How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask DrRussMD Your Own Question

DrRussMD
DrRussMD, Board Certified MD
Category: Medical
Satisfied Customers: 64052
Experience:  Board certified Internal medicine and Integrative medicine. Many years of experience all areas.
24257177
Type Your Medical Question Here...
DrRussMD is online now

Hi my father had a stroke in january 2014 however he was still

Resolved Question:

Hi my father had a stroke in january 2014 however he was still moving his arms and legs and talking although mumbling his words due to stroke.  It took the hospital in the uk 2 weeks to diagnose the stroke as it was not obvious with the ct and mri scan and apart from mobility and mublinng his sentences he was fine.
Within a few days he was discharged and was able to walk with support with a frame.
However his mobility went poor again in march 2014 and since then he became withdrawn.  They did scans but said there is nothing wrong and discharged him.
However we noticed he became totally dependant and he was no longer having much communication.  Just a few words like I'm ok. I want to sleep.  I'm hungry.  And calling our names.
We took him to India in July to sept 14 and over there he spoke a little more. We came back in sept and his mobility was poor and we put that down to tiredness so let him rest for a couple of weeks.
Then all of a sudden on friday 24th October 14 he seemed confused.  Wasnt saying anything at all. Not even a single word but was still eating if we fed him and drank water if we fed him but he just stared.
Over the weekend he improved whereby he would acknowledge us by not speaking but saying hmm and if we called him turning his head or eyes.
We took him to hospital and they did scans but said there is no change in his scans since Januarys stroke.  He suddenly spoke yesterday a couple of words but today he stopped again and wasnt even turning around if we called him.  He would still chew and swallow food etc if we fed him but isnt acknowledging us.
The doctor is saying that due to his age and his stroke in January its affecting him.  I said how can he be ok all this time and then suddenly stop but they are saying that its a general deterioration due to age and stroke.  He is 59 years old.
They go he will have some days where he will briefly talk but others where he its like hes not there. I don't understand how this can be.  How can he go from talking and now like this and they link to his stroke in January.
It feels like are just dismissing it. They said some people are ok but even though don't have another stroke they can deteriorate and they fluctuate.
Please can you help.
Our gp thought it was depression a while ago when his level of communication reduced in feb but he would still talk a little.
His date of birth is 30 oct 1952
He has stage 4 renal failure but its steady. Ct and mri didn't show anything new they said. Hes also diabetic.
They are now saying on the day he was about to be discharged that he has two legions on the right side of his chest. It was clear they said on his chest xray they did a week ago.  They want to do a full body ct scan to rule out that the two legions are cancerous or not.  They said this is a seperate issue to how he is now. But that if the legions turn out to be cancerous then they will have to take this into account in deciding whether to treat or not.
In regards ***** ***** not taking suddenly and not a knowledging why could this be?  He is alert and opens his mouth and eats if we feed.  Like I said yesterday he spoke suddenly and today he didn't.
You can call me on *********** for more info.
Thanks
Submitted: 2 years ago.
Category: Medical
Expert:  DrRussMD replied 2 years ago.
Hello
It can be, a new stroke.
Depression.
Pre senile dementia
B 12 deficiency
Hypothyrodism.
All of these could account for his behavvior and all should be checked.
He really needs to be seen by a neurologist if not done.
Some types of lung cancer can contribute to such effects as well.
OK, so that is an initial answer….
Please use reply to expert if you have further questions. When you are ready, please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.
Customer: replied 2 years ago.

The hospital did a ct scan a couple of days ago and are saying there is nothing new showing from his Januarys stroke and they are ruling out a stroke.

He had a blood test for vitamin deficiencys as part of his kidney appoint in September and said they were good. However his blood tests in hospital have also come back good they are saying. Would the blood tests have shown b12 deficiency?

I asked for the nero team to see him but they are saying the mri would have shown differences if there is a change in his brain but the hospital is saying there is no change in brain.

Can someone just decline in communication and then stop one day but it be due to his old stroke combined with his age? That sudden?

They go he will fluctuate from talking one day limited to nothing and not even looking at his if we call him on some days.

How can this be. It doesn't seem right what the hospital is saying that its just his age and his stroke he had taking effect.

Customer: replied 2 years ago.

Also in regards ***** ***** two legions they are doing a full body ct scan for this weekend.

They are saying that last weeks chest xray did not show these legions.

They want to do a full body ct scan to see if any further legions and also they are saying it will 95 percent rule out whether it is cancerous legions or not. They initially said it could have been new or progressed slowly these legions on chest right side . 2 of them. But when I asked them why it was not spotted when he was admitted into hospital they looked at xray and are saying it was clear them - just few days ago and these are new and that they want to rule out cancerous legions.

But they are saying this is not what is causing his fluctuation of communication and engagement but that the effects of his january Stoke due to his age is making him like this.

I don't get how it can happen so quick when he was ok.

He is anemic. Due to his kidneys last year the kidney specialists said his iron was low and gave him iron injections. They were going to give him this hormone injection weekly but his hemoglobin levels return to ok levels so they didn't. But then recently it dipped again and they doubled his iron tabs to 644mg for the past 3 weeks.

His hemoglobin levels are around 10 I think but they said for someone with stage 4 kidney disease that's normal.

Expert:  DrRussMD replied 2 years ago.
Any of the conditions I have mentioned can build up and have a sudden onset.
It does not have to be a stroke.
So the concerns are the same list.
I would discuss this list with his doctors.
Please use reply to expert if you have further questions. When you are ready, please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.
Customer: replied 2 years ago.

Do you think what the consultants in the stroke unit are saying makes sense?

That due to his age and stroke in January its effects due to age are coming back. Can that be a cause of why he gradually reduced communication but then suddenly stopped even though ct scans showing nothing new.

I feel like they are just putting a reason to why he is suddenly not talking but how can that be the c reason when he was talking. Yes a week a go he spoke less and now nothing but just stares but still eats when feeding but it seems wrong diagnostic to say oh its the Jan stroke.

What are your thoughts on this.

Expert:  DrRussMD replied 2 years ago.
Depending on the size of the stroke, yes.
But I would rule out all of the other possibilities.
I would not assume this is due to his age.
OK, so that is an initial answer….
Please use reply to expert if you have further questions. When you are ready, please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.
Customer: replied 2 years ago.

Hi in regards ***** ***** list of things we should ask to test for, what kind of tests should they be doing?

How do you test for them?

Also what type of treatments.

Could it be vascular depression? Been looking on the internet but how are the above and this treated and tested. Want to make sure when I go and ask its done right

Customer: replied 2 years ago.

Also these are the medications he is on

Clopidogrel teva 75mg

Furosemide 40mg

Adcal d3 1500mg

Omeprazole 20mg

Amlodipine 10mg

Senokot 5ml

Ferrous fumate 322mg one teo times day

Humilin m3 20 in the morning.

However his hemoglobin levels last year went to 5 and they started him on the above iron tablets. They were going to give him epo injections but his hemoglobin levels moved up to 10 so the doctor said epo injections were not necessary. However it dipped a little again before moving back up. Our gp a week ago doubled his iron dosage to 644mg instead of the 322mg listed above. Hes been on double dosage for 2 weeks and then this happen.

Expert:  DrRussMD replied 2 years ago.
Hello
I could not respond to your last post due to a site problem.
Please remember that I have no control over site functions.
OK
I still think he needs the same work up as I mentioned.
None of his meds particularly have these side effects.
Omeprazole rarely, can have depression. And neurologic effects.
Clopedogrel is another rare possibility. So this needs to be considered as well.
OK
Further questions?
Please use reply to expert if you have further questions. When you are ready, please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.
Customer: replied 2 years ago.

Hi my dad seems to have further deteriorated.

On Saturday evening the nursing staff didn't give him anything to eat. This made his blood sugar levels drop to 2.1. He already in hospital had an issue with falling sugar levels.

My mom and sister noticed he wouldn't wake up. The doctor checked his bloods and when they were 2.1 and wasn't waking up they gave a gluecose injection as quick reacting. This then shot his blood to 16.

He finally opened his eyes 30 minutes later and we tried to feed him but he wouldn't open his mouth. Before you just had to put your finger on his lip or spoon there and he would open his mouth to eat even though looked into nothing. But when he came round on Saturday he wouldn't open mouth. After an hour he slowly opened mouth and let us feed him. But very slowly.

On Sunday we noticed again he was no longer opening mouth to eat. He would only open his mouth only slightly. We thought another stroke due to the drop in sugar levels or the incident causing some sort of damage.

Once every hour though he opens his mouth to yawn fully. He still stares into nothing but opens eyes when you call him and just stares into nothing. He moves about a little.

They put him on an ng tube to keep his nutrients up and go they will encourage him to eat and hopefully in a few days he will slowly start eating. They go because hes tired he has been through a lot.

Today is Monday and they put him on ng yesterday. He's still not opening his mouth to eat. He is really clenching teeth. U can't even open. He only opens slightly. They are still saying because he opens mouth occasionally its not a stroke and that he will get his appetite back.

What do you think has caused this. Its since his bloods dropped to 2.1 and wouldn't wake up till gave injection. What medication may help?

Last night I put a straw and an ensure drink and he seemed to slowly suck up the drink to half of it. The rest I had to put in a glass n push to his lips before he started gulping down. I gave him his tab, had to push in due to teeth clenched and he chewed the tab slightly but didn't open his mouth.

When he fell asleep though he fell asleep with his mouth open.

What do you think is or has caused this? And meds that may help?

The hospital doctor has dismissed b12 saying he has spoken to neuro and this type of symptoms isn't anything neuro and that the way he is he wouldn't cope with any advance testing etc but that he may consider testing for b12.

As he has stopped eating. Not purposely as when u do get a spoon into his mouth he doesn't chew but like slips it in. They are now going to get a neurological consultant to see him.

Expert:  DrRussMD replied 2 years ago.
Hi your next step is the neurologist, and that is way over due.
B12 is certainly a possibility.
Low sugars are always going to make him worse.
They better have checked thyroid function at this point.
Depending on the size of the stroke, this can be a main reason.
The neurologist might consider getting an EEG to make sure he is not having seizures [you don't always see them].
There is no specific medication until you know a cause.
OK, so that is an initial answer….
Please use reply to expert if you have further questions. When you are ready, please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.
Customer: replied 2 years ago.

Hi many thanks for your input. The neurologist consultant has had a look and come up with some recommendations. We pushed for a b12 test but at first they said don't use external doctors as they cant see him but then they said they will do the b12 and folate blood test.

They are puzzled how sudden he got like this. It seems they have moved away from their initial explanation of age and his January stroke.

Although the neurologist thinks its unlikely they have done a lumbar puncture and also took some fluid from brain.

They are saying although nothing showing on bloods that there must be an underlying infecting happening in the back ground that may have flared up. After they have got spinal results tomorrow they said they will then do a couple more tests to rule out any clinical issues then will refer to psychological team to see if depression.

They said he could have tb that although he had 15 years ago and was treated for that has stared dormant in spine that has flared up. And want to rule this n a couple of other things out. Which I'm not sure about.

Expert:  DrRussMD replied 2 years ago.
Hi
The lumbar puncture should rule out the TB idea.
He should go forth with testing.
Please do not forget a positive rating. We are only paid by JA PER positive rating.
Customer: replied 2 years ago.

Hi Thanks yes. Hes always had a lot of fluid in his ducts brain. They also said they took some fluid from brain through lumbar punchure however that works.

Many thanks for your help so far.

Don't worry I will be giving you the full possible positive rating. You have been so helpful through this time. Many thanks

Expert:  DrRussMD replied 2 years ago.
I have nothing else to add at this time.
Did you have another question?
Customer: replied 2 years ago.

HI the hospital have done spinal lumbar puncture and fluid from brain but its come up negative for infection and no tb. The b12 apparently came 300 and they said its well within range as well as folate sodium and potassium levels. They said his hypothyroidism they look at within bloods seem fine too.

They are puzzled. They are doing eeg tests and a couple of others. Can you think of anything else?

Expert:  DrRussMD replied 2 years ago.
I already suggested the EEG
This is a step by step process.
And neurology should come up with a tentative diagnosis.
Please click a positive rating.
We are only paid per positive rating.
Customer: replied 2 years ago.

Hi they did the eeg and nothing came up. Mri also didn't show anything.

They did say eeg showed no seizures but showed inflammation of brain which they said they were expecting. They go that they were hoping all these tests would show up something that they could then treat and try and reverse but its one of those cases where they don't know whats wrong.

My dad is now able to open his mouth though and eat his food again if we feed him. He just suddenly started.

But we have noticed he has his head turned to side now and when he opens his eyes they are also both looking to the left had side. His eyes pupils are towards the corner of his eyes. He tries moving and they do move a little towards the middle but not by much. They mainly seem to be looking towards the left hand cornor side.

As I mentioned earlier his hands he clenches towards his chest. If we move his hands he feels pain n moves away.

The doctors go its stiffness and general deteriation and they are giving him this medication for past few weeks that relaxes his muscles.

However although he has now started eating and more alert, the past 4 days he just instead of just staring his eyes are to the side along with his head. I could understand if in middle but his eyes are looking in the corner.

Could it be the muscle relaxing medication?

What do you think could be causing this.

All his b12, folate, thyroid all came back fine and in good ranges.

Expert:  DrRussMD replied 2 years ago.

Hi

This is yet another new question, and I have receive no positive ratings from you on any of my answers.

We are only paid by JA PER positive rating Did you have a problem rating?

Please rate and come back as needed.

Customer: replied 2 years ago.

Hi its not a new question. They still haven't found the cause. Hes started eating now but noticed this with his eyes.

I was only adding to the initial ongoing description.

I intend to rate highest positive. You've been good.

Expert:  DrRussMD replied 2 years ago.
We can not diagnose for you on the site.
We are only paid per positive rating by the customer, not by time spent.
This is a apparently a new symptom, and a new question about this symptom.
Specifically, can the muscle relaxers be causing his head going to one side with the eyes.
Not if these symptoms started before the medicine was started.
A muscle relaxer would not typically cause muscle spasm symptoms like this, but would be used to treat those symptoms.
Inflammation of the brain is serious...it is not "expected" unless the person has encephalitis, ceribritis or some other reason to inflame the brain, which would be more likely to account for his symptoms.
Please click a positive rating.
Some back as needed.
Customer: replied 2 years ago.

No he has been on muscle relaxers for 2 weeks. A week ago they increased the dosage. A few days later hes now able to open mouth and eat but we noticed now his eyes look to side and stay looking to side.

Expert:  DrRussMD replied 2 years ago.
This is a palsy of the nerves controlling the muscles in the eye.
This is called a conjugate palsy, and most often this is from a lesion or stroke in the brain stem.
These are very serious.
I would ask about this.
ready, please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.
DrRussMD, Board Certified MD
Category: Medical
Satisfied Customers: 64052
Experience: Board certified Internal medicine and Integrative medicine. Many years of experience all areas.
DrRussMD and 4 other Medical Specialists are ready to help you

What Customers are Saying:

 
 
 
  • I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me FROM a serious, even life threatening situation. I am very grateful to the experts who answered me. Susan O.
< Previous | Next >
  • I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me FROM a serious, even life threatening situation. I am very grateful to the experts who answered me. Susan O.
  • Wonderful service, prompt, efficient, and accurate. Couldn't have asked for more. I cannot thank you enough for your help. Mary C.
  • This expert is wonderful. They truly know what they are talking about, and they actually care about you. They really helped put my nerves at ease. Thank you so much!!!! Alex
  • Thank you for all your help. It is nice to know that this service is here for people like myself, who need answers fast and are not sure who to consult. GP
  • I couldn't be more satisfied! This is the site I will always come to when I need a second opinion. Justin
  • Just let me say that this encounter has been entirely professional and most helpful. I liked that I could ask additional questions and get answered in a very short turn around. Esther
  • Wonderful service, prompt, efficient, and accurate. Couldn't have asked for more. I cannot thank you enough for your help. Mary C.
 
 
 

Meet The Experts:

 
 
 
  • Family Physician

    Family Physician

    Doctor

    Satisfied Customers:

    2418
    GP with over 27 years experience including emergency medicine
< Previous | Next >
  • http://ww2.justanswer.co.uk/uploads/FA/FamilyPhysician/2013-8-31_191624_JA550x500Photo.64x64.jpg Family Physician's Avatar

    Family Physician

    Doctor

    Satisfied Customers:

    2418
    GP with over 27 years experience including emergency medicine
  • http://ww2.justanswer.co.uk/uploads/DO/DoctorRich/2012-9-12_72454_Doctorweb.64x64.jpg Dr. Natasha's Avatar

    Dr. Natasha

    Doctor

    Satisfied Customers:

    7887
    American Board Certified in Emergency Medicine, Ivy League trained
  • http://ww2.justanswer.co.uk/uploads/DR/DrK99/newpic2.64x64.jpg Dr. K.'s Avatar

    Dr. K.

    Board Certified MD

    Satisfied Customers:

    255
    Board certified with experience in primary care.
  • http://ww2.justanswer.co.uk/uploads/agketch/2008-7-14_184046_drketchresized.jpg Dr. Ketch's Avatar

    Dr. Ketch

    Board Certified Physician

    Satisfied Customers:

    76
    Medical Degree, Former Assistant Professor at School of Medicine at Yale University
  • http://ww2.justanswer.co.uk/uploads/JA/JACUSTOMERjtu60wne/2011-2-14_183449_passportphoto2.64x64.jpg docwithheart's Avatar

    docwithheart

    Board Certified Physician

    Satisfied Customers:

    0
    Board certified pediatrician, with special experience in general pediatrics, hospital pediatrics, and pediatric cardiology
  • http://ww2.justanswer.co.uk/uploads/DR/drappapo/2013-8-16_22576_drdavid.64x64.jpg Dr. David's Avatar

    Dr. David

    Board Certified Physician

    Satisfied Customers:

    224
    Treat children/young adults, former chief resident, multiple publications
  • http://ww2.justanswer.co.uk/uploads/TA/tazechip/2012-6-7_135230_drpic.64x64.png Dr. Chip's Avatar

    Dr. Chip

    Board Certified Physician

    Satisfied Customers:

    12373
    20 yrs. in practice, includinge surgery, general medicine, addiction medicine and pain.
 
 
 

Related Medical Questions