Thursday, 9 October 2014

Straight from the Heart (VII) : The Story of My Tryst With My Heart Ailment, Part VII of VII


Straight from the Heart :
The Story of My Tryst With My Heart Ailment

Part-VII of VII
(the last part)



                                                                                                                                               

    Post-Operational Recovery 

                                                                                                                                               



____________________________________________________________
Good Bye to Kokilaben Hospital


You don't appreciate life until you get to the other side.
Like lying in a hospital bed.
~ Fabrice Muamba





As I have mentioned in my earlier blog, my two daughters, Manasi and Manini, proved extremely helpful—rather indispensable, besides my wife Debu. Manasi promptly, methodically and very capably carried out two more tasks before my discharge from the hospital—that given my state I could not have done myself.

Manasi cleared out the last remaining payment, completed other necessary formalities and obtained necessary papers that could facilitate timely discharge.

She also purchased beautiful “Thank You” cards and chocolates and distributed them among all concerned (doctors, nurses and attendants in the ICU and in the ward)  as a very modest token of our gratitude to them all.

In my subsequent email to my daughters after returning home I could not help quoting Deanna Beisser: “A daughter is a miracle that never ceases to be miraculous...full of beauty and forever beautiful...loving and caring and truly amazing.”

Completion of all formalities for discharge was over by about 2 pm on Tuesday, 15 July 2014, and readily surrendering my hospital outfit and donning my shirt and trousers, I happily moved out.

As I moved out, I re-resolved to write about my experiences in the hospital and with my heart ailment in a series of blogs. We all are so quick to criticise, I thought. But, when it comes to appreciating good work, are we equally prompt? I resolved that soon after I am in a position to sit across my PC and write, my first blog-post would heartily acknowledge and thank all those doctors and nurses and other staff who helped me regain a healthy heart; and put on record the excellent services provided by Kokilaben Dhirubhai Ambani Hospital (KDAH). I am glad I did what I resolved. This is the last in the series of those blog-posts.


Exemplary KDAH Courtesy
I was glad to receive email acknowledgement for my first blog-post in the series from Kokilaben (KDAH) Hospital. The text of their email is reproduced below.

================================================
On 31 July 2014 12:45, <TAA.Office@relianceada.com> wrote:
----------------------------------------------------------------------------------
Dear Mr. Puranik,
Our Dr. Vidyadhar Lad has forwarded your blog details to me about your experience at Kokilaben Hospital.

I personally felt extremely delighted that the team led by Dr. Lad & Dr. Sunil Wani has given you a pleasant experience at The Kokilaben Hospital.

As a team, we constantly strive to treat all our patients with the utmost care and compassion and the highest level of quality, safety and service during their stay.

Your words of appreciation are indeed very encouraging and will go a long way in motivating all of us.

We wish you a healthy and joyful life at all times.
Warmest Regards
Tina Ambani
===========


____________________________________________________________
Back Home!





 Ekta Bhoomi Gardens, Borivali-East : My Home

Back home from the hospital by the evening of Tuesday, 15 July 2014, along with my wife Debu and elder daughter, Manasi, I felt much relieved.

Finally, the ordeal was over! The real possibility of a far, far worse and disastrous eventuality had I not gone in for the operation was what had prodded me to “go and get over with it!” I knew it was a tough call, but something that had to be taken. Besides, the ordeal had to get over some day. And, that’s what had happened. I felt elated, and patted myself for not having shied away from it or postponed it. It felt so light!

My wife had kept the home as clinically clean as possible to minimise the chances of any infection.


Happy to be Home, and in my Study
I was mighty happy to be back home, and back in my study.



With books and iPad and PC I knew I could happily sail through the three months of recovery period.


Prescribed Regime
The hospital, KDAH, had provided me with a set of printed sheets detailing the prescribed regime at home: what to do and what not to do, including what to eat, what not to eat, what medicines to take, and what exercises to do. For exercises, walks, swimming and so on, it prescribed a graduated regime over the next three months.


Prescribed Food

Let food be thy medicine, and let thy medicine be food.
~ Hippocrates


True healthcare reform starts in your kitchen.

He who takes medicine and neglects to diet
wastes the skill of his doctors.

~Chinese Proverb


When diet is wrong medicine is of no use.
When diet is correct medicine is of no need.
~ Ancient Ayurvedic Proverb

Here I didn’t have to do much compromise, as my eating habits had anyway been healthy. The only change was regular intake of healthy, hot soup before lunch and dinner. The soup varied: from spinach to a mix of tomato, beetroot and carrot to mixed-vegetables and so on, all tinged with healthy spices.

An additional item was flaxseeds, which are rich in antioxidants and contain Omega-3 fatty acids.


Prescribed Medicines
These I have tabulated in sufficient detail below under a separate main heading.


Hunger
Surprisingly, during the first ten days after return from the hospital I used to feel really hungry and became a voracious eater—by my standards. Earlier, before the operation, if I took heavy breakfast, particularly the one which included even one egg, I would not feel much hunger for lunch. Dinner used to be very frugal. However, after returning from hospital, I found I could have both sumptuous breakfast and sumptuous lunch. And, I felt hungry for dinner too.

However, after about 10 days it was back to what was normal prior to the operation: moderate breakfast; soup followed by lunch with only 2 chapattis and a small cup of rice, vegetables, dal and curd; and very light dinner. Of course, fruits, flaxseeds, normal-tea, green-tea and milk were the additional items.



____________________________________________________________
Health

From the bitterness of disease man learns the sweetness of health.
Health and cheerfulness naturally beget each other.
~Joseph Addison


To insure good health: eat lightly, breathe deeply, live moderately, cultivate cheerfulness, and maintain an interest in life.
~William Londen


A man too busy to take care of his health is like a mechanic
too busy to take care of his tools.
~Spanish Proverb



Initial Recovery
Recovery during the first 27 days after the operation, that is, till 5 August 2014 was rather quick.

I could take short walks without any difficulty. I also resumed my normal reading and writing, though I could not sit long hours.

The 9-inch long vertical wound on my chest (thanks to the incision for cutting the sternum (breastbone) in the middle to allow access to the heart for the operation: details and diagrams in the previous blog-post) and the three 1-inch holes in my chest and stomach (for the tubes inserted through them to drain blood) filled-up sufficiently to allow me to have bath after a week of returning home; although the wound-marks were still many weeks away from fading. Skin on the left side of the chest, from under which an artery (Left Internal Thoracic/Mammary Artery: LITA/LIMA) was harvested, remained insensitive.

The wounds (three 1-inch cuts) on the left arm, from which an artery (Radial Artery: RA) was harvested, took much, much longer to fill-in; and the flesh/skin in-between the wounds remained swollen and insensitive. Initially, I had to daily clean it after bath with the anti-bacterial solution Bactorub, then wipe it with Betadine solution, then apply T-Bact ointment over it, followed by Soframycin ointment over it; and then bandage it. After two weeks, bandage was no longer necessary. Gradually, Bactorub and Betadine were dispensed with, and only T-Bact and Soframycin ointments were applied. All these were as per the advice of the doctors at KDAH, where I made periodic trips for a check-up. However, one problem that came up were the skin eruptions on the arm around the wounds. I was told that once Bactorub and Betadine, that irritated the skin, were dispensed with, the problem would go away. But, it didn’t. Finally, my wife Debu suggested that after I apply T-Bact and Soframycin, I also apply Betnovate cream on and around the wounds, and wherever the eruptions appear. It worked—the eruptions disappeared! They must have been some kind of allergy, that subsided with Betnovate.

One irritant was the insulin-pen: having to take insulin thrice a day. Of course, it was substituted with tablets later.


Health suddenly deteriorates—takes a plunge!

Sickness comes on horseback but departs on foot.
~Dutch Proverb


The smooth and relatively faster recovery in my health for full 27 days after the operation on 9 July 2014 suddenly took a drastic downturn from 5 August 2014 onwards.

I distressingly found that I was getting tired even when having a bath—which was NOT the case hitherto. Things began to get progressively worse. I was becoming breathless after a short walk—that too was a surprise reversal, after the relatively much longer walks that I had been taking earlier. Worst was from 8 August 2014 night onwards when I found I was unable to sleep in the night till very late. I was sitting in bed and keeping awake till 3am to 4am trying to read something to somehow pass time. At times, I began to get breathless even while sitting—that is, while not exerting myself. It was like the days before the operation—only much, much worse!

What had happened? There was no apparent reason. I had been taking medicines regularly, I was sticking to the prescribed diet and the exercise regimen. I had not over-exerted. I had not even been going out to Malls or Multiplexes or for outings. My outings were restricted to the mandatory hospital visits to KDAH.

After a few days of the ordeal and wait-and-see-if-the-condition-improves, my wife Debu took the initiative to have certain blood tests done that she thought fit. The blood-test report on 11 August 2014 showed alarming drop in Haemoglobin: 7.2 against the normal range of 13 to 17!

My wife and I panicked. My wife sent an SoS–SMS to both Dr Lad and Dr Wani at KDAH on 11 August 2014. They gave prompt appointment the next day morning.


Dr Sejao to the rescue!

Dr Lad advised chest x-ray, which was promptly done in the hospital. The x-ray didn’t reveal anything abnormal. After check-up, both Dr Lad and Dr Wani felt my case should be examined by an expert physician as it fell in that domain (they being surgeons), and said they would immediately refer my case to an appropriate physician in KDAH.

I told them I already had in Dr Sejao, who had recommended me to KDAH, an expert physician, and that I would rather consult him. Dr Wani then and there tried contacting Dr Sejao over his mobile, but unable to get through, sent him an SMS. As we were coming back in our car from KDAH, I received an SMS from Dr Sejao. He was kind and prompt enough to give me an appointment that day itself! He asked me to see him at Riddhi Vinayak Critical Care & Cardiac Centre, SV Road, Malad-West at 4.15 pm on that day itself.

The hospital was on the way back to our home, and we had no difficulty in reaching there by 4pm. It was raining. Dr Sejao came in time, and called us in. Dr Sejao examined my blood-test report that we had taken along, did his check-ups that also involved checking up chest with his stethoscope. He didn’t seem to find an apparent problem, Then he suddenly asked me to again climb on to the examination-bed and expose my back. He checked my back thoroughly and repeatedly with a stethoscope. “I hear a very mild abnormal noise in the lower right lung,” he declared. He had apparently hit upon the clue.

He prescribed a set of medicines, substituting some that I had been taking; and advised a set of blood-tests (CBC-5, Liver Profile, Iron Studies, Biochemistry tests, Immunology Tests, Hematology Tests and Culture & Sensitivity, Aerobic) and Multislice CT Scan of Chest (please see the details and the tabulated results below under separate heads).

The test-results that became available on 13 August 2014 confirmed Dr Sejao’s suspicion—I had caught infection in the lungs leading to all the problems. My problem had nothing to do with the heart operation or its after-effects. To my plea that I had been taking all care, so how come the unexpected problem occurred, he responded that I might have caught the infection from the air, and as I had not been going out to Malls or Multiplexes or markets, I might have caught the infection in the hospital itself when I visited there for periodic check-ups—hospitals being the most infection-prone places, with so many patients with varied ailments visiting it.

The antibiotics and other medicines prescribed by Dr Sejao had dramatic effect. Within 2 days I was feeling much better; and thereafter my condition steadily improved.


Current Health Status as on 9 October 2014
On 9 October 2014 I complete 3 months from the date of the operation (9 July 2014), and it’s a good time to take stock.


The Wounds Thanks to the Operation
The three 1-inch cuts on the left arm have healed. I have been applying no medicines on them for the past one month. The cut marks are still prominently visible, and have not faded or disappeared yet. The flesh and skin between the first two cuts is slightly swollen and is insensitive, though there is no pain. Left hand’s little finger is slightly insensitive.

The 9-inch wound on the chest has healed. The cut marks have faded, but have not disappeared yet. Portion of the left chest is still insensitive, but there is no pain now.

The spot on the right wrist through which Angiography was done has healed, though the mark is still visible.

The spots on the back of both the hands where IV-fixtures were put have healed.


Skin Eruptions
One thing that had been bothering me mildly were skin eruptions. Very small, red eruptions occurred on the hands, thighs, chest, stomach and back from time to time. Not in large numbers, but just 2 or 3 at a time. They pained initially for a day, then gradually disappeared. They didn’t get larger than a millimetre across nor did any pus develop in them. They seemed like allergy. Reaction to some medicine I have been taking? They have since decreased substantially, but have not disappeared completely.


Breathlessness
Breathlessness is completely gone.

Since last many years whenever I used to walk down from my Ekta Bhoomi Gardens residence in Borivali-East to Shri Sai Baba Temple on the Western Express Highway in Thakur Complex in Kandivali-East, I had to stop in-between two to three times (it varied from day to day) for one to two minutes to catch breath. However, now I walk the distance without stopping even once, and do not at all feel tired or breathless even upon reaching the destination!

Shri Sai Baba Temple

Five rounds at the BMC garden that I go to for a walk each evening used to be more than enough, for I used to get tired after that. Of course, for a fortnight before the operation, even one round required rest in-between. Now, however, I take 10 rounds without feeling tired or breathless!


Outing
When my friend from college (IIT, Kharagpur), Akhil Chandra, came over from Delhi on 10 September 2014 along with his wife Archana, I thought why not give a try to what I had been consciously avoiding: outings.

As a test case, we first visited Kanheri Buddhist Caves in the National Park at Borivali-East on the afternoon of Thursday, 11 September 2014. The caves—a total of 109—are rock-cut inside the mountain. They date from the first century BCE to the tenth century CE. The National Park Main Gate is only 2km from my residence; and Kanheri Caves are situated deep in the jungle about 6km from the Main Gate of the National Park. We went by car. Going up the stairs to the main entrance gate of the caves and then going up the stairs inside the caves complex to reach caves situated at higher levels is a steep climb which used to be a demanding endeavour for me earlier to the operation, for it used to make me breathless and required halts several times to catch my breath. However, it proved to be quite manageable this time, and I didn’t feel breathless or tired. This could only have been thanks to the operation.




My sister Poornima @Kanheri Caves in 2012 

Akhil-Archana @Kanheri Caves, 11.Sept.2014


We decided for an overnight outing to Malshej Ghat located at a distance of about 140km from my residence in Borivali-East. We went there by my car (I didn’t drive—we had employed a driver) early morning on Friday, 12 September 2014, and stayed overnight, returning on Saturday afternoon. As my wife Debu was a little indisposed, she didn't accompany us.

Route to Malshej Ghat

Free Car Wash thanks to Malshej Ghat Waterfalls




If there is one spot in the world, or at least in India, which is at its grandest during the Monsoons, especially during heavy rains, it is Malshej Ghat! One of highlights of Malshej Ghat is the unusually fascinating ten kilometre drive on the highway through the ghats with  deep verdant valley on one side and tall, steep rocky mountains forming a boundary on the other side, from top of which numerous seasonal waterfalls cascade down on to the highway providing free washing for your car as your car passes under them. Of course, since the rainy season was almost over, the waterfalls were not that many, nor was there the usual fog through which you had to cut through on your way up, and missing too were the scores of picnicking groups which you normally observe dancing and bathing in the rains and under dozens of waterfalls all along the ten-kilometre stretch of the ghats. Akhil-Archana missed that thrill, but still felt exhilarated with the grand spectacle of the nature presented by Malshej Ghat. 

Malshej Ghat, 2012: My sister Poornima and wife Debu.

Archana, Akhil and myself (extreme right) @Malshej Ghat

Archana-Akhil @Malshej Ghat

My sojourn at Malshej Ghat, my not getting tired with the relatively long car journey and my long walks there gave confidence to me that I had recovered sufficiently, and I must thank Akhil-Archana for accompanying me to that place.


Swimming



Swimming Pool & Club House in Our Building, Ekta Bhoomi Gardens

In the swimming pool in our club in our building, I used to cross the length a maximum of 10 times (it’s a modest-sized swimming pool), with rest after each lap, to catch my breath. I had been avoiding swimming, but I tried it out in the late evening on 24 September 2014. I could complete 10 laps with pauses after each. I would need to gradually build my stamina in swimming.



____________________________________________________________
Medicines

The best and most efficient pharmacy is within your own system.  
~Robert C. Peale


KDAH-prescribed Medicines wef 16 July 2014
With effect from 16 July 2014, the medicines that were prescribed were as under.



Medicine
Frequency
Duration
T
Ceftum 500mg (GSK)
1—0—1
3 days
T
Pan 40mg (Alkem)
1—0—1 (BF)
3 days
T
Dolo 650mg (Micro)
1—1—1
7 days
T
Lasilactone 50mg (Sanofi-Aventis)
1—0—0
7 days
T
Ativan 1mg (Wyeth)
0—0—1
7 days
S
Syrup Cremafin Plus 2tsf (Abbot)
0—0—1
7 days
P
Diabeta Resource (Powder)
2—2—2
1 month




T
Nikoran 5 mg (Torrent)
1—0—1
Lifelong
T
Betaloc 25mg  (AstraZeneca)
1—0—1
Lifelong
T
Clopivas AP, 150mg (Cipla)
0—1—0
Lifelong
T
Storvas EZ 10mg (Ranbaxy)
0—0—1
Lifelong





Insulin (for Type 2 Diabetics)


I
Actrapid S/C
16—18—0

I
Mixtard 30/70 S/C
0—0—16


Notation X—X—X means {Breakfast}—{Lunch}—{Dinner}. Normally, all medicines are taken after food, except where prescribed otherwise. 1—0—1 means 1 tablet after breakfast, none (0) after lunch, and 1 after dinner. BF means “Before Food”.

Medicine
Purpose/Remarks
Ceftum 500mg
An antibiotic for bacterial (not viral) infection of lung, ear, throat, sinuses, skin and urinary tract.

Pan 40mg
Pan, that is, Pantoprazole is a gastric medicine for gastro-esophageal reflux disease (GERD), a condition that causes gastric juices to flow upward from the stomach and into the esophagus. Reflux is also known as "heartburn", in which food or acid from your stomach backs up into your mouth, leaving a sour or bitter taste. It is taken before food.

Dolo 650mg
It is Paracetamol which is an analgesic (relieves pain) and an antipyretic (prevents and alleviates fever).

Lasilactone 50mg
This helps reduce extra fluid and salt in the body—to be passed into urine. It help stop build-up of extra water in the body to prevent shortness of breath, feeling more tired than usual. It contains (a)spironolactone, a potassium-sparing diuretic and (b)furosemide,  a loop diuretic.

Ativan 1mg
Also called Lorazepam, it is meant to help you sleep. Belonging to benzodiazepines class, it relieves excessive anxiety by slowing down the communication between the nerves in the brain/central nervous system.

Syrup Cremafin Plus
Laxative

Diabeta Resource
Adjunct to diet for type 2 diabetics.



Nikoran 5 mg
Vasodilatory drug. It dilates arterioles and large coronary arteries by opening the potassium channels. It improves coronary blood flow.

Betaloc 25mg
Contains Metroprolol Tartrate 25mg. It is a beta-blocker used to prevent heart-related complications and to also lower high blood pressure. It widens the blood vessels in the body and helps heart beat more regularly.

Clopivas AP, 150mg
Contains Clopidogrel + Aspirin. It inhibits platelet aggregation.

Storvas EZ 10mg
Statins. Contains Atorvastatin + Ezetimibe. For decrease in hepatic cholesterol levels.

Insulin Actrapid S/C  Mixtard 30/70 S/C
Taken through FlexPen manufactured by Novo Nordisk A/S, Denmark.


While I took the above medicines regularly, I found I didn’t need the laxative Cremafin Plus, so I didn’t use it. I took Pan-40, Dolo-650 and Ativan only if required. For example, I took Pan-40 only upon stomach upset; Dolo-650 only if the pain was too much; and Ativan only if I could not go to sleep.


KDAH-prescribed Medicines wef 16 July 2014
I was called for a check-up at KDAH on Friday, 18 July 2014, when the medicines were marginally varied as under:

(Strikethrough items (like Ceftum 500mg  below) to indicate the medicine that I had been taking before, but since discontinued.)


Medicine
Frequency
Duration
T
Ceftum 500mg (GSK)
1—0—1
3 days
T
Pan 40mg (Alkem)
1—0—1 (BF)
3 7 days
T
Dolo 650mg (Micro)
1—1—1
7 5 days
T
Lasilactone 50mg (Sanofi-Aventis)
1—0—0
7 5 days
T
Ativan 1mg (Wyeth)
0—0—1
7 5 days
S
Syrup Cremafin Plus 2tsf (Abbot)
0—0—1
7 days
P
Diabeta Resource (Powder)
2—2—2
1 month
T
(New Addition)
Linezolid 600mg (Cipla) or
Lizolid 600mg (Glenmark)
1—0—1
5 days








T
Nikoran 5 mg (Torrent)
1—0—1
Lifelong
T
Betaloc 25mg  (AstraZeneca)
1—0—1
Lifelong
T
Clopivas AP, 150mg (Cipla)
0—1—0
Lifelong
T
Storvas EZ 10mg (Ranbaxy)
0—0—1
Lifelong





Insulin (for Type 2 Diabetics)


I
Actrapid S/C
16—18—0

I
Mixtard 30/70 S/C
0—0—16


Medicine
Purpose/Remarks
Linezolid 600mg
An antibiotic for bacterial infection.


KDAH-prescribed Medicines wef 24 July 2014
I was called for a check-up at KDAH on Thursday, 24 July 2014, when the medicines were changed/reduced as under:

Medicine
Frequency
Duration
T
Ceftum 500mg (GSK)
1—0—1
3 days
T
Pan 40mg (Alkem)
1—0—1 (BF)
5 days
T
Dolo 650mg (Micro)
1—1—1
5 days
T
Lasilactone 50mg (Sanofi-Aventis)
1—0—0
5 days
T
Ativan 1mg (Wyeth)
0—0—1
5 days
S
Syrup Cremafin Plus 2tsf (Abbot)
0—0—1
7 days
P
Diabeta Resource (Powder)
2—2—2
1 month
T
Linezolid 600mg (Cipla)
1—0—1
5 days








T
Nikoran 5 mg (Torrent)
1—0—1
Lifelong
T
Stamlo 5 mg (Dr Reddy’s)
1—0—1

T
Coversyl AM 4/5 (Serdia)
1—0—1

T
Betaloc 25mg  (AstraZeneca)
1—0—1
Lifelong
T
Clopivas AP, 150mg (Cipla)
0—1—0
Lifelong
T
Storvas EZ 10mg (Ranbaxy)
0—0—1
Lifelong
T
Razel 10mg (Glenmark)
0—0—1
Lifelong





Insulin (Changed dosage)


I
Actrapid S/C
18—18—0

I
Mixtard 30/70 S/C
0—0—12


Medicine
Purpose/Remarks
Stamlo 5 mg
Anti-hypertensive/for angina. Helps keep blood pressure under control. Also used for chest pain.

Coversyl AM 4/5
Contains Perindopril Erbumine 4mg and Amlodipine Besilate 5mg. Treats high blood pressure. It is a long-acting calcium channel blocker (dihydropyridine class) used as an anti-hypertensive and in the treatment of angina. Like other calcium channel blockers, amlodipine acts by relaxing the smooth muscle in the arterial wall, decreasing peripheral resistance and hence reducing blood pressure; in angina it increases blood flow to the heart muscle.

Razel 10mg
Contains Rosuvastatin Calcium. Meant to reduce cholesterol. It is a HMG-CoA reductase inhibitor (statin). It slows the production of cholesterol in the body. Excessive cholesterol in your body can clog up your blood vessels. Razel is marketed as Rozavel by Sun pharma.



KDAH-prescribed Medicines wef 31 July 2014
I was called for a check-up at KDAH on 31 July 2014, when the medicines were changed/reduced as under:

Medicine
Frequency
Duration
T
Ceftum 500mg (GSK)
1—0—1
3 days
T
Pan 40mg (Alkem)
1—0—1 (BF)
5 days
T
Dolo 650mg (Micro)
1—1—1
5 days
T
Lasilactone 50mg (Sanofi-Aventis)
1—0—0
5 days
T
Ativan 1mg (Wyeth)
0—0—1
5 days
S
Syrup Cremafin Plus 2tsf (Abbot)
0—0—1
7 days
P
Diabeta Resource (Powder)
2—2—2
1 month
T
Linezolid 600mg (Cipla)
1—0—1
5 days








T
Nikoran 5 mg (Torrent)
1—0—1
Lifelong
T
Stamlo 5 mg (Dr Reddy’s)
1—0—1

T
Coversyl AM 4/5 (Serdia)
1—0—1

T
Betaloc 25mg  (AstraZeneca)
1—0—1
Lifelong
T
Clopivas AP, 150mg (Cipla)
0—1—0
Lifelong
T
Storvas EZ 10mg (Ranbaxy)
0—0—1
Lifelong
T
Razel 10mg (Glenmark)
0—0—1
Lifelong





Insulin (for Type 2 Diabetics)


I
Actrapid S/C
18—18—0

I
Mixtard 30/70 S/C
0—0—12



Dr Sejao-prescribed Medicines
wef 12 August 2014
Consequent to catching of infection and down with its adverse effects of plunge in haemoglobin and iron level, I visited KDAH on Tuesday, 12 August 2014. On their advice, I then visited Dr Sejao, who advised a set of blood tests and Multi-slice CT Scan of Chest, and prescribed revised set of medicines as under:


Medicine
Frequency
Duration
T
Cefdiel 300mg (Ranbaxy)
1—0—1
10 days
T/C
Orofer XT 100/1.5mg (Emcure)
0—1—0
1 month
T
Odimont FX (German Remedies)
0—0—1
10 days
T
Restyl 0.5mg (Cipla)
0—0—1
10 days




T
Olmezest AM (20/5) (Sun Pharma)
1—0—0
Lifelong
T
Betaloc 25mg  (AstraZeneca)
1—0—1
Lifelong
T
Clopivas AP, 150mg (Cipla)
0—1—0
Lifelong
T
Razel 10mg (Glenmark)
0—0—1
Lifelong





Insulin (for Type 2 Diabetics)


I
Actrapid S/C
18—18—0

I
Mixtard 30/70 S/C
0—0—12


Medicine
Purpose/Remarks
Cefdiel 300mg
(Cefdinir) A cephalosporin antibiotic for a wide variety of bacterial infections. Most commonly used to treat respiratory tract infections, soft tissue infections, pneumonia, acute exacerbations of chronic bronchitis, ENT and skin infections.

Olmezest AM (20/5)
Also known as Benicar/Olmesartan. It is anti-hypertensive. Contains olmesartan medoxomil, an angiotensin II receptor blocker (ARB). Olmesartan in Olmezest 20 blocks the binding of Angiotensin II to its receptor, preventing its pressor actions (blood pressure increasing) resulting in dilation (widening) of blood vessel and increased salt and water removal by the kidneys into the urine, which together result in lower blood pressure.

Orofer XT (Emcure)
Ferrous Ascorbate & Folic Acid. Each tables contains 100mg Elemental Iron and 1.1mg Folic Acid. For Iron-deficiency anemia. Iron-deficiency adversely affects production of haemoglobin.

Possible Side-Effects:
Itchy skin eruptions, skin rash, etc.

Odimont FX
Main contents: Generic drug Fexofenadine. For Allergic rhinitis and allergic skin conditions.

Restyl 0.5mg
For sleep. Contains Alprazolam. Alprazolam is in a group of drugs called benzodiazepines . It works by slowing down the movement of chemicals in the brain that may become unbalanced. This results in a reduction in nervous tension (anxiety).




Dr Sejao-prescribed Medicines
wef 23 August 2014
Consequent to the relief felt by the medicines prescribed by Dr Sejao, the following were continued:


Medicine
Frequency
Duration
T
Cefdiel 300mg (Ranbaxy)
1—0—1
4 days
T/C
Orofer XT 100/1.5mg (Emcure)
0—1—0
1 month
T
Odimont FX (German Remedies)
0—0—1
10 days
T
Restyl 0.5mg (Cipla)
0—0—1
10 days




T
Olmezest AM (20/5) (Sun Pharma)
1—0—0
Lifelong
T
Betaloc 25mg  (AstraZeneca)
1—0—1
Lifelong
T
Clopivas AP, 150mg (Cipla)
0—1—0
Lifelong
T
Razel 10mg (Glenmark)
0—0—1
Lifelong





For Type2 Diab. (Insulin stopped)


T
Reclimet 80/500 (Dr Reddy’s)
0—1—1
Lifelong
T
Istamet 50/500mg (Sun Pharma)
1—0—0
Lifelong

Medicine
Purpose/Remarks
Reclimet 80/500
Each tablet contains 80mg Gliclazide & 500mg Metformin Hydrochloride.

 Gliclazide stimulates insulin secretion from pancreatic β-cells, reduces hepatic gluconeogenesis, and lowers blood glucose concentrations. It also inhibits platelet aggregation at therapeutic doses. Its duration: ≥12 hr.

     The exact mechanism of action of metformin is unclear but it appears to reduce glucose absorption from the GI tract, reduce gluconeogenesis and enhance insulin sensitivity by increasing peripheral glucose uptake and utilisation. Max: 2.25gm or 2250mg daily.

Istamet 50/500mg
(Imported by Sun Pharma; Mfd by MSD—Merck Sharp & Dohme, Netherlands)
Each tablet contains 50mg Sitagliptin Phosphate and 500mg Metformin Hydrochloride.

     Sitagliptin inhibits dipeptidyl peptidase IV (DPP-IV), resulting in prolonged active incretin levels. Incretin hormones increases insulin synthesis and release from pancreatic β-cells and reduces glucagon secretion from pancreatic β-cells. Reduced glucagon secretion leads to decreased hepatic glucose production.




____________________________________________________________
Blood Tests Conducted

Looking to sudden plunge in my health, which hitherto had been steadily getting better after the heart-operation on 9 July 2014, we, of our own volition and as suggested by my wife, got the initial blood-tests done on 11 August 2014, before calling on the doctors, and subsequently got the tests redone or additional tests done as per the advice of Dr Sejao. There was a steady improvement following Dr Sejao’s medication. Iron is now well within the normal range, and haemoglobin is nearing the normal value.

Test for
Reference Range
11
Aug
13
Aug
22
Aug
7
Sep
8
Oct

CBC-5







Red Blood Cell Count
4.5 — 5.5
2.5

3.2
3.8
4.1

Haemoglobin
13 — 17
7.2

9.0
10.5
11.4

Hemetocrit
40 — 50
21.6

27.9
32.7
33.3

White Blood Cell Count
4 — 10
17.4

12.6
10.5
6.5

Lymphocytes
20 — 40
10.0



34

Iron







Iron
59 — 158

24.4
35.0
68.0
109

Iron Binding Capacity
250 — 450

274
301
343
366

% Saturation
13 — 45

8.9
12.0
20.0
29.8



____________________________________________________________
Multislice CT Scan of Chest

This was done on 14 August 2014 on the advice of Dr Sejao, following the plunge in my health on account of the suspected infection in the chest. The test confirmed infection in the lungs and deposit of some fluid.

Computed tomography, more commonly known as a CT or CAT scan, is a diagnostic medical test that, like traditional x-rays, produces multiple images or pictures of the inside of the body. The cross-sectional images generated during a CT scan can be reformatted in multiple planes, and can even generate three-dimensional images. These images can be viewed on a computer monitor, printed on film or transferred to a CD or DVD.




Chest CT is used to help diagnose the causes of clinical signs or symptoms of disease of the chest, such as cough, shortness of breath, chest pain, or fever; detect and evaluate the extent of tumors that arise in the chest; and so on.

* * * * *

Rajnikant Puranik
Thursday, October 9, 2014
91-22-2854 2170, 91-98205 35232
rkpuranik@gmail.com
www.rkpbooks.com
http://rajnikantp.blogspot.in
https://twitter.com/Rajnikant_rkp


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