Please read the below case history & awnser the questions at the end



Mr. Gurcharan Singh / Male

DOB: 24.12.1936

Initially Strong Athletic Built / Non Vegetarian / Tea totaller / Strong Willed





1980: His BP raised to 170/250 and effected all vital organs, resulting swelling in brain, heart enlargement & renal failure (RCF). One of his heart beat got missed in readings of ECGs. He was treated in PGI, Chandigarh (India) and was put on to medicines.

1993: He was taken to local cardiologist due to sudden excess nose bleeding & said cardio physician put him on to some medicines for keeping the BP low.

2001: He felt angina pain in the chest. Was again taken to PGI, Chandigarh (India) for angiography & then was shifted to Escorts Heart Hosp., Delhi (India) & Heart Bye Pass surgery was performed there (CABG done (LIMA to LAD)).

2002: Dr. K.S. Chug (Ex – HOD, Nephrology (PGI-Chandigarh) was consulted. He pointed out that though his BP is stable (80/140) but Urea, Cratenine was on higher side (Createnine – 4.5 & Urea – 132) and put him on additional medicines for the same. Below said is the complete medicine list that was recommended:

1.     Tab Dytor 20 mg, once daily

2.     Tab Amlopres 5 mg, once daily

3.     Shelcal 500 mg, twice a day

4.     Alfacip 0.25 mg, once daily

5.     Heamup (Iron), once daily

6.     Clavix 75 mg, once daily

7.     Simcard 10 mg, once daily

8.     Razo-D (SOS, if vomit sensation persists)

2005: He again had a severe nose bleeding & nose coterie procedure was done in Silver Oak Hosp., Mohali (India) by an ENT surgeon.

2007: Fistula was made on his left wrist due to Ctatenine – 7.5 & Urea - 220. Consulted dietician again and started recommended dietary precautions & strict medicine routine.

Feb’ 2010:

-     Started taking Homeopathy medicines along with allopathic medicines (primarily as: BERBERIS VULGARIS & ECHINACEA ANGUSTIFOLIA) from a qualified Homeo Physician

-     Started checking parameters (Urea & Cratenine) on monthly basis & after 2 – 3 months of homeopathy medicines, slight reverse trend in the said parameters was observed for the first time in last 2 years. BP is observed stable on the whole.

-     Fistula was never used for dialysis but it started budging out like a water filled balloon so we approached local surgeon for closing said fistula & he did the same for us.

-     Swelling in the feet, itching on back side of neck, less appetite, laziness (feeling sleepy/drowsy in whole of the day time), red/blood coloured patches on his hands & arms, etc. were discussed with homoeopathic physician on weekly basis and with his medicines the same got partially managed.

-     Body immunity level seems low as frequently catching cough, cold, etc. increased.

-     Hernia problem also there from quite long but aggravates rarely and got subsided of its own after some time (5 – 6 hrs.)

Oct’ 2010:

-     Mucus (chocolate/brown coloured) vomiting

-     Severe giddiness/dizziness

Was immediately taken to Local Hosp. & was observed in ICU for 24 hrs., CT Scan/MRI done and everything was found normal. Then it was guessed that it may happen due to intake of vegetable with high urea/pesticide spray or aftereffects of Iron capsule (was regularly taking Iron capsule from last 5 -6 years)

Jan’ 2011 – Jun’2011:

-     Cratnine toggled between 6 to 7

-     Urea toggled between 180 to 195

Jul’ 2011: Cratnine reached 7.8

Oct’ 2011:

-     Cratnine crossed 8

-     Continuous low appetite / itching on back of neck increased / vomit sensation quite frequently / drowsiness increased during day time / feeling chest pain once to twice a day



-     Got him admitted in local hospital :

•     Angiography done: CART done on 15.11.2011 s/o triple vessel disease, patent graft and cardiologist advised that his angina to be controlled with medicines itself as major blood vessels are in OK shape & only a small blood flow interruption in one of the minor veins so no need for putting stunt.

•     Found that suffering from chronic kidney disease stage V , chronic AF/CVR, unstable angina, hypertension, BPH, coronary artery disease P/S CABG in 2001 (LIMA to LAD). Having frail body & weighing 50.4 Kg.

•     Started hemo-dialysis ( done on 15 oct, 17 oct & 25 oct)

Now it is recommended by the nephrologist that Mr. Gurcharan Singh being a heart patient should opt for Peritoneal Dialysis & surgery to be performed to tackle his hernia, making fresh fistula again & putting catheter in his kidneys.

Presently he is on below said medicines:

1.     Tab Pantocid-D, twice a day (empty stomach)

2.     Tab Urimax-D 0.4 mg, once a day

3.     Tab Clavix 75 mg, once a day

4.     Tab Flavedon MR, Twice a day

5.     Tab Monit GTN 6.4 mg, twice a day

6.     Tab Modlip-ASP (10+75 mg), once a day

7.     Tab Dytor 40 mg, once a day

8.     Tab Shelcal 500 mg, twice a day

9.     Tab Alpha-Cip 0.25 mg, once a day

10.     Tab Nikoran 5 mg, twice a day

11.     Tab Amtas 5 mg, twice a day

Our Queries:

1.     What type of dialysis is best for him & why?

2.     Generally, till how long he can comfortably continue with present heart & kidneys situation.

3.     He has been given his first hepatitis shot on 15th Oct’11 & said injection course shall be continued till Apr’12. How to protect him from any type of infections till then?

4.     If peritoneal dialysis is recommended, then:

-      it should be done manually (3 times a day) or with machine (Baxter brand is available here).

-     What all precautions needed to be taken for making the possibility of infection as ZERO.

-     Dietary routine (extensive list of items: ‘To be taken with qty.’ & “Not to be taken”)

5.     Other precautions (living routine / medicine / diet / which path tests with what frequency)

6.     His HB is low as 8.0 so if we will go for HB increasing injections then how to control his BP?