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Treatment of BP with hemorrhagic stroke - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Very Good Posted in: Brain and Spine
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2408 Questions
Doctor :   Hi
User :   Hello
Doctor :  
how can i help you?
User :   Yes I have a question that you may or may not be able to answer
Doctor :   is it medical related?
User :   My father who is 55yrs old had a hemorraghic stroke 13 days ago. His blood pressure has never been under control for the last 10 years. They now have him on several meds to keep his BP under control...more to say
User :   He is still in the hospital and are going to release him tommorrow but he has had several BP spikes that were elevated. The doctors say they wouldn't release him untill they have the BP under control but it appears it isn't. What do you think could be done?
Doctor :  
yes it is very important to control blood pressure
Doctor :  
as elevated bp could be dangerous in systemic illness.
User :   I agree
User :   But is there something we could ask the doctor to make sure it is the right decision to release him with occational BP spikes?
Doctor :   During the hospital stay the most probable way of controlling or regulating the BP is through Intra venous drip

Doctor :  
This is because the BP medicine is given via drops per minute
Doctor :  
The staff records the BP at various intervals
Doctor :   It seems you moved away
Doctor :  
please login back
User :   Sorry. Like I was saying, they did have him on a IV during the ICU but were trying to ween him off to just oral meds.
Doctor :   Yes
Doctor :  
That is the way they do slowly wean him off the iv drip
Doctor :  
and then put on the Oral medicine
Doctor :  
and then discharge him after seeing the oral medicine is working
Doctor :  
properly
Doctor :  
so that he does not have problems after getting home
User :   But is it normal to see elevated BP at certain times?
Doctor :   Yes
User :   We are talking like 205 over 118
User :   That was taken at 2:00pm today
Doctor :  
It is slightly tricky for the Neurologist to control the BP, as it a situation where he cannot institute drugs which suddenly drop the BP
Doctor :   This is always a challenge for the Doctors
Doctor :  
to regulate the BP in a hemorrhagic stroke
User :   We are just worried he will have another stroke with that kind of BP
Doctor :  
Ok how is your father otherwise
Doctor :  
Is he conscious
Doctor :  
or coherent?
User :   Yes and alert
Doctor :  
How is his speech
User :   His numbers are mixed up. He can't tell the time or know the date.
User :   And he gets things mixed up such as saying hospital when he means home
Doctor :   So not oriented in the time and day

Doctor :  
and the place
User :   Not really. He seems to know when its dark but he has only alittle aspect of time.
Doctor :  
He is not oriented to time and place, Is it not?
User :   They said it hit the Pariatal Lobe area
User :   No. He's not too good with the time or place
Doctor :   Did they take the opinion of the Cardiologist to control the Blood pressure?

User :   I am not sure. I know they spoke of a Cardiologist but we never heard anything about it. They did say his Potassium levels are very low.
Doctor :  
Ok
User :   I know they are doing a 24 hr urine test as well to rule out a certain hormone level
Doctor :   Ok
User :   They think it is more a Secondary blood pressure problem is what they are calling it.
Doctor :  
Did they scan the abdomen
Doctor :  
Ok
User :   Yes. No tumors were found.
Doctor :  
Ok
Doctor :  
The BP of such high levels are surely of concern
Doctor :   usually the BP should be controlled within 3 to 4 days of hospital stay
Doctor :  
and maximum of one week
User :   Are family is also concerned. We are just not sure if it is the right thing to be doing in releasing him.
Doctor :  
If they are not able to, then they look for secondary causes of High Blood pressure
User :   Yes he has been there going on the 14th day
Doctor :  
I would let him stay in the hospital with such high numbers of BP
User :   But what should my mother tell the doctor to ensure he stays?
Doctor :  
At such high BP, which is called accelerated Hypertension
Doctor :  
there is a risk of repeat stroke, heart failure, kidney failure
User :   They are saying he is displaying ICU Psychosis and is not a very good patient. I'm not sure if that is why they want to release him.
Doctor :   No hospital should deny a treatment to any patient with the above reasons
Doctor :  
So insist on his staying
Doctor :  
back at hospital
User :   Okay. And I'm hoping surely they aren't releasing him because of insurance reasons. My parents have no health insurance to cover the bills.
Doctor :  
otherwise shift him to a better facility which is a tertiary care, if you think the Doctors are not competent
Doctor :  
to control the BP
Doctor :  
You can take a second opinion from a Cardiologist if you have all the medical records
Doctor :  
I know you will not be given access to it
Doctor :  
*them
User :   Okay. I will relay that to my mother. My dad may not be happy to know he has to stay longer but.......
Doctor :  
Yes
User :   Now his nurse said something about talking to my dads doctor about issuing a stabilizer medication? Does that sound like an option?
Doctor :  
What is the stabilizer medication, any generic name?
User :   No they didn't say. But from what I understand is they said when his BP spikes that they have also given him a stabilizer med to help lower his BP
Doctor :  
Ok that is usually done
Doctor :  
so that that spike does not cause physical damage to any other organ
Doctor :  
or cause complications of it
User :   Right.
Doctor :  
Since he is conscious and coherent
Doctor :  
the prognosis is still good
User :   Yes he can take oral meds with no problems. They have him on 5 different kinds of meds right now. Three for BP, one for seizures, and a potassium pill.
Doctor :  
You know at this time, any Doctor would require the serial measurements of BP for the past one week to be able to ascertain
Doctor :  
an opinion
User :   What does that mean?
Doctor :   A Doctor shall critically analyze the past BP measurements recorded within the past 72 hours and then change the medicines accordingly
User :   Okay I understand.
Doctor :  
I can only say that with such high numbers, it is not wise to get him back home
User :   I know they would not let him out of the ICU because of his blood pressure but they are releasing him from the hospital with his BP not stay down.
Doctor :  
whatever it takes, he has to stay back and control the BP medicines, it may need a different hospital or a better hospital
Doctor :  
* with medicines
User :   I would have to agree. We would like to know what they find out with this urine test shows before they release him but they have other opinions.
Doctor :  
Urine test, they test for a by product of a hormon called VMA, which may predict one tumor in adrenal gland
Doctor :  
called Pheochromocytoma
User :   Okay. So that image of the belly wouldn't show that particular type of tumor?
Doctor :  
Yes, a CT scan would show
Doctor :  
may not be an Ultrasound scan
User :   He said he was in a machine that felt claustrophobic and they told him to hold his breath then breath out. Sort of sounds like an MRI?
Doctor :  
Ok
Doctor :  
Both of the test are done in a claustrophobic machine
Doctor :  
CT and MRI
Doctor :  
CT uses radioactive rays, MRI uses electromagnetic
Doctor :  
rays
Doctor :  
sorry field
User :   If that was the case the doctor said no tumors were found after that test. So I'm not sure what the urine test is for. The Internal Medicine doctor said they are suspecting something in corlation with his low potassium levels.
Doctor :  
ok, even in that tumor there are low potassium levels
Doctor :  
If it is not that as it is ruled out in MRI, then there is something else
Doctor :  
I am sorry I do not know what it is
User :   Thats fine. You've been a great help.
Doctor :   Thank you
Doctor :  
I pray for your father's health
Doctor :  
Is there anything else I can help you with?
User :   Thank you. Nothing else thanks so much for the help
Doctor :  
Please fill the feedback form say done when done.
Doctor :   Thanks for consulting me
Doctor :  
Bye for nwo
User :   Have a good night
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