Guest guest Posted October 11, 2005 Report Share Posted October 11, 2005 Why is she getting TPN if her gut works? If she is really edematous, albumin I believe is something that can be diluted and appear lower that what it is. PAB I believe is not affected by hydration status so might be a better indicator of protein level. Gregoline, RD -----Original Message-----From: [mailto: ]On Behalf Of Janelle HeusingerSent: Tuesday, October 11, 2005 2:25 PM Subject: Difficult patient I have a patient 37yowf surgery 1 year ago and lost 200#. Came in with severe protein deficiency, swollen feet, calves and hands. Tpn was started a month ago (home TPN) supplying 1700 calories, 120g protein, 360g carbs and lipids MWF(44g) Pt is on a regular diet and eats very well, protein before her chips. Protein pudding made with whey protein 60g/day. Pt taking MVI with Fe, calcium Citrate, B12. Temp 104. Dx with chronic anemia. Here alb last month was 1.2, now 1.9. She keeps getting Picc line infections. What Else would you do?check? She keeps going home and coming back with the same symptoms. r/o rheumatoid arthritis and going check bone marrow. Why is her protein levels not increasing? Janelle Heusinger RD/LD Grinnell Regional Medical Center 641-236-2488 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 11, 2005 Report Share Posted October 11, 2005 I have suggested a Peg be placed . Her Pre-alb was 11. Maybe after 3 infected PICC line the surgeon will place a PEG. The patient is losing Hope. Thanks RE: Difficult patient Why is she getting TPN if her gut works? If she is really edematous, albumin I believe is something that can be diluted and appear lower that what it is. PAB I believe is not affected by hydration status so might be a better indicator of protein level. Gregoline, RD -----Original Message-----From: [mailto: ]On Behalf Of Janelle HeusingerSent: Tuesday, October 11, 2005 2:25 PM Subject: Difficult patient I have a patient 37yowf surgery 1 year ago and lost 200#. Came in with severe protein deficiency, swollen feet, calves and hands. Tpn was started a month ago (home TPN) supplying 1700 calories, 120g protein, 360g carbs and lipids MWF(44g) Pt is on a regular diet and eats very well, protein before her chips. Protein pudding made with whey protein 60g/day. Pt taking MVI with Fe, calcium Citrate, B12. Temp 104. Dx with chronic anemia. Here alb last month was 1.2, now 1.9. She keeps getting Picc line infections. What Else would you do?check? She keeps going home and coming back with the same symptoms. r/o rheumatoid arthritis and going check bone marrow. Why is her protein levels not increasing? Janelle Heusinger RD/LD Grinnell Regional Medical Center 641-236-2488 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 11, 2005 Report Share Posted October 11, 2005 I believe pre-albumin is an acute phase responder. If she keeps getting these infections her pre-alb will remain low until the infections has resolved. I think the greater the infection the lower the pre-albumin is. If she is on high doses of antibiotics I would consider a lactobacillus supplement in addition to her current regimen. Good luck with her. Jerry Janelle Heusinger <jheusinger@...> wrote: I have suggested a Peg be placed . Her Pre-alb was 11. Maybe after 3 infected PICC line the surgeon will place a PEG. The patient is losing Hope. Thanks RE: Difficult patient Why is she getting TPN if her gut works? If she is really edematous, albumin I believe is something that can be diluted and appear lower that what it is. PAB I believe is not affected by hydration status so might be a better indicator of protein level. Gregoline, RD -----Original Message-----From: [mailto: ]On Behalf Of Janelle HeusingerSent: Tuesday, October 11, 2005 2:25 PM Subject: Difficult patient I have a patient 37yowf surgery 1 year ago and lost 200#. Came in with severe protein deficiency, swollen feet, calves and hands. Tpn was started a month ago (home TPN) supplying 1700 calories, 120g protein, 360g carbs and lipids MWF(44g) Pt is on a regular diet and eats very well, protein before her chips. Protein pudding made with whey protein 60g/day. Pt taking MVI with Fe, calcium Citrate, B12. Temp 104. Dx with chronic anemia. Here alb last month was 1.2, now 1.9. She keeps getting Picc line infections. What Else would you do?check? She keeps going home and coming back with the same symptoms. r/o rheumatoid arthritis and going check bone marrow. Why is her protein levels not increasing? Janelle Heusinger RD/LD Grinnell Regional Medical Center 641-236-2488 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 12, 2005 Report Share Posted October 12, 2005 Sjogrens syndrome? this usually also includes symptom "dry eye", increased ESR. Reduced salivary gland secretion-->I think could lead to increased bacteria and foul odors. Most probably though this would be picked up by GI guy. hope this helps! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 28, 2009 Report Share Posted March 28, 2009 Hi Amy This year i visited a doctor who uses alternative treatments.After he checked me i asked him what was his treatment plan was for me. he told me he would not be able to help me because my case was complicated and he did not wish to give me false hopes(!) I thought this was honest though:) bw nil difficult patient > on the topic of difficult patient > I'd like to tell everyone that in the past few weeks I was denied > treatment as a potential new patient by a MD who speicialized in treating > thyroid that doesnt show up wrong on tests, (referred by a friend) The dr > spoke to me at length and then told me they wouldnt take my difficult > case. > > An endodontist refused to even do an x-ray after reading my health info, > even though I already had made an appointment and showed up for the > consult and xray.. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 28, 2009 Report Share Posted March 28, 2009 I was talking to Ken once and he told me (I'm paraphrasing) that our illnesses are too complex for the average doctor to really diagnose and treat on his or her own. This is based on the current amount of time doctors spend on the average patient. We can thank the insurance companies for that. I think about the amount of time I have spent researching pubmed and other medical databases, trying to interpret research documents, as well as working to benchmark and study case studies. And including analyzing my body changes and reactions to different treatment protocols, I cannot imagine a regular doctor dedicating this much time to my case. While I've seen a some of you relay extraordinary experiences with doctors, I think most doctors apply a cookie cutter, one size fits all approach to our illnesses. Perhaps that is why most of the doctor's that I have read having the best result with their patients, do not except insurance (at least in the Seattle area) From: [mailto: ] On Behalf Of wonderer Sent: Saturday, March 28, 2009 5:17 AM Subject: Re: difficult patient Hi Amy This year i visited a doctor who uses alternative treatments.After he checked me i asked him what was his treatment plan was for me. he told me he would not be able to help me because my case was complicated and he did not wish to give me false hopes(!) I thought this was honest though:) bw nil difficult patient > on the topic of difficult patient > I'd like to tell everyone that in the past few weeks I was denied > treatment as a potential new patient by a MD who speicialized in treating > thyroid that doesnt show up wrong on tests, (referred by a friend) The dr > spoke to me at length and then told me they wouldnt take my difficult > case. > > An endodontist refused to even do an x-ray after reading my health info, > even though I already had made an appointment and showed up for the > consult and xray.. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 30, 2009 Report Share Posted March 30, 2009 I have come to the painful conclusion, that I am most likely going to have to handle this myself, for the very reasons you mentioned. I had given the NP at my old pain management doctors office a " packet " of info I pulled up online, and was told he would give it to the doctor to look at. 3 months later I brought the packet in to my appointment with the doctor, and he had not looked at the original one. He then proceeded to tell me their was nothing else he could do for me, and transferred me back to my primary. I don't feel like it, and It is going to take time, especially since I have no medical training, but given that those trained medically extend apparently zero effort into my case outside of my actual office visit, I don't see an alternative. I am seeing a new neurologist and my primary offered to refer me to Emory university, but I had been down there several years back and had the doctor tell me I was " depressed " and needed antidepressants, I replied that I had taken 7 in the past year or 2 and had zero effect, he just turned and left. I guess doctors are as lazy as the rest of us, and unless the problem affects you personally 90% or more of us have no desire to investigate further. Quote Link to comment Share on other sites More sharing options...
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