[karty_83]

Originally Posted by SILVERWOOD

Whats her age and for how long has she been a diabetic. (Type 1 or Type 2.?)

Whats her protienurea levels.?

She is 52 and diabetic Type 2.
I don't know about the protienurea levels. Couldn't find that term anywhere in the test report.

[SILVERWOOD]

Originally Posted by karty_83

She is 52 and diabetic Type 2.
I don't know about the protienurea levels. Couldn't find that term anywhere in the test report.

Look for Microalbuminurea in the lab reports.

BTW-Nothing wrong if she is prescribed Sartel.

[karty_83]

Originally Posted by SILVERWOOD

Look for Microalbuminurea in the lab reports.

BTW-Nothing wrong if she is prescribed Sartel.

Could not find the term Microalbuminurea anywhere in the report.
And thanks for the clarification on Sartel.

[drmohitg]

Originally Posted by karty_83

Could not find the term Microalbuminurea anywhere in the report.
And thanks for the clarification on Sartel.

It will protect her kidneys from developing any complications due to the diabetes. She can safely take the drug.

[vivekiny2k]

Help needed from pediatricians/urologists:

my son has a case of phimosis and recently developed urinary tract infection. the symptoms were high fever and pain on the right abdomen while urinating. A culture confirmed the infection. That was 3 weeks back.

After a dose of antibiotics he is doing fine now. But the doctor referred us to urologist who wanted an ultrasound and they discovered some swelling and scarring in kidney.

Now they are recommending VCUG to rule our reflux, thinking that may have been the cause. I am a little hesitant because it's an invasive procedure and being done as a precautionary measure rather than to treat anything. I know he was holding back when he had the infection and that may have cause the infection to spread up. We don't have any family history of a reflux either.

I need to know if the scarring and inflammation of kidney are permanent and concerning? and if we should get it further examined/treated. We are going to get the phimosis treated/operated for sure.

[Deep Blue]

@vivekiny2k- How old is your son?

[vivekiny2k]

he turned 5 in march.

[Deep Blue]

It would be advisable to get the VCUG to rule out a reflux considering your son had an acute pyelonephritis(acute bacterial infection of the kidney) and ultrasound shows swelling of the kidney (hydronephrosis or hydroureteronephrosis - dilatation of renal pelvis and/or ureter) and scarring.
Phimosis, though can cause obstruction,is unlikely to be the cause for the infection to ascend to the kidneys. Any urinary tract infection in a child, particularly a male child requires investigation to rule out an anomalous urinary tract. Coupled with the ultrasound findings, it would be better to do the VCUG. A normal urinary tract shouldnt cause UTI,that too pyelonephritis.
Scar is permanent. The inflammation in a pyelonephritis heals with a scar. Your urologist may also recommend a radionuclide scan(DMSA) after the VCUG, if a reflux is present. This is again to assess the extent of scar.

[ramki067]

Hi to Doctors/Dentists over here,

I have been suffering from tooth ache from the past 1 year. To be specific its only one tooth at the last of my tooth chain (don't know what to call it!), towards the hole inside my mouth. I had consulted a dentist regarding this and the last time they filled silver by removing the black part inside the tooth. Now when i eat any sweet or drink chilled water i get the tooth pain or else i don't feel any pain.

When i went now for a checkup they insisted to pick out the tooth, which i don't wish to do. Could you dentists please recommend me some other methods to save my teeth?

Thanks,
Ramki

[JMaruru]

Originally Posted by ramki067

Hi to Doctors/Dentists over here,

I have been suffering from tooth ache from the past 1 year. To be specific its only one tooth at the last of my tooth chain (don't know what to call it!), towards the hole inside my mouth. I had consulted a dentist regarding this and the last time they filled silver by removing the black part inside the tooth. Now when i eat any sweet or drink chilled water i get the tooth pain or else i don't feel any pain.

When i went now for a checkup they insisted to pick out the tooth, which i don't wish to do. Could you dentists please recommend me some other methods to save my teeth?

Thanks,
Ramki

Seems like you might have to undergo root canal treatment. But let the dentists here confirm the same. Right now, am done with root canal for one, and waiting for another to happen.

[chakri400]

Can anyone recommend a good glucometer to use? Any dealers who can provide a good price would also help.

I currently use easygluco but I think it is not working as well as the readings differ drastically from the blood test reports (test done almost at the same time). For easygluco, I get test strips at a good price becauseI procure them from a dealer.

Thanks!
Chakri

[SS-Traveller]

Originally Posted by ramki067

...when i eat any sweet or drink chilled water i get the tooth pain or else i don't feel any pain.

When i went now for a checkup they insisted to pick out the tooth, which i don't wish to do. Could you dentists please recommend me some other methods to save my teeth?

Sounds like an improperly done silver filling.

You need to either replace the filling (with a composite restoration preferably), or in the worst case (if the x-ray says so), have a root canal treatment done followed by a crown.

Extraction need not be an option unless the tooth is badly damaged or mobile.

[CBlazer]

Hi,

My mother is around 70 and has been unwell for a few weeks now. I would appreciate any suggestion / advice from doctors on this forum. Please bear with my rather long post, but I don't think people would be able to help unless I gave the full picture. (Please note that I am a non-medical person and anything I mention below is purely based on my perceptions or what I've been told by doctors / their reports)

Her medical history:

My mother is non-diabetic, not had a history of hyper-tension. She had a peptic ulcer operation in her younger days and was always known to have a very sensitive stomach. She had a paralytic stroke (affecting her speech, right side movements) about 13 years ago - she had been undergoing treatment for Pott's spine then. I remember her BP was extremly low when we rushed her to NIMHANs after the stroke. About 6 months later she finished her antibiotics (for Pott's spine) and did all follow ups regularly till about a year after her stroke. Later the doctor adviced that she didn't need any more visits for her condition. She wasn't suggested any blood thinners.

Wrt her paralysis, she recovered to a large extent except that her speech was not clear and was unable to quickly recollect names. Her right hand movement was also very limited, but she was otherwise quite independent. We attribute a large part of her recovery to her will power.

Her current problem:

Since mid-June, 2011 her appetite came down a lot. She wanted to eat very little quantities that too bland food. One morning around mid-July, she developed symptoms of a very bad cold - lot of flem, her voice sounded very nasal. She didn't have fever. She was vommiting anything she ate/drank. When we took her to the hospital we were told that she had an aspiration pneumonia. She was immediately put on Ryle's tube feed, IV and kept in ICU for 3 days. On the 4th day they did an MRI (brain) and found the aspiration was due to a stroke affecting her swallowing. We were initially told she could recover her swallowing ability in 2-3 weeks. (The neurologist's report says - acute infarct in right lateral medulla/inf cerebellar peduncle -probably causing dysphagia/dysarthria. She was immediately put on blood thinners.)

Bleeding episode 1:

They did a tracheostomy (even while on thinners) to prevent aspiration and told they could take if off once her swallowing improves. She was okay for a couple of days and the doctors even suggested we could take her to a smaller nursing home with good nursing care. Before we could act, one day during suctioning she had a lot of bleeding from her mouth. She was rushed to the OT and the bleeding was stopped . The ENT surgeon said, as such he couldn't really see where so much bleeding was happening from and that he had cauterized some bleeding sites. (She lost close to 300 ml of blood.) The doctor also showed me a marble sized blood clot that he removed from the trachea - which had caused her Oxygen level to drop badly. She stabilized in a few hours, but was kept in ICU for about 3 days for observation. They were giving her Oxygen to maintain saturation. They felt the bleeding maybe due to the thinners. The thinners were stopped and she was also given platelets to stop bleeding.

Bleeding episode 2:

Back in the ward they restarted the thinners after a few days. Things were more or less eventless for a few weeks. Just as we were preparing to move her she had another bleeding episode - this time from the stomach. While the nurses were trying to change the Ryle's tube, they found blood (dark - seemed like old blood) coming through the tube. Her Haemogloben levels too started dropping. She was back in the ICU for another 3 days.

They did an endoscopy - found there were ulcerations in the oesophagus and a large bleeding ulcer in the junction of the food pipe and stomach. Again they felt this was due to the blood thinners. They haven't restarted the thinners since then, but plan to do so next week. For the ulcerations in the food pipe we were told to choose between a Freka tube and PEG tube (preferably the latter).

I chose the Freka since I was told that it was a fragile tube and also because I wasn't sure how my mother would take another surgical procedure. After all doctors advised us we had a PEG tube inserted early this week. She is stable and is being fed. She is also being ambulated - she is very weak, but is able to move around. About a week ago the doctor mentioned her lungs were now pretty clear.

My concerns:

1. Is it safe to bring her home in this condition? Her secretions have increased suddenly today. Why does this happen? How safe is it to get her home given these fluctuations?

2. I have purchased a suction machine, home oxygen, water bed, etc. But I just can't find nurses qualified to handle tracheostomy/ suction, etc. I've contacted all the big agencies in Bangalore. The ones that showed up are charging heftily don't have qualified nurses, but some folks who've taken training. Doctors say the family members can handle everything by ourselves and rush her to the hospital if there is an emergency. I am apprehensive given what happened in the past.

3. Is it safe to restart the thinners especially given her history of peptic ulcer? Can any precaution be taken?

4. How does one know she is ready for removal of the tracheostomy? I am not convinced with the swallowing assessment made so far - none of the doctors have monitored the assessment. Once a speech therapist did an assessment, my mother managed to eat all the semi-solid food given to her except for the last spoon which she coughed out. The doctors say her cough reflex is bad. The other time they assessed her by giving her a spoonful of water in the ICU. But only nurses were involved. I don't think they should have tried with water anyway.

5. Isn't it possible that they remove the tracheostomy, but we still feed her via the PEG tube? We can make sure she is not given anything orally till the doctors agree to. This way we can avoid all the suctioning and the risks of having the tracheostomy. Till yesterday even her oral secretions were very minimal - so I'm assuming she can swallow her saliva at least.

6. Does a PEG tube facilitate better nourishment compared to a Ryle's tube? This was one of the reasons why we were told to go for the PEG tube. But I still find the frequency/quantity of feed same as while on RT feed.

[CBlazer]

Originally Posted by CBlazer

My mother is around 70 and has been unwell for a few weeks now. I would appreciate any suggestion / advice from doctors on this forum.

Folks,

Any inputs / thoughts? I really would appreciate any help in this matter.

[drkakkilaya]

Originally Posted by CBlazer

Folks,

Any inputs / thoughts? I really would appreciate any help in this matter.

Hey pal,
Sorry to hear the stress your mother is going through. Considering your history ,

Simple fact that she is not able to take adequate food is itself a cause for ulcers , blood thinners could ve a role along with it. Timely food into stomach is important to keep free of ulcers.
Now between ryles tube feeding and peg , since the problem of stroke and tracheostomy is already there peg is always a better option. Keeping ryles tube , which itself a extreme irritation to nose is not tolerated well by patients.high chance she ll pull it out by herself.

With peg , her nutrition can be restored well. But her treating doctor is in the best position to identify fitness to undergo surgery.

Again what i said is only an opinion, as i said your treating doctor is in the best position to understand the needs of his patients.