Question: What are your firm's fees for a consultation with a Urologist/Surgeon specialist ?
Thanks for the fee schedule. I will check out your reviews and be back if they are good.
2015-09-10
What is the recommended buffered chemolysis solution for prophylactic kidney irrigagion through a PNT (Percutaneous Nephrostomy Tube) ? Please state the composition of the solution, recommended frequency of irrigation, contraindications, effectiveness in dissolution of calcification buildup on PNTs, and dissolution primarily of Calcium Oxalate calculi and other types of calculi.

2015-09-12 Transported my wife to her new Urologist yesterday for a review of her CT Scan which was done on 2015-08-31. In reviewing the CTS, it showed that the right ureter stent, around the calculi blockage (since Sept 2012), is completely encased with thick calcification. The encasement is throughout the stent, pressuring the ureter walls, and extending into the bladder. The Urologist said that it cannot be removed. The right kidney pelvis is significantly enlarged. This right kidney is the primary functioning kidney since the left kidney is significantly smaller and it's PNT output averages 100 cc or less per day. The Urologist said that insertion of additional PNTs or surgery would require General Anesthesia, and restated that the Indwelling Stent and PNT are not removable. With these constraints, I asked the initial question about the feasibility of dissolution by chemolysis in kidney irrigation. The Urologist also stated that there is no present approved method for chemolysis of Calcium Oxalate stones. At this point, any additional suggestions would be appreciated.

Wife's Age is 72. Her Renal condition is with calculi in both kidneys and calculi in bladder. MS was diagnosed as Secondary Progressive and confirmed in 1996 with MRI and Spinal Tap.      1990, First major surgery to correct congenital abnormalities in left ureter, calculi in left kidney, calculi and outpouching in bladder. Left Kidney stones were removed with Lithotripsy. She had surgical removal of bladder stones and reconstruction of bladder outpouching, and ureter reconstruction on duplex system with smaller additional kidney on left side.
     In Feb 2004, she was hospitalized for a drug reaction to Lisinopril, low blood sodium, and impaction. She was put on another Blood Pressure reducing medication. Over the years, her blood pressure has normalized. Her recent reading was 101 / 57 pulse=75 with an O2 Saturation of 99%.
     In October 2004, she had an infection (probably urinary). She had a temperature of 91.8F at admission. Overheating, dehydration, and lack of O2 monitoring in the ER resulted in Heat Stroke. She was in Intensive Care for several days on a ventilator, given antibiotics, and released in one week. This was the first major step-down in her health.
     In October 2005, she was hospitalized for bleeding which was determined to be originating at the base of the Esophagus. This was probably due to the suctioning and ventilator from her previous hospitalization in October 2004.
     In Feb 2005, she was hospitalized with a high temp / UTI and treated with Cipro/ / Kyflex which resulted in an allergic reaction and the rare condition of Bullous Pemphigoid which lasted for several months. She was treated with Levaquin for 10 days in April 2005, and with Macrobid for 8 days in XXXXXXX 2005.
     In Feb. 2007, she had a shutdown of urinary and bowel systems, and sepsis.
     In Feb. 2008, she had a left kidney ureter blockage, serious hemorrhaging, kidney infection, and two PNTs were installed into Left Kidney.
     In XXXXXXX 2008, a Cysto Removal of Bladder stones was performed.
     In Sept 2008, there was a removal of one PNT and a replacment of the 2nd PNT in the Left Kidney.
     In May 2009, the Left Kidney PNT was replaced.
     In XXXXXXX 2010, the Left Kidney PNT was replaced.
     In Feb 2012, she was hospitalized for vomiting blood due to excess Zinc and Vitamin C which was prescribed by the Wound Care Center for a Stage-4 Sacral Pressure wound wihich developed during the 2004 Hospitalization. This Sacral wound was finally closed in August 2015.
      In May 2012, there was a replacement of the Left PNT due to an obstruction.
     In Sept 2012, there was a hospitalization for a 1 x 1.5 cm calculi that moved from right kidney into right ureter causing a kidney infection and sepsis. An indwelling stent was placed from the right kidney around the calculi in the ureter to the bladder. This stent is still in place. The right kidney is very enlarged which may be an indication that it is carrying the primary load. Presently, the left kidney has a PNT (percutaneous nephrostomy tube) in place which has not been changed since Sept 2012. This tube is backflushed once each day.
     On August, 31, 2015 a CTS (mentioned previously) was done and an attempt was made by the radiology doctor to remove and replace the PNT. It was not successful. The doctor said that the PNT is not removable due to calcification, and indwelling stent is probably in a similar condition (confirmed by CT Scan Review).
The patient also has a neurogenic bladder and is straight cathed four times a day. She has a fragile brain due to the MS with significant atrophy. After her surgery in Sept. 2012, she had a steep decline, came close to dying in XXXXXXX 2013, continued to decline, and came close to dying twice in July 2013 (about 40 lbs weight) before making a turnaround. Assisted her turnaround recovery by giving her sugar-nutrition drinks with whey protein (approximately 60-80 gm. per day of whey protein). She became diabetic in Sept 2014. (Blood Glucose=149). Her diet was adjusted with reduced sugar and carbohydrates. Over a year, her Glucose levels have returned into the safe, middle 90s range. She has improved to the present (weight about 65 lbs). Another surgery with anesthesia is of concern for her continued survival. I realize that she has done well in an end-stage case, and I continue to seek knowledge to extend her longevity until it is no longer in her best interest to continue in this life.

2015-09-13
I can answer parts of your request presently. I have requested her latest CT Scan, Bloodwork, and latest Emergency Room tests which were performed at a new Hospital and I visited and registered her there with a new Urologist who I feel more confidently with concerning my wife's future procedures.
In her last major hospitalization (Sept 2012), she contracted a C-Def infection in her 2nd week there. She was put on Antibiotics and kept another week for it to be brought under control. So this was a 3 week hospitalization. I then brought her home and cared for her. As I stated earlier, she began a decline for the balance of 2012, and came close to dying 3 times in 2013. She lost substantial weight, and the Hospice Nurses who visited me stated that she was very near death twice in July 2013. I then put her on a high sugar-protein diet and she did a turn-around out of her death spiral. She had a very slow recovery for the balance of 2013, 2014, and up until the present in 2015. I decided not to do any further surgical interventions until she was at a "stable" point and I thought that she might have a chance of surviving another surgery.
Additionally, I was very dissatisfied with the Hospital which we were using for many years. I have spent many weeks there with my wife's hospitalizations. In my observations, I have concluded that this hospital has a serious hygiene problem. I did not want to expose my wife again to this environment. In her previous procedures, she aquired proteus mirabilis, pseudomonas A.(type I and type II), staf infections, and the latest C-Def. During one of the years, she contracted a Bladder/Kidney E.coli infection since stool entered her urethra. Having a neurogenic bladder, her body could not flush it out, and it entered the Bladder/Kidney. The good aspect of the infection was that the E.coli wiped out the other 3 bacteria which were in that environment and also had permeated into the struvite stones. The E.coli was later removed with another antibiotic which was administered.
The latest hospital which I have chosen was recommended by a Nurse who worked there previously. It was a good recommendation. My observations (8/31/2015) of personnel observing proper hygiene, cleanliness of the ER, and the Radiological area indicated that they were disciplined in hygiene of themselves and their facility. There was also excellent communication between Doctors and Staff with me which I was very satisfied with. It's a longer trip, but I will have her transported there for future procedures.
Concerning present medications which she is using: Baclofen x3 daily (for her MS spasms), and Prempro (conjugated estrogens 0.3 mg/medroxyprogesterone acetate 1.5 mg) x1 every other day. She is also given 1/2 tablet each day of a women's age 50+ multivitamin.
I have taken care of my wife for the past 19 years, and have cared for her 24x7 for the past 12 years. I imagine you are wondering Why? Well...She was an Excellent Wife, Mother, and worked as a Registered Nurse in many Hospitals during her working career helping thousands of people as Nurses do. I feel that I need to do my best in her care during the end of her life. Hopefully, when I am Reincarnated, I will be a Good Doctor as you are.
I will provide additional information when I receive it from the Hospital Records Departmet.