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Renal stone, arrhythmia and cellulitis - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Kidney Conditions
Answered by

General & Family Physician
Practicing since : 2009
Answered : 667 Questions
User :   need kidney surgery but heart is too weak, drs wont do surgery I recently had a kidneystone removal surgery ATTEMPT. Before the stone could be removed i lost all vitals, and the surgeon could not remove the stone, instead had to resuscitate me to save my life . I lost alot of blood and turned septic on him. Today i was to have the stone removed but he sent me home from the hospital. He and the anesthesiologist both agree, my heart could not hold up to surgery. Ive had fluid retention badly, i am a diabetic. I also have had shortness of breath ost recently and can barely walk on legs due to the swelling and a new symptom , severe cellulitis. I appreciate them caring enuff to get me healthy before surgery. Only i dont know what i can do. I used to dance 20 mins a day and lost after 3 mos 36 lbs but since this surgery i cannot walk, so therefore dancing is out . I just don t kno what to do to get healthy heart here for surgery. I currently am wearing a drainage tube in my kidney until the stone can be removed, but i dont see myself being able to wear this forever. If the kidney stone moves to the top of my ureter, they said it will kill me. So i MUST get healthy for surgery. I am on Cardizem CD 120 mg for a high heart rate, 120 detected in urologists office. He requested the cardiologist to do an ECG wich the cardiologist did not do .. I am in wait. As a kid i had a heart murmur that required surgical procedure, yet my parents did not take care of it, as an adult i m not very active, but I try. In the cardiolosits office, the ekg showed tachycardia of which the cardiologist said he didnt know why . Should i ignore the foot and swelling pain and just do my dancing work out anyway? Ive been trying to eat fish/salmon, healthy foods as well. the cardiologist told me my heart beat on the ekg was strong, yet three days later in hosp they are saying its too weak. I m really
User :   upset over this, and no where to turn :( . please offer suggestions as to what to do . thanku
Doctor :   Hi
Doctor :   Let me read the query.
User :   Hi
User :   kk
Doctor :   May I know your age?
User :   57
Doctor :   Do you have the latest reports on the heart status apart from the EKG's?
User :   only tht today in hosp the urologist and anesthesi guy said its too weak to undergo surgery
User :   that i need to get healthy heart before they can and i am at a loss how
User :   i could not reach my reg dr as he's ill today
User :   maybe i should relax and not worry but i'm worried :(
Doctor :   How big is the kidney stone?
Doctor :   And since how long are you suffering from this kidney stone?
User :   close to an inch , there were two , he did remove one smaller one before i had problems
User :   i dont kno its been all summer with several kidney infections
User :   i am a diabetic as well, and on high blood pressure med also , my diabets A1c is 6.3 atm
User :   the 42 lbs of fluid they put in me two weeks ago from the other surgery, ive lost all but 5 lbs
User :   its basicaly in my left leg/and foot. severe cellulitis , and ive had shortness of breath this past week , noticebly , but cardiologist did not address that issue .
Doctor :   Ok
Doctor :   Has the infection/cellulitis recovered now?
User :   its still there , tho alot better
User :   the urlogy surgeon saw that as well today and said much better
Doctor :   Let me explain to you.
User :   ty
Doctor :   Based on what you have suggested, you have the following 3 problems
Doctor :   1. Arrhythmia secondary to heart pathology
Doctor :   2. Renal stone
Doctor :   3. Cellulitis probably affected by diabetes
Doctor :   Of these 3 conditions, the first and later are the primary issues.
Doctor :   Since I do not have proper access to your heart records(no reports of echo and other investigations), I am unable to guess the type of heart disease you suffer from.
User :   the cardiologist said my heart was strong, only had tachycardia.. so i can still have a type of heart disease?
Doctor :   Tachycardia is a finding, clinical sign.
User :   ok
Doctor :   which can happen in number of heart conditions.
Doctor :   Since you report of a heart murmur
Doctor :   a valvular disease/congenital heart condition
User :   so i need to get my heart healthy for srugery and i don t know how to do this
Doctor :   or valve prolapse may be causing the murmur
Doctor :   which may also be responsible for the tachycardia / arrhythmia.
Doctor :   The second problem, that needs to be addressed before the surgery
Doctor :   is the cellulitis.
Doctor :   Surgical treatment in the presence of preexisting illness can do more damage to body system than good.
User :   i understand
User :   and appreciate the surgeons response to get me healthy before hand. shows me that this team is a caring team
Doctor :   The cellulitis can probably be contributing to the shortness of breathe significantly.
Doctor :   So the appropriate means of approaching the problem is (I think)
Doctor :   1. Address the cellulitis by means of proper antibiotics and diabetic control (HbA1c value of 6.3 is pretty good diabetic control)
User :   two yrs ago the A1c was 12.9 ive done really well with diet and exercise and losing wt
Doctor :   Yes, 6.3 values are pretty good now,
Doctor :   so continue with the diabetic treatment which you are presently on
Doctor :   along with appropriate antibiotics to treat cellulitis.
User :   the surgeon today in hosp before i came home did give me iv fluid of antibiotic
Doctor :   2. Proper bed rest with minimal activity.
User :   should i contact my primary care physician tomoro ? to increase the diuretic i am taking?
Doctor :   I think it's better not to think of dancing now, once you recover well (which I think is quite possible with time) you may plan to do your daily activities
Doctor :   Since I do not have the access to your current medical records, I am not the right person to decide on the drug dosage that you need.
User :   atm its 25 mg spironolactone
User :   if it helps with the sweling, thinking maybe needs adjustment
Doctor :   Good diuretic is essential to counter any fluid overload and the shortness of breath.
Doctor :   Your nephrologist and cardiologist are the best person to decide on the dose of spironolactone.
Doctor :   Take their advice on the dose of spironolactone.
User :   ok
Doctor :   3. Once these issues are addressed
User :   it was prescribed by the primary care who has been overseeing 3 visits a week this past two weeks with this issue
Doctor :   renal stone can be addressed by invasive surgeries or by extracorporal shock wave lithotripsy
Doctor :   The use of ESWL is subjected to the site and size of the renal stone.
User :   i understand that, this urologist showed me the sizes and decided teh lapraoscopic was best
Doctor :   ESWL is a minimally invasive procedure where the stone is subjected to ultrasound waves to break the stones into smaller size
User :   and i have another stone in the other kidney larger than an inch as well
Doctor :   so that they pass through easily through the urinary system.
User :   but want to get heart working properly before anything else at this point
User :   so tackling this cellulitis is primary concern it seems
Doctor :   I agree with your doctors, that presently cellulitis and stabilizing the heart is the primary concern.
User :   ok
Doctor :   Cellulitis can affect the heart functions, so you need to wait atleast till there is complete recovery from cellulitis
Doctor :   before thinking of the any surgery.
User :   okay
User :   i didnt really understand taht till u explained it, ty
Doctor :   Have I answered your query?
User :   yes u have
Doctor :   Do you have any other query?
User :   and more in fact, i can see where i need to focus on most
User :   not at this time
Doctor :   Thanks for consulting me.
User :   ty
Doctor :   Wish you speedy recovery.
Doctor :   Bye for now.
User :   thanku so much bye
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