage the pain.

From here on out, it’s all about getting stronger without pushing too hard or fast.  Luckily, I have multiple people in my life that will stop me before I injure myself again.

I have lost 11 pounds (5 pounds of muscle) since the beginning of the fevers. My appetite is finally coming back, and I am slowly working to improve my stamina. At this time, I can walk up the stairs without stopping due to shortness of breath. Please excuse the bathroom selfie, but these 2 scars will be my lifelong reminder to never ignore my health and to never take it for granted. I hope you do the same.

After 3 days of being discharged, I was allowed to take the bandage off.

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Thank you to everyone who showed their love, kindness, and support for me.  You made an extremely difficult situation more tolerable and pleasant.

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