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Dr. Thomas, MD
Dr. Thomas, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 57712
Experience:  Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
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Greetings:My mother-in-law (early 80s)...

Customer Question

Greetings: My mother-in-law (early 80's) had surgery (Mercy Hospital, St. Louis, MO) to repair an aortic aneurysm (7 cm?); she was told her health was good enough for the surgery, and even though she had successfully recovered from myeloma and hip transplants, she was in good spirits, bright, and conversational. It took her three days to wake up fully from the surgery. Since that time, she has been either other-directed (non-responsive) or lethargic (responsive with little energy or initiation of conversation, etc.). She could not swallow at first, and was not on solid food--even mechanical. She has recently been starting to eat somewhat, but no appetite--and still lethargic. She was told her kidneys were only operating at 40% after the surgery; she is now on dialysis; however, the original symptomatic issues persist. It has been over three weeks now, and she is still essentially like she was two weeks ago: awake most of the time, but no energy, little initiation of conversation, and lethargic (uninterested). I am of the opinion (while far from being a medical doctor) that the overriding reasons behind the lack of recovery and mental lethargy have very little to do with her kidneys, and more to do with undiagnosed symptoms--since her dialysis treatment (they put her back into ICU last Friday and began the dialysis) has not had a dramatic effect. My advice to my wife was to get a specialist of a certain type that has seen this type of thing before; can isolate, identify, and rectify her condition; and get her back on her feet. This is my first step at being of assistance; the Mayo Clinic is unparalleled in its reputation. I am asking both for your opinion as to what you think the underlying and undiagnosed problem(s) may be, and direction as to the specific type of doctor (geriatrist, etc.) that we should pursue to assist in her recovery. It seems as though they are wandering around a bit down here, and too much guesswork is involved. I thank you in advance. Brian xxxx. xxxx, for Lynne xxxx. xxxx, daughter of Marsulite xxxx. xxxxx E-Mail:XXX@XXXXXX.XXX

Submitted: 1 year ago.
Category: Medical
Expert:  Dr. Thomas, MD replied 1 year ago.
Hello from JA
Has she had an MRI of the brain?
What findings
Customer: replied 1 year ago.

CAT Scan--no anomalies

Expert:  Dr. Thomas, MD replied 1 year ago.
OK
Has she had
Neurology assessment
EEG
Assessment of electrolytes, magnesium and calcium
Thyroid testing
Customer: replied 1 year ago.

My wife is at the hospital now; working on getting your answers.


 


Please allow ten to fifteen minutes--stay with me!

Expert:  Dr. Thomas, MD replied 1 year ago.
OK

Will be here
Customer: replied 1 year ago.

Thanks--efforting the information you requested!

Expert:  Dr. Thomas, MD replied 1 year ago.
OK
If she can find out what the BUN and creatinine are...any other abnormal labs...great
Customer: replied 1 year ago.

Will inquire right now as well!

Expert:  Dr. Thomas, MD replied 1 year ago.
OK
Customer: replied 1 year ago.

For Dr. Thomas:


 


Answers to previous questions regarding Marsulite Madison, From XXXXX XXXXX (Continuation of information string started yesterday morning):


 


1) They have not done an EEG 2) No seizures or suspected seizures 3) a CT Scan given was negative 4) Thyroid test OK 5) Electrolytes OK 6) Hemoglobin and blood oxygenation OK 7) Magnesium levels good 8) Calcium slightly low 9) Creatinine a little high...


 


Today, she is alert, but lethargic and still far from the woman who existed both mentally and physically before the surgery. She also has developed edema around her heart and in her abdomen; they are discussing Lasix, plus a feeding tube...


 


My favorite philosopher, Spinoza, stated that "the question is more important than the answer..." I hear a lot of SYMPTOMS discussion; treatments for the symptoms; and a lot of head-scratching--but I have yet to have a doctor ascertain the answer to this question: "What happened?"


 


What is the nuclear, basic thing that occurred which has resulted in this myriad of symptomatic effects and concerns? That is my "Spinozan" question. So do we need a special type of doctor, or a geriatrist who is familiar with reactions like these in older people surrounding surgeries? Was it an anastethia miscalculation (would they even admit it?)?


 


Please stay with me on this, and I thank you for your great support...


 


 

Expert:  Dr. Thomas, MD replied 1 year ago.
The CT scan should be repeated , or MRI, hypoxia damage would not show up immediately in some cases on CT, nor would stroke, so a repeat in 48 hours is indicated.

She needs to be cleared by neurology.

If the repeat scans are clear, EEG. Not all seizures show up as other than absence behavior.

If no findings, geriatrics or psychiatry.

If she had compensated dementia at all before surgery, it is common to have a week or 2 of decompensation after surgery, even just in older people...so it can be part of recovery in this case.
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Dr. Thomas, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 57712
Experience: Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
Dr. Thomas, MD and 3 other Medical Specialists are ready to help you
Customer: replied 1 year ago.

Should we employ a geriatrist to assist at this point? Sometimes, or at least it seems logical, a doctor who specializes in older people may have had more experience in the unknown syndrome she is experiencing...

Expert:  Dr. Thomas, MD replied 1 year ago.
Yes that is an internist who has specialized in geriatrics. That is fine to coordinate the whole case and decide which consultants are needed.

Good luck
Let me know how it goes.
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Otherwise please choose a positive rating . But, still come back if you need to…think of something later, etc. Bonuses are appreciated.

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Dr. Thomas, MD
Dr. Thomas, MD
Internal med/integrative med/family med
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Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc