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What Do These Following Lab Reports Indicate?
Question: Dear Doctor,
XXXX here from XXXXXXX
Past History:
I am 47 yr old, since 17 yr. Old uricemia (high uric acid) taking xylorix SOS, smoking history quitted last month Oct 2015.
In 2014 whole health check up done TMT was positive thyroid was high 10.7, Uric acid was high 9.8, trigkycerides 295, FBS-115, PP-173, platelets mildly reduced (1lac), grade I fatty lever, Mild Obstructive airway disease and was prescribed medicine for the same BUT I IGNORED IT THOROUGHLY AND DIDNT TOOK ANY MEDICINE WHICH I REGRET NOW.
on 18th Oct 2015 I felt congested chest and heaviness and breathlessness and admitted to local nursing home which I got normal after administering nebulisation, they took bed side ECHO and diagnose calcified Bicuspid Valve stenosis with LVH (left ventricular hypertrophy), I got it cross checked at specialised cardiac center at XXXXXXX and seeing the gradient they advise me to undergo surgery AVR.
Before surgery they wanted to perform Angiography to know if there is any arterial blockage, so that both bye-pass and AVR can be taken care thru (CBAG), if angiography is normal they can go for endoscopic aortic valve replacement, they will be using tissue valve.
Diagnosis:
a) Bicuspid Valve.
b) Calcific Severe Aortic Stenosis
c) Severe Aortic regurgitation.
d) Left Ventricular hypertrophy
e) Obstructive airways disease 2014
f) Blood Platelet Count 150000
g) Lost 8-9kg in last 1 month.
h) Grade I fatty lever
i) Hypothyroidism-TSH-11.77
j) TMT positive 2014
k) Sodium-132
l) SGOT-78
m) SGPT-157
n) HDL-28 (L)
o) LDH-118(H)
p) CHOLESTEROL.HDL RATIO-5.29
q) UROC ACID-7.8
r) GAMA GLYTOMYL TRANSFERATE-139 (H)
s) BH-15
t) CREATININE-1.37
Past History:
a) Raise Uric Acid 17yr
b) Smoking-Quitted 1 month back
Plan of action as per XXXXXXX Hrudyalaya:
1) Haematology assessment for low platelet count.
2) Angiogram
3) If 1&2 goes well go for AVR thru endoscopic aortic valve replacement if any blockage diagnose go for (CABG+AVR).
QWERIES:
A. Please advise on Best cardiac medical center in XXXXXXX and cardiac surgeon expert in AVR+CBAG.
B. Is the line of treatment and plan of action is OK and we should go ahead with this.
C. Metallic Vs Tissue Valve-Please advise with reason in this age which valve shall we use doctors have difference of opinion on this.
D. Which is better technique of surgery conventional CABG or endoscopic aortic valve replacement and safe for longer run.
E. Specific hospital name and surgeon name we shall be opting for in XXXXXXX
F. How safe and success % and recovery time in this kind of surgery and how it is going to affect and impact my quality of life.
G. Current medication: Thyroxin 50 and patocid 40
H. Shall I take wheat grass for increasing platelets though the haematologist says 150000 platelets is enough for performing angiogram or CBAG.
I. Feeling blurdness of vision for few seconds and numbness in any area if I remains in same posture for long.
J. I have no other symptoms, I am climbing stairs, walking for 1-2 km doing my day to day activity-almost asymptomatic no chest pain or so.
K. Can my disease be cured or reverse by medical management or medicine And life style change or surgery is the only option left with.
Apologise for this long narration, pls. share your view at the earliest as I need to take a call sooner.
Live long and prosper,
XXXX
XXXX here from XXXXXXX
Past History:
I am 47 yr old, since 17 yr. Old uricemia (high uric acid) taking xylorix SOS, smoking history quitted last month Oct 2015.
In 2014 whole health check up done TMT was positive thyroid was high 10.7, Uric acid was high 9.8, trigkycerides 295, FBS-115, PP-173, platelets mildly reduced (1lac), grade I fatty lever, Mild Obstructive airway disease and was prescribed medicine for the same BUT I IGNORED IT THOROUGHLY AND DIDNT TOOK ANY MEDICINE WHICH I REGRET NOW.
on 18th Oct 2015 I felt congested chest and heaviness and breathlessness and admitted to local nursing home which I got normal after administering nebulisation, they took bed side ECHO and diagnose calcified Bicuspid Valve stenosis with LVH (left ventricular hypertrophy), I got it cross checked at specialised cardiac center at XXXXXXX and seeing the gradient they advise me to undergo surgery AVR.
Before surgery they wanted to perform Angiography to know if there is any arterial blockage, so that both bye-pass and AVR can be taken care thru (CBAG), if angiography is normal they can go for endoscopic aortic valve replacement, they will be using tissue valve.
Diagnosis:
a) Bicuspid Valve.
b) Calcific Severe Aortic Stenosis
c) Severe Aortic regurgitation.
d) Left Ventricular hypertrophy
e) Obstructive airways disease 2014
f) Blood Platelet Count 150000
g) Lost 8-9kg in last 1 month.
h) Grade I fatty lever
i) Hypothyroidism-TSH-11.77
j) TMT positive 2014
k) Sodium-132
l) SGOT-78
m) SGPT-157
n) HDL-28 (L)
o) LDH-118(H)
p) CHOLESTEROL.HDL RATIO-5.29
q) UROC ACID-7.8
r) GAMA GLYTOMYL TRANSFERATE-139 (H)
s) BH-15
t) CREATININE-1.37
Past History:
a) Raise Uric Acid 17yr
b) Smoking-Quitted 1 month back
Plan of action as per XXXXXXX Hrudyalaya:
1) Haematology assessment for low platelet count.
2) Angiogram
3) If 1&2 goes well go for AVR thru endoscopic aortic valve replacement if any blockage diagnose go for (CABG+AVR).
QWERIES:
A. Please advise on Best cardiac medical center in XXXXXXX and cardiac surgeon expert in AVR+CBAG.
B. Is the line of treatment and plan of action is OK and we should go ahead with this.
C. Metallic Vs Tissue Valve-Please advise with reason in this age which valve shall we use doctors have difference of opinion on this.
D. Which is better technique of surgery conventional CABG or endoscopic aortic valve replacement and safe for longer run.
E. Specific hospital name and surgeon name we shall be opting for in XXXXXXX
F. How safe and success % and recovery time in this kind of surgery and how it is going to affect and impact my quality of life.
G. Current medication: Thyroxin 50 and patocid 40
H. Shall I take wheat grass for increasing platelets though the haematologist says 150000 platelets is enough for performing angiogram or CBAG.
I. Feeling blurdness of vision for few seconds and numbness in any area if I remains in same posture for long.
J. I have no other symptoms, I am climbing stairs, walking for 1-2 km doing my day to day activity-almost asymptomatic no chest pain or so.
K. Can my disease be cured or reverse by medical management or medicine And life style change or surgery is the only option left with.
Apologise for this long narration, pls. share your view at the earliest as I need to take a call sooner.
Live long and prosper,
XXXX
Brief Answer:
please get your coronary angiography first
Detailed Answer:
Hello Mr XXXXXXX
I am Dr.Rajesh Teli,MD.
Thanks for using HCM.
I have gone through your hostory and nicely narrated details of your case.I must congratulate you for giving details so well.
Now lets come to your case,
one thing is very clear that you will need Aortic valve replacement.You have different kind of Aortic valve since birth and you could get away with it till age of 47 but now it has becone significantly narrow and is leaking as well, so undoubtedly you need AVR.as you are rightly informed that you must get coronary angiography done so as to decide whether you need bypass along with AVR or not.There high chances that you will need bypass .so get angio done at earliest.My advise regarding endoscopic AVR us guarded because this procedure is not widely practiced as it is new technique and not mastered by many.so my request will be to go for conventional open heart surgery .There are high chances that you shall need bypass as well so mostly the issue of endoscopic surgery will be out of question.
Another most important issue is selection of valve.metallic v/s tissue valve.Life span of metallic valve is longer than tissue valve.Present tissue valve are good enough with span of 8 to 10 years.(may be more).tissue valve will save you from oral anticoagulants which needs blood monitoring,adjustment of dose,risk of bleeding etc.so i would suggest you to opt for tissue valve.
majority of centres at Banglore are doing good work so you may get it done at XXXXXXX Hrudaylay which will be surely excellent centre.
your platelet of 1,50,000 is acceptable and should not cause any rpoblem for surgery.wheat Grass will not help you anyway.Your best and only option is surgery.In good centres result of procedure will be excellent and will have negligible risk.
My best wishes
Dr.Rajesh Teli,MD.
please get your coronary angiography first
Detailed Answer:
Hello Mr XXXXXXX
I am Dr.Rajesh Teli,MD.
Thanks for using HCM.
I have gone through your hostory and nicely narrated details of your case.I must congratulate you for giving details so well.
Now lets come to your case,
one thing is very clear that you will need Aortic valve replacement.You have different kind of Aortic valve since birth and you could get away with it till age of 47 but now it has becone significantly narrow and is leaking as well, so undoubtedly you need AVR.as you are rightly informed that you must get coronary angiography done so as to decide whether you need bypass along with AVR or not.There high chances that you will need bypass .so get angio done at earliest.My advise regarding endoscopic AVR us guarded because this procedure is not widely practiced as it is new technique and not mastered by many.so my request will be to go for conventional open heart surgery .There are high chances that you shall need bypass as well so mostly the issue of endoscopic surgery will be out of question.
Another most important issue is selection of valve.metallic v/s tissue valve.Life span of metallic valve is longer than tissue valve.Present tissue valve are good enough with span of 8 to 10 years.(may be more).tissue valve will save you from oral anticoagulants which needs blood monitoring,adjustment of dose,risk of bleeding etc.so i would suggest you to opt for tissue valve.
majority of centres at Banglore are doing good work so you may get it done at XXXXXXX Hrudaylay which will be surely excellent centre.
your platelet of 1,50,000 is acceptable and should not cause any rpoblem for surgery.wheat Grass will not help you anyway.Your best and only option is surgery.In good centres result of procedure will be excellent and will have negligible risk.
My best wishes
Dr.Rajesh Teli,MD.
Above answer was peer-reviewed by :
Dr. Sonia Raina
Dear Doctor,
Appreciate your earliest review and response to my qwery.
Follow-up qweries:
1. As you are advising XXXXXXX Hrudyalaya, here Dr. XXXXXXX is having a team who would be performing surgery would it matter in precision level if Dr. XXXXXXX would do surgery himself or some other person in his team would be performing that (though I know he would be keeping best in class in hi team).
2. How long will be the healing process and post-operative care; what all things I should be keeping in mind and taking care of in long run to avoid any further complication?
3. I am 47 yr old with 2 kids and family hearing this news I am shaken from inside, how do you take this surgery from success point of view and my future course and different it would be from my current life style to what extent it is going to affect my life.
4. You are suggesting tissue valve which is 8-10 yrs..life after 10 years probably I must be again undergoing AVR for replacing tissue valve that means my life is now this recurrent AVR (every 10 years) and restricted life style.
5. I am working with BPCL my profile is of taking care of Oil depot/terminal inspection surely my profile is going to affect or I can continue with walking 2-3 km per day, driving and my normal schedule of work (though mostly I sit back in office and monitor).
6. How about transcatheter AVR?
7. My walking schedule-yoga-climbing stairs is it going to be affected and if yes for how long
8. What is the recovery duration post-operative how long and to what extent my life sty;e would be restricted?
9. Do you know any surgeon by name performing this AVR+CBAG and an expert in that (or any endoscopic AVR specialised expertise cardiac center across XXXXXXX or globe (here at Apollo XXXXXXX Dr. XXXXXXX advised us for endoscopic AVR and confirmed that around 80 such surgeries are performed at APoLLO every year and are quite safer and better that conventional procedure.
10. Pls. Guide me up with post-operative care and any psychiatry or holistic approach required.
I really thank you and I am blessed in this whole lot of doctors I met with you and you have taken up my qweries and patiently answering it in details.
Live long and prosper,
XXXX
Appreciate your earliest review and response to my qwery.
Follow-up qweries:
1. As you are advising XXXXXXX Hrudyalaya, here Dr. XXXXXXX is having a team who would be performing surgery would it matter in precision level if Dr. XXXXXXX would do surgery himself or some other person in his team would be performing that (though I know he would be keeping best in class in hi team).
2. How long will be the healing process and post-operative care; what all things I should be keeping in mind and taking care of in long run to avoid any further complication?
3. I am 47 yr old with 2 kids and family hearing this news I am shaken from inside, how do you take this surgery from success point of view and my future course and different it would be from my current life style to what extent it is going to affect my life.
4. You are suggesting tissue valve which is 8-10 yrs..life after 10 years probably I must be again undergoing AVR for replacing tissue valve that means my life is now this recurrent AVR (every 10 years) and restricted life style.
5. I am working with BPCL my profile is of taking care of Oil depot/terminal inspection surely my profile is going to affect or I can continue with walking 2-3 km per day, driving and my normal schedule of work (though mostly I sit back in office and monitor).
6. How about transcatheter AVR?
7. My walking schedule-yoga-climbing stairs is it going to be affected and if yes for how long
8. What is the recovery duration post-operative how long and to what extent my life sty;e would be restricted?
9. Do you know any surgeon by name performing this AVR+CBAG and an expert in that (or any endoscopic AVR specialised expertise cardiac center across XXXXXXX or globe (here at Apollo XXXXXXX Dr. XXXXXXX advised us for endoscopic AVR and confirmed that around 80 such surgeries are performed at APoLLO every year and are quite safer and better that conventional procedure.
10. Pls. Guide me up with post-operative care and any psychiatry or holistic approach required.
I really thank you and I am blessed in this whole lot of doctors I met with you and you have taken up my qweries and patiently answering it in details.
Live long and prosper,
XXXX
Brief Answer:
please get coronary angiography done
Detailed Answer:
hello,
Our vital decision of choosing endoscopic v/s open heart surgery depends on report of angiography,so please get it done at earliest so you may come to definite conclusion.
I have almost 300 to 500 valve replaced with me in follow up.But i have yet to have a single patient who has undergone trans catheter AVR, so I m not the right person to tell you with full confidence in the procedure.I can answer your query of post operative state and recovery from open heart surgery.usually surgery lasts for 3 to 4 hours.There is intensive monitoring in ICu for 48 hours and subsequent 5 days stay in hosptail.After discharge you need to rest for about 4 weeks.You can resume duites from 5th wek onwards.You have to be careful in heavy work including driving for about 2 months more.At the end of 3 months you can lead normal life.In your case your heart function is normal ,so after surgery you will have normal working efficiency.
i request to continue with Dr XXXXXXX XXXXXXX and his team,.Trans catheter procedure provide only metallic valve no option of tissue valve with this procedure(as far as my latest information is concerned).
Coming to stress ,social issue and real life scenario,i would like to tell you only one thing... have full faith in God and full faith in treating doctor.I have been practicing medicine and cardiology for about 3 decades and i have seen that even worst of cases, who have full faith in me and my decision, have made miraculous recovery not expected by me.So i always tell me patient Faith is GOd.
secondly prayers have immense power of healing,recovery and success.It is my habit to pray daily in morning for all my ICU and indoor patients.I have experienced miraculous result.prayers by family and freidns while surgery is going on will certainly make it 100% successful.I am quite sure of your complete recovery.
So, Dear XXXXXXX have full faith and you shall recover completely.You may inform me the day of your surgery I will definitely pray for 100% success
My best wishes
Dr.Rajesh Teli.
please get coronary angiography done
Detailed Answer:
hello,
Our vital decision of choosing endoscopic v/s open heart surgery depends on report of angiography,so please get it done at earliest so you may come to definite conclusion.
I have almost 300 to 500 valve replaced with me in follow up.But i have yet to have a single patient who has undergone trans catheter AVR, so I m not the right person to tell you with full confidence in the procedure.I can answer your query of post operative state and recovery from open heart surgery.usually surgery lasts for 3 to 4 hours.There is intensive monitoring in ICu for 48 hours and subsequent 5 days stay in hosptail.After discharge you need to rest for about 4 weeks.You can resume duites from 5th wek onwards.You have to be careful in heavy work including driving for about 2 months more.At the end of 3 months you can lead normal life.In your case your heart function is normal ,so after surgery you will have normal working efficiency.
i request to continue with Dr XXXXXXX XXXXXXX and his team,.Trans catheter procedure provide only metallic valve no option of tissue valve with this procedure(as far as my latest information is concerned).
Coming to stress ,social issue and real life scenario,i would like to tell you only one thing... have full faith in God and full faith in treating doctor.I have been practicing medicine and cardiology for about 3 decades and i have seen that even worst of cases, who have full faith in me and my decision, have made miraculous recovery not expected by me.So i always tell me patient Faith is GOd.
secondly prayers have immense power of healing,recovery and success.It is my habit to pray daily in morning for all my ICU and indoor patients.I have experienced miraculous result.prayers by family and freidns while surgery is going on will certainly make it 100% successful.I am quite sure of your complete recovery.
So, Dear XXXXXXX have full faith and you shall recover completely.You may inform me the day of your surgery I will definitely pray for 100% success
My best wishes
Dr.Rajesh Teli.
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Answered by
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