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What Does My Lab Test Report Indicate?
Question: Doctor Please review the following reports and do let us know what has to be done?
My brother's heart is only functioning 20-25 % from the past 3 weeks. Doctors say he has myocarditis. And needs rest. What is your opinion.?
Why is there No sign of recovery?
My brother's heart is only functioning 20-25 % from the past 3 weeks. Doctors say he has myocarditis. And needs rest. What is your opinion.?
Why is there No sign of recovery?
Brief Answer:
Recovery is a Slow and a natural process
Detailed Answer:
Hello xxxxxx ,
I do understand your concern about your brothers health .
Even last time i had told you that the recovery is a slow process and repeating echo every day or in such short interval is not going to change or fasten the recovery process , rather it will add to unnecessary anxiety , which may increase the adrenalin in the blood circulation , which is not good for the heart .
Now to when it will recover and how much it will recover ?
I believe No doctor in the world can say that .
However as i said its a slow process and may take 6 months to one year for optimum recovery. The positive part is that your brother is young and hence the chances of recovery are bright .
So if your brother is symptomatically better and getting his normal strength to do work , he shall be just fine .
NOW AN IMPORTANT NOTE :
Rather than repeating echo every time , i will suggest A Cardiac MRI and if it shows galodinium enhancement (ie. Signs of active inflammation, Something call IVIg ( immunoglobulin) may be considered . I have got good results with it in my patients and there is enough scientific data to back it .
However do discuss it with your doctor about important consideration .
Post 3 weeks , how much benefit , cost of treatment and whether it will help him individually .
The above is just mentioned as an alternative and considering his recovery is not justified in his case , giving the time frame and natural recovery things should be good .
The medication he is on is good though dose modification may be considered based on his Vitals
Regards Dr. Priyank Mody
Recovery is a Slow and a natural process
Detailed Answer:
Hello xxxxxx ,
I do understand your concern about your brothers health .
Even last time i had told you that the recovery is a slow process and repeating echo every day or in such short interval is not going to change or fasten the recovery process , rather it will add to unnecessary anxiety , which may increase the adrenalin in the blood circulation , which is not good for the heart .
Now to when it will recover and how much it will recover ?
I believe No doctor in the world can say that .
However as i said its a slow process and may take 6 months to one year for optimum recovery. The positive part is that your brother is young and hence the chances of recovery are bright .
So if your brother is symptomatically better and getting his normal strength to do work , he shall be just fine .
NOW AN IMPORTANT NOTE :
Rather than repeating echo every time , i will suggest A Cardiac MRI and if it shows galodinium enhancement (ie. Signs of active inflammation, Something call IVIg ( immunoglobulin) may be considered . I have got good results with it in my patients and there is enough scientific data to back it .
However do discuss it with your doctor about important consideration .
Post 3 weeks , how much benefit , cost of treatment and whether it will help him individually .
The above is just mentioned as an alternative and considering his recovery is not justified in his case , giving the time frame and natural recovery things should be good .
The medication he is on is good though dose modification may be considered based on his Vitals
Regards Dr. Priyank Mody
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
Thank You so much Doctor for your regular support and response.
Today we are taking him for Cardiac MRI IN AIMS under XXXXXXX XXXXXXX
And we will surely convey what you have suggested to us.
My mother has really forwarded her heartfelt thanks for your support.
Will be admitting him to the hospital as they have asked us to admit him for his cardiac MRI.
I will be updating you about todays result.
Good day doctor.
Thank You so much do keep us in your prayers.
You are in ours.
Today we are taking him for Cardiac MRI IN AIMS under XXXXXXX XXXXXXX
And we will surely convey what you have suggested to us.
My mother has really forwarded her heartfelt thanks for your support.
Will be admitting him to the hospital as they have asked us to admit him for his cardiac MRI.
I will be updating you about todays result.
Good day doctor.
Thank You so much do keep us in your prayers.
You are in ours.
Brief Answer:
All the best. Would pray for an early recovery.
Detailed Answer:
Happy I could help,
It's just to stress upon the fact that anxiety will do only harm to the patient and the family. Stay firm and the good lord is always there to take care of the rest.
Regards Dr Priyank Mody
All the best. Would pray for an early recovery.
Detailed Answer:
Happy I could help,
It's just to stress upon the fact that anxiety will do only harm to the patient and the family. Stay firm and the good lord is always there to take care of the rest.
Regards Dr Priyank Mody
Above answer was peer-reviewed by :
Dr. Prasad
Hi Doctor,
XXXXXXX is now admitted in CCU in AIMS and they are giving him the dosage of the same medicine u suggested (IVIg) after his MRI was done. They have told us to keep him admitted for 4 days and they are giving him everyday 37.5 gms in 18 hours as of now.
Please give me your views on this.
And also my doubt is whether to reduce his 1 Liter normal Liquid intake when he is on this medication??
Please do let me know we are a little tensed, thinking if anything is going wrong here.
Also Doctors were discussing whether to do Biopsy. How important do you think it is? Because we thought of discharging him from AIMS and taking him home once the Injection is done.
Really grateful to you.
Regards.
Thank You.
XXXXXXX is now admitted in CCU in AIMS and they are giving him the dosage of the same medicine u suggested (IVIg) after his MRI was done. They have told us to keep him admitted for 4 days and they are giving him everyday 37.5 gms in 18 hours as of now.
Please give me your views on this.
And also my doubt is whether to reduce his 1 Liter normal Liquid intake when he is on this medication??
Please do let me know we are a little tensed, thinking if anything is going wrong here.
Also Doctors were discussing whether to do Biopsy. How important do you think it is? Because we thought of discharging him from AIMS and taking him home once the Injection is done.
Really grateful to you.
Regards.
Thank You.
Brief Answer:
All seems to be going good :)
Detailed Answer:
hello,
1] Yes the dosage of the medication seems adequate and it s a per weight of your brother .
2] To prevent any side effect of the medication good hydration is needed , however don't worry for the same , he being in iccu . the status of the body hydration is continuously monitored and the doctors in XXXXXXX are very qualified to manage such a patient
A good Cardiac MRI gives enough information about the disease process and biopsy in present era is not needed . though in experienced hands its very safe a procedure , however a very small risk of perforation because the cardiac muscle are little friable post myocarditis , hence if absolute need , better avoid for the very simple reason that it is not going to change out treatment plan . However if the doctors are suspecting anything in particular , let them go ahead with the biopsy as its pretty safe as a procedure .
Trust in God and everything should be ok .
Do let me know the follow up . Also you can directly contact me through HCM , in ask a specialist /Dr. Priyank Mody , so there is no Delay in answering .
Regards Dr. Mody
All seems to be going good :)
Detailed Answer:
hello,
1] Yes the dosage of the medication seems adequate and it s a per weight of your brother .
2] To prevent any side effect of the medication good hydration is needed , however don't worry for the same , he being in iccu . the status of the body hydration is continuously monitored and the doctors in XXXXXXX are very qualified to manage such a patient
A good Cardiac MRI gives enough information about the disease process and biopsy in present era is not needed . though in experienced hands its very safe a procedure , however a very small risk of perforation because the cardiac muscle are little friable post myocarditis , hence if absolute need , better avoid for the very simple reason that it is not going to change out treatment plan . However if the doctors are suspecting anything in particular , let them go ahead with the biopsy as its pretty safe as a procedure .
Trust in God and everything should be ok .
Do let me know the follow up . Also you can directly contact me through HCM , in ask a specialist /Dr. Priyank Mody , so there is no Delay in answering .
Regards Dr. Mody
Above answer was peer-reviewed by :
Dr. Raju A.T
Hi Doctor,
Hope you are doing great.
XXXXXXX is now receiving the IVIg dose and we are giving him normal food at regular intervals and he is also drinking upto 1 litre water.
He had his thyroid test done and it was found that his Thyroid is very high he has THY 20 (Hypothyroid) and we have started giving him Thyrox-25 mg. Also doctor has increased the dosage of Cardivas 3.125 and we give him 2 tablets each now morning and night.
On how he feels now from outside, He has started getting a headache from the time we have started IVIg and he said he feels weak. Doctors have planned his Biopsy for Wednesday but to be XXXXXXX we don't want to do that now. We plan of taking him home once IVIg is done and give him rest and medication as suggested before.
Doctor please give your views.
And thanks for all your support.
Your advise has been key to us, and is helping us a lot.
God bless you Sir.
Hope you are doing great.
XXXXXXX is now receiving the IVIg dose and we are giving him normal food at regular intervals and he is also drinking upto 1 litre water.
He had his thyroid test done and it was found that his Thyroid is very high he has THY 20 (Hypothyroid) and we have started giving him Thyrox-25 mg. Also doctor has increased the dosage of Cardivas 3.125 and we give him 2 tablets each now morning and night.
On how he feels now from outside, He has started getting a headache from the time we have started IVIg and he said he feels weak. Doctors have planned his Biopsy for Wednesday but to be XXXXXXX we don't want to do that now. We plan of taking him home once IVIg is done and give him rest and medication as suggested before.
Doctor please give your views.
And thanks for all your support.
Your advise has been key to us, and is helping us a lot.
God bless you Sir.
Brief Answer:
Re check, Tsh with free t3/t4. Review hydration
Detailed Answer:
Important observations
1) headache is when hydration is not adequate with ivig, in echo see if there is no IVC congestion, increase intake to 1200-1400 ml
2) why should a young guy suddenly become hypothyroid.
If the Tsh was sent after starting ivig, than the assay results will be false. As these are immunoglobulin and the Tsh is tested in most labs in XXXXXXX by immunoassay.
So get a Free T3/ free t4 if normal reconsider giving thyroxine as hyperthyroidism can itself cause dilation of heart
The decision to do biopsy completely rests with the family and I would be supportive to the decision, as I said there is not anything more is going to change in treatment.
Increase dose of both cardivas and cardace to maximum tolerable dose as it will help.
Let me know how he is feeling after a week.
Regards Dr Priyank Mody
Re check, Tsh with free t3/t4. Review hydration
Detailed Answer:
Important observations
1) headache is when hydration is not adequate with ivig, in echo see if there is no IVC congestion, increase intake to 1200-1400 ml
2) why should a young guy suddenly become hypothyroid.
If the Tsh was sent after starting ivig, than the assay results will be false. As these are immunoglobulin and the Tsh is tested in most labs in XXXXXXX by immunoassay.
So get a Free T3/ free t4 if normal reconsider giving thyroxine as hyperthyroidism can itself cause dilation of heart
The decision to do biopsy completely rests with the family and I would be supportive to the decision, as I said there is not anything more is going to change in treatment.
Increase dose of both cardivas and cardace to maximum tolerable dose as it will help.
Let me know how he is feeling after a week.
Regards Dr Priyank Mody
Above answer was peer-reviewed by :
Dr. Sonia Raina
Sure Doctor I have forwarded this message.
Also just to inform you:
The Thyroid test was taken before the start of IVIg and the doctors just said that nothing much is shown in the MRI and that it shows the same result as his Echo that his Left Ventricle is enlarged and heart functioning 25 % and nothing specific has come up in his Cardiac MRI so they want to do a Biopsy on Wednesday.
Hope all gets normal soon.
Also just to inform you:
The Thyroid test was taken before the start of IVIg and the doctors just said that nothing much is shown in the MRI and that it shows the same result as his Echo that his Left Ventricle is enlarged and heart functioning 25 % and nothing specific has come up in his Cardiac MRI so they want to do a Biopsy on Wednesday.
Hope all gets normal soon.
Brief Answer:
It's always better to be double sure with thyroid .Biopsy if needed is safe
Detailed Answer:
Thanks for the info,
I just want to be extra sure in your brothers case, as if we are not doing much good, we should surely not harm the natural recovery.
Generally a MRI will show galodinium enhancement if there is evidence of inflammation in the heart muscle, it being negative, rules out active inflammation , which makes our giving Ivig questionable (though it's never going to harm, but benefit may be limited)
As I said Aims is a good and academic institutions the doctor s there are seeing the patient on daily basis measuring the recovery of patients, which to My bad luck I can't do, so I can only assure you that your are in expert hands, and even of biopsy is planned its not very risky and a safe procedure in expert hands.
Do keep me informed and never hesitate for asking smallest of your doubts, and I would try to answer with best of my capabilities.
Regards Dr Priyank Mody
It's always better to be double sure with thyroid .Biopsy if needed is safe
Detailed Answer:
Thanks for the info,
I just want to be extra sure in your brothers case, as if we are not doing much good, we should surely not harm the natural recovery.
Generally a MRI will show galodinium enhancement if there is evidence of inflammation in the heart muscle, it being negative, rules out active inflammation , which makes our giving Ivig questionable (though it's never going to harm, but benefit may be limited)
As I said Aims is a good and academic institutions the doctor s there are seeing the patient on daily basis measuring the recovery of patients, which to My bad luck I can't do, so I can only assure you that your are in expert hands, and even of biopsy is planned its not very risky and a safe procedure in expert hands.
Do keep me informed and never hesitate for asking smallest of your doubts, and I would try to answer with best of my capabilities.
Regards Dr Priyank Mody
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
Hi Doctor,
XXXXXXX is having unbearable headache and he is unable to move his head much we gave him flexon and also he feels nauseatic. We have decided to stop IVIg as we feel it is not suiting him and we plan to discharge him and take him home and give him rest. He has one more day of IVIg remaining as of now his BP was low in the morning and now it has become ok. Hope taking him home and taking care of him wont cause any further complications or problems. We are very tensed as he said that the head ache is not bearable.
waiting for your view on this.
THANK YOU.
and T3 and t4 test was done before that came normal.
Regards
Sir we brought XXXXXXX Back home they competed 22.5 bottles out of the 30 bottles they had plan for IVIg, his migrane came down a little after giving him flexon and also it came down well after we gave him Nupatch. Now he had his lunch and is sleeping. But complains of severe headache whenever he moves his head and feels chills and nauseatic.
Hope it should be fine in few days. And that we can take care of him as normal. I am attaching the MRI report with this mail and also his T3 T4 and TSH report
Do let me know for anything else.
Thank You so much Sir.
XXXXXXX is having unbearable headache and he is unable to move his head much we gave him flexon and also he feels nauseatic. We have decided to stop IVIg as we feel it is not suiting him and we plan to discharge him and take him home and give him rest. He has one more day of IVIg remaining as of now his BP was low in the morning and now it has become ok. Hope taking him home and taking care of him wont cause any further complications or problems. We are very tensed as he said that the head ache is not bearable.
waiting for your view on this.
THANK YOU.
and T3 and t4 test was done before that came normal.
Regards
Sir we brought XXXXXXX Back home they competed 22.5 bottles out of the 30 bottles they had plan for IVIg, his migrane came down a little after giving him flexon and also it came down well after we gave him Nupatch. Now he had his lunch and is sleeping. But complains of severe headache whenever he moves his head and feels chills and nauseatic.
Hope it should be fine in few days. And that we can take care of him as normal. I am attaching the MRI report with this mail and also his T3 T4 and TSH report
Do let me know for anything else.
Thank You so much Sir.
Brief Answer:
Avoid too much flexon, Complete rest and healthy diet for next 48 hours
Detailed Answer:
Hello,
As you have already brought him home, wouldn't discuss that part now.
The most common reason for headache when you give ivig is due hyperviscocity of the protein concentrate. That is a reason in a normal patient, one will try hydrating to the maximum, but in your brothers case as it would lead to fluid overload maybe the reason the doctor s couldn't do the same.
I did go through the reports, to be XXXXXXX the MRI ejection fraction is 10%, I don't want to say that there is deterioration because MRI is more specific than echocardiography, so we should be stringent about all medication and good rest.
Yes the headache will subside mostly in 2 days.
Flexon had brufen too, generally when you are on heart medication, we should avoid it as that can harm the kidney the most and that's the last thing we want. You can give him tab dolo 650 mg 3 times a day, it's plain paracetamol and so wouldn't harm him in any way. Can continue n u patch.
Avoid fried / spicy food too for sometime, which I had previously said yes for because of the report s I have reviewed today as we should so maximum from our front for a good recovery. First 3-6 months are important
Keep me in loop for any new developments, as after so long I am myself curious of how the recovery would progress.
Let me know if anything needed.
Regards Dr Priyank Mody
Avoid too much flexon, Complete rest and healthy diet for next 48 hours
Detailed Answer:
Hello,
As you have already brought him home, wouldn't discuss that part now.
The most common reason for headache when you give ivig is due hyperviscocity of the protein concentrate. That is a reason in a normal patient, one will try hydrating to the maximum, but in your brothers case as it would lead to fluid overload maybe the reason the doctor s couldn't do the same.
I did go through the reports, to be XXXXXXX the MRI ejection fraction is 10%, I don't want to say that there is deterioration because MRI is more specific than echocardiography, so we should be stringent about all medication and good rest.
Yes the headache will subside mostly in 2 days.
Flexon had brufen too, generally when you are on heart medication, we should avoid it as that can harm the kidney the most and that's the last thing we want. You can give him tab dolo 650 mg 3 times a day, it's plain paracetamol and so wouldn't harm him in any way. Can continue n u patch.
Avoid fried / spicy food too for sometime, which I had previously said yes for because of the report s I have reviewed today as we should so maximum from our front for a good recovery. First 3-6 months are important
Keep me in loop for any new developments, as after so long I am myself curious of how the recovery would progress.
Let me know if anything needed.
Regards Dr Priyank Mody
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Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
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