Jill answers:

All the surgeries have possible complications. It is necessary that-
1. The surgeon is aware of the complications,
2. They recognize the complications when those ocur, &,
3. They treat the complications effectively.
On the basis of the above, it will be decided whether the surgeon was at fault or not. You are alive & healthy that indicates that most probably the surgeon managed the complication well. Good luck!

Jill answers:

In itself no. It is quite easy to treat. However, It can lead to pneumonia though if not treated. All the little “balloons” Called alveoli in the bases of the lungs can collapse when you are lying in a bed not exercizing or breathing deeply. It is extremely common after any kind of surgery. There are two things you can do to help the atelectasis resolve. One: walk as much as you can tolerate. That will expand your lungs and help all those little balloons pop back open. Two: if you are watching tv, everytime a commercial comes on take ten slow deep breaths to fully inflate your lungs. You’ll be good as new in no time

Jill answers:

Although these worrying things are happening to you, it sounds like you’re in safe hands, if the head of the practice is following your case. Often the scariest thing is the uncertainty and powerlessness, of the situation, so take time to understand what your doctor tells you and how you can take some control over the situation by knowing you body and what it needs/wants. It sounds like you’re already getting on top of the situation, which is reassuring that things are set for healthy course.

A few questions – what kind of kidney stone? How do you know it was diverticulosis – did they investigate with a camera? Is it diverticulosis of the large bowel or small bowel? And how long has this burning stomach pain been going on form and where is it?

Assuming you do you gave diverticulosis, which has been diagnosed with colonscopy/imaging – you can prevent its progression by making sure you never get constipation. The stool softners and laxatives are a good idea to stick with, and a life-long high fibre diet with low fat is also a great idea. If you can avoid meat, that will also make a difference. Do you have a history of long-standing constipation? – If not, its a bit of a mystery as to why you have diverticulosis.

A possible link between kidney stones (calcium stones), constipation and abdominal pain is hypercalcaemia. If I was in your situation, I would want to know that my blood levels of calcium were normal. Other symptoms of hypercalcaemia (high calcium in the blood) are bony pain and depression/difficulty concentrating/poor memory/lethargy.

If you haven’t had the diverticulosis diagnosed with imaging/colonscopy, this is essential to exclude other causes. One common cause for bleeding per rectum in young people is Meckel’s diverticulum. This is a pouch on the small intestine, which often contains stomach lining. Because this secretes acid, it can cause ulceration, pain and bleeding.

One final thing – if you have burning in your stomach high up (almost under the chest) and it really is gastritis, vicodin isn’t good enough. You need to treat the cause of the pain, which may be ulcer, bacterial infection with H. Pylori, too much aspirin (or other meds), or increased acid secretion. You should definitely also be on an acid suppressant such as omeprazole – if the pain does not go away after 4 weeks treatment with omeprazole, then it would be wise to get a camera into the stomach to see what’s going on.

Hope that makes some sense.

Jill answers:

I would do what the surgeon said they are knowledgeable. The PA is only a physician assistant. Just don’t take regular aspirn it causes errosion.

Jill answers:

This is a very confused and jumbled history and in addition you go from stating that she takes no anticoagulants to saying that she takes warfarin. I don’t know if you are a medical professional or not, but if so I would rationalise this before you present it to a senior doctor.

From the sound of things this patient is complex with a number of serious co-morbidities, although it does sound like the underlying cause of the presentation of fatigue and dyspnoea is going to be the (presumed) anaemia. So to answer your questions:

1. Differential has anaemia very high on the list, but should also include diabetes (common in this group of patients), thyroid disease (notably hypothyroidism), worsening cardiovascular disease (particularly important would be to note that myocardial ischaemia does not necessarily involve pain; particularly in the group of patients who have had what I assume is open chest surgery (for the MVR), and it would also be important to exclude failure of this device, which sounds unlikely from your examination), also would want to exclude renal failure here. As a distant last you should also exclude mitotic disease, particularly the insipid presentations of myeloma and CLL. As a curio the only other thing that springs to mind is Hydes syndrome, whereby the presence of Aortic stenosis (not typically this type or murmur), and angiodysplasia coexist. I dont this it is this for one minute, but that is an interesting phenomenon worth reading about.

2. Anaemia is the favourite by a long shot.

3. FBC with reticulocyte count, U&E, Thyroid, random (or fasting) glucose and HbA1c, haematinics, bone profile (Ca, phosphate etc), LFT’s with a serum protein electrophoresis, coag.

I would also want a chest xray, ECG, echocardiogram and urinalysis.

4. Tricky. Could be continuing angiodysplasia, diverticular disease or gastritis from the gut. It could be haemolysis from the valve replacement. Other potentials are the haematological causes, eg B12 or folate deficiency, iron deficiency (although on supplements), or at its worst a haematological malignancy (myeloma or CLL/CML with marrow infiltration). Outside causes are EPO deficiency as a result of CRF (chronic renal failure).

5. See 3. And also if Hb below 8 then admit for therapy (transfusion), and thereafter management would be heavily dependent on results of investigations.

I hope that helps, but be reassured that this is a complex case, not an easy one!