Brief Answer:
Please shift him back to hospital immediately

Detailed Answer:
Hi XXXX,
Thanks for writing in to us.

I have read through your query in detail.
Please find my observations below.

1. Severe breathlessness is a serious concern and you might have to shift your father back to the hospital immediately.

2. In the last discussion, you have mentioned that dexamethasone is one of the medications given to him. Initially you might give him the recommended dose of medication dexamethasone after consulting his doctors. Please call an ambualnce and he might be given oxygen support till he reaches the hospital.

3. Please make an emergency call to his doctor and proceed.

Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
His health condition appears to be unstable

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

1. There appears to a be an instability in his health condition.

2. The exact cause for this to happen cannot be specifically pointed out but it is true that his continuing dehydration and not being able to eat has caused a kind of energy crisis and he is getting too weak.

3. Since he is in the hospital and breathing without distress right now, it will be important to provide supportive care to your father. By supportive care is meant to keep his health stable and reduce his pain and discomfort and also emotional support. Unfortunately at this moment we cannot predict the course of his illness due to the sudden change in blood reports which shows a deteriorating picture. However efforts should be put in place to stabilize his health condition.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
There appears to be toxins building up causing renal function loss

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

1. It is possible that toxins are building up inside his body and this is not getting filtered due to impaired functioning of the kidneys.

2. The role of the kidneys is to eliminate toxins and clean the blood of metabolic waste products. When the kidney is malfunctioning, not only does the waste not get filtered adequately but there is more stress on the already stressed out kidneys and probably this caused the kidney impairment to enter stage 3 disease condition.

3. The CRP appears to be a risk marker for renal function loss and therefore increasing levels are seen.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
Medical measures are recommended and if not responding then hemodialysis

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

1. Attempts are to be made to revive the kidney functioning.

2. The electrolyte imbalances including high potassium level need to be regulated. If the anemia increases then it requires attention.

3. If the treatment measures with medicine is not responding then doctors might consider hemodialysis to decreased elevated creatinine levels.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
Dialysis treatment is decided depending on clinical condition

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

1. The decision on treating critically ill cancer patients having kidney disease with dialysis or not depends on certain factors like older age, impaired performance status, presence of an uncontrolled cancer, and whether more than two other organ dysfunctions. If present, these patients are associated with an adverse outcome.

2. Research shows that the simultaneous presence of all these factors is almost invariably indicative of an adverse outcome.

3. However, selected patients might benefit from ICU care and advanced organ support like dialysis.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
Cancer elsewhere affects kidneys in some patients

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

1. Cancer affected cells might release proteins and toxins which affect the normal functioning of the kidneys.

2. The effect of kidneys cannot be predicted by the cancer and this also depends on other factors including chemotherapy and amount of cells lysed and reaching the kidney.

3. The kidneys in a cancer patient might also get affected as a consequence of multiple organ failure in end stage cancer.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
The largest liver metastasis is 7 cm in diameter

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

1. The report shows the presence of sludge in the gall bladder probably because he has stopped oral intake The bile has got condensed and formed a sludge.

2. Largest metastasis in liver presently measures 7 cm in diameter and the necrotic center signifies that the central part of the metastasis is dead tissue, an expected finding.

3. The right kidney measures 68 mm and is smaller than normal. This has to be checked with previous records.

His doctors were essentially looking out for an abscess in the abdomen which might be causing the spikes of fever. However no abdominal abscess has been found.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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