What to do For Walking Pneumonia

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This survival-medicine website provides general information, not individual advice. Most scenarios assume the victim cannot get expert medical help. Please see the disclaimer.

What to Do for Pneumonia

In this X-ray, pneumonia covers most of this child’s left lung (which is on your right when looking at the picture). It looks white because there’s not just air in there; there’s fluid and swollen tissue.

by James Hubbard, MD, MPH

I have a confession. I’m a pneumonia survivor. And it wasn’t walking pneumonia either. I was in the bed for a week.

Yes, a few years ago, The Survival Doctor ended up a whimpering mess, dependent on other people’s care. It took a good month to feel like doing much walking. But I was lucky. Each year millions in the U.S. get pneumonia, and over 50,000 die. In a prolonged disaster situation, that number would be much higher.

Symptoms and severity of pneumonia can vary greatly. Me, I thought I was as healthy as a horse, doing just fine, wasn’t even feeling sick. Then, out of the blue, I had a teeth-chattering chill. I just shook all over. After that, I started feeling weak, my heart beating fast. I wasn’t coughing much, but I took my temperature, and it was over 102 F.

I took a couple of Tylenol and crawled in the bed. Soon my bedclothes were soaked in sweat. After the Tylenol wore off, I had another chill. The cough started next, but I thought I had the flu. Now I wasn’t thinking right because anytime anyone comes to my office, otherwise healthy, and they’re running fever, I ask if they’ve had a shaking-all-over type chill. If they have, my first thought is pneumonia.

Well, luckily, after a couple of days of lying in the bed, my wife made me see a doctor, of all things. I mean, I am a doctor. Although he couldn’t hear much in my chest, a chest X-ray proved the diagnosis. I started on antibiotics, but it took me a good week to feel able to go back to work, and a month before I felt like doing anything like going on a walk.

How Did I Get It?

I came down with pneumonia just before my daughter Leigh Ann’s wedding. Though I didn’t have the walking pneumonia type, I managed to deliriously walk her down the aisle—and promptly get driven home to bed. I couldn’t even stay for the reception, so you know I’m not exaggerating when I say this thing can get bad.

Pneumonia can be divided into two very general types, community acquired and hospital acquired. The first is what will be more prevalent during a disaster—especially if many people are sheltering together.

Community Acquired Pneumonia (CAP)

I expect I got mine from breathing in bacteria left in the air from someone coughing. It could have been in some public place as easy as it could have been in my office.

Walking Pneumonia
There’s really no such official diagnosis as walking pneumonia. If you have pneumonia and you still feel like walking around, you have walking pneumonia. Okay, it is true that usually this milder version is caused by the bacteria called mycoplasma. And it’s usually treated with some sort of erythromycin antibiotic like azithromycin (Z-Pak) or clarithromycin (Biaxin) or some sort of tetracycline, like doxycycline.

Pneumococcal Pneumonia
One of the most common types of CAP, and the kind I probably had, is caused from the bacteria pneumococcus. We usually treat these with erythromycins or quinolones (Cipro, Levaquin, etc.).

Others
Legionnaire’s disease was first diagnosed in 1976 after several people attending an American Legion convention in Philadelphia came down with severe pneumonia. A bacteria now called legionella coming from the air-conditioning vent was isolated as the cause. The pneumonia can be severe but usually responds to erythromycin.

Pneumonia from the klebsiella bacteria is found in chronic smokers. Ciprofloxacin usually kills it.

Books adIn addition to bacteria, viruses are a common cause of CAP. Rarely a fungus can cause it.

Now, don’t get me wrong. Community acquired pneumonia can often be treated on an outpatient basis, but it can also be severe. You may need hospitalization, and people die each year from this type.

Hospital Acquired Pneumonia (HAP)

You are classified with this type if you’ve been in the hospital for more than a day or two and you get pneumonia. Many types of germs can cause HAP—things like MRSA from staph, other bacteria such pseudomonas, and fungi. HAP is usually treated with two or three different IV antibiotics. I won’t go into this type any further for the obvious reason that you won’t be seeing it out of the hospital

Pneumonia Diagnosis If You Can’t Get to a Doctor

As with my case, shaking chills and/or sweats is a clue, but high fever for any reason can cause that. Suspect pneumonia in someone who also has fever and a cough. Chest pain or discomfort is another clue, but it’s less common.

Often, if you have a stethoscope or put your ear on the person’s chest and you know what you’re listening for, you can hear crackles in an area of one or both lungs. If your hair is long enough, rub a few strands together next to your ear. That’s what one type of crackles (medical term—rales) sounds like. Sometimes rales can sound coarser.

Many people with pneumonia get short of breath with exertion. Some are short of breath at rest.

How Contagious Is Pneumonia?

Pneumonia is contagious but not highly so. When treating someone who has it, using a mask would be of small benefit. Better would be having fresh air if possible, along with taking the typical disease-prevention precautions such as washing your hands.

Treatment

It’s very hard to get an exact cause for the pneumonia even if you’re in the hospital. Fortunately, any antibiotic in the ciprofloxacin, erythromycin, or tetracycline family usually treats the community acquired type. Rest and fluids help also. Bring down the fever with acetaminophen (Tylenol) or ibuprofen (Advil).

I usually save the ciprofloxacin for smokers or those who appear pretty sick. Of course, the really sick ones—the ones short of breath who don’t respond to an asthma inhaler, the ones who can’t keep down fluids, the confused ones—I usually send to the hospital.

People with chronic diseases, such as heart disease, diabetes, or emphysema, are at higher risk for complications also, as are even healthy people over 65 and under age 2.

Prevention

The most common community acquired pneumonia is caused by pneumococcus bacteria or comes on after a bout of the flu. You already know about the annual flu vaccine, but you may not know that there’s a pneumococcus vaccine you can get every ten years. It doesn’t prevent them all, but it can cut down on your risk considerably. It’s usually recommended for people age 65 and older or who are at high risk for complications.

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X-ray courtesy Mike Blyth.

  • Crystal

    on wed I was diagnosed with mild or walking pnemounia I was prescibed amoxicilin, blue puffer (which i take anyways) and symbicort puffer I have been following the directions for all and not gettig much relief its now saturday night havent been having the best sleep and with having a 3 year old I cannot rest as much as I would like to when do I get a second opinion or go to emerg if nothing is working and yes I am a smoker but have cut down since I was told this all on wed

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      I don’t know what not getting much relief means. If you’re getting extremely short of breath, then perhaps you should go to an emergency room or maybe an urgent care clinic. If you’re running more fever, not drinking fluids, etc., then maybe also. If your just feeling weak and coughing that could go on for weeks. Either way, you should at least check with your regular doctor on Monday.

  • karen

    dear doctor, I live in England though am American and cant get good healthcare advice here. I was refused antibiotics when I went in with pneumonia last feb, 2013. fought it off by myself but ongoing cough til dec last year. couldn’t breathe when running, chronic cough, night sweats, fatigue, dull aching pain on left side under breast, wet cough with white light sputum. they didn’t check my lungs, said I may be anemic, then etc. in feb in so much pain and couldn’t breathe one night on way home. doctor sent me to pulmonolgist who said I had had untreated pneumonia. I had insisted on a course of antibiotics from my gp by then so it cleared up a bit. amox 500mg x 2 per day. some improviemetn. then I asked for more because really not gone. gp gave me same course again. better but still not gone. in meantime, pulmonolgist testing me for asthma, allergies, ct scan etc to be certain. this all takes 6 weeks here so in meantime some improvement from amox, which I was given by gp for general chest infection even though separately at same time lung doctor found pneumonia and crackles in lungs. so, I got somewhat better, anemia corrected, thyroid corrected, night sweats stopped. got food poisoning and lungs all back again last month. dr said pneumonia back and put me on 500mg amox 3 x per day. im on day 9. she said lungs are clearing, and I feel some improvement but my cough isn’t gone and lungs ache still and v tired. I don’t feel its gone, still a wet cough. can you advise me? should I double my amox dose? take augmentin? or try to get levofloxacin? my gp here wont give me more antibiotics – there is a strict restriction. but I am afraid the bug isn’t gone and if it stop now, it will be hard to treat further. kind thanks,

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Karen, I can’t specifically recommend treatment to anyone without an exam. I couldn’t imagine a doctor not giving you antibiotics if it was thought you have a bacterial infection that hadn’t cleared. I would hope you’ve expressed your concerns to your gp and to your pulmonologist, because, again without an exam and tests I couldn’t even make an educated guess since the symptoms can linger after the infection. However, if you were running a high fever, say above 100.5 F, that would likely mean an infection is still there.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Karen, I can’t specifically recommend treatment to anyone without an exam. I couldn’t imagine a doctor not giving you antibiotics if it was thought you have a bacterial infection that hadn’t cleared. I would hope you’ve expressed your concerns to your gp and to your pulmonologist, because, again without an exam and tests I couldn’t even make an educated guess since the symptoms can linger after the infection. However, if you were running a high fever, say above 100.5 F, that would likely mean an infection is still there.
      I do know that, even after pneumonia has been treated, it can sometimes take weeks to get over the cough and weakness.

  • Ryan

    Hi, I had pneumonia before when I was little. I’m 16 now and very athletic due to the fact that I play ice hockey. Last week, I had a pretty bad cold with a runny nose, popping ears, and fatigue. This week, I am experiencing mild headaches, dry mouth, coughing up mucus (only coughing up mucus a few times a day), and the fatigue continued. At first, my parents thought I had mono. But now I think I may have walking pneumonia. I went to a doctor a few days ago and she said that I had sinus issues and the pressure from the congestion was resulting in the headaches. Since the doctors appointment, the headaches have gotten a little better. What should I do?
    -Ryan

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Tell your parents your concerns. If you’re not a lot better in a certain amount of time, usually a doctor would like you to have a recheck.

      • Ryan

        Thanks!

  • Jason

    What have you heard about Levaquin? I have been taking it for 8 days now and have seen nothing but absolute problems for people. I have not gotten any negative side effects yet, but it worries me and am a little hesitant to take my last two doses. What do you recommend?

    • Teresa

      Yes definitely finish this antibiotic! I wish I had more options for antibiotics bc I have had pnuemonia for 3 months now and none of the antibiotics have worked.I’m severly allergic to levaquin but levaquin is one of the best antibiotics that is used in the hospitals in my area.I am allergic to a few others too.I’m tired of taking antibiotics and them not working! Trust me…finish it all bc you will relaspe if not! Best of luck with feeling better!

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Any medicine has side effects in some people. Let’s see if I get this straight. The Levaquin seems to be clearing up your pneumonia (it was only 3 days ago you were still having symptoms). You have no problems taking the Levaquin, but want to forego your last 2 doses because you’ve heard that other people have had problems? So, it comes down to whether you take the Levaquin which you’ve had no trouble with so far, and better assure you’ve cleared up the pneumonia. Or you don’t take it, just to make sure you don’t have trouble, but run the risk that the pneumonia (the real problem here) may not be cleared and you might have a relapse, or worse, have a new infection now resistant to the Levaquin. I could never give you an individual recommendation but, in general, if you’re going to take an antibiotic take the recommended dose and don’t stop before it’s finished. If you have side-effects talk to your prescriber about alternatives.

  • Jason

    I was just diagnosed with pneumonia in my right lung 6 days ago. I have been taking Levofloxacin since then. I generally have been feeling better and breathing doesn’t hurt. I do have a tickle in the throat that makes me cough. Last night i just had a really bad night sweat and just wondering if this is normal as you are trying going through the treatment? How long should I expect periodic things like this happening to me?
    Thanks
    Jason

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Jason, in general, pneumonia can make a person very weak for weeks or months. Also the cough can linger for months. But, once the fever, chills, and sweats go away, coming back would be suspicious the pneumonia is not responding to antibiotics. Hopefully, you have a followup appointment and it never hurts to call if you have concerns. If, today, you’re feeling a lot worse than yesterday, you should at least call. If not, I think it would be a good idea to take your temperature a couple of times today and at bedtime. If the sweats are related to fever, it’s too late to take it then. With fever, chills means it’s going up. Sweats means it’s doing down.

      • Jason

        After that night sweat I have been feeling the best i have for last 24 hours in a long time. 3 more doses of Levoflaxin to go. I’m crossing my fingers
        Thanks
        Jason

        • Teresa

          This is such wonderful news jason! Yay!! Glad your feeling better! !

  • crystal

    I am a 40 year old african american women with heart and stage 3 kidney failure. My first time ever getting the flu was amost two years ago. I went to the er last week and was told I have walking pneumonia. First time with this as well. I was givin a z pack and felt better as I finished the medicine, now I’m gradually starting to feel the severe fatigue feeling creeping up again. It’s hard to tell witg the fatigue because of my condition. Will I be ok? Kind of a who thinks I’m dying all the time.

  • Momma2Boo

    I was diagnosed with walking pneumonia last week after teeth chattering chills (rigors, really), drenching sweats with fever, severe muscle aches/pain, and malaise/fatigue. The back of my lungs still ache and hurt. I have one more day left on the Zpak. I would like to go to the gym and workout one of these days…plus, I start a new job on Monday…but I’m worried about pushing myself too far too fast. I also have asthma. How do I judge when to return to the gym and how should I manage a new job when still recovering? By 2pm each afternoon, I’m wiped and need a nap but can’t do that at work! Any advice would be great!

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      It usually takes several weeks to recuperate. A followup visit with your doctor would be a good idea. He/she can recommend activity specifically for your case. Otherwise it sounds like your best bet is to continue rest until Monday. And don’t plan any other activities, except for work, until you can manage work without getting so tired. Be sure to drink plenty of fluids and eat well. Allow your body to use all the energy and resources it can to recuperate.

  • vegskye

    I have walking pneumonia and I’m on an inhaler and a strong amoxicillian. I’ve been out of work for a week and although I think I’m improving the fatigue is the worse. I can’t imagine going back to work on Monday.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Hopefully you have a follow-up with your doctor.

  • arley

    scary to see how many people are put on quinolines… please do your research on the medicine before you take it. I am a Cipro victim, there are many more like me out there…please look up Fluoroquines before you take it. there are other antibiotics out there with less side effects ( and ones that don’t permanently damage you… I still suffer from CNS side effect 3.5 years later )

  • Nickmbb

    Four weeks ago I sneezed, two days later I had rattling chills, went to MD and X-ray showed pneumonia in lower right lung. Z-pack did nothing so my doctor told me it’s viral. I wasn’t hospitalized, but stayed home for last 4 weeks. It’s really cold outside and I need to go out, how dangerous is breathing cold air with this still in me?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      You should ask your doctor. In general, breathing cold air from, say, the house to the car to a store, shouldn’t be so bad. Breathing it for a long time or exercising in the cold might trigger some wheezing (really more due to the dryness of the cold air.) The other thing, of course, is has the pneumonia cleared. Do you have fever, did you have a followup with your doctor to see if it has cleared.