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Suggest Treatment For Extreme Fatigue In An Elderly Person Post A Cataract Surgery
Question: My father 73 years old.. Underwent cataract in Sept alp level 76 then.. Lft normal..
Laser surgery for kidney stone in October.. Kidney obstructive changes.. High creatinine then.. Symptoms and blood results came to normal after surgery..
Prostate surgery and stent removal in November.. No malignancy in biopsy.. Alp now 156..
Two weeks later Extreme fatigue.. Low intake of food.. Wight loss... . Esr 70
Two weeks later.. Esr 96 two weeks after.. Alp 440.. The symptoms continues..
Would love to know differential diagnosis... Recommended investigations
Thank you
Laser surgery for kidney stone in October.. Kidney obstructive changes.. High creatinine then.. Symptoms and blood results came to normal after surgery..
Prostate surgery and stent removal in November.. No malignancy in biopsy.. Alp now 156..
Two weeks later Extreme fatigue.. Low intake of food.. Wight loss... . Esr 70
Two weeks later.. Esr 96 two weeks after.. Alp 440.. The symptoms continues..
Would love to know differential diagnosis... Recommended investigations
Thank you
Brief Answer:
Confirmation on absence of prostatic malignancy
Detailed Answer:
Hello,
First of all I apologize for late reply due to hectic schedule today.
I can understand your worry towards your father's health.
1) ALP in liver function test indicate abnormal liver function.
2) High ESR value might be due to inflammation anywhere in body (specifically inflammation since long duration).
3) On follow-up evaluation, both ALP and ESR are increasing. This indicate primary pathology due to which these values are abnormal are still present.
4) Therefore, your father need further evaluation to find cause for these continuous abnormal values.
5) About ALP, what was bilirubin level in both investigation? Does USG abdomen was done? It is essential to check structure and function of liver for rise in ALP level
6) Was biopsy from prostate negative for malignancy or it was inconclusive for malignancy? Being inconclusive for malignancy, it does not rule out possibility of malignancy. High ALP value can also be found in prostate malignancy with spread to bone. This can be ruled out by doing serum PSA value which give indirect idea about prostatic malignancy.
7) For high ESR, was chest x-ray done recently? If so then what was finding in x-ray?
thus your father need evaluation with liver function, confirmation of absence of prostatic malignancy, status of lungs in chest x-ray.
Hope I have answered your query. If you have further question then i would happy to help you.
Have a good day!
Confirmation on absence of prostatic malignancy
Detailed Answer:
Hello,
First of all I apologize for late reply due to hectic schedule today.
I can understand your worry towards your father's health.
1) ALP in liver function test indicate abnormal liver function.
2) High ESR value might be due to inflammation anywhere in body (specifically inflammation since long duration).
3) On follow-up evaluation, both ALP and ESR are increasing. This indicate primary pathology due to which these values are abnormal are still present.
4) Therefore, your father need further evaluation to find cause for these continuous abnormal values.
5) About ALP, what was bilirubin level in both investigation? Does USG abdomen was done? It is essential to check structure and function of liver for rise in ALP level
6) Was biopsy from prostate negative for malignancy or it was inconclusive for malignancy? Being inconclusive for malignancy, it does not rule out possibility of malignancy. High ALP value can also be found in prostate malignancy with spread to bone. This can be ruled out by doing serum PSA value which give indirect idea about prostatic malignancy.
7) For high ESR, was chest x-ray done recently? If so then what was finding in x-ray?
thus your father need evaluation with liver function, confirmation of absence of prostatic malignancy, status of lungs in chest x-ray.
Hope I have answered your query. If you have further question then i would happy to help you.
Have a good day!
Above answer was peer-reviewed by :
Dr. Yogesh D
Thank you Sir,
Liver function test a week back was normal.
No malignancy in prostate.. Histopathology report states that specifically.
Abdominal usg and chest xray will get it done tomorrow.
But no coughing and no pain on palpitation in liver or spleen area. Doctor has asked usg to rule out lymphadenopathy.
Montaeux test done today morning so far there is no obvious reaction.
The causing factor is still obscured.. Let me know what you think.
Liver function test a week back was normal.
No malignancy in prostate.. Histopathology report states that specifically.
Abdominal usg and chest xray will get it done tomorrow.
But no coughing and no pain on palpitation in liver or spleen area. Doctor has asked usg to rule out lymphadenopathy.
Montaeux test done today morning so far there is no obvious reaction.
The causing factor is still obscured.. Let me know what you think.
Brief Answer:
Suspect extra-pulmonary TB
Detailed Answer:
Hello,
First of all I apologize for late reply
1) Pain on palpitation would be present only in presence of inflammation to that area (hepatitis).
2) High ESR and suspicion of lymphadenopathy is to rule our extra-pulmonary type of TB. Mantoux test would come positive if this is so.
3) If lymph node in enlarged in any region in background of high ESR and suspicious Mantoux test then that enlarged lymph node must be excised for histopathological evaluation to confirm TB. This is most sensitive test to confirm presence of TB.
4) If USG shows enlarged lymph nodes then it is advisable to do USG guided per-cutaneous or endoscopic FNAC from that lymph node as complete excision of lymph node would not be possible.
5) Does your father has any abdominal symptoms?
Suspect extra-pulmonary TB
Detailed Answer:
Hello,
First of all I apologize for late reply
1) Pain on palpitation would be present only in presence of inflammation to that area (hepatitis).
2) High ESR and suspicion of lymphadenopathy is to rule our extra-pulmonary type of TB. Mantoux test would come positive if this is so.
3) If lymph node in enlarged in any region in background of high ESR and suspicious Mantoux test then that enlarged lymph node must be excised for histopathological evaluation to confirm TB. This is most sensitive test to confirm presence of TB.
4) If USG shows enlarged lymph nodes then it is advisable to do USG guided per-cutaneous or endoscopic FNAC from that lymph node as complete excision of lymph node would not be possible.
5) Does your father has any abdominal symptoms?
Above answer was peer-reviewed by :
Dr. Remy Koshy
Hello sir,
Usg done.. Multiple enlarged hypoechoic paraaortic left external iliac lymph nodes.. Largest 2.7*1.9 in left para aortic region
Too deep to do biopsy i feel..
Will try to assess submandibular or brachial..
What you feel about it? Alp 536 now.c protein 131.5
Mantoux test done yesterday.. Lab technician will assess it on Monday.
What will be your differential diagnosis with this, sir?
Thanks
Usg done.. Multiple enlarged hypoechoic paraaortic left external iliac lymph nodes.. Largest 2.7*1.9 in left para aortic region
Too deep to do biopsy i feel..
Will try to assess submandibular or brachial..
What you feel about it? Alp 536 now.c protein 131.5
Mantoux test done yesterday.. Lab technician will assess it on Monday.
What will be your differential diagnosis with this, sir?
Thanks
Brief Answer:
Must do serum PSA level
Detailed Answer:
Hello,
I feel hard to say but my suspicion is malignancy which spread to para-aortic lymph nodes and also spread to bone. Bone metastasis produce high ALP.
Prostate surgery + persistent increasing ALP + para-aortic lymph nodes = suspicion of malignancy.
This can be confirmed by serum PSA (prostate specific antigen test). You must do this test.
Other less possible causes are - lymphoma, TB
Kind Regards
Must do serum PSA level
Detailed Answer:
Hello,
I feel hard to say but my suspicion is malignancy which spread to para-aortic lymph nodes and also spread to bone. Bone metastasis produce high ALP.
Prostate surgery + persistent increasing ALP + para-aortic lymph nodes = suspicion of malignancy.
This can be confirmed by serum PSA (prostate specific antigen test). You must do this test.
Other less possible causes are - lymphoma, TB
Kind Regards
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Hello Sir
I will get it done for sure. But TURP slice histopatholgical report states benign mass and no malignancy..
Would love to know your comment
I have uploaded the report of TURP CHIPS
Thanks
I will get it done for sure. But TURP slice histopatholgical report states benign mass and no malignancy..
Would love to know your comment
I have uploaded the report of TURP CHIPS
Thanks
Brief Answer:
Assocciated symptoms are favoring to malignancy
Detailed Answer:
Hello,
I agree with your surety on report. Although histopathology report clearly mentioned it as a benign lesion, all other parameters ALP, lymph node enlargements, high ESR, low grade fever suggest symptoms associated with malignancy.
May be it is not related to prostate but detailed evaluation is must to find out any hidden cause.
Once serum PSA will be done and if it comes within normal range then I would suggest you to consult medical oncologist for suspicion of lymphoma.
Regards
Assocciated symptoms are favoring to malignancy
Detailed Answer:
Hello,
I agree with your surety on report. Although histopathology report clearly mentioned it as a benign lesion, all other parameters ALP, lymph node enlargements, high ESR, low grade fever suggest symptoms associated with malignancy.
May be it is not related to prostate but detailed evaluation is must to find out any hidden cause.
Once serum PSA will be done and if it comes within normal range then I would suggest you to consult medical oncologist for suspicion of lymphoma.
Regards
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Hello Doctor
Got the PSA test done as you had suggested and the level is 176.. That is suggestive of malignancy as you said..
PET scan is another step towards it I guess
Would love to know your comment and future plan of action
Got the PSA test done as you had suggested and the level is 176.. That is suggestive of malignancy as you said..
PET scan is another step towards it I guess
Would love to know your comment and future plan of action
Brief Answer:
PET scan is must
Detailed Answer:
Hello,
Sorry to hear this but I guess chemotherapy has excellent effect on survival of prostate cancer patients. Unfortunately this is beyond my specialty.
Yes PET scan is must to determine extent of spread of malignancy.
Also, you must consult urologist and medical oncologist to decide further treatment plan.
PET scan is must
Detailed Answer:
Hello,
Sorry to hear this but I guess chemotherapy has excellent effect on survival of prostate cancer patients. Unfortunately this is beyond my specialty.
Yes PET scan is must to determine extent of spread of malignancy.
Also, you must consult urologist and medical oncologist to decide further treatment plan.
Above answer was peer-reviewed by :
Dr. Prasad
Yes sir, going for pet scan tomorrow morning.
I am a dentist and I know how patient Google!! But I have done the same. I found out infection can cause rise in psa..so depending on pet scan Ofcourse but do you feel excisional biopsy of approachable lymph nodes like left iliac would be first choice to determine the cause if scan is not concluding enough , before straight going for chemo.
Or may be Abdominal Ct to see if lymph nodes are necrotic or not? As mantoux can be tricky sometimes.
Let me know your views
Thanks for support and kind words
Updating Pet scan report...
Please let me know what future treatment you would recommend.. I know it is outside your specialisation
But if you can that will be great.. Or you can direct me to clinical onvologist
I am a dentist and I know how patient Google!! But I have done the same. I found out infection can cause rise in psa..so depending on pet scan Ofcourse but do you feel excisional biopsy of approachable lymph nodes like left iliac would be first choice to determine the cause if scan is not concluding enough , before straight going for chemo.
Or may be Abdominal Ct to see if lymph nodes are necrotic or not? As mantoux can be tricky sometimes.
Let me know your views
Thanks for support and kind words
Updating Pet scan report...
Please let me know what future treatment you would recommend.. I know it is outside your specialisation
But if you can that will be great.. Or you can direct me to clinical onvologist
Brief Answer:
Work-up to determine site, extent of malignancy
Detailed Answer:
Hello,
First of I deeply apologize for delay in answer due to work-related trip.
1) Infection related rise in PSA would not be so high. Also there must be local symptoms of infections based on site of infection. Parallel progressive rise in ALP would not be there in infection related false positive rise in PSA.
2) Of course, before any chemotherapy diagnosis is must to confirm type, site and extent of malignancy. Therefore FNAC of accessible lymph node is must. Necrosis can occur due to secondary infection in metastatic enlarged lymph node.
3) Montoux test would not be first line on investigation after this PSA value. Now main concern would be to locate and decide extent of malignancy.
Yes I also advice you to consult oncologist once PET-CT scan report is available.
Work-up to determine site, extent of malignancy
Detailed Answer:
Hello,
First of I deeply apologize for delay in answer due to work-related trip.
1) Infection related rise in PSA would not be so high. Also there must be local symptoms of infections based on site of infection. Parallel progressive rise in ALP would not be there in infection related false positive rise in PSA.
2) Of course, before any chemotherapy diagnosis is must to confirm type, site and extent of malignancy. Therefore FNAC of accessible lymph node is must. Necrosis can occur due to secondary infection in metastatic enlarged lymph node.
3) Montoux test would not be first line on investigation after this PSA value. Now main concern would be to locate and decide extent of malignancy.
Yes I also advice you to consult oncologist once PET-CT scan report is available.
Note: For further follow up on digestive issues share your reports here and Click here.
Above answer was peer-reviewed by :
Dr. Remy Koshy
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