h*******r
发帖数: 182 | 1 贴在Medicareer只有围观没人回应, 只好来这里求助.原来贴在Medicareer, 也是希望
教授,老师们能评点以下这一治疗方案,让成长的麦穗们学习一下.多谢多谢!
Last Easter Sunday, We had dinner with friends. 男主人头发半年之内全白了, 看
了让人难
过.
Earlier his wife called us, asking us praying for his health, especially for
his deteriorating renal function. When I asked the detail, he could not
give the exact number, but he said if it still goes down, he has to consider
dialysis. He took too many medications, a lot of them I don't quite agree.
Please take a look, and give some kind suggestions.
75 year old African American, 20+ years high BP,12+ year prostate cancer
after chemo and radiotherapy, 5+ years of DM-II. BP is not well controlled,
about 160/100, glucose level swings around 130mg/dl. Last Feb, one
metastatic tumor of prostate was found around T2 and was resected.
Here are the medications:
furosemide
metoprolol
amlodipine
lisinopril (what if he has renal a. stenosis, or atherosclerosis?)
Minoxidil (is it good for DM?)
venlafaxine (increase BP?)
Liptor
Januvia (oral hypoglycemic of DPP4 I, there is concern about cancer growth)
Bicalutamide
Zaleplon
insulin injection (type and dose unknown)
As he could not provide lab numbers, I could not give much advice. What I
could say is eat better, control glucose level better, and have retina
checked annually.
I wish someone can help to adjust his medications to slow down the dipping
of his renal function.
Appreciate your kind helps. | A*******s
发帖数: 9638 | 2 Although DM nephrolopathy could be the cause of renal insufficiency, I would
rather believe HTN is the main culprit to blame.
He needs better control on his HTN. | h*******r
发帖数: 182 | 3 I just could not understand he was given 5 medications for HTN, and still
not well-controlled. Besides, he was prescribed with Venaflaxine, which also
has potential to increase BP.
If it were your patient, how would you control BP and what kind of workup
need to adjust? Thank you so much.
would
【在 A*******s 的大作中提到】
: Although DM nephrolopathy could be the cause of renal insufficiency, I would
: rather believe HTN is the main culprit to blame.
: He needs better control on his HTN.
| A*******s
发帖数: 9638 | 4 Compliance and close monitoring.
Don't believe BP could not be controlled.
also
【在 h*******r 的大作中提到】
: I just could not understand he was given 5 medications for HTN, and still
: not well-controlled. Besides, he was prescribed with Venaflaxine, which also
: has potential to increase BP.
: If it were your patient, how would you control BP and what kind of workup
: need to adjust? Thank you so much.
:
: would
| h*******r
发帖数: 182 | 5 I really admire you, A++. Last spring, he skipped some of his medications,
that ended up into hospitalization on Christmas. His glucose has also been
swinging up and down. What sould I say, senior people are just like baby,
they don't know how to control themselves. Sad, really sad.
【在 A*******s 的大作中提到】
: Compliance and close monitoring.
: Don't believe BP could not be controlled.
:
: also
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