Can any one help me to understand a medical report.

[Bill Poster]

 

One of my Thai wife's relatives , a male age 48 had been suffering from the following symptoms........

 

1. Loss of weight

2. Loss of appetite

3. Constant coughing and throat clearing.

4. Difficulty in sleeping .

 

Those above symptoms the relative had for around 2 years , but never went to see a doctor.

 

Towards the end of that 2 year period , in the last few months 2 more symptoms appeared .

 

A. Blood being coughed up.

B. Blood in feces ( stools )

 

Once the blood symptoms started to appear, he went to see a doctor at a local Thai government hospital .

 

He was admitted to an open ward for observation , but his symptoms became worse and he was transferred to the hospital ICU room. He remained in the ICU room for a week while undergoing a range of tests .

 

He was moved from the ICU room and onto an open ward , where he remained for another week,

 

The doctor has today allowed the relative to leave the hospital and return home.

 

The drugs the doctor prescribed to take at home are….

 

1. Propranolol

2. Omeprazole

3. Augmentin 625

4. Folic acid

5. Spironolactone

6. Simethicone

7.Furosemide

8. Lactulose

9. Vitamin B

 

I have looked at the 2 medical reports the doctor gave the relative, which are both in English and included 2 DVD disks.

 

Ive tried to research the information shown on the 2 medical reports , but I’m still not sure what those 2 medical reports really mean. I am planning to accompany the relative back to hospital on the 1^st of next month for his appointment to see the doctor , and I hope to ask the doctor a few questions . In the meantime I’m wondering if any one could shed some light on the 2 medical reports .

 

 

Thanks

 

 

 

 

 

 

[pikao]

Did or does he drink a lot?

 

Certainly @Sheryl can give you answers

[sqwakvfr]

I think a Colonoscopy and/or Endoscopy should be next.  Age along with blood in the stool are factors that would lead to a recommendation for a colonoscopy.  

[MrJ2U]

Perhaps tuberculosis.

 

Its endemic in Thailand.

 

Typical symptoms of TB include:

a persistent cough that lasts more than 3 weeks and usually brings up phlegm, which may be bloody.

weight loss.

night sweats.

high temperature.

tiredness and fatigue.

loss of appetite.

swellings in the neck..

 

Hopefully they tested him for that.

 

Its contagious.

[Sheryl]

From the report, he has severe cirrhosis which may be secondary to cancer. There is a mass in the liver.  The various symptoms are likely  due to liver failure.

[bbko]

Cirrhosis, ascites and esophageal varices to the point of throwing up blood in a 48 y/o, Ouch!  Must be a hard core alcoholic.

[jastheace]

38 minutes ago, bbko said:

Cirrhosis, ascites and esophageal varices to the point of throwing up blood in a 48 y/o, Ouch!  Must be a hard core alcoholic.

severe liver damage. agree. sorry.

[KhunLA]

Good luck with the meds / treatment.

 

"Cirrhotic morphology ....

Cirrhosis of the liver is a disease due to progressive scarring of the liver caused by various conditions such as chronic hepatitis, biliary disease, fatty liver and alcohol abuse. The scarring reduces the ability of your liver to function normally."

[scubascuba3]

Strange that the relative doesn't seem to be aware of the alcohol cause, Dr said nothing

[Bill Poster]

First a big thank you to every one for your comments .

 

As far as I understand the relative has always been a long time big drinker , but stopped when he started to experience the symptoms. 

 

Now I'm wondering several things .

 

As I'm accompany the relative back to hospital on the 1^st of next month for his appointment to see the doctor , I want to ask the doctor questions about the relatives medical condition , but I'm not sure exactly what to ask . So any recommendations on that subject would be most welcome.

 

The other area I'm wondering about is this.

 

Would it be of any real benefit to seek a second opinion at another hospital , the relative is not financially able to afford access to a private hospital.

 

As far as I understand the doctor made no direct comment relating to past alcohol use , and the relative has also not commented on his past alcohol life style.

 

 

Thanks.

 

 

 

 

 

 

[bbko]

OP, sorry to hear about your relative's condition. My wife's uncle passed away a few months ago from long term alcohol abuse and he was in his early 60's, the relatives and I say "he drank himself to death", he'd wake up and hit the bottle everyday all day, but they did nothing to stop him, saying his immediate family tried many years ago but he refused to listen.  Maybe the question you could ask are to the family and the man himself, "Is he able to stop drinking?" Because the next step after cirrhosis is liver failure/death unless he get's a liver transplant.  Ask the doc, what's his outlook if does vs doesn't stop drinking or is it too late?

Good luck.

[Bill Poster]

15 minutes ago, bbko said:

OP, sorry to hear about your relative's condition. My wife's uncle passed away a few months ago from long term alcohol abuse and he was in his early 60's, the relatives and I say "he drank himself to death", he'd wake up and hit the bottle everyday all day, but they did nothing to stop him, saying his immediate family tried many years ago but he refused to listen.  Maybe the question you could ask are to the family and the man himself, "Is he able to stop drinking?" Because the next step after cirrhosis is liver failure/death unless he get's a liver transplant.  Ask the doc, what's his outlook if does vs doesn't stop drinking or is it too late?

Good luck.

Thanks 

In the past the wife's relative was a daily drinker of Lao khao and Chang beer , but when he first started getting his symptoms about 2 years ago he stopped drinking alcohol altogether ( or so he says ) . When he first started getting the symptoms he did not want to go and see a doctor , thinking that the symptoms would just disappear . The question I’m wondering is did he stop drinking soon enough and whats the level of damage done to his liver . I’m still not sure why the doctor sent the relative home so soon .

[steven100]

1 hour ago, Bill Poster said:

Would it be of any real benefit to seek a second opinion at another hospital

Sorry to hear about the relatives condition.  As for seeking a second doctors opinion,  I doubt you will receive anything different to what has already been given,   a medical report is just that, it shows what the doctor has found, it doesn't have to show what caused the findings.     Just my opinion .....

[Denim]

16 minutes ago, Bill Poster said:

( or so he says )

A hard core drinker is unlikely to be able to easily quit.

[HAPPYNUFF]

As far as I am aware, the liver is     the only organ in  ones body  able to "repair"  itself, to some degree, if  alcohol, which was the cause of the problem, is abstained from.  That is providing the damage done is not to far gone.   The report also refers to mild brain  damage, again a symptom of  excessive alcohol abuse.  That is not reversible.  It is  sad so many people, Thais as well,   cause so much damage to their body by excess  use of alcohol, but considering the    hard life many Thais live,   it is the only form of   relaxation  they  have.

[Sheryl]

11 hours ago, bbko said:

Cirrhosis, ascites and esophageal varices to the point of throwing up blood in a 48 y/o, Ouch!  Must be a hard core alcoholic.

Not necessarily, the scans show a mass in the liver.

 

Liver cancer (which may be primary cancer or a metastasis from another tumor site) would cause the same thing.

 

Primary liver cancer is relatively common in Asia due to a high prevalence of Hepatitis B, often present from birth due to perinatal transmisison.

[Sheryl]

3 hours ago, Bill Poster said:

Thanks 

In the past the wife's relative was a daily drinker of Lao khao and Chang beer , but when he first started getting his symptoms about 2 years ago he stopped drinking alcohol altogether ( or so he says ) . When he first started getting the symptoms he did not want to go and see a doctor , thinking that the symptoms would just disappear . The question I’m wondering is did he stop drinking soon enough and whats the level of damage done to his liver . I’m still not sure why the doctor sent the relative home so soon .

Since a mass is present in the liver it is quite likely this has little or nothing to do with drinking. (Though of course, given his liver function is badly damaged, he should not drink now).

 

He was probably sent home because there is nothing medically that can be done. His prognosis is likely terminal.

 

It would be worthwhile his getting under the care of a palliative care team if available where he lives.

[bbko]

Cirrhosis of the liver from alcohol abuse or from Hepatitis, either way his life expectancy is on the fast track to buy-buy town.   Is there lab tests?

[The Hammer2021]

You can choose a good doctor with good language skills from another hospital for a 'second opinion  and full explanation ' About 1200 baht

[Chris.B]

9 minutes ago, The Hammer2021 said:

You can choose a good doctor with good language skills from another hospital for a 'second opinion  and full explanation ' About 1200 baht

How do you know he is a 'good' doctor?

[The Hammer2021]

55 minutes ago, Chris.B said:

How do you know he is a 'good' doctor?

Reputation, references, qualifications, assessment based on personal  interaction including chats and emails. We get a lot more information here in Thailand  about doctors than we do in UK. In this instance the OP wants helps understanding a medical report. I would choose a doctor from Bumrungrad and ask then for their help. A consultation helping to explain the medical report would be about 1500 baht

Edited January 19, 2022 by The Hammer2021

[scubascuba3]

Go back to see the same doctor and this time get him to explain properly

[Bill Poster]

Last night around 7 pm my wife received a telephone call from her relatives family who were pancaking . The relative who had just been discharged from hospital was now having difficulty in breathing ( described as constant hiccuping ) so my wife contacted the emergency services and an ambulance then took the relative back to the original hospital (  Nang Rong Hospital Buri Ram )  who had been treating him.

My wife telephoned me around 11 pm to say that her relative had been admitted to the hospitals ICU room and that she was going to sleep at the hospital that night . 

 

I’m now waiting for an update , but it does not sound to good.

[Sheryl]

13 hours ago, Bill Poster said:

Last night around 7 pm my wife received a telephone call from her relatives family who were pancaking . The relative who had just been discharged from hospital was now having difficulty in breathing ( described as constant hiccuping ) so my wife contacted the emergency services and an ambulance then took the relative back to the original hospital (  Nang Rong Hospital Buri Ram )  who had been treating him.

My wife telephoned me around 11 pm to say that her relative had been admitted to the hospitals ICU room and that she was going to sleep at the hospital that night . 

 

I’m now waiting for an update , but it does not sound to good.

As mentioned, his condition is almost certainly terminal.

 

Thai doctors are often reluctant to say this directly.

 

The most helpful thing you can do is help the family:

 

- understand that this is likely the case

- ask the doctor directly (and understand what may be euphemistic replies)

- consider under these circumstances whether it is really in the patient's interests to artificially prolong life (i.e. consider instead a palliative approach)

 

[MrJ2U]

15 hours ago, The Hammer2021 said:

You can choose a good doctor with good language skills from another hospital for a 'second opinion  and full explanation ' About 1200 baht

With such dire results a second opinion is a good idea.

Of course it all depends on whos paying for it.

 

If it was my wife I'd pay for it.

 

If it was her slovenly brother I wouldn't.

[Sheryl]

7 hours ago, MrJ2U said:

With such dire results a second opinion is a good idea.

Of course it all depends on whos paying for it.

 

If it was my wife I'd pay for it.

 

If it was her slovenly brother I wouldn't.

As he is now in hospital in the US he is not in any condition to go see another doctor.

 

And frankly the CT scan result is abundantly clear.

[Neeranam]

On 1/19/2022 at 6:13 AM, Bill Poster said:

As far as I understand the doctor made no direct comment relating to past alcohol use , and the relative has also not commented on his past alcohol life style.

Liver disease is often caused the food Thais eat, esp. in the NE. Khon Kaen has the highest rate of liver disease in the world, I believe.

[Neeranam]

7 hours ago, MrJ2U said:

With such dire results a second opinion is a good idea.

Of course it all depends on whos paying for it.

 

If it was my wife I'd pay for it.

 

If it was her slovenly brother I wouldn't.

My wife and I share our money, so if she wants to help her brother, it's up to her. If I want to help my brother, it's up to me. 

[alextrat1966]

12 minutes ago, Neeranam said:

Liver disease is often caused the food Thais eat, esp. in the NE. Khon Kaen has the highest rate of liver disease in the world, I believe.

Sadly, this is more than just liver disease. 

 

The report mentions a relatively huge arterial enhancing mass in the liver .(7.2x7.4x8.3-cm) This is just a technical way of saying "cancer". 

 

His liver will never recover from this, and it is likely that the cancer either has either spread from somewhere else to the liver, OR has spread from the liver to somewhere else... 

 

Sadly, probably terminal.

Edited January 20, 2022 by alextrat1966

[cardinalblue]

You can remove the word “probably” from the previous sentence….