Please read the below case history & awnser the questions at the end
Mr. Gurcharan Singh / Male
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.
- 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.)
- 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
- 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
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?