How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.
Ask DrHoellering Your Own Question
DrHoellering
DrHoellering, Doctor
Category: Medical
Satisfied Customers: 22356
Experience:  Doctor of internal and general medicine self employed
61885400
Type Your Medical Question Here...
DrHoellering is online now
A new question is answered every 9 seconds

Sir

Customer Question

Hi sir
Submitted: 9 months ago.
Category: Medical
Expert:  DrHoellering replied 9 months ago.

Or madam... How can I help you? Good morning!

Customer: replied 9 months ago.
Posted by JustAnswer at customer's request) Hello. I would like to request the following Expert Service(s) from you: Live Phone Call. Let me know if you need more information, or send me the service offer(s) so we can proceed.
Customer: replied 9 months ago.
Can we rather talk?
Expert:  DrHoellering replied 9 months ago.

Since I am not in the U.K. I will open the question for other experts.

Customer: replied 9 months ago.
Should I write my question here
Expert:  DrHoellering replied 9 months ago.

Yes please!

Customer: replied 9 months ago.
My brother has Ckd 4 from many years and last 2-3 months creatinine has started to increase
Expert:  DrHoellering replied 9 months ago.

Sorry to read this.

Customer: replied 9 months ago.
His blood sugars and blood pressure is being managed at the moment but given Creatinine is in the rise from last consective 3 months -- we are worried
Expert:  DrHoellering replied 9 months ago.

I understand. What's your question? How is the creatinine now?

Customer: replied 9 months ago.
He has been managing this on 3.8 but last three monthly readings are 4.18 , 4.62 and now 5.18 ....Similarly egfr 15, 13 and now 11
Customer: replied 9 months ago.
the question is , can we do something to bring this down?
Expert:  DrHoellering replied 9 months ago.

You can't, I am afraid. He will need dialysis, and sometimes the kidneys recover after some of them so they work a littel better for a while after. As you noiced blood pressure and sugar are important parameters to be taken care of. He should drink enough, but not too much.

Customer: replied 9 months ago.
One time dialysis or on regular basis to be started now?
Expert:  DrHoellering replied 9 months ago.

Depends on the creatinine. He will at least need a couple of them.

Customer: replied 9 months ago.
I have heard once you start dialysis -- you have to keep doing that. Can you please explain that
Expert:  DrHoellering replied 9 months ago.

I can't, because this is definitely wrong!

Customer: replied 9 months ago.
I am happy to call you in US
Expert:  DrHoellering replied 9 months ago.

I am in Germany. Shall I send you an offer?

Customer: replied 9 months ago.
Whatsapp?
Expert:  DrHoellering replied 9 months ago.

Skype?

Customer: replied 9 months ago.
mahadmian
Expert:  DrHoellering replied 9 months ago.

I send you an offer. This is an extra premium service.

Customer: replied 9 months ago.
Do you mean I have to pay more
Expert:  DrHoellering replied 9 months ago.

Yes, its not included.

Customer: replied 9 months ago.
See the attached
Expert:  DrHoellering replied 9 months ago.

Nothing new. He needs dialysis.

Customer: replied 9 months ago.
Not Skype then please
Customer: replied 9 months ago.
What should we expect from dialysis
Expert:  DrHoellering replied 9 months ago.

Prolongation of your brother's life.

Customer: replied 9 months ago.
Thanks I mean in terms of creatinine values
Expert:  DrHoellering replied 9 months ago.

That depends on his underlying issue. Anyhow the machine will do the work the kidneys can't.

Customer: replied 9 months ago.
How much creatinine would be lower from 2 rounds of dialysis ? Also how much water he should drink? What are the optimum values he need to maintain for blood sugar and blood pressure ?
Expert:  DrHoellering replied 9 months ago.

I wish your brother all the luck he neerds and thank you for a positive rating for this long consultation.

Customer: replied 9 months ago.
Ok thanks - understand water and bp and sugars. Really need to understand more about dialysis. So far his egfr was between 13-17 and doctor suggested that as long the values remains stable he can avoid dialysis. This is the first time creatinine crossed 5 and egfr touched 11 ... So really I want to understand if we put on the dialysis and assuming values goes back on again around Creatinine being 4 and egfr around 15 and stays there .... Can we avoid dialysis further if LFT stays around these numbers ? Or this is confirmed now that dialysis can't be avoided as he has reached the tipping point? Apologies if I am repeating myself
Expert:  DrHoellering replied 9 months ago.

I understand your point, but I can't tell tell since I don't know his underlying condition! You will have to wait and see, hoping that he won't need dialysis forever.

Customer: replied 9 months ago.
What do you mean by wait and see? Can you please explain this bit? At what values or conditions generally you go for further dialysis or not? Happy to share if you need to understand more about the history
Expert:  DrHoellering replied 9 months ago.

I did this already. You have to ask this your brother's doctors, because only THEY know what issue made your brother's kidneys sick. You go for further dialysis when the kidneys don't recover to do the job themselves. This is what you have to see.

I have been attending you vor 45 minutes already, much more than you initially requested and paid for. If you need more informations, please accept a permium service. Thank you for your understanding!

Customer: replied 9 months ago.
Thanks - I thought I have paid already but the extent of my question is not fully understood maybe. I can go and talk to HIS doctor but point was really to take a second opinion and understand our options going forward. Sorry but you keep sending me offers to pay more. I don't know what time was allocated to me and how can I have exhausted my time limit already. ūüôÉ
Expert:  DrHoellering replied 9 months ago.

Ok, you might understand that expert's time is precious, especially on weekends, and I can't stay with you for an hour ore more . Let's summarize then: I told you that dialysis is necessary. Maybe his kidneys recover, that depends on the underlying condition. Maybe not, then dialysis will save his life until he might get a new kidney. This is your brother's only option except taking care of fluid, blood pressure and sugar.

Is this quite clear?

Customer: replied 9 months ago.
Ok thanks.
Expert:  DrHoellering replied 9 months ago.

You are very welcome. I thank you for clicking a positive rating for my help and wish your brother all the luck he needs!

Expert:  DrHoellering replied 9 months ago.

And you, too.

Expert:  DrHoellering replied 8 months ago.

Hi again,

The only way I am paid here by the website and the money that you have deposited is released is when you rate me.
Therefore, I would appreciate a rating.

If something is still not clear: Just feel free to ask! I want you to be happy with me and Justanswer.

Thank you!