d*******n
发帖数: 216 | 1 我妈妈有糖尿病， 05年时脑出血手术， 住了4个月的医院。出院后到现在能基本缓慢
行走，但右腿比较笨拙，右手基本无力， 语言功能基本丧失（只能说简单的几个字)，
所幸思维一切正常。 两星期前有呕吐发热现象，去医院检查，CT有"腔隙性脑梗阻”
。 但医生说程度轻，而且是正常老化想象（不知是否bullshit)， 不需治疗。在我们
的要求治疗的情况下，开了血塞通，吃了一两次，右脚就开始疼起来，每天例行的活动
都基本停下来了。到现在已经有10多天了， 还没有好,是那种一阵阵的比较激烈的疼痛
。 我们觉得是血色通里的三七的问题(我记得原先05年妈妈住院的时候有医生说过不能
吃血色通，因为该要的唯一成份是三七总皂干，药性太猛，脑出血病人不能吃.) 但我
爸爸很担心是糖尿病病足，看了好多资料， 排除了所有的病足症状，就是有一点不清
楚： “足背动脉，胫后动脉活动减弱甚至消失。" 我上网查了啥是足背动脉和胫后动
脉，都是专业术语，看不懂。 想问问这里的高人如何检查这两项动脉的活动强度？Ｃ
Ｔ, MRI之类的能检查嘛？还是要别的检查？医生能够凭目测或触摸断定吗？
哥哥下周要带妈妈去省城医院检查，因为是 | g***r
发帖数: 285 | 2
not enough details, such as her stroke, what had caused it and what is the
treatment, how well is her diabetes controlled, and such,
if you are concerned about if she has peripheral arterial disease, you can
perform a simple screening test at home ABI, an ankle-brachial index, you
basically measure systolic pressure at brachial and ankle, and check their
ratio,
【在 d*******n 的大作中提到】
: 我妈妈有糖尿病， 05年时脑出血手术， 住了4个月的医院。出院后到现在能基本缓慢
: 行走，但右腿比较笨拙，右手基本无力， 语言功能基本丧失（只能说简单的几个字)，
: 所幸思维一切正常。 两星期前有呕吐发热现象，去医院检查，CT有"腔隙性脑梗阻”
: 。 但医生说程度轻，而且是正常老化想象（不知是否bullshit)， 不需治疗。在我们
: 的要求治疗的情况下，开了血塞通，吃了一两次，右脚就开始疼起来，每天例行的活动
: 都基本停下来了。到现在已经有10多天了， 还没有好,是那种一阵阵的比较激烈的疼痛
: 。 我们觉得是血色通里的三七的问题(我记得原先05年妈妈住院的时候有医生说过不能
: 吃血色通，因为该要的唯一成份是三七总皂干，药性太猛，脑出血病人不能吃.) 但我
: 爸爸很担心是糖尿病病足，看了好多资料， 排除了所有的病足症状，就是有一点不清
: 楚： “足背动脉，胫后动脉活动减弱甚至消失。" 我上网查了啥是足背动脉和胫后动
| d*******n
发帖数: 216 | 3 非常感谢你的回复。
我妈妈的糖尿病是03年检查出来的，当时大家都不是十分清楚它的危害，没有足够的重
视，就只吃药治疗了，血糖倒是经常测，都控制在8以内。正因为血糖控制的不错，所
以都觉得没问题，根本没有预料到后来会脑出血，而且不时量量血压，也都正常。 05
年脑出血，当时送到医院时血压极高，260/130。 医生诊断是”高血压基底节区出血
50cm."做了开颅手术,清除了积血。后来昏迷了半个月左右才慢慢恢复意识。 我们问医
生为啥事前血压都正常，血糖控制也正常，他们也说不出来个所以来就说事前是“糖尿
病引发的隐形高血压。” 我们也不懂。
我们出院后就吃两种药，诺和龙控制血糖，洛丁新＋尼群地平控制血压。 血糖绝大部
分时候在9。0以内，大部分时候在7,8左右。偶尔出现过几次10.几的情况。但是血糖肯
定是在缓慢升高，因为她的诺和龙用量已经从开始时的每次0.5ml 上升到现在的每次1.
0ml 了。
不好意思，没有中文词典， systolic pressure是指量血压得到的两个数字里高的那个
吧？还有brachial是指那个部位呢？就用一般的血压计就可以量了吗？我觉得脚踝那里
瘦骨伶仃，
【在 g***r 的大作中提到】
:
: not enough details, such as her stroke, what had caused it and what is the
: treatment, how well is her diabetes controlled, and such,
: if you are concerned about if she has peripheral arterial disease, you can
: perform a simple screening test at home ABI, an ankle-brachial index, you
: basically measure systolic pressure at brachial and ankle, and check their
: ratio,
| g***r
发帖数: 285 | 4 2nd attempt for copy and paste | g***r
发帖数: 285 | 5
wow, it worked, didn't know how to post pictures,
anyway, when you get ankle brachial index done, the blood pressure was
measured using a dopplar probe, but you can get by with a stethscope at home,
the idea behind it is that, if you have significant peripheral arterial
disease, it will limit blood perfusion/flow to the distal vessels, such as
vessels in feet/toes, by measuring and comparing the pressure difference you
can get a guesstimate of the peripheral arterial disease, with the theory
th
【在 g***r 的大作中提到】
: 2nd attempt for copy and paste
| g***r
发帖数: 285 | 6
05
as for her diabetes, not sure what is 诺和龙? is it an oral medication she
takes by mouth, or injectable insulin? and i never understood the numbers(
like, 7, 8, 9, 10) from chinese patients as far as their glucose control, is
it hemoglobin a1c they are talking about? if it is, ideally you want to
keep your a1c as close to 6 as possible, maybe under 6.5, the record a1c i'
ve seen was 24,
looked it up on 洛丁新 and 尼群地平, it's lotensin and a calcium channel
blocker, not sure what dose she is on, and
【在 d*******n 的大作中提到】
: 非常感谢你的回复。
: 我妈妈的糖尿病是03年检查出来的，当时大家都不是十分清楚它的危害，没有足够的重
: 视，就只吃药治疗了，血糖倒是经常测，都控制在8以内。正因为血糖控制的不错，所
: 以都觉得没问题，根本没有预料到后来会脑出血，而且不时量量血压，也都正常。 05
: 年脑出血，当时送到医院时血压极高，260/130。 医生诊断是”高血压基底节区出血
: 50cm."做了开颅手术,清除了积血。后来昏迷了半个月左右才慢慢恢复意识。 我们问医
: 生为啥事前血压都正常，血糖控制也正常，他们也说不出来个所以来就说事前是“糖尿
: 病引发的隐形高血压。” 我们也不懂。
: 我们出院后就吃两种药，诺和龙控制血糖，洛丁新＋尼群地平控制血压。 血糖绝大部
: 分时候在9。0以内，大部分时候在7,8左右。偶尔出现过几次10.几的情况。但是血糖肯
| d*******n
发帖数: 216 | 7 很感谢你的详细恢复。 我今晚就打电话让他们去测一下妈妈的ＡＢＩ。We can also
get dopplar probe on the legs done in the hospital. She just had that done
on her head and neck two months ago. It shows 脑血流量偏低，有脑动脉硬化，
but the doctors said this is unavoidable given her health history, and the
best we can do is to ignore it. Don't know whether they are bullshitting or
just stating the truth. Sometimes, I strongly feel that due to the low
standard living in my hometown, doctors also have a very low standards for
their patient's healt
【在 g***r 的大作中提到】
:
: 05
: as for her diabetes, not sure what is 诺和龙? is it an oral medication she
: takes by mouth, or injectable insulin? and i never understood the numbers(
: like, 7, 8, 9, 10) from chinese patients as far as their glucose control, is
: it hemoglobin a1c they are talking about? if it is, ideally you want to
: keep your a1c as close to 6 as possible, maybe under 6.5, the record a1c i'
: ve seen was 24,
: looked it up on 洛丁新 and 尼群地平, it's lotensin and a calcium channel
: blocker, not sure what dose she is on, and
| g***r
发帖数: 285 | 8 very interesting, the ophthalmologists here will care less about PAD,
also, i think that tech is full of it, the main risk for arteriogram is
contrast induced renal failure, bleeding and infection and such, but the
risk of stroke is relatively small, as you'd think the arterial blood will
flow forward(toward legs/toes) and any manipulations will be difficult to
cause a stroke,
as far as diabetes controls, then it's very likely the number they are
looking at is hgb a1c, if her a1c is close to 10, | g***r
发帖数: 285 | 9
05
just read your initial post again, just some curious points,
1. i looked it up and 基底节区 it basal ganglia, assume she had significant
spontaneous intracranial bleed due to poorly controlled hypertension and the
bleed extended into ventricules, so she had ventriculostomy to relieve the
intracranial pressure, is that right? this would be much different than
subarachnoid bleed that needs to look for any aneurysms or vasculitis and
such,
2. since she was diagnosed with diabetes, how often do they
【在 d*******n 的大作中提到】
: 非常感谢你的回复。
: 我妈妈的糖尿病是03年检查出来的，当时大家都不是十分清楚它的危害，没有足够的重
: 视，就只吃药治疗了，血糖倒是经常测，都控制在8以内。正因为血糖控制的不错，所
: 以都觉得没问题，根本没有预料到后来会脑出血，而且不时量量血压，也都正常。 05
: 年脑出血，当时送到医院时血压极高，260/130。 医生诊断是”高血压基底节区出血
: 50cm."做了开颅手术,清除了积血。后来昏迷了半个月左右才慢慢恢复意识。 我们问医
: 生为啥事前血压都正常，血糖控制也正常，他们也说不出来个所以来就说事前是“糖尿
: 病引发的隐形高血压。” 我们也不懂。
: 我们出院后就吃两种药，诺和龙控制血糖，洛丁新＋尼群地平控制血压。 血糖绝大部
: 分时候在9。0以内，大部分时候在7,8左右。偶尔出现过几次10.几的情况。但是血糖肯
| d*******n
发帖数: 216 | 10 Thanks again for all your answers.
I am not sure whether my mom had intracranial or subarachnoid bleed. I
looked up these two terms in wikipedia but don't understand the difference.
What I knew was on the onset, she started to lose balance (she was walking
at that time) and walked zig-zag. And just after she utterred "what's wrong
with me today?" her body started to fall. Fortunately my family caught her
so she didn't fall onto the ground. ANd then we sent her to the hospital.
She vomitted seve
【在 g***r 的大作中提到】
:
: 05
: just read your initial post again, just some curious points,
: 1. i looked it up and 基底节区 it basal ganglia, assume she had significant
: spontaneous intracranial bleed due to poorly controlled hypertension and the
: bleed extended into ventricules, so she had ventriculostomy to relieve the
: intracranial pressure, is that right? this would be much different than
: subarachnoid bleed that needs to look for any aneurysms or vasculitis and
: such,
: 2. since she was diagnosed with diabetes, how often do they
| | | g*****j
发帖数: 1211 | 11 Hey gomer, I had the same confusion about glucose level in China. A1c has
not been the standard of care in most places. They are truly reporting
serum glucose concentration, but in mM instead of mg/dL. Darkgreen's
calculation is right, num in mM X 18 (180 is the MW for glucose) converts it
to mg/dL. I hope that helps. | d*******n
发帖数: 216 | 12 Thanks for your reply.
Most of the time her blood pressure is around 110+/70+. Occasionally she
would get high numbers (like 150+/90+),like after a walk or when she feels
nervous(e.g., when she is in the hospital waiting room) , but those numbers
would drop say within half an hour. But that time when she had the 腔隙性脑
梗阻，her blood pressure were 150+/90+. And it kept dropping within an hour
and then it came down to 110+/60+. Is it possible to stabilize the
pressure or there isn't much to do ab | d*******n
发帖数: 216 | 13 I know this "multiplying by 18" because I got blood glucose monitors for her
from here. And sometimes, I would get one which only shows numbers in the
U.S. metric and the manual would mention the conversion rate.
So the A1c gomer talks about is a different thing?
Thanks.
it
【在 g*****j 的大作中提到】
: Hey gomer, I had the same confusion about glucose level in China. A1c has
: not been the standard of care in most places. They are truly reporting
: serum glucose concentration, but in mM instead of mg/dL. Darkgreen's
: calculation is right, num in mM X 18 (180 is the MW for glucose) converts it
: to mg/dL. I hope that helps.
| g*****j
发帖数: 1211 | 14 Hemoglobin A1c measures glycosylation on the hemoglobin protein due to
high glucose concentration in the blood. Since normal red blood cell has
a life span of 120 days, Hemoglobin A1c provides an averaged estimate of
blood glucose concentration in 3 months, in comparison to direct glucose
measurement, which is always a snapshot and can be influenced by multiple
factors. It is beginning to be used in Chinese hospitals and you just
need to ask for it. In a healthy individual, A1c should be <7.0 | d*******n
发帖数: 216 | 15 Is A1c called in chinese“c-肽” 反应实验还是叫别的? 谢谢。I need the
Chinese name so that we can ask the doctor to prescribe it.
【在 g*****j 的大作中提到】
: Hemoglobin A1c measures glycosylation on the hemoglobin protein due to
: high glucose concentration in the blood. Since normal red blood cell has
: a life span of 120 days, Hemoglobin A1c provides an averaged estimate of
: blood glucose concentration in 3 months, in comparison to direct glucose
: measurement, which is always a snapshot and can be influenced by multiple
: factors. It is beginning to be used in Chinese hospitals and you just
: need to ask for it. In a healthy individual, A1c should be <7.0
| g*****j
发帖数: 1211 | 16 c-肽 is C-reactive peptide. It is a marker for general inflammation. You
can have your family members to ask for 血红蛋白Ａ１Ｃ，and if the doctor
doesn't know what that is, the test is likely not available in that hospital
. | d*******n
发帖数: 216 | 17 不好意思，你说的urine analysis就是国内说的尿常规 or some more sophisticated
procedure？If it is, she had it done two months ago and everything was moral
. If not, what's the Chinese name?
She had an all-rounded medical check-up two months ago, which also included
the lipid check. Among the 30 items, she had 5 or 6 which were marginally
out of the reference range. I vaguely remember 2 or 3 items were related to
cholesterol. The technician said she was fine because all those numbers were
just marginally high. We w | d*******n
发帖数: 216 | 18 Thanks a lot. Was talking to my dad and he said he had read about it too. My
brother will surely ask the doctor for it. I am keeping my finger crossed
that the test is available....
hospital
【在 g*****j 的大作中提到】
: c-肽 is C-reactive peptide. It is a marker for general inflammation. You
: can have your family members to ask for 血红蛋白Ａ１Ｃ，and if the doctor
: doesn't know what that is, the test is likely not available in that hospital
: .
| g***r
发帖数: 285 | 19
it
thanks man for the help, that makes more sense then,
【在 g*****j 的大作中提到】
: Hey gomer, I had the same confusion about glucose level in China. A1c has
: not been the standard of care in most places. They are truly reporting
: serum glucose concentration, but in mM instead of mg/dL. Darkgreen's
: calculation is right, num in mM X 18 (180 is the MW for glucose) converts it
: to mg/dL. I hope that helps.
| g***r
发帖数: 285 | 20 i'd agree with whiteriver that she had intraparenchymal bleed from poorly
controlled hypertension, and the procedure she had, did they really remove a
piece of skull? which will be craniotomy, often done to relieve
subarachnoid bleed; or they drilled a hole and connected a tube through it?
then most likely that's ventriculostomy,
if you have intraparenchymal bleed, you will not be able to operate on since
it's within the brain tissue, but if the bleed extended into ventricules,
or significant ed | | | g***r
发帖数: 285 | 21 a1c is not a diagnostic test and probably will not be, since as whiteriver
indicated, that it is associated with red cells turn over, which roughly is
about 120 days, but for patients with quick turn over or longer turn over,
it will affect the measurement, especially with patients with underlying
chronic kidney disease, | g***r
发帖数: 285 | 22 as far as renal function goes, if her urinalysis is normal, then there is no
proteinuria, which is always a good sign,
you can get her serum creatinine level, and based on her age and sex and
weight, you can calculate her GFR, or glomerular filtration rate, that can
tell how much off her kidney functions are, you can find such formular
calculators throughout internet, | g***r
发帖数: 285 | 23 as far as lipid control goes, if her LDL( the so called bad cholesterol) is
greater than 100, you'd want her to be started on statins to lower it, again
depends on who you talk to, some cardiologists/neurologists really
recommend very aggressive lowering target, | g***r
发帖数: 285 | 24 as of aspirin therapy, i think after 10 days of intracranial bleed, provided
blood pressure is well controlled, and no active bleeding, patient can be
safely restarted on antiplatlet therapy with aspirin, | g***r
发帖数: 285 | 25 regarding diabetes, type 1 is because the lack of insulin so they often have
to be started on insulin right away, type 2 we think the pancrease still
produce insulin, but either not enough, or there is resistence in the body,
so oral agents are used to either stimulate the pancrease to increase the
production, or sensitize the insulin receptors in the body for insulin to
work better,
most people are afraid of needles, plus the insulin had to be stored in the
right temp, so people shy away from i | d*******n
发帖数: 216 | 26 Thanks a lot for all the replies. I will do as you suggested.
Yeah, they removed a piece of the skull on her left side of the head. And
the piece is still gone now. The doctors said given her condition, it's
probably not worthwhile to put it back, since that would put the burden of
another surgery on her already fragile body. We have been extremely careful
about that soft spot on her head, but I still often worry that something
terrible would happy since it's just such a thin layer of skin an
【在 g***r 的大作中提到】
: i'd agree with whiteriver that she had intraparenchymal bleed from poorly
: controlled hypertension, and the procedure she had, did they really remove a
: piece of skull? which will be craniotomy, often done to relieve
: subarachnoid bleed; or they drilled a hole and connected a tube through it?
: then most likely that's ventriculostomy,
: if you have intraparenchymal bleed, you will not be able to operate on since
: it's within the brain tissue, but if the bleed extended into ventricules,
: or significant ed
|
|
