Please read the below case history & awnser the questions at the end Mr. Gurcharan Singh / Male DOB: 24.12.1936 Initially Strong Athletic Built / Non Vegetarian / Tea totaller / Strong Willed 1980: His BP raised to 170/250 and effected all vital organs, resulting swelling in brain, heart enlargement & renal failure (RCF). One of his heart beat got missed in readings of ECGs. He was treated in PGI, Chandigarh (India) and was put on to medicines. 1993: He was taken to local cardiologist due to sudden excess nose bleeding & said cardio physician put him on to some medicines for keeping the BP low. 2001: He felt angina pain in the chest. Was again taken to PGI, Chandigarh (India) for angiography & then was shifted to Escorts Heart Hosp., Delhi (India) & Heart Bye Pass surgery was performed there (CABG done (LIMA to LAD)). 2002: Dr. K.S. Chug (Ex – HOD, Nephrology (PGI-Chandigarh) was consulted. He pointed out that though his BP is stable (80/140) but Urea, Cratenine was on higher side (Createnine – 4.5 & Urea – 132) and put him on additional medicines for the same. Below said is the complete medicine list that was recommended: 1. Tab Dytor 20 mg, once daily 2. Tab Amlopres 5 mg, once daily 3. Shelcal 500 mg, twice a day 4. Alfacip 0.25 mg, once daily 5. Heamup (Iron), once daily 6. Clavix 75 mg, once daily 7. Simcard 10 mg, once daily 8. Razo-D (SOS, if vomit sensation persists) 2005: He again had a severe nose bleeding & nose coterie procedure was done in Silver Oak Hosp., Mohali (India) by an ENT surgeon. 2007: Fistula was made on his left wrist due to Ctatenine – 7.5 & Urea - 220. Consulted dietician again and started recommended dietary precautions & strict medicine routine. Feb’ 2010: - Started taking Homeopathy medicines along with allopathic medicines (primarily as: BERBERIS VULGARIS & ECHINACEA ANGUSTIFOLIA) from a qualified Homeo Physician - Started checking parameters (Urea & Cratenine) on monthly basis & after 2 – 3 months of homeopathy medicines, slight reverse trend in the said parameters was observed for the first time in last 2 years. BP is observed stable on the whole. - Fistula was never used for dialysis but it started budging out like a water filled balloon so we approached local surgeon for closing said fistula & he did the same for us. - Swelling in the feet, itching on back side of neck, less appetite, laziness (feeling sleepy/drowsy in whole of the day time), red/blood coloured patches on his hands & arms, etc. were discussed with homoeopathic physician on weekly basis and with his medicines the same got partially managed. - Body immunity level seems low as frequently catching cough, cold, etc. increased. - Hernia problem also there from quite long but aggravates rarely and got subsided of its own after some time (5 – 6 hrs.) Oct’ 2010: - Mucus (chocolate/brown coloured) vomiting - Severe giddiness/dizziness Was immediately taken to Local Hosp. & was observed in ICU for 24 hrs., CT Scan/MRI done and everything was found normal. Then it was guessed that it may happen due to intake of vegetable with high urea/pesticide spray or aftereffects of Iron capsule (was regularly taking Iron capsule from last 5 -6 years) Jan’ 2011 – Jun’2011: - Cratnine toggled between 6 to 7 - Urea toggled between 180 to 195 Jul’ 2011: Cratnine reached 7.8 Oct’ 2011: - Cratnine crossed 8 - Continuous low appetite / itching on back of neck increased / vomit sensation quite frequently / drowsiness increased during day time / feeling chest pain once to twice a day - Got him admitted in local hospital : • Angiography done: CART done on 15.11.2011 s/o triple vessel disease, patent graft and cardiologist advised that his angina to be controlled with medicines itself as major blood vessels are in OK shape & only a small blood flow interruption in one of the minor veins so no need for putting stunt. • Found that suffering from chronic kidney disease stage V , chronic AF/CVR, unstable angina, hypertension, BPH, coronary artery disease P/S CABG in 2001 (LIMA to LAD). Having frail body & weighing 50.4 Kg. • Started hemo-dialysis ( done on 15 oct, 17 oct & 25 oct) Now it is recommended by the nephrologist that Mr. Gurcharan Singh being a heart patient should opt for Peritoneal Dialysis & surgery to be performed to tackle his hernia, making fresh fistula again & putting catheter in his kidneys. Presently he is on below said medicines: 1. Tab Pantocid-D, twice a day (empty stomach) 2. Tab Urimax-D 0.4 mg, once a day 3. Tab Clavix 75 mg, once a day 4. Tab Flavedon MR, Twice a day 5. Tab Monit GTN 6.4 mg, twice a day 6. Tab Modlip-ASP (10+75 mg), once a day 7. Tab Dytor 40 mg, once a day 8. Tab Shelcal 500 mg, twice a day 9. Tab Alpha-Cip 0.25 mg, once a day 10. Tab Nikoran 5 mg, twice a day 11. Tab Amtas 5 mg, twice a day Our Queries: 1. What type of dialysis is best for him & why? 2. Generally, till how long he can comfortably continue with present heart & kidneys situation. 3. He has been given his first hepatitis shot on 15th Oct’11 & said injection course shall be continued till Apr’12. How to protect him from any type of infections till then? 4. If peritoneal dialysis is recommended, then: - it should be done manually (3 times a day) or with machine (Baxter brand is available here). - What all precautions needed to be taken for making the possibility of infection as ZERO. - Dietary routine (extensive list of items: ‘To be taken with qty.’ & “Not to be taken”) 5. Other precautions (living routine / medicine / diet / which path tests with what frequency) 6. His HB is low as 8.0 so if we will go for HB increasing injections then how to control his BP?
Hi, my mom is 65 yr old. Hx of DM, CKD on dialysis. Had temporary dialysis catheter in the neck for 3 months, recently pulled out. But noticed a small lump at the site after the line pulled out. Biopsy was sent. Now suffering from gum motions x 3 days. What could be the problem?
Dear Dr What are the side effects of being put in the life supp machine (the one that is put in the trout) for more than 3 weeks? What are the side effects of dialysis, if you are put on dialysis every day? You enter ICU without having the problem of renal failure and after being put onn life supp machines, all of a sudden you have a renal fuilure, what causes that?
Hi. I was told after my first child that the lumps that are on my collarbone and up my throat are caused by the hormone that loosens your joints and ligaments and something has broken off? Im pregnant with my second child due in a week. The lumps have now grown, caused purple bruises where they are growing and are so painful it makes me cry. What are these and what treatment can i have to get rid of them. Please help!
Hi Dr, I am a 45 year old male with a history of factor five laden. But have been off my warfarin for more than 3 years on doctor's advice. Haven't had any additional problems in the last few years, however, the last few days I have a sore lower inner thigh, running from under my groin to knee as a red sunburn or rash that is sore to touch (feels bruised). It has grown from a small patch to the knee in the last two days. The muscle also feels sore. I cycle and did so on Fri and Sat (the bruising feeling started Sat morning) I had originally thought the bruising pain was from my young son kicking my thigh with his shoes on but it seems to be getting worse. Other than that I feel no other symptoms. Can you give me some advice? Thanks
I had arthroscopic surgery on my knee 2weeks ago and now have a bruise going up from my knee to my groin, and experiencing painful feeling when I lift my leg, there is also a red rash on my inner thigh that itches on part of the bruising... What could this be. Also somewhat sensitive to touch.
My 5 year old active daughter woke up in the middle of the night (3 nights ago) complaining of pain in her right leg. She had a noticeable bruise on her shin. By morning, we noticed black and blue marks on both legs but the pain was no longer. We took her to our local ER who did bloodwork that came out normal. They recommended we go to our primary care pediatrician. He took one look at my daughter and diagnosed her with HSP. Her urine was normal. In looking at cases of HSP online, the symptoms don t match with my daughter s. She never had red marks -- they are all black and blue. She doesn t have abdominal pain either. Our pediatrician said it was nothing to worry about but as you can i agine, looking at your child with bruises all over is heartbreaking and scary. We have decided to take our daughter to a Rheumatologist but they cannot fit her in until mid June. Now I am contemplating taking her to the ER at our local Children s Hosipital (CHOP) so we can get answers more quickly. Just looking for some advice. Thanks for your help!
Patient: Female, 73 years, 6 months old, 5'7" tall, 230 lbs., in generally good health. Hypertension well controlled with medication, lifelong history of recurring clinical depression . Currently takes medication for depression and hypertension,...
I had routine bloodwork done and all tests came back normal except for a raised ferratin 575. When tested again 6 weeks later it came back at another high value 445. No other tests for inflammation were done. CBC with differential all normal. I'm...
My 6 year old daughter has a bump on her forehead right below her hairline. It is about the size of a small pea. She says it is painful. It is non-movable. It has a bluish tint similar to a bruise but much lighter. It does not seem like a bump...