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What Does My Blood Report Suggest?
Question: hi
my father who is aged 65+ is suffering wound below toes due to thorn/needle stab and not sure when this was happened but identified when he got sever pain till the knee and after that met few doctors and they identified there is some infection also suffering with diabetic. In addition to this Lower Extremity physiological study (Ankle Brachial Index Assessment)
RIght now he is not able to walk due to severe pain in right leg foot. spending time on bed only for everything.
Yesterday blood sugar report:
Fasting: 241 mg/dl
Post porandial : 389 mg/dl
Lower Extremity physiological study (Ankle Brachial Index Assessment) Report
Right PT - 56 mmHG
Left PT - 163 mmHG
Right DP - 42 mm HG
Left DP - 152 mmHG
Wound SWAB culture Report (collected from right leg toes and foot):
Oranisim : Escherichia coli
Colony count : 1,00,000 COL/M:
Impression : Significant.
Please let me know what kind of severe problem this and to whom we have to meet means speciality doctor?
Your advise is highly appricaite.
Thanks.
Till now we are consulting Vascular surgeon, Neurologist, DIABETIC specialist and general medicine doctors but each one suggested some medicines altogether 45+ tablets (apart from medicines for BP and heart problem) per day which is difficult to take.
Please let me know whether the above problem is curable with medicines or do we need to opt for surgery. If surgery who is the right specialist to meet instead of approaching different specialist doctors/hospitals.
my father who is aged 65+ is suffering wound below toes due to thorn/needle stab and not sure when this was happened but identified when he got sever pain till the knee and after that met few doctors and they identified there is some infection also suffering with diabetic. In addition to this Lower Extremity physiological study (Ankle Brachial Index Assessment)
RIght now he is not able to walk due to severe pain in right leg foot. spending time on bed only for everything.
Yesterday blood sugar report:
Fasting: 241 mg/dl
Post porandial : 389 mg/dl
Lower Extremity physiological study (Ankle Brachial Index Assessment) Report
Right PT - 56 mmHG
Left PT - 163 mmHG
Right DP - 42 mm HG
Left DP - 152 mmHG
Wound SWAB culture Report (collected from right leg toes and foot):
Oranisim : Escherichia coli
Colony count : 1,00,000 COL/M:
Impression : Significant.
Please let me know what kind of severe problem this and to whom we have to meet means speciality doctor?
Your advise is highly appricaite.
Thanks.
Till now we are consulting Vascular surgeon, Neurologist, DIABETIC specialist and general medicine doctors but each one suggested some medicines altogether 45+ tablets (apart from medicines for BP and heart problem) per day which is difficult to take.
Please let me know whether the above problem is curable with medicines or do we need to opt for surgery. If surgery who is the right specialist to meet instead of approaching different specialist doctors/hospitals.
Brief Answer:
Need more information
Detailed Answer:
Hi,
Thanks for the query.
I have gone through the description and understand your concern.
But I need more information before suggesting you:
1. When did he suffer from injury?
2. Since when he is suffering from pain?
3. What is the size of the wound?
4. Does his leg pain is present through out the day?
5. How does the leg pain increase or decrease?
6. Have you got Colour doppler of the leg done? If yes, please upload the report.
7. Please upload all the reports of the investigations done till now.
8. What were the advise of the all the doctors you have visited? Please mention the tablets which have been prescribed.
9. How is his diabetic control? Recent report you have mentioned show high blood sugar levels. Have you got HB1Ac test done?
10. Does he smokes or consume alcohol? If yes, how many per day of smokes and frequency and volume of alcohol?
11. Has he been diagnosed with any other medical history other than diabetes and Blood pressure?
12. Please mention any other history you feel is significant to his symptoms.
Would like to reply you back after knowing the details.
Awaiting for your reply.
Regards.
Need more information
Detailed Answer:
Hi,
Thanks for the query.
I have gone through the description and understand your concern.
But I need more information before suggesting you:
1. When did he suffer from injury?
2. Since when he is suffering from pain?
3. What is the size of the wound?
4. Does his leg pain is present through out the day?
5. How does the leg pain increase or decrease?
6. Have you got Colour doppler of the leg done? If yes, please upload the report.
7. Please upload all the reports of the investigations done till now.
8. What were the advise of the all the doctors you have visited? Please mention the tablets which have been prescribed.
9. How is his diabetic control? Recent report you have mentioned show high blood sugar levels. Have you got HB1Ac test done?
10. Does he smokes or consume alcohol? If yes, how many per day of smokes and frequency and volume of alcohol?
11. Has he been diagnosed with any other medical history other than diabetes and Blood pressure?
12. Please mention any other history you feel is significant to his symptoms.
Would like to reply you back after knowing the details.
Awaiting for your reply.
Regards.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
1. When did he suffer from injury?
3 months back
2. Since when he is suffering from pain? Was it after the injury or before?
Pain was there only at inured location that time but from past 3 weeks pain is high and spreaded till the knee
3. Where is the site, size of wound? Is there any pus discharge?
In between 2nd and 3rd toes (bottom side). Small white color layer we can visualize. But there is no discharge of pus as of now.
4. Does his leg pain is present through out the day?
Yes through out the day pain is there but restricted to foot only now. May be due to vascular surgeon medicines.
5. How does the leg pain increase or decrease?
Came down. Now only right foot is paining but it is severe and can't move.
6. Have you got Colour doppler of the leg done? If yes, please upload the report.
No. None of the doctor suggested.
7. Please upload all the reports of the investigations done till now.
Let me check healthe care magic how to upload or share with you the reports.
8. What were the advise of the all the doctors you have visited? Please mention the tablets which have been prescribed.
Yesterady DIABETIC specialist prescribed some medicine and one injection (may be insulin also suggested to admit in hospital to CONTROL BLOOD SUGAR LEVELS. Vascular surgeon prescribed some more medicine for a week and next will go for angiogram based on that will deccide what to do. But not confirmed this problem will be solved or not
9. How is his diabetic control? Recent report you have mentioned show high blood sugar levels. Have you got HB1Ac test done?
Only last week and this week we done blood sugar tests. We did almost 5 months but it was in normal range only. HB1Ac test not done.
10. Does he smokes or consume alcohol? If yes, how many per day of smokes and frequency and volume of alcohol?
stopped smoking/drinking from 1985 when he got first heart stroke. (very strict about diet and these things from there after)
11. Has he been diagnosed with any other medical history other than diabetes and Blood pressure?
Heart stroke 3 times (1984, 1997, 2001)
12. Please mention any other history you feel is significant to his symptoms.
(high) cholesterol levels are on border range most of the times.
Awaiting for your reply.
Thanks,
XXXX
3 months back
2. Since when he is suffering from pain? Was it after the injury or before?
Pain was there only at inured location that time but from past 3 weeks pain is high and spreaded till the knee
3. Where is the site, size of wound? Is there any pus discharge?
In between 2nd and 3rd toes (bottom side). Small white color layer we can visualize. But there is no discharge of pus as of now.
4. Does his leg pain is present through out the day?
Yes through out the day pain is there but restricted to foot only now. May be due to vascular surgeon medicines.
5. How does the leg pain increase or decrease?
Came down. Now only right foot is paining but it is severe and can't move.
6. Have you got Colour doppler of the leg done? If yes, please upload the report.
No. None of the doctor suggested.
7. Please upload all the reports of the investigations done till now.
Let me check healthe care magic how to upload or share with you the reports.
8. What were the advise of the all the doctors you have visited? Please mention the tablets which have been prescribed.
Yesterady DIABETIC specialist prescribed some medicine and one injection (may be insulin also suggested to admit in hospital to CONTROL BLOOD SUGAR LEVELS. Vascular surgeon prescribed some more medicine for a week and next will go for angiogram based on that will deccide what to do. But not confirmed this problem will be solved or not
9. How is his diabetic control? Recent report you have mentioned show high blood sugar levels. Have you got HB1Ac test done?
Only last week and this week we done blood sugar tests. We did almost 5 months but it was in normal range only. HB1Ac test not done.
10. Does he smokes or consume alcohol? If yes, how many per day of smokes and frequency and volume of alcohol?
stopped smoking/drinking from 1985 when he got first heart stroke. (very strict about diet and these things from there after)
11. Has he been diagnosed with any other medical history other than diabetes and Blood pressure?
Heart stroke 3 times (1984, 1997, 2001)
12. Please mention any other history you feel is significant to his symptoms.
(high) cholesterol levels are on border range most of the times.
Awaiting for your reply.
Thanks,
XXXX
Brief Answer:
As advised by your doctors
Detailed Answer:
Hi,
Thanks for the details.
I have gone through the details and is of opinion that your doctors have advised you right.
The pain in the leg could be due to vascular abnormalities as he was a smoker which can lead to narrowing of the arteries in the legs producing pain(known as Buerger's disease).
And the wound, as he is a diabetic with uncontrolled blood sugar levels he needs to be taken care of with precautionary measures as there are very high chances of the infection spreading to the other parts. Treating him in home would be a difficult and I suggest you to consider your doctor's advise to admit him.
The treatment plan would be to control Blood sugar levels along with the wound. Once the wound is completely healed and his blood sugar levels and Blood pressure are under control depending on the angiogram report the vascular surgeon might suggest for vascular grafting if there is narrowing of the blood vessels or vasodilators which will help in keep the arteries dilated.
So, Consider your doctors advise in treating the wound first and get the angiogram for further treatment.
Hope this answers your query. If any further clarifications, will be happy to help you.
Regards.
As advised by your doctors
Detailed Answer:
Hi,
Thanks for the details.
I have gone through the details and is of opinion that your doctors have advised you right.
The pain in the leg could be due to vascular abnormalities as he was a smoker which can lead to narrowing of the arteries in the legs producing pain(known as Buerger's disease).
And the wound, as he is a diabetic with uncontrolled blood sugar levels he needs to be taken care of with precautionary measures as there are very high chances of the infection spreading to the other parts. Treating him in home would be a difficult and I suggest you to consider your doctor's advise to admit him.
The treatment plan would be to control Blood sugar levels along with the wound. Once the wound is completely healed and his blood sugar levels and Blood pressure are under control depending on the angiogram report the vascular surgeon might suggest for vascular grafting if there is narrowing of the blood vessels or vasodilators which will help in keep the arteries dilated.
So, Consider your doctors advise in treating the wound first and get the angiogram for further treatment.
Hope this answers your query. If any further clarifications, will be happy to help you.
Regards.
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
I have uploaded few attachments and also just to remind he is non smoker/drinker from past 30 years. Requesting you to please refer the attachment and suggest me the doctor to consult
MEDICINE PRESCRIBED YESTERDAY
vASCULER SURGEON :
CLOPIVASAP75
LEVOCAT 500
PRECLAAUD
LUDENS10
GEMCLAV 625
PAN D
AMITIN 10
GLUCORE HEALTHCARE
DIABETIC: XXXXXXX SPACE -INJECTION XXXXXXX 50MG -TAB
ULTRACEL - TAB
GLYCOMET G -TAB
REZARA - TAB
MEDICINE PRESCRIBED YESTERDAY
vASCULER SURGEON :
CLOPIVASAP75
LEVOCAT 500
PRECLAAUD
LUDENS10
GEMCLAV 625
PAN D
AMITIN 10
GLUCORE HEALTHCARE
DIABETIC: XXXXXXX SPACE -INJECTION XXXXXXX 50MG -TAB
ULTRACEL - TAB
GLYCOMET G -TAB
REZARA - TAB
Brief Answer:
Follow as previously advised
Detailed Answer:
Hi,
Thanks for the details
I have gone through the medications and the reports attached.
The Ankle branchial index of the right leg is 0.33 and 0.24, suggests of severe peripheral vascular disease as mentioned in previous reply and requires intervention. But this can be false positive in Diabetics due to hardening of blood vessels and need to confirmed with Angiogram as your doctor has suggested.
One of the prescription says web space infection is present(03/11/2014) and I feel no insulin is prescribed.
In diabetic people with uncontrolled sugar levels it is very important to control is at the earliest due to increase in chances of spread of infection and Insulin has found out to be controlling well. So, as suggested in my previous reply, would be better to follow your doctor's advise on admission.
The medications are advised right by your doctors and need to be followed regularly and get the Angiogram of the foot to confirm the narrowing of the blood vessels. Vascular surgeon might advise vascular bypass surgery on seeing the angiogram.
Hope this answers your query. If any further clarifications, will be happy to help you.
Regards.
Follow as previously advised
Detailed Answer:
Hi,
Thanks for the details
I have gone through the medications and the reports attached.
The Ankle branchial index of the right leg is 0.33 and 0.24, suggests of severe peripheral vascular disease as mentioned in previous reply and requires intervention. But this can be false positive in Diabetics due to hardening of blood vessels and need to confirmed with Angiogram as your doctor has suggested.
One of the prescription says web space infection is present(03/11/2014) and I feel no insulin is prescribed.
In diabetic people with uncontrolled sugar levels it is very important to control is at the earliest due to increase in chances of spread of infection and Insulin has found out to be controlling well. So, as suggested in my previous reply, would be better to follow your doctor's advise on admission.
The medications are advised right by your doctors and need to be followed regularly and get the Angiogram of the foot to confirm the narrowing of the blood vessels. Vascular surgeon might advise vascular bypass surgery on seeing the angiogram.
Hope this answers your query. If any further clarifications, will be happy to help you.
Regards.
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Sorry for looking one more clarification. Here we consulting two different hospitals
one is vascular surgeon and sencond hospital is Diabetic related. So which one we have to go and admit now. Diabetic hospital or vascular hospital? Your sugesstion would help more in this regard.
one is vascular surgeon and sencond hospital is Diabetic related. So which one we have to go and admit now. Diabetic hospital or vascular hospital? Your sugesstion would help more in this regard.
Brief Answer:
Multispeciality hospital
Detailed Answer:
Hi,
Thanks for the follow up.
Do not worry regarding the followups. We are here to guide you.
I would suggest multispeciality hospitals where both the departments are present. You can find out which is a good hospital in your location or if your doctor suggests a particular hospital where they are visiting then you can get him admitted there.
The treatment would be clearance of infection first then the treatment of vascular pathology. In case, both do not visit a hospital then you can discuss with the vascular surgeon regarding this and treat him first for the infection.
Hope this answers your query.
Regards.
Multispeciality hospital
Detailed Answer:
Hi,
Thanks for the follow up.
Do not worry regarding the followups. We are here to guide you.
I would suggest multispeciality hospitals where both the departments are present. You can find out which is a good hospital in your location or if your doctor suggests a particular hospital where they are visiting then you can get him admitted there.
The treatment would be clearance of infection first then the treatment of vascular pathology. In case, both do not visit a hospital then you can discuss with the vascular surgeon regarding this and treat him first for the infection.
Hope this answers your query.
Regards.
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
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