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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for coma after a stroke

Farhat Ali Akhtar Preamble: Let me inform the reader that the findings in this report are based upon my interview with the attendants of the patient and my cross checking the reports. Please also bear in mind that I am not a medical professional but as my immediate family are professional’s medical specialists hence, my understanding of terms and treatment are well understood. Furthermore, the serious condition of Farhat came to our knowledge on 13th of August 2010. At this stage, we asked the family to urgently get a second opinion from specialists. As his reports casted serious doubts in our minds. Prognosis: Dr. Osman Obaidullah diagnosed Farhat with Gall Bladder ailment and performed Laparoscopy on 27th of July 2010, after the surgery he informed his family that he observed 1 INTESTINES WERE STICKING TOGETHER? Furthermore, Dr. Obaidullah reports indicate solitary stone. (See report dated 27/7/2020). His report is contradicted by the biopsy report of Shaukat Khanum Hospital. On 28th of July 2010, the patient was discharged and latter he resumed his duties. Soon after, started to complain about pain in the abdomen and this time was admitted in Fazil Hospital for treatment? . Ultra-Sound dated 9th of August conducted by Anjum Clinic indicates 10mm stone in the right kidney. Latter this stone is nowhere seen or mentioned? However, this report also states THICK FLUID SEEN IN THE LOWER PELVIC AREA INFLAMMATORY PELVIC ABSCESS. (The second part of this report is confirmed further by the third ultra conducted at CMH on 14th of August 2010) What treatment was carried out at Fazil Hospital, we have only one clue that expensive antibiotics were administered to stop the infection Three questions pertinent to this case arise. 1.     At the time laparoscopy was been performed and the surgeon observed abnormality of intestines, he should have stopped the laparoscopy and performed cholecystectomy and corrected the actual problem, but he choose otherwise a Gross professional blunder. 2.      My view is supported, by the biopsy report dated 29th of July 2010 at Shaukat Khanum Cancer Hospital, Lahore of the gall bladder indicate NO GALLSTONES SEEN. MUCOSA IS GREEN AND VELVETY. 3.     The second professional blunder was made when it became apparent when ultra sound test indicated 3“WATER SEEN IN THE LOWER PELVIC AREA” . The patient should have been operated upon immediately. It is my perception that coagulant drugs/antibiotics were administrated to stop the seepage in the intestine. Here the embolic blood clotting took its roots causing the subsequent strokes. There are three types of strokes: 1.     Thrombotic Stroke: A clot forms and blocks the artery in the brain. 2.     Embolic Stroke: A clot breaks off from somewhere in the body and travels to the brain. 3.     Ischemic Stroke: Blood clots in the heart, these small clots then travel to the brain. This is called cerebral embolism. One professional tried to cover up the blunder of his other colleague. This is normal in our country where life of a human being comes cheap and law is void. Right from the beginning, the ailment of the patient has been misdiagnosed. Latter when the patient was admitted at CMH on 14th August, he was diagnosed with ACUTE PERITONITIS and according to Col: Khalil 1.75 liters of puss was drained from the stomach of Farhat. He recovered from this and was duly discharged walking home. Another question looms in the mind, the patient was regularly visiting the hospital for bandage changing, yet no one observed the weakness in the right hand? Whereas the attendants observed at times incoherent speech. After his first mild stroke, he was shifted to Doctors hospital from CMH. Where, instead of treating him for stroke the team of doctors started treatment for his stomach ailment. His vomiting was mistaken for blockage in intestines. Whereas a massive stroke was in progress and no neurologist visited the patient to check, as throat muscles were weakening and swallowing was a becoming a difficult process, all food was accumulated in the gullet and soon it was thrown out which everyone mistook as a vomit. Second opinion: As the patient condition was, deteriorating with the passage of time second opinion from other medical professionals was sought. Their views: 1. Blood Plasma transfusion required. 2. Albumin Infusion required. 3. Treatment for stroke be carried out. Farhat was discharged from the hospital on 17th October 30, 2010 whereas his condition was not stable. The travel from Lahore to Gujranwala further aggravated his condition. On what grounds was the patient discharged by the Doctors this is a question? Now as the patient is in complete immobility or in medical term he is in a state of COMA. Proper medical care and patience is required until recovery, which will be indeed a miracle. my question is what treatment should be given now??
Wed, 8 Jul 2015
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Neurologist 's  Response
I read your question carefully and I am sorry about the condition your beloved one was in. Judging from the dates I assume a long time has gone by and his condition might be changed for better or for worse, but I am answering anyway so that you can have perhaps some more clarity.

First you blame the stroke on coagulant drugs that the patient has supposedly been given, but unless you have any documentation on that I doubt that to be the case. Surgeons do not give coagulant drugs in their routine work, actually often times they actually give low dose anticoagulant drugs because of the risk of deep vein thrombosis in their patients due to immobility.
So the cause must be looked elsewhere. Unfortunately you say nothing on previous history which could reveal risk factors for stroke, data such as age, hypertension, diabetes, smoking, heart abnormal rhythm, high cholesterol. You mention also nothing on the tests he had, stroke location, heart tests (as many thrombi form in the heart, or can travel from the veins and tranverse through a hole between the atria), tests to look for atheroclerotic plaques in major arteries supplying the brain. So it is hard to pinpoint the origin of the stroke, let alone point fingers for it not being prevented.
I can not comment why weren't the symptoms noticed, perhaps you might be right in that. Regarding what you call premature discharge though it seems to be 3 months after the stroke. That time is more than enough in my opinion, a stroke is an acute event, after the first few weeks have passed there is no specific treatment for it, only physical therapy to help recovery.
Since he fell into a coma later I assume he had another stroke. Whether that could have been prevented depends on the origin for which the data I mentioned above would be necessary as well as info on the treatment he was taking, treatment lowers the risk for stroke recurrence though doesn't completely eliminate it.

I hope to have been of help. In case you still care to discuss the issue please bring some more info and I would be happy to review it and try to give a better answer.
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