Hello and thank you for submitting your question.

Your question is a good one and I will work on providing you with some good information and recommendations regarding what is going on with your father.

From the information you submitted I am focusing on his complete blood count. The complete blood count reveals his hemoglobin to be low at 10. In addition is played that count is at the lower end of normal. His white blood cell can't appears normal. The remainder of his blood work shows that he might have some degree of dehydration in addition to the fact that his level of nutrition might be sub optimal. this is due to the fact that his albumin level is low. In addition his sedimentation rate is elevated and his uric acid level is elevated. All of this needs to be considered when looking at the big picture.

Focusing on his blood cells he does have anemia. This is possibly related to his diabetes as the diabetes does cause a mild degree of chronic kidney disease. The kidneys are very important in the process of forming new blood cells. The kidney makes a hormone called Epo. It might be a good idea for his doctors to check a few additional blood tests including iron as well as total iron binding capacity and ferritin. This will give us some idea as to what his iron level is and if he might need some iron supplementation. In addition his doctors might check Epo level as some patients might also benefit from supplementation of this hormone.

In addition I assume he has had a colonoscopy and upper endoscopy to evaluate for any possible gastrointestinal blood loss. His white blood cell count looks normal at this time and I am not concerned that he has any issue with the white blood count right now. However it will be necessary to check his blood count again in a couple of months to see if there are any changes. Sometimes a mild infection can cause the white blood cell count to go down. This is especially common all month viral infections.

Regarding the elevated uric acid level this is something which needs to be evaluated. If he does have this on a chronic basis he might benefit from a medication to lower the uric acid level. This is something his primary care doctor or kidney specialist can handle.

Regarding his nutrition it is critically important that somebody evaluate his diet. A nutritionist is usually specially trained in this type of field and he might benefit from a consultation with one of these specialists. He. must focus on good calorie intake as well as protein nutrition.

I thank you again for submitting your question. I again want to reassure you that I am not concerned he's dealing with any problem with his white blood count right now. I am concerned about his low hemoglobin and this is something which should certainly be evaluated. In addition I want to emphasize again that his blood count should be checked once again in about two or three months. I hope you have found my response to be helpful and informative here. If you have any additional concerns I would be happy to address them.

Sincerely,

Dr. Robert

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Hello and thank you for the follow up question.

At this point there has been no data to suggest that I'll be many injections provide a long-term benefit. The problem with albumin injections is that the album that does not stay in the body very long. It is otherwise critically important that you try to make some changes in his daily oral intake of food. there are several different types of proteins supplements which contain excellent sources of proteins which can improve his overall nutritional status. I would advise that you inquire about these from a nutritionist or a local health food store. if he is able to tolerate one of these proteins supplements I would recommend that you try to have him drink at least one or two servings per day.

It is my impression that he is severely deconditioned. I think it would be appropriate to have a physical therapist or occupational therapist or possibly both visit with him to determine his needs. It would then be important to put together a therapeutic plan for him. Even small amounts of activity can improve overall strength and he is obviously in a state where his muscles are very weak. These therapists provide excellent advice and good treatment plans which have done very well for the majority of my patients who XXXXXXX with them.

One additional test I would recommend it would be for his thyroid hormone status. If his thyroid is under active it might cause this severe degree of fatigue.

I think his current medication regimen is adequate and I would not make any changes along those lines.

Again I can appreciate that you're dealing with a very stressful situation. I hope my words of advice and recommendations have served to be helpful. If you have any additional concerns I would be happy to discuss those with you. If you're happy with my response please accept the answer.

Sincerely,

Dr. Robert

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