* BANGLADESH MAN ASKS WHY HE HAS FEVER FOR MONTHS AT A TIME?

"Dear sir, can I talk to you???

Can you suggest me some advice to be safe from fever???  In a year, i suffer from fever a lots of time like 3-5 month with isolated period. But this sickness keeps me always weaker than everyone, I want to be healthy. Plz.. Help me  Ok...! Till then I will wait for you."  ("JRahm",  Bangladesh)

Dear "JRahm,"

I am glad we were able to visit on Facebook, 2016 Thanksgiving weekend, as your question revolves around trying to locate a fever of unknown origin.  We doctors try to narrow the source of a fever to the following, four general classes:  human immunodeficiency virus- related (HIV), immunocompromised related, classic, and nosocomial; thus, my questions were directed to target the most likely possible source of your fever.   Your original statements, " I'm from Bangladesh. Fever could me almost 3-4months of an year on different spell," along with telling me you were hospitalized "It was for typhoid.  I was hospitalized on almost a year ago, that's the reason," spoke volumes of information.  Specifically, your fever falls in the "classic" category.  A classic fever is a fever of at least 100.9F or higher, a fever with a duration of greater than three weeks, and a fever requiring an evaluation of at least three outpatient visits or three days in the hospital.  However, when I asked how long were you in the hospital, you said " Just 2days."  Technically, the fact that you were in the hospital only two days places you outside the classic fever category; however, I do believe, your timeline of events might lend an explanation as to why you have had "3-5 months"  of fever after hospitalization. 

Let me explain.  When I asked you what medication did the hospital provide, you said, " I can't remember, and the prescription has run out."  Salmonella typhi is a gram negative bacterium that causes typhoid fever in humans.  Typhoid fever is a disease marked by the following symptoms not limited to prolonged fever, nausea, diarrhea, fatigue, headache, low energy, stomach pain, or sore  throat.  The drug of choice to treat typhoid fever is Ciprofloxicin or Ceftriaxone, both of which are provided to a patient over two weeks.  Other medications that have proven effective against typhoid fever include amoxicillin and trimethoprim-sulfamethoxazole.  There exist over 100 different strains of Salmonella typhi; thus, resistance of this bacteria is common to many antibiotics.  In other words, many antibiotics are not effective in killing the Salmonella typhi.  Although you tried your best to remember details of your typhoid fever treatment, two items became clear to me about you, 1) possibly, the correct antibiotic may not have been chosen to kill the Salmonella bacteria or 2) the antibiotics prescribed may have been correct; however, the duration of treatment may not have been long enough.  Therefore, the Salmonella typhi may still be abundant in your bloodstream, causing the "3-4months of an year" fever. 

Remember, the most common source of infection, in acquiring typhoid fever, is water contaminated by the urine and feces of infected individuals; thus, if possible, as a means to prevent transmission, drink bottled water or boil local water sources prior to ingestion.  Furthermore, once the boiled water has cooled, wash fruits and vegetables in that cleaned water, and ALWAYS WASH YOUR HANDS repeatedly throughout the day.   Typhoid fever is treatable and reversible; however, when the Salmonella typhi bacteria is not killed, a person becomes a carrier and a likely transmitter of infection to other people. 

My recommendation is for you to revisit the hospital personnel, requesting blood work to identify if Salmonella typhi still exists in your blood.  If confirmed, the hospital should be able to run tests that would determine which antibiotic(s) is/are effective to kill those strain(s) of bacteria in your body.   

Thank you for your question and trust in my opinion.  Please stay in touch as I wish to know the outcome of hospital tests.  In the meantime, thanks for your compliments and peaceful prayers.  God Bless you and God Bless Bangladesh.

Respectfully,

Dr. Roshin

*

• 
  

  12/1, 10:32am
  

  "JRahm"
  

  
  

  
  

  Ok...!

  
  

  My prayer always within you

PHILIPPINE LADY ASKS WHY HER MOTHER'S KIDNEYS SHRINKING

“ Hi Roshin, I would like to ask, my mother went through an ultrasound and the doctor said the left kidney of my mother is getting smaller.  May I ask what kind of illness is that? this time, they did not yet gave any medicine but only buscopan hyocine and vitamins only. What will I do next? please help me how to find cure for my mother, what to do and where doctor will we go. Thank you.. i'm quite nervous and worry of what will you say regarding the result of my mother's ultrasound, I hope she can be cured the soonest. thank you for finding some time for my mother's case.. I will be online tonight until midnight to catch your time.  gratefulness is mine.. from the bottom of my heart.. my sincere thankfulness to you//”  (Ms. Evelyn, Philippines)

Dear Evelyn,

I am glad we visited on Facebook this past weekend.  After viewing your mother’s ultrasound report and gathering her pertinent medical history from you, your mother’s present day health course has a direct link to past conditions; however, her test results do not indicate any glaring medical concerns, as long as she maintains her prescribed, treatment regimen.

 Specifically, you mentioned your mother has “maybe 20 yeas” of hypertension, and is taking “Plendil 5 - once a day.”  In addition, you mentioned that your mom is taking “vestar twice a day” for “she had chest paint maybe from 6 months.”  You mentioned she had high cholesterol of “300” but “after taking prabastatin, yes they get normal now.”  You said “she loves to eat meat before, mostly pork mybe 4 times/week, with soup, sometimes fry, we she always use soy sauce.”  When I asked if your mother was a smoker, you said, “before yes, when shes still at age 30 to 45.”   Fortunately, your mother has no history of kidney problems, urinary problems, diabetes mellitus, allergies, or cancers. 

Your mom’s past medical history is directly linked to her present state of health.  The sonography report does indicate “small size both kidneys, good corticomedullary differentiation, but otherwise unremarkable.”  Although the report indicates small sized kidneys, her kidney function tests are normal; thus, there is little concern. 

I am of the belief that your mom’s “smaller kidney size may be due to effects on her blood vessels from her past history of smoking, high cholesterol, and high blood pressure.  Smoking causes direct damage to the vasculature, thus blood flow often slows.  Cholesterol is fatty deposits that accumulate in a blood vessel, also preventing blood flow.   Thus, the combination of smoking and high cholesterol makes blood flow very difficult, and the lack of blood flow, causes a backup of blood in the vessels, leading to hypertension (high blood pressure).  Remember, blood carries oxygen, and oxygen is needed by every organ in the body to survive.  Thus, smoking, high cholesterol, and hypertension decrease blood flow to the organs.  When decreased blood flow affects the heart, chest pains occur. 

Fortunately, your mom’s medication regimen has her blood pressure normal (110/70), no chest pains, and normal cholesterol levels.   Now, all she has to do is make lifestyle modifications.   Since she is an 80 year old ambulatory woman, she should take a 15-30 minute walk, if tolerable, every day to help keep her heart healthy.   In addition, you mentioned, “she loves to eat meat” however, your mom needs to limit her meat intake to 1 or 2 servings per week.  Instead of eating pork, she should consider eating lean cuts of poultry as well as seafood.    After our discussion on the importance of a diet change, I am glad to hear that you also agree, “she need to shun from those.”  Eating plenty of fruits and vegetables will also keep her heart healthy, decrease cholesterol, and maintain normal blood pressure.  Please consult a doctor in your area before beginning an exercise regimen or beginning any treatment plan. 

The bottom-line is that your mom’s longevity is in her own hands.  Improved eating habits, a tolerable, exercise regimen, and taking her medications as directed, will literally add years to her life.  Surrounding your mom with family support will keep her mental state healthy too.  Thank you for your question and trust.  God Bless your mom, God Bless you, and God Bless the Philippines.

Respectfully,

Dr. Roshin

*

         "THE MAGIC CURE FOR HCV"  - ONE MAN'S STORY

Doctoradvisor,

"As per your request, I have written a brief story of my experience with the HCV.  I hope this helps some of your readers and wish all of them the best in their quest to eradicate this awful disease."

Cordially,

R.S. (Newark, NJ)

"Harvoni - THE MAGIC CURE for HCV"

I had originally heard about the "MAGIC CURE' in 2012.  I was dealing with Hep C since 2002 (at least that was the year it was discovered) and it was rapidly deteriorating my liver.  My prognosis was not encouraging.  My first severe episode was in February of 2007 when the varices ruptured on my esophagus.  Chance of survival is about 30% but I was fortunate.  They were banded and I lived.  

That was the beginning of the journey.  I had episodes with hepatic encepolopathy and they became more frequent as time went by.  I was moved from Monmouth Medical to University Hospital, and they were able to save my life there.  

The Harvoni treatment was approved by the FDA on December 8, 2013.  I was blessed with a most outstanding Hepatologist, who got me into the program in February of 2014.  At that time my viral load was in the multi-millions.  At the end of the program, no virus was detected.  A true miracle.  My prognosis before treatment indicated that I did not have much time left.  After treatment, prognosis is 15 years or better.

The big issue with the treatment is it's cost.  I was on an 8 week program that cost close to $100,000.  That's something like $1,300 a pill...and you take 2 a day.  Hopefully the cost comes down and everyone can get the treatment.  It is a true miracle.  My doctors now have me on a magic cocktail.  To sum it up, I haven't felt this good in many, many years.

Thank you,

Rico (Newark, New Jersey)

-----------------------

Dear Mr. R.S.,

Thank you for sharing your story with DoctorAdvice4u readers.  You are a walking miracle.

Respectfully,

Dr. Roshin

*

" CHINESE LADY ASKS WHY FACE & FINGERTIPS HAVE PINS & NEEDLES SENSATION?"

“My mom had her thyroid removed so they have to take a lot of other supplements. One of the supplements is calcium. They originally have to take 4 pills (500 mg +D per pill) 2 times a day but it doesn't seems to work for my mom because once in a while, her fingertips and face feels the pins and needles sensation. When she spoke with the endocrinologist, he didn't bother to think of any alternatives but to increase her intake of pills. which means she would have to take additional 2 more pills each time. So my question is should she still take the additional two pills and wont it affect her her kidneys or even makes her constipate?”  

(Ms. Lin, New York City)

  

Hi Ms. Lin,

After visiting with you this past week, your mother presented with “fingertips and face feels the pins and needles sensation,” a term in medicine called paresthesias.  Based on your mom’s past medical history, your mom’s paresthesias have an unknown etiology which must be identified by the doctor.  Specifically, in the medical paperwork you sent me, your mother’s Hemoglobin A1c level was 6.1 (normal <5.7), an indication that her blood glucose levels are likely running much higher than normal.  Why is this important?  Diabetes mellitus could cause paresthesias.  She must work with her doctor to reduce high blood glucose levels, which will help rule out diabetes as a cause of the paresthesias.  In addition, your mom, every day, has been taking 4000 mg calcium (four 500 mg calcium pills morning and night) for the past two years; yet, on the blood test, her calcium level was below normal at 7.1 mg/dL.   Low calcium can cause paresthesias (especially of the face).  Your mom’s doctor recommending she take two additional 500 mg calcium pills morning and night should be followed, if only to increase blood calcium levels back into the normal range (8-10 mg/dL).  Once your mother’s calcium levels have returned to the normal level, hopefully, her paresthesias will disappear. 

However, you are correct, hypercalcemic states, could lead to constipation, kidney stones…etc; however, since your mother had a total thyroidectomy in 2012, the body’s ability to regulate calcium levels became greatly diminished.  Normal recommended daily calcium consumption for adults is 1000-1500 mg/day.  The higher than normal calcium intake might be the new norm for your mom, a value that must be monitored by her physician, and discontinued or modified, if hypercalcemic signs or symptoms occur.

You might suggest to your mom’s physician to run a B12 level, which is also a potential cause of paresthesias.

I will address your brain tumor question in a different post.   Thank you for your question and trust.  God Bless you, God Bless China, God Bless New York, and God Bless New York City.   Stay in touch, and remember, “Always walk in peace.”

Respectfully,

Dr. Roshin








*