Dr. Ashok Kumar
Geriatrics
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My aunt is 85 years old and is bedridden. She had suffered a stroke some years back but had recovered with loss of mobility in her left part. Gradually she became bedridden and was treated by a cardiologist, physiotherapist, and general medicine doctors but there was no improvement. She also developed uncontrolled shaking in her left hand. No doctor offered any advice. Lately, I came across some information on Parkinson and I believe she has the disease. She has not been treated for the disease at all but wants to see if it will help to get any treatment at this stage.
Hello,
Welcome to icliniq.com.
I read your query and understand your concerns about your bedridden aunt. Although I am not sure whether the tremors are the result of stroke or Parkinson's disease, if they are disabling, the treatment should be started. I must also inform you that the effect of treatment is limited when there are multiple other conditions such as diabetes, cardiac disease, and stroke sequel but still there remains great room for improvement in such cases. However, I find it difficult to digest that no opinion from a neurologist or old age specialist has been sought to date. The condition is best treated by a neurologist, a geriatrician, or a geriatric psychiatrist. I request you to see the one in your city. If you think that it is not possible to take her to a doctor or the right doctor is not available for her condition in online consultation. I hope this helps you. Feel free to contact me if you have more questions or need a second opinion in regard to her treatment.
Thank you.
Patient's Query
Hello doctor,
Thanks for replying. It is difficult to take her to a clinic. Can you tell me what investigations need to be done before I see or get an online consultation?
Hello,
Welcome back to icliniq.com.
Considering her diabetes, cardiac condition, and the possibility of stroke she will need the following investigations.
1. Complete blood count with ESR (erythrocyte sedimentation rate).
2. Blood urea and serum creatine.
3. Liver function tests.
4. Lipid profile.
5. T3, T4, and TSH (thyroid stimulating hormone).
6. Blood sugar.
7. HbA1c.
8. Echocardiography.
9. ECG (electrocardiogram).
10. MRI brain.
11. MR angiogram of the brain.
12. Serum vitamin D.
It is possible that you may have some of the above investigations. In case they are of the latest duration repetition of any investigation should be avoided at least at this stage.
Thank you.
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Geriatrics
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